Hemoptisis asociada a maniobra de valsalva secundaria a malformación arteriovenosa pulmonar rota en paciente con cirugía de Fontan. Revisión a propósito de un caso / Hemoptysis associated with valsalva maneuver secondary to ruptured pulmonary arteriovenous malformation in a patient with Fontan surgery. Review regarding a case

Se presenta un caso poco frecuente de hemoptisis en un paciente adolescente con cirugía de Fontan, causada por el sangrado de una malformación arteriovenosa pulmonar (MAVP), tras la práctica de un instrumento de viento (saxofón). El paciente se estudió con angiografía y se realizó cierre percutáneo, consiguiendo posteriormente mejoría clínica y evitando la aparición de nuevos episodios de hemoptisis. Actualmente existe escasa literatura que reporte casos de hemoptisis en pacientes con cirugía de Fontan y ningún caso publicado en relación a gatillantes relacionados a las maniobras de valsalva; como la generada al practicar instrumentos de viento. Por esta razón, se decide publicar este caso clínico en pro de generar mayores conocimientos en este grupo de pacientes con cardiopatías congénitas operadas con procedimientos paliativos como es la cirugía de Fontan.

A rare case of hemoptysis is presented in an adolescent patient with Fontan surgery, caused by bleeding from a pulmonary arteriovenous malformation (PAVM), after playing a wind instrument (saxophone). The patient was studied with angiography and percutaneous closure was performed, subsequently achieving clinical improvement and preventing the appearance of new episodes of hemoptysis. Currently, there is little literature on hemoptysis in patients with Fontan surgery and no case published in relation to triggers related to valsalva maneuvers; like that generated when practicing wind instruments. For this reason, it was decided to publish this clinical case in order to generate greater knowledge in this group of patients with congenital heart disease operated on with palliative procedures such as Fontan surgery.

Primer reporte de un brote de dengue en balsas, Amazonas, Perú, durante 2021 y 2022

Introducción: El aumento de casos de dengue en Amazonas es un riesgo para la salud pública. En el 2021, Balsas reportó por primera vez un brote de dengue. Métodos: La población incluyó a pacientes que cumplían con la definición de caso entre diciembre 2021 y febrero 2022. La identificación de los serotipos se determinó mediante una qRT-PCR múltiplex. Resultados: Se identificaron 72 pacientes de los cuales 53 (74%) se confirmaron por serología (Ag NS1). El serotipo prevalente fue DENV-2 (94%), y el 6% fue DENV-1. Los pacientes de 19 a 45 años presentaron el mayor porcentaje de casos (59%). Los síntomas más frecuentes fueron cefalea, mialgias, fiebre y artralgias; el 23 % presentó dolor abdominal intenso. Conclusión: Este fue el primer brote de dengue confirmado en el distrito de Balsas, siendo DENV-2 el principal causante, destacando la necesidad de mejorar la vigilancia en zonas sin transmisión autóctona de la enfermedad.

Introduction: The increase in dengue cases in Amazonas represents a public health risk. In 2021, Balsas reported a dengue outbreak for the first time. Methods: The population included patients who met the case definition between December 2021 and February 2022. Serotype identification was determined using a multiplex qRT-PCR. Results: A total of 72 patients were identified, of which 53 (74%) were confirmed by serology (NS1 Ag). The prevalent serotype was DENV-2 (94%), and 6% were DENV-1. Patients aged 19 to 45 years had the highest percentage of cases (59%). The most frequent symptoms were headache, myalgia, fever, and arthralgia; 23% had intense abdominal pain. Conclusion: This was the first confirmed dengue outbreak in the Balsas district, with DENV-2 being the main cause of the outbreak, highlighting the need to improve surveillance in areas without autochthonous transmission of the disease.

Evaluación de los parámetros eritrocitarios en donantes recurrentes de plaquetas, Medellín / Evaluation of the red blood cell parameters in recurrent platelet donors from Medellín

Introducción: El efecto de la donación a repetición de plaquetas por aféresis sobre el eritrograma se desconoce para población colombiana. Objetivo: Evaluar los cambios en la línea eritroide de donantes habituales de plaquetoaféresis de dos bancos de sangre de Medellín. Métodos: Estudio longitudinal con 100 donantes repetitivos de plaquetoaféresis con 3 donaciones o más. La fuente de información fueron las bases de datos de los bancos de sangre participantes. Los datos demográficos, tiempo entre donaciones y parámetros eritocitarios fueron consignados en una base de datos de excel y analizados empleando el software SPSS versión 27.0. Se realizó descripción de variables mediante medidas de resumen y se emplearon las siguientes pruebas estadísticas: T de Student, U de Mann Whitney, correlaciones, T pareada y Wilcoxon, considerándose un nivel de significación estadística de <0,05. Resultados: El 58% de los donantes fueron mujeres, el 75% tenían 30 años o más y 70% residían en el área metropolitana. No se observaron diferencias estadísticamente significativas para la hemoglobina según sexo y grupo etario, el VCM aumentó en la segunda, tercera y cuarta donación respecto a la primera, el HCM disminuyó en la cuarta donación respecto a la primera y el CHCM disminuyó continuamente entre donaciones. Conclusiones: Se observaron cambios en los parámetros eritrocitarios en los donantes recurrentes de plaquetas correspondientes a mecanismos medulares compensatorios normales sin afectación clínica de los donantes. Se sugiere realizar estudios complementarios para evaluar otras variables relacionadas con la eritropoyesis y los efectos de la circulación extracorpórea durante la plaquetoaféresis.

Introduction: The effect of repeated platelet donation by apheresis on the erythrogram is unknown for the Colombian population. Objective: evaluate the changes in the erythroid line in regular plateletpheresis donors from two blood banks in Medellin. Methods: Longitudinal study with 100 repetitive plateletpheresis donors with 3 donations or more. The source of information was the databases of the participating blood banks. Demographic data, time between donations and erythrocyte parameters were recorded in an excel database and analyzed using SPSS version 27.0 software. Variables were described using summary measures and the following statistical tests were used: Student's t-test, Mann-Whitney U, correlations, paired t-test, and Wilcoxon, considering a level of statistical significance of <0.05. Results: 58% of the donors were women, 75% were 30 years old or older, and 70% resided in the metropolitan area. No statistically significant differences were observed for hemoglobin according to sex and age group, the MCV increased in the second, third and fourth donations compared to the first, the HCM decreased in the fourth donation compared to the first, and the CHCM decreased continuously between donations. Conclusions: Changes in erythrocyte parameters were observed in recurrent platelet donors corresponding to normal compensatory medullary mechanisms without clinical involvement of the donors. Complementary studies are suggested to evaluate other variables related to erythropoiesis and the effects of extracorporeal circulation during plateletpheresis.

Adaptive governance and coping strategies in the Yucatan Peninsula coasts facing COVID-19.

The COVID-19 pandemic has abruptly transformed all social structures around the world, and coastal zones where tourist and fishing activities take place is no exception. Due to the sanitary measures, restrictions to travel and lock down periods, the tourist sector has been one of the economic sectors most affected by this health and economic crisis. However, it is not the only sector to have been affected, the fisheries sector, being highly dependent on the export market, has also suffered the consequences of this crisis. In this article, we aim to identify the main characteristics and key aspects of the fishing and tourist sectors in the states of Yucatan and Campeche, in Mexico, under pandemic dynamics. What are the organizational and governance structures that have been developed in response to this world phenomena? To answer this question, we conducted phone interviews and reviewed governmental and community actions. Results show that individual survival strategies prevail as a response to COVID-19, over community or governmental actions. There was limited coordination among the different governance structures, between the community and governmental levels. However, this crisis has also been a period of learning and innovation to implement adaptive governance structures to build resilience and a "new normal social reality".

Ungovernable systems: The strength of informal institutions in the sea cucumber fishery in Yucatan, Mexico.

Formal and informal institutions govern fisheries around the world. Yucatan's sea cucumber fishery is not an exemption, the sudden and fast development of the fishery in 2010 has motivated the creation of informal and illegal forms of organization. The prices, buyers' interest and the fishing effort substantially increased, being followed by illegal fishing-fishers and traders, creating informal fishing-trade channels and severe social and biological concerns. This article aims to give account of the emergence and dynamics of the informal institutions which currently dominate this fishery. It was sought to identify the extent to which rules and regulations are not being respected and how they are affecting fish resources and coastal communities. We considered the case of the port of Sisal, Yucatan, Mexico to illustrate our argument and here we applied a mixture of qualitative and quantitative methodologies including informal and in-depth interviews applied to 17 key informants, a questionnaire applied to 47 fishers and an estimation of the degree of compliance from three of the main management measures. Socio-biological negative impacts were identified in Yucatan's coastal communities and its fisheries. Foreign buyers and local middlemen exert high pressure on fishers to exceed the quota and catch the highest possible volumes facilitating the fisheries decline. This and the growing economic interest motivated the development of strong informal institutions supporting illegal fishing and informal trade. Social problems emerged and women were particularly affected. The economic power of the fishery is likely to overcome any type of governance structure. The enforcement of entry rules was not effective, so the governance base was around informality and illegal actions. Local and foreign buyers are exerting pressure to increase the catch volume thus it is recommended that rules and regulations be directed at buyers and exporting companies rather than at fishers.

Prospective study on the effect of blood donation in the iron status

Introduction: blood donation can generate iron metabolism imbalance and deficiency of this micronutrient, mainly in frequent donors. Objective: to evaluate the effect of blood donation in the iron status in repeat donors of a blood bank in Medellín. Methods: prospective study with 70 repeat donors randomly selected. Ferritin, erythrogram, reticulocytary haemoglobin, coprological, physical activity, and iron ingestion tests were carried out; previous blood donations was collected of the blood bank database. Summary measures, frequencies, results of Friedman test, McNemars test, Student's t-test for paired samples, and the Spearman correlation were calculated on the SPSS 25.0® software. Results: the physical activity frequency, the prevalence of intestinal parasites, the parameter of leuko-plateletgram, and the iron ingestion in the diet did not show statistically significant differences between the two moments of the study, unlike the MCV (Mean Corpuscular Volume), MCHC (Mean Corpuscular Hemoglobin Concentration) and ferritin. In the second stage, ferritin (which decreases as the amount of donations increases) decreased 10% in women and 15% in men. Conclusion: blood donation decreases storage iron and the plundering of the reserves becomes more serious as the amount of donations increases, and also as the period of time between donations decreases. It is necessary to implement strategies to reduce the prevalence of iron deficiency, which include nutritional education, pre-donation iron deficiency determining, and medical guidance on the ingestion of dietary iron supplements.

Prospective study on the effect of blood donation in the iron status / Estudio prospectivo sobre el efecto de la donación de sangre en el estado del hierro / Estudo prospetivo sobre o efeito da dádiva de sangue no estado do ferro

Introduction: blood donation can generate an imbalance in iron metabolism and deficiency of this micronutrient, mainly in repeat donors. Objective: to evaluate the effect of donation on iron behavior in repeat donors of a blood bank in Medellin. Methods: prospective study in 70 repeat donors selected probabilistically. Ferritin, erythrogram, reticulocyte hemoglobin, coprologic, physical activity and dietary iron intake were evaluated. Information on previous donations was collected from the blood bank database. Summary measures, frequencies, Friedman, Mc Nemar, Student's t-test for paired samples, Wilcoxon and Spermanen SPSS.21® correlation were calculated. Results: frequency of physical activity, prevalence of intestinal parasitism, leukogram, plateletogram and dietary iron intake did not show statistically significant differences between donations, unlike VCM, CHCM and ferritin parameters. Ferritin decreased by 10% in women and 15% in men, and decreased as the number of donations increased.

Introducción: la donación de sangre puede generar un desequilibrio en el metabolismo del hierro y deficiencia de este micronutriente, principalmente en los donantes a repetición Objetivo: evaluar el efecto de la donación en el comportamiento del hierro en donantes a repetición de un banco de sangre de Medellín Métodos: estudio prospectivo en 70 donantes a repetición seleccionad de forma probabilística. Se evaluó ferritina, eritrograma, hemoglobina reticulocitaria, coprológico, actividad física y consumo de hierro en la dieta. La información sobre donaciones anteriores se recolectó a partir de la base de datos del banco de sangre. Se calcularon medidas de resumen, frecuencias, prueba de Friedman, Mc Nemar, T de Student para muestras pareadas, Wilcoxon y correlación de Spermanen SPSS.21® Resultados: la frecuencia de actividad física, la prevalencia de parasitismo intestinal, el leucograma, el plaquetograma y el consumo de hierro en la dieta no presentaron diferencias estadísticamente significativas entre las donaciones, a diferencia de los parámetros VCM, CHCM y ferritina. La ferritina descendió un 10% en mujeres y 15% en hombres, ésta disminuye en la medida que aumenta el número de donaciones.

Introdução: a dádiva de sangue pode gerar um desequilíbrio no metabolismo do ferro e uma deficiência de ferro, principalmente em dadores repetidos. Objetivo: avaliar o efeito da dádiva no comportamento do ferro em dadores repetidos de um banco de sangue em Medellín. Métodos: estudo prospetivo em 70 dadores repetidos seleccionados de forma probabilística. Foram avaliados a ferritina, o eritrograma, a hemoglobina reticulocitária, o coprológico, a atividade física e a ingestão de ferro na dieta. A informação sobre dádivas anteriores foi recolhida da base de dados do banco de sangue. Foram calculadas medidas de resumo, frequências, Friedman, Mc Nemar, teste t de Student para amostras emparelhadas, correlação de Wilcoxon e Spermanen SPSS.21®. Resultados: a frequência de atividade física, a prevalência de parasitismo intestinal, o leucograma, a contagem de plaquetas e a ingestão de ferro na dieta não apresentaram diferenças estatisticamente significativas entre as doações, ao contrário dos parâmetros VCM, CHCM e ferritina. A ferritina diminuiu 10% nas mulheres e 15% nos homens, sendo que a ferritina diminuiu com o aumento do número de doações.

Linfografía como opción diagnóstica y terapéutica en la fuga quilosa posoperatoria de cáncer colorrectal.

La fuga quilosa es una complicación muy poco frecuente tras la cirugía colorrectal. Se presenta el caso de un paciente de 70 años con neoplasia de recto medio intervenido de forma electiva tras un ciclo largo de neoadyuvancia mediante una resección anterior de recto por laparoscopia. El cuarto día de posoperatorio presentó un drenaje pélvico de aspecto quiloso y el día 13 se confirmó la fuga quilosa en la linfografía. Posteriormente el débito se redujo de forma rápida. La linfografía no solo es un método diagnóstico, sino que en el 35-70% de los casos puede también ser terapéutica.Chylous leakage is an extremely rare complication after colorectal surgery. We report the case of a 70 year-old male with a mid-rectal cancer who underwent a laparoscopic anterior resection of the rectum after long course neoadjuvant therapy. On postoperative day 4 the patient presented with chylous pelvic drainage, and a chylous leakage was proved by lymphography on postoperative day 13. Hereinafter, the drainage was drastically reduced. The lymphography is not only a diagnostic technique, but it can be also a therapeutic method in up to 35-70% of the cases.

Conservative management in iatrogenic splenic trauma after chest tube insertion.

Insertar un tubo torácico es una maniobra terapéutica de gran valor, pero no exenta de complicaciones. Nuestro objetivo es poner de manifiesto una nueva opción de tratamiento mediante técnicas radiológicas intervencionistas que eviten los riesgos de una cirugía en pacientes seleccionados. Presentamos el caso de un paciente pluripatológico con diagnóstico de empiema pulmonar izquierdo al que de manera accidental se le insertó un tubo torácico en el polo superior esplénico. La comorbilidad del paciente y la presencia de estabilidad hemodinámica abogaron por un tratamiento conservador mediante cateterización esplénica supraselectiva e introducción de cola quirúrgica en la retirada del tubo.

Inserting a chest tube is a therapeutic tool of great value not without complications. Our objective is to highlight a new treatment option using interventional radiological techniques that avoid the risks of surgery in selected patients. We present the case of a multi-pathological patient with a diagnosis of left pulmonary empyema who accidentally inserted a chest tube into the splenic superior pole. The comorbidities of the patient and the presence of hemodynamic stability advocated conservative treatment through supraselective splenic catheterization and the introduction of surgical glue in the withdrawal of the tube.

Effect of plateletpheresis on total platelet count and mean platelet volume: A meta-analysis.

OBJECTIVE: Currently, there are discrepancies in the reports on the extent of the reduction in platelet count after platelet donation by apheresis, and its impact on mean platelet volume (MPV). This study was conducted to meta-analyze the effect of plateletpheresis on platelet count and on mean platelet volume, based on studies published between 1980 and 2018. METHODS: Medline-Pubmed, Scielo, ScienceDirect, and Scopus databases were searched from inception to December 31 2019. The PRISMA guidelines, reproducibility, and evaluation of the methodological quality were guaranteed. Heterogeneity was evaluated with DerSimonian-Laird's, publication bias with a Begg's test. Sensitivity analysis and cumulative meta-analysis were also conducted, as well as a forest plot. RESULTS: Twenty-five studies with 3769 donors were systematized to analyze platelet count, and seven studies with 1176 donors to observe MPV. Most studies were published in India and the United States. There was a postprocedure reduction in both variables. The reduction in platelet count was 14.3 × 103 /µL (95% CI 11.4 to 17.1 × 103 /µL). The reduction in MPV was 1.43 fL (95% CI 0.3 to 2.5 fL). The analysis of subgroups showed that, in the case of platelet count, the reduction is not statistically significant two weeks after donation. CONCLUSION: Platelet donation by apheresis reduces platelet count and MPV in donors, which is detrimental to the purposes of the procedure; although the decrease is not clinically significant for the donor or the recipient. This demonstrates the need for subsequent studies to evaluate variables, such as donation frequency and donation intervals, should be considered to evaluate if the reported decrease is easily compensated, without adverse consequences for donors, or if modifications in donor selection criteria are required.

Effect of plateletpheresis on hematocrit, hemoglobin and erythrocyte count: Meta-analysis 1980-2018.

The effects of platelet donation by apheresis on different parameters of the erythrogram are still unclear. The objective was to meta-analyze the effect of plateletpheresis on hematocrit, hemoglobin, and erythrocyte count, with a systematic review with random effects meta-analysis of the mean difference. The PRISMA guidelines were considered, as well as 133 search strategies on four different databases. Reproducibility was guaranteed and methodological quality was evaluated. Heterogeneity was evaluated with Galbraith and DerSimonian-Laird's, publication bias with a funnel plot and a Begg's test, sensitivity analysis and a cumulative meta-analysis were also conducted. Eighteen (18) articles were included, 17 evaluated the effects on hematocrit in 2,564 donors; 13 on hemoglobin in 1,640 donors; and 4 on red blood cell count in 243 donors. A decrease of 2.26% (CI95% = 2.11-2.41) was observed in hematocrit, of 0.80 g/dL (CI95% = 0.75-0.86) in hemoglobin and -0.21 × 1012/L (CI95% = -0.13; -0.29) in red blood cell count. Plateletpheresis has a negative effect on the erythrogram parameters, explained by blood loss in the kits used for the procedure and cell lysis. Such evidence is relevant to secure the efficiency and safety of the procedure, improve selection processes or determine the number of donations that can be performed without affecting donors' health.

Muerte súbita de causa cardíaca en pediatría. Análisis de 95 casos en los últimos 20 años / Sudden death of cardiac etiology in pediatrics. Analysis of 95 cases in the last 20 years / Morte súbita de etiologia cardíaca em pediatria. Análises de 95 casos nos últimos 20 anos

Resumen: Introducción: acerca del tema muerte súbita de origen cardíaco en niños y adolescentes es mucho lo que se describe en la literatura mundial, pero son pocos los datos publicados en nuestro país. Más de la mitad de los casos de muerte súbita en este grupo etario responden a una etiología cardíaca. Objetivo: analizar los eventos de muerte súbita en edad pediátrica a partir de casos de muerte súbita (incluidas las frustras o abortadas) referidos por los colegas intervinientes en su evaluación de manera correlativa, según fueron sucediendo en el tiempo, tratando de investigar en ellos y en sus familiares cercanos la existencia de patologías cardíacas responsables de dicho evento. Evaluar mecanismos de prevención. Resultados: se estudiaron 95 casos, el 68% de sexo masculino, con edades entre 6 meses y 18 años. En el 65% de los casos se encontró una etiología cardíaca responsable. De ellos, en dos tercios se trató de una patología estructural cardíaca y en el tercio restante de una canalopatía o arritmia. Hubo antecedentes familiares de muerte súbita en el 50% de los casos. En el 35% de éstos se encontró una etiología potencialmente causante de muerte súbita. Conclusiones: la muerte súbita en edad pediátrica es un hecho real. Desconocemos su incidencia en nuestro país. La etiología cardíaca tuvo un papel preponderante en los casos estudiados. Por lo tanto, debemos poder detectar las situaciones de riesgo de un evento de muerte súbita previo a su aparición, y, si este ocurriera, tener previstos los mecanismos necesarios para revertirla.

Summary: Introduction: much has been described in the global literature about Sudden Cardiac Death, but few reliable data is available in Uruguay. More than half of the cases of sudden death in this age group arise from a cardiac etiology. Objective: to analyze sudden death in pediatric populations by studying sudden death cases (including frustrated or aborted deaths) referred to by colleagues involved in their assessment, as they happened over time. We studied the existence of cardiac pathologies in patients and their close relatives and evaluated prevention mechanisms. Results: 95 cases were studied, 68% males, aged between 6 months and 18 years. In 65% of the cases, we were able to find a cardiac etiology responsible for the event, in two thirds of the cases it was a structural cardiac pathology, and in the remaining third it was a canalopathy or arrhythmia. There was a family history of sudden death in 50% of cases. Of these cases, 35% showed a potential etiology that caused the sudden death. Conclusions: sudden death in children is a real fact. We do not know its incidence in Uruguay. Cardiac etiology played a significant role in the cases studied. Therefore, we should be able to detect situations of risk of a sudden death event prior to its appearance and if it occurred, we should be able to prevent the necessary mechanisms to reverse it.

Resumo: Introdução: muito tem sido descrito na literatura internacional sobre morte súbita cardíaca, mas poucos dados confiáveis estão disponíveis no Uruguai. Mais da metade dos casos de morte súbita nessa faixa etária vem duma etiologia cardíaca. Objetivo: analisar eventos de morte súbita durante a idade pediátrica, estudando casos de morte súbita (incluindo mortes frustradas ou abortadas) referidos pelos colegas envolvidos em sua avaliação, assim tal como ocorreram ao longo do tempo. Estudamos a existência de patologias cardíacas em pacientes e familiares próximos e avaliamos os mecanismos de prevenção. Resultados: foram estudados 95 casos, 68% do sexo masculino, com idade entre 6 meses e 18 anos. Em 65% dos casos, conseguimos encontrar uma etiologia cardíaca responsável pelo evento, e em dois terços dos casos era uma patologia cardíaca estrutural e no terço restante era uma canalopatia ou arritmia. Em 50% dos casos existia história familiar de morte súbita. Desses casos, 35% mostraram uma etiologia potencial que causou a morte súbita. Conclusões: a morte súbita em crianças é um fato real. Não sabemos sua incidência em Uruguai. A etiologia cardíaca teve um papel importante nos casos estudados. Portanto, devemos ser capazes de detectar situações de risco de morte súbita antes de que ocorra e, se ocorrer, devemos prever os mecanismos necessários para revertê-lo.

Estimating the influence of the network topology on the agility of food supply chains.

Several studies have shown that the performance of a supply chain is heavily influenced by the pattern of relationships among firms. This paper analyzes the structure of relationships (network topology) that leads to the highest agility of a food supply chain when sudden demand changes occur. To do this, a simulation model that represents a supply chain and specific rules to allocate orders is built. The supply chain in the model follows the specific characteristics of trade in the primary sector. The model is fitted to the conditions of a real seafood supply chain in Mexico. Agility is measured through the effect on the order fulfillment of a sudden demand shock and the recovery time of this rate to previous values. The simulation results show that the most suitable structure depends on how product is distributed among suppliers. If product is evenly shared, supply chains with homogeneous topologies are more agile than supply chains with heterogeneous topologies, but the result is the opposite if product is unevenly shared among suppliers. Other previous recommendations, such as having multiple suppliers and horizontal links, are confirmed by the simulations. These findings contribute to the general debate on which is the optimal topology for an agile supply chain.

Hemorragia alveolar difusa no inmune en pediatría / Non-inmune mediated diffuse alveolar hemorrage in children / A hemorragia alveolar difusa não imune em pediatria

Resumen: La hemorragia alveolar difusa no inmune es una patología poco frecuente tanto en la población pediátrica como en los adultos. Si bien se conocen factores determinantes de dicha patología, la interacción de éstos a la hora de producirse el sangrado no es del todo comprendida. Para cumplir con la función de intercambio gaseoso la membrana alvéolo-capilar debe tener un espesor bajo, lo que la expone a falla por estrés y eventualmente extravasación de sangre al parénquima pulmonar. La membrana basal, sumado a la disposición de los alvéolos y el intersticio pulmonar, le dan resistencia extraordinaria a dicha membrana. Si ocurre efracción de la membrana alvéolo capilar puede haber pasaje de sangre al alvéolo e intersticio pulmonar, este fenómeno es conocido como falla por estés. En los casos que existe fragilidad de la membrana alvéolo-capilar, ya sea por inmadurez o por situaciones patológicas, existe un riesgo significativo de efracción de la misma. Alteraciones hemodinámicas y de la cascada de la coagulación pueden ser factores determinantes en el desarrollo de hemorragia alveolar. En el presente trabajo se discuten cuatro casos clínicos de hemorragia alveolar difusa no inmune y en base a éstos se desarrolla una hipótesis con el objetivo de explicar la interrelación de los factores que inciden en el desarrollo de dicha entidad.

Summary: Non-immune mediated alveolar hemorrhage is a rare pathology affecting both children and adults. Although the causes of this disease are known, their interaction in case of bleeding is not clearly understood. The present paper discusses 4 clinical cases of non-immune mediated alveolar hemorrhage and a hypothesis is presented with the objective of explaining the interrelation of the factors that may affect the its development. In order to comply with the gas exchange function, the alveolar-capillary membrane must not be too thick, since this might lead to stress failure and to eventual blood extravasation to the lung parenchyma. The basement membrane (type IV) collagen, plus the alveoli arrangement and the pulmonary interstitium, provide extraordinary resistance to such membrane. Whenever the alveolar-capillary membrane is weak, either due to immaturity or to pathological situations, there is a significant risk of rupture. Hemodynamic and coagulation alterations can be determining factors in the development of this pathology, since they affect the development of stress failure or perpetuate the passage of blood to the pulmonary interstitium.

Resumo: A hemorragia alveolar não imune é uma patologia rara tanto nas crianças como nos adultos. Embora os determinantes dessa patologia sejam conhecidos, sua interação no momento de determinar o sangramento não é completamente compreendida. Neste estudo discutimos quatro casos clínicos de hemorragia alveolar não imune e desenvolvimos hipóteses para explicar a inter-relação de fatores que afetam o desenvolvimento da doença. Para que a membrana possa cumprir a sua função de troca de gás alveolar-capilar deve ter baixa espessura, o que a expõe à tensão de ruptura e, eventualmente, o extravasamento de sangue para o parênquima pulmonar. O colagénio tipo IV da membrana basal, adicionado à disposição dos alvéolos e ao interstício pulmonar, confere extraordinária resistência à referida membrana. Nos casos nos que há fragilidade da membrana alvéolo-capilar, seja por imaturidade ou por situações patológicas, existe risco significativo de sua ruptura. Alterações hemodinâmicas e de coagulação podem ser fatores determinantes no desenvolvimento dessa patologia, uma vez que afetam o desenvolvimento de falha de estresse ou perpetuam a passagem do sangue para o interstício pulmonar.

Effects of an ergonomic program on the quality of life and work performance of university staff with physical disabilities: A clinical trial with three-month follow-up.

BACKGROUND: Problems related to physical disability may have an extremely negative impact in the work environment, reducing productivity and contributing to health problems and a worsening quality of life. OBJECTIVE: To assess the effects of an ergonomic intervention program on the quality of life and the work performance of people with physical disabilities working in a university environment. METHODS: A pilot clinical trial with three-month follow-up was conducted at the Physiotherapy Clinic of the Federal University of Paraíba (Brazil). Eight workers at the university took part in an ergonomic adjustment (using ErgoDis/IBV software) and physiotherapy program at their workplace for twelve weeks, in two 60-min sessions per week. The measuring instruments used were the WHOQoL-BREF questionnaire for quality of life and the Work Ability Index for work ability. A repeated-measures ANOVA analysis and Wilcoxon signed-rank test were also performed. RESULTS: Significant intra-group changes were observed in the QoL subscales for the physical dimension (F = 5.487, p = 0.017) and the environment dimension (F = 7.510, p = 0.006). The post-treatment analysis revealed significant changes for both the physical dimension (Z = -2.552, p = 0.011) and the environment dimension (Z = -2.201, p = 0.028). After the three-month follow-up period, only the environment dimension recorded a significant change (Z = -1.965, p = 0.049). The effect sizes were large. Regarding work ability, the repeated-measures ANOVA analysis showed a significant time effect (F = 5.067, p = 0.022), with large pre-post treatment improvement (Z = -2.555, p = 0.011, d = 0.914). CONCLUSIONS: The program based on ergonomic and physiotherapy program greatly enhanced the subjects' quality of life and work ability.

Efficacy and safety of a novel nitric oxide generator for the treatment of neonatal pulmonary hypertension: Experimental and clinical studies.

Persistent pulmonary hypertension of the newborn (PPHN) is a complex pathology resulting from a failure of the post-natal reduction in pulmonary vascular resistance leading to hypoxemia. The standard therapy is inhaled Nitric Oxide (NO) improving oxygenation but its availability is limited, especially in hospitals with restricted financial resources. We evaluated the efficacy and safety of a new device generating NO (TAS + PLUS), in three experimental piglet models of pulmonary hypertension (PH), and we later tested its application in a pilot study of newborn patients suffering from PPHN. Piglets with experimentally induced PH showed a decrease in pulmonary arterial pressure (PAP) after breathing NO. Both acute and chronic exposure of piglets and rats did not cause any adverse effect in blood gas levels and biological parameters. A pilot study including 32 patients suffering from PPHN showed an increase in oxygen saturation (SatO2) and partial pressure of oxygen in arterial blood (PaO2) leading to a decrease of Oxygenation Index (OI) after compassionate treatment with NO from TAS + PLUS device. The device showed effectiveness and safety both in experimental PH and in the clinical setting. Therefore, it represents an excellent alternative for PPHN management in conditions where commercial NO is unavailable.

Estenosis valvular aórtica congénita. ¿Qué debemos esperar? ¿Cómo actuar? / Congenital aortic valve stenosis. What can we expect? How should we act? / O que esperar e como agir nos casos de estenose valvar aórtica congênita?

Resumen: La estenosis valvular aórtica congénita en edad pediátrica es una cardiopatía que debe ser valorada adecuadamente considerando en especial su potencial grado de severidad, a los efectos de realizar el tratamiento de forma adecuada y oportuna, evitando una complicación mayor: la muerte súbita. Se analizan los lineamientos generales para el diagnóstico y reconocimiento de su severidad así como el accionar terapéutico indicado. Por último se ejemplifica mediante cuatro casos clínicos diferentes situaciones evolutivas, mostrando los procedimientos diagnósticos y tratamientos realizados.

Summary: Congenital aortic valve stenosis in children is a heart disease that must be adequately evaluated. The potential degree of severity should be especially considered for a timely treatment in order to prevent sudden death. Guidelines for the diagnosis, recognition of severity and therapeutic action are suggested. Finally, the study presents four clinical cases, with the applied treatment and follow up.

Resumo: A estenose valvar aórtica congênita em pacientes pediátricos é uma doença cardíaca que deve ser avaliada adequadamente, considerando, em particular, seu potencial grau de severidade, a fim de realizar o tratamento adequado e oportuno, evitando a grave complicação da morte súbita. Analisamos as diretrizes gerais para o diagnóstico e reconhecimento de sua gravidade, bem como a ação terapêutica indicada. Finalmente, diferentes situações evolutivas são exemplificadas por quatro casos clínicos, mostrando os procedimentos diagnósticos e os tratamentos realizados.

Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial.

BACKGROUND: Informal caregivers of post-stroke patients usually undergo high levels of pain and stress and have a reduced quality of life. OBJECTIVE: To evaluate the effectiveness of two home ergonomic interventions aimed at reducing pain intensity and perceived stress and enhancing the quality of life in informal caregivers of chronic post-stroke patients. METHODS: A randomized single-blind controlled clinical trial was conducted, with a sample of 33 informal caregivers of patients with stroke. Three groups were included: one received postural hygiene training and kinesiotherapy, for 12 weeks, two days a week, one hour per session; another received adaptation of the home environment, and the third was a control group. Pain intensity, stress level and general quality of life were evaluated at three-time points: pre-intervention, post-intervention, and after a follow-up period of three months. RESULTS: Neck pain decreased in the two experimental groups, and increased in the control group. Pain in the shoulders and knees was alleviated in the group that received postural hygiene and kinesiotherapy. In addition, regarding quality of life, this group obtained an improvement in the physical health dimension, while the home adaptation group reported improved social relationships. CONCLUSIONS: These results suggest that 12 weeks of training in postural hygiene, combined with kinesiotherapy, and home adaptations can reduce pain and improve several aspects of the quality of life of this population. CLINICALTRIALS. GOV ID: NCT03284580.

Mortalidad prenatal en el Centro Hospitalario Pereira Rossell, Montevideo. Análisis de 845 casos de autopsia entre 2005 y 2016 / Stillbirth at Pereira Rossell Hospital in Montevideo. Analysis of 845 autopsies between 2005 and 2016

Resumen: Antecedentes: con la mejora de la atención del embarazo se ha reducido el número de mortinatos en el mundo desarrollado. Pero en los países subdesarrollados y en vías de desarrollo constituyen un problema sanitario. Objetivo: conocer las patologías que subyacen en los casos de autopsia de mortinatos del Centro Hospitalario Pereira Rossell, a los efectos de contribuir a la reducción de la mortalidad fetal. Material y método: se realiza un estudio observacional, descriptivo de recolección de información en forma retrospectiva de las autopsias de los de mortinatos del Centro Hospitalario Pereira Rossell de los últimos 12 años (2005-2016). Las autopsias y las placentas fueron realizadas de acuerdo al protocolo habitual en patología perinatal. Los datos del estudio se analizaron conjuntamente. Resultados: se constataron malformaciones congénitas en 17,7% e infección congénita en la autopsia en 20,4%. La infección en conjunto (en autopsia y/o placenta) se identificó en 383 casos (45,3%). Se identificó lúes en 10,5% de los mortinatos. Había elementos fetales de asfixia en 11,5% y una miscelánea de patologías en 3,5% de los casos. En 50,4% la autopsia propiamente dicha no tenía alteraciones, pero en 90% de ellas se identificaron lesiones placentarias que pudieron ser responsables de la muerte fetal. Se observó bajo flujo sanguíneo útero placentario en 14,2% de las placentas, corioamnionitis en 30,5% de las placentas, y hematoma retroplacentario en 26,6% de las placentas. La muerte fue indeterminada en 4,9% de los casos. Conclusiones: un elevado porcentaje de los casos tienen patologías evitables y tratables. Se identificaron patologías potencialmente recurrentes y enfermedades que ameritan tratar a la madre. Los estudios de los mortinatos deben ser considerados en los protocolos sanitarios a los efectos de reducir la mortalidad fetal.

Summary: Background: the number of stillbirth cases has been reduced in the developed countries due to improvements in pregnancy care. It is important to know the causes in order to prevent fetal death. Early identification of risk factors for stillbirth may reduce the number of cases. The objective of this paper is to identify the underlying pathologies of the cases that underwent an autopsy at Pereira Rossell Hospital in Montevideo, in order to contribute to the reduction of fetal mortality. Methods: this is a retrospective and descriptive study of autopsy and placental examinations, performed at the Pediatric Pathology Laboratory of Pereira Rossell Hospital in Montevideo. A standard protocol was applied. Data were analyzed overall. Results: congenital malformations were identified in 17.7% of cases; congenital infection in the fetus was found in 20.4%. Infection altogether (in the autopsy and/or the placenta) was identified in 383 cases (45.3%). Syphilis was diagnosed in 10.5% of the stillborn. Fetal evidence of asphyxia accounted for 11.5% and miscellaneous pathologies 3.5%. In 50.4% of cases the autopsy did not reveal alterations, but 90% of corresponding placentas had lesions that could have caused the death of the fetus. Maternal underperfusion or malperfusion was found in 14.2% of the placentas. Chorioamnionitis was seen in 30.5%. A retroplacental hematoma was seen in 26.6%. Stillbirth was of unexplained in 4.9% of the cases. Conclusion: a high percent of the cases studied had a preventable pathology. Many recurrent lesions were identified as well as cases that required additional medication to the mother. The results of the pathology examination should be considered in order to reduce the stillbirth rate.