El modelo Precede-Procede: un marco contextual para la salud comunitaria en entornos educativos / O modelo Precede-Proceeds: um quadro contextual para a saúde comunitária em ambientes educativos / The Precede-Procede-Model: a contextual framework for community health in educational settings

Educational communities have the potential to project themselves as transforming niches of living conditions around the identification of health needs and the search for alternatives to solve them. Withinthe framework of the Master's in Public Health at the Universidad de La Sabana, progress has been made in strategies to generate this link, through support in the formulation of a community health program in an educational environment, based on the adaptation of the model PrecedeProcede, a method to plan, conduct and evaluate health education interventions. Taking into account the above, the objective of this article is to reflect on the contributions of the model for the formulation of community health programs in educational settings, regarding primary health care and the policies of healthy educational settings, considering that they are referents regulations in the Colombian territory. In summary, this model is considered a favorable option for the formulation of health programs in the educational context because it privileges community participation, addresses contextualized problems and gives the possibility for students to integrate from an early age and educational communities to become social managers of their own health.(AU)

Las comunidades educativas tienen el potencial de proyectarse como nichos transformadores de las condiciones de vida en torno a la identificación de las necesidades en salud y la búsqueda de alternativas para resolverlas. En el marco de la maestría en Salud Pública de la Universidad de La Sabana se ha avanzado en estrategias para generar este vínculo, a través del acompañamiento en la formulación de un programa de salud comunitaria en un entorno educativo, basados en la adaptación del modelo Precede-Procede, un método para planear, conducir y evaluar intervenciones de educación para la salud. Teniendo en cuenta lo anterior, el objetivo de este artículo es reflexionar sobre los aportes del modelo para la formulación de programas de salud comunitaria en entornos educativos, a propósito de la atención primaria de salud y las políticas de entornos educativos saludables, considerando que son referentes normativos en el territorio colombiano. En síntesis, dicho modelo se considera una opción favorable para la formulación de programas de salud en el contexto educativo porque privilegia la participación comunitaria, aborda problemáticas contextualizadas y da la posibilidad para que desde edades tempranas se integren estudiantes y las comunidades educativas se constituyan como gestoras sociales de su propia salud.(AU)

As comunidades educativas têm potencial para se projetarem como nichos transformadores das condições de vida em torno da identificação das necessidades de saúde e da busca de alternativas para solucionálas. No âmbito do Mestrado em Saúde Pública da Universidad de La Sabana, avançou-se nas estratégias para gerar este vínculo, através do apoio na formulação de um programa de saúde comunitária em ambiente educativo, baseado na adaptação do modelo Precede -Proceder, um método para planejar, conduzir e avaliar intervenções de educação em saúde. Levando em conta o exposto, o objetivo deste artigo é refletir sobre as contribuições do modelo para a formulação de programas de saúde comunitária em ambientes educativos, no que diz respeito à atenção primária à saúde e às políticas de ambientes educativos saudáveis, considerando que são normas de referência em território colombiano. Em síntese, esse modelo é considerado uma opção favorável para a formulação de programas de saúde no contexto educacional, pois privilegia a participação da comunidade, aborda problemas contextualizados e dá a possibilidade de os alunos se integrarem desde cedo e comunidades educativas em formação gestores sociais de sua própria saúde.(AU)

A new theropod dinosaur from the early cretaceous (Barremian) of Cabo Espichel, Portugal: Implications for spinosaurid evolution.

Spinosaurids are some of the most enigmatic Mesozoic theropod dinosaurs due to their unique adaptations to aquatic environments and their relative scarcity. Their taxonomy has proven to be especially problematic. Recent discoveries from Western Europe in general, specifically Iberia, provide some of the best specimens for the understanding of their phylogeny, leading to the description of the spinosaurid Vallibonavenatrix cani and the recognition of the Iberian dinosaur Camarillasaurus cirugedae as one of them. Portuguese associated spinosaurid remains (ML1190) from the Papo Seco Formation (early Barremian) were previously assigned to Baryonyx walkeri but new material recovered in 2020 along with new phylogenetic analyses suggests a different phylogenetic placement, making their revision necessary. Here we show that these remains are not attributable to Baryonyx walkeri, but to a new genus and species, Iberospinus natarioi, gen. et sp. nov. The new taxon is characterized by the presence of a single Meckelian foramen in the Meckelian sulcus, a straight profile of the ventral surface of the dentary and a distal thickening of the acromion process of the pubis between other characters. Iberospinus natarioi is recovered as a sister taxon of the clade formed by Baryonyx and Suchomimus, and outside Spinosaurinae when Vallibonaventrix cani is excluded from the analysis. The description of this taxon reinforces Iberia as a hotspot for spinosaur biodiversity, with several endemic taxa for the region. As expected for the clade, the dentary displays a highly vascularized neurovascular network. The morphometric analysis of parts of the skeleton (pedal phalanx and caudal vertebrae, among others) shows an intermediate condition between basal tetanurans and spinosaurines.

Robust keratoconus detection with Bayesian network classifier for Placido-based corneal indices.

PURPOSE: To evaluate in a sample of normal and keratoconic eyes a simple Bayesian network classifier for keratoconus identification that uses previously developed topographic indices, calculated directly from the digital analysis of the Placido ring images. METHODS: A comparative study was performed on a total of 60 eyes from 60 patients (age 20-60 years) from the Department of keratoconus of INVISION Ophthalmology clinic (Almería, Spain). Patients were divided into two groups depending on their preliminary diagnosis based on the classical topographic criteria: a control group without topographic alteration (30 eyes) and a keratoconus group (30 eyes). The keratoconus group included all grades except grade IV with excessively distorted corneal topography. All cases were examined using the CSO topography system (CSO, Firenze, Italy), and primary corneal Placido-indices were computed, as described in literature. Finally, a classifier was built by fitting a conditional linear Gaussian Bayesian network to the data, using the 5- and 10-fold cross-validation. For comparison, the original data were perturbed with random white noise of different magnitude. RESULTS: The naïve Bayes classifier showed perfect discrimination ability among normal and keratoconic corneas, with 100% of sensibility and specificity, even in the presence of a very significant noise. CONCLUSIONS: The Bayesian network classifiers are highly accurate and proved a stable screening method to assist ophthalmologists with the detection of keratoconus, even in the presence of noise or incomplete data. This algorithm is easily implemented for any Placido topographic system.

Artiflex foldable lens for myopia correction results of 10 years of follow-up.

PURPOSE: The aim of this study was to evaluate the long-term efficacy and safety of the Artiflex® lens implant and to follow the evolution of the number of corneal endothelial cells over time. DESIGN: It was a retrospective study of an observational case series of patients who underwent surgery at "The INVISION Ophthalmic Hospital" (Almería, Spain) in 2007 and who were followed for 10 years. METHODS: Setting: Clinical practice. Study population included 53 eyes of 30 patients who underwent an Artiflex® lens implant for the correction of myopia from -4 to -14 D. Each patient included in this study had stable myopia for at least 2 years and a contraindication for corneal refractive surgery. The efficacy index was defined as the quotient between uncorrected distance visual acuity postoperative and best-corrected distance visual acuity (BCDVA) preoperative. The safety index was calculated as the quotient between BCDVA postop and BCDVA preop. RESULTS: The average efficacy and safety indices of the lenses implanted were 1.1 (SD 0.30) and 1.06 (SD 0.2) at 10 years of follow-up. In this period of time there has been a loss of 12% of the corneal endothelial cells. The postoperative complications were pigment dispersion in four eyes (7%) of four patients and decentration of phakic intraocular lens in two eyes (4%) of another two patients. CONCLUSIONS: The Artiflex® foldable phakic lens could be a safe and effective long-term alternative for myopic patients in whom laser surgery was contraindicated.

Behavior of squamous cell carcinoma of the floor of the mouth. Is supraomohyoi neck dissection sufficiently safe to manage clinically N0 patients? / Carcinoma epidermoide del suelo de la boca. ¿Es suficientemente seguro el vaciamiento cervical supraomohioideo para tratar clínicamente a los pacientes N0?

Aim: The main aim of the present report is to study the behavior of SCC of the floor of the mouth. Materials and method: A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the floor of the mouth between 2000 and 2012 in the HUVN. Ninety-three patients with squamous cell carcinoma of the floor of the mouth treated with tumourectomy and selective neck dissection were included in the study. The pattern of distribution of cervical metastases and numerous histological features such as T-stage, N stage, surgical margins, tumor thickness, ECS (extracapsular spread) and vascular invasion were analyzed. Results: Level I was the most affected level, followed by Level II. T stage, tumor thickness, and surgical margins showed a strong relationship with the risk of developing a local or cervical failure at follow-up. Overall survival was 52.7%. T stage, tumor thickness, N stage, recurrence, extracapsular spread, and vascular invasion were also associated with a poor prognosis. Conclusions: SCC of the floor of the mouth is an aggressive disease even at early stages. Due to the low rate of positive nodes observed at level IV and V in clinically N0 patients, supraomohyoid neck dissection might be considered sufficiently safe in this group

Objetivo: El principal objetivo de este estudio es estudiar el comportamiento clínico del carcinoma epidermoide del suelo de la boca. Materiales y método: Se realizó un estudio retrospectivo utilizando los registros de pacientes diagnosticados de carcinoma de células escamosas del suelo de la boca entre 2000 y 2012 en el Hospital Universitario Virgen de las Nieves de Granada. En el estudio se incluyeron 93 pacientes con carcinoma epidermoide del suelo de boca tratados con tumorectomía y disección selectiva del cuello. Se analizó el patrón de distribución de las metástasis cervicales y numerosas características histológicas, como el estadio T, el estadio N, los márgenes quirúrgicos, el espesor tumoral, la diseminación extracapsular y la invasión vascular. Resultados: El nivel I fue el más afectado, seguido del nivel II. El estadio T, el espesor tumoral y los márgenes quirúrgicos mostraron una fuerte relación con el riesgo de desarrollar una recidiva local o cervical durante el seguimiento. La supervivencia global fue del 52,7%. El estadio T, el espesor tumoral, el estadio N, la recurrencia, la diseminación extracapsular y la invasión vascular también se asociaron a un mal pronóstico. Conclusión: El carcinoma epidermoide del suelo de la boca representa una enfermedad agresiva incluso en estadios tempranos. Debido a la baja tasa de ganglios positivos observada en los niveles IV y V en pacientes clínicamente N0, la disección supraomohioidea del cuello puede considerarse suficientemente segura en este grupo de pacientes

Behavior of squamous cell carcinoma of the floor of the mouth. Is supraomohyoid neck dissection sufficiently safe to manage clinically N0 patients?

AIM: The main aim of the present report is to study the behavior of SCC of the floor of the mouth. MATERIALS AND METHOD: A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the floor of the mouth between 2000 and 2012 in the HUVN. Ninety-three patients with squamous cell carcinoma of the floor of the mouth treated with tumourectomy and selective neck dissection were included in the study. The pattern of distribution of cervical metastases and numerous histological features such as T-stage, N stage, surgical margins, tumor thickness, ECS (extracapsular spread) and vascular invasion were analyzed. RESULTS: Level I was the most affected level, followed by Level II. T stage, tumor thickness, and surgical margins showed a strong relationship with the risk of developing a local or cervical failure at follow-up. Overall survival was 52.7%. T stage, tumor thickness, N stage, recurrence, extracapsular spread, and vascular invasion were also associated with a poor prognosis. CONCLUSIONS: SCC of the floor of the mouth is an aggressive disease even at early stages. Due to the low rate of positive nodes observed at level IV and V in clinically N0 patients, supraomohyoid neck dissection might be considered sufficiently safe in this group.

Endovascular treatment of an intraosseous arteriovenous malformation of the mandible in a child. A case Report.

The modern application of interventional radiology techniques is revolutionizing the treatment of the vascular malformations of the head and neck. In fact, the morbidity related with the surgical extirpation of the malformation might be drastically reduced with the use of an endovascular approach. The present report describes the case of a 11 years old male affected by a large intraosseous arteriovenous malformation of the mandible. The coil embolization of the main drainage vein caused the spontaneous regression of the lesion and avoided a mutilating surgery and severe psychological sequels. A multidisciplinary approach of these case is mandatory. A careful clinical and radiological study of the patient is essential for a proper management. The choice of the treatment should be based on the location and extension of the malformation, age of the patient, experience with endovascular techniques and clinic. Key words:Endovacualr approach, intraosseous arteriovenous malformation, head and neck, child.

Self-report health-related quality of life among children and adolescents from Bogotá, Colombia. The FUPRECOL study.

OBJECTIVE: To describe by self-report the HRQoL among schoolchildren from Bogotá, Colombia belonging to the FUPRECOL study. METHODS: A cross-sectional study in 3,245 children and 3,354 adolescents, between 9 and 17.9 years old, participated in the study. Spanish version of the EQ-5D-Y was self-assessment. Percentages of missing values and reported problems were calculated. The data was analyzed by measurement of central tendency stratified by age group, and to compare them to international references. RESULTS: A total of 58.3%, (n= 3,848) were women. In all ages, the HRQoL was higher in boys than in girls. To compare by sex, the dimensions of the EQ-5D-Y "feeling worried, sad or unhappy" and "having pain or discomfort", showed the highest frequency among women. Overall, our HRQoL were higher than South Africa, Germany and Italy references. CONCLUSION: The HRQoL was higher in boys than in girls The HRQoL. The dimensions of the EQ-5D-Y "feeling worried, sad or unhappy" and "having pain or discomfort", showed the highest frequency. The HRQoL by age and sex may be used in the evaluation of the health perceived among schoolchildren from Bogotá.

OBJETIVO: Describir por autoreporte la calidad de vida relacionada con la salud (CVRS) en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. MÉTODOS: Estudio descriptivo y transversal, en 3,245 niños y 3,354 adolescentes, entre 9 y 17.9 años de edad, de 24 instituciones educativas oficiales de Bogotá, Colombia. Se aplicó de manera auto-administrada del instrumento de CVRS infantil EQ-5D-Y proxy, versión validada al castellano. Se analizaron los datos por medidas de tendencia central y se realizó una comparación de los observados en Colombia con estudios internacionales. RESULTADOS: De la población evaluada, el 58.3% (n= 3,848), fueron mujeres. En general, se observaron puntuaciones elevadas en la CVRS en niños y adolescentes de ambos sexos. Al comparar por género, las dimensiones del EQ-5D-Y proxy "sentirse triste/preocupado o infeliz" y "tener dolor/malestar", presentaron la mayor frecuencia de respuesta en el grupo de las mujeres. Al comparar los resultados de este estudio, por grupos de edad, con trabajos internacionales de niños y adolescentes, se observó que las puntuaciones del EQ-5D-Y proxy fueron superiores a los reportados en Suráfrica, Alemania e Italia. CONCLUSIÓN: Los niños acusan menor porcentaje de problemas en todas las dimensiones que los adolescentes. Las dimensiones relativas a "dolor/malestar" y "sentirse triste/preocupado o infeliz", fueron en las que se indicaron más problemas. Se presentan valores de la CVRS según edad y sexo que podrán ser usados en la evaluación de la salud percibida en el ámbito escolar en Bogotá, Colombia.

Case-Control Study of Risk Factors for Meningococcal Disease in Chile.

An outbreak of meningococcal disease with a case-fatality rate of 30% and caused by predominantly serogroup W of Neisseria meningitidis began in Chile in 2012. This outbreak required a case-control study to assess determinants and risk factors for infection. We identified confirmed cases during January 2012-March 2013 and selected controls by random sampling of the population, matched for age and sex, resulting in 135 case-patients and 618 controls. Sociodemographic variables, habits, and previous illnesses were studied. Analyses yielded adjusted odds ratios as estimators of the probability of disease development. Results indicated that conditions of social vulnerability, such as low income and overcrowding, as well as familial history of this disease and clinical histories, especially chronic diseases and hospitalization for respiratory conditions, increased the probability of illness. Findings should contribute to direction of intersectoral public policies toward a highly vulnerable social group to enable them to improve their living conditions and health.

Self-report health-related quality of life among children and adolescents from Bogotá, Colombia. The FUPRECOL study / Autoreporte de la calidad de vida en niños y adolescentes colombianos: Estudio FUPRECOL

Abstract Objective: To describe by self-report the HRQoL among schoolchildren from Bogotá, Colombia belonging to the FUPRECOL study. Methods: A cross-sectional study in 3,245 children and 3,354 adolescents, between 9 and 17.9 years old, participated in the study. Spanish version of the EQ-5D-Y was self-assessment. Percentages of missing values and reported problems were calculated. The data was analyzed by measurement of central tendency stratified by age group, and to compare them to international references. Results: A total of 58.3%, (n= 3,848) were women. In all ages, the HRQoL was higher in boys than in girls. To compare by sex, the dimensions of the EQ-5D-Y "feeling worried, sad or unhappy" and "having pain or discomfort", showed the highest frequency among women. Overall, our HRQoL were higher than South Africa, Germany and Italy references. Conclusion: The HRQoL was higher in boys than in girls The HRQoL. The dimensions of the EQ-5D-Y "feeling worried, sad or unhappy" and "having pain or discomfort", showed the highest frequency. The HRQoL by age and sex may be used in the evaluation of the health perceived among schoolchildren from Bogotá.

Resumen Objetivo: Describir por autoreporte la calidad de vida relacionada con la salud (CVRS) en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, en 3,245 niños y 3,354 adolescentes, entre 9 y 17.9 años de edad, de 24 instituciones educativas oficiales de Bogotá, Colombia. Se aplicó de manera auto-administrada del instrumento de CVRS infantil EQ-5D-Y proxy, versión validada al castellano. Se analizaron los datos por medidas de tendencia central y se realizó una comparación de los observados en Colombia con estudios internacionales. Resultados: De la población evaluada, el 58.3% (n= 3,848), fueron mujeres. En general, se observaron puntuaciones elevadas en la CVRS en niños y adolescentes de ambos sexos. Al comparar por género, las dimensiones del EQ-5D-Y proxy "sentirse triste/preocupado o infeliz" y "tener dolor/malestar", presentaron la mayor frecuencia de respuesta en el grupo de las mujeres. Al comparar los resultados de este estudio, por grupos de edad, con trabajos internacionales de niños y adolescentes, se observó que las puntuaciones del EQ-5D-Y proxy fueron superiores a los reportados en Suráfrica, Alemania e Italia. Conclusión: Los niños acusan menor porcentaje de problemas en todas las dimensiones que los adolescentes. Las dimensiones relativas a "dolor/malestar" y "sentirse triste/preocupado o infeliz", fueron en las que se indicaron más problemas. Se presentan valores de la CVRS según edad y sexo que podrán ser usados en la evaluación de la salud percibida en el ámbito escolar en Bogotá, Colombia.

Tapia's syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series.

BACKGROUND: Tapia's syndrome is an uncommon disease described in 1904 by Antonio Garcia Tapia, a Spanish otolaryngologist. It is characterized by concomitant paralysis of the hypoglossal (XIIth) and pneumogastric (Xth) nerves. Only 69 cases have been described in the literature. Typically, the reported patients presented with a history of orotracheal intubation. Common symptoms are dysphonia, tongue deviation toward the affected side, lingual motility disturbance, and swallowing difficulty. CASE PRESENTATION: In the report, we describe three cases of Tapia's syndrome in three Caucasian patients who underwent surgery with general anesthesia. Two of these patients underwent neck abscess drainage, and the third had an open reduction of a shoulder fracture. The clinical symptoms of Tapia's syndrome appeared after extubation. All three of our patients recovered their lost function at 3 months after diagnosis. CONCLUSIONS: We underline the importance of performing airway endoscopy and a specific program of swallowing rehabilitation for the proper management of Tapia's syndrome.

[Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak]. / Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013.

INTRODUCTION: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. OBJECTIVE: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. MATERIAL AND METHODS: Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying. RESULTS: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. DISCUSSION: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013 / Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

[Clinical characterization of cases with meningococcal disease by W135 group in Chile, 2012]. / Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile.

BACKGROUND: During 2012 in Chile, there were 60 cases of serogroup W135 meningococcal disease, which accounts for 57.7% of identified serogroup cases. AIM: To describe main clinical features of patients with serogroup W135 meningococcal disease confirmed in 2012. MATERIAL AND METHODS: Descriptive study of case series based on retrospective review of medical records. RESULTS: Male patients represented 61.7% and 46.7% were children under 5 years. At first clinical attention, 3.4% of patients were suspected of meningococcal disease, while 83.3% had meningococcemia as final diagnosis. Also at first attention, the most common symptoms or clinical signs were fever ≥ 38.0° C (60.3%), cold symptoms (52.5%), and nausea or vomiting (46.7%). Meningeal signs had a low frequency (8.7%). Diarrhea was the second most common symptom found among deceased patients (55.6%) and statistically higher than survivors (26.8%; p = 0.034). Six cases reported with sequelae: limb amputation, hearing loss or neurological damage, and mortality was 31.7%. DISCUSSION: In 2012, serogroup W135 meningococcal disease reported high mortality, atypical clinical presentation, low initial meningococcal disease diagnosis, and a high number of cases with poor clinical course.

Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile / Clinical characterization of cases with meningococcal disease by W135 group in Chile, 2012

Background: During 2012 in Chile, there were 60 cases of serogroup W135 meningococcal disease, which accounts for 57.7% of identified serogroup cases. Aim: To describe main clinical features of patients with serogroup W135 meningococcal disease confirmed in 2012. Material and Methods: Descriptive study of case series based on retrospective review of medical records. Results: Male patients represented 61.7% and 46.7% were children under 5 years. At first clinical attention, 3.4% of patients were suspected of meningococcal disease, while 83.3% had meningococcemia as final diagnosis. Also at first attention, the most common symptoms or clinical signs were fever ≥ 38.0° C (60.3%), cold symptoms (52.5%), and nausea or vomiting (46.7%). Meningeal signs had a low frequency (8.7%). Diarrhea was the second most common symptom found among deceased patients (55.6%) and statistically higher than survivors (26.8%; p = 0.034). Six cases reported with sequelae: limb amputation, hearing loss or neurological damage, and mortality was 31.7%. Discussion: In 2012, serogroup W135 meningococcal disease reported high mortality, atypical clinical presentation, low initial meningococcal disease diagnosis, and a high number of cases with poor clinical course.

Introducción: En el año 2012 en Chile, se presentaron 60 casos de enfermedad meningocóccica (EM) causadas por serogrupo W135, que representa 57,7% de los casos seroagrupables. Objetivo: Describir las características clínicas de los casos de EM por serogrupo W135 confirmados durante el año 2012. Material y Métodos: Estudio descriptivo, de series de casos basada en la revisión de las fichas clínicas. Resultados: El 61,7% de los casos fueron varones y 46,7% tenía menos de 5 años. En la primera consulta, 3,4% tuvo sospecha de EM, en tanto 83,3% tuvo diagnóstico final de meningococcemia. En la primera consulta, los síntomas y/o signos más frecuentes fueron fiebre ≥ 38,0°C (60,3%), cuadro catarral respiratorio (52,5%) y náuseas y/o vómitos (46,7%). Mientras que los signos de irritación meníngea se presentaron en 8,7%. En los fallecidos la diarrea fue el segundo síntoma más frecuente (55,6%), y estadísticamente superior respecto de los sobrevivientes (26,8%; p = 0,034). Seis casos presentaron secuelas: amputaciones de extremidades, hipoacusia o daño neurológico y la letalidad fue de 31,7%. Discusión: la EM por el serogrupo W135 en el año 2012, tuvo una elevada letalidad, presentación clínica inespecífica, sospecha diagnóstica inicial baja y un alto número de casos cursaron con una mala evolución.

Screening subclinical keratoconus with placido-based corneal indices.

PURPOSE: To assess in a sample of normal, keratoconic, and keratoconus (KC) suspect eyes the performance of a set of new topographic indices computed directly from the digitized images of the Placido rings. METHODS: This comparative study was composed of a total of 124 eyes of 106 patients from the ophthalmic clinics Vissum Alicante and Vissum Almería (Spain) divided into three groups: control group (50 eyes), KC group (50 eyes), and KC suspect group (24 eyes). In all cases, a comprehensive examination was performed, including the corneal topography with a Placido-based CSO topography system. Clinical outcomes were compared among groups, along with the discriminating performance of the proposed irregularity indices. RESULTS: Significant differences at level 0.05 were found on the values of the indices among groups by means of Mann-Whitney-Wilcoxon nonparametric test and Fisher exact test. Additional statistical methods, such as receiver operating characteristic analysis and K-fold cross validation, confirmed the capability of the indices to discriminate between the three groups. CONCLUSIONS: Direct analysis of the digitized images of the Placido mires projected on the cornea is a valid and effective tool for detection of corneal irregularities. Although based only on the data from the anterior surface of the cornea, the new indices performed well even when applied to the KC suspect eyes. They have the advantage of simplicity of calculation combined with high sensitivity in corneal irregularity detection and thus can be used as supplementary criteria for diagnosing and grading KC that can be added to the current keratometric classifications.

Placido-based indices of corneal irregularity.

PURPOSE: To construct a set of indices that measure the irregularity of the anterior corneal surface, computed directly from the image of the Placido disks reflected on the cornea. Besides the high sensitivity and specificity, this approach allows bypassing the surface or curvature reconstruction step that is currently performed by the software of any commercial Placido topographer. METHODS: Several basic indices are proposed to detect irregularities on the anterior surface of the cornea, via analyzing some geometric and mathematical properties of the mires. These individual primary indices are built directly from the displacement of the digitized images of the rings reflected on the cornea. In addition, compound metrics are proposed (such as the generalized linear model or the classification trees) by combining some of the primary indices to improve their efficiency. The computed metrics were developed and tested for the CSO topography system (CSO, Firenze, Italy), but the methodology proposed here extends easily to any other commercial Placido disks topographer. RESULTS: The primary indices allow discriminating, with excellent accuracy, between normal eyes and eyes with keratoconic corneas. Sensitivity and specificity of the primary indices is analyzed by using the receiver operating characteristic (ROC) curve methodology. Some combined indices are presented, which raise the efficiency to optimal. CONCLUSIONS: All the primary indices proposed in this work exhibit very good performance in discriminating between normal and irregular corneas. The accuracy of the combined indices is optimal within the test group (perfect classification), allowing their use in clinical practice as corneal markers of a disease. All these indices are fast to compute and can be easily implemented in any corneal topography system.

Adaptive cornea modeling from keratometric data.

PURPOSE: To introduce an iterative, multiscale procedure that allows for better reconstruction of the shape of the anterior surface of the cornea from altimetric data collected by a corneal topographer. METHODS: The report describes, first, an adaptive, multiscale mathematical algorithm for the parsimonious fit of the corneal surface data that adapts the number of functions used in the reconstruction to the conditions of each cornea. The method also implements a dynamic selection of the parameters and the management of noise. Then, several numerical experiments are performed, comparing it with the results obtained by the standard Zernike-based procedure. RESULTS: The numerical experiments showed that the algorithm exhibits steady exponential error decay, independent of the level of aberration of the cornea. The complexity of each anisotropic Gaussian-basis function in the functional representation is the same, but the parameters vary to fit the current scale. This scale is determined only by the residual errors and not by the number of the iteration. Finally, the position and clustering of the centers, as well as the size of the shape parameters, provides additional spatial information about the regions of higher irregularity. CONCLUSIONS: The methodology can be used for the real-time reconstruction of both altimetric data and corneal power maps from the data collected by keratoscopes, such as the Placido ring-based topographers, that will be decisive in early detection of corneal diseases such as keratoconus.