Typology and characterization of the agricultural productive units in the NE Amazonian region of Ecuador.

Objective: Many studies have observed different characteristics among productive systems in the rural territories of Latin America. Therefore, understanding and characterizing them while they function plays an essential role in determining their relationship between development and environment. A study has been conducted in the Orellana province of NE Ecuador to determine their typology and then classify them according to the variables that describe their main traits or attributes using cluster analysis (CA). Materials and Methods: A survey was structured to investigate physical, productive, environmental, as well as socioeconomic character variables, which were subsequently applied to a random sample of the 5,963 agricultural productive units (APUs) through face-to-face contact with producers during an in situ visit to their farms. Result: The CA allowed us to identify three typologies of APUs in the Orellana Province. The first has been Type 1, which is denominated as the most conventional (40%), while Type 2 uses more efficient natural resources but represents an amount of only 9.4%. In contrast, type 3 (50.6%) depends on a significant part of local or national development programs. Conclusion: All groups indicated some peculiarities in common, as there were marked differences in the use and distribution of land as well as production methods among them. Consequently, this pioneering study allowed us to identify different production methods. Therefore, we encourage local and national governments to establish policies for natural resource conservation in such high-diversity zones.

Review: Impact of bilateral trade on the promotion of animal welfare rules. The case of trade relations between the European Union and Mercosur.

The paper analyzes the impact of trade relations between the European Union (EU) and Mercosur with its member states (Argentina, and Brazil, in particular), on the adoption of legislation on animal welfare inspired by the EU model. In the first part, the paper focuses on the historical roots of the European framework, which led "animal welfare" to become an EU value. Then, it briefly explores the EU legal instrument dedicated to breeding, transport and commercialization of animals, identified as core issues when dealing with international trade. Finally, it examines how Argentina and Brazil have adapted their national rules to the European model, thanks to a "mirroring" legislation strategy. In conclusion, the analysis shows how trade relations with the EU have an impact on the worldwide diffusion of European standards.

Slit lamp polarized dermoscopy: a cost-effective tool to assess eyelid lesions.

PURPOSE: Dermoscopy is a complementary examination of skin lesions, which allows the observation of anatomical features invisible to the naked eye. Its use increases the diagnostic accuracy of skin tumors. The development of polarized dermoscopy allowed the observation of deeper skin structures, without the need of skin contact. The purpose of this study was to present a low-cost prototype through the adaptation of polarized lenses on a slit lamp in order to assess anatomical aspects invisible to conventional biomicroscopy in eyelid lesions. METHODS: Twenty two eyelid lesions were documented using a prototype, compound of two polarizing filters, orthogonal to each other, adapted to a slit lamp with an integrated digital camera. Images of the eyelid lesions were also obtained with non-polarized biomicroscopy and with a portable dermatoscope, and were compared regarding anatomical aspects. RESULTS: Anatomical structures imperceptible to conventional ophthalmic examination were evidenced using the polarized lenses, demonstrating that this tool can be useful to the ophthalmologist when assessing eyelid lesions. We have obtained high-quality images of the lesions. The slit lamp provided higher magnification, better focus control and easier assessment of eyelid lesions than the portable dermatoscope. CONCLUSION: Ophthalmologists already use the slit lamp in their practice. The adaptation of polarized lenses to this device is a cost-effective, fast and non-invasive method that permits to improve the diagnostic accuracy of eyelid lesions, evidencing anatomical structures imperceptible to conventional ophthalmic examination.

Integrating Clinics, Laboratory, and Imaging for the Diagnosis of Common Variable Immunodeficiency-Related Granulomatous-Lymphocytic Interstitial Lung Disease.

Background: Granulomatous-lymphocytic interstitial lung disease (GLILD) is a distinct clinic-radio-pathological interstitial lung disease (ILD) that develops in 9% to 30% of patients with common variable immunodeficiency (CVID). Often related to extrapulmonary dysimmune disorders, it is associated with long-term lung damage and poorer clinical outcomes. The aim of this study was to explore the potential use of the integration between clinical parameters, laboratory variables, and developed CT scan scoring systems to improve the diagnostic accuracy of non-invasive tools. Methods: A retrospective cross-sectional study of 50 CVID patients was conducted in a referral unit of primary immune deficiencies. Clinical variables including demographics and comorbidities; analytical parameters including immunoglobulin levels, lipid metabolism, and lymphocyte subpopulations; and radiological and lung function test parameters were collected. Baumann's GLILD score system was externally validated by two observers in high-resolution CT (HRCT) scans. We developed an exploratory predictive model by elastic net and Bayesian regression, assessed its discriminative capacity, and internally validated it using bootstrap resampling. Results: Lymphadenopathies (adjusted OR 9.42), splenomegaly (adjusted OR 6.25), Baumann's GLILD score (adjusted OR 1.56), and CD8+ cell count (adjusted OR 0.9) were included in the model. The larger range of values of the validated Baumann's GLILD HRCT scoring system gives it greater predictability. Cohen's κ statistic was 0.832 (95% CI 0.70-0.90), showing high concordance between both observers. The combined model showed a very good discrimination capacity with an internally validated area under the curve (AUC) of 0.969. Conclusion: Models integrating clinics, laboratory, and CT scan scoring methods may improve the accuracy of non-invasive diagnosis of GLILD and might even preclude aggressive diagnostic tools such as lung biopsy in selected patients.

Eyelid malignancies in young individuals: clinical peculiarities.

OBJECTIVE: The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The purpose of this study was to identify particularities in individuals under 40 years of age affected by eyelid malignancies. METHODS: Clinical charts of patients under 40 years of age who underwent eyelid tumor excision from 2014 to 2020 in two reference centers, one in Brazil and one in the USA, were reviewed. Demographic and outcome measures included: age, gender, skin phototype, comorbidities, diagnosis, time until diagnosis, lesion location, recurrence and metastasis. In addition, associated characteristics, including chronic sun exposure, intentional tanning (outdoor or artificial), history of smoking, use of sunscreen, family history of skin cancer and exposure to pesticides or herbicides, were reviewed. RESULTS: A total of 24 malignant eyelid tumors from 17 patients were identified. Twelve (70.6%) patients were female, and the most prevalent tumor was basal cell carcinoma (62.5%). Three (17.6%) patients had xeroderma pigmentosum and presented with multiple lesions. Family history of skin cancer was reported by 47% of patients. Prolonged sun exposure was reported by 41.2%; history of smoking and intentional tanning were reported by 23.5 and 17.6%, respectively, and might have played a role in carcinogenesis. CONCLUSIONS: Although uncommon in young subjects, eyelid malignancies present some peculiarities in individuals under 40 years of age. Our results suggest that women with family history of skin cancer and history of chronic exposure to ultraviolet radiation are at risk. Association with genetic syndromes is also relevant among younger age groups.

Effects of the COVID-19 pandemic on the Colombian labour market: Disentangling the effect of sector-specific mobility restrictions.

We assess the effect of the COVID-19 pandemic and particularly the sector-specific mobility restrictions on the Colombian labour market. We exploit the sectoral and temporal variation of the restriction policies to identify their effect. Mobility restrictions significantly reduced employment, accounting for approximately a quarter of the total job loss between February and April of 2020. The remaining three quarters of the job losses could be attributed to the disease's regional patterns and other epidemiological and economic factors affecting the whole country. Therefore, we should expect important employment losses even in the absence of such restrictions. We also assess the effect of restrictions on the intensive margin, finding negative, although smaller effects on the number of hours worked and wages. Most of the employment effect is driven by salaried workers, while self-employment was more responsive to the disease spread. Finally, we find that women are disproportionally affected: mobility restrictions account for a third of the recent increase of the gender gap in salaried employment.

Effets de la pandémie de COVID­19 sur le marché du travail colombien : analyse des répercussions liées aux restrictions de mobilité par secteur. Dans cet article, nous évaluons les répercussions de la pandémie de COVID­19, et notamment des restrictions en matière de mobilité propres à chaque secteur, sur le marché du travail colombien. Nous nous appuyons sur les variations temporelles et sectorielles des politiques de restriction pour déterminer leurs effets. Les restrictions de mobilité ont sensiblement détérioré l'emploi en détruisant environ un quart du nombre total d'emplois supprimés entre février et avril 2020, les trois­quarts restants pouvant être imputés aux caractéristiques régionales de la pandémie ainsi qu'à d'autres facteurs épidémiologiques et économiques touchant l'ensemble du pays. Nous pourrions donc nous attendre à d'importantes destructions d'emplois, même en l'absence de telles restrictions. Nous évaluons également les effets des restrictions à la marge intensive, et nous constatons des effets négatifs mais plus faibles sur le nombre d'heures travaillées ainsi que sur les salaires. Les effets de ces restrictions sur l'emploi sont motivés en grande partie par les travailleurs salariés, les travailleurs indépendants se montrant plus réactifs face à la propagation de la maladie. Enfin, nous constatons que les femmes sont touchées de façon disproportionnée, les restrictions de mobilité comptant pour un tiers de l'accentuation récente de l'écart hommes­femmes en matière d'emploi salarié.

Aporte de la 18F-FDG PET/TC en la enfermedad de Creutzfeldt-Jakob esporádica / Contribution of the 18F-FDG PET/CT IN sporadic Creutzfeldt-Jakob disease

La enfermedad de Creutzfeldt-Jakob esporádica (ECJe) es un trastorno neurodegenerativo transmisible, extremadamente raro, caracterizado por demencia rápidamente progresiva. En la tomografía por emisión de positrones con 18F-fluoro-2-desoxi-D-glucosa (18F-FDG-PET/TC) de estos pacientes se ha descrito hipometabolismo cortical bilateral parietal, frontal y occipital, sin alteraciones en el cerebelo ni en los ganglios basales, lo que podría contribuir con el diagnóstico diferencial de demencia rápidamente progresiva. Se presenta el caso de un hombre de 75 años de edad, con antecedente de cáncer de próstata y trastorno afectivo bipolar, con cuadro de dos semanas de cambios comportamentales y anímicos, déficit cognitivo, alucinaciones visuales y auditivas y desorientación espacial con rápida progresión. Posteriormente, el paciente presenta marcha lenta, temblor en miembros inferiores y Babinski derecho. La resonancia magnética (RM) cerebral mostró restricción a la difusión en la corteza frontal y temporal bilateral y giro del cíngulo, con sospecha diagnóstica de síndrome paraneoplásico versus enfermedad por priones. La 18F-FDG-PET/TC demostró hipometabolismo en la corteza frontal bilateral y lóbulo temporal y parietal derechos. La medición de la proteína 14-3-3, proteína T-Tau y conversión de proteína priónica inducida por agitación en tiempo real (RT-QUIC) en líquido cefalorraquídeo confirmó el diagnóstico de enfermedad por priones.

Sporadic Creutzfeldt-Jakob disease (sCJD) is an extremely rare transmissible neurodegenerative disorder characterized by rapidly progressive dementia. 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET/CT) in these patients has described bilateral parietal, frontal and occipital cortical hypometabolism, without alterations in the cerebellum or basal ganglia, which could contribute to the differential diagnosis of rapidly progressive dementia. We present the case of a 75-year-old man with a history of prostate cancer and bipolar affective disorder, with a two-week picture of behavioral and mood changes, cognitive deficit, visual and auditory hallucinations and spatial disorientation with rapid progression. Subsequently, the patient presented slow gait, tremor in lower limbs and right Babinski. Brain magnetic resonance imaging (MRI) showed diffusion restriction in the bilateral frontal and temporal cortex and cingulate gyrus, with diagnostic suspicion of paraneoplastic syndrome versus prion disease. 18F-FDG-PET/CT showed hypometabolism in the bilateral frontal cortex and right temporal and parietal lobe. Measurement of 14-3-3 protein, T-Tau protein and real-time shake-induced prion protein conversion (RT-QUIC) in cerebrospinal fluid confirmed the diagnosis of prion disease.

La humanización como parte de la atención integral al paciente: revisión narrativa / Humanização como parte do cuidado integral ao paciente: revisão narrativa / Humanization as a part of comprehensive patient health care: a narrative review

Objetivo: identificar los principales criterios, características, enfoques, normas y lineamientos que orientan el desarrollo de atenciones en salud humanizadas, las características y enfoques de la humanización de la atención, así como las políticas, planes e incluso de programas desarrollados actualmente en algunos países. Métodos: se realizó una búsqueda de artículos entre el 2012 y 2020 en los idiomas portugués, español e inglés, en las bases de datos Scielo, Pubmed, Medline, Lilacs, así como también en Epistemonikos, a través de palabras clave seleccionadas con base en los objetivos a investigar y que respondieran la siguiente pregunta de investigación: ¿cuáles son las percepciones sobre el trato no humanizado de los sujetos de atención a partir del análisis de las quejas del sistema distrital de peticiones, quejas y reclamos y los principales criterios, normas y pautas de la atención humanizada? Resultados: se encontraron 62 artículos que se organizaron en las siguientes categorías: trato irrespetuoso; mal servicio y no garantía de derechos; negligencia en la atención; comportamiento abusivo y falta de ética; mala comunicación e información; discriminación y no enfoque diferencial. Conclusiones: 1) la estructura para evidenciar la humanización en las instituciones de salud se basa tanto en el diseño como en la aplicación de políticas y programas de humanización en Colombia y diferentes lugares del mundo. Dentro de esta perspectiva de la humanización de los servicios de salud es una constante la necesidad de comprender el rol que juega el personal de la salud como actor determinante en la garantía del derecho a la salud y la calidad en la prestación de los servicios. 2) Existe una relación directa en lo que determinan los Estados a través de la normatividad para el cumplimiento de atenciones más humanas y unas realidades diferentes en lo que se vive durante el proceso de atención. De allí la importancia que toman las prácticas de estos Estados y organizaciones en salud en torno a la humanización que permita la replicabilidad de estas, y mejorar así las condiciones de salud de los ciudadanos y la prestación de los servicios. 3) La apuesta está en reconocernos más humanos. La revisión sistemática de la bibliografía hace énfasis en los criterios que se deben cumplir frente a los procesos de atención en salud; sin embargo, es necesario generar espacios de formación que no se centren exclusivamente en los conocimientos técnicos, sino que a través de estos le permitan al personal de la salud fortalecer las diferentes habilidades que demanda el proceso de atención en salud, de allí la importancia de comunicarse asertivamente, manejar adecuadamente los conflictos, empatizar frente a las situaciones que puedan estar presentando los usuarios y sus familias, y la respuesta efectiva a las necesidades y expectativas que presentan, permitiendo realizar una simbiosis entre el ser, el hacer y el deber ser en la atención en salud.

Objective: To identify the main criteria, characteristics, approaches, regulations and guidelines that guide the development of humanized health care, the characteristics and approaches of the humanization of health care, and the policies, plans and even programs currently developed in some countries. Methodology: A search was performed for articles between 2012 and 2020 in Portuguese, Spanish and English in the Scielo, Pubmed, Medline, Lilacs and Epistemonikos databases, using keywords selected based on the objectives to be researched. The articles had to be able to answer the following research question: What are the perceptions of health care subjects regarding non-humanized treatment, based on an analysis of complaints in the district petition, complaint and claims system and the main criteria, regulations and guidelines for humanized health care? Results: 62 articles were found, which were organized into the following categories - disrespectful treatment, bad service and a failure to ensure rights; negligence in health care, abusive behavior and a lack of ethics; bad communication and information; discrimination and a lack of a differential approach. Conclusions: 1) The structure for demonstrating humanization in health care institutions is based on both designing and applying humanization policies and programs in Colombia and different parts of the world. There is a constant need to understand the role health care staff play as determining actors in ensuring the right to health and quality in the provision of services, within this perspective of the humanization of health care services. 2) There is a direct relationship between what States determine through regulations in terms of providing more humane health care and the different realities patients experience during the health care process. Therefrom comes the importance of the practices of States and health care organizations when it comes to humanization that facilitates replicating those practices, improving the health conditions of citizens and the provision of services in this way. 3) The challenge is to recognize ourselves as more human. The systematic review of the bibliography emphasizes the criteria to be met in health care processes. However, it is necessary to create training spaces that do not exclusively focus on technical knowledge, but which, through that technical knowledge, help health care staff strengthen the different skills required for the health care process. This explains the importance of communicating assertively, adequately managing conflicts, empathizing with the situations of users and their families, and responding effectively to their needs and expectations, allowing for a symbiosis between being, doing and what should be in health care.

Objetivo: identificar os principais critérios, características, abordagens, normas e diretrizes que orientam o desenvolvimento de cuidados da saúde humanizados, as características e abordagens da humanização da atenção, bem como as políticas, planos e até programas desenvolvidos atualmente em alguns países. Metodologia: foi realizada uma busca de artigos entre 2012 e 2020 nos idiomas português, espanhol e inglês, nas bases de dados Scielo, Pubmed, Medline, Lilacs, bem como na Epistemonikos, por meio de palavras-chave selecionadas com base nos objetivos de investigação e respondendo à seguinte questão de pesquisa: quais as percepções sobre o tratamento não humanizado dos sujeitos do atendimento a partir da análise das denúncias do sistema distrital de petições, denúncias e reclamações e os principais critérios, normas e diretrizes do atendimento humanizado? Resultados: foram encontrados 62 artigos, organizados nas seguintes categorias: tratamento desrespeitoso; atendimento precário e sem garantia de direitos; negligência de cuidados; comportamento abusivo e falta de ética; má comunicação e informação; discriminação e nenhuma abordagem diferencial. Conclusões: 1) a estrutura para evidenciar a humanização nas instituições de saúde se baseia tanto na formulação quanto na aplicação de políticas e programas de humanização na Colômbia e em diferentes partes do mundo. Dentro dessa perspectiva de humanização dos serviços de saúde, há uma necessidade constante de compreender o papel desempenhado pelo pessoal de saúde como ator determinante na garantia do direito à saúde e a qualidade na prestação dos serviços. 2) Existe uma relação direta entre o que os Estados determinam por meio de regulamentações para o cumprimento de um cuidado mais humanizado e as diferentes realidades do que é vivenciado durante o processo de cuidar. Daí a importância das práticas destes Estados e das organizações de saúde em torno da humanização que permita a sua replicabilidade, e assim melhorar as condições de saúde dos cidadãos e a prestação de serviços. 3) A aposta consiste em nos reconhecermos mais humanos. A revisão sistemática da bibliografia enfatiza os critérios que devem ser atendidos diante dos processos de atenção à saúde; no entanto, é preciso criar espaços de formação que não se concentrem exclusivamente no conhecimento técnico, mas que por meio deles permitam que os profissionais de saúde fortaleçam as diferentes habilidades que o processo de cuidar em saúde exige, daí a importância de se comunicar de forma assertiva, lidar adequadamente com os conflitos, ter empatia com as situações que os usuários e seus familiares possam estar apresentando e a resposta efetiva às necessidades e expectativas que apresentam, permitindo uma simbiose entre o ser, o fazer e o que deveria ser no cuidado à saúde.

Enhancing recovery in pediatric major abdominal surgery: a narrative review of the literature / Recuperación intensificada en cirugía abdominal mayor en pediatría: revisión narrativa de la literatura

Abstract Introduction: Enhanced recovery after surgery (ERAS) programs in adults have positively impacted morbidity, mortality, and healthcare costs. Its effects on the pediatric population is recognized. Objective: To prepare a narrative review on the current evidence of the various strategies within the framework of enhancing recovery after pediatric surgery, in the context of major abdominal surgery. Methods: A search was conducted on the scientific evidence available in databases (Pubmed/Medline, Science Direct, OVID, SciELO), in order to prepare a narrative literature review. Conclusion: Notwithstanding the limited evidence on the practicality of the ERAS protocols in the pediatric population undergoing major abdominal surgery, better results could be accomplished if these strategies are adopted.

Resumen Introducción: Los programas de recuperación intensificada después de cirugía (ERAS, por sus siglas del inglés enhanced recovery after surgery) en adultos han impactado positivamente en morbilidad, mortalidad y costos en salud. Es conocido su efecto respecto a su efectividad en población pediátrica. Objetivo: Elaborar una revisión narrativa respecto a la evidencia actual de las diferentes estrategias en el marco de programas de recuperación intensificada en cirugía pediátrica (ERPS, por sus siglas del inglés enhancing recovery in pediatric surgery), en el contexto de cirugía abdominal mayor. Métodos: Se realizó una búsqueda sobre la evidencia científica disponible en bases de datos (Pubmed/Medline, Science Direct, OVID, SciELO) para elaborar una revisión narrativa de la literatura. Conclusiones: Aunque existe evidencia limitada sobre la utilidad de los protocolos ERAS en la población pediátrica sometida a cirugía abdominal mayor, podrían lograrse mejores resultados si se adoptan estas estrategias en pacientes pediátricos.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair / 15 anos de experiência em suspensão frontal com fio de politetrafluoretileno (Gore-Tex®) na correção de ptose palpebral

ABSTRACT Purpose: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. Methods: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. Results: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. Conclusion: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

RESUMO Objetivo: Revisar os resultados de cirurgias de sus pensão ao músculo frontal com o uso de fio de politetrafluoretileno em pacientes com blefaroptose. Métodos: Em um estudo observacional retrospectivo, foram analisados os resultados das cirurgias de músculo frontal de uma instituição, realizadas entre 2003 e 2018. Todos os procedimentos foram realizados com incisão fechada e técnica de pentágono. Os desfechos foram classificados como satisfatórios ou insatisfatórios com definição satisfatória definida como distância margem-reflexo >3mm e <1mm entre as pálpebras e insatisfatória como hipocorreção, complicações cirúrgicas e assimetria. Resultados: Incluímos um total de 76 pálpebras de 52 pacientes em nosso estudo. Com um tempo médio de seguimento pós-operatório de 16,8 ± 18,5 meses (intervalo 3-95), 59 (77,6%) pálpebras apresentaram desfecho satisfatório e 17 (22,4%) insatisfatórios (8 casos de assimetria, 3 granulomas, 3 extrusões de sutura, 2 abscessos e 1 caso de celulite). Nove pálpebras do grupo insatisfatório necessitaram de reoperação. Entre os pacientes com seguimento ³12 meses (38 cirurgias), resultados duradouros foram observados na maioria dos casos, exceto por 2 extrusões de sutura de surgimento tardio. Conclusão: O uso de politetrafluoretileno na cirurgia de músculo frontal mostrou ser previsível, seguro e duradouro, Nossos achados corroboram com estudos prévios que mostraram resultados funcionais adequados e baixos índices de complicação.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair.

PURPOSE: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. METHODS: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. RESULTS: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. CONCLUSION: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

Bilateral periorbital necrotizing fasciitis: case report.

Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.

Bilateral periorbital necrotizing fasciitis: case report / Fasciite necrosante periorbital bilateral: relato de caso

ABSTRACT Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.

RESUMO Fasciite necrosante é uma infecção grave do tecido subcutâneo, caracterizada pela necrose da fáscia superficial e da pele sobrejacente. Traumas prévios e cormobidades geralmente estão associados à fasciite necrosante. Fasciite necrosante periorbital é rara. Perda visual e defeitos em tecidos moles são as morbidades mais comuns. Diagnóstico precoce, tratamento clínico rápido e intervenção cirúrgica oportuna levam a um melhor prognóstico. Reportamos um caso incomum de fasciite necrosante periorbital bilateral sem eventos desencadeantes. Uma paciente de 50 anos apresentou edema e eritema na pálpebra superior direita, que progrediu em 24 horas para ambas pálpebras bilateralmente. Ela era previamente hígida. A paciente foi submetida a debridamento cirúrgico do tecido necrótico, no mesmo dia. A paciente foi submetida a outras duas cirurgias, o que melhorou o fechamento palpebral e a aparência. Apesar da gravidade da doença, antibioticoterapia e cirurgias oportunas foram cruciais para o desfecho bem sucedido deste caso.

Síntomas presentes en la esclerosis múltiple: serie de casos / Symptoms present in multiple sclerosis: case series

RESUMEN INTRODUCCIÓN: Existen síntomas presentes en la esclerosis múltiple (EM) que no están relacionados directamente con el carácter desmielinizante de los brotes, que afectan y deterioran la calidad de vida de los pacientes y que no han sido adecuadamente caracterizados en la población colombiana. OBJETIVO: Describir las características clínicas, sociodemográficas y los síntomas en los pacientes con EM del servicio de Neurología del Hospital de San José de Bogotá. MATERIALES Y MÉTODOS: Estudio de serie de casos. Pacientes consecutivos, con diagnóstico de EM (según criterios McDonald 2010) que asistieron al Hospital de San José entre agosto de 2015 y marzo de 2017. Se midieron variables sociodemográficas, clínicas y síntomas evaluados con la escala de intensidad de la fatiga, escala de depresión de Hamilton, escala de discapacidad (EDSS) y cuestionario sobre la sexualidad e intimidad en la EM. Se analizaron datos en STATA 13. RESULTADOS: Se incluyeron 65 pacientes, el 72 % de sexo femenino. Síntomas presentes: fatiga (75 %), cefalea (43 %), disfunción urinaria (38 %), depresión (39 %), trastornos del sueño (32 %), disfunción ano-rectal (27 %) y disfunción sexual (20 %). En depresión, el 64 % presenta trastorno del sueño. El 50 % de los pacientes con fatiga y depresión tenía 9 años o menos de evolución de enfermedad y 11 años o menos en los que presentan disfunción urinaria. DISCUSIÓN Y CONCLUSIONES: Es probable que la fatiga y depresión estén relacionados con mayor presentación de trastornos del sueño y disfunción sexual, evidenciándose en pacientes con mayor tiempo de evolución de la enfermedad.

SUMMARY INTRODUCTION: There are symptoms present in multiple sclerosis (MS), they are not directly related with the demyelinating nature of relapses, they affect and deteriorate patients' quality of life and they have not been adequately characterized in the colombian population. OBJECTIVE: To describe the clinical, sociodemographic and symptomatic characteristics of patients with MS in the Neurology Department of the Hospital San José de Bogotá. MATERIALS AND METHODS: A case series study. Consecutive patients with a diagnosis of MS according to Mc Donald 2010 criteria who were attended at the Hospital de San José between August 2015 and March 2017. Sociodemographic, clinical and symptom variables were evaluated with fatigue intensity scale, Hamilton depression scale, disability scale (EDSS), and questionnaire of sexuality and intimacy in MS. Data were analyzed in STATA 13. RESULTS: 65 patients were included. 72% female. Symptoms present: fatigue (75 %), headache (43 %), urinary dysfunction (38 %), depression (39 %), sleep disorders (32 %), anorectal dysfunction (27 %) and sexual dysfunction (20 %). In patients with depression, 64 % have sleep disorders associated. 50 % of patients with fatigue and depression had 9 years or less of disease progression and 11 years or less of those with urinary dysfunction. DISCUSSION AND CONCLUSIONS: Fatigue and depression are likely to be associated with increased of presentation of sleep disorders and sexual dysfunction, they are evidenced in patients with a longer evolution of the disease.

Obesity and health-related decisions: An empirical model of the determinants of weight status across the transition from adolescence to young adulthood.

We estimate a structural dynamic model of the determinants of obesity. In addition to including many of the well-recognized endogenous factors mentioned in the literature as obesity determinants, we also model the individual's residential location as a choice variable, which is the main contribution of this paper to the literature. This allows us to control for an individual's self-selection into communities that possess the types of amenities in the built environment, which in turn affect their obesity-related behaviors such as physical activity (PA) and fast food consumption. We specify reduced form equations for a set of endogenous demand decisions, together with an obesity structural equation. The whole system of equations is jointly estimated by a semi-parametric full information log-likelihood method that allows for a general pattern of correlation in the errors across equations. Our model predicts a reduction in adult obesity of 7 percentage points as a result of a continued high level PA from adolescence into adulthood; a reduction of 0.7 (3) percentage points in adult obesity as a result of one standard deviation reduction in weekly fast food consumption for women (men); and a reduction of 0.02 (0.05) in adult obesity as a result of one standard deviation change in several neighborhood amenities for women (men). Another key finding is that controlling for residential self-selection has substantive implications. To our knowledge, this has not been yet documented within a full information maximum likelihood framework.

Programa innovador de rehabilitación integral para habitantes de la calle en condición de discapacidad mental crónica / Innovative Program of integral Rehabilitation for People Living on the Streets in Condition and Mental Disabilities Chronic / Programa inovador de reabilitação integral para as pessoas que vivem nas ruas no estado e a deficiência mental crônica

Introducción: El Hospital Nazareth I Nivel ESE, ubicado en la Localidad 20 de Bogotá, D. C., desarrolla e implementa acciones de promoción de la salud, prevención de la enfermedad y recuperación de la salud, a través del Centro de Desarrollo del Potencial Humano (CDPH), el cual es un espacio agroambiental que contempla tres componentes:1) el Programa Ecoterapia, el 2) Parque Temático en Salud Chaquen y 3) el aprendizaje experiencial. Todos ellos se fundamentan en el modelo de ocupación humana como herramienta de inclusión social y laboral, para fortalecer las redes de apoyo primario, la potencialización de habilidades comunicacionales y la aceptación de la comunidad rural, en un entorno natural que favorece los procesos de autonomía e interdependencia en el desempeño personal, familiar, social y organizacional. Objetivo: Sistematizar el proceso desarrollado con los usuarios del programa de Ecoterapia, a partir de una revisión documental. Métodos: De acuerdo con Carvajal Burbano (2004), la sistematización es un proceso teórico y metodológico, que ayuda, a partir de un ordenamiento, de la reflexión crítica, de la evaluación, del análisis y de la interpretación de las experiencias, a conceptualizar y construir conocimiento a través de su comunicación, para así orientar otras experiencias con el fin de mejorar las prácticas sociales. Resultados: Con el cumplimiento del programa, se busca el cuidado individual de los usuarios manteniendo su nivel de independencia en las actividades básicas cotidianas (como el baño, la alimentación y el vestido) e instrumentales (como las llamadas telefónicas, las compras, el cuidado de la casa y de sus elementos, el cumplimiento de los horarios para tomar la medicación y el manejo del dinero). Además, busca la identificación de intereses y el restablecimiento de redes de apoyo familiar, que permiten la inclusión social y familiar de personas en condición de discapacidad mental crónica. El programa ha promovido la inclusión familiar y social del 23 % de los usuarios que han estado en el procesode rehabilitación

Introduction: Nazareth is a Level 1Hospital located at the 20th locality of Bogota, D.C., that develops and introduces actions of health promotion, disease prevention and health recovery, through Centro de desarrollo del potencial humano (CDPH), which is an agro-environmental space that contemplates three components: Eco-therapy Program, Health Themed Chaquen Park, and Experiential Learning. These are based on the Human Occupation model, as a tool for labor and social inclusion, strengthening primary care networks, communication abilities and the acceptance of rural communities, in a natural environment that benefits autonomy processes and interdependence for the personal, family, social, and organizational performance. Objective: Systematization of the developed process with the Eco therapy program users, starting from a literature revision. Methods: According to Carvajal Burbano (2014), the systematization is a theoretical and methodological process. By an arrangement, critical reflection, evaluation, analysis and interpretation of different experiences, it allows conceptualizing and to create knowledge through their communication, and that way, to orient other experiences to improve the social practices. Results: With the programs compliance, it is intended to provide individual care, maintaining its independence levels in daily basic activities such as: bathing, feeding, and dressing, and instrumentals such as: telephone calls, shopping, homecare and its elements, compliance with the schedules to take medicines, and money management. Additionally, it seeks to identify interest and the reestablishment of family support networks that allow for social and family inclusion for people with chronic mental disability. This program has promoted family and social inclusion for 23 % of the users that have been on rehabilitation.

Introdução: O Hospital Nazareth I Nível E.S.E. situado na localidade 20 na cidade de Bogotá, D.C., desenvolve e implementa ações de promoção da saúde, prevenção de doenças e recuperação da saúde, através do Centro de Desenvolvimento do potencial Humano (CDPH) que é um espaço agroambiental que inclui três componentes, o Programa Ecoterapia, o Parque Temático em Saúde e o Aprendizagem Experiencial. Estes são fundamentados no modelo de Ocupação Humana como instrumento de inclusão social e de trabalho, fortalecendo as redes de apoio primário, a potencialização de habilidades comunicativas e a aceitação da comunidade rural em um ambiente natural que favorece os processos de autonomia e interdependência no desempenho pessoal, familiar, social e organizacional. Objetivo: Sistematização do processo desenvolvido com usuários do programa de Ecoterapia, a partir de uma revisão documental. Método: De acordo com Carvajal Burbano (2004) a sistematização é um processo teórico e metodológico, que ajuda a partir de um ordenamento, o pensamento crítico, avaliação, análise e interpretação de experiências para conceituar e construir conhecimentos através de sua comunicação e assim orientar outras experiências para melhorar as práticas sociais. Resultados: Com o cumprimento do programa buscou-se o atendimento individual de usuários, mantendo seu nível de independência em atividades diárias básicas tais como: (banho, alimentação e vestuário) e instrumental como (telefonemas, compras, trabalho doméstico e seus elementos, cumprimento dos horários para tomar a medicação e utilização do dinheiro). Como também, procura a identificação de interesses e restauração das redes de apoio familiar, que permitam a inclusão social e familiar das pessoas que vivem em deficiência mental crônica. O programa tem promovido a inclusão familiar e social de 23 % dos usuários que em processo de reabilitação

Percepções de alunos de medicina sobre marketing médico / Undergraduate medical student's perceptions regarding professional marketing

INTRODUÇÃO: Marketing médico é um assunto controverso, principalmente no que concerne a princípios éticos. Portanto, frente à competição acirrada de mercado, é necessário o preparo profissional. Conhecer a percepção dos alunos de Medicina pode auxiliar na estruturação de alternativas de capacitação. METODOLOGIA: Inicialmente, identificaram-se crenças sobre marketing médico através de grupo focal composto por 12 alunos. Com base nesses dados, dez afirmações para avaliar atitudes foram aplicadas aos alunos de uma Faculdade de Medicina pública brasileira. RESULTADOS: Observou-se falta de clareza sobre o conceito de marketing, preocupação com princípios éticos e necessidade de marketing no mercado competitivo. Na fase de aplicação, foram obtidas 280 respostas de diversos estágios do curso. Apenas 16,8% admitiram contato com o tema. Houve clareza sobre ética em relação ao paciente, influenciada positivamente pela progressão no curso, mas houve divergência na ética entre profissionais. CONCLUSÕES: Marketing médico é uma área pouco compreendida e relegada ao currículo oculto, sendo influenciada por transposições inadequadas de métodos didáticos destinados à comunicação profissional para a população leiga. Novos métodos de ensino, como a educação tutorial, podem ser uma alternativa para lidar com essas situações.

BACKGROUND: Professional marketing is a controversial topic, mainly regarding ethical principles. Therefore, increasing market competion turns professional capacitation mandatory. To know under graduation medical student's perceptions could help to develop educational alternatives to face this problem. METODOLOGY: First, professional marketing believes were identified through focus group methodology including twelve students. Based on these results, ten affirmatives were constructed to evaluate attitudes and applied to the students of a Brazilian public medicine school. RESULTS: It was observed lack of a clear definition of marketing, preoccupation regarding ethical principles and need to employ marketing strategies in a competitive market. At the survey stage, 280 answers from different stages of the course were obtained. Only 16.8% admitted to have had previous contact with the topic. Clear ethical standards for medical-patient relationship were determined, increasing with course progression. However inter-professional ethical principles was more subject to confusion. CONCLUSION: Professional marketing is poorly understood and it is relegated to the occult curricula, being influenced by didactic methods inadequately transposed for marketing strategies. Newer educational methods, like mentoring, could be an alternative to deal with these situations.Tutoria.

Toxina botulínica tipo a: Experiencia con 2.000 aplicaciones / Botulinum toxin type a: An experience with 2.000 injections

Los múltiples usos terapéuticos de la toxina botulínica tipo A son una herramienta importante para el abordaje de algunos trastornos del movimiento. Damos a conocer la experiencia, resultados y conclusiones obtenidas en el servicio de neurología del Hospital de San José de Bogotá DC, al completar más de 2.000 aplicaciones en distonías, espasticidad y cefalea. En espasmo hemifacial la mejoría varió entre 60 y 80%, en blefaroespasmo 70 y 90%, en distonía cervical con patrones básicos 70-80% y en complejas (dos o más patrones de movimiento) de 50 a 60%. En espasticidad la mejoría se evidenció por aumento en los rangos de movimientos medidos con goniómetro antes y después de la aplicación, siendo variable de acuerdo con el tiempo de evolución, severidad y patrón de la espasticidad, haciendo seguimiento con la escala de sistema de clasificación de la función motora global (GMFCS). En cefalea crónica diaria hubo remisión total del dolor en 60%, disminución marcada en 30% y sin mejoría el 10%. Conclusión: La administración de toxina botulínica es segura y debe ser un proceso dinámico ajustado a cada paciente, el efecto terapéutico se evidencia a partir del segundo día de la aplicación con una expresión máxima a los 14 días, la duración del efecto oscila entre 2 y 6 meses con una media de 2.8. Los efectos adversos desaparecen en los siguientes treinta días de la aplicación...

Botulinum toxin type A is used extensively for the management of motility disorders constituting an important therapeutic tool. This report shows the experience, results and conclusions obtained at the neurology service of Hospital de San José de Bogotá DC, through 2.000 botulinum toxin injections to treat dystonia, spasticity and migraine. Hemifacial spasm improved between 60 and 80%, blepharospasm between 70 and 90%, cervical dystonia between 70 and 80%, and complex dystonia (deterioration of two or more movement patterns) from 50 to 60%. Improvement in spasticity was evidenced by increased range of motion measured with a goniometer before and after the injection. Spasticity improvement varied according to the rate of progression, severity and spasticity pattern. Follow-up was conducted using the gross motor function classification system (GMFCS). Total remission of pain was achieved in 60 % of patients with chronic daily headaches, was significantly reduced in 30% and did not improve in 10%. Conclusions: botulinum toxin injection appears to be safe and must be a dynamic process adjusted to each patient needs. Therapeutic effects are evidenced on the second day after injection and maximum expression is seen on day 14. Duration of effect ranges from 2 to 6 months with a media of 2.8. Adverse effects fade about 30 days after injection...

Necrólisis epidérmica tóxica asociada a anticonvulsivantes: presentación de un caso en el Hospital Universitario de Santander, Bucaramanga, Colombia / Toxic epidermal necrolysis: case report at Hospital Universitario de Santander, Bucaramanga, Colombia

La necrólisis epidérmica tóxica es una patología de escasa ocurrencia, que se acompaña de mortalidad elevada y se caracteriza por lesiones cutáneas vesículo ampollosas que con frecuencia afecta la mucosa respiratoria, digestiva y ocular. Se presenta un caso de la enfermedad atendido en el Hospital Universitario de Santander en octubre del año 2007 desencadenado por el tratamiento con fenitoína – ácido valproico como terapia anticonvulsiva, con desenlace fatal y al cual se le practicó autopsia médico científica. Se pretende con este trabajo presentar una revisión del tema y analizar los factores relacionados con esta grave condición clínica...

Toxic epidermal necrolysis is an infrequent pathology, accompanied of high mortality risk in concordance with extension of comprised skin characterized for blisters. Frequently these are present in respiratory, digestive and ocular mucous. An autopsy case is presented occurred in Hospital Universitario de Santander in October 2007 of toxic epidermal necrolysis secondary to treatment with phenytoin associated with valproic acid as anticonvulsivant therapy for messial hippocampal sclerosis. It pretends with this work show a review and to analyze related factors with this condition...

El primer año de vida lingüístico del niño / The first year of the child's linguistic life

La investigación el primer año de vida lingüístico del niño tuvo como objeto de estudio el desarrollo de la adquisición del lenguaje del infante de cero a doce meses, tomando también el discurso materno como objeto de estudio, ya que es a partir de los cuidados de la madre, de la interacción niño­madre, que hace que este último adquiera la representación y con esta vaya adquiriendo el lenguaje, el cual le servirá para comunicarse. Lo anterior implicó una observación directa de dicha relación, de cómo el niño se comunicaba con su madre en los primeros meses, o para ser más exactos, de cómo la madre interpretaba la vida de su hijo.

The investigation the first year of the child's linguistic life had as an object of study the development of the acquisition of the language of the infant from zero to twelve months, also taking the maternal speech as an object of study, since it is from the care of the mother, from the child-mother interaction, which makes the latter acquire the representation and with it he acquires the language, which will serve to communicate. The above implied a direct observation of this relationship, of how the child communicated with his mother in the first months, or to be more exact, of how the mother interpreted her son's life.