Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary.

In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.

Sospechando de la monstruosidad en el otro desde el pensamiento abismal y la subalternidad. Una mirada desde la discapacidad y la disciplina odontológica / Suspecting the monstrosity in the other from abysmal thinking and subalternity. A look from disability and dental discipline

Introducción: este ensayo surge de la reflexión sobre el quehacer de la práctica odontológica en el cuidado-atención de la salud bucal en las personas con discapacidad, y la influencia del modelo disciplinar en esta interacción. Se considera pertinente este abordaje, teniendo en cuenta los imaginarios colectivos de los que siguen siendo protagonistas las personas con discapacidad y su asociación con el aspecto monstruoso. Objetivo: poner en el contexto de la duda las prácticas disciplinares de la odontología con respecto a las personas con discapacidad, cuestionando su enfoque y utilizando, para ello, la categoría de la sospecha propuesta por Foucault como punto de partida. Método: el texto expuesto es un ensayo reflexivo y crítico, en el que se discute la atención-cuidado en la práctica odontológica con las personas con discapacidad, bajo las categorías del modelo disciplinar, la teoría de la sospecha, el pensamiento abismal y la subalternidad, con sus correspondientes autores. Esto posibilita una reflexión profunda sobre esta temática. Conclusiones: la medicina y sus afines como la odontología son ciencias disciplinares, están soportadas fijamente en el icono significativo de la academia científica, por ello, es necesario reflexionar sobre la práctica propia de la odontología y su hacer disciplinar. Si bien, estos conocimientos han sido oficializados, niegan en su esencia otros conocimientos, pero, si la condición es tratar al ser humano en su totalidad y con sus diferentes condiciones, se debe considerar en el proceso el uso de conocimiento proveniente de otros saberes o formas de leer las realidades.

Introduction: This essay emerges from the reflection of a dental professional who is also trained in other areas of knowledge. It explores the role, significance, and actions of dentists in providing oral health care for individuals with disabilities, who are often still stigmatized in societal perception. Additionally, it examines how the disciplinary model of dentistry influences interactions in this context. Objective: The objective of this essay is to question and provide support for the theory of "Suspicion" regarding the disciplinary model of dentistry and its approach to caring for individuals with disabilities. Method: This essay presents a reflective and critical analysis of the issue of dental care for people with disabilities, employing the categories of the disciplinary model, the theory of suspicion, abysmal thinking, and subalternity along with their respective authors. This approach allows for a more profound reflection on the subject matter. Conclusions: Medicine, including dentistry, is a disciplinary science that heavily relies on the esteemed symbol of scientific academia. It is crucial, however, to critically examine the practice of dentistry and its disciplinary nature. While this knowledge has been formalized, it often disregards other forms of knowledge. Yet, when treating individuals holistically, considering their diverse conditions, it becomes imperative to incorporate different knowledge systems and ways of interpreting realities into the process.

Spatio-temporal trend of BIRADS classification suggestive of malignancy: a national analysis of mammograms, 2013-2017.

INTRODUCTION: Promoting breast cancer (BC) detection in women by means of mammography is a viable strategy to reduce the number of diagnoses at clinically advanced stages and mortality. OBJECTIVES: To describe the results reported by mammography studies in women, carried out nationally during 2013-2017, and to analyze the spatiotemporal trend of Breast Imaging Reporting and Data System (BIRADS) categories suggestive of malignancy by State. METHOD: Longitudinal, analytical design that included information on mammography studies of women according to age group (< 40 and ≥ 40), evaluated in units of the Ministry of Health of Mexico during 2013-2017. The frequency of BIRADS categories and a standardized rate suggestive of malignancy (categories 4 and 5) were estimated in women aged ≥ 40 years, and spatial statistics were used to analyze the trend by State. RESULTS: A total of 3,659,151 mammograms were analyzed, 98.5 % in women aged ≥ 40 years. The malignancy-suggestive rate decreased from 38.3 (2013) to 31 (2017) per 100,000 women aged ≥ 40 years; however, the risk of detection increased up to 13 times in ten States. CONCLUSIONS: Although the risk of detection in categories suggestive of malignancy decreased at the national level, some States need to reinforce the application of BC detection programs through mammography and increase the participation of the target population.

INTRODUCCIÓN: Promover la detección de cáncer de mama (CaMa) en mujeres mediante mastografía es una estrategia viable para disminuir los diagnósticos en fases clínicamente avanzadas y la mortalidad. OBJETIVOS: Describir los resultados reportados por estudios de mastografía en mujeres realizados a nivel nacional durante 2013-2017 y analizar la tendencia espaciotemporal de categorías BIRADS (Breast Imaging Reporting and Data System) sugestivas de malignidad por Estado. MÉTODO: Diseño analítico longitudinal que incluyó información sobre estudios de mastografía de mujeres según grupo de edad (< 40 e ≥ 40), valoradas en unidades de la Secretaría de Salud, México, durante 2013-2017. Se estimó la frecuencia de categorías según BIRADS, tasa estandarizada sugestiva de malignidad (categorías 4 y 5) en mujeres ≥ 40 años y se utilizó estadística espacial para analizar la tendencia por Estado. RESULTADOS: Se analizaron 3,659,151 mastografías, el 98.5 % en mujeres ≥ 40 años. La tasa sugestiva de malignidad disminuyó de 38.3 (2013) a 31 (2017) por 100 mil mujeres ≥ 40 años; sin embargo, el riesgo de detección aumentó hasta 13 veces en diez Estados. CONCLUSIONES: Aunque el riesgo de detección en categorías sugestivas de malignidad disminuyó a nivel nacional, algunos Estados requieren reforzar la aplicación de programas de detección del CaMa mediante mastografía e incrementar la participación de la población blanco.

Cardiólogo encuentra un caso de enfermedad de Fabry / Cardiologist finds a case with Fabry disease

Resumen En este reporte se llama la atención de los colegas ante la posibilidad de encontrar un caso de enfermedad de Fabry entre múltiples pacientes que consultan. Se exponen las condiciones clínicas de estos pacientes que los hacen únicos, a causa de una enfermedad huérfana. Es posible que muchas de estas condiciones clínicas hayan pasado inadvertidas y al no tenerlas presentes no se tenga un grado de sospecha que lleve al diagnóstico.

Abstract In this report is call the attention of our colleagues the possibility of finding a case of Fabry's disease within the multitude of patients in our practice. It is expose the clinical conditions of these patients which make them unique, due to a disease denominated as orphan. It is possible that many of these clinical conditions have gone unnoticed and by not having them present prevent/impide us from having a high degree of suspicion which would lead to a diagnosis.

Tendencia espacio-temporal de clasificación BIRADS sugestiva de malignidad: un análisis nacional de mastografías, 2013-2017 / Spatio-temporal trend of BIRADS classification suggestive of malignancy: a national analysis of mammograms, 2013-2017

Resumen Introducción: Promover la detección de cáncer de mama (CaMa) en mujeres mediante mastografía es una estrategia viable para disminuir los diagnósticos en fases clínicamente avanzadas y la mortalidad. Objetivos: Describir los resultados reportados por estudios de mastografía en mujeres realizados a nivel nacional durante 2013-2017 y analizar la tendencia espaciotemporal de categorías BIRADS (Breast Imaging Reporting and Data System) sugestivas de malignidad por Estado. Método: Diseño analítico longitudinal que incluyó información sobre estudios de mastografía de mujeres según grupo de edad (< 40 e ≥ 40), valoradas en unidades de la Secretaría de Salud, México, durante 2013-2017. Se estimó la frecuencia de categorías según BIRADS, tasa estandarizada sugestiva de malignidad (categorías 4 y 5) en mujeres ≥ 40 años y se utilizó estadística espacial para analizar la tendencia por Estado. Resultados: Se analizaron 3,659,151 mastografías, el 98.5 % en mujeres ≥ 40 años. La tasa sugestiva de malignidad disminuyó de 38.3 (2013) a 31 (2017) por 100 mil mujeres ≥ 40 años; sin embargo, el riesgo de detección aumentó hasta 13 veces en diez Estados. Conclusiones: Aunque el riesgo de detección en categorías sugestivas de malignidad disminuyó a nivel nacional, algunos Estados requieren reforzar la aplicación de programas de detección del CaMa mediante mastografía e incrementar la participación de la población blanco.

Abstract Introduction: Promoting breast cancer (BC) detection in women by means of mammography is a viable strategy to reduce the number of diagnoses at clinically advanced stages and mortality. Objectives: To describe the results reported by mammography studies in women, carried out nationally during 2013-2017, and to analyze the spatiotemporal trend of Breast Imaging Reporting and Data System (BIRADS) categories suggestive of malignancy by State. Method: Longitudinal, analytical design that included information on mammography studies of women according to age group (< 40 and ≥ 40), evaluated in units of the Ministry of Health of Mexico during 2013-2017. The frequency of BIRADS categories and a standardized rate suggestive of malignancy (categories 4 and 5) were estimated in women aged ≥ 40 years, and spatial statistics were used to analyze the trend by State. Results: A total of 3,659,151 mammograms were analyzed, 98.5 % in women aged ≥ 40 years. The malignancy-suggestive rate decreased from 38.3 (2013) to 31 (2017) per 100,000 women aged ≥ 40 years; however, the risk of detection increased up to 13 times in ten States. Conclusions: Although the risk of detection in categories suggestive of malignancy decreased at the national level, some States need to reinforce the application of BC detection programs through mammography and increase the participation of the target population.

Diagnostic yield of sequencing familial hypercholesterolemia genes in individuals with primary hypercholesterolemia.

INTRODUCTION AND OBJECTIVES: Our objective was to approximate the prevalence of mutations in candidate genes for familial hypercholesterolemia (FH) in a middle-aged Spanish population and to establish the predictive value of criteria for clinical suspicion in the detection of causative mutations. METHODS: Unrelated individuals aged ≥ 18 years from the Aragon Workers' Health Study (AWHS) with high low-density lipoprotein cholesterol (LDL-C) and clinical suspicion of FH (participants with LDL-C concentrations above the 95th percentile, participants with premature cardiovascular disease and/or participants with high LDL-C [130 mg/dL] under statin therapy), assuming that any participant with FH exhibits at leats 1 trait, were selected and the LDLR, APOB, PCSK9, APOE, STAP1 and LDLRAP1 genes were sequenced by next generation sequencing technology. RESULTS: Of 5400 individuals from the AWHS, 4514 had complete data on lipid levels and lipid-lowering drugs, 255 participants (5.65%) met the criteria for suspicion of FH, 24 of them (9.41%) were diagnosed with hyperlipoproteinemia(a), and 16 (6.27% of those sequenced) were found to carry causative mutations in candidate genes: 12 participants carried 11 different pathogenic LDLR alleles and 4 participants carried 1 pathogenic mutation in PCSK9. LDL-C concentrations> 220 mg/dL and LDL-C> 130 mg/dL despite statin therapy showed the strongest association with the presence of mutations (P=.011). CONCLUSIONS: Our results show that the prevalence of FH in Spain is 1:282 and suggest that the combination of high untreated LDL-C and high levels of LDL-C despite statin therapy are the best predictors of a positive FH genetic test.

Enfermedad de Niemann-Pick en una escolar / Niemann-Pick Disease in a scholar girl

Introducción: La enfermedad de Niemann-Pick tipo C es una enfermedad poco frecuente, autosómica recesiva, caracterizada por el depósito de lípidos a nivel lisosomal, que, a pesar de ser tratable, es mortal en todos los casos y representa una importante carga para los pacientes y sus familias. Objetivo: Contribuir al conocimiento de esta rara enfermedad neurovisceral progresiva de curso fatal. Presentación del caso: Se trata de una niña de 7 años de edad, que a los 2 años asistió a consulta por trastornos de la marcha, con deterioro progresivo de esta, así como del lenguaje y el comienzo de crisis epilépticas. Evolutivamente presentó cataplejías gelásticas, paresia de la mirada vertical y esplenomegalia. Estos elementos clínicos evolutivos fueron lo suficientemente distintivos para orientar la sospecha clínica y las investigaciones necesarias para llegar al diagnóstico definitivo de la enfermedad. Con la confirmación de que se trataba de la enfermedad de Niemann-Pick tipo C, se comenzó tratamiento con miglustad a dosis de 100 mg dos veces al día. Conclusiones: El deterioro neurológico progresivo, la cataplejía gelástica, la paresia de la mirada vertical y la esplenomegalia, unido a los resultados del medulograma y el estudio genético permitieron el diagnóstico de esta entidad(AU)

Introduction: Niemann-Pick type C disease is a non-frequent, recessive autosomal one, which is characterized by lipids deposit in the lysosomal level. Although this disease is treatable, it is fatal in all the cases and it represents a important burden to patients and their families. Objective: To contribute to the knowledge on this rare, progressive neurovisceral disease with fatal evolution. Case presentation: Seven- years- old girl, whom at two years old attended to a consultation for walk disorders presenting a progressive worsening of it, as well of the speech, and also presented an onset of epileptic crisis. In the evolution she presented gelastic cataplexy, vertical look´s paresia and splenomegaly. These clinical evolutive elements were sufficiently distinctive to indicate the clinical suspicion and the necessary research to reach its definitive diagnostic. With the confirmation of Niemann-Pick type C disease, miglustad was used as treatment with a dose of 100 mg twice in the day. Conclusions: Progressive neurological worsening, gelastic cataplexy, vertical look´s paresia and splenomegaly joined with the results of a medulogram and the genetic study permitted this disease to be identified(AU)

Características clínicas y para clínicas de los pacientes con fiebre manchada por Ricketts ia ricketts ii en Panamá (1950­-1951; 2004­-2017) / Clinical and para clinical characteristics of patients with fevers potted by Rickettsiarickettsii in Panama (1950­1951; 2004­2017)

La fiebre manchada causada por Ric ketts ia ric ketts iies por mucho la enfermedad transmitida por garrapatas más importante en América Latina y una de las zoonosis más relevante del continente. En Panamá esto es notorio si se considera que los casos confirmados de la misma se han registra­ do en dos series: 1950­1951, donde se presentaron cinco casos, donde los dos primeros fueron re­ sultaron fatales, y de 2004­2017, donde se confirmaron 10 casos, con nueve fallecimientos. A pes ar de lo anterior, la fiebre manchada causada por Rrickettsii es una enfermedad de baja preva­lencia y está dentro de las enfermedades desatendidas. El diagnóstico oportuno de Rrickettsii en personas afectadas por la misma, incrementa la posibilidad de sobrevivencia del paciente; sin em­bargo, a pesar de su alto porcentaje de mortalidad, esta enfermedad es poco reconocida y no se cuenta con sospecha clínica. Con el objetivo de presentar sus características clínicas en Panamá, se analizan individualmente cada reportes de caso, incluyendo datos etarios , de localidad, sínto­mas descritos, análisis aplicados y tratamiento.

The spotted fever caused by Ric ketts ia rickettsii is by far the most important tick­borne disease in Latin America and one of the most important zoonoses in the continent. In Panama this is notorious if it is considers that the confirmed cases have been registered in two series: 1950­1951, with five cas es and two fatal; and 2004­2017, with 10 cases and nine deaths. Despite the above, spotted fe­ver caused by R. rickettsii is a disease of low prevalence and is among the neglected diseases. The timely diagnosis of Rrickettsii in people affected by it, increases the possibility of survival of the pa­tient; however, despite its high mortality rate, this disease is poorly recognized and there is no clini­ cal suspicion. In order to present their clinical characteristics in Panama, each reports of case is analyzed individually, including age, location, symptoms described, applied analysis and treatmen

Diagnosis and clinical behavior in patients with Lynch-like syndrome. / Diagnóstico y comportamiento clínico de pacientes con sospecha de síndrome de Lynch sin mutación conocida.

INTRODUCTION AND AIMS: Lynch-like syndrome is diagnosed when there is an expression deficit in DNA mismatch repair proteins but a normal genetic study. The behavior and management of that pathology are currently a subject of debate. We present herein the characteristics of patients with Lynch-like syndrome, together with a surveillance proposal. MATERIALS AND METHODS: Immunohistochemistry was carried out on families suspected of presenting with Lynch syndrome. Germline analysis was done if there was loss of mismatch repair protein expression and no BRAF mutation. RESULTS: Of the 148 patients that underwent immunohistochemistry testing, 23 presented with loss of mismatch repair protein expression. Seven of those patients were identified as having Lynch-like syndrome: 3had colon cancer, 2had endometrial tumor, and 2were healthy, with an affected relative. Mean patient age was 56.9 years and only one patient presented with another tumor associated with Lynch syndrome. CONCLUSIONS: Until there is a better understanding of the etiology of that heterogeneous entity, intermediate surveillance is an adequate strategy.

La lógica de la sospecha. Sobre criminalización del uso de drogas: complots y barreras de acceso al sistema de salud / The logic of suspicion. Criminalization of drug abuse, complots and access barriers to health system

Partiendo de los resultados de un estudio etnográfico desarrollado en dos barrios pobres del sur del Gran Buenos Aires, en este artículo, examino las consecuencias de la criminalización del consumo de drogas, en los vínculos entre instituciones de salud y usuarios/as de drogas que viven bajo condiciones de pobreza y marginación social. Específicamente, defino y caracterizo la lógica de la sospecha, es decir, aquel conjunto de prácticas simbólicas que incluye desde la duda, la desconfianza, la sospecha, la modificación del significado de los mensajes, la dificultad de fijar la intencionalidad del interlocutor hasta la elaboración de teorías sobre planes de aniquilación de determinados grupos sociales. Partiendo del análisis de una dispersión de experiencias, narraciones, posiciones, actitudes y elaboraciones, examino a la sospecha que estructura esta lógica como una barrera entre los usuarios/as de drogas y las instituciones de salud

. Based on results of the ethnographic research that were carried out in two shantytowns located in the Greater Buenos Aires, in this paper, I exam the criminalization of drug use and its multiple consequences on the bonds between health institutions and poor and marginalized consumers. Specifically, I define and characterize what I named "the logic of suspicion". This logic refers to a diverse set of symbolic practices that includes: doubt, distrust, suspicion, alteration in the meaning of messages from state institutions, difficulties to determine the intentionality of other people and construction of theories about annihilation plans. By analyzing drug users experiences, narratives, positions, attitudes and constructions, in this article I interpret the logic of suspicion as a barrier that regulates the gap and types of bonds between drug users and health institutions

Partindo dos resultados de um estudo etnográfico desenvolvido em dois bairros pobres do Sul do Gran Buenos Aires, examino, neste artigo, as consequências da consideração criminosa do consumo de drogas, nos vínculos entre instituições de saúde e usuários/as de drogas que vivem sob condições de pobreza e marginação social. Especificamente, defino e caracterizo a lógica da suspeita, quer dizer, aquele conjunto de práticas simbólicas que parte da dúvida, a desconfiança, a suspeita, a modificação do significado das mensagens, a dificuldade de fixar a intencionalidade do interlocutor e chegar até a elaboração de teorias relativas aos planos de aniquilação de determinados grupos sociais. Partindo da análise da dispersão de experiências, narrativas, posições, atitudes e elaborações, examino a suspeita que estrutura esta lógica como una barreira entre os usuários/as de drogas e as instituições de saúde

An examination of the hypothesis that intraocular pressure elevation episodes can have prognostic significance in glaucoma suspects.

The efficacy of intraocular pressure reduction in retarding the progression of glaucoma has been demonstrated. This review examines the potential for prognostic advantage for glaucoma suspects in reducing their optic nerve head exposure to elevated intraocular pressure associated with activities which have been shown to elevate intraocular pressure. In this observational study, patients examined at the Centre for Eye Health (University of New South Wales) with a diagnosis of glaucoma suspect were surveyed to determine their histories for participation in activities which are known to elevate intraocular pressure. The evidence regarding the pathological significance of these sources of elevation in susceptible patients was examined. Apart from the universality of sleep-related intraocular pressure elevations, the histories from 183 confirmed glaucoma suspects indicate a wide range and variation in frequency of participation in other intraocular pressure elevating activities. A reduction in exposure to elevated intraocular pressure may improve the prognosis for glaucoma suspects. Additional patient specific assessment of the results of this screening could provide an indication of the degree (frequency, intensity level and duration) of exposure to elevated intraocular pressure. Such information may provide the basis for improving a patient's prognosis by helping them to identify opportunities to reduce such exposure to elevated intraocular pressure. Any benefit of reduction of such exposure appears likely to be greater if activities which elevate intraocular pressure are of long duration, occur frequently, occur over a long period of time, and/or involve high levels of intraocular pressure elevation.

Peripheral yttrium aluminium garnet (YAG) iridotomy versus phacoemulsification in primary angle closure: prospective comparative study.

PURPOSE: A study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC). METHODS: Forty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n=29) or LPI (n=18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique. RESULTS: Phacoemulsification reduces IOP after one and 3 months (P<.01). LPI reduces IOP after 3 months (P<.04), and after one month (P<.38). IOP was 16.2mmHg (SD: 3.59) in the phacoemulsification group vs. 16.83mmHg (SD: 2.36) in the LPI group after one month (P=.4), and 15.52 (SD: 2.95) vs. 16.05 (SD: 2.46) in the third month (P=.5). There were no significant differences in the antiglaucoma drugs. Shaffer gonioscopy grading was greater in the phacoemulsification group vs. in the LPI group one and 3 months after the intervention (P=.01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months (P<.01). CONCLUSIONS: Although phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI.

Aspiración de cuerpo extraño durante la consulta dental en pediatría: Reporte de un caso / Foreign body aspiration in dental office: Founded suspicion for late diagnosis. Case presentation and literature review

Dentro de la práctica clínica en pediatría existen situaciones en las que el diagnóstico oportuno de una enfermedad involucra la meditación de situaciones insospechadas; en niños muy pequeños el interrogatorio indirecto bien realizado y detallado se convierte en herramienta fundamental para su tratamiento. En un evento de aspiración de cuerpo extraño existen indicadores específicos para tener sospecha de que estamos ante un caso; sin embargo, no todos los pacientes presentan signos y síntomas clásicos, por lo que la experiencia del clínico es vital. Se presenta el caso de un niño de veintiún meses de edad que broncoaspiró una corona de acero cromo en un consultorio dental; ésta no fue identificada sino hasta 60 días después del accidente. Es importante que los clínicos encargados de la salud bucal de los niños estén capacitados para auxiliar a sus pacientes ante un evento de aspiración de cuerpo extraño, tanto de forma inmediata como mediata, teniendo una conducta responsable ante la sospecha fundamentada de que ocurrió un accidente de esta naturaleza.

Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. The present study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax X-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient's safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient's life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.

Empleo de la Tarjeta Amarilla y el Formato NOM220 para las notificaciones de sospechas de reacciones adversas a medicamentos / Use of Yellow Card and of NOM220 Format for reporting of suspected adverse drug reactions

Introducción: la notificación de reacciones adversas a medicamentos es una obligación a nivel mundial. Aunque se han establecido muchas metodologías para esta acción, en la actualidad existen problemas. Objetivo: determinar la frecuencia de sospecha de reacciones adversas a la administración de medicamentos en pacientes y comparar la accesibilidad del llenado del formato de la NOM220 de la Secretaría de Salud y la Tarjeta Amarilla propuesta por la Organización Mundial de la Salud. Métodos: estudio transversal y observacional. Participaron 50 médicos responsables de las clínicas de diabetes del Estado de Hidalgo. Inicialmente, los médicos fueron capacitados para identificar las sospechas de reacciones adversas a la administración de medicamentos en los pacientes atendidos. Se realizó un diseño cruzado, en el que el 50 por ciento de los médicos utilizaron por tres meses el formato de la NOM220 y 50 por ciento la Tarjeta Amarilla. Después intercambiaron formatos y los utilizaron durante los tres meses siguientes. Al cabo de este periodo, respondieron un cuestionario para determinar la utilidad, claridad, tiempo de llenado y practicidad de ambos formatos. Se realizó estadística descriptiva y análisis bivariado para determinar los factores asociados a las sospecha de reacciones adversas a medicamentos, con el software SPSS (versión 17). Resultados: se registraron 46 sospechas de reacciones adversas a medicamentos en 46 pacientes con el formato de la NOM220 y 78 sospechas de reacciones adversas a medicamentos con la Tarjeta Amarilla en 78 pacientes. Todas las sospechas de reacciones adversas a la administración de medicamentos fueron tipo A. Los médicos recomiendan la utilización de la Tarjeta Amarilla, consideran claro el formato, sencillo, legible, fácil de llenar, entendible y accesible (p< 0,05). Conclusiones: los resultados permiten proponer la Tarjeta Amarilla como una alternativa más accesible para la notificación de sospechas de reacciones adversas a medicamentos, o se hagan adecuaciones al formato de la NOM220(AU)

Introduction: the reporting of adverse drug reactions is a global obligation. Although many methods have been implemented, there are still problems at present. Objective: to determine the frequency of suspected adverse reactions in patients and to compare the access to filling out the NOM220 formats of the Secretaría de Salud and the Yellow Card suggested by the World Health Organization. Methods: a cross-sectional and observational study was made. Fifty physicians responsible for the diabetes clinics in the state of Hidalgo participated in the study. First, the physicians were trained to identify the suspected adverse drug reactions in their patients. A crossover design was created where 50 percent of physicians used the NOM220 format and 50 percent the Yellow Card. Three months later, they exchanged the formats and used them during the following three months. After this period, questionnaire was administered to determine the usefulness, clarity, filling out time and convenience of the formats. Descriptive statistics and bivariate analyses were applied to determine the factors associated with the suspected adverse drug reactions with SPSS software (version 17). Results: a total of 46 suspected adverse reactions were registered in 46 patients using NOM220 format and 78 with the Yellow Card in 78 patients. All the suspected adverse reactions were type A. The physicians recommended the use of Yellow Card since they considered that it is practical, simple, readable, understandable, accessible and requires less time to fill it out (p< 0.05). Conclusions: the results allow selecting the Yellow Card as the most accessible choice for reporting suspected drug adverse reactions; additionally, they suggest that adjustments should be also made in the NOM220 format(AU)

Características estructurales del disco óptico y la capa de fibras neurorretinianas mediante tomografía confocal láser en la sospecha de cierre angular primario / Structural characteristics of the optic disc and the neuroretinal nerve fiber layer observed by confocal laser tomography in suspected primary angle closure

Objetivo: evaluar las características del disco óptico y la capa de fibras neurorretinianas en la sospecha de cierre angular primario, el desempeño de las funciones discriminantes y la influencia del tamaño del disco en estos.Métodos: estudio de serie de casos de corte transversal en 47 ojos (30 pacientes) con sospecha de cierre angular primario. Se utilizó el tomógrafo confocal de barrido láser (HRT 3, Heidelberg Engineering, Alemania). Para el análisis de la influencia del tamaño del disco se consideraron tres grupos: área de disco menor de 1,6 mm2, entre 1,6 y 2 mm2 y mayor de 2,0 mm2.Resultados: el área de disco se relacionó positivamente con el área de copa, área de anillo, volumen de copa, área de sección transversal de la capa de fibras neurorretinianas y tamaño de copa (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectivamente) y negativamente con la curvatura horizontal de la capa de fibras neurorretinianas (p=0,019). Hubo una relación significativa con la variación de la altura del contorno (p=0,008), fundamentalmente a expensas de las diferencias de los discos pequeños con los medianos. Para las funciones MRA, GPS y FSM el mejor desempeño fue en el disco pequeño (aproximandamente 92 porciento de concordancia con el disco sano en cada una). La función RB mostró la mayor coincidencia (100, 96 y 100 porciento; según grupos de área de disco), mientras el GPS, la menor (92, 72 y 55,6 porciento respectivamente).Conclusiones: el área de disco se relaciona con el área de copa, área de anillo, volumen de copa, área de sección transversal y curvatura horizontal de la capa de fibras neurorretinianas, tamaño de copa y variación de altura del contorno. Las funciones MRA, GPS y FSM identifican el disco sano con mayor certeza cuando es pequeño. La función RB se desempeña mejor mientras el GPS peor, independientemente del valor de área de disco

Objective: to evaluate the characteristics of the optic disc and of the retinal nerve fiber layer in the suspected primary angle closure, the performance of glaucomatous discriminant functions, and the influence of the optic disc size in the results.Methods: a cross-sectional case series study in 47 eyes (30 patients) with suspected primary angle-closure, for which the confocal laser tomography (HRT 3, Heidelberg Engineering, Germany), was used to obtain the images. The influence of the optic disc size was analized in 3 groups: < 1,6mm2, 1,6 - 2,0 mm2 y > 2,0 mm2.Results: the disc area was positively related to the cup area, the rim area, the cup volume, the retinal nerve fiber layer cross sectional area, and the cup size (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectively) and negatively related with the horizontal curvature of the retinal nerve fiber layer (p=0,019). There was a significant relation to the variation of contour height (p=0,008), particularly to differences between small and medium size discs. Discriminant functions such as MRA, GPS and FSM performed better in small discs (approximately 92 per cent of agreement with the normal discs for each one). The RB function obtained the greater coincidence (100, 96 and 100 per cent for respective groups of disc areas), whereas GPS obtained the smallest (92, 72 and 55,6 per cent respectively).Conclusions: the disc area is related to cup area, rim area, cup volume, retinal nerve fiber layer cross sectional area, retinal nerve fiber layer horizontal curvature, cup size and the variation of contour height. The MRA, GPS and FSM discriminant functions identify better the normal optic disc when it is small. The RB function performs the best whereas the GPS performs the worst, regardless of the disc area

Características estructurales del disco óptico y la capa de fibras neurorretinianas mediante tomografía confocal láser en la sospecha de cierre angular primario / Structural characteristics of the optic disc and the neuroretinal nerve fiber layer observed by confocal laser tomography in suspected primary angle closure

Objetivo: evaluar las características del disco óptico y la capa de fibras neurorretinianas en la sospecha de cierre angular primario, el desempeño de las funciones discriminantes y la influencia del tamaño del disco en estos.Métodos: estudio de serie de casos de corte transversal en 47 ojos (30 pacientes) con sospecha de cierre angular primario. Se utilizó el tomógrafo confocal de barrido láser (HRT 3, Heidelberg Engineering, Alemania). Para el análisis de la influencia del tamaño del disco se consideraron tres grupos: área de disco menor de 1,6 mm2, entre 1,6 y 2 mm2 y mayor de 2,0 mm2.Resultados: el área de disco se relacionó positivamente con el área de copa, área de anillo, volumen de copa, área de sección transversal de la capa de fibras neurorretinianas y tamaño de copa (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectivamente) y negativamente con la curvatura horizontal de la capa de fibras neurorretinianas (p=0,019). Hubo una relación significativa con la variación de la altura del contorno (p=0,008), fundamentalmente a expensas de las diferencias de los discos pequeños con los medianos. Para las funciones MRA, GPS y FSM el mejor desempeño fue en el disco pequeño (aproximandamente 92 porciento de concordancia con el disco sano en cada una). La función RB mostró la mayor coincidencia (100, 96 y 100 porciento; según grupos de área de disco), mientras el GPS, la menor (92, 72 y 55,6 porciento respectivamente).Conclusiones: el área de disco se relaciona con el área de copa, área de anillo, volumen de copa, área de sección transversal y curvatura horizontal de la capa de fibras neurorretinianas, tamaño de copa y variación de altura del contorno. Las funciones MRA, GPS y FSM identifican el disco sano con mayor certeza cuando es pequeño. La función RB se desempeña mejor mientras el GPS peor, independientemente del valor de área de disco(AU)

Objective: to evaluate the characteristics of the optic disc and of the retinal nerve fiber layer in the suspected primary angle closure, the performance of glaucomatous discriminant functions, and the influence of the optic disc size in the results.Methods: a cross-sectional case series study in 47 eyes (30 patients) with suspected primary angle-closure, for which the confocal laser tomography (HRT 3, Heidelberg Engineering, Germany), was used to obtain the images. The influence of the optic disc size was analized in 3 groups: < 1,6mm2, 1,6 - 2,0 mm2 y > 2,0 mm2.Results: the disc area was positively related to the cup area, the rim area, the cup volume, the retinal nerve fiber layer cross sectional area, and the cup size (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectively) and negatively related with the horizontal curvature of the retinal nerve fiber layer (p=0,019). There was a significant relation to the variation of contour height (p=0,008), particularly to differences between small and medium size discs. Discriminant functions such as MRA, GPS and FSM performed better in small discs (approximately 92 percent of agreement with the normal discs for each one). The RB function obtained the greater coincidence (100, 96 and 100 per cent for respective groups of disc areas), whereas GPS obtained the smallest (92, 72 and 55,6 percent respectively).Conclusions: the disc area is related to cup area, rim area, cup volume, retinal nerve fiber layer cross sectional area, retinal nerve fiber layer horizontal curvature, cup size and the variation of contour height. The MRA, GPS and FSM discriminant functions identify better the normal optic disc when it is small. The RB function performs the best whereas the GPS performs the worst, regardless of the disc area(AU)

Seguimiento farmacoterapéutico a pacientes con diabetes mellitus tipo 2 en la farmacia principal municipal Santiago de Cuba

Se desarrolló un servicio de seguimiento farmacoterapéutico a 30 pacientes con Diabetes Mellitus de tipo 2, dispensarizados en la farmacia principal de Santiago de Cuba , en el periodo comprendido desde noviembre del 2009 hasta febrero del 2010, siguiendo la metodología Dáder actualizada con adaptaciones de acuerdo a las condiciones experimentales y los resultados se analizaron a través de la estadística correlacional, clasificados según el Tercer Consenso de Granada, siendo la inseguridad no cuantitativa (40 por ciento) y la inefectividad no cuantitativa (30 por ciento) los de mayor incidencia. Se realizaron 40 intervenciones farmacéuticas, lo que posibilitó la solución y prevención del 97,50 por ciento de las sospechas y resultados negativos asociados a la medicación permitiendo la detección de 40 sospechas y resultados negativos asociados a la medicación. El resultado del servicio desarrollado luego de la evaluación se consideró satisfactorio pues se obtuvieron índices de resultados altos en los indicadores de de intervenciones farmacéuticas aceptadas, resultados negativos asociados a la medicación prevenidas(AU)

A service of pharmacotherapy monitoring was developed to 30 patients suffering from type 2 Mellitus Diabetes , dispensed in the Principal Municipal Pharmacy of Santiago of Cuba, in the period included from November of the 2009 to February of the 2010, following the Dáder methodology updated with adaptations according to the experimental conditions and the results were analyzed through the statistic correlation, permitting the detection of 40 suspicion and negative outcomes related to medication , classified according to the Third Consensus of Granada, this being the non-quantitative safely problem (40 percent) and the non-quantitative ineffectiveness (30 percent) the one of greater incidences. 40 pharmaceutical interventions were performed, which enabled the solution and associated prevention of 97.50 percent of the suspicions and negative outcomes related with medication . After the evaluation, the result of the service provided was considered satisfactory since high results index were obtained in the indicators of the accepted pharmaceutical interventions negative outcomes related the medication. prevented(AU)

Problemas auditivos en preescolares, según estudio audiológico y percepción de educadores: Región Metropolitana, diciembre 2005 / Hearing problems in preschool children according to audiologic examination and teachers perception: Metropolitan Region, 2005

Introducción: La relación entre audición y desarrollo neuropsicológico está ampliamente demostrada. Pérdidas auditivas leves o incluso unilaterales se asocian a retraso del lenguaje y dificultades escolares. En Chile no existe un tamizado auditivo masivo para los preescolares y escolares, sino una pesquisa en base a estimación subjetiva de la audición en los programas de salud escolar de la Junta Nacional de Auxilio Escolar y Becas. Objetivo: Conocer la prevalencia de hipoacusia en preescolares y correlacionarlo con la percepción de educadores sobre la audición y lenguaje de los niños. Sujetos y Métodos: Durante diciembre de 2005 se citó a todos los niños de 4 y 5 años de un jardín infantil del área norte de la RM, a una evaluación audiológica consistente en otoscopía, audiometría e impedanciometría, realizada en el laboratorio de Otoneurología de la Escuela de Tecnología Médica (Universidad de Chile). Previamente y sin mediar entrenamiento se interrogó a las educadoras acerca de la sospecha de pérdida auditiva o problemas de lenguaje en los niños evaluados. Resultados: Se evaluaron 87 de 100 preescolares, edad promedio 4,4 años. Trece niños (15%) tenía problemas audiológicos, de éstos, diez no pasaron el tamizado auditivo, lo que da una tasa de hipoacusia de 11,6%; todos correspondieron a hipoacusia de transmisión. La sensibilidad de las educadoras para pesquisarla fue 50%. No se correlacionó la percepción de problemas de lenguaje con hipoacusia. Conclusión: Destaca la alta frecuencia de problemas audiológicos encontrados. La sola sospecha de hipoacusia por parte de los educadores es insuficiente como método de preselección, ya que pesquisa sólo a la mitad de los afectados. Estos hallazgos hacen plantearnos la necesidad de implementar tamizados auditivos objetivos a todos los niños al comenzar su educación formal.

The relationship between hearing and neuropsychological development has been widely demostrated. Mild or unilateral hearing lost are linked to language development delay and learning difficulties. Chile does not have a universal audition screening program for preschool and school children. The school health programs sponsored by the JUNAEB relay on teachers suspicion for early detection of hearing problems. Objective: To determine the prevalence of hearing lost in preschool children and correlate these findings with teachers perception in relation to audition and language development. Method: Children 4 and 5 years-old attending school in the northern area of Santiago during December 2005 were scheduled for an audiological evaluation, consisting in otoscopy, audiometry and tympanometry performed at the School of Medical Technology and Otoneurology Laboratory, University of Chile. Previously and without training, teachers gave their perception on hearing lost and language problems in the evaluated children. Results: 87 children were evaluated, with mean age 4,4 years-old. 15% presented audition problems and 8,7% did not pass the hearing evaluation, corresponding to conductive hearing lost. Detection of hearing problems by teachers presented a 50% sensibility. There was no correlation between language problems and hearing lost. Conclusions: The frequency of audition problems is remarkable high. The teachers suspicion alone is not enough as a screening method, because it only detects 50% of children with hearing problems. These findings point out the need to implement a universal audition screening for children beginning their formal education.

El deterioro cognitivo: una mirada previsora / Cognitive deterioration: a foresighted look

El deterioro cognitivo constituye un frecuente motivo de consulta. Estaremos en disposición de poder diagnosticarlo tras la integración de los datos obtenidos en la entrevista clínica (anamnesis tests psicométricos). Ante su sospecha es obligatorio realizar una correcta valoración del estado mental de la persona que incluirá la evaluación de las capacidades cognitivas y de la función ejecutiva, así como la valoración de su estado emocional. Se valorará conjuntamente el estado funcional del individuo que abarcará la personalidad y su conducta, además del grado de afectación de las actividades instrumentales y básicas de la vida diaria. La implicación real de la APS en la detección y manejo de los problemas cognitivos es escasa. En nuestro medio la exploración del estado mental no constituye una práctica sistemática, por lo que persiste un grado no despreciable de subregistro para dicho diagnóstico.

Cognitive deterioration is a frequent reason to seek medical attention. We will be able to diagnose it after the integration of the data obtained in the clinical interview (anamnesis + psychometric tests). In case of suspicion, it is compulsory to carry out a correct evaluation of the mental status of the person, including the assessment of the cognitive capacities, of the executive function and of his emotional state. The functional state of the individual will be evaluated as a whole, taking into consideration the personality and his behavior, in addition to the degree of affectation of the instrumental and basic activities of daily life. The real implication of PHC in the detection and management of the cognitive problems is infrequent. In our setting, the exploration of the mental status is not a systematic practice, and that's why there is a nondespicable degree of subregister for this diagnosis.