Analysis of the Internal and External Morphology of the Mandibular First Molar in a Chilean Sub-Population Using Cone-Beam Computed Tomography / Análisis de la Morfología Interna y Externa del Primer Molar Mandibular en una Subpoblación Chilena Mediante Tomografía Computarizada de Haz Cónico

SUMMARY: The mandibular first molar (MFM) commonly presents two roots with two canals in the mesial root and one or two canals in the distal root. However, morphological variations have been described in different populations, which must be considered when planning endodontic treatment. The aim of this study was to analyze the internal and external morphology of the MFM in a Chilean sub-population using cone-beam computed tomography (CBCT) images. An in vivo cross-sectional, descriptive, and observational study was conducted using CBCT exams from 351 right and left MFM. The data were analyzed by descriptive statistics using the Chi- Square test for categorical variables, Fisher's exact test, the Mann-Whitney U non-parametric test for two independent samples, and the Wilcoxon non-parametric test for related samples. Of the total sample, 1 root was observed in 2.27 % of the cases, 2 roots in 93.73 %, and 3 roots in 4 %. In relation to the number of canals, 71.23 % of the MFM showed 3 root canals, 16.81 % 4 canals, 9.69 % 2 canals, and 2.28 % 1 canal. Of all the studied cases, 2.3 % had a C-shaped anatomy. In terms of morphology, using Zhang's classification, variant 3 was observed in 71.23 %, variant 4 in 12.82 %, variant 1 in 9.67 %, variant 6 in 4 %, and variant 8 in 2.28 %. In conclusion, the morphology of the MFM is variable in a Chilean sub-population, and these variations must be considered before and during endodontic therapy. CBCT proved to be an effective tool for the in vivo study of tooth morphology.

El primer molar mandibular (MFM) comúnmente presenta dos raíces con dos canales en la raíz mesial y uno o dos canales en la raíz distal. Sin embargo, se han descrito variaciones morfológicas en distintas poblaciones, las que se deben tener en consideración al momento de planificar el tratamiento endodóntico. El objetivo de este estudio fue analizar la morfología interna y externa del MFM en una sub población chilena mediante el uso de imágenes de tomografía computarizada Cone Beam (CBCT). Se realizó un estudio transversal, descriptivo y observacional in vivo empleando exámenes CBCT de 351 MFM tanto derechos como izquierdos. Los datos se analizaron mediante estadística descriptiva empleando la prueba Chi-Cuadrado para variables categóricas, el test exacto de Fisher, la prueba no paramétrica de U-Mann-Whitney para dos muestras independientes y la prueba no paramétrica de Wilcoxon para muestras relacionadas. Del total de la muestra se observó 1 raíz en un 2.27 % de los casos, 2 raíces en 93.73 % y 3 raíces en un 4 %. En relación al número de canales un 71.23 % de los MFM mostraron 3 canales radiculares, un 16.81 % 4 canales, un 9.69 % 2 canales y un 2.28 % 1 canal. Del total de los casos estudiados un 2.3 % se presentó anatomía en forma de C. En relación a la morfología, empleando la clasificación de Zhang, se observó en un 71.23 % la variante tipo 3, en un 12.82 % la variante tipo 4, en un 9.67 % la variante tipo 1, en un 4 % variante tipo 6 y en un 2,28 % variante tipo 8. En conclusión, la morfología del MFM es variable en una subpoblación chilena y estas variaciones deben ser consideradas antes y durante la terapia endodóntica. El CBCT demostró ser una herramienta eficaz para el estudio in vivo de la morfología dentaria.

Identificación molecular de microorganismos hemotrópicos transmitidos por vectores en caninos domésticos de diferentes centros veterinarios de Medellín, Colombia / Molecular identification of hemotropic microorganisms transmitted by vectors in domestic canines from different veterinary centers in Medellín, Colombia

RESUMEN Los patógenos transmitidos por vectores, comúnmente conocidos como hemoparásitos, son organismos hemotrópicos que varían desde nematodos, protozoos, virus y bacterias. El presente es un estudio retrospectivo de las bases de datos de 3.300 perros cuyo objetivo es evaluar la frecuencia mediante qPCR para 9 hemotrópicos en la ciudad de Medellín entre junio de 2021 y marzo de 2022 y la correlación de su presencia con las manifestaciones clínicas y hemoleucogramas de 20 perros positivos. Del total de perros testeados, el 60% fueron positivos para uno o más agentes. El número de animales infectados con uno, dos o tres agentes fue del 42,9% (1.416/3.300), 17,7% (583/3.300) y 1,3% (42/3.300), respectivamente. En orden de mayor a menor presencia de hemoparásitos, el número de perros positivos a un solo agente fue de: Anaplasma spp. (14,1%), Mycoplasma spp. (13,9%), Ehrlichia spp. (6,1%), Hepatozoon spp. (5,4%), Babesia spp. (1%), filarias (0,9%), y Bartonella spp. (0,6%). Las principales alteraciones clínico-patológicas en 9 de 20 perros positivos a algún hemoparásito y con signos clínicos inespecíficos (fiebre, anorexia, mialgia, letargo) fueron de anemia y/o trombocitopenia, con o sin un leucograma inflamatorio. No obstante, la ausencia de alteraciones clínico-patológicas en 11/20 animales positivos no descarta la presencia de infección, ya que los animales presentaban un hemograma normal. Estudios experimentales y de campo han mostrado que muchos perros positivos por serología y/o qPCR están clínicamente normales, y aunque no presentan una infección activa, sí pueden ser portadores asintomáticos de hemoparásitos. En este estudio se discuten los resultados y se comparan con otros realizados en Colombia para los principales hemoparásitos de perros.

ABSTRACT Vector-borne pathogens commonly known as "haemoparasites" are hemotropic organisms that range from nematodes, protozoa, viruses, and bacteria. This is a retrospective study of the databases of 3,300 dogs that aims to evaluate the frequency by qPCR for 9 hemotropics in the city of Medellín between June 2021 and March 2022, and the correlation of the presence of these agents with the Clinical manifestations and hemoleukograms of 20 positive dogs. Of the total dogs tested, 60% were positive to one or more agents. The number of animals infected with one, two, or three agents was 42.9% (1416/3,300), 17.7% (583/3,300), and 1.3% (42/3,300), respectively. In order from highest to lowest presence of haemoparasites, the number of dogs positive for a single agent was: Anaplasma spp. (14.1%), Mycoplasma spp. (13.9%), Ehrlichia spp. (6.1%), Hepatozoon spp. (5.4%), Babesia spp. (1%), filariae (0.9%), and Bartonella spp. (0.6%). The main clinicopathological alterations in 9 of 20 dogs positive for some haemoparasite and with nonspecific clinical signs (fever, anorexia, myalgia, lethargy) were anemia and/or thrombocytopenia, with or without an inflammatory leukogram. However, the absence of clinicopathological alterations in 11/20 positive animals does not rule out the presence of infection since the animals had a normal blood count. Experimental and field studies have shown that many dogs positive by serology and/or qPCR are clinically normal, and although they do not present an active infection, they may be asymptomatic carriers of haemoparasites. In this study the results are discussed and compared with others carried out in Colombia for the main haemoparasites of dogs.

Enfermedades transmitidas por vectores en gatos: una mirada molecular en ambientes urbanos de Medellín, Colombia / Vector-borne diseases in cats: a molecular look at urban environments in Medellin, Colombia

RESUMEN Los microorganismos hemotrópicos en felinos son agentes infecciosos que varían desde nematodos, protozoos y bacterias. El presente estudio retrospectivo tiene como objetivo evaluar la frecuencia de agentes hemotrópicos mediante qPCR de las bases de datos de 1.418 felinos en Medellín entre julio de 2021 y marzo de 2022, periodo en el que se evidencia una frecuencia del 70%, con un número de animales infectados con uno, dos o tres agentes del 56%, 14%, y 2,3%, respectivamente. La frecuencia para cada uno de los agentes es: Rickettsia spp. 0,21%, Babesia spp. 0,35%, Ehrlichia spp. 0,49%, Dirolifaria spp. 0,64%, Anaplasma spp 0,7%, Hepatozoon spp. 5,4%, Mycoplasma spp. 24,4% y Bartonella spp. 37,9%. Las coinfecciones evidenciadas de dos agentes hemotrópicos son: Bartonella spp. y Mycoplasma spp. 7,9%, Bartonella spp. y Hepatozoon spp. 2,1%, Mycoplasma spp. y Hepatozoon spp. 2% y Ehrlichia spp. y Anaplasma spp. 0,5%. De los 15 hemogramas de felinos infectados, 11 de ellos tienen hemogramas sin alteraciones significativas. Dos de los felinos positivos evidencian anemia moderada y severa y reticu-locitos de 0,9% y 0,4%, respectivamente. Solo un individuo positivo para Mycoplasma spp. presenta trombocitopenia y tres plaquetas en limites inferiores. Se concluye que la PCR es la prueba más confiable para el diagnóstico de agentes hemotrópicos.

ABSTRACT Hemotropic microorganisms in felines are infectious agents that vary from nematodes, protozoa, and bacteria. The objective of this retrospective study is to evaluate the frequency of hemotropic agents by means of qPCR from the databases of 1,418 felines in the city of Medellín between July 2021 and March 2022, where a frequency of 70% is evidenced, with several infected animals, with one, two, or three agents of 56%, 14%, and 2.3%, respectively. With a frequency for each of the agents of: Rickettsia spp. 0.21%, Babesia spp. 0.35%, Ehrlichia spp. 0.49%, Dirolifaria spp. 0.64%, Anaplasma spp. 0.7%, Hepatozoon spp. 5.4%, Mycoplasma spp. 24.4%, and Bartonella spp. 37.9% The evidenced coinfections of two hemotropic agents is: Bartonella spp. and Mycoplasma spp. 7.9%, Bartonella spp. and Hepatozoon spp. 2.1%, Mycoplasma spp. and Hepatozoon spp. 2% and Ehrlichia spp. and Anaplasma spp. 0.5%. Of the 15 blood counts from infected cats, 11 of them had blood counts without significant changes. Two of the positive cats show moderate and severe anemia, and reticulocytes of 0.9% and 0.4%, respectively. Only one individual positive for Mycoplasma spp. presented thrombocytopenia, and three platelets in lower limits. It is concluded that PCR is the most reliable test for the diagnosis of hemotropic agents.

Neumatocele traumático: una presentación inusual del trauma cerrado de tórax en paciente de 21 años / Traumatic pneumatocele: an unusual presentation of blunt chest trauma in a 21-year-old patient

El neumatocele traumático, o pseudoquiste pulmonar traumático, es una complicación infrecuente del trauma cerrado de tórax, caracterizada por lesiones cavitadas únicas o múltiples de paredes fibrosas bien delimitadas, sin revestimiento epitelial. Representa un reto diagnóstico ante la prevalencia de etiologías más frecuentes de cavitación pulmonar, presentación clínica inespecífica y el carácter subreportado de la patología. Se presenta el caso de un paciente de 21 años, con cuadro clínico de fiebre y dolor torácico posterior a traumatismo contuso por accidente en motocicleta, con identificación de una lesión cavitada rodeada de vidrio esmerilado, ubicada en lóbulo superior derecho en tomografía de tórax. Se ofreció tratamiento antibiótico ante la sospecha clínica de sobreinfección. Sin embargo, se atribuyó la alteración pseudoquística pulmonar al antecedente traumático. En ocasiones las cavitaciones pulmonares postrauma no son identificadas en la atención inicial, por ende, es fundamental la evaluación clínica e imagenológica subsecuente.

Traumatic pneumatocele, or traumatic pulmonary pseudocyst, is a rare complication of blunt chest trauma, characterized by multiple or unique cavitary lesions, with well-defined fibrous walls without epithelial lining. It represents a diagnostic challenge due to the higher prevalence of other etiologies of lung cavities, nonspecific clinical features and the under-reported nature of this pathology. We present the case of a 21-year-old male with fever and chest pain after a blunt chest trauma in a motorcycle accident, with identification of a cavity in the right upper lobe, surrounded by ground glass opacities. Antibiotic therapy was administered after clinical suspicion of superinfection, however, the cavitary lesion was attributed to the trauma. Occasionally, traumatic pulmonary pseudocysts are not identified during initial assessment, therefore, clinical and imagenologic follow-up is essential.

Características clínicas y epidemiológicas asociadas con internación en niños con COVID-19 en un hospital pediátrico de alta complejidad: Estudio de cohorte enero-marzo 2022 / Clinical and epidemiologic characteristics associated with hospital admission in children with COVID19 in a tertiary-care pediatric hospital: A January-March 2022 cohort study

Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)

Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)

Factores de riesgo de bacteriemia en niños con cáncer y neutropenia febril / Risk factors for bacteremia in children with cancer and febrile neutropenia

La bacteriemia representa una importante causa de morbimortalidad en pacientes oncológicos. Durante el episodio de neutropenia inducida por quimioterapia, un 15%­25% de los pacientes tendrá bacteriemia. Objetivo: identificar factores de riesgo asociados con bacteriemia en pacientes oncológicos pediátricos con neutropenia y fiebre. Material y métodos: estudio de cohorte prospectivo. Se incluyeron pacientes con enfermedades hematooncológicas y neutropenia febril, internados en un hospital pediátrico de alta complejidad entre julio de 2018 y mayo de 2019. Se excluyeron receptores de trasplante de médula ósea. Se compararon las características clínicas según se documentara bacteriemia (B) o no. Resultados: Se incluyeron 160 pacientes (p). Eran varones 93 (58%). La mediana de edad fue 81,5 meses (RIC 36-127,5). La enfermedad de base (EB) más frecuente fue: leucemia linfoblástica aguda (LLA) 88 (55%). Se identificaron 20 (12,5%) pacientes con bacteriemia (B). En el análisis univariado hubo asociación entre B y LMA (p=0,003) y la internación en UCI (p=0,0001). En el modelo multivariado, ajustado por el resto de las variables, se identificaron la LMA (OR 8,24, IC95% 2,5-26,4; p<0,001) y la tiflitis (OR 5,86, IC95% 1,2-27,3; p=0,02) como factores relacionados con bacteriemia. Los principales microorganismos identificados fueron: estreptococos del grupo viridans 6 (30%), Escherichia coli 4 (20%) y estafilococos coagulasa negativos 3 (15%). Quince (75%) fueron bacteriemias secundarias a un foco clínico. El foco más frecuente fue el mucocutáneo (n=7, 35%). En esta cohorte de niños con cáncer y neutropenia febril, los factores asociados con bacteriemia fueron: la LMA, la tiflitis y la internación en UCI (AU)

Bacteremia is an important cause of morbidity and mortality in oncology patients. During an episode of chemotherapy-induced neutropenia, 15%-25% of patients will develop bacteremia. Objective: to identify risk factors associated with bacteremia in pediatric oncology patients with neutropenia and fever. Material and methods: prospective cohort study. Patients with hematology-oncology diseases and febrile neutropenia, admitted to a tertiary-care pediatric hospital between July 2018 and May 2019 were included. Bone marrow transplant recipients were excluded. Clinical characteristics were compared according to whether or not bacteremia was recorded. Results: 160 patients were included of whom 93 (58%) were male. Median age was 81.5 months (IQR 36-127.5). The most common underlying disease was acute lymphoblastic leukemia (ALL) in 88 patients (55%). Twenty (12.5%) patients with bacteremia were identified. In univariate analysis, an association was found between bacteremia and acute myeloid leukemia (AML) (p=0.003) and ICU admission (p=0.0001). In the multivariate model, adjusted for the remaining variables, AML (OR 8.24; 95%CI 2.5-26.4; p<0.001) and typhlitis (OR 5.86; 95%CI 1.2-27.3; p=0.02) were identified as factors related to bacteremia. The main microorganisms identified were viridans group streptococci in 6 (30%), Escherichia coli in 4 (20%), and coagulase negative staphylococci in 3 (15%). In 15 cases (75%), bacteremia was secondary to a clinical focus. The most frequent focus was mucocutaneous (n=7, 35%). In this cohort of children with cancer and febrile neutropenia, the factors associated with bacteremia were AML, typhlitis, and ICU admission (AU)

Cefalea en la disección aórtica, a propósito de un caso clínico / Headache as a symptom in aortic dissection: about a clinical case / Cefaleia em dissecção de aorta, tema de caso clínico

Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.

We describe the case of a 70-year-old patient, who seeks medical advice due to sudden, thunder headache, without alteration of the state of consciousness, accompanied by chest pain of 1 hour of evolution and of low intensity. Upon his admission, the patient was treated as a thunderclap headache, which is considered a red flag. His troponin was negative, and his head tomography was interpreted as normal. From admission he had normal vital signs, but when he was going to be discharged, he became hypotensive (completely asymptomatic) and due to his cardinal symptom (headache) that was asso-ciated with mild non-anginal chest pain, a thoracoabdominal angioCT was requested, with which dissecting aneurysm of the aorta was evidenced. With the presentation of this case, we seek to highlight the importance of the association of thunder-type headache with possible vascular conditions such as aortic dissection in the emergency department.

Descrevemos o caso de uma paciente de 70 anos que consultou por quadro de cefaleia súbita, tipo trovão, sem alteração do estado de consciência, acompanhada de dor torácica de uma hora de evolução e de baixa intensidade. Na admissão, foi tratado como cefaleia em trovoada, que é classificada, em termos de atenção, como bandeira vermelha. A me-dição da troponina foi negativa e uma tomografia de crânio foi lida como normal. Desde a admissão apresentava sinais vitais normais, quando ia receber alta ficou hipotenso (totalmente assintomático) e devido ao seu sintoma cardinal (cefaleia), que se associou a dores torácicas ligeiras e não anginosas, foi solicitada angiografia toracoabdominal, com cujo aneurisma dissecante da aorta foi demonstrado. Com a apresentação deste caso, o objetivo é destacar a importância no pronto-socorro da associação da cefaleia do tipo trovão com afecções vasculares como a dissecção da aorta.

Características clínicas y evolutivas de niños con infección por SARS-CoV-2 en un hospital de alta complejidad: estudio de cohorte / Clinical and outcome characteristics of children with SARS CoV-2 infection in a tertiary-care hospital: a cohort study

Introducción: Las infecciones por SARS-CoV-2 representan un problema de salud pública a nivel mundial. En los niños se reporta menor incidencia y cuadros clínicos más leves. Se realizó el presente estudio con el objetivo de describir las características clínicas y evolutivas de los niños con diagnóstico de infección por SARS CoV-2 en el Hospital Juan P. Garrahan. Material y métodos: estudio de cohorte prospectivo. Se incluyeron todos los pacientes con diagnóstico confirmado por PCR de COVID-19 desde 20.4.20 hasta el 3.07.21 y con seguimiento en el hospital de Pediatría Juan P. Garrahan. Resultados: n: 1644. Eran varones 836 (51%). La mediana de edad fue 75 meses (RIC 22- 143). Tenían alguna enfermedad de base previa al diagnóstico de COVID-19: 884 pacientes (53,7%), la más frecuente fue la enfermedad oncohematológica. Estaban asintomáticos 423 pacientes (25,7%). De los pacientes sintomáticos, 1071 (65,1%) presentaron cuadro leve, 5 (0,3%) moderado, 69 (4,2%) grave y 76 (4,6%) crítico. La fiebre fue el hallazgo más frecuente n: 782; (47,5%). Se internaron 900 pacientes (54,7%), 33 en UCI (2%). Fallecieron 7 pacientes (0,4%), todos ellos con comorbilidades graves. Conclusiones: En este estudio de cohorte de niños con infección por SARS-CoV-2 confirmada, predominaron los pacientes con enfermedad de base y las formas leves de COVID-19. El ingreso a UCI fue menor al 2%. Fallecieron 7 pacientes (0.4%) todos ellos con comorbilidades y coinfecciones (AU)

Introduction: SARS-CoV-2 infections represent a worldwide public health problem. A lower incidence and milder clinical pictures are reported in children. The aim of this study was to describe clinical and outcome characteristics of children diagnosed with SARS-CoV-2 infection at Hospital de Pediatría Juan P. Garrahan. Methods: A prospective cohort study was conducted. All patients with a PCR-confirmed diagnosis of COVID-19 seen between 20.4.20 and 3.07.21 and followed-up at Hospital de Pediatría Juan P. Garrahan were included. Results: n: 1644; 836 males (51%) were male. Median age was 75 months (IQR, 22-143). Overall, 884 patients (53.7%) had an underlying disease prior to COVID-19 diagnosis, most frequently hematologic/ oncologic disease. 423 patients (25.7%) were asymptomatic. Of the symptomatic patients, 1071 (65.1%) had mild, 5 (0.3%) moderate, 69 (4.2%) severe, and 76 (4.6%) critical disease. Fever was the most frequent finding (n: 782; 47.5%). A total of 900 patients (54.7%) were admitted, 33 of whom to the ICU (2%). Seven patients (0.4%) died, all with severe comorbidities. Conclusions: In this cohort study of children with confirmed SARSCoV-2 infection, patients with underlying disease and mild forms of COVID-19 predominated. ICU admission occurred in less than 2%. Seven patients (0.4%) died, all of them with comorbidities and coinfections. (AU)

Síndrome inflamatorio multisistémico pediátrico (SIMS) asociado con el SARS-CoV-2: Un estudio de cohorte retrospectivo / SARS-CoV-2-associated pediatric multisystemic inflammatory syndrome: A retrospective cohort study

Introduccion: El Síndrome inflamatorio multisistémico pediátrico (SIMS) asociado con el SARS-CoV-2 es una enfermedad aguda acompañada de un síndrome hiperinflamatorio, con falla multiorgánica y shock, asociada a la infección por SARS CoV2, que produce alta morbilidad en la población pediátrica, que hasta el momento es la afectada por este síndrome. Objetivo: Evaluar las características diferenciales del síndrome multisistémico inflamatorio asociado al SARS-COV-2 (SIMS) en niños. Métodos: se realizó un estudio de cohorte retrospectivo. La definición de SIMS se basó en los criterios de la OMS. Los pacientes con COVID-19 relacionados temporalmente se incluyeron como controles. Resultados: se incluyeron 25 pacientes con SIMS y 75 controles. El modelo de regresión logística múltiple de las variables que mostraron ser significativas en el análisis univariado reveló que la edad ≥ 2 años (OR 24,7; IC del 95%: 1,03 -592,4; P = 0,048), la linfopenia (OR 9,03; IC del 95%: 2,05-39,7; P = 0,004), y el recuento de plaquetas <150x109 / L (OR 11,7; IC del 95%: 1,88-75,22; P = 0,009) se asociaron significativamente con SIMS. La presencia de una enfermedad subyacente pareció reducir el riesgo de SIMS (OR 0,06; IC del 95%: 0,01-0,3). Conclusión: El SIMS fue más común en pacientes mayores de 2 años y en aquellos con linfopenia o trombocitopenia. La enfermedad subyacente parece reducir el riesgo del mismo. (AU)

Introduction: SARS-CoV-2-associated pediatric multisystemic inflammatory syndrome (PMIS) is an acute disease accompanied by a hyperinflammatory syndrome, with multiorgan failure and shock associated with SARS CoV2 infection, producing high morbidity in the pediatric population, which so far is affected by this syndrome. Objective: To evaluate the differential characteristics of SARS-COV-2-associated PMIS in children. Methods: A retrospective cohort study was conducted. The definition of PMIS was based on WHO criteria. Patients with temporally related COVID-19 were included as controls. Results: 25 patients with PMIS and 75 controls were included. A multiple logistic regression model of the variables shown to be significant in univariate analysis revealed that age ≥ 2 years (OR 24.7; 95% CI: 1.03 -592.4; P = 0.048), lymphopenia (OR 9.03; 95% CI 2.05-39.7; P = 0.004), and platelet count < 150x109/L (OR 11.7; 95% CI: 1.88-75.22; P = 0.009) were significantly associated with PMIS. The presence of an underlying disease appeared to reduce the risk of PMIS (OR 0.06; 95% CI: 0.01-0.3). Conclusion: PMIS was more common in patients older than 2 years and in those with lymphopenia or thrombocytopenia. Underlying disease appears to reduce the risk of SMIS.(AU)

Dexamethasone-induced intrauterine growth restriction modulates expression of placental vascular growth factors and fetal and placental growth.

Prenatal exposure to glucocorticoids (GC) is a central topic of interest in medicine since GCs are essential for the maturation of fetal organs and intrauterine growth. Synthetic glucocorticoids, which are used in obstetric practice, exert beneficial effects on the fetus, but have also been reported to lead to intrauterine growth retardation (IUGR). In this study, a model of growth restriction in mice was established through maternal administration of dexamethasone during late gestation. We hypothesised that GC overexposure may adversely affect placental angiogenesis and fetal and placental growth. Female BALB/c mice were randomly assigned to control or dexamethasone treatment, either left to give birth or euthanised on days 15, 16, 17 and 18 of gestation followed by collection of maternal and fetal tissue. The IUGR rate increased to 100% in the dexamethasone group (8 mg/kg body weight on gestational days 14 and 15) and pups had clinical features of symmetrical IUGR at birth. Dexamethasone administration significantly decreased maternal body weight gain and serum corticosterone levels. Moreover, prenatal dexamethasone treatment not only induced fetal growth retardation but also decreased placental weight. In IUGR placentas, VEGFA protein levels and mRNA expression of VEGF receptors were reduced and NOS activity was lower. Maternal dexamethasone administration also reduced placental expression of the GC receptor, αGR. We demonstrated that maternal dexamethasone administration causes fetal and placental growth restriction. Furthermore, we propose that the growth retardation induced by prenatal GC overexposure may be caused, at least partially, by an altered placental angiogenic profile.

Cytosolic and Metallothionein-Bound Hepatic Metals and Detoxification in a Sentinel Teleost, Dules auriga, from Southern Rio de Janeiro, Brazil.

Dules auriga, a native Brazilian teleost, was applied as a sentinel species regarding metal contamination at Ilha Grande Bay, previously considered a reference site in Southeastern Brazil. Cytosolic (S50) and metallothionein-bound (HTS50) hepatic iron (Fe), zinc (Zn), copper (Cu), manganese (Mn), cadmium (Cd), and silver (Ag) were determined by inductively coupled plasma optical emission spectrometry (ICP-OES), while metallothionein (MT) concentrations were determined by polarography. Ag concentrations in both cytosolic fractions were below the limit of detection. All other HTS50 metal contents were significantly lower than S50 contents. No significant associations were found for MT. Fe and Mn S50 were positively and moderately correlated to total length, as well as HTS50 Mn, while total weight was correlated to both Mn fractions, suggesting that environmental Mn and Fe concentrations may influence fish growth. A moderate correlation between the condition factor and the S50 Cu fraction was observed, also indicating that Cu may affect fish growth. Inter-element correlations were observed, including between Cd, a toxic element, and Mn and Zn, both essential elements. Calculated molar ratios indicate that both Mn and Zn are in molar excesses compared with Cd, corroborating literature assessments regarding protective Mn and Zn effects against Cd. Lack of MT correlations suggests that metal concentrations may not be high enough to reach an MT induction threshold and that MT variability is probably linked to environmental metal concentrations. Therefore, the increased environmental contaminant levels observed in the study area indicate the need for biomonitoring efforts aiming at the application of efficient mitigation measures.

Hypervirulent and hypermucoviscous extended-spectrum ß-lactamase-producing Klebsiella pneumoniae and Klebsiella variicola in Chile.

Convergence of virulence and antibiotic-resistance has been reported in Klebsiella pneumoniae, but not in Klebsiella variicola. We, hereby, report the detection and genomic characterization of hypervirulent and hypermucoviscous K. pneumoniae and K.variicola recovered in Chile from health-care associated infections, which displayed resistance to broad-spectrum cephalosporins. One hundred forty-six K. pneumoniae complex isolates were screened by hypermucoviscosity by the "string test." Two hypermucoid isolates, one hypermucoviscous K. pneumoniae (hmKp) and one K. variicola (hmKv), were further investigated by whole-genome sequencing. In vivo virulence was analyzed by the Galleria mellonella killing assay. In silico analysis of hmKp UCO-494 and hmKv UCO-495 revealed the presence of multiple antibiotic-resistance genes, such as blaCTX-M-1, blaDHA-1 and blaLEN-25 among others clinically relevant resistance determinants, including mutations in a two-component regulatory system related to colistin resistance. These genetic features confer a multidrug-resistant (MDR) phenotype in both strains. Moreover, virulome in silico analysis confirmed the presence of the aerobactin gene iutA, in addition to yersiniabactin and/or colicin V encoding genes, which are normally associated to high virulence in humans. Furthermore, both isolates were able to kill G. mellonella and displayed higher virulence in comparison with the control strain. In summary, the convergence of virulence and the MDR-phenotype in K. pneumoniae complex members is reported for the first time in Chile, denoting a clinical problem that deserves special attention and continuous surveillance in South America.

Relationship between unintentional canal overfilling and the long-term outcome of primary root canal treatments and nonsurgical retreatments: a retrospective radiographic assessment.

AIM: To determine retrospectively the long-term radiographic outcome of root canal treatments and root canal retreatments with unintentional root canal overfilling. METHODOLOGY: A total of 220 root canal treatments (143 primary/77 retreatments) with postoperative unintentional canal overfilling and performed by two endodontists during their 45 years of private practice were included in the study. Lateral condensation techniques and nine different sealers were used. Overfilling was confirmed with a postoperative periapical radiograph and patients were scheduled regularly for recall visits. Average recall time was 4.86 years (maximum = 30 years). Two calibrated observers evaluated the radiographs and determined the long-term outcome using the PAI score pooled in a 3-category scale. The persistence or resorption of the extruded material was registered. The Kappa coefficient (K) was calculated and a logistic regression was used for further analysis. Odds ratios and their 95% CI were estimated. RESULTS: The level of inter-observer agreement was 66.1%. Primary root canal treatments had a significantly (P = 0.015) greater rate of success (91.6%) than retreatments (81.8%). Tooth location (P = 0.019) was the only other factor that significantly affected the outcome. The type of extruded material, and its resorption or persistence did not relate to the outcome. Persistence of extruded material was significantly affected by tooth location and recall time after treatment. CONCLUSION: The outcome of root canal treatment with unintentional canal overfilling was not associated with the type of extruded material or its resorption or persistence. The persistence of extruded material did not relate to a favourable or unfavourable outcome.

Location and course of the mandibular canal in dentate patients: morphometric study using cone-beam computed tomography.

BACKGROUND: The morphometric characteristics of the mandibular canal (MC) may vary according to the characteristics of the population studied. Correct location of the MC is fundamental for the indication and planning of different dental treatments, and it is therefore essential to have clinical parameters indicating its approximate location. The aim of this study was to describe the location and course of the MC by morphometric relations in the mandibular body, from the mental foramen to distal of the first molar, in dentate adult patients. MATERIALS AND METHODS: We analysed 55 cone-beam computed tomography (CBCT) of male and female patients, aged over 18 years and with fully dentate to the first molar. In each CBCT we selected five coronal sections (A-E) of the mandibular body at different levels using the teeth as references. We determined different morphometric measurements in each section to relate the MC with the corticals of the mandibular body (m1, m2, m3, m4), their orientation to lingual (F) and the thickness of the mandibular corticals (B1, B2 and B3). RESULTS: The distance between the MC and the alveolar crests was greater in males than in females in all the sections. In general, in all the hemiarches, the MC courses away from the vestibular cortical of the mandible (and in some cases significantly towards the lingual cortical) from anterior to posterior in the mandibular body. In the left hemiarch of dentate females the MC describes a descent in the molar zone within the mandibular body. Any intervention in the mandible must be carried out with extreme caution to avoid damaging the vasculo-nervous bundle which passes through the MC. CONCLUSIONS: Cone-beam computed tomography is the best tool currently available for the planning and execution of surgical procedures, and is the only tool in clinical use which allows the precise course of the MC to be identified.

Hepatic Metal and Metallothionein Levels in a Potential Sentinel Teleost, Dulesauriga, from a Southeastern Brazilian Estuary.

The identification of estuarine sentinel species is of paramount importance. The potential of the species Dules auriga sampled from Guanabara Bay, Brazil regarding metal contamination was assessed. Hepatic metallothionein (MT) and Fe, Zn, Cu, Mn, Cd and Ag concentrations were determined in cytosolic fractions (S50 and HT S50) by polarography and ICP-OES, respectively. HT S50 Fe, Mn and Zn were lower than in the S50 fraction, indicating MT-detoxification. MT was correlated to HT S50 Zn, indicating Zn homeostasis. Zn was negatively correlated to weight (TW) and length (TL), suggesting environmental Zn influence. A moderate negative correlation between HT S50 Cu and the condition factor (CF) was observed, indicating that increasing environmental Cu concentrations may decrease D. auriga CF. Several inter-elemental correlations were observed. No MT, TW and TL correlations were found. Thus, MT variability is probably linked to environmental metal concentrations. D. auriga fulfills most sentinel requisites, and MT may be an adequate metal contamination biomarker in this species.

Morphological variations of the mandibular canal in digital panoramic radiographs: a retrospective study in a Chilean population.

BACKGROUND: Morphological variations of the mandibular canal (MC) have been described in literature, so the clinician must be able to recognise them and adapt their treatment accordingly. The aim of this study was to determine the prevalence of morphological variations of the MC using digital panoramic radiographs (DPR) of Chilean patients. MATERIALS AND METHODS: A retrospective study in which 1400 DPR were analysed to identify cases of bifid, trifid and retromolar MC. The radiographs were analysed independently by two examiners who had previously been trained by a specialist in oral and maxillofacial radiology. Inclusion and exclusion criteria were applied to reach a final sample. RESULTS: Nine hundred and twenty-five radiographs were included (599 female, 326 male; mean age 36.1 ± 15.54 years). The prevalence of bifid MC was 11% (n = 102), with no significant differences by sex (p = 0.069). Proportion of bifid MC was higher among younger patients (p = 0.038). Prevalence of morphologi- cal variations of type 1 bifid MC was 7.4% (n = 69), type 2 was 2.3% (n = 23), type 3 was 0% (n = 0) and type 4 was 1.1% (n = 10). Prevalence of retromolar canal was 0.9% (n = 8), with no significant differences by sex (p = 0.893) or age (p = 0.371); of these, 2 (0.2%) cases were forward type and 6 (0.6%) cases were retromolar type. No cases of trifid MC were found. CONCLUSIONS: Digital panoramic radiographs are useful for detecting morphological variations of the MC; we were able to identify three types of bifid MC as well as retromolar canals. Proper identification of these variations by an easily accessible examination is important for avoiding possible complications in clinical-surgical practice.

La oferta de atención al servicio de guardia del hospital escuela de salud mental en Paraná / The offer of attention to the guard service of the hospital mental health school in Paraná

INTRODUCCIÓN Aún no se han analizado en profundidad las representaciones sociales y significados personales que caracterizan la oferta de atención hospitalaria en salud mental en Paraná. OBJETIVOS Describir el Servicio de Guardia del Hospital Escuela de Salud Mental de la ciudad de Paraná durante el período 2015-2016 y analizar sus modalidades de atención tradicional, médica e interdisciplinaria, a partir de indicadores que permitan saber qué condiciones inciden en la atención de la urgencia subjetiva. MÉTODOS Se realizó un estudio descriptivo y analítico. Se desarrolló una estructura compleja, con una dialéctica metodológica cuali-cuantitativa mediante una triangulación de ambos abordajes. Se contempló el análisis de documentos, encuestas a usuarios y entrevistas semiestructuradas a trabajadores, personal administrativo, autoridades institucionales, asesores legales y directores provinciales vinculados al servicio, realizadas luego de una selección aleatoria. RESULTADOS La oferta de atención ha mejorado la calidad en su modalidad interdisciplinaria logró disminuir el uso de psicofármacos e internaciones, posibilitó un diagnóstico situacional complejo, acotó los tiempos de espera, amplió la red de contención del usuario, permitió atravesar las crisis en los contextos cotidianos y flexibilizó las estrategias de acceso en el vínculo servicio-trabajador-usuario. DISCUSIÓN Estos hallazgos constituyen una referencia institucional y regional, y se consideran insumos para la reflexión de los actores involucrados y la evaluación del funcionamiento y rendimiento de esta oferta sanitaria. Cabe esperar que incidan en las estrategias políticas de gestión para que continúe la progresiva transformación del sistema de salud, ampliando la modalidad interdisciplinaria de atención de la urgencia en salud mental en el territorio provincial, acorde a las necesidades de los usuarios.

Bacteriemia por Pseudomonas aeruginosa (PAE) en niños / Pseudomonas aeruginosa-associated bacteremia en children

Introducción. La bacteriemia por Pseudomonas aeruginosa (PAE) en niños es infrecuente. Objetivo.Describir las características epidemiológicas, clínicas, microbiológicas y evolutivas en niños con bacteriemia por PAE. Métodos. Estudio de cohorte retrospectivo. Resultados. Se incluyeron 100 pacientes (p). La mediana de edad fue de 27 meses (RIC 6-88).Tenían enfermedad de base: 93 p (93%) y 36 de ellos estaban neutropénicos. Ochenta y cinco p (85%) habían recibido antibióticos en el último mes, 60 (60%) tuvieron procedimientos invasivos previos y 81 (81%) tuvieron internaciones previas. Ingresaron con shock séptico 42 p (42%), 56 p (56%) fueron admitidos en unidad de cuidados intensivos (UCI) y 49 (49%) requirieron ventilación mecánica (VM). La bacteriemia fue primaria en 17 p (17%); asociada a catéter en 15 p (15%) y secundaria en 68 p (68%). El foco más frecuente fue mucocutáneo, 21 p, seguido por el pulmonar, 20 p. El tratamiento empírico fue adecuado en 84 p (84%). La resistencia a uno o más grupos de antibióticos se dio en el 38% de los casos, 11% fueron multirresistentes y 15% fueron resistentes sólo a carbapenemes. Fallecieron 31 p (31%). Pseudomonas aeruginosa resistente a carbapenemes en forma exclusiva o combinada con otros antibióticos se relacionó en esta serie a exposición previa a antibióticos, (p≤0,03), tratamiento empírico inicial inadecuado (p≤0,006) y mayor mortalidad (p≤0,01), prolongación de la internación y del tiempo de tratamiento (p≤0,001)

Introduction. Pseudomonas aeruginosa (PAE) associated bacteremia is uncommon in children. Objective. To describe the epidemiological, clinical, and microbiological features and outcome in children with PAE-associated bacteremia. Methods. A retrospective cohort study. Results. 100 patients (p) were included. Median age was 27 months (IQR 6-88). Overall 93 p (93%) had an underlying disease, 36 of whom had neutropenia. Eighty-five p (85%) had received antibiotics over the previous month, 60 (60%) had undergone previous invasive procedures, and 81 (81%) had been previously admitted. Forty-two p (42%) were admitted because of septic shock, 56 p (56%) were admitted to the intensive care unit (ICU), and 49 (49%) required mechanical ventilation (MV). Seventeen p (17%) had primary bacteremia, 15 p (15%) had catheter-related bacteremia, and 68 p (68%) had secondary bacteremia. The most common focus was mucocutaneous (21 p), followed by pulmonary (20 p). Emperical treatment was adequate in 84 p (84%). Resistance to one or more groups of antibiotics was observed in 38% of the cases; 11% were multiresistant and 15% were only resistant to carbapenems. Thirty-one p (31%) died. In our series, Pseudomonas aeruginosa resistant to carbapenems only or combined with other antibiotics was associated with previous exposition to antibiotics (p≤0.03), inadequate initial emperical treatment (p≤0.006), and higher mortality (p≤0.01), and longer hospital stay and treatment duration (p≤0.001)

[Review of cases of zoophilia in patients with Parkinson's disease]. / Revision de casos de zoofilia en pacientes con enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease (PD) is characterized by motor symptoms such as bradykinesia, rigidity, alteration of postural reflexes and tremor at rest and other non-motor symptoms such as changes in sleep patterns and sexual behavior. However, little is known about paraphilic sexual behaviors. AIM: To summarize the number of cases of zoophilic behaviors in patients with PD between January 2000 and December 2017. DEVELOPMENT: A review was carried out in PubMed, Scopus and Virtual Health Library. Eleven articles were identified by title; six were excluded because they did not present cases related to zoophilic behavior. We found five cases of men, usually with PD of several years of course, taking dopamine agonists and who presented the zoophilic behaviors followed increasing of the dose. The zoophilic behaviors decreased with reducing doses of dopamine agonists and taking atypical antipsychotic such as clozapine or quetiapine. CONCLUSIONS: It is limited the case reports of zoophilic behaviors in patients with PD. The patients reported are men in whom the dose of dopamine agonists was increased. It is important that the clinical follow-up of patients with PD disease includes a careful review of sexual behaviors including those of the paraphilic spectrum.

TITLE: Revision de casos de zoofilia en pacientes con enfermedad de Parkinson.Introduccion. La enfermedad de Parkinson (EP) se caracteriza por sintomas motores, como bradicinesia, rigidez, alteracion de reflejos posturales y temblor en reposo, y otros sintomas no motores, como cambios en el patron de sueño y el comportamiento sexual. Sin embargo, se conoce poco sobre los comportamientos sexuales parafilicos. Objetivo. Resumir el numero de casos de comportamientos zoofilicos en pacientes con EP entre enero de 2000 y diciembre de 2017. Desarrollo. Se realizo una revision en PubMed, Scopus y la Biblioteca Virtual en Salud. Se identificaron por el titulo 11 articulos; se excluyeron seis porque no presentaban casos relacionados con un comportamiento zoofilico. Se encontraron cinco casos de hombres, generalmente con EP de varios años de curso, polimedicados con agonistas dopaminergicos, quienes presentaron los comportamientos parafilicos despues del incremento de la dosis. Los comportamientos zoofilicos cedieron con la reduccion de la dosis de los agonistas dopaminergicos y antipsicoticos atipicos, como clozapina o quetiapina. Conclusiones. Es limitada la notificacion de casos de comportamientos zoofilicos en pacientes con EP. Los pacientes notificados son hombres en quienes se incremento la dosis de agonistas dopaminergicos. Es importante que el seguimiento clinico de los pacientes con EP incluya una revision de los comportamientos sexuales, incluidos los del espectro parafilico.