Analyzing the relationship between individual and cumulative score of adverse childhood experiences (ACEs) with self-reported mental health disorders in Chile.

BACKGROUND: Adverse Childhood Experiences (ACEs) are widely recognized as significant predictors of poor mental health in adulthood. Latin America presents several unique challenges regarding ACEs, such as higher prevalence of violence and income and political inequality. However, little is known about this issue from nationally representative samples in the region, particularly in Chile. OBJECTIVE: This investigation examines the association between individual and cumulative ACE scores and seven self-reported mental health conditions (substance abuse, depression, PTSD, generalized anxiety, suicide ideation, non-suicidal self-harm, and learning disorders) in a representative Chilean urban sample. METHODS: A representative urban sample of 2101 adult Chileans completed the International Adverse Childhood Experiences Questionnaire (ACE-IQ) and disclosed any prior mental health diagnoses. RESULTS: Around 40 % of the sample had experienced four or more ACEs in their lifetime. For these individuals, the risk of reporting a mental health disorder was significantly higher. Several logistic regression analyses were conducted to address the associations between ACEs and the seven mental health conditions. Notably, sexual abuse, bullying, and exposure to collective violence were the ACEs most strongly associated with self-reported mental health issues. Additionally, a cumulative ACE score was found to be a significant predictor of having a previous mental health diagnosis. CONCLUSIONS: We found a significant predictive association between exposure to collective violence and six out of the seven self-reported mental health disorders. Similarly, sexual abuse demonstrated an association with all mental health conditions. Finally, individuals who experienced four or more ACEs had a notably higher chance of reporting a previous mental health diagnosis. We recommend conducting further ACE research in Latin America due to its cultural and contextual singularities.

Are Medium Cut-off Membranes the Future, or the Promising Reality for Chronic Hemodialysis Patients?

ABSTRACT The development of hemodialysis (HD) membranes has substantially advanced in the last decade. This has resulted in the manufacturing of medium cut-off membranes (MCO) whose internal architecture is based on greater pore size and a smaller diameter, thus promoting the clearance of particles of greater size as well as retrofiltration. Multiple studies have proven their efficacy in the clearance of uremic mid-sized molecules such as β2-microglobulin, free light chains, and some interleukins; this clearance is far superior with MCO membranes when compared with high-flux HD, and similar to that obtained with online hemodiafiltration. This review summarizes the results of the most relevant clinical studies of this membrane in terms of uremic toxin clearance, as well as the features of some clinical outcomes such as quality of life and hospitalizations.

Are medium cut-off membranes the future, or the promising reality for chronic hemodialysis patients?

The development of hemodialysis (HD) membranes has substantially advanced in the last decade. This has resulted in the manufacturing of medium cut-off membranes (MCO) whose internal architecture is based on greater pore size and a smaller diameter, thus promoting the clearance of particles of greater size as well as retrofiltration. Multiple studies have proven their efficacy in the clearance of uremic mid-sized molecules such as ß2-microglobulin, free light chains, and some interleukins; this clearance is far superior with MCO membranes when compared with high-flux HD, and similar to that obtained with online hemodiafiltration. This review summarizes the results of the most relevant clinical studies of this membrane in terms of uremic toxin clearance, as well as the features of some clinical outcomes such as quality of life and hospitalizations.

Aprendizaje automático aplicado a la predicción de diabetes mellitus, utilizando información socioeconómica y ambiental de usuarios del sistema de salud

Objetivo: Se propuso aplicar modelos basados en técnicas de aprendizaje automático como apoyo para el diagnóstico temprano de la diabetes mellitus, utilizando variables de datos ambientales, sociales, económicos y sanitarios, sin la dependencia de la toma de muestras clínicas. Metodología: Se utilizaron datos de 10 889 usuarios afiliados al régimen subsidiado de salud de la zona suroccidental en Colombia, diagnosticados con hipertensión y agrupados en usuarios sin (74,3 %) y con (25,7 %) diabetes mellitus. Se entrenaron modelos supervisados utilizando k vecinos más cercanos, árboles de decisión y bosques aleatorios, así como modelos basados en ensambles, aplicados a la base de datos antes y después de balancear el número de casos en cada grupo de diagnóstico. Se evalúo el rendimiento de los algoritmos mediante la división de la base de datos en datos de entreno y de prueba (70/30, respectivamente), y se utilizaron métricas de exactitud, sensibilidad, especificidad y área bajo la curva. Resultados: Los valores de sensibilidad aumentaron considerablemente al utilizar datos balanceados, pasando de valores máximos del 17,1 % (datos sin balancear) a valores de hasta 57,4 % (datos balanceados). El valor más alto de área bajo la curva (0,61) fue obtenido con los modelos de ensambles, al aplicar un balance en el número de datos por cada grupo y al codificar las variables categóricas. Las variables de mayor peso estuvieron asociadas con aspectos hereditarios (24,65 %) y con el grupo étnico (5.59 %), además de la dificultad visual, el bajo consumo de agua, una dieta baja en frutas y verduras, y el consumo de sal y azúcar. Conclusiones: Aunque los modelos predictivos, utilizando información socioeconómica y ambiental de las personas, surgen como una herramienta para el diagnóstico temprano de la diabetes mellitus, estos aún deben ser mejorados en su capacidad predictiva.

Objective: The objective was to apply models based on machine learning techniques to support the early diagnosis of diabetes mellitus, using environmental, social, economic and health data variables, without dependence on clinical sample collection. Methodology: Data from 10,889 users affiliated with the subsidized health system in the southwestern area of Colombia, diagnosed with hypertension and grouped into users without (74.3%) and with (25.7%) diabetes mellitus, were used. Supervised models were trained using k-nearest neighbors, decision trees, and random forests, as well as ensemble-based models, applied to the database before and after balancing the number of cases in each diagnostic group. The performance of the algorithms was evaluated by dividing the database into training and test data (70/30, respectively), and metrics of accuracy, sensitivity, specificity, and area under the curve were used. Results: Sensitivity values increased significantly when using balanced data, going from maximum values of 17.1% (unbalanced data) to values as high as 57.4% (balanced data). The highest value of area under the curve (0.61) was obtained with the ensemble models, by applying a balance in the amount of data for each group and by coding the categorical variables. The variables with the greatest weight were associated with hereditary aspects (24.65%) and with the ethnic group (5.59%), in addition to visual difficulty, low water consumption, a diet low in fruits and vegetables, and the consumption of salt and sugar. Conclusions: Although predictive models, using people's socioeconomic and environmental information, emerge as a tool for the early diagnosis of diabetes mellitus, their predictive capacity still needs to be improved.

Objetivo: Propôs-se aplicar modelos baseados em técnicas de aprendizagem automática como apoio para o diagnóstico precoce da diabetes mellitus, utilizando variáveis de dados ambientais, sociais, econômicos e sanitários, sem a dependência da coleta de amostras clínicas. Metodologia: Usaram-se dados de 10.889 usuários filiados ao regime subsidiado de saúde da zona sudoeste da Colômbia, diagnosticados com hipertensão e agrupados em usuários sem (74,3%) e com (25,7%) diabetes mellitus. Foram treinados modelos supervisionados utilizando k vizinhos mais próximos, árvores de decisão e florestas aleatórias, assim como modelos baseados em montagens, aplicados à base de dados antes de depois de equilibrar o número de casos em cada grupo de diagnóstico. Avaliou-se o desempenho dos algoritmos por meio da divisão da base de dados de treino e teste (70/30, respectivamente), e utilizaram-se métricas de exatidão, sensibilidade, especificidade e área sob a curva. Resultados: Os valores de sensibilidade aumentaram de maneira significativa ao utilizar dados equilibrados, passando de valores máximos de 17,1% (dados sem equilibrar) a valores de até 57,4% (dados equilibrados). O valor mais elevado de área sob a curva (0,61) foi obtido com os modelos de montagens, ao aplicar um balanço no número de dados por cada grupo e codificar as variáveis categóricas. As variáveis de maior peso estiveram associadas com fatores hereditários (24,65%) e com o grupo étnico (5,59%), além da dificuldade visual, o baixo consumo de água, um regime baixo em frutas e vegetais e o consumo de sal e açúcar. Conclusões: Embora os modelos preditivos, utilizando informação socioeconômica e ambiental das pessoas, surgem como uma ferramenta para o diagnóstico precoce da diabetes mellitus, ainda devem ser melhorados em sua capacidade preditiva.

Nefrectomía laparoscópica pediátrica en Honduras: Informe de los primeros 25 casos / Pediatric laparoscopic nephrectomy in Honduras: Report of the First 25 cases

Antecedentes: La primera nefrectomía laparoscópica en pediatría fue realizada por el Dr. Martin Koyle en un niño de 8 meses con displasia renal multiquística. En la actualidad este procedimiento es aceptado como estándar de oro para realizar cualquier nefrectomía en patología renal benigna en adultos o niños, ya que permite una mejor exposición anatómica y mejor control vascular con una estancia más corta, menor uso de analgésicos y mejor resultado estético. Descripción de los casos clínicos: se presenta una serie de casos de nefrectomía laparoscópica comprendidas desde agosto 2001 a agosto de 2019 realizadas en el Hospital de Especialidades del Instituto Hondureño del Seguro Social localizado en el Barrio La Granja de Tegucigalpa, incluyendo en forma consecutiva todos los pacientes que ameritaron una nefrectomía programada en riñón no funcional por patología renal benigna. Durante ese período se diagnosticaron 12 displasias renales, 9 hidronefrosis obstructivas, 2 nefropatías por reflujo y 2 riñones ectópicos, de los cuales 23 fueron diagnósticos prenatales y 2 posnatales, una infección urinaria y una hipertensión. Se realizó un total de 25 nefrectomías laparoscópicas de forma segura y exitosa sin ninguna conversión a cirugía abierta ni morbilidades. Todos los pacientes iniciaron la vía oral a las 6 horas postoperatorias y fueron dados de alta antes de completar las 24 horas intrahospitalarias. Conclusiones: La nefrectomía laparoscópica es un procedimiento seguro y exitoso en pediatría, aun cuando el tiempo operatorio es más prolongado, permite en forma más temprana el inicio de la vía oral alta precoz con resultados estéticos superiores...(AU)

Nudo verdadero como causa de taquicardia fetal persistente Reporte de un caso / True Knot as a Cause of Persistent Fetal Tachycardia. Case Report

Resumen Las anomalías del cordón umbilical están asociadas a efectos adversos durante el embarazo. El nudo verdadero del cordón umbilical está presente en el 0.3-2.1% de los embarazos y se ha asociado a muerte fetal. Dentro de los factores de riesgo se incluye, la edad materna, índice de masa corporal (IMC) elevado, multiparidad, trastornos hipertensivos, tabaquismo, polihidramnios, diabetes gestacional, sexo masculino del feto y otras malformaciones. El diagnóstico prenatal del nudo verdadero es raro y un desafío. La mayoría se diagnostica durante el nacimiento y sólo el 0.08% de los nudos verdaderos son diagnosticados de manera prenatal. El registro cardiotocográfico puede registrar trazos no tranquilizadores que reflejan que hay un estrés hipóxico o mecánico que interrumpe la oxigenación fetal. El objetivo de este reporte es mostrar un caso de nudo verdadero del cordón umbilical que presentó taquicardia fetal persistente durante el trabajo de parto con terminación del embarazo vía vaginal.

Abstract Umbilical cord abnormalities are associated with adverse effects during pregnancy. The true umbilical cord knot is present in 0.3-2.1% of pregnancies and has been associated with fetal death. Risk factors include maternal age, high BMI, multiparity, hypertensive disorders, smoking, polyhydramnios, gestational diabetes, male sex of the fetus, and other malformations. Prenatal diagnosis of the true knot is rare and challenging. Most are diagnosed at birth and only 0.08% of true knots are diagnosed prenatally. Non-reassuring cardiotocography traces may be present, reflecting hypoxic or mechanical stress disrupting fetal oxygenation. The aim of this case report is to present a case of true umbilical cord knot presenting with persistent fetal tachycardia during labor, resolved by vaginal delivery.

Splanchnic vein thrombosis as a manifestation of latent myeloproliferative neoplasm associated with sticky platelet syndrome / Trombosis esplácnica como presentación de neoplasia mieloproliferativa latente asociada con síndrome de plaqueta pegajosa

Abstract Vein thrombosis of unusual sites such as the splanchnic region continues to be not only a diagnostic but also a therapeutic challenge for the clinician due to its manifestation and associated pathologies. Latent JAK2 (Janus kinase 2) positive myeloproliferative neoplasm associated with sticky platelet syndrome is unusual. We present a clinical case of a 38-year-old female patient who presented with sudden onset abdominal pain of a possible vascular origin. Splanchnic thrombosis was diagnosed in latent myeloproliferative neoplasm by identifying the JAK2V617F mutation and sticky platelet syndrome via platelet aggregometry. Off-label anticoagulation with rivaroxaban 20 mg/day was administered. During her outpatient follow-up, she did not suffer any new thrombotic episodes.

Resumen La trombosis venosa de sitios inusuales como la esplácnica continúa siendo un reto no solo diagnóstico sino también terapéutico para el clínico debido a su forma de presentación y las patologías asociadas. La neoplasia mieloproliferativa latente JAK2 (cinasa de Janus 2) positiva asociada con síndrome de plaqueta pegajosa es inusual. Se presenta un caso clínico de una paciente de 38 años de edad que debutó con dolor abdominal de inicio súbito que sugirió un posible origen vascular. Se diagnosticó trombosis esplácnica en relación con neoplasia mieloproliferativa latente por la identificación de la mutación de la JAK2V617F y síndrome de plaqueta pegajosa mediante agregometría plaquetaria. Se administró de manera off-label anticoagulación con rivaroxabán 20 mg/día. Durante su seguimiento ambulatorio no ha presentado nuevos episodios trombóticos.

Thermodynamic analysis and applications of the Abraham solvation parameter model in the study of the solubility of some sulfonamides / Análisis termodinámico y aplicaciones del modelo de parámetros de solvatación de Abraham en el estudio de la solubilidad de algunas sulfonamidas

SUMMARY Solubility of sulfadiazine (SD), sulfamerazine (SMR) and sulfamethazine (SMT) in cosolvent mixtures octanol+methanol was investigated to 278.15 K, 298.15 and 313.15 K. In all cases, the lowest solubility of each drug was obtained in pure octanol at 278.15 K. The maximum solubility depends on the polarity of the drug, thus SMR and SMT reached their maximum solubility in cosolvent mixtures methanol-rich. The solution thermodynamic functions were calculated from the experimental solubility data, using the van't Hoff and Gibbs equations, following the approach proposed by Krug et al. The enthalpy of solution is positive in all cases, which is an indication of the endothermic process with a marked entropic favor. Theoretical solubility and mean lethal concentration were calculated using the Abraham model.

RESUMEN Se investigó la solubilidad de sulfadiazina (SD), sulfamerazina (SMR) y sulfametazina (SMT) en mezclas codisolventes de octanol + metanol a 278,15 K, 298,15 y 313,15 K. En todos los casos, la solubilidad más baja de cada fármaco se obtuvo en octanol puro a 278,15 K. La solubilidad máxima depende de la polaridad del fármaco, por lo que SMR y SMT alcanzaron su máxima solubilidad en mezclas cosolventes ricas en metanol. Las funciones termodinámicas de solución se calcularon a partir de los datos experimentales de solubilidad, utilizando las ecuaciones de van't Hoff y Gibbs, siguiendo el enfoque propuesto por Krug et al. La entalpia de la solución es positiva en todos los casos, lo cual es una indicación del proceso endotérmico con un marcado favorecimiento entrópico. La solubilidad teórica y la concentración letal media se calcularon utilizando el modelo de Abraham.

Accuracy of linear measurements and visibility of the mandibular canal of cone-beam computed tomography images with different voxel sizes: an in vitro study.

BACKGROUND: The major use of cone-beam computed tomography (CBCT) is in implant planning. Although CBCT has been shown to be a reliable tool for measurements, we were unable to find studies comparing the differences between images acquired using different voxel sizes for implant planning. The aims of the present in vitro study are to verify the accuracy of linear measurements and to analyze the visibility of the mandibular canal on CBCT images obtained using different voxel sizes. METHODS: Twelve dry human hemimandibles were scanned using voxel sizes of 0.2, 0.3, and 0.4 mm, and 108 transversal CBCT images were generated, on which two examiners performed 648 linear measurements and evaluated the visibility of the mandibular canal. RESULTS: The global mean ± SD error between measurements on images and direct measurements was 0.23 ± 0.20 mm. CBCT measurements underestimated direct measurements in 390 cases (60.2%). All measurement errors found were <1 mm. There was a statistically significant difference (P = 0.0001 and P = 0.0028) between the two examiners only when measuring the width in two posterior sites. There was a statistically significant difference (P = 0.0242) between voxel sizes only for one of the examiners, for a measurement of height. It was possible to visualize the mandibular canal in all of the 108 images evaluated. CONCLUSIONS: Transversal CBCT images are adequate for linear measurements in the posterior region of the mandible and provide adequate visualization of the mandibular canal using voxel sizes of 0.2, 0.3, or 0.4 mm. A voxel of 0.3 mm is a good compromise between image quality and low radiation dose.

Angioplastia primaria: experiencia de un programa de disponibilidad permanente, análisis de los tiempos en su realización e implicación pronóstica a corto plazo / Primary angioplasty: experience of a program of continuous availability, the time analysis is performed and short-term prognostic implications

Objetivos. El propósito de este estudio ha sido mostrar la experiencia a un año de contar con angioplastia coronaria transluminal percutánea (ACTP) primaria de disponibilidad permanente como tratamiento de elección del infarto agudo de miocardio con elevación del segmento ST (IAMSTE) en el Hospital Nacional Edgardo Rebagliati, así como analizar los tiempos involucrados en cada etapa de la realización de una ACTP, como primer paso para un programa de optimización de los tiempos y determinar el pronóstico a corto plazo de los pacientes según el tiempo total de isquemia. Material y métodos. Se recoge de manera retrospectiva los datos clínicos y angiográficos, los tiempos hasta la reperfusión del vaso culpable del infarto y se realiza seguimiento a corto plazo de los pacientes a los que se realizó una ACTP primaria de enero a diciembre de 2010. Resultados. Se realizó ATCP en 78 pacientes ingresados con diagnóstico de IAM. La medianas de los tiempos simples fueron: tiempo 1 (inicio de síntomas-llegada hospital), 180 min; tiempo 2 (llegada al hospital-evaluación por cardiólogo), 40 min; tiempo 3 (evaluación por cardiólogo-llegada del paciente a sala hemodinamica), 35 min; tiempo 4 (llegada del paciente a sala hemodinamica-apertura de arteria responsable con balón), 32 min. De esta manera, las medianas de los tiempos compuestos fueron: tiempo cardiólogo-balón (tiempo 3 + tiempo 4), 69 min; tiempo puerta-balón (tiempo 2+ tiempo 3 + tiempo 4), 111 min; tiempo total de isquemia (TTI = tiempo 1 + tiempo 2 + tiempo 3 + tiempo 4), 347 min. La ocurrencia de eventos cardiovasculares mayores en relación al TTI se presentaron exclusivamente en el grupo con TTI mayor de tres horas. Hubo una mejoría significativa (p = 0,02) de la Fracción de eyección con mejor clase funcional (I) en el grupo con TTI menor de tres horas. ..

Objectives. The purpose of this study was to show one year's experience of having always-available primary PTCA as a treatment of choice IAMSTE in the Edgardo Rebagliati Hospital, and analyzethe time involved in each stage of the realization of a PTCA as a first stepina program of optimization of time and determine the short-term prognosis of patients according to the total time of ischemia. Material and methods. We retrospectively collected clinical and angiographic data, time to reperfusion of the infarct culprit vesseland carried out short-term monitoring of patients who underwent primary angioplasty from January to December 2010. Results. PTCA was performed in 78 patients hospitalized with AMI. The median simple times were: time I (onset of symptoms-hospital arrival), 180 min; time 2 (arrival at hospital-evaluation by cardiologist), 40 min; time 3 (evaluation by your cardiologist-patient in hemodynamics room), 35 min; time 4 (patient in hemodynamics room-first inflated balloon), 32 min. ln this way, the complex times were made: cardiologist-balloon time (time 3 + 4),69 min; door-to-balloon time (time 2 + 3 + long time 4), III min and total ischemia time (TTI) (time I + 2 + 3 + 4), 347 min. The occurrence of MACE in relation to TTI were presented only in the group with TTI > 3 h There was a significant improvement (p =0,02) of the ejection fraetion and improved funetional class (I) in the TTI group with less than 3. Conclusions. In patients undergoing primary angioplasty for the longest time interval was used by the patient to seek medical care (3 hours). The time door-to-balloon time was I I Imin. Relationship exists between improved ejection fraction with a lower functional class improved ischemia time.

Pseudoaneurisma de arteria carótida interna tratado con stent cubierto / Covered stent graft treatment of internal carotid artery pseudoaneurysm

Los pseudoaneurismas de la arteria carótida interna son una complicación poco frecuente de traumatismos penetrantes o cerrados, y por lo general de tratamiento quirurgico difícil, debido a que la resolución por esta técnica requiere de amplia exposición cervical, que puede conllevar a daño de uno o varios nervios craneales o de otras extructuras incluidas las vasculares. El diagnóstico puede retardarse si el traumatismo es no penetrante. El usio de stent cubiertos es relativamente nuevo y lucen como una alternativa atractiva. Los pseudoaneurismas tienen alto riesgo de tromboembolismo por lo qu el diagnóstico oportuno es importante. Los stents cubiertos del tipo autoexpandible surgen como una alternativa interesante al tratamiento quirúrgico, con una tasa muy baja de complicaciones. Es necesario dar al paciente una antiagregaciòn plaquetaria dual (aspirina y clopidogrel) o anticoagulación.

Internal carotid artery pseudo aneurysms are a rare complication following blunt or penetrating trauma and its surgical treatment is difficult, because if they are resolved by surgery they need a large cervical exposure, wich could cause cranial nerve damage or damage of structures, such as the vasculature. The use of stent-graft is relatively new and it appears as an attractive alternative. Pseudo aneurysms have a high risk of thromboembolism, so its early detection is important. Auto-expandable Stent- grafts are an attractive alternative to surgical treatment, with a low incident of complications. It is necessary to give the patient dual antiplatelet treatment (Aspirin plus Clopidogrel) or anticoagulation. There are not studies with follow up to determine its safety and efficacy.

Comparative study of linear measurements performed in magnetic resonance and computed tomography images with the aid of an image realignment software / Estudo comparativo de medidas realizadas em imagens por ressonância magnética e por tomografia computadorizada com auxílio de um software de realinhamento de imagens

The aim of this study was to compare linear measurements of implant sites performed in magnetic resonance and computed tomography images with the aid of an image alignment software. Four patients from the Dental Implant Research and Teaching Center of Universidade Federal de Santa Catarina, Florianópolis, Brazil, were submitted to both computed tomography and magnetic resonance scans. An image realignment software was used to allow measuring the exact same sites on the images of both modalities. A total of eighty linear measuremensts of the posterior regions and twelve linear measurement of the anterior regions were performed with each modality. Measurements were carried out by one calibrated observer. Observer's reproducibility was higher than 97% (Dalberg's error). Student's t-test was used to compare the results of the height of the alveolar process in the computed tomography and magnetic resonance images. There was no statistically significant differences between the measurements performed in the computed tomography and magnetic resonance images (p = 0.4136). with a strong correlation between them (r = 0.8346). Similarly, there was no statistically significant differences between the measurements produced by the two modalities when the analysis discriminated the anterior and posterior regions (p = 0.7801 and p = 0.4381, respectively), with a strong correlation between the measurements in the posterior region of the jaws (r = 0.8547), and a weak correlation in the anterior region (r = 0.5472). Linear measurements of the alveolar process obtained from magnetic resonance and computed tomography images are comparable.

Comparação entre imagem digital convencional e invertida na detecção e estimativa da profundidade de cáries proximais / Comparison of conventional and inverted digital images for the detection and depth estimation of proximal caries

O presente trabalho teve como propósito comparar a imagem digital convencional (modalidade 1), a imagem digital invertida (modalidade 2) e a análise simultânea de ambos (modalidade 3) na detecção e estimativa da profundidade de lesões cariosas proximais. Imagens digitais diretas de 41 dentes posteriores foram utilizadas neste estudo. Vinte observadores foram treinados e calibrados para a interpretação dos dois tipos de imagens digitais. As respostas dos observadores, obtidas em três sessões de observação, foram comparadas ao estado real das superfícies dentais conhecido pelo exame histológico. Áreas sob as curvas ROC ("Receiver Operating Characteristic") e valores de sensibilidade, especificidade e acurácia foram utilizados com medidas de desempenho dos observadores na detecção de lesões cariosas. O teste estatístico Kappa ponderado foi usado com medida do desempenho dos observadores na tarefa da estimativa da profundidade das lesões cariosas. Todos os valores foram avaliados por análise de variância (ANOVA). Valores médios das áreas sob as curvas ROC (Az) para a imagem digital convencional, a imagem digital invertida e para o uso simultâneo das duas foram 0,702, 0,690 e 0,712, respectivamente. Valores mádios de especificidade foram 0,860, 0,875 e 0,843, respectivamente. Valores médios de acurácia foram 0,795, 0,787 e 0,799, respectivamente. Em relação à estimativa da profundidade de cárie, os valores médios do teste estatístico Kappa ponderado foram 0,378, 0,383 e 0,420, respectivamente, para as modalidades 1, 2 e 3. ANOVA não demonstrou diferenças estatisticamente significantes entre as três modalidades testadas, tanto na tarefa de detecção de lesões cariosas quanto na tarefa de determinação de sua profundidade. Conclui-se que imagens invertidas não devem ser consideradas fundamentais na detecção de cárie e na avaliação de sua profundidade

Diagnóstico radiográfico com imagens digitais invertidas: um estudo piloto / Radiographic diagnosis with reversed digital images: a pilot study

O presente trabalho teve como propósito comparar o desempenho diagnóstico da imagem digital convencional, o da imagem digital invertida e o de ambas simultaneamente no diagnóstico de cáries proximais. Imagens digitais diretas de 41 dentes posteriores foram utilizadas neste estudo. Dez observadores, todos alunos do curso de Pós-graduação em Radiologia Odontológica da Universidade Federal de Santa Catarina, foram treinados e calibrados para interpretação das três modalidades de imagem quanto à presença ou não de cárie, utilizando para isto uma escala de 1 a 5 pontos. As respostas dos estudantes, obtidas em três sessões de observação, uma para cada modalidade, foram comparadas ao estado real das superfícies dentárias conhecido pelo exame microscópico. Valores de sensibilidade, especificidade e acurácia foram utilizados como medidas do desempenho diagnóstico dos observadores, e testados estatisticamente por meio de análise de variância. Os resultados mostraram que não houve diferença estatisticamente significativa entre as três modalidade de imagem. De modo geral, as modalidade proporcionaram baixa sensibilidade e alta especificidade no diagnóstico de cárie

[Leaf anatomy of the subtribe Conceveibinae (Euphorbiaceae)]. / Anatomía foliar de la subtribu Conceveibinae (Euphorbiaceae).

A comparative study of the leaf anatomy of the subtribe Conceveibinae was carried out. Leaves show a similar structural arrangement in all species, however, there are small variations among the taxa that allow definitions of species or groups. It is not possible to recognize infrageneric divisions or to maintain some genera as different from Conceveiba. The analysis included the study of 11 characters of taxonomic importance of the leaf: the form, the size and the apex of the papillae of the lower side of the blade, the number of layers of the palisade parenchyma, the presence or absence of the midrib pith, the number of vascular bundles of petiole as well as the central cylinder and the medulla, and the presence or absence of the sclerenchyma in the different levels of the petiole. The results are evaluated from a taxonomical point of view. With leaf anatomy characters only, it is possible to separate the genus Conceveiba in the subtribe.

Modificações do retalho de Moberg para o polegar / Modifications of the Moberg flap to the thumb

Os autores apresentam o resultado obtido com o tratamento de cinco pacientes portadores de lesão da polpa digital do polegar. A técnica cirúrgica empregada foi a do retalho de deslizamento descrito por Moberg em 1964, acrescida das modificações publicadas respectivamente por Joshi em 1970 e por Argamaso em 1974, constituídas pela introdução de um segundo retalho de rotação para cobrir o defeito criado pela secção da base do retalho principal. Tais modificações representam um enriquecimento da técnica original e permitiram um resultado funcional e estético satisfatório; no entanto, elas não têm sido citadas na literatura nos últimos vinte anos.

Microlitiasis testicular: presentación de un caso y revisión / Testicular microlithiasis: case presentation and review

La microlitiasis testicular es una patología rara, usualmente un hallazgo incidental, que ha cobrado mucha importancia diagnóstica en los últimos años por su asociación con un alto porcentaje de neoplasia testicular y una gran variedad de anormalidades genéticas y urológicas. Su diagnóstico es radiológico y puede confirmarse por histopatología. La ecografía revela múltiples lesiones puntiformes hiperecoicas con distribución difusa en el parénquima afectado. Histologicamente cosiste en la presencia de cálculos en los túbulos seminíferos. Presentamos un caso que destaca la apariencia sonográfica más comunmente encontrada en esta patología. Una radiografía y biopsia testicular confirmó la naturaleza calcificada de las lesiones. Este constituye el primer caso reportado por la literatura nacional