Los desencadenantes reflejos en la epilepsia mioclónica juvenil / Reflex triggers in juvenile myoclonic epilepsy

Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

Actualización del análisis de los movimientos mandibulares a través de articulografía electromagnética / Updating the analysis of mandibular movements through electromagnetic articulography

El objetivo de registrar los movimientos mandibulares es obtener parámetros relevantes que permitan evaluar el estado de la articulación temporomandibular (ATM) y de los músculos involucrados en la masticación. El movimiento mandibular se debe a un conjunto complejo de rotaciones y traslaciones tridimensionales realizadas por la ATM, limitado por los ligamentos y las superficies articulares de estas, y por la morfología y la alineación de los dientes, cuando la mandíbula se desplaza sobre estos límites, se llaman movimientos bordeantes mandibulares. El objetivo de este artículo es realizar una descripción actualizada de los movimientos mandibulares a través de articulografía electromagnética. Los movimientos mandibulares bordeantes se clasifican según el plano del espacio en que se muevan, de esta manera tenemos movimientos bordeantes en el plano sagital, en el plano horizontal y el plano frontal, y en cada plano dibujan un polígono distinto, llamados polígonos de Posselt. Estos polígonos pueden ser registrados mediante Articulografía electromagnética, gracias a esta tecnología también se pueden extraer algunos parámetros interesantes, como por ejemplo: la trayectoria total recorrida por la mandíbula al describir cada polígono, rangos de desplazamiento en cada plano, área total de cada polígono de Posselt. La apertura mandibular se mide como la distancia entre los márgenes incisales de los incisivos centrales superiores e inferiores en apertura máxima más la sobremordida. El análisis de esta es una parte importante del examen clínico en odontología, ya que una apertura limitada puede ser resultado de trastornos en la articulación temporomandibular, fibrosis oral submucosa, enfermedad reumática o trauma facial. Las mediciones tridimensionales que se obtienen gracias a la Articulografía electromagnética, son apropiados para determinar los rangos normales de apertura, su exactitud permite la realización de investigaciones en el área, abriendo un amplio campo en el análisis de los movimientos mandibulares.

SUMMARY: The objective of recording mandibular movements is to obtain relevant parameters that allow the evaluation of the state of the temporomandibular joint (TMJ) and of the muscles involved in mastication. Mandibular movement is due to a complex set of three-dimensional rotations and translations performed by the TMJ, limited by the ligaments and their articular surfaces, and by the morphology and alignment of the teeth, when the mandible moves over these limits, they are called mandibular border movements. The aim of this article is to provide an updated description of mandibular movements through electromagnetic articulography. Mandibular border movements are classified according to the plane of space in which they move, thus we have border movements in the sagittal plane, in the horizontal plane and the frontal plane, and in each plane they draw a different polygon, called Posselt polygons. These polygons can be recorded by electromagnetic articulography, thanks to this technology some interesting parameters can also be extracted, such as: the total trajectory covered by the mandible when describing each polygon, displacement ranges in each plane, total area of each polygon of Posselt. Mandibular opening is measured as the distance between the incisal edges of the upper and lower central incisors at maximum opening plus the overbite. The analysis of mandibular opening is an important part of the clinical examination in dentistry as a preliminary evaluation, since limited opening can be the result of temporomandibular joint disorders, submucous oral fibrosis, rheumatic disease or facial trauma. The three-dimensional measurements that are obtained thanks to the electromagnetic Articulography, are appropriate to determine the normal ranges of opening, its accuracy allows the realization of investigations in the area, opening a wide field in the analysis of mandibular movements. Analysis of mandibular opening is an important part of the clinical examination in dentistry, since limited opening can be the result of temporomandibular joint disorders, oral submucous fibrosis, rheumatic disease, or facial trauma. Analysis of mandibular opening is an important part of the clinical examination in dentistry, since limited opening can be the result of temporomandibular joint disorders, oral submucous fibrosis, rheumatic disease, or facial trauma. The three-dimensional measurements that are obtained thanks to the electromagnetic Articulography, are appropriate to determine the normal ranges of opening, its accuracy allows the realization of investigations in the area, opening a wide field in the analysis of mandibular movements.

Importancia de la apertura bucal para cirugía guiada de implantes dentales. Reporte de caso y recomendaciones

La cirugía guiada asistida por computadora consiste en la fabricación de una guía quirúrgica mediante un protocolo digital que nos brinda diversos beneficios a la hora de colocar los implantes dentales; sin embargo, no todos los pacientes son candidatos para operar con este procedimiento, especialmente en el sector posterior debido a las limitaciones de la apertura bucal. En el presente caso, incluimos en el protocolo completo el registro de las dimensiones de apertura bucal del paciente como requisito previo al flujo de trabajo digital, como un elemento importante en la toma de decisión previa a la planificación para la fabricación de la guía quirúrgica. Adicionalmente, según el contexto, brindamos recomendaciones para tener en cuenta con respecto a la apertura bucal mínima suficiente para la colocación de implantes de diferentes longitudes mediante el protocolo guiado Straumann®.

Computer-guided surgery consists of the manufacture of a surgical guide using a digital protocol that provides various benefits when placing dental implants; however, not all patients are candidates to be operated with this procedure, especially in the posterior sector due to the limitations of the mouth opening. In the present case, the recording of the patient's mouth opening dimensions was included in the complete protocol as a prerequisite to the digital workflow, as an important element in the decision-making prior to the planning for the manufacture of the surgical guide. In addition, depending on the context, we provide recommendations to consider regarding the sufficient minimum mouth opening for the placement of implants of different lengths using the Straumann® Guided Protocol.

Comparison of different methods to manage supralevator rectal opening in anal fistulas: A retrospective cohort study.

INTRODUCTION: Supralevator fistula-in-ano are difficult to manage. If these fistulas have an additional supralevator internal-opening in rectum apart from the primary internal-opening at the dentate line, then the management becomes even more difficult. There is no literature/guidelines available on the management of supralevator rectal opening (SRO). METHODS: All consecutive supralevator fistula-in-ano patients having a SRO were retrospectively analyzed. The operative management of SRO in these fistulas was reviewed. All the fistulas were managed by the same procedure, transanal opening of intersphincteric space (TROPIS). The latter was a modification of LIFT (ligation of intersphincteric tract) procedure in which the intersphincteric tract was opened-up in the rectum rather than ligated (as is done in LIFT). The SRO was managed in three ways, group-1:SRO was laid-open into the rectum in continuity with the primary opening at dentate line, group-2:the mucosa around SRO was cauterized, group-3:nothing could be done to SRO. RESULTS: Out of 836 patients operated between 2015 and 2020, 138 patients (16.5%) had supralevator extension. Amongst these, 23/138 (16.6%) patients had a SRO. 2 patients were excluded (short follow-up) and 21 patients were included in the analysis. 12/13(92%) patients in group-1, 4/5 (80%) patients in group-2 and 2/3(67%) patients in group-3 got healed (p=0.47, Chi-square test). The overall healing rate was 18/21(86%). CONCLUSIONS: The supralevator rectal opening (SRO) heals well irrespective of the method utilized. Thus, proper management of the primary opening at the dentate line holds the key to fistula healing and SRO is perhaps not much responsible for persistence of the fistula. However, more studies are needed to corroborate these findings.

Comparison of different methods to manage supralevator rectal opening in anal fistulas: A retrospective cohort study

Introduction Supralevator fistula-in-ano are difficult to manage. If these fistulas have an additional supralevator internal-opening in rectum apart from the primary internal-opening at the dentate line, then the management becomes even more difficult. There is no literature/guidelines available on the management of supralevator rectal opening (SRO).Methods All consecutive supralevator fistula-in-ano patients having a SRO were retrospectively analyzed. The operative management of SRO in these fistulas was reviewed. All the fistulas were managed by the same procedure, transanal opening of intersphincteric space (TROPIS). The latter was a modification of LIFT (ligation of intersphincteric tract) procedure in which the intersphincteric tract was opened-up in the rectum rather than ligated (as is done in LIFT). The SRO was managed in three ways, group-1:SRO was laid-open into the rectum in continuity with the primary opening at dentate line, group-2:the mucosa around SRO was cauterized, group-3:nothing could be done to SRO.Results Out of 836 patients operated between 2015 and 2020, 138 patients (16.5%) had supralevator extension. Amongst these, 23/138 (16.6%) patients had a SRO. 2 patients were excluded (short follow-up) and 21 patients were included in the analysis. 12/13(92%) patients in group-1, 4/5 (80%) patients in group-2 and 2/3(67%) patients in group-3 got healed (p=0.47, Chi-square test). The overall healing rate was 18/21(86%).Conclusions The supralevator rectal opening (SRO) heals well irrespective of the method utilized. Thus, proper management of the primary opening at the dentate line holds the key to fistula healing and SRO is perhaps not much responsible for persistence of the fistula. However, more studies are needed to corroborate these findings (AU)

Introducción Las fístulas anales del supraelevador son difíciles de manejar. Si estas fístulas tienen una apertura interna supraelevador adicional en el recto además de la apertura interna primaria en la línea dentada, el manejo se vuelve aún más difícil. No hay literatura o pautas disponibles sobre el manejo del orificio rectal supaelevador (ORS).Métodos Se analizó retrospectivamente a todos los pacientes consecutivos con fístula en el ano supraelevador que tenían un ORS. Se revisó el manejo operatorio del ORS en estas fístulas. Todas las fístulas fueron manejadas por el mismo procedimiento, apertura transanal del espacio interesfinteriano (TROPIS). El último fue una modificación del procedimiento ligadura del tracto interesfinteriano (LIFT) en el que el tracto interesfinteriano se abrió en el recto en lugar de ligarse (como se hace en LIFT). El ORS se manejó de 3 maneras: grupo 1: el ORS se abrió en el recto en continuidad con la apertura primaria en la línea dentada; grupo 2: se cauterizó la mucosa alrededor del ORS, y grupo 3: no se pudo hacer ORS.ResultadosDe 836 pacientes operados entre 2015 y 2020, 138 pacientes (16,5%) tenían extensión del supraelevador. Entre estos, 23/138 (16,6%) pacientes tenían un SRO. Se excluyó a 2 pacientes (seguimiento corto) y se incluyó a 21 pacientes en el análisis; 12/13 (92%) pacientes en el grupo 1, 4/5 (80%) pacientes en el grupo 2 y 2/3 (67%) pacientes en el grupo 3 se curaron (p=0,47, prueba de la chi al cuadrado). La tasa de curación general fue 18/21 (86%).Conclusiones El ORS cicatriza bien, independientemente del método utilizado. Por lo tanto, el manejo adecuado de la abertura primaria en la línea dentada es la clave para la curación de la fístula y el ORS quizás no sea muy responsable de la persistencia de la fístula. Sin embargo, se necesitan más estudios para corroborar estos hallazgos

Where the central canal begins: endoscopic in vivo description.

OBJECTIVE: Although evidence and descriptions of the central canal (CC) along the medulla oblongata and the spinal cord have been provided by several anatomical and radiological studies, a clear picture and assessment of the opening of the CC, or apertura canalis centralis (ACC), into the fourth ventricle is lacking, due to its submillimetric size and hidden position in the calamus scriptorius. METHODS: The authors reviewed all of their cases in which patients underwent ventricular transaqueductal flexible endoscopic procedures and selected 44 cases in which an inspection of the region of the calamus scriptorius had been performed and was suitable for study inclusion. Patients were divided into different groups, based on the presence or absence of a chronic pathological process involving the fourth ventricle. In each case, the visual appearance of the opening of the CC of the ACC was classified as no evidence (A0), indirect evidence (A1), or clear evidence (A2). Morphometric measurements were inferred from surrounding structures and the size of surgical tools visible in the field. RESULTS: The opening of the CC could be clearly observed in all cases (A1 4.5%, A2 95.5%). In normal cases, a lanceolate shape along the median sulcus was most frequently found, with an average size of 600 × 250 µm that became rounded and smaller in size in cases of hydrocephalus. The distance between the caudal margin of the ACC and the obex was about 1.8 mm in normal cases, 2.1 mm in cases of obstructive hydrocephalus, and 1 mm in cases of normal pressure hydrocephalus. The two wings of the area postrema, variable in size and shape, were sited just caudal to the opening. CONCLUSIONS: A flexible scope inserted through the cerebral aqueduct can approach the hidden calamus scriptorius like a pen fits into an inkpot. With this privileged viewpoint, the authors provide for the first time, to their knowledge, a clear and novel vision of the opening of the CC in the fourth ventricle, along with the precise location of this tiny structure compared to other anatomical landmarks in the inferior triangle.

Sentidos construídos por atletas de elite sobre a abertura dos jogos olímpicos da juventude de Buenos Aires / Signification constructed by elite athletes about the opening of the youth olympic games of Buenos Aires / Sentidos construidos por atletas de élite sobre la apertura de los juegos olímpicos de la juventud de Buenos Aires

O objetivo do presente estudo é compreender os sentidos construídos por atletas de elite sobre a sua experiência de participação na abertura dos Jogos Olímpicos da Juventude de Buenos Aires. Para tanto, o propósito desta investigação apontou para uma abordagem de natureza qualitativa, a partir dos pressupostos teórico-metodológicos da etnometodologia. Os resultados apontaram que a cerimônia de abertura representou para os atletas entrevistados uma espécie de "rito de passagem", compondo-se pela incorporação dos etnométodos próprios a um determinado grupo de elite esportiva. Conclui-se que a produção de sentidos desses sujeitos foi mediada pela identificação de alguns símbolos e ritos que também aparecem na versão adulta (AU).

The objective of the present study is to understand the significations constructed by elite athletes from the experience of participating in the opening of the Youth Olympic Games in Buenos Aires. For the purpose of this investigation pointed to a qualitative approach, based on the theoretical and methodological assumptions of ethnomethodology. The results show that the opening ceremony represented a kind of 'rite of passage' for the athletes interviewed, consisting of the incorporation of ethnomethods belonging to a certain group of the sports elite. It was concluded that the production of the signification of these subjects was mediated by the identification of some symbols and rituals that also appear in the adult version (AU)

El objetivo del presente estudio es comprender los sentidos construidos por los deportistas de élite sobre la experiencia de participar en la inauguración de los Juegos Olímpicos de la Juventud en Buenos Aires. Para el propósito de esta investigación se apuntó a un abordaje cualitativo, basado en los supuestos teóricos y metodológicos de la etnometodología. Los resultados muestran que la ceremonia inaugural representó una especie de 'rito de paso' para los deportistas entrevistados, consistente en la incorporación de etnometodos pertenecientes a un determinado grupo de la élite deportiva. Se concluyó que sus producciones de sentidos fueron mediadas por la identificación de algunos símbolos y rituales que también aparecen en la versión adulta (AU).

Tree structure and diversity of a Humid Mountain Forest in the protected natural area La Martinica, Veracruz, Mexico / Estructura y diversidad arbórea de un bosque húmedo de montaña en el Área Natural Protegida La Martinica, Veracruz, México

Abstract Introduction: The Humid Mountain Forest (HMF) has the highest number of plants per unit of surface, whose vegetation grows under heterogeneous environmental conditions and possess a high floristic variation. HMF conservation is important due to the biodiversity it harbors and the environmental services it provides. Objective: This work evaluated the effect of the terrain aspect and density of the forest canopy on the structure and tree diversity in La Martinica Protected Natural Area, Mexico. Methods: Stratified sampling was performed in four terrain aspects and two canopy density conditions. Twenty five sampling units of 20 x 25 m were considered, in which the normal diameter (ND), total height and the largest and smallest diameters of the crown of the individuals with a ND ≥ 10 cm were registered. The diversity was estimated by rarefaction curves and the structure was analyzed through the importance value index (IVI) and the forest value index (FVI). Results: 37 species belonging to 30 genera and 24 families were recorded. Greater diversity was observed in the north terrain aspect and in the closed canopy. Tree species with the highest structural values were different between terrain aspect and canopy types; Carpinus tropicalis presented the highest values in the zenithal terrain aspect, Lippia myriocephala in the east and south terrain aspect, and Liquidambar styraciflua in the north. In both canopy types Lippia myriocephala obtained the highest IVI values and FVI in the open canopy; Carpinus tropicalis reached a higher FVI in the closed canopy. Conclusions: Tree structure was different in the four terrain aspects and two canopy conditions studied. The greatest difference in species composition and diversity was observed between the north and east terrain aspects; the north presented the highest richness values, frequent and dominant species.

Resumen Introducción: El Bosque Húmedo de Montaña (BHM) posee el mayor número de especies vegetales por unidad de superficie, cuya vegetación se desarrolla en condiciones ambientales muy heterogéneas y presenta una alta variación florística. La conservación del BHM es importante debido a la biodiversidad que alberga y los servicios ambientales que proporciona. Objetivo: Este trabajo evaluó el efecto de la orientación del terreno y la densidad del dosel del bosque sobre la estructura y diversidad arbórea en el Área Natural Protegida La Martinica, México. Métodos: Se efectuó un muestreo estratificado en cuatro orientaciones del terreno y dos condiciones de densidad del dosel; se consideraron 25 unidades de muestreo de 20 x 25 m, en las que se registró: el diámetro normal (DN), la altura total y los diámetros mayor y menor de la copa de los individuos con un DN ≥10 cm. La diversidad se estimó por medio de curvas de rarefacción y la estructura se analizó con el índice de valor de importancia (IVI) y el índice de valor forestal (IVF). Resultados: Se registraron 37 especies pertenecientes a 30 géneros y 24 familias. Se observó una mayor diversidad en la orientación norte y en el dosel cerrado. Las especies arbóreas con valores estructurales más altos fueron diferentes entre orientaciones y tipos de dosel; Carpinus tropicalis presentó los valores más elevados en la orientación cenital, Lippia myriocephala en las orientaciones este y sur, y Liquidambar styraciflua en la norte. En ambos tipos de dosel Lippia myriocephala obtuvo los valores más altos del IVI e IVF en el dosel abierto; Carpinus tropicalis alcanzó un IVF más elevado en el dosel cerrado. Conclusiones: La estructura arbórea fue diferente en las cuatro orientaciones estudiadas y en las dos condiciones del dosel. La mayor diferencia en composición de especies y diversidad se observó entre las orientaciones norte y este, de ellas, la norte presentó los valores más altos de riqueza, especies frecuentes y dominantes.

Congenital pyriform aperture stenosis: Ten years experience.

INTRODUCTION: Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and a rare cause of respiratory distress in neonates that may require early surgical intervention. The aim of this study is to report our experience in patients operated for CNPAS and present characteristics of this population. MATERIAL AND METHODS: A retrospective, analytical cohort study was conducted of patients who underwent surgical treatment for CNPAS in the Hospital de Pediatría Garrahan from May 2008 to May 2018. RESULTS: Nineteen patients underwent surgical treatment; 47.36% had some associated genetic syndrome. The surgical approach was sublabial. Follow-up was more than 45 days in 14 patients, 9 did not require additional treatment, and the remaining 5 required further surgical and/or medical treatment. Short-term post-surgical outcome was good in 85.7%. CONCLUSIONS: Better post-surgical results were obtained in patients in whom endonasal stenting was not used and who did not present associated craniofacial malformations.

Estenosis congénita de apertura piriforme: diez años de experiencia / Congenital pyriform aperture stenosis: ten years experience

Introducción: La estenosis congénita de la apertura piriforme (ECAP) es una malformación infrecuente y una causa rara de distress respiratorio en neonatos que puede requerir de intervención quirúrgica temprana. El objetivo del estudio es reportar nuestra experiencia en pacientes operados por ECAP y las características de la población.Material y métodosPacientes operados de ECAP desde mayo del 2008 hasta mayo del 2018 en el Hospital de Pediatría Garrahan. Estudio de cohorte analítico retrospectivo.ResultadosSe intervinieron quirúrgicamente 19 pacientes. El 47,36% presentaba algún síndrome genético asociado. El abordaje quirúrgico fue por vía sublabial. Se logró el seguimiento por más de 45 días en 14 pacientes, 9 no requirieron tratamiento adicional, y los 5 restantes requirieron otro tratamiento quirúrgico y/o médico. El éxito global posquirúrgico en primera instancia fue del 85,7%.ConclusionesSe obtuvieron mejores resultados posquirúrgicos en los pacientes en que no se utilizaron tutores endonasales y que no presentaban malformaciones craneofaciales asociadas. (AU)

Introduction: Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and a rare cause of respiratory distress in neonates that may require early surgical intervention.The aim of this study is to report our experience in patients operated for CNPAS and present characteristics of this population.Material and methodsA retrospective, analytical cohort study was conducted of patients who underwent surgical treatment for CNPAS in the Hospital de Pediatría Garrahan from May 2008 to May 2018.ResultsNineteen patients underwent surgical treatment; 47.36% had some associated genetic syndrome. The surgical approach was sublabial. Follow-up was more than 45 days in 14 patients, 9 did not require additional treatment, and the remaining 5 required further surgical and/or medical treatment. Short-term post-surgical outcome was good in 85.7%.ConclusionsBetter post-surgical results were obtained in patients in whom endonasal stenting was not used and who did not present associated craniofacial malformations. (AU)

Coexistence of idiopathic intracranial hypertension and optic disc drusen in a latin american patient: case report.

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optical nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare, the drusen of the optic nerve and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. The case is presented of a 34 year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and the eye sockets. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension.

Descentralización fiscal y apertura económica en Colombia 19902020 / Fiscal Decentralization and Economic Openness in Colombia 1990-2020

Resumen El proceso de descentralización fiscal en Colombia, determinada por la descentralización hacia el mercado, tiene una relación intrínseca con las políticas de apertura económica que pueden ser rastreadas desde finales de la década de los años 60 del siglo XX, en la que se evidencia como el aumento del gasto derivado de las políticas de descentralización fiscal conllevaron a la adopción de políticas enfocadas en la liberalización y desregulación de la economía. Todo esto en sincronía con la puesta en marcha de la Modernización del Estado en Colombia. Este proceso genera un aumento de la opresión fiscal de corte indirecto y regresivo en el país y una pérdida de derechos del pueblo colombiano a partir de los postulados de eficiencia y eficacia impartida por el mercado, los cuales han evidenciado todo lo contrario al no comprender la descentralización atada a las relaciones sociales, económicas, culturales y políticas en el país que han generado una captura del Estado con procesos de corrupción, detrimentos patrimoniales y baja responsabilidad en la prestación de los servicios públicos y los derechos sociales.

Abstract The process of fiscal decentralization in Colombia, which is determined by decentralization to the market, has an intrinsic relationship with the policies of economic openness, which can be traced back to the late 1960s, which shows how increased spending from fiscal decentralization policies led to the adoption of policies focused on the liberalization and deregulation of the economy. All this in synchrony with the implementation of the Modernization of the State in Colombia. This process generates an increase in indirect and regressive fiscal oppression in the country and a loss of rights of the Colombian people from the postulates of efficiency and effectiveness imparted by the market, which have proven quite the opposite by not understanding the decentralization tied to social, economic, cultural and political relations in the country, which have generated a capture of the State with processes of corruption, property detriments, and low responsibility for the provision of public services and social rights.

Coexistencia de hipertensión intracraneal idiopática y drusas del nervio óptico en una paciente latinoamericana: reporte de caso / Coexistence of idiopathic intracranial hypertension and optic disc drusen in a latin american patient: case report

Las drusas del nervio óptico son concreciones acelulares de calcio localizadas en el parénquima de la cabeza del nervio óptico, descritas como la causa más frecuente de pseudopapiledema, lo cual las hace difícil de diferenciar de un verdadero edema del disco óptico. A pesar de su poca frecuencia, las drusas del nervio óptico y el papiledema secundario a una hipertensión intracraneal idiopática pueden coexistir en el mismo paciente. Reportamos el caso de una mujer de 34 años de vida remitida al servicio de oftalmología con molestias visuales, cefalea, y tinnitus pulsátil de dos meses de evolución; al examen físico se encontró borramiento del margen del disco óptico de manera bilateral sin pulsación venosa espontánea. El diagnóstico de hipertensión intracraneal idiopática se realizó por una punción lumbar con medición de la presión de apertura, y por los hallazgos de resonancia magnética cerebral y de órbitas. Se observó incidentalmente las drusas del nervio óptico en una tomografía de coherencia óptica con angiografía, que luego se confirmarían con una ecografía ocular. Este es el primer caso reportado en América Latina de la coexistencia de drusas del nervio óptico y papiledema secundario a hipertensión intracraneal idiopática para nuestro conocimiento (AU)

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optic nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare optic nerve drusen and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. We present a case of a 34-year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and orbits. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension (AU)

Comparison of different methods to manage supralevator rectal opening in anal fistulas: A retrospective cohort study.

INTRODUCTION: Supralevator fistula-in-ano are difficult to manage. If these fistulas have an additional supralevator internal-opening in rectum apart from the primary internal-opening at the dentate line, then the management becomes even more difficult. There is no literature/guidelines available on the management of supralevator rectal opening (SRO). METHODS: All consecutive supralevator fistula-in-ano patients having a SRO were retrospectively analyzed. The operative management of SRO in these fistulas was reviewed. All the fistulas were managed by the same procedure, transanal opening of intersphincteric space (TROPIS). The latter was a modification of LIFT (ligation of intersphincteric tract) procedure in which the intersphincteric tract was opened-up in the rectum rather than ligated (as is done in LIFT). The SRO was managed in three ways, group-1:SRO was laid-open into the rectum in continuity with the primary opening at dentate line, group-2:the mucosa around SRO was cauterized, group-3:nothing could be done to SRO. RESULTS: Out of 836 patients operated between 2015 and 2020, 138 patients (16.5%) had supralevator extension. Amongst these, 23/138 (16.6%) patients had a SRO. 2 patients were excluded (short follow-up) and 21 patients were included in the analysis. 12/13(92%) patients in group-1, 4/5 (80%) patients in group-2 and 2/3(67%) patients in group-3 got healed (p=0.47, Chi-square test). The overall healing rate was 18/21(86%). CONCLUSIONS: The supralevator rectal opening (SRO) heals well irrespective of the method utilized. Thus, proper management of the primary opening at the dentate line holds the key to fistula healing and SRO is perhaps not much responsible for persistence of the fistula. However, more studies are needed to corroborate these findings.

¿Dentro o fuera del clóset? Apertura y/o encubrimiento de la orientación sexual de estudiantes de Medicina de la Universidad Nacional de Asunción

RESUMEN Introducción: la orientación sexual es la atracción emocional, afectiva, romántica o sexual que uno siente hacia los demás. Su apertura y encubrimiento son variables que han sido ampliamente relacionadas con el estado de salud mental. Metodología: estudio observacional descriptivo, de corte transversal y temporalmente prospectivo, con muestreo no probabilístico, que incluyó a 277 estudiantes de Medicina (campus de Sajonia y de San Lorenzo, y Filial Santa Rosa del Aguaray) de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. La apertura/encubrimiento de la orientación sexual se determinó a través de adaptaciones españolas del "Outness Inventory" y de la "Sexual Orientation Concealment Scale". Resultados: las escalas utilizadas mostraron buenas consistencias internas (alpha de Cronbach=0,90). 17,3% de los encuestados se definía como parte de las minorías sexuales. Se encontraron diferencias estadísticamente significativas en cuanto a los niveles de apertura de la orientación sexual en personas heterosexuales y en personas LGB+ [t(275)=8,2, p<0,01]. En la población de estudiantes de Medicina LGB+, se observaron menores niveles de apertura primero hacia la religión, y luego hacia la familia, Facultad y amigos (p<0,01). El 75% de los estudiantes de Medicina LGB+ ocultaron de alguna forma su orientación sexual en las últimas dos semanas. Conclusión: la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción debe considerar examinar de cerca su ambiente y cultura organizacional, así como su currículo, con el fin de garantizar que exista un entorno positivo e inclusivo para todos los estudiantes. La adopción de la diversidad en la educación médica permite formar médicos que puedan practicar la Medicina de manera competente, compasiva y con enfoque de derechos humanos.

ABSTRACT Introduction: Sexual orientation is the emotional, affective, romantic or sexual attraction that one feels towards others. Its disclosure and concealment are variables that have been widely related to mental health status. Methodology: This was a descriptive, cross-sectional and temporally prospective observational study, with a non-probabilistic sample, which included 277 medical students (Sajonia, San Lorenzo, and Santa Rosa del Aguaray campuses) from the Faculty of Medical Sciences of the National University of Asunción. The disclosure/concealment of sexual orientation was determined through Spanish adaptations of the "Outness Inventory" and the "Sexual Orientation Concealment Scale". Results: The scales used showed good internal consistencies (Cronbach's α=0.90). 17.3% of those surveyed defined themselves as part of sexual minorities. Statistically significant differences were found in the levels of disclosure of sexual orientation in heterosexual people and in LGB+ people [t(275)= 8.2, p<0.01]. In the population of LGB+ medical students, lower levels of disclosure were observed, first towards religion, and then towards family, Faculty, and friends (p<0.01). 75% of LGB+ medical students concealed their sexual orientation in some way in the past two weeks. Conclusion: The Faculty of Medical Sciences of the National University of Asunción should consider closely examining its environment and organizational culture, as well as its curriculum, in order to guarantee that there is a positive and inclusive environment for all students. The adoption of diversity in medical education enables the training of physicians who can practice medicine competently, compassionately, and with a human rights approach.

Sentidos construídos por atletas de elite sobre a abertura dos jogos olímpicos da juventude de Buenos Aires / Signification constructed by elite athletes about the opening of the youth olympic games of Buenos Aires / Sentidos construidos por atletas de élite sobre la apertura de los juegos olímpicos de la juventud de Buenos Aires

O objetivo do presente estudo é compreender os sentidos construídos por atletas de elite sobre a sua experiência de participação na abertura dos Jogos Olímpicos da Juventude de Buenos Aires. Para tanto, o propósito desta investigação apontou para uma abordagem de natureza qualitativa, a partir dos pressupostos teórico-metodológicos da etnometodologia. Os resultados apontaram que a cerimônia de aber-tura representou para os atletas entrevistados uma espécie de "rito de passagem", compondo-se pela incorporação dos etnométodos próprios a um determinado grupo de elite esportiva. Conclui-se que a produção de sentidos desses sujeitos foi mediada pela identificação de alguns sím-bolos e ritos que também aparecem na versão adulta.

The objective of the present study is to understand the significations constructed by elite athletes from the experience of participating in the opening of the Youth Olympic Games in Buenos Aires. For the purpose of this investigation pointed to a qualitative approach, based on the theoretical and methodological assumptions of ethnomethodology. The results show that the opening ceremony represented a kind of 'rite of passage' for the athletes interviewed, consisting of the incorporation of ethnomethods belonging to a certain group of the sports elite. It was concluded that the production of the signification of these subjects was mediated by the identification of some symbols and rituals that also appear in the adult version.

El objetivo del presente estudio es comprender los sentidos construidos por los deportistas de élite sobre la experiencia de participar en la inauguración de los Juegos Olímpicos de la Juventud en Buenos Aires. Para el propósito de esta investigación se apuntó a un abordaje cualitativo, basado en los supuestos teóricos y metodológicos de la etnometodología. Los resultados muestran que la ceremonia inaugural representó una especie de 'rito de paso' para los deportistas entrevistados, consistente en la incorporación de etnometodos pertenecientes a un determinado grupo de la élite deportiva. Se concluyó que sus producciones de sentidos fueron mediadas por la identificación de algunos símbolos y rituales que también aparecen en la versión adulta.

The influencing factors of opening of college sports resources in the background of national public fitness services / Os fatores que influenciam a abertura de recursos esportivos universitários no contexto do serviço público de educação física nacional / Factores que influyen en la apertura de los recursos deportivos en las universidades

ABSTRACT There are some problems such as few and old equipment in urban community sports fitness facilities, which makes it difficult for community fitness resources to continue to meet the fitness needs of community residents. The opening of university sports resources can alleviate the problem of residents' fitness difficulty to a certain extent. In order to explore the problems faced by the opening of university sports resources, this study established the analytic hierarchy process model based on the analytic hierarchy process (AHP) and Delphi law in the background of national public service of fitness, and combined with the questionnaire survey method to study the influencing factors of opening of college sports. The model modified by the Delphi method contains 6 first-level and 22 second-level influencing factors. It is found that the most important factor in the first level is the hardware factor of college sports resources, and the most important factor of the second level is the spatial layout of university sports resources. The results show that improving the hardware facilities of university sports resources, improving the management mode of sports resources, and increasing the targeted financial subsidies and tax reduction and exemption are helpful to enhance the willingness to open sports resources and improve the quality of opened sports resources. It is hoped that this study can promote the opening of college sports resources and promote the continuous improvement of the service level of sports resources.

RESUMO Há alguns problemas, tais como equipamentos antiquados e em menores quantidades em instalações esportivas na Comunidade urbana, o que dificulta que os recursos de exercícios físicos continuem atendendo as necessidades de atividades físicas dos moradores das comunidades. A abertura de recursos desportivos universitários pode atenuar, em certa medida, o problema da dificuldade dos moradores de praticar atividades físicas. A fim de explorar os problemas enfrentados pela abertura dos recursos desportivos universitários, este estudo estabeleceu o modelo de processo hierárquico analítico baseado no processo hierárquico analítico (Analytic Hierarchy Process — AHP) e na Lei Delphi no contexto do serviço público nacional de atividades físicas, combinado com o método de inquérito por questionário para estudar os fatores que influenciam a abertura dos recursos esportivos universitários. O modelo modificado pelo método Delphi contém 6 fatores influenciadores de primeiro nível e 22 fatores influenciadores de segundo nível. Constata-se que o fator de primeiro nível mais importante é o fator físico dos recursos esportivos universitários, e o fator de segundo nível mais importante é a disposição espacial dos recursos esportivos universitários. Os resultados mostram que a melhoria das instalações físicas dos recursos desportivos universitários, a melhoria do modo de gestão dos recursos desportivos e o aumento dos subsídios financeiros e a redução e isenção de impostos são úteis para aumentar a disponibilidade da abertura dos recursos desportivos e melhorar a qualidade dos recursos desportivos abertos. Espera-se que este estudo possa promover o processo de abertura dos recursos esportivos universitários e promover a melhoria contínua do nível de serviço de recursos esportivos.

RESUMEN Explorar los problemas que enfrenta la apertura de los recursos deportivos universitarios, este estudio estableció el proceso de jerarquía analítica (PJA) y la ley Delphi en el contexto del servicio público nacional de educación física, y los combinó con la encuesta por cuestionario para estudiar los factores que influyen en la apertura de los deportes universitarios. El modelo modificado por el método Delphi contiene 6 factores de influencia de primer nivel y 22 de segundo nivel. Encontramos que el factor más importante en el primer nivel es el factor hardware de los recursos deportivos universitarios, y el factor más importante del segundo nivel es la distribución espacial de los recursos deportivos universitarios. Los resultados muestran que mejorar las instalaciones de hardware de los recursos deportivos universitarios, mejorar el modo de gestión de los recursos deportivos y aumentar los subsidios financieros específicos y la reducción y exención de impuestos son útiles para mejorar la disposición a abrir recursos deportivos y mejorar la calidad de los recursos deportivos abiertos. Esperamos que este estudio pueda promover la apertura de recursos deportivos universitarios y promover la mejora continua del nivel de servicio de los recursos deportivos.

Improving service performance in organizations for individuals with intellectual disability: an intervention focused on participation of families / A melhoria do desempenho do serviço em organizações para indivíduos com deficiência intelectual: uma intervenção com foco na participação das famílias / La mejora del desempeño del servicio en organizaciones para personas con discapacidad intelectual: una intervención centrada en la participación de las familias

To improve service performance in organizations for individuals with intellectual disability, the authors tested an intervention based on collaborative teams. Specifically, professionals and families cooperated in the design and implementation of projects to improve the quality of life of individuals with intellectual disability. We considered two service performance indicators reported by family members (N = 342; 78% women; and a mean age of 57.17 years): service quality and self-determination communication openness. Our results revealed that family members assigned to the experimental condition improved their service quality evaluations from pre-intervention to post-intervention, whereas family members assigned to the control condition did not change their evaluations. The intervention was not effective for communication openness. Perceptions remained stable in family members who participated in the teams (experimental condition), whereas communication openness decreased in family members in the control condition. We discuss the implications of our findings for service research.

Para melhorar o desempenho do serviço em organizações para indivíduos com deficiência intelectual, os autores testaram uma intervenção baseada em equipes colaborativas. Especificamente, profissionais e famílias cooperaram na concepção e implementação de projetos para melhorar a qualidade de vida das pessoas com deficiência intelectual. Foram considerados dois indicadores de desempenho do serviço relatados pelos familiares (N = 342; 78% mulheres; idade média de 57,17 anos): qualidade do serviço e abertura de comunicação autodeterminada. Nossos resultados revelaram que os membros da família atribuídos à condição experimental melhoraram suas avaliações de qualidade de serviço de pré-intervenção para pós-intervenção, enquanto os membros da família atribuídos à condição de controle não mudaram suas avaliações. A intervenção não foi eficaz para a abertura de comunicação. As percepções permaneceram estáveis ​​nos familiares que participaram das equipes (condição experimental), enquanto a abertura comunicativa diminuiu nos familiares na condição controle. Discutimos as implicações de nossas descobertas para a pesquisa de serviços.

Para mejorar el desempeño del servicio en organizaciones para personas con discapacidad intelectual, los autores pusieron a prueba una intervención basada en equipos colaborativos. En concreto, profesionales y familias colaboraron en el diseño e implementación de proyectos para mejorar la calidad de vida de las personas con discapacidad intelectual. Se consideraron dos indicadores de desempeño del servicio reportados por los miembros de la familia (N = 342; 78% mujeres; y una edad promedio de 57,17 años): calidad del servicio y apertura en comunicación sobre autodeterminación. Nuestros resultados revelaron que los miembros de la familia asignados a la condición experimental mejoraron sus evaluaciones de calidad del servicio desde la preintervención hasta la postintervención, mientras que los miembros de la familia asignados a la condición de control no cambiaron sus evaluaciones. La intervención no fue eficaz para la apertura en comunicación. Las percepciones se mantuvieron estables en los familiares que participaron en los equipos (condición experimental), mientras que la apertura en comunicación disminuyó en los familiares en la condición de control. Se analizan las implicaciones de nuestros hallazgos para la investigación de servicios.

Pedra de Bolonha / The Bologna stone / Piedra de Bolonia / Pierre de Bologne

Transcrevo aqui a minha contribuição à abertura das atividades de mais um semestre do Instituto de Psicanálise "Durval Marcondes", da SBPSP, a cerimônia de boas-vindas a uma nova turma que inicia aqui a sua formação. Trago reflexões com base na minha própria experiência inaugural e de todos os anos em que participei desta instituição em várias de suas funções. Essa reflexão é uma aula apenas no sentido de propiciar um espaço aberto e arejado para promover as trocas internas. O que é psicanálise? O que faz um psicanalista? Quais seriam os veios de ouro da formação de um psicanalista? Para mim, mais uma questão de alquimia do que de garimpo. Alquimia representada pela pedra de Bolonha, que reflete à noite, como luz, a energia que armazenou durante o dia. Essa cerimônia ocorreu no dia 29/2/2020, uma quinzena antes do fechamento das instalações físicas de nossa sociedade, motivada pela pandemia da covid-19, a que faço breve menção sob forma de um pós-escrito.

I present here the transcription of the contribution to the opening of a new semester at the Durval Marcondes Institute of Psychoanalysis of the Brazilian Society of Psychoanalysis of São Paulo (SBPSP). This ceremony welcomed a new cohort at the beginning of psychoanalytical training. My reflections draw from my own experience with such an inaugural event, and also from my many years participating in the various activities and functions of this institution. If my reflection can be considered a lecture or a class, it is only in the sense of fostering a free and open-minded space for mutual internal exchanges. What is psychoanalysis? What makes a psychoanalyst? What would be the gold veins for the education of a psychoanalyst? To me, it's more about alchemy than gold mining - a kind of alchemy represented by the Bologna stone, which at night glowed with the light from the energy it had stored during the day. The kickoff session transcribed here took place on February 29, 2020, two weeks before the physical spaces of our Society had to be closed due to the covid-19 pandemic, to which I allude briefly in the form of a postscript.

Transcribo aquí mi contribución a la apertura de las actividades de otro semestre del Instituto de Psicoanálisis Durval Marcondes (SBPSP) la ceremonia de bienvenida a una nueva clase que comienza su formación aquí. Traigo reflexiones basadas en mi propia experiencia inaugural y de todos los años que participé en esta institución en varias de sus funciones. Esta reflexión es una lección solo en el sentido de proporcionar un espacio abierto y aireado para promover los intercambios internos. ¿Qué es el psicoanálisis? ¿Qué hace un psicoanalista? ¿Cuáles serían las venas doradas de la formación de un psicoanalista? Para mí, es más una cuestión de alquimia que de minería. La alquimia representada por la piedra de Bolonia, que refleja en la noche, como luz, la energía que almacena durante el día. Esta ceremonia se celebró en 29/2/2020, una quincena antes del cierre de las instalaciones físicas de nuestra sociedad, motivada por la pandemia de covid-19, que menciono brevemente en forma de posdata.

Je retranscrit ici ma contribution à l'ouverture des activités d'un autre semestre de l'Institut de Psychanalyse Durval Marcondes (SBPSP), la cérémonie d'accueil à une nouvelle classe qui commence sa formation ici. J'apporte des réflexions basées sur ma propre expérience inaugurale et sur toutes les années où j'ai participé à cette institution dans plusieurs de ses fonctions. Cette réflexion n'est une leçon que dans le sens de fournir un espace ouvert et aéré pour favoriser les échanges internes. Qu'est-ce que la psychanalyse? Que fait un psychanalyste? Quelles seraient les veines dorées de la formation d'un psychanalyste? Pour moi, c'est plus une question d'alchimie que d'exploitation minière. Alchimie représentée par la pierre de Bologne, qui réfléchit la nuit, sous forme de lumière, l'énergie qu'elle emmagasine pendant la journée. Cette cérémonie a eu lieu le 29/2/2020, quinze jours avant la fermeture des installations physiques de notre société, motivée par la pandémie de covid-19, que je mentionne brièvement sous forme de post-scriptum.

The determination of the piriform aperture morphometry and golden ratio in healthy Turkish subjects: a CT study / Determinación de la morfometría de la apertura piriforme y la proporción áurea en sujetos turcos sanos: un estudio con TC

This study was undertaken to determine the morphometry of the piriform aperture width and height in Turkish population aged between 18-60 years. It was a retrospective study in which 200 subjects were included 106 males and 94 females, ranging from 18 up to 60 years. Subjects having brain CT in the Radiology Department. Statistical analysis were evaluated with SPSS 21.00 programme. ANOVA Test were used to determine the significance between measurements and age group. The p<0.05 value was considered as significant. The groups were divided into four groups according to age. The overall means and standard deviations of the measurements were: piriform aperture height, 45.19±2.91 mm; piriform aperture width, 24.98±2.85 mm; the golden ratio, 1.84±0.19 in males, respectively whereas, the same measurements were 42.84±2.88; 23.46±2.15 mm; 1.83±0.19 in females, respectively. Also there were an increase in piriform aperture width measurement as the age increased. These anatomical values provides more important knowledge to determine the dimensions of these structures in clinic, surgical processes.

El estudio se realizó para determinar la morfometría del ancho y la altura de la abertura piriforme en la población turca de entre 18 y 60 años. Se llevó a cabo un análisis retrospectivo en el que se incluyeron 200 sujetos 106 hombres y 94 mujeres, entre los 18 y 60 años. Sujetos con TC cerebral en el Departamento de Radiología. El análisis estadístico se evaluó con el programa SPSS 21.00. La prueba ANOVA se utilizó para determinar la importancia entre las mediciones y el grupo de edad. El valor p <0,05 se consideró significativo. La muestra se dividió en cuatro grupos según la edad. Las medias generales y las desviaciones estándar de las mediciones fueron: altura de apertura piriforme, 45,19 ± 2,91 mm; ancho de apertura piriforme, 24,98 ± 2,85 mm; la proporción áurea, 1,84 ± 0,19 en varones, mientras que las mismas medidas fueron 42,84 ± 2,88; 23,46 ± 2,15 mm; 1,83 ± 0,19 en mujeres. También hubo un aumento en la medición del ancho de apertura piriforme a medida que la edad aumentó. Estos valores anatómicos proporcionan un conocimiento más importante para determinar las dimensiones de estas estructuras en procesos clínicos y quirúrgicos.