Valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto / Value of elastography by color patterns in the restaging of rectal cancer i: en

Introducción: La elastografía cualitativa por ecografía endoscópica es una técnica para examinar las propiedades elásticas de los tejidos, que puede distinguir la fibrosis del tumor mediante patrones de colores. Objetivo: Determinar el valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto. Métodos: Se efectuó un estudio observacional y descriptivo (serie de casos) de 54 pacientes con cáncer de recto atendidos en el Centro Nacional de Cirugía de Mínimo Acceso, en La Habana, entre septiembre del 2018 y diciembre del 2022, a quienes se les realizó elastografía por ecografía endoscópica para la reevaluación del tumor. Para determinar el valor de dicha técnica se calculó la sensibilidad, la especificidad, los valores predictivos positivo y negativo, las razones de verosimilitud positiva y negativa, así como el índice de Youden. Se estableció la concordancia diagnóstica según el índice kappa y el estudio histológico de la muestra tomada fue el estándar de referencia. Resultados: La concordancia de la elastografía con el resultado anatomopatológico fue buena (κ=0,84). La especificidad y el índice de validez resultaron ser de 91,7 y 94,4 %, respectivamente; mientras que el valor predictivo negativo fue de 84,6 %. Los 16 pacientes con patrón elastográfico mixto (ye3) tenían tumor residual localizado en alguna de las capas de la pared del recto. El índice de Youden alcanzó valores cercanos a 1. Conclusiones: El valor de esta técnica radica en su especificidad diagnóstica y en el valor predictivo negativo al diferenciar la fibrosis del tumor residual en la pared rectal.

Introduction: The qualitative elastography by endoscopic echography is a technique to examine the elastic properties of tissues that can distinguish the fibrosis of the tumor by means of color patterns. Objective: To determine the value of elastography by color patterns in the reestadification of the rectum cancer. Methods: An observational and descriptive study (serial cases) of 54 patients with rectum cancer was carried out, who were assisted in the National Center of Minimum Access Surgery, in Havana, between September, 2018 and December, 2022 to whom elastography by endoscopic echography were carried out for the reevaluation of the tumor. To determine the value of this technique the sensibility, specificity, the predictive positive and negative values, the positive and negative true ratio, as well as the index of Youden were calculated. The diagnostic consistency was established according to the kappa index and the histologic study of the sample was the reference standard. Results: The elastography consistency with the pathologic result was good (ĸ=0.84). The specificity and the index of validity were 91.7 and 94.4%, respectively; while the negative predictive value was 84.6%. The 16 patients with mixed elastographic pattern (ye3) had residual tumor located in some of the layers of the rectum wall. The Youden index reached values close to 1. Conclusions: The value of this technique resides in its diagnostic specificity and negative predictive value when differentiating fibrosis from the residual tumor in the rectal wall.

Hallazgos radiográficos asociados a la COVID-19: una mirada desde la atención primaria / Radiographic findings associated with the COVID-19: a glance from the primary health care

La actual pandemia de COVID-19 ha afectado múltiples sectores económicos y sociales a escala mundial, con especial afectación sobre el sector de la salud, ya que constituye un reto adicional para la atención primaria, dada la marcada escasez de recursos. La infección por SARS-CoV-2 ocasiona morbilidad y mortalidad crecientes, por lo que el diagnóstico mediante imágenes es una herramienta imprescindible en la práctica clínica; sin embargo, el acceso limitado a algunos medios como la tomografía axial computarizada en diferentes niveles de atención, justifica el uso de la radiografía de tórax como una opción costo-efectiva y accesible en muchas regiones. En el presente artículo se exponen los hallazgos asociados a procesos infecciosos virales sugestivos de infección por el nuevo coronavirus y una serie de escalas de clasificación que buscan estandarizar la lectura e interpretación radiográfica por parte del personal médico.

The pandemic of COVID-19 has affected multiple economic and social sectors worldwide, with special effects on the health sector, since it constitutes an additional challenge for the primary health care, given the marked lack of resources. The infection due to SARS-CoV-2 causes increasing morbidity and mortality, reason why the diagnosis by means of images is an indispensable tool in the clinical practice; however, the limited access to some means as the computerized axial tomography in different levels of care, justifies the use of the thorax x-ray as a cost-effective and accessible option in many regions. Findings associated with suggestive viral infectious processes of infection due to the new coronavirus and a series of classification scales that seek to standardize reading and radiographic interpretation by the medical staff are exposed in this work.

Digital dermoscopy: a complementary method in the diagnosis of scabies

Abstract Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.

Digital dermoscopy: a complementary method in the diagnosis of scabies.

Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.

Acromion fracture and lateral angle of the scapula spine: Case report and literature review.

INTRODUCTION: Scapular fractures are uncommon and correspond to 0.5-1% of all body fractures. The study objective was to present a rare case report of a fracture (lateral acromion and angle of the scapula spine) and review of the literature on which will greatly contribute to diagnosis and treatment. PRESENTATION OF CASE: A 74-year-old female patient with comminuted fracture of the acromial process and lateral angle of the spine of the scapula with subacromial space. The patient underwent surgical treatment with open reduction and use of blocked plaque, two plain Steinmann wires 2.0 and local bone graft. DISCUSSION: Segmental fracture of acromion and spine of the scapula needs early diagnosis for the proper treatment. In our case report, the patient presented fracture of the acromion and lateral angle of the spine of the scapula, classified as Ogawa 1 and 3; Kunt 3; and AO A1, respectively. CONCLUSION: Segmental fracture of the acromion and lateral angle of the spine of the scapula with subacromial space reduction requires surgical intervention in order to avoid secondary complications. Early diagnosis favors better prognosis.

Avaliação de métodos radiográficos utilizados na localização vertical de sítios eleitos para instalação de mini-implantes / The accuracy of radiographic techniques used for vertical localization of mini-implants fixture placement

OBJETIVO: avaliar a efetividade de métodos de diagnóstico por imagem utilizados na localização vertical de sítios eleitos para inserção de mini-implantes. METODOLOGIA: a amostra foi composta de quatro pacientes, nos quais foram estabelecidos 32 sítios inter-radiculares, na região posterior, para instalação de mini-implantes, sítios estes representados por orifícios preenchidos com guta-percha em moldeiras de acetato (PCg - ponto de contato das coroas dentárias na moldeira de acetato; PIg - ponto de inserção do mini-implante na moldeira de acetato). Foram feitas radiografias periapicais, interproximais e tomografias computadorizadas de feixe cônico, com as moldeiras posicionadas em boca, sendo considerados os seguintes pontos: PC - imagem radiodensa do ponto PCg; PI - imagem radiodensa do ponto PIg; PCx - ponto de contato entre as coroas dentárias, determinado sobre a radiografia. Medidas verticais utilizadas: padrão-ouro - de PCg a PIg; medida 1 - de PC a PI; e medida 2 - de PCx a PI. As medidas foram comparadas através de análise descritiva e do teste t de Student. RESULTADOS: para a medida 1, foi observada diferença estatisticamente significante, em relação ao padrão-ouro, em 4,1 por cento, 25 por cento e 100 por cento das medidas avaliadas nas tomografias computadorizadas, radiografias interproximais e periapicais, respectivamente. Para a medida 2, foi observada diferença estatisticamente significante, em relação ao padrão-ouro, em 4,1 por cento, 56,2 por cento e 100 por cento das medidas avaliadas nas tomografias computadorizadas, radiografias interproximais e periapicais, respectivamente CONCLUSÕES: a tomografia computadorizada de feixe cônico foi o exame mais preciso na avaliação da posição vertical dos sítios eleitos para instalação de mini-implantes; a radiografia interproximal pode, com reserva, ser utilizada; a radiografia periapical apresentou resultados insatisfatórios, sendo contra-indicada para este fim.

OBJECTIVE: Evaluate the effectiveness of image diagnosis methods used in the vertical location of sites elect to insert mini-implants. METHODS: The sample was composed of four patients, in which 32 inter-radicular sites were established in the subsequent area, for setting up mini-implants. These sites were represented by holes filled out with guta-percha in acetate moulder (PCg - contact point of dental crowns in the acetate moulder; PIg - point of insertion of the mini-implant in the acetate moulder). Periapical X-rays, interproximal and computerized tomographies of cone-beam, with the moulders positioned in mouth, were performed and the following points were taken into consideration: PC - radiodense image of the PCg point; PI - radiodense image of the PIg point; PCx - contact point among the determined dental crowns on the X-ray. Vertical measures used: gold-pattern from PCg to PIg; measure 1 - from PC to PI; and measure 2 - from PCx to PI. The measures were compared through descriptive analysis and test t of Student. RESULTS: For the measure 1, differences statistically significant were observed (4.1 percent), in relation to the gold-pattern, 25 percent and 100 percent of the appraised measures in the computerized tomographies, interproximal and periapical X-rays, respectively. For the measure 2, differences statistically significant were observed in relation to the gold-pattern (4.1 percent), 56.2 percent and 100 percent of the appraised measures in the computerized tomographies, interproximal and periapical X-rays, respectively CONCLUSIONS: The cone-beam computerized tomography was the most precise exam in the evaluation of the vertical position of the elect sites to install mini-implants; the interproximal X-ray can, with reservation, be also used; the periapical X-ray presented unsatisfactory results, being contraindicated for this purpose.

Diagnóstico pré-natal das cardiopatias congênitas e arritmias pela ecodopplercardiografia / Prenatal diagnosis of congenital heart diseases and cardiac dysrrhythmias by echocardiography

Detectar precocemente cardiopatias congênitas e arritmias pela EcoDopplercardiografia em gestantes pertencentes ao grupo de risco para tais alteraçöes de acordo com as indicaçöes clássicas. Ecocardiografia bidimensional associada ao Modo M e Doppler foi realizada em 200 gestantes pelas seguintes indicaçöes: diabete materna, arritmia fetal, filho anterior com cardiopatia, retardo de crescimento intra-uterino, hidropsia fetal näo imune, rubéola materna, isoimunizaçäo, malformaçöes fetais ao ultra-som, polihidrámnio, gemelidade, oligoâmnio, ingestäo materna de drogas, lupus eritematoso sistêmico e outros. Anormalidades estruturais isoladas foram encontradas em 6 casos e associadas com bradiarritmia em 5 casos (total 5,5%). Arritmias fetais sem malformaçäo cardíaca ocorreram em 30 casos (15%) sendo a extrrasistolia atrial a mais freqüente. Os achados deste estudo inicial indicam que a anatomia e funçäo cardíaca fetal podem ser avaliados com precisäo. Baseados nisto, temos divulgado o método enfatizando suas indicaçöes, com a finalidade de proporcionar cada vez mais assistência adequada ao feto e ao recém-nascido portadores de cardiopatia congênita ou arritmia

Purpose - To detect in prenatal life fetal arrhythmia and congenital heart disease. We performed fetal echocardiography following classical indications according to the literature. Patients and Methods - Two-dimensional echocardiography associated with M-mode and Doppler was performed in 200 patients according to the indications: maternal diabetes, fetal arrhythmia, maternal congenital heart disease, previous fetus with cardiac defect, intrauterine growth retardation, nonimmune fetal hydrops, rubeola, isoimunization, fetal malformation by ultrasound, polyhidramnio, gemelarity, olygohydramnio, maternal ingestion of drugs, lupus and others. Results - Structural abnormalities of the heart were found in 6 cases and associated with bradiarrhythmia in 5 cases (total of 5,5%). Fetal arrhythmias without cardiac malformation were found in 35 cases (17,5%) and premature atrial contractions were the most frequent. Conclusion - The findings in this study indicate that it is possible the accurate definition of the cardiac anatomy and function. We have enphazised the method trying to spread it, objecting to improve assistance to the fetus and newborn with arrhythmias anal or congenital heart disease