First Colombian consensus on congenital Chagas and clinical approach for women of child-bearing age diagnosed with Chagas / Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital¼, «prevention and control¼, «diagnosis¼, «therapeutics¼ and «pregnancy¼. Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas con- génito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos Mes (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizo, clasifico y organizo en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.

Simultaneous Papillary Carcinoma in Thyroglossal Duct Cyst and Thyroid.

Thyroglossal duct cyst (TDC) is a cystic expansion of a remnant of the thyroglossal duct tract. Carcinomas in the TDC are extremely rare and are usually an incidental finding after the Sistrunk procedure. In this report, an unusual case of a 36-year-old woman with concurrent papillary thyroid carcinoma arising in the TDC and on the thyroid gland is presented, followed by a discussion of the controversies surrounding the possible origins of a papillary carcinoma in the TDC, as well as the current management options.

Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas / First Colombian consensus on congenital Chagas and clinical approach to women of fertile age diagnosed with Chagas

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas congénito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos MeSH (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizó, clasificó y organizó en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. In order to generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: " Chagas disease/congenital " , " prevention and control " , " diagnosis " , " therapeutics " and " pregnancy " . Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-toface discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

Conceptual design pattern for ergonomic workplaces.

In this paper, we analyzed two laboratories of liquid chromatography (LC), separation technique of mixtures and identification of its components, in order to identify projectual gaps relating to the environment and the working station. The methodology used was the ergonomic analysis with interactional and participatory techniques applied during the activity performance. This work incorporated and adapted the concept developed by Alexander (1979)--pattern languages--passing from architectural projects to workstations project and physical arrangement of the work environment. The adaptation of the concept resulted in a list of recommendations, requirements and concepts that have brought design solutions for the problematic aspects observed in the ergonomic analysis. The employed methodology, strongly supported in ergonomics principles, and in interactional and participatory techniques, contributed to achieve our gold that is what we now call Conceptual Standards. The patterns go beyond of a usual model of book a of ergonomics specification, once incorporating the viewpoint of the end user, it is also a set of best project practices and of project management in conception ergonomics.

[Survival and larval development of Spodoptera frugiperda (J E Smith) (Lepidoptera: Noctuidae) on alternatives host]. / Sobrevivência e desenvolvimento larval de Spodoptera frugiperda (J E Smith) (Lepidoptera: Noctuidae) em hospedeiros alternativos.

Two bioassays were conducted to evaluate the suitability of host plants of fall armyworm (FAW), Spodoptera frugiperda (J E Smith), in the Brazilian agro-ecosystem. Larval development and survival were analyzed by infesting leaves of maize, grain sorghum, Johnson grass, soybean, Brachiaria and tobacco with FAW newly hatched larvae in a no choice test. No significant differences of survival were observed among insects reared on different hosts, except for tobacco, where no survivors were recorded. Larvae fed on soybean and artificial diet grew larger than those fed on the other hosts. The heaviest pupa was observed from larva fed on artificial diet and the lighter from larva fed on Brachiaria grass. No significant differences were reported on larval development time on natural hosts, but it was longer for larvae reared on artificial diet. Three classes of larval development time were observed on maize, four on sorghum, Brachiaria and soybean, and five on artificial diet. Nearly 85% of FAW larvae completed development within 12 d on maize; 77% on grain sorghum, 80% on Johnson grass, 68% on Brachiaria and 83% on soybean within 14 d and 69% on artificial diet within 17 d. The host suitability to FAW decreases from maize to sorghum, soybean and Brachiaria.

Sobrevivência e desenvolvimento larval de Spodoptera frugiperda (J E Smith) (Lepidoptera: Noctuidae) em hospedeiros alternativos / Survival and larval development of Spodoptera frugiperda (J E Smith) (Lepidoptera: Noctuidae) on alternatives host

Dois bioensaios foram conduzidos para avaliar a adaptação da lagarta-do-cartucho (LCM), Spodoptera frugiperda (J E Smith), em alguns de seus hospedeiros mais comuns nos agroecossistemas brasileiros. Em testes de confinamento, utilizando lagartas recém-eclodidas e seções de folhas de milho (Zea mays), sorgo granífero (Sorghum bicolor), sorgo selvagem (Sorghum sp.), braquiária Brachiaria sp., soja (Glycine max) e fumo (Nicotiana tabacum), foram observados a sobrevivência e o desenvolvimento larval da LCM. A sobrevivência da LCM nos diferentes hospedeiros foi acima de 80 por cento, exceto nas folhas de fumo, que foi nula. O acúmulo de biomassa nas lagartas desenvolvidas na soja e na dieta artificial foi maior do que nos demais hospedeiros. A maior biomassa foi das pupas de lagartas alimentadas na dieta artificial e a menor nas lagartas e pupas provenientes da braquiária. A menor média do período larval foi dos insetos desenvolvidos no milho e a maior nos alimentados na dieta artificial Foram observadas três classes de período larval no milho; quatro no sorgo, na braquiária e na soja e cinco na dieta artificial As porcentagens aproximadas dos indivíduos da LCM que completaram o período larval foram 85 por cento até o 12º. dia em milho; 77 por cento em sorgo granífero, 80 por cento em sorgo selvagem, 83 por cento em soja e 68 por cento em braquiária, até o 14º dia; e 69 por cento na dieta artificial até o 17º dia. Portanto, a adaptação da LCM foi melhor no milho, intermediária no sorgo e na soja e pior na braquiária.

Two bioassays were conducted to evaluate the suitability of host plants of fall armyworm (FAW), Spodoptera frugiperda (J E Smith), in the Brazilian agro-ecosystem. Larval development and survival were analyzed by infesting leaves of maize, grain sorghum, Johnson grass, soybean, Brachiaria and tobacco with FAW newly hatched larvae in a no choice test. No significant differences of survival were observed among insects reared on different hosts, except for tobacco, where no survivors were recorded. Larvae fed on soybean and artificial diet grew larger than those fed on the other hosts. The heaviest pupa was observed from larva fed on artificial diet and the lighter from larva fed on Brachiaria grass. No significant differences were reported on larval development time on natural hosts, but it was longer for larvae reared on artificial diet. Three classes of larval development time were observed on maize, four on sorghum, Brachiaria and soybean, and five on artificial diet. Nearly 85 percent of FAW larvae completed development within 12 d on mayze; 77 percent on grain sorghum, 80 percent on Johnson grass, 68 percent on Brachiaria and 83 percent on soybean within 14 d and 69 percent on artificial diet within 17 d. The host suitability to FAW decreases from maize to sorghum, soybean and Brachiaria.

Terceira janela da orelha interna: o que significa / Third window: what is it means

A deiscência do canal semicircular superior foi descrita por Minor e cols. em 1998 e tem como definição a ausência de cobertura óssea sobre o canal semicircular superior na zona próxima à duramáter na fossa craniana média, o que seria equivalente a uma terceira janela. Sabe-se que qualquer processo que crie uma comunicação adicional com o labirinto leva a sinais e sintomas clínicos semelhantes, sendo, portanto, denominado terceira janela. Os objetivos deste trabalho são apresentar o conceito de terceira janela, destacar a fisiopatologia, a clínica e os diagnósticos diferenciais, e discutir os achados de imagem, inclusive com casos de nosso serviço. As janelas redonda e oval são as duas aberturas fisiológicas do sistema hidráulico da orelha interna. Medianteuma terceira janela, este sistema é rompido e há alteração da fisiologia do labirinto, gerando sinais e sintomas auditivos e vestibulares. Terceira janela é um novo conceito no campo da otologia. O tratamento por parte do otorrinolaringologista depende da identificação desse distúrbio peloradiologista.

The superior semicircular canal dehiscence was described first time by Minor in 1998 and the definition is the absence of bone cover on superior semicircular canal in the zone adjacent duramater, equivalent third window. Any process that does a labyrinth additional communication produces similar signs and symptoms, denominated third window. The objective of this study was to introduce the third window conception, emphasizing physiology,pathology, clinical issues and different diagnostic, discussing imaging findings, together with cases of owner service. The oval and round windows are physiologies openings hydraulic system of the inner ear. Through a third window, this system is breaking and has a labyrinth physiology disorder, producing vestibular signs and symptoms and hearing loss. Third window is a new conception. Adequate treatment by specialist doctor depends on correct identification by radiologist.

Experiência inicial com o uso de adesivo tissular contendo trombina para tratamento do pseudo-aneurisma femoral / Treatment of femoral pseudoaneurysm with thrombin tissue adhesive: initial experience

O pseudo-aneurisma (PSA) após cateterização femoral tem sido diagnosticado com regularidade em serviços com grande movimento de intervenções percutâneas, com incidência variando de 0,05 a 6 por cento. PSA femorais pequenos podem ser acompanhados até a resolução espontânea. As opções de tratamento são: compressão guiada por ultra-som, injeção de trombina para trombose do PSA e tratamento cirúrgico. A injeção percutânea de trombina tem a vantagem de ser um procedimento indolor e rápido. Podem ser utilizados trombina isolada ou preparados contendo trombina associada a fibrinogênio e fatores de coagulação. A experiência inicial dos autores de cinco casos tratados com injeção de adesivo tissular contendo trombina mostrou resultado satisfatório em quatro; um caso necessitou tratamento cirúrgico. Não houve sucesso com uso isolado de trombina humana, porém, ocorreu trombose imediata após injeção de preparado de trombina associada a fibrinogênio/fator XIII. Neste artigo, são discutidas as opções de tratamento dos PSA femorais e a técnica do uso de trombina percutânea.

Ultra-som na avaliaçäo da doença nodular da tireóide: experiência de um grupo multidisciplinar / Ultrasonography in the evaluation of thyroid nodular disease: experience of a multidisciplinary group

O objetivo do trabalho foi correlacionar as características ecográficas dos nódulos tireóideos aos achados citológicos, para determinar a importância da ultra-sonografia na doença nodular da tireóide. Foram realizadas punçöes aspirativas por agulha fina orientadas por ultra-som, após avaliaçäo e classificaçäo ecográfica de 436 nódulos. Obteve-se celularidade adequada para análise em 401 nódulos (92 por cento), procedendo-se à correlaçäo ecográfico/citológica. A classificaçäo utilizada permitiu distribuir as características ecográficas de acordo com o risco de malignidade, identificando nódulos Grau III císticos com foco sólido (citologia positiva em 23,8 por cento) e sólidos hipoecóicos (40 por cento) como suspeitos e os Grau IV (95,2 por cento) como altamente suspeitos. Os nódulos Grau II sólidos iso e hiperecóicos (5 por cento) e mistos (1 ,9 por cento), em acordo com a literatura, foram considerados provavelmente benignos. O ultra-som forneceu auxílio importante à avaliaçäo clínica e determinaçäo da conduta a ser tomada, devendo fazer parte dos protocolos para avaliaçäo inicial e acompanhamento da doença nodular da tireóide.