Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

Image quality, reading, and mammography service in four diagnostic imaging centers in Manizales, Colombia / Calidad de las imágenes, la lectura y el servicio de mamografía en cuatro centros de imagenología de Manizales, Colombia.

Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city's diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.

Introducción. La calidad de la mamografía está directamente relacionada con la capacidad para detectar anormalidades y, por ello, es necesario el control de calidad en los centros de imágenes diagnósticas. Objetivo. Evaluar la calidad de la imagen, la lectura y el servicio de mamografía de algunos centros de imágenes diagnósticas en Manizales, Colombia. Materiales y métodos. Cuatro centros participaron de forma voluntaria y bajo acuerdos de confidencialidad en el estudio. De las 520 mujeres atendidas en ellos, a 318 se les hicieron mamografías. A partir de una inspección visual del servicio, se evaluaron la infraestructura, la tecnología y el personal de la unidad. Un radiólogo experto en lectura e interpretación clínica de imágenes mamarias evaluó la calidad de la imagen y la de su lectura. El análisis estadístico se hizo utilizando un anova y determinando el índice kappa y el porcentaje de desacuerdo. Resultados. Se encontró falta de calidad de las imágenes obtenidas, principalmente, por presencia de artificios en el 75 % de ellas, e identificación y rotulación deficientes; además, en la toma de la proyección oblicua medio-lateral, se encontró falta de visualización del ángulo inframamario. El grado de concordancia en el reporte BI-RADS fue bajo en los cuatro centros, con diferencias importantes en el informe y la descripción de los hallazgos. Conclusión. Los centros de imágenes diagnósticas evaluados están habilitados para el funcionamiento, pero se encontraron deficiencias importantes en la calidad de las imágenes y en su lectura, lo que pone de manifiesto la necesidad de establecer estándares de calidad y mejorar los aspectos que se puedan mejorar.

Calidad de las imágenes, la lectura y el servicio de mamografía en cuatro centros de imagenología de Manizales, Colombia / Image quality, reading, and mammography service in four diagnostic imaging centers in Manizales, Colombia

Resumen | Introducción. La calidad de la mamografía está directamente relacionada con la capacidad para detectar anormalidades y, por ello, es necesario el control de calidad en los centros de imágenes diagnósticas. Objetivo. Evaluar la calidad de la imagen, la lectura y el servicio de mamografía de algunos centros de imágenes diagnósticas en Manizales, Colombia. Materiales y métodos. Cuatro centros participaron de forma voluntaria y bajo acuerdos de confidencialidad en el estudio. De las 520 mujeres atendidas en ellos, a 318 se les hicieron mamografías. A partir de una inspección visual del servicio, se evaluaron la infraestructura, la tecnología y el personal de la unidad. Un radiólogo experto en lectura e interpretación clínica de imágenes mamarias evaluó la calidad de la imagen y la de su lectura. El análisis estadístico se hizo utilizando un anova y determinando el índice kappa y el porcentaje de desacuerdo. Resultados. Se encontró falta de calidad de las imágenes obtenidas, principalmente, por presencia de artificios en el 75 % de ellas, e identificación y rotulación deficientes; además, en la toma de la proyección oblicua medio-lateral, se encontró falta de visualización del ángulo inframamario. El grado de concordancia en el reporte BI-RADS fue bajo en los cuatro centros, con diferencias importantes en el informe y la descripción de los hallazgos. Conclusión. Los centros de imágenes diagnósticas evaluados están habilitados para el funcionamiento, pero se encontraron deficiencias importantes en la calidad de las imágenes y en su lectura, lo que pone de manifiesto la necesidad de establecer estándares de calidad y mejorar los aspectos que se puedan mejorar.

Abstract | Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city's diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.

A comprehensive analysis on nanostructured materials in a thermoelectric micro-system based on geometric shape, segmentation structure and load resistance.

In this study, we report the novel energy behavior of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG). Several physical elements of the materials must be considered to determine their behavior in the thermoelectric energy conversion: temperature dependence of material properties, geometric structure, segmentation, and the symmetry of each or both p-type and n-type nanostructure semiconductor thermoelements. Recently, many efforts have reported effects independent on the thermoelectric performance of semiconductor materials. In this work, exhaustive research on the performance of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG) was carried out. Our results show the efficiency and output power of the TEG using the temperature-dependent model, i.e., a variable internal resistance for a load resistance of the system. Our approach allows us to analyze symmetrical and asymmetric geometries, showing maximum and minimum peaks values in the performance of the TEG for specific [Formula: see text] values. The performance of the TEG is improved by about [Formula: see text] and [Formula: see text], for efficiency, and output power, respectively, considering a trapezoidal geometric shape in the 2p-3n segmented system, compared with the conventional rectangular shape.

Health Services, Socioeconomic Indicators, and Primary Care Coverage in Mortality by Lower Genital Tract and Breast Neoplasias in Brazilian Women during Reproductive and Non-Reproductive Periods.

Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (ß = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (ß = 9.7; 95% CI, 1.5 to 18.0).

Design of Nano-Structured Micro-Thermoelectric Generator: Load Resistance and Inflections in the Efficiency.

In recent years the interest for the harvest of energy with micro thermoelectric generators ( µ TEG) has increased, due to its advantages compared to technologies that use fossil fuels. There are three ways to improve the performance of the device, by modifying its structure, type of material and operation control. In this study, the role of the load resistance R L on the performance of a µ TEG with nanostructured materials is investigated. The interaction of the load resistance with the thermoelements exhibits interesting features, arising from the coupling of the temperature-dependent electrical and thermal transport properties at different temperature ranges and the architecture of nanostructured thermoelectric materials. This coupling results in inflections on the efficiency, i.e., maximum and minimum values of the efficiency at higher temperatures, 600-900 K. We show the explicit dependence of the performance of the µ TEG in terms of the load resistance and discuss the underlying physics. The unusual features of the efficiency of nanostructured thermoelectric materials are a result of the behavior of the power factor and the nonequilibrium properties of the system. We also analyze the effect of the geometric shape of the thermoelements on the device. We determine the performance of the µ TEG, evaluating the generation power and its efficiency. The results show that the efficiency of the device can decrease or increase depending on the value of R L , while the power decreases with an increase of the load resistance.

Performance of Segmented Thermoelectric Cooler Micro-Elements with Different Geometric Shapes and Temperature-Dependent Properties.

In this work, the influences of the Thomson effect and the geometry of the p-type segmented leg on the performance of a segmented thermoelectric microcooler (STEMC) were examined. The effects of geometry and the material configuration of the p-type segmented leg on the cooling power ( Q c ) and coefficient of performance ( C O P ) were investigated. The influence of the cross-sectional area ratio of the two joined segments on the device performance was also evaluated. We analyzed a one-dimensional p-type segmented leg model composed of two different semiconductor materials, B i 2 T e 3 and ( B i 0.5 S b 0.5 ) 2 T e 3 . Considering the three most common p-type leg geometries, we studied both single-material systems (using the same material for both segments) and segmented systems (using different materials for each segment). The C O P , Q c and temperature profile were evaluated for each of the modeled geometric configurations under a fixed temperature gradient of Δ T = 30 K. The performances of the STEMC were evaluated using two models, namely the constant-properties material (CPM) and temperature-dependent properties material (TDPM) models, considering the thermal conductivity ( κ ( T ) ), electrical conductivity ( σ ( T ) ) and Seebeck coefficient ( α ( T ) ). We considered the influence of the Thomson effect on C O P and Q c using the TDPM model. The results revealed the optimal material configurations for use in each segment of the p-type leg. According to the proposed geometric models, the optimal leg geometry and electrical current for maximum performance were determined. After consideration of the Thomson effect, the STEMC system was found to deliver a maximum cooling power that was 5.10 % higher than that of the single-material system. The results showed that the inverse system (where the material with a higher Seebeck coefficient is used for the first segment) delivered a higher performance than the direct system, with improvements in the C O P and Q c of 6.67 % and 29.25 % , respectively. Finally, analysis of the relationship between the areas of the STEMC segments demonstrated that increasing the cross-sectional area in the second segment led to improvements in the C O P and Q c of 16.67 % and 8.03 % , respectively.

Breast cancer screening in developing countries.

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms "Breast Cancer" or "Breast Cancer Screening" and "Developing Country" or "Developing Countries". In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.

Breast cancer screening in developing countries

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.

Cirurgia oncoplástica e reconstrutiva da mama: Reunião de Consenso da Sociedade Brasileira de Mastologia / Oncoplastic and reconstructive surgery of the breast: Consensus Meeting of the Brazilian Society of Mastology

Objetivo: Apesar do grande número de publicações em cirurgia oncoplástica e reconstrutiva da mama, diversas questões permanecem controversas. Assim, o objetivo desta Reunião de Consenso, foi desenvolver um guia prático de recomendações baseadas nas melhores evidências disponíveis na literatura. Método: Os painelistas foram os membros da Comissão de Cirurgia Oncoplástica e Reconstrutiva da Sociedade Brasileira de Mastologia. A reunião foi realizada em agosto de 2015 em Bento Gonçalves (RS). Cada painelista recebeu e respondeu previamente um questionário com 46 itens, com base na melhor evidencia cientifica e em sua experiência. Foi considerado consenso a concordância de 75% entre painelistas. Resultados: Houve consenso em 25 itens, dos quais para oito houve concordância de 100%. O mais importantes foram: comprometimento das margens em cirurgia oncoplástica pode ser resolvido com ampliação de margens na maioria dos casos; tumores multifocais não são contraindicação para cirurgia oncoplástica; idade >70 anos não representa contraindicação para uso de técnicas oncoplásticas; reconstrução imediata pode ser indicada com segurança para a maioria das candidatas à mastectomia; pacientes com indicação de radioterapia pós-mastectomia podem ser submetidas à reconstrução imediata, devendo ter ciência dos riscos maiores para mau resultado estético; mastectomia com preservação do complexo areolopapilar é segura nos casos de câncer; radioterapia após a mastectomia com preservação do complexo areolopapilar não está indicada fora dos critérios clássicos de irradiação do plastrão; tela abdominal reduz chances de hernia no caso de reconstrução com TRAM. Conclusão: através desta reunião foi possível estabelecer importantes pontos consensuais de acordo com a opinião dos especialistas, que poderão auxiliar os mastologistas na tomada de decisões em cirurgias oncoplásticas e reconstrutivas da mama.

Objective: Despite the large number of publications in oncoplastic and breast reconstructive surgery, several issues remain controversial. The aim of this Consensus Meeting was to develop a practical guide of recommendations based on the best evidence in the literature. Method: All panelists were members of the Oncoplastic Commission of the Brazilian Society of Mastology. The Consensus Meeting was held in Bento Gonçalves (RS), in August 2015. Each panelist received and answered a questionnaire with 46 items, based on the best evidence in the literature and in their expertise. It was considered consensus the agreement of 75% between panelists. Results: There was consensus on 25 items, of which eight were for 100% agreement. The most important of these topics were: involvement of the margins in oncoplastic surgery can be solved by resection of margins in most cases; multifocal tumors is not a contraindication for oncoplastic surgery; age >70 years is not a contraindication for use of oncoplastic techniques; immediate reconstruction can be performed safely to most candidates for mastectomy; patients for post-mastectomy radiotherapy may be subject to immediate reconstruction and should be aware of the risks for poor aesthetic result; mastectomy with preservation of the nipple and areola complex is safe in cancer; radiotherapy after mastectomy with preservation of the nipple and areola complex is not indicated outside the classical criteria of irradiation chest wall; abdominal mash reduces chances of hernia in TRAM flaps. Conclusion: In this meeting it was possible to establish important consensus points according to the opinion of experts, which can help breast surgeons in their decision-making in oncoplastic and reconstructive surgery of the breast.

Enfermedad de Vogt-Koyanagi-Harada y rehabilitación visual / Vogt-Koyanagi-Harada disease and visual rehabilitation

La enfermedad de Vogt-Koyanagi-Harada es una entidad infrecuente, multisistémica, de etiología desconocida, presuntamente autoinmune, caracterizada por panuveítis granulomatosa crónica bilateral y difusa, acompañada de participación tegumentaria, neurológica y auditiva, que afecta con mayor frecuencia la raza no caucasiana y, por lo general, a mujeres. Se presenta generalmente entre los 20-50 años de edad. Su incidencia varía geográficamente. Se estima que el 25 por ciento de los pacientes con esta enfermedad son ciegos legales; que el 25 por ciento puede presentar baja visión y el 50 por ciento agudeza visual mayor de 20/50. Se presenta una paciente de 50 años de edad con antecedentes de enfermedad de Vogt-Koyanagi-Harada, de 8 años de evolución, quien ha llevado tratamiento con antinflamatorios esteroideos sistémicos e inmunosupresores, así como terapia de apoyo con antinflamatorios esteroideos tópicos y ciclopléjicos. Acudió a la consulta de baja visión y se le realizó examen oftalmológico completo, estudios complementarios y se rehabilitó mediante el uso de ayudas ópticas y no ópticas para lograr el mayor aprovechamiento de su resto visual(AU)

Vogt-Koyanagi-Harada (VKH) is a rare, multisystemic, allegedly autoimmune disease of unknown etiology. It is characterized by chronic bilateral granulomatous and diffuse panuveitis, accompanied by tegumentary, neurological and hearing impairments that often affect the non-Caucasians and usually women. It usually occurs in the 20-25 years age group and its incidence varies with the geographic location. It is estimated that 25 percent of the patients with this disease are legally blind, the other 25 percent may have low vision and 50% present with visual acuity over 20/50. There is a 50 years-old patient with a history of Vogt - Koyanagi - Harada disease for 8 years. He had been treated with systemic steroid anti-inflammatory drugs and immunosuppressive therapy as well as supporting therapy with topical and cycloplegic steroid anti-inflammatories. The patient had gone to the low vision service looking for rehabilitation. He was performed a complete eye examination, supplementary studies and he was finally rehabilitated through the use of optical and non-optical aids in order to maximize his remaining vision(AU)

Capacidad funcional y calidad de vida en los ancianos con degeneración macular y baja visión / Functional capacity and quality of life in elderly patients with macular degeneration and low vision

OBJETIVO: caracterizar la capacidad funcional y la calidad de vida en los ancianos con degeneración macular y baja visión, atendidos en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” en el período comprendido de enero a junio de 2013. MÉTODOS: se realizó un estudio descriptivo, de corte transversal. Fueron estudiadas las siguientes variables: edad, sexo, color de la piel, agudeza visual mejor corregida de cerca con cartilla Zeiss, antes y después de la rehabilitación visual, discapacidad visual, capacidad funcional para las actividades de la vida diaria, tipo clínico de degeneración macular, factores de riesgo de la enfermedad, motivación para la rehabilitación visual y ayudas ópticas y no ópticas prescritas. RESULTADOS: existió un predominio de la enfermedad en las mujeres (55,2 %), entre los 75-79 años de edad y en el color de la piel blanca. La discapacidad visual que prevaleció fue la baja visión ligera a moderada; la capacidad funcional mayormente encontrada fue la independencia con alguna limitación. La degeneración macular seca se presentó en el 82,7 % de los casos; el factor de riesgo más frecuente fue el tabaquismo (82,7 %); la lectoescritura fue la motivación principal y el mayor número de pacientes mejoró la agudeza visual después de la rehabilitación visual. Las ayudas ópticas y no ópticas que más se prescribieron fueron los microscopios y la iluminación. CONCLUSIONES: el grupo de edades entre 75 y 79 años, el sexo femenino y la piel blanca o caucasiana son los factores que aportan un mayor número de casos de degeneración macular y baja visión. La discapacidad visual que prevalece es la de los clasificados como baja visión ligera a moderada. La degeneración macular seca se presenta en casi la totalidad de los casos. Los factores de riesgo más frecuentes son el tabaquismo, la herencia y las enfermedades cardiovasculares. El mayor número de pacientes mejora después de la rehabilitación visual.

OBJECTIVE: to characterize the functional capacity and the quality of life of the elderly people with macular degeneration and low vision who were seen at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from January to June 2013. METHODS: cross-sectional and descriptive study that included the following variables: age, sex, race, best corrected near visual acuity using Zeiss chart before and after visual rehabilitation, visual disability, functional capacity for daily life activities, clinical type of macular degeneration, risk factors for the disease, reason for visual rehabilitation and prescribed optical and non-optical aids. RESULTS: the disease prevailed in females (55,2 %), 75-79 years-old age group and Caucasians. Predominant visual disability was mild to moderate low vision; the mostly found functional capacity was independence with some limitations. Dry macular degeneration was present in 82,7 % of cases; the most frequent risk factor was smoking (82,7 %); reading and writing was the main motivation and a large number of patients improved their visual acuity after rehabilitation. The optical and non-optical aids that were mostly prescribed included microscopes and lighting. CONCLUSIONS: females, 75-79 years-old age group and Caucasians are the risk factors that cause the highest number of cases with macular degeneration and low vision. Visual disability prevailed among those classified as mild to moderate low vision patients. Dry macular degeneration was present in almost all the cases. The most frequent risk factors were smoking, heredity and cardiovascular diseases. Most of the patients improved their condition after visual rehabilitation.

Caracterización actualizada del síndrome de ALTE / Upadated characterization of ALTE syndrome

El ALTE no es una enfermedad específica en sí misma, sino una forma de presentación clínica de diversas enfermedades, su incidencia se estima en 6 por 1 000 en aquellos lactantes nacidos a término, y asciende a un 86 por 1 000 en los nacidos pretérmino. Su etiología es multifactorial, el diagnóstico es difícil y precisa de experiencia, y la conducta depende de las causas que lo originen. Esta afección poco reconocida en la práctica médica actual, genera una enorme ansiedad en la familia, y constituye un desafío en cuanto al diagnóstico, manejo y consejos por parte del pediatra

Apparent life-threatening event (ALTE) is not a specific disease, rather a form of clinical presentation of several diseases. Its incidence rate is estimated to be 6 per 1000 in the term infants and 86 per 1000 in preterm infants. The etiology of the event is multifactoral, the diagnosis is difficult and requires experience, and the behavior to be adopted depends on the causes that bring it about. This poorly recognized illness in the present medical practice gives rise to a lot of anxiety for the family and represents a true challenge in terms of diagnosis, management and counseling by the pediatrician