Modified PATIO technique for urethrocutaneous fistula after hypospadias repair: Experience from a tertiary referral hospital.

INTRODUCTION: Urethrocutaneous fistula (UCF) is a common complication after hypospadias repair with an incidence of 5-10%. Several techniques are described for its repair: small UCFs are frequently corrected by isolation, excision, and closure with apposition of a protective second layer. In 2008 Malone described the PATIO technique: the fistula tract is turned inside out in the urethral lumen preventing contact with passing urine without direct urethral sutures. OBJECTIVE: Aim of our study is to present our outcomes using a modified version of the PATIO technique, with a more reproducible isolation of the tract and without its fixation at the urethral meatus. STUDY DESIGN: We retrospectively reviewed all cases of UCFs corrected with a modified PATIO technique at our center between 2016 and 2020. Data collected from electronical clinical notes were age at UCF closure, location of UCF, presence of meatal stenosis and clinical outcomes. Data are presented as median and IQR. RESULTS: In the study period we performed 425 urethroplasties for distal and mid penile hypospadias. The incidence of UCFs was 7% (30/425) and 25 patients underwent UCF correction with modified PATIO. Median age at repair was 4.5 years (IQR: 2.5-6.2). At a median follow-up of 3 years (IQR: 2-4) recurrence was observed in 5 cases out of 24 with one patient who was lost at follow-up (20.8%). One case was corrected successfully with re-do modified PATIO technique, while 4 are awaiting repair. One cases was lost at follow-up. UFC-recurrence was homogeneously distributed along the study period. DISCUSSION: Risk factors for UCF recurrence are mostly the type of hypospadias, neo-urethral length, and quality of the urethral plate. Among the many existing techniques, we propose a modified version of Malone's PATIO repair. We believe that the use of four stay-suture to isolate the fistula allows a well-defined dissection of the tract along its surface, compared to the use of a single stay-suture. In our experience, there is no need to keep and fix the traction on the fistula tract to the urethral meatus, probably reflecting the efficacy of the fistula closure during the introflection, which is then maintained without traction. Limitations to our study include the retrospective nature of the review, the small sample size of the cohort and the absence of control groups. CONCLUSIONS: Our results appear consistent with literature regarding the efficacy of PATIO principles in treating UCF. Modified PATIO seem to be particularly reproducible, showing encouraging results.

Application of the ERAS guidelines in pediatric urological surgery: a systematic review.

INTRODUCTION: Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children. EVIDENCE ACQUISITION: A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed. EVIDENCE SYNTHESIS: Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies. CONCLUSIONS: There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.

[Depressive disorder and issues related to DiabetIMSS beneficiaries]. / Trastorno depresivo y aspectos relacionados con beneficiarios DiabetIMSS.

BACKGROUND: Diabetes mellitus type 2 (DM2) is the leading cause of death in people from 15 to 64 years in Mexico, and other regions in the world. For the chronic nature of diabetes and complications caused by inadequate metabolic control, patients may have mood disorders such as depression. Several studies have demonstrated higher prevalence of depression in diabetic patients than in general population. Our objective: is to determine prevalence and factors associated with depressive disorder in patients with type 2 diabetes mellitus enrolled in DiabetIMSS during 2010. METHODS: Analytical study with random probability sampling. The analysis included prevalence, odds ratios with 95% confidence intervals. The Center Epidemiological Studies Depression Instrument was used. RESULTS: Prevalence of depression was 32.7% at 95% CI = 26.4-38.9%), 67.3% for women, 32.7 % for men; good metabolic control was 51.9%, CI = 95% (45.13-58.66%). CONCLUSIONS: We found a higher prevalence of depressive disorders than in the general population, no statistical association with glycemic control, keeping a greater proportion of women as well as the main aspect of depression associated with the perception of emotional support. We discuss DiabetIMSS program effectiveness.

[Design and validation of an instrument about quality of the advance care planning for professionals]. / Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales.

OBJECTIVE: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD: Instrumental questionnaire validation study. SCOPE: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS: Pilot study with 28 professionals. Reliability É·=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

Obesity, physical activity and prediabetes in adult children of people with diabetes.

OBJECTIVES: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). METHODS: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. RESULTS: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). CONCLUSIONS: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

Efecto del contexto, rutinas y funcionamiento en la salud de familias mexicanas con diabetes tipo 2

RESUMEN Objetivo: Explicar el efecto del contexto, rutinas y funcionamiento familiar en la salud de familias mexicanas donde un integrante padece Diabetes mellitus tipo 2 (DM2). Material y Métodos: Diseño transversal-correlacional; previo consentimiento informado el reclutamiento y recogida de datos fue entre enero a abril de 2015; participaron 60 díadas familiares (n=120), conformadas por persona con DM2 y cuidador familiar, entre 18 a 66 años, sin distinción de género, que hubieran convivido bajo el mismo techo al menos por un año y asistían a consulta en una institución de salud en México durante el 2015. El contexto familiar se midió con una cédula, dos escalas midieron rutinas, funcionamiento y salud familiar. Resultados: Predominaron las mujeres (64,2%), de 47,5 (±11,5) años de edad, con escolaridad de 7,2 años (± 4,4), los enfermos diagnosticados hace 11,5 años (± 8,4), con tratamiento desde hace 9,2 años (± 8,6). Se encontraron interrelaciones significativas entre las variables del contexto (edad, años de estudio, tiempo de diagnóstico y tratamiento), rutinas y funcionamiento con la salud familiar (todas entre p≤ ,0001 y p ≤ ,005). El funcionamiento explicó el 39,1% y las rutinas el 18,8% de la varianza de la salud familiar (R2 ajustada= , 391; F(1,118)= 77,4; p≤ ,0001; R2ajustada= ,188; F(1,118)= 28,6; p≤ ,0001). El funcionamiento explicó la varianza de rutinas en 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusiones: La salud familiar se relaciona significativamente con el contexto, rutinas y funcionamiento de las díadas familiares que viven con diabetes tipo 2; además la salud familiar está influida significativamente por rutinas y funcionamiento familiar.

ABSTRACT Objective: To explain the effect of the context, routines and family functioning on the health of Mexican families where a member suffers from Type 2 Diabetes mellitus. Materials and Methods: Cross-correlational design; after prior informed consent, recruitment and data collection were carried out between January and April 2015. The sample included 60 family dyads (n = 120), consisting of a person with 2DM and a family caregiver, between 18 and 66 years old, without gender distinction, who had lived in the same home for at least one year and attended a consultation in a health institution in Mexico during 2015. The family context was measured with a card, two scales measured routines, family functioning and health. Results: There were more women (64.2%), aged 47.5 (± 11.5), with 7.2 years (± 4.4) of schooling; patients diagnosed 11.5 years ago (± 8.4), under treatment for 9.2 years (± 8.6). Significant interrelations were found between the context variables (age, years of study, diagnosis and treatment time), routines, and functioning regarding family health (all between p≤ .0001 and p ≤ .005). Functioning explained 39.1% and routines 18.8% of the family health variance (adjusted R2= .391; F (1.118) = 77.4 p≤ .0001; adjusted R2= .188; F (1.118) = 28.6 p≤ .0001). Functioning also explained the variance of routines in 19.3% (R2 = .193; F (1.118) = 28.1 p≤ .0001). Conclusions: Family health is significantly related to the context, routines and functioning of family dyads living with type 2 diabetes. In addition, family health is significantly influenced by routines and family functioning.

RESUMO Objetivo: Explicar o efeito do contexto, rotinas e funcionamento na saúde de famílias mexicanas onde um membro sofre de Diabetes mellitus Tipo 2 (DM2). Material e Métodos: Desenho transversal-correlacional; com consentimento informado prévio o recrutamento e coleta dos dados foram entre janeiro e abril de 2015; participaram 60 díades familiares (n = 120), formadas por pessoa com DM2 e cuidador familiar, entre 18 e 66 anos, sem distinção de gênero, que moraram na mesma casa por pelo menos um ano e que assistiam a uma consulta em uma instituição de saúde no México durante 2015. O contexto familiar foi medido com um cartão, duas escalas avaliaram as rotinas, o funcionamento e a saúde familiar. Resultados: Predominaram as mulheres (64,2%), de 47,5 (±11,5) anos, com escolaridade de 7,2 anos (± 4,4), as pessoas diagnosticadas há 11,5 anos (± 8,4), com tratamento há 9,2 anos (± 8,6). Foram encontradas inter-relações significativas entre as variáveis do contexto (idade, anos de estudo, tempo de diagnóstico e de tratamento), rotinas e funcionamento com a saúde familiar (todas entre p≤ ,0001 e p≤ ,005). O funcionamento explicou o 39,1% e as rotinas o 18,8% da variância da saúde familiar (R2ajustada= ,391; F(1,118)= 77,4 p≤ ,0001; R2 ajustada= ,188; F(1,118)= 28,6 p≤ ,0001). O funcionamento explicou a variância das rotinas em 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusões: A saúde familiar está significativamente relacionada ao contexto, rotinas e funcionamento das díades familiares que vivem com diabetes tipo 2; além disso, a saúde familiar está significativamente influenciada por rotinas e funcionamento familiar.

[Food insecurity and social vulnerability in chiapas : the face of poverty]. / Inseguridad alimentaria y vulnerabilidad social en chiapas: el rostro de la pobreza.

OBJECTIVE: To estimate the frequency, distribution, and trends of food security/insecurity conditions of families in Chiapas and their relationship with low income factor and sociodemographic characteristics. METHODS: Retrospective and cross-sectional descriptive study. Information of 1430 households from The National Health and Nutrition Survey 2012 was included. The Food Insecurity was measured using the harmonized version of the Latin and Caribbean Food Security Scale for México. RESULTS: 83% of households in Chiapas has some type of food insecurity, 86.5% is concentrated in the lower socioeconomic levels, 85% of households in rural areas have food insecurity, 87% of households beneficiary of Oportunidades still have food insecurity. DISCUSSION: A large part of this population continues to have high levels of Food Insecurity. Clearly targeted social programs designed to eliminate this lag, fail to reduce levels of access to food which affects the physical and intellectual potential development of Chiapas people, becoming an obstacle to the development of the State. Reorientation of food policy in México is considered.

Objetivo: estimar la frecuencia y distribución de seguridad o inseguridad alimentaria entre las familias en Chiapas, relacionar con condiciones de bienestar (CB) y características sociodemográficas. Método: Estudio transversal retrospectivo, descriptivo; incluye información proveniente de la Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT 2012) en total 1,430 viviendas de Chiapas. La Inseguridad Alimentaria se midió usando la versión armonizada para México de la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA). Resultados: El 83% de los hogares en Chiapas tiene algún tipo de inseguridad alimentaria; 86.5% se concentra en los niveles socioeconómicos más bajos; sólo 15 de cada 100 hogares en zonas rurales registran seguridad alimentaria; 87% de los hogares beneficiarios de Oportunidades mantiene inseguridad para alimentarse. Discusión: Más de cuatro de cada cinco familias reportan inseguridad alimentaria, queda claro que los programas sociales focalizados destinados a abatir este rezago no impactan los niveles de acceso a los alimentos, lo que repercute en el potencial desarrollo físico e intelectual de los chiapanecos, convirtiéndose en un obstáculo más para el desarrollo de la entidad. Se plantea analizar y reorientar las políticas sociales.

Suicidio y depresión en adolescentes: una revisión de la literatura Autores/as / Suicide and depress ion in adolescents: a literature review

ANTECEDENTES: Aunque el suicidio es un problema secular de la salud pública, la reciente preocupación es la edad y magnitud de ocurrencia, particularmente al asociarse a depresión. OBJETIVO: Revisar el estado del arte sobre el fenómeno del suicidio, sus vínculos con depresión en población adolescente y de adultos jóvenes e identificar los principales aspectos asociados, con el propósito de plantear estrategias de prevención. MÉTODO: Se realizó una revisión de la literatura usando las bases de datos científicas Scielo, Redalyc y Pubmed y los descriptores adolescencia, jóvenes, depresión, intento suicida, conducta suicida, suicidio, tanto en castellano como en inglés. Se incluyó un total de 53 artículos publicados entre 2013 y 2017 y se atendió fundamentalmente a la epidemiología y los factores asociados. RESULTADOS: Se reporta un amplio rango de prevalencia en el mundo, que va de 2.4 (Egipto) hasta 46.5 (Lituania) suicidas de entre 15 y 29 años por cada 100 mil habitantes, con un predominio de hombres. Además, se registra ideación suicida en hasta un tercio de la población menor de 20 años. Se reportan asociaciones con atributos de personalidad, adicciones, ambientes familiares y sociales hostiles, y carencia de credo religioso. DISCUSIÓN: El suicidio en jóvenes se percibe vinculado a violencia de tipo estructural, lo cual obliga a reflexionar sobre las opciones viables de desarrollo humano.

BACKGROUND: Although suicide has long been a public health concern, recent attention has focused on its elevated prevalence, particularly when associated with depression, and the age of the affected individuals. OBJECTIVE: To review literature related to the phenomenon of suicide and its association with depression in the adolescent population and to identify the principal associated factors, in order to propose prevention strategies. METHODS: A literature review was conducted using the databases Scielo, Redalyc and Pubmed and the keywords adolescence, youth, depression, suicide attempt, suicidal behavior, and suicide, in Spanish and in English. A total of 53 articles, published between 2013 and 2017, were included, and the analysis focused on the phenomenon's epidemiology and related associated factors. RESULTS: Suicide prevalence rates range widely worldwide, from 2.4 (Egypt) to 46.5 (Lithuania) per 100,00 inhabitants between 15 and 29 years of age, affecting more men than women. Additionally, approximately a third of individuals under 20 years of age have presented suicide ideation. There are reported associations between suicide and personality attributes, addictions, hostile family and social environments, and the absence of religious beliefs. DISCUSSIONS: Suicide in young adults is perceived to be linked to structural violence, which necessitates the exploration of viable options for human development.

Obesity, physical activity and prediabetes in adult children of people with diabetes / Obesidade, atividade física e pré-diabetes em filhos de pessoas com diabetes / Obesidad, actividad física y prediabetes en hijos de personas con diabetes

ABSTRACT Objectives: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). Methods: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. Results: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). Conclusions: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

RESUMO Objetivos: Determinar a prevalência de obesidade/sobrepeso, atividade física (AF) e pré-diabetes em filhos de pessoas com diabetes mellitus tipo 2; identificar diferenças de acordo com variáveis sociodemográficas e descrever a relação de obesidade/sobrepeso com a glicose em jejum (GJ) e a hemoglobina glicosilada (HbA1c). Métodos: Estudo transversal em 30 famílias mexicanas com 53 filhos participantes. A obesidade/sobrepeso foi determinada por meio do Índice de Massa Corporal (IMC), Circunferência da Cintura (CC) e percentual de gordura corporal (GC); a AF com o Questionário Internacional de Atividade Física curto (IPAQ) e pré-diabetes com a GJ. Resultados: 64% dos participantes apresentaram obesidade/sobrepeso, 32% baixa AF e 19% pré-diabetes. Os homens tiveram maior CC do que as mulheres (U= 219, p= 0.03). As mulheres mostraram mais GC do que os homens (U= 142, p <0.01). A glicose sanguínea esteve relacionada com a GC (rs= 0.336, p < 0.05), a HbA1c com o IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) e AF intensa (rs= - 0.285, p<0.05). Conclusões: Foram encontradas altas prevalências de obesidade/sobrepeso e baixa AF. A GJ esteve relacionada somente com a GC e a HbA1c, além da GC, teve relação com o IMC, CC e de maneira inversa com a AF intensa. Recomenda-se modificar as estratégias educativas de enfermagem a nível familiar.

RESUMEN Objetivos: Determinar prevalencia de obesidad/sobrepeso, actividad física (AF) y prediabetes en hijos de personas con diabetes tipo 2; identificar diferencias de acuerdo a variables sociodemográficas y describir la relación de obesidad/sobrepeso con glucosa en ayuno (GA) y hemoglobina glucosilada (A1c). Métodos: Estudio transversal en 30 familias mexicanas con 53 hijos participantes. La obesidad/sobrepeso se determinó con Índice de Masa Corporal (IMC), Circunferencia de Cintura (CC) y porcentaje de grasa corporal (GC); la AF con el cuestionario IPAQ corto y prediabetes con GA. Resultados: 64% de los participantes presentó obesidad/sobrepeso, 32% baja AF y 19% prediabetes. Los hombres tuvieron mayor CC que las mujeres (U= 219, p= 0.03). Las mujeres mostraron más GC que los hombres (U= 142, p <0.01). La glucosa sanguínea estuvo relacionada con la GC (rs= 0.336, p < 0.05), la A1c con el IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) y AF intensa (rs= - 0.285, p<0.05). Conclusiones: Se encontraron altas prevalencias de obesidad/sobrepeso y baja AF. La GA estuvo relacionada sólo con GC y la A1c además con el IMC, CC y de manera inversa con la AF intensa. Se recomienda modificar las estrategias educativas de enfermería a nivel familiar.

Prevalencia de dolor en niños hospitalizados en el Centro Hospitalario Pereira Rossell

RESUMEN Introducción: el reconocimiento y tratamiento del dolor es esencial en el cuidado del paciente pediátrico. Existe evidencia que indica que el dolor en niños hospitalizados es habitualmente subdiagnosticado e infratratado. En 1999 se realizó un trabajo que evaluó la prevalencia de dolor en pacientes pediátricos hospitalizados en el Centro Hospitalario Pereira Rossell (CHPR). El 78% de los pacientes incluidos presentaron dolor; de estos, 73% presentaba un dolor que fue catalogado como severo. No existen datos actuales sobre la prevalencia de dolor en niños hospitalizados en el CHPR. Objetivo: el objetivo principal de este trabajo es conocer la prevalencia de dolor en la población pediátrica internada en el CHPR. Metodología: se realizó un estudio descriptivo, transversal, mediante una encuesta a todos los pacientes pediátricos internados en el CHPR entre el 19 y 23 de diciembre de 2011. Mediante una ficha de recolección de datos se evaluaron, entre otras, variables demográficas, presencia y causa de dolor y tratamiento recibido. Resultados: se incluyó el 97% de los pacientes internados (99 pacientes) en el hospital. La prevalencia de dolor fue de 34,3% (34/99; IC95% = 25,1 - 44,6). En ocho pacientes (8,1%) el dolor fue catalogado como severo, mientras que 26 pacientes (26,3%) presentaron dolor leve a moderado. La prevalencia de dolor posoperatorio fue de 54,5% (12/22; IC95% = 32,2-75,6). Solo en 48,8% de los casos (21/43) se realizó una prescripción adecuada de analgésicos en cuanto a la dosis y solo en 43,1% (28/65) de los pacientes en cuanto al intervalo de tiempo. Discusión: la prevalencia de dolor observada en este trabajo fue más baja que la observada en 1999. Puede deberse a que existe mayor reconocimiento del dolor en niños por parte de los médicos y al funcionamiento de la unidad de dolor en el CHPR. Solamente en tres de los ocho pacientes con dolor severo fueron prescriptos fármacos opiáceos. Existen técnicas con eficacia ...

SUMMARY Introduction: identification and treatment of pain are essential in pediatric patient care. There is evidence that pain in hospitalized children is underdiagnosed and undertreated. In 1999, a study was performed to assess the prevalence of pain in pediatric patients hospitalized in the Pereira Rossell Hospital Center (CHPR). Results indicated that 78% of patients had pain, and in 73% of them pain was classified as severe. There is no current data on prevalence of pain in children hospitalized in the Pereira Rossell Hospital Center. Objective: the main objective of this work is to know the prevalence of pain in the pediatric population hospitalized in the CHPR. Methodology: a descriptive and transversal study was carried out through a survey among all pediatric patients hospitalized in the Pereira Rossell Hospital Center between December 19 and 23, 2011. A data collection sheet was used to assess demographic variables, presence and cause of pain and treatment received, among others. Results: there were included 97% of inpatients (99 patients). Prevalence of pain reached 34,3% (34/99; IC95%= 25,1 - 44,6). In 8 (8,1 %) patients, pain was classified as severe, while in 26 patients (26,3%) pain was mild to moderate. Prevalence of post-surgical pain was 54,5% (12/22; IC95%= 32,2 - 75,6). Only in 48,8% of the cases (21/43) the prescription of analgesics was correct in terms of dose and just in 43,1% (28/65) of the patients, in terms of dosing interval. Discussion: the prevalence of pain observed in this work was lower than the one observed in 1999. It may be due to a better recognition of pain in children by the physicians and to the performance of the pain unit of the Pereira Rossell Hospital. Only 3 of the 8 patients with severe pain were prescribed opioid drugs. There are proven techniques for the treatment of severe post-surgical pain, i.e. patient-controlled analgesia, peripheral nerve blocks, caudal epidural analgesia, the use of epidural catheters, and the design of treatment protocols. A broader application of the above might reduce the high prevalence of acute post-surgical pain. Conclusions: a high prevalence of pain was detected. Proven actions may be applied to reduce the high prevalence of pain and post-surgical pain observed.

RESUMO Introdução: o reconhecimento e tratamento da dor são essenciais no cuidado do paciente pediátrico. Há evidencias que sugerem que a dor em crianças hospitalizadas é habitualmente sub-diagnosticada e ineficazmente tratadas. Em 1999 realizou-se um trabalho que analisou a prevalência da dor em pacientes pediátricos hospitalizados no Centro Hospitalar Pereira Rossell (CHPR). O 78 % dos pacientes incluídos apresentaram dor, deles, 73 % apresentaram dor severo. Não existem dados atuais sob a prevalência da dor em crianças hospitalizados no CHPR. Objetivo: nosso objetivo principal deste trabalho foi conhecer a prevalência da dor na população pediátrica internada no CHPR. Metodologia: realizou-se um estudo descritivo, transversal, por meio de enquete a todos os pacientes pediátricos internados no CHPR entre o 19 e 23 de dezembro de 2011. Por meio de uma ficha de recolhimento de dados se avaliou entre outras, as variáveis demográficas, presença e causa de dor e tratamento recebido. Resultados: inclui-se o 97 % dos pacientes internados no hospital (99 pacientes). A prevalência da dor foi de 34,3 % (34/99; IC 95%= 25,1 - 44,6). Em oito pacientes (8,1%) a dor foi catalogada como severa, porem 26 pacientes (26,3%) apresentaram dor leve a moderada. A prevalência da dor pós-operatório foi de 54,5% (12/22; IC95%=32,2-75,6). Somente em 48,8% dos casos (21/43) realizou-se uma prescrição apropriada de analgésicos em quanto a doses, e apenas 43,1% (28/65) dos pacientes em quanto ao intervalo de tempo. Discussão: a prevalência da dor observada neste trabalho foi menor que a observada em 1999. Pode ter como causa um maior reconhecimento da dor em crianças por parte dos médicos e ao funcionamento da unidade de dor no CHPR. Só em três dos oito pacientes com dor severa foram prescritos fármacos opiáceos. Existem técnicas com eficácia provada no tratamento da dor severa pós-operatório; estas som: a analgesia controlada pelo paciente, os bloqueios de nervo periféricos, a analgesia peridural caudal, a utilização de cateteres epidurales, e a desenho de protocolos de tratamento. Sua maior aplicação pode diminuir a elevada prevalência da dor aguda pós-operatório. Conclusões: deparamos-nos com uma alta prevalência da dor. Existem medidas eficazes demonstradas que se podem aplicar para diminuir a alta prevalência da dor e também da dor pós-operatório observada.

Quiste periodontal lateral: presentación de tres casos clínicos / Periodontal lateral cyst: presentation of three clinical cases

Se presentan tres casos de quiste periodontal lateral, diagnosticados en los últimos años en la Cátedra de Patología y Semiologíade la Facultad de Odontología de la Universidad Católica del Uruguay y se realiza una revisión de la bibliografía acerca de estas lesiones.El quiste periodontal lateral es un quiste odontogénico del desarrollo, fue incluido en la clasificación de quistes de los maxilares de la Organización Mundial de la Salud (OMS) en el año 1992, descrito por Kramer. Es una entidad poco frecuente, no obstante debe plantearse el diagnóstico diferencial con otras de similares características clínico-radiográficas, cuya etiología y evoluciónson diferentes. Por este motivo, es necesario el diagnóstico histológico. La microscopía muestra un epitelio fino no queratinizado con células que contienen glucógeno, formando placas. Su tratamiento es la enucleación total y control a distancia por presentar,aunque menor, la posibilidad de recidivar.

Three cases of lateral periodontal cyst that were diagnosed in the last years in the Pathology and Semiology Chair of theDentistry Faculty - UCU are presented and a bibliographic research of this lesions is made. The lateral periodontal cyst is a developmental odontogenic cyst that was included in 1992 in the World Health Organization (WHO) classifications of cysts of the jaws described by Kramer. Is an uncommon entity notwithstanding the differentialdiagnosis has to be establish with other entities with similar clinical radiographic characteristics but with different aetiology and evolution. For this reason the histological diagnosis is necessary. The microscopy shows a thin non-keratinized epithelium with clear glycogen-containing cells that form plaques. The treatment is the total enucleation and distance control for present although minor the possibility of relapse.

Medicina translacional / Translational medicine

A falta de integração entre a ciência básica e a clinica é considerada como um grande obstáculo para o progresso de novas descobertas cientificas. Atualmente, a rota de uma idéia ate o desenvolvimento de uma nova forma de diagnostico ou tratamento de doenças apresenta diversos obstáculos, por ocorrer através de um processo demorado e muito fragmentado. A medicina translacional visa uma integração racional entre pesquisas básicas e clínicas, acelerando a obtenção de resultados e tendo como objetivo principal a melhora da saúde da população. As barreiras intelectuais, regulatórias e econômicas tem sido apontadas como os principais fatores que contribuem para o atraso nas pesquisas. Esse trabalho tem seu escopo em definir o termo medicina translacional, assim como discorrer sobre suas barreiras e as soluções.

Series de Pediatría Garrahan. El niño con trastornos del neurodesarrollo / Garrahan Pediatrics Series. The child with neurodevelopmental disorders

La infancia es una etapa vital clave, ya que en ella se forman los cimientos que luego determinarán el desarrollo físico y mental de las personas. Por eso, brindar las herramientas necesarias para satisfacer las necesidades y los derechos del niño es fundamental para garantizar la inclusión y la igualdad de oportunidades de todos. El desarrollo del niño conlleva cambios biológicos, psicológicos y emocionales que ocurren desde el nacimiento hasta la adolescencia, a medida que el individuo pasa de la dependencia al aumento de la autonomía. La frecuencia de los trastornos del neurodesarrollo es importante y creciente y el pediatra desempeña un papel crucial en su detección oportuna, asesoría a las familias y estrategias de manejo o derivación para asegurar las mejores posibilidades de prevención y asistencia. Asimismo, la elevada morbilidad pediátrica asociada al concepto de enfermedad crónica requiere una actitud diagnóstica anticipatoria de la disfunción neurocognitiva y madurativa a la que están expuestos estos niños. En este nuevo volumen de las Series de Pediatría Garrahan destacados profesionales estudian la temática del desarrollo desde un abordaje interdisciplinario centrado en el rol del pediatra. Entre sus características se destacan: Presentación mediante casos y ejemplos de la práctica clínica de los trastornos más frecuentes del desarrollo infantil estructurados según las diferentes etapas de lactante, preescolar y escolar, así como el abordaje de la discapacidad intelectual, el impacto de la enfermedad crónica en el aprendizaje y los marcos normativos en educación. El cierre de cada capítulo con un recordatorio de puntos clave y lecturas recomendadas, además del material complementario disponible en el sitio web. Una obra sólida y práctica, que transmite la experiencia de los profesionales del Hospital de Pediatría Prof. Dr. Juan P Garrahan, dedicada a los pediatras, dondequiera que trabajen al servicio de la salud de los niños.

Lesiones cromáticas de la cavidad bucal: lesiones blancas, rojas y pigmentadas. Tercera parte: lesiones blancas / Cromatic lesions of the oral cavity: white, red and pigmented lesions. Third part: White lesions

Se realizó una revisión de lesiones blancas de la cavidad bucal de etiología del desarrollo, por agresiones externas físicas oquímicas e infecciosas. La importancia de esta revisión radica en la alta incidencia de estas lesiones que tienen un pronósticofavorable y que, en su mayoría no requieren tratamiento. Sin embargo, es necesario su diagnóstico diferencial con otras entidadesclínicamente blancas, pero de pronóstico menos favorable o desfavorable. Se Realizó una revisión de la etiología y de las característicasclínicas de las lesiones mencionadas. Además, en los casos que correspondió, también se realizó una reseña terapéutica.

A review of white lesions of the oral cavity of developmental, external aggressions physical or chemical and infectious ethiologyis done. The importance of this review lies in the high incidence of most of these entities that have a favourable prognosis and donot require treatment. Differential diagnosis is require with other entities also clinically white of worse or unfavourable prognosiswas done. Also, in somes cases the therapeutic was discussed.

Lesiones cromáticas de la cavidad bucal; lesiones blancas, rojas y pigmentadas. Segunda parte: lesiones blancas / Cromatic lesions of the oral cavity; white, red and pigmented lesions. Second part: White lesions

En un artículo anterior se presentó una reseña sobre la importancia de la historia clínica y el análisis de cada uno de sus pasospara llegar al diagnóstico de las lesiones cromáticas (LC) de la cavidad bucal (CB). Además, se recalcó la importancia de sudiagnóstico y tratamiento precoz.En este trabajo se realiza una revisión sobre algunas de las lesiones blancas (LB) más frecuentes en la CB, una breve descripciónde su etiología, de sus características clínicas e histológicas y de su tratamiento. Y se discute además, en los casos que corresponda,su probabilidad de transformación maligna.

In a previous article the importance of the clinic history and physical examination in order to achieve the diagnosis of the chromaticlesions that could be find in the oral cavity (OC) were reviewed. In addition, its diagnosis and early treatment was emphasized.In this paper, a review of the most frequent white lesions (WL) in the OC is done. A brief description of its etiology, clinical andhistological characteristic and treatment are presented. Also the probability of malignant transformation is discussed.

Lesiones cromáticas de la cavidad bucal: lesiones blancas, rojas y pigmentadas: introducción / Cromatic lesions of the oral cavity: white, red and pigmented lesions: introduction

El diagnóstico y tratamiento precoz de las lesiones de la cavidad bucal (CB) es necesario debido a su posible significado. Dichas patologías pueden ser entidades benignas; manifestaciones de enfermedades sistémicas ya diagnosticadas o no, e inclusive lesiones malignas. Es frecuente, encontrar en la CB lesiones de color blanco, rojo, marrón, azul, o de otros colores que, a los efectos de este artículo, se les denominará lesiones cromáticas (LC). El dentista debe conocerlas y tratarlas en consecuencia o, si loconsidera oportuno, derivar al especialista correspondiente. Se presentaran una serie de artículos, cuyo propósito es realizar una revisión de los pasos de la historia clínica (HC), junto conuna breve descripción de la etiología, las características clínicas y el tratamiento de las LC. Además, se ilustran los diferentes tipos de lesiones con algunos casos clínicos.

The diagnosis and the early treatment of the lesions that could be find in the oral cavity (OC) is very important due to itssignificance. Those lesions could range from benign, meaningless lesions to oral manifestation of systemic disease with or without diagnosis and also malignant lesions. White, red and pigmented lesions are found very frequent in the OC, which for this paperwould be called chromatic lesions (CL). The dentist should know them, treat them or send the patient for proper treatment. The aim of these papers is review the clinic history and physical examination with a brief description of the etiology, clinical characteristic and the treatment of the CL. Also some clinical cases are presented in order to illustrated the different lesions.

Candidiasis bucal / Oral candidiasis

La candidiasis oral (CO) es una infección frecuente de la mucosa bucal provocada por hongos la familia de la Cándida spp. Estoshongos son integrantes de la flora bucal habitual pero, por diferentes factores locales y sistémicos, pueden transformarse en lainfección denominada CO.En este trabajo se presentan los factores locales y sistémicos que favorecen la infección por Cándida spp, se revisan las diferentesformas clínicas de presentación y los métodos de diagnóstico más empleados. Se presentan, además, las características especialesde esta infección en los pacientes VIH - SIDA.

Oral candidiasis (OC) is a frequent infection of the oral cavity due to fungus of the Candida spp. Those microorganisms aremembers of bucal flora but local and systemic factors collaborates to produce an infection called Oral candidiasis.We review those factors; the clinical forms of presentation of the OC and the laboratories diagnostic methods. Also, the presentationof this infection in HIV – AIDS patients are reviewed.