Signs and symptoms of human T-lymphotropic virus 1 and 2 infections in paediatric patients.

OBJECTIVE: To determine the prevalence of signs and symptoms of HTLV-1 and 2 infection in paediatric patients. METHODS: We included cohort, case-control and descriptive observational studies that reported the prevalence of signs and symptoms of HTLV-1 and 2 infections in paediatric patients. Searches were performed in MEDLINE® (Ovid), EMBASE and LILACS from inception to the present, and we saturated information with other sources of published and unpublished literature. We decided not to perform meta-analysis according to heterogeneity. RESULTS: A total of eight studies met the inclusion criteria for qualitative analysis. No studies of HTLV-2 were found. Females predominated and there was vertical transmission in nearly 100% of cases. Infective dermatitis was a common manifestation of HTLV in paediatric patients. In addition, persistent hyperreflexia, clonus and the Babinski sign were early neurological alterations observed in patients carrying the virus. CONCLUSION: HTLV screening is recommended in patients presenting infective dermatitis, persistent hyperreflexia, walking disturbances and in those who come from endemic zones.

Epileptic Encephalopathy with Variants in the PHACTR1 and AFF2 Genes: A Case Report.

Developmental and epileptic encephalopathy 70 (DEE70) is an epileptic encephalopathy associated with multiple neurological abnormalities and global developmental delay, among other characteristics. It has recently been established that it is caused by a heterozygous variant of the PHACTR1 gene, with currently four cases reported in the literature. This article presents a case report of a patient with DEE70 with a heterozygous variant in the PHACTR1 gene, who also presents a hemizygous variant in the AFF2 gene, associated with FRAXE syndrome. A phenotypic comparison is made between this case and the four other previously reported cases with variants in the PHACTR1 gene. In addition, the possible participation of the PHACTR1 and AFF2 genes in the clinical characteristics of the individual is discussed.

The effects of dissociation on willingness to eat meat are moderated by exposure to unprocessed meat: A cross-cultural demonstration.

Dissociating meat from its animal origins helps consumers deal with the cognitive dissonance resulting from liking meat but disliking causing pain to animals. Extending previous research, we tested whether dissociation would play less of a role for meat consumption in a country where average consumers are more frequently exposed to unprocessed meat (i.e., Ecuador) than where such exposure is rare (i.e., the US). Specifically, we randomly showed Ecuadorians and US Americans a pork roast with the head present or removed. Showing the head led to less dissociation, and subsequently more disgust and empathy for the killed animal in both countries, but to significantly larger degrees in the US. Follow-up analyses with participants' self-reported exposure to unprocessed meat supported the notion that these cross-cultural variations indeed reflected differences in unprocessed meat exposure. In contrast, disgust and empathy, in turn, predicted a lower willingness to eat meat and a higher willingness to choose a vegetarian alternative dish equally in both countries. Because the dissociation part of our model was substantially stronger in the US, it explained about double as much variance in willingness to eat meat and vegetarian choice in the US (63-72%) as compared to Ecuador (30-32%). In sum, the potency of the dissociation mechanism seems to depend on how used consumers in a country are to seeing unprocessed meat, whereas the subsequent affective mechanisms universally influence meat consumption.

Comparison of Visual Field Test Measurements With a Novel Approach on a Wearable Headset to Standard Automated Perimetry.

PRCIS: This study of inter-test comparability of a novel visual field application installed on an augmented-reality portable headset and Humphrey field analyzer Swedish interactive thresholding algorithm (SITA) Standard visual field test demonstrates the excellent correlation of mean deviation (MD) and mean sensitivity (MS). PURPOSE: To determine the correlation between visual field testing with novel software on a wearable headset versus standard automated perimetry. PATIENTS AND METHODS: Patients with and without visual field defects attributable to glaucoma had visual field testing in one eye of each patient with 2 methods: re:Imagine Strategy (Heru, Inc.) and the Humphrey field analyzer (Carl Zeiss Meditec, Inc.) SITA Standard 24-2 program. Main outcome measures included MS and MD, which were evaluated by linear regression, intraclass correlation coefficient (ICC), and Bland Altman analysis for assessment of the mean difference and limits of agreement. RESULTS: Measurements from 89 eyes of 89 patients (18 normal and 71 glaucomas) were compared with both instruments. Linear regression analysis demonstrated an excellent Pearson correlation coefficient of r = 0.94 for MS and r = 0.95 for MD. ICC analysis demonstrated high levels of concordance (ICC = 0.95, P < 0.001 for MS and ICC = 0.94, P < 0.001 for MD). Bland-Altman analysis determined a small mean difference between the two devices (Heru minus Humphrey) of 1.15 dB for MS and 1.06 dB for MD. CONCLUSIONS: The Heru visual field test correlated well with SITA Standard in a population of normal eyes and eyes with glaucoma.

Triad of diabetic ketoacidosis-acute pancreatitis-hypertriglyceridaemia: interest of genetic exploration / Triade acidocétose-pancréatite aiguë-hypertriglycéridémie : cas où l'exploration génétique peut s'avérer utile

A 16-year-old child with no medical history was admitted to the hospital emergency for abdominal pain associated with polyuria-polydipsia and weight loss (baseline BMI: 25,4 kg/m2). Diagnosis of severe ketoacidosis was quickly raised regarding major metabolic acidosis, high ketonemia and glycemia. Acute pancreatitis was then diagnosed according to a plasmatic lipase more than tenfold normal values associated with a severe hypertriglyceridemia superior to 100 mmol/L. The triad composed of diabetic ketoacidosis-acute pancreatitis-hypertriglyceridemia is rarely found in childhood and can have deleterious consequences. The etiology of this disease is still enigmatic, as one can be both, cause and consequence of the other. Genetic investigation of familial chylomicronemia legitimated to invalidate the dyslipidemia etiology of this event. On the other hand, the association of a genetic variant of lipoprotein lipase leading to a decrease in its activity, with the insulinopenia of type 1 diabetes most certainly triggered this episode of hypertriglyceridemia.

Une jeune adolescente de 16 ans, sans antécédent médical, s'est présentée aux urgences pour douleurs abdominales dans un contexte de polyuro-polydipsie avec amaigrissement (IMC initial : 25,4 kg/m2). Une acidocétose sévère a rapidement été évoquée devant une acidose métabolique majeure, ainsi qu'une cétonémie et glycémie élevées. Une pancréatite aiguë a ensuite été diagnostiquée devant une lipase plasmatique supérieure à 10 fois les valeurs normales associée à une hypertriglycéridémie majeure de plus de 100 mmol/L. La triade acidocétose-pancréatite aiguë-hypertriglycéridémie est un phénomène très rarement retrouvé dans l'enfance et qui peut avoir des conséquences dramatiques. Il s'agit d'une pathologie à l'étiologie encore énigmatique, l'une pouvant être la cause et la conséquence de l'autre. L'exploration génétique d'une hyperchylomicronémie a pu permettre d'infirmer l'étiologie dyslipidémique de cet épisode. En revanche, l'association d'un variant génétique de la lipoprotéine lipase conduisant à une diminution de son activité, à l'insulinopénie du diabète de type 1 a très certainement déclenché cet épisode d'hypertriglycéridémie.

Medical decision support system using weakly-labeled lung CT scans.

Purpose: Determination and development of an effective set of models leveraging Artificial Intelligence techniques to generate a system able to support clinical practitioners working with COVID-19 patients. It involves a pipeline including classification, lung and lesion segmentation, as well as lesion quantification of axial lung CT studies. Approach: A deep neural network architecture based on DenseNet is introduced for the classification of weakly-labeled, variable-sized (and possibly sparse) axial lung CT scans. The models are trained and tested on aggregated, publicly available data sets with over 10 categories. To further assess the models, a data set was collected from multiple medical institutions in Colombia, which includes healthy, COVID-19 and patients with other diseases. It is composed of 1,322 CT studies from a diverse set of CT machines and institutions that make over 550,000 slices. Each CT study was labeled based on a clinical test, and no per-slice annotation took place. This enabled a classification into Normal vs. Abnormal patients, and for those that were considered abnormal, an extra classification step into Abnormal (other diseases) vs. COVID-19. Additionally, the pipeline features a methodology to segment and quantify lesions of COVID-19 patients on the complete CT study, enabling easier localization and progress tracking. Moreover, multiple ablation studies were performed to appropriately assess the elements composing the classification pipeline. Results: The best performing lung CT study classification models achieved 0.83 accuracy, 0.79 sensitivity, 0.87 specificity, 0.82 F1 score and 0.85 precision for the Normal vs. Abnormal task. For the Abnormal vs COVID-19 task, the model obtained 0.86 accuracy, 0.81 sensitivity, 0.91 specificity, 0.84 F1 score and 0.88 precision. The ablation studies showed that using the complete CT study in the pipeline resulted in greater classification performance, restating that relevant COVID-19 patterns cannot be ignored towards the top and bottom of the lung volume. Discussion: The lung CT classification architecture introduced has shown that it can handle weakly-labeled, variable-sized and possibly sparse axial lung studies, reducing the need for expert annotations at a per-slice level. Conclusions: This work presents a working methodology that can guide the development of decision support systems for clinical reasoning in future interventionist or prospective studies.

Self-Esteem, Attitudes toward Love, and Sexual Assertiveness among Pregnant Adolescents.

Adolescence is a stage of growth and development of great relevance. Unplanned teenage pregnancies can be considered a global public health problem due to the high impact on the present and future of these young people, as well as their possible offspring. The aim of this study was to analyze the relationship between self-esteem, attitudes toward love, and sexual assertiveness among pregnant and non-pregnant teenagers. We also considered whether their pregnancy was planned or not. The study was conducted with 225 women from Ecuador (34.2% pregnant; Mean age = 16; SD = 1.15). We administered self-reported measures such as the Rosenberg Self-Esteem Scale, the Love Attitudes Scale, and the Sexual Assertiveness Scale between 2018 and 2019. Self-esteem was higher in adolescents with a planned pregnancy than in those women whose pregnancy was not planned. Pregnant women reported greater acceptance and endorsement of beliefs related to the myth of "soulmate" in comparison to non-pregnant women. Sexual assertiveness related to the negotiation of the use of contraceptive methods was greater in non-pregnant adolescents than in pregnant girls. We discuss the implications of our findings in terms of sexual education and prevention in the sex education field. This study shows differences in self-esteem, attitudes toward love, and sexual assertiveness between pregnant and non-pregnant adolescents.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report.

INTRODUCTION: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. CLINICAL CASE: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. TREATMENT AND OUTCOMES: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. CLINICAL AND SCIENTIFIC RELEVANCE: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. CONCLUSION: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.

INTRODUCCIÓN: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (∼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. CASO CLÍNICO: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. TRATAMIENTO Y RESULTADOS: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. RELEVANCIA CLÍNICA Y CIENTÍFICA: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. CONCLUSIÓN: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.

Large septic pulmonary embolus complicating streptococcus mutans pulmonary valve endocarditis.

Large septic pulmonary embolus is a rare finding in right-sided endocarditis. The entity represents a challenging diagnosis due to its variable and nonspecific clinical and radiological presentation and similarities with other conditions. We present a case of a 41 year-old woman who developed a large main pulmonary artery embolus and bilateral cavitary lung nodules in the setting of severe sepsis. Pulmonary artery exploration and clot retrieval ultimately revealed a large septic embolus from Streptococcus mutans native pulmonary valve endocarditis. The diagnosis of septic pulmonary emboli from right-sided endocarditis should be considered in patients with ancillary findings of septic embolic phenomenon, particularly the presence of multifocal cavitary nodules and in the setting of appropriate predisposing factors.

Indigenous ecological calendars and seasonal vector-borne diseases in the Colombian Amazon: an intercultural and interdisciplinary approach / Calendarios ecológicos indígenas y enfermedades estacionales transmitidas por vectores en la Amazonia colombiana: un enfoque intercultural e interdisciplinario

Traditional ecological knowledge of indigenous groups in the southeastern Colombian Amazon coincides in identifying the two main hydrological transition periods (wet-dry: August-November; dry-wet: March-April) as those with greater susceptibility to disease in humans. Here we analyze the association between indigenous knowledge about these two periods and the incidence of two vector-borne diseases: malaria and dengue. We researched seven "ecological calendars" from three regions in the Colombian Amazon, malaria and dengue cases reported from 2007 to 2019 by the Colombian National Institute of Health, and daily temperature and precipitation data from eight meteorological stations in the region from 1990-2019 (a climatological normal). Malaria and dengue follow a seasonal pattern: malaria has a peak from August to November, corresponding with the wet-dry transition (the "season of the worms" in the indigenous calendars), and dengue has a peak in March and April, coinciding with the dry-wet transition. Previous studies have shown a positive correlation between rainfall and dengue and a negative correlation between rainfall and malaria. However, as the indigenous ecological knowledge codified in the calendars suggests, disease prediction cannot be reduced to a linear correlation with a single environmental variable. Our data show that two major aspects of the indigenous calendars (the time of friaje as a critical marker of the year and the hydrological transition periods as periods of greater susceptibility to diseases) are supported by meteorological data and by the available information about the incidence of malaria and dengue.(AU)

Los conocimientos ecológicos tradicionales de grupos indígenas del sureste de la Amazonia colombiana coinciden en identificar dos principales periodos de transición hidrológica (seco-húmedo: agosto-noviembre; húmedo-seco: marzo-abril) como los de mayor susceptibilidad a enfermedades en humanos. Aquí analizamos la asociación entre el conocimiento indígena sobre estos dos periodos y la incidencia de dos enfermedades transmitidas por vectores: malaria y dengue. Investigamos siete calendarios ecológicos de tres regiones en la Amazonia colombiana, casos de dengue y malaria reportados de 2007 hasta 2019 por el Instituto Nacional de Salud de Colombia y datos diarios de temperatura y precipitación de ocho estaciones meteorológicas en la región, de 1990 a 2019 (una normal climatológica). Malaria y dengue siguen un patrón estacional, la malaria tiene un pico de agosto a noviembre, correspondiendo con la transición húmedo-seco (el "tiempo de gusano" según los calendarios indígenas), mientras que dengue tiene un pico de marzo a abril, coincidiendo con la transición seco-húmedo. Estudios previos mostraron una correlación positiva entre precipitación y dengue, y una correlación negativa entre precipitación y malaria. Sin embargo, como lo sugiere el conocimiento ecológico codificado en los calendarios indígenas, la predicción de enfermedades no puede reducirse a una correlación lineal con una sola variable medioambiental. Nuestros datos muestran que dos aspectos principales de los calendarios indígenas (el tiempo de friaje como un marcador crítico anual y los periodos de transición hidrológica como épocas de mayor susceptibilidad a enfermedades) están soportados por datos meteorológicos e información disponible acerca de la incidencia de malaria y dengue.(AU)

Impacto de rehabilitación física y sistema súper inductivo generando magnetismo en fractura postquirúrgica de tobillo: Reporte de caso / Impact of physical rehabilitation and super inductive system by generating magnetism in postsurgical ankle fracture: A case report

Las fracturas pueden producir impotencia funcional, deformidad, hematoma, entumecimiento, dolor y cosquilleo. Muchas requieren cirugía y rehabilitación física por personal calificado y equipos adecuados. El objetivo de este estudio fue aplicar la rehabilitación física y el sistema súper inductivo de alta intensidad como tratamiento en fractura postquirúrgica. La paciente de 46 años, sufre caída de propia altura fracturándose la tibia y peroné derechos, confirmado el diagnóstico, se le realiza la reducción abierta más fijación interna, recibe el alta con férula suropédica que se retira seis semanas después, inicia marcha con apoyo parcial progresivo con incremento de dolor eva 6/10, limitación de la movilidad y edema bimaleolar. La radiografía muestra solución de continuidad del maléolo tibial con material de osteosíntesis. Recibe propuesta terapéutica no invasiva, suspensión de la carga, rehabilitación física por cinco semanas más sistema súper inductivo de alta intensidad tres veces por semana. A la valoración radiográfica de tobillo derecho postero anterior, lateral, y oblicua, presenta reducción correcta del maléolo tibial, la flexión, extensión, inversión y eversión son valorables sin dolor ni edema. Se puede concluir que la rehabilitación y el sistema súper inductivo de alta intensidad con campos electromagnéticos de alta potencia, sí bioestimula la reparación ósea, también acelera el plazo de osteosíntesis con reducción del dolor logrando la recuperación funcional en la paciente.

Fractures can cause functional impotence, deformity, bruising, numbness, pain, and tingling. Many require surgery and physical rehabilitation provided by qualified personnel and adequate equipment. The objetive of this study was to apply physical rehabilitation and high intensity super inductive system as a treatment for postsurgical fracture. A 46-year-old woman suffered a fall from her own height, fracturing the right tibia and fibula, and, an open reduction plus internal fixation was performed, afer confirming the diagnosis. She wadischarged with a south-pedic splint, which was removed 6 weeks later the patient, began to walk with progressive partial support with 6/10 increased eva pain, limitation of mobility and bimalleolar edema. e radiograph shows a solution of continuity of the tibial malleolus with osteosynthesis material. She receives a non-invasive therapeutic proposal, suspension of the load, physical rehabilitation for 5 weeks, and a high intensity super inductive system 3 times a week. Radiographic evaluation of the right ankle anterior, lateral, and oblique shows correct reduction of the tibial malleolus. Flexion, extension, inversion and eversion are assessable without pain or edema. Rehabilitation and high intensity super inductive system with high power electromagnetic fields, biostimulate bone repair and accelerates bone treatment, relieving pain. It can be concluded that the rehabilitation and the high-intensity super-inductive system with high-power electromagnetic fields, biostimulates bone repair, and accelerates the osteosynthesis period with pain reduction, achieving functional recovery of the patient.

Caracterización de la apnea del sueño en pacientes cardiópatas e internación por enfermedad grave por COVID-19 / Characterization of sleep apnea and hospitalization for severe illness due to COVID-19

La COVID-19 ha generado mundialmente una morbi-mortalidad considerable, particularmente entre aquellos con comorbilidades crónicas: hipertensión, diabetes y enfermedad cardiovascular. Investigaciones han demostrado que la apnea del sueño puede agravar el pronóstico vital, al causar o agudizar la disfunción endotelial, inflamación, estrés oxidativo, microaspiración y lesiones pulmonares, lo que amplifica el riesgo de hospitalización e incluso de sufrir de insuficiencia respiratoria. Se realizó un estudio descriptivo retrospectivo y transversal, se evaluaron 187 pacientes cardiópatas con clínica sugestiva a apnea obstructiva del sueño con resultaron positivo para SARS-CoV-2, entre 2020-2021.Se aplicaron la metodología de Castro et al., 2021 y cuestionario de STOP-BANG para valorar la disnea y caracterizar la AOS respectivamente. Se corroboró la fuerte asociación entre la enfermedad cardíaca y la presencia de AOS; más de la mitad de los pacientes estudiados presentaron, enfermedad grave por COVID-19, con disnea moderada-grave, que amerito hospitalización con cuidados intensivos, observándose mayor frecuencia en el sexo masculino, con más de 50 años y con IMC >30. Sin embargo, las féminas presentaron valores significativos de STOP-BANG, lo que sugiere a la HTA y obesidad como factores de riesgo para AOS, independiente al sexo. Se recomienda realizar el descarte de AOS como rutina médica, que permita establecer la epidemiología y estrategias para abordaje adecuado de estos pacientes(AU)

COVID-19 has generated considerable morbidity and mortality worldwide, particularly among those with chronic comorbidities: hypertension, diabetes, and cardiovascular disease. Research has shown that sleep apnea can worsen the vital prognosis, by causing or exacerbating endothelial dysfunction, inflammation, oxidative stress, microaspiration and lung damage, which amplifies the risk of hospitalization and even respiratory failure. A retrospective and cross-sectional descriptive study was carried out, 187 heart patients with clinical signs suggestive of obstructive sleep apnea were evaluated and were positive for SARS-CoV-2, between 2020-2021. The methodology of Castro et al., 2021 and questionnaire were applied. STOP-BANG to assess dyspnea and characterize OSA, respectively. The strong association between heart disease and the presence of OSA was confirmed; More than half of the patients studied presented severe disease due to COVID-19, with moderate-severe dyspnea, which required hospitalization with intensive care, with a higher frequency observed in males, over 50 years of age and with BMI >30. However, females presented significant STOP-BANG values, which suggests hypertension and obesity as risk factors for OSA, regardless of gender. It is recommended to rule out OSA as a medical routine, which allows establishing the epidemiology and strategies for an adequate approach to these patients(AU)

Aciclovir endovenoso como tratamiento en la parálisis facial periférica e idiopática en un recién nacido. Reporte de caso

Introducción: la parálisis facial neonatal debida a la parálisis de Bell es rara. El mecanismo de parto traumático representa una etiología más común. Caso clínico: neonato, previamente sano, con parto espontáneo no instrumentalizado y sin complicaciones obstétricas, que cursó con parálisis facial derecha aguda. La imagen cerebral fue normal y los hallazgos clínicos compatibles con parálisis de Bell, con buena respuesta al manejo antirretroviral y fisioterapia. Discusión: la mayoría de infantes con parálisis de Bell mejora con o sin tratamiento y sin secuelas graves. No hay evidencia concluyente en la población pediátrica sobre el beneficio de usar esteroides, solos o con antirretrovirales. Actualmente, tampoco existe un consenso sobre la seguridad de usar esteroides posnatales tardíos, que se deben reservar para neonatos sin otra opción. El aciclovir a dosis de 60 mg/Kg/día es seguro en neonatos. Conclusiones: la parálisis de Bell neonatal puede presentar una respuesta favorable a la terapia antirretroviral y fisioterapia, prescindiendo del uso de esteroides.

SUMMARY Introduction: Neonatal facial palsy due to Bell's palsy is rare. A traumatic delivery mechanism represents a common etiology. Clinical case: Neonate, without previous illnesses, born by spontaneous non-instrumentalized delivery and without any obstetric complications; who presented acute right facial palsy, with normal brain imaging and clinical findings compatible with Bell's palsy, who had a good response to antiretroviral management and physical therapy. Discussion: Most infants with Bell's palsy improve with or without treatment, with no serious sequelae. In pediatric population, evidence on benefits of steroids use, alone or with antiretrovirals, has not been conclusive. There is not a current consensus on the safety of late postnatal steroid use, and they should be reserved for neonates who have no other treatment choice. Acyclovir use at 60/mg/Kg/day it's safe in neonates. Conclusions: Neonatal Bell's palsy may present a favorable response to antiretroviral therapy and an adherent physical rehabilitation program, irrespective of steroids use.

Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12-Month Randomized Controlled Clinical Study.

BACKGROUND: Clinical studies have explored the relationship between toothbrushing and development of gingival recession (GR), but relevant GR data for the multidirectional power toothbrush (PT) are lacking. The aim of this study is to evaluate the effect of brushing with either a multidirectional PT or American Dental Association reference manual toothbrush (MT) on mid-buccal preexisting GR (PreGR) during 12 months. METHODS: This was a 12-month prospective, single-masked, parallel-group, randomized, controlled clinical study. Healthy participants without periodontitis with at least two teeth showing PreGR ≥2 mm were randomized to a group brushing with either an MT or PT. The primary outcome parameter was change at sites with PreGR ≥2 mm. All clinically based GR measurements were performed by one calibrated examiner at baseline, 6, and 12 months. Secondary outcomes were changes of GR at all mid-buccal sites (with or without PreGR), changes in percentage of GR sites demonstrating a change of ≥1 mm, and changes in probing depths. RESULTS: A total of 107 participants completed the study (PT: 55, MT: 52). During the 12-month study period the mean recession at sites with PreGR ≥2 mm decreased significantly from 2.2 to 2.1 mm in both groups (P <0.05). The extent of GR parameters did not differ between MT and PT groups at any time point. GR evaluated clinically and on stone casts was well correlated. CONCLUSION: Neither the PT nor MT led to an increase in PreGR during 12 months of daily use.

Factores predisponentes que conllevan a los pacientes a una neumonía asociada ventilación mecánica de la unidad de cuidados intensivos del hospital Teodoro Maldonado Carbo. Periodo 2018 ­ 2019 / Predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado carbo hospital's intensive care unit. period 2018 ­ 2019

Hay varios factores de riesgo que pueden conllevar a una neumonía asociada a ventilación mecánica, tanto intrínseco como extrínseco, y el porcentaje de la neumonía asociada a ventilación mecánica va en aumento, por lo que el personal médico tiene una dura lucha para tratar de disminuir esta problemática. Objetivo: Determinar los factores predisponentes que conllevan a los pacientes a una neumonía asociada a la ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Teodoro Maldonado Carbo durante el periodo 2018 ­ 2019. Materiales y Métodos: paradigma positivista, enfoque cuantitativo; de modalidad de campo, no experimental. De tipo descriptivo y transversal. La población fue 285 pacientes y la muestra de 60, seleccionado de manera probabilística y sistemático. La técnica fue la encuesta y el instrumento el cuestionario con 15 ítems, revisados y validados por juicios de expertos en el tema, que dieron una confiabilidad de 95%. Resultados: Se evidenció que los factores predominantes, que aumentan los riesgos de padecer una NAVM son elementos de tipo Extrínseco, entre ellos los más comunes son: intubación prolongada, re intubaciones, aspiraciones de secreciones y el traslado del paciente. Mientras que los del factor intrínseco son: desnutrición, edad y etnia. Conclusión: se evidenció la importancia de un diagnóstico oportuno y seguir las normas de bioseguridad establecidas antes, durante y después del proceso de entubación como mecanismo de disminución de probabilidad de que el paciente desarrolle un NAVM(au)

There are several risk factors can lead to pneumonia associated with mechanical ventilation both, intrinsic and extrinsic, and the percentage of pneumonia associated with mechanical ventilation is increasing, which is why medical personnel have a tough fight to try to reduce this problem. Objective: To determine the predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado Carbo Hospital's Intensive Care Unit during the period 2018 - 2019. Materials and Methods: positivist paradigm, quantitative approach; field modality, not experimental. Descriptive and transversal. The population was 285 patients and the sample of 60, selected in a probabilistic and systematic way. The technique was the survey and the instrument was the questionnaire with 15 items, reviewed and validated by expert judgments on the subject, which gave a reliability of 95%. Results: It was evident that the predominant factors that increase the risks of suffering from AVM are extrinsic elements, among them the most common are prolonged intubation, re-intubations, aspiration of secretions and the transfer of the patient. While those of the intrinsic factor are malnutrition, age and ethnicity. Conclusion: the importance of a timely diagnosis and following the biosafety standards established before, during and after the intubation process was evidenced as a mechanism to decrease the probability that the patient develops a VAP(AU)

Supervivencia de implantes dentales y complicaciones intra y posoperatorias en elevación de seno maxilar con ventana lateral e implante dental simultáneo en rebordes con reabsorción severa / Survival of dental implants and intra and post operative complications in elevation of the maxillary sinus with side window and simultaneous dental implant in sever resorbed RIMS

Objetivo: El posicionamiento de implantes dentales simultáneo a la elevación del seno maxilar en rebordes con reabsorción ósea severa (≤4 mm) es una técnica quirúrgica que disminuye los tiempos operatorios. Sin embargo, es considerada sensible por ser dependiente del operador y, en el caso que no se dé un manejo adecuado, puede presentar complicaciones. En este estudio se realiza una revisión de la literatura sobre la supervivencia de los implantes dentales y las complicaciones intra y posoperatorias en procedimientos de elevación del seno maxilar con la colocación simultánea de implante dental en rebordes con reabsorción ósea severa. Materiales y métodos: Se realizó una búsqueda bibliográfica de la literatura publicada en los últimos 10 años, durante el periodo de mayo y junio del 2019, en las bases de datos Medline­PubMed, EBSCOhost y Scopus. Esta se complementó con una búsqueda manual en revistas especializadas en periodoncia y cirugía oral Q1, posicionadas en el top 5 del 2018 en www.scimagojr.com. Se incluyeron ensayos clínicos y estudios prospectivos y retrospectivos. Se identificó 2562 artículos científicos. Tras el análisis de los títulos, la lectura de los resúmenes y los textos completos, se seleccionaron 6 artículos para el análisis de la técnica quirúrgica y 35 para complementar la información. Conclusiones: La colocación simultánea de implantes dentales a la elevación del seno maxilar es una de las técnicas utilizadas para restituir la función en el maxilar posterior. La complicación intraoperatoria más frecuente es la perforación de la membrana sinusal y la posoperatoria es la infección asociada con perforación de la membrana, o la migración del implante al seno maxilar. La supervivencia promedio del implante observada en los estudios es mayor al 94%. (AU)

Aim: The positioning of dental implants simultaneous to the elevation of the maxillary sinus in ridges with severe bone resorption (≤4mm) is a surgical technique that reduces operative times. However, it is considered sensitive, being dependent on the operator, and in the absence of appropriate handling, complications can occur. This study aimed to provide a review of the literature on the survival of dental implants and intra- and post-operative complications in maxillary sinus lift procedures with the simultaneous placement of a dental implant in ridges with severe bone resorption. Materials and methods: A bibliographic search of the literature published in the last 10 years in the Medline-Pubmed, EBSCO HOST and SCOPUS databases was carried out from May to June 2019. This was complemented with a manual search in journals specialized in Periodontology and Oral Surgery Q1, positioned in the Top 5 of the year 2018 at www.scimagojr.com. Prospective, retrospective and clinical trials were included 2562. A total of 2562 prospective, retrospective and clinical trials were included. After analyzing the titles and reading the abstracts and full texts, 6 articles were selected for analysis of the surgical technique and 35 to complement information. Conclusions: The placement of dental implants simultaneously with maxillary sinus elevation is one of the techniques used to restore function in the posterior maxilla. The most frequent intra-operative complication is perforation of the sinus membrane, and the most common post-operative complication is infection associated with perforation of the membrane, or migration of the implant to the maxillary sinus. The average implant survival reported is greater than 94%. (AU)

Prevalencia y Factores Asociados al Sobrepeso en estudiantes de Ciencias de la Salud, Universidad de Cuenca, 2016 / Prevalence and associated factors with overweight in students of health Sciences, Universidad de Cuenca, 2016

INTRODUCCIÓN: El sobrepeso constituye un problema mundial de salud pública y está asociado a factores que pueden ser modificables. La población de universitarios no está exenta de su in-fluencia y su prevalencia está en aumento por lo que es un asunto de interés creciente. El objetivo de este estudio fue determinar la prevalencia e identificar los factores asociados al sobrepeso en estudiantes de pregrado de la Facultad de Ciencias de la Salud de la Universidad de Cuenca. MATERIALES y MÉTODOS: Estudio descriptivo de diseño transversal, se incluyó en la muestra 250 estudiantes, seleccionados aleatoriamente del registro del período lectivo 2016. Se analizó: edad, sexo, estado civil y residencia. Para determinar el sobrepeso se utilizó el Índice de Masa Corporal y se identificó los factores: estilo de vida mediante FANTASTIC, actividad física mediante IPAQ y resistencia a la insulina mediante HOMA-IR. Se determinó la prevalencia de sobrepeso y se buscó asociación entre sobrepeso y sus factores mediante RP (IC95%). RESULTADOS: La edad de la población de estudio varió de 18 a 26 años, con un promedio de 20.4 ± 1.9 años. El 70.8% estuvo entre 18 a 21 años. El 82% cursaba del 1º al 5º ciclos. Predominó el sexo femenino (55.6%), estado civil soltero (93.2%) y residencia urbana (78%). La prevalencia de sobrepeso fue 26.8% (21.6 ­ 32.6), con mayor frecuencia en el sexo femenino y en el grupo de 18 a 21 años. Hubo asociación de sobrepeso con actividad física [RP 4.2 (IC95%: 1.1 ­ 16.4)], p = 0.010 y de sobrepeso con resistencia a la insulina [RP 3.1 (IC95%: 2.1 ­ 4.5)] p < 0.001. No hubo asociación significativa con el estilo de vida. CONCLUSIÓN: La prevalencia de sobrepeso en la población de estudio es similar a la reportada en la literatura actual. Existió asociación con sedentarismo y resistencia a la insulina, pero el estilo de vida no mostró asociación.(au)

BACKGROUND: Overweight is a global public health problem and it is associated with modifiable factors. The universitary population is not exempt from its influence and its prevalence is rising, so it is a matter of increasing interest. The aim of this study was to determine the prevalence and the associated factors with overweight in undergraduate students of Facultad de Ciencias de la Salud, Universidad de Cuenca. METHODS: Descriptive, cross-sectional design, included 250 students, randomly selected from the 2016 school year record.We analyzed age, sex, marital status and residence. To determine overweight, we used the Body Mass Index; lifestyle was determined by FANTASTIC test, physical activity using IPAQ and insulin resistance by HOMA-IR. We determined the overweight prevalence; the association between overweight and other variables was obtained with PR (IC95%). RESUlTS: The age of the study population ranged from 18 to 26 years, with an average of 20.4 ± 1.9 years, 70.8% between the age of 18 and 21, 82% were students of first to fifth term. The female sex constituted 55.6% of the sample; most of the sample was single (93.2%) and urban residents (78%). The prevalence of overweight was 26.8% (21.6 ­ 32.6), more common in women and in students from 18 to 21 years old. There was association between overweight and physical activity [RP 4.2 (IC95%: 1.1 ­ 16.4)] (p= 0.010) and between overweight and insulin resistance [RP 3.1 (IC95%: 2.1 ­ 4.5)]( p < 0.00)1. There was no association with the lifestyle. CONClUSION: The prevalence of overweight in the population was similar to the prevalence reported in literature. There was association between overweight and sedentary lifestyle and insulin resistance, but there was not association with lifestyle.(au)

Síndrome opsoclonus-mioclonus-ataxia asociado con un teratoma ovárico maduro en un paciente pediátrico / Opsoclonus-mioclonus-ataxia syndrome associated with a mature ovarian teratoma in a pediatric patient

Resumen El síndrome de opsoclonus-mioclonus-ataxia es una entidad rara que cursa con síntomas motores, neurocognitivos y psiquiátricos, con frecuencia marcadamente debilitantes. El síndrome se reporta con mayor frecuencia en adultos que en niños, la etiología es variada, pero en pediatría se presenta en la mayoría de los casos como un síndrome paraneoplásico. En este contexto la neoplasia más frecuentemente asociada es el neuroblastoma. La evidencia actual apoya la tesis de que este es un síndrome mediado inmunológicamente al haberse identificado una serie de auto-anticuerpos en los pacientes afectados, y a que muchos de ellos responden a terapia inmunosupresora. La importancia del reconocimiento de este síndrome radica en que existe tratamiento médico y quirúrgico que podría mejorar el pronóstico neurológico y psiquiátrico. Presentamos el caso de una paciente que se presentó con este síndrome en nuestra institución.

Abstract The opsoclonus-myoclonus-ataxia syndrome is a rare entity that presents with motor, neurocognitive and psychiatric symptoms, often markedly de bilitating. The syndrome is reported more frequently in adults than in chil dren, the etiology is varied, but in pediatrics it occurs in most cases as a paraneoplastic syndrome. In this context, the most frequently associated neoplasm is neuroblastoma followed by gynecological tumors. The current evidence supports the thesis that this is an immune-mediated syndrome because a series of circulating autoantibodies has been described in the affected patients, in addition to many of them responding to immuno suppressive therapy. The importance of recognizing this syndrome is that there is medical/surgical treatment available that could improve the neu rological and psychiatric prognosis. Next, we present the case of a patient who presented with this syndrome in our institution.