Lambda-double-fixation for medial epicanthoplasty in Blepharophimosis - Ptosis - Epicanthus Inversus Syndrome.

PURPOSE: This study aims to describe a novel approach to medial epicanthoplasty in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and evaluate the surgical outcome of this technique. METHODS: A retrospective, noncomparative, interventional case series involving 22 BPES patients who underwent medial epicanthoplasty using the Lambda-Double-Fixation technique (LDFT) performed by a single surgeon. Pre- and postoperative measurements of inner intercanthal distance (DIC) and horizontal palpebral fissure (HPFL) were recorded. Concurrent or staged ptosis surgery and lateral cantholysis, along with any complications, were documented. RESULTS: The mean age of the patients was 2.9 ± 2.2 years. Preoperatively, the mean DIC measured 34.0 ± 2.7 mm, significantly reducing to 23.7 ± 2.1 mm postoperatively (p < 0.001). A notable increase in mean HPFL was observed in both eyes postoperatively: right eye form 18.4 ± 2.4 mm to 23.7 ± 1.8 mm (p < 0.001) and left eye from 18.3 ± 2.4 mm to 23.8 ± 1.9 mm (p < 0.001). Postoperative scars were barely visible in all patients. CONCLUSION: LDFT is a simple and reproducible technique for medial epicanthoplasty in BPES. Our results affirm that LDFT induces a physiologically concave reshaping of the medial canthal region, optimizing access to the peritarsal zone and ensuring a secure fixation of the new canthus. These benefits lead to a reduction in ICD and an increase in HPFL, leading to a cosmetically appealing postoperative outcome.

It Takes a Village: An Interdisciplinary Approach to Preparing Internal Medicine Residents to Care for Patients at the Intersection of Women's Health, Gender-Affirming Care, and Health Disparities.

Objective: To create an interdisciplinary curriculum to teach key topics at the intersection of women's health, gender-affirming care, and health disparities to internal medicine (IM) residents. Materials and Methods: A core team of faculty from IM, Obstetrics and Gynecology, and Surgery partnered with faculty and fellows from other disciplines and with community experts to design and deliver the curriculum. The resulting curriculum consisted of themed half-day modules, each consisting of three to four inter-related topics, updated and repeated on an ∼3-year cycle. Health equity was a focus of all topics. Module delivery used diverse interactive learning strategies. Modules have been presented to ∼175 residents annually, beginning in 2015. To assess the curriculum, we used formative evaluation methods, using primarily anonymous, electronic surveys, and collected quantitative and qualitative data. Most surveys assessed resident learning by quantifying residents' self-reported comfort with skills taught in the module pre- and postsession. Results: Of 131 residents who completed an evaluation in 2022/23, 121 (90%) "somewhat" or "strongly" agreed with their readiness to perform a range of skills taught in the module. In all previous years where pre- and postsurveys were used to evaluate modules, we observed a consistent meaningful increase in the proportion of residents reporting high levels of comfort with the material. Residents particularly valued interactive teaching methods, and direct learning from community members and peers. Conclusion: Our interdisciplinary curriculum was feasible, valued by trainees, and increased resident learning. The curriculum provides a template to address equity issues across a spectrum of women's and gender-affirming care conditions that can be used by other institutions in implementing similar curricula.

Sedation level with midazolam: A pediatric surgery approach.

Midazolam (MDZ) is a short-acting benzodiazepine that is widely used to induce and maintain general anesthesia during diagnostic and therapeutic procedures in pediatric patients due to its sedative properties. The aim of this study was to perform a systematic review without a meta-analysis to identify scientific articles and clinical assays concerning MDZ-induced sedation for a pediatric surgery approach. One hundred and twenty-eight results were obtained. After critical reading, 37 articles were eliminated, yielding 91 publications. Additional items were identified, and the final review was performed with a total of 106 publications. In conclusion, to use MDZ accurately, individual patient characteristics, the base disease state, comorbidities, the treatment burden and other drugs with possible pharmacological interactions or adverse reactions must be considered to avoid direct alterations in the pharmacokinetics and pharmacodynamics of MDZ to obtain the desired effects and avoid overdosing in the pediatric population.

Long-term stability of transconjunctival midface lift surgery for postblepharoplasty lower eyelid retraction.

Lower eyelid retraction occurring as a complication of lower eyelid blepharoplasty may give rise to symptoms of exposure keratitis as well as cosmetic considerations. This retrospective longitudinal study describes our clinical experience with 74 patients with bilateral lower eyelid retraction postblepharoplasty (148 eyes) undergoing a transconjunctival subperiosteal midface lift with the implantation of a hard palate spacer graft over the period 2002 to 2019. All patients had a forced-up traction test result of less than or equal to 2 mm, indicating a significant fibrosis of the middle lamellae. Margin reflex distances (MRD2) were examined at follow-up visits scheduled for 2 weeks, 1 month, and 1, 3, 6, 9, and 12 years. Mean follow-up duration was ± 102 months (range 6 to 144 months). In all patients, MRD2 varied up until 1-year postsurgery and stabilized thereafter. Last follow-up MRD2 values indicated retraction improvements of 1.4, 2.4, and 3.2 mm, respectively, for those with mild: MRD2 6.3 mm [5.5 - 6.6], moderate: 7.0 mm [6.7 - 7.8], and severe retraction: 8.5 mm [7.9 - 9]. This improvement was statistically significant in patients with severe baseline retraction (p = 0.04). This approach proved to be safe and functional, and cosmetic results were excellent and remained stable over time.

Diagnóstico y tratamiento multidisciplinario de melanoma temprano y localmente avanzado. Consenso de expertos. Asociación Colombiana de Hematología y Oncología (ACHO) / Diagnosis and multidisciplinary treatment of early-stage and locally advanced melanoma: Expert consensus, Colombian Association of Hemato-Oncology (ACHO)

Resumen Introducción: El melanoma ocasiona el 75% de las muertes por cáncer de piel. Según GLOBOCAN, en 2018 se presentaron 287.723 casos nuevos de melanoma, con una mortalidad de 60.712 casos, que equivale al 20% del total de los casos incidentes. Las alternativas para el tratamiento del melanoma se fundamentan en la estatificación de la enfermedad, y en las características moleculares de la enfermedad. Objetivo: Consensuar, por común acuerdo de expertos, sugerencias para el diagnóstico y manejo de melanoma temprano basadas en la evidencia y ajustadas al contexto colombiano. Métodos: Se llevó a cabo un consenso de expertos multidisciplinario, constituido por 19 oncólogos clínicos, 2 cirujanos de mama y tejidos blandos, 2 dermatólogos, 2 patólogos y 2 radioterapeutas, miembros activos de la Asociación Colombiana de Hemato Oncología (ACHO). Este consenso se realizó en 4 etapas: 1. Estructuración de 29 preguntas, que se calificaron de 1 a 9. 2. Reenvío de las preguntas no consensuadas. 3. Análisis y discusión de las respuestas. 4. Las respuestas no consensuadas se llevaron a un consenso nominal. Resultados: Se discutieron 29 preguntas relacionadas con el diagnóstico y tratamiento de melanoma temprano, se construyeron sugerencias basadas en evidencia utilizada por los expertos y en guías de manejo de oncología reconocidas internacionalmente, adaptadas al contexto y realidad colombianos. Conclusiones: Se presentan sugerencias multidisciplinarias para el diagnóstico y tratamiento de melanoma temprano, las cuales debe considerarse para orientar la toma de decisiones y homogenizar la práctica clínica de acuerdo al contexto colombiano y a las características propias del sistema de salud del país. Este es un documento académico y no regulatorio.

Abstract Introduction: Melanoma causes 75% of deaths from skin cancer. In 2018, according to GLOBOCAN, 287,723 new melanoma cases were registered, with a mortality of 60,712 cases, which is equivalent to 20% of all incident cases. Alternatives for the treatment of melanoma are based on disease staging and the molecular characteristics of the disease. Objective: To establish a consensus by common agreement of experts and construct suggestions for the diagnosis and management of early-stage melanoma based on evidence and adjusted to the Colombian context. Methods: A multidisciplinary expert consensus was established, wth the participation of 19 clinical oncologists, 2 soft tissue surgeons, 2 dermatologists, 2 pathologists, and 2 radiotherapists, active members of the Colombian Association of Hemato-Oncology (ACHO). This consensus was carried out in four stages: 1) Structuring of 29 questions, which were scored from 1 to 9; 2) Resubmission of non-consensual questions; 3) Analysis and discussion of responses; and 4) Validation of non-consensual responses by nominal consensus. Results: Twenty-nine questions related to the diagnosis and treatment of early-stage melanoma were discussed in order to construct suggestions based on evidence proven by experts, as well as on internationally recognized oncology management guidelines adapted to the Colombian context and reality. Conclusions: Multidisciplinary suggestions are offered for the diagnosis and treatment of early-stage melanoma, which should be considered in order to guide decision-making and homogenize clinical practice according to the Colombian context and the characteristics of the Colombian health care system. This is an academic and non-regulatory document.

Periorbital Surgical Anatomy.

This article discusses the periocular anatomy region thoroughly because its knowledge in detail is of paramount importance for any surgeon dedicated to periocular surgery or any practitioner who dedicate their practice to aesthetic medicine. Mastering the anatomical details permits obtaining consistently good results with the minimal amount of complications possible.

Retroauricular myoperiosteal autograft for orbital implant exposure: 11 years of experience.

PURPOSE: To describe our experience with retroauricular myoperiosteal autograft for surgical coverage of exposed orbital implants. METHODS: This was a single-center, retrospective, observational cohort study, in which demographic and clinical data were compiled by reviewing the clinical records of anophthalmic patients with implant exposure treated with an autogenous retroauricular myoperiosteal graft at the Instituto de Microcirugía Ocular (IMO, Barcelona, Spain) over the period January 2007 to December 2017. Main outcome was the long-term coverage of implant after retroauricular myoperiosteal autograft; secondary outcome was the rate of post-surgical complications and management. RESULTS: Over the 11-year period, 27 eyes of 27 patients with implant exposure received a retroauricular myoperiosteal autograft. Mean participant age was 47.3 ± 17.9 years (range 9-78, median 45). Primary surgery was enucleation in 8 eyes (29.6%) and evisceration in 19 (70.4%). Implant materials were porous polyethylene in 17 (63%), hydroxyapatite in 3 (11.1%), and bioceramics in 4 (14.8%). In the remaining three patients (11.1%), the implant material and size were unknown. Implant exposure was diagnosed after a mean of 98 ± 111.7 months. Mean exposure diameter was 5.9 ± 3.1 mm. Mean follow-up duration after graft surgery was 37.5 ± 39 months. In four patients (14.8%), implant re-exposure was recorded and in two of these patients a re-graft using the same technique was performed. In the last follow-up session, all patients showed good implant coverage. CONCLUSIONS: Myoperiosteal graft could be a valid option for the long-term management of implant exposure irrespective of primary surgery, exposed area, and implant material.

Orbital and peri-orbital amyloidosis: a report of four cases.

Our objective was to describe our experience with orbital amyloidosis, and illustrate the different forms of presentation. This was a retrospective case series of four patients with biopsy-proven orbital amyloi- dosis, over the period from 2014 to 2016. We describe its diagnostic and clinical characteristics, management and systemic study. The series comprised three women and one man of mean age 52 ± 9.4 years. Affected sites were the lacrimal gland, tarsal conjunctiva, lacrimal sac and orbit. In three of the four patients, calcifications were observed. Three patients had associated ptosis. The patient with orbital involvement suffered an unusual vascular complication during surgery and systemic disease was detected. Management included debulking and complete resection of the lesion. In conclusion, orbital amyloidosis presents as a wide variety of forms. Its diagnosis is biopsy-based. Calcifications in biopsy specimens or images should raise suspicion of amyloidosis. It is important to always check for systemic amyloidosis.

Postoperative Care of the Facial Plastic Surgery Patient-Forehead and Blepharoplasty.

In any kind of surgery, postoperative care is essential for a good result, but especially when the matter at stake is facial plastic surgery. Despite having performed a perfect surgery, with the least amount of damage to the soft tissues and osteocartilaginous structures, minimal bleeding, and in terms of the surgical time, without adequate postoperative care our results can be affected considerably in the short and long run. Therefore, we must have very clear guidelines regarding postoperative care and the duties of our patients, which should be emphasized during the informed consent of the intervention. It is also essential to comment on the warning signs of postoperative complications, which need to be detected and treated in time to achieve the expected post-surgery results. Before being discharged from the hospital, the patient again receives the postoperative instructions, as well as receiving a paper copy to avoid any possible misunderstandings. In this article, we will detail the postoperative care and complications of brow lift and upper and lower blepharoplasty.

Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital Ptosis.

PURPOSE: To compare 2 surgical techniques (frontalis flap versus maximal anterior levator resection) as first surgical options for the treatment of congenital ptosis with poor levator function in patients younger than 2 years of age with a follow up of 10 years. METHODS: A retrospective study of 58 patients (71 eyelids) with severe ptosis and poor levator function who underwent frontalis muscle flap (FMF = 47) or maximal anterior levator resection (ALR = 24) for correction of their ptosis. Eyelid measurements were taken at baseline, 1, 5, and 10 years after surgery. The presence of complications, need for reoperations, and palpebral contour were evaluated. RESULTS: Most patients in both groups required only one surgical procedure with a stable average margin-reflex distance 1 over the 10-year follow-up period in both groups, with no statistically significant difference between the 2 techniques in achieving an adequate palpebral height after one single procedure. Eleven eyelids treated with FMF (23%) and 12 treated with ALR (50%) needed a reoperation, with a statistically significant difference between the 2 techniques. Five ALR patients (21%) and 6 FMF patients (13%) had alterations of eyelid contour. Pop-eyelid and eyelash ptosis were observed in 8% of patients operated with FMF. CONCLUSION: Good functional and aesthetic results were obtained with both surgical techniques. FMF required fewer reoperations compared with maximal ALR, offering a better long-term result without residual ptosis.

Nanopartículas de paladio soportadas en hidroxisales laminares: uso potencial en reacciones de Sonogashira / Palladium nanoparticles supported in laminar hydroxide salts: potential use in Sonogashira reactions / Nanopartículas de paládio suportadas em hidroxisais laminares: uso potencial em reacções de Sonogashira

Resumen En este artículo se reporta la síntesis de nanopartículas de paladio soportadas en hidroxisales de acetato de zinc y modificadas con un surfactante (LHS-Zn-Ac/Pd0 y LHS-Zn-Suf/Pd0 respectivamente), mediante inserción de [PdCl4]2- y su posterior reducción con etanol en reflujo. Con la inserción de surfactante, la distancia interlaminar de la hidroxisal de partida (LHS-Zn-Ac) se incrementó de 13,8 Å a 29,8 Å, mientras que los materiales finales, que contenían paladio metálico registraron distancias interlaminares de 22,4 Å y 29,4 Å para LHS-Zn-Ac/Pd0 y LHS-Zn-Suf/Pd0 respectivamente. Las hidroxisales de acetato de zinc y de surfactante con nanopartículas metálicas de paladio incorporadas fueron ensayadas como potenciales catalizadores en la reacción de Sonogashira partiendo de fenilacetileno y yoduros de arilo, particularmente yodobenceno o 2-yodofenol, dando lugar a difenilacetileno (32% de rendimiento de producto aislado y purificado) o 2-fenilbenzofurano (18%). Todos los materiales inorgánicos fueron caracterizados mediante las siguientes técnicas: difracción de rayos X (XRD), microscopia electrónica de barrido (SEM y SEM-EDS), microscopia electrónica de transmisión (TEM) y espectroscopía de Infrarrojo con Transformada de Fourier (FT-IR). Por su parte los compuestos orgánicos se caracterizaron por resonancia magnética nuclear (1H-NMR y 13C-NMR) y cromatografía de gases acoplada a espectrometría de masas (GC-MS).

Abstract This article reports the synthesis of palladium nanoparticles supported on zinc acetate hydroxysalts and modified with a surfactant (LHS-Zn-Ac/Pd0 and LHS-Zn-Suf/Pd0 respectively), by insertion of [PdCl4]2- and its subsequent reduction with ethanol at reflux. With the surfactant insertion, the interlaminar distance of the starting hydroxysalt (LHS-Zn-Ac) increased from 13.8 Å to 29.8 Å, while the final materials containing palladium metal registered interlaminar distances of 22.4 Å and 29.4 Å for LHS-Zn-Ac/Pd0 and LHS-Zn-Suf/Pd0 respectively. Zinc acetate hydroxysalt and surfactant with incorporated palladium metal nanoparticles were tested as potential catalysts in the Sonogashira reaction starting from phenylacetylene and aryl iodides, particularly iodobenzene or 2-iodophenol, giving diphenylacetylene (32% yield of isolated and purified product) or 2-phenylbenzofuran (18%). All inorganic materials were characterized by the following techniques: X-ray diffraction (XRD), scanning electron microscopy (SEM and SEM-EDS), transmission electron microscopy (TEM) and Fourier transformed infrared spectroscopy (FT-IR). The organic compounds were characterized by nuclear magnetic resonance (1H-NTMR and 13C-NMR) and gas chromatography coupled to mass spectrometry (GC-MS).

Resumo Neste artigo se reporta a síntese de nanopartículas de paládio suportadas em hidroxisais de acetato de zinco e modificadas com um surfactante (LHS-Zn-Ac/Pd0 e LHS-Zn-Suf/Pd0 respectivamente), mediante inserção de [PdCl4]2- para depois fazer uma redução com etanol em refluxo. Com a inserção do surfactante, a distância interlaminar da hidroxisal inicial (LHS-Zn-Ac) aumentou de 13,8 Å até 29,8 Å, enquanto que os materiais finais que continham paládio metálico registraram distâncias interlaminares de 22,4 Å até 29,4 Å para LHS-Zn-Ac/Pd0 e LHS-Zn-Suf/Pd0 respectivamente. As hidroxisais do acetato de zinco e do surfactante com nanopartículas metálicas de paládio incorporadas foram testados como potenciais catalisadores na reação de Sonogashira a partir de fenilacetileno e iodetos de arilo, particularmente iodobenzeno ou 2-iodofenol, levando respectivamente difenilacetileno (32% de rendimento de produto isolado e purificado) ou 2-fenilbenzofurano (18%). Todos os materiais inorgânicos foram caracterizados pelas seguintes técnicas: difração de raios X (XRD), microscopia eletrônica de varredura (SEM e SEM-EDS), Microscopia Eletrônica de Transmissão (TEM) e espectroscopia de infravermelho com transformada de Fourier (FT-IR). Por outro lado, os compostos orgânicos foram caracterizados por ressonância magnética nuclear (1H-NMR y 13C-NMR) e cromatografia gasosa acoplada à massa (GC-MS).

Inferior tarsal muscle-conjunctivectomy for reverse ptosis repair: A novel technique.

We describe a new technique for treatment of reverse ptosis in a patient with Horner Syndrome by means of excision of conjunctiva and inferior tarsal muscle. Surgery with eversion of inferior ptotic eyelid, placement of the Putterman ptosis clamp on the conjunctiva under inferior tarsus, suturing under incarcerated tissue and resection of 6mm of conjunctiva and inferior tarsal muscle was done under local anaesthesia in a short operating time with good cosmetic results without eyelid malposition or skin scar.

9-[(E)-2-feniletenil]antraceno Y 9-[(E)-2-(naftalen-2-il)etenil] antraceno COMO TRAMPAS PARA OXÍGENO SINGULETE: OXIDACIÓN FOTOSENSIBILIZADA Y EFECTO FOTODINÁMICO SOBRE PARÁSITOS Leishmania tarentolae / 9-[(E)-2-phenylethenyl]anthracene AND 9-[(E)-2-(naphthalen-2-yl)ethenyl] anthracene AS TRAPS FOR SINGLET OXYGEN: PHOTOSENSITIZED OXIDATION AND PHOTODYNAMIC EFFECT ON Leishmania tarentolae PARASITES

Introducción: El oxígeno singulete es una especie reactiva que se obtiene mediante transferencia energética usando un fotosensibilizador. Su cuantificación directa requiere de instrumentación costosa, por lo cual es necesario recurrir a métodos indirectos que tengan suficiente selectividad y bajo costo. Estos procedimientos se basan en la interceptación química del oxígeno singulete produciendo una especie que se pueda detectar por métodos analíticos convencionales. En este artículo se describe la utilización del 9-[(E)-2-feniletenil] antraceno 1 (PEA) y del 9-[(E)-2-(naftalen-2-il) etenil]antraceno 2 (NEA), como alternativas viables y económicas para la cuantificación indirecta del oxígeno singulete, en medios acuosos. Su ventaja radica en la fácil detección de la desactivación de su fluorescencia una vez son oxidados por el oxígeno singulete. Materiales y Métodos: Los compuestos se sintetizaron y caracterizaron siguiendo procedimientos previamente reportados. Su capacidad para atrapar oxígeno singulete se determinó siguiendo su oxidación fotosensibilizada en solución de H2O/THF y en parásitos de Leishmania tarentolae, empleando azul de metileno o rosa bengala como fotosensibilizadores. Las muestras experimentales se iluminaron con una lámpara de emisión de luz visible, y se utilizaron métodos espectroscópicos (absorción UV-Vis, fluorescencia, RMN-1H) y espectrometría de masas para monitorear el atrapamiento y fotooxidación. Resultados y Discusión: Las pruebas espectroscópicas demostraron la capacidad que tienen los compuestos PEA 1 y NEA 2 para atrapar oxígeno singulete en solución acuosa y dentro de parásitos de L. tarentolae. Estudios de viabilidad parasitaria demuestran que PEA 1 es citotóxico en la oscuridad y cuando los cultivos son expuestos a la luz, mientras que NEA 2 no es citotóxico en la oscuridad, pero sí lo es cuando el cultivo es expuesto a la luz. En conclusión, los compuestos estudiados pueden servir como sondas para detectar y medir la producción de oxígeno singulete en medio acuoso y potencialmente en cultivos celulares, aunque es recomendable evaluar su actividad citotóxica en la oscuridad y bajo iluminación en estos casos.

Introduction: Singlet oxygen is a reactive species obtained via energy transfer using a photosensitizer. Its direct quantification requires expensive instrumentation, so it is necessary to use indirect methods having sufficient selectivity and low cost. These procedures are based on the chemical interception of singlet oxygen producing a species that can be detected using conventional analytical methods. This article describes the utilization of 9-[(E)-2-phenylethenyl]anthracene 1 (PEA) and 9-[(E)-2-(naphtalen-2-yl)ethenyl]anthracene 2 (NEA) as suitable and economic alternatives for the indirect quantification of singlet oxygen in aqueous media. Their advantage is the easy detection of their fluorescence once they are oxidized by singlet oxygen. Materials and Methods: Compounds were synthesized and characterized following procedures previously reported. Their capacity to trap singlet oxygen was determined by monitoring their photosensitized oxidation in either a H2O/THF solution or within Leishmania tarentolae parasites, utilizing methylene blue or rose bengal as photosensitizers. Experimental samples were illuminated with a lamp emitting visible light, while spectroscopical techniques (absorption, fluorescence, 1 H-NMR) and mass spectrometry were used to monitor trapping and photooxidation. Results and Discussion: Spectroscopical evidence demonstrates that both PEA 1 and NEA 2 are capable of trapping singlet oxygen in both aqueous media and within L. tarentolae parasites. Viability studies demonstrate that PEA 1 is cytotoxic in the dark and when parasite cultures were exposed to light, while NEA 2 does not show dark cytotoxicity, but is toxic when cultures were exposed to light. It can be concluded that both compounds under study may be utilized as probes to detect and quantify the production of singlet oxygen in aqueous media and potentially in cell cultures, although it is recommended to evaluate their cytotoxic activity both in the dark and upon light exposure in these cases.

Nivel de conocimientos sobre fiebre que tienen las madres de niños menores de 5 años que acuden al Servicio de Emergencia del Hospital Nacional Sergio E. Bernales febrero 2014 / Level of knowledge about the fever of the mothers of children under 5 attended in the Emergency Service at the National Hospital Sergio E. Bernales, February 2014

La fiebre es un signo frecuente de diversas enfermedades y causante de alarma en la madre de niños menor de 5 años obligándolas a acudir a un centro de salud. El presente trabajo tiene como objetivo determinar el nivel de conocimientos sobre fiebre que tienen las madres de niños menores de 5 años que acuden al servicio de emergencia del Hospital Sergio E. Bernales febrero 2014; para el logro de dicho objetivo fue necesaria la revisión bibliográfica lo que permitió obtener las herramientas teóricas necesarias para su posterior análisis. Se aplicó un cuestionario dirigido a las madres donde se obtuvieron datos relevantes que fueron procesados y analizados. Para la recolección de datos se utilizó la encuesta y como instrumento, el cuestionario. En el análisis de datos, las respuestas se codificaron con el programa Excel SPSS y fueron analizados mediante el coeficiente de correlación de Spearman y la Prueba de Independencia Chi2. En los resultados de este estudio se observó que el conocimiento sobre fiebre es medio 57 por ciento; en cuanto a la dimensión identificación el 60 por ciento conocimiento bajo, dimensión tratamiento el 54 por ciento, conocimiento medio; dimensión complicación 53 por ciento conocimiento medio; por lo tanto se concluye que las madres de niños menores de 5 años del servicio de emergencia del Hospital Sergio E. Bernales tienen un conocimiento medio sobre fiebre, siendo una limitación relevante el no poder identificarla o hacerlo erróneamente; sin embargo en cuanto al manejo y a sus complicaciones su conocimiento es medio, ya que no saben identificarla correctamente, pero si manejarla según su idiosincrasia y su experiencia asociándose también los demás factores sociodemográficos intervinientes.

The fever is a frequent sign of diverse diseases and causer of alarm in the minor mother of 5-year-old children forcing them to come to a center of health. The present work has as aim determine the level of knowledge on fever that there have the mothers of 5-year-old minor children of the emergency service of the Hospital Sergio E. Bernales February, 2014; for the achievement of the above mentioned aim the bibliographical review was necessary what allowed to obtain the theoretical tools necessary for his later analysis. A questionnaire directed the mothers was applied where there was obtained relevant information that were processed and analyzed. For the compilation of information the survey was in use and as instrument, the questionnaire. In the analysis of information, the answers codified with the program Excel SPSS and 2 were analyzed by means of the coefficient of Spearman's correlation and the Test of Independence Chi2. In the results of this study was observed that the knowledge on fever is average 57 per cent; as for the dimension identification 60 per cent low knowledge, dimension treatment 54 per cent, average knowledge; dimension complication 53 per cent average knowledge; Therefore one concludes that the mothers of 5-year-old minor children of the emergency service of the Hospital Sergio E. Bernales have an average knowledge on fever, being a relevant limitation not to be able to identify or do it erroneously her; nevertheless as for the managing and his complications his knowledge is average, since they cannot identify her correctly, but if to handle it according to his idiosyncrasy and his experience other factors being associated also demographic partner interveners.

Feocromocitoma y paraganglioma. pilares para el manejo de una enfermedad rara: [Editorial] / Pheochromocytoma and paraganglioma. pillars for handling a rare disease: [Editorial]

El feocromocitoma y el paraganglioma son tumores neuroendocrinos infrecuentes. La localización adrenal o extra-adrenal determina la denominación, feocromocitoma para aquellos adrenales y paraganglioma para los localizados en los paraganglios. En todas las enfermedades raras, pocos centros y personas logran experiencias suficientes para poder llamarse expertos. En este sentido, el personal médico que se enfrenta a los pacientes con feocromocitoma o paraganglioma se ve retado a actualizarse en una enfermedad infrecuente, para la que apenas recientemente se crearon guías y para la que la mayoría de médicos no alcanzará a manejar un paciente con esta entidad en su vida académica. De allí que el diagnóstico sea difícil y el manejo y seguimiento heterogéneo.En este número de Medicina & Laboratorio se presenta una revisión de tema sobre feocromocitoma y paraganglioma como un paso inicial de educación médica continua y, en particular, para alertar a la población médica sobre dos tópicos a veces olvidados en el manejo del paciente con este tipo de tumor neuroendocrino, la posibilidad de malignidad y el seguimiento de por vida que necesitan estos pacientes. Respecto al primer punto, previamente se consideraba al feocromocitoma y al paraganglioma la enfermedad del 10%, dado que se estimaba que el 10% eran de origen genético, 10% eran bilaterales, 10% malignos, 10% extra-adrenales y 10% en niños. Sin embargo, los feocromocitomas hoy en día tienen un evento genético somático o germinal hasta en el 50% de los casos y más del 10% son malignos.

Lagophthalmos after facial palsy: current therapeutic options.

As the facial nerve carries sensory, motor and parasympathetic fibres involved in facial muscle innervation, facial palsy results in functional and cosmetic impairment. It can result from a wide variety of causes like infectious processes, trauma, neoplasms, autoimmune diseases, and most commonly Bell's palsy, but it can also be of iatrogenic origin. The main ophthalmic sequel is lagophthalmos. The increased surface exposure increases the risk of keratitis, corneal ulceration, and potentially loss of vision. Treatment options are wide; some are temporary, some permanent. In addition to gold standard and traditional therapies and procedures, new options are being proposed aiming to improve not only lagophthalmos but also the quality of life of these patients.

Embarazo adolescente: características maternas y su asociación con el peso al nacer del neonato / Adolescent pregnancy: maternal characteristics and their association with birth weight of the newborn

En Colombia, el embarazo adolescente es un problema de salud pública, con serias implicaciones en la salud y nutrición del binomio madre-hijo. El objetivo del estudio fue evaluar características sociodemográficas, económicas, de seguridad alimentaria, de salud y el estado nutricional por antropometría en adolescentes en el tercer trimestre de embarazo y asociar estos factores con el peso de los recién nacidos. Se realizó un estudio analítico de corte transversal con 294 embarazadas (semana 27-40) del programa de control prenatal de la Red Pública Hospitalaria de Medellín-Colombia. Se buscó asociación del peso al nacer del neonato con las variables explicativas. El bajo peso en embarazadas se presentó en mayor proporción en adolescentes cuyas familias devengaron menos de un Salario Mínimo Mensual -SMMLV-, en las que tenían 15 años o menos y con edad ginecológica menor de cinco años. La mayor proporción de pequeños para la edad gestacional se presentó en adolescentes con infecciones, bajo peso gestacional e ingresos menores a un SMMLV. Devengar menos de un SMMLV disminuye 118 gramos el peso del recién nacido (IC95%:-2,5a-234,7) y por cada kilogramo que aumentó el peso pregestacional materno, el peso al nacer aumentó 10,3 g (IC95%: 2,0 - 18,5). Los ingresos económicos inferiores a un SMMLV se asociaron con bajo peso materno y con recién nacidos pequeños para la edad gestacional. El peso pregestacional, el índice de masa corporal bajo en tercer trimestre de gestación y la presencia de infecciones urinarias y/o vaginales de la madre se asociaron con recién nacidos pequeños para la edad gestacional.

In Colombia, adolescent pregnancy is a public health problem, with serious implications for the health and nutrition of the binomial mother-child. Objective: assess socio-demographic, economic, food security, health and maternal nutritional status characteristics by anthropometric measures in a group of pregnant adolescents in Medellin-Colombia on their third trimester of pregnancy and associate them with the newborns weight. Methods and materials: A cross sectional analytical study was made with 294 pregnant women (week 27 to 40), who participating in prenatal control program of the public hospital network in Medellin-Colombia. We sought Association of weight at birth with the explanatory variables. Results: underweight in pregnant women was presented in families that had lower income wages than the Standard Minimum Wage Income - SMWI-, adolescents who were younger than 15 years old and those who had a gynecological age less than five years. In newborns, the highest proportion of small children for pregnancy age was found in mothers who presented infections, low pregnancy weight and low family income less than the minimum wage. For those whose earnings was less than the minimum income the newborn weight decreased 118g (CI95%:-2,5 a - 234,7), in addition, for each kilogram that increased the prepregnancy weight, newborn weight increased in 10,26g (CI95%:1,98 a -18,5). Conclusions: low-weight pregnancy and low-weight newborns are associated with low family income. Pre-pregnancy weight, body mass index in the third trimester of pregnancy and mother`s presence of urinary tract and vaginal infections were associated with the newborn´s weight.

[Adolescent pregnancy: maternal characteristics and their association with birth weight of the newborn]. / Embarazo adolescente: características maternas y su asociación con el peso al nacer del neonate.

UNLABELLED: In Colombia, adolescent pregnancy is a public health problem, with serious implications for the health and nutrition of the binomial mother-child. OBJECTIVE: assess socio-demographic, economic, food security, health and maternal nutritional status characteristics by anthropometric measures in a group of pregnant adolescents in Medellin-Colombia on their third trimester of pregnancy and associate them with the newborns weight. METHODS AND MATERIALS: A cross sectional analytical study was made with 294 pregnant women (week 27 to 40), who participating in prenatal control program of the public hospital network in Medellin-Colombia. We sought Association of weight at birth with the explanatory variables. RESULTS: underweight in pregnant women was presented in families that had lower income wages than the Standard Minimum Wage Income--SMWI-, adolescents who were younger than 15 years old and those who had a gynecological age less than five years. In newborns, the highest proportion of small children for pregnancy age was found in mothers who presented infections, low pregnancy weight and low family income less than the minimum wage. For those whose earnings was less than the minimum income the newborn weight decreased 118g (CI 95%: -2.5 a - 234.7), in addition, for each kilogram that increased the pre-pregnancy weight, newborn weight increased in 10,26g (CI 95%: 1.98 a-18.5). CONCLUSIONS: low-weight pregnancy and low-weight newborns are associated with low family income. Pre-pregnancy weight, body mass index in the third trimester of pregnancy and mother's presence of urinary tract and vaginal infections were associated with the newborn's weight.

Direct frontalis flap with and without levator pulley for correction of severe ptosis with poor levator function in the same patient.

PURPOSE: To compare two techniques of frontalis muscle flap suspension in different eyelids of the same patient for correction of severe ptosis with minimal levator function. MATERIAL AND METHODS: A prospective study of four patients with severe bilateral ptosis and poor levator function, who underwent direct frontalis muscle flap on the right eyelid and frontalis muscle flap with levator pulley on the left eyelid was conducted. Eyelid studies measurements were taken at baseline, 2 months, one year and 5 years after surgery. The presence of complications, flap function and palpebral contour were evaluated. RESULTS: Despite the surgical technique performed, good results in terms of functionality, contour and aesthetics were observed. In the eyes that underwent frontalis muscle flap (FMF)-direct, there were 2 cases with moderate anteriorization of eyelid margin in extreme upgaze and all patients showed eyelash ptosis that persisted one year after surgery, but improved after 5 years. In the eyes that underwent FMF-pulley, no upgaze anteriorization of eyelid margin was observed and three patients had eyelash ptosis of lesser extent than the fellow eye, improving after 1 year follow-up. FMF-pulley showed more long-term stability in eyelid height, compared with FMF-direct. CONCLUSIONS: Frontalis muscle flap with a pulley in the levator aponeurosis prevents some complications caused by the excessive vertical component of the direct frontalis muscle flap, especially in deep-set eye patients, with better stability of the eyelid height and contour over time.