Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.

Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse / Avaliação genotóxica e citotóxica da venlafaxina em ensaio agudo e subcrônico em camundongos

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.

Relaxation of thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) by endothelium-derived 6-nitrodopamine

6-Nitrodopamine is a novel catecholamine released by vascular tissues, heart, and vas deferens. The aim of this study was to investigate whether 6-nitrodopamine is released from the thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) and to evaluate the relaxing and anti-contractile actions of this catecholamine. Release of 6-nitrodopamine, dopamine, noradrenaline, and adrenaline was assessed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The relaxations induced by 6-nitrodopamine and by the selective dopamine D2 receptor antagonist L-741,626 were evaluated on U-46619 (3 nM)-pre-contracted vessels. The effects of 6-nitrodopamine and L-741,626 on the contractions induced by electric-field stimulation (EFS), dopamine, noradrenaline, and adrenaline were also investigated. Both aorta and pulmonary artery rings exhibited endothelium-dependent release of 6-nitrodopamine, which was significantly reduced by the NO synthesis inhibitor L-NAME. Addition of 6-nitrodopamine or L-741,626 caused concentration-dependent relaxations of both vascular tissues, which were almost abolished by endothelium removal, whereas L-NAME and the soluble guanylate cyclase inhibitor ODQ had no effect on 6-nitrodopamine-induced relaxations. Additionally, pre-incubation with 6-nitrodopamine antagonized the dopamine-induced contractions, without affecting the noradrenaline- and adrenaline-induced contractions. Pre-incubation with L-741,626 antagonized the contractions induced by all catecholamines. The EFS-induced contractions were significantly increased by L-NAME, but unaffected by ODQ. Immunohistochemical assays showed no immunostaining of the neural tissue markers S-100 and calretinin in either vascular tissue. The results indicated that 6-nitrodopamine is the major catecholamine released by marmoset vascular tissues, and it acts as a potent and selective antagonist of dopamine D2-like receptors. 6-nitrodopamine release may be the major mechanism by which NO causes vasodilatation.

Caracterización epidemiológica: descripción de mortalidad para hemorragia subdural aguda no traumática en el período 2017-2021, en Chile / Epidemiological characterization: description of mortality for non-traumatic acute subdural hemorrhage in the 2017-2021 period, in Chile

Introducción: La hemorragia subdural aguda no traumática (HSDNT) es una patología relacionada a factores de riesgo cardiovascular (RCV). Por falta de estudios epidemiológicos nacionales, se plantea estudiar la tasa de mortalidad (TM) y defunciones por HSDNT entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, transversal, sobre defunciones por HSDNT entre los años 2017-2021 en Chile (N=878), según grupo etario, sexo y lugar de defunción, usando datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva y cálculo de TM. No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 0,99/100.000 habitantes entre los años 2017-2021, siendo la mayor los años 2017-2019 y 2020 con TM de 1/100.000. El sexo masculino presentó TM de 1,27/100.000, el grupo etario mayor a 80 años presentó una TM de 19,28/100.000 habitantes. Según lugar de defunción, el año 2020 un 83% (148) de las defunciones fue en hospital o clínica. Discusión: La prevalencia del RCV hace relevante el estudio de mortalidad por HSDNT, donde la principal hipótesis de su mortalidad en Chile estaría basada en estos factores riesgo latentes. Según lugar de defunción, se podría suponer dadas mayores complicaciones en aquellos pacientes hospitalizados por HSDNT. Conclusión: Dada la nula existencia de datos sobre esta patología en Chile, se realizó una caracterización epidemiológica en conjunto a un análisis de defunciones según el lugar, aportando una perspectiva nacional de mortalidad sobre este cuadro en particular.

Introduction: Non-traumatic acute subdural hemorrhage (NTSDH) is related to cardiovascular risk factors (CVR). Due to lack of national epidemiological studies, it is proposed to study mortality rate (MR) and deaths from HSD between the years 2017-2021 in Chile. Methodology: Descriptive, observational, cross-sectional study on deaths due to SDH between the years 2017-2021 in Chile (N=878), in a population older than 15 years, according to age group, sex and place of death, using data obtained from Departamento de estadísticas e información en salud. Descriptive statistics and MR calculation were used. It did not require approval by an ethics committee. Results: A MR of 0.99/100,000 inhabitants was calculated between the years 2017-2021, the year being the highest in the years 2017-2019 and 2020 with MR of 1/100,000. Male sex presented a MR of 1.27/100,000, the age group over 80 years presented a MR of 19.28/100,000 inhabitants. By place of death, in 2020 there were 148 deaths in hospitals or clinics. Discussion: The prevalence of CVR makes the study of mortality from NTSDH relevant, where the hypothesis of its mortality in Chile would be based on these risk factors. Depending on the place of death, it could be assumed that there are greater complications in those patients hospitalized for NTSDH. Conclusion: Given the null existence of data on this pathology in Chile, an epidemiological characterization was carried out together with an analysis of deaths according to the place, providing a national perspective of mortality about this disease.

Rendimiento del ASAS Health Index en pacientes con Espondiloartritis de la vida real / Performance of ASAS Health Index in real life spondyloarthritis patients

Introducción: El cuestionario "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) fue desarrollado para medir de manera global la funcionalidad y el estado de salud en pacientes con espondiloartritis (EspA). Se han propuesto puntos de corte para determinar diferentes estados de salud que fueron poco evaluados en pacientes de la vida real. Objetivos: Describir el estado de salud medido por ASAS-HI en pacientes argentinos con EspA axial (EspAax) y periférica (EspAp) en la práctica diaria y evaluar los factores asociados al pobre estado de salud. Materiales y métodos: Estudio de corte transversal, analítico y multicéntrico. Se incluyeron consecutivamente pacientes con EspAax y EspAp según criterios ASAS, de 15 centros argentinos. Análisis estadístico: Se realizó estadística descriptiva, análisis bivariado y multivariado (regresión logística múltiple) para evaluar los factores asociados al pobre estado de salud (ASAS-HI ≥12). Para analizar la validez de constructo de la herramienta se realizó correlación de Spearman entre el ASAS-HI y otros parámetros de evaluación de la enfermedad. Resultados: Se incluyeron 274 pacientes con EspA, con una edad media de 49 (±14) años y una duración mediana de la enfermedad de 62 meses (p25-75: 24-135), 155 (56,6%) de los pacientes eran de sexo masculino, 129 pacientes (47%) con EspAax y 145 (52,9%) EspAp. Según el ASAS-HI 119 pacientes (43,4%) presentaban buen estado de salud, 117 (42,7%) tenían estado de salud moderado y 38 (13.9%) pobre estado de salud. En los pacientes con EspAp el valor de ASAS-HI mediano fue de 7 (p25-75: 3-10). El ASAS-HI correlacionó positivamente con: DAS28: rho: 0.5 (p<0.001) y HAQ: rho: 0.54 (p<0.001). La variable asociada de manera independiente con pobre estado de salud fue el DAS28 (OR: 1.9, IC95% 1.1-3.4, p: 0.029). En los pacientes con EspAax el valor de ASAS-HI mediano fue de 6 (p25-75: 2.75-10). El ASAS-HI mostró correlación con: BASDAI: rho: 0.7 (p<0.001), ASDAS-ERS: rho: 0.7 (p<0,001), ASQoL: rho: 0.8 (p<0.001), BASFI rho: 0.75 (p<0.001). La variable que se asoció de manera independiente a pobre estado de salud fue el ASDAS-ERS (OR 6.6, IC95% 2-22, p 0.002). Conclusión: Un pobre estado de salud se asoció independientemente a mayor actividad de la enfermedad en pacientes con EspAax y EspAp. El ASAS-HI correlacionó con otros parámetros de la enfermedad, lo que refuerza la validez de constructo de esta nueva herramienta.

Introduction: The "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) questionnaire was developed to globally measure function and health status in patients with spondyloarthritis (SpA). Cut-off points have been proposed to determine different health states that were poorly evaluated in real-life patients. Objectives: To describe the health status measured by ASAS-HI in Argentine patients with axial SpA (AxSpA) and peripheral SpA (SpAp) in daily practice and to evaluate the factors associated with poor health. Materials and methods: Cross-sectional, analytical and multicenter study. Patients with SpAax and SpAp were consecutively included according to ASAS criteria, from 15 Argentine centers. Statistical analysis: Descriptive statistics, bivariate and multivariate analysis (multiple logistic regression) were performed to evaluate the factors associated with poor health status (ASAS-HI ≥12). To analyze the construct validity of the tool, Spearman correlation was performed between the ASAS-HI and other disease evaluation parameters. Results: 274 patients with SpA were included, with a mean age of 49 (± 14) years and a median duration of the disease of 62 months (p25-75: 24-135), 155 (56.6%) were male, 129 patients (47%) with AxSpA and 145 (52.9%) SpAp. According to the ASAS-HI, 119 patients (43.4%) had good health, 117 (42.7%) had moderate health and 38 (13.9%) had poor health. In patients with SpAp, the mean ASAS-HI value was 7 (p25-75: 3-10). The ASAS-HI positively correlated with: DAS28: rho: 0.5 (p <0.001) and HAQ: rho: 0.54 (p <0.001). The variable independently associated with poor health status was DAS28 (OR: 1.9, 95% CI 1.1-3.4, p: 0.029). In patients with AxSpA, the mean ASAS-HI value was 6 (p25-75: 2.75-10). The ASAS-HI showed correlation with: BASDAI: rho: 0.7 (p <0.001), ASDAS-ERS: rho: 0.7 (p <0.001), ASQoL: rho: 0.8 (p <0.001), BASFI rho: 0.75 (p <0.001). The variable that was independently associated with poor health was the ASDAS-ERS (OR 6.6, 95% CI 2-22, p 0.002). Conclusion: Poor health status was independently associated with higher disease activity in patients with AxSpA and SpAp. The ASAS-HI correlated with other parameters of the disease, which reinforces the construct validity of this new tool.

Cirugía mínimamente invasiva del cáncer gástrico / Minimally invasive surgery for gastric cancer

Resumen La cirugía estándar del cáncer gástrico ha sido definida en las últimas décadas por evidencia principalmente entregada desde oriente, donde se han incorporado actualizaciones para el manejo mínimamente invasivo, especialmente en estadios iniciales de esta enfermedad. Existe evidencia actual, entregada por múltiples estudios randomizados y controlados, que comparan la cirugía mínimamente invasiva y cirugía abierta en cáncer gástrico. Es así que podemos afirmar con suficiente respaldo, que en cáncer gástrico incipiente la gastrectomía subtotal laparoscópica se puede considerar como el tratamiento estándar. Sin embargo, aún se deben esperar más resultados para aseverar lo mismo en el caso de las gastrectomías totales, tanto para cáncer incipiente como avanzado. Nuestro objetivo en esta actualización es incluir la evidencia actual disponible en el manejo del cáncer gástrico en relación al tratamiento mínimamente invasivo.

Standard surgery for gastric cáncer has been defined in recent decades by evidence mainly from the East, where updates for minimally invasive management have been incorporated, especially in the early stages of this disease. There is current evidence from múltiple randomized and controlled studies comparing minimally invasive surgery and open surgery in gastric cancer. Consequently, we can affirm with sufficient support that in early gastric cancer, laparoscopic distal gastrectomy can be considered as the standard treatment. However, more results should be expected to make the same statement for total gastrectomies, both for early and locally advanced gastric cancer. The aim in this update is to report on the current available evidence in the management of gastric cancer with minimally invasive treatment.

Embarazo y nuevo coronavirus: experiencia global reportada / Pregnancy and novel coronavirus: worldwide reported experience

INTRODUCCIÓN: La Organización Mundial de La Salud ha reportado recientemente que el nuevo foco de la pandemia global de la enfermedad Covid-19 es el continente americano. OBJETIVO: Realizar una revisión de la literatura sobre la experiencia internacional de la pandemia Covid 19 y embarazo. MÉTODO: Se realiza una búsqueda de la base de datos PubMed para las palabras clave Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, desde el 1 de noviembre 2019 hasta el 21 de mayo 2020. RESULTADOS: Un total de 365 artículos fueron inicialmente seleccionados de acuerdo con la estrategia de búsqueda diseñada. El total de artículos revisados de acuerdo con los criterios fueron 42. Las series clínicas seleccionadas acumularon un total de 1098 embarazadas y enfermedad de Covid-19. Las co-morbilidades mas frecuentes fueron hipertensión arterial, diabetes mellitus, obesidad y asma. La mortalidad en relación con el total de pacientes fue de un 1,2 % y la transmisión al recién nacido de 1,7% (15 de 875). CONCLUSIÓN: La información obtenida permite inferir que la presentación clínica de la enfermedad es a lo menos equivalente a la de mujeres de la misma edad no embarazadas. Dada la severidad de la enfermedad por SARS-CoV-2 reportada, las lecciones aprendidas deben ser rápidamente asimiladas y utilizadas en el contexto de la situación nacional epidémica.

INTRODUCTION: The World Health Organization has recently reported that the new focus of the global pandemic of Covid-19 disease is the American continent. OBJECTIVE: To conduct a literature review on the international experience of the Covid 19 pandemic and pregnancy. METHOD: A PubMed database search is performed for the keywords Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, from November 1, 2019 to May 21, 2020. RESULTS: A total of 365 articles were initially selected according to the designed search strategy. The total of articles reviewed according to the criteria was 42. The selected clinical series accumulated a total of 1098 pregnant women and Covid-19 disease. The most frequent comorbidities were hypertension, diabetes mellitus, obesity, and asthma. Mortality in relation to the total number of patients was 1.2% and transmission to the newborn was 1.7% (15 of 875). CONCLUSION: The information obtained allows us to infer that the clinical presentation of the disease is at least equivalent to that of non-pregnant women of the same age. Given the severity of the reported SARS-CoV-2 disease, the lessons learned must be quickly assimilated and used in the context of the national epidemic situation.

La simulación clínica en la adquisición de conocimientos en estudiantes de la Licenciatura de Enfermería / Clinical simulation in acquisition of knowledge among undergraduate nursing students / A simulação clínica na aquisição de conhecimentos em estudantes da Licenciatura de Enfermagem

Resumen Introducción: La simulación clínica es una herramienta educativa que permite a los estudiantes de enfermería experimentar la representación de un hecho real, para practicar, aprender y adquirir los conocimientos necesarios para el desempeño de su profesión. En Oaxaca, la Universidad de la Sierra Sur (UNSIS), tiene una clínica robotizada, que apoya a los estudiantes en el desarrollo de su práctica clínica, pero aún no cuenta con una metodología específica para llevar a cabo simulación clínica. Objetivo: Comparar la adquisición de conocimientos en estudiantes de enfermería con el método tradicional y otro basado en simulación clínica. Metodología: Estudio de pre y postest para evaluar conocimiento del tema trabajo de parto en alumnos de 4° semestre; se compararon dos metodologías, la tradicional utilizada en la universidad y otra basada en simulación clínica; la primera consistió en dar la clase teórica en aula y replicarla con un simulador; la segunda consistió en clase teórica, escenario de simulación clínica, caso clínico y debriefing. Resultados: Hubo diferencia estadísticamente significativa (p <.001) entre pretest y postest en ambas metodologías, pero quienes recibieron la metodología basada en simulación clínica obtuvieron mayores puntajes (p=0.004). Discusión: El uso de una metodología basada en simulación clínica permitió que los alumnos obtuvieran mayores conocimientos en el tema trabajo de parto, respecto a la metodología tradicional que se utiliza en la universidad. La UNSIS empieza a generar evidencia sobre el uso de la simulación clínica adaptada a su modelo educativo. Conclusiones: Utilizar la simulación clínica logró que los estudiantes obtuvieran mayores conocimientos.

Abstract Introduction: Clinical simulation is an educational tool which allows nursing students to experience representations of real events in order to practice, learn, and acquire the necessary knowledge to perform in their profession. In Oaxaca, Mexico, the Universidad de la Sierra Sur (UNSIS), has a robotic clinic which helps nursing students in their clinical learning; however, a specific clinical simulation methodology needs to be developed. Objective: To contrast the acquisition of knowledge among nursing students as a result of using the traditional method in comparison to using a method based on clinical simulation. Methodology: This is pre and post-test study to assess the knowledge development related to labor among nursing students from the 4th semester. Two teaching methodologies were compared: the traditional one, which included classroom classes and a replication using a simulator, and the clinical simulation based one, which included classroom classes, a clinical simulation scenario, a clinical case, and a debriefing session. Results: Statistically significant differences (p <.001) were found between the pre and post test knowledge status with both teaching methodologies; but the improvement of those who learned through the clinical simulation based methodology was higher (p=0.004). Discussion: The use of the methodology based on clinical simulation allowed the students to acquire more knowledge on labor among in comparison to the use of the traditional methodology. The UNSIS is now collecting evidence on the use of clinical simulation in order to adapt this methodology to its educational model. Conclusion: The use of clinical simulation resulted in the acquisition of more knowledge by the nursing students.

Resumo Introdução: A simulação clínica é uma ferramenta educativa que permite aos estudantes de enfermagem experimentar a representação de um fato real, para praticar, aprender e adquirir os conhecimentos necessários para o desempenho de sua profissão. Em Oaxaca, a Universidad de la Sierra Sur (UNSIS), tem uma clínica robotizada, que apoia aos estudantes no desenvolvimento de sua prática clínica, mas ainda não conta com uma metodologia específica para levar a cabo simulação clínica. Objetivo: Comparar a aquisição de conhecimentos em estudantes de enfermagem com o método tradicional e outro baseado na simulação clínica. Metodologia: Estudo de pre e postest para avaliar conhecimento do tema trabalho de parto nos alunos de 4° semestre; compararam-se duas metodologias, a tradicional utilizada na universidade e outra baseada em simulação clínica; a primeira consistiu em dar a aula teórica na sala e replicá-la com um simulador; a segunda consistiu na aula teórica, cenário de simulação clínica, caso clínico e debriefing. Resultados: Houve diferença estatisticamente significativa (p <.001) entre pretest e postest em ambas as metodologias, mas aqueles que receberam a metodologia baseada em simulação clínica obtiveram maiores pontuações (p=0.004). Discussão: O uso de uma metodologia baseada em simulação clínica permitiu que os alunos obtivessem maiores conhecimentos no tema trabalho de parto, ao respeito da metodologia tradicional que se utiliza na universidade. A UNSIS começa a gerar evidência sobre o uso da simulação clínica adaptada a seu modelo educativo. Conclusões: Utilizar a simulação clínica conseguiu que os estudantes obtivessem maiores conhecimentos.

La paradoja de la inmigración: las madres haitianas y latinoamericanas en Chile / The Immigration Paradox: Haitian and Latin American Mothers in Chile

Introducción: Existe información internacional sobre las diferencias en parto prematuro y peso al nacer para madres migrantes de diferentes etnias originarias. El objetivo de este trabajo es evaluar parto prematuro y peso al nacer de madres de nacionalidad diferente, cuyos partos ocurrieron en Chile. Materiales y métodos Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile. Se incluyeron los recién nacidos del período Septiembre 2012 a Diciembre 2016. Se evaluaron los datos perinatales básicos, parto prematuro, bajo peso al nacer y su relación con la edad gestacional de nacidos de madres chilenas y de otras nacionalidades. Resultados En el periodo estudiado hubo 1.048490 nacimientos, de los cuales 50995 son de madres extranjeras. El porcentaje de nacidos antes de 37 semanas en madres de Bolivia, Colombia, Ecuador, Perú y Venezuela es entre un 4.8 y 7.3 %, versus 8% en madres chilenas. Los percentiles 10 para el peso al nacer entre 30 y 40 semanas para madres chilenas y Haitianas (en paréntesis) expresados en gramos: 1045 (1102), 1195 (1160), 1360 (1370), 1550 (1503), 1750 (1508), 2000 (1669), 2235 (1982), 2500 (2237), 2810 (2607), 2970 (2710), 3080 (2858). Los z-score de madres Haitianas fueron significativamente menores después de las 35 semanas. Conclusiones La paradoja de la inmigración se verifica en la experiencia nacional, con tasas de natalidad prematuras y bajo peso al nacer más favorables para las madres extranjeras en comparación con las mujeres chilenas y con sus países de origen. Las madres afro-caribeñas tuvieron nacimientos con peso menor, en edades gestacionales donde se toman decisiones frecuentes, con diferencias de hasta un 20 % entre las 35- 37 semanas.

SUMMARY The immigration paradox: Haitian and Latin American mothers in Chile Introduction There is international information on the differences in preterm birth and birth weight for migrant mothers of different ethnicities. The objective is to evaluate prematurity and birth weight of mothers of different national origin, whose deliveries occurred in Chile. Materials and methods The national database of the Department of Informatics of the Ministry of Health of Chile was used. Newborns from the period of September 2012 to December 2016 were included. Basic perinatal data, preterm birth, low birth weight and their relationship with the gestational age of babies born to mothers of local origin and other nationalities were evaluated. Results 1,048,490 births, 50,995 foreign mothers were studied. The percentage of those born before 37 weeks of mothers from Bolivia, Colombia, Ecuador, Peru, and Venezuela is between 4.8 and 7.3%, compared to nationals with 8%. The 10th percentiles for birth weight from 30 to 40 weeks for Chilean and Haitian mothers (in parentheses) were (g): 1045 (1102), 1195 (1160), 1360 (1370), 1550 (1503), 1750(1508 ), 2000 (1669), 2235 (1982), 2500 (2237), 2810 (2607), 2970 (2710), 3080 (2858). The z-scores of Haitian mothers were significantly lower. Conclusions The immigration paradox is verified in the national experience, with preterm birth rates and low birth weight more favorable to foreign mothers compared to chileans Afro-Caribbean mothers had births with a lower weight, at gestational ages where relevant decisions are made, with differences of up to a 20% between 35-37 weeks.

Disforia de género: la evaluación psicológica para un cambio de sexo de hombre a mujer / Gender dysphoria: the psychological evaluation for a change of sex from male to female

La disforia de género es una condición psicológica que requiere una evaluación específica para definir el cambio de sexo. Se describe el caso de un adulto de sexo biológico masculino de 50 años de edad que se atiende en una Unidad de Atención de personas viviendo con VIH-SIDA quien es derivado para una evaluación psicológica por fiscalía. Se realizaron entrevistas en profundidad y la aplicación de las siguientes pruebas psicológicas: test de Rorschach, test de los colores de Max Lüscher y el Cuestionario Desiderativo. Se concluyó una prueba de realidad conservada, presencia de estabilidad emocional y una identificación profunda con el sexo femenino, elementos claves para proceder al cambio de sexo.

Gender dysphoria is a psychological condition that requires a specific evaluation to define the sex change. We describe the case of a 50-year old adult male biological sex that is treated in a Unit of Care for people living with HIV-AIDS who is referred for a psychological evaluation by a public prosecutor's office. In depth interviews and the application of the following psychological tests were carried out: Rorschach test, Max Lüscher color test and the Desiderative Questionnaire. A conserved reality test, presence of emotional stability and a deep psychological identification with the female sex, key elements to proceed to the sex change, was concluded.

Perfil neuropsicológico y efectos de la rehabilitación cognitiva en la leucemia linfoblástica aguda: a propósito de un caso / Neuropsychological profile and cognitive rehabilitation training effects on acute lymphoblastic leukaemia: a case study

La Leucemia Linfoblástica Aguda (LLA) infantil es el cáncer pediátrico más frecuente. Actualmente cuenta con un alto porcentaje de supervivencia, pero dichos pacientes presentan secuelas cognitivas secundarias a la enfermedad debidas, principalmente, al tratamiento médico recibido para evitar la recidiva del cáncer. Por lo tanto, resulta necesaria la implementación de programas de rehabilitación cognitiva específicos para este tipo de población. Es por ello que el objetivo del presente estudio fue describir los déficits cognitivos en un varón de 17 años que fue diagnosticado con LLA a los 9 años. Tras la valoración neuropsicológica inicial se desarrolló un programa de rehabilitación cognitiva intensivo durante dos años consecutivos. Realizamos un estudio pre-post en el que administramos el Conners Continuous Performance Test (CPT-II) y la Escala de Inteligencia de Wechsler para niños (WISC-IV). Los resultados, antes de la intervención, mostraron que el paciente manifestaba una menor velocidad de procesamiento y dificultades de atención sostenida y alternante, comprensión verbal y razonamiento perceptivo. Además, también presentó un número considerable de errores perseverativos, signo de dificultades de flexibilidad cognitiva y control inhibitorio. Dichos déficits mejoraron notablemente tras el programa de rehabilitación cognitiva. En conclusión, nuestro estudio pone de manifiesto la necesidad de aplicar programas de rehabilitación cognitiva tempranos para paliar las secuelas cognitivas derivadas de la LLA y de su tratamiento médico, así como mejorar la calidad de vida del paciente, ya que las mejoras cognitivas redundarán en su rendimiento académico y en su funcionamiento cotidiano.

Childhood Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. It currently has a high survival rate, but these patients have cognitive sequelae secondary to the disease, mainly due to the medical treatment received to prevent cancer recurrence. Therefore, it is necessary to implement specific cognitive rehabilitation programs for this type of population. Hence, the main objective of this study was to describe cognitive deficits in a 17-year-old male who was diagnosed with ALL when he was 9 years old. After the initial neuropsychological evaluation, an intensive cognitive rehabilitation program was developed during two consecutive years. We conducted a pre-post study in which we administered the Conners Continuous Performance Test (CPT-II) and the Wechsler Intelligence Scale for Children (WISC-IV). Results, before the intervention, showed that the patient presented a lower processing speed and difficulties of sustained and alternating attention, verbal comprehension and perceptive reasoning; in addition to a large number of perseverative errors, sign of self-monitoring difficulties and inhibitory control. These deficits improved markedly after a program of cognitive rehabilitation. In conclusion, our study highlights the need to apply early cognitive rehabilitation programs to alleviate the cognitive sequelae derived from ALL and its medical treatment. In addition, any improvement in their cognitive capabilities will have a positive impact in their academic performance and quality of life.

Estudio longitudinal del estado nutricional y de la condición física de estudiantes de enseñanza media de un liceo municipal de Talca, Chile / Longitudinal study of the nutritional status and physical condition of high school students of a municipal high school of Talca, Chile

El objetivo de esta investigación es analizar las variables de estado nutricional y condición física de estudiantes de dos niveles de enseñanza media (primero y cuarto) durante los años 2016, 2017 y 2018, para saber cómo ingresan y cómo egresan del establecimiento. Se evaluaron parámetros de peso, talla y perímetro de cintura para el estado nutricional, mientras que para la condición física se contemplaron pruebas físicas de salto horizontal y flexo-extensión de codos. Las variables peso y salto horizontal sufrieron cambios. La primera tuvo un aumento constante durante los años de estudio en Primer Año Medio (p<0,068), lo cual conllevó a un aumento del IMC (p<0,054) mientras el salto horizontal tuvo una disminución significativa en Cuarto Año Medio (p<0,004). Con esto se determina que los parámetros de estado nutricional y condición física de los estudiantes evaluados sufren efectos negativos durante los años de investigación.

The objective of this research is to analyze the variables or nutritional status and physical condition of students from two high school grades (first and fourth year) during the years 2016, 2017 and 2018, to know their measurements upon entering and when leaving the establishment. For this, parameters of weight, height and waist circumference were evaluated in terms of nutritional status, while for physical condition; physical tests such as horizontal jump and elbow flexionextension were contemplated. The variables of weight and horizontal jumps underwent changes. The first had a constant increase during the years of study in first year (p<0,068), which led to an increase in BMI (p<0,054) while the horizontal jump had a significant decrease in fourth year (p<0,004). This determines that the parameters of nutritional status and physical condition of the students evaluated suffered negative effects during this research.

Estabilização vertebral segmentar modificada no tratamento de trauma medular em ouriço-cacheiro (Coendou spinosus): relato de caso / Modified segmental vertebral stabilization in the treatment of spinal cord trauma in a Paraguaian hairy dwarf porcupine (Coendou spinosus): case report

Uma fêmea, adulta, de ouriço-cacheiro (Coendou spinosus, F. Cuvier, 1823), foi atendida com histórico de trauma medular. No exame neurológico, foi constatada paraplegia com nocicepção preservada e sinais compatíveis com choque espinhal. Exame radiográfico e mielografia apontaram presença de fratura e luxação vertebral torácica entre T10-11. O paciente foi submetido à técnica de estabilização vertebral segmentar modificada, com pinos de Steinmann e fios de cerclagem. A técnica utilizada mostrou-se eficaz na estabilização da fratura/luxação vertebral e na recuperação dos sinais neurológicos. O paciente apresentou recuperação progressiva da deambulação. Para o conhecimento dos autores, este é o primeiro relato utilizando estabilização vertebral segmentar modificada para o tratamento de fratura/luxação vertebral torácica em Coendou spinosus.(AU)

An female, adult Paraguayan hairy dwarf porcupine (Coendou spinosus, F. Cuvier, 1823) was referred to the Veterinary Hospital with clinical history of spinal cord injury. In the neurological examination, paraplegia with preserved nociception compatible with signs of spinal shock were observed. Radiographic and myelographic examinations showed evidence of a vertebral dislocation and fracture between the 10th and 11th thoracic vertebrae. The patient underwent surgical stabilization of the lesion using the modified segmental vertebral stabilization technique with Steinmann pins and cerclage wires. Under the conditions reported in this case, the technique was effective in stabilizing vertebral fracture/dislocation and in recovering neurological functions. The patient presented progressive recovery from ambulation. To the authors' knowledge, this is the first case report that performed modified segment stabilization for thoracic vertebral fracture/luxation treatment in Coendou spinosus.(AU)

Controversias en el tratamiento de la estrumosis peritoneal: caso clínico y revisión bibliográfica / Controversies in the management of peritoneal strumosis: Case report and literature review

Resumen ANTECEDENTES: el estruma ovárico es un teratoma monodérmico, sumamente complejo, constituido en más de 50% por tejido tiroideo. Una forma infrecuente de manifestación es la estrumosis peritoneal, que consiste en múltiples implantes peritoneales benignos compuestos por estruma ovárico. No existe consenso en relación con el tratamiento; además, la malignidad de la estrumosis peritoneal es tema de controversia. CASO CLÍNICO: paciente nuligesta de 33 años de edad a quien, durante el estudio de esterilidad primaria, se le diagnosticó estruma ovárico derecho. A los tres años postratamiento recurrió en forma de estruma ovárico izquierdo y estrumosis peritoneal (hallazgo intraoperatorio). En ambos casos se efectuó quistectomía laparoscópica, y en la segunda ocasión se practicó, además, la exéresis de los implantes macroscópicos. Después de recibir quimioterapia con 131I (100 mCi) y entrar en remisión completa, se produjo una nueva recidiva cuatro años después; fue necesaria la cirugía citorreductora y un nuevo ciclo de quimioterapia con 131I (100 mCi). En la actualidad la paciente permanece en remisión completa. CONCLUSIONES: ante la escasez de casuística de estrumas ováricos y, sobre todo, de estrumosis peritoneal, resulta imprescindible individualizar el tratamiento en cada paciente, en donde es decisiva la participación de un equipo multidisciplinario. La cirugía citorreductora puede ser una opción terapéutica para favorecer la respuesta al tratamiento ablativo con 131I.

Abstract BACKGROUND: Struma ovarii is a highly specialized monodermic teratoma composed of thyroid tissue in more than 50%. An infrequent form of presentation is peritoneal strumosis, which consists of multiple peritoneal implants of benign mature thyroid tissue. In both situations, there is no consensus about the management of those entities. In addition, malignancy of peritoneal strumosis is controversial. CLINICAL CASE: We report a case of a 33-year-old nulligravid woman that during a sterility study was diagnosed with a right struma ovarii. Three years after treatment, it recurred as a left struma ovarii and a peritoneal strumosis (intraoperative finding). A laparoscopic ovarian cystectomy was performed in both cases, as well as the excision of all macroscopic implants in the second one. She remained in remission after 131I ablative chemotherapy (100 mCi), but a new recurrence took place four years later, requiring a cytoreductive surgery and a second 131I chemotherapy (100 mCi). She is now in complete remission. CONCLUSIONS: Due to the lack of casuistry of struma ovarii and paucity of information, especially in the case of peritoneal strumosis, decisions must be individualized on each patient and must be taken by a multidisciplinary team. Cytoreductive surgery might be an option to improve the response to ablative 131I chemotherapy.

Endometrioma con elevación inusual de CA-19.9. Reporte de un caso / Endometrioma with an unusual CA-19.9 elevation. A case report

Resumen Antecedentes: la prueba diagnóstica de referencia para endometriosis es la visualización de focos endometriósicos en un procedimiento quirúrgico. Los valores de CA-125 > 35 UI/mL y de CA-19.9 > 37 UI/mL sugieren endometriosis o tumores de ovario (teratomas, endometriomas y mucinosos). Los valores de CA-19.9 > 300 UI/mL tienen un valor predictivo positivo mayor de 90% para cáncer de páncreas. Caso clínico: paciente de 32 años de edad, con infertilidad primaria de 10 años, tumoración compleja en el ovario derecho de 209 cc y en el ovario izquierdo de 14.81 cc, con CA-19.9 de 2,920 UI/mL y CA-125 de 142.37 UI/mL. Por tomografía y panendoscopia se descartó la posibilidad de malignidad en el aparato gastrointestinal. En la laparotomía exploradora, protocolizada para tumor de ovario, se encontró un tumor de 10 x 8.0 cm en el ovario derecho y uno de 3.0 x 2.0 cm en el izquierdo. El reporte de patología fue de quistes endometriósicos, sin malignidad coexistente. En el seguimiento a los 40 días se encontró un CA-19.9 de 41.38 U/mL y a los 60 días logró un embarazo espontáneo. Conclusiones: los marcadores tumorales se utilizan para descartar algún proceso maligno en el ovario. Se carece de pruebas suficientes para recomendarlos rutinariamente para diagnosticar endometriosis. Cuando inusualmente sus valores se encuentran por encima del punto de corte, es importante descartar cualquier malignidad en el aparato gastrointestinal. Se recomienda asumir el tratamiento de estas pacientes con un equipo multidisciplinario.

Abstract Background: Endometriosis is the presence of ectopic non-neoplastic endometrial tissue. The gold standard diagnosis is a visual inspection by laparoscopy. A CA-125 >35 IU/mL and a CA-19.9 >37 IU/mL have been present in endometriosis and ovarian tumors (teratomas, endometriomas or mucinous). However, an elevation >300 IU/mL have a positive predictive value >90% for pancreatic cancer. Case report: 32-year-old female, with 10-year primary infertility. With a complex tumor in the right ovary of 209cc and in the left one of 14.81cc. The CA-19.9 was at 2,920 IU/mL and the CA-125 at 142.37 IU/mL. In which have ruled out gastrointestinal malignancy with tomography and panendoscopy. A laparotomy exploratory was performed, finding a tumor of 10x8.0cm in the right ovary and 3.0x2.0cm in the left one. The pathology report was of endometriosis cysts, with no coexisting malignancy. At follow-up at 40 days a CA-19.9 of 41.38 IU/mL was found and at 60 days achieved a spontaneous pregnancy. Conclusions: Tumor biomarkers are generally used to rule out malignant ovary pathology. There is insufficient evidence to recommend its routine use to diagnose endometriosis. However, when they are unusually above the cut-off point, it is important to specifically rule out gastrointestinal malignancy, working in a multidisciplinary way.

Resolver problemas y tomar decisiones, esencia de práctica reflexiva en enfermería. Análisis de la literatura / Problem-solving and decision-making, essence of reflexive practice in nursing: A literature review / Resolver problemas e tomar decisões, essência de prática reflexiva em enfermagem. Análise da literatura

Dada la importancia de la formación de profesionales reflexivos, y en el marco de la búsqueda de una nueva epistemología de la práctica de enfermería, este artículo de revisión analiza diversas fuentes teóricas que representan evidencias científicas relativas a la resolución de problemas, toma de decisiones clínicas y su relación con las características de los recién egresados del pregrado, quienes al realizar servicio social (residencias), vivencian un proceso de transición: dejar de ser estudiante, pero a la vez enfrentarse a situaciones de ejercicio profesional que requieren habilidades para resolver problemas y tomar decisiones en situaciones inciertas y complejas. La revisión implicó búsquedas sistemáticas en bases de datos como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden y Redalyc, que permitieron localizar: 3 revisiones sistemáticas, 11 estudios con enfoque cuantitativo, 11 con enfoque cualitativo y 2 mixto, 14 artículos de revisión y 5 libros, publicados en los últimos 15 años. Aunque las publicaciones analizadas proceden de todos los continentes, predominan las de América en un 50%, seguidas por las europeas en un 22%. Se concluye que existen modelos que pueden apoyar el desarrollo de habilidades para los procesos cognitivos referidos, lo que coadyuvaría a un ejercicio profesional reflexivo y autónomo, en lugar de la adhesión a prácticas asistenciales rutinarias. También que las escuelas de Enfermería tienen el compromiso para incorporar en el currículo diversas estrategias deliberadas y progresivas que apoyen el desarrollo de dichas habilidades, así como de generar ambientes de aprendizaje áulicos y clínicos que las promuevan.

Considering the importance of forming reflexive professionals, and also within the frame of a new epistemology of nursing practice, this review explores diverse theoretical sources which represent scientific evidence related to problem-solving and clinical decision-making skills, and also to the characteristics of newly nursing graduates who, during their social service (residency), experience a process of transition facing professional realities which require them to use those skills within complex and uncertain situations. The review included systematic searches in databases such as Medline, CINHAL, Scielo, Lilacs, Cochrane, Cuiden, and Redalyc, and yielded: 3 systematic reviews, 11 studies with quantitative approaches, 11 studies with qualitative ones, 2 with mixed ones, 14 review articles, and 5 books published in the last 15 years. The analyzed publications came from all continents, but there was a higher prevalence of those from America (50%) and Europe (22%). This review suggested that there are models which can support the development of these important skills and thus help consolidate a professional performance which is autonomous-reflexive rather than repetitive. Moreover, the schools of nursing can consider incorporating these models into their curricula and also generate school and clinical environments which further support the development of these skills.

Dada a importância da formação de profissionais reflexivos e no quadro da busca de uma nova epistemologia da prática de enfermagem, este artigo de revisão, analisa diversas fontes teóricas que representam evidencias científicas relativas à resolução de problemas, toma de decisões clínicas e a sua relação com as caraterísticas dos recém-formados da pre-graduação, os quais ao fazer o estágio (residências), vivenciam um processo de transição: deixar de ser estudante, mas ao mesmo tempo confrontar-se a situações de exercício profissional, eles requerem habilidades para resolver problemas e tomar decisões em situações incertas e complexas. A revisão envolveu buscas sistemáticas em bases de dados como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden e Redalyc, que permitiram localizar 3 revisões sistemáticas, 11 estudos com abordagem quantitativa, 11 com abordagem qualitativa e 2 mista, 14 artigos de revisão e 5 livros, publicados nos últimos 15 anos. Ainda que as publicações analisadas procedam de todos os continentes, predominam as da América em um cinquenta por cento, seguidas pelas europeias em vente e dois por cento. Conclui-se que existem modelos que podem apoiar o desenvolvimento de habilidades para os processos cognitivos referidos, o qual contribuiria a um exercício profissional reflexivo e autônomo, em vez da adesão de práticas assistenciais rotineiras. Também que as escolas de Enfermagem têm o compromisso para incorporar no currículo diversas estratégias intencionais e progressivas que apoiem o desenvolvimento de tais habilidades, assim como para gerar ambientes de aprendizagem escolares e clínicos que as promovam.

Construcción de un instrumento para valorar la actitud a la obesidad en adolescentes / Construction of an instrument to assess the attitude to obesity in adolescents

Objectives: a) To validate a scale of attitudes to obesity by teenagers, b) verify their ability for reproducibility c) propose scales for assessment according to age and sex. Subjects and methods: A descriptive study of survey type was conducted in 1252 adolescents between 12-17 years of three Municipal Facilities of the Province of Talca, Chile (584 males and 668 females). A survey was applied involving three indicators (factors): a) preference/ rejection, b) concern/disinterest) and c) will/apathy. Construct validity, internal consistency reliability (Cronbach) and scales were developed by the LMS method was evaluated. Results: Construct validity, after Varimax rotation showed 14 questions: a) preference /rejection (4 questions), b) concern/disinterest (6 questions) and c) will/apathy (4 questions). The variance for each factor was 23.5%, 41.0% and24.1%, respectively totaling 88.6% of explanation. The reliability showed highly reliable values, ranging from 0.73 to 0.75 for each factor. The scales developed from the LMS method showed the following cutoffs points: p <10 is low attitude, ≥p10 to p90 moderate attitude, p90 to p97 high attitude and ≥p97 very high attitude to obesity. Conclusion: The results suggests that this method can be used and applied in the adolescent education system in the region of Maule, Chile, whose main purpose in making the diagnosis of possible predispositions toward obesity.

Objetivos: a) validar una escala de actitud a la obesidad para adolescentes, b) verificar su capacidad de reproductibilidad y c) proponer baremos para su valoración en función de la edad y sexo. Sujetos y métodos: Se efectuó un estudio de tipo descriptivo por encuesta. Se encuestó a 1252 adolescentes entre 12 a 17 años de tres Establecimientos Municipales de la Provincia de Talca, Chile (584 varones y 668 mujeres). Se aplicó un cuestionario con tres indicadores (factores): a) preferencia/ rechazo, b) preocupación/desinterés y c) voluntad/apatía. Se evaluó la validez de constructo, la fiabilidad por consistencia interna (Cronbach) y los baremos fueron desarrollados por medio del método LMS. Resultados: La validez de constructo, tras la rotación Varimax evidenció 14 preguntas: a) preferencia/rechazo (4 preguntas), b) preocupación/desinterés (6 preguntas) y c) voluntad/apatía (4 preguntas). El porcentaje de explicación de la varianza para cada factor fue 23,5%, 41,0% y 24,1%, totalizando un 88,6% de explicación. La fiabilidad evidenció valores altamente confiables, oscilando entre 0,73 a 0,75 para cada factor. Los baremos desarrollados a partir del método LMS, mostraron los siguientes puntos de corte: p<10 es baja actitud, ≥p10 a p90 moderada actitud, p90 a p97alta actitud y ≥p97 Muy alta actitud a la obesidad. Conclusión: El instrumento elaborado mostró validez de constructo satisfactoria y moderado nivel de consistencia interna. Los resultados sugieren su uso y aplicación en adolescentes escolares del sistema educativo de la región del Maule de Chile. Este instrumento puede ser utilizado en la escuela para diagnosticar posibles predisposiciones hacia la obesidad.

Educación participativa comunitaria en adultos mayores para el manejo de Diabetes Mellitus e Hipertensión Arterial / Participative communitary education on the elderly for the manegement of Diabetes Mellitus and Arterial Hipertension

El presente artículo describe una intervención educativa que fomenta la participación activa de la comunidad como protagonista de su aprendizaje, con el propósito de empoderarla en el manejo de su salud en relación a crisis hipertensiva y diabética. MÉTODOS: se utilizó el Proceso de Enfermería y el modelo de Comunidad como Socio de Anderson y McFarlane, con los cuales se realizó la valoración, levantamiento de necesidades y análisis. Además, se utilizaron metodologías participativas, establecidas en el modelo de educación descrito por Jane Vella, para las intervenciones. En la valoración, se empleó un instrumento diseñado para recolectar datos del núcleo y los subsistemas educación y recreación. La población estuvo conformada por un grupo de diez mujeres, nueve de ellas adultos mayores, pertenecientes a la comuna de Puente Alto, seleccionadas por el programa de adultos mayores de la Municipalidad de dicha comuna. Los encuentros con la comunidad se iniciaron el día jueves 12 de marzo de 2015 y finalizaron el día martes 31 de marzo del mismo año, completando un total de cinco sesiones. RESULTADOS: en el primer encuentro, se identificó la necesidad de aprender acerca del manejo de enfermedades crónicas en situaciones de crisis, tales como Diabetes Mellitus tipo II e Hipertensión Arterial. Conjuntamente, resultó que toda la comunidad fue capaz de reconocer el manejo correcto de una emergencia diabética e hipertensiva. CONCLUSIÓN: las metodologías participativas logran el empoderamiento de la comunidad para actuar frente a situaciones de descompensación de diabéticos tipo II e hipertensos.

OBJECTIVE: The present arcticle describes an educational intervention that encourages active communitary participation, ensuring to make them the main character of their learning, with the purpose of empowering their health management regarding hypertensive and diabetic crisis. METHODS: the method used was based on the Nursing process, and the Community-as-partner model by Anderson and McFarlane, with this approach a valuation, a list of needs, and an analysis were carried out. Furthermore, Jane Vella's participative methodology was used for the development of the interventions. For the assessment, an instrument was designed to collect the data. The data consisted of the core, the education subsistem and the recreation subsistem. The community consisted of a ten women group; nine of them were elderly, and all of them lived in the area of Puente Alto. They were selected by the Municipality's elderly program. The communitary meetings began on Thursday March 12, 2015, and ended on Tuesday March 31, of the same year. There were a total of five sessions. RESULTS: on the first meeting, the need to learn about the management of crisis situations in chronic diseases, such as Diabetes and Hypertension, was identified. All the community's members were able to recognize by themselves the right diabetic and hypertensive crisis management. CONCLUSION: the participative methodology achieves the community's empowering to face the diabetic and hypertensive decompensations.

Hipospadia perineal em um cão: relato de caso / Perineal hypospadias in a dog: case report

A hipospadia é uma anomalia congênita da genitália externa, na qual a uretra peniana termina ventral e caudalmente à sua abertura normal. Pode ser classificada, com base na localização da abertura uretral, como glandular, peniana, escrotal, perineal e anal. O objetivo deste trabalho é relatar um caso raro de hipospadia perineal, em que são abordados seus aspectos clínicos e terapêuticos, em um cão macho, sem raça definida, com seis meses de idade. Um canino com histórico de suspeita de hermafroditismo e presença de um orifício, logo abaixo do ânus, pelo qual urinava foi atendido no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (UFRGS). Durante o exame físico, foi observado o meato uretral localizado ventralmente ao ânus, além de alterações no prepúcio, pênis e escroto. Foram realizados exames de triagem, tais como: hemograma completo, urinálise, ecografia abdominal e uretrocistografia. O cão foi encaminhado para a cirurgia, quando foi submetido à amputação peniana e prepucial total e também à orquiectomia. O canino recebeu antibioticoterapia, analgésicos, anti-inflamatório e limpezas diárias dos pontos e da região perineal e apresentou excelente recuperação pós-operatória. Após 30 dias da cirurgia, o paciente retornou ao hospital, e foi verificada completa cicatrização da ferida cirúrgica, sem sinais de infecção urinária e inflamação ou assaduras na região perineal. A hipospadia perineal é um caso raro de anomalia uretral congênita, ainda pouco documentada em medicina veterinária. O procedimento cirúrgico realizado demonstrou ser importante, uma vez que removeu toda a genitália externa defeituosa, onde, futuramente, poderiam desenvolver-se infecções e/ou inflamações. Com isso, minimizou as complicações dessa doença e melhorou a qualidade de vida do paciente...

Hypospadias is a congenital anomaly of the external genitalia, where the penile urethra finishes its normal opening ventrally and caudally. It can be classified based on the location of the urethral opening as glandular, penile, scrotal, perineal and anal. The aim of this work was report an uncommon case of perineal hypospadias, working on the clinical and therapeutic aspects in a six-month-old male dog of undefined race. A dog with a history of suspected hermaphroditism and presenting a hole below the anus by which it urinated, was rescued at the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (UFRGS). During the physical exam, it was observed that the urethral meatus was situated ventrally to the anus. Foreskin, penis and scrotum alterations were also seen on the dog. Screening exams such as complete blood count, urinalysis, abdominal ultrasound and cystourethrography were done. The dog went straight to surgery, where it had total penile and total preputial amputation and also orchiectomy. The canine showed excellent postoperative recovery, receiving antibiotic therapy, analgesics, anti-inflammatories and daily cleaning on stitches and the perineal region. Thirty days after surgery the patient went back to the Hospital presenting a complete healing of the surgical wound, without reporting signs of urinary infection and inflammation or rashes on the perineal region. The perineal hypospadias is a rare case of urethral congenital anomaly, still not well documented by veterinary medicine. The surgical procedure done demonstrated to be important, since there was the removal of all of the defective external genitalia where, in the future, inflammation and infection could develop, decreasing the complications of this disease and improving this patient's quality of life...

Osteossíntese de mandíbula e maxila em equinos adultos: relato de quatro casos / Mandibular and maxillary osteosynthesis in adult horses: a report of four cases

Fraturas da mandíbula secundárias a trauma externo não são raras em equinos, sendo este o osso mais comumente fraturado quando o trauma é na região da cabeça. Na maioria dos casos, são abertas e com dano aos tecidos moles adjacentes. Como os ossos da cabeça não são submetidos às forças de carga do apoio, a exigência para fixação da fratura é menos desafiadora. O presente trabalho descreve o tratamento cirúrgico de quatro fraturas de mandíbula em equinos, sendo que, em um caso, havia também fratura de maxila. Quatro cavalos adultos com histórico de traumatismo na região da cabeça foram atendidos, avaliados clinicamente, radiografados e, após diagnóstico, submetidos a tratamento cirúrgico. No primeiro caso, o equino apresentava fratura rostral da mandíbula, sendo esta tratada com cerclagens. Além disso, o animal apresentava fratura múltipla de maxila, que foi corrigida com uma cerclagem próxima aos dentes incisivos, uma placa com parafusos e duas hemicerclagens na região entre os dentes incisivos e pré-molares. O segundo animal apresentava fratura múltipla dos ramos horizontal e vertical direito da mandíbula e foi tratado com uso de cinco placas de reconstrução e parafusos. No terceiro paciente foi diagnosticada fratura simples no ramo horizontal da mandíbula esquerda, que foi estabilizada com uma placa e parafusos. O quarto paciente apresentava fratura rostral de mandíbula, com avulsão de quatro dentes incisivos, sendo realizada a extração dos dentes incisivos e sutura da mucosa labial. Todos os animais obtiveram consolidação das fraturas em diferentes períodos de pós-operatório, o que permitiu melhora na qualidade de vida.

Secondary mandible fracture due to external trauma is not uncommon in horses, that being the most commonly fractured bone when the injure is on the animal´s head. In most cases, the injuries are open and damaging to surrounding soft tissues. As the bones of the head are not subjected to load forces, the support requirements for fracture fixation are less challenging. This paper describes the surgical treatment of four mandible fractures in horses, and, in one case, the animal had also suffered a fractured jaw. Four horses with a history of trauma to the head region have been examined, clinically and radiographically evaluated, and after being diagnosed, each of them was submitted to surgical treatment. In the first case, the horse showed rostral fracture of the jaw, thus being treated with cerclage. Moreover, the animal had multiple jaw fractures that were fixed with a cerclage next to the incisors, with a plate and two screws and cerclage in the region between the incisors and the premolars. The second animal had multiple fractures of the horizontal and vertical branches of the right jaw and was treated with the use of five reconstruction plates and screws. The third patient was diagnosed with a simple horizontal branch fracture of the left mandible that was stabilized with a plate and screws. The fourth patient had a fracture of the rostral mandible with avulsion of four incisors, and received the extraction of incisors and labial mucosa suture. All animals received fracture treatment in different post surgical periods, allowing improved quality of life.