Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML) / Estimativa da taxa de filtração glomerular na prática clínica: posicionamento consensual da Sociedade Brasileira de Nefrologia (SBN) e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial (SBPC/ML)

ABSTRACT Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease - Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica.

Development and validation of a diagnostic prediction model for severe periventricular-intraventricular hemorrhage in newborns: insights from a retrospective analysis utilizing the MIMIC-III database

Abstract Objective: Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. Method: This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. Results: A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model's predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. Conclusions: This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists.

Los diagnósticos, la clínica psicoanalítica y el posicionamiento ético / Diagnosis, psychoanalytic clinic and ethical positioning / Diagnostics, clinique psychanalytique et positionnement ethique / Diagnósticos, clínica psicanalítica e posicionamento ético

El ser humano está signado por el conflicto, por los deseos contradictorios, por el intercambio nunca simple con los otros. Suponer que el otro debe ser una máquina que siga pautas implica desvitalizarlo, lo que es equivalente al aniquilamiento de lo humano. Las niñas y los niños no tienen que ser encerrados ni con clasificaciones psicopatológicas, ni con medicamentos. Las niñas y los niños tienen que tener un sostén esperanzado por parte del entorno, un suelo a partir del cual puedan desplegar sus alas... Transmitir esperanzas es parte importante de nuestra tarea. Debemos dejar que la vida fluya y aportar para que ese fluir derive en nuevos vuelos AU

The human being is marked by the conflict, the contradictory desires, by the never easy exchange with other people.Supposing that the other person must be a machine which follows guidelines means devitalize him and implies the annihilation of the human being.Girls and boys cannot be bounded, nor with psychopathological classifications either with medicines. Girls and boys must have a hopeful support by their environment, a ground which helps them to open their wings... Giving hope is a very important part of our duty.We must let the life flows and contribute to that flowing leads to new flights AU

L'être humain est marqué par le conflit, par les désirs contradictoires, par l'échange jamais simple avec autrui.Supposer que l'autre doit être une machine qui suit des directives implique de le dévitaliser, ce qui équivaut à l'anéantissement de l'humain.Les filles et les garçons ne doivent pas être enfermés, ni avec des classifications psychopathologiques, ni avec des médicaments.Les filles et les garçons doivent bénéficier du soutien plein d'espoir de leur environnement, d'un terrain à partir duquel ils peuvent déployer leurs ailes...Transmettre l'espoir est une partie importante de notre tâche.Il faut laisser lavie couler et contribuer à ce que ce flux conduise à de nouveaux envols AU

A pessoa humana está marcada pelo conflito, pelos desejos contraditórios, pela troca nunca simples com os outros.Assumir que a outra pessoa deve ser um aparelho que segue directrizes implica desvitalizá-lo, o que equivale à aniquilação do que é humano.As crianças não devem ser trancadas, nem com clasificações psicopatológicas, nem com medicação.As crianças devem ter um apoio esperançoso do seu ambiente, uma base a partir do qual possam abrir suas asas... Transmitir esperanças é uma parte importante da nossa tarefa. Devemos deixar a vida fluir e contribuir para garantir que esse fluxo conduzca a novos voos AU

La construcción del diagnóstico / The construction of the diagnosis / La construction du diagnostic / A construção do diagnóstico

Este trabajo, que gira entorno a la consulta por una joven de 14 años, permite desplegar algunas ideas acerca del diagnóstico en psicoanálisis. Se sostiene en una palabra clave: la construcción. Construir un diagnóstico habla de un recorrido singular que lleva tiempo y en la especificidad de la clínica con adolescentes pone en juego múltiples transferencias. Por lo tanto, diagnosticar para un psicoanalista no consiste en subsumir un ejemplar a una clase nosológica sino delinear un trayecto: el trayecto de alguien frente a sus circunstancias AU

This work revolves around the consultation of a 14-year-old girl, allowing us to display some ideas about diagnosis in psychoanalysis. It is based on a key word: construction. Building a diagnosis speaks of a unique journey that takes time and in the specificity of the clinic with adolescents, multiple transfers come into play.Therefore, diagnosing for a psychoanalyst does not consist of subsuming a specimen to a nosological class but rather outlining a path: someone's path in the face of their circumstances AU

Ce travail, qui s'articule autour d'une consultationd'une jeune fille de 14 ans, permet de développer quelques idées sur le diagnosticen psychanalyse. Il repose sur un mot clé: construction. Construire un diagnostic parle d'un parcours unique qui prend du temps et dans la spécificité de la clinique auprès des adolescents, de multiples transferts entrent en jeu.Ainsi, diagnostiquer pour un psychanalyste ne consiste pas à subsumer un spécimen à une classe nosologique mais plutôt à tracer un chemin: le chemin de quelqu'un face à sa situation AU

Este trabalho, que gira em torno da consulta de uma menina de 14 anos, permite-nos desdobrar algumas ideias sobre o diagnóstico em psicanálise. Baseia-se numa palavra-chave: construção. Construir um diagnóstico fala de um percurso único que leva tempo e na especificidade da clínica com adolescentes coloca em jogo múltiplas transferências.Portanto, diagnosticar para um psicanalista não consiste em subsumir um exemplar a uma classe nosológica, mas sim delinear um caminho: o caminho de alguém diante de suas circunstancias AU

¿Cuál es la importancia de diferenciar entre síntoma y trastorno al momento de llevar a cabo un tratamiento? Estrategias de trabajo que se abren frente a estas presentaciones / What is the importance of differentiating between symptom and disorder when carrying out treatment?work strategies that open in face of these presentations / Quelle est l'importance de différencier entre symptôme et trouble lors de la réalisation d'un traitement? stratégies de travail qui s'ouvrent face à ces présentations / Qual é a importância de diferenciar entre sintoma e transtorno ao realizar o tratamento? Estratégias de trabalho que se abrem diante destas apresentações

En este escrito los autores puntualizan la diferencia entre los conceptos de síntoma y trastorno en la infancia. A los fines diagnósticos establecer esta diferenciación permite pensar estrategias de intervención adecuadas a las características metapsicológicas de estos modos de presentación de sufrimiento en la infancia AU

In this writing the authors point out the difference between the concepts of symptom and disorder in childhood.For diagnostic purposes, establishing this differentiation allows us to think about intervention strategies appropriate to the metapsychological characteristics of these modes of presentation of suffering in childhood AU

Dans cet écrit, les auteurs soulignent la différence entre les concepts de symptôme et de trouble dans l'enfance.À des fins diagnostiques, établir cette différenciation permet de réfléchir à des stratégies d'intervention adaptées aux caractéristiques métapsychologiques de ces modes de présentation de la souffrance dans l'enfance AU

Neste escrito os autores apontam a diferença entre os conceitos de sintoma e transtorno na infância.Para fins diagnósticos, estabelecer essa diferenciação permite pensar estratégias de intervenção adequadas às características metapsicológicas desses modos de apresentação do sofrimento na infancia AU

Utilidad de GeneXpert MTB/RIF en el diagnóstico de tuberculosis frente a la baciloscopia / Utility of GeneXpert MTB/RIF in the Diagnosis of Tuberculosis Compared to Sputum Smear Microscopy

Introducción: La implementación de un método diagnóstico adecuado y eficiente es crucial para la detección temprana de la tuberculosis. Esto no solo permite un control efectivo de la enfermedad para evitar su transmisión y progresión hacia estadios más graves, además previene el desarrollo de resistencia a los fármacos en los pacientes.Objetivo: Evaluar la utilidad de la prueba molecular GeneXpert MTB/RIF en el diag-nóstico de Mycobacterium tuberculosis complex, en comparación con la bacilos-copia, utilizando el cultivo como referencia.Material y Métodos: Se realizó un estudio descriptivo, observacional y no expe-rimental de corte transversal, se incluyeron 253 muestras de pacientes de ambos sexos y de variados rangos de edad, que fueron evaluadas mediante baciloscopia, GeneXpert MTB/RIF y cultivo. El estudio se centró en muestras procesadas en un Hospital público de la ciudad de Quito durante el período de enero de 2021 a mayo de 2022Resultados: La prueba molecular GeneXpert MTB/RIF mostró una sensibilidad del 94,7% y una especificidad del 93,9% para el diagnóstico de Mycobacterium tu-berculosis complex. Además, se identificó un caso de resistencia a la rifampicina.Conclusión: Este estudio confirma la eficacia de la prueba molecular GeneXpert MTB/RIF sobre la baciloscopia para el diagnóstico oportuno de Mycobacterium tu-berculosis complex. Sin embargo, es esencial considerar las diversas condiciones de las muestras y pacientes para optimizar la precisión diagnóstica

Introduction: Implementing an appropriate and efficient diagnostic method is cru-cial for the early detection of tuberculosis. This not only allows for effective control of the disease to prevent its transmission and progression to more severe stages but also prevents the development of drug resistance in patients.Objective: To evaluate the utility of the GeneXpert MTB/RIF molecular test in diag-nosing Mycobacterium tuberculosis complex, compared to sputum smear micros-copy, using culture as the reference. Material and Methods: A descriptive, observational, and non-experimental cross-sectional study was conducted, including 253 samples from patients of both sexes and various age ranges, which were assessed using sputum smear micros-copy, GeneXpert MTB/RIF, and culture. The study focused on samples processed at a Quito ́s Public Hospital during the period from January 2021 to May 2022.Results: The GeneXpert MTB/RIF molecular test showed a sensitivity of 94.7% and a specificity of 93.9% for the diagnosis of Mycobacterium tuberculosis com-plex. Additionally, a case of resistance to rifampicin was identified.Conclusion: This study confirms the effectiveness of the GeneXpert MTB/RIF mo-lecular test over sputum smear microscopy for the timely diagnosis of tuberculosis. However, it is essential to consider the diverse conditions of the samples and pa-tients to optimize diagnostic accuracy

Enfrentamiento diagnóstico de la rinosinusitis aguda en pacientes adultos ambulatorios / Diagnostic Approach of acute rhinosinusitis in adults outpatients

Acute rhinosinusitis is a common condition, mainly of viral etiology and self-limiting course. There is coexistence of microbiological agents that favor bacterial superinfection. Therefore, it is necessary to know evidence that supports diagnostic approach in adults out- patients. Having reviewed the evidence, we mention the isolated symptoms and signs have such a low performance to guide the diagnostic approach, some with statistical evidence such as hemifacial pain, colored nasal discharge and radiographic alterations suggestive of rhinosinusitis. Also, it is possible to improve clinical performance by combining suggestive findings. The imaging study has little evidence that supports them, because non-specific and non-concordant findings. Finally, empirical management with antibiotics does not statistically or clinically modify the evolution of an acute non-complicated condition.

La rinosinusitis aguda es una condición frecuente, principalmente de etiología viral y de curso autolimitado. Existe coexistencia de agentes microbiológicos que favorece la sobreinfección bacteriana. Por ello, es necesario conocer la evidencia que dirige el enfrentamiento diagnóstico en pacientes adultos ambulatorios. Habiéndose revisado la evidencia, mencionamos que los síntomas y signos aislados poseen bajo rendimiento para guiar el proceso diagnóstico, destacando algunos con mejores atributos diagnósticos, pero de significancia estadística bastante discreta, como lo son el dolor hemifacial, la descarga nasal coloreada y alteraciones de la radiografía sugerentes de rinosinusitis. También, que se puede mejorar discretamente el rendimiento clínico combinando algunos de estos hallazgos sugerentes. El estudio imagenológico posee poca evidencia que lo respalde, dado la presencia de hallazgos inespecíficos o no concordantes, inclusive en pacientes asintomáticos. Finalmente, respecto de manejo empírico con antibióticos, destaca que su uso no modifica estadística ni clínicamente la evolución de un cuadro agudo no complicado.

Psicanálise profana: diagnóstico e experiência trans / Psychanalyse profane: diagnostic et expérience trans / Profane psychoanalysis: diagnosis and trans experience

Este artigo parte do exame da relação entre o poder de normalização, o dispositivo diagnóstico e a patologização da transexualidade para expor a função da norma em diferentes prismas na discussão sobre o normal e o patológico no contexto da experiência trans. São pautadas as dificuldades decorrentes dos pressupostos normativos que servem como diretrizes para políticas públicas e privadas de acesso ao processo transexualizador. Mediante uma discussão epistêmica, a experiência trans e sua patologização são analisadas em relação à função diagnóstica na psiquiatria e na psicanálise, observando o rigor de suas especificidades. Por fim, a orientação lacaniana é apresentada como alternativa à psiquiatrização e patologização da experiência trans, tendo em vista o seu distinto uso diagnóstico, o privilégio da singularidade em sua prática e o caráter subversivo de sua epistemologia.

Cet article commence par examiner la relation entre le pouvoir de normalisation, le dispositif de diagnostic et la pathologisation de la transsexualité pour exposer la fonction de la norme sous différents angles dans la discussion sur le normal et le pathologique dans le contexte de l'expérience trans. Les difficultés découlant des hypothèses normatives qui servent de lignes directrices aux politiques publiques et privées sur l'accès au processus de transsexualisation sont mises en question. À travers une discussion épistémique, l'expérience trans et sa pathologisation sont analysées en relation avec la fonction diagnostique en psychiatrie et en psychanalyse, en observant la rigueur de leurs spécificités. Enfin, l'orientation lacanienne est présentée comme une alternative à la psychiatrisation et à la pathologisation de l'expérience trans, compte tenu de son usage diagnostique distinct, du privilège de la singularité dans sa pratique et du caractère subversif de son épistémologie

This article begins by examining the relationship between the power of normalization, the diagnostic device and the pathologization of transsexuality to expose the function of the norm from different perspectives in the discussion about the normal and the pathological in the context of the trans experience. Difficulties arising from normative assumptions that serve as guidelines for public and private policies on access to the transsexualization process are examined. Through an epistemic discussion, the trans experience and its pathologization are analyzed in relation to the diagnostic function in psychiatry and psychoanalysis, observing the rigor of their specificities. Finally, the Lacanian orientation is presented as an alternative to the psychiatrization and pathologization of the trans experience, given its distinct diagnostic use, the privilege of singularity in its practice and the subversive character of its epistemology

Hipertensão Arterial Pulmonar com Características de Envolvimento Venoso: Um Trabalho Investigativo / Pulmonary Arterial Hypertension with Features of Venous Involvement: A Detective's Task

Resumo A doença veno-oclusiva pulmonar (DVOP) e a hemangiomatose capilar pulmonar são tipos raros de substratos histopatológicos dentro do espectro da hipertensão arterial pulmonar (HAP) com prognóstico muito ruim. Caracterizam-se por um processo fibroproliferativo generalizado das veias e/ou capilares de pequeno calibre com preservação das veias maiores, resultando em um fenótipo de hipertensão pulmonar pré-capilar. A apresentação clínica é inespecífica e semelhante a outras etiologias de HAP. O diagnóstico definitivo é obtido por meio de análise histológica, embora a biópsia pulmonar não seja aconselhada devido ao maior risco de complicações. No entanto, alguns achados adicionais podem permitir um diagnóstico clínico presuntivo de DVOP, especialmente história de tabagismo, uso de drogas quimioterápicas, exposição a solventes orgânicos (particularmente tricloroetileno), baixa capacidade de difusão do monóxido de carbono (DLCO), dessaturação ao esforço e evidências de doença venosa sem doença cardíaca esquerda no exame de imagem, manifestada por uma tríade clássica de opacidades em vidro fosco, linhas septais, e linfadenopatias. O transplante pulmonar é o único tratamento eficaz e os pacientes devem ser encaminhados no momento do diagnóstico, devido à rápida progressão da doença e ao prognóstico ruim. Apresentamos o caso de um homem de 58 anos com HAP com características de envolvimento venoso/capilar em que a suspeita clínica, o pronto diagnóstico e o encaminhamento precoce para transplante pulmonar foram determinantes para um bom desfecho.

Abstract Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome.

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay / Validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay

Introducción: El dengue es la enfermedad arboviral más común en los seres humanos. Un diagnóstico temprano y preciso del dengue puede respaldar el manejo clínico, la vigilancia y el control de la enfermedad y es fundamental, por ello en el diagnóstico del dengue es importante contar con pautas clínicas y epidemiológicas que permitan la identificación oportuna y una conducta terapéutica adecuada. Objetivos: Evaluar la validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay durante los años de 2012 a 2020. Materiales y métodos: Estudio analítico de tipo observacional, retrospectivo correspondientes a pacientes pediátricos (0 a 18 años) internados en el Hospital de Referencia de Paraguay el periodo enero 2012 a julio 2020 con diagnostico presuntivo de dengue al ingreso. Se realizó́ un análisis bivariado relacionando las frecuencias de 20 grupos de criterios diagnósticos combinados y 3 criterios diagnósticos aislados (OMS 2009, nexo epidemiológico y antigenemia NS1 para dengue) con el gold standard de diagnóstico que fue la conversión serológica. Resultados: Participaron del estudio 342 sujetos. EL 44% tenía edad escolar y 70% tenía 5 años o más. El 52,76% (191) fueron masculinos. Se encontraron desnutrición y sobrepeso en el 13% y 2%, respectivamente. La combinación de proteína C reactiva con plaquetopenia se encontró́ en 0.45% de los pacientes sin dengue y en el 6% de los pacientes con diagnóstico final de dengue (p=0.004). Conclusión: Este resultado aporta la alternativa de uso de una combinación sencilla de exámenes de laboratorio que puede replicarse en salas de urgencias como en salas de internación en un primer contacto con pacientes febriles con sospecha de fiebre dengue.

Introduction: Dengue is the most common arboviral disease in humans. An early and accurate diagnosis of dengue can support the clinical management, surveillance and control of the disease and is essential, therefore in the diagnosis of dengue it is important to have clinical and epidemiological guidelines that allow timely identification and appropriate therapeutic conduct. Objectives: To evaluate the validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay during the years 2012 to 2020. Materials and methods: Analytical study of case and control type, observational, longitudinal, retrospective corresponding to pediatric patients (0 to 18 years) admitted to the Reference Hospital of Paraguay from January 2012 to July 2020 with a presumptive diagnosis of dengue at income. A bivariate analysis was performed relating the frequencies of 20 groups of combined diagnostic criteria and 3 isolated diagnostic criteria (WHO 2009, epidemiological link and NS1 antigenemia for dengue) with the gold standard of diagnosis, which was serological conversion. Results: 342 subjects participated in the study. 44% were school age and 70% were 5 years old or older. 52.76% (191) were male. Malnutrition and overweight were found in 13% and 2%, respectively. The combination of C-reactive protein with thrombocytopenia was found in 0.45% of patients without dengue and in 6% of patients with a final diagnosis of dengue (p=0.004). Conclusion: This result provides the alternative of using a simple combination of laboratory tests that can be replicated in emergency rooms and inpatient wards in a first contact with febrile patients with suspected dengue fever.

Quistes Dentígeros Asociados a Mesiodens. Revisión de la Literatura a Propósito de Dos Casos

El mesiodens es el diente supernumerario que se origina en la premaxila, siendo considerado el más prevalente o el más diagnosticado debido a las numerosas alteraciones que producen y que incluyen malposición de los dientes permanentes, formación de diastemas, retraso en la erupción de los incisivos anteriores superiores, y formación de quistes. La etiología de los mesiodens no está completamente comprendida, aunque se piensa que pueda deberse a la proliferación de la lámina dental u otros factores genéticos. El diagnóstico generalmente es tardío debido a que la mayoría permanece sin erupcionar, pudiendo generar complicaciones dentomaxilares que finalmente son el motivo de consulta de los pacientes. El quiste dentígero es un quiste odontogénico del desarrollo asociado a la corona de un diente incluido, numerario o supernumerario y su tratamiento es quirúrgico. El diagnóstico temprano y la planificación del tratamiento debe considerar una anamnesis minuciosa, un examen clínico e imágenes 3D. La cirugía debe consistir en la desinclusión del diente causal, la exéresis y legrado de la lesión, con o sin regeneración ósea inmediata del lecho quirúrgico con injerto. Se presentan dos casos de quiste dentígero asociado a un mesiodens que se diagnosticaron como hallazgo radiográfico. El plan de tratamiento consistió en evaluación y tratamiento endodóntico de los dientes desvitalizados, enucleción y legrado del quiste, junto a la desinclu sión del diente supernumerario, y seguimiento clínico y radiográfico en el largo plazo.

Mesiodens is the supernumerary tooth that originates in the premaxilla, considered the most prevalent or, the most diagnosed due to the multiple alterations that produce and that include malposition of the permanent teeth, formation of gaps, delayed eruption of the upper anterior incisors and cyst formation. The etiology of mesiodens is not fully established, although it is thought that it may be due dental lamina alteration or other genetic factors. Diagnosis is usually late because most remain unerupted, and can generate dentomaxillary complications that are ultimately the reason for patient consultation. The dentigerous cyst is a developmental odontogenic cyst associated with the crown of an included, numerary or supernumerary tooth and its treatment is surgery. Early diagnosis and treatment planning should consider a careful history, clinical examination, and 3D imaging. The surgery must consist of the disinclusion of the offending tooth, the exeresis and curettage of the lesion, with or without immediate bone regeneration of the surgical bed with a graft. Two cases of a dentigerous cyst associated with a mesiodens that were diagnosed as a radiographic finding are presented. The treatment plan consisted in evaluation and endodontic treatment of devitalized teeth, enucleation and curettage of the cyst, together with the disinclusion of the supernumerary tooth, and long-term clinical and radiographic follow-up.

Comparación de desempeño de algoritmos para el diagnóstico de sífilis / Performance comparison of algorithms for the diagnosis of syphilis / Comparação de desempenho de algoritmos para o diagnóstico da sífilis

Resumen La sífilis es una de las infecciones de transmisión sexual con mayor incidencia en la Argentina. Para su diagnóstico, el Ministerio de Salud de la Nación avala distintos algoritmos, entre ellos, el algoritmo tradicional y el reverso. En el algoritmo tradicional, la VDRL constituye la prueba de screening y los resultados positivos se confirman con la prueba treponémica de aglutinación de partículas (TPPA). El algoritmo reverso con un test rápido, avalado más recientemente, consiste en la realización de un test rápido treponémico como screening y posterior VDRL en las muestras que resulten positivas. Se realizó una comparación entre ambos algoritmos para evaluar si era factible y conveniente la implementación del algoritmo reverso con un test rápido en el laboratorio del H.I.G.A. Dr. Oscar Alende. El objetivo fue determinar la concordancia entre el algoritmo tradicional, utilizado actualmente en la institución (VDRL seguido por TPPA), y el nuevo algoritmo propuesto (test rápido treponémico Alere Determine Syphilis TP seguido por VDRL-USR). Para ello se realizó un estudio prospectivo de desempeño de métodos cualitativos. Se realizó VDRL-USR, TPPA y test rápido Alere Determine Syphilis TP en muestras de 580 pacientes, de los cuales 558 cumplieron con los criterios de inclusión. Se obtuvieron 51 muestras con resultados positivos y 507 con resultados negativos para el diagnóstico de sífilis por ambos algoritmos, con un porcentaje de concordancia global del 100%, lo cual indica que podría reemplazarse el algoritmo tradicional por el reverso en aquellas situaciones que lo requieran en la población estudiada.

Abstract Syphilis is one of the sexually transmitted infections with the highest incidence in Argentina. For its diagnosis, the Ministry of Health of the Nation endorses different algorithms, among them, the traditional algorithm and the reverse. In the traditional algorithm, VDRL constitutes the screening test and positive results are confirmed with particle agglutination assay TPPA. The reverse algorithm with rapid test, endorsed more recently, consists of performing a rapid treponemal test as screening and subsequent VDRL in the samples that are positive. A comparison was made between both algorithms to evaluate if the implementation of the reverse algorithm with rapid test in Dr. Oscar Alende Hospital would be feasible and convenient. The objective of this work was to determine the concordance between the traditional algorithm, currently used in the institution (VDRL followed by TPPA), and the new algorithm proposed (rapid treponemal test Alere Determine Syphilis TP followed by VDRL-USR). For that purpose, a prospective study of the performance of qualitative methods was carried out. VDRL-USR, TPPA and Alere Determine Syphilis TP Rapid Test were performed on samples from 580 patients, of which 558 met the inclusion criteria. A total of 51 samples with positive results and 507 with negative results for the diagnosis of syphilis were obtained by both algorithms, with an overall concordance percentage of 100%, which indicates that the traditional algorithm could be replaced by the reverse in those situations that require it in the studied population.

Resumo A sífilis é uma das infecções sexualmente transmissíveis com maior incidência na Argentina. Para o seu diagnóstico, o Ministério da Saúde da Nação endossa diversos algoritmos, incluindo o algoritmo tradicional e o reverso. No algoritmo tradicional, o VDRL constitui o teste de triagem e os resultados positivos são confirmados com o teste treponêmico de aglutinação de partículas (TPPA). O algoritmo reverso com teste rápido, endossado mais recentemente, consiste na realização de um teste rápido treponêmico como triagem e posterior VDRL nas amostras positivas. Foi feita uma comparação entre os dois algoritmos para avaliar se a implementação do algoritmo reverso com um teste rápido no laboratório H.I.G.A. Dr. Óscar Alende era viável e conveniente. O objetivo foi determinar a concordância entre o algoritmo tradicional, atualmente utilizado na instituição (VDRL seguido de TPPA), e o novo algoritmo proposto (teste rápido treponêmico Alere Determine Syphilis TP seguido de VDRL-USR). Para tanto, foi realizado um estudo prospectivo de desempenho de métodos qualitativos. O VDRL- -USR, o TPPA e o teste rápido Alere Determine Syphilis TP foram realizados em amostras de 580 pacientes, dos quais 558 preencheram os critérios de inclusão. Foram obtidas 51 amostras com resultados positivos e 507 com resultados negativos para o diagnóstico de sífilis por ambos os algoritmos, com um percentual de concordância global de 100%, o que indica que o algoritmo tradicional poderia ser substituído pelo reverso nas situações que o exigissem na população estudada.

Infarto com Supra-ST em Adulto Jovem: Rara Apresentação de Mixoma Atrial Gigante / Acute ST-Elevation Myocardial Infarction in a Young Adult: Rare Presentation of Giant Atrial Myxoma

Resumo Neoplasias cardíacas são raras, tendo como principal representante o mixoma atrial (MA), que corresponde a cerca de metade de todos os casos. O MA tem incidência estimada entre 0.001% e 0.3% na população em geral, no entanto apenas aproximadamente 0,06% desses cursam com eventos embólicos coronarianos. Homem de 33 anos, tabagista, admitido com quadro de precordialgia intensa e irradiação para membro superior esquerdo com duração de uma hora. O eletrocardiograma evidenciou elevação de segmento ST nas derivações D2, D3 e aVF troponina sérica elevada, confirmando infarto com supra desnivelamento do segmento ST (IAMCSST). Foi realizada cineangiocoronariografia, a qual revelou oclusão em terço proximal de artéria coronária direita por trombo. Realizada tentativa de aspiração do trombo, sem sucesso, seguido por angioplastia primária com balão sem colocação de stent. Durante a investigação do quadro, paciente realizou ecocardiograma transtorácico o qual demonstrou massa homogênea de superfície regular, de 5.2 cm x 2.3 cm, aderida ao septo interatrial, com lobulações de características emboligênicas prolapsando para valva mitral e ventrículo esquerdo na diástole, compatível com MA. Foi realizada ressecção cirúrgica com paciente evoluindo assintomático, recebendo alta para seguimento ambulatorial. O caso relatado difere em idade e sexo do perfil epidemiológico típico sendo um dos poucos descritos com acometimento da parede inferior apresentando a artéria coronária direita como culpada. Este relato ratifica a importância do diagnóstico diferencial frente às apresentações de IAMCSST em jovens.

Abstract Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.

Enfermedad de Lhermitte-Duclos y síndrome de Cowden. Reporte de un caso / Lhermitte-Duclos Disease and Cowden Syndrome. A Case Report

Presentación del caso. Se trata de una paciente femenina de 45 años con antecedentes de hipertensión arterial y múltiples cirugías por cáncer, entre ellas, cáncer de tiroides, carcinoma de parótida, cáncer de mama y cáncer endometrial. De manera incidental se identificó una lesión en el hemisferio cerebeloso derecho en una tomografía de senos paranasales, que fue confirmada a través de una resonancia magnética cerebral. La lesión presentaba una apariencia estriada, característica de gangliocitoma displásico del cerebelo o enfermedad de Lhermitte-Duclos. Considerando los antecedentes de diversos tipos de cáncer y los criterios de diagnóstico propuestos por el Consorcio Internacional Cowden y la Red Nacional Integral del Cáncer, se estableció el diagnóstico de síndrome de Cowden que había pasado desapercibido hasta el momento. Intervención terapéutica. Posteriormente, la paciente fue hospitalizada debido al crecimiento de una masa metastásica en el hemicuello derecho con afectación del plexo braquial, adenopatías cervicales, infraclaviculares y axilares derechas. Evolución clínica. En la actualidad, se encuentra recibiendo tratamiento paliativo con el objetivo de controlar los síntomas y mejorar su calidad de vida, ya que expresó su negativa a someterse a una intervención quirúrgica de resección tumoral

Case presentation. The report is of a 45-year-old female patient with a history of high blood pressure and multiple surgeries for cancer, including thyroid cancer, parotid carcinoma, breast cancer, and endometrial cancer. Incidentally, a lesion in the right cerebellar hemisphere was identified in a tomography of the paranasal sinuses, which was later confirmed in a brain magnetic resonance. The lesion had a striated appearance, characteristic of dysplastic gangliocytoma of the cerebellum or Lhermitte-Duclos disease. Considering the history of various types of cancer and the diagnostic criteria proposed by the International Cowden Consortium and the National Comprehensive Cancer Network, the diagnosis of Cowden syndrome, which had gone unnoticed until now, was established. Treatment. Subsequently, the patient was hospitalized due to the growth of a metastatic mass in the right hemicollar with involvement of the brachial plexus, cervical, infraclavicular, and right axillary lymph nodes. Outcome. She is receiving palliative treatment to control the symptoms and improve her quality of life, since she expressed her refusal to undergo tumor resection surgery

Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis / Diagnostic performance of biliopancreatic endosonography in patients with intermediate risk of choledocholithiasis

RESUMEN Objetivo: Determinar la sensibilidad y la especificidad de la endosonografía biliopancreática (ESBP) para diagnóstico en pacientes con riesgo intermedio de coledocolitiasis, derivados a un centro especializado de Gastroenterología quirúrgica de Unión de Cirujano SAS - Oncólogos de Occidente grupo Zentria - Manizales - Colombia entre el 01 de marzo de 2020 al 31 de enero de 2022. Materiales y métodos: Estudio retrospectivo transversal en pacientes con riesgo intermedio para coledocolitiasis. Se calculó el rendimiento diagnóstico de la ESBP y se confirmó con CPRE. Se hizo seguimiento telefónico a los ESBP negativas. Resultados: Se analizaron 752 casos con ESBP de los cuales el 43,2% (n=325) fue positivo y el 56,8% (n=427) fue negativo. Se practicó CPRE en los casos positivos que aceptaron el procedimiento (n=317); el 73,5% (n=233) fueron positivos para coledocolitiasis, el 25,8% (n=82) tumores y el 0,6% (n=2) áscaris biliares. Pacientes con ESBP positiva fueron intervenidos con CPRE. Se obtuvo S= 98,3% (IC 95%: 95,7-99,5); E= 88,1% (IC 95%: 79,2-94,1); VPP = 95,8% (IC 95%: 92,4-98,0); VPN = 94,9% (IC 95%: 87,4-98,7). El AUC de ESBP fue de 0,9319 (IC 95% 0,8961-0,967). Conclusión: En pacientes con riesgo intermedio para coledocolitiasis, la ESBP es una opción diagnostica útil en el estudio de patologías pancreáticas, árbol biliar extrahepático, y la identificación de microlitiasis biliares; por lo que nos permite además poder complementarla con una intervención terapéutica como la CPRE en un solo tiempo.

ABSTRACT Objective: Determine the sensitivity and specificity of the ESBP for diagnosis in patients with intermediate risk of choledocholithiasis, referred to the specialized surgical Gastroenterology center of Unión de Cirujanos SAS - Oncologists of the West Zentria group - Manizales - Colombia between March 01, 2020 to January 31, 2022. Materials and methods: Retrospective cross-sectional study in patients with intermediate risk for choledocholithiasis. The diagnostic performance of ESBP was calculated and confirmed with ERCP. Negative ESBPs were followed up by telephone. Results: 752 cases with ESBP were analyzed, of which 43.2% (n=325) were positive and 56.8% (n=427) were negative. ERCP was performed in positive cases who accepted the procedure (n=317); 73.5% (n:233) were positive for choledocholithiasis, 25.8% (n=82) tumors and 0.6% (n=2) biliary roundworms. Patients with positive ESBP underwent ERCP. S= 98.3% (95% CI: 95.7-99.5) was obtained; E= 88.1% (95% CI: 79.2-94.1); PPV = 95.8% (95% CI: 92.4-98.0); NPV = 94.9% (95% CI: 87.4-98.7). The AUC of ESBP was 0.9319 (95% CI 0.8961-0.967). Conclusion: In patients with intermediate risk for choledocholithiasis, ESBP is a useful diagnostic option in the study of pancreatic pathologies, extrahepatic biliary tree, and the identification of biliary microlithiasis; Therefore, it also allows us to complement it with a therapeutic intervention such as ERCP in a single time.

Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions

Abstract Background: Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. Objective: To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. Methods: 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. Results: The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. Study limitations: The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). Conclusion: This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.

A 50 años de la exclusión de la homosexualidad del Manual diagnóstico y estadístico de los trastornos mentales (DSM) / 50 years after the exclusion of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM)

RESUMEN Se cumple medio siglo del hecho histórico constituido por la remoción de la homosexualidad como ítem diagnóstico en la clasificación norteamericana de trastornos psiquiátricos, es decir, en el Manual diagnóstico y estadístico de los trastornos mentales (DSM). Aunque es un período breve, cuesta trabajo creer que, hasta hace 50 años, las personas homosexuales carecían de numerosos derechos civiles elementales en EE. UU. y que diversas leyes penalizaban actos sexuales privados y libremente consentidos entre adultos. Rememorar estos hechos significativos en el contexto de una acotada reseña de la historia conceptual de la homosexualidad como trasfondo es el objetivo fundamental de este artículo que, a la vez, constituye un recordatorio de muchas tareas pendientes en la salud mental y derechos humanos de las minorías sexuales, todavía víctimas de homofobia, estigma y segregación, más aún en países como el nuestro.

ABSTRACT It is half a century since the historical event constituted by the removal of homosexuality as a psychiatric diagnosis from the North American Diagnostic and Statistical Manual of Mental Disorders (DSM). Although it is a short period of time, it is hard to believe that fifty years ago, homosexual people lacked many basic civil rights in the United States and various laws criminalized private, freely consented sexual acts between adults. Recalling these significant events in the context of a summarized conceptual history of homosexuality is the main objective of this brief account which, at the same time, can serve as a reminder of many tasks pending in the mental health and human rights of sexual minorities, still victims of homophobia, stigma, and segregation, even more so in countries like Peru.