Shock séptico de foco respiratorio por Pasteurella multocida en un paciente inmunocompetente. Caso Clínico / Septic shock originating from a pulmonary focus caused by Pasteurella multocida. Report of one case

Pasteurella multocida is a gram-negative coccobacillus bacterium found as a commensal in the oropharynx of domestic animals such as cats and dogs and some farm animals. Soft tissue infections and occasionally bacteremia in immunocompromised patients with direct contact with animals are described. We report a 61 year old male with a history of scratches and close contact with domestic cats, with a septic shock originating from a pulmonary focus, requiring mechanical ventilation and vasopressors. Blood cultures disclosed the presence of Pasteurella multocida. He responded successfully to antimicrobials.

Efectos biológicos de la exposición a distintas concentraciones de oxígeno: desde la hipoxia hipobárica al oxígeno hiperbárico / Biological effects due to exposure to different concentrations of oxygen from hypo to hyperoxemia

The systemic effects of oxygen deficiency or excess are not thoroughly described. Knowledge is evolving towards the description of beneficial and detrimental effects of both extremes of partial pressure of oxygen (PaO2). The cellular and tissue mediators derived from the modulation of the oxidative tone and the production of reactive oxygen species (ROS) are widely characterized biochemically, but the pathophysiological characterization is lacking. Preclinical models support the use of hypobaric hypoxia preconditioning, based on its beneficial effects on ventricular function or its reduction in infarct size. A very important use of oxygen today is in commercial diving. However, novel clinical indications for oxygen such as the healing of diabetic foot ulcers and bone injury caused by radiotherapy are increasingly used. On the other hand, the modulation of the hypoxic response associated with exposure to high altitude environments (hypobaric), favors Chile and its highlands as a natural laboratory to determine certain cardiovascular, cerebral and metabolic responses in the resident population. Also, the consequences of the intermittent exposure to high altitudes in workers also deserves attention. This review discusses the physiopathological response to hypo and hyperoxemia, associated with environments with different oxygen concentrations, and brings back the concept of oxygen as a pharmacological mediator in extreme environments such as high altitudes and hyperbaric medicine in divers, decompression sickness, osteonecrosis associated with radiotherapy and sudden sensorineural hearing loss.

Prevalência e fatores associados aos sintomas de depressão, ansiedade e estresse em professores universitários durante a pandemia da COVID-19 / Prevalence and factors associated with depression, anxiety, and stress symptoms among professors during COVID-19 pandemic

OBJETIVO: Estimar a prevalência e os fatores associados aos sintomas da depressão, ansiedade e estresse em professores universitários da área da saúde no período da pandemia da COVID-19. MÉTODOS: Trata-se de um estudo analítico, de caráter transversal e abordagem quantitativa com 150 professores universitários da área da saúde. Os instrumentos utilizados foram: um formulário de coleta de dados sociodemográficos, econômicos e trabalhistas. A saúde mental foi avaliada pela Escala de Depressão, Ansiedade e Estresse-21 (DASS-21). A associação entre as variáveis estudadas e a prevalência de sintomas da depressão, ansiedade e estresse foi verificada por análise bivariada seguida de regressão de Poisson, com variância robusta. RESULTADOS: A amostra final foi composta por 150 indivíduos, sendo a média de idade de 41,4 ± 7,9 anos, e a maioria da amostra investigada é do sexo feminino (74%). Entre os professores, 50% apresentaram sintomas de depressão, 37,4% relataram sintomas de ansiedade e 47,2% apresentaram sintomas de estresse. Após análise múltipla, observou-se que os sintomas da depressão estiveram associados à variável trabalhar em mais de uma instituição de ensino superior. As variáveis que se mostraram associadas à ansiedade foram: faixa etária ≥ 40 anos e pessoas sem companheiro fixo. Já o estresse se mostrou associado à variável estado civil sem companheiro fixo. CONCLUSÃO: A prevalência de sintomas da depressão, ansiedade e estresse em professores universitários da área da saúde foi elevada, e fatores sociodemográficos e trabalhistas se mantiveram associados aos desfechos investigados.

OBJECTIVE: To estimate the prevalence and factors associated with symptoms of depression, anxiety and stress in university professors in the health field during the pandemic period of COVID-19. METHODS: This is an analytical, cross-sectional study with a quantitative approach with 150 university professors in the health field. The instruments used were: a form for collecting socio-demographic, economic and labor data. Mental health was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). The association between the variables studied and the prevalence of symptoms of depression, anxiety and stress was verified by bivariate analysis followed by Poisson regression, with robust variance. RESULTS: The final sample consisted of 150 individuals with a mean age of 41.4 ± 7.9 years with the majority being female (74%). 50% of the teachers had symptoms of depression, 37.4% reported symptoms of anxiety and 47.2% had symptoms of stress. After multiple analysis, it was observed that the symptoms of depression were associated with the variable working in more than one institution of higher education. The variables that were shown to be associated with anxiety were: age group ≥ 40 years and people without a steady partner. Stress was associated with the variable marital status without a steady partner. CONCLUSION: The prevalence of symptoms of depression, anxiety and stress in university professors in the health area was high, and sociodemographic and labor factors remained associated with the investigated outcomes.

Correlación radiológica y clínica en niños con COVID-19. Servicio de Emergencia, Hospital General Quito Sur. 2020 / Radiological and clinical correlation in children with COVID-19. Emergency Department, Hospital General Quito Sur. 2020

RESUMEN Introducción: Una nueva cepa de coronavirus fue aislada, produciendo una nueva enfermedad febril respiratoria, llamada por la OMS enfermedad corona-virus 2019 (COVID-19), anunciando una emergencia sanitaria. Las imágenes se consideran un componente crítico de la evaluación diagnóstica y monitoreo de la progresión de la enfermedad en adultos, de ahí la importancia de conocer los hallazgos en pacientes pediátricos. El objetivo del estudio era identificar los hallazgos radiológicos y su correlación clínica en niños con COVID-19 atendidos en Emergencias Pediátricas del Hospital General del Sur de Quito entre abril-junio 2020. Métodos: Estudio descriptivo, retrospectivo de tipo transversal, incluyó 54 niños con infección confirmada por el virus SARS-CoV-2. Los datos se obtuvieron del sistema AS400. El análisis se realizó con el programa estadístico SPSS, se determinaron porcentajes en las variables nominales y centrales. Resultados: Se realizó tomografía computarizada (TC) de tórax al 46% de los pacientes, no se encontraron alteraciones tomográficas en el 64%, el hallazgo más común fue las opacidades en vidrio esmerilado en el 100% de los casos, seguido por signo del halo asociado a este último en el 44%. El 67% tuvo afectación bilateral. De los pacientes con alteraciones tomográficas, la mayoría se presentó con síntomas leves. Solo los que tuvieron afectación pulmonar mayor al 25% presentaron sintomatología respiratoria importante, uno requirió cuidados intensivos. Conclusiones: La TC no demostró ser útil de manera rutinaria para la evaluación y diagnóstico de COVID-19 en pediatría, reservándose su uso a pacientes con afección respiratoria importante o dete-rioro clínico; se evidenció patrón en vidrio deslustrado y signo de halo. Palabras claves: COVID-19, radiología, tomografía, neumonía, niños.

ABSTRACT new strain of coronavirus was isolated, being responsible for a new febrile and respiratory disease, whose pulmonary syndrome was called coronavirus disease 2019 (COVID-19) by the World Health Organization, announcing a health emergency. Imaging is a critical component of diagnostic evaluation and monitoring of disease progression in adults, hence comes the importance of knowing the findings in pediatric patients. Method: Descriptive, retrospective, cross-sectional study, which included 54 children with confirmed SARS-CoV-2 virus infection. Data was obtained from the AS400 system. The analysis was performed with the SPSS statistical program, percentages were determined in the nominal and central variables. Results: Chest computerized tomography (CT) was performed in 46% of patients, no tomographic alterations were found in 64%, the most common finding on chest CT being ground glass opacities in 100% of cases, followed by the halo sign in 44%. 67% had bilateral involvement. Of the patients with tomographic alterations the majority had mild symptoms. Only those with pulmonary involvement greater than 25% presented significant respiratory symptoms, one required intensive care. Conclusions: CT did not prove to be useful routinely for the evaluation and diagnosis of COVID-19 in pediatrics, reserving its use for patients with significant respiratory disease or clinical deterioration, ground glass pattern and halo sign were evidenced.Keywords: Analgesia, sedation, delirium, withdrawal, multidisciplinary team.

Nexo epidemiológico en niños con diagnóstico de COVID-19. Hospital General del Sur de Quito. 2020 / Epidemiological link in children with diagnosis of COVID-19. Hospital General del Sur de Quito. 2020

Introducción: Los niños con COVID-19 han mostrado antecedentes claros de agrupamiento en infectados en el hogar y comunidad extendida, por lo que es interesante identificar el nexo epidemiológico (contactos) por grados de consanguinidad de casos positivos para COVID-19, desde el punto de vista de prevención de la enfermedad. Método: Estudio descriptivo, retrospectivo de tipo transversal, muestreo no probabilístico, que incluyó 54 niños con infección confirmada por el virus SARS-CoV-2, atendidos en la Emergencia Pediátrica del Hospital General del Sur de Quito durante los meses de abril a junio 2020. Los datos se obtuvieron del sistema de historias clínicas AS400. El análisis se realizó con el programa estadístico SPSS. Se determinaron porcentajes en las variables nominales. Resultados: Se incluyeron 54 niños, la mayoría adolescentes de 10 a 14 años (27,8%), predominó el sexo masculino (55,6%). El 79,65% tuvo contacto con personas COVID-19. El 53,5% tuvo solo un contacto directo, mientras que el resto, dos o más contactos. El nexo epidemiológico de contagio primario correspondió a la madre (32,55%). Conclusión: La investigación arrojó que el sexo masculino, los escolares y adolescentes fueron los más afectados por COVID-19. Por otra parte, el primer contacto con personas enfermas fue un miembro de la familia que, en su mayoría, correspondió a uno o ambos padres. No está claro si algún niño presentó la infección antes que el resto de miembros de la familia.Palabras claves: COVID-19, nexo epidemiológico, grado de consanguinidad, transmisión, contacto

ABSTRACTIntroduction: Children with COVID-19 have shown a clear history of infected grouping at home and in their extended community, that is why it is very inter-esting to define and identify the epidemiological links evidenced in pediatric patients, from the point of view of disease prevention. Objective: To know the epidemiological links of pediatric patients between 1 month and 17 years old with positive result to the Reverse Polymerase Chain Reaction (RT-PCR) test for SARS-CoV-2. Method: Descriptive, retrospective, cross-sectional study, which included 54 children with confirmed infection by the SARS-CoV-2 virus, treated at the Pediatric Emergency of the General Hospital of the South of Quito during the months of April to June 2020. The data was obtained from the AS400 system. The analysis was performed with the SPSS statistical program; percentages were determined in the nominal variables. Results: 54 children were included, most of them adolescents from 10 to 14 years old (27,8%), the male sex predominated (55,6%). 79,65%, had contact with COVID-19 infected people. 53,50% had only one direct contact, while the rest had two or more contacts, 20,95% and 25,55% respectively. The epidemiological nexus for primary contagion corresponds to the mother (32,55%). Conclusion: The research showed that males, school-age children, and adolescents were the most affected by COVID-19. On the other hand, the first contact with sick people was a family member that mostly corresponded to one or both parents. It is not clear if any child developed the infection earlier than other family members.

Idioventricular rhythm and shock after a honeybee sting / Ritmo idioventricular y shock después de un piquete de abeja

Abstract Objective: The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting. Methods: The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced. Results: The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment. Conclusions: A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes.

Resumen Objetivo: Describir el caso de un paciente masculino de 19 años que presenta bradicardia e hipotensión después de una picadura de abeja haciendo una revisión de la literatura y fisiopatología de los cambios cardiovasculares y electrocardiográficos después de una picadura de abeja. Métodos: Se inspeccionó y aseguró la vía aérea del paciente. Un rastreo de ECG realizado al ingreso reveló ritmo idioventricular a una ritmo de 41 latidos por minuto. Se administró oxígeno, se estableció un acceso IV y se colocaron los cables del marcapasos transcutáneo en el tórax del paciente, luego se indujo el manejo de las guías publicadas. Resultados: El electrocardiograma mostró un ritmo idioventricular a una frecuencia de 41 latidos por minuto que se resolvió a un ritmo sinusal normal después del tratamiento. Conclusiones: Se debe realizar una evaluación cardiovascular completa y rápida en todos los pacientes que se presentan al departamento de emergencias después de una picadura de abeja, y se deben seguir las pautas publicadas sobre el manejo de la bradicardia y la anafilaxia para lograr resultados exitosos.

Biological and physico-mechanical properties of poly (methyl methacrylate) enriched with graphene oxide as a potential biomaterial / Propiedades físicas-mecánicas-biológicas del poli (metilmetacrilato) enriquecido con óxido de grafeno como potencial biomaterial

Objective: To determine the cytotoxicity and effects of graphene oxide (GO) on cellular proliferation of gingival-fibroblasts, pulp-dental cells and human osteoblasts in culture, and to determine the physical, mechanical and biological properties of poly (methyl methacrylate) (PMMA) enriched with GO. Material and Methods: The GO was characterized with SEM. Cytotoxicity and cell proliferation were determined by the MTT bioassay. The physical mechanical tests (flexural strength and elastic modulus) were carried out with a universal testing machine. Sorption and solubility were determined by weighing before and after drying and immersion in water. Porosity was evaluated by visual inspection. Data were analyzed with Student's t-test and Tukey's posthoc ANOVA. Results: The GO has a heterogeneous morphology and a particle size of 66.67±64.76 µm. GO has a slight to no-cytotoxicity (>50-75% viability) at 1-30 days, and at 24 hours incubation of PMMA with GO significantly stimulates osteoblasts (45±8%, p<0.01). The physical and mechanical properties of PMMA with GO increase considerably without altering sorption, solubility and porosity. Conclusion: GO alone or with PMMA has an acceptable biocompatibility, could contribute to cell proliferation, cell regeneration and improve the physical mechanical properties of PMMA.

Objective: To determine the cytotoxicity and effects of graphene oxide (GO) on cellular proliferation of gingival-fibroblasts, pulpdental cells and human osteoblasts in culture, and to determine the physical, mechanical and biological properties of poly (methyl methacrylate) (PMMA) enriched with GO. Material and Methods: T he G O w as c haracterized with SEM. Cytotoxicity and cell proliferation were determined by the MTT bioassay. The physical-mechanical tests (flexural strength and elastic modulus) were carried out with a universal testing machine. Sorption and solubility were determined by weighing before and after drying and immersion in water. Porosity was evaluated by visual inspection. Data were analyzed with Student's t-test and Tukey's post-hoc ANOVA. Results: The GO has a heterogeneous morphology and a particle size of 66.67±64.76 ?m. GO has a slight to no-cytotoxicity (>50-75% viability) at 1-30 days, and at 24 hours incubation of PMMA with GO significantly stimulates osteoblasts (45±8%, p<0.01). The physical and mechanical properties of PMMA with GO increase considerably without altering sorption, solubility and porosity. Conclusion: GO alone or with PMMA has an acceptable biocompatibility, could contribute to cell proliferation, cell regeneration and improve the physical-mechanical properties of PMMA.

As formas da simpatia e o seu papel na compreensão das vivências alheias em Scheler / The forms of sympathy and its role in understanding other's experiences in Scheler / Las formas de simpatía y su papel en la compresión de las experiencias de otros en Scheler

Objetiva-se descrever os principais traços do fenômeno da simpatia a partir da fenomenologia de Max Scheler. O problema central é demonstrar como a simpatia se mostra enquanto "lugar" privilegiado para a compreensão das vivências alheias, pois ela implica uma unificação psíquico-afetiva com quem se compadece ou se congratula. Contudo, o compadecer e o co-alegrar não podem ser entendidos, sem mais, como a apreensão de conteúdos psíquicos alheios ao modo da reprodução dos sentimentos do outro, equiparando erroneamente o simpatizar com o contágio afetivo. Assim, primeiramente, delineiam-se algumas razões e caminhos de transformações das antropologias e de consolidação histórica da ratio moderna que conduziram a tal equívoco. Em seguida, após distinguir as formais plurais da simpatia, mostrando a sua lei de fundamentação interna, discute-se em que sentido a simpatia é sofrer-com e co-alegrar ao explicitar sua estrutura intencional. Conhecer o outro, entretanto, não é só unir-se afetivamente ao próximo, mas a decisão livre, própria de um ser espiritual, de tomar parte na abertura do ser pessoal alheio, participar de seus atos intencionais. Conclui-se, então, que o simpatizar pressupõe a forma suprema do amor.

The objective is to describe the main features of the sympathy phenomenon from Max Scheler's phenomenology. The central problem is to show how sympathy shows itself as a privileged "place" for understanding the experiences of others, because it implies a psychic-affective unification with whom one sympathizes or welcomes. However, compassion and co-rejoicing cannot be understood as the apprehension of psychic contents unrelated to the reproduction of the feelings of the other, mistakenly equating sympathizing with affective contagion. Thus, first, some reasons and ways of transformations of anthropologies and historical consolidation of the modern ratio that led to such mistake are outlined. Then, after distinguishing the plural forms of sympathy, showing its law of internal reasoning, it is discussed in what sense sympathy is to suffer and to rejoice by spelling out its intentional structure. To know the other, however, is not only to unite affectionately with others, but the free decision, proper of a spiritual being, to take part in the opening of the personal being of others, to participate in their intentional acts. It follows, then, that sympathizing presupposes the supreme form of love.

El objetivo es describir las características principales del fenómeno de simpatía a partir de la fenomenología de Max Scheler. El problema central es demostrar cómo se muestra la simpatía como un "lugar" privilegiado para la comprensión de las experiencias de otras personas, porque implica una unificación psíquico-afectiva con la que uno simpatiza o da la bienvenida. Sin embargo, la compasión y el regocijo no pueden entenderse como la aprehensión de contenidos psíquicos no relacionados con la reproducción de los sentimientos del otro, equiparando erróneamente la simpatía con el contagio afectivo. Así, primero, se describen algunas razones y formas de transformación de las antropologías y la consolidación histórica de la relación moderna que condujo a tal error. Luego, después de distinguir las formas plurales de simpatía, mostrando su ley de fundamento interno, se discute en qué sentido la simpatía es sufrir y regocijarse al deletrear su estructura intencional. Sin embargo, conocer al otro no es solo unirse afectuosamente con los demás, sino la libre decisión, propia de un ser espiritual, de participar en la apertura del ser personal de los demás, de participar en sus actos intencionales. Se deduce finalmente, entonces, que simpatizar presupone la forma suprema de amor.

Hallazgos clínicos en niños con COVID-19 atendidos en el Servicio de Emergencia / Clinical findings in children with COVID-19 treated in the Emergency Department

RESUMEN Introducción: Los niños han mostrado una menor prevalencia de infección por el virus SARS-CoV-2, así como un curso leve de la enfermedad. Los síntomas que presentan son reflejo de la afectación a nivel respiratorio, digestivo, neurológico y sistémico. Reconocerlos facilita el abordaje de un paciente con sos-pecha de COVID-19. Métodos: Estudio descriptivo, retrospectivo de tipo transversal, que incluyó 51 niños con infección confirmada por el virus SARS-CoV-2 atendidos en la Emergencia Pediátrica del Hospital General del Sur de Quito durante los meses de abril a junio, con edades entre 1 mes y 17 años 11 meses y 29 días. Los datos se obtuvieron del sistema AS400. El análisis se realizó con el programa estadístico SPSS, se determinaron porcentajes en las variables nominales y medidas de tendencia central y dispersión en las numéricas. Resultados: Se incluyeron 51 niños, la mayoría adolescentes de 10 a 14 años (29,4%), y más de la mitad de sexo masculino (56,9%). El 82,4% refirieron manifestaciones clínicas respiratorias. Los síntomas más prevalentes fueron fiebre y tos (68,6%). La mayoría de pacientes presentaron un curso leve de la enfermedad (60,8%), pero los menores de un año presentaron enfermedad severa con mayor frecuencia. Conclusiones: Existe un predominio de afectación del sexo masculino. La mayoría acude por síntomas respiratorios y presentan enfermedad leve. Las manifestaciones clínicas más comunes son fiebre y tos

ABSTRACT Introduction: Children have shown a lower prevalence of SARS-CoV-2 virus infection, as well as a mild course of the disease. The symptoms they present are a reflection of its effect on the respiratory, digestive, neurological and systemic levels. Recognizing them makes it easier to approach a patient with suspected COVID-19. Methods: Descriptive, retrospective, cross-sectional study, which included 51 children with confirmed infection by the SARS-CoV-2 virus treated in the Pediatric Emergency Department of the Hospital General del Sur de Quito during the months of April to June, with ages between 1 month and 17 years 11 months and 29 days. The data was obtained from the AS400 system. The analysis was carried out with the SPSS statistical program, percentages were determined in the nominal variables, whilst measures of central tendency and dispersion were determined in the numerical ones. Results: 51 children were included, most of them adolescents from 10 to 14 years old (29.4%). More than half were male (56,9%). 82,4% reported respiratory clinical manifestations. The most prevalent symptoms were fever and cough (68,6%). Most of the patients had a mild course of the disease (60,8%), but those under one year of age had severe disease more most frequently. Conclusions: There is a predominance of the male sex. Most patients have come with respiratory symptoms and present mild illness. The most common clinical manifestations are fever and cough.

Consensus on the treatment of vitiligo - Brazilian Society of Dermatology

Abstract Background: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.

Recurrence of laryngeal squamous cell carcinoma in patients undergoing organ preservation therapy: are there symptoms associated with recurrence?

Introduction: The larynx is a organ of the upper aerodigestive tract that plays an essential role in protecting the airways during swallowing. Squamous cell carcinoma is the most common malignant neoplasm affecting this region and early diagnosis has an important role in treatment outcome. Objectives: This study aims to evaluate whether patients with hypopharyngeal and/or laryngeal squamous cell carcinoma (SCC) who underwent organ preservation therapy (OPT) present at the time of relapse some factor that determines the local recurrence of the disease. Methods: Patients submitted to OPT were selected at the Cancer Institute of the State of São Paulo (ICESP), at the end of treatment, from January 2012 to December 2017. We collected retrospective data on demographics, clinical staging, location of the primary tumor, presence or absence of recurrence, weight and percentage of weight loss at different moments, alimentary pathway and symptomatology at the time of relapse. Results: The absence of symptoms was associated with the absence of relapse (p <0.001). Fully oral diet at the last visit was a significant factor for the absence of relapse (p = 0.005). The weight comparison of all the patients before the beginning of OPT and after the end of the treatment, showed an average drop of 3.4 kg. In the group-separated analysis, patients who did not recur showed an average loss of 0.7%. Patients with relapse, showed a loss of 2.0% of the weight at the time of relapse. Conclusion: Weight loss and the presence of symptoms were important predictors of recurrence with statistical significance. These factors may help to better manage these patients, with earlier investigations and, therefore, the possibility of rescue treatments with a shorter duration.

Fasting insulin and alanine amino transferase, but not FGF21, were independent parameters related with irisin increment after intensive aerobic exercising

Abstract Background Irisin is a protein cleaved from fibronectin type III domain-containing protein 5 and has been implicated in the beneficial effects of exercise. However, it is unknown which factors contribute to irisin increment after intensive exercising in humans. This study aimed to assess independent factors related with serum irisin after 2 weeks of supervised physical activity in young sedentary healthy women. Design and Methods We developed a comparative, interventional, longitudinal, and prospective study at a third-level specialty health center. Between March 2010 and August 2011, 82 sedentary young adult women, without chronic diseases or regular medical treatments, were recruited. A total of 38 women fulfilled selection criteria, and irisin concentrations were quantified before and after the intervention. Independent factors related with irisin increment were evaluated according to mild to moderate and vigorous intensity of physical activity. A supervised treadmill exercise test following the Bruce’s protocol was conducted from Monday to Friday during 2 weeks. In addition, anthropometric measurements were taken, and fibroblast growth factor 21 (FGF21), glucose, insulin, and liver transaminases were measured. Results Intensity of exercising was directly related to irisin (p = 0.02) and FGF21 (p = 0.01) serum levels. However, an independent and significant relationship between FGF21 and irisin was not confirmed. A novel association was found between alanine aminotransferase (ALT) and irisin, showing a positive and significant correlation (r = 0.37, p = 0.02). The association was particularly strong with higher intensity of aerobic exercising (r = 0.64, p = 0.01). Linear regression model adjusted for glucose and body mass index confirmed an independent association between ALT and irisin and also between insulin and irisin (adjusted R² = 0.12, p = 0.04). Such association increased after grouping in moderate to vigorous physical activity intensity (adjusted R² = 0.46, F = 4.7, p = 0.03). Conclusions Serum irisin and FGF21 levels significantly increased after 2 weeks of supervised physical activity. However, only fasting insulin and ALT, but not FGF21, were independent parameters explaining irisin increment, mainly after moderate to vigorous exercising.

Amor e finitude: um diálogo entre Agostinho de Hipona e Max Scheler / Love and finitude: a dialogue between Augustine of Hippo and Max Scheler / Amor y finitud: un diálogo entre Agustín de Hipona y Max Scheler

Priorizando como fio condutor a relação entre amor e finitude, a discussão estabelece um constante diálogo entre o pensamento filosófico-teológico de Agostinho e a fenomenologia de Scheler. Primeiramente, esclarece-se o horizonte a partir do qual a fenomenologia de Scheler visualiza o pensamento agostiniano ao considerá-lo sob a ótica da estrutura vivencial e fundamental do viver cristão. Evidenciando a ideia de ordo amoris, mostra-se a correspondência desta estrutura à reviravolta do amor cristão, assinalada por Scheler como a emergência da compreensão de um Deus amante. Para tanto, em seguida, discutem-se traços da hermenêutica agostiniana da vida cristã, até revelar a caritas como sendo o amor que responde pela intencionalidade ordenadora da estrutura da existência humana no seu todo segundo o seu dinamismo essencial. Sob o ponto de vista desta função central da caridade, conclui-se indicando a necessidade de considerar a interdependência entre viver e morrer, para melhor compreender o sentido da estruturação da existência humana a partir da ideia de amor ordenado.

Prioritizing the guiding thread of the relationship between love and finitude, the discussion establishes a constant dialogue between Augustine's philosophical-theological thinking and Scheler's phenomenology. Firstly, it clears the horizon in which Scheler's phenomenology visualizes the Augustinian thought considered from the perspective of the experiential and fundamental structure of Christian living. Demonstrating the idea of ordo amoris, the harmony of this structure is shown in the change of the concept of Christian love, signaled by Scheler as the emergence of the understanding of a loving God. In order to do so, the traits of the Augustinian hermeneutics of the Christian life are discussed, until it reveals caritas as being the love that answers the intentionality of the structure of human existence as a whole according to its essential dynamism. From the point of view of this central function of charity, it concludes by indicating the need to consider the interdependence between living and dying, in order to better understand the sense of the structuring of human existence from the idea of ordered love.

Priorizando como hilo conductor la relación entre amor y finitud, la discusión establece un constante diálogo entre el pensamiento filosófico-teológico de Agustín y la fenomenología de Scheler. Primero, se aclara el horizonte a partir del cual la fenomenología de Scheler visualiza el pensamiento agustiniano al considerarlo bajo la óptica de la estructura vivencial y fundamental del vivir cristiano. Evidenciando la idea de ordo amoris, se muestra la correspondencia de esta estructura a la revolución del amor cristiano, señalada por Scheler como la emergencia de la comprensión de un Dios amante. Para ello, a continuación, se discuten rasgos de la hermenéutica agustiniana de la vida cristiana, hasta revelar la caritas como el amor que responde por la intencionalidad ordenadora de la estructura de la existencia humana en su totalidad según su dinamismo esencial. Desde el punto de vista de esta función central de la caridad, se concluye indicando la necesidad de considerar la interdependencia entre vivir y morir, para comprender mejor el sentido de la estructuración de la existencia humana a partir de la idea de amor ordenado

Riesgo ambiental por arsénico y boro en las cuencas hidrográficas Sama y Locumba de Perú / Environmental risk due to arsenic and boron in the watersheds Sama y Locumba from Perú

Se efectuó un estudio para estimar el riesgo ambiental sostenible relativo ante concentraciones totales de arsénico y boro en aguas superficiales de las cuencas hidrográficas Sama y Locumba, en Tacna, Perú, a través de muestreos de tipo no probabilístico por conveniencia en puntos referenciales, durante los meses de agosto y noviembre del 2016, así como abril y junio del 2017. Se obtuvo que los valores de arsénico en los respectivos meses fueron 0,0731; 0,29835; 0,287 y 0,711 mg.L-1, lo que superó el límite máximo permisible (0,01 mg.L-1); este incumplimiento fue similar en cuanto al boro, pues se hallaron concentraciones de 8,681 y 4,148 mg.L-1, pero el valor máximo establecido es de 2,4 mg.L-1. Las concentraciones determinadas por meses revelaron diferencias estadísticamente significativas (pd≤0,05). Se concluyó que las aguas superficiales como recurso natural fueron no sostenibles y representaban un riesgo ambiental y para la salud humana

A study was carried out to estimate the relative sustainable environmental risk with total concentrations of arsenic and boron in superficial waters of the watersheds Sama and Locumba, in Tacna, Peru, through samplings of non probabilistic type by convenience in reference sites, during the months of August and November of 2016, as well as April and June, 2017. It was obtained that the arsenic values in the respective months were 0,0731; 0,29835; 0,287 and 0,711 mg.L-1, which overcame the permissible maximum limit (0,01 mg.L-1); this unfulfillment was similar as for the boron, because concentrations of 8,681 and 4,148 mg.L-1 were found, but the established maximum value is 2,4 mg.L-1. Concentrations determined per months revealed statistically significant differences (pd≤0,05). It was concluded that the superficial waters as natural resource were not sustainable and they represented an environmental risk and for the human health

Efectos de la estructura de las redes personales en la red sociocéntrica de una cohorte de estudiantes en transición de la enseñanza secundaria a la universidad / Effects of the Structure of Personal Networks in the Acquaintances Network of a Cohort of Students in Transition from High School to University

Resumen En este trabajo se examina la transición normativa de una cohorte de estudiantes de Enseñanza Secundaria de Alcalá de Guadaíra, que empiezan sus estudios universitarios en Sevilla. Se analiza la evolución de la red social de la cohorte de estudiantes junto con los cambios que experimentan en la composición y la estructura de sus redes personales. El seguimiento longitudinal se desarrolla a lo largo de 17 meses en los que los encuestados (n = 57) empiezan a distribuir su tiempo entre la localidad en la que residen y la ciudad en la que estudian, de modo que en su conjunto aumentan la frecuencia de los viajes de ida y vuelta a la capital. Este es uno de los primeros estudios que recoge información de las redes personales de los miembros de una red social completa, combinando ambos indicadores en los análisis. Con el modelo de simulación longitudinal de redes sociales, utilizando el software RSIENA, comprobamos que la intermediación promedio de las redes personales tiene un efecto significativo en la evolución de la red social de los estudiantes que terminan la Enseñanza Secundaria. La intermediación promedio también parece incidir en la tasa de cambio del sentido de comunidad con la ciudad de residencia. Concluimos proponiendo que el desacoplamiento de las relaciones, junto con la competencia entre relaciones múltiples activas, constituyen dos mecanismos clave de los cambios en la estructura de las redes personales en proceso de transición ecológica.

Abstract In this work the normative transition of a cohort of secondary school students from Alcalá de Guadaíra that start college education in Seville is examined. The evolution of the social network of the cohort of students together with the changes experienced in the composition and structure of their personal networks is analyzed. The longitudinal tracking is developed over 17 months when respondents (n = 57) begin to distribute their time between the town in which they live and the city where they study, so there is an increase in the frequency of commuting to the capital. This is one of the first studies collecting information from the personal networks of the members of a complete social network, and combining both personal and sociocentric indicators in the analysis. With models for the longitudinal analysis of social networks, using the RSIENA software, we found that average betweenness of personal networks has a significant effect on the social network of students completing secondary education. The average betweenness also seems to influence the change rate in the sense of community with the city of residence. We conclude by proposing that the decoupling of relations, as well as active competition between multiple relationships, are two key mechanisms of changes in the structure of personal networks in the process of ecological transition.

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).

Exenteración orbitaria: experiencia de seis años / Orbital exenteration: six years of experience

Objetivo: describir las características clínico-patológicas y los resultados obtenidos en pacientes sometidos a exenteración orbitaria. Métodos: se realizó un estudio descriptivo, retrospectivo, de serie de casos, en el Instituto de Oncología y Radiobiología, desde enero del año 2011 a diciembre de 2016. La muestra se conformó con 71 pacientes exenterados y fue caracterizada según la edad, el sexo, el origen de la lesión, el diagnóstico histopatológico, los tratamientos previos, el tipo de exenteración orbitaria, el estado de los bordes de la sección quirúrgica, los tratamientos adyuvantes, los abordajes quirúrgicos asociados, la reconstrucción de la cavidad y las complicaciones posoperatorias. Resultados: el 67,6 por ciento de la muestra estudiada fue del sexo masculino. El 43,7 por ciento se encontró en el grupo de 60 a 79 años de edad; en el 38 por ciento de los pacientes la lesión primaria estuvo localizada en los párpados y en el 56,3 por ciento el diagnóstico histopatológico fue el carcinoma epidermoide. El 100 por ciento de la muestra había recibido algún tipo de tratamiento médico previo. Al 69 por ciento de la muestra se le realizó exenteración orbitaria tipo III, y solo en el 15,5 por ciento se reportaron bordes de la sección quirúrgica positivos. El 29,6 por ciento recibió tratamiento adyuvante con radioterapia. Se necesitó la combinación con otros abordajes quirúrgicos en el 28,2 por ciento de los pacientes y en el 69 por ciento se permitió la cicatrización espontánea de la cavidad orbitaria. La fístula senorbital fue la complicación más frecuente, con el 8,5 por ciento. Conclusiones: el carcinoma epidermoide es el tumor periocular que con mayor frecuencia invade la órbita. En la mayoría de los casos exenterados se logra la resección total del tumor con complicaciones posoperatorias mínimas(AU)

Objective: to describe the clinical and pathological characteristics and the results obtained in patients undergoing orbital exenteration. Methods: a descriptive, case series and retrospective study was carried out at the Institute of Oncology and Radiobiology from January 2011 to December 2016. The sample of 71 exenterated patients was characterized according to age, sex, origin of the lesion, histopathological diagnosis, previous treatments, type of orbital exenteration, state of the surgical section edges, adjuvant treatments, associated surgical approaches, reconstruction of the cavity and postoperative complications. Results: in this sample, 67.6 percent of the studied sample were men, 43.7 % were in the 60-79 age group; the primary lesion of 38 percent was located in the eyelids and and the histopathological diagnosis in 56.3 percent of patients was squamous cell carcinoma. One hundred percent of the sample had received some type of previous medical treatment, 69 percent of the sample underwent type III orbital exenteration, and only in 15.5 percent, the surgical section edges were reported as positive. Also, 29.6 percent received adjuvant treatment with radiotherapy. The combination with other surgical approaches was required in 28.2 percent of patients and percent spontaneous healing of the orbital cavity was allowed in 69 percent. The sino-orbital fistula was the most frequent complication (8.5 percent). Conclusions: squamous cell carcinoma is the periocular tumor that most frequently invades the orbit. Most exenterated cases managed to achieve total resection of the tumor with minimal postoperative complications(AU)

Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo

Abstract Background: Vitiligo is a chronic disease characterized by the appearance of achromic macules caused by melanocyte destruction. Surgical treatments with melanocyte transplantation can be used for stable vitiligo cases. Objectives: To evaluate treatment response to the autologous transplantation of noncultured epidermal cell suspension in patients with stable vitiligo. Methods: Case series study in patients with stable vitiligo submitted to noncultured epidermal cell suspension transplantation and evaluated at least once, between 3 and 6 months after the procedure, to observe repigmentation and possible adverse effects. The maximum follow-up period for some patients was 24 months. Results: Of the 20 patients who underwent 24 procedures, 25% showed an excellent rate of repigmentation, 50% good repigmentation, 15% regular, and 10% poor response. The best results were observed in face and neck lesions, while the worst in extremity lesions (88% and 33% of satisfactory responses, respectively). Patients with segmental vitiligo had a better response (84%) compared to non-segmental ones (63%). As side effects were observed hyperpigmentation of the treated area and the appearance of Koebner phenomenon in the donor area. Study limitations: Some limitations of the study included the small number of patients, a subjective evaluation, and the lack of long-term follow-up on the results. CONCLUSION: Noncultured epidermal cell suspension transplantation is efficient and well tolerated for stable vitiligo treatment, especially for segmental vitiligo on the face and neck.