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A comunicação buco-sinusal, uma conexão direta entre boca e seios maxilares, ocorre comumente pela extração de dentes próximos ao seio maxilar e outros procedimentos. O diagnóstico precoce é crucial para prevenir complicações graves. A abordagem terapêutica varia conforme o tamanho do defeito, presença de infecção e localização específica. Realizou-se uma breve revisão de literatura qualitativa abordando as principais complicações da comunicação buco sinusal na cirurgia bucal e como intervi-las. Buscou-se artigos científicos indexados nas seguintes bases de dados: Google Scholar, Pubmed e Biblioteca Scielo com lapso temporal de 2013 a 2023. Foram utilizados para esta busca os seguintes descritores: Comunicação buco-sinusal; Complicações; Seio maxilar. Os critérios de inclusão desta pesquisa foram artigos em inglês, português e espanhol, sendo selecionados 26 trabalhos. Os principais critérios de exclusão foram artigos com mais de 10 anos de publicação. A prevenção e gestão eficaz das complicações na comunicação oral em cirurgias são essenciais. Identificar fatores de risco, usar técnicas cirúrgicas precisas e agir imediatamente diante de sinais de comunicação com os seios da face são medidas cruciais para garantir a segurança do paciente e aprimorar os resultados cirúrgicos.

Oral-sinusal communication, a direct connection between the mouth and maxillary sinuses, commonly occurs due to the extraction of teeth close to the maxillary sinus and other procedures. Early diagnosis is crucial to prevent serious complications. The therapeutic approach varies according to the size of the defect, presence of infection and specific location. A brief qualitative literature review was carried out looking at the main complications of oral sinus communication in oral surgery and how to intervene. We searched for scientific articles indexed in the following databases: Google Scholar, Pubmed and Scielo Library with a time span from 2013 to 2023. The following descriptors were used for this search: Oral-sinus communication; Complications; Maxillary sinus. The inclusion criteria for this study were articles in English, Portuguese and Spanish, and 26 papers were selected. The main exclusion criteria were articles published more than 10 years ago. The prevention and effective management of oral communication complications during surgery are essential. Identifying risk factors, using precise surgical techniques and acting immediately in the event of signs of communication with the sinuses are crucial measures to ensure patient safety and improve surgical outcomes.

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Cemento-ossifying fibroma (COF) is a slow-growing, well-defined unilocular benign mesenchymal odontogenic tumor, that can have sclerotic edges and mixed areas. This case report details a conservative surgical treatment approach for COF that preserved both the cortical basal bone and the tooth segment. A thirty-three-year-old female presented with an asymptomatic extensive lesion in the anterior mandible, manifesting mild facial asymmetry, with one year of evolution. Imaging revealed a mixed dense lesion with sclerotic edges, with extension to the periapex of the teeth 33-44, expanding and thinning the cortical bone. Histopathology confirmed COF, showing fibrous stroma with spherical cementoid calcifications, overlayed with intact bone tissue. Conservative surgery was performed combining enucleation and curettage, with peripheral ostectomy, maintaining the cortical basal bone from the mandibulae, and tooth by apicoectomies. Three- and ten-months postoperative imaging displayed peripheral bone neoformation at the site, indicating effectiveness in the short-term follow-up, with no evidence of residual disease or recurrence. (AU)

ABSTRACT

Introducción. América Latina presenta un problema de desigualdad en el acceso a los servicios de salud en relación con el contexto sociocultural de la población,que se acentúa en relación con las actividades quirúrgicas. Ante esta situación, la cirugía global busca soluciones que permitan zanjar la brecha. Métodos. Planteamos el uso de la inteligencia artificial (IA) como una herramienta con gran potencial para expandir el alcance de los cirujanos a las poblaciones más desatendidas de esta región. Resultados. Las potenciales aplicaciones de la IA son innumerables. En este contexto, los recursos educacionales (chatbots) y las plataformas de telemedicina podrían acercar al profesional de la salud a donde es más necesario. Los algoritmos de seguimiento postoperatorio podrían alertarnos de factores de riesgo y posibles complicaciones. Los sistemas de análisis de información facilitarían la asignación de recursos humanos y materiales para brindar una atención más oportuna. La digitalización de las labores burocráticas y administrativas reduciría la carga para el cirujano, permitiendo dedicar este tiempo a la atención de los pacientes. Conclusiones. Pese a que existen limitaciones, como el acceso a la tecnología, la inversión requerida y la barrera idiomática, si los gobiernos, los profesionales de la salud y los desarrolladores tecnológicos apuestan por aplicar esta herramienta en el campo de la cirugía, podríamos estar cerca de una revolución de la atención de salud.

Introduction. Latin America presents great inequality in access to health services in relation to the sociocultural context of the population, which is accentuated in relation to surgical activities. Faced with this situation, global surgery seeks solutions that allow to close the gap. Methods. We propose the use of artificial intelligence (AI) as a tool with great potential to expand the reach of surgeons to the most underserved populations in the region. Results. The potential applications of AI are countless. In this context, educational resources (chatbots) and telemedicine platforms could bring health professional closer to where they are most needed. Postoperative monitoring algorithms could alert us of risk factors and possible complications. Information analysis systems would facilitate the allocation of human and material resources to provide more timely care. The digitalization of bureaucratic and administrative tasks would reduce the burden on the surgeon, allowing this time to be dedicated to patient care. Conclusions. Although there are limitations, such as reduced access to technology, the investment required and the language barrier, if governments, health professionals and technological developers commit to applying this tool in the field of surgery, we could be close to a health care revolution.

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Introducción. La validez del conocimiento derivado de un estudio depende de la ausencia de error. Todo diseño epidemiológico es susceptible de errores, por lo que los investigadores deben planear cuidadosamente cada una de las fases de su estudio para controlarlos. Métodos. Revisión narrativa de la literatura, resumiendo los puntos sobresalientes relacionados con error, sesgo y confusión en investigación relacionada con cirugía. Resultados. Cuando se formula una pregunta de investigación se puede incurrir en dos tipos de errores que llevan a conclusiones equivocadas: el error tipo 1 (alfa), en el que se observan diferencias cuando en realidad no existen, y el error tipo 2 (beta), en el que no se encuentran diferencias cuando en realidad las hay. La lista de posibles sesgos es larga y pueden estar originados en tres fuentes, unas propias del sujeto de estudio, otras del investigador, y finalmente, unas que dependen del instrumento o sistema de recolección de la información. Conclusión. La validez de un estudio depende de la ausencia de errores, sin embargo, no es posible eliminar por completo los sesgos de los estudios epidemiológicos. En investigación en cirugía general, incluso en los diseños más sencillos, como los reporte de caso, puede haber errores y sesgos. Por eso, uno de los objetivos de un investigador debe ser reducir al mínimo los errores, identificar los sesgos que no se pueden evitar, determinar su impacto, tenerlos en mente en la interpretación de los resultados y manifestarlo en la publicación de su artículo.

Introduction. The validity of knowledge derived from a study depends on the absence of error. All epidemiological designs are susceptible to errors, so researchers must carefully plan each phase of their study to control them. Methods. Narrative review of the literature, summarizing the salient points related to error, bias, and confusion in surgery-related research. Results. When formulating a research question, two types of errors can occur that lead to wrong conclusions: type 1 error (alpha), in which differences are observed when in reality there are none, and type 2 error (beta), in which no differences are found when in reality there are. The list of possible biases is long and can originate from three sources, some belonging to the subject of the study, others to the researcher, and finally, others that depend on the instrument or system of information collection. Conclusion. The validity of a study depends on the absence of errors; however, it is not possible to completely eliminate biases from epidemiological studies. In general surgical research, even in the simplest designs such as case reports, errors and biases can occur. Therefore, one of the objectives of a researcher should be to reduce errors to a minimum, identify biases that cannot be avoided, determine their impact, keep them in mind when interpreting the results and express this in the publication of the article.

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Introducción. El síndrome de desgaste profesional es un problema relevante en la formación quirúrgica; sin embargo, es limitada la literatura reciente sobre su conceptualización general durante la formación quirúrgica, a partir de fundamentos teóricos y evidencia empírica. Métodos. Este artículo es una revisión narrativa del síndrome, con énfasis en su prevalencia, precursores, consecuencias y estrategias de mitigación en residentes de cirugía, a partir de la literatura global y las publicaciones disponibles en Colombia. Resultados. El síndrome de desgaste profesional afecta a más de 50 % de los residentes de cirugía general a nivel global en algún punto de su formación. No obstante, la prevalencia acumulada en Colombia es menor. Los principales precursores se encuentran en el ambiente quirúrgico, especialmente en la pobre cultura académica de los departamentos quirúrgicos y las instituciones hospitalarias y universitarias. El síndrome se asocia con consecuencias negativas para el residente, la organización y el sistema sanitario. Existen nueve estrategias que pueden ayudar a mitigar el problema, las cuales implican acciones de los sistemas educativo y sanitario, y de los residentes, como parte de su autorregulación profesional. Conclusión. El síndrome de desgaste profesional en residentes de cirugía general es un problema latente en Colombia. Existen factores modificables que pueden ser atendidos con base en las recomendaciones disponibles de estudios publicados a nivel global y local.

Introduction. Burnout syndrome is a relevant problem in surgical training; however, recent literature on its conceptualization during surgical training, based on theoretical foundations and empirical evidence, is limited. Methods. This article is a narrative review of the syndrome, with emphasis on its prevalence, precursors, consequences, and mitigation strategies in surgical residents, based on the global literature and publications available in Colombia. Results. Burnout syndrome affects more than 50% of general surgery residents globally at some point of their training. However, the accumulated prevalence in Colombia is lower. The main precursors are found in the surgical environment, especially in the poor academic culture of surgical departments, and hospital and university institutions. The syndrome is associated with negative consequences for the resident, the organization, and the healthcare system. There are nine strategies that can help to mitigate the problem, which involve actions by the educational and health systems, and by residents, as part of their professional self-regulation. Conclusion. Burnout syndrome in general surgery residents is a latent problem in Colombia. There are modifiable factors that can be addressed based on the recommendations available from studies published at global and local levels.

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Introducción. El compromiso laboral, o work-engagement, es crucial para el bienestar psicológico y desempeño de los residentes de cirugía; sin embargo, la información sobre su conceptualización durante la formación quirúrgica, a partir de fundamentos teóricos y evidencia empírica es limitada. Métodos. El presente artículo presenta una revisión narrativa del compromiso laboral en residentes de cirugía, con énfasis en sus precursores, desenlaces y estrategias para su fortalecimiento, a partir de la literatura global y la evidencia empírica disponible en nuestro país. Resultados. El compromiso laboral representa un estado de bienestar en el ambiente de trabajo, caracterizado por vigor, dedicación y absorción. En general, el compromiso laboral de los residentes es alto en diferentes contextos. Sus principales precursores se encuentran en el ambiente quirúrgico, especialmente en la cultura y el clima educativo. El compromiso laboral se asocia con consecuencias positivas para el residente, la organización y el sistema sanitario. El ambiente sano de aprendizaje, el liderazgo educativo y la capacidad de los residentes para controlar su trabajo, son las tres principales estrategias para fortalecer el compromiso laboral. Conclusión. El compromiso laboral es un estado de bienestar positivo en el trabajo. Con base en estudios publicados a nivel global y local, existen intervenciones concretas para fortalecerlo en el médico residente de cirugía.

Introduction. Work commitment, or work engagement, is crucial for the psychological well-being and performance of surgical residents; however, Information on its conceptualization during surgical training, based on theoretical foundations and empirical evidence, is limited. Methods. This article presents a narrative review of work commitment in surgery residents, with emphasis on its precursors, outcomes, and strategies for its strengthening, based on the global literature and the empirical evidence available in our country. Results. Work commitment represents a state of well-being at work characterized by vigor, dedication, and absorption. In general, residents' work commitment is high in different contexts. Its main precursors are found in the surgical environment, especially in the culture and educational climate. Work commitment is associated with positive consequences for the resident, the organization, and the health system. A healthy learning environment, educational leadership, and the ability of residents to control their work are the three main strategies to strengthen work commitment. Conclusion. Work commitment is a state of positive well-being at work. Based on studies published globally and locally, there are specific interventions to strength it in surgical residents.

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Introducción. Se estima que ocurren 4,2 millones de muertes anuales en los primeros 30 días postoperatorios. La Comisión de Lancet en Cirugía Global resalta la importancia de medir y reducir esta mortalidad. Este estudio desarrolló una calculadora de mortalidad perioperatoria específica para la población colombiana, pretendiendo identificar e intervenir tempranamente los pacientes con alto riesgo. Métodos. Se utilizaron datos del estudio multicéntrico ColSOS, en el que se incluyeron 3807 pacientes de 54 centros en Colombia. Se recopilaron variables clínicas, sociodemográficas y perioperatorias; se manejaron los datos faltantes con imputación múltiple. La selección de variables se realizó mediante análisis bivariado, regresión Lasso y Recursive Feature Elimination (RFE). Se compararon modelos predictivos utilizando regresión logística y XGBoost, evaluando su rendimiento con validación cruzada. Resultados. El modelo XGBoost fue seleccionado por mostrar una mejor sensibilidad y menor número de falsos negativos que la regresión logística. Se destacó la importancia en la predicción de la clasificación ASA, enfermedad pulmonar obstructiva crónica, inestabilidad hemodinámica y urgencia del procedimiento. El modelo predijo mortalidad con un área bajo la curva (AUC) de 0,87. Conclusión. El presente estudio ha desarrollado la primera calculadora de mortalidad perioperatoria diseñada para la población colombiana, incluyendo múltiples especialidades quirúrgicas. El modelo de machine learning seleccionado presenta una sensibilidad y especificidad que la hacen equiparable a las mejores herramientas internacionales. La implementación de esta herramienta permite identificar y manejar tempranamente a los pacientes en riesgo, con lo que se podría mejorar la atención quirúrgica en Colombia.

Introduction. It is estimated that 4.2 million deaths occur annually within the first 30 postoperative days. The Lancet Commission on Global Surgery highlights the importance of measuring and reducing this mortality. This study developed a specific perioperative mortality calculator for the Colombian population, aiming to identify and intervene early in high-risk patients. Methods. Data from the multicenter ColSOS study were used, in which 3807 patients from 54 centers in Colombia were included. Clinical, sociodemographic, and perioperative variables were collected; missing data were handled with multiple imputations. Variable selection was performed through bivariate analysis, Lasso regression, and Recursive Feature Elimination (RFE). Predictive models were compared using logistic regression and XGBoost, evaluating their performance with cross-validation. Results. The XGBoost model was selected because of its superior sensitivity and fewer false negatives than logistic regression. The importance in predicting ASA classification, COPD, hemodynamic instability, and urgency of the procedure was highlighted. The model predicted mortality with an area under the curve (AUC) of 0.87. Conclusion.This study has developed the first perioperative mortality calculator designed for the Colombian population, including multiple surgical specialties. The selected machine learning model demonstrates sensitivity and specificity comparable to the best international tools. The implementation of this tool allows for early identification and management of patients at risk, which could improve surgical care in Colombia.

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Introducción. La resonancia magnética nuclear es un estudio ampliamente usado, que se ha convertido actualmente en una herramienta imprescindible para la toma de decisiones terapéuticas en los pacientes con cáncer de recto. El objetivo de este estudio fue esclarecer si los informes actuales cumplen con las recomendaciones internacionales respecto a los ítems que deben incluir para tomar mejores decisiones en el manejo y el seguimiento de los pacientes. Métodos. Estudio observacional, retrospectivo, de una cohorte de seguimiento de pacientes con cáncer de recto a quienes se les realizó resonancia magnética nuclear para estadificación o re-estadificación posterior a una terapia neoadyuvante, entre julio de 2020 y julio del 2022, en 2 centros de referencia de la ciudad de Medellín, Colombia. Resultados. En total se evaluaron 205 informes de resonancia magnética nuclear tomadas en pacientes con cáncer de recto, de los cuales el 50,2 % fueron de diagnóstico inicial sin terapia neoadyuvante y el 49,7 % fueron informes de re-estadificación posterior a terapia neoadyuvante. Se evaluaron 13 ítems de los reportes de las resonancias. Se encontró que un 2 % de los reportes fueron de alta calidad, 14,6 % de moderada calidad y 83,4 % de baja calidad. Conclusiones. La mayoría de los reportes de resonancia magnética nuclear en pacientes con cáncer de recto son de baja calidad, por lo tanto, serán necesarias estrategias que mejoren la comunicación, la estandarización y la calidad de los estudios.

Introduction. Magnetic resonance imaging (MRI) is the widely used study, which today has become an essential tool for therapeutic decisions in patients with rectal cancer. The objective of this study was to clarify whether current reports comply with international recommendations regarding the items they should have to make better decisions in the patients management and follow-up. Methods. Observational, retrospective study of a follow-up cohort of patients with rectal cancer who underwent MRI for staging or re-staging after neoadjuvant therapy, between July 2020 and July 2022, in two reference centers in the city of Medellín, Colombia. Results. In total, 205 MRI reports in patients with rectal cancer were reviewed, of which 50.2% were initial diagnosis without neoadjuvant therapy and 49.7% were reports of restaging after neoadjuvant therapy; 13 items from the MRI reports were evaluated. It was found that 2% of the reports were of high quality, 14.6% of moderate quality and 83.4% of low quality. Conclusions. Most MRI reports in patients with rectal cancer are of low quality; therefore, strategies will be necessary to improve communication, standardization and quality of the studies.

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Introducción. La fuga anastomótica es una complicación que en las últimas tres décadas ha mantenido sus tasas de incidencia entre 1 % y 19 % y ha alcanzado una mortalidad que varía entre 6 % y 22 %. Tiene una alta morbilidad, siendo responsable del 56 % de los estomas definitivos en pacientes sometidos a cirugía colorrectal. El objetivo de este estudio fue identificar los factores asociados con un mayor riesgo de incidencia de fuga anastomótica, para lograr impactar en la morbilidad y mortalidad de los pacientes llevados a cirugía colorrectal. Métodos. Estudio de casos y controles multicéntrico enfocado en los factores de riesgo preoperatorios e intraoperatorios asociados con la fuga anastomótica después de la resección de colon. Resultados. Se incluyeron 480 pacientes llevados a cirugía colorrectal entre enero de 2014 y diciembre de 2019. Se estimó que existe mayor riesgo de presentar dehiscencia de anastomosis con nivel de hemoglobina menor de 9 g/dl (p=0,001; OR=3,2; IC95%: 1,64-6,25), clasificación ASA > 3 (p=0,001; OR=9,96; IC95%: 4,75-20,9), duración prolongada de la cirugía (p=0,005) y necesidad de transfusión intraoperatoria (p=0,001; OR=4,57; IC95%: 2,32-9,01). El reforzamiento de la anastomosis se relacionó a un menor número de fugas anastomóticas (p=0,001; OR=0,14; IC95%: 0,04-0,46). Conclusión. La anemia y la transfusión de glóbulos rojos se relacionaron con un aumento de fuga anastomótica. Por otro lado, el refuerzo de la anastomosis se presenta como una medida potencialmente beneficiosa para mitigar la incidencia de esta complicación. La identificación precisa de estos factores de riesgo ofrece la oportunidad de transformar la fuga anastomótica en una complicación prevenible.

Introduction. Anastomotic leak is a complication that in the last three decades has maintained its incidence rates between 1% and 19% and has reached a mortality rate that varies between 6% and 22%. It has a high morbidity rate, being responsible for 56% of definitive stomas in patients undergoing colorectal surgery. The objective of this study was to identify factors associated with a higher risk of anastomotic leak incidence, in order to impact the morbidity and mortality of patients undergoing colorectal surgery. Methods. Multicentric case-control study focused on preoperative and intraoperative risk factors associated with anastomotic leak after colon resection. Results. 480 patients who underwent colorectal surgery between January 2014 and December 2019 were included. It was estimated that there is a higher risk of anastomotic dehiscence with hemoglobin levels <9 mg/dl (p=0.001; OR=3.2; 95% CI: 1.64-6.25), ASA classification >3 (p=0.001; OR=9.96; 95% CI: 4.75-20.9), prolonged surgery duration (p=0.005), and the need for intraoperative transfusion (p=0.001; OR=4.57; 95% CI: 2.32-9.01). Anastomosis reinforcement was related to fewer anastomotic leaks (p=0.001; OR=0.14; 95% CI: 0.04-0.46). Conclusion. Anemia and red blood cell transfusion were associated with an increased anastomotic leak. On the other hand, anastomosis reinforcement is presented as a potentially beneficial measure to mitigate the incidence of this complication. Accurate identification of these risk factors offers the opportunity to transform anastomotic leak into a preventable complication.

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Introduction. Ultrasound is now an essential tool in assessing trauma patients. It is the preferred initial imaging method for trauma care and is included in the Advanced Trauma Life Support guidelines established by the American College of Surgeons. Methods. A prospective, cross-sectional, observational study was conducted to determine the sensitivity and specificity of E-FAST (Extended Focused Assessment with Sonography in Trauma) performed by general surgeons at Hospital Universitario "Miguel Enríquez", in Havana, Cuba. Results. The diagnostic accuracy (AUC) for E-FAST was 0.964 (0.909 - 0.990), with a sensitivity in the detection of free fluid and pneumothorax of 96.4% (87.8-99.5%), and a specificity of 96.2% (87.0-99.5%). The confidence interval (CI) for these measures was 95%. Conclusions. The E-FAST test performed by general surgeons presents diagnostic values that make it a fast, reliable tool for the evaluation of trauma patients. It is a feasible method with high sensitivity, specificity and positive and negative predictive values.

Introducción. La ecografía es actualmente una herramienta esencial en la evaluación de los pacientes con trauma. Es el método de imagen inicial preferido para la atención del trauma y está incluido en las guías de soporte vital avanzado en trauma establecidas por el Colegio Americano de Cirujanos. Métodos. Se realizó un estudio observacional, transversal y prospectivo para determinar la sensibilidad y especificidad de la prueba E-FAST (Extended Focused Assessment with Sonography in Trauma) realizada por cirujanos generales en el Hospital Universitario "Miguel Enríquez", en La Habana, Cuba. Resultados. La precisión diagnóstica (AUC) de la prueba E-FAST fue de 0,964 (0,909 - 0,990), con una sensibilidad en la detección de líquido libre y neumotórax del 96,4 % (87,8-99,5 %) y una especificidad del 96,2 % (87,0-99,5 %). El intervalo de confianza (IC) para estas medidas fue del 95 %. Conclusiones. La evaluación ecográfica del trauma realizada por cirujanos generales presenta valores diagnósticos que la convierten en una herramienta rápida y confiable para la valoración de los pacientes con trauma. Es un método factible, con alta sensibilidad, especificidad y valores predictivos positivos y negativos.

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Introducción. El grupo etario de ancianos está en aumento a nivel mundial y nuestro medio no es la excepción. Los pacientes ancianos presentan con frecuencia urgencias quirúrgicas, las cuales pueden conllevar a desenlaces desfavorables. La implementación de un programa para el manejo integral del paciente anciano que será sometido a un procedimiento quirúrgico podría traer múltiples beneficios. Métodos. Revisión narrativa y análisis reflexivo de la información disponible sobre los programas quirúrgicos para la atención integral de los pacientes ancianos y su importancia. Resultados. Entre los beneficios de establecer un programa quirúrgico para la atención de pacientes ancianos se encuentran ofrecer una mejor atención, más comprensiva y empática y lograr mejores desenlaces quirúrgicos y, en ciertos casos, precisamente no quirúrgicos. Es altamente posible que así se disminuya la morbimortalidad de los procedimientos emprendidos, o que, por lo menos, se preserve la funcionalidad basal del paciente. Un servicio organizado de co-manejo entre cirugía y geriatría, que adopte protocolos de atención e identifique el riesgo particular de los pacientes mediante escalas validadas y adoptadas de forma consensuada, favorecería la toma de decisiones informadas por parte del paciente, su familia y el cirujano. Conclusiones. Las consideraciones previas nos impulsan a sugerir la necesidad de implementar programas especializados para atender integralmente las necesidades de la población creciente de personas mayores, que con una alta frecuencia requieren procedimientos quirúrgicos para la solución de patologías complejas.

Introduction. The elderly population is increasing worldwide, and our region is no the exception. Elderly patients frequently present surgical emergencies, which can lead to unfavorable outcomes. The implementation of a program for the comprehensive management of elderly patients who will undergo a surgical procedure could bring multiple benefits. Methods. Narrative review and reflective analysis of available information on surgical programs for the comprehensive care of elderly patients and their importance. Results. Among the benefits of establishing a surgical program for the care of elderly patients are offering better surgical and, in certain cases, precisely non-surgical outcomes. It is highly possible that the morbidity and mortality of the procedures undertaken will be reduced, or at least the patient's baseline functionality will be preserved. An organized co-management service between surgery and geriatrics, which adopts management protocols and identifies the particular risk of patients through validated scales adopted by consensus, would favor informed decision-making by the patient, their family, and the surgeon. Conclusions. The previous considerations lead us to suggest the need to implement specialized programs to comprehensively address the needs of the growing elderly population, who frequently require surgical procedures to solve complex pathologies.

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O presente artigo tem como objetivo relatar um caso clínico de abordagem cirúrgica em um paciente pediátrico cursando com a fratura de parassínfise mandibular. Trata-se de um paciente pediátrico, do sexo masculino, 12 anos, que compareceu ao ambulatório bucomaxilofacial acompanhado de genitora, apresentando limitação de abertura bucal após acidente ciclístico. Após realização de exame físico e avaliação de exame tomográfico de face, observou-se uma fratura de parassínfise mandibular direita, sendo instituído o manejo cirúrgico como tratamento. As fraturas mandibulares em pacientes pediátricos necessitam de uma abordagem individual buscando menor morbidade e restabelecendo estética e função adequadas. A abordagem cirúrgica tem alcançado bons resultados e sempre devem ser considerados fatores como a idade do paciente, o nível de deslocamento da fratura, o tipo de fratura, comprometimento oclusal e a cronologia de erupção dentária na tomada de decisão da conduta terapêutica.

This article aims to report a clinical case of surgical approach in a pediatric patient with a fracture of the mandibular parasymphysis. A 12-year-old male pediatric patient presented to the oral and maxillofacial outpatient clinic accompanied by a mother, presenting limited mouth opening after a bicycle accident. After a physical examination and evaluation of a tomographic examination of the face, a fracture of the right mandibular parasymphysis was observed, and surgical management was instituted as treatment. Mandibular fractures in pediatric patients require an individual approach seeking less morbidity and restoring adequate aesthetics and function. The surgical approach has achieved good results, and factors such as the patient's age, the level of fracture displacement, the type of fracture, occlusal involvement, and the chronology of tooth eruption should always be considered in the decision-making of the therapeutic approach.

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ABSTRACT Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was −0.10 ± 0.35 and −0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively.

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ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

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ABSTRACT Purpose: This study aimed to analyze variations in intraoperative corneal thickness during corneal cross-linking in patients with keratoconus and to investigate its possible correlation with presurgical maximal keratometry (Kmax) and pachymetry. Methods: This was a prospective case series. We used a method similar to the Dresden protocol, with the application of hydroxypropyl methylcellulose 0.1% hypo-osmolar riboflavin in corneas between 330 and 400 µm after epithelium removal. Corneal thickness was measured using portable calipers before and immediately after epithelium removal, and 30 and 60 min after the procedure. Results: The 30 patients in this study were followed up for one year. A statistically significant difference was observed in pachymetry values during the intraoperative period (p<0.0001) and an increase of 3.05 µm (95%C1: 0.56-5.54) for each diopter was seen after epithelium removal (p0.019). We found an average Kmax difference of —2.12 D between men and women (p0.013). One year after treatment, there was a statistically significant reduction in pachymetry (p<0.0001) and Kmax (p0.0170) values. Conclusions: A significant increase in pachymetry measurements was seen during the procedure, and most patients showed a regression in Kmax and pachymetry values one year after surgery.

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ABSTRACT Objective: The objective of this study was to report two cases of successive multiple spontaneous bilateral pneumothorax in children with massive lung involvement due to Langerhans cell histiocytosis (LCH), emphasizing the possibility of this differential diagnosis for the general pediatrician. Additionally, published cases describing pediatric patients with pulmonary manifestations of LCH were reviewed in the literature. Case description: Case #1: A 3-year-old male patient with a sudden episode of spontaneous right-sided pneumothorax, surgically drained. After 2 months, he experienced two new episodes of contralateral pneumothorax. A pulmonary lymph node biopsy revealed the diagnosis of LCH. He underwent bilateral video-assisted thoracic surgery and mini-thoracotomy with mechanical pleurodesis, in addition to chemotherapy, requiring prolonged hospitalization. Case #2: A 4-year-old boy with progressive dyspnea and wheezing for 5 months. A pulmonary biopsy revealed LCH. He developed significant respiratory distress and right pneumothorax, requiring drainage. Silver nitrate pleurodesis and different chemotherapy regimens were performed. Both patients responded well to multiple chemotherapy treatments, surgeries, and intensive care support. Comments: LCH is a challenging disease. Its clinical manifestation is variable, and pulmonary involvement occurs in about 10-15% of cases. We consider specialized surgical management and multidisciplinary support essential for the treatment of patients with massive pulmonary LCH. Although rare, massive pulmonary involvement by LCH should be considered in cases of recurrent pneumothorax in children.

RESUMO Objetivo: Relatar dois casos de pneumotórax bilateral espontâneo múltiplo sucessivo em crianças com envolvimento pulmonar maciço por histiocitose de células de Langerhans (HCL), alertando para a possibilidade desse diagnóstico diferencial para o pediatra geral. Ademais, casos publicados que descrevem pacientes pediátricos com manifestações pulmonares de HCL foram revisados na literatura. Descrição do caso: Caso 1: Paciente masculino, três anos, com episódio súbito pneumotórax espontâneo à direita, drenado cirurgicamente. Após dois meses, apresentou dois novos episódios de pneumotórax contralateral. Biópsia linfonodal pulmonar revelou diagnóstico de HCL. Foi submetido a cirurgia torácica assistida por vídeo (VATS) bilateral e minitoracotomia com pleurodese mecânica, além de tratamento quimioterápico, necessitando de internação prolongada. Caso 2: Menino, quatro anos, apresentando dispneia progressiva e sibilância por cinco meses. Biópsia pulmonar revelou HCL. Evoluiu com importante desconforto respiratório e pneumotórax direito, necessitando drenagem. Foi realizada pleurodese com nitrato de prata e diferentes esquemas de quimioterapia. Ambos os pacientes evoluíram bem após tratamentos quimioterápicos múltiplos, cirurgias e suporte intensivo. Comentários: A HCL é uma doença desafiadora. Sua manifestação clínica é variável, e o envolvimento pulmonar ocorre em cerca de 10-15% dos casos. Consideram-se o manejo cirúrgico especializado e o suporte multidisciplinar essenciais para o tratamento de pacientes com HCL pulmonar maciça. Ainda que raro, o envolvimento pulmonar maciço por HCL deve ser considerado em quadros de pneumotórax recorrentes em crianças.

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Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]

Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]

Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]

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Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados ​​478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.