Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem / Riscos ocupacionais associados à doença renal crônica de origem não tradicional (DRCnt) no Brasil: é hora de nos aprofundarmos em um problema negligenciado

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança.

Assessment by the Scheimpflug imaging system of corneal clarity and anterior segment properties in rosacea patients

Abstract Objective To evaluate the effects of rosacea on ocular surface changes such as alterations in dry eye parameters, corneal densitometry, and aberrations, in comparison with healthy controls. Methods A total of 88 eyes of 44 patients diagnosed with rosacea and 88 eyes of 44 healthy controls were enrolled in this cross-sectional study. All participants underwent a comprehensive dermatologic and ophthalmic examination and Tear Break-Up Time (TBUT) and Schirmer-1 tests were performed. The rosacea subtype and Demodex count and OSDI scores of all participants were recorded. Corneal topographic, densitometric, and aberrometric measurements were obtained using the Scheimpflug imaging system. Results The mean age of the 44 patients was 41.2 ± 11.0 years of whom 31 (70.5%) were female. The mean TBUT and Schirmer-1 test values were significantly decreased and OSDI scores were significantly increased in the rosacea group compared to healthy controls (p < 0.01 for all). The most common subtype of rosacea was erythematotelangiectatic rosacea (70.4%). The severity grading of rosacea revealed that 18 (40.9%) patients had moderate erythema. The median (min-max) Demodex count was 14.0 (0-120) and the disease duration was 24.0 (5-360) months. The comparison of the corneal densitometry values revealed that the densitometry measurements in all concentric zones, especially in central and posterior zones were higher in rosacea patients. Corneal aberrometric values in the posterior surface were also lower in the rosacea group compared to healthy controls. The topographic anterior chamber values were significantly lower in the rosacea group. Study limitations Relatively small sample size, variable time interval to hospital admission, and lack of follow-up data are among the limitations of the study. Future studies with larger sample sizes may also enlighten the mechanisms of controversial anterior segment findings by evaluating rosacea patients who have uveitis and those who do not. Conclusion Given the fact that ocular signs may precede cutaneous disease, rosacea is frequently underrecognized by ophthalmologists. Therefore, a comprehensive examination of the ocular surface and assessment of the anterior segment is essential. The main priority of the ophthalmologist is to treat meibomian gland dysfunction and Demodex infection to prevent undesired ocular outcomes.

Reporte de caso clínico: embarazo en el istmo cervical posterior a fertilización in vitro

El embarazo ectópico de implantación baja incluye al embarazo cervical, localizado entre el istmo y la cicatriz de cesárea. Se caracteriza por la implantación del blastocisto fuera de la cavidad uterina. Esta condición se presenta entre 1% y 2% de todos los embarazos y es la principal causa de muerte materna en el primer trimestre de gestación. Tiene baja incidencia en comparación con otras localizaciones, y alto riesgo de morbilidad materna debido a la probabilidad de sangrado durante la intervención. Se presenta un caso en el Hospital Militar Central de Bogotá de un embarazo ectópico ístmico cervical posterior al proceso de fertilización in vitro en mujer de 37 años con antecedente cesárea, ultima hace 17 años, y esterilización quirúrgica. El objetivo es documentar el proceso y las intervenciones, ya que el manejo de esta patología depende de las condiciones clínica y el deseo de reproducción de la mujer. (provided by Infomedic Intl).

Low implantation ectopic pregnancy includes cervical pregnancy, located between the isthmus and the cesarean scar. It is characterized by implantation of the blastocyst outside the uterine cavity. This condition occurs in 1% to 2% of all pregnancies and is the leading cause of maternal death in the first trimester of gestation. It has a low incidence compared to other locations, and a high risk of maternal morbidity due to the probability of bleeding during the intervention. We present a case of a cervical isthmic ectopic pregnancy following in vitro fertilization in a 37 year old woman with a history of cesarean section, last 17 years ago, and surgical sterilization at the Hospital Militar Central de Bogotá. The objective is to document the process and the interventions, since the management of this pathology depends on the clinical conditions and the woman's desire to reproduce. (provided by Infomedic Intl).

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

El tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis. Reporte de caso / Pott's puffy tumor: A rare complication of sinusitis. A case report

Una complicación infrecuente de la sinusitis frontal es el tumor inflamatorio de Pott. Se manifiesta como una tumefacción en la frente por la presencia de un absceso subperióstico secundario a una osteomielitis del hueso frontal. El diagnóstico oportuno permite un tratamiento intensivo médico y quirúrgico precoz, esencial para evitar complicaciones intracraneales graves. Se presenta el caso de un varón de 12 años con un tumor inflamatorio de Pott como complicación de una pansinusitis. Representó un desafío diagnóstico; sin embargo, la instauración del tratamiento oportuno permitió una evolución clínica favorable.

A rare complication of frontal sinusitis includes Pott's puffy tumor. It manifests as a swelling of the forehead due to the presence of a subperiosteal abscess secondary to osteomyelitis of the frontal bone. A timely diagnosis allows for an early, intensive medical and surgical treatment, which is critical to prevent serious intracranial complications. Here we describe the case of a 12-year-old boy with Pott's puffy tumor as a complication of pansinusitis. This case was a diagnostic challenge; however, a timely treatment allowed for a favorable clinical course.

Púrpura fulminante postinfecciosa: a propósito de un caso / Postinfectious purpura fulminans: A case report

La púrpura fulminante adquirida postinfecciosa es una entidad aguda y grave, poco frecuente, caracterizada por necrosis cutánea asociada a coagulopatía intravascular diseminada (CID), en ausencia de infección activa o alteraciones previas de la coagulación. Afecta fundamentalmente a la población pediátrica y, en el 90 % de los casos, está precedida por un proceso infeccioso. El mecanismo fisiopatológico es un déficit transitorio de proteína S mediado por autoanticuerpos que favorece un estado de hipercoagulabilidad. Se presenta el caso de un varón de 8 años previamente sano, con lesiones cutáneas purpúricas características de púrpura fulminante asociada a CID en ausencia de sepsis. Se constató deficiencia plasmática transitoria de proteína S. Requirió tratamiento sustitutivo con plasma fresco congelado y anticoagulación; la evolución fue favorable. La actividad de la proteína S permaneció disminuida durante 2 meses.

Acquired postinfectious purpura fulminans is a rare, acute, and severe disease characterized by skin necrosis associated with disseminated intravascular coagulation (DIC) in the absence of active infection or previous coagulation disorders. It mainly affects the pediatric population and, in 90% of cases, it is preceded by an infectious process. The pathophysiological mechanism is a transient autoantibodymediated protein S deficiency that favors a hypercoagulable state. Here we describe the case of a previously healthy 8-year-old boy with purpuric skin lesions typical of purpura fulminans associated with DIC in the absence of sepsis. A transient plasma protein S deficiency was confirmed. He required replacement therapy with fresh frozen plasma and anticoagulation; he had a favorable course. Protein S activity remained decreased for 2 months.

Ethnobotanical knowledge on non-conventional food plants and medicinal plants in Extractivist Reserve in the Brazilian Amazon / Conocimiento etnobotánico sobre plantas alimenticias no convencionales y plantas medicinales en una Reserva Extractivista en la Amazonía Brasileña

Information on the knowledge and ways of using food and medicinal plants by traditional populations, family farmers and Brazilian native population in the Amazon is essential to guarantee the food sovereignty of these groups. This study was conducted using semi-structured interviews applied to local respondents. A total of 269 species of both non-conventional food plants and medicinal plants were identified, distributed in 83 botanical families and 198 genera. The Arecaceae and Lamiaceae families had the highest species richness (11 and 7, respectively). The Shannon-Wiener (H') and Pielou (J') diversity indices were considered high (5.02 and 0.9, respectively) when compared to other ethnobotanical works. In the environment in which these families are found, these species become the only food and medicinal resources available.

La información sobre los saberes y formas de uso de las plantas alimenticias y medicinales por parte de las poblaciones tradicionales, agricultores familiares e indígenas brasileños en la Amazonía es fundamental para garantizar la soberanía alimentaria de estos grupos. Este estudio se realizó utilizando entrevistas semiestructuradas aplicadas a encuestados locales. Se identificaron un total de 269 especies tanto de plantas alimenticiasno convencionales como de plantas medicinales, distribuidas en 83 familias botánicas y 198 géneros. Las familias Arecaceae y Lamiaceae tuvieron la mayor riqueza de especies (11 y 7, respectivamente). Los índices de diversidad de Shannon-Wiener (H') y Pielou (J') fueron considerados altos (5,02 y 0,9, respectivamente) en comparación con otros trabajos etnobotánicos. En el ambiente en que se encuentran estas familias, estas especies se convierten en los únicos recursos alimenticios y medicinales disponibles.

Importancia cultural de la flora empleada por la comunidad nativa Asheninka Sheremashe, Ucayali, Perú / Cultural importance of the flora used by the Asheninka Sheremashe native community, Ucayali, Peru

The cultural significance of the flora used by the native Asheninka Sheremashe community in Ucayali, Peru was determined. To do this, a fieldwork of over 4 months was conducted, involving semi-structured interviews with 106 residents through non-probabilistic convenience sampling. The community utilizes 139 plant species in their daily lives, belonging to 120 genera and 52 families, with the most abundant being Fabaceae, Arecaceae, Malvaceae, Solanaceae, Poaceae, and Rutaceae. Furthermore, 25.9% of the species are of significant importance to theinhabitants according to the Cultural Index (CI), such as Manihot esculenta, Theobroma cacao, Bixa orellana, Musa paradisiaca, Ficus insipida, among others. It can be concluded that the flora plays a prominent role in the life of the community, with the categories reporting the highest number of species being: food (29.35%), medicine (28.36%), culture (9.95%), construction (9.45%), lumber (6.97%), commerce (3.48%), craftsmanship (2.49%), toxic (2.49%), and other uses (7.46%)

Se determinó la importancia cultural de la flora empleada por la comunidad nativa Asheninka Sheremashe, en Ucayali, Perú. Para ello, se realizó un trabajo de campo de más de 4 meses, donde se aplicaron entrevistas semiestructuradas a 106 habitantes mediante un muestreo no probabilístico por conveniencia. La comunidad emplea 139 especies vegetales en su día a día, pertenecientes a 120 géneros y 52 familias; siendo las más abundantes las Fabaceae, Arecaceae, Malvaceae, Solanaceae, Poaceae y Rutaceae. Además, el 25.9% de las especies tiene gran importancia para los pobladores según el Índice Cultural (IC): Manihot esculenta, Theobroma cacao, Bixa orellana, Musa paradisiaca, Ficus insipida, entre otras. Se concluye que la flora tiene un rol preponderante en la vida de la comunidad, siendo las categorías que presentaron mayor reporte de especies: alimentación (29.35%), medicina (28.36%), cultura (9.95%), construcción (9.45%), aserrío (6.97%), comercio (3.48%), artesanía (2.49%), tóxico (2.49%) y otros usos (7.46%)

Effects of a Multi-professional Intervention on Quality of Life of Women with Overweight or Obesity Post-Covid-19: A Pragmatic Trial

Obesity is a global Non-Communicable Chronic Disease (NCD) associated with various comorbidities and a high mortality rate. This scenario has increasingly affected the female population, leading to a rise in prevalence and related health issues. Therefore, the present study aimed to assess the health-related quality of life of women with overweight or obesity and symptoms of COVID-19 using a multi-professional intervention model. This research was conducted as a parallel group and repeated measures pragmatic trial, in which 28 participants aged between 25 and 65 were allocated into two groups: experimental (intervention group) and control (non-intervention participants). The Body Mass Index (BMI) was (30.5 ± 5.45 kg/m²) in the Experimental Group, and the Control Group was (31 ± 8.2 kg/m2). The 12-Item Health Survey (SF-12) questionnaire was applied to assess the quality of life in the physical and mental domains of COVID-19 survivors with different symptom severities (mild, moderate, severe) compared to the control group. At the end of the program, 28 participants finished the study (15 from the experimental group and 13 from the control group). The results indicated a significant improvement in the mental health domain only in the experimental group after the intervention period (p 0.05). Considering these findings, multi-professional actions emerge as a crucial component for enhancing the quality of life, particularly within mental health, during the 16-week intervention period.

La obesidad es una Enfermedad Crónica No Transmisible (ECNT) global asociada a diversas comorbilidades y una alta tasa de mortalidad. Este escenario ha afectado cada vez más a la población femenina, lo que ha llevado a un aumento en la prevalencia y problemas de salud relacionados. El presente estudio tiene como objetivo evaluar la calidad de vida relacionada con la salud de mujeres con sobrepeso u obesidad y síntomas de COVID-19 mediante un modelo de intervención multiprofesional. Esta investigación se llevó a cabo como un ensayo pragmático de grupos paralelos y medidas repetidas, en el que 48 participantes con edades comprendidas entre 25 y 65 años fueron alocadas en dos grupos: experimental (participantes de la intervención) y control (participantes de la no intervención). En el grupo experimental el Índice de Masa Corporal (IMC) fue de (30,5 ± 5,45 kg/m²). En el grupo control, el IMC fue (31 ± 8,2 kg/m²). Se utilizó el cuestionario de 12-Item Health Survey (SF-12) para evaluar la calidad de vida en los dominios físico y mental de las sobrevivientes de COVID-19 con diferentes grados de gravedad de síntomas (leves, moderados, graves) en comparación con el grupo de control (participantes que no recibieron intervenciones). Al final del programa, 28 participantes terminado el estudio (15 participantes de la intervención y 13 sin intervención). Los resultados indicaron una mejora significativa en el dominio de la salud mental solo en el grupo experimental después del período de intervención (p 0.05). A la luz de estos hallazgos, la rehabilitación multiprofesional emerge como un componente crucial para mejorar la calidad de vida, especialmente en el ámbito de la salud mental durante el período de intervención de 16 semanas.

A obesidade é uma Doença Crônica Não-Transmissível (DCNT) com alcance mundial, associada a diversas comorbidades e alta taxa de mortalidade. Esse quadro tem afetado cada vez mais o público feminino, com aumento da prevalência e doenças correlatas. O objetivo deste estudo foi avaliar a qualidade de vida relacionada à saúde de mulheres com sobrepeso ou obesidade com sintomas da COVID-19 utilizando um modelo de intervenção multiprofissional. Esta pesquisa foi conduzida como um ensaio pragmático de grupos paralelos e medidas repetidas, no qual 28 participantes de idade entre 25 a 65 anos foram distribuídas em dois grupos: experimental (participantes das intervenções) e controle (não participantes das intervenções). No grupo experimental o Índice de Massa Corporal (IMC) foi de (30,5 ± 5,45 kg/m²) e no grupo controle, IMC foi de (31 ± 8,2 kg/m²). Utilizou-se o questionário 12-Item Health Survey (SF-12) para analisar a qualidade de vida nos domínios físico e mental das sobreviventes da COVID-19 nas diferentes sintomatologias (COVID leve, moderada e grave) em comparação com o grupo controle (não participantes das intervenções). Ao final do programa, 28 participantes finalizaram o estudo (15 do grupo experimental e 13 do grupo controle). Os resultados indicaram uma melhoria significativa no domínio de saúde mental apenas no grupo experimental após o período de intervenção (p 0,05). Diante dos resultados a reabilitação multiprofissional emerge como componente importante para a melhoria da qualidade de vida, especialmente no âmbito da saúde mental durante as 16 semanas de intervenção.

Personalidad Grit y rendimiento anaeróbico en taekwondistas estadounidenses

El propósito de este estudio fue evaluar la relación entre el rendimiento anaeróbico y la personalidad Grit en taekwondistas estadounidenses, su grado de influencia, así como las diferencias que puedan existir entre sexos. Este estudio tuvo una metodología cuantitativa, descriptiva-correlacional, realizada en una población de (n=121) taekwondistas, vinculados a la USAT. La personalidad Grit fue medida mediante la escala Grit, y el rendimiento anaeróbico a través de la prueba del sprint anaeróbico basado en la carrera (Rast). De acuerdo con los resultados se pudo identificar en hombres, una correlación positiva y significativa entre la capacidad y potencia anaeróbica con el Grit (p<0.005 y p<0.007 respectivamente). Asimismo, estas dos variables se relacionaron significativamente con el Grit (p<0.001) en el total de la muestra. En el caso de las mujeres, no hubo relaciones significativas. El índice de fatiga no presentó correlaciones significativas. La personalidad Grit influyó hasta un 14% en la capacidad y potencia anaeróbica en hombres (p<0.001 y p<0.002, respectivamente) y un 12% en estos dos mismos aspectos para la muestra total (p<0.000 en ambos casos). Finalmente, los hallazgos indican una relación entre la potencia, capacidad anaeróbica con la personalidad Grit en hombres y en el total de la muestra, con una influencia significativa del Grit en el rendimiento anaeróbico. No se encontraron tales relaciones en mujeres. Aunque no se hallaron diferencias significativas por sexo en el Grit, capacidad y potencia anaeróbica, sí que se encontró en el índice de fatiga, indicando una disparidad en la resistencia a la fatiga entre sexos.

The purpose of this study was to assess the relationship between anaerobic performance and Grit personality in American taekwondo practitioners, its degree of influence, as well as any differences that may exist between genders. This study employed a quantitative, descriptive-correlational methodology, conducted on a population of (n=121) taekwondo practitioners affiliated with the USAT. Grit personality was measured using the Grit Scale, and anaerobic performance was assessed through the Anaerobic Sprint Test based on running (Rast). According to the results, a positive and significant correlation between anaerobic capacity and power with Grit was identified in men (p<0.005 and p<0.007 respectively). Likewise, these two variables were significantly related to Grit (p<0.001) in the total sample. In the case of women, there were no significant relationships. The fatigue index showed no significant correlations. Grit personality influenced up to 14% in anaerobic capacity and power in men (p<0.001 and p<0.002, respectively) and 12% in these two aspects for the total sample (p<0.000 in both cases). Finally, the findings indicate a relationship between power, anaerobic capacity, and Grit personality in men and the total sample, with a significant influence of Grit on anaerobic performance. Such relationships were not found in women. Although no significant gender differences were found in Grit, anaerobic capacity, and power, differences were found in the fatigue index, indicating a disparity in fatigue resistance between genders.

O objetivo deste estudo foi avaliar a relação entre o desempenho anaeróbico e a personalidade Grit em praticantes de taekwondo americanos, seu grau de influência, bem como as diferenças que possam existir entre os sexos. Este estudo utilizou uma metodologia quantitativa, descritiva-correlacional, realizada em uma população de (n=121) praticantes de taekwondo afiliados à USAT. A personalidade Grit foi medida usando a Escala Grit, e o desempenho anaeróbico foi avaliado através do Teste de Sprint Anaeróbico baseado em corrida (Rast). De acordo com os resultados, foi possível identificar nos homens uma correlação positiva e significativa entre a capacidade e potência anaeróbica com o Grit (p<0.005 e p<0.007, respectivamente). Da mesma forma, essas duas variáveis estavam significativamente relacionadas ao Grit (p<0.001) na amostra total. No caso das mulheres, não foram encontradas relações significativas. O índice de fadiga não apresentou correlações significativas. A personalidade Grit influenciou até 14% na capacidade e potência anaeróbica em homens (p<0.001 e p<0.002, respectivamente) e 12% nesses dois aspectos para a amostra total (p<0.000 em ambos os casos). Finalmente, os achados indicam uma relação entre potência, capacidade anaeróbica e a personalidade Grit em homens e na amostra total, com uma influência significativa do Grit no desempenho anaeróbico. Tais relações não foram encontradas em mulheres. Embora não tenham sido encontradas diferenças significativas por sexo no Grit, capacidade e potência anaeróbica, foi encontrada diferença no índice de fadiga, indicando uma disparidade na resistência à fadiga entre os sexos.

Calcifilaxis, factores de riesgo, tratamiento y evolución. Estudio retrospectivo de 39 pacientes / Calciphylaxis, risk factors, treatment and outcomes. Retrospective study of 39 patients

Resumen Introducción : La calcifilaxis es un trastorno vascular grave caracterizado por depósito de calcio en túnica me dia arteriolar, trombosis y necrosis cutánea. Se describió en pacientes con insuficiencia renal (CU), aunque puede producirse en su ausencia (CNU). Sus factores de riesgo están en estudio y su diagnóstico puede ser complejo. Su mortalidad se estimaba en 60-80%, aunque trabajos recientes indican que ha disminuido (40%). Métodos : Estudio retrospectivo entre el 1/1/2011 y el 31/12/2019. Se revisaron los antecedentes, las ca racterísticas clínicas, los hallazgos de laboratorio e histopatológicos, y la evolución de todos los pacientes con diagnóstico de calcifilaxis evaluados en el Hospital Italiano de Buenos Aires. Resultados : Se incluyeron 39 pacientes. El 61.5% (24) eran hombres y 38.5% (15) fueron casos de CNU. De éstos, 82% presentaba hipertensión arterial, 66% obesidad y 46% diabetes. El 49% recibía anticoagulantes dicumarínicos. Todos los pacientes con CNU y 75% con CU presentaron úlceras de fondo necrótico, localizadas con mayor frecuencia en las piernas. En 72% de los casos el diagnóstico histológico se efectuó con una toma de biopsia. En todos, el tratamiento fue multimodal y la mortalidad al año fue de 42%. Conclusión : Observamos una elevada proporción de pacientes con CNU, en relación con lo comunicado en la literatura, y la mitad recibía anticoagulantes di cumarínicos. El diagnóstico histológico se efectuó por biopsia en la mayor parte de los casos, para lo cual la toma quirúrgica de la muestra, la tinción con Von Kossa y la evaluación por un patólogo experto fueron claves.

Abstract Introduction : Calciphylaxis is a serious vascular dis order characterized by calcification of tunica media, in timal hyperplasia, thrombosis, and skin necrosis. It was described in patients with renal failure (UC), although it can occur in its absence (NUC). Its risk factors are under study and its diagnosis can be complex. Over a decade ago, its mortality was estimated at 60-80%. Recent stud ies indicate that it has decreased (40%). Methods : A retrospective study was carried out in the period between January 1, 2011 and December 31, 2019. The past medical record, clinical characteristics, labo ratory and histopathological findings, and evolution of all patients with calciphylaxis evaluated at the Hospital Italiano de Buenos Aires were reviewed. Results : Thirty-nine patients were included. Sixty-one percent were men and 39% were NUC cases. Eighty-two percent had arterial hypertension, 66% obesity and 46% diabetes. Of those, 49% received coumarin anticoagulants. All patients with NUC and 75% with UC presented ulcers with necrosis, located more frequently on the legs. In 72% of the cases the histological diagno sis was made with one biopsy. In all the treatment was multimodal and mortality at one year was 42%. Conclusion : We observed a high proportion of pa tients with NUC, in relation to what is reported in the literature, and that half received vitamin K antagonists. The histological diagnosis was made with one biopsy in most of the cases, as the surgical technique for taking the sample, the Von Kossa staining and the evaluation by an expert pathologist were the key of it.

De trastorno neuropsiquiátrico a insulinoma, corrección diagnóstica y resolución mediante resección pancreática mayor / From a neuropsychiatric disorder to the correct diagnosis of insulinoma resolved by major pancreatic resection

RESUMEN El insulinoma es un tumor pancreático poco frecuente con una incidencia del 0,4%, generalmente benigno. Se presenta más frecuentemente en mujeres con una relación 2:1. Es el tumor neuroendocrino funcionante más común del páncreas1, responsable del 70 al 75% de hiperinsulinemía en la práctica clínica. El diagnóstico suele representar un desafío, y el retraso diagnóstico poner en riesgo la vida del paciente. El tratamiento quirúrgico es curativo en más del 90% de los casos; la táctica conservadora, siempre que sea posible, es la de elección. Informamos acerca de una duodenopancreatectomía cefálica (DPC) por insulinoma en un paciente de sexo masculino, con mala interpretación diagnóstica previa de enfermedad neuropsiquiátrica y tratado con anticonvulsivantes.

ABSTRACT Insulinomas are rare pancreatic tumors usually benign with an incidence of 0.4%. They are more common in women with a female-to-male ratio of 2:1. It is the most common functioning neuroendocrine tumor of the pancreas and is responsible for 70-75% of hyperinsulinemia in clinical practice1. The diagnosis is often a challenge, and a delay in diagnosis can have serious consequences for the patient. Surgical treatment is curative in more than 90% of cases, and the conservative approach is the treatment of choice whenever possible. We report the case of a cephalic pancreaticoduodenectomy (CPD) due to an insulinoma in a male patient with a previous misdiagnosis of a neuropsychiatric disorder treated with anticonvulsants.

Tratamiento de la Colecisto-coledocolitiasis mediante la técnica de Rendez-vous laparo-endoscópico: implementación y desarrollo de la técnica en un hospital universitario

Objetivo: La litiasis biliar es una patología frecuente en Chile y el mundo, que suele presentarse como colecistocoledocolitiasis. Dentro de las alternativas para su manejo está el rendez-vous laparoendoscópico (RVLE), que consiste en una colecistectomía laparoscópica asociada a colangiopancreatografía endoscó-pica retrograda (ERCP). Este trabajo tiene como objetivo evaluar la implementación de esta técnica para el tratamiento de la colecistocoledocolitiasis en un hospital universitario. Materiales y Métodos: Cohorte retrospectiva de 4 años de pacientes con colecistocoledocolitiasis en quienes se realizó un RVLE. Resultados: Se incluyeron 296 pacientes, de edad promedio de 52 años, siendo un quinto mayor de 70 años, y presentando un 29,3% comorbilidades significativas. Un 65,2% fueron urgencias y un 12,2% presentó colangitis aguda. El éxito de la técnica fue de un 82,8%. Los cálculos mayores de 5 mm se asociaron al fracaso de ésta. La principal causa de fracaso fue el no paso de la guía hacia el duodeno (13,5%). La morbilidad, clínicamente significativa, fue de 9,5% y la mortalidad global a los 90 días fue de 0,68%. Discusión: El RVLE es un tratamiento eficaz para la colecistocoledocolitiasis en un tiempo quirúrgico, incluso en pacientes mayores de 70 años con comorbilidades, aunque con mayor morbilidad en colangitis aguda. La colangioresonancia magnética es útil en el diagnóstico y aporta información como el tamaño de los cálculos. El no paso de la guía es la principal causa de fracaso, pero se resuelve en la mayoría de los casos con una ERCP tradicional.

Objective: Gallstone disease is a common condition in Chile and worldwide, often manifesting as cholecystocholedocholithiasis. One of the treatment options is laparoendoscopic rendezvous (RVLE), involving laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the effectiveness of this technique in managing cholecystocholedocholithiasis at a university hospital. Materials and Methods: A retrospective cohort study spanning four years was conducted on patients diagnosed with cholecystocholedocholithiasis who underwent RVLE. Results: The study included 296 patients, with an average age of 52 years. One-fifth of them were over 70 years old, and 29.3% had significant comorbidities. Of these cases, 65.2% were classified as emergencies, and 12.2% presented with acute cholangitis. The overall success rate of the RVLE procedure was 82.8%. Notably, the presence of gallstones larger than 5 mm was associated with a higher likelihood of procedure failure. The primary reason for failure was the inability of the guidewire to advance into the duodenum (13.5%). Clinically significant morbidity occurred in 9.5% of cases, and the overall mortality rate at 90 days was 0.68%. Discussion: RVLE is an effective treatment for cholecystocholedocholithiasis within a single surgical intervention, even in patients over 70-years-old with comorbidities. However, it is important to note that the procedure is associated with increased morbidity when performed in cases of acute cholangitis. Magnetic resonance cholangiopancreatography serves as a valuable diagnostic tool, providing insights into stone size. The most common cause of procedure failure is the inability of the guidewire to pass through, although this issue can often be resolved with a traditional ERCP.

Disfunción de cuerdas vocales post tiroidectomía, reporte de un caso

Objetivo: Describir un caso de disfunción glótica post tiroidectomía, hecho infrecuente asociado a esta cirugía. Material y Método: Revisión de caso clínico y de la literatura. Caso clínico: Mujer con cáncer de tiroides que evoluciona post tiroidectomía, con disfunción de cuerdas vocales. Se decide su intubación e ingreso a UCI. Luego de 48 horas evoluciona favorablemente y logra ser extubada. Discusión: Se discuten las causas, formas de presentación y manejo de esta condición. Conclusión: El diagnóstico de disfunción glótica debe sospecharse ante disnea y estridor inspiratorio en el postoperatorio de una tiroidectomía.

Objective: To describe a case of post thyroidectomy glottic dysfunction, an infrequent event associated with this surgery. Material and Method: review of clinical case and literature Clinical Case: Woman with thyroid cancer that evolves after thyroidectomy with vocal cord dysfunction. Her intubation and admission to the ICU is decided. After 48 hours, the patient evolved favorably and was extubated. Discussion the causes, forms of presentation and management of this condition are discussed. Conclusion: The diagnosis of glottic dysfunction should be suspected in the presence of dyspnea and inspiratory stridor in the postoperative period of a thyroidectomy.

Documento de posición para la mejora en la reperfusión del infarto agudo de miocardio con elevación del ST en Latinoamérica / Position statement for improvement in reperfusion of ST-elevation myocardial infarction in Latin America

Resumen El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.

Abstract The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.