Percepção profissional sobre tratamento endodôntico em sessão única e múltiplas sessões / Professional perception of single and multi-session endodontic treatment

Na odontologia a decisão do tratamento é exclusiva dos cirurgiões dentistas e suas percepções, incluindo filosofia de tratamento, fazendo com que a prática de novos conceitos, tratamentos ou técnicas dependam não apenas de sua lógica ou eficácia biológica. Sendo assim, este estudo teve como objetivo avaliar os parâmetros envolvidos na tomada de decisão de cirurgiões dentistas clínicos e especialistas para a realização do tratamento endodôntico em sessão única ou múltiplas sessões. Para tanto, este estudo contou com uma coleta de dados através de um questionário online, aplicado cirurgiões dentistas clínicos gerais e especialistas em endodontia. As respostas foram tabuladas e analisadas por meio de estatística descritiva. Os resultados revelaram que a maioria dos endodontistas e dos clínicos gerais prefere realizar tratamento endodôntico em sessão única, devido ao menor desperdício de material, além do melhor domínio da anatomia e tratamento em um único momento. O motivo mais comum para os endodontistas e clínicos gerais escolherem o tratamento com múltiplas visitas é para dentes com prognóstico duvidoso e os casos em que o profissional aguarda a remissão dos sintomas antes da obturação. Em conclusão, a maioria dos endodontistas e dos clínicos gerais preferiu realizar tratamento endodôntico em sessão única.

In dentistry, treatment decisions are made exclusively by dental surgeons and their perceptions, including treatment philosophy, which means that the practice of new concepts, treatments or techniques depends not only on their logic or biological efficacy. Therefore, the aim of this study was to evaluate the parameters involved in clinical and specialist dental surgeons' decision to carry out endodontic treatment in single or multiple sessions. To this end, data was collected using an online questionnaire administered to general dental surgeons and endodontic specialists. The answers were tabulated and analyzed using descriptive statistics. The results revealed that the majority of endodontists and general practitioners prefer to carry out endodontic treatment in a single session, due to less wastage of material, as well as better mastery of the anatomy and treatment at a single time. The most common reason for endodontists and general practitioners to choose treatment with multiple visits is for teeth with a doubtful prognosis and cases in which the professional is waiting for symptoms to remit before filling. In conclusion, the majority of endodontists and general practitioners preferred to carry out endodontic treatment in a single session.

Caracterización clínica de dengue con signos de alarma y dengue grave en adultos. Hospital Roosevelt, Guatemala

Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

The effectiveness of psychotherapies in reducing further suicide attempts: a systematic review with meta-analysis of randomized controlled trials

There is little evidence on the effectiveness of psychotherapeutic interventions in reducing new suicide attempts. This article aims to evaluate the effectiveness of psychotherapeutic interventions in reducing suicide attempts among patients with a history of previous attempts. We selected 17 articles from four databases: PubMed, Cochrane, APA PsycInfo and LILACS, in 2023. Six studies showed statistical differences that favored psychotherapeutic intervention at some point during the follow-up period. These psychotherapies addressed: problem-solving, hope induction, skills training. When comparing psychotherapy with usual care, a meta-analysis revealed an odds ratio of 0.41 (95 % CI, 0.17-0.99, p = .05) in the analysis up to 12 months of follow-up, and an odds ratio of 0.48 (95 % CI, 0.30-0.78, p < .001) after 12 months of follow-up. The results indicate the efficacy of these interventions in reducing additional suicide attempts, but they should be analyzed with caution, given the heterogeneity of the sample, treatments, and comparators. This review supports the development of prevention strategies indicated for patients who have attempted suicide.

Hay poca evidencia sobre la eficacia de las psicoterapias para reducir los nuevos intentos de suicidio. Este artículo tiene como objetivo evaluar la efectividad de las intervenciones psicoterapéuticas en la reducción de los intentos de suicidio entre pacientes con intentos previos. Se seleccionaron 17 artículos de cuatro bases de datos: PubMed, Cochrane, APA PsycInfo y LILACS. Seis estudios mostraron diferencias estadísticas que favorecieron la intervención psicoterapéutica en algún momento durante el período de seguimiento. Estas psicoterapias abordaron: resolución de problemas, inducción de esperanza y entrenamiento de habilidades. Al comparar la psicoterapia con el tratamiento habitual, el metanálisis reveló un odds ratio de 0.41 (IC del 95 %, 0.17 a 0.99, p = .05) en el análisis hasta los 12 meses de seguimiento, y un odds ratio de 0.48 (IC del 95 %, 0.30 a 0.78, p < .001) después de 12 meses de seguimiento. Los resultados apuntan a la eficacia de estas intervenciones para reducir los intentos de suicidio adicionales, pero deben analizarse con cautela, dada la heterogeneidad de la muestra, los tratamientos y los comparadores. Esta revisión apoya el desarrollo de estrategias de prevención indicadas para pacientes que han intentado suicidarse.

Mecánica y energética durante la marcha en cinta caminadora en adultos uruguayos saludables: efecto del IMC y la edad / Mechanics and energy during treadmill walking in healthy uruguayan adults: effect of BMI and age / Mecânica e energia durante a caminhada em esteira em adultos uruguaios saudáveis: efeito do IMC e Idade

La evaluación de la marcha en cinta caminadora puede resultar relevante para la toma de decisiones clínicas. No obstante, factores demográficos como la edad y el IMC pueden alterar la interpretación de los resultados. Nuestro objetivo fue obtener variables espacio- temporales, energéticas y costo de transporte durante la velocidad autoseleccionada en cinta caminadora para una muestra representativa de adultos uruguayos (n=28) y evaluar si diferentes rangos de edades e IMC pueden ser factores a tener en cuenta en pruebas clínicas donde se consideren dichas variables. Participaron 17 hombres y 11 mujeres (39,3 ± 14,8 años, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Se realizó una reconstrucción 3D del movimiento en forma sincronizada con el consumo energético. Se obtuvieron valores de referencia y luego de agrupar los participantes según su IMC y rango de edad se compararon los datos mediante test de t (p≤0.05). Los resultados revelaron discrepancias significativas en las medidas espacio-temporales y energéticas de los adultos uruguayos al caminar en cinta con respecto a la literatura. La marcha difiere entre adultos jóvenes y de mediana edad en su velocidad autoseleccionada (p=0,03), longitud de zancada (p=0,01), trabajo mecánico externo (<0,001) y recuperación de energía mecánica (0,009), destacando la importancia de considerar la edad en evaluaciones clínicas. El IMC no influyó significativamente en estas variables. Estos hallazgos subrayan la necesidad de ajustar las interpretaciones de las pruebas clínicas de la marcha sobre cinta caminadora en adultos uruguayos de mediana edad (45 a 65 años).

Treadmill gait assessment can be relevant for clinical decision-making. However, demographic factors such as age and BMI may alter result interpretation. Our aim was to obtain spatiotemporal, energetic, and cost of transport variables during self-selected treadmill walking speed for a representative sample of Uruguayan adults (n=28) and to assess if different age ranges and BMI could be factors to consider in clinical tests involving these variables. Seventeen men and eleven women participated (39.3 ± 14.8 years, 75.9 ± 12.5 kg, 1.74 ± 0.09 m, BMI 25.2 ± 4.06). A synchronized 3D motion reconstruction was performed with energy consumption. Reference values were obtained and data were compared using t-tests (p≤0.05), after grouping participants by BMI and age range. Results revealed significant discrepancies in spatiotemporal and energetic measures of Uruguayan adults walking on the treadmill, compared to the literature. Gait differed between young and middle-aged adults in their self-selected speed (p=0.03), stride length (p=0.01), external mechanical work (p<0.001), and mechanical energy recovery (0.009), emphasizing the importance of considering age in clinical evaluations. BMI did not significantly influence these variables. These findings underscore the need to adjust interpretations of treadmill gait clinical tests in middle-aged Uruguayan adults (45 to 65 years).

A avaliação da marcha na esteira pode ser relevante para a tomada de decisões clínicas. No entanto, fatores demográficos como idade e IMC podem alterar a interpretação dos resultados. Nosso objetivo foi obter variáveis espaço-temporais, energéticas e custo de transporte durante a velocidade de caminhada autoselecionada na esteira para uma amostra representativa de adultos uruguaios (n = 28) e avaliar se diferentes faixas etárias e IMC podem ser fatores a serem considerados em testes clínicos que envolvam essas variáveis. Dezessete homens e onze mulheres participaram (39,3 ± 14,8 anos, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Foi realizada uma reconstrução tridimensional do movimento sincronizada com o consumo de energia. Foram obtidos valores de referência e os dados foram comparados usando testes t (p≤0,05), após agrupar os participantes por IMC e faixa etária. Os resultados revelaram discrepâncias significativas nas medidas espaço-temporais e energéticas dos adultos uruguaios ao caminhar na esteira, em comparação com a literatura. A marcha diferiu entre adultos jovens e de meia-idade em sua velocidade autoselecionada (p=0,03), comprimento da passada (p=0,01), trabalho mecânico externo (<0,001) e recuperação de energia mecânica (0,009), destacando a importância de considerar a idade em avaliações clínicas. O IMC não influenciou significativamente essas variáveis. Esses achados destacam a necessidade de ajustar as interpretações dos testes clínicos de marcha na esteira em adultos uruguaios de meia- idade (45 a 65 anos).

Escala de alerta precoce na identificação de pacientes com risco de deterioração clínica / Early warning scale for identifying patients at risk of clinical deterioration / Escala de alerta temprana en la identificación de pacientes con riesgo de deterioro clínico

Objetivo: avaliar pontuação da National Early Warning Score (NEWS) em relação ao tipo de desfecho e perfil dos pacientes da enfermaria clínica médica de um hospital em Teresina, Piauí, Brasil. Método: estudo quantitativo realizado num hospital público, em Teresina, com 150 prontuários de pacientes internados no setor clínica médica de fevereiro de 2022 a dezembro de 2022, a partir de registros demográficos, clínicos e valores da escala na admissão e desfecho. Resultados: houve associação dos valores da escala com a faixa etária (p=0,029), tempo de internação (p=0,023) e tipo de desfecho (p < 0,001). Alto risco clínico prevaleceu entre pacientes do sexo masculino (13%), na faixa etária de 60 a 94 anos (13%), com permanência de 21 a 57 dias (19,2%) e óbito como desfecho (100%). Conclusão: implementação da referida escala evidenciou ser fundamental para prever agravos clínicos e melhorar qualidade da assistência.

Objective: to evaluate the National Early Warning Score (NEWS) in relation to the type of outcome and profile of patients in the medical clinical ward of a hospital in Teresina, Piauí, Brazil. Method: a quantitative study conducted in a public hospital in Teresina, with 150 medical records of patients admitted to the medical clinic sector from February 2022 to December 2022, based on demographic and clinical records and scale values at admission and outcome. Results: there was an association between the scale values and the age group (p=0.029), length of stay (p=0.023) and type of outcome (p < 0.001). High clinical risk prevailed among male patients (13%), aged between 60 and 94 years (13%), with a stay of 21 to 57 days (19.2%), and death as an outcome (100%). Conclusion: implementation of the aforementioned scale proved to be fundamental for predicting clinical problems and improving care quality.

Objetivo: evaluar el puntaje de la National Early Warning Score (NEWS) con respecto al tipo de desenlace y el perfil de los pacientes de la enfermería clínica médica de un hospital en Teresina, Piauí, Brasil. Método: estudio cuantitativo realizado en un hospital público en Teresina, con 150 historiales médicos de pacientes internados en el sector de clínica médica desde febrero de 2022 hasta diciembre de 2022, a partir de registros demográficos, clínicos y valores de la escala en la admisión y desenlace. Resultados: hubo asociación de los valores de la escala con la edad (p=0,029), tiempo de internación (p=0,023) y tipo de desenlace (p < 0,001). El alto riesgo clínico prevaleció entre los pacientes del sexo masculino (13%), en la franja de edad entre 60 y 94 años (13%), con una estancia de 21 a 57 días (19,2%) y fallecimiento como desenlace (100%). Conclusión: la implementación de dicha escala demostró ser fundamental para prever agravios clínicos y mejorar la calidad de la asistencia.

Doppler ultrasound protocol for patients with hidradenitis suppurativa

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. Objective To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. Methods A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. Results Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. Study limitations The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. Conclusions The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.

Pityriasis lichenoides: assessment of 41 pediatric patients

Abstract Objectives This study aims to evaluate the characteristics and treatment response of patients with pityriasis lichenoides seen in the last 43 years in a pediatric dermatology service. Methods This was a retrospective, analytical, longitudinal study of patients under 15 years of age. The medical records were reviewed and data were presented as frequencies, means and variances. Student's t-test, Mann-Whitney test, Fisher's exact test, Pearson/Yates chi-square test and multivariate logistic regression model were used, with p < 0.05 considered. Results 41 patients were included, 32 (78.0%) with pityriasis lichenoides chronica (PLC), five (12.2%) with pityriasis lichenoides et varioliformis acuta (PLEVA) and four (9.8%) with clinical PLC without biopsy. The age range of school children and adolescents was 19 (46.3%) and 13 (31.7%) respectively and 27 (65.8%) were male. Two peaks of the highest frequency were observed between 2004 and 2006 (10 patients - 24.4%) and another between 2019 and 2021 (6 patients - 14.7%). There was remission in 71.9% (n = 23), with 56.6% (n = 17) of those who used antibiotic therapy and 80% (n = 4) of those who had phototherapy. The chance of remission was 13 times greater in patients with disease onset after 5 years of age. Conclusions The clinical form most commonly found was PLC mainly in school children and adolescents. The frequency peaks coincided with infectious outbreaks. The remission rate was satisfactory with antibiotic therapy, but higher with phototherapy. Remission was greater in patients with disease onset after 5 years of age.

Innovative perspectives on the value of diagnostic tests in clinical practice / Perspectivas innovadoras sobre el valor de las pruebas diagnósticas en la práctica clínica

Abstract Diagnostic tests have intrinsic characteristics such as sensitivity, specificity, overall accuracy and likelihood ratios which define their operational performance. It is not uncommon to find in the literature that test value and clinical utility are defined based exclusively on those characteristics. This paper introduces several arguments aimed at prompting a reflection regarding the characteristics that define the true value of diagnostic tests in clinical practice. It concludes with the view that the value of each diagnostic test needs to be established in accordance with the circumstances in which it is used, taking into account extrinsic characteristics such as in whom it is used, when, where and by who.

Resumen Las pruebas diagnósticas tienen características intrínsecas, como la sensibilidad, especificidad, exactitud global y las razones de verosimilitud, que definen su desempeño operacional. No es infrecuente encontrar en la literatura que se valore la prueba y se defina su utilidad clínica exclusivamente de acuerdo con estas características. En este documento se presentan varios argumentos que permiten reflexionar sobre las características que verdaderamente definen el valor de las pruebas diagnósticas en la práctica clínica. Se concluye con una perspectiva en la que el valor de cada prueba diagnóstica se establece de acuerdo con las circunstancias de uso de la misma: de quién, cuándo, dónde y en quién se use la prueba, y todas estas son características extrínsecas de una prueba diagnóstica.

Agências de regularização técnica odontológica em relação ao manejo clínico em crianças: uma revisão de literatura / Dental technical regularization agencies in relation to management clinic in children: a review of the literature

O manejo clínico em Odontopediatria é individual, podendo variar nas diversas culturas mundiais. O objetivo desta revisão de literatura é reunir as principais diretrizes de diferentes países ao redor do mundo, incluindo o Brasil, visando identificar como em cada lugar o uso das técnicas de comportamento são aplicadas e sua eficiência. Inicialmente, foram selecionados os principais guias nacionais e internacionais, sendo eles retirados da Associação Internacional de Odontopediatria (IAPD) e Associação Americana de Odontopediatria (AAPD), além de artigos de diferentes países e continentes, como Argentina, Brasil, Europa e Ásia, também foram analisados se o protocolo dos principais guias estão condizentes com os protocolos do Departamento de Clínica Infantil da Faculdade de Odontologia de Ribeirão Preto - USP. Os resultados obtidos nos guias para manejo clínico odontológico brasileiro, americano, internacional e os artigos estudados recomendam inicialmente utilizar técnicas menos invasivas, com o intuito proporcionar um atendimento tranquilo e sem criar traumas para a criança, uma vez que muito do comportamento não cooperativo vem de experiências anteriores traumáticas. Entretanto, técnicas avançadas podem ser utilizadas para casos mais desafiadores. Concluímos com o estudo dos guias e artigos, que o cirurgião dentista possui diversas técnicas a serem aplicadas para que o atendimento infantil seja atraumático e restabelecer saúde ao paciente.

Clinical management in Pediatric Dentistry is individual and varies across different cultures around the world. The objective of this literature review is to bring together the main guidelines from different countries around the world, including Brazil, aiming to identify how the use of behavioral techniques are applied and their efficiency in each place. Initially, the main national and international guides were selected, taken from the International Association of Pediatric Dentistry (IAPD) and the American Association of Pediatric Dentistry (AAPD), as well as articles from different countries and continents, such as Argentina, Brazil, Europe and Asia, as well as It was analyzed whether the protocols of the main guides are consistent with the protocols of the Children's Clinic Department of the Faculty of Dentistry of Ribeirão Preto - USP. The results obtained in the guides for Brazilian, American and international dental clinical management and the articles studied recommend initially using less invasive techniques, with the aim of providing calm care and without creating trauma for the child, since much of the uncooperative behavior comes from previous traumatic experiences. However, advanced techniques can be used for more challenging cases. We conclude from studying the guides and articles that the dental surgeon has several techniques to be applied so that child care is atraumatic and restores health to the patient.

Diagnóstico de tuberculosis en pediatría / Diagnosis of tuberculosis in pediatrics

La tuberculosis sigue siendo una epidemia mundial y en Chile no ha mostrado una tendencia descendente en los últimos años, con un aumento en los casos infantiles. En los niños, el diagnóstico es un reto debido a la baja carga bacilar y las características de las lesiones, que suelen ser cerradas. Métodos tradicionales como los cultivos, considerados anteriormente como el gold standard, con frecuencia arrojan resultados negativos. Sin embargo, los avances en pruebas moleculares han permitido un progreso significativo en la confirmación bacteriológica. Otras herramientas diagnósticas, como la prueba de tuberculina (PPD) y los ensayos de liberación de interferón gamma (IGRAs), tienen sensibilidades y especificidades variables, siendo útiles como pruebas complementarias. Las imágenes juegan un papel clave en la evaluación diagnóstica de tuberculosis pulmonar y extrapulmonar en pacientes pediátricos. Esta revisión aborda la epidemiología y el proceso diagnóstico de la tuberculosis infantil.

Tuberculosis remains a global epidemic, and in Chile, it has not shown a downward trend in recent years, with an increase in pediatric cases. Diagnosing tuberculosis in children presents challenges due to the low bacillary load and the closed nature of the lesions. Traditional methods like cultures, once considered the gold standard, often yield negative results. However, advances in molecular testing have significantly improved bacteriological confirmation. Other diagnostic tools, such as the tuberculin skin test (PPD) and interferon-gamma release assays (IGRAs), offer variable sensitivities and specificities and are useful as complementary tests. Imaging plays a critical role in the diagnostic evaluation of pulmonary and extrapulmonary tuberculosis in pediatric patients. This review addresses the epidemiology and diagnostic process of pediatric tuberculosis.

Pasado y presente de la Paracoccidioidomicosis en Paraguay / Past and present of Paracoccidioidomycosis in Paraguay

RESUMEN La Paracoccidioidomicosis (PCM), es una enfermedad sistémica endémica de países de América Latina, con alto impacto en términos de morbilidad, mortalidad y costos para el sistema de salud si los enfermos progresan a sus estadios avanzados. Este trabajo tuvo como objetivo recopilar datos divulgados en publicaciones sobre casos autóctonos de PCM, desde los primeros casos diagnosticados en Paraguay, con una descripción del contexto histórico e identificando a los pioneros en el diagnóstico en Paraguay, siguiendo un orden cronológico, hasta los casos más recientemente informados. Metodología: búsqueda en bibliotecas nacionales y bases de datos online de casos de PCM en Paraguay, publicados en revistas científicas históricas nacionales y otras fuentes disponibles en formato impreso, y artículos científicos más recientes disponibles en formato electrónico, respectivamente. Resultados: Se identificaron 479 casos de PCM en publicaciones entre los años 1935 y 2023, correspondientes a casos autóctonos y cuyos diagnósticos fueron realizados en territorio paraguayo. El Dr. Juan Boggino y colaboradores fueron los responsables de los primeros diagnósticos en el país. La forma clínica predominante fue la crónica. La media de edad de 45,78 años. La gran mayoría de los pacientes diagnosticados fueron oriundos de la Región Oriental del país, predominantemente hombres agricultores. Conclusión: La PCM es una enfermedad endémica del Paraguay, desde los primeros casos diagnosticados y hasta hoy en día, son detectados pacientes con una evolución grave y discapacitante de la enfermedad, lo que demuestra la necesidad de la difusión de su conocimiento y ampliación de la capacidad diagnóstica precoz a nivel nacional. Debido a su pleomorfismo clínico y su capacidad de simular otras enfermedades, es importante incluir a la PCM como diagnostico diferencial de pacientes que presenten factores de riesgo para el desarrollo de la enfermedad.

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic disease endemic to Latin American countries, with a high impact in terms of morbidity, mortality and costs for the health system if patients progress to advanced stages. This work aimed to collect data published in publications on autochthonous cases of PCM, from the first cases diagnosed in Paraguay, with a description of the historical context and identifying the pioneers in the diagnosis in Paraguay, following a chronological order, to the most recently reported cases. Methodology: search in national libraries and online databases of PCM cases in Paraguay, published in national historical scientific journals and other sources available in print format, and more recent scientific articles available in electronic format, respectively. Results: 479 cases of PCM were identified in publications between the years 1935 and 2023, corresponding to autochthonous cases and whose diagnoses were made in Paraguayan territory. Dr. Juan Boggino and collaborators were responsible for the first diagnoses in the country. The predominant clinical form was chronic. The average age was 45.78 years. The vast majority of patients diagnosed were from the Eastern Region of the country, predominantly male farmers. Conclusion: PCM is an endemic disease in Paraguay. Since the first cases were diagnosed and until today, patients with a severe and disabling course of the disease have been detected, which demonstrates the need to disseminate its knowledge and expand the early diagnostic capacity at the national level. Due to its clinical pleomorphism and its ability to simulate other diseases, it is important to include PCM as a differential diagnosis for patients who present risk factors for the development of the disease.

Epidemiología y clínica de los pacientes con lepra en un centro de referencia de Paraguay / Epidemiology and clinical features of patients with leprosy in a reference center in Paraguay

RESUMEN Introducción: lepra (enfermedad de Hansen) es una patología infecciosa desatendida que afecta piel y nervios periféricos, desencadenando neuropatías y complicaciones como deformidades y discapacidades. Objetivos: determinar características epidemiológicas y clínicas de pacientes con lepra en el Centro de Especialidades Dermatológicas del Ministerio de Salud Pública y Bienestar Social de Paraguay, de enero 2021 a diciembre 2022. Metodología: estudio descriptivo, observacional, retrospectivo, de corte transversal. La gestión y análisis de datos se realizó en planilla electrónica (Excel del programa Microsoft Office 365 versión 2405), luego se realizó estadística descriptiva. Resultados: se diagnosticaron 123 casos de lepra, 45 (36,58 %) eran mujeres y 78 (63,42 %) varones; las edades estaban entre 17 y 86 años, el rango más afectado fue de 41 a 50 años. Eran lepra multibacilar 112 casos (91,06%). El signo más frecuente fue la placa infiltrada, presentada en 88 casos (71,54%). 58 pacientes (47,15%) presentaron reacciones lepromatosas, siendo, 31 casos de tipo 1 (53,45 %). 34 casos (27,64%) presentaron discapacidad grado 1 y 10 casos (8,13%) discapacidad grado 2. Conclusión: el perfil del paciente con lepra fue del sexo masculino entre 41 a 50 años, siendo la mayoría casos multibacilares. Es fundamentales el diagnóstico precoz y el tratamiento adecuado para reducir la carga de la enfermedad y las discapacidades.

ABSTRACT Introduction: Leprosy (Hansen's disease) is a neglected infectious disease that affects skin and peripheral nerves, triggering neuropathies and complications such as deformities and disabilities. Objective: determine epidemiological and clinical characteristics of patients with Leprosy in the Dermatological Specialties Center of the Ministry of Public Health and Social Welfare of Paraguay, from January 2021 to December 2022. Methodology: descriptive, observational, retrospective, cross-sectional study. Data management and analysis was carried out in an electronic spreadsheet (Excel from Microsoft Office 365 version 2405), then descriptive statistics were performed. Results: 123 cases of leprosy were diagnosed, 45 (36.58 %) were women and 78 (63.42 %) were men; the ages were between 17 and 86 years, the most affected range was 41 to 50 years. 112 cases (91.06 %) were multibacillary leprosy. The most frequent sign was infiltrated plaque, present in 88 cases (71.54 %). 58 patients (47.15 %) presented lepromatous reactions, 31 cases of type 1 (53.45 %). 34 cases (27.64 %) presented grade 1 disability and 10 cases (8.13 %) grade 2 disability. Conclusion: The profile of the patient with leprosy was male between 41 and 50 years, the majority being multibacillary cases. Early diagnosis and adequate treatment are essential to reduce the burden of the disease and disabilities.

Estimación del impacto de utilizar el punto de corte de 100 mg/dL para glucemia en ayunas alterada en una población adulta ambulatoria de Bahía Blanca / Estimation of the impact of using the cutoff point of 100 mg/dL for impaired fasting glucose in an adult outpatient population in Bahía Blanca / Estimativa do impacto da utilização do ponto de corte de 100 mg/dL para glicemia em jejum alterada, em uma população adulta ambulatorial de Bahía Blanca

Resumen El objetivo de este estudio observacional y retrospectivo fue evaluar el punto de corte de 100 mg/dL para glucemia en ayunas alterada (GAA) en una población adulta ambulatoria de la Argentina en 2023. Se obtuvo aprobación del Comité de Ética. Se utilizó Chi cuadrado y concordancia Kappa. Se incluyeron 510 individuos. Se obtuvieron los siguientes resultados para GAA (diferencia en porcentaje estadísticamente significativa entre 100 mg/dL y 110 mg/dL, p=0,0001): total (36 vs. 10); mujeres (31 vs. 9); hombres (51 vs. 14); <40 años (24 vs. 3); ≥40 años (46 vs. 17); mujeres ≥40 años (40 vs. 16); hombres ≥40 años (60 vs. 19). La concordancia fue entre pobre y moderada. El valor de 100 mg/dL clasificó un 26% más de personas con GAA que el valor 110 mg/dL, lo que evidencia su impacto en la prevención de la diabetes, en particular en hombres ≥40 años.

Abstract The aim of this observational and retrospective study was to evaluate the value of 100 mg/dL for impaired fasting glucose (IFG) in an adult outpatient population from Argentina, in 2023. Approval was obtained from the Ethics Committee. Chi-square test and Kappa agreement were used. A total of 510 individuals were included. The following results were obtained for IFG (statistically significant difference in percentage between 100 mg/dL and 110 mg/dL; p=0.0001): total (36 vs. 10); women (31 vs. 9); men (51 vs. 14); <40 years old (24 vs. 3); ≥40 years old (46 vs. 17); women ≥40 years old (40 vs. 16); men ≥40 years old (60 vs. 19). Agreement ranged from poor to moderate. The value of 100 mg/dL classified 26% more people with IFG than the value of 110 mg/dL, making evident its impact on the prevention of diabetes, particularly in men ≥40 years of age.

Resumo O objetivo deste estudo observacional e retrospectivo foi avaliar o ponto de corte de 100 mg/dL para glicemia em jejum alterada (GJA) em uma população adulta ambulatorial da Argentina em 2023. A aprovação foi obtida do Comitê de Ética. Qui-quadrado e concordância Kappa foram utilizados. Foram incluídos 510 indivíduos. Os seguintes resultados foram obtidos para GJA (diferença estatisticamente significativa em percentual entre 100 mg/dL e 110 mg/dL; p=0,0001): total (36 vs. 10); mulheres (31 vs. 9); homens (51 vs. 14); <40 anos (24 vs. 3); ≥40 anos (46 vs. 17); mulheres ≥40 anos (40 vs. 16); homens ≥40 anos (60 vs. 19). A concordância foi entre pobre-e moderada. O valor de 100 mg/dL classificou 26% mais pessoas com GJA do que o valor de 110 mg/dL, demonstrando seu impacto na prevenção do diabetes, principalmente em homens ≥40 anos.

La gestión de la calidad y la acreditación ISO 15189 en los laboratorios clínicos de Latinoamérica / Quality management and ISO 15189 accreditation in clinical laboratories in Latin America / Gestão da qualidade e acreditação ISO 15189 nos laboratórios clínicos da América Latina

Resumen El presente trabajo fue realizado por el Grupo de Trabajo Gestión de Acreditación de la Confederación Latinoamericana de Bioquímica Clínica (COLABIOCLI) con el objetivo de conocer el estado de los Laboratorios Clínicos (LC) con respecto a la gestión de la calidad y el estatus de la acreditación ISO 15189 en Latinoamérica. La investigación fue de tipo observacional, transversal y descriptiva; se utilizó como herramienta la encuesta y como instrumento el cuestionario. Los resultados se expresaron en frecuencias simples y porcentajes y se analizaron por estadística descriptiva. En las 253 encuestas aceptadas participaron LC de 15 de 16 países integrantes de COLABIOCLI. El 80% de los LC tenían procedimientos de la fase preanalítica y posanalítica. Más del 85% contaba con registros de gestión de la calidad y participaban en programas de evaluación externa de la calidad (PEEC), principalmente en las disciplinas de química clínica (mayor del 80%) y hematología (mayor del 70%). El 7,51% estaban acreditados por ISO 15189 y 10,27% certificados por ISO 9001. La gestión de la calidad y los PEEC presentan un importante avance en los LC de Latinoamérica; sin embargo, es deseable que todas las partes interesadas armonicen intereses, para que este proceso sea introducido paulatinamente y como parte de las normativas y/o regulaciones obligatorias respectivas, lo que podrá contribuir a que más LC se acrediten en base a ISO 15189 en la región.

Abstract The present work was carried out by the Accreditation Management Working Group of the Latin American Confederation of Clinical Biochemistry (COLABIOCLI) with the aim of knowing the status of Clinical Laboratories (LC, for its acronym in Spanish) with respect to quality management and the status of the ISO 15189 accreditation in Latin America. The research was observational, cross-sectional, and descriptive, using the survey as a tool and the questionnaire as an instrument. The results were expressed in simple frequencies and percentages and analysed by descriptive statistics. LCs from 15 of the 16 member countries of COLABIOCLI participated in the 253 surveys accepted. Eighty percent of LCs had pre-analytical and post-analytic procedures, and more than 85% had quality management records and participated in external quality assessment services (EQAS), mainly in the disciplines of clinical chemistry (greater than 80%) and hematology (greater than 70%); 7.51% were ISO 15189 accredited and 10.27% ISO 9001 certified. Although quality management and EQAS represent an important advance in LCs in Latin America, it is desirable that all stakeholders harmonise interests, so that this process is introduced gradually and as part of the respective mandatory standards and/or regulations, thus contributing to more LCs being accredited based on ISO 15189 in the region.

Resumo O presente trabalho foi realizado pelo Grupo de Trabalho de Gestão de Acreditação da Confederação Latino-Americana de Bioquímica Clínica (COLABIOCLI) com o objetivo de conhecer o status dos Laboratórios Clínicos (LC) com relação à gestão da qualidade e o status da acreditação ISO 15189 na América Latina. A pesquisa foi observacional, transversal e descritiva, utilizando a enquete como ferramenta e o questionário como instrumento. Os resultados foram expressos em frequências simples e porcentagens e analisados por estatística descritiva. LCs de 15 dos 16 países membros do COLABIOCLI participaram das 253 pesquisas aceitas; 80% dos LCs tinham procedimentos da fase pré-analítica e pós-analítica, e mais de 85% tinham registros de gestão da qualidade e participavam de programas de avaliação externa da qualidade (PEEC), principalmente nas disciplinas de química clínica (maior de 80%) e hematologia (maior de 70%); 7,51% estavam acreditados pela ISO 15189 e 10,27% certificados pela ISO 9001. Embora a gestão da qualidade e os PEECs apresentem um importante avanço nos LCs da América Latina, é desejável que todas as partes interessadas harmonizem interesses, para que esse processo seja introduzido gradualmente e como parte das respectivas normas e/ou regulações obrigatórias, o que poderá contribuir para que mais LCs sejam acreditados com base na ISO 15189 na região.

Atención médica de body packers en un territorio colombiano / Medical care for body packers in a Colombian territory

Introducción. El número de capturas a los body packers, que son aquellas personas que ingieren paquetes con estupefacientes para tráfico ilegal, ha aumentado paulatinamente. El objetivo de este estudio fue presentar los casos de body packers atendidos en dos instituciones de salud de Florencia, un territorio al sur de Colombia, entre 2003 y 2017. Métodos. Este es un estudio retrospectivo descriptivo. Se hizo un análisis univariado en RStudio y Microsoft Excel® de variables sociodemográficas y clínicas. Se emplearon medidas de tendencia central y dispersión para las variables continuas, frecuencias y proporciones para las variables categóricas. Resultados. Se incluyeron 72 pacientes. La mayoría de los casos fueron reportados entre 2007 y 2012 (77,5 %). La relación entre hombres y mujeres fue de 4,9:1. La edad media fue de 29,1 años. El principal motivo de admisión fue para chequeo médico tras captura por parte de los organismos de seguridad nacional (76,4 %). En 9 de cada 10 admitidos se realizaron estudios de imagen (94,4 %); la principal ayuda diagnóstica fue la radiografía de abdomen simple (84,7 %), con una sensibilidad del 91,6 %. Se realizó manejo expectante en tres de cada cuatro pacientes (74,6 %). El 6,9 % presentaron complicaciones, con una mortalidad (1,4 %). Conclusiones. La radiografía de abdomen simple es una ayuda diagnóstica adecuada para el tamizaje de los body packers. El manejo conservador es aceptable, teniendo en cuenta el porcentaje bajo de complicaciones.

Introduction. The number of arrests of body packers, who are those people who ingest packages with narcotics for illegal trafficking, has gradually increased. The objective of this study was to present the cases of body packers treated in two health institutions in Florencia, a territory in southern Colombia, between 2003 and 2017. Methods. This is a descriptive retrospective study. A univariate analysis was performed in RStudio and Microsoft Excel® of sociodemographic and clinical variables. Measures of central tendency and dispersion were used for continuous variables, frequencies and proportions for categorical variables. Results. 72 patients were included. Most cases were reported between 2007 and 2012 (77.5%). The ratio between men and women was 4.9:1. The mean age was 29.1 years. The main reason for admission was for medical check-up after capture by national security agencies (76.4%). In nine out of ten admitted patients, imaging studies were performed (94.4%); the main diagnostic imaging was simple abdominal X-ray (84.7%), with a sensitivity of 91.6%. Expectant management was performed in three out of four patients (74.6%). 6.9% presented complications, with one mortality (1.4%). Conclusions. Simple abdominal x-ray is an adequate diagnostic tool for screening body packers. Conservative management is acceptable, taking into account the low percentage of complications.

A randomized, double-blind, parallel and placebo-controlled clinical study to evaluate the efficacy and safety of KaraCalm™: a dietary supplement to support sleep and manage stress

Background: KaraCalm™ is a novel polyherbal formulation obtained from the combination of Valeriana officinalis extract, Passiflora incarnata extract, Ocimum sanctum extract, Ziziphus jujuba extract, Rosmarinus officinalis extract, and Nigella sativa extract. The objective of the present investigation was to assess the efficacy and safety of KaraCalm™ to manage stress and improve sleep in healthy subjects in a randomized, double-blind, placebo-controlled clinical study. Methods: A total of 60 healthy volunteers were randomized into two groups, with 30 subjects in the KaraCalm™ group and 30 in the placebo group. Participants were asked to take KaraCalm™ 500 mg or placebo once daily for 56 days. As primary outcomes, sleep analysis was performed by using Actiwatch, while stress level was evaluated with the Perceived Stress Scale (PSS) scores from baseline to the end of the study period. Serum cortisol, and hs-CRP from baseline to the end of the study period were assessed as secondary endpoints. Results: An increase in overall sleep quality was observed in the KaraCalm™ group compared to the placebo as measured by total sleep time, onset latency, wake after sleep onset minutes, and number of awakenings. There was also a reduction in PSS scores in the KaraCalm™ group from baseline to the end of the study, indicating reduced stress levels. A significant reduction in Serum cortisol and hs-C-reactive protein (CRP) levels in the KaraCalm™ group from baseline to the end of the study further supported the effectiveness of KaraCalm™ in reducing stress. There was no significant change in the safety analyses of the patients in the intervention group when assessed from the start of the study to the end. Conclusions: KaraCalm™ can be considered a safe and effective dietary herbal Supplement to reduce stress and improve sleep quality.

A clinical research site pharmacy for the division of AIDS sponsored clinical trials in a low middle income country

This review article provides information on the role of clinical research site (CRS) Pharmacies in supporting the division of AIDS (DAIDS)-sponsored clinical trials at the CRS, their legislative framework, and how they differ from community pharmacies. These pharmacies are relatively few, and little information is available about their operation, setup, and requirements in low-and middle-income countries (LMICs). The information in this article is pertinent to pharmacy associations and regulators who formulate policies and guidelines and to pharmacy professionals eager to enhance their skills and competencies through knowledge sharing to improve the quality of healthcare services. Moreover, this information is relevant in establishing a CRS pharmacy and understanding its interaction with various administrative and financial institutions. This article provides information on how CRS pharmacies achieve uninterrupted power supply for investigational medicinal products (IMP) throughout the year, the sponsor and regulatory requirements for the CRS pharmacy and the processes for IMP shipment, from its dispensation to the study participants. The article also provides information on quality control and assurance processes for maintaining a CRS pharmacy. CRS pharmacies in LMICs have unique requirements, operations, services, and setups, and regulatory authorities must develop policies and guidelines that align with these distinct features. More so, leveraging the existing CRS pharmacies to disseminate skills and knowledge to trainees, community pharmacies, and other medicine outlets can significantly enhance the quality of health services delivered to the community.

Study of clinical features, haematological changes and outcome in snake bite cases

Background: Snake bite is a common acute medical emergency faced by rural populations in tropical and subtropical countries. In India, a large proportion of snake bites occur when people are working barefoot in the fields or while walking at night. More than 2,000 species of snakes are known worldwide, of which around 400 are poisonous. These snakes belong to the families Elapidae, Viperidae, Hydrophiidae and Colubridae. Methods: A prospective was done at medicine department of SDH Sawantwadi, Sindhudurgh. Study duration was 3 months (May 2023 to July 2023). Study population included all cases admitted in SDH Sawantwadi with history of snake bite. Sample size was 50. Results: Majority of cases found in the age group of 18-30 years 19 cases (38%) followed by 9 cases in 31-45 age group, 12 in 46-60 age group and 10 cases in 61 and above group. Majority of patients with history of snake bite were males contributing 27 (54%). Snake bites were more common in males as compared to females 23 (46%). 14% snake bite cases have activated partial thromboplastin time (APTT) >30 seconds, 10% of snake bite cases had prothrombin time (PT) >15 sec, 30% had platelet count <100000, increased leucocyte count >11000 was seen in 22% cases and 12% victims showed whole blood clotting test (WBCT) >20 minutes. Clinical outcome was 90% discharged after treatment and 10% death during treatment. Correlation between PT and clinical outcome is significant at p<0.5. Conclusions: Association between PT and mortality among snake bite patients was statistically significant.

New horizons in sickle cell crisis treatment

Even if life expectancy has increased, sickle cell disease (SCD) still presents difficulties, especially because of the painful episodes that occur frequently and without warning, known as Vaso-occlusive crises (VOCs). These crises are brought on by different cells adhering to one another and obstructing tiny blood veins, which can cause excruciating agony and eventually harm organs and tissues. While the majority of current treatments concentrate on symptom management and pain relief with the use of medications, hydration, and other general approaches, new discoveries about the fundamental mechanisms of VOCs provide intriguing new therapeutic options. With the goal of precisely addressing the pathways causing inflammation and cell adhesion, these cutting-edge treatments may lessen the frequency of VOCs and shield vital organs from harm. Though these treatments provide hope for improved SCD management, careful assessment and analysis of their efficacy and accessibility are necessary to guarantee their general benefit.

Tratamento integrado para correção do sorriso gengival: relato de caso / Integrated treatment for correction of gingival smile: case report

O sorriso gengival possui inúmeras causas, podendo acontecer por motivos esqueléticos, musculares ou por alteração no desenvolvimento dos tecidos de suporte. No entanto, na atualidade, a estética vermelha e a branca têm se apresentado completamente passíveis de transformações e com uma gama de procedimentos cirúrgicos ou não cirúrgicos para sanar as queixas dos pacientes. O objetivo geral deste trabalho é mostrar o poder que a odontologia tem frente às questões estéticas, como, por exemplo, a vergonha de sorrir por não se sentir confortável com os dentes curtos e com uma grande faixa de gengiva sendo exposta. O método utilizado foi um relato de caso. Que descreve todos os passos clínicos do tratamento de um paciente de 40 anos, que estava insatisfeita com o seu sorriso por apresentar erupção passiva alterada juntamente com hiperatividade do lábio superior. O plano de tratamento escolhido foi de realizar a cirurgia de aumento de coroa clínica estético, seguido de clareamento dentário e posteriormente um reposicionamento labial, com ajuda da toxina botulínica. Finalizando, para ajudar na cicatrização, o uso de laserterapia. O resultado de todo o processo cirúrgico envolvido neste trabalho, é satisfação do paciente, materializando o sonho deste, devolvendo segurança e espontaneidade ao sorrir. Pôde-se observar que através da combinação de técnicas cirúrgicas periodontais para tratar o sorriso gengival, obtém-se êxito tanto no sentido científico quanto no biológico, alcançando um sorriso esteticamente mais atrativo(AU)

Gummy smile has numerous causes, which can occur for skeletal or muscular reasons or due to changes in the development of supporting tissues. However, nowadays, the red and white aesthetics have been completely capable of transformation and with a range of surgical or non-surgical procedures to resolve patients' complaints. The general objective of this work is to show the power that dentistry has in the face of aesthetic issues, such as, for example, the shame of smiling due to not feeling comfortable with short teeth and a large strip of gum being exposed. The method used was a case report. Which describes all the clinical steps of the treatment of a 40-year-old patient, who was dissatisfied with her smile due to an altered passive eruption together with hyperactivity of the upper lip. The chosen treatment plan was to perform aesthetic clinical crown augmentation surgery, followed by tooth whitening and later lip repositioning, with the help of botulinum toxin. Finally, to help with healing, the use of laser therapy. The result of the entire surgical process involved in this work is patient satisfaction, materializing the patient's dream, restoring security and spontaneity when smiling. It was observed that through the combination of periodontal surgical techniques to treat gummy smile, success is achieved both in the scientific and biological sense, achieving a more aesthetically attractive smile(AU)