RESUMO
Este estudo teve como objetivo avaliar o dimorfismo sexual em uma coleção de mandíbulas portuguesas através de uma metodologia métrica digital, utilizando análise estatística descritiva, inferencial e multivariada para identificar quais parâmetros são mais dimórficos e quais são os melhores preditores de sexo. Trinta e três mandíbulas (14 mulheres e 19 homens) e pertences pessoais foram fotograficamente registrados com código e sexo. Os dados foram coletados por tomografia e as medidas foram feitas pelo software Simplant Pro. Foram registrados a largura máxima e mínima do ramo mandibular, altura condilar, altura do processo coronoide, altura da sínfise mandibular, ângulo mandibular, distâncias bimentual, biantegonial, bigonial e bicondilar e comprimento máximo mandibular. A análise estatística foi realizada utilizando IBM® SPSS. Os resultados mostraram diferenças estatisticamente significativas para os seguintes parâmetros: altura do processo coronoide, altura do côndilo, comprimento máximo da mandíbula e largura mínima do ramo mandibular. Na análise estatística multivariada foi possível identificar a altura do processo coronoide como melhor preditor de sexo com precisão em 72,2% dos casos. Isto permite uma diferenciação mais fácil entre mandíbulas femininas e masculinas com uma precisão de 64,3% e 78,9%, respectivamente. Foi possível concluir que a altura do processo coronoide é o parâmetro mais dimórfico e o melhor preditor de sexo na amostra.
This study aimed to assess sex dimorphism in a collection of Portuguese mandibles through a digital metric methodology by using descriptive, inferential, and multivariate statistical analysis to identify which parameters are the most dimorphic and which are the best sex predictors. Thirty-three mandibles (14 females and 19 males) and personal belongings were photographically registered with code and sex. Data was collected using tomography, and measurements were made using the Simplant Pro software. The maximum and minimum width of the mandibular ramus, condylar height, coronoid process height, mandibular symphysis height, mandibular angle, bi-mental, bi-antegonial, bi-gonial and bi-condylar distances, and maximal mandibular length were registered. Statistical analysis was performed using IBM® SPSS. The results showed statistically significant differences for the following parameters: coronoid process height, condyle height, the maximum length of the mandible, and the minimum width of the mandibular ramus. In the multivariate statistical analysis, it was possible to identify the coronoid process height as the best sex predictor accurately in 72.2% of cases. This allows for easier differentiation between female and male mandibles with an accuracy of 64.3% and 78.9%, respectively. It was possible to conclude that the coronoid process height is the most dimorphic parameter and the best sex predictor in the sample.
RESUMO
A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.
Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.
RESUMO
ABSTRACT Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.
RESUMO
ABSTRACT Langerhans cell histiocytosis comprises a heterogeneous range of clinical manifestations secondary to clonal proliferation of histiocytes, characterized by the accumulation of these cells in various organs and tissues. The ophthalmological component commonly involved is the orbit. Herein, we report a rare case of Langerhans cell histiocytosis with eyelid involvement, which resulted in severe ocular surface complications, which subsequently significantly impacted the patient's quality of life. This case report highlights the fact that despite being rare, Langerhans cell histiocytosis should be included in the differential diagnosis of eyelid lesions. Furthermore, a multidisciplinary approach with a systemic overview is crucial for managing the ocular complications.
RESUMO
ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas.
RESUMO
ABSTRACT Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.
RESUMO
ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.
RESUMO
ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.
RESUMO
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.
RESUMO
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.
RESUMO
La maloclusión clase III esqueletal por hipoplasia maxilar puede provocar la retención de algunas piezas dentales, ocupando los caninos superiores el tercer lugar de los dientes más afectados; por lo que es necesario el trabajo interdisciplinario con otras especialidades odontológicas para su correcto abordaje quirúrgico. Mientras que, para la corrección de la hipoplasia maxilar, el expansor Hyrax es el tratamiento ortopédico más utilizado en pacientes con crecimiento remanente. Se presenta caso clínico de paciente femenina de 14 años, clase III esqueletal por hipoplasia maxilar, biotipo mesofacial, perfil cóncavo, mordida cruzada anterior y posterior unilateral izquierda con canino superior derecho retenido. Los principales objetivos fueron: corregir la mordida cruzada y traccionar el canino retenido a su correcta posición. Al finalizar el tratamiento se eliminó la mordida cruzada y se logró la expansión palatina, incorporando así, el canino retenido en el arco dentario. En conclusión, el correcto diagnóstico, el adecuado plan de tratamiento y la atención temprana de la paciente fueron factores indispensables ya que proporcionaron un pronóstico favorable y un tratamiento conservador, evitando futuras complicaciones y tratamientos invasivos.
Skeletal class III malocclusion due to maxillary hypoplasia can cause the retention of some teeth, with the upper canines occupying the third place of the most affected teeth; therefore, interdisciplinary work with other dental specialties is necessary for its correct surgical approach. Likewise, for the correction of maxillary hypoplasia, the Hyrax expander is the most commonly used orthopedic treatment in patients with remnant growth. We present a clinical case of a 14-year-old female patient, skeletal class III due to maxillary hypoplasia, mesofacial biotype, concave profile, left unilateral anterior and posterior crossbite with retained right upper canine. The main objectives were: to correct the crossbite and pull the retained canine to its correct position. At the end of the treatment, the crossbite was eliminated and palatal expansion was achieved, thus incorporating the canine retained in the dental arch. In conclusion, the correct diagnosis, the adequate treatment plan and the early care of the patient were indispensable factors since they pro-vided a favorable prognosis and conservative treatment, avoiding future complications and invasive treatments.
RESUMO
El ameloblastoma multiquístico, una neoplasia odontogénica de crecimiento lento, pero comportamiento agresivo, suele manifestarse en la mandíbula, generando deformidades faciales, pérdida dentaria y desplazamiento de tejidos adyacentes. Este estudio tiene como objetivo describir el tratamiento quirúrgico multidisciplinario del ameloblastoma multiquístico en una localización inusual, destacando el compromiso de estructuras vitales y los estudios complementarios necesarios para un diagnóstico preciso. Se presenta el caso de un paciente masculino con una lesión en la hemicara izquierda, que se había desarrollado durante aproximadamente ocho meses, abarcando desde la región temporoparietal hasta la región maseterina ipsilateral. La evaluación clínica y radiológica inicial sugirió la posibilidad de un ameloblastoma multiquístico, confirmado posteriormente mediante biopsia. Como parte del equipo multidisciplinario del Hospital San Vicente Fundación de Medellín, se optó por una resección quirúrgica radical, que incluyó hemi-craneotomía y hemi-mandibulectomía, seguida de una reconstrucción exitosa. Se señala la importancia de un abordaje coordinado entre cirujanos maxilofaciales, estomatólogos y otros especialistas, así como la relevancia de los estudios complementarios para determinar el curso terapéutico óptimo. La cirugía reconstructiva demostró ser efectiva tanto en la restauración funcional como estética, aunque destaca los desafíos inherentes a la gestión de localizaciones poco comunes de esta enfermedad.
Multicystic ameloblastoma, a slow-growing but aggressive odontogenic neoplasm, usually manifests in the mandible, causing facial deformities, tooth loss and displacement of adjacent tissues. This study aims to describe the multidisciplinary surgical management of multicystic ameloblastoma in an unusual location, highlighting the involvement of vital structures and the complementary studies necessary for an accurate diagnosis. We present the case of a male patient with a lesion in the left hemiface, which had developed over approximately eight months, spanning from the temporoparietal region to the ipsilateral maseterine region. Initial clinical and radiological evaluation suggested the possibility of multicystic ameloblastoma, subsequently confirmed by biopsy. As part of the multidisciplinary team of the Hospital San Vicente Fundación de Medellín, a radical surgical resection was chosen, including hemi-craniotomy and hemi-mandibulectomy, followed by successful reconstruction. The importance of a coordinated approach between maxillofacial surgeons, stomatologists and other specialists is emphasized, as well as the relevance of complementary studies to determine the optimal therapeutic course. Reconstructive surgery proved to be effective in both functional and cosmetic restoration, although it highlights the challenges inherent in managing rare locations of this disease.
RESUMO
This paper examines how participants in genetic counseling sessions interactionally manage situations where the results of tests to investigate the causes of identified fetal malformations are inconclusive or missing. The dataset consists of 54 audio-recorded interactions at a unit specialized in moderate- and high-risk pregnancies at a Brazilian public hospital. Conversation analysis was used to examine the data, revealing that the participants deployed interactional actions that exhibited highly negative valence toward diagnostic inconclusiveness, demonstrating that when there is a motivation for a medical examination, insofar as its results will serve as a basis for subsequent decision-making (in this case about future pregnancies), there is a preference for bad diagnostic news over absent or inconclusive diagnostic news. These findings are consistent with prior interactional studies.
Este artigo examina como os participantes em sessões de aconselhamento genético gerenciam interacionalmente resultados de testes genéticos inconclusivos ou ausentes testes para investigar as causas das malformações fetais identificadas. O conjunto de dados consiste em 54 interações gravadas em áudio em uma unidade de gestação de médio e alto risco de um hospital público brasileiro. A abordagem da Análise da Conversa utilizada para examinar os dados revela que os participantes desenvolvem ações interacionais que exibem uma orientação de valência altamente negativa em relação à inconclusividade diagnóstica, demonstrando que quando há motivação para um exame médico, ou seja, usando o resultado do teste diagnóstico como base para tomada de decisão, tal como acontece com futuras gestações, haja uma preferência por más notícias diagnósticas em detrimento de notícias diagnósticas ausentes ou inconclusivas. Tais resultados são consistentes com estudos interacionais anteriores.
Este artículo examina cómo los participantes en las sesiones de asesoramiento genético gestionan de forma interactiva los resultados de pruebas genéticas no concluyentes o faltantes, pruebas para investigar las causas de las malformaciones fetales identificadas. El conjunto de datos consta de 54 interacciones grabadas en audio en una unidad de embarazo de riesgo medio y alto de un hospital público brasileño. El enfoque de Análisis de Conversación utilizado para examinar los datos revela que los participantes desarrollan acciones interaccionales que exhiben una orientación de valencia altamente negativa hacia la falta de conclusión del diagnóstico, lo que demuestra que cuando hay motivación para un examen médico, es decir, utilizar el diagnóstico del resultado de la prueba como base para la toma de decisiones, como ocurre con futuros embarazos, se prefieran las malas noticias diagnósticas a las noticias diagnósticas ausentes o no concluyentes. Estos resultados son consistentes con estudios interaccionales previos.
Assuntos
Anormalidades Congênitas , Testes Genéticos , Tomada de Decisões , Estudo Observacional , Aconselhamento Genético , Exames Médicos , Técnicas e Procedimentos Diagnósticos , Aconselhamento , MétodosRESUMO
Tinea nigra is a chronic fungal infection of the stratum corneum caused by the fungus Hortaea werneckii, clinically manifested by asymptomatic and hyperchromic macules ranging in color from light brown to black and affecting mainly the palmar and plantar areas. must be differentiated mainly from acral melanoma. It occurs mainly in South America (Brazil, Colombia, Venezuela), Central America and the Caribbean (Panama, Cuba), Asia (India, Japan, Sri Lanka) and the coastal regions of Africa and is uncommon in Europe, correlated with travel and immigration intercontinental. In relation to Brazil in the period 1916-2020, 203 cases were reported. We present a case of palmar tinea nigra in an adult patient with 3 months of evolution, diagnosed through clinical examination, direct mycological examination, Sabouraud agar culture, and dermatoscopy of the lesion was also performed. who fully responded to topical therapy with miconazole.
RESUMO
Background: Type 2 diabetes mellitus (T2DM) is known to be associated with cognitive impairment, but the Impact of the timing of diagnosis on cognitive function remains unclear. This pilot project aims to assess the cognitive function of people diagnosed with T2DM at an early vs. late stage. The study will examine several cognitive domains, such as attention, memory, executive function, visuospatial skills, and sensorimotor abilities. Methods: We recruited 80 adults diagnosed with T2DM, evenly split into 2 groups-one with early diagnosis (?5 years) (n=40) and other with late diagnosis (?6 years) (n=40) depending on when their disease was identified. Both groups underwent evaluation for demographic and clinical factors. Cognitive function was assessed using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and Addenbrooke's cognitive examination (ACE-III). Specific domain of cognition wasmeasured as span of attention (Tachitoscope), memory (PGI Battery scale), executive function (Stroop test), visuospatial function (Corsi block test), sensorimotor abilities (auditory /visual reaction time), and intelligence (Koh抯 Block design test). Results: Preliminary findings suggest that the early diagnosis group showed significantly average cognitive performance compared to the late diagnosis group. They also showed improved metabolic control and increased levels of physical activity. Individuals in the early diagnosis group had higher educational levels and socioeconomic status, potentially leading to improved disease detection and more effective health management. Conclusions: These findings indicate that identifying T2DM at an early stage, help in preserving cognitive function as compared to a diagnosis made at a later stage.
RESUMO
Resumen Introducción : Objetivo: comparar sensibilidad diag nóstica de videocolposcopia con inteligencia artificial (IA) auxiliar, con la videocolposcopia común realizada por colposcopistas. Métodos : Estudio descriptivo de corte transversal retrospectivo, en 782 historias clínicas anonimizadas del Sistema Informático para el Tamizaje (SITAM), de mujeres a las cuales se les efectuaron videocolposcopia con IA y colposcopías con videocolposcopio común rea lizadas por especialistas, con sus biopsias (gold standard). Se evaluó la relación entre los resultados de videocol poscopia con IA y videocolposcopia común con resulta dos de las biopsias. Se calculó precisión global de cada procedimiento diagnóstico. Se determinó sensibilidad y concordancia de los resultados de la videocolposcopia con IA, con el gold standard. Resultados : Se analizaron 395 historias clínicas de pacientes con videocolposcopia con IA y 387 con vi deocolposcopia común. La precisión diagnóstica de resultados fue 80% (IC 95%: 75-83%) en videocolposco pias con IA y 65% (IC 95%: 60-69%) en videocolposcopia común (p<0.001). Los resultados de videocolposcopia con IA y colposcopia común se correlacionaron signifi cativamente con los resultados de las biopsias, rs=0.75 vs. rs=0.57 respectivamente (p<0.001). La sensibilidad de videocolposcopia con IA fue 96% (IC 95%: 94-98%), y 93% (IC 95%: 89-95%) en colposcopías comunes. La concordancia general de las impresiones colposcópicas clasificadas por videocolposcopia con IA y enfermedad fue mayor que la de la interpretación colposcópica de los colposcopistas (90% frente a 83%, Kappa 0.59 frente a 0.47, p<0.001). Conclusión : La alta precisión diagnóstica de video colposcopia con IA permite aumentar la sensibilidad del estudio y mejorar la detección precoz de lesiones precursoras de neoplasias cervicouterinas.
Abstract Introduction : To compare the diagnostic sensitivity of artificial intelligence (AI) assisted videocolposcopy with standard videocolposcopy performed by specialist colposcopists. Methods : A descriptive retrospective cross-sectional study, 782 anonymized medical records from the Com puterized System for Screening (SITAM) of women who underwent videocolposcopy with AI and colposcopy with common videocolposcopy performed by specialists, with their corresponding biopsies (gold standard) were analyzed. The relationship between the results of IA videocolposcopy and regular videocolposcopy and the results of biopsies was evaluated. The overall accuracy of each diagnostic procedure was calculated. The sensitiv ity and concordance of the results of AI videocolposcopy with the gold standard (biopsy) were determined. Results : A total of 395 patient records of patients with IA videocolposcopy and 387 with regular vi-deocolposcopy were analyzed. The accuracy of results was 80% (IC 95%: 75-83%) in IA videocolposcopy and 65% (IC 95%: 60-69%) in regular videocolposcopy (p<0.001). Videocolposcopy results with IA and com mon colposcopy were significantly correlated with bi opsy results, rs=0.75 vs. rs=0.57 respectively (p<0.001). The sensitivity of videocolposcopy with AI was 96% (95% CI: 94-98%), and 93% (95% CI: 89-95%) for regu lar colposcopy. The overall agreement of colposcopic impressions classified by videocolposcopy with AI and disease was higher than that of colposcopic interpretation by colposcopists (90% vs. 83%, Kappa 0.59 vs. 0.47, p<0.001). Conclusion : The high diagnostic accuracy of AI vi-deocolposcopy allows obtaining highly sensitive studies that help in the early detection of precursor lesions of cervical neoplasia.
RESUMO
Resumen Introducción : Los retrasos en el tratamiento anti microbiano adecuado de las bacteriemias prolongan la estadía hospitalaria, aumentan la mortalidad e in crementan los costos. Aún hoy en día se requiere un tiempo considerable para obtener la identificación y antibiograma de los microorganismos en los hemocul tivos positivos. El objetivo fue evaluar el impacto de la implementa ción del panel BCID2 de FilmArray® (FA) sobre el tiempo de inicio de tratamientos antimicrobianos adecuados y sobre los costos potenciales de los mismos. Métodos : Estudio observacional retrospectivo de los hemocultivos positivos de pacientes hospitalizados, procesados por FA y por metodología tradicional. Se evaluaron los cambios de antimicrobianos en base a los resultados del FA. Se calcularon los días de reducción de tratamiento antimicrobiano y el ahorro potencial en el uso de los mismos, teniendo en cuenta también los costos del FA. Resultados : Se analizaron 87 episodios de bacte riemia. En 42 (48.3%) de ellos se desescaló el trata miento a antimicrobianos de menor espectro, en 7 (8%) se escaló a antimicrobianos de mayor espectro, en 8 (9.2%) se cambió el antimicrobiano sin variar el espectro y en 30 (34.5%) no se realizaron cambios con los resultados del FA. Los cambios de antimicrobianos se realizaron en promedio 2.3 días más rápido que con los métodos convencionales. Se calculó un ahorro potencial de US$ 7408. Conclusión : La implementación del panel BCID2 de FilmArray ® permitió adecuar los tratamientos antimi crobianos más rápidamente acortando la duración de los tratamientos empíricos de amplio espectro, lo cual resultó costo-efectivo.
Abstract Introduction : Delay in initiating appropriate anti microbial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Cur rently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential anti microbial costs. Methods : This is a retrospective observational study focused on positive blood cultures in hospitalized pa tients. FA processing was conducted concurrently with routine sample processing. Changes in antibiotic treat ments based on FA results were evaluated, and the re duction in antimicrobial therapy duration and associated cost savings were calculated. Results : Eighty-seven bacteremia episodes were ana lysed. In 42 (48%) of them antimicrobial therapy was de-escalated to narrower spectrum agents, while in 7 (8%) therapy was escalated to broader spectrum anti microbials. Additionally, in 8 (9%) antimicrobials were switched without changing spectrum and in 30 (34%) no changes were made based on FA results. Antimicrobial changes were made 2.3 days faster than with routine sample processing resulting in calculated potential sav ings of US$ 7408. Conclusion : The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broad-spectrum empirical antimicrobial therapy and subse quent economic savings.
RESUMO
Abstract Cephalometry is a morphological and descriptive diagnostic method that provides relevant data on skeletal and dentoalveolar malocclusions of patients seeking orthodontics treatment. Several authors have proposed different cephalometric measurements to determine facial growth direction and facial biotype, the results of these different measurements from the same patient do not always agree on the diagnosis. The aim of this study was to determine the level of agreement between Ricketts and Björk-Jarabak cephalometric analyses for the determination of facial growth direction and facial biotype in patients from a population of Yucatan, Mexico. A total of 260 lateral cephalograms of patients between 18 and 59 years of age were digitally traced using the Ricketts and Björk-Jarabak cephalometric analyses to determine the direction of facial growth and facial biotype using Dolphin Imagine software. Cohen's kappa statistical test was performed to establish the strength of agreement between the diagnostic results obtained by the cephalometric analyses. A poor diagnostic concordance strength was found for growth direction (K=0.105), and acceptable for facial biotype (K=0.362). The concordance strengths for each diagnostic possibility (level) ranged from slight to acceptable, except for the brachyfacial and dolichofacial biotypes, with a moderate strength of agreement. In conclusion, the Ricketts and Björk- Jarabak cephalometric measurements used for the determination of facial biotype and facial growth direction could suggest non-concordant diagnostic assessments in some individuals.
Resumen La cefalometría es un método diagnóstico morfológico y descriptivo que proporciona datos relevantes sobre maloclusiones esqueléticas y dentoalveolares de pacientes que buscan tratamiento de ortodoncia. Varios autores han propuesto diferentes mediciones cefalométricas para determinar la dirección del crecimiento facial y el biotipo facial, los resultados de estas diferentes mediciones de un mismo paciente no siempre coinciden en el diagnóstico. El objetivo de este estudio fue determinar el nivel de concordancia entre los análisis cefalométricos de Ricketts y Björk-Jarabak para la determinación de la dirección del crecimiento facial y el biotipo facial en pacientes de una población de Yucatán, México. Se trazaron digitalmente un total de 260 cefalogramas laterales de pacientes entre 18 y 59 años de edad utilizando los análisis cefalométricos de Ricketts y Björk-Jarabak para determinar la dirección del crecimiento facial y el biotipo facial utilizando el software Dolphin Imagine. Se realizó la prueba estadística kappa de Cohen para establecer la fuerza de concordancia entre los resultados diagnósticos obtenidos por los análisis cefalométricos. Se encontró una fuerza de concordancia diagnóstica deficiente para la dirección del crecimiento (K=0.105) y aceptable para el biotipo facial (K=0.362). Los niveles de concordancia para cada posibilidad diagnóstica (nivel) variaron de leve a aceptable, excepto para los biotipos braquifacial y dolicofacial, con un nivel de concordancia moderado. En conclusión, las mediciones cefalométricas de Ricketts y Björk-Jarabak utilizadas para la determinación del biotipo facial y la dirección del crecimiento facial podrían sugerir evaluaciones diagnósticas no concordantes en algunos individuos.
RESUMO
RESUMEN La hiperostosis cortical infantil (HIC) o enfermedad de Caffey es un trastorno óseo autolimitado que se caracteriza por fiebre, irritabilidad, inflamación de los tejidos blandos y engrosamiento cortical de uno o más huesos. Es más común en el primer semestre de vida. Se informa el caso de un lactante de 3 meses con las características clínico-radiográficas propias de la enfermedad y los hallazgos de laboratorio más comunes que permitieron un acertado diagnóstico y seguir una conducta adecuada. El cuadro agudo se mantuvo durante pocos días y se observó resolución total del edema en cuatro semanas. El reconocimiento de esta rara infección evitará adoptar métodos diagnósticos y terapéuticos invasivos para el paciente.
ABSTRACT Infantile cortical hyperostosis (ICH) or Caffey disease is a self-limiting bone disorder characterized by fever, irritability, soft tissue swelling and cortical bone thickening. It is more common in infants < 6 months of age. We report the case of a 3-month-old infant with the clinical and radiographic characteristics of the disease and the most common laboratory findings which enabled an accurate diagnosis and appropriate management. The acute episode persisted for several days, followed by a complete resolution of the edema within four weeks. Identifying this rare infection will help avoid invasive diagnostic and therapeutic strategies.
RESUMO
RESUMEN La hernia de Spiegel es un defecto de la pared abdominal en la que hay protrusión de la grasa preperitoneal, del peritoneo o de algún otro órgano, a través de la línea semilunar situada en el cruce de las fibras de los músculos oblicuos y transverso en el borde lateral del recto anterior del abdomen. Representa el 1 al 2% de todas hernias de la pared abdominal y, en total, ha habido menos de 1000 casos notificados. Se presenta el caso de una paciente de 80 años que consultó por dolor abdominal intermitente en flanco izquierdo. En el examen físico se identificó aumento de volumen de 6 cm en el flanco izquierdo (cinturón de Spiegel) que protruyó con la maniobra de Valsalva, reductible manualmente. Con diagnóstico clínico de hernia lumbar de Spiegel se le realizó una hernioplastia abierta con malla de polipropileno, sin complicaciones.
ABSTRACT Spigelian hernias are defined as a protrusion of preperitoneal fat, peritoneum or an organ through the semilunar line located in the junction of the fibers of the transverse and oblique abdominal muscles laterally to the rectus abdominis muscle. They account for 1% to 2% of all abdominal wall hernias with less than 1000 reported cases. We report the case of an 80-year-old female patient who sought medical care due to intermittent pain in the left lumbar region. On physical examination, an increase in volume of approximately 6 cm was observed in the left lumbar region (Spigelian belt). With the Valsalva maneuver, the structure protruded and was manually reduced. A diagnosis of Spigelian hernia was made, and the patient underwent open repair using polypropylene mesh, without complications.