The effects of HIV and aging on subcortical shape alterations: A 3D morphometric study.

Standard volumetric neuroimaging studies have demonstrated preferential atrophy of subcortical structures among individuals with HIV. However, to our knowledge, no study has investigated subcortical shape alterations secondary to HIV and whether advancing age impacts that relationship. This study employed 3D morphometry to examine the independent and interactive effects of HIV and age on shape differences in nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus in 81 participants ranging in age from 24 to 76 including 59 HIV+ individuals and 22 HIV-seronegative controls. T1-weighted MRI underwent a preprocessing pipeline followed by automated subcortical segmentation. Parametric statistical analyses were used to determine independent effects of HIV infection and age on volume and shape in each region of interest (ROI) and the interaction between age and HIV serostatus in predicting volume/shape in each ROI. Significant main effects for HIV were found in the shape of right caudate and nucleus accumbens, left pallidum, and hippocampus. Age was associated with differences in shape in left pallidum, right nucleus accumbens and putamen, and bilateral caudate, hippocampus, and thalamus. Of greatest interest, an age × HIV interaction effect was found in the shape of bilateral nucleus accumbens, amygdala, caudate, and thalamus as well as right pallidum and putamen such that increasing age in HIV participants was associated with greater shape alterations. Traditional volumemetric analyses revealed main effects for both HIV and age but no age × HIV interaction. These findings may suggest that age and HIV infection conferred additional deleterious effects on subcortical shape abnormalities beyond the independent effects of these factors. Hum Brain Mapp 38:1025-1037, 2017. © 2016 Wiley Periodicals, Inc.

Comparing the unmatched count technique and direct self-report for sensitive health-risk behaviors in HIV+ adults.

Researchers often rely on self-report measures to assess sensitive health-risk behaviors in HIV+ individuals, yet the accuracy of self-report has been questioned, particularly when inquiring about behaviors that may be embarrassing, risky, and/or taboo. We compared an anonymous reporting method - the unmatched count technique (UCT) - to direct self-report (DSR) in order to assess reporting differences for several health-risk behaviors related to medication adherence and sexual risk. Contrary to hypotheses, the UCT only produced a significantly higher estimated base rate for one sensitive behavior: reporting medication adherence to one's physician, which may have been contextually primed by our study design. Our results suggest that anonymous reporting methods may not increase disclosure compared to DSR when assessing several health-risk behaviors in HIV+ research volunteers. However, our results also suggest that contextual factors should be considered and investigated further, as they may influence perception of sensitive behavior.

Dopamine overdose hypothesis: evidence and clinical implications.

About a half a century has passed since dopamine was identified as a neurotransmitter, and it has been several decades since it was established that people with Parkinson's disease receive motor symptom relief from oral levodopa. Despite the evidence that levodopa can reduce motor symptoms, there has been a developing body of literature that dopaminergic therapy can improve cognitive functions in some patients but make them worse in others. Over the past two decades, several laboratories have shown that dopaminergic medications can impair the action of intact neural structures and impair the behaviors associated with these structures. In this review, we consider the evidence that has accumulated in the areas of reversal learning, motor sequence learning, and other cognitive tasks. The purported inverted-U shaped relationship between dopamine levels and performance is complex and includes many contributory factors. The regional striatal topography of nigrostriatal denervation is a critical factor, as supported by multimodal neuroimaging studies. A patient's individual genotype will determine the relative baseline position on this inverted-U curve. Dopaminergic pharmacotherapy and individual gene polymorphisms can affect the mesolimbic and prefrontal cortical dopaminergic functions in a comparable, inverted-U dose-response relationship. Depending on these factors, a patient can respond positively or negatively to levodopa when performing reversal learning and motor sequence learning tasks. These tasks may continue to be relevant as our society moves to increased technological demands of a digital world that requires newly learned motor sequences and adaptive behaviors to manage daily life activities.

Screen use, sleep duration, daytime somnolence, and academic failure in school-aged adolescents.

In this study, we examined the relationship between screen time use, sleep characteristics, daytime somnolence, and academic performance in school-aged adolescents. We surveyed 1,257 12- to 18-year-old adolescents attending 52 schools in urban or suburban areas of Argentina. We recorded the daily exposure to various screen-based activities, including video- and online-gaming, social media, TV or streaming. Screen time and device type in the hour before bedtime, sleep patterns during weekdays and weekends, somnolence (Pediatric Daytime Sleepiness Scale score), and grades in language and mathematics were also assessed. Structural Equation Modelling was used to identify a path connecting the latent variables. Results are expressed as standardized regression weights (srw). Missing data were present in 393 subjects, and thus the final sample consisted of 864 complete responses. Daytime somnolence (i.e., PDSS score ≥ 15) was observed in 614 participants (71%), and academic failure (i.e., grades < 7/10) in 352 of them (41%). Time spent using video gaming consoles was negatively associated with sleep duration (srw = -0.22, p<0.01) and positively connected with daytime somnolence (srw = 0.11, p<0.01). Use of mobile devices was associated with lower academic performance (srw = -0.11, p<0.01). Sleep duration was inversely related to daytime somnolence (srw = -0.27, p<0.01), which was in turn negatively associated with academic performance (srw = -0.18, p<0.05). Bedtime computer use did not influence any outcome. In summary, among adolescents, screen use adversely affected nighttime sleep, daytime somnolence, and academic performance. These findings call for the implementation of educational public campaigns aimed at promoting healthy sleep and reducing screen exposure among adolescents.

SARS-CoV-2 seroprevalence in the city of Puerto Madryn: Underdiagnosis and relevance of children in the pandemic.

BACKGROUND: Reported cases of COVID-19 may be underestimated due to mild or asymptomatic cases and a low testing rate in the general population. RESEARCH QUESTION: What is the seroprevalence of SARS-CoV-2 infection in the general population and how it compares with the data on SARS-CoV-2 cases reported by a national health surveillance system (SNVS 2.0). STUDY DESIGN AND METHODS: This was a population-based, seroepidemiological, cross-sectional study in the city of Puerto Madryn, a middle size city in the Province of Chubut, Argentina. The study period was between March 3 and April 17, 2021. The sample size was calculated using the technique of calculation of confidence intervals for a proportion. Participants were selected using stratified and cluster probability sampling. A total of 1405 subjects were invited to participate in the study. Participants were divided into the following four age groups: 1) 0 to 14, 2) 15 to 39, 3) 40 to 64, and 4) 65 or older. After informed consent was obtained, a blood sample was taken by puncture of the fingertip, and a structured questionnaire was administered to evaluate demographics, socioeconomic status, level of education, comorbidities and symptoms suggestive of COVID-19. COVID-19 seroprevalence was documented using an immunoenzymatic test for the in vitro detection of IgG antibodies specific to the spike protein of SARS-CoV-2. RESULTS: A total of 987 participants completed the survey. Seropositivity in the full study population was 39,2% and in those under 15 years of age, 47.1%. Cases reported by the SNSV 2.0 amounted to 9.35% of the total population and 1.4% of those under 15 years of age. INTERPRETATION: The prevalence of COVID-19 infection in the general population is four times higher than the number of cases reported by the SNVS 2.0 in the city of Puerto Madryn. For each child under the age of 15 identified by the SNVS 2.0 with COVID-19, there are more than 30 unrecognized infections. Seroepidemiological studies are important to define the real extent of SARS-CoV-2 infection in a particular community. Children may play a significant role in the progression of the current pandemic.

Clinical presentation and outcomes of the first patients with COVID-19 in Argentina: Results of 207079 cases from a national database.

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.

Medication Adherence in HIV-Positive African Americans: The Roles of Age, Health Beliefs, and Sensation Seeking.

We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV+ African Americans, and whether these factors mediate the association between age and adherence. Two-hundred-and-eighty-six HIV+ African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation-seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which was directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation-seeking tendencies to help identify HIV+ African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV+ individuals with poorer neurocognitive function.

Neuroimaging abnormalities, neurocognitive function, and fatigue in patients with hepatitis C.

OBJECTIVE: This study examined neurologic abnormalities (as measured by proton magnetic resonance spectroscopy imaging and diffusion tensor imaging), neurocognitive performance, and fatigue among a sample of adults with hepatitis C virus (HCV). We hypothesized that HCV+ individuals would demonstrate structural brain abnormalities and neurocognitive compromise consistent with frontostriatal dysfunction as well as increased fatigue compared to controls. METHOD: Participants were 76 individuals diagnosed with HCV and 20 controls who underwent a comprehensive neurocognitive evaluation and clinical assessments. A subset of the HCV+ participants (n = 29) and all controls underwent MRI. RESULTS: Individuals diagnosed with chronic HCV infection demonstrated greater fractional anisotropy in the striatum as well as greater mean diffusivity in the fronto-occiptal fasciculus and external capsule compared to HCV- controls. HCV+ participants also demonstrated lower levels of N-acetylaspartate in bilateral parietal white matter and elevations in myo-inosital (mI) in bilateral frontal white matter compared to HCV- controls (all p values < 0.05). HCV+ participants also demonstrated significantly poorer neuropsychological performance, particularly in processing speed and verbal fluency. HCV+ patients reported higher levels of fatigue than controls, and fatigue was significantly correlated with diffusivity in the superior fronto-occipital fasciculus, elevations in mI in frontal white matter, and overall cognitive performance. CONCLUSIONS: Our results suggest that HCV-associated neurologic complications disrupt frontostriatal structures, which may result in increased fatigue and poorer cognitive performance, particularly in those cognitive domains regulated by frontostriatal regions.

Trastornos respiratorios del sueño durante el embarazo / Respiratory sleep disorders during pregnancy

El embarazo es un momento especial en la vida de las mujeres. En la futura madre conviven la alegría por la gesta en curso con los temores de que algo pueda suceder en la evolución de la misma, tanto en ella, como en el niño que va creciendo dentro de su cuerpo. Sin dudas, los cambios anatómicos y hormonales generan variaciones funcionales de distintos sistemas y órganos con la posible aparición de patologías con directa repercusión para el binomio en cuestión. En este artículo haremos una revisión de la relación entre la evolución del embarazo y patologías asociadas al sueño de la gestante así como los posibles métodos diagnósticos y terapéuticos con los que contamos para, finalmente, proponer un algoritmo para sistematizar la búsqueda de la patología del sueño en la mujer embarazada.

Pregnancy is a special condition during women life where several physiologic, morphologic, metabolic and emotional changes take place. Due to the interaction of these changes sleep complaints are frequent during pregnancy. Breathing disorders during sleep are unusual in young non-obese women; however pregnancy may promote snoring and in certain cases sleep apnea. In this review we will discuss the relationship between pregnancy progression and sleep complaints. We will present different approaches to confirm the diagnosis as well as the therapeutic strategies with special focus in sleep apnea. An algorithm for the detection and treatment of sleep breathing disorders during sleep is proposed.

Enfermedad quística pulmonar como manifestación de Sindrome de Sjögren primario / Cystic lung disease as a manifestation of primary Sjögren's syndrome

El Síndrome de Sjögren primario es una enfermedad autoinmune caracterizada por un proceso inflamatorio que afecta, fundamentalmente, las glándulas de secreción exocrina pero que puede comprometer también otros órganos1, 2. Es la segunda enfermedad autoinmune multisistémica más frecuente después de la artritis reumatoidea. Predomina en el sexo femenino (relación estimada respecto de los hombres 3 a 10 según diferentes cohortes), en particular entre los 40 y 60 años. Se estima una incidencia de entre 3.9 y 5.3 casos por 100.000 personas-años en Europa y una prevalencia que oscila entre 43 y 282 enfermos por cada 100.000 habitantes3 . Clínicamente, el Síndrome de Sjögren primario se manifiesta por compromiso glandular que, de acuerdo a su localización, origina xeroftalmía, xerostomía, xerodermia, xerovagina, xerotráquea y tumefacción parotídea. Un 30 a 40% de los pacientes puede presentar compromiso extraglandular, aunque estudios recientes muestran que aplicar índices validados de actividad sistémica identifica esta afectación hasta en un 92% de los pacientes, en un seguimiento de 75 meses4 . Entre estas manifestaciones se encuentran artritis, artralgias, púrpura, polineuropatía, fenómeno de Raynaud, acidosis túbulo-renal, glomerulonefritis, anemia, leucopenia e hipergamaglobulinemia1, 2. Asimismo, un síntoma frecuentemente asociado es la fatiga, de etiología multifactorial. Las manifestaciones pulmonares del Síndrome de Sjögren primario incluyen anomalías de las vías respiratorias, neumonía intersticial y trastornos linfoproliferativos. Mucho menos frecuente, e incluso en algunas series sin encontrarse caso alguno5 , es la presencia de quistes pulmonares como único compromiso respiratorio como el que se observa en la paciente que describimos a continuación

Paciente con enfisema severo: ¿Combinado con fibrosis? / Patient with severe emphysema Combined with fibrosis?

Se presenta un paciente masculino, de 67 años, residente en la provincia de La Rioja, quien concurre al Servicio de Neumonología del Hospital Vera Barros. Ex fumador importante (60 p/y hasta hace 5 años), trabajó en curtiembre y con forrajes. Consultó por disnea de esfuerzo grado III en la escala modificada del Medical Researh Council (mMRC) y tos seca de 3 o 4 años de evolución. Estos síntomas se agudizaban 3 o 4 veces al año y requerían medicación que no podía precisar

Indicación de cesación tabáquica en la evaluación preoperatoria: conociendo la realidad de nuestra práctica / Indication of smoking cessation in the preoperative assessment: knowing the reality of our practice

Introducción: El consumo de tabaco puede ser factor causal de múltiples complicaciones en el posoperatorio de personas fumadoras. El período previo a la cirugía es un momento de especial receptividad por parte de los pacientes para intentar la cesación tabáquica. Existen diversas intervenciones basadas en la mejor evidencia científica (MBE) para conseguir el éxito. El seguimiento de los pacientes luego del procedimiento estimula a mantener la cesación. Sin embargo, la actuación de los profesionales en la vida real no siempre coincide con dichas recomendaciones. Objetivos: Averiguar la conducta que adoptan los profesionales médicos ante el paciente tabaquista derivado para evaluación de riesgo quirúrgico, qué tipo de intervenciones aplican y si las mismas se basan en las evidencias científicas disponibles. Material y métodos: Diseño observacional, prospectivo de corte transversal. Se encuestó de manera voluntaria y anónima a médicos asistentes a un Congreso de Medicina Respiratoria. El cuestionario fue diseñado a los fines de la investigación y validado por el Método Delphi. Se compuso de 15 preguntas con respuesta de opciones múltiples excepto el último de los dominios que solicitó señalar bibliografía para basar la conducta asumida. Resultados: Se recopilaron 152 encuestas. Respondieron el cuestionario 86 mujeres (66,7%), la edad mayor a 30 años fue dominante y predominó la especialidad en neumonología. Casi el 50% realizaba evaluaciones de riesgo quirúrgico de 2 a 10 veces/ semana. Más del 80% de los profesionales indicaba cesación tabáquica preoperatoria en los casos en que se detectaba el hábito. El intervalo libre de consumo de tabaco previo a la cirugía que indicaron con mayor frecuencia fue 8 semanas (54,6%) y la intervención más seleccionada, la mixta (farmacológica y verbal) con 62%. El seguimiento posterior lo realizaba el 74,8%. Más de la mitad respondió que basaban su actitud en la propia experiencia y sólo 15,8% pudo citar bibliografía de referencia. Conclusiones: La mayoría de los encuestados adhiere a la necesidad de indicar tratamiento para cesación en los pacientes fumadores en la evaluación preoperatoria, más de la mitad hace su recomendación basándose en su propia experiencia y menos del 20% puede recordar algún tipo de bibliografía que justifique sus recomendaciones. Resulta necesario que las sociedades científicas, vinculadas a la valoración preoperatoria, incluyan este capítulo en la agenda de educación médica continua a fin de disminuir las complicaciones posoperatorias.

Introduction: Smoking can be a causal factor of multiple complications after surgery. The pre-surgical period is key for smoking patients to quit. According to different evidence-based medicine (EBM) interventions, postoperative follow-up to corroborate quitting stimulates sustainable smoking cessation. However, not all professionals follow these recommendations in their practice. Objectives: to determine how physicians act with smoking patients referred for surgical risk evaluation, which interventions they apply and to what extent they are evidence-based. Material and methods: it is an observational, prospective, cross-sectional design. Physicians attending a congress of respiratory medicine were voluntarily and anonymously interviewed. The questionnaire was designed for this research and it was validated by the Delphi method. It has 15 multiple-choice questions except for the last domain which requests mentioning bibliography supporting their behavior. Results: 152 surveys were collected. Respondents were mostly pulmonologists and over 30 years of age. 86 (66.7%) were women. Almost 50% performed surgical risk assessments on 2 to 10 patients per week. In the case of current smokers, over 80% of physicians advised smoking cessation. 54.6% recommended an 8 week smoking-free interval prior to surgery; and 62% applied a mixed (pharmacological and verbal) approach. 74.8% of this group referred they monitored patients postoperatively. More than half respondents said that their recommendations were empirical and only 15.8 per cent quoted reference bibliography. Conclusions: Most respondents agree to the need to indicate smoking cessation in the preoperative evaluation but only 15.8% mentioned bibliography that supports their recommendation. We can conclude that scientific associations related with surgical risk evaluation should include this subject in their continuous medical education programs in order to reduce postop complications and foster smoking cessation.

Estudio multicéntrico sobre prevalencia de tabaquismo en mujeres embarazadas en 15 centros de salud de argentina / Multicenter Study on Prevalence of the Tobacco Smoking Habit among Pregnant Women in 15 Health Centers of Argentina

Introducción: No se conoce con exactitud cuál es el número de mujeres que fuman durante el embarazo y es difícil su evaluación, ya que muchas de ellas niegan ser fumadoras en sus consultas médicas. Ante la falta de datos epidemiológicos en Argentina, se realizó esta encuesta a fin de estimar la prevalencia de consumo de tabaco en una población de mujeres embarazadas en distintos centros de salud de la Argentina. Material y métodos: Se realizó un estudio prospectivo, transversal, no terapéutico, descriptivo, a través de una encuesta anónima a mujeres gestantes en cualquier trimestre y sin límite de edad. El cuestionario utilizado fue diseñado a tal fin por un grupo de especialistas en neumonología de la Sección Neumonología Clínica de la Asociación Argentina de Medicina Respiratoria. Resultados y discusión: La prevalencia de fumadoras del total de encuestadas fue del 19.8%. La casuística analizada, al igual que la de otros autores, demostró que un alto porcentaje de embarazadas mantiene el consumo de cigarrillos a pesar de conocer los riesgos de la adicción sobre el feto y la madre.

Introduction: It is not known exactly the number of women who smoke during pregnancy and its estimate is difficult because many of them deny being smokers at the medical consultation. In the absence of epidemiological data in Argentina, this survey was conducted to estimate the prevalence of the tobacco smoking habit in a population of pregnant women in different health centers in Argentina. Material and methods: We performed a prospective, cross sectional, non-therapeutic, and descriptive, through an anonymous survey of pregnant women in any quarter and without age limit. The questionnaire was designed for this purpose by a group of specialists of the Pulmonary Clinic Pulmonary Section of the Argentina Association of Respiratory Medicine. Results and discussion: The prevalence of smoking habit of the total respondents was 19.8%. The data analysis, like in other publications, showed that a high percentage of pregnant keeps the smoking habit despite knowing the risks of addiction on the fetus and mother.

Ambientes libres de humo de tabaco. Impacto de una ordenanza municipal en docentes de escuelas de Puerto Madryn / Tobacco smoke-free environments. Impact of a municipal ordinance on school teachers in Puerto Madryn

El tabaquismo es una adicción de altísima morbimortalidad en el mundo dándose la particularidad de que el inicio de la misma ocurre, en general, en jóvenes, muchos de ellos escolarizados. Las legislaciones restrictivas respecto del consumo en espacios públicos tienen como objetivo disminuir la exposición al humo de segunda mano pero también hacen que los fumadores, que desarrollan sus actividades en estas áreas, disminuyan o cesen en su consumo. En este trabajo analizamos el impacto de una ordenanza municipal sobre ambientes 100% libres de humo de tabaco seguida de un importante trabajo de divulgación, en docentes en contacto directo con jóvenes, comparando una encuesta realizada dosaños antes y otra similar dos años después de promulgada la ordenanza. Se observó disminución del consumo de tabaco dentro del ámbito escolar (del 60.7 al 17.9%), se revirtió la extensión de zonas “permitidas” para fumar dentro de los establecimientos escolares (del 49% al 6,6%) y disminuyó o cesó el hábito de fumar en un elevado porcentaje de docentes (70,5%), lo que sin duda refleja el cambio en la visión de los alumnos sobre esta adicción.Concluimos que las legislaciones restrictivas (ambientes 100% libres de humo de tabaco) asociadas a trabajo de difusión y esclarecimiento sobre el tema, tienen un importante impacto en la lucha contra el tabaquismo.

Smoking is an addiction associated to high morbidity and mortality worldwide with the peculiarity that the smoking habit starts in young people during the school years. Restrictive laws on tobacco consumption in public spaces aim to reduce exposure to second-handsmoke but also to induce smokers to reduce or stop their consumption in these spaces. This paper analyzes the impact of a municipal ordinance on 100% tobacco smoke-free environments, followed by an important communication program, on teachers in direct contact with young people, comparing a survey two years before and a similar survey two years after the enactment of the ordinance. Tobacco consumption decreased in the school settings (from 60.7 to 17.9%), the availability of smoking areas diminished (from 49% to 6.6%) and the smoking habit was reduced or stopped in a significant percent of teachers (70.5%), which undoubtedly reflects a change in the view of the students about this addiction. We conclude that restrictive laws (environments 100% free of tobacco smoke) associated with communication activities have an important impact in the fight against smoking.

Profilaxis de enfermedad tromboembólica venosa en pacientes adultos sometidos a cirugía. Estudio multicéntrico en instituciones públicas y privadas de Argentina / Tromboembolic venous disease prophylaxis in patients undergoing surgery. Multicentric study in public and private institutions in Argentina

ntroducción: La incidencia real de la enfermedad tromboembólica venosa (ETV) es difícil de precisar. La mayoría de los casos son asintomáticos y generalmente no se diagnostican, pero se sabe que el tromboembolismo pulmonar (TEP) es la tercera causa de muerte en el medio hospitalario. El subdiagnóstico de la patología complica el conocimiento exacto de la incidencia y no hay demasiados trabajos que evalúen la calidad de la prevención que se aplica. Objetivos: El principal fue determinar la frecuencia de la utilización de profilaxis de la ETV en los pacientes sometidos a cirugías de alto y/o mediano riesgo para la presentación de dicha patología en diferentes instituciones médicas de nuestro país. Se establecieron como objetivos secundarios evaluar la calidad de la prevención empleada y la variabilidad de la misma de acuerdo a la especialidad médica del profesional que la indica, su relación con el número de camas de la institución como criterio de complejidad de la misma y las diferencias entre el ámbito público o privado.

Material y métodos: Se analizaron las historias clínicas de 258 pacientes sometidos a cirugías consideradas de mediano y alto riesgo para enfermedad tromboembólica venosa (ETV) en 9 centros hospitalarios del país, en la semana del 25 al 30 de julio de 2011. Resultados: La profilaxis se indicó y se consideró adecuada en el 46,51% de aquellos que debieron recibirla. Se observaron diferencias significativas según el carácter público o privado de las instituciones (estos últimos indicaron con más frecuencia en los procedimientos de mediano riesgo), el tipo de profesionales intervinientes en la evaluación del riesgo (los cardiólogos prescribieron menos profilaxis) y el número de camas de las instituciones (las de mayor número de camas indicaron profilaxis más frecuentemente). Conclusiones: El bajo cumplimiento de las normas en esta pequeña muestra de las cirugías que ocurren en el país, alerta sobre la necesidad de implementar estrategias para aumentar la cobertura de esta práctica sencilla y costo efectiva.

ntroduction: The actual incidence of venous thromboembolism (VTE) is difficult to quantify. More cases are asymptomatic and generally are not diagnosed, but it is known that pulmonary thromboembolism (PTE) is the third cause of death at hospitals. The lack of diagnosis of this pathology impairs the reliability of its incidence estimates and there are few studies which have assessed the effectiveness of preventive measures. Objectives: The main objective was to determine the proportion of high and medium risk surgical patients in which preventive measures against VTE are prescribed in several medical institutions of the country. Secondary objectives were to assess the quality of the prescribed preventive measures and to correlate the type of preventive measure with the professional background of the medical doctor who made the prescription, the level of complexity of the institution as indicated by the number of beds and the kind of institution, whether public or private.

Material and methods: the study included the review of 258 clinical records of surgical patients with medium and high risk for VTE in 9 hospitals of the country from 25 to 30 July 2011. Results: The prescribed preventive measures were adequate in 46.51% of patients who met the requirements for their prescription. There were significant differences between public and private institutions. Private institutions prescribed these measures more often in patients with medium risk. Cardiologists were less likely and institutions with a larger number of beds were more likely to prescribe the preventive measures.Conclusions: The low compliance with guidelines on prevention of VTE in this study shows that there is a need to implement strategies to promote the use of simple and cost-effective preventive measure.

Divertículo traqueal / Tracheal diverticulum

Dentro de las lesiones quísticas con aire que podemos hallar en la región cervical o mediastinal superior se encuentra el divertículo traqueal. El origen del mismo pueden ser congénito o adquirido y la resolución puede ser médica o quirúgica de acuerdo a la sintomatología que ocasione. Presentamos un caso que se diagnosticó en la Tomografía Computada (TC) de un paciente que consultó por tos con expectoración recurrente que se atribuyó a tal formación. Ante el diagnóstico causal de tal sintomatología se decidió un tratamiento médico conservador.

Tracheal diverticulum was already described as an aired cystic lesion in the cervical and superior mediastinal areas by Rokitanski in 1838. It can be a congenital or acquired disorder and its treatment can be either medical or surgical. We present a case in which a tracheal diverticulum was diagnosed using computed tomography (CT) in a patient who complained of recurrent productive cough. The patient was given conservative medical treatment.