Clinical presentation and management of atypical hemolytic uremic syndrome in Latin America: a narrative review of the literature.

INTRODUCTION: Comprehensive information about atypical hemolytic uremic syndrome (aHUS) is relatively scarce outside of Europe and North America. This narrative review assembles available published data about the clinical presentation and management of aHUS in Latin America. AREAS COVERED: A search conducted in February 2023 of the MEDLINE (from inception), Embase (from inception), and LILACS/IBECS (1950 to 2023) databases using search terms 'atypical hemolytic uremic syndrome' and 'Latin America' and their variations retrieved 51 records (full papers and conference abstracts) published in English, Spanish, or Portuguese. After de-duplication, manual screening of titles/abstracts and addition of author-known articles, 25 articles were included of which 17 (68%) are full papers. All articles were published during the years 2013-2022. Articles include cohort studies, a registry analysis, and case reports from Argentina, Brazil, Chile and Columbia. Overall, Latin American patients with aHUS present the classic epidemiological, clinical, and genetic characteristics associated with this condition as described in other world regions. Depending on the country and time of reporting, aHUS in Latin America was treated mainly with plasma therapy and/or eculizumab. Where reported, eculizumab substantially improved aHUS-related outcomes in almost all adult and pediatric patients. EXPERT OPINION: Eculizumab has dramatically altered the natural course of aHUS, improving prognosis and patient outcomes. Addressing economic challenges and investing in healthcare infrastructure will be essential to implement strategies for timely detection and early treatment of aHUS in Latin America.

Use of audiovisual devices in transnasal endoscopy without sedation to improve tolerance. A prospective clinical trial.

INTRODUCTION AND AIM: Transnasal endoscopy (TNE) has proven its diagnostic utility, but it has not been widely accepted given that it is performed without sedation. There are no previous studies on the use of methods to improve its tolerability. Our aim was to evaluate the tolerability of TNE, when simultaneously performed with an audiovisual device as a distractor. METHODS: We evaluated 50 patients, 10 of whom did not agree to participate. The performance of the procedure was explained, using an audiovisual device. Before randomization, we applied anxiety and depression scores. Patients were divided into 2 groups: Group I (using an audiovisual device during the procedure) and Group II (without a device). Anxiety and numeric pain rating scales were used, and vital signs were monitored and recorded before, during, and after the endoscopy. An overall procedure satisfaction score was applied at the end of the study and 24 h later. RESULTS: Mean age was 41.6 years and 35 of the patients were women (87.5%). The most frequent indication for TNE was refractory gastroesophageal reflux disease. There were no severe comorbidities, and none of the patients had a significant anxiety or depression score. One patient in Group II did not tolerate TNE due to nasal pain. There was no statistically significant difference between groups, regarding anxiety, pain, vital signs, and satisfaction scale. CONCLUSION: Our study showed that TNE was well tolerated and had a high acceptance rate in our patients. The use of distracting audiovisual devices did not increase tolerance to the endoscopic procedure.

Granuloma Anular diseminado: a propósito de un caso / Disseminated annular granuloma: on the purpose of a case

RESUMEN El granuloma anular es un trastorno relativamente frecuente, se desconoce la prevalencia exacta, tiene mayor frecuencia en niños y adultos jóvenes. Se caracteriza por pequeñas pápulas agrupadas, en configuración anular, a menudo con distribución simétrica y acra. La mayor parte los casos se resuelve en forma espontánea dentro de los 2 años, pero la tasa de recidivas es del 40%. Presentamos el caso clínico de una paciente de 72 años de edad con granuloma anular diseminado, tratado con pentoxifilina, con buen resultado terapéutico.

ABSTRACT Annular granuloma is a relatively frequent disorder, the exact prevalence is unknown, it is more frequent in children and young adults. It is characterized by small grouped papules, in annular configuration, often with symmetric and acrid distribution. Most cases resolve spontaneously within 2 years, but the recurrence rate is 40%. We present the clinical case of a 72-year-old patient with disseminated annular granuloma, treated with pentoxifylline, with good therapeutic results.

Contracción paradojal del puborrectal como causa de defecación obstructiva: resultados a corto plazo del tratamiento con biofeedback y rehabilitación pelviperineal / Puborectal paradoxical contraction as a cause of obstructive defecation: short-term outcomes of treatment with biofeedback and pelviperineal rehabilitation

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.

Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.

Hippocampal electrophysiological changes during the elicited metabolic syndrome in Wistar rats.

The Metabolic Syndrome (MS) is a set of alterations that increase the risk of developing type 2 diabetes mellitus (DM2). There is evidence that obesity and the development of metabolic syndrome lead to alterations in cognitive processes. In this work it was proposed to determine if generating the metabolic syndrome produces changes in the electric unitary spontaneous activity in the hippocampus as a possible sustain of the learning alterations. In Wistar rat with a hypercaloric diet, metabolic syndrome was provoked, and this was confirmed with the determination of body and metabolic parameters as a measure of intraperitoneal fat, glucose, triglycerides, and cholesterol. Electrophysiological records were made in the hippocampus and it was determined that rats treated with a hypercaloric diet show a significant decrease in such activity. Thus, it is shown that rats that were caused metabolic syndrome, alter their hippocampal electrophysiological activity.

Assessment of two glycated hemoglobin immunoassays.

INTRODUCTION: Glycated hemoglobin (HbA1c) level reflects chronic glycemic status if reliable tests are used, however, in some regions worldwide high performing assays might not be readily available. This study aimed to asses two HbA1c immunoassays, comparing them with high-performance liquid chromatography (HPLC) assay, three methods available in Ecuador. MATERIAL AND METHODS: HbA1c were measured in 114 fresh whole blood-samples by DCA-Vantage point-of-care analyzer, I-Chroma portable fluorescent scanner immunoassay and BioRad Variant II Turbo HPLC. Normal and pathological HbA1c ranges were included. Blood samples with variants of hemoglobin were excluded. HbA1c values were expressed in National Glycohemoglobin Standardization Program percentages and mmol/mol, as mean±standard deviation. RESULTS: HbA1c results by HPLC and DCA-Vantage were similar: 6.3±1.7% (45±18.6mmol/mol) vs. 6.3±1.8% (45±19.7mmol/mol), respectively, P=0.057; while HbA1c values by I-Chroma were lower than HPLC, 5.8±1.9% (40±20.8mmol/mol), P<0.001. The coefficient of variation was below 2% for high and low HbA1c levels, in all methods studied. HbA1c values by HPLC and DCA-Vantage were highly correlated (Spearman's Rank Correlation [SRC]: 0.916), while the correlation among HPLC and I-Chroma was weak (SRC: 0.368). The mean bias between DCA-Vantage and HPLC was -0.02±0.29% (-0.2±3.2mmol/mol), while for I-Chroma and HPLC mean bias was -0.50±1.62% (-5.5±17.7mmol/mol). CONCLUSION: HbA1c immunoassays DCA-Vantage was comparable to HPLC assay, showing good correlation, appropriate precision and low bias, whereas I-Chroma assay was precise but inaccurate. Therefore, DCA-Vantage has better performance than I-Chroma. These findings suggest that is convenient to assess the HbA1c immunoassays commercially available in our country, Ecuador.

Oceanographic Variability induced by Tides, the Intraseasonal Cycle and Warm Subsurface Water intrusions in Maxwell Bay, King George Island (West-Antarctica).

We examine the hydrographic variability induced by tides, winds, and the advance of the austral summer, in Maxwell Bay and tributary fjords, based on two recent oceanographic campaigns. We provide the first description in this area of the intrusion of relatively warm subsurface waters, which have led elsewhere in Antarctica to ice-shelf disintegration and tidewater glacier retreat. During flood tide, meltwater was found to accumulate toward the head of Maxwell Bay, freshening and warming the upper 70 m. Below 70 m, the flood tide enhances the intrusion and mixing of relatively warm modified Upper Circumpolar Deep Water (m-UCDW). Tidal stirring progressively erodes the remnants of Winter Waters found at the bottom of Marian Cove. There is a buoyancy gain through warming and freshening as the summer advances. In Maxwell Bay, the upper 105 m were 0.79 °C warmer and 0.039 PSU fresher in February than in December, changes that cannot be explained by tidal or wind-driven processes. The episodic intrusion of m-UCDW into Maxwell Bay leads to interleaving and eventually to warming, salinification and deoxygenation between 80 and 200 m, with important implications for biological productivity and for the mass balance of tidewater glaciers in the area.

The effect of aromatherapy with lavender (Lavandula angustifolia) on serum melatonin levels.

OBJECTIVE: Physiologically, blood melatonin levels decrease as a person ages and the older adult commonly presents with insomnia and other types of sleep disorders. Alternative therapies can be used to attenuate sleep disturbances. The aim of the present study was to analyze the effect of aromatherapy with lavender on serum melatonin levels in the noninstitutionalized older adult (OA). DESIGN AND SETTING: A pre-experimental, quantitative study with a pre-test - post-test design was conducted on 67 OAs that included both sexes. MAIN OUTCOME MEASURES: Serum melatonin levels were measured before and after eight sessions of aromatherapy with lavender that lasted 4 weeks. The results were expressed as mean ±â€¯standard deviation of melatonin levels (pg/ml). The differences were compared using the Student's t-test and statistical significance was set at a p ≤ 0.05. RESULTS: Blood melatonin levels significantly increased in the total population after the intervention with aromatherapy (pg/ml): 102.3 ±â€¯33.4 VS 132.5 ±â€¯42.3, p = 0.000004. There were significant differences in the pre-test and post-test phases in the women and men measured as separate groups (p = 0.00005 and p = 0.026), respectively. However, those differences were not observed when the measurements were compared between the two sexes, before (p = 0.64) or after (p = 0.31) the intervention. CONCLUSION: Aromatherapy with lavender essential oil similarly favors an increase in blood melatonin levels in both older adult men and women.

Ajuste de la cifra de hemoglobina glucosilada para el diagnóstico de diabetes mellitus en México / Adjustment of the glycated hemoglobin value to diagnose diabetes mellitus in Mexico

Resumen ANTECEDENTES En la actualidad la Asociación Americana de Diabetes (ADA) acepta el uso de tres pruebas para el diagnóstico de diabetes mellitus, que incluyen la determinación de hemoglobina glucosilada (HbA1c). OBJETIVO Evaluar si la cifra establecida de HbA1c de 6.5% para el diagnóstico de diabetes mellitus es válida para la población mexicana. MATERIAL Y MÉTODO Estudio descriptivo, transversal y analítico en el que en octubre de 2016 se incluyeron personas en quienes se determinó HbA1c en sangre capilar y glucemia en sangre venosa. RESULTADOS Se incluyeron 388 pacientes. Se determinó que ni la edad ni el sexo predisponen a la obtención de una cifra determinada de HbA1c. La prueba de HbA1c capilar tendió a diagnosticar mayor número de casos de prediabetes (170 vs 63) y diabetes (27 vs 13) en comparación con la prueba de glucosa sérica, con diferencia en el número de personas sanas entre ambos grupos de 121 (191 personas sanas con HbA1c y 312 personas sanas con glucosa sérica); sin embargo, ambas variables compartieron 90.2% de similitud (p < 0.001). Se obtuvo un nuevo nivel de corte de HbA1c para el diagnóstico de diabetes de 6.65% (con sensibilidad y especificidad de 76 y 97%, respectivamente). CONCLUSIÓN Con el nuevo punto de corte disminuyó la incidencia de casos de diabetes en el grupo de HbA1c, con reducción de 7 a 4.9% (27 a 19 casos).

Abstract BACKGROUND Nowadays, the American Diabetes Association (ADA) recognizes the use of three tests for the diagnosis of diabetes mellitus, including the determination of glycated hemoglobin (HbA1c). OBJECTIVE To evaluate if the established value of 6.5% of glycated hemoglobin for the diagnosis of diabetes mellitus is applicable to the Mexican population. MATERIAL AND METHOD A descriptive, transversal and analytic study was done in October 2016 in persons that were subjected to a capillary test for HbA1c and serum glucose. RESULTS There were included 388 subjects in whom it was determined that the age and the sex did not influence on the obtaining of a determinate level of HbA1c. Capillary HbA1c test tended to diagnose a greater number of cases of prediabetes (170 vs 63) and diabetes (27 vs 13) compared with serum glucose test, with a difference in the number of healthy persons between the two groups of 121 (191 healthy persons with HbA1C and 312 healthy persons with serum glucose); however, both variables shared a 90.2% of similarity (p < 0.001). It was obtained a new threshold of HbA1C for the diagnosis of diabetes of 6.65% (with sensitivity and specificity of 76% and 97%, respectively). CONCLUSION With the new cutoff value the incidence of cases of diabetes decreased in the HbA1c group, with a reduction of 7% to 4.9% (27 to 19 cases).

Efecto de un tratamiento experimental de una superficie sobre la resistencia flexural en una zirconia Y-TZP / Effect of an experimental surface treatment on Y-TZP zirconia flexural strength

RESUMEN Objetivo: Analizar el efecto del microgranallado superficial como tratamiento experimental de regeneración, en la resistencia flexural y esfuerzos residuales de una Zirconia Y-TZP, una vez ha sido alterada con otros tratamientos mecánicos como microarenado y fresado. Métodos: Un total de 75 probetas de Zirconia Y-TZP fueron divididas en cinco grupos n=15 y sometidas a tratamientos de superficie así: fresado y microarenado (Grupos 2 y 4) microarenado + microgranallado y fresado + microgranallado (Grupos 3 y 5), y comparadas con un grupo control (Grupo 1), mediante Difracción de Rayos X (DRX), Microscopía electrónica de barrido (SEM), Microscopía confocal (CLSM) y sometida a falla en máquina universal de ensayos. Resultados: Los grupos de microgranallado y microarenado presentaron un aumento significativo de la resistencia flexural p=0.0082 con relación al grupo de fresado. Las mediciones mediante DRX no mostraron relación estadística con los cambios en la resistencia flexural. Significancia: Es posible que el microgranallado se considere un tratamiento para regenerar las propiedades mecánicas reducidas por fresado o arenado en la Zirconia Y-TZP.

ABSTRACT Objective: To analyze the effect of surface micro shot peening as an experimental regeneration treatment on the flexural strength and residual stresses of a Y-TZP Zirconia, once it has been altered with other mechanical treatments such as micro sandblasting and milling. Methods: A total of 75 Zirconia Y-TZP specimens were divided into five n = 15 groups and subjected to surface treatments such as: milling and micro sandblasting (Groups 2 and 4) micro sandblasting + micro shot peening; and milling + micro shot peening (Groups 3 and 5), compared to a control group (Group 1), by X-ray diffraction (XRD), scanning electron microscopy (SEM), confocal microscopy (CLSM) and subjected to failure in a universal testing machine. All the results were compared to find a statistical relationship between them using a mixed linear model and Tuckey. Results: The groups of micro shot peening and micro sandblasting presented a significant increase of the flexural strength p = 0.0082 vs the milling group. The XRD technique is not related to flexural strength measurements. Significance: It is possible that the micro shot peening be considered a treatment to regenerate the mechanical properties reduced by milling or sandblasting in Zirconia Y-TZP.

Choque séptico. Lo que sabíamos y lo que debemos saber.. / Septic shock. What we knew and what we should know..

Resumen En el mundo, la prevalência de sepsis es de más de 19 millones de casos por año, con mortalidad estimada de 30%. Los factores de riesgo identificados más frecuentemente son las enfermedades crónicas (VIH-SIDA, EPOC y neoplasias), así como la administración de agentes inmunosupresores. La población más susceptible de padecer estas complicaciones es la que se encuentra en los extremos de la vida. De los múltiples agentes patógenos, las bacterias son los microorganismos principalmente implicados en la aparición de la sepsis grave. Entre los focos infecciosos, en primer lugar está la neumonía, seguida de infecciones intraabdominales, de las vías urinarias e infecciones primarias del torrente sanguíneo. Se ha demostrado que el tratamiento temprano aumenta la supervivencia de manera significativa. Las intervenciones que deben realizarse incluyen: tratamiento antimicrobiano, resucitación hídrica, apoyo ventilatorio y tratamiento de soporte (profilaxis antitrombótica, control de la glucemia y profilaxis para evitar úlceras gástricas por estrés y nutrición, entre otras medidas).

Abstract Globally, the prevalence of sepsis is more than 19 million cases per year with an estimated mortality of 30%. The most frequently identified risk factors are chronic diseases (HIV-AIDS, COPD and neoplasms) and the use of immunosuppressive agents. The most susceptible popula tion to develop these complications are the ones in babyhood or the elderly. Among the multiple pathogens, bacteria are considered the microorganisms primarily involved in the development of severe sepsis. Within the foci of infection, pneumonia is considered to be the most common, followed by intra-abdominal infections, urinary tract and primary bloodstream infections. It has been demonstrated that early treatment significantly improves survival. Interventions to be performed include antimicrobial therapy, fluid resuscitation, ventilatory support and supportive measures (antithrombotic prophylaxis, glycemic control and prophylaxis to prevent stress gastric ulcers and nutrition).

Rehidratación en el paciente pediátrico / Rehydration in pediatric patients / Rehidratação em pacientes pediátricos

La deshidratación en el paciente pediátrico es una de las causas de morbimortalidad más importantes en países en vía de desarrollo; por tanto, es imprescindible el correcto manejo de esta patología con el fin de disminuir los desenlaces fatales y prevenibles de la enfermedad. Se realizó una revisión de la literatura con respecto a la fisiología, la fisiopatología, la clínica, el mecanismo de acción, las indicaciones y las contraindicaciones de las sales de rehidratación oral y las soluciones de administración endovenosa, con el fin de brindar ciertas pautas y recomendaciones basadas en la evidencia actual, a todos los profesionales de la salud, que a diario enfrentan este tipo de patología. La investigación demostró que las sales de rehidratación oral siguen siendo el Gold Estándar en el tratamiento de la deshidratación leve a moderada en pacientes con indicaciones de uso y que las soluciones de administración endovenosa son de vital apoyo en aquel grupo de pacientes con deshidratación grave con intolerancia a la vía oral, shock, íleo paralitico, ciertas patologías quirúrgicas y con contraindicaciones de terapia con sales de rehidratación oral.

Dehydration in pediatric patients is one of the most common causes of mobility and mortality in developing countries; therefore, the right management of this disease is essential in order to reduce fatal and preventable disease outcomes. A review of the literature was made with respect to the physiology, pathophysiology, clinical manifestations, mechanism of action, indications and contraindications of oral rehydration salts and intravenous solutions, in order to provide some recommendations based on current evidence, to all physicians, who daily work on this kind of pathology. The investigation showed that ORS remains the Gold Standard in the treatment of mild to moderate dehydration in patients with indications and intravenous solutions, are of vital support in the group of patients with severe dehydration, oral intolerant, shock, paralytic ileus, certain surgical pathologies and therapy contraindications ORS.

A desidratação em pacientes pediátricos é uma das causas mais comuns de mobilidade e mortalidade nos países em desenvolvimento; Portanto, o manejo correto desta doença é essencial para reduzir os resultados fatais e evitáveis da doença. Realizou-se revisão da literatura em relação à fisiologia, fisiopatologia, manifestações clínicas, mecanismo de ação, indicações e contra-indicações dos sais de reidratação oral e soluções intravenosas, a fim de fornecer algumas recomendações baseadas em evidências atuais a todos os médicos, que diariamente Trabalho sobre esse tipo de patologia. A investigação mostrou que a SRO permanece como padrão-ouro no tratamento da desidratação leve a moderada em pacientes com indicações e soluções intravenosas, são de suporte vital no grupo de pacientes com desidratação grave, intolerância oral, choque, íleo paralítico, certas patologias cirúrgicas e Terapia contra-indicações ORS.

Assessment of Mesial Root Morphology and Frequency of MB2 Canals in Maxillary Molars using Cone Beam Computed Tomography / Determinación de la Morfología de la Raíz Mesial y la Frecuencia del Canal MB2 en Molares Maxilares usando Tomografía Computadorizada de Haz Cónico

The aim of this study was to assess the morphology of the mesial root canal system of maxillary molars and the frequency of MB2 canals using cone-beam computed tomography (CBCT). A total of 1374 teeth, first maxillary (1MS, n= 802) and second maxillary molars (2SM, n= 572) of 508 Chilean patients between 8 to 77 years were evaluated through CBCT. The mesiobuccal root was evaluated in all three thirds. Root canal morphology was classified according to Vertucci's method. Data were analyzed by Pearson's Chi-square and Cuzick trend tests. MB2 canal frequency in 1MS was 73.44% and in 2MS 42.48%. The most frequent morphology in 1MS and 2MS were Vertucci type II and I, respectively. No statistically significant association was found between frequencies and side or according to gender (P>0.05). A positive association was found as the age increased in both 1MS and 2MS (P<0.001 and P= 0.023, respectively). Given the anatomical complexity of the mesiobuccal root and the frequent presence of the MB2 canal, the clinician must assume the existence of two canals in this root. CBCT scanning is a good way to initially identify this canal in the different root thirds.

Determinar la morfología del sistema de canales de la raíz mesial de molares maxilares y la frecuencia del canal MB2 usando tomografía computadorizada de haz cónico (TCHC). Un total de 1374 dientes, primeros molares maxilares (1MS, n= 802) y segundos molares maxilares (2MS, n= 572) de 508 pacientes Chilenos entre 8 y 77 años fueron evaluados a través de la TCHC. Se evaluó la raíz mesiobucal en todos sus tercio. La clasificación de Vertucci fue utilizada para determinar la morfología del sistema de canales. Los datos fueron analizados con los test Chi-Cuadrado de Pearson y la prueba de tendencia de Cuzick. La frecuencia del canal MB2 para el 1MS fue 73,44% y el 2MS 42,48%. La morfología mas frecuente en el 1MS y 2MS fueron el tipo II y I de Vertucci, respectivamente. No se encontró asociación significativa entre la frecuencia y el lado o sexo (p>0,005). Una asociación positive fue encontrada a medida que aumentaba la edad en ambos 1MS y 2MS (p<0,001 y p= 0,023, respectivamente). Dada la complejidad de la anatomía de la raíz mesiobucal y la frecuente presencia del canal MB2, el clínico debe asumir la existencia de dos canales en esta raíz. La TCHC es una buena manera de identificar tempranamente el canal en los diferentes tercio radiculares.

Importancia del pensamiento reflexivo y crítico en enfermería / Importance of reflective and critical thinking in nursing", "_e": "n

Pensar de manera reflexiva y crítica permite conocer y discriminar una acción de otra, en función de las prioridades establecidas para la atención de la persona, interactuando con ella de manera emancipadora, donde deben buscarse formas o puentes de unión entre la parte más artística de la enfermería y aquellos elementos más asociados al campo de la ciencia, procurando así una mayor calidad en la prestación de los cuidados. El desarrollo del pensamiento reflexivo y crítico en los estudiantes de enfermería en México es un tema poco estudiado. En este artículo se hace una revisión sobre lo investigado y escrito, imprescindible en la agenda educativa de enfermería, así como algunas reflexiones y posicionamientos de un grupo colegiado, perteneciente a la región México y El Caribe de la Red Iberoamericana de Investigación en Educación en Enfermería (RIIEE).

Think in a reflexive and critical way allows knowing and distinguishing one action of another, according to established priorities for the care of person interacting in a emancipatory way, where ways or links between the most artistic part of nursing and those elements associated with the field of science should be looked for, in order to give a better quality in professional care of nursing. The development of reflexive and critical thinking in students of nursing in Mexico, it is a subject that hasn’t been researched enough. This article a review is made about what has been researched and written, essential subject in the field education in Nursing, as well as some reflections and stance of association from Mexico and The Caribbean region, of the Red Iberoamericana de Investigación en Educación en Enfermería (RIIEE).

Evaluación del cumplimiento de la elevación de la cabecera de la cama en pacientes críticamente enfermos sometidos a ventilación mecánica en una unidad de cuidados intensivos polivalente / Evaluation of the compliance with the elevation of the head of the bed in critically ill patients undergoing mechanical ventilation in a polyvalent intensive care unit

Objetivos. Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar losfactores que pueden influir sobre el cumplimientoy comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación...

Budd-Chiari Syndrome in a Patient with JAK-2 V617F and Factor V G1691A Mutations.

Myeloproliferative neoplasms (MPN) are considered a risk factor for Budd-Chiari syndrome (BCS). The current classification of MPN by the World Health Organization is based on the presence of JAK-2 V617F somatic mutation, which is present in 40 to 60% of patients with BCS. Factor V Leiden mutation is found in around 53% of patients with BCS, representing the most common prothrombotic disease associated with the disorder. We describe a 48-year old woman with a past medical history of deep venous thrombosis in the left upper extremity and one episode in both lower extremities, one episode of transient ischaemic attack and essential thrombocythemia, who presented with jaundice, ascites and hepatomegaly. Budd-Chiari syndrome was diagnosed based on findings on Doppler ultrasound and liver biopsy. Doppler ultrasound showed narrowness of hepatic veins and inferior vena cava in its hepatic portion, diffuse echotexture and portal hypertension. Liver biopsy showed congestion of sinusoids and portal fibrosis. The patient was found to be a heterozygous carrier of Factor V and homozygous wild type G20210A prothrombin mutations. The JAK-2 V617F mutation was detected by allele-specific polymerase chain reaction (AS-PCR). The association of these mutations is rare, with only a few cases reported in the literature. The patient was treated with oral anticoagulation and antiplatelets with good results and proper follow-up. In conclusion, due to the possible coexistence of multiple prothrombotic factors in patients with Budd-Chiari syndrome, the approach to these patients must be focussed on searching for multiple factors and should include the JAK-2 V617F mutation.