Assessing need for advance imaging among children with back pain using pain intensity as clinical marker.

Introduction: Pediatric back pain evaluation nowadays relies on patient history, physical examination, and plain radiographs to identify underlying pathologies. Constant pain, night pain, radicular pain, and abnormal neurological examination were previously recommended as clinical markers to assess the need for magnetic resonance imaging evaluation. Recent studies have challenged the use of these clinical markers, recommending further studies. This study aimed to assess pain intensity as a predictor of underlying magnetic resonance imaging pathology in children with back pain. Methods: An observational cross-sectional study of pediatric patients between 8 and 17 years with back pain for more than 4 weeks from 2009 to 2021 was conducted. A whole spine magnetic resonance imaging was performed on patients with back pain without an identifiable cause and no prior spine treatment. The numerical rating scale questionnaire was administered to each patient, and answers were divided into three groups: mild (1-3), moderate (4-6), and severe (7-10) numerical rating scale score. Student's t-test and chi-square analysis were used to correlate differences between continuous and categorical values, respectively. Results: Of 590 patients (70% female and a mean age of 15.25 years), there were 35.1% of patients had a magnetic resonance imaging underlying pathology. No association was found between severe numerical rating scale score and the presence of underlying MRI pathology (p = 0.666). Patients with low or moderate numerical rating scale scores had similar associations to an underlying magnetic resonance imaging pathology as patients with a severe numerical rating scale score (p = 0.256; p = 0.357, respectively). Conclusions: Back pain intensity was not found to be an effective clinical marker for predicting underlying magnetic resonance imaging pathology in pediatric patients with back pain.

How to adapt sexual and reproductive health services to the needs and circumstances of trans people- a qualitative study in Colombia.

BACKGROUND: People living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people's needs, identities and circumstances. METHODS: This is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people's needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo. RESULTS: Once access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries. CONCLUSIONS: The evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people's needs, identities, and circumstances.

Optimization of silver nanoparticle synthesis by chemical reduction and evaluation of its antimicrobial and toxic activity.

BACKGROUND: Chemical reduction has become an accessible and useful alternative to obtain silver nanoparticles (AgNPs). However, its toxicity capacity depends on multiple variables that generate differences in the ability to inhibit the growth of microorganisms. Thus, optimazing parameters for the synthesis of AgNPs can increase its antimicrobial capacity by improving its physical-chemical properties. METHODS: In this study a Face Centered Central Composite Design (FCCCD) was carried out with four parameters: A g N O 3 concentration, sodium citrate (TSC) concentration, N a B H 4 concentration and the pH of the reaction with the objective of inhibit the growth of microorganisms. The response variables were the average size of AgNPs, the peak with the greatest intensity in the size distribution, the polydispersity of the nanoparticle size and the yield of the process. AgNPs obtained from the optimization were characterized physically and chemically. The antimicrobial activity of optimized AgNPs was evaluated against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans and compared with AgNPs before optimization. In addition, the cytotoxicity of the optimized AgNPs was evaluated by the colorimetric assay MTT (3- (4,5- Dimethylthiazol- 2- yl)- 2, 5 - Diphenyltetrazolium Bromide). RESULTS: It was found that the four factors studied were significant for the response variables, and a significant model (p < 0.05) was obtained for each variable. The optimal conditions were 8 for pH and 0.01 M, 0.0 6M, 0.01 M for the concentration of TSC, A g N O 3, and N a B H 4, respectively. Optimized AgNPs spherical and hemispherical were obtained, and 67.66% of it had a diameter less than 10.30 nm. A minimum bactericidal concentration (MBC) and minimum fungicidal Concentration (MFC) of optimized AgNPs was found against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans at 19.89, 9.94, 9.94, 2.08 µg/mL, respectively. Furthermore, the lethal concentration 50 (L C 50) of optimized AgNPs was found on 19.11 µg/mL and 19.60 µg/mL to Vero and NiH3T3 cells, respectively. CONCLUSIONS: It was found that the factors studied were significant for the variable responses and the optimization process used was effective to improve the antimicrobial activity of the AgNPs.

Odontólogos y Obligación de Denuncia del Abuso Sexual Infantil en Chile: oportunidades perdidas / Dentists and Mandatory Reporting of Child Sexual Abuse in Chile: missed opportunities

RESUMEN: La obligación de denunciar representa la estrategia clave para abordar al abuso sexual infantil, y se encuentra justificada en la suposición de que la detección temprana ayudará a prevenir lesiones graves (incluso la muerte del niño), aliviará a las víctimas de tener que buscar ayuda por su propia cuenta, y potenciará la coordinación entre las respuestas legales, médicas y sociales. Entre los profesionales sanitaristas con esta obligación se encuentran los odontólogos, quienes se han visto firmemente comprometidos a nivel mundial en la detección, denuncia y la prevención del abuso sexual a partir de la asumida y demostrada presencia de lesiones en boca. Sin embargo, y aunque la legislación vigente manifiesta esta obligación de denuncia, los odontólogos en Chile aparentan no estar preparados ni conceptual ni técnicamente para asumir esta responsabilidad, con lo que este tipo de prueba jurídica se encuentra subvalorada, abordada mínimamente por otras disciplinas no idóneas para tal efecto y virtualmente desconocida en los medios judiciales. En resumidas cuentas, una "oportunidad perdida" en un escenario donde las profundas miradas críticas y el severo juicio social obligan a afinar la mirada y ajustar la totalidad de las herramientas disponibles para lograr suficiencia de la prueba.

ABSTRACT: Mandatory reporting represents the key strategy in child sexual abuse cases. It is based on the assumption that early detection will help prevent serious injuries (even the death of the child), will alleviate victims from the responsibility of asking for help themselves, and at their own risk, and will also encourage coordination between legal, medical, and social response units. Among health professionals with a reporting obligation are odontologists. Worldwide, dentists have actively committed to take part in the detection, reporting and prevention of child sexual abuse from presumed and proven lesions in the mouth. However, although current legislation explicitly states this mandatory reporting, it appears that Chilean dentists are neither conceptually nor technically prepared to take on this responsibility. Hence, this type of forensic legal evidence is undervalued, inadequately addressed within other medical professions, and practically unknown in the judicial system. In summary, this is a "missed opportunity" in circumstances that warrant serious scrutiny, resulting in severe social judgment and criticism. A complete review and regulation of the guidelines in this area must be carried out in order to use all means available, and apply legal measures to provide the necessary proof in these cases.

[Surgical approach of traumatic urethral injury in children. Experience at San Vicente of Paul Universitary Hospital. Medellín 1987-2007]. / Experiencia en reconstrucción postraumática de uretra posterior en niños. Hospital Universitario San vicente de Paúl. Medellín 1987-2007.

OBJECTIVE: In order to evaluate the efficacy of different surgical techniques for the correction of traumatic lesions of the urethra, we performed a retrospective study in those patients, and evaluated different complications such as postsurgical stenosis of the urethra, incontinence and impotence (erectile dysfunction). METHODS: A retrospective study was conducted, reviewing the clinical charts of 43 patients admitted to the San Vicente of Paul Hospital, with diagnosis of traumatic rupture of the posterior urethra from 1987 to 2007. We analyzed different demographic data, type of surgical correction, early and late complications. RESULTS: The average age of the patients was 7.7 years, the average follow up was 30.6 months, and all the patients were male with a posterior urethral rupture. 27 Patients underwent a primary urethral repair (63%), 13 patients underwent a cistostomy with later urologic reconstruction (30%), in 3 patients (7%) other surgical procedures were made. Overall complication rate was 39.5%. These complications were: Urethral stenosis, 26 patients (60.5%), urinary retention secondary to obstruction, 10 patients (23.3%), incontinence 10 patients (23.3%) and impotence 7 patients (16.3%). Patients treated with a primary urethral repair presented a significantly less development of infection, obstruction and stenosis, (p<0.05). Patients with pelvis fracture associated to urethral trauma had a significant higher risk of developing stenosis and impotence. (p<0.05). CONCLUSIONS: Both different surgical techniques compared showed a similar complication and morbidity rates in middle follow up. Each procedure should be selected according to clinical condition of the patient, the extension of the urethral damage, the associated traumatic lesions and the surgeon's expertise. In our searched patients, treated with a primary urethral repair we found a significantly less development of infection, obstruction and stenosis.

Experiencia en reconstrucción postraumática de uretra posterior en niños. Hospital Universitario San Vicente de Paúl. Medellín 1987-2007 / Surgical approach of traumatic urethral injury in children. Experience at San Vicente of Paul Universitary Hospital. Medellin 1987-2007

Objetivo: Explorar el desenlace de los diferentes abordajes quirúrgicos para el tratamiento del trauma de uretra en los pacientes pediátricos, evaluando en cada caso, sus secuelas tales como son la estenosis, la incontinencia y la impotencia. Métodos: Se revisaron en forma retrospectiva las historias clínicas de 43 pacientes que consultaron al servicio de urgencias del Hospital Infantil San Vicente de Paúl, con ruptura de la uretra posterior, desde el año 1987 hasta el 2007. En estos pacientes se evaluaron los datos demográficos, el tipo de procedimiento quirúrgico realizado y las complicaciones tempranas y tardías. Resultados: El tiempo promedio de seguimiento fue de 30.6 meses, y el promedio de edad, al momento del trauma, fue de 7,7 años. Todos los pacientes fueron del sexo masculino y todos con ruptura de uretra posterior. En 27 pacientes se realizó uretroplastia primaria (62,8%), en 13 se realizó cistostomía y reparo tardío (30,2%) y en 3 pacientes se realizaron otros procedimientos (7%). El 39,5% de los pacientes presentaron en algún momento del seguimiento complicaciones. En el grupo de pacientes estudiados, las complicaciones fueron estenosis uretral en 26 pacientes (60,5%), retención urinaria por obstrucción en 10 pacientes (23,3%), la incontinencia en10 pacientes (23.3%) y la impotencia en 7 pacientes (16,3%).Los pacientes en los cuales se realizó uretroplastia primaria presentaron un riesgo significativamente menor de desarrollar infección, obstrucción y estenosis. Aquellos pacientes con fractura de pelvis asociada al trauma uretral, tuvieron un riesgo significativamente mayor de desarrollar estenosis e impotencia (p<0,05). Conclusión los diferentes abordajes quirúrgicos utilizados presentan tasas de complicación y de morbilidad a mediano plazo similares. El procedimiento de elección debe ser individualizado de acuerdo a las características del paciente, la extensión del daño uretral, las lesiones asociadas y la experiencia del cirujano en el manejo del trauma uretral. En nuestro estudio encontramos que los pacientes en los cuales se realizo uretroplastia primaria presentaron un menor riesgo de infección, estenosis y obstrucción (AU)

Objective: In order to evaluate the efficacy of different surgical techniques for the correction of traumatic lesions of the urethra, we performed a retrospective study in those patients, and evaluated different complications such as postsurgical stenosis of the urethra, incontinence and impotence (erectile dysfunction).Methods: A retrospective study was conducted, reviewing the clinical charts of 43 patients admitted to the San Vicente of Paul Hospital, with diagnosis of traumatic rupture of the posterior urethra from 1987 to 2007. We analyzed different demographic data, type of surgical correction, early and late complications. Results: The average age of the patients was 7.7 years, the average follow up was 30.6 months, and all the patients were male with a posterior urethral rupture. 27 Patients underwent a primary urethral repair (63%), 13 patients underwent a cistostomy with later urologic reconstruction (30%), in 3patients (7%) other surgical procedures were made. Overall complication rate was 39.5%. These complications were: Urethral stenosis, 26 patients (60.5%), urinary retention secondary to obstruction, 10 patients (23.3%), incontinence 10 patients (23.3%) and impotence 7 patients (16.3%). Patients treated with a primary urethral repair presented a significantly less development of infection, obstruction and stenosis. (p<0.05). Patients with pelvis fracture associated to urethral trauma had a significant higher risk of developing stenosis and impotence. (p<0.05). Conclusions: Both different surgical techniques compared showed a similar complication and morbidity rates in middle follow up. Each procedure should be selected according to clinical condition of the patient, the extension of the urethral damage, the associated traumatic lesions and the surgeon`s expertise. In our searched patients, treated with a primary urethral repair we found a significantly less development of infection, obstruction and stenosis (AU)

Carcinoma anaplastico de tiroides: biopsia aspiracion con aguja fina para su diagnostico / Anaplastic thyroid carcinoma: BiopSia fine needle aspiration for diagnosis

Se presentan 5 pacientes con carcinoma anaplásico de tiroides que consultaron al Hospital Pablo Tobón Uribe (H.P.'f.U.) de Medellín, Colombia, durante el periodo comprendido entre enero de 1995 y diciembre de 2001 con cuadros clínicos de diferentes características y tiempo de evolución. El carcinoma anaplásico es considerado una de las neoplasias más agresivas y fatales en el hombre; constituye aproximadamente el 5 al 14% de los tumores malignos de la glándula tiroides. El tumor presenta un pico de incidencia en la séptima década de la vida y la relación hombre-mujer es de 1.3 a 1; el 20% de los pacientes tiene historia previa de neoplasia tiroidea bien diferenciada y el 30% historia de bocio. La biopsia aspiración con aguja fina hace el diagnóstico en el carcinoma anaplásico de tiroides en un 94.7% vs. 90% de los casos según la literatura; la citomorfología es altamente específica y fácil de reconocer y se considera el método de elección en este tipo de carcinoma. Los cinco pacientes pertenecían al sexo femenino, su edad oscilaba entre 60 y 70 años. El tiempo de evolución de la enfermedad fue aproximadamente de dos meses, 3 pacientes presentaban patología tiroidea previa y los síntomas predominantes fueron la obstrucción de la vía aérea superior, disfonía y síndrome de vena cava; se llegó al diagnóstico de estas pacientes a través de BACAF ( Biopsia Aspiración con Aguja Fina) en dos pacientes y se confirmó con el estudio del espécimen quirúrgico. El tratamiento realizado fue radioterapia en una paciente y cirugía en dos pacientes; una de estas recibió además radioterapia; dos pacientes no recibieron tratamiento y la sobrevida fue de 4 meses.

La evolución / Evolution

A manera de introducción citaremos un fragmento del libro del físico químico Peter Atkins de Oxford, con su interesante libro la creación, en el cual dice: Llevaré tu mente a un viaje. Es un viaje de entendimiento, que nos llevará al borde del espacio, el tiempo y la comprensión. Durante el mismo discutiré que no hay nada que no pueda ser comprendido, que no hay nada que no pueda ser explicado y que todas las cosas son extraordinariamente simples... Una gran parte del universo no necesita ninguna explicación. Por ejemplo, los elefantes. Una vez que las moléculas han aprendido a competir y a crear otras moléculas a su propia imagen, los elefantes y las cosas que son como los elefantes se encontrarán, a su debido tiempo, vagando por los campos. En este trabajo trataremos, un tema muy complejo y de por si muy extenso, abarcarlo todo en tan solo unas páginas es más que imposible. La evolución es un tema muy discutido, son muchas las corrientes que surgen a su alrededor alternativas, científicas, e incluso la religión está relacionada con este tema. El hombre siempre ha querido conocer sus orígenes, dando hipótesis, teorías, religiones, dogmas, mitos y leyendas. Pero la discusión está latente y seguirá así por muchos años. Quiénes somos y de dónde venimos? Una incógnita universal que siempre estará en las mentes de los hombres...