Os desamparos da maternidade em um contexto de vulnerabilidade social / The helplessness of motherhood in a context of social vulnerability / El desamparo de la maternidade en un contexto de vulnerabilidad social

Algumas mães, mesmo acompanhadas de um parceiro, desempenham solitariamente múltiplos papéis, cuidando da rotina de casa, do trabalho e, precariamente, de si mesmas. Com o objetivo de discutir a maternidade em um contexto de vulnerabilidade e suas implicações no estabelecimento da relação mãe e filhos, a partir de um caso, utilizou-se um método observacional psicanalítico inspirado no Método Bick de Observação, sendo uma pesquisa qualitativa. As observações foram realizadas considerando os três tempos: observação semanal, no mesmo dia e hora; relato da observação, de forma descritiva e implicada; e, seminário de supervisão, para discussão das observações. Evidenciou-se o desamparo sentido por essa mulher-mãe que, apesar da presença da família e do esposo, não recebia o apoio necessário. Sua exaustão, oriunda do desamparo, resultava em perda de controle emocional em relação aos filhos. Ressalta-se o valor do Método Bick de Observação ao possibilitar um olhar sensível à maternidade

Some mothers, even when joined by a partner, end up playing multiple roles alone, taking care of the household chores, their work lives and, precariously, of themselves. In order to discuss motherhood in a context of vulnerability and its implications in the establishing of the relationship between a mother and her children, based on a specific case, an psychoanalytic observational method inspired by the Bick Method of Observation was employed, being a qualitative research. The observations were carried out considering three tempos: weekly observation, on the same day and time; observation report, in an involved and descriptive way; and supervision seminar, to discuss the observations. It was made evident the helplessness experienced by this woman-mother, who, despite the presence of her husband and family, did not receive the necessary support. Her exhaustion, stemming from this helplessness, resulted in a loss of emotional control over her children. The value of the Bick Observation Method is highlighted, as it enables a sensitive outlook towards motherhood

Algunas madres, incluso las acompañadas de pareja, desempeñan múltiples papeles solas, cuidando la rutina de la casa, el trabajo y, precariamente, ellas mismas. Para discutir la maternidad en un contexto de vulnerabilidad y sus implicaciones para el establecimiento de la relación entre las madres y sus hijos, a partir de un caso, se utilizó un método observacional psicoanalítico inspirado en el Método de Observación Bick, haciendo de esta una investigación cualitativa. Las observaciones se realizaron considerando los tres tiempos: observación semanal, en el mismo día y hora; informe de la observación, de forma descriptiva y implícita; y, seminario de supervisión, para discutir las observaciones. Se hizo evidente el desamparo que siente esta mujer-madre, quien, a pesar de la presencia de su familia y esposo, no recibe el apoyo necesario. Su agotamiento, derivado del desamparo, resultó en una pérdida del control emocional sobre sus hijos. Se destaca el valor del método de observación de Bick, que permite una mirada sensible a la maternidad

Transformations to regenerative food systems-An outline of the FixOurFood project.

This paper provides an outline of a new interdisciplinary project called FixOurFood, funded through UKRI's 'Transforming UK food systems' programme. FixOurFood aims to transform the Yorkshire food system to a regenerative food system and will work to answer two main questions: (1) What do regenerative food systems look like? (2) How can transformations be enabled so that we can achieve a regenerative food system? To answer these questions, FixOurFood will work with diverse stakeholders to change the Yorkshire food system and use the learning to inform change efforts in other parts of the UK and beyond. Our work will focus on shifting trajectories towards regenerative dynamics in three inter-related systems of: healthy eating for young children, hybrid food economies and regenerative farming. We do this by a set of action-orientated interventions in schools and the food economy, metrics, policies and deliverables that can be applied in Yorkshire and across the UK. This article introduces the FixOurFood project and concludes by assessing the potential impact of these interventions and the importance we attach to working with stakeholders in government, business, third sector and civil society.

Ultrasonografía del diámetro de la vaina del nervio óptico en paciente con meningoencefalitis complicada / Ultrasonography of the optic nerve sheath diameter in patient with complicated meningoencephalitis

RESUMEN La ultrasonografía del diámetro de la vaina del nervio óptico es un método no invasivo para monitorizar la presión intracraneal. Se ha utilizado en múltiples patologías neurocríticas, incluyendo la infección complicada del sistema nervioso central. Se presenta el caso de una paciente femenina de 47 años, quien ingresó en la Unidad de Cuidados Intensivos luego de presentar progresión al estado comatoso secundario a cuadro de meningoencefalitis bacteriana. Al ingreso se constata midriasis bilateral arreactiva, ausencia parcial de reflejos del tallo encefálico y bradicardia. Ante la sospecha clínica de hipertensión intracraneal, se indica ultrasonografía del diámetro de la vaina del nervio óptico en plano axial. Se realizaron tres mediciones para cada ojo, mostrando un valor de 6,3, 6,6 y 6,00 mm en ojo derecho, y 6,8, 6,6 y 6,8 mm en el izquierdo (promedio biocular: 6,5 mm). Con esta medición se complementó el diagnóstico sospechado. Esta técnica representa un proceder seguro y no invasivo. Su uso completa los datos recogidos en el examen clínico. El punto de corte universalmente aceptado para el diagnóstico es de 5,0 mm o más para un valor de presión intracraneal > 20 mmHg.

ABSTRACT The optic nerve sheath ultrasonography is a non-invasive method for monitoring intracranial pressure. It has been used in multiple neurocritical pathologies, including the complicated infection of the central nervous system. The case of a 47-year-old female patient is presented; she was admitted to the Intensive Care Unit after presenting progression to comatose state secondary to bacterial meningoencephalitis. On admission, bilateral arreactive mydriasis, partial absence of brainstem reflexes and bradycardia are confirmed. Given the clinical suspicion of intracranial hypertension, ultrasonography of the optic nerve sheath diameter in the axial plane is indicated. Three measurements were made for each eye, showing a value of 6.3, 6.6 and 6.00 in the right eye, and 6.8, 6.6 and 6.8 in the left one (biocular average: 6.5 mm). With this measurement the suspected diagnosis was completed. This technique represents a secure and non-invasive procedure. Its use completes the data collected in the clinical examination. The universally accepted cut-off point for diagnosis is 5.0 mm or more for an intracranial pressure value of > 20 mmHg.

Building community resilience in a context of climate change: The role of social capital.

Social capital is considered important for resilience across social levels, including communities, yet insights are scattered across disciplines. This meta-synthesis of 187 studies examines conceptual and empirical understandings of how social capital relates to resilience, identifying implications for community resilience and climate change practice. Different conceptualisations are highlighted, yet also limited focus on underlying dimensions of social capital and proactive types of resilience for engaging with the complex climate change challenge. Empirical insights show that structural and socio-cultural aspects of social capital, multiple other factors and formal actors are all important for shaping the role of social capital for guiding resilience outcomes. Thus, finding ways to work with these different elements is important. Greater attention on how and why outcomes emerge, interactions between factors, approaches of formal actors and different socio-cultural dimensions will advance understandings about how to nurture social capital for resilience in the context of climate change.

Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic.

In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training's effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs' ratings strongly indicated that providers' application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.

Ultrasonografía del diámetro de la vaina del nervio óptico en el monitoreo de la presión intracraneal / Ultrasound of optic nerve sheath diameter for monitoring intracranial pressure

Introducción: El neuromonitoreo no invasivo en pacientes críticos representa una opción de primera línea para el manejo de complicaciones fatales derivadas del aumento de la presión intracraneal. En esta modalidad se incluye la ultrasonografía del diámetro de la vaina del nervio óptico, la cual representa una técnica rápida, fácil de realizar y disponible a la cabecera del paciente. Objetivos: Describir aspectos fundamentales y actualizados sobre el uso de la ultrasonografía en el monitoreo de la presión intracraneal a través de la medición del diámetro de la vaina del nervio óptico en los diferentes escenarios neuroclínicos. Métodos: Se realizó una revisión de la literatura publicada en bases de datos como: PubMed/Medline, SciELO y Google académico entre los meses mayo y julio de 2020. Se revisaron publicaciones en inglés y español. Se seleccionaron 46 bibliografías que cumplieron con los criterios de inclusión. Se describen aspectos fundamentales como la anatomía ecográfica del nervio óptico, descripción de la técnica y su uso en entidades neurocríticas como el traumatismo craneoencefálico, ictus, muerte encefálica, entre otros. Conclusiones: La ecografía de la vaina del nervio óptico representa una alternativa no invasiva ampliamente aceptada para la medición del incremento de la presión intracranial. Con un diámetro de 5,0 hasta 5,9 mm o más se puede asumir el diagnóstico de hipertensión intracraneal con alta sensibilidad y especificidad, aunque debe individualizarse su uso en cada patología neurocrítica. La curva de aprendizaje para la realización del proceder es de breve tiempo y satisface las habilidades necesarias(AU)

Introduction: Noninvasive neuromonitoring in critically ill patients is a first-line option for the management of fatal complications derived from increased intracranial pressure. This modality includes ultrasound of optic nerve sheath diameter, which is a quick technique, easy to perform and available at the bedside. Objectives: To describe significant and state-of-the-art aspects regarding the use of ultrasound for monitoring intracranial pressure through measurement of the optic nerve sheath diameter in different neuroclinical settings. Methods: A review was carried out, between May and July 2020, of the literature published in databases such as PubMed/Medline, SciELO and Google Scholar. Publications in English and Spanish were reviewed. Forty-six bibliographic sources were chosen, as long as they met the inclusion criteria. Fundamental aspects are described, such as the ultrasound anatomy of the optic nerve, the technique procedures and its use in neurocritical entities such as head trauma, stroke and brain death, among others. Conclusions: Ultrasound of the optic nerve sheath is a widely accepted noninvasive choice for measurement of increased intracranial pressure. With a diameter of 5.0 to 5.9 mm or more, the diagnosis of intracranial hypertension can be assumed with high sensitivity and specificity, although its use should be individualized in each neurocritical pathology. The learning curve for carrying out the procedure is short and satisfies the necessary skills(AU)

Saúde mental e Covid-19: uma revisão integrativa da literatura / Mental health and Covid-19: an integrative literature review

RESUMO A pandemia do novo coronavírus (Covid-19) é uma realidade no Brasil e no mundo com potencial para desencadear sintomas psicológicos. O objetivo deste trabalho foi realizar uma revisão integrativa da literatura sobre saúde mental e pandemias. Foram cruzados os unitermos "saúde mental AND Covid-19 OR coronavírus OR pandemias AND intervenções em saúde mental OR psicotrópicos OR sintomatologia psiquiátrica OR psicopatologias OR fator de proteção em saúde mental" nas bases Scientific Electronic Library Online, Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde e National Library of Medicine (PubMed), resultando em 1.642 artigos publicados em português, inglês e espanhol, no período de 2015 a 2020. Foram selecionados 43 artigos, de acordo com critérios de inclusão e exclusão, e todos foram publicados em 2020, referindo-se ao primeiro ano da pandemia de Covid-19. Sintomas depressivos e ansiosos, estresse e insônia foram frequentemente relatados e estiveram relacionados a ser profissional da saúde, adulto jovem, mulher; ter menor escolaridade e renda, histórico de doença crônica ou transtorno psiquiátrico e maior exposição nas mídias. Algumas intervenções psicológicas podem ser utilizadas para minimizar os impactos negativos da pandemia de Covid-19. Além disto, fatores de proteção podem ser explorados para reduzir os prejuízos na saúde mental dos indivíduos e das coletividades.

ABSTRACT The new coronavirus pandemic (Covid-19) is a reality in Brazil and worldwide, with potential to generate psychological symptoms. The aim of this study was to carry out an integrative literature review of mental health and pandemics. We used the crossing of the keywords: "mental health AND Covid-19 OR coronavirus OR pandemics AND mental health interventions OR psychotropics OR psychiatric symptoms OR psychopathologies OR protective factor in mental health" in Scientific Electronic Library Online, Latin American and Caribbean Center on Health Sciences Information and National Library of Medicine - PubMed databases, with 1.642 articles published in Portuguese, English and Spanish. After reading the titles, the preselection abstracts and following inclusion and exclusion criteria, 43 studies were included in this review. All articles were from 2020 and referred to the first year of the Covid-19 pandemic. Several reports of depression and anxiety symptoms, stress and insomnia were found and were related to being a health professional, young adult, woman, low level of education and income, history of chronic illness or psychiatric disorder and high media exposure. Some psychological interventions can minimize the negative impacts of the Covid-19 pandemic and protective factors can reduce damage to mental health of individuals and communities.

Diversity lost: COVID-19 as a phenomenon of the total environment.

If we want to learn how to deal with the COVID-19 pandemic, we have to embrace the complexity of this global phenomenon and capture interdependencies across scales and contexts. Yet, we still lack systematic approaches that we can use to deal holistically with the pandemic and its effects. In this Discussion, we first introduce a framework that highlights the systemic nature of the COVID-19 pandemic from the perspective of the total environment as a self-regulating and evolving system comprising of three spheres, the Geosphere, the Biosphere, and the Anthroposphere. Then, we use this framework to explore and organize information from the rapidly growing number of scientific papers, preprints, preliminary scientific reports, and journalistic pieces that give insights into the pandemic crisis. With this work, we point out that the pandemic should be understood as the result of preconditions that led to depletion of human, biological, and geochemical diversity as well as of feedback that differentially impacted the three spheres. We contend that protecting and promoting diversity, is necessary to contribute to more effective decision-making processes and policy interventions to face the current and future pandemics.

Signo de la arteria cerebral media hiperdensa e ictus isquémico con transformación hemorrágica / Hyperdense Middle Cerebral Artery Sign and Ischemic Stroke with Hemorrhagic Transformation

RESUMEN El signo de la arteria cerebral media hiperdensa es un patrón imagenológico que tiene una incidencia de un 30 a un 40 % de las oclusiones de esta arteria demostrada angiográficamente. Representa un signo temprano de ictus isquémico de mala evolución. Se presenta el caso de un paciente de 56 años de edad que comenzó con manifestaciones clínicas de afasia y hemiparesia derecha a predominio crural. En la tomografía al ingreso se observó hiperdensidad del trayecto de la arteria cerebral media izquierda que correspondió con un ictus isquémico extenso con conversión hemorrágica en escaneo evolutivo a las 72 horas. Se presenta el caso por lo poco frecuente que resulta realizar este diagnóstico a partir de los resultados hallados en la tomografía axial monocorte y porque hubo correlación entre las imágenes encontradas y el deterioro clínico posterior del paciente.

ABSTRACT The hyperdense middle cerebral artery sign is an imaging pattern that has an incidence from 30 to 40 % of occlusions of this artery demonstrated angiographically. It represents an early sign of poorly progressive ischemic stroke. A 56-year-old patient who began with clinical manifestations of aphasia and right hemiparesis, predominantly femoral it is presented. On admission tomography, hyperdensity of the left middle cerebral artery trajectory was observed, corresponding to an extensive ischemic stroke with hemorrhagic conversion in evolutionary scan at 72 hours. The case is presented because of how infrequent it is to make this diagnosis based on the results found in the single slice axial tomography and because there was a correlation between the images found and the subsequent clinical deterioration of the patient.

El odontólogo: actual pandemia y su legado / The dentist: current pandemic and its legacy

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Calle 13 y su discurso social

Calle 13 era una banda puertorriqueña que a lo largo de su trayectoria musical produjo diferentes canciones que abren los ojos a la realidad por su discurso social y temas controversiales. También, estas promueven la búsqueda de identidad y resistencia a la opresión. Este artículo propone el análisis del último disco de la banda, Multi Viral (2014), el cual está dividido en diferentes apartados, como las raíces y las influencias del estilo de la banda con La Nueva Canción y el folclore. Además se explicarán temáticas como la violencia, manipulación, desigualdad y represión, presentadas en las canciones "El aguante", "Multi Viral", "Adentro" y "Cuando los pies besan el piso".

Calle 13 was a Puerto Rican band that throughtout its musical trajectory produced different songs that open the eyes due to social discourse and controversial subjects. Also, these songs promote the identity search and resistance to oppression. Thus, this article proposes an analysis about the band's last record, Multi Viral (2014); it is divided in different sections as the roots and the style influences of the band with La Nueva Canción and the folklore. Moreover, it explains topics like violence, manipulation, inequality and repression, that are presented in the songs "El aguante", "Multi Viral", "Adentro", and "Cuando los pies besan el piso".

[Pediatric acute liver failure. Working group of the Latinamerican Society of Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN).] / Insuficiencia hepática aguda pediátrica. Grupo de trabajo de la Sociedad Latinoamericana de Gastroenterología, Heapatología y Nutricion Pediátrica (SLAGHNPP).

Pediatric acute liver failure is a syndrome ofsevere and sudden dysfunction of the hepatocytes which produces a failure in synthetic and detoxifyingfunction. It is an infrequent and severe disease butpotentiallyfatal, occurring in children with no prior history of liver disease. Etiology is related to the age and geographic region of the patient, recognizing the origin: metabolic, infectious, drug exposure, autoinmune, vascular and oncologic. Indeterminate cause where all the etiological search is negative, can range between 18 and 47%, depending on the center and access to the realization of etiological studies. The process which determines the liver injury is still not well known and is considered multifactorial. Essentially, it depends on host susceptibility, the cause and severity of the damage and the ability of liver regeneration. The clinical presentation depends on the etiology, which usually begins with an episode ofacute hepatitis, that in the following days or weeks presents unfavorable outcome, deepening jaundice, affecting the general state and presenting severe coagulopathy that characterizes the syndrome. The treatment consists of general measures which take into account the metabolic disorders, nutritional aspect, and the prevention and treatment of all complications that occur in the evolutionary course (infectious, neurological, etc). Besides it is also vital to implement the specific treatment of those diseases which can benefit from it (alloimmune hepatitis, galactosemia, tyrosinemia, herpes simplex infection, Wilson's disease, etc.). However, despite therapeutic advances, acute liver failure results in death or liver transplantation in over 45% ofcases.

Sigilo e integralidade no cuidado em saúde mental: desafios à atuação do psicólogo no Sistema Único de Saúde / Secrecy and integrality in mental health care: challenges to the performance of psychologists in the SUS

A Reforma Psiquiátrica propôs inúmeras mudanças no cuidado em saúde mental, e os profissionais que atuam nesse campo são desafiados a promover esse cuidado diferenciado. O objetivo deste estudo foi identificar a percepção de psicólogos que atuam nos Centros de Atenção Psicossocial (CAPS), de um município da região metropolitana de Porto Alegre (RS), acerca da relação entre sigilo e integralidade no trabalho em saúde mental. Trata-se de uma pesquisa qualitativa, descritiva e exploratória que entrevistou 10 psicólogos. Foram realizadas entrevistas semiestruturadas que foram analisadas a partir dos pressupostos da Análise Temática (Minayo, 2010). Os resultados demonstram que os psicólogos consideram um grande desafio aliançar atenção integral com garantia de sigilo, pois há a necessidade de comprometimento e esforço coletivo no resguardo dos direitos dos usuários do CAPS. Considera-se imprescindível que novas pesquisas enfoquem o sigilo no cuidado em saúde mental, visto que há pouca produção científica a esse respeito.

The Psychiatric reform proposed several changes in the caring of mental health and the professionals that work in this field, are challenged to promote this kind of differentiated care. The objective of this study was to identify the perception of psychologists that work in the Psycosocial Care Center (CAPS), from a city located in the suburb of Porto Alegre (State of Rio Grande do Sul, Brazil), about the relation between confidentiality and integrity in the daily operation in mental health. This work is about a quality, descripted and exploratory research that analysed the answers of 10 psychologists. Semistructured interviews were realized, that later were analyzed taking on bases assumptions of the Thematic Analysis ( Minayo, 2010). The results demonstrate that psychologists consider a challenge to ally comprehensive care with guaranteed confidentiality, since there is the need for commitment and collective efforts in the protection of the rights of CAPS users. It is considered essential that further research take the issue of confidentiality in mental health care in the public health network , since there is little scientific literature on this subject .

Assessing Compliance With Established Pneumonia Core Measures at a Comprehensive Cancer Center.

Healthcare organizations use Pneumonia Core Measures (PCMs) to ensure delivery of high-quality care. In this study, a multidisciplinary team was organized to optimize care and enhance compliance in a comprehensive cancer emergency center. We performed a four-phase study, three of which were interventional: intense education regarding PCM; microbiologic analysis of the pathogens responsible for the pneumonias; development and implementation of an institutional pneumonia algorithm and order set. In phase 4, we analyzed five PCMs. The percentage of pneumonia patients from whom blood cultures were obtained increased from 73% to 91% after intervention (p < .001); sputum cultures increased from baseline 24.6% to 51% (p = .004) post order-set implementation, and order-set utilization increased from 40% to 77%. We achieved the benchmark for only one PCM, PN 3a. More than 80% of patients met clinical and microbiological criteria for healthcare-associated pneumonia. We identified a gap between our patient population and some PCMs that relates to antibiotics selection. The treatment of cancer patients and pneumonia falls outside established guidelines for treating community-acquired pneumonia. Although the algorithm and order set implemented optimized care and minimized variation, national benchmarks for four of the PCMs were not met. Our findings provide information for policymakers considering pneumonia measurements for antibiotic selection in a cancer care setting.

Pesquisa de cáncer de mama por Mamografía. Hospital Celia Sánchez Manduley, Enero 2010-2011 / Breast cancer investigation with Mammography. Celia Sánchez Manduley Hospital. January 2010 - 2011

Se realizó un estudio descriptivo, prospectivo y analítico a trabajadoras de la vicedirección de aseguramientos médicos del Hospital Celia Sánchez Manduley en el periodo enero 2010 enero 2011, con el propósito de pesquisar cáncer de mama por mamografía. El universo estuvo constituido por 262 mujeres y la muestra por 248 pacientes de 40 y más años, a las cuales se les realizó mamografía tomando en consideración las siguientes variables: edad, factores de riesgos, hallazgos mamográficos; así como diferenciar lesiones benignas y malignas según signos radiológicos. Los resultados obtenidos arrojaron que el riesgo de padecer lesiones mamarias aumenta con la edad, que el destete precoz fue el factor de mayor causalidad y que la enfermedad se presentó con más frecuencia en mujeres con factores de riesgos, existiendo fuerza de asociación entre la causa y el efecto. Predominaron las calcificaciones en mujeres postmenopáusicas y los nódulos en premenopáusicas; el grupo etáreo de mayor incidencia fue el de 55-59 años, prevalecieron individualmente hallazgos mamográficos de benignidad. Se realizan recomendaciones para promover la detección del cáncer de mama en etapas tempranas(AU)

It was carried out a descriptive, prospective and analytic study to workers from the medical insurance vice-direction at Celia Sánchez Manduley Hospital in the period from January 2010 to January 2011, with the intention to investigate breast cancer by mammography. The universe was constituted by 262 women and the sample by 248 patients of 40 years and older, applying the mammography to them, taking into consideration the following variables: age, risk factors, mammographic findings; benign and malignant lesions were differentiated as well. The results obtained showed that the risk of suffering from mammary lesions increases with age and precociously stop weaning was the most frequent factor and that the disease appears more frequently in women having risk factors, showing great association between the cause and the effect. The calcifications prevailed in post-menopausic women and the nodules in premenopausic ones; the age group with a greatest incidence was the one from 55 to 59 years, benign findings prevailed individually. Recommendations were made to promote breast cancer detection in the early stages(EU)

Tomografía axial computadorizada en traumatismos encéfalocraneanos. Experiencia en 6 años: Enero 2006-Diciembre 2012 / Computerized axial tomography in encephalocranial traumatisms. Six years of experience: January 2006- December 2012

En la actualidad se ha observado un significativo incremento del trauma craneal relacionado fundamentalmente con los accidentes automovilísticos, que constituyen una de las principales causas de morbilidad y mortalidad en muchos países y específicamente en Cuba. Este hecho convierte el traumatismo craneoencefálico en una problemática de marcado impacto epidemiológico. La tomografía axial computadorizada proporciona información rápida y no invasiva en estos casos. Se realizó un estudio descriptivo prospectivo en pacientes con traumatismos craneoencefálicos, a los que se les practicó tomografía axial computarizada, en el departamento de Imagenología del Hospital Universitario Clínico Quirúrgico Docente Celia Sánchez Manduley de Manzanillo, Granma, en el período comprendido desde enero 2006 a diciembre de 2012, con el objetivo de describir los resultados del estudio tomográfico. El universo estuvo constituido por todos los pacientes que llegaron al cuerpo de guardia con traumatismo cráneo encefálico y que le indicaron tomografía axial computarizada. Se tuvieron en cuenta variables como: edad, sexo y resultados de la tomografía inicial. Los resultados mostraron que el grupo de edad más afectado fue el comprendido entre 41-50 años, así como el sexo masculino, hubo un predominio de pacientes con examen tomográfico positivo y el hematoma subdural y los focos contusionales fueron las lesiones encontrada con mayor frecuencia, el hematoma epidural fue la lesión que más se asoció a fractura, el edema cerebral y el efecto de masa están presentes en gran número de lesiones extracerebrales(AU)

Nowadays it has been observed a significant increase of the cranial trauma, mainly related to car accidents, what constitute one of the main causes of morbility and mortality in lots of countries and specifically in Cuba. This fact turns the encephalocranial traumatisms into a problem of epidemiological impact. The computerized axial tomography provides fast and non- invasive information in these cases. It was performed a descriptive and prospective study in patients with traumatic brain injuries, and it was applied the computerized axial tomography to them, in the Imaging department of the Clinical Surgical University Teaching Hospital Celia Sánchez Manduley of Manzanillo, Granma, in the period between January 2006 to December of 2012, with the aim to describe the results of the tomographic study. The universe was constituted by all the patients that came to the emergency service with cranio encephalic traumatism and it was applied the computerized axial tomography to them. There were taken into account some variables like: age, sex and the results of the initial tomography. The results showed that the most affected group of age was between 41-50 years, as well as the male sex, there was a predominance of patients with positive tomographic examination and the subdural hematoma and the contusional foci were the injuries with greater frequency, the epidural hematoma was mostly associated to fractures, the cerebral edema and the mass effect were presented in great numbers of extracerebral injuries(EU)

Hepatitis B y C en pacientes oncológicos / Hepatitis B and C oncological patients

La mayoría de los niños que padecen enfermedades hemato-oncológicas reciben múltiples transfusiones y esto aumenta el riesgo para adquirir estas infecciones. Por otro lado, en estos niños inmunosuprimidos la infección suele ser subclínica. Suele diagnosticarse al observar elevación de aminotransferasas. Evaluar la respuesta al tratamiento de hepatitis en niños con antecedentes oncológicos. 80 pacientes con antecedentes de tratamiento hematoncológico, del año 2000 a 2008 con serologías positivas para hepatitis viral. 39 (48,75%) presentan Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfección Hepatitis B y C. En el grupo HBV, 7 negativizaron espontáneamente DNAHBV. 20 recibieron tratamiento con diferentes esquemas: 3 IFN, 4 lamivudina, 3 lamivudina + IFN, 10 Lamivudina + PEG; 7/20 negativizaron ADN VHB. 6/10 con tratamiento combinado negativizaron DNAHBV (60%). En el grupo con Hepatitis C, todos genotipo 1; 3 negativizaron RNAHCV espontáneamente; 10 recibieron tratamiento, 3/10 tratados con IFN + RIBAVIRINA y 7 con PEG + RIBAVIRINA. 1/3 y 4/7 (57,14%), negativizaron RNAHCV, respectivamente. En el grupo con coinfección, 14 tratados: 2 IFN; 4 IFN + RIBAVIRINA; 8 PEG + RIBAVIRINA. 11/12 con esquema combinado culminaron tratamiento; negativizaron 1/11 (9%) DNAHBV y 5/11 (45,45%) RNAHCV. 8/80 desarrollaron complicaciones, cirrosis y hepatocarcinoma. Los pacientes pediátricos presentan respuesta al tratamiento para hepatitis B y C crónicas, similar al del adulto. Hubo diferencia estadísticamente significativa en la respuesta al tratamiento relacionado con el grado de inflamación en pacientes coinfectados. Cirrosis y hepatocarcinoma también se presentan en este grupo de edad...

Most children with hemato-oncological diseases receive multiple transfusions, and this increases the risk of acquiring these infections. On the other hand, in these immunosuppressed children the infection is usually subclinical. It’s usually diagnosed by observing an elevation in aminotransferases figures. To evaluate the response to the treatment for hepatitis in children with a history of cancer. 80 patients with a history of hemato-oncological treatment, from 2000 to 2008, with positive viral hepatitis serologies/for viral hepatitis. 39 (48,75%) had Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfection Hepatitis B and C. In the HBV group, 7 had spontaneous HBV-DNA negative, 20 received treatment with different schemes: 3 IFN, 4 lamivudine, 3 lamivudine + IFN, 10 lamivudine + PEG; 7/20 had HBV-DNA negative. 6/10 with combined treatment had HBV-DNA negative (60%). In the group with Hepatitis C, all genotype 1; 3 had spontaneous HCV-RNA negative; 10 received treatment, of which 3/10 were treated with IFN + RIBAVIRIN and 7 with PEG + RIBAVIRIN. 1/3 and 4/7 (57.14%) had HCV-RNA negative, respectively. In the group with HBV/HCV co-infection, 14 patients treated: 2 IFN, 4 IFN + RIBAVIRIN, 8 PEG + RIBAVIRIN. 11/12 with combined scheme ended treatment; 1/11 (9%) and 5/11 (45,45%) had HBV-DNA and HCV-RNA negative, respectively. 8/80 developed complications, such as, cirrhosis and hepatocellular carcinoma. Pediatric patients presented similar response to adult patients, to the treatment for chronic hepatitis B and C. There was a statistically significant difference in treatment response related to the degree of inflammation in coinfected patients. Cirrhosis and hepatocellular carcinoma are also evidenced in this age group...

Timoma Aberrante en Mediastino Inferoanterior: presentación de un caso / Aberrant thymoma in the anterior mediastinum: a case report

La glándula tímica puede ser el sitio de origen de una gran variedad de neoplasias malignas y benignas. Aunque estos tumores son relativamente infrecuentes en la población general, son de gran interés para la literatura médica por sus manifestaciones clínico-patológicas. Se reporta un caso de una mujer de 45 años de edad quien presentó dolor torácico derecho leve y disnea además de ensanchamiento mediastinal infero anterior derecho, en una radiografía de tórax (vista postero-anterior y lateral). La tomografía computarizada mostró una imagen hiperdensa, con realce de contraste de forma homogenea que hacia cuerpo con la aurícula derecha, desplazándola. Se realizó mediastinotomía transesternal y fue extraido un tumor blando, amarillento, el cual fue diagnosticado histológicamente como un timoma linfocítico(AU)

The thymic gland may be the place for a variety of malign and benign neoplasias. Although these tumors are relatively weird in the population, they are of paramount interest in the medical literature for their clinical- pathological manifestations. It is reported a case of a 45 year-old woman who presented minor right thoracic pain and dispnea with a mediastinal right anterior enlargement perceived in a thoracic radiography (lateral post- anterior view). The computerized tomography showed a hyperdense area, with homogeneous contrast . The transternal mediastinotomy was performed and a soft, yellowish tumor wa spotted. It was histologically diagnosed as a lymphocytic thymoma(EU)