Blockchain in clinical trials: Bibliometric and network studies of applications, challenges, and future prospects based on data analytics.

This study conducts a comprehensive analysis on the usage of the blockchain technology in clinical trials, based on a curated corpus of 107 scientific articles from the year 2016 through the first quarter of 2024. Utilizing a methodological framework that integrates bibliometric analysis, network analysis, thematic mapping, and latent Dirichlet allocation, the study explores the terrain and prospective developments within this usage based on data analytics. Through a meticulous examination of the analyzed articles, the present study identifies seven key thematic areas, highlighting the diverse applications and interdisciplinary nature of blockchain in clinical trials. Our findings reveal blockchain capability to enhance data management, participant consent processes, as well as overall trial transparency, efficiency, and security. Additionally, the investigation discloses the emerging synergy between blockchain and advanced technologies, such as artificial intelligence and federated learning, proposing innovative directions for improving clinical research methodologies. Our study underscores the collaborative efforts in dealing with the complexities of integrating blockchain into the areas of clinical trials and healthcare, delineating the transformative potential of blockchain technology in revolutionizing these areas by addressing challenges and promoting practices of efficient, secure, and transparent research. The delineated themes and networks of collaboration provide a blueprint for future inquiry, showing the importance of empirical research to narrow the gap between theoretical promise and practical implementation.

An IoT-fuzzy intelligent approach for holistic management of COVID-19 patients.

In this study, an internet of things (IoT)-enabled fuzzy intelligent system is introduced for the remote monitoring, diagnosis, and prescription of treatment for patients with COVID-19. The main objective of the present study is to develop an integrated tool that combines IoT and fuzzy logic to provide timely healthcare and diagnosis within a smart framework. This system tracks patients' health by utilizing an Arduino microcontroller, a small and affordable computer that reads data from various sensors, to gather data. Once collected, the data are processed, analyzed, and transmitted to a web page for remote access via an IoT-compatible Wi-Fi module. In cases of emergencies, such as abnormal blood pressure, cardiac issues, glucose levels, or temperature, immediate action can be taken to monitor the health of critical COVID-19 patients in isolation. The system employs fuzzy logic to recommend medical treatments for patients. Sudden changes in these medical conditions are remotely reported through a web page to healthcare providers, relatives, or friends. This intelligent system assists healthcare professionals in making informed decisions based on the patient's condition.

Safety, Efficacy, and Visual Performance of an Orthokeratology Lens with Increased Compression Factor.

The aim was to evaluate the safety, efficacy, and visual performance of an orthokeratology lens with an increased compression factor (ICF) of 1.25 D in a 3-month follow-up. Thirty-six myopic patients (5 males and 31 females; 24.2 ± 5.8 years) were fitted with Alexa AR (Tiedra Farmacéutica S.L., Madrid, Spain) contact lenses (CLs) and twenty participants finished the follow-up. Visual acuity (VA), subjective refraction, primary spherical and primary coma aberrations, keratometry, central pachymetry, and ocular surface evaluation were performed at baseline and after 1 night, 1 week, 1 month, and 3 months of CL wear. The differences among visits were analyzed using a repeated-measures analysis of variance or the Friedman test. The spherical equivalent decreased (p ≤ 0.005), and the uncorrected VA improved (p < 0.001) until the first week. Corneal and ocular aberrations showed a significant increase (p ≤ 0.02). A significant decrease (p < 0.001) was found for keratometry values. No significant changes were observed in either central pachymetry or ocular surface parameters among study visits. In conclusion, an orthokeratology CL with an ICF of 1.25 D provides good safety, efficacy, and visual performance in a 3-month follow-up. Seven days of orthokeratology wear are enough to achieve the full myopic compensation, resulting in satisfactory VA.

Seguridad de las drogas biológicas y sintéticas dirigidas utilizadas en pacientes con enfermedades reumáticas inmunomediadas. Datos del registro BIOBADASAR 3.0 / Safety of biological and targeted synthetic drugs in patients with immune-mediated rheumatic diseases. Data from the BIOBADASAR 3.0 registry

Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Percepção e Vivência da Morte de Estudante de Medicina durante a Graduação / Medical Undergraduate Student's Perception and Experience of Death

Resumo: Introdução: o estudo da morte envolve a exploração que o indivíduo faz na busca de si mesmo. A Medicina tende a negá-la e controlá-la por meio de avanços tecnológicos e medicalização, o que leva ao pensamento de que o médico pode regular a duração dela. A morte é carregada de significados simbólicos e faz parte do processo de desenvolvimento humano, contudo muitas vezes é desconhecida do estudante de Medicina, o que leva ao temor pela indefinição do momento em que ocorrerá o encontro. Inerente às atividades do médico, há a crença de que poderá ser sempre evitada, sendo entendida como falha ou insucesso do tratamento, ou como desconhecimento do profissional, provocando ansiedade e cobrança tanto por parte da população como dos médicos. Este estudo objetivou relatar a vivência e percepção sobre a morte entre estudantes de Medicina. Método: trata-se se um estudo qualitativo, observacional, realizado com 50 alunos de três períodos de um curso de Medicina em Alagoas, em 2018. Usou-se um questionário com a seguinte pergunta aberta: "Após a vivência da morte durante o curso, o que mudou na sua atuação como estudante e na sua vida?". Os dados foram analisados manualmente em quatro etapas. A primeira fase consistiu na organização dos dados, procurando ideias que emergiram das respostas à questão norteadora, quando foi realizada a pré-análise, por meio de uma leitura aprofundada, na busca da criação das categorias, uma vez que elas não foram elaboradas previamente. A segunda fase correspondeu à elaboração da segunda planilha que armazenou as ideias explícitas (categorias provisórias) e implícitas (focos) com a identificação dos sentidos. A terceira fase procurou responder à pergunta da pesquisa por meio das unidades de registro, em que se relacionou a fala com o foco/tema e se identificou o sentido da inferência. A quarta fase compreendeu duas planilhas: uma com a interpretação dos focos e suas unidades de registros e outra com elaboração de síntese para cada foco. A vivência da morte pode acontecer em relação ao outro ou à própria morte, ocorrendo diferenças nos dois processos. Aqui abordagem concentrou-se na morte do outro e em como ela é vivenciada pelo estudante de Medicina durante a graduação. Resultados: Os dados obtidos resultaram em três categorias relacionadas à vivência da morte durante a graduação, refletindo o preparo ou não para lidar com o fenômeno. Cada categoria apresentou duas subcategorias: significação da morte, com as subcategorias "vida pessoal" e "vida profissional"; qualificação profissional, com as subcategorias "limites de atuação profissional" e "curso em relação à morte"; humanização, com as subcategorias "relação médico-paciente" e "cuidados paliativos". Conclusão: A pesquisa mostrou que os discentes modificaram sua visão da morte após a vivência durante o curso e que estão despertos para o tema, revelando a importância deste para sua formação e também a necessidade da ampliação de sua discussão durante a graduação.

Abstract Introduction: the study of death involves the exploration in the search of oneself. Medicine tends to deny death and control it through technological advances and medicalization, leading to the thought that the doctor can regulate the duration of the process. Death is full of symbolic meanings and it is an important part of the human development process, often unknown by the medical students, which makes them fearful for not knowing when this meeting is going to happen. It is inherent to the doctor's activities, believing it can be always avoided, being understood as a failure or unsuccessful treatment, or lack of knowledge by the professional, generating anxiety and demands, by the population and the doctors themselves. This research aims to report the experience and perception of death among medical students. Methods: it is a qualitative, observational study carried out with 50 students from three different semesters from a School of Medicine in the state of Alagoas, Brazil, in 2018. It was applied an instrument with an open question: After the experience of death during the course, what has changed in your performance as a student and in your life? The data was analyzed manually during four steps. The first phase consisted of organizing the data, looking for ideas that emerged from the answers to the guiding question, when the pre-analysis was carried out, through a deep reading aiming to define categories, since they had not been previously created; the second phase corresponded to the preparation of the second worksheet that stored the explicit and implicit ideas, the former being the temporary categories and the latter being the focus along with identification of the senses; the third phase sought to answer the study question through the record units, associating the speech to the focus/theme, identifying the sense of inference; the fourth phase was based on two spreadsheets, the first one with the interpretation of the main topics and their record units, and the second one with the creation of the synthesis for each focus. The experience of death may occur in relation to the other or to death itself, with differences between them. This research focus on the death of others and how undergraduate medical students experience it during the course, of which data resulted in three categories related to the experience of death during medical school, reflecting their capacity or not to deal with the phenomenon. Results: the three categories showed two subcategories, as follows: Acceptance of death, with subcategories in personal and professional life; Professional qualification with two subcategories: limits of professional performance and of the course in relation to death. The last category was Humanization, with two more subcategories: medical-patient relationship and palliative care. Conclusion: the research showed that the students modified their views about death during the course, and that they are aware of the topic, disclosing the value of this subject and also the need to discuss it during undergraduate school.

Doença periodontal: associação com hábitos tabagísticos e doenças sistêmicas / Periodontal disease: association with smoking habit and systemic diseases

Este trabalho associa graus de severidade de periodontite agressiva e crônica ao hábito de fumar e à ocorrência de doenças sistêmicas. Selecionaram-se 83 pacientes com periodontite agressiva e crônica, classificados segundo parâmetros clínicos e radiográficos. A periodontite agressiva apresentou forte associação estatística com o hábito de fumar e moderada associação com doenças sistêmicas e a coexistência de ambas as variáveis. A periodontite crônica associou-se a ambos os fatores de modo independente. Hábito de fumar e doenças sistêmicas associaram-se fortemente aos diagnósticos de periodontite moderada e severa, tanto para periodontite agressiva como crônica. Quando coexistiram ambos os fatores, a severidade da doença relacionou-se ao número de cigarros e à complicação sistêmica.

This article addresses the association of the severity of aggressive, chronic periodontitis and smoking habits, and the establishment of systemic diseases. Eighty-three patients presenting aggressive, chronic periodontitis were selected, according to clinical and radiographical parameters. It has been established a strong correlation between the periodontitis and smoking, and a moderate correlation to the establishment of systemic diseases and the presence of both variables. Chronic periodontitis was associated to both factors independently. Smoking habit and systemic diseases have been strongly associated to moderate and severe periodontitis, regardless they were aggressive or chronic. When both factors were present, the severity of the disease was related to the number of cigarettes and systemic complications.

Yoga e doenças crônicas: inovações no cuidado do câncer e diabetes / Yoga and chronic diseases: innovations in cancer care and diabetes

As doenças crônicas apresentam longa duração, lenta progressão e estão entre as principais causas de mortalidade atualmente. As bases terapêuticas medicamentosas para o tratamento destas doenças não tem sido exitosa e, por isso, a Organização Mundial de Saúde propôs a introdução de inovações no cuidado, que extrapolam o modelo biomédico. No Brasil, o Yoga e outras práticas corporais foram introduzidas no Sistema Único de Saúde por meio da Portaria 719, de 7 de abril de 2011, com a criação do Programa da Academia de Saúde, pelo Ministério da Saúde. A expansão do uso do Yoga como prática terapêutica motivou o crescimento do número de pesquisas sobre o tema. O objetivo do presente trabalho foi analisar sistematicamente a literatura científica sobre a aplicação do yoga no cuidados de pessoas portadoras de câncer e diabetes. As buscas foram conduzidas nas bases de dados "PubMed", "Embase", "Web of Science" e "Ebsco Host" para o período de vinte anos (1991 a 2011), utilizando as descritores "yoga and cancer" e "yoga and diabetes". Foram analisados 36 e 22 artigos respectivamente referentes ao câncer e diabetes segundo o país de desenvolvimento das pesquisas, os periódicos de publicação, as tradições e técnicas de yoga empregadas, objetos dos estudos e os resultados e conclusões obtidas pelos mesmos. Os artigos analisados indicaram que o yoga é um recurso terapêutico viável e favorável ao cuidado de pessoas com câncer e diabetes. É possível verificar avanço das investigações na área, embora haja carência de trabalhos que aprofundem de forma conceitual e filosófica a relação do Yoga com o cuidado de pacientes oncológicos e diabéticos. Desse modo, torna se evidente que, em futuros estudos, é importante considerar metodologias mais adequadas que explorem tal relação.

Chronic diseases have long-lasting, slow progression and are among the main causes of mortality. Therapies based exclusively on drugs for the treatment of these diseases have not been successful and, therefore, the World Health Organization proposed the introduction of innovations in care that go beyond the biomedical model. In Brazil, yoga and other body practices were introduced in the public health system through the 719 Ordinance of April 7, 2011, with the creation of the "academy of health program", by the ministry of health. The expansion of the use of yoga as therapeutic practice led to the growth of researches on the topic. The aim of this study was to systematically review the scientific literature on the application of yoga in the care of people with cancer and diabetes. The searches were conducted in the databases "PubMed", "Embase", "Web of Science" and "Ebsco Host" for the period of twenty years (1991 to 2011), using the keywords "yoga and cancer" and "yoga and diabetes ". Were analyzed 36 and 22 articles respectively regarding cancer and diabetes by country of research development, periodicals publishing, traditions and yoga techniques employed, objects of studies, results and conclusions obtained by them. Papers analyzed indicated that yoga is a therapeutic resource feasible and favorable to the care of people with cancer and diabetes. It is possible check advance of research in the area, although there are few studies that deepen the conceptual and philosophical form on the relationship of yoga in the cancer and diabetics patients care. Thus, it becomes apparent that, in future studies, it is important to consider the most appropriate methodologies that exploit this relationship.

Yoga e doenças crônicas: inovações no cuidado do câncer e diabetes / Yoga and chronic diseases: innovations in cancer care and diabetes

As doenças crônicas apresentam longa duração, lenta progressão e estão entre as principais causas de mortalidade atualmente. As bases terapêuticas medicamentosas para o tratamento destas doenças não tem sido exitosa e, por isso, a Organização Mundial de Saúde propôs a introdução de inovações no cuidado, que extrapolam o modelo biomédico. No Brasil, o Yoga e outras práticas corporais foram introduzidas no Sistema Único de Saúde por meio da Portaria 719, de 7 de abril de 2011, com a criação do Programa da Academia de Saúde, pelo Ministério da Saúde. A expansão do uso do Yoga como prática terapêutica motivou o crescimento do número de pesquisas sobre o tema. O objetivo do presente trabalho foi analisar sistematicamente a literatura científica sobre a aplicação do yoga no cuidados de pessoas portadoras de câncer e diabetes. As buscas foram conduzidas nas bases de dados "PubMed", "Embase", "Web of Science" e "Ebsco Host" para o período de vinte anos (1991 a 2011), utilizando as descritores "yoga and cancer" e "yoga and diabetes". Foram analisados 36 e 22 artigos respectivamente referentes ao câncer e diabetes segundo o país de desenvolvimento das pesquisas, os periódicos de publicação, as tradições e técnicas de yoga empregadas, objetos dos estudos e os resultados e conclusões obtidas pelos mesmos. Os artigos analisados indicaram que o yoga é um recurso terapêutico viável e favorável ao cuidado de pessoas com câncer e diabetes. É possível verificar avanço das investigações na área, embora haja carência de trabalhos que aprofundem de forma conceitual e filosófica a relação do Yoga com o cuidado de pacientes oncológicos e diabéticos. Desse modo, tornase evidente que, em futuros estudos, é importante considerar metodologias mais adequadas que explorem tal relação. (AU)

Chronic diseases have long-lasting, slow progression and are among the main causes of mortality. Therapies based exclusively on drugs for the treatment of these diseases have not been successful and, therefore, the World Health Organization proposed the introduction of innovations in care that go beyond the biomedical model. In Brazil, yoga and other body practices were introduced in the public health system through the 719 Ordinance of April 7, 2011, with the creation of the "academy of health program", by the ministry of health. The expansion of the use of yoga as therapeutic practice led to the growth of researches on the topic. The aim of this study was to systematically review the scientific literature on the application of yoga in the care of people with cancer and diabetes. The searches were conducted in the databases "PubMed", "Embase", "Web of Science" and "Ebsco Host" for the period of twenty years (1991 to 2011), using the keywords "yoga and cancer" and "yoga and diabetes ". Were analyzed 36 and 22 articles respectively regarding cancer and diabetes by country of research development, periodicals publishing, traditions and yoga techniques employed, objects of studies, results and conclusions obtained by them. Papers analyzed indicated that yoga is a therapeutic resource feasible and favorable to the care of people with cancer and diabetes. It is possible check advance of research in the area, although there are few studies that deepen the conceptual and philosophical form on the relationship of yoga in the cancer and diabetics patients care. Thus, it becomes apparent that, in future studies, it is important to consider the most appropriate methodologies that exploit this relationship.(AU)

Planejamento e execução de revisões sistemáticas da literatura / Planning and execution of systematic literature reviews

Tendo em vista que as revisões sistemáticasda literatura têm sido a principal fontede informação para adoção da prática baseada emevidências, e que são escassas as publicações nacionaisque orientem o processo de sua elaboração, oartigo apresenta as etapas de planejamento dessetipo de revisão.

Considering that systematic literature reviews have been the main source of information for the adoption of evidence-based practice and that there are few national publications to guide the process of preparing systematic literature reviews, this article presents the steps for planning and executing this process.

Utilidad de los signos clínicos y parasitológicos en el pronóstico de la malaria grave en Colombia

Introducción. El pronto reconocimiento de los signos de peligro en los pacientes con malaria puede reducir las complicaciones y muertes. Sin embargo, se conoce poco sobre su valor pronóstico para la malaria complicada, especialmente en las zonas de transmisión baja e inestable de la enfermedad. Objetivo. Estimar el valor pronóstico de gravedad que tienen diversos signos clínicos y parasitológicos en los pacientes con malaria. Materiales y métodos. Se hizo un estudio en una cohorte prospectiva con pacientes de cinco municipios de Colombia, con diagnóstico de malaria por Plasmodium falciparum y P. vivax, en quienes se estudió la asociación de los signos clínicos y los parasitológicos con la malaria complicada. Resultados. Se obtuvo un modelo de predicción con una sensibilidad de 47,4 % y especificidad de 92,8 %, valor pronóstico positivo de 63,2 % y valor pronóstico negativo de 87,1 %, el cual incluye ictericia, orina oscura, hiperpirexia y signos de deshidratación. Conclusiones. Con el fin de causar un impacto en la morbilidad complicada de la malaria, se propone una estrategia de reconocimiento de los signos de peligro por el personal no médico, que se acompañe de otros elementos de la atención, como el suministro de un tratamiento antipalúdico adecuado y oportuno. Se proponen los criterios del diagnóstico de complicación moderada.

Prognostic value of clinical and parasitological signs for severe malaria in patients from Colombia.

Introduction. Early recognition of danger signs in patients with malaria can reduce complications and deaths, but little is known about their prognostic value for severe malaria, especially in areas of low transmission and unstable malaria. Objective. To assess the prognostic value for severity of different clinical and parasitological signs in patients with malaria. Materials and methods. A prospective cohort of patients from five municipalities in Colombia with diagnosis of Plasmodium falciparum or P. vivax malaria in whom the association between clinical and parasitological signs with complicated malaria was studied. Results. A predictive model with 47.4% sensitivity, 92.8% specificity, 63.2% positive predictive value and 87.1% negative predictive value was obtained which includes jaundice, dark urine, hyperpyrexia and signs of dehydration. Conclusions. To impact the morbidity of complicated proposed a strategy is proposed for the early recognition of danger signs by non-medical personnel, which could be complemented by other elements of health care, such as providing adequate and appropriate antimalarial treatment. Diagnostic criteria for moderate complication are also proposed.

Changes in saliva protein composition in patients with periodontal disease

Periodontitis is a chronic inflammatory disease characterized by tissue destruction which is usually diagnosed through clinical and radiographic signs. The detection of changes in the chemical composition of saliva could be used to reflect gingivo- periodontal alterations. The aim of this study was to identify salivary parameters that could identify different stages of the periodontal disease. The study group included 118 adults, 89 of them with mild, moderate or severe chronic periodontitis. The remaining participants comprised the control group. Total saliva was analyzed for physical and chemical properties. Dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) was used for protein detection and zymography for type IV collagenase identification. Salivary flow rate, pH and buffer capacity showed similar values in all groups. Proteins were augmented in severe periodontitis, as also shown by SDS-PAGE. Hydroxyproline rose significantly in all periodontal groups as secretory Immunoglobulin A significantly diminished compared with the control group. An increase in peroxidase was detected in moderate and severe periodontitis. All salivary samples contained 200-116-92 kDa gelatinases; minor bands at 66-31 kDa were also present in all periodontitis groups. Calcium levels showed significant differences between all periodontitis groups compared with the control group. Quantitative changes in the chemical composition of the saliva of patients with periodontal disease could be of significance in the diagnosis and progression of periodontal disease.

La Periodontitis es una enfermedad inflamatoria crónica caracterizada por destrucción tisular que se diagnostica generalmente a través de signos clínicos y radiográficos. Sin embargo la detección de cambios en la composición química de la saliva podrían ser empleados para reflejar alteraciones gingivo-periodontales. El objetivo de este estudio fue encontrar parámetros salivales que pudieran identificar diferentes estadios de la enfermedad periodontal. El grupo de estudio incluyo 118 adultos, 89 de los cuales con enfermedad periodontal crónica leve, moderada o severa El resto constituyo el grupo control. Se analizaron las propiedades físicas y químicas de la saliva total. La separación de proteínas fue realizada empleando la electroforesis en geles de poliacrilamida conteniendo dodecil sulfato de sodio y la identificación de colagenasa tipo IV se realizo empleando la zimografia. Flujo salival, pH y capacidad bufferante mostraron valores similares en todos los grupos. Las proteínas estuvieron aumentadas en la periodontitis grave lo cual también se mostró por medio de la electroforesis. Hidroxiprolina aumento significativamente en todos los grupos de pacientes con enfermedad periodontal, mientras IgA secretoria se encontró significativamente disminuida respecto al grupo control. Un incremento en los valores de peroxidasa se detecto en las periodontitis moderada y grave. Todas las muestras contenían gelatinasas de 200-116-92 kDa; sin embargo todos los grupos de pacientes con enfermedad periodontal también presentaron bandas de peso molecular menor (66-31 kDa). Los niveles de calcio mostraron diferencias significativas entre todos los grupos de pacientes con periodontitis cuando se los comparo con el grupo control. Cambios cuantitativos en la composición química de la saliva de pacientes con enfermedad periodontal podrían tener significancia en el diagnostico y progresión de la enfermedad periodontal.

La medicina familiar en Panamá / Family medicine in Panama

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Resultados postmórtem e infecciones oportunistas en pacientes VIH positivos de un hospitalpúblico del Perú / Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru

Existen pocos estudios que reporten datos acerca de autopsias de pacientes con VIH en Sudamérica y ninguno que documente los resultados post mórtem en los pacientes con VIH/SIDA en el Perú. Objetivos: Determinar el espectro de las infecciones oportunistas y las causas de mortalidad en pacientes VIH-positivos en un hospital público en Lima. Asimismo, se revisa la información clínico-epidemiológica con respecto a la infección con VIH en el Perú. Materiales y métodos: Se incluyeron en este análisis retrospectivo, 16 autopsias relacionadas con VIH del Hospital Dos de Mayo, realizadas entre 1999-2004. Resultados: La causa primaria de la muerte fue establecida en 12 pacientes: uno murió de neoplasia y 11 de enfermedades infecciosas, incluyendo tres con infección pulmonar, siete con infección diseminada, y dos con infección del sistema nervioso central (un caso presentó patología dual). Las infecciones oportunistas fueron identificadas en 14 casos, incluyendo citomegalovirus, histoplasmosis, criptococcosis, toxoplasmosis, neumonía por Pneumocistis, aspergilosis, tuberculosis, virus de la varicela-zoster y criptosporidiosis. Catorce pacientes tenían por lo menos una enfermedad relacionada con el SIDA que no había sido sospechada clínicamente ni diagnosticada antes de la muerte. Por otra parte, 82% de los diagnósticos considerados de significancia clínica importante, no habían sido sospechados antes de la muerte. Conclusiones: El espectro y la frecuencia de ciertas infecciones oportunistas reportadas en el presente estudio lo diferencia de otros estudios de autopsias realizados en Sudamérica; destacando la importancia de realizar necropsias en VIH/SIDA en países de recursos limitados, con el fin de observar los patrones locales específicos de la enfermedad.

There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. Objectives: The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Material and methods: Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999-2004, were included in this retrospective analysis. Results: The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses deemed of important clinical significance, had not been suspected antemortem. Conclusions: The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locallyspecific disease patterns may be observed.

Marcadores bioquímicos de la enfermedad periodontal / Biochemical markers of the periodontal ligament

Durante muchos años el diagnóstico de la Enfermedad Periodontal se ha basado en métodos clínicos y radiográficos. Otros métodos más recientes tienen por objeto el estudio de la respuesta inflamatoria del huésped. Así, métodos inmunológicos o bioquímicos determinan los mediadores liberados en la infección periodontal. Los componentes del líquido o fluido gíngivo-crevicular se usan para identificar o diagnosticar la enfermedad activa, anticipar el riesgo de padecerla y determinar su progresión. Para que ello sea clínicamente útil se deben registrar cambios importantes tales como, que un sitio específico se torne activo o, que un sitio previamente afectado por la enfermedad mejore su condición como producto de la terapia periodontal. La respuesta de los granulocitos neutrófilos juega un importante papel en la detección de la Enfermedad Periodontal. El sistema de defensa inespecífica en el fluido gíngivo-crevicular se puede determinar a través de citoquinas y/o interleuquinas, que sirven para identificar sitios de riesgo en el paciente. En la Enfermedad Periodontal, las citoquinas no son solamente mediadores de la defensa del líquido del surco gingival, sino también son un indicador de la destrucción de los tejidos. La liberación de altos niveles de enzimas lisosomales por parte de los neutrófilos, enzimas proteolíticas, como las colagenasas, o enzimas intracitoplasmáticas como lactato dehidrogenasa y aspartato amino transferasa pueden igualmente ayudar a monitorear la progresión de la Enfermedad Periodontal (AU)

Parasitosis intestinal en niños en edad escolar (6 - 12 años) Escuela Graduada Nº 1994 Dr. Raúl Peña José Augusto Saldivar

Estudio prospectivo, analítico-descriptivo realizado en niños en edad escolar, que presenta las características de los infectados. Clasifica la parasitosis con sus repercusiones inmediatas en los niños

El que hacer del psicoanalista de niños. Caso Marina / The specific task of the child psychoanalyst

El artículo presenta el caso clínico de una niña de 8 años que padecía en el momento de la consulta de vómitos frecuentes, sin que los estudios médicos realizados hasta el momento encontraran explicación alguna para los mismos. El material expuesto describe las primeras entrevistas realizadas con la niña y con una tía, quien en ese momento, era la que se hacía cargo de ella. Así mismo, propone abrir algunas preguntas y reflexiones que posibiliten el acercamiento a la comprensión y análisis del caso. Por otra parte, el trabajo permite pensar entre otros temas, el quehacer específico del psicoanalista con niños.

Empiema pleural: estudio retrospectivo 1995-1998 Hospital León Becerra de Guayaquil / Empyema 1995-1998 retrospective study at Leon Becerraïs Hospital in Guayaquil

Los autores hacen una revisión de 21 casos de niños ingresados con diagnóstico de derrame pleural purulento de 1995 a 1998, ocurridos en el Hospital de Niños León Becerra de Guayaquil.

El que hacer del psicoanalista de niños. Caso Marina / The specific task of the child psychoanalyst

El artículo presenta el caso clínico de una niña de 8 años que padecía en el momento de la consulta de vómitos frecuentes, sin que los estudios médicos realizados hasta el momento encontraran explicación alguna para los mismos. El material expuesto describe las primeras entrevistas realizadas con la niña y con una tía, quien en ese momento, era la que se hacía cargo de ella. Así mismo, propone abrir algunas preguntas y reflexiones que posibiliten el acercamiento a la comprensión y análisis del caso. Por otra parte, el trabajo permite pensar entre otros temas, el quehacer específico del psicoanalista con niños.(AU)