Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy.

BACKGROUND: In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE: A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING: Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS: 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA: Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS: All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION: Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.

COVID-19 associated with disseminated histoplasmosis in a kidney transplant patient / COVID-19 asociado a histoplasmosis diseminada en un paciente trasplantado renal

Abstract We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.

Resumen Se presenta un caso de histoplasmosis diseminada e infección por COVID-19 en un paciente trasplantado renal en Argentina. El paciente presentó un cuadro clínico respiratorio, y la tomografía computarizada (TC) de tórax mostró múltiples opacidades centrolobulillares bilaterales con patrón de árbol en brote. El paciente fue tratado inicialmente con antibióticos para agentes causantes de neumonía bacteriana adquirida en la comunidad y luego como tuberculosis. Un mes después se le diagnosticó una histoplasmosis diseminada y el hongo fue aislado del esputo, la piel y la mucosa oral. El hongo fue tipificado molecularmente como Histoplasma capsulatum clado LAmB. El paciente fue hospitalizado y se inició tratamiento con anfoteric-ina B liposomal vía intravenosa. Durante el transcurso de la terapia antifúngica los síntomas respiratorios del paciente empeoraron, una nueva TC de tórax mostró una lesión unilateral con apariencia de vidrio esmerilado y se detectó SARS-CoV-2 en el hisopado nasofaríngeo. El paciente fue tratado con plasmoterapia y se modificó el régimen de inmunosupresión (se interrumpió everolimus, se redujo micofenolato de mofetilo y se incrementó la meprednisona). La evolución del paciente fue favorable y fue dado de alta con tratamiento oral con itraconazol.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome.

Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren's syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23-83) years were recruited; pSS mean duration of 87 (5-275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42-60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01-15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

COVID-19 associated with disseminated histoplasmosis in a kidney transplant patient.

We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.

Smart Homes as Enablers for Depression Pre-Diagnosis Using PHQ-9 on HMI through Fuzzy Logic Decision System.

Depression is a common mental illness characterized by sadness, lack of interest, or pleasure. According to the DSM-5, there are nine symptoms, from which an individual must present 4 or 5 in the last two weeks to fulfill the diagnosis criteria of depression. Nevertheless, the common methods that health care professionals use to assess and monitor depression symptoms are face-to-face questionnaires leading to time-consuming or expensive methods. On the other hand, smart homes can monitor householders' health through smart devices such as smartphones, wearables, cameras, or voice assistants connected to the home. Although the depression disorders at smart homes are commonly oriented to the senior sector, depression affects all of us. Therefore, even though an expert needs to diagnose the depression disorder, questionnaires as the PHQ-9 help spot any depressive symptomatology as a pre-diagnosis. Thus, this paper proposes a three-step framework; the first step assesses the nine questions to the end-user through ALEXA or a gamified HMI. Then, a fuzzy logic decision system considers three actions based on the nine responses. Finally, the last step considers these three actions: continue monitoring through Alexa and the HMI, suggest specialist referral, and mandatory specialist referral.

[Primary effusion lymphoma with multisystemic extracavitary involvement in HIV negative diagnosed by autopsy] / Linfoma primario de las efusiones con afectación extracavitaria multisistémica en HIV negativo diagnosticado mediante autopsia.

Introduction: Primary effusion lymphoma is a low-frequency and high-grade non-Hodgkin lymphoma caused by the Human Herpes virus 8. It mainly affects individuals infected with the human immunodeficiency virus (HIV), although it has also been described in HIV-negative cases. It is characterized by the presence of a malignant lymphomatous effusion in the different serous cavities, the pleural cavity being the most affected. Involvement outside the serosae is very rare. Diagnosis is made by analysis of the fluid accumulated in the serosae or by biopsy of the same, demonstrating the presence of characteristic neoplastic lymphocytes. Treatment consists of different chemotherapy regimens associated with antiretroviral therapy in HIV-positive patients. The prognosis of this disease is poor, with a survival of a few months after diagnosis. Methodology: We present the case of an 83-year-old man, HIV negative, with left pleural effusion and ascites, observing a fluid with a predominance of mononuclear cells without the presence of malignant cells on cytological examination. Results: The patient died and the autopsy made the diagnosis of Primary effusion lymphoma, also observing multisystemic extracavitary involvement. Conclusion: Although Primary effusion lymphoma preferentially affects HIV-positive individuals, the absence of HIV infection should not rule out the disease. Extracavitary involvement should be sought even in asymptomatic patients.

Introducción: El Linfoma primario de las efusiones es un Linfoma no Hodgkin de alto grado y escasa frecuencia producido por el virus Herpes Humano 8. Afecta principalmente a individuos infectados por el virus de la inmunodeficiencia humana (HIV), aunque también se ha descripto en HIV negativos. Se caracteriza por la presencia de derrame linfomatoso maligno en las distintas cavidades serosas siendo la cavidad pleural la más afectada. La afectación fuera de las serosas es muy poco frecuente. El diagnóstico se realiza por análisis del líquido acumulado en las serosas o mediante biopsia de las mismas demostrando la presencia de linfocitos neoplásicos característicos. El tratamiento consiste en distintos regímenes de quimioterapia asociados a terapia antirretroviral en pacientes HIV positivos. El pronóstico de esta enfermedad es pobre, con una supervivencia de escasos meses posteriores al diagnóstico. Metodología: Presentamos el caso de un varón de 83 años, HIV negativo, con derrame pleural izquierdo y ascitis, observándose un líquido con predominio de mononucleares sin presencia de células malignas al examen citológico. Resultados: El paciente falleció y mediante la autopsia se llegó al diagnóstico de Linfoma primario de las efusiones, observándose además afectación extracavitaria multisistémica. Conclusión: Si bien el Linfoma primario de las efusiones afecta preferentemente a individuos HIV positivos, la ausencia de infección por HIV no debe descartar la enfermedad. El compromiso extracavitario debe ser buscado aún en pacientes asintomáticos.

Micosis rino-orbito-cerebral: coinfección por Aspergillus sclerotiorum y Rhizopus microsporum en un huésped inmunosuprimido. Reporte de un caso / Rhino-orbital-cerebral mycoses: Aspergillus sclerotiorum infection and Rhyzopus microsporum in an immunosuppres sed host. A case report

Las micosis rino-cerebral, rino-orbito-cerebral y sinusopulmonar ocasionadas por especies de Mucorales y de Aspergillus se constituyen como una causa importan te de infección fúngica invasora asociada a una mortalidad mayor al 30%. La coinfección por dos o más especies en la forma rino-orbito-cerebral es infrecuente. Se describe un paciente con linfoma no Hodgkin, expuesto a múltiples esquemas quimioterápicos, en remisión completa, que presentó micosis con compromiso rino-orbito-cerebral por Aspergillus sclerotiorum y Rhizopus microsporum de rápida progresión con necesidad de tratamiento quirúrgico agresivo y terapia anti fúngica sistémica y local.

Rhino-orbital-cerebral and pulmonary mycosis caused by Mucorales and Aspergillus species have become an important cause of invasive fungal infection, with a 30% overall mortality rate. Rhino-orbital-cerebral disease caused by two or more species is uncommon. We present a patient with non-Hodgkin lymphoma, ex posed to aggressive chemotherapy, under complete remission, with acute onset of rhino-orbital-cerebral disease caused by Aspergillus sclerotiorum and Rhizopus microsporum, treated with aggressive surgery and both local and systemic antifungal therapy.

Trace analysis of parabens preservatives in drinking water treatment sludge, treated, and mineral water samples.

Parabens have been widely used as antimicrobial agents, mainly in food products, pharmaceuticals, and cosmetics. Although they are known as safe preservatives, they also cause some harm to human health, which has been discussed lately. Therefore, the aim of this study was to evaluate the occurrence of nine parabens (including isomers) in mineral and drinking waters, besides in drinking water treatment sludge (DWTS) samples with determination by liquid chromatography tandem mass spectrometry (LC-MS/MS). Both methods solid phase extraction (SPE) and QuEChERS were validated. Calibration curves showed a correlation coefficient of 0.99 for all compounds. LOQ values ranged from 0.04 to 4 µg L-1 in aqueous matrices and from 5 to 500 ng g-1 in DWTS. Recoveries between 70 and 115% were reached with RSD below 20% for all compounds in SPE whereas recoveries between 62 and 119% were found with RSD below 20% for almost all compounds in QuEChERS. Matrix effect had low values (< 20%); it was only above 20% for methylparaben in the SPE and for pentylparaben in the QuEChERS. Using a quick and simple extraction procedures with SPE, QuEChERS, and LC-MS/MS analyses, these methods proved to be selective and sensitive. They were successfully applied to real samples (treated water, mineral water, and sludge), and methylparaben was detected at concentration levels below 0.242 µg L-1 in mineral and treated water samples and 10 ng g-1 in DWTS samples.

Neuropatía axonal sensitivo motora aguda de causa infecciosa en una octogenaria. Reporte de un caso / Infectious acute motor-sensory axonal neuropathy in an octogenarian. A case report

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Conocimiento histórico de la estomatología pinareña: necesidad de un material docente como complemento bibliográfico / Historical knowledge of Pinar del Río dentistry: necessity for a teaching material as a bibliographical complementation

La Educación Superior Cubana centra su atención en formar profesionales capaces de orientar su actuación en la profesión con iniciativa, flexibilidad y autonomía, partir de la integración de conocimientos, habilidades, motivos y valores que se expresan en su desempeño. La limitante del diseño curricular de la asignatura Historia de la Estomatología y del libro de texto, que no incluye los elementos del contexto universitario local motivó la investigación que trazó como. Determinar las limitantes existentes de los materiales de enseñanza empleados en el proceso de aprendizaje de la asignatura Historia de la Estomatología del Plan D Investigación pedagógica con enfoque dialéctico materialista que empleo diversos métodos, materialista-dialéctico, análisis histórico-lógico y empírico. Se revisaron documentos, se realizaron encuestas, y valoraciones de expertos. Los resultados fueron analizados mediante estadística descriptiva. Los estudiantes de 2do y 4to año de la Carrera de Estomatología evidenciaron desconocimiento en mas del 80 por ciento de los encuestados sobre la Historia de la formación de recursos humanos en Estomatología en la Provincia de Pinar del Río, el 100 por ciento creyó importante conocer el desarrollo de dicha formación y coincidieron en la necesidad de literatura docente para adquirir estos conocimientos.Es insuficiente la literatura existente para el estudio de los referentes locales en la formación de recursos humanos en Estomatología y se propone elaborar un material docente para la asignatura Historia de la Estomatología, que describa La Historia de la formación de recursos Humanos en Pinar del Río desde 1959 hasta 2013(AU)

Cuban Higher Education centers its attention towards training professional capable of directing their performance profile with initiative, flexibility and autonomy, starting from the integration of knowledge, skills, motivation, and values expressed in their performance. The limiting component of the syllabus design for the subject History of Dentistry and the textbook, not including the elements of the university local context, motivated this research.The objective was to determine the limiting aspects existing in regard to the teaching material used in the learning process of the subject History of Dentistry in the D Syllabus Plan. Cross-sectional descriptive research using diverse methods: materialistic-dialectical, historic and logical analysis and empirical ones. Papers were reviewed, surveys were conducted, and experts were interviewed for their evaluations. The results were analyzed by means of descriptive statistics. The second and fourth years Dentistry students showed lack of knowledge in more than 80 per cent of the surveyed, regarding the history of human resources training in Dentistry in Pinar del Río Province. The total 100 per cent considered important to know the development of such training and coincided in the idea that the teaching materials and bibliography are needed to acquire these knowledge.The existing literature is insufficient for the study of the local referents in the training of human resources in Dentistry, and it has been proposed to elaborate a teaching material for the subject History of Dentistry, which describes the history of human resources training in Pinar del Río from1959 to 2013(AU)

Conocimiento histórico de la estomatología pinareña: necesidad de un material docente como complemento bibliográfico / Historical knowledge of Pinar del Río dentistry: necessity for a teaching material as a bibliographical complementation

Introducción: la Educación Superior Cubana centra su atención en formar profesionales capaces de orientar su actuación en la profesión con iniciativa, flexibilidad y autonomía, partir de la integración de conocimientos, habilidades, motivos y valores que se expresan en su desempeño. La limitante del diseño curricular de la asignatura Historia de la Estomatología y del libro de texto, que no incluye los elementos del contexto universitario local motivó la investigación que trazó como Objetivo: determinarlas limitantes existentes de los materiales de ense ñanza empleados en el proceso de aprendizaje de la asignatura Historia de la Estomatología del Plan D. Material y método: investigación pedagógica con enfoque dialéctico materialista que empleo diversos métodos, materialista-dialéctico, análisis histórico-lógico y empírico. Se revisaron documentos, se realizaron encuestas, y valoraciones de expertos. Los resultados fueron analizados mediante estadística descriptiva. Resultados: los estudiantes de 2do. y 4to. año de la Carrera de Estomatología evidenciaron desconocimiento en mas del 80% de los encuestados sobre la Historia de la formación de recursos humanos en Estomatología en la Provincia de Pinar del Río, el 100% creyó importante conocer el desarrollo de dicha formación y coincidieron en la necesidad de literatura docente para adquirir estos conocimientos. Conclusiones: es insuficiente la literatura existente para el estudio de los referentes locales en la formación de recursos humanos en Estomatología y se propone elaborar un material docente para la asignatura Historia de la Estomatología, que describa La Historia de la formación de recursos Humanos en Pinar del Río desde 1959 hasta 2013.

Introduction: Cuban Higher Education centers its attention towards training professional capable of directing their performance profile with initiative, flexibility and autonomy, starting from the integration of knowledge, skills, motivation, and values expressed in their performance. The limiting component of the syllabus design for the subject History of Dentistry and the textbook, not including the elements of the university local context, motivated this research. Objective: to determine the limiting aspects existing in regard to the teaching material used in the learning process of the subject History of Dentistry in the D Syllabus Plan. Material and method: cross-sectional descriptive research using diverse methods: materialistic-dialectical, historic and logical analysis and empirical ones. Papers were reviewed, surveys were conducted, and experts were interviewed for their evaluations. The results were analyzed by means of descriptive statistics. Results: the second and fourth years Dentistry students showed lack of knowledge in more than 80% of the surveyed, regarding the history of human resources training in Dentistry in Pinar del Río Province. The total 100% considered important to know the development of such training and coincided in the idea that the teaching materials and bibliography are needed to acquire these knowledge. Conclusions: the existing literature is insufficient for the study of the local referents in the training of human resources in Dentistry, and it has been proposed to elaborate a teaching material for the subject History of Dentistry, which describes the history of human resources training in Pinar del Río from1959 to 2013.

Aplicación del Consentimiento Informado por Estomatólogos en la Atención Primaria de Salud / Application of the Informed Consent by the dentists in Primary Health Care

La bioética se sustenta en el principio de la autonomía, que es el respeto a la dignidad del hombre y se manifiesta a través del consentimiento informado, sin embargo, se desconoce cómo se aplica por los estomatólogos pinareños. Se realizó un estudio descriptivo y transversal para determinar el nivel de aplicación del consentimiento informado por los estomatólogos de la Atención Primaria de Salud del municipio Pinar del Río en junio de 2007, lo que se considera de vital importancia para un ejercicio de la profesión, que implique el cumplimiento de los principios bioéticos, específicamente del consentimiento informado. De un universo de 134 estomatólogos, fueron incluidos en la investigación 100, a los cuales se le realizó una encuesta y guía de observación. Los datos se procesaron y se utilizaron los métodos de la estadística descriptiva. Se encontró que no hay un conocimiento completo, ni se aplica de forma correcta el consentimiento informado, siendo los elementos más violados: la solicitud de autorización al paciente y la incorporación del mismo a las decisiones sobre el tratamiento a realizar.

Bioethics is supported in the principle of autonomy, the respect of the human dignity and it is stated by means of the informed consent; however dentists in Pinar del Rio do not know how to apply it. A descriptive and cross-sectional study was carried out to determine the level of application of the informed consent by the dentists of the Primary Health Care in Pinar del Rio municipality on June 2007, which is considered a matter of vital importance to practice the profession implying the fulfillment of the bioethical principles, mainly the informed consent. Out of a universe of 134 dentists, 100 were included into the research applying a survey and an observation guide. Data were processed using descriptive statistical methods. Findings showed incomplete knowledge about the proper application of the informed consent. The most violated elements were request for the authorization and the incorporation of the patents to decision-making about the treatment to be followed.

Aplicación del Consentimiento Informado por Estomatólogos en la Atención Primaria de Salud / Application of the Informed Consent by the dentists in Primary Health Care

La bioética se sustenta en el principio de la autonomía, que es el respeto a la dignidad del hombre y se manifiesta a través del consentimiento informado, sin embargo, se desconoce cómo se aplica por los estomatólogos pinareños. Se realizó un estudio descriptivo y transversal para determinar el nivel de aplicación del consentimiento informado por los estomatólogos de la Atención Primaria de Salud del municipio Pinar del Río en junio de 2007, lo que se considera de vital importancia para un ejercicio de la profesión, que implique el cumplimiento de los principios bioéticos, específicamente del consentimiento informado. De un universo de 134 estomatólogos, fueron incluidos en la investigación 100, a los cuales se le realizó una encuesta y guía de observación. Los datos se procesaron y se utilizaron los métodos de la estadística descriptiva. Se encontró que no hay un conocimiento completo, ni se aplica de forma correcta el consentimiento informado, siendo los elementos más violados: la solicitud de autorización al paciente y la incorporación del mismo a las decisiones sobre el tratamiento a realizar...(AU)

Bioethics is supported in the principle of autonomy, the respect of the human dignity and it is stated by means of the informed consent; however dentists in Pinar del Rio do not know how to apply it. A descriptive and cross-sectional study was carried out to determine the level of application of the informed consent by the dentists of the Primary Health Care in Pinar del Rio municipality on June 2007, which is considered a matter of vital importance to practice the profession implying the fulfillment of the bioethical principles, mainly the informed consent. Out of a universe of 134 dentists, 100 were included into the research applying a survey and an observation guide. Data were processed using descriptive statistical methods. Findings showed incomplete knowledge about the proper application of the informed consent. The most violated elements were request for the authorization and the incorporation of the patents to decision-making about the treatment to be followed...(AU)