Colgajo supraclavicular, revisión de la literatura y serie de casos / Supraclavicular flap, literature review and case series

Los procedimientos reconstructivos en cabeza y cuello son todo un desafío debido a que son áreas expuestas, con gran movimiento, y desempeñan funciones esenciales de la vida como el habla, la alimentación y la respiración. El colgajo supraclavicular es un colgajo locorregional, fasciocutáneo, fino, axial a la arteria supraclavicular, versátil, con baja morbilidad, que se usa ampliamente para cubrir defectos en cuello y sector inferior de la cara ya que proporciona tejido similar al de estas regiones, y técnicamente rápido y sencillo.Se puede usar en asociación con otros colgajos para reconstrucciones complejas. Es un colgajo infrautilizado que es una buena alternativa frente a los colgajos tradicionales musculares regionales y libres. Las principales indicaciones son secuelas de quemaduras como las contracturas esternomentonianas, defectos oncológicos ya sea piel o mucosa oral, faringostomas y fístulas traqueocutáneas. Se mencionan 3 casos clínicos en los cuales se llevó a cabo un colgajo supraclavicular en el Hospital Pasteur, Montevideo, Uruguay.

Reconstructive head and neck procedures are challenging because they are exposed areas, are highly mobile, and perform essential life functions such as speaking, eating, and breathing. The supraclavicular flap is a locoregional, fasciocutaneous, thin flap, axial to the supraclavicular artery, versatile, with low morbidity, which is widely used to cover defects in the neck and lower face since it provides tissue similar to that of these regions, and Technically fast and simple. It can be used in association with other flaps for complex reconstructions. It is an underutilized flap that is a good alternative to traditional regional and free muscle flaps. The main indications are sequelae of burns such as sternomental contractures, oncological defects in the skin or oral mucosa, pharyngostomies and tracheocutaneous fistulas. Three clinical cases are mentioned in which a supraclavicular flap was performed at the Pasteur Hospital, Montevideo, Uruguay

Lipomas gigantes da mão, série de casos / Giant lipomas of the hand, case series

Introdução: Os lipomas são esporádicos na mão e representam menos de 5% dos tumores de partes moles nesta topografia. Os lipomas gigantes, ainda menos comuns, são definidos por terem um diâmetro maior do que 5cm. Métodos: Executamos uma análise retrospectiva dos casos de pacientes com lipomas gigantes de mão, atendidos no período de 2017-2020, no Hospital Pasteur e Hospital de Clínicas, em Montevidéu, Uruguai. Resultados: Obtivemos quatro pacientes no período estudado. A idade de apresentação foi entre 51 e 62 anos (média de 57 anos). Três dos lipomas eram intramusculares profundos e um era superficial aos músculos regionais. O maior possuía eixo mais extenso de 70mm. Todos eram sintomáticos. A ressecção marginal foi realizada em todos eles, e o pós-operatório transcorreu sem intercorrências ou recorrências. A histopatologia confirmou lipoma típico em três casos, e lipoma com metaplasia óssea no outro. Conclusão: Lipomas gigantes de mão se apresentam como tumores indolores e de crescimento lento, que podem ser sintomáticos ao comprimir estruturas adjacentes. A ressonância magnética é o estudo de imagem escolhido para estes casos. O tratamento aplicável é a ressecção cirúrgica marginal e a recorrência é pouco comum.

Introduction: Lipomas are sporadic in hand and represent less than 5% of soft tissue tumors in this topography. Giant lipomas, even less common, are defined as having a diameter greater than 5 cm. Methods: We performed a retrospective analysis of the cases of patients with giant lipomas of the hand seen in the period 2017-2020, at Hospital Pasteur and Hospital de Clínicas, in Montevideo, Uruguay. Results: We obtained four patients during the study period. The age of presentation was between 51 and 62 years (mean 57 years). Three lipomas were deep intramuscular, and one was superficial to the regional muscles. The largest had a longer axle of 70mm. All were symptomatic. Marginal resection was performed in all of them, and the postoperative period was uneventful or recurrent. Histopathology confirmed typical lipoma in three cases and lipoma with bone metaplasia in the other. Conclusion: Giant lipomas of the hand present as painless, slow-growing tumors that may be symptomatic when compressing adjacent structures. Magnetic resonance imaging is the imaging study of choice for these cases. The applicable treatment is marginal surgical resection, and recurrence is uncommon.

Families' experiences in oral health care of Down Syndrome children from a foundation in Bucaramanga, Colombia / Experiencias de familias en el cuidado de la salud bucal de niños con Síndrome de Down de una Fundación en Bucaramanga, Colombia

Abstract Introduction: several studies highlight the importance of the relationship between family dynamics and oral hygiene in people with intellectual disabilities. In the case of children with Down Syndrome (DS), the studies generally focus on clinical aspects, disregarding the factors that can influence the way families experience oral health care. Understanding these experiences is key to contributing from the professional practice to the improvement in the quality of life of this population group. Methods: qualitative, phenomenological study in eight families of children with DS, using in-depth and episodic interviews. Results: the experiences go beyond good hygiene practices, since caregivers tend no not separate other fundamental aspects of their children's lives. This is important from a comprehensive view of human beings, their health and care. The experiences are characterized by a preeminence of females' roles and the fathers' absence or presence, in addition to daily experience, social support, and opportunities. Conclusions: experiences during oral hygiene practices in families are gratifying in cases where they discover that their children become autonomous to carry out their own oral health care. In most families, mothers accompany and reinforce. However, it was shown that women feel they are not capable enough to help their children when they notice no progress in children's autonomy to perform their own oral health care.

Resumen Introducción: diversos estudios han destacado la importancia de la relación entre la dinámica familiar y la higiene bucal de personas con discapacidad intelectual. En el caso de niños y niñas con Síndrome de Down (SD), los estudios se orientan con mayor frecuencia a la revisión de aspectos clínicos; los factores que pueden influir en la forma en que las familias viven y experimentan el cuidado de la salud bucal han sido menos explorados. Comprender estas experiencias resulta entonces de vital importancia para aportar desde la práctica profesional a la mejora en la calidad de vida de este grupo de población. Métodos: estudio cualitativo con enfoque fenomenológico, con ocho familias de niños con SD. Se utilizaron entrevistas en profundidad y episódicas. Resultados: las experiencias van más allá de buenas prácticas de higiene, pues los cuidadores no desligan otros aspectos fundamentales de la vida de sus hijos. Esto resulta importante desde una visión integral del ser humano, su salud y su cuidado. Se caracterizaron por la preeminencia del rol femenino, son influenciadas por la ausencia o presencia paterna, y se nutren además de la vivencia cotidiana, el apoyo social y las oportunidades. Conclusiones: las experiencias durante las prácticas de higiene buccal en el entorno familiar son gratificantes en los casos en que descubren que sus niños tienen autonomía para realizar sus propios cuidados. En la mayoría de las familias, las madres acompañan y refuerzan. Sin embargo, se evidenció que las mujeres se perciben con poca capacidad para ayudar a sus hijos cuando observan que no hay avances en la autonomía para asumir su propio cuidado.

Multimedia metodológica para perfeccionar el proceso de enseñanza aprendizaje en las carreras de ciencias médicas / Methodological multimedia to perfect the process of teaching- learning in the medical sciences careers

Fundamento: A raíz de las transformaciones necesarias en el sector de la salud se requiere de una mejor organización del proceso de enseñanza aprendizaje para garantizar la calidad de la formación de los futuros egresados. Objetivo: Evaluar la utilidad de la multimedia metodológica para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje de las ciencias médicas. Metodología: Investigación de desarrollo tecnológico que tiene tres fases: la fase de diagnóstico (la identificación de necesidades de aprendizaje mediante el grupo focal); la fase de diseño, la cual contiene una sección superior con las imágenes de la Universidad Médica, una sección central que registra los contenidos fundamentales de la multimedia y una sección lateral con las temáticas fundamentales; y la fase de evaluación con la entrevista al azar a 762 profesores de los 24 departamentos docentes de la provincia Sancti Spíritus. Resultados: El 100 % de los entrevistados refirió que la multimedia facilita acceder a las principales normativas para el trabajo docente metodológico, más del 95 % que ayuda a una correcta planificación y control, además, que contribuye a la auto preparación y actualización pedagógica. Conclusiones: La multimedia metodológica resultó de gran utilidad para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje por su nivel de generalización y actualización.

Background: Soon after the necessary transformation in the health sector is required a better organization of the process of teaching- learning to guarantee the quality of the formation of the future graduated. Objective: To evaluate the utility of the methodological multimedia to perfect the planning, execution and control of the process of teaching- learning of the medical sciences. Methodology: Investigation of technological development that has three phases: the phase of diagnostic (the identification of learning necessities by means of the focal group); the design phase, which contains a superior section with the images of the Medical University, a central section that registers the fundamental contents of the multimedia and a lateral section with the most important thematic; and the evaluation phase with the interview at random to 762 professors of the 24 educational departments of the municipality of Sancti Spíritu. Results: 100% of the interviewees referred that the multimedia facilitates to have access to the main normative for the methodological educational work, more than 95% that helps to a correct planning and control, also that contributes to the self- preparation and pedagogic upgrade Conclusions: The methodological multimedia was of great utility to perfect the planning, execution and control of the process of teaching- learning by its generalization level and upgrade.

Campylobacter spp como causa de disentería: opciones diagnósticas: A propósito de dos casos clínicos / Campylobacter spp as a cause of dysentery: diagnostic options: Presentation of two clinical cases

En los últimos años se ha observado un aumento en la incidencia de Campylobacter spp (CSSP) como agente de diarrea, enteritis y disentería. Constituye una zoonosis así como una enfermedad trasmitida por alimentos. El diagnóstico de GEA por CSPP se realiza por identificación del agente etiológico en las heces del paciente. El objetivo de la siguiente observación es presentar dos casos clínicos de GEA en niños con diagnóstico etiológico de colitis causada probablemente por Campylobacter spp mediante la utilización de examen directo de materia fecal. El cultivo de la bacteria es el gold standard; en Uruguay sólo está disponible con fines de investigación. El método más fácil de poner en práctica en los laboratorios clínicos es la tinción y observación directa con un Gram modificado el cual sumado a la clínica, permite un diagnóstico con alto grado de presunción. En ambos pacientes el resultado motivó la instauración de un tratamiento antibiótico específico que determinó una buena evolución.

In recent years an increase in the incidence of Campylobacter spp (CSSP) as the agent of diarrhea, enteritis and dysentery was observed. It constitutes a zoonosis, as well as a food transmitted disease. Diagnosis of acute gastroenteritis by CSPP is done by identifying the etiological agent on the patients’ feces. The objective of the following observation is to present two clinical cases of acute gastroenteritis in children with an etiological diagnosis of colitis, probably caused by Campylobacter spp by means of a direct study of the stool. Culture of the bacteria is the gold standard, although in Uruguay it is only available for research purposes. The easiest method to put into practice in the clinical laboratories is staining and the direct observation with a modified Gram, which, together with the clinical examination, enables diagnosis with a high degree of presumption. In both patients, the result caused the adoption of a specific antibiotic, which determined a good evolution.

Automated Electroglottographic Inflection Events Detection. A Pilot Study.

Vocal-fold vibration can be analyzed in a noninvasive way by registering impedance changes within the glottis, through electroglottography. The morphology of the electroglottographic (EGG) signal is related to different vibratory patterns. In the literature, a characteristic knee in the descending portion of the signal has been reported. Some EGG signals do not exhibit this particular knee and have other types of events (inflection events) throughout the ascending and/or descending portion of the vibratory cycle. The goal of this work is to propose an automatic method to identify and classify these events. A computational algorithm was developed based on the mathematical properties of the EGG signal, which detects and reports events throughout the contact phase. Retrospective analysis of EGG signals obtained during routine voice evaluation of adult individuals with a variety of voice disorders was performed using the algorithm as well as human raters. Two judges, both experts in clinical voice analysis, and three general speech pathologists performed manual and visual evaluation of the sample set. The results obtained by the automatic method were compared with those of the human raters. Statistical analysis revealed a significant level of agreement. This automatic tool could allow professionals in the clinical setting to obtain an automatic quantitative and qualitative report of such events present in a voice sample, without having to manually analyze the whole EGG signal. In addition, it might provide the speech pathologist with more information that would complement the standard voice evaluation. It could also be a valuable tool in voice research.

Multimedia metodológica para perfeccionar el proceso de enseñanza aprendizaje en las carreras de ciencias médicas / Methodological multimedia to perfect the process of teaching- learning in the medical sciences careers

A raíz de las transformaciones necesarias en el sector de la salud se requiere de una mejor organización del proceso de enseñanza aprendizaje para garantizar la calidad de la formación de los futuros egresados. Objetivo: Evaluar la utilidad de la multimedia metodológica para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje de las ciencias médicas. Metodología: Investigación de desarrollo tecnológico que tiene tres fases: la fase de diagnóstico (la identificación de necesidades de aprendizaje mediante el grupo focal); la fase de diseño, la cual contiene una sección superior con las imágenes de la Universidad Médica, una sección central que registra los contenidos fundamentales de la multimedia y una sección lateral con las temáticas fundamentales; y la fase de evaluación con la entrevista al azar a 762 profesores de los 24 departamentos docentes de la provincia Sancti Spíritus. Resultados: El 100 porciento de los entrevistados refirió que la multimedia facilita acceder a las principales normativas para el trabajo docente metodológico, más del 95 porciento que ayuda a una correcta planificación y control, además, que contribuye a la auto preparación y actualización pedagógica. Conclusiones: La multimedia metodológica resultó de gran utilidad para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje por su nivel de generalización y actualización(AU)

Soon after the necessary transformation in the health sector is required a better organization of the process of teaching- learning to guarantee the quality of the formation of the future graduated. Objective: To evaluate the utility of the methodological multimedia to perfect the planning, execution and control of the process of teaching- learning of the medical sciences. Methodology: Investigation of technological development that has three phases: the phase of diagnostic (the identification of learning necessities by means of the focal group); the design phase, which contains a superior section with the images of the Medical University, a central section that registers the fundamental contents of the multimedia and a lateral section with the most important thematic; and the evaluation phase with the interview at random to 762 professors of the 24 educational departments of the municipality of Sancti Spíritus. Results: 100 percent of the interviewees referred that the multimedia facilitates to have access to the main normative for the methodological educational work, more than 95percent that helps to a correct planning and control, also that contributes to the self- preparation and pedagogic upgrade. Conclusions: The methodological multimedia was of great utility to perfect the planning, execution and control of the process of teaching- learning by its generalization level and upgrade(AU)

Neonatal lupus erythematosus: a report of four cases.

Neonatal lupus erythematosus is a very rare disease, clinically characterized by skin lesions that resemble those of subacute or discoid lupus erythematosus and/or congenital heart block. Generally, when patients have skin manifestations, they have no cardiac defects and vice-versa; however, in 10% of cases these manifestations may coexist. Other findings may include hematologic, hepatic and neurological abnormalities. This condition is caused by the transplacental passage of maternal autoantibodies against Ro (95%), La and, less frequently, U1-ribonucleoprotein (U1-RNP). The present case report describes four patients with clinical, histopathological and immunological findings compatible with neonatal lupus erythematosus, their treatment and progress.

Lupus eritematoso neonatal: reporte de cuatro casos / Neonatal lupus erythematosus: a report of four cases

El lupus eritematoso neonatal es una enfermedad poco frecuente, caracterizada clínica mente por alteraciones cutáneas semejantes al lupus subagudo o discoide y/o bloqueo cardíaco congénito. Generalmente, cuando los pacientes presentan manifestaciones cutáneas, no tienen anormalidades cardiológicas y viceversa, aunque en un 10 por ciento de los casos ambas manifestaciones pueden coexistir. Puede acompañarse también de alteraciones hematológicas, hepáticas y neurológicas. Es causado por el pasaje trasplacentario de anticuerpos maternos anti Ro (95 por ciento), anti La y menos frecuentemente anti U1RNP. Presentamos cuatro pacientes con hallazgos clínicos, histopatológicos e inmunológicos compatibles con lupus eritematoso neonatal, su tratamiento y evolución.

Neonatal lupus erythematosus is a very rare disease, clinically characterized by skin lesions that resemble those of subacute or discoid lupus erythematosus and/or congenital heart block. Generally, when patients have skin manifestations, they have no cardiac defects and vice-versa; however, in 10 percent of cases these manifestations may coexist. Other findings may include hematologic, hepatic and neurological abnormalities. This condition is caused by the transplacental passage of maternal autoantibodies against Ro (95 percent), La and, less frequently, U1-ribonucleoprotein (U1-RNP). The present case report describes four patients with clinical, histopathological and immunological findings compatible with neonatal lupus erythematosus, their treatment and progress.

Wavelet leader based multifractal analysis of heart rate variability during myocardial ischaemia.

Heart rate variability is a non invasive and indirect measure of the autonomic control of the heart. Therefore, alterations to this control system caused by myocardial ischaemia are reflected in changes in the complex and irregular fluctuations of this signal. Multifractal analysis is a well suited tool for the analysis of this kind of fluctuations, since it gives a description of the singular behavior of a signal. Recently, a new approach for multifractal analysis was proposed, the wavelet leader based multifractal formalism, which shows remarkable improvements over previous methods. In order to characterize and detect ischaemic episodes, in this work we propose to perform a short-time windowed wavelet leader based multifractal analysis. Our results suggest that this new method provides appropriate indexes that could be used as a tool for the detection of myocardial ischaemia.

A pattern recognition approach to spasmodic dysphonia and muscle tension dysphonia automatic classification.

Spasmodic dysphonia (SD) and muscle tension dysphonia (MTD) are two voice disorders that present similar characteristics. Usually, they can be differentiated only by experienced voice clinicians. There are many reasons that support the idea that SD is a neurological disease, requiring surgical treatments or, more usually, laryngeal botulinum toxin A injections as a therapeutic option. On the other hand, MTD is a functional disorder correctable with voice therapy. The importance of a correct diagnosis of these two disorders is critical at the treatment-selection moment. In this article, we present and compare the results of neural network and support vector machine-based methods that can help the clinicians to confirm their diagnosis. As a preliminary approach to the problem, we used only a sustained vowel /a/ to extract eight acoustic parameters. Then, a pattern recognition algorithm classifies the voice as normal, SD, or MTD. For comparison with previous works, we also separated the voices into normal and pathological (SD and MTD) voices with the methods proposed here. The results overcome the best classification rates between normal and pathological voices that have been previously reported, and demonstrate that our methods are very effective in distinguishing between MTD and SD.