Individualized Prediction of SARS-CoV-2 Infection in Mexico City Municipality during the First Six Waves of the Pandemic.

After COVID-19 emerged, alternative methods to laboratory tests for the individualized prediction of SARS-CoV-2 were developed in several world regions. The objective of this investigation was to develop models for the individualized prediction of SARS-CoV-2 infection in a large municipality of Mexico. The study included data from 36,949 patients with suspected SARS-CoV-2 infection who received a diagnostic tested at health centers of the Alvaro Obregon Jurisdiction in Mexico City registered in the Epidemiological Surveillance System for Viral Respiratory Diseases (SISVER-SINAVE). The variables that were different between a positive test and a negative test were used to generate multivariate binary logistic regression models. There was a large variation in the prediction variables for the models of different pandemic waves. The models obtained an overall accuracy of 73% (63-82%), sensitivity of 52% (18-71%), and specificity of 84% (71-92%). In conclusion, the individualized prediction models of a positive COVID-19 test based on SISVER-SINAVE data had good performance. The large variation in the prediction variables for the models of different pandemic waves highlights the continuous change in the factors that influence the spread of COVID-19. These prediction models could be applied in early case identification strategies, especially in vulnerable populations.

Validación de la versión breve del “Cociente de empatía” con adolescentes de México / Validation of the short version of the “quotient of empathy” with adolescents from mexico

La empatía es una habilidad que permite la identificación e interpretación de experiencias subjetivas de otros. El objetivo de este estudio fue validar el “Cociente de empatía” (CE) en adolescentes mexicanos a partir de una muestra de 573 estudiantes (350 mujeres y 223 hombres) con una edad media de 14,8 años (DT= 1,96). Se realizó un análisis factorial exploratorio, identificando dos factores, uno con 16 ítems asociados a la dimensión afectiva y otro de 13 ítems con la dimensión cognitiva (índices de bondad de ajuste: GFI= 0,984, RMSEA= 0,034 y RMSR= 0,072). Para evaluar el modelo bifactorial obtenido, se realizó un análisis factorial confirmatorio, presentando adecuados índices de ajuste (RMSEA= 0,020, RMSR= 0,045, CFI= 0,998, GFI= 0,988). En la consistencia interna se encontró un coeficiente de correlación ω de McDonald de 0,941 para la dimensión afectiva y 0,772 para la dimensión cognitiva (p< 0,001). La validación de este instrumento de empatía apoyará su uso como herramienta de evaluación en investigación clínica en adolescentes mexicanos. (AU)

Empathy is a skill that enables the identification with and interpretation of others' subjective experiences. The purpose of this study was to validate the Empathy Quotient (EQ) in adolescents in Mexico. A sample of 573 Mexican adolescent students (350 female and 223 male) with an age range of 12-19 years was employed (Mage= 14.8 years, SD= 1.96). An exploratory factor analysis (EFA) was carried out which identified two factors, one with 16 items associated with the affective dimension and one with 13 items related to the cognitive dimension (model fit indices: GFI= .984, RMSEA= .034, and RMSR= .072). To evaluate the resultant bifactor model, a confirmatory factor analysis (CFA) was performed, showing good fit indexes (RMSEA= .020, RMSR= .045, CFI= .998, GFI= .988). Regarding internal consistency, we found a McDonald's ω correlation coefficient of= .941 for the affective dimension and ω= .772 for the cognitive dimension, with p< .001. The validation of this empathy instrument will support its use as a clinical research assessment tool in Mexican adolescents. (AU)

Compressed Sensing Technique for the Localization of Harmonic Distortions in Electrical Power Systems.

The present work proposes to locate harmonic frequencies that distort the fundamental voltage and current waves in electrical systems using the compressed sensing (CS) technique. With the compressed sensing algorithm, data compression is revolutionized, a few samples are taken randomly, a measurement matrix is formed, and according to a linear transformation, the signal is taken from the time domain to the frequency domain in a compressed form. Then, the inverse linear transformation is used to reconstruct the signal with a few sensed samples of an electrical signal. Therefore, to demonstrate the benefits of CS in the detection of harmonics in the electrical network of this work, power quality analyzer equipment (commercial) is used. It measures the current of a nonlinear load and issues its results of harmonic current distortion (THD-I) on its screen and the number of harmonics detected in the network; this equipment acquires the data based on the Shannon-Nyquist theorem taken as a standard of measurement. At the same time, an electronic prototype senses the current signal of the nonlinear load. The prototype takes data from the current signal of the nonlinear load randomly and incoherently, so it takes fewer samples than the power quality analyzer equipment used as a measurement standard. The data taken by the prototype are entered into the Matlab software via USB, and the CS algorithm run and delivers, as a result, the harmonic distortions of the current signal THD-I and the number of harmonics. The results obtained with the compressed sensing algorithm versus the standard measurement equipment are analyzed, the error is calculated, and the number of samples taken by the standard equipment and the prototype, the machine time, and the maximum sampling frequency are analyzed.

Anal cytology screening in men who have sex with men with HIV at a university hospital in Bogotá, Colombia.

BACKGROUND: Risk of anal squamous cell carcinoma (anal cancer) is greater among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). We describe the frequency of and factors associated with abnormal anal cytology results in Colombian MSM living with HIV. METHODS: This retrospective observational cohort study included MSM ≥18 years old living with HIV screened with anal cytology at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2019 and February 2020. A multivariable log-binomial regression model estimated associations with abnormal anal cytology. RESULTS: A total of 211 patients were included. Mean age was 35.6 years. Sixty-eight (32.3%) had an abnormal anal cytology result: ASC-US 33.8% (n = 23); LSIL 60.3% (n = 41); and HSIL 5.9% (n = 4). MSM with an STI diagnosis in the previous 12 months (RR 1.48, [95% CI 1.03-2.12], p = 0.032) or with a CD4+ T cell count <200 (RR 2.08 [95% CI 1.16-3.73], p = 0.014) were significantly more likely to have abnormal anal cytology. CONCLUSIONS: These data provide crucial information to guide scale up of anal cancer screening at select centers in Colombia. Our results also suggest STI prevention efforts and improved virological control among MSM living with HIV may have the secondary benefit of reducing the risk of anal cancer.

Long-term outcomes in Primary congenital glaucoma, aniridia and anterior segment dysgenesis.

AIM: To determine the long-term outcomes of a cohort of complex patients with primary congenital glaucoma, aniridia and anterior segment dysgenesis. METHODS: Retrospective consecutive series between 1990-2021 in two UK tertiary centres: Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust. We recorded the number and types of surgical and laser treatments along with preoperative and postoperative data, including intraocular pressures (IOP) and anti-glaucoma medications. RESULTS: A total of 41 eyes of 21 patients were included. Primary diagnoses were primary congenital glaucoma in 16 eyes (39.0%), aniridia in 14 eyes (34.2%), and anterior segment dysgenesis in 8 eyes (19.5%). Sixteen eyes (39.0%) had one or more glaucoma surgery or laser procedures for advanced glaucoma, and the long-term follow-up was 12.8 ± 3.6 years. There was a significant decrease in postoperative IOP (mmHg) at 3 months (16.5 ± 1.6; p = 0.0067), 6 months (18.7 ± 2.1; p = 0.0386), 12 months (18.6 ± 1.7; p = 0.0229), 3 years (14.7 ± 1.2; p = 0.0126), 5 years (15.5 ± 1.8; p = 0.0330) and 10 years (15.4 ± 2.3; p = 0.7780), compared to preoperatively (24.1 ± 2.6). Surgical success (complete and qualified) was 62.5%, 50.0%, 43.8%, 46.2%, 45.5% and 28.6% at 3 months, 6 months, 12 months, 3 years, 5 years and 10 years, respectively. There was no significant change in the number of anti-glaucoma drugs postoperatively (p > 0.05). Four eyes (25.0%) had postoperative complications (hyphaema, hypotony) that resolved after conservative management. CONCLUSIONS: Surgical management of these complex eyes with advanced glaucoma is challenging. Overall, the cohort had good surgical outcomes with a significant decrease in IOP by 36.1% after long-term follow-up.

Screening with Anal Cytology in Colombia: Initial Experience and Need for High-Resolution Anoscopy.

BACKGROUND: Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia. MATERIAL AND METHODS: This retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively. RESULTS: Of 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection. CONCLUSIONS: Few studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá.

Invaginación del apéndice: un hallazgo poco frecuente en colonoscopia. Informe de caso / Appendiceal intussusception: a rare finding during colonoscopy. Case report

Resumen Se presenta el caso de una mujer joven con hallazgo endoscópico incidental en una colonoscopia de seguimiento, que consistía en una lesión en el ciego con histología benigna. Se describe el proceso diagnóstico y el tratamiento quirúrgico. Se revisa la literatura existente y se discuten la incidencia, el cuadro clínico y las indicaciones de tratamiento quirúrgico de una patología rara de baja aparición.

Abstract This is the case of a young patient with an incidental endoscopic finding of a lesion in the cecum during follow-up colonoscopy with benign histology. The diagnostic process and surgical treatment are described. The existing literature was reviewed and the incidence, symptoms and indications of surgical treatment of this rare condition are discussed.

Cáncer colorrectal durante la pandemia COVID-19, recomendaciones de la Asociación Colombiana de Coloproctología / Recommendations of the Colombian Association of Coloproctology for Management of Colorectal Cancer during the COVID-19 Pandemic

Resumen La pandemia por el coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), (coronavirus disease-19 [COVID-19]), ha alterado por completo toda la realidad mundial con repercusiones económicas, sociales y grandes compromisos de los sistemas de salud. La enfermedad ha afectado a todos los países en los 5 continentes; y en nuestro país, desde el primer caso, se han venido tomando medidas para prepararnos mejor ante esta crisis. Pese a que se trata de un virus respiratorio, se ha documentado su presencia en diferentes tejidos y órganos de los seres humanos. Aunque la presentación clínica en su mayoría tiene síntomas leves, se sabe que un porcentaje importante tiene manifestaciones graves que pueden llevar a complicaciones graves y la muerte. El cáncer colorrectal es un tumor prevalente en nuestra población y obliga a tener una mejor preparación para tratarlo durante este período. Desde la Asociación Colombiana de Coloproctología, basados en los diferentes reportes de la literatura, en las recomendaciones de las diferentes asociaciones internacionales y en nuestra propia experiencia, se realiza una revisión del cáncer colorrectal durante la pandemia de COVID-19 y se comparten algunas recomendaciones para el manejo de los pacientes con esta patología revisando las diferentes opciones de manejo según la presentación de la enfermedad.

Abstract The economic and social repercussions and the enormous commitment required of health care systems by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease [COVID-19]) has completely altered world reality. The disease has affected all countries on all five continents. In Colombia, from diagnosis of the very first case, measures have been taken to better prepare ourselves for this crisis. Although it is a respiratory virus, its presence in various human tissues and organs has been documented. Despite the fact that its clinical presentation is most often in the form of mild symptoms, a significant percentage of those infected have severe manifestations that can lead to serious complications and death. Colorectal cancer is a prevalent tumor in our population, and this pandemic forces to prepare ourselves better to treat it during this period. The Colombian Coloproctology Association has reviewed reports in the literature and recommendations of various international associations and on our own experience with colorectal cancer during the COVID-19 pandemic. We present our recommendations for management of patients with this pathology and review management options according to disease presentation.

Neurological Soft Signs and cognitive processes in Mexican schoolchildren aged 6 to 11 years / Sinais Neurológicos Sutis e processos cognitivos em crianças escolares mexicanas de 6 a 11 anos / Signos Neurológicos Blandos y procesos cognitivos en niños escolares mexicanos de 6-11 años

Abstract Neurological Soft Signs (NSS) are indicative of generalized disruptions in neurological networks of cortico-subcortical areas. Their presence leads to problems in children's cognitive development with future academic repercussions. The presence of NSS was assessed and compared in 144 children aged 6 to 11 years of low-medium socioeconomic status from Mexico City and the metropolitan area through the Infant Neuropsychological Maturity Questionnaire (CUMANIN, for its Spanish acronym) and the School Neuropsychological Maturity Questionnaire (CUMANES, for its Spanish acronym). Results indicate significant differences by sex. Girls showed better performance in word articulation. In groups by age, significant differences were found in leximetric-comprehension, visual perception and executive function-errors. Participants showed the presence of developmental NSS which include: language (articulation disorders, oral and written language disturbances, difficulty finding words), psychomotricity, visual perception and other cognitive functions. There are several factors related to those impairments such as age, socioeconomic context and critical stages in child's development. Identification and early diagnosis can reduce the risk of school failure.

Resumo Os Sinais Neurológico Sutis (SNS) são indicadores de interrupções generalizadas nas redes de trabalho neural de áreas córtico-subcorticais, cuja presença leva a problemas no desenvolvimento neurocognitivo da criança que representam repercussões acadêmicas negativas. Na presente pesquisa, foi avaliada e comparada a presença de SNS com os processos cognitivos de 144 participantes mexicanos de estrato socioeconómico médio-baixo com idades entre 6 e 11 anos, sem antecedentes neurológicos ou psiquiátricos, por meio dos Cuestionarios de Madurez Neuropsicológica (CUMANIN) e Madurez Neuropsicológica Escolar (CUMANES). Os resultados indicaram diferenças significativas por gênero, já que as meninas apresentaram melhor desempenho na articulação de palavras. Nos grupos por idade, as diferenças significativas foram encontradas na velocidade de leitura e compreensão, visuopercepção e função executiva e erros. Em geral, os participantes mostraram presença de SNS de desenvolvimento, que incluem interferências na linguagem (problemas articulatórios, alterações da linguagem oral e escrita, dificuldade para encontrar palavras), psicomotricidade, visuopercepção e outras funções cognitivas. Ao final, conclui-se que a identificação e o diagnóstico precoce dos SNS permite diminuir o risco de fracasso escolar.

Resumen Los Signos Neurológicos Blandos (SNB) son indicativos de interrupciones generalizadas en las redes de trabajo neuronal de áreas cortico-subcorticales, cuya presencia conlleva a problemas en el desarrollo neurocognitivo del niño que representan repercusiones académicas negativas. En la presente investigación se evaluó y comparó la presencia de SNB con los procesos cognitivos de 144 participantes mexicanos de estrato socioeconómico medio-bajo con edades entre los 6 y 11 años sin antecedentes neurológicos o psiquiátricos por medio de los Cuestionarios de Madurez Neuropsicológica (CUMANIN) y Madurez Neuropsicológica Escolar (CUMANES). Los resultados indicaron diferencias significativas por sexo, ya que las niñas presentaron mejor desempeño en la articulación de palabras. En los grupos por edad, las diferencias significativas se encontraron en leximetría-comprensión, visopercepción y función ejecutiva-errores; y, en general, los participantes mostraron presencia de SNB de desarrollo, que incluyen afectaciones en: lenguaje (problemas articulatorios, alteraciones del lenguaje oral y escrito, dificultad para encontrar palabras), psicomotricidad, visopercepción y otras funciones cognitivas. Al final, se concluye que la identificación y diagnóstico temprano de los SNB permite disminuir el riesgo de fracaso escolar.

Gang truce for violence prevention, El Salvador.

OBJECTIVE: To estimate the effects on homicide rates of the gang truce that was brokered in El Salvador in 2012. METHODS: Mathematical models based on municipal-level census, crime and gang-intelligence data were used to estimate the effect of the truce on homicide rates. One model estimated the overall effect after accounting for the linear trend and seasonality in the homicide rate. In a moderated-effect model, we investigated the relationship between the truce effect and the numbers of MS13 (Mara Salvatrucha 13) and Eighteenth-Street gang members imprisoned per 100 000 population. We then ran each of these two models with additional control variables. We compared values before the truce - 1 January 2010 to 29 February 2012 - with those after the truce - 1 March 2012 to 31 December 2013. FINDINGS: The overall-effect models with and without additional control variables indicated a homicide rate after the truce that was significantly lower than the value before the truce, giving rate ratios of 0.55 (95% confidence interval, CI: 0.49-0.63) and 0.61 (95% CI: 0.54-0.69), respectively. For any given municipality, the effectiveness of the truce appeared to increase as the number of MS13 gang members imprisoned per 100 000 population increased. We did not observe the same significant relationship for imprisoned Eighteenth-Street gang members. CONCLUSION: In the 22 months following the establishment of a national gang truce, the homicide rate was about 40% lower than in the preceding 26 months. The truce's impact appeared particularly strong in municipalities with relatively high numbers of imprisoned MS13 gang members per 100 000 population.

Alteraciones neuropsicológicas asociadas en pacientes con infarto lacunar / Neuropsychological disorders associated with patients with lacunar infarct / Alterações neuropsicológicas associadas em pacientes com enfarte lacunar

Existe poca evidencia del deterioro cognoscitivo que defina el perfil del paciente con Infarto Lacunar (IL). El propósito de este estudio fue identificar las alteraciones neuropsicológicas en este tipo de pacientes. La muestra estuvo compuesta por 16 pacientes con IL y 16 participantes sanos con una edad promedio de 63 ± 9.41 y 64.75 ± 9.06 años y una escolaridad de 7.55 ± 4.34 y 7.94 ± 3.51, respectivamente. Se valoró la función cognoscitiva mediante un instrumento de tamizaje y una batería neuropsicológica. El análisis estadístico se llevó a cabo a través de la prueba Kruskal-Wallis y la U de Man-Whitney. Los pacientes con IL se caracterizan por la alteración de dominios como planeación, fluidez verbal, cambio atencional, habilidad visoconstructiva y velocidad de procesamiento de la información (p < 0.050). El IL se relaciona con el deterioro del funcionamiento ejecutivo y de velocidad de procesamiento, debido a la interrupción de circuitos frontocortico-subcorticales asociados con su correcto desempeño.

There is little evidence of cognitive impairment to define the profile of patients with Lacunar Infarction (IL). The purpose of this study was to identify the neuropsychological disorders in these patients. The sample consisted of 16 patients with IL and 16 healthy control participants with an average age of 63 ± 9.41 and 64.75 ± 9.06 years, and average schooling of 7.55 ± 4.34 and 7.94 ± 3.51, respectively. Cognitive function was assessed using a screening tool and a neuropsychological battery. Statistical analysis was carried out by the Kruskal-Wallis and Mann-Whitney U tests. Patients with IL are characterized by the alteration of domains such as planning, verbal fluency, attention switching, visoconstructive skill and information processing speed (p <0.050). The IL is related to the impairment of executive functioning and processing speed, due to the interruption of frontocortico-subcortical circuits associated with their proper performance.

Existe pouca evidência da deterioração cognoscitiva que defina o perfil do paciente com Enfarte Lacunar (IL). O propósito deste estudo foi identificar as alterações neuropsicológicas neste tipo de pacientes. A mostra foi composta por 16 pacientes com IL e 16 participantes sãos com uma idade média de 63 ± 9.41 e 64.75 ± 9.06 anos e uma escolaridade de 7.55 ± 4.34 e 7.94 ± 3.51, respectivamente. Avaliou-se a função cognoscitiva mediante um instrumento de tamizagem e uma bateria neuropsicológica. A análise estadística foi feita através do teste Kruskal-Wallis e a U de Man-Whitney. Os pacientes com IL se caracterizan pela alteração de dominios como planejamento, fluêcia verbal, mudança atencional, habilidade visoconstructiva e velocidade de processamento da informação (p < 0.050). O IL se relaciona com a deterioração do funcionamento executivo e da velocidade de processamento, devido à interrupção de circuitos frontocortico-subcorticais associados com seu correto desempenho.

Atuação do Time de Resposta Rápida no processo educativo de atendimento da parada cardiorrespiratória / Performance of the Rapid Response Team in the educational process for cardiopulmonary arrest care

JUSTIFICATIVA E OBJETIVOS: A criação de Times de Resposta Rápida (TRR) dentro das instituições de saúde tem aumentado paralelamente ao maior interesse na melhoria da qualidade da assistência. Os objetivos deste estudo foram avaliar o conhecimento da equipe multiprofissional (enfermagem e fisioterapia) no reconhecimento e tratamento da parada cardiorrespiratória (PCR) e mostrar um modelo de gestão do time de resposta rápida no processo educacional destes profissionais. MÉTODOS: Aplicou-se um questionário para avaliação do conhecimento do reconhecimento da parada cardiorrespiratória da equipe multiprofissional. Depois foi realizado treinamento pelo Times de Resposta Rápida e feita avaliação após o treinamento. RESULTADOS: No grupo de enfermeiros, a nota média no pré-teste foi de 5,83 ± 1,95 e 8,87 ± 1,25, no pós-teste. Dentre os fisioterapeutas,as notas médias foram 4,02 ± 1,85 e 9,00 ± 1,24, no pré e pós-teste respectivamente. No grupo composto de auxiliares e técnicos de enfermagem, a nota de pré-teste foi de 4,85 ± 1,93 no pré-teste e 7,70 ± 1,72 no pós-teste. CONCLUSÃO:Os resultados mostram deficiência no conhecimento da equipe multiprofissional diante das situações de parada cardiorrespiratória , sendo importante a realização de programas de educação continuada para a equipe.

BACKGROUND AND OBJECTIVES: The creation of Rapid Response Teams (RRT) within the health institutions has been increasing parallel to the increased interest in improving the quality of care. The objectives of this study were to evaluate the knowledge of the multidisciplinary team (nursing and physiotherapy) in the recognition and treatment of cardiopulmonary arrest (CPA) and show a model for managing the rapid response team regarding the educational process of these professionals. METHODS: We gave a questionnaire to evaluate the multidisciplinary team knowledge on the recognition of cardiac arrest.After this, Rapid Response Teams was trained, and eventually evaluated. RESULTS: In the group of nurses, the average scorein the pretest was 5.83 ± 1.95 and 8.87 ± 1.25 at posttest. Among the physiotherapists, the average scores were 4.02 ± 1.85 and 9.00 ± 1.24 in pre-and posttest, respectively. In the group of nurse assistants and technicians, the pre-test score was 4.85 ± 1.93 and 7.70 ± 1.72 at posttest. CONCLUSION: There sults of this study show little knowledge of the multidisciplinary team in situations of cardiac arrest, and that it is important to conduct continuing education programs for the team.

Meningite como complicação de endocardite infecciosa / Meningitis as a complication of infective endocarditis

As complicações neurológicas estão presentes em aproximadamente 30% dos pacientes com endocardite infecciosa; no entanto, a meningite apresenta-se como uma complicação rara. Apresenta-se aqui o caso de paciente do gênero feminino com quadro de meningite decorrente de endocardite em valva mitral, que necessitou de procedimento cirúrgico em razão de quadro agudo de insuficiência cardíaca por ruptura de cordoalha valvar.

Although approximately 30% of patients with endocarditis present with neurological complications, the development of meningitis in these patients is rare. This case report describes a female patient who developed meningitis as a complication of mitral valve endocarditis, and surgery was required for this patient due to acute heart failure resulting from the rupture of the chordae tendineae.

Meningitis as a complication of infective endocarditis. / Meningite como complicação de endocardite infecciosa.

Although approximately 30% of patients with endocarditis present with neurological complications, the development of meningitis in these patients is rare. This case report describes a female patient who developed meningitis as a complication of mitral valve endocarditis, and surgery was required for this patient due to acute heart failure resulting from the rupture of the chordae tendineae.

Condutas no paciente com trauma cranioencefálico: [revisão] / Managements in patients with traumatic brain injury: [review]

JUSTIFICATIVA E OBJETIVOS: Definir e atualizar protocolos de atendimento a vítimas de trauma cranioencefálico (TCE) na emergência médica, visando o diagnóstico e tratamento precoce.Há aumento do interesse em se definir protocolos e condutas de atendimento para vítimas de TCE, visando não somente ocontrole e estabilização da pressão intracraniana (PIC) e da pressão de perfusão cerebral (PPC), mas também de todos os outros parâmetros de suporte hemodinâmico adequado ao paciente com TCE, visando a redução de complicações pós-trauma e na taxa demortalidade. CONTEÚDO: O TCE tem grande impacto na saúde da população em geral, tendo notória importância tanto na morbidade quanto na mortalidade no trauma, representando aproximadamente 15% a 20% das mortes em pessoas com idade entre 5 e 35 anos e é responsável por 1% de todas as mortes em adultos. Nos Estados Unidos são admitidos por ano, mais de 250 mil pacientes com traumatismo craniano, e a cada ano ocorre óbito de aproximadamente 60 mil pacientes decorrente deste tipo de trauma. Aproximadamente 60% dos pacientes que sobrevivem a traumas cranianos têm sequelas significativas como déficit motor e cognitivo, trazendo grande impacto socioeconômico e emocional aos pacientes e seus familiares. As opções terapêuticas disponíveis na maioria das vezes como a hipotermia, manutenção da glicemia, hiperventilação, quando empregadas de forma correta melhoram o prognóstico dos pacientes com TCE. Considerando os altos gastos em saúde e para a sociedade com sua alta mortalidade, é preciso cada vez mais investigar novas formas de tratamento e elaborar protocolos e revisões sobre TCE, visando condutas diretas e concisas no trauma cranioencefálico. CONCLUSÃO: O TCE é uma situação comum no cotidiano médico, sendo responsável por altas taxas de mortalidade e morbidade em todo o mundo...

BACKGROUND AND OBJECTIVES: Define and update treatment protocols for victims of traumatic brain injury (TBI) in medical emergencies, for the diagnosis and early treatment. There is an increased interest in defining protocols and practicesof care for victims of head trauma, aiming not only the controland stabilization of the intracranial pressure (ICP) and cerebral perfusion pressure (CPP), but also all other parameters appropriate hemodynamic support for patients with TBI, aimed at reducing complications after trauma and the mortality rate. CONTENTS: Traumatic brain injury (TBI) has great impact on population health in general, with notable importance in morbidity and in mortality in trauma, representing approximately 15% to 20% of deaths in people aged between 5 and 35 years and is responsible for 1% of all deaths in adults. In the United States are admitted per year, more than 250.000 patients withhead injury, and death occurs every year approximately 60.000 patients induced by this trauma. Approximately 60% of patients who survive head injuries have significant sequelae such as motorand cognitive deficits, bringing great socioeconomic and emotional impact on patients and their families. The therapeutic options available in most cases as hypothermia, maintaining glucose levels, hyperventilation, when used correctly improve the prognosis of patients with TBI. Considering the numerous health expenditures and to society with its high mortality, we must increasingly explore new ways of treatment and develop protocolsand reviews about TBI, direct and concise in order to conductthe head injury, minimizing the time spent on patient care. CONCLUSION: TBI is a common situation in daily practice, isresponsible for high rates of morbidity and mortality worldwide...

Vici syndrome associated with sensorineural hearing loss and evidence of neuromuscular involvement on muscle biopsy.

Vici syndrome is a rare, genetically unresolved congenital multisystem disorder comprising agenesis of the corpus callosum, cataracts, immunodeficiency, cardiomyopathy, and hypopigmentation. An associated neuromuscular phenotype has not previously been described in detail. We report on an infant with clinical features suggestive of Vici syndrome and additional sensorineural hearing loss. Muscle biopsy revealed several changes including markedly increased variability in fiber size, increased internal nuclei, and abnormalities on Gomori trichrome and oxidative stains, raising a wide differential diagnosis including neurogenic atrophy, centronuclear myopathy (CNM) or a metabolic (mitochondrial) cytopathy. Respiratory chain enzyme studies, however, were normal and sequencing of common CNM-associated genes did not reveal any mutations. This case expands the clinical spectrum of Vici syndrome and indicates that muscle biopsy ought to be considered in infants presenting with suggestive clinical features. In addition, we suggest that Vici syndrome is considered in the differential diagnosis of infants presenting with congenital callosal agenesis and that additional investigation has to address the possibility of associated ocular, auditory, cardiac, and immunologic involvement when this radiologic finding is present.