Abordaje de la vía aérea difícil en un paciente con ameloblastoma gigante en maxilar inferior / Difficult airway approach in a patient with giant ameloblastoma in lower jaw

Entre las principales manifestaciones de tumores de cabeza y específicamente de la cavidad oral se encuentran los de tipo odontógenicos, y de estos el más frecuente es el ameloblastoma. Este puede condicionar la presencia de una vía aérea difícil para el anestesiólogo, que debe estar entrenado para todos los escenarios disponibles en su manejo. El objetivo del presente trabajo es presentar y discutir el caso clínico de un paciente con diagnóstico de ameloblastoma gigante con predictores positivos de vía aérea difícil. Se trata de un paciente masculino de 39 años, quien refiere inicio de enfermedad actual hace ocho años, caracterizado por una lesión tumoral a nivel de maxilar inferior de 13 centímetros de largo y 16 centímetros de ancho, unilobulada y de consistencia dura a la palpación. La preparación de la fosa nasal se realizó con la administración de oximetazolina, seguido de lidocaína al 2 % (atomizador 3 push), por catéter nasal; también se le realizó bloqueo del nervio laríngeo superior bilateral, y se le administró atropina como antisialogogo. Se procedió a introducir el broncofibroscopio. El abordaje de la vía aérea difícil con un broncofibroscopio en el paciente estudiado fue realizado eficazmente, a pesar de tener el diagnóstico de un ameloblastoma gigante en maxilar inferior, que condicionó la presencia de predictores de vía aérea difícil. El paciente estudiado presentó una clasificación de Mallampati grado III. El abordaje de vía aérea difícil predecible con el uso del broncofibroscopio es efectivo en manos entrenadas en pacientes con diagnóstico de ameloblastoma gigante(AU)

Among the main manifestations of head tumors and specifically of the oral cavity are those of the odontogenic type, and of these the most frequent is the ameloblastoma, this can condition the presence of a difficult airway, where the anesthesiologist must be trained for all scenarios available for handling this. The objective of this paper is to present and discuss the clinical case of a patient diagnosed with giant ameloblastoma with difficult airway predictors. The case involves a 39-yearold male patient, who refers to the onset of current disease eight years ago, characterized by a tumor lesion at the lower jaw level 13 centimeters long and 16 centimeters wide, unilobed and hard consistency to the palpation. The preparation of the nostril was performed with the administration of oxymetazoline, followed by 2 % lidocaine (3 push atomizer), by nasal catheter; a bilateral upper laryngeal nerve block was also performed, and atropine was given as an antisialogue. The bronchofibroscope was introduced. The approach of the difficult airway with a brocofibroscope in the patient studied was performed effectively, despite having the diagnosis of a giant ameloblastoma in the lower jaw, which conditioned the presence of difficult airway predictors. The patient studied presented a classification of Mallampati grade III. The predictable difficult airway approach with the use of brocofibroscope is effective in trained hands in patients diagnosed with giant ameloblastoma(AU)

Application of the Public Health Exposome Framework to Estimate Phenotypes of Resilience in a Model Ohio African-American Women's Cohort.

We report integration of the United States Environmental Protection Agency's (USEPA) United States Environmental Justice Screen (EJSCREEN) database with our Public Health Exposome dataset to interrogate 9232 census blocks to model the complexity of relationships among environmental and socio-demographic variables toward estimating adverse pregnancy outcomes [low birth weight (LBW) and pre-term birth (PTB)] in all Ohio counties. Using a hill-climbing algorithm in R software, we derived a Bayesian network that mapped all controlled associations among all variables available by applying a mapping algorithm. The results revealed 17 environmental and socio-demographic variables that were represented by nodes containing 69 links accounting for a network with 32.85% density and average degree of 9.2 showing the most connected nodes in the center of the model. The model predicts that the socio-economic variables low income, minority, and under age five populations are correlated and associated with the environmental variables; particulate matter (PM2.5) level in air, proximity to risk management facilities, and proximity to direct discharges in water are linked to PTB and LBW in 88 Ohio counties. The methodology used to derive significant associations of chemical and non-chemical stressors linked to PTB and LBW from indices of geo-coded environmental neighborhood deprivation serves as a proxy for design of an African-American women's cohort to be recruited in Ohio counties from federally qualified community health centers within the 9232 census blocks. The results have implications for the development of severity scores for endo-phenotypes of resilience based on associations and linkages for different chemical and non-chemical stressors that have been shown to moderate cardio-metabolic disease within a population health context.

[Health research priorities in Colombia from the researchers' point of view]. / Prioridades de investigación en salud en Colombia: Perspectiva de los Investigadores.

Colombia lacks experience in identifying health research priorities. A project for identifying health research priorities was begun in 2004 (meaning those arising from weighting and ordering health and disease problems which could be mainly resolved by research and knowledge). The Global Forum for Health Research combined matrix method, and other methods, was used as reference for developing projects and putting two main methodological paths into practice: designing and applying a method for qualitatively and quantitatively weighting and ordering health research problems and building consensus with researchers and scientific community representatives. Two national meetings, two regional meetings and a virtual forum were held for identifying predominant health problems. Once the predominant health problems had been identified (with the respective estimation of disease load), then they were evaluated by politicians and decision-makers and rated by basic science, clinical science and public health researchers in terms of making a contribution towards knowledge for facing, controlling or resolving such problems. Some health research priorities were obtained (by areas and others being overall priorities): chronic diseases, emergent infectious diseases, tuberculosis/leprosy, nosocomial infection and sexually transmitted diseases/HIV/AIDS.

Prioridades de investigación en salud en Colombia: perspectiva de los investigadores / Health research priorities in Colombia from the researchers' point of view

Colombia tiene una escasa experiencia en identificar prioridades de investigación en salud. En el año 2004 se inició un proyecto para identificar prioridades de investigación en salud, entendiendo por tales las que resultan de un ejercicio ordenado de ponderación basado en una valoración juiciosa de problemáticas sanitarias cuya respuesta y/o solución puede lograrse en gran parte por medio de conocimientos y procesos de investigación. Como referentes del proyecto se tuvieron en cuenta algunos de los métodos de priorización utilizados y recomendados en el ámbito internacional, entre ellos la matriz combinada del Global Forum for Health Resarch. Se pusieron en práctica dos trayectos metodológicos principales: por una parte, diseño y aplicación de un método para ponderar u ordenar, de manera cualitativa y cuantitativa, las problemáticas de investigación en salud; por otra parte, construcción de consensos con investigadores y representantes de comunidades científicas. Para identificar las problemáticas de salud predominantes se realizaron dos reuniones nacionales, dos reuniones regionales y un foro virtual. Una vez identificadas las problemáticas de salud predominantes, con su respectiva estimación de carga de enfermedad, estas se valoraron por políticos y decisores y se calificaron por investigadores de ciencias básicas, ciencias clínicas y salud pública, en términos del aporte del conocimiento requerido para afrontar, controlar o resolver tales problemáticas. Se obtuvieron unas prioridades de investigación en salud por áreas globales: enfermedades crónicas, enfermedades infecciosas emergentes, Tuberculosis/Lepra, infección nosocomial e infecciones de transmisión sexual/VIH/SIDA.

Colombia lacks experience in identifying health research priorities. A project for idenifying health research priorities was begun in 2004 (meaning those arising from weighting and ordering health and disease problems which could be mainly resolved by research and knowledge). The Global Forum for Health Research combined matrix method, and other methods, was used as reference for developing projects and putting two main methodological paths into practice: designing and applying a method for qualitatively and quantitatively weighting and ordering health research problems and building consensus with researchers and scientific community representatives. Two national meetings, two regional meetings and a virtual forum were held for identifying predo­minant health problems. Once the predominant health problems had been identified (with the respective estimation of disease load), then they were evaluated by politi­cians and decision-makers and rated by basic science, clinical science and public health researchers in terms of making a contribution towards knowledge for facing, controlling or resolving such problems. Some health research priorities were obtained (by areas and others being overall priorities): chronic diseases, emergent infectious diseases, tuberculosis/leprosy, nosocomial infection and sexually transmitted diseases/HIV/AIDS.