Estenosis laringotraqueal recurrente asociada a Klebsiella pneumoniae subsp. rhinoscleromatis / Recurrent laryngotracheal stenosis associated with Klebsiella pneumoniae subsp. rhinoscleromatis

Introducción: Klebsiella rhinoscleromatis (KR) es una enterobacteria asociada con formación de granulomatosis crónica. Cuando este microorganismo afecta el tracto respiratorio se denomina escleroma, afectando principalmente la cavidad nasal; puede comprometer nasofaringe, laringe, tráquea y bronquios. Caso clínico: paciente femenina con antecedente de laringotraqueítis crónica con diagnóstico de estenosis traqueal y aislamiento en cultivos de Klebsiella pneumoniae ssp rhinoscleromatis multisensible, sin compromiso nasosinusal o extralaríngeo. Discusión: el escleroma puede afectar todo el tracto respiratorio y se deben tener presentes factores de riesgo asociados, como condiciones de hacinamiento, inmunosupresión y sexo femenino. El pilar del tratamiento es médico, basado en antibióticos; adicionalmente, se reserva manejo quirúrgico en la etapa esclerótica, donde hay ausencia del fenómeno inflamatorio. Conclusión: el escleroma es una patología rara con una evolución crónica y compromiso principalmente en cavidad nasal, que requiere alta sospecha diagnóstica para realizar manejo oportuno.

Introduction: Klebsiella rhinoscleromatis (KR) is an enterobacterium associated with the formation of chronic granulomatosis. When this microorganism affects the respiratory tract, it is called scleroma, the nasal cavity is the main one affected; additionally, it can involve nasopharynx, larynx, trachea, and bronchi. Clinical case: female patient with a history of chronic laryngotracheitis, with diagnosis of tra-cheal stenosis and isolation in cultures of multisensitive Klebsiella pneumoniae ssp rhinoscleromatis, without nasosinusal or extralaryngeal involvement. Discussion: scleroma can affect the entire respiratory tract, so associated risk factors should be taken into account, mainly overcrowding, immunosuppression, and female sex, in whom it is more common. The mainstay of treatment is medical, based on antibio-tics; additionally, surgical management is reserved for sclerotic stage, when there is no inflammatory phenomenon. Conclusion: scleroma is a rare pathology, with a chronic evolution, with involvement mainly in the nasal cavity, which requires a high diagnostic suspicion for its timely management.

Prevalencia de estenosis subglótica posintubación en paciente pediátrico en un hospital de tercer nivel en Colombia entre 2017 y 2020 / Prevalence of pediatric postintubation subglottic stenosis in a third level hospital in Colombia between 2017 and 2020

Introducción: la intubación orotraqueal en pediatría aumenta la supervivencia en patologías graves; sin embargo, una consecuencia es el desarrollo de estenosis subglótica cuya población tiene más riesgo de desarrollarla por diferencias anatómicas con los adultos. La incidencia de estenosis subglótica posterior a intubación orotraqueal ha disminuido en el tiempo según lo reportado en la literatura. En este estudio se evaluó la prevalencia de la patología en nuestra población y su objetivo fue describir las características clínicas, demográficas y diagnósticas en población pediátrica, diagnosticados con estenosis subglótica en el Hospital San Vicente Fundación, posterior a intubación orotraqueal y evaluar la prevalencia del diagnóstico en el período mencionado. Materiales y métodos: se realizó un estudio retrospectivo mediante revisión de historias clínicas de pacientes con códigos CIE 10 de estenosis laríngea o subglótica secundaria a procedimientos y con código CUPS de intubación orotraqueal; se realiza un análisis descriptivo según la distribución de las variables. Resultados: la prevalencia de estenosis subglótica fue del 13 %. La mayoría fueron hombres, la causa principal de intubación fueron las infecciones respiratorias inferiores, principalmente bronquiolitis; las comorbilidades fueron prematuridad, trastorno de deglución y síndrome bronco-obstructivo. Hubo una mediana 19 días de intubación y las estenosis de bajo grado se diagnosticaron más frecuente. Conclusiones: la estenosis subglótica es una complicación de la intubación orotraqueal pediátrica, en este estudio con una prevalencia del 13 %. Los pacientes que desarrollan esta patología requieren la realización de uno o más procedimientos para obtener una vía aérea permeable con estancias hospitalarias prolongadas.

Introduction: Pediatric orotracheal intubation has increased survival rates in severe illnesses; however, one of the consequences maybe the development of subglottic stenosis. This population is at a higher risk of developing it due to anatomical diffe-rences compared to adults. The incidence of subglottic stenosis following orotracheal intubation has decreased over time as reported in the literature. This study aimed to assess the prevalence of this condition in our population and describe the clinical, demographic, and diagnostic characteristics in the pediatric population diagnosed with subglottic stenosis following orotracheal intubation at the San Vicente Fun-dación Hospital. Additionally, it aimed to evaluate the prevalence of this diagnosis during the mentioned period. Materials and Methods: A retrospective study was conducted by reviewing medical records of patients with ICD-10 codes for laryn-geal stenosis and for subglottic stenosis secondary to procedures. Also, the patients with the procedure code for orotracheal intubation were identified. A descriptive analysis was performed based on the distribution of variables. Results: The preva-lence of subglottic stenosis was 13%. There was a majority of male cases, and the primary cause of intubation was lower respiratory tract infection, mainly bronchio-litis. The most frequent comorbidities included prematurity, swallowing disorders, and broncho-obstructive syndrome. Median duration of intubation was 19 days, and lower-grade stenosis was more commonly encountered. Conclusions: Subglottic ste-nosis is a complication of pediatric orotracheal intubation, with a prevalence of 13% in this study. Patients who develop this condition require one or more procedures to establish a patent airway and often experience prolonged hospital stays.

Síndrome destructivo de línea media secundario a infección por Paracoccidioides sp. Reporte de un caso

El síndrome destructivo de línea media es un grupo de enfermedades inflamatorias y tumorales destructivas del área centrofacial, entre las cuales la paracoccidioidomicosis es una de las etiologías a considerar en los países del trópico. La paracoccidioidomicosis es causada por hongos del género Paracoccidioides. Su forma de blastoconidia favorece la diseminación hematógena, afectando diversos tejidos como glándulas suprarrenales, tejido retículo-endotelial o mucosa oral, esta última donde puede manifestarse como un síndrome destructivo de línea media. Presentamos un caso de paracoccidioidomicosis con afección en cavidad oral, el cual debutó como un síndrome destructivo de línea media crónico, asociado a compromiso grave de la vía aérea que requirió manejo quirúrgico por riesgo de obstrucción y presentó mejoría con manejo antimicótico sistémico.

Summary Midline destructive disease is a group of severe and destructive inflammatory and tumor diseases of the midface area, among which paracoccidioidomycosis is one of the main etiologies in tropical countries. Paracoccidioidomycosis is an endemic mycosis caused by fungi of the genus Paracoccidioides. Its blastoconidia form favors hematogenous spread, affecting various tissues such as adrenal glands, reticulo-endothelial tissue, or oral mucosa, where it can manifest as a destructive midline syndrome. We present a case of paracoccidioidomycosis with affection in the oral cavity, which debuted as a chronic midline destructive disease with sever airway compromise that required surgical treatment for the risk of obstruction of the airway. The patient received systemic treatment with good response.

Dietas vegetarianas en niños: conocimientos de pediatras de la Sociedad Uruguaya de Pediatría: encuesta 2020 / Vegetarian diet in children: pediatric knowledge from the Uruguayan Society of Pediatrics: 2020 survey / Dietas vegetarianas em crianças: conhecimento dos pediatras da Sociedade Uruguaia de Pediatria: inquérito 2020

Introducción: en los últimos años el incremento de vegetarianos es considerable. Se debe tener cautela al incorporar este tipo de dietas en la población pediátrica. No son contempladas en las actuales guías de nutrición nacionales, generando incertidumbre al realizar recomendaciones. Objetivo: describir los conocimientos sobre dietas vegetarianas en niños por parte de médicos pediatras, posgrados y residentes socios de la Sociedad Uruguaya de Pediatría en el período de junio-setiembre 2020. Determinar la necesidad de incorporar dietas vegetarianas a las guías uruguayas de nutrición pediátrica por parte de los encuestados. Material y método: estudio observacional descriptivo, tipo encuesta transversal, en el período entre junio y setiembre de 2020. Los criterios de inclusión fueron médicos residentes/posgrados en pediatría y pediatras de la Sociedad Uruguaya de Pediatría, de Montevideo y el interior del país. La fuente de datos fue una encuesta online anónima. El análisis de datos fueron frecuencias relativas y absolutas para variables cualitativas. Resultados: se enviaron 1.080 encuestas online, de las que se incluyeron 119. Sobre la autopercepción en el conocimiento de los encuestados, el 58,0% se calificó dentro del rango medio. Acerca del concepto de dieta ovolactovegetariana, 63,9% seleccionó la opción correcta. Más de 50,0% respondió correctamente acerca de conocimientos sobre nutrientes en la mayoría de los ítems. Iniciar estas dietas en la alimentación complementaria fue desaconsejado por el 58% de los socios. Un 79,8% pretende adquirir más conocimientos del tema. Conclusiones: más de la mitad de los profesionales tiene los conocimientos correctos acerca de la correcta planificación y suplementación de dietas vegetarianas en niños. Se destaca la necesidad de incluir dietas vegetarianas en las guías de alimentación pediátrica en territorio uruguayo.

Introduction: the number of vegetarian people has increased considerably in recent years. Caution is suggested when incorporating this type of diet to the pediatric population. This diet has not been contemplated in the current national nutritional guidelines, generating uncertainty among pediatricians when making recommendations. Objective: describe the knowledge Pediatric Physicians and graduate / resident members of the Uruguayan Society of Pediatrics have regarding vegetarian diets in children during the period June-September 2020. Determine the need of the participants of the survey to incorporate vegetarian diet information into the Uruguayan Pediatric Nutritional Guidelines. Materials and methods: descriptive observational study, cross-sectional survey carried out from June to September 2020. The inclusion criteria included resident doctors / postgraduate pediatricians and pediatricians from the Uruguayan Society of Pediatrics of Montevideo and the interior of the country. The data source was an anonymous online survey. The data analyses were relative and absolute frequencies of qualitative variables. Results: 1.080 online surveys were sent and 119 were included. Regarding the respondents' self-perception of knowledge, 58.0% were rated within the medium range. Regarding the concept of lacto-ovo-vegetarian diet, 63.9% selected the correct option. Regarding knowledge about nutrients, we obtained more than 50.0% of correct answers in most of the items. Starting these diets as supplementary food was discouraged by 58% of the participants. 79.8% expressed the intention to acquire more knowledge regarding the subject. Conclusions: more than half of the professionals have the correct knowledge about the correct planning and supplementation of vegetarian diets in children. They stressed the need to include vegetarian diets in pediatric food guidelines in Uruguay.

Introdução: nos últimos anos, o aumento das pessoas vegetarianas tem sido considerável. Deve-se ter cuidado ao incorporar esse tipo de dieta na população pediátrica. Ela não está incluída nas atuais diretrizes nacionais de nutrição, gerando incerteza nos pediatras no momento de fazer recomendações. Objetivo: descrever o conhecimento sobre dietas vegetarianas em crianças dos Pediatras e pós-graduados/residentes da Sociedade Uruguaia de Pediatria no período de junho a setembro de 2020 para poder determinar a necessidade de incorporar dietas vegetarianas às diretrizes nutricionais pediátricas uruguaias. Material e métodos: estudo observacional descritivo, tipo de pesquisa transversal realizada no período de junho a setembro de 2020. Os critérios de inclusão foram médicos residentes/pós-graduados em pediatria e pediatras da Sociedade Uruguaia de Pediatria, Montevidéu e interior do país. A fonte de dados foi uma pesquisa on-line anônima sobre a necessidade de incorporar dietas vegetarianas às diretrizes uruguaias para nutrição pediátrica. As análises dos dados foram frequências relativas e absolutas de variáveis qualitativas. Resultados: 1.080 pesquisas online foram enviadas e 119 foram incluídas. Quanto à autopercepção de conhecimento dos entrevistados, 58,0% foram avaliados dentro da faixa média. Quanto ao conceito de dieta lacto-ovo-vegetariana, 63,9% selecionaram a opção correta. Quanto ao conhecimento sobre nutrientes, obtivemos mais de 50,0% das respostas corretas na maioria dos itens. O início dessas dietas como alimentos suplementares foi desencorajado por 58% dos participantes. 79,8% expressaram a intenção de adquirir mais conhecimento sobre o assunto. Conclusões: mais da metade dos profissionais têm o conhecimento correto sobre o planejamento correto e suplementação de dietas vegetarianas em crianças. Eles enfatizaram a necessidade de incluir dietas vegetarianas nas diretrizes de alimentos pediátricos no Uruguai.

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension.

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment.

Artroplastía total de cadera en paciente con enfermedad de Paget: presentación de un caso / Total hip arthroplasty in a patient with Paget's disease. A case report

Introducción: La enfermedad de Paget es un trastorno metabólico de etiología desconocida, secundario a un incremento en la función de los osteoclastos y la consecuente respuesta de los osteoblastos a la formación exagerada de hueso. Compromete con mayor frecuencia el fémur proximal y, a menudo, se diagnostica incidentalmente. Se presenta el caso de una mujer con antecedente de enfermedad de Paget y pseudoartrosis de cadera izquierda, con indicaciones de prótesis total de cadera izquierda y un episodio único de luxación, sin complicaciones posteriores y una adecuada evolución. Conclusión: El manejo quirúrgico en casos de fractura de cadera permite restablecer la marcha y mejorar la calidad de vida de los pacientes con enfermedad de Paget. A pesar de ser una patología que dificulta el manejo de los pacientes, la enfermedad de Paget no es una contraindicación para la artroplastia total de cadera y permite mejorar el dolor y recuperar la funcionalidad. Nivel de Evidencia: IV

Introduction: Paget's disease is a metabolic disorder of unknown etiology, secondary to an increase in the function of osteoclasts and the consequent response of osteoblasts to excessive bone formation. It most commonly involves the proximal femur and is often diagnosed incidentally. We present the case of a woman with a history of Paget's disease and nonunion of the left hip, with indications for a total left hip prosthesis and a single episode of dislocation, without subsequent complications and an adequate evolution. Conclusion: Surgical management in cases of hip fracture allows to restore walking and improves the quality of life of patients with Paget's disease. Despite being a pathology that makes patient management difficult, Paget's disease is not a contraindication for total hip arthroplasty and allows the improvement of pain and restoration of functionality. Level of Evidence: IV

Effects of Beef Protein Supplementation in Male Elite Triathletes: A Randomized, Controlled, Double-Blind, Cross-Over Study.

OBJECTIVE: Beef protein extracts are growing in popularity in recent years due to their purported anabolic effects as well as to their potential benefits on hematological variables. The present randomized, controlled, double-blind, cross-over study aimed to analyze the effects of beef protein supplementation on a group of male elite triathletes (Spanish National Team). METHODS: Six elite triathletes (age, 21 ± 3 years; VO2max, 71.5 ± 3.0 ml·kg·min-1) were randomly assigned to consume daily either 25 g of a beef supplement (BEEF) or an isoenergetic carbohydrates (CHO) supplement for 8 weeks, with both conditions being separated by a 5-week washout period. Outcomes, including blood analyses and anthropometrical measurements, were assessed before and after each 8-week intervention. RESULTS: No effects of supplement condition were observed on body mass nor on skinfold thicknesses, but BEEF induced significant and large benefits over CHO in the thigh cross-sectional area (3.02%, 95%CI = 1.33 to 4.71%; p = 0.028, d = 1.22). Contrary to CHO, BEEF presented a significant increase in vastus lateralis muscle thickness (p = 0.046), but differences between conditions were not significant (p = 0.173, d = 0.87). Although a significantly more favorable testosterone-to-cortisol ratio (TCR) was observed for BEEF over CHO (37%, 95% CI = 5 to 68%; p = 0.028, d = 1.29), no significant differences were found for the hematological variables (i.e., iron, ferritin, red blood cell count, hemoglobin or hematocrit). CONCLUSION: Beef protein supplementation seems to facilitate a more favorable anabolic environment (i.e., increased TCR and muscle mass) in male elite triathletes, with no impact on hematological variables.

Onychomycosis caused by the environmental mold Neoscytalidium dimidiatum in Colombia, and in vitro antifungal susceptibility evaluation.

Neoscytalidium dimidiatum is a plant pathogen, but can also cause onychomycosis. We compared clinical and epidemiological data of cases of onychomycosis caused by N. dimidiatum and Trichophyton rubrum. We also evaluated the in vitro antifungal susceptibility of N. dimidiatum clinical isolates. It was not possible to establish any statistical differences between groups, except the place of residence and the number of affected nails. The results suggest that onychomycosis caused by N. dimidiatum is clinically similar to that caused by T. rubrum; besides, N. dimidiatum has been shown to have low sensitivity to itraconazole, but high to terbinafine. LAY SUMMARY: Cases of onychomycosis caused by Neoscytalidium dimidiatum were studied and compared to cases of onychomycosis caused by T. rubrum. The individuals affected were adults, and the clinical characteristics were not different between groups; accordingly, mycological diagnosis is mandatory.

Acute Responses to On-Court Repeated-Sprint Training Performed With Blood Flow Restriction Versus Systemic Hypoxia in Elite Badminton Athletes.

PURPOSE: Repeated-sprint training (RS) is commonly conducted in normoxia, but its completion with localized (blood-flow restriction [BFR]) or systemic hypoxia has been proven effective for performance enhancement. Yet, few studies have applied these types of RS sessions in racket sports. The authors aimed to determine the acute responses to these types of training in elite badminton players. METHODS: Eight male elite badminton players participated in this randomized crossover study. They performed 3 on-court RS sessions, each consisting of 3 sets of 10 repetitions of 10-s badminton-specific movements in normoxia (RSN), systemic normobaric hypoxia (RSH, FiO2 = 14%), or with BFR (RS-BFR, 40% arterial occlusion pressure). Performance, perceptual (ie, rating of perceived exertion), and physiological (ie, pulse saturation, muscle oxygenation, blood lactate, creatine kinase, heart-rate variability) responses were measured after each set and up to 48 h postsession. RESULTS: RS-BFR induced a greater performance impairment (lower distance and accelerations) and a higher local perceived exertion in the legs than RSN and RSH (P < .05), whereas greater overall fatigue was reported with RSH (P < .05). RSH induced a lower saturation (P < .001), but no differences were observed in muscle oxygenation between conditions. No differences in creatine kinase or heart-rate variability were observed at any time point (from baseline up to 48 h after the session). CONCLUSIONS: RS-BFR-and, to a lower extent, RSH-resulted in impaired performance and a higher perceived strain than RSN. However, these 2 hypoxic methods do not seem to induce a long-lasting (post 24-48 h) physiological stress in elite badminton players.

¿Cómo resignifica sus experiencias una víctima del conflicto armado colombiano a partir de sus sueños? / ¿How does a victim of the colombian armed conflict re-signify their experiences from their dreams?

Este artículo presenta un acercamiento a los sueños como herramienta de autoconocimiento, y su relación con la capacidad de resignificar ciertos eventos de la vida. Se precisa desde las experiencias de una víctima del conflicto armado colombiano, por medio de un estudio de caso. Se vislumbra el andamiaje del conflicto armado en Colombia; se precisa en los fenómenos oníricos como proceso psíquico y representación simbólica que permite la exteriorización de la información inconsciente. Y finalmente, se concreta la importancia de la resignificación como entrada de entendimiento y reparación del significado, y las características comunes contenidas en las experiencias oníricas del caso estudiado.

This article presents an approach to the dreams as a tool for self-knowledge, and its relationship with the ability to re-signify certain life events. It is required from the experiences of a victim of the Colombian armed conflict, through a case study. In addition; observing the scaffolding of the armed conflict in Colombia; Emphasis is placed on dream phenomena as a psychic process and symbolic representation that allows the externalization of unconscious information. And finally, the importance of resignification is determined as an entrance of understanding and repair of meaning, and the common characteristics contained in the dream experiences of the case studied.

Impact of reduction of tinnitus intensity on patients' quality of life.

OBJECTIVE: Assess the impact of a reduction of tinnitus intensity achieved through sound stimulation during sleep on the improvement in the patients' quality of life. DESIGN: Acoustic stimuli consisted of a highly customized sound that reproduced the spectral and intensity characteristics of the tinnitus in each patient. This stimulus was uploaded into a portable electronic device and delivered through customized ear buds during sleep, every night for three months. STUDY SAMPLE: Twelve patients with subjective idiopathic chronic tinnitus were studied. RESULTS: Results were assessed through: (1) the measurement in dB SPL of tinnitus intensity reduction over time; (2) the results of three psychometric tests: Tinnitus handicap inventory (THI), Tinnitus reaction questionnaire (TRQ), Tinnitus functional index (TFI); and (3) a Visual analog scale (VAS) for tinnitus annoyance. After three months of treatment, we observed an average decrease in tinnitus intensity of 14.1 dB SPL (p < 0.001), implying a 62% reduction of the perceived sound. This improvement was followed by a statistically significant decrease of TRQ (78%), THI (65%), and TFI (77%). CONCLUSIONS: These results suggested that the intensity reduction achieved through the protocol used in this study had a direct impact on the improvement in the patients' quality of life.

Validation of a new scoring system: Rapid assessment faecal incontinence score.

AIM: To implement a quick and simple test - rapid assessment faecal incontinence score (RAFIS) and show its reliability and validity. METHODS: From March 2008 through March 2010, we evaluated a total of 261 consecutive patients, including 53 patients with faecal incontinence. Demographic and comorbidity information was collected. In a single visit, patients were administered the RAFIS. The results obtained with the new score were compared with those of both Wexner score and faecal incontinence quality of life scale (FIQL) questionnaire. The patient without influence of the surgeon completed the test. The role of surgeon was explaining the meaning of each section and how he had to fill. Reliability of the RAFIS score was measured using intra-observer agreement and Cronbach's alpha (internal consistency) coefficient. Multivariate analysis of the main components within the different scores was performed in order to determine whether all the scores measured the same factor and to conclude whether the information could be encompassed in a single factor. A sample size of 50 patients with faecal incontinence was estimated to be enough to detect a correlation of 0.55 or better at 5% level of significance with 80% power. RESULTS: We analysed the results obtained by 53 consecutive patients with faecal incontinence (median age 61.55 ± 12.49 years) in the three scoring systems. A total of 208 healthy volunteers (median age 58.41 ± 18.41 years) without faecal incontinence were included in the study as negative controls. Pearson's correlation coefficient between "state" and "leaks" was excellent (r = 0.92, P < 0.005). Internal consistency in the comparison of "state" and "leaks" yielded also excellent correlation (Cronbach's α = 0.93). Results in each score were compared using regression analysis and a correlation value of r = 0.98 was obtained with Wexner score. As regards FIQL questionnaire, the values of "r" for the different subscales of the questionnaire were: "lifestyle" r = -0.87, "coping/behaviour" r = -0.91, "depression" r = -0.36 and "embarrassment" r = -0.90, (P < 0.01). A multivariate analysis showed that all the scoring systems measured the same factor. A single factor may explain 80.84% of the variability of FI, so all the scoring systems measure the same factor. Patient's continence improves when RAFIS and Jorge-Wexner scores show low values and when the values obtained in the FIQL questionnaire are high. CONCLUSION: RAFIS is a valid and reliable tool to assess Faecal Incontinence.

Lidocaine-prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study.

OBJECTIVE: The efficacy of lidocaine-prilocaine cream (EMLA(®)) analgesia in the practice of hysterosalpingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography. STUDY DESIGN: A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients' intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit. TRIAL REGISTRATION: NCT01303614. RESULTS: The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: -0.481 to 1.641). No differences were found between the two groups (P=0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495-3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034-1.806), significantly less pain was experienced by the EMLA group than the placebo group: P=0.000 and P=0.042, respectively. CONCLUSION: Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step.

Detección temprana en trastornos del espectro autista: una decisión responsable para un mejor pronóstico / Early detection of autism spectrum disorders: a responsible decision for a better prognosis

Introducción. La detección temprana del autismo es una variable determinante de un mejor pronóstico. Métodos. Se realizó un estudio descriptivo y retrospectivo del proceso de detección y diagnóstico de 42 niños con trastornos del espectro autista (TEA) por medio de una entrevista semiestructurada y a través de la revisión de historias clínicas. Resultados. Se encontró que los padres son las personas que inicialmente sospechan la presencia de algún trastorno, alrededor de un año diez meses de edad. Los signos de alarma más frecuentes son los comportamientos ausentes, la falta de lenguaje y el retraso motor. Para la detección y diagnóstico participan, en promedio, cinco profesionales. El neurólogo infantil y el psicólogo fueron quienes más diagnósticos de TEA realizaron, entre los tres y los cinco años de edad. Se recibieron diagnósticos de discapacidad intelectual, trastornos de déficit de atención e hiperactividad y retraso en el desarrollo. Conclusiones. Se resalta la importancia de formar y capacitar profesionales de la salud, para lograr que la detección e intervención de los TEA sea cada vez más oportuna.

Background. Early detection of autism is a decisive variable for a better prognosis. Methods. A study was conducted describing the process of detection and diagnosis of 42 children with autism spectrum disorders [ASD]. Results. Parents are those who initially suspect the presence of a disorder at about the age of 22 months. The most common warning signs include behavior described as appearing absent, lack of language, and motor delays. Five different health care professionals are involved in the detection process. The pediatric neurologist and psychologist are the professionals who most frequently diagnosed ASD between 3 and 5 years of age. Diagnoses given to the families include intellectual disability, attention deficit disorder with hyperactivity, and developmental delay. Conclusions. The results of the study show the importance of training healthcare professionals, leading to the early detection and intervention of ASD.

La Computación como alternativa sociocultural de la Tercera Edad / Informatics as a sociocultural alternative of the Third Age

El empleo de las Tecnologías de la Información y las Comunicaciones (TIC) está presente en todas las esferas del que hacer de la sociedad contemporánea. Cuba no está ajena a este proceso de informatización de la sociedad, en el que se inserta el movimiento de los Joven Club de Computación y Electrónica. En tal sentido se realizó una intervención educativa en el Joven Club de Computación y Electrónica del Consejo Popular Camilo Cienfuegos del municipio Bayamo, con el objetivo de propiciar un entorno sociocultural apropiado para la motivación de las personas de la Tercera Edad por el aprendizaje de la Computación, con este fin se integró un equipo multidisciplinario formado por profesores de la Filial de Ciencias Médicas de Bayamo, la Universidad de Granma y del Joven Club de Computación y Electrónica. Como resultado se obtuvo un software diseñado en la plataforma Moodle; su validación se realizó a través de un pilotaje y el criterio de expertos. Con la puesta en práctica de este software se logró la motivación por el estudio de la Computación en las personas de la Tercera Edad, evidenciada a través de los índices de asistencia, puntualidad, retención, y resultados de promoción cualitativos y cuantitativos(AU)

The current society is characterized by the application of the Information and Communication Technologies (ICT), Cuba is not far from this technological advance, in the country there is evidenced a project to educate and prepare the citizens in these technologies, in this process of computerization of the society it is included the movement of the Young Club of Informatics and Electronic. In this sense it was performed an educational intervention in the Young Club of Informatics and Electronics of the Popular Council Camilo Cienfuegos in Bayamo, with the aim to facilitate the appropriate sociocultural environment for the motivation of the Third Age people by the learning of Informatics, as a contribution to get a satisfactory lifestyle of this people, with this purpose it was created a multidisciplinary team integrated by professors from the Medical Science Filial of Bayamo, the University of Granma and from the Young Club of Informatics and Electronic. The proposal integrated a software designed in the Moodle platform and a group of informatics tools. The validation was made through a pilotage, it was used the test of difference of proportions with a level of significance of 0.05, to compare the indicators of retention, assistance, punctuality and quantitative and qualitative results between the experimental and the control groups. Besides the proposal was under the criterion of experts, by means of the Delphi method, they considered it effective to obtain of the objectives proposed(EU)

[Resources and delays in the diagnosis of sleep apnea-hypopnea syndrome]. / Recursos y demoras en el diagnóstico del síndrome de apneas-hipopneas durante el sueño (SAHS).

OBJECTIVE: The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals. METHODS: We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Health's 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis. RESULTS: Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP systems was 0.99 per 100,000 inhabitants, while the recommended number is 3 per 100,000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100,000 inhabitants, while the recommended number is 1 per 100,000. CONCLUSIONS: We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that healt hcare authorities allocate more resources to this public health problem.

Recursos y demoras en el diagnóstico del síndrome de apneas-hipopneas durante el sueño (SAHS) / Resources and delays in the diagnosis of sleep apnea-hypopnea syndrome

Objetivo: La demanda de consultas y estudios diagnósticos del síndrome de apneas-hipopneas durante el sueño (SAHS) se ha incrementado, lo que ha llevado a importantes demoras. Por tanto, es precisa una evaluación actualizada de la situación del diagnóstico que sirva como herramienta de gestión a especialistas y las administraciones sanitarias que tienen la responsabilidad de solventar el problema. El objetivo del presente estudio ha sido realizar un análisis descriptivo de la situación del diagnóstico del SAHS en los hospitales españoles. Métodos: Se ha realizado un estudio descriptivo, observacional y transversal. Se estableció contacto con los centros públicos y privados incluidos en el catálogo de instituciones sanitarias del Ministerio de Sanidad de 2005. Se incluyeron aquellos que evaluaban habitualmente a pacientes con SAHS. El responsable de cada centro rellenó un cuestionario sobre disponibilidad de recursos y demoras para el diagnóstico. Resultados: De los 741 centros con los que se estableció contacto, 217 evaluaban habitualmente a pacientes con SAHS. El 88% disponía de poligrafía respiratoria (PR) (n = 168) o polisomnografía (PSG) (n = 97). La demora media en consulta fue de 61 días, y la demora media para realizar PR, de 224 días. La media de equipos de PR fue de 0,99/100.000 habitantes, cuando lo recomendable es 3/100.000. La demora media para PSG fue de 166 días. La media de camas de PSG fue de 0,49/100.000 habitantes y lo recomendable es 1/100.000. Conclusiones: Se observa una notable deficiencia de recursos que lleva a inaceptables listas de espera. Aunque la situación del diagnóstico de SAHS ha cambiado favorablemente con respecto a estudios previos, sigue siendo mejorable y es imprescindible que las autoridades sanitarias dediquen más recursos a este problema de salud pública

Objective: The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals. Methods: We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Health's 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis. Results: Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP systems was 0.99 per 100 000 inhabitants, while the recommended number is 3 per 100 000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100 000 inhabitants, while the recommended number is 1 per 100 000. Conclusions: We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that healt hcare authorities allocate more resources to this public health problem

[Blood cultures in the emergency department]. / Hemocultivos en el servicio de urgencias.

INTRODUCTION: Culture of emergency room blood samples is common practice, but open to controversy. As compared to other emergency tests, blood collection requires twice as much time and needs a refined technique to avoid contamination, and the study has no immediate diagnostic utility. METHODS: This prospective study includes consecutive adult patients with positive emergency room blood cultures. We analyzed the diagnostic sensitivity and contamination rate of the cultures and the etiology, clinical features and prognosis of the bacteremias encountered. RESULTS: During the study period, 5.2 blood cultures were indicated per 1000 patients attended in the emergency room. The diagnostic yield (positive blood cultures/total cultures) was 20% and the contamination rate (contaminated blood cultures/total cultures) was 1%. The incidence of bacteriemia was 0.99 episodes per 1000 patients attended in the emergency room and 10.3 episode per 1000 hospitalized patients. Gram-negative bacteria predominated (57%). Sepsis was the most frequent clinical manifestation (50%), followed by severe sepsis (40%) and septic shock (10%). Mortality was 22%. Diabetes mellitus and severe sepsis/septic shock were independent factors associated with mortality. CONCLUSIONS: Diagnostic performance and quality of emergency room blood cultures was high. The predominant etiology was gram-negative bacteria. Patients had a severe clinical presentation. Diabetes mellitus and severe sepsis and/or septic shock were independent prognostic factors of mortality.

Hemocultivos en el servicio de urgencias / Blood cultures in the emergency department

INTRODUCCIÓN. La realización de hemocultivos en el servicio de urgencias es una práctica común pero discutida porque, comparada con otros análisis de urgencias, requieren el doble de tiempo para la extracción y una técnica depurada para evitar contaminaciones, y carecen de utilidad diagnóstica inmediata. MÉTODOS. Estudio prospectivo de todos los pacientes adultos con hemocultivos positivos realizados en el servicio de urgencias y análisis de la rentabilidad, la calidad, la incidencia, la etiología, la clínica y el pronóstico de estas bacteriemias. RESULTADOS. Durante el período de estudio se indicaron 5,2 hemocultivos por cada 1.000 pacientes atendidos en urgencias. La rentabilidad diagnóstica (n.º de bacteriemias/n.º de hemocultivos realizados) fue del 20% y la tasa de contaminación (n.º de contaminantes/n.º de hemocultivos realizados) fue del 1%. La incidencia de bacteriemia fue de 0,99 episodios por cada 1.000 pacientes atendidos en el servicio de urgencias y de 10,3 episodios por cada 1.000 ingresos. La etiología predominante fueron las bacterias gramnegativas (57%). La sepsis fue la manifestación clínica más frecuente (50%), seguida de la sepsis grave (40%) y del shock séptico (10%).La mortalidad fue del 22%. La diabetes mellitus y la sepsis grave/shock séptico fueron los factores independientes asociados con la mortalidad. CONCLUSIONES. La rentabilidad y la calidad de los hemocultivos en el servicio de urgencias es elevada. Las bacterias gramnegativas son la etiología predominante. La presentación clínica de los pacientes con bacteriemia es grave y los factores independientes de mal pronóstico son la diabetes mellitus y la sepsis grave y/o el shock séptico (AU)

INTRODUCTION. Culture of emergency room blood samples is common practice, but open to controversy. As compared to other emergency tests, blood collection requires twice as much time and needs a refined technique to avoid contamination, and the study has no immediate diagnostic utility. METHODS. This prospective study includes consecutive adult patients with positive emergency room blood cultures. We analyzed the diagnostic sensitivity and contamination rate of the cultures and the etiology, clinical features and prognosis of the bacteremias encountered. RESULTS. During the study period, 5.2 blood cultures were indicated per 1000 patients attended in the emergency room. The diagnostic yield (positive blood cultures/total cultures) was 20% and the contamination rate(contaminated blood cultures/total cultures) was 1%.The incidence of bacteriemia was 0.99 episodes per 1000 patients attended in the emergency room and 10.3 episode per 1000 hospitalized patients. Gram-negative bacteria predominated (57%). Sepsis was the most frequent clinical manifestation (50%), followed by severe sepsis (40%) and septic shock (10%). Mortality was 22%. Diabetes mellitus and severe sepsis/septic shockwere independent factors associated with mortality. CONCLUSIONS. Diagnostic performance and quality of emergency room blood cultures was high. The predominant etiology was gram-negative bacteria. Patients had a severe clinical presentation. Diabetes mellitus and severe sepsis and/or septic shock were independent prognostic factors of mortality (AU)