Guía en redes sociales de radiología. ¿Hacia un nuevo paradigma en educación médica? / Social networks in radiology: Toward a new paradigm in medical education?

El sistema universalmente aceptado para la transmisión del conocimiento científico en medicina se basa desde hace mucho en las publicaciones científicas. Las redes sociales (RRSS) son una alternativa o complemento que puede ser útil. Las RRSS (Twitter, Instagram, Facebook, LinkedIn, YouTube, TikTok) tienen generadores de contenidos educativos que pueden proporcionar formación de calidad, a pesar de su informalidad. Cada una tiene sus puntos fuertes y sus debilidades, que conviene conocer. Son gratuitas y permiten discutir en vivo, incorporar contenidos ágilmente y contactar directamente con expertos o fuentes de conocimiento. Las editoriales son conscientes de su influencia y han incorporado métricas que miden el impacto en ellas de los artículos (Altmetrics). La estrategia formativa de cualquier servicio debe incorporarlas ya. Sin embargo, navegar en ellas es complejo y el sistema de búsqueda, basado en hashtags, es ineficiente, por lo que su uso en educación sigue siendo cosa de excéntricos. El conocimiento generado en las RRSS, a pesar de su informalidad, es una fuente cada vez más importante de conocimiento. Los servicios de radiología deben definir una estrategia de RRSS, no con fines de propaganda, sino educativos, creando grupos focales bien formados que busquen contenidos mediante revisión sistemática y filtros, repositorios digitales y sesiones de revisión y los compartan dentro y fuera del servicio. Igualmente, debe ser implementada una estrategia de comunicación a través de redes.(AU)

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.(AU)

Social networks in radiology: Toward a new paradigm in medical education?

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.

Epidemiología y clínica de las metástasis vertebrales / Epidemiology and clinic of vertebral metastasis

El cáncer es en España la segunda causa de muerte en mujeres (22%) y la primera en varones (31%). En este capítulo describimos los tipos más frecuentes de metástasis raquídeas, sus localizaciones más habituales dentro de la columna vertebral, así como su comportamiento clínico. Analizamos también los cuadros neurológicos más comúnmente asociados a las metástasis de columna: compresión radicular, compresión medular, cauda equina y afectación medular.(AU)

Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.(AU)

[Translated article] Epidemiology and clinic of vertebral metastasis / Epidemiología y clínica de las metástasis vertebrales

El cáncer es en España la segunda causa de muerte en mujeres (22%) y la primera en varones (31%). En este capítulo describimos los tipos más frecuentes de metástasis raquídeas, sus localizaciones más habituales dentro de la columna vertebral, así como su comportamiento clínico. Analizamos también los cuadros neurológicos más comúnmente asociados a las metástasis de columna: compresión radicular, compresión medular, cauda equina y afectación medular.(AU)

Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.(AU)

Exoftalmos y dolor ocular como presentación clínica de linfoma de Hodgkin con afectación intracraneal al diagnóstico / Exophthalmos and ocular pain as clinical debut of intracranial Hodgkin's lymphoma at diagnosis

La afectación intracraneal del linfoma de Hodgkin (LH) es extremadamente rara, especialmente como forma de presentación de la enfermedad. Muestra un patrón radiológico inespecífico, pudiendo ser confundido con otras entidades de mayor frecuencia y pronóstico radicalmente distinto. Anatomopatológicamente se caracteriza por la presencia de células grandes binucleadas (células de Reed-Sternberg) eIntracranial involvement in Hodgkin's lymphoma (HL) is extremely unusual, especially at the time of diagnosis. Because of its non-specific radiological behaviour, it can be confused with more common entities with a radically different prognosis. Pathologically, large and bi-nucleated cells, called Reed-Sternberg cells, embedded in an inflammatory network.

In this report we describe the clinical case of a patient, with no medical history, with left ocular pain and exophthalmos as presentation of intracranial HL at diagnosis and review the most current literature. Intracranial involvement is often associated with extracranial disease. Therefore, a systemic study including body computed tomography, bone marrow biopsy and ophthalmological evaluation is necessary. Intracranial lesions respond favourably to treatment and the prognosis depends on the extracranial involvement. To date, there is no standardised management scheme for these patients. For us, the primary role of surgery in this context is to perform a biopsy to confirm the histological diagnosis (AU)mbebidas en un entramado inflamatorio. Presentamos el caso de una paciente con dolor ocular y exoftalmos izquierdo como presentación clínica de afectación intracraneal por LH al diagnóstico de su enfermedad y revisamos la literatura más reciente al respecto. En pacientes con LH intracraneal es necesario realizar un estudio de extensión con tomografía computarizada corporal, biopsia de médula ósea y examen oftalmológico. Se asocia con gran frecuencia a enfermedad extracraneal, que marca el pronóstico. La lesión intracraneal presenta buena respuesta al tratamiento, que no sigue un esquema estandarizado. El papel de la cirugía es la realización de una biopsia para confirmar el diagnóstico (AU)

Exophthalmos and ocular pain as clinical debut of intracranial Hodgkin's lymphoma at diagnosis.

Intracranial involvement in Hodgkin's Lymphoma (HL) is extremely unusual, especially at the time of diagnosis. Because of its non-specific radiological behaviour, it can be confused with more common entities with a radically different prognosis. Pathologically, large and bi-nucleated cells, called Reed-Sternberg cells, embedded in an inflammatory network. In this report we describe the clinical case of a patient, with no medical history, with left ocular pain and exophthalmos as presetation of intracranial HL at diagnosis and review the most current literature. Intracranial involvement is often associated with extracranial disease. Therefore, a systemic study including body computed tomography, bone marrow biopsy and ophthalmological evaluation is necessary. Intracranial lesions respond favourably to treatment and the prognosis depends on the extracranial involvement. To date, there is no standardised management scheme for these patients. For us, the primary role of surgery in this context is to perform a biopsy to confirm the histological diagnosis.

Enhancing early parenting in the community: Preliminary results from a learning collaborative approach to scale up Attachment and Biobehavioral Catch-up.

Attachment and Biobehavioral Catch-up (ABC) is a promising home-visiting intervention promoting sensitive caregiving and secure parent-child attachment in families with young children. The goal of this study was to examine a learning collaborative approach to disseminating ABC in a community setting. Training outcomes (e.g., trainee completion, satisfaction, effectiveness of training methods) and intervention outcomes (e.g., parent behavior, parent beliefs, child socioemotional development) were examined. Eighteen practitioners participated in the ABC learning collaborative; 13 completed training. Quantitative and qualitative measures indicated that trainees were satisfied with their experience and valued the unique collaboration opportunities offered by the learning collaborative. In addition, trainees served 67 families in the community, 37 of whom completed all sessions of ABC. The study was conducted in the United States. Racial demographics of the children in the sample included: 56.7% White, 22.4% Black/African-American, 17.9% Bi- or Multi-racial, and 3.0% unknown. Regarding ethnicity, 80.6% were Non-Hispanic/Latino, 10.4% were Hispanic/Latino, and 9.0% were unknown. Caregivers who completed ABC showed more sensitive parenting behavior and reported positive changes in their perceived self-efficacy and their beliefs around infant crying. Children who received ABC showed increased socioemotional functioning. Results demonstrate successful dissemination of ABC in the community using a learning collaborative approach.

El Alcance de Afectividad y Bio-comportamiento (ABC) es una prometedora intervención de visita a casa que promueve el cuidado sensible y una relación progenitor-niño segura en familias con niños pequeños. El propósito de este estudio fue examinar un acercamiento de aprendizaje colaborativo para diseminar el ABC en un escenario comunitario. Se examinaron los resultados de entrenamiento (v.g. que el entrenado completó el proceso, satisfacción, efectividad de los métodos de entrenamiento) y los resultados de intervención (v.g. comportamiento del progenitor, creencias del progenitor, desarrollo socioemocional del niño). Dieciocho profesionales en la práctica participaron en el proceso de aprendizaje colaborativo; 13 completaron el entrenamiento, Las medidas cuantitativas y cualitativas indicaron que quienes se entrenaban estaban satisfechos con su experiencia y valoraron las oportunidades de colaboración que el proceso de aprendizaje colaborativo ofrecía de manera única. Adicionalmente, quienes se entrenaban les sirvieron a 67 familias en la comunidad, 37 de las cuales completaron todas las sesiones del ABC. El estudio se llevó a cabo en los Estados Unidos. Los perfiles demográficos raciales de los niños incluyen: 56.7% de raza blanca, 22.4% de raza negra o Afroamericanos, 17.9% birraciales o multirraciales, con un 3.0% cuya raza se desconoce. En cuanto a la etnicidad, 80.6% no eran hispanos o latinos, 10.4% eran hispanos o latinos, con un 9.0% cuya etnicidad se desconoce. Los cuidadores que completaron el ABC mostraron una conducta de crianza más sensible y reportaron cambios positivos en cuanto a su percepción de auto efectividad y su creencia acerca del llanto del infante. Los niños que recibieron el ABC mostraron un aumento en su funcionamiento socioemocional. Los resultados demuestran una exitosa diseminación del ABC en la comunidad usando un acercamiento de aprendizaje colaborativo.

L'attachement et le rattrapage bio-comportemental (en anglais Attachment and Biobehavioral Catch-up, soit ABC) est une intervention prometteuse de visite à domicile promouvant des soins sensibles et un attachement parent-enfant sécure chez les familles avec de jeunes enfants. Le but de cette étude est d'examiner une approche collaborative d'apprentissage à la dissémination de l'ABC dans le contexte d'une communauté. Les résultats de la formation (par exemple le fait de terminer le stage, la satisfaction, l'efficacité des méthodes de formation) et les résultats de l'intervention (par exemple le comportement du parent, les croyances parentales, le développement socio-émotionnel de l'enfant) ont été examinés. Dix-huit praticiens ont participé à la collaboration d'apprentissage ABC; 13 ont terminé la formation. Les mesures quantitatives and qualitatives ont indiqué que les stagiaires étaient satisfaits de leur expérience et avaient apprécié la chance d'une collaboration unique offerte par la collaboration d'apprentissage. De plus les stagiaires ont aidé 67 familles dans la communauté, 37 d'entre elles ayant terminé toutes les séances de l'ABC. L'étude a été faite aux Etats-Unis d'Amérique. Les données démographiques raciales des enfants dans l'échantillon ont inclus: 56,7% blancs, 22,4% noirs américains, 17,9% métisses ou multi-ethniques, et 3,0% de race inconnue. Concernant l'ethnicité, 80,6% était Non-Hispaniques/Non-Latinos, 10,4% étaient Hispaniques/Latinos et 9,0% étaient d'une ethnicité inconnue. Les personnes prenant soin des enfants qui ont complété l'ABC ont fait preuve d'un comportement de parentage plus sensible et fait état de changements positifs dans leur auto-efficacité perçue et leurs croyances concernant les pleurs des bébés. Les enfants ayant reçu l'ABC ont démontré un fonctionnement socio-émotionnel plus élevé. Les résultats démontrent une dissémination réussie de l'ABC dans une communauté en utilisant une approche collaborative d'apprentissage.

[Translated article] Epidemiology and clinic of vertebral metastasis.

Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter, we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behaviour. We also analyse the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.

Shedding of infectious SARS-COV-2 in two asymptomatic children / Excreción de SARS-CoV-2 infeccioso en dos niños asin tomáticos

Abstract Asymptomatic infections with SARS-CoV-2 are associ ated with viral transmission and have a key role in the propagation of the pandemic. Understanding viral shed ding during asymptomatic infections is critical. Unfor tunately, data on asymptomatic SARS-CoV-2 infection in children is extremely limited. To determine the presence of viral viable shedding, we prospectively followed two healthy children of a family where both parents devel oped mild COVID-19 (April 2021). SARS-CoV-2 detection was made by RT-PCR and virus isolation by cell culture from saliva samples. Positive samples were sequenced to identify variants of SARS-CoV-2. Serum samples were evaluated to determine the presence of antibodies using a single enzyme-linked immunosorbent assay (ELISA, COVIDAR IgG). Both children were SARS-CoV-2 positive and asymptomatic. In addition, the virus grew in cell cul ture from saliva samples. Furthermore, one child showed viable SARS-CoV-2 for at least 17 days after the onset symptoms from his father. The recommended isolation period for asymptomatic contacts during the acquisition of data had been established for 10 days; however, this child remained with viable virus beyond that period. The positive samples from both children were consistent with B.1.1.28.1 lineage (Gamma). In both asymptomatic children, anti-Spike IgG was detected. Asymptomatic children may represent a source of infection that should not be underestimated during this pandemic.

Resumen Las infecciones asintomáticas por SARS-CoV-2 están asociadas a la transmisión viral y tienen un papel cla ve en la propagación de la pandemia. Comprender la excreción viral durante las infecciones asintomáticas es fundamental. Desafortunadamente, los datos sobre la infección asintomática por SARS-CoV-2 en niños son extremadamente limitados. Para determinar la presencia de excreción de virus viable, se siguió prospectivamente a dos niños sanos de una familia en la que ambos padres desarrollaron COVID-19 leve (abril 2021). La detección de SARS-CoV-2 se realizó por RT-PCR y el aislamiento del virus por cultivo celular a partir de muestras de saliva. Las muestras positivas se secuenciaron para identificar variantes de SARS-CoV-2. En las muestras de suero se determinó la presencia de anticuerpos utilizando un ensayo de ELISA (COVIDAR IgG). Ambos niños fueron positivos para SARS-CoV-2 y asintomáticos. Además, el virus creció en cultivos celulares a partir de muestras de saliva. Uno de los niños mantuvo SARS-CoV-2 via bles durante al menos 17 días después de la aparición de los síntomas de su padre. El período de aislamiento recomendado para contactos asintomáticos durante la adquisición de datos se había establecido en 10 días, sin embargo, este niño permaneció con virus viable más allá de ese período. Las muestras positivas de estos niños correspondieron al linaje B.1.1.28.1 (Gamma). En ambos niños asintomáticos se detectó anticuerpos IgG anti-Spike. Concluimos que los niños asintomáticos pueden representar una fuente de infección que no debe subestimarse durante esta pandemia.

Epidemiology and clinic of vertebral metastasis. / Epidemiología y clínica de las metástasis vertebrales.

Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.

Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre.

Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies.Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre.Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge.Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes.Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.

The objective of the present study was to investigate the transportability of the DBT-PTSD programme to a real word clinical setting in a residential mental health centre.The DBT-PTSD treatment outperformed the TAU condition in the reduction of trauma-related symptoms, dissociative symptoms and DSO related but with lower effect sizes compared to previously published RCTs.The study results indicate the influence of treatment adherence on estimates of treatment effects and stress the necessity to routinely monitor the symptoms of patients who are at high risk of dropout or deterioration.

An Integrated Analysis of the Impact of Spanish Family Support Programmes with Informed Evidence / Un análisis integrado del impacto de los programas españoles de apoyo familiar basados en la evidencia

A description is made of the quality of Spanish family support programmes, based on their impact, dissemination, scaling up in communities, and sustainability; 57 implemented programmes with informed evidence were selected by EurofamNet. Most of the programmes were shown to make a positive impact, using quantitative methodologies, and they were manualized, while about half of them defined the core contents and included professional training. From a cluster analysis of programmes with scaling up, those with a high and moderate level of systematization were identified, based on the existence of defined core contents, implementation conditions, institutional support, professional training, and reports of findings. The highly systematized programmes were characterized by a greater use of mixed methodologies, their scientific dissemination through different means, and their inclusion in services. A programme quality analysis is proposed, taking an integrated approach that relates the programme’s impact with its design, implementation, and evaluation of sustainability.(AU)

En este trabajo se presenta una descripción de la calidad de los programas españoles de apoyo a las familias, basándose en su impacto, difusión, diseminación institucional y sostenibilidad. En el marco de EurofamNet se seleccionaron 57 programas implementados con evidencia fundamentada. La mayoría de los programas mostraron un impacto positivo utilizando metodologías cuantitativas y estaban manualizados, mientras que cerca de la mitad de ellos definían los contenidos clave e incluían la formación de los profesionales. A partir de un análisis de conglomerados se identificaron los que tenían un nivel de sistematización alto y moderado, definidos los contenidos clave y las condiciones de implementación, apoyo institucional, formación profesional e informes de resultados. Los programas con alto nivel de sistematización se caracterizaron por un mayor uso de metodologías mixtas, su difusión científica a través de diferentes medios y su inclusión en las instituciones. Se propone un análisis de la calidad de los programas, con un enfoque integrado que relacione el impacto del programa con su diseño, implementación y la evaluación de la sostenibilidad.(AU)

Meningitis neoplásica en tumores sólidos: revisión actualizada de diagnóstico, pronóstico, manejo terapéutico y direcciones futuras / Neoplastic meningitis in solid tumours: Updated review of diagnosis, prognosis, therapeutic management, and future directions

La meningitis neoplásica (MN) es una complicación metastásica relativamente frecuente en pacientes con cáncer, con alta morbilidad neurológica y en general pobre pronóstico. La prevalencia está en torno al 5-15% de los tumores sólidos, y los más frecuentes son el cáncer de mama, el de pulmón y el melanoma. La clínica se produce por afectación de hemisferios cerebrales, nervios craneales, médula y raíces nerviosas, siendo en muchos casos multifocal, y presenta a menudo síntomas y signos de hipertensión intracraneal. Las principales herramientas diagnósticas son la exploración neurológica, la resonancia magnética cerebral y medular con contraste, y el análisis y la citología del líquido cefalorraquídeo (LCR), aunque recientemente se están investigando técnicas como la detección de células tumorales y ADN circulante en el LCR, que aumentan la sensibilidad diagnóstica. Con las terapias disponibles en la actualidad el objetivo del tratamiento no es curativo, sino retrasar y disminuir los síntomas y preservar la calidad de vida de los pacientes, e implica un enfoque multimodal que puede incluir radioterapia, quimioterapia intratecal y/o sistémica y cirugía. El tratamiento debe ser individualizado y se basa principalmente en guías y opiniones de expertos. Actualmente se están llevando a cabo ensayos clínicos prometedores de fármacos contra dianas moleculares e inmunoterápicos. Este artículo es una revisión actualizada de la MN, e incluye epidemiologia, presentación clínica, diagnóstico, pronóstico, manejo y opciones terapéuticas; se dirige al neurólogo general, y en particular al neurólogo que ejerce su práctica en centros con pacientes oncológicos. (AU)

Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients. (AU)

Hematogenous dissemination mediastinitis: case report / Mediastinitis de diseminación hematogena: Reporte de un caso

Abstract Background: Acute mediastinitis is the inflammation of the connective tissue and fat surrounding the mediastinal structures. It is a high-mortality entity and its most frequent causes include sternotomy infections from cardiovascular surgery, esophageal perforation and extension of head and neck infections. Isolated cases of acute mediastinitis from hematogenous spread are described in the literature. Case presentation: 58 year-old man, with history of gouty arthritis managed with steroids, diagnosed with acute mediastinitis by S. aureus, secondary to septic arthritis of the ankle, managed with drainage of mediastinal collections by thoracoscopy and antibiotic therapy, with satisfactory evolution. Conclusions: In patients with acute mediastinitis, hematogenous dissemination should be considered when the etiologies most frequently associated with the entity are ruled out. Early surgical treatment derived from a multidisciplinary diagnostic approach improves the prognosis of these patients.

Resumen Antecedentes: la mediastinitis aguda es la inflamación del tejido conectivo y la grasa que rodea las estructuras mediastínicas. Es una entidad de alta mortalidad y sus causas más frecuentes incluyen infecciones de la esternotomia de la cirugía cardiovascular, perforación esofágica y extensión de infecciones de cabeza y cuello. Casos aislados de mediastinitis aguda por diseminación hematógena se describen en la literatura. Caso: Hombre de 58 años, con antecedente de artritis gotosa manejado con esteroides, diagnosticado de mediastinitis aguda por S. aureus, secundaria a artritis séptica de tobillo, manejada con drenaje de colecciones mediastínicas por toracoscopia y antibioterapia, con evolución satisfactoria. Conclusiones: En pacientes con mediastinitis aguda, se puede considerar la diseminación hematógena cuando las etiologías más frecuentemente asociadas a la entidad están descartados. El tratamiento quirúrgico precoz derivado de un abordaje diagnóstico multidisciplinar mejora el pronóstico de estos pacientes.

Neoplastic meningitis in solid tumours: updated review of diagnosis, prognosis, therapeutic management, and future directions.

Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients.

Repercussões da infodemia associada ao COVID-19 na saúde mental do idoso no Brasil / Repercusiones de la infodemia asociada al COVID-19 en la salud mental de los ancianos en Brasil / Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

O fenômeno denominado infodemia refere-se ao aumento do volume informacional sobre um tema em específico, que se multiplica rapidamente em um curto período de tempo, e tem-se destacado frente ao contexto da crise sanitária desencadeada pela pandemia de COVID-19. O excesso de informações pode suscitar sentimentos de medo, ansiedade, estresse e outras condições de sofrimento mental. O estudo tem como objetivo descrever o perfil de exposição a informações sobre COVID-19 e suas repercussões na saúde mental de idosos brasileiros. Trata-se de um estudo transversal realizado com 1924 idosos brasileiros. Coletaram-se dados por meio de web-based survey enviada aos idosos por redes sociais e e-mail, no período de julho a outubro de 2020. Os resultados da análise descritiva dos dados demonstram que a maioria dos idosos apresentou idade entre 60 e 69 anos (69,02por cento), é do sexo feminino (71,26por cento), casados (53,79 por cento) e de cor branca (75,57por cento). Cerca de 21,67por cento (n = 417) concluíram a graduação, 19,75por cento (380) concluíram especialização e 16,63por cento (320) concluíram mestrado ou doutorado. Foram reportados como fontes frequentes de exposição às notícias ou informações sobre a COVID-19, a televisão 862 (44,80por cento) e as redes sociais 651 (33,84por cento). Os participantes assinalaram que a televisão (46,47por cento; n = 872), as redes sociais (30,81por cento; n = 575) e o rádio (14,48por cento; 251) os afetavam psicológica e/ou fisicamente. Receber notícias falsas sobre a COVID-19 pela televisão (n = 482; 19,8por cento) e pelas redes sociais (n = 415; 21,5por cento) repercutiu, principalmente, estresse e medo. As informações disseminadas contribuem para conscientização, mas, também, afetam física e/ou psicologicamente muitos idosos, principalmente gerando medo e estresse(AU)

El fenómeno denominado infodemia hace referencia al aumento del volumen de información sobre un tema específico, que se multiplica rápidamente en un corto período, y ha destacado en el contexto de la crisis sanitaria desencadenada por la pandemia de la COVID-19. Demasiada información puede desencadenar sentimientos de miedo, ansiedad, estrés y otras condiciones de angustia mental. El estudio tiene como objetivo describir el perfil de exposición a la información sobre la COVID-19 y sus repercusiones en la salud mental de los ancianos brasileños. Se trata de un estudio transversal realizado con 1924 ancianos brasileños. Los datos fueron recolectados a través de una encuesta web enviada a los ancianos a través de redes sociales y correo electrónico, de julio a octubre de 2020. Los resultados del análisis descriptivo de los datos muestran que la mayoría de los ancianos tenían entre 60 y 69 años (69,02 por ciento), mujer (71,26 por ciento), casada (53,79 por ciento) y blanca (75,57 por ciento). El 21,67 por ciento (n = 417) concluyó su graduación, el 19,75 por ciento (380) concluyó especialización y el 16,63 por ciento (320) concluyó maestría o doctorado. La televisión 862 (44,80 por ciento) y las redes sociales 651 (33,84 por ciento) se reportaron como fuentes frecuentes de exposición a noticias o información sobre el COVID-19. Los participantes indicaron que la televisión (46,47 por ciento; n = 872), las redes sociales (30,81 por ciento; n = 575) y la radio (14,48 por ciento; 251) les afectaban psicológica y/o físicamente. Recibir noticias falsas sobre el COVID-19 en la televisión (n = 482; 19,8 por ciento) y en las redes sociales (n = 415; 21,5 por ciento) resultó principalmente en estrés y miedo. La información difundida contribuye a la sensibilización, pero también afecta física y/o psicológicamente a muchas personas mayores, generando principalmente miedo y estrés(AU)

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02percent), female (71.26percent), married (53.79percent) and white (75.57percent). About 21.67percent (n = 417) concluded their graduation, 19.75percent (380) concluded their specialization and 16.63percent (320) concluded their master's or doctoral degrees. Television 862 (44.80percent) and social networks 651 (33.84percent) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47percent; n = 872), social networks (30.81percent; n = 575) and radio (14.48percent; 251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482; 19.8percent) and on social media (n = 415; 21.5percent) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress(AU)

Comunicação em saúde sobre COVID-19 e Diabetes Mellitus em mídias sociais: verdadeiro e falso / Comunicación de salud sobre COVID-19 y Diabetes Mellitus en las redes sociales: verdadero y falso / Health communication about COVID-19 and Diabetes Mellitus in social media: true and false

Resumo Objetivos Identificar em canais de veiculação midiática, os assuntos verdadeiros e falsos relacionados à COVID-19 e às pessoas com diabetes mellitus. Método Pesquisa documental realizada em postagens no Twitter e nos sites da Sociedade Brasileira de Diabetes e do Ministério da Saúde e submetidas à análise temática e discutidas à luz das evidências científicas sobre o tema. Resultados Das 110 postagens, 71 eram do Twitter, 31 do Ministério da Saúde e 8 da Sociedade Brasileira de Diabetes. As fake news correspondiam a 88 postagens; sete divulgavam informações sobre estudos não concluídos; seis eram notícias equivocadas; e nove verdadeiras. Os assuntos foram agrupados em alimentos e substâncias, condições de vida (socioeconômica e hábitos), medicações, COVID-19 e diabetes mellitus, gravidade e fatores de risco. Há excesso de desinformação com a finalidade de enganar e negar a realidade, dadas as disputas de saberes e poderes políticos, econômicos e ideológicos. Conclusão e implicações para a prática A maior parte das postagens eram fake news. Em sendo as mídias sociais um lugar para a fácil disseminação de informações verdadeiras ou falsas, os cientistas e profissionais de saúde precisam se aproximar das comunidades virtuais dessas mídias e usá-las como ferramentas aliadas da comunicação em saúde.

Resumen Objetivos Identificar cuestiones verdaderas y falsas relacionadas con el COVID-19 y personas con diabetes mellitus en los canales de comunicación. Método Investigación documental realizada en publicaciones en Twitter y en los sitios web de la Sociedad Brasileña de Diabetes y el Ministerio de Salud, sometida a análisis temático y discutida a la luz de la evidencia científica sobre el tema. Resultados De las 110 publicaciones, 71 fueron de Twitter, 31 del Ministerio de Salud y 8 de la Sociedad Brasileña de Diabetes. Las noticias falsas correspondieron a 88 publicaciones; siete revelaron información sobre estudios inconclusos; seis fueron noticias equivocadas; y nueve verdaderas. Los temas se agruparon en alimentos y sustancias, condiciones de vida (socioeconómicas y de hábitos), medicamentos, COVID-19 y diabetes mellitus, gravedad y factores de riesgo. Existe un exceso de desinformación con el propósito de engañar y negar la realidad, dadas las disputas sobre conocimientos y poderes políticos, económicos e ideológicos. Conclusión e implicaciones para la práctica La mayoría de las publicaciones eran noticias falsas. Dado que las redes sociales son un lugar para la fácil difusión de información verdadera o falsa, los científicos y los profesionales de la salud deben acercarse a las comunidades virtuales de estos medios y utilizarlos como herramientas aliadas para la comunicación en salud.

Abstract Objectives To identify true and false issues related to COVID-19 and to people with diabetes mellitus in media channels. Method A documentary research study carried out in posts on Twitter and on the websites of the Brazilian Society of Diabetes and Ministry of Health, submitted to thematic analysis and discussed in the light of the scientific evidence on the topic. Results Of the 110 posts, 71 were from Twitter, 31 by the Ministry of Health and 8 by the Brazilian Society of Diabetes. Fake news corresponded to 88 posts; seven disclosed information about unfinished studies; six were wrong news items; and nine were true. The topics were grouped into food products and substances, living conditions (socioeconomic and habits), medications, COVID-19 and diabetes mellitus, severity and risk factors. There is an excess of disinformation with the purpose of deceiving and denying reality, given the disputes over political, economic and ideological knowledge and powers. Conclusion and implications for the practice Most of the posts were fake news. As the social media are a place for the easy dissemination of true or false information, scientists and health professionals need to approach the virtual communities of these media and use them as allied tools for communication in health.

Ganglioglioma anaplásico: diseminación leptomeníngea cervico-dorso-lumbar. A propósito de un caso / Anaplasic ganglioglioma: Cervical-dorso-lumbar leptomeningeal dissemination. About a case

Los ganglioglioma son tumores bien diferenciados, de crecimiento lento, compuestos por una mezcla de células ganglionares maduras y gliales. La mayoría son de grado I de la OMS. Aparecen predominantemente en niños y adultos jóvenes. La mayoría se localizan a nivel del lóbulo temporal, y la sintomatología más frecuente son las crisis epilépticas de difícil control farmacológico. En general tienen buen pronóstico tras la resección quirúrgica. La variante anaplásica, considerada grado III de la OMS, presenta mayor agresividad clínica y radiológica. La diseminación leptomeníngea es excepcional en estos tipos de tumores, pero cuando es diagnosticada presenta un curso rápidamente progresivo y fatal para el paciente (AU)

Gangliogliomas are well-differentiated, slow-growing tumors. The majority are grade I of WHO. It appears predominantly in children and young adults. Most are located at the temporal lobe, and as symptomatology more frequent epileptic seizures of difficult pharmacological control. In general, they have a good prognosis after surgical resection. The anaplasic variant, considered to be grade III of the WHO, presents greater clinical and radiological aggressiveness. Leptomeningeal dissemination is exceptional in these types of tumors, but when diagnosed it presents a rapidly progressive and fatal course for the patient (AU)

Aceitação entre estudantes do ensino básico do desenho animado O X na Xistose para construção de conhecimentos sobre esquistossomose / Acceptance of the cartoon O X na Xistose for the knowledge construction about schistosomiasis among middle school students / Aceptación entre estudiantes del ciclo básico de lo dibujo animado O X na Xistose para el desarrollo del conocimiento sobre la esquistosomiasis

O trabalho dos educadores pode ser enriquecido com o uso de recursos pedagógicos importantes no processo de ensino e aprendizagem. Considerando este aspecto, uma animação baseada no livro O feitiço da lagoa, de Virginia Schall, que trata do tema esquistossomose foi construída para estimular o conhecimento sobre a doença entre escolares e exibida para alunos do ensino básico em quatro municípios endêmicos: Jaboticatubas, Malacacheta e Santa Luzia, em Minas Gerais; e João Pessoa, na Paraíba. Após sua exibição, um questionário foi aplicado com a finalidade de verificar a aceitação e o entendimento do material. De acordo com as respostas, o desenho animado apresentou boa aceitação. Todos identificaram a esquistossomose como a doença retratada e o caramujo como o transmissor do esquistossomo. Os resultados apontaram que o desenho pode ser um importante recurso pedagógico no processo educativo, auxiliando os programas de controle da endemia, especialmente quando desenvolvidos no espaço escolar.

The educators' work can be enriched with the use of pedagogical resources which are important in the teaching and learning process. With this aspect in mind, a cartoon with the theme schistosomiasis was created, so as to promote knowledge about the disease among middle school students, and exhibited in four endemic municipalities - Jaboticatubas, Malacacheta and Santa Luzia in the state of Minas Gerais; and João Pessoa in the state of Paraíba. The animation was based on the book O feitiço da lagoa by Virginia Schall and it was shown to students in those four towns. A questionnaire was answered by them after the respective exhibitions in order to verify the acceptance and understanding of the material that was shown. According to the responses, the cartoon presented good acceptance. Everyone identified schistosomiasis as the disease displayed, and the snail that transmits the schistosome. The results showed that the cartoon can be an important pedagogical resource in the educational process, helping endemic control programs, especially when these programs are developed in the school environment.

El trabajo de los educadores puede ser enriquecido con el uso de recursos pedagógicos importantes en el proceso de enseñanza y aprendizaje. Considerando este aspecto, un dibujo animado sobre el tema esquistosomiasis fue realizado para estimular el conocimiento, entre estudiantes del ciclo básico, acerca de la enfermedad y exhibido en cuatro municipios endémicos: Jaboticatubas, Malacacheta y Santa Luzia en Minas Gerais; y João Pessoa en Paraíba. La animación fue basada en el libro O feitiço da lagoa de Virginia Schall y fue mostrada a alumnos en las cuatro localidades. Un cuestionario fue aplicado, después de cada proyección, con la finalidad de verificar la aceptación y el entendimiento del material exhibido. De acuerdo con las respuestas, el dibujo tuvo buena aceptación. Todos identificaron la esquistosomiasis como la enfermedad retratada y el caracol como el transmisor del esquistosoma. Los resultados indicaran que el dibujo animado puede ser un importante recurso pedagógico en el proceso educativo, auxiliando a los programas de control de la endemia, especialmente cuando desarrollados en el espacio escolar.

Anaplasic ganglioglioma: Cervical-dorso-lumbar leptomeningeal dissemination. About a case. / Ganglioglioma anaplásico: diseminación leptomeníngea cervico-dorso-lumbar. A propósito de un caso.

Gangliogliomas are well-differentiated, slow-growing tumors. The majority are gradeI of WHO. It appears predominantly in children and young adults. Most are located at the temporal lobe, and as symptomatology more frequent epileptic seizures of difficult pharmacological control. In general, they have a good prognosis after surgical resection. The anaplasic variant, considered to be gradeIII of the WHO, presents greater clinical and radiological aggressiveness. Leptomeningeal dissemination is exceptional in these types of tumors, but when diagnosed it presents a rapidly progressive and fatal course for the patient.