Diseño de una plantilla de escenarios de simulación clínica. Una propuesta para la formación en Obstetricia y Puericultura / Design of a clinical simulation scenario template. A proposal for training in Obstetrics and Child Care

Objetivo: Elaborar un esquema de diseño de escenarios de simulación clínica apoyados en un modelo de plantilla aplicable a la formación del grado de Obstetricia y Puericultura en universidades chilenas. Material y métodos: Se revisaron las mallas curriculares de 19 universidades que imparten el grado de Obstetricia y Puericultura en Chile, y se analizaron detalladamente seis planes de estudio de ellas. Se detectaron 26 competencias susceptibles de enseñarse con metodología de simulación. Se delimitaron los campos necesarios para ejecutar una sesión o actividad basada en simulación clínica de acuerdo con las recomendaciones de diseño identificadas en la bibliografía, la experiencia del Centro de Innovación en Simulación CISARC de la Universitat de Vic-Universitat Central de Catalunya, Campus Manresa, y la propia experiencia de las autoras. El proceso de diseño incluyó una validación de las plantillas en varias competencias y pruebas piloto. Resultados: Se diseñaron cuatro plantillas: dos fueron plantillas didácticas para la enseñanza de dos niveles de complejidad de la competencia de patología mamaria y otras dos fueron plantillas de evaluación del desempeño durante la simulación. Estas plantillas fueron validadas aplicándolas a tres competencias técnicas y no técnicas, para finalmente elaborar nuestro propio esquema de plantilla que guiará los diseños de la formación con simulación para estudiantes del grado de Obstetricia y Puericultura. Conclusiones: Las plantillas de simulación propuestas son aplicables a las competencias del grado de Obstetricia y Puericultura, y facilitarán la aplicación correcta de la simulación a los docentes.(AU)

Aim: To elaborate a model for the design of clinical simulation scenarios supported by a template applicable to Obstetrics and Puericulture (Obstetricia y Puericultura) degree training in Chilean universities. Material and methods: The curricula of 19 universities that offer the degree of Obstetrics and Puericulture. in Chile were reviewed and six curricula of these universities were analyzed in detail. Twenty-six competencies susceptible to be taught with simulation methodology were detected. The necessary fields to execute a session or activity based on clinical simulation were delimited according to design recommendations identified in the literature, the experience of the Center for Innovation in Simulation CISARC of the Universitat de Vic-Universitat Central de Catalunya Manresa Campus and the authors' own experience. The design process included a validation of the templates in several competencies and pilot tests. Results: Four templates were designed, two were teaching template for teaching two levels of complexity of the competence breast diseases and other two were assessment templates for the performance during the simulation. These templates were validated by applying them to three technical and non-technical competences, to finally elaborate our own scheme of template that will guide the designs of the training with simulation for students of the degree of Obstetrics and Puericulture. Conclusions: The proposed simulation templates are applicable to the competencies of the Obstetrics and Puericulture degree and will facilitate the correct application of simulation to teachers.(AU)

Perforación timpánica y colesteatoma, una patología de niños y adultos / Tympanic perforation and cholesteatoma, a pathology of children and adults

INTRODUCCIÓN. La patología de oído es una enfermedad frecuente en nuestro medio, asociada a infecciones a repetición del oído, con la presencia de perforación timpánica y colesteatoma, que determinará la presencia de lesiones mucho más acentuadas en cuanto a la evolución auditiva o complicaciones locales o sistémicas. OBJETIVO. Determinar la asociación existente entre la presencia de colesteatoma y perforación timpánica en pacientes con otitis media crónica. MATERIALES Y MÉTODOS. Estudio epidemiológico analítico retrospectivo. Población de 4 733 y muestra de 75 pacientes para casos y 75 para controles basados en historias clínicas tomadas del sistema informático AS 400, que acudieron a la consulta externa de torrinolaringología del Hospital de Especialidades Carlos Andrade Marín en el periodo de enero de 2018 a diciembre de 2019; Criterios de inclusión para grupo de casos: Hombres y mujeres de 20 a 65 años de edad, diagnóstico de otitis media crónica, diagnóstico de colesteatoma ótico. Criterios de inclusión para grupo controles: Hombres y mujeres de 20 a 65 años de edad, no presentar diagnóstico de colesteatoma. RESULTADOS. Se observó una relación fuerte entre el poseer perforación timpánica y el desarrollo de colesteatoma con un valor de OR 33,14 con un IC al 95% de 31,94 ­ 34,34, con lo que se comprobó la hipótesis del estudio. Se determinó que la perforación timpánica es un factor de riesgo asociado con el desarrollo de colesteatoma en pacientes con otitis media crónica, la prevalencia de colesteatoma en relación a la edad estuvo en un 72% en pacientes de 41 a 65 años, con mayor predominancia en mujeres en un 57,3%. DISCUSIÓN. La presencia de perforación timpánica de acuerdo a lo observado es un factor de riesgo para el desarrollo de colesteatoma, ligado en su mayoría a cuadros de Otitis Media Crónica. CONCLUSIONES. Se confirmó que la perforación timpánica, es un factor de riesgo en el desarrollo del colesteatoma en los pacientes que tienen otitis media crónica, lo que demuestra la necesidad de manejo actualizado y continuo en pacientes con esta patología de oído. Se requieren estudios con muestras más amplias para determinar otros factores de riesgo como sexo, nivel de educación y edad que podrían influir en el desarrollo de colesteatoma.

INTRODUCTION. Ear pathology is a frequent disease in our environment, associated with repeated ear infections, with the presence of tympanic perforation and cholesteatoma, which will determine the presence of much more accentuated lesions in terms of auditory evolution or local or systemic complications. OBJECTIVE. To determine the association between the presence of cholesteatoma and tympanic perforation in patients with chronic otitis media. MATERIALS AND METHODS. Retrospective analytical epidemiological study. Population of 4 733 and sample of 75 patients for cases and 75 for controls based on clinical histories taken from the AS 400 computer system, who attended the Otorhinolaryngology outpatient clinic of the Carlos Andrade Marín Specialties Hospital in the period from January 2018 to December 2019; Inclusion criteria for case group: Men and women aged 20 to 65 years, diagnosis of chronic otitis media, diagnosis of otic cholesteatoma. Inclusion criteria for controls group: men and women aged 20 to 65 years, no diagnosis of cholesteatoma. RESULTS. A strong relationship was observed between having tympanic perforation and the development of cholesteatoma with an OR value of 33,14 with a 95% CI of 31,94 - 34,34, thus proving the study hypothesis. It was determined that tympanic perforation is a risk factor associated with the development of cholesteatoma in patients with chronic otitis media, the prevalence of cholesteatoma in relation to age was 72% in patients aged 41 to 65 years, with greater predominance in women in 57,3%. DISCUSSION. The presence of tympanic perforation according to what was observed is a risk factor for the development of cholesteatoma, mostly linked to Chronic Otitis Media. CONCLUSIONS. It was confirmed that tympanic perforation is a risk factor in the development of cholesteatoma in patients with chronic otitis media, which demonstrates the need for updated and continuous management in patients with this ear pathology. Studies with larger samples are required to determine other risk factors such as sex, education level and age that could influence the development of cholesteatoma.

Covid-19 lockdown and consequences in Child and Adolescent Neuropsychiatrists' work and symptomatology perception.

Objectives: The Sars-Cov-2 pandemic changed children everyday activities and the way medical doctors visit their patients, especially during lockdown periods. Object of this work is to investigate the Sars-Cov-2 lockdown consequences in Latium Region, Italy, from the perspective of the Child and Adolescent Neuropsychiatrists operating in the area. Materials and Methods: A ten questions questionnaire was arranged and sent immediately after the end of the lockdown: it included a preliminary query on the reduction of the specialists' clinical activity, and nine queries on the perception of changes in their patients' psychopathological symptoms and/or adaptive behaviors during the lockdown. Results: We found little difference in the overall time devoted to clinical activities, with remote sessions largely replacing face to face sessions and the general impression for this very first phase, of a stability in the child and adolescent psychological symptoms. Conclusions: The informants had the impression of a general worsening of the adaptive strategies in children and adolescents with major neuro-developmental disorders and an increased difficulty in switching off the devices at all ages.

Plesiochorus Cymbiformis (Rudolphi, 1819) Looss, 1901 (Digenea: Gorgoderidae) in Olive Ridley Sea Turtles Lepidochelys Olivacea (Eschscholtz, 1829) (Testudines: Chelonidae) from The Brazilian Coast: New Geographic Occurrence and Associated Injuries.

The present study reports the first occurrence of Plesiochorus cymbiformis (Digenea: Gorgoderidae), in two Olive Ridley Sea turtles Lepidochelys olivacea (Testudines: Chelonidae), from the states of São Paulo and Sergipe in Brazilian coast. Concerning the Neotropical region, P. cymbiformis has been previously reported in green sea turtles (Chelonia mydas) from Panama and Brazil, in loggerhead sea turtles (Caretta caretta) from Brazil, in hawksbill sea turtles (Eretmochelys imbricata) from Puerto Rico, and in Olive Ridley Sea turtles only in Costa Rica. Lesions resulting from the presence of parasites in the hosts' urinary bladders are also presented. This is the second report on endoparasites in Olive Ridley sea turtles from Brazil.

Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

Serum proteinogram of the Campeiro horse / Proteinograma sérico de equinos da raça Campeiro

The aim of this study to measure the fractions of the total serum proteins of the Campeiro horse and identify the influences of biological variants. Blood samples were taken in 138 horses of the breed Campeiro for measuring the concentration of total serum protein by the biuret method. Serum concentrations of protein fractions were measured by electrophoresis using agarose gel. Groups were formed according to age, sex and reproductive condition. The average values of serum fractions: albumin (2.85±0.36g/dl), alpha 1 (0.28±0.11g/dl), alpha 2 (0.26±0.08g/dL) beta 1 (0.57±0.15g/dl), beta 2 (0.89±0.28g/dL), gamaglobulinas (1.86±0.34g/dL), albumin/globulin ratio (0.75±0.18) and 2.5% percentile and 97.5% had slight differences in relation to the reference interval proposed for the species. They observed higher values of alpha 1 and 2 globulins in the group from that had six to eight years old and gammaglobulins in group above 13 years old. Serum protein concentrations were similar in horses and mares and between non-pregnant and pregnant. Sex and pregnancy status did not affect serum proteinogram. Alpha and gammaglobulins have higher values as the age increases. Serum proteinogram of Campeiro horses shows variations that have to be considered in the interpretation of laboratory tests.(AU)

Este trabalho tem por objetivo mensurar as frações das proteínas totais séricas de equinos Campeiros e identificar as influências de variantes biológicas. Foram colhidas amostras de sangue de 138 equinos, machos e fêmeas da raça Campeiro. A determinação da concentração de proteínas totais séricas foi realizada pelo método de biureto. As concentrações séricas das frações proteicas foram determinadas por eletroforese, utilizando-se gel de agarose. Formaram-se grupos em relação à idade, ao sexo e à condição reprodutiva. Os valores médios das frações séricas albumina (2,85±0,36g/dL), alfa 1 (0,28±0,11g/dL), alfa 2 (0,26±0,08g/dL), beta 1 (0,57±0,15g/dL), beta 2 (0,89±0,28g/dL), gamaglobulinas (1,86±0,34g/dL), relação albumina/globulina (0,75±0,18) e os percentis 2,5% e 97,5% apresentaram diferenças pontuais em relação aos intervalos propostos para a espécie. Observaram-se maiores valores de alfa 1, alfa 2 globulinas, no grupo de seis a oito anos, e de gamaglobulinas, no grupo acima de 13 anos de idade. O proteinograma sérico foi similar entre machos e fêmeas e entre fêmeas vazias e gestantes. Sexo e estado gestacional não afetaram o proteinograma sérico. Alfa e gamaglobulinas têm incrementos em função de idades crescentes. O proteinograma sérico de equinos Campeiros tem variações que devem ser consideradas em exames laboratoriais.(AU)

Healing of brain lesions in sheep recovered from amprolium-induced polioencephalomalacia / Cicatrização das lesões cerebrais em ovinos recuperados de polioencefalomalacia induzida por amprólio

To evaluate the outcome of acute lesions in the brains of sheep that completely clinically recover from acute polioencephalomalacia (PEM), ten sheep were used in this experiment. Eight of those sheep received varying doses of amprolium to induce PEM. Four sheep were treated intramuscularly with 40mg/kg/body weight with thiamine to allow recovery and four sheep were left untreated. Two control sheep did not receive either amprolium or thiamine and were kept along with the other eight sheep for the duration of the experiment. Except for the two drugs, the diet and water source were the same for the ten sheep. Two sheep receiving high daily doses of amprolium and one sheep receiving a lower dose had acute deaths and developed acute brain lesions consisting of neuronal laminar cortical necrosis (red neurons), edema, reactive astrocytes, swollen endothelial cells and gitter cells infiltration. Four sheep that recovered from lower doses of amprolium-induced PEM after being treated with thiamine and another one that recovered spontaneously were euthanatized six months after clinical recovery and had gross changes consisting of segmental absence of cortical tissue. Histologically these segmental cortex-deprived areas corresponded to quasi-empty spaces where only vessels and gitter cells existed. No changes were seen in the brains of the two control sheep.(AU)

Para avaliar a evolução das lesões agudas no cérebro de ovinos que se recuperam clinicamente de polioencefalomalacia aguda (PEM), dez ovinos foram usados neste experimento. Oito desses ovinos receberam doses variáveis de amprólio para induzir PEM. Quatro ovinos foram tratados intramuscularmente com 40mg/kg/peso corporal de tiamina para permitir a recuperação, e outros quatro ficaram sem tratamento. Dois ovinos controles não receberam amprólio nem tiamina e foram mantidos com os outros oito ovinos durante a duração do experimento. Exceto pelas duas drogas, a dieta e a fonte de água eram as mesmas para os dez ovinos. Dois ovinos que receberam doses diárias altas de amprólio, e um que recebeu doses menores, tiveram mortes agudas e desenvolveram lesões cerebrais constituídas por necrose neuronal laminar cortical (neurônios vermelhos), edema, tumefação de células endoteliais, astrócitos reativos, tumefação de células endoteliais e infiltração por células gitter. Quatro ovinos que se recuperam da PEM induzida por amprólio, após tratamento com tiamina, e outro que se recuperou espontaneamente, permaneceram clinicamente normais e foram submetidos a eutanásia seis meses após a recuperação clínica. Na necropsia, apresentavam alterações macroscópicas caracterizadas por ausência segmentar de tecido corticocerebral. Histologicamente, essas áreas privadas de tecido cortical consistiam de espaços praticamente vazios onde apenas vasos e células gitter eram vistos. Não foram encontradas alterações no encéfalo das duas ovelhas controle.(AU)

Lesões intestinais em suínos abatidos no Rio Grande do Sul / Intestinal lesions in pigs slaughtered in Rio Grande do Sul, Brazil

O Rio Grande do Sul se destaca na suinocultura nacional pelos altos índices de produção, baseada em sistema de criação intensivo, fato que propicia a ocorrência de doenças entéricas. Este estudo foi realizado para diagnosticar e determinar a frequência das causas de condenação de intestinos na linha de abate. As amostras de intestino e linfonodos mesentéricos foram colhidas para análise histológica e imuno-histoquímica, de um frigorífico de suínos localizado na Região do Vale do Taquari, no Rio Grande do Sul (RS), que conta com Serviço de Inspeção Federal (SIF). A colheita ocorreu durante 18 dias nos meses de verão (janeiro e fevereiro) e 19 dias nos meses de inverno (junho, julho e agosto) de 2016. Os suínos eram provenientes de 55 municípios diferentes, que fazem parte de sete microrregiões do RS (microrregião de Passo Fundo, Soledade, Guaporé, Santa Cruz do Sul, Lajeado-Estrela, Montenegro e São Jerônimo). Dos 2.523 intestinos condenados no verão e 2.747 no inverno, 216 e 199 foram avaliados, respectivamente. Os três principais diagnósticos foram serosite crônica (43,1%), ascaridiose (21,4%) e enteropatia proliferativa suína (20%), seguidos por casos de tampão caseoso em válvula ileocecal (5,0%), abscesso intestinal (1,0%), pneumatose (1,0%), circovirose (0,7%), esofagostomíase (0,7%), salmonelose (0,7%) e um caso de intussuscepção (0,2%). A serosite crônica foi diagnosticada em 82/216 (38%) no verão e 97/199 (48,7%) no inverno, ascaridiose teve maior ocorrência no verão com 64/216 (29,6%) comparado com o inverno em que observou-se 25/199 (12,6%). A enteropatia proliferativa suína foi diagnosticada em 37/216 (17,1%) casos no verão e 46/199 (23,1%) no inverno.(AU)

Rio Grande do Sul stands out in the national swine industry due to high production rates, based on an intensive breeding system, which leads to the occurrence of enteric diseases. This study was performed to diagnose and determine the frequency of causes of bowel condemnation in the slaughter line. The samples of intestine and mesenteric lymph nodes were collected for histological and immunohistochemical analysis of a pig slaughterhouse located in the Vale do Taquari area, in Rio Grande do Sul (RS), which has Federal Meat Inspection Service (SIF). The collection occurred during 18 days in the summer (January and February) and 19 days during winter (June, July and August) of 2016. The pigs were from 55 different counties from of seven microregions of RS (microregion of Passo Fundo, Soledade, Guaporé, Santa Cruz do Sul, Lajeado-Estrela, Montenegro and São Jerônimo). Out of 2,523 condemned intestines in the summer and 2,747 in the winter, 216 and 199 were evaluated, respectively. The three main diagnoses were chronic serositis (43.1%), ascaridiosis (21.4%), and porcine proliferative enteropathy (20%), followed by cases of plug caseous in ileocecal valve (5.0%), intestinal abscess (1.0%), pneumatosis (1.0%), circovirosis (0.7%), oesophagostomiasis (0.7%), salmonellosis (0.7%) and a case of intussusception (0.2%). Chronic serositis was diagnosed in 82/216 (38%) in summer and 97/199 (48.7%) in winter, ascaridiosis had a higher occurrence in the summer with 64/216 (29.6%) compared to the winter when it was observed 25/199 (12.6%). Porcine proliferative enteropathy was diagnosed in 37/216 (17.1%) in summer and 46/199 (23.1%) in winter.(AU)

A retrospective study of quadrigeminal arachnoid cysts diagnosed by Magnetic Resonance Imaging and Computed Tomography in 26 dogs / Estudo retrospectivo de cistos aracnoides da cisterna quadrigeminal diagnosticados pela ressonância magnética e tomografia computadorizada em 26 cães

Arachnoid cysts are accumulations of cerebrospinal fluid that occur within the arachnoid membrane due to the splitting or duplication of this structure. The aim of this retrospective study is to report the occurrence of this condition in 26 dogs, as well as to describe the findings of computed tomography imaging and magnetic resonance image scans and to correlate these with the clinical signs. A prevalence of the condition was observed in males, predominantly in the small breeds Miniature Pinscher and Shih Tzu, with age raging from 2 months to 9 years. The mainly clinical signs observed in these dogs were seizures and cerebellar ataxia. The study concluded that in 17 dogs the quadrigeminal arachnoid cyst was regarded as an incidental finding, in 6 dogs this condition was regarded as the determinant cause of the clinical signs, and in 3 dogs some clinical signs were associated with arachnoid cyst, but they also presented clinical signs involving others sites of intracranial lesion. (AU)

Cistos aracnoide são acúmulos de líquido cefalorraquidiano que ocorre dentro da membrana aracnoide devido à divisão ou duplicação desta estrutura. O objetivo desse estudo retrospectivo é relatar a ocorrência dessa condição em 26 cães, assim como descrever os aspectos de imagem pela tomografia computadorizada e ressonância magnética e correlacionar com os sinais clínicos. No estudo observamos a prevalência em machos, em raças de pequeno porte, com predomínio de Pinscher miniatura e Shih Tzu, com idade variando de dois meses a nove anos. Os principais sinais neurológicos observados nestes animais foram crises epiléticas e ataxia cerebelar. Foi possível concluir que em 17 cães o cisto aracnoide quadrigeminal foi considerado um achado incidental, em seis cães essa condição foi considerada a causa determinante dos sinais clínicos, e em três cães alguns sinais estavam associados com o cisto aracnoide, porém esses animais apresentaram sinais clínicos relacionados a outros sítios de lesão intracraniana.

Encefalopatía posterior reversible durante el puerperio, secundaria a eclampsia. Reporte de dos casos / Reversible posterior encephalopathy during puerperium secondary to eclampsia. Report of two cases

Resumen ANTECEDENTES: El síndrome de encefalopatía posterior reversible es una alteración rara, que aparece en el tercer trimestre del embarazo y en el puerperio, asociada con preeclampsia-eclampsia y síndrome de Hellp. Los estudios de radioimagen son decisivos para establecer el diagnóstico y diferenciarlo de otros trastornos neurológicos, por su tratamiento y pronóstico diferentes. CASOS CLÍNICOS: Reporte de dos casos de encefalopatía posterior reversible con factores de riesgo diferentes para su manifestación (choque séptico, insuficiencia orgánica múltiple y síndrome de preeclampsia-eclampsia). El diagnóstico se estableció con base en la enfermedad subyacente, la sospecha clínica y los hallazgos en la resonancia magnética. En ambos casos coincidió la mayor parte de los síntomas relacionados con eclampsia. El tratamiento oportuno y la corrección del desequilibrio hidroelectrolítico, ácido-base, sepsis y sobrecarga de volumen fueron decisivos para revertir el cuadro y prevenir la evolución del síndrome. El diagnóstico de encefalopatía posterior reversible se corroboró por estudios radiológicos. Las pacientes egresaron de cuidados intensivos con remisión completa del cuadro neurológico. CONCLUSIONES: La prevalencia de encefalopatía posterior reversible en pacientes embarazadas es desconocida, su manifestación obedece a diferentes causas y las mujeres suelen recuperarse completamente; sin embargo, el diagnóstico y tratamiento deben individualizarse en cada caso.

Abstract BACKGROUND: Reversible posterior encephalopathy syndrome is a rare entity. It occurs most frequently in the third trimester and puerperium, associated with cases of preeclampsia-eclampsia and Hellp's syndrome. Radioimage studies are basic for its diagnosis and must be differentiated from other neurological pathologies, due to its different treatment and prognosis. CASES REPORT: This study presents two cases of reversible posterior encephalopathy syndrome with different risk factors for its presentation (septic shock, multiple organ failure and preeclampsia-eclampsia syndrome). The diagnosis is based on the underlying disease, clinical suspicion and magnetic resonance findings. In both cases, most of the symptoms related to eclampsia. The timely treatment and correction of fluid-electrolyte imbalance, acid-base, sepsis and volume overload are decisive in reversing the condition and preventing the evolution of the syndrome. The diagnosis of reversible posterior encephalopathy was corroborated by radiological studies. The patients withdrew from the care unit with complete remission of the neurological symptoms. CONCLUSIONS: Reversible posterior encephalopathy is a rare entity, of unknown prevalence in the pregnant patient, which occurs for different reasons, with full recovery, but which requires a specific diagnosis and treatment.

Quiste odontogénico inflamatorio: aislamiento de Pseudomonas stutzeri. Relevancia diagnóstica / Isolation of Pseudomonas stutzeri from an odontogenic inflammatory cyst: Diagnostic relevance

Pseudomonas stutzeri se encuentra ampliamente distribuido en el medio ambiente, ocupando diversos nichos ecológicos; pero su aparición en procesos infecciosos de interés clínico es el de patógeno oportunista. El aislamiento de P. stutzeri en un quiste inflamatorio odontogénico es un verdadero hallazgo microbiológico que no presenta antecedentes en la bibliografía científica odontológica. En este caso particular, el aislamiento se obtuvo a partir de material quirúrgico proveniente de un quiste odontogénico inflamatorio ubicado en la pieza dentaria 1.2 con necrosis pulpar concomitante. Se emplearon técnicas diagnósticas complementarias como radiografías, tomografías, estudios anatomopatológicos y microbiológicos. Los resultados permitieron clasificar el proceso como quiste inflamatorio infectado con P. stutzeri. La tipificación y la caracterización del perfil de sensibilidad de la cepa aislada permitieron adecuar la terapéutica antibiótica de manera específica. El análisis microbiológico permitió establecer la etiología del proceso infeccioso, la adecuación del tratamiento y el restablecimiento de los tejidos comprometidos.

Pseudomonas stutzeri is distributed widely in the environment, and occupies different ecological niches. However, it is found in clinically relevant infections as an opportunistic pathogen. Isolation of P. stutzeri from an odontogenic inflammatory cyst is an uncommon microbiological finding that has not been reported to date. In the case presented here, the bacterium was isolated from surgical material obtained from excision of an inflammatory odontogenic cyst located in the tooth 1.2, and presenting with concomitant pulp necrosis. Complementary techniques such as radiographs, CAT scans, and histopathological and microbiological studies were used to establish definitive diagnosis. The obtained results allowed classifying the process as an inflammatory cyst infected by P. stutzeri. Biotyping and characterization of the susceptibility profile of the isolated strain allowed adjusting the antibiotic therapy more specifically. The microbiological studies allowed establishing the etiology of the infectious process, adjusting the treatment plan, and re-establishing tissue integrity.

[Isolation of Pseudomonas stutzeri from an odontogenic inflammatory cyst: Diagnostic relevance]. / Quiste odontogénico inflamatorio: aislamiento de Pseudomonas stutzeri. Relevancia diagnóstica.

Pseudomonas stutzeri is distributed widely in the environment, and occupies different ecological niches. However, it is found in clinically relevant infections as an opportunistic pathogen. Isolation of P. stutzeri from an odontogenic inflammatory cyst is an uncommon microbiological finding that has not been reported to date. In the case presented here, the bacterium was isolated from surgical material obtained from excision of an inflammatory odontogenic cyst located in the tooth 1.2, and presenting with concomitant pulp necrosis. Complementary techniques such as radiographs, CAT scans, and histopathological and microbiological studies were used to establish definitive diagnosis. The obtained results allowed classifying the process as an inflammatory cyst infected by P. stutzeri. Biotyping and characterization of the susceptibility profile of the isolated strain allowed adjusting the antibiotic therapy more specifically. The microbiological studies allowed establishing the etiology of the infectious process, adjusting the treatment plan, and re-establishing tissue integrity.

Expressão imuno-histoquímica dos marcadores angiogênicos CD105 (endoglina) e CD34 em hemangiomas e granulomas piogênicos orais / Immunohistochemical expression of angiogenic markers CD105 (endoglin) and CD34 in oral pyogenic granulomas and hemangiomas

A angiogênese é um mecanismo fundamental para o desenvolvimento tumoral, sendo utilizada para fins de diagnóstico diferencial e determinação de prognóstico em várias neoplasias de cabeça e pescoço. Este trabalho se propôs avaliar a atividade angiogênica através da expressão imuno-histoquímica dos anticorpos anti-CD105 e anti-CD34 em 20 casos de hemangiomas e 20 casos de granulomas piogênicos orais, além de averiguar a utilidade destes marcadores como um dos recursos de diagnóstico diferencial para estas duas lesões orais. Os resultados deste experimento demonstraram que não houve diferença estatisticamente significativa entre as médias de contagem microvascular (MVC) determinadas pelos os anticorpos anti-CD105 (p=0,803) e anti-CD34 (p=0,279). O número médio dos vasos obtidos pela MVC nos espécimes de hemangiomas orais imunomarcados pelo anti-CD105 e anti-CD34 foram respectivamente 18,75 e 59,72, enquanto nos granulomas piogênicos orais, o número médio dos vasos obtidos pela MVC pelo anti-CD105 e anti-CD34 foram respectivamente 20,22 e 48,09. Foi verificado, também, que o CD34 foi mais efetivo na identificação de vasos sangüíneos quando comparado com o CD105. Entretanto, faz-se necessário destacar, que o anticorpo anti-CD105 parece estar mais relacionado com a neoformação vascular. Em linhas gerais, este ensaio reforça a participação dos fatores angiogênicos na etiopatogênese dos hemangiomas e granulomas piogênicos orais, porém os resultados mostraram que a quantificação da angiogênese não pode ser utilizada como parâmetro de diagnóstico diferencial entre as duas lesões analisadas. (AU)

Angiogenesis, a fundamental mechanism in tumor development, is used for differential diagnosis and prognosis purposes in various neoplasias of the head and neck. This study proposes to assess angiogenic activity using immunohistochemical expression by anti-CD105 and anti-CD34 antibodies in 20 cases of hemangiomas and 20 cases of oral pyogenic granulomas, in addition to determining the usefulness of these markers as one of the differential diagnosis resources for these two oral lesions. The results showed no statistically significant difference between microvascular count (MVC) means determined by anti-CD105 (p = 0.803) and anti-CD34 (p = 0.279) antibodies. The mean number of vessels obtained by MVC in the oral hemangiomas immunostained by anti-CD105 and anti-CD34 was 18.75 and 59.72, respectively, whereas in the oral pyogenic granulomas, the mean number was 20.22 and 48.09 respectively. It was also shown that CD34 was more effective than CD105 in identifying blood vessels. However, it must be pointed out that the anti-CD105 antibody seems to be more related to vascular neoformation. Overall, this assay reinforces the role of angiogenic factors in the etiopathogenesis of hemangiomas and oral pyogenic granulomas, but the results showed that angiogenesis quantification cannot be used as a differential diagnosis parameter between the two lesions analyzed. (AU)

Detección de virus papiloma humano (HPV) a partir de muestras celulares de cuello uterino en base líquida: Correlación con la inmunorreactividad de la proteína p16INK4a / Detection of human papilloma virus (HPV) in liquid-based cervical samples: Correlation with protein p16INK4a expression

La citología del cuello uterino en base líquida mejora la calidad de la muestra y el material residual podría ser utilizado para realizar pruebas complementarias, como la detección del virus papiloma humano (HPV) y estudio inmunocitoquímico de biomarcadores. El propósito de este estudio fue correlacionar la presencia de HPV y la inmunoexpresión de p16INK4a en las muestras citológicas en base líquida para examinar la utilidad de estas nuevas herramientas en la detección de cáncer de cuello uterino. Las pacientes incluidas (n=67) presentaban una citología anormal o patología cervical previa. La detección y genotipificación de HPV se realizó con PCR-SPF10/LiPA (INNOLiPA Extra Amp) y para la inmunodetección de p16INK4a se utilizó el anticuerpo clon E6H4. La citología convencional proporcionó los mismos hallazgos citológicos que la citología en base líquida. La prevalencia general del HPV fue de 43,3% (29/67). El HPV16 fue el tipo viral mas frecuente (31,03%) y el 48,3% de los casos presentó infección múltiple. En el 35,8% de las muestras cervicales se detectó inmunoexpresión de la p16INK4a y ésta fue significativamente (p<0,020) asociada a la presencia de HPV. Estos resultados apoyan la evidencia que la implementación de nuevas tecnologías en la rutina diaria del laboratorio contribuye significativamente en la detección precoz del cáncer de cuello uterino y en el aporte de datos importantes para facilitar en el manejo clínico adecuado de la paciente. La detección de HPV combinada con la p16INK4a podría ser utilizado en la evaluación de pacientes con mayor riesgo a desarrollar lesiones cervicales significativas.

The liquid-based cervical cytology improves the quality of the sample and the residual sample could be used efficiently to carry out complementary tests, such as the detection of HPV DNA and the immunocytochemical biomarkers study. The purpose of this study was to correlate the presence of HPV and immunoexpression of p16INK4a in liquid-based cervical samples to examine the utility of these new tools in the detection of cervical cancer. The included patients (n=67) presented an abnormal cytology or previous cervical pathology. The HPV detection and genotyping were carried out with PCR-SPF10/LiPA (INNOLiPA Extra Amp) and for p16INK4a immunodetection was used antibody clone E6H4. The conventional cytology provided the same cytologic interpretations that those of liquid-based cytology. The overall HPV prevalence was 43.3% (29/67). HPV16 was the most frequent viral type (31.03%) and 48.3% of the cases were infected with multiple HPV types. p16INK4a immunoexpression was observed in 35.8% of liquid-based cytological samples and this was significantly (p < 0.020) associated to the HPV presence. These results support the evidence that the implementation of new technologies in the daily routine of the laboratory, contribute significantly in the early detection of cervical cancer and provide important data to help in the patient’s efficient management. The combined use of HPV detection and p16INK4a expression could be used for evaluation of patients with more risk to develop significant cervical lesions.

Artroplastia de superfície no tratamento da osteoartrose primária e/ou secundária do ombro pelo sistema HemiCAP-Arthrosurface® / Surface arthroplasty for treating primary and/or secondary shoulder osteoarthrosis by means of the HemiCAP-Arthrosurface® system

OBJETIVO: Apresentar a técnica cirúrgica pelo sistema HemiCAP-Arthrosurface® e a avaliação dos resultados com esta técnica no tratamento da osteoartrose primária e/ou secundária do ombro. MÉTODO: Entre junho/2007 e junho/2009, 10 ombros de 10 pacientes, sendo nove com osteoartrose primária e um com necrose avascular da cabeça umeral, foram submetidos à artroplastia de superfície pelo sistema HemiCAP-Arthrosurface para correção do problema. O tempo de seguimento variou de seis a 29 meses, com média de 17 meses. A idade variou de 62 a 73 anos com média de 67,5 anos. Seis pacientes eram do sexo feminino e quatro do sexo masculino. Os pacientes foram acompanhados semanalmente no primeiro mês e a cada três meses após o procedimento cirúrgico. A avaliação clínica foi feita por meio dos critérios da University of Califórnia at Los Angeles (UCLA) e escala analógica de dor. RESULTADOS: Todos os pacientes operados encontravam-se satisfeitos com os resultados do tratamento cirúrgico, com uma média de 30 pontos e dois pontos nas escalas de avaliação da UCLA e analógica de dor, respectivamente. CONCLUSÃO: O sistema HemiCAP-Arthrosurface® utilizado na cirurgia do ombro para um grupo específico de pacientes é uma técnica cirúrgica que preserva o estoque ósseo com bons resultados funcionais e antálgicos.

OBJECTIVE: To present the surgical technique for the HemiCAP-Arthrosurface® system and evaluate our results from this technique for treating primary and/or secondary shoulder osteoarthrosis. METHOD: Between June 2007 and June 2009, 10 shoulders of 10 patients (nine with primary osteoarthrosis and one with avascular necrosis of the humeral head) underwent surface arthroplasty using the HemiCAP-Arthrosurface® system to correct the problem. The follow-up time ranged from six to 29 months (mean of 17 months). The patients' ages ranged from 62 to 73 years (mean of 67.5 years). Six patients were female and four patients were male. The patients were followed up weekly for the first month after the surgical procedure and every three months thereafter. The clinic evaluation was done using the criteria of the University of California at Los Angeles (UCLA) and a visual analogue pain scale. RESULTS: All the patients said that they were satisfied with the results from the surgical treatment, with a mean UCLA score of 30 points and a mean analogue pain score of two points. CONCLUSION: The HemiCAP-Arthrosurface® system for shoulder surgery for a specific group of patients is a technique that preserves the bone stock with good functional and antalgic results.

Toxoplasma gondii em suínos com ênfase na contribuição brasileira: [revisão] / Toxoplasma gondii in swine with emphasis in Brazilian contribution: [review]

Objetivos: revisar a literatura nacional referente aos principais dados de estudos de toxoplasmose sobre a epidemiologia, patologia e imunologia, frequência de anticorpos e isolamento do parasito em suínos, e as literaturas nacional e internacional sobre avaliação molecular de cepas isoladas de suínos. Fonte de dados: foram pesquisadas as bases de dados Scielo, Scopus, Science Direct e Google Scholar. Síntese dos dados: a toxoplasmose em suínos apresenta alta prevalência sorológica e de identificação do parasito, por isolamento ou detecção de DNA, em grande parte do território nacional, causando problemas neurológicos, reprodutivos e econômicos e aumentando o risco de transmissão para a população humana. As principais fontes de infecção para os suínos ainda são os gatos errantes, responsáveis pela disseminação e adaptação do parasito a novos hospedeiros e condições de sobrevivência alternativas. A biologia molecular trouxe grande contribuição, não somente para a detecção em amostras de animais mortos, mas, principalmente, na elucidação do comportamento evolutivo do parasito na espécie suína. Conclusões: a toxoplasmose em suínos é um problema real tanto na criação como produção de alimentos, o que resulta em grave problema econômico e de saúde pública. Apresenta prevalência variável em suínos no mundo e alta variabilidade genotípica, principalmente na América do Sul.

Aims: To review the national literature of toxoplasmosis about epidemiology, pathology, immunology, antibody frequency and parasite isolation in swine, and the national and international literature on molecular evaluation of strains isolated from swine. Source of data: Survey was performed in Scielo, Scopus, Science Direct and Google Scholar databases. Summary of findings: Toxoplasmosis in swine presents high serological prevalence and parasite identification by isolation or DNA detection, is widely distributed in national territory, causing neurological, reproductive, and economical problems, and increases the risk of transmission to human population. Errant cats, which are the main source of infection to swine, are responsible for the dissemination and adaptation of the parasite to new hosts and alternative survival conditions. Molecular biology contributed significantly to the parasite detection in samples from dead animals and, particularly, in the elucidation of the parasite evolutional behavior in swine species. Conclusions: Toxoplasmosis in swine is a real problem in both breeding and food production, becoming a serious problem to public health. It presents a variable prevalence in swine around the world, and presents high genotypic variability, particularly in South America.

Granuloma piogênico em paciente odontopediátrico: revisão da literatura e relato de caso clínico / Pyogenic granuloma in pedodontic patient: literature review and case report

O granuloma piogênico é uma lesão benigna de tecido mole, que se desenvolve a partir do tecido conjuntivo como uma reação inflamatória do tipo proliferativo a uma irritação local não específica, crônica e de baixa intensidade. É representado clinicamente por uma massa elevada de tecido mole com superfície lisa ou verrucosa e frequentemente lobulada, inserção pediculada ou séssil, consistência mole e firme e coloração variando de rosa a vermelho vivo e um vermelho intenso. A tendência ao sangramento e a rápida evolução são manifestações clínicas importantes e constituem-se nos principais motivos de preocupação por parte do paciente ou responsáveis. O tratamento consiste em excisão cirúrgica conservativa completa seguida de exame anátomo-patológico. O propósito do presente trabalho é apresentar as principais características clínicas de um granuloma piogênico, analisar criticamente a literatura, bem como relatar um caso clínico em paciente infantil.

The pyogenic granuloma is a bening lesion of soft tissue. It is a proliferative inflammatory reaction of connective tissue that developes as a response of non-specific local low intensity irritation. Clinically is represented y an elevated mass with smooth or warty surface frequently lobulated, pedunculated or sessile, soft to firm consistence and coloration varying from rose to alive red to an intense red. The bleeding tendency and the rapid evolution are important clinical manifestations that constitute in the main reasons of patient pr responsible concem. The treatment consists of complete preservative surgical excision followed by anatomo-pathological exam. This paper aims to present the main clinical features of pyogenic granuloma to make a literature critical analysis and report a clinical pediatric case.

Subretinal neovascularization following ruptured retinal arterial macroaneurysm: case report

A 51-year-old black woman was referred to our Retina Clinic for evaluation of loss of vision in her left eye. She was previously diagnosed with a ruptured retinal arterial macroaneurism (RAM) in the same eye. The ophthalmoscopic examination of the affected eye disclosed a subretinal lesion with some hemorrhage and exudation in the same area previously diagnosed with ruptured RAM. Fluorescein angiography revealed a gradually hyperfluorescent net of vessels located in the subfoveal region, consistent with the diagnosis of subretinal neovascular membrane. In this paper we stress the possibility of subretinal neovascularization following a ruptured RAM, even as a rare event.

Paciente de 51 anos foi encaminhada ao Setor de Retina para avaliação de perda visual no olho esquerdo. A paciente apresentava o diagnóstico prévio de macroaneurisma arterial retiniano (MAR) rôto no referido olho. O exame oftalmológico revelou lesão sub-retiniana hemorrágica associada à exsudação na área previamente diagnosticada com MAR. A angiofluoresceinografia revelou hiperfluorescência gradual localizada na região subfoveal, consistente com o diagnóstico de membrana neovascular sub-retiniana (MNSR). Nosso artigo aponta para a possibilidade, embora rara, da formação de uma MNSR após MAR rôto.