Modelo para la evaluación de la eficacia diagnóstica de la tomografía computarizada de haz cónico en odontología / A model of diagnostic efficacy for the evaluation of CBCT in dentistry

Introducción: Debido al riesgo que conlleva la exposición a radiación ionizante, se han establecido los principios de protección radiológica, con el propósito de regular las actividades que involucran su uso. Uno de estos principios es la justificación de los exámenes, es decir, la indicación del examen cuando exista la posibilidad de que éste entregue información en beneficio del paciente. Esto implica que dicho examen se evalúe en cuanto a su rendimiento, de manera que exista evidencia que indique su capacidad de entregar la información necesaria para la indicación específica del paciente. Revisión: Para evaluar el rendimiento de los exámenes imagenológicos, con el fin de orientar su uso como herramienta diagnóstica en las distintas indicaciones odontológicas, se ha usado el modelo de Eficacia Diagnóstica descrito por Fryback y Thornbury en 1991.En odontología, el uso de la tomografía computarizada de haz cónico (TCHC) ha aumentado debido a sus ventajas como herramienta diagnóstica. Aún así, son pocas las investigaciones en altos niveles del modelo de Eficacia Diagnóstica -más relacionados con características aplicables al paciente--y muchas las investigaciones en bajos niveles -más relacionado con calidad técnica y de exactitud diagnóstica-. Conclusiones: La evidencia del rendimiento de la TCHC en bajos niveles puede generar una idea equivoca sobre sus indicaciones, dando la impresión de que cuenta con respaldo científico suficiente que justifica su uso. Es necesaria investigación enfocada en el beneficio de los pacientes con el uso de TCHC para las distintas indicaciones en odontología. (AU)

Introduction: Due to the risk of exposure to ionizing radiation, principles of radiation protection have been established, with the aimto regulate activities that involve the use of ionizing radiation. The principle of justification means that the indication of the exam must be associated to the possibility of providing information for the benefit of the patient. The indication of an exam that results in a benefit for the patient entails the evaluation of the exam in terms of its performance. This evaluation should demonstrate the exam has ability to deliver the necessary information for the specific need of the patient. Review: The Diagnostic Efficacy model, described by Fryback and Thornbury in 1991, is used to evaluate the performance of imaging tests, in order to guide its use as a diagnostic tool in different dental indications. In dentistry, the use of TCHC has increased due to the advantages as a diagnostic tool. Still, there are few investigations at high levels of the Diagnostic Efficacy model - related to characteristics that involve the patient - and many investigations at low levels - more related to technical quality and diagnostic accuracy. Conclusions: Evidence of the performance of CBCT at low levels generates a misunderstanding about its use, giving the impression that CBCT has sufficient scientific support to justify its use. Currently, the evaluation of the performance of the TCHC has focused on evaluating the lowest levels of this model, the image quality and the diagnostic precision, although evidence at this level remains limited. Research focusing on the benefit of patients with the use of CBCT for the different indications in dentistry is needed. (AU)

In vivo efficacy and safety of artemetherlumefantrine and amodiaquine­artesunate for uncomplicated Plasmodium falciparum malaria in Mozambique, 2018

Background: Artemisinin-based combination therapy (ACT) has been the recommended first-line treatment for uncomplicated malaria in Mozambique since 2006, with artemether­lumefantrine (AL) and amodiaquine­artesunate (AS­AQ) as the first choice. To assess efficacy of currently used ACT, an in vivo therapeutic efficacy study was conducted. Methods: The study was conducted in four sentinel sites: Montepuez, Moatize, Mopeia and Massinga. Patients between 6 and 59 months old with uncomplicated Plasmodium falciparum malaria (2000­200,000 parasites/µl) were enrolled between February and September of 2018, assigned to either an AL or AS­AQ treatment arm, and monitored for 28 days. A Bayesian algorithm was applied to differentiate recrudescence from new infection using genotyping data of seven neutral microsatellites. Uncorrected and PCR-corrected efficacy results at day 28 were calculated. Results: Totals of 368 and 273 patients were enrolled in the AL and AS­AQ arms, respectively. Of these, 9.5% (35/368) and 5.1% (14/273) were lost to follow-up in the AL and AS­AQ arms, respectively. There were 48 and 3 recurrent malaria infections (late clinical and late parasitological failures) in the AL and AS­AQ arms, respectively. The day 28 uncorrected efficacy was 85.6% (95% confidence interval (CI) 81.3­89.2%) for AL and 98.8% (95% CI 96.7­99.8%) for AS­AQ, whereas day 28 PCR-corrected efficacy was 97.9% (95% CI 95.6­99.2%) for AL and 99.6% (95% CI 97.9­100%) for AS­AQ. Molecular testing confirmed that 87.4% (42/48) and 33.3% (1/3) of participants with a recurrent malaria infection in the AL and AS­AQ arms were new infections; an expected finding in a high malaria transmission area. Adverse events were documented in less than 2% of participants for both drugs. Conclusion: Both AL and AS­AQ have therapeutic efficacies well above the 90% WHO recommended threshold and remain well-tolerated in Mozambique. Routine monitoring of therapeutic efficacy should continue to ensure the treatments remain efficacious.

Contribution of a physical education undergraduate program in the teaching self-efficacy beliefs / Contribuição de um curso de graduação em educação física nas crenças de auto-eficácia docente

ABSTRACT The objective of this study was to analyze the contribution of a Physical Education program on constructing beliefs in teacher self-efficacy, taking into account the teaching dimensions of instruction, organization, and social environment. A qualitative research was conducted through a semistructured interview with 11 college students in their last year of a Physical Education Degree at a public University in Santa Catarina, Brazil. The data were obtained through semi-structured interviews. The results showed that the mandatory internship was the main learning context, and the main sources of learning were direct teaching experiences and feedbacks during the internship, followed by professor observations within the required classes for the degree. Therefore, we concluded that college students attributed teaching self-efficacy to the teaching and learning experiences in the mandatory internship and the observations made during regular classes.

RESUMO O objetivo deste estudo foi analisar a contribuição de um curso de graduação em Educação Física para a construção de crenças de autoeficácia docente, levando em consideração as dimensões de ensino de instrução, organização e clima social. Realizou-se uma pesquisa qualitativa, através de entrevista semiestruturada com 11 universitários do último ano do curso de Licenciatura em Educação Física. Os dados foram obtidos através de entrevista semiestruturada. Os resultados evidenciaram que o principal contexto de aprendizagem foi o estágio obrigatório e, que as principais fontes ocorreram mediante as experiências diretas de ensino e feedbacks nos estágios, seguidas das observações de professores no contexto das disciplinas. Conclui-se que os universitários atribuíram a origem da autoeficácia docente às experiências de ensino e aprendizagem nos estágios obrigatórios e de observação nas disciplinas.

Evaluación de la eficacia larvicida de Rapidall NP3 (Bacillus thuringiensis) contra Aedes aegypti (Linnaeus) (Diptera: Culicidae) en condiciones de laboratorio / Evaluation of the larvicidal efficacy of Rapidall NP3 (Bacillus thuringiensis) against Aedes aegypti (Linnaeus) (Diptera: Culicidae) in laboratory conditions

Los mosquitos son vectores trasmisores de enfermedades como: dengue, zika y chikunguya. El control biológico es una alternativa viable a tener en cuenta por los programas de control. Bacillus thuringiensis es el microorganismo más usado en salud pública. Su efectividad como larvicida contra culícidos depende, en gran medida, de la eficiencia del proceso productivo. El objetivo es evaluar y comparar la eficacia larvicida contra Aedes aegypti de la formulación en polvo Rapidall NP3 con la del producto Bactivec®, formulación líquida utilizada en Cuba. Se realizaron bioensayos de laboratorio según los procedimientos descritos y sugeridos por la OMS para determinar la eficacia, exponiendo las larvas a las concentraciones recomendadas por los fabricantes de los productos Rapidall NP3 y Bactivec®. A los recipientes utilizados se les realizó recambio de agua medio, total y sin recambio, con una frecuencia semanal. A las 24 h se calculó la mortalidad obtenida y se analizó estadísticamente mediante un ANOVA de una vía; cuando existieron diferencias significativas se aplicó un análisis Post-hoc mediante la prueba de Tukey. El producto evaluado Rapidall NP3, provocó 100 por ciento de mortalidad larvaria durante 11 semanas, independientemente de la proporción de recambio de agua, mientras que el Bactivec® solo provocó 100 por ciento de mortalidad hasta las 6 semanas de iniciado el experimento. El biolarvicida Rapidall NP3 mostró buena eficacia y actividad residual prolongada al compararlo con Bactivec®, por lo que recomendamos su evaluación en el terreno en el control larvario de depósitos que constituyen sitios de cría habituales y que no pueden ser eliminados físicamente(AU)

Mosquitoes are vectors of human diseases such as dengue, zika and chikungunya. Biological control is a viable alternative to be taken into account in control programs. Bacillus thuringiensis is the microorganism most commonly used in public health. Its effectiveness as a larvicide against culicides depends to a great extent to the production process. The objectives of the study were to evaluate and compare the larvicidal efficacy against Aedes aegypti of the Rapidall NP3 powder formulation with Bactivec®, a liquid formulation used in Cuba. Laboratory bioassays were conducted to determine efficacy following WHO protocols. Larvae were exposed to the concentrations recommended by Rapidall NP3 and Bactivec® manufacturers. The water in the containers used in the study was replaced once a week: half, whole and no replacement. At 24 hours mortality was estimated and statistically analysis were done by one-way ANOVA. When significant differences were found, post-hoc analysis was performed with Tukey's test. Rapidall NP3 caused 100 percent larval mortality for 11 weeks, regardless of the water replacement proportion, whereas Bactivec® caused 100 percent mortality for only 6 weeks after the start of the experiment. When compared with Bactivec®, biolarvicide Rapidall NP3 displayed better efficacy and more prolonged residual activity. We therefore recommend its field evaluation for larval control of containers constituting habitual breeding sites which cannot be physically eliminated(AU)

The Effectiveness of the Use of "Special Grip Toothbrushes" on Dental Hygiene for Indonesian Patients with Ischemic Stroke

Objective: To find out the effectiveness of specially made brushes with special grips for use by groups of ischemic stroke sufferers for oral hygiene. Material and Methods: A sample of 30 stroke patients were taken at the Makassar Stroke Center, Indonesia, with criteria for extreme hemisphere ischemic stroke patients and willing to participate in the study and fill out informed consent. Brush making with a special grip design (modified brush) with Clay mixed material. The oral hygiene assessment procedure of the sample using a modified toothbrush was done in 3 stages before the brush, after brush and on the seventh day. Oral and oral hygiene was measured using the index of Oral Hygiene Index Simplified (OHI-S). The oral hygiene assessment procedure was done in 3 stages before the brush, after brush and on the seventh day. To find out the difference in effectiveness before and after the intervention was analyzed using the paired t test. The level of significance was set at 5%. Results: The highest percentage of stroke patients were female (53.3%), aged 40-60 years (66.7%) with an education level below junior high school (56.7%). There is a difference in the average OHIS score before and after using a special grip toothbrush (p<0.01). Conclusion: A special grip toothbrush that is used for Stroke sufferers can help to clean his teeth and mouth.

Avaliação das formas e métodos de eficácia de esterilização empregados por cirurgiões dentistas da cidade de Teresina/PI / Evaluation of sterilization forms and verification methods used by dentists in Teresina ­ PI

Este estudo teve como objetivo analisar os métodos de esterilização utilizados pelos cirurgiões dentistas, observando se fazem o uso de indicadores que verificam a eficácia da esterilização, quais indicadores são empregados e com que frequência. Cinquenta cirurgiões dentistas participaram da pesquisa, respondendo a um questionário com perguntas abordando aspectos sobre a forma de esterilização realizada no local onde o profissional atua. O método de esterilização mais utilizado foi a autoclave. Apenas 44,9% dos entrevistados souberam responder a correta relação tempo/temperatura da autoclave, e metade dos que utilizavam estufa respondeu de forma errônea. 96% dos profissionais fazem uso de algum indicador de verificação de eficácia de esterilização. O indicador mais utilizado foi a fita adesiva externa, empregada diariamente. O meio biológico é pouco utilizado e numa frequência inadequada. A maioria dos entrevistados faz descontaminação do instrumental com lavagem com água e detergente e acondicionamento em papel grau cirúrgico. As respostas obtidas nesta pesquisa indicam que há necessidade de maior conscientização por parte dos profissionais em relação à sua responsabilidade no controle de infecção, sendo necessária uma busca maior por conhecimento em relação às formas de esterilização e o uso de indicadores para verificação de eficácia (AU).

The aim of this study was to analyze the sterilization methods used by dentists, observing if they use indicators that verify the effectiveness of sterilization, which are the indicators and how often are they used. Fifty dentists participated of the survey, answering a questionnaire with questions about aspects of form of sterilization carried out at the place where the professional woks. The most widely used sterilization method was the autoclave. Only 44.9% of those interviewed could answer the correct relation of autoclave time/temperature and half of those that used ovens answered wrongly. 96% of professionals make use of some sterilization effectiveness check indicator. The most widely used indicator was the external tape used daily. The biological indicator is underutilized and in an inadequate frequency. Most of the dentists interviewed perform decontamination of instruments washing with water and detergent and packaging in surgical grade paper. The answers obtained in this study indicate that there is need of greater awareness from professionals in relation to their responsibility to control infection, requiring a greater search of knowledge about ways of sterilization and the use of indicators for efficacy verification (AU).

Pericarditis aguda recurrente idiopática: presentación de un caso con respuesta favorable a anakinra / Idiopathic relapsing acute pericarditis: Report of one case with favorable response to anakinra

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Eficiencia de las terapias: ¿un paso más allá de la eficacia? Análisis crítico del modelo cognitivo-conductual / Efficiency of therapies: A step beyond effectiveness? Critical analysis of the cognitive-behavioral model

La proliferación de la investigación de resultados ha colocado al modelo cognitivo-conductual como la terapia de elección para la mayoría de problemas psicológicos. Este tipo de investigación deja a un lado el análisis de los procesos de cambio conductual que subyacen al éxito de las diferentes técnicas de tratamiento, ya no sería importante saber qué es lo que hace que una técnica funcione siempre que ésta sea eficaz. Como consecuencia, el modelo cognitivo-conductual ha perdido la reflexión teórica y la fundamentación experimental que caracterizaba a la modificación de conducta sobre la cual se sustentaba en sus orígenes. Desde nuestra perspectiva, la investigación de procesos sería un paso previo necesario a la investigación de resultados de forma que los primeros puedan explicar cómo y por qué funcionan los tratamientos psicológicos, evitando así que el clínico se limite a aplicar procedimientos descritos en manuales protocolizad

The proliferation of outcome research has placed the cognitive-behavioral model as the therapy of choice for most psychological problems. This type of research leaves aside the analysis of behavioral change processes that underlie the success of different treatments techniques. Therefore, it would no longer be important to know what is that makes a technique works as long as it gives the expected results. Consequently, the cognitive-behavioral model has lost the theoretical reflection and the experimental foundation that characterized the modification of behavior on which it was based on its origins. From our perspective, process research would be a necessary preliminary step to outcome research so that it could explain how and why psychological treatments work, avoiding that the clinician simply applies the procedures described in the standardized manuals

Key issues in the infected patient care in the Emergency Department / Cuestiones claves en la atención del paciente infectado en Urgencias

Objective. To develop a set of recommendations, by consensus of Emergency Medicine experts, on key aspects related to the care of adult patients with acute infection attended in Spanish emergency departments (ED). Methodology. The study was divided into three phases: 1) To design a questionnaire by a coordinating group; 2) To conduct a survey in ED physicians in order to know their opinion on the issues raised by the coordinating group; 3) To develop a number of recommendations based on the responses to the questionnaire and their subsequent discussion. Results. A group of 28 experts from different Spanish ED, as well as 5 members of the coordinating group, with knowledge and experience in the management of infectious diseases in ED, conducted a round of voting to a questionnaire of 18 issues grouped into three sections: 1) identification and stratification of the severity; 2) diagnosis and treatment; 3) management. Conclusions. A monitoring system and proper training of the entire healthcare team are required, as well as extensive knowledge on these issues, to ensure adequate and effective care for these patients. It is essential to educate and train all health staff, especially in the ED, because it is the initial point of contact for most patients with an infection. The experts established proposals based on survey questions and the discussion (AU)

Objetivo. Elaborar un conjunto de recomendaciones basadas en la opinión de expertos en medicina de urgencias sobre aspectos claves relacionados con la atención del paciente con sospecha de infección en los servicios de urgencias. Metodología. El estudio se desarrolló en tres fases: 1) Diseño de un cuestionario por un grupo coordinador; 2) Realización de una encuesta para conocer la opinión de los profesionales en urgencias y emergencias sobre las cuestiones formuladas por el grupo coordinador; 3) Elaboración de una serie de recomendaciones basadas en las respuestas al cuestionario y su posterior discusión. Resultados. Un grupo de 28 expertos procedentes de distintos servicio de urgencias hospitalarios españoles, así como 5 miembros del grupo coordinador, formado por médicos con experiencia en urgencias y patología infecciosa, realizaron una ronda de votación a un cuestionario de 18 preguntas clasificadas en tres bloques: identificación y estratificación del paciente infectado, diagnóstico y tratamiento, y gestión hospitalaria. Conclusiones. Para garantizar una atención adecuada y eficaz de estos pacientes se requiere una atención estructurada y un entrenamiento adecuado de todo el equipo sanitario, así como un amplio conocimiento en estos temas. Resulta fundamental educar y concienciar a todo el personal sanitario especialmente en los servicios de urgencias, punto de contacto inicial de la mayoría de los pacientes que padecen una infección. En base a las preguntas y su discusión, se consensuaron una serie de propuestas (AU)

Eficacia y seguridad de movilización al inicio del ictus (AVERT): un ensayo controlado / Efficacy and safety of early mobilisation after stroke onset (AVERT): a randomised controlled trial

Introducción: La movilización temprana, después de un ictus, se ha relacionado con la eficacia de una unidad de ictus, sin embargo, la intervención no está bien definida y no existe una clara evidencia al respecto. Objetivo: Comparar la eficacia de una movilización muy temprana después de un ictus con respecto a los cuidados habituales. Métodos: Se diseñó un ensayo clínico, simple ciego, realizado en 56 unidades de ictus de 5 países diferentes. Pacientes mayores de 18 años con ictus isquémico o hemorrágico, inicial o recurrente, fueron distribuidos de forma aleatoria (1:1) para recibir cuidados habituales o movilización muy temprana (antes de 24h) añadida a los cuidados habituales. La aleatorización fue estratificada por lugar del estudio y la severidad del ictus. El tratamiento con activador tisular del plasminógeno recombinante fue permitido. La variable principal del estudio fue una evolución favorable definida por la escala de Rankin (0-2) a los 3 meses del ictus. El análisis de datos se hizo por intención de tratar. Resultados: Entre julio de 2006 y octubre del 2011 fueron aleatorizados 2.104 pacientes a recibir movilización muy temprana con cuidados habituales (N=1.054) o simplemente cuidados habituales (N=1.050). Se valoró a los 3 meses de seguimiento a 2.083 pacientes (99%). Novecientos sesenta y cinco (92%) de los pacientes fueron movilizados dentro de las primeras 24h del ictus en el grupo de movilización muy temprana, y 623 (59%) en el grupo de cuidados habituales. Menos pacientes en el grupo de movilización muy temprana tuvieron una evolución favorable que los del grupo control, 480 (46%) frente a 525 (50%) OR: 0,73; IC 95%: 0,59-0,90; p=0,004. Ochenta y ocho pacientes (8%) fallecieron en el grupo de muy temprana movilización frente a 72 (7%) del grupo control (OR: 1,34; IC 95%: 0,93-1,93; p=0,113). Doscientos uno (19%) pacientes en el grupo de movilización muy temprana y 208 (20%) del grupo control tuvieron un evento adverso no fatal, no se observó una reducción significativa de las complicaciones relacionadas con la inmovilidad en el grupo de movilización muy temprana. Conclusiones: La primera movilización tuvo lugar dentro de las primeras 24h en la mayoría de los pacientes del ensayo. La movilización muy temprana fue asociada con una disminución del riesgo de la variable principal a los 3 meses. La movilización temprana después de un ictus es recomendada en la mayoría de las guías de práctica clínica en todo el mundo, y los hallazgos de este estudio deberían afectar a la práctica clínica y redefinir las guías actuales, sin embargo, las recomendaciones clínicas deberían tener en cuenta futuros análisis dosis-respuesta (AU)

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XVI Congreso SEINAP. Fórmulas extensamente hidrolizadas / XVI Congreso SEINAP. Extensively hydrolized formulas

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Effects of a positive emotion-based adjuvant psychological therapy in colorectal cancer patients: a pilot study / Efectos de una terapia psicológica adyuvante en pacientes con cáncer colorrectal: un estudio piloto

Objective: To examine the effectiveness of an "Enhancing Positive Emotions Procedure" (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up. Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient’s assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales. Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource Conclusions: CRC patients receiving EPEP during chemotherapy believed that this intervention was important. Furthermore, EPEP seems to improve positive affect and quality of life. EPEP has potential benefits, and its implementation to CRC patients should be considered

Objetivo: Examinar la eficacia de un programa basado en la Psicología Positiva y en la terapia cognitivo-conductual (EPEP) para incrementar emociones positivas y reducir malestar en pacientes de cáncer colorrectal (CRC) que reciben quimioterapia adyuvante. Se espera que el EPEP mejore calidad de vida y estados de ánimo durante la quimioterapia y en el seguimiento un mes después. Método: Un grupo de 24 CRC recibió el EPEP (grupo de intervención: GI), y otro grupo de 20 CRC no recibió el EPEP (grupo control: GC). Se evaluaron la calidad de vida (EORTC-QLQC30) y los estados de ánimo (PANAS) en tres momentos: al entrar en el estudio (T1); 6 semanas después, tiempo de aplicación del EPEP (T2), y un mes después del T2 (seguimiento:T3). Las opiniones de los pacientes sobre el EPEP (mejoría del estado de ánimo e importancia de la atención recibida) fueron evaluadas con escalas Lickert. Resultados: El GI mostró mejores puntuaciones en estado de ánimo positivo, aunque sin diferencias significativas con el GC. Las puntuaciones en T2 y T3 tendían a ser mejores en el GI en nivel global de salud, y en las escalas física, social y de rol, El GI redujo el nivel de insomnio. Los pacientes indicaron que el EPEP era importante y mejoraba el estado de ánimo. Conclusiones: Los datos sugieren que el EPEP mejora el estado de ánimo positivo y la calidad de vida, y los pacientes lo consideraron importante y útil. El EPEP es potencialmente beneficioso y debería considerarse la posibilidad de implementarlo en pacientes CRC

Resultados clínicos de una nueva estrategia quirúrgica (CHIVA modificado) en el tratamiento de las varices dependientes de la vena safena magna accesoria anterior / Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins

INTRODUCCIÓN: Tradicionalmente la insuficiencia de safena anterior se trataba mediante crosectomía y resección de los paquetes varicosos. El objetivo del trabajo es mostrar la seguridad y eficacia de una nueva estrategia terapéutica en las varices dependientes de la vena safena magna accesoria anterior. MÉTODOS: Estudio prospectivo no ramdomizado que incluyó 65 pacientes con varices dependientes de la safena anterior con safena interna anterógrada. La modificación en la técnica consiste en hacer solamente flebectomía de los paquetes varicosos, sin ligar el cayado de la safena. Se realizó un estudio hemodinámico venoso preoperatorio, al mes y al año, y para la valoración clínica se utilizó la escala de Fligelstone. RESULTADOS: Clasificación clínica basal CEAP: C2 58%, C3 26% y C4-6 15%. Complicaciones: 3 hematomas, 7 casos de trombosis parciales asintomáticas de safena anterior. Se observó una reducción del diámetro medio inicial de safena anterior de 6,4 mm a 3,4 mm al año (p < 0,001). A los doce meses mantenían un flujo anterógrado el 82% de los casos. Hubo una recidiva de varices visibles en el 8% de los casos. Todos los pacientes han reflejado una mejoría clínica en la escala de Fligelstone. El diámetro de safena anterior mayor de 7,5 mm y la obesidad se identifican como predictores de un peor resultado clínico y hemodinámico. CONCLUSIONES: La modificación de la estrategia quirúrgica sobre las varices dependientes de la safena anterior presenta un resultado clínico favorable al año de la intervención

INTRODUCTION: Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. METHODS: This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. RESULTS: The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. Complications: 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p < 0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. CONCLUSIONS: This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively

Metotrexato en el tratamiento de la artritis psoriásica / Methotrexate in the treatment of psoriatic arthritis

A pesar de la falta de evidencia sólida en la bibliografía, las recomendaciones de los diferentes grupos internacionales para el tratamiento de la artritis psoriásica sitúan al metotrexato como el fármaco de primera elección. La experiencia clínica acumulada por los reumatólogos con el metotrexato, su perfil de seguridad y el nivel de retención que demuestran los registros nacionales, avalan dicha posición en el algoritmo terapéutico. Sin embargo faltan evidencias sobre su eficacia en otras manifestaciones extraarticulares de la artritis psoriásica, por lo que no se recomienda para el tratamiento de la entesitis ni de la espondilitis. En artritis psoriásica, a diferencia de la artritis reumatoide, no se ha demostrado que el tratamiento combinado sea superior al anti-TNFa. Sin embargo, el metotrexato puede alargar la supervivencia de los fármacos anti-TNFa, fundamentalmente la de los anticuerpos. Se requieren ensayos clínicos controlados para determinar la eficacia del metotrexato en la entesitis y dactilitis psoriásica, así como su papel en la terapia combinada (AU)

Despite the lack of solid evidence in the literature, methotrexate (MTX) is recommended as the first choice drug for the treatment of psoriatic arthritis (PsA) by distinct international groups. This position in the therapeutic algorithm is supported by the clinical experience of MTX accumulated by rheumatologists, its safety profile and retention level shown by national registries. However, there is a lack of evidence on the effectiveness of MTX in other extra-articular manifestations of PsA and therefore it is not recommended for the treatment of enthesitis and spondylitis. Combination therapy has not been shown to be superior to anti-TNFa therapy in PsA, unlike rheumatoid arthritis. However, MTX may prolong the survival of anti-TNFa drugs, mainly that of antibodies. Controlled clinical trials are required to determine the efficacy of MTX in enthesitis and psoriatic dactylitis, as well as its role in combination therapy (AU)

Tratamento intralesional de malformações linfáticas com ênfase na escleroterapia com picibanil (OK-432): revisão sistemática / Intralesional treatment of lymphatic malformations with emphasis on Picibanil (OK-432) sclerotherapy: a systematic review

INTRODUÇÃO: Conduziu-se revisão sistemática retrospectiva da literatura incluindo estudos relatando o uso de picibanil para tratar malformações linfáticas (ML). MÉTODOS: A pesquisa foi realizada com estudos publicados no PubMed de janeiro de 1990 a 14 de abril de 2013. Na estratégia de busca, usou-se os descritores "OK-432" ou "Picibanil" e "lymphatic malformation". Os seguintes elementos foram comparados aos de outras modalidades relatadas e, então, compilados: mecanismo de ação, indicações, contraindicações, eficácia, administração, efeitos colaterais, complicações, vantagens e desvantagens. RESULTADOS: Foram encontrados 44 estudos, 27 dos quais atenderam aos critérios de inclusão. O picibanil é uma preparação liofilizada de uma cepa de baixa virulência de Streptococcus pyogenes inativada pela penicilina G. Seu mecanismo de ação ainda não definido claramente, mas especula-se que provoque uma resposta inflamatória controlada com adesão das paredes dos cistos. O picibanil é indicado quase que unanimemente para o tratamento da ML macrocística, cuja resposta é mais efetiva do que em lesões microcísticas ou mistas. Em geral, o picibanil é administrado por meio de punção com visualização direta ou guiada por ultrassonografia, com o paciente sob anestesia geral. A preparação comumente utilizada consiste em 0,1 mg de picibanil em 10 ml de soro fisiológico. Os efeitos colaterais são, em geral, leves; sendo dor, inchaço e febre os mais frequentemente relatados. CONCLUSÃO: Os estudos apresentam pouca evidência científica. A revisão sistemática identificou que o picibanil é útil no tratamento da ML de qualquer tipo, mas tem resultados melhores em lesões macrocísticas. A eficácia foi comparável à de outras terapias. Não foi apresentada nenhuma contraindicação específica. Embora o mecanismo de ação ainda não tenha sido determinado, o picibanil trata-se de opção de tratamento.

INTRODUCTION: We performed a retrospective systematic review of studies reporting the use of Picibanil for treatment of lymphatic malformations (LMs). METHODS: We searched the PubMed database for available studies, including those published between January 1990 and April 14, 2013. The search strategy involved the use of the keywords "OK-432" or "Picibanil" and "lymphatic malformation." Information was compiled regarding the reported mechanism of action, indications, contraindications, efficacy, administration, side effects, complications, and advantages and disadvantages compared to those of other modalities. RESULTS: Forty-four studies were found, of which 27 fulfilled the inclusion criteria. Picibanil is a lyophilized preparation of a low-virulence strain of Streptococcus pyogenes inactivated with penicillin G. Its mechanism of action is unclear, but it has been speculated that it causes a controlled inflammatory response with adhesion of cyst walls. Picibanil is almost unanimously indicated for the treatment of macrocystic LMs, which show a greater effectiveness response compared to that shown by microcystic or mixed LMs. Picibanil is usually administered by puncturing, either with direct visualization or guided by ultrasound, with the patient under general anesthesia. The most widely used preparation comprises 0.1 mg of Picibanil in 10 mL of saline. Side effects are mostly mild, with pain, swelling, and fever being the most frequently reported. CONCLUSION: The studies had low scientific evidence. A systematic review found that Picibanil is useful against any LM, with better results in macrocystic lesions. Efficacy was comparable to that of other therapies. No specific contraindication was presented. Although the mechanism of action has not been established, the inclusion of Picibanil as a treatment option is warranted.

Tratamento cirúrgico do câncer de pele pelo cirurgião plástico / Surgical treatment of skin cancer by the plastic surgeon

Introdução: O câncer de pele é a neoplasia mais frequente no Brasil e corresponde a 25% de todos os tumores malignos. O melhor tratamento é a ressecção cirúrgica em fases iniciais. O cirurgião plástico, juntamente com uma equipe multiprofissional, participa no tratamento desta doença. O objetivo é analisar a eficácia dos procedimentos cirúrgicos realizados pelo cirurgião plástico no tratamento do câncer de pele. Método: Foram analisados 404 prontuários de pacientes operados no período de fevereiro de 2009 a dezembro de 2012 e analisados gênero, idade, diagnóstico, localização e evolução. Resultados: Faixa etária com média de 62 anos. 53% de casos de carcinoma basocelular, 25,5% melanoma e 15,1% carcinoma espinocelular. Houve predomínio de mulheres nos carcinomas basocelulares (56%) e no melanoma (54%) e de homens nos carcinomas espinocelulares (61%). Os carcinomas basocelulares (92,99%) e espinocelulares (72,13%) tiveram sua predominância na região de cabeça e pescoço; enquanto o melanoma predominou em região de tronco (36,89%) e membros inferiores (24,27%). Foram realizadas 67 cirurgias com pesquisa de linfonodo sentinela, com positividade em 14,93%. 7,76% dos pacientes de melanoma apresentaram metástases e 2,91% vieram a óbito. Conclusão: O cirurgião plástico é um dos profissionais importantes para o tratamento do câncer de pele, sendo o mais apto para realizar as reconstruções após as ressecções tumorais, pois tem em sua formação os conceitos de reparação, utilizando-se de enxertos e retalhos e considerando o aspecto estético dos pacientes. Cabe-lhe também a realização da cirurgia de pesquisa de linfonodo sentinela e o seguimento dos pacientes com câncer de pele.

Introduction: Skin cancer is the most common neoplasm in Brazil and it corresponds to 25% of all diagnosed malignant tumors. The best treatment is surgical resection in early stages. The disease is treated by a plastic surgeon along with a multidisciplinary team. The objective is to assess the effectiveness of surgical procedures performed by plastic surgeons to treat skin cancer. Methods: We analyzed medical records of 404 patients operated on between February 2009 and December 2012. Data analyzed included gender, age, diagnosis, localization and evolution. Results: Patients' mean age was 62 years. A total of 53% of patients had basal cell carcinoma, 25.5% melanoma and 15.1% squamous cell carcinoma. There was a predominance of women in basal cell carcinomas (56%) and melanoma (54%) and predominance of men in squamous cell carcinomas (61%). Basal cell carcinomas (92.99%) and squamous (72.13%) were predominant in the head and neck, melanoma predominated in the trunk region (36.89%) and in lower limbs (24.27%). We performed 67 surgeries with sentinel lymph node, with positivity in 14.93%. Patients with melanoma who had metastasis accounted for 7.76% and 2.91% patients died. Conclusion: Plastic surgeons are one of the important professionals for skin cancer treatment. These professionals are the most skilled one to perform reconstructions after tumor resections, because during education they learn repair concepts using grafts and flaps especially focused on aesthetic appearance of patients. They can also perform surgery for sentinel lymph node and offer follow-up to patients with skin cancer.

Diagnóstico serológico de las infecciones congénitas y algoritmos para mejorar la eficacia diagnóstica / Serological diagnosis of congenital infections and algorithms to improve diagnostic efficacy

Puede ocurrir por vía transplacentaria o por contacto directo con el patógeno durante el parto o en el período posnatal. Se puede producir infección congénita tanto por virus (rubéola, citomegalovirus, herpes simple, varicela-zóster, hepatitis B y C, virus de la inmunodeficiencia humana, erythrovirus B19) como por bacterias (Treponema pallidum) y parásitos (Toxoplasma gondii y Trypanosoma cruzi). El diagnóstico serológico de la infección congénita se basa tanto en el conocimiento de la serología infecciosa en la madre, incluyendo el control serológico sistemático y aspectos del diagnóstico por determinación de IgM y métodos confirmatorios, como los ensayos de avidez de IgG o el establecimiento de perfiles de anticuerpos, como en el diagnóstico en el neonato. El diagnóstico serológico de la infección congénita en el recién nacido se basa fundamentalmente en la detección de IgM específica, generalmente mediante técnicas inmunoenzimáticas o de inmunoquimioluminiscencia; en ocasiones es de importancia realizar el seguimiento serológico del recién nacido para confirmar la infección congénita

Congenital infection is those transmitted by the mother to the fetus before delivery. It can occur transplacentally or by direct contact with the pathogen during birth or in the immediate postnatal period. Congenital infection can be due to viruses (rubella, cytomegalovirus, herpes simplex, varicella-zoster, hepatitis B and C virus, human inunodeficiencia, erythrovirus B19) as bacteria (Treponema pallidum) and parasites (Toxoplasma gondii and Trypanosoma cruzi). Serological diagnosis of congenital infection is based on both the knowledge of infectious serology in the mother, including the systematic serological screening and diagnostic aspects of the determination of IgM and confirmatory methods, IgG avidity tests, establishment of antibody profiles, and in the diagnosis the neonate. Serological diagnosis of congenital infection in the newborn is mainly based on the detection of specific IgM usually by immunoenzymatic assays or immunochemiluminescence techniques. In some instances it is important to perform the serological follow up of the newborn to confirm the congenital infection

Seguridad y eficacia de la vacuna antigripal en el embarazo / Safety and efficacy of Influenza vaccine in pregnancy

Solo el 22.7 % de las gestantes se inmunizan contra el virus de la gripe, por la creencia popular de que la vacuna puede causar la aparición de la enfermedad u otras complicaciones. Objetivo. Revisar la evidencia científica existente con respecto a la seguridad y eficacia de las vacunas antigripales en las embarazadas. Metodología. Revisión bibliográfica de la literatura científica. Resultados. Las embarazadas y el feto pueden tener complicaciones si contraen la gripe. La vacuna antigripal en la mujer embarazada es efectiva en la reducción de los cuadros de gripe durante el embarazo y no se observa ningún aumento de efectos adversos de la vacuna en madres ni en niños, comparados con las no embarazadas. Conclusiones. La vacunación es segura para la embarazada y para el feto y se tolera bien. Por lo tanto, la vacunación es el método más seguro y efectivo para prevenir la infección en cualquier trimestre de la gestación (AU)

Only 22.7 % of pregnant women are immunized against the flu virus, by the popular belief that the vaccine can cause the onset of the disease or other complications. Objective. To review the scientific evidence regarding the safety and efficacy of influenza vaccines in pregnant women. Methodology. Literature review of the scientific literature. Results. Pregnant women and the fetus can have complications if they contract the flu. The influenza vaccine in pregnant women is effective in reducing flu boxes during pregnancy, and it is not observed any increase in adverse effects of the vaccine in mothers or children, compared with non pregnant women. Conclusions. Vaccination is safe for pregnant women and fetus and is well tolerated. Therefore, vaccination is the safest and most effective method to prevent infection in any trimester (AU)

Plicatura dos retos do abdome em dois planos versus plano único contínuo / Plication of the rectus abdominis muscles in one continuous and two planes

Introdução: A correção da diástase dos músculos retos do abdome é realizada principalmente pela sua plicatura, procedimento que consome muito tempo cirúrgico. O objetivo deste estudo é avaliar a eficácia e o tempo necessário para a correção da diástase dos retos do abdome comparando a plicatura com sutura contínua em plano único à plicatura em dois planos. Método: Foram incluídas 20 mulheres com história de pelo menos uma gestação. Foram randomizadas em dois grupos, um submetido à plicatura dos retos do abdome em dois planos (controle) e outro à sutura em plano único contínuo (estudo) com mononylon 2-0. Mediu-se o tempo necessário para a realização de cada uma das técnicas. Para análise estatística, foram usados os testes não paramétricos de Mann-Whitney, Friedman e Wilcoxon, considerando estatisticamente significante p < 0,05. Todas as pacientes foram submetidas à ultrassonografia previamente à cirurgia, 3 semanas e 6 meses de pós-operatório. Resultados: A plicatura do grupo estudo mostrou-se tão eficaz quanto à do grupo controle, mantendo seu resultado em longo prazo, apresentando diferença estatisticamente significante (p = 0,018) na comparação das medidas pré e pós-operatórias. No grupo estudo, porém, a plicatura consumiu menor tempo cirúrgico para ser realizada, também com diferença estatisticamente significante (p = 0,002). Conclusão: Com este estudo, pode ser concluído que tanto a sutura em dois planos como a em plano único contínuo são eficazes na correção da diástase dos retos do abdome e mantêm o resultado por longo tempo. Concluiu-se também que a técnica de sutura contínua demanda menor tempo para ser realizada.

Introduction: The correction of diastasis of the rectus abdominis muscles is primarily performed using the plication technique, which involves a surgical procedure. To evaluate the efficacy and the surgical time necessary to correct diastasis of the rectus abdominis muscles using plication and sutures in one continuous or two planes. Method: Twenty women with at least one pregnancy were included in the study. The study participants were randomized into two groups: the control group was subjected to plication in two planes, and the experimental group was subjected to plication using suture in one continuous plane with mono-nylon 2-0. The time required to perform each of these techniques was measured. For statistical analysis, the nonparametric Mann-Whitney test, Friedman test, and Wilcoxon test were used, and p-values of < 0.05 were considered statistically significant. All patients underwent ultrasonography before surgery, and at 3 weeks and 6 months postoperatively. Results: The plication technique was similarly effective in the two groups, achieving a long-term surgical outcome; however, the differences in the ultrasound measurements in the pre- and postoperative periods were statistically significant (p = 0.018). In addition, plication was performed in a significantly shorter time in the experimental group (p = 0.002). Conclusion: Sutures in one continuous plane and in two planes were effective in correcting diastasis of the rectus abdominis muscles, with the maintenance of a long-term surgical outcome. In addition, the continuous suture technique can be performed in a shorter time.