Factores de riesgo asociados a mala adherencia en adolescentes trasplantados hepáticos en transición / Risk factors associated with poor adherence in adolescent liver transplant recipients in transition

Cada vez más pacientes trasplantados hepáticos durante la edad pediátrica alcanzan la adultez debido al aumento en las tasas de sobrevida a largo plazo, por lo que requieren continuar su atención en un centro de adultos. Este pasaje entre centros se asocia con peores resultados clínicos y mayor mala adherencia, debido al momento de vulnerabilidad que representa este momento en la atención médica y por el mismo momento vital atravesado por el paciente adolescente. La mayoría de los centros de trasplantes establecieron programas de transición para mejorar estos resultados. Para que estos programas sean efectivos, deben conocerse las barreras y los facilitadores de adherencia tanto en el paciente como en su entorno. El objetivo de este trabajo es reconocer estos factores de riesgo y su relación con mala adherencia y resultados clínicos, y realizar un seguimiento a corto plazo de los pacientes transferidos a un centro de atención de adultos. Para esto, se realizó una encuesta pre y post derivación a una cohorte de pacientes adolescentes del Hospital Garrahan. Para medir mala adherencia se utilizaron métodos objetivos y subjetivos, cada uno de los cuales correlacionó con distintos factores de riesgo, como presencia de violencia, consumo de sustancias y déficit educativo. Como conclusión, medir la mala adherencia es complejo debido a que su origen es multifactorial. Al parecer, combinar cuestionarios validados con entrevistas no estructuradas es la estrategia más efectiva para detectar mala adherencia en la consulta médica. Luego, las variables psicosociales están cobrando cada vez más relevancia y deben ser consideradas en los programas de transición de los servicios de trasplante si se quiere lograr un seguimiento a largo plazo exitoso (AU)

An increasing number of pediatric liver transplant patients reach adulthood due to the increase in long-term survival rates, and therefore require continued care in an adult center. This transition between centers is associated with worse clinical outcomes and poorer adherence, due to the vulnerability that this moment in medical care represents and the same vital moment that the adolescent patient goes through. Most transplant centers have established Transition Programs to improve these outcomes. For these programs to be effective, the barriers and facilitators of adherence in both the patient and their environment should be known. The aim of this study was to identify these risk factors and their relationship with poor adherence and clinical outcomes, and to perform a short-term follow-up of patients transferred to an adult care center. For this purpose, a pre- and post-referral survey was conducted on a cohort of adolescent patients from the Garrahan Hospital. Objective and subjective methods were used to measure poor adherence, each of which correlated with different risk factors, such as the presence of violence, substance use, and educational deficits. In conclusion, measuring poor adherence is complex because its origin is multifactorial. Combining validated questionnaires with unstructured interviews seems to be the most effective strategy for detecting poor adherence in the medical consultation. Therefore, psychosocial variables are becoming increasingly relevant and should be considered in the Transition Programs of transplantation services if a successful longterm follow-up is to be achieved (AU)

Calidad asistencial y seguimiento de los pacientes operados por cáncer colorrectal en un Hospital de Paysandú, Uruguay / Quality of care and follow-up of patients operated on forcolorectal cancer at the Paysandú Hospital, Uruguay

Introducción: el cáncer colorrectal (CCR) es la segunda causa de muerte dentro de las enfermedades neoplásicas. El pronóstico individual está signado por el estadio de la enfermedad al momento del diagnóstico y la posibilidad de realizar un tratamiento curativo. Este también depende de la estratificación post quirúrgica y de la aparición de complicaciones ulteriores. El objetivo del seguimiento es diagnosticar la recidiva en un estadio potencialmente curable y detectar otros cánceres primarios. Objetivo: realizar una valoración de la calidad de la cirugía colorrectal y el seguimiento de los pacientes operados de CCR en nuestro hospital. Diseño: estudio descriptivo, observacional, retrospectivo. Material y métodos: se analizaron todos los pacientes con CCR operados en el servicio de cirugía del Hospital de Paysandú entre enero de 2017 y diciembre de 2020. Se describen diversas variables que influyen en la calidad quirúrgica y se analizan las relacionadas al seguimiento post operatorio dividiendo a los pacientes en 3 grupos, seguimiento completo, perdidos y sin datos de seguimiento. Resultados: se incluyeron 39 pacientes, con una edad media de 68 años. El 28% se diagnosticaron en estadio IV, con porcentajes bajos en estadios tempranos. Hubo 57% de cirugías de urgencia y 43% electivas. La causa más frecuente de urgencia fue la oclusión intestinal (36,6%). La tasa de dehiscencia anastomótica fue 16,6% y la de mortalidad 15,3%. Solo el 33% de los pacientes tuvieron seguimiento completo. Conclusión: existe un déficit en la atención y el seguimiento de los pacientes operados por CCR en nuestro hospital. Se impone la creación de un equipo específico en el área de coloproctología, así como un protocolo de seguimiento unificado para mejorar estos resultados. (AU)

Introduction: colorectal cancer (CRC) is the second cause of death among neoplastic diseases. The individual prognosis is determined by the stage of the disease at the time of diagnosis and the possibility of curative treatment. This also depends on the postsurgical stratification and the appearance of subsequent complications. The goal of follow-up is to diagnose recurrence at a potentially curable stage and detect other primary cancers. Objective: to carry out an evaluation of the quality of colorectal surgery and the follow-up of patients operated on for CRC in our hospital. Design: descriptive, retrospective observational study. Material and methods: all patients with CRC operated on in the surgery service of the Paysandú Hospital between January 2017 and December 2020 were analyzed. Variables that influence surgical quality are described and those related to postoperative follow-up are analyzed by dividing patients in 3 groups, complete follow-up, lost to follow-up and without follow-up data. Results: Thirty-nine patients were included, with a mean age of 68 years. Twenty-eight percent were diagnosed in stage IV, with low percentages in early stages. There were 57% emergency procedures and 43% elective proceduress. The most common cause of emergency was intestinal obstruction (36.6%). The anastomotic dehiscence rate was 16.6% and the mortality rate was 15.3%. Only 33% of patients had complete follow-up. Conclusion: there is a deficit in the care and follow-up of patients undergoing CRC surgery in our hospital. The creation of a specific team in the area of coloproctology is required, as well as a unified monitoring protocol to improve these results. (AU)

Ligadura del trayecto fistuloso interesfinteriano. Nuestros resultados / Ligation of the intersphincteric fistulatract. Our results

Introducción: existen varias técnicas para el tratamiento quirúrgico de las fístulas anales, con variables resultados. La técnica de ligadura del trayecto fistuloso interesfinteriano (LIFT) consiste en la disección del espacio entre ambos esfínteres para localizar el trayecto fistuloso y proceder a su ligadura y sección. Objetivo: evaluar nuestros resultados con la técnica de LIFT para del tratamiento de las fístulas anales transesfinterianas. Diseño: retrospectivo, observacional de corte transversal. Materiales y métodos: Se incluyeron todos los pacientes con fístulas transesfinterianas tratados con LIFT desde enero de 2013 a diciembre 2020. El seguimiento postoperatorio se realizó hasta los 2 años. Resultados: se operaron 62 pacientes. El sexo predominante fue masculino. Hubo 47 pacientes con fístulas transesfinterianas bajas y 15 con fístulas transesfinterianas altas. En todos se identificó el trayecto fistuloso realizándose ligadura de ambos cabos del trayecto interesfinteriano y se procedió a un curetaje del trayecto a través del orificio externo. Cinco pacientes (8%) presentaron dehiscencia de piel a nivel de la incisión del espacio interesfinteriano, manejado en forma conservadora. Este grupo tuvo una cicatrización mas retardada de 4 semanas. Ocurrió recidiva en 22 (35,5%) pacientes. Conclusión: La técnica de LIFT parece una alternativa eficaz y segura para el tratamiento de las fístulas transesfinterianas bajas y altas ya que no altera la anatomía ni la continencia. (AU)

Introduction: there are various techniques for the surgical treatment of anal fistulas, with variable results. The ligation procedure of the intersphincteric fistulous tract (LIFT) consists of dissecting the space between both sphincters to locate the fistulous tract and proceed to its ligation and section. Objective: to evaluate our results with the LIFT procedure for the treatment of transsphincteric anal fistulas. Design: retrospective, cross-sectional observational study. Material and methods: all patients with transsphincteric fistulas treated with LIFT from January 2013 to December 2020 were included. Postoperative follow-up was carried out for up to 2 years. Results: sixty-two patients underwent surgery. The predominant sex was male. There were 47 patients with low transsphincteric fistulas and 15 with high transsphincteric fistulas. After identifying the fistulous tract in the intersphincteric groove, both ends were ligated and the tract was cut. Finally, curettage of the tract through the external orifice was performed. Five patients (8%) presented skin dehiscence at the level of the intersphincteric groove incision, managed conservatively. This group had a longer healing time of four weeks. Recurrence occurred in 22 (35.5%) patients. Conclusion: the LIFT procedure appears to be an effective and safe alternative for the treatment of low and high transsphincteric fistulas, since it does not alter the anatomy or continence. (AU)

Long-term outcomes of the obstruction treatment in benign and malignant colonic obstruction: a multicentre study

Introduction: Patients with colonic obstruction are at risk for emergency resection, which is a risk factor for increased mortality and morbidity. In left-sided obstructive colon cancer, the principle of bridge-to-surgery is already recommended to reduce complications. From this treatment strategy, the obstruction treatment is derived. In this treatment strategy, bowel wall distention is reduced by minimizing stool production through laxatives and dietary measures. Short-term outcomes have already shown promising results. This study aims to evaluate long-term outcomes in patients treated with this obstruction treatment. Methods: This is a multicenter prospective study that included patients who presented with symptomatic colonic obstruction and radiologic confirmation of obstruction between May 2019 and August 2020 in the contributing hospitals. Patients with malignant and benign colonic obstruction were included. Follow-up in this study consisted of at least 36 months. Endpoints of the study included 1- and 3-year stoma and mortality rates. Results: Ninety-eight patients were included in this study. For the overall cohort complication, reoperation, and readmission rates after one year were 37%, 14%, and 10% respectively. Overall, 3-year mortality was 21%. The presence of a stoma after 1 year was 18%, and after 3 years 17% in this cohort. Conclusion: Long-term results of this study indicate that obstruction treatment has acceptable long-term outcomes in terms of mortality and stoma rates, compared to literature on emergency surgery and bridge-to-surgery alternatives. Permanent stoma rates are lower, compared to the literature on other treatment strategies in bowel obstruction. (AU)

Psicoterapia breve operacionalizada na adaptação de mulheres com câncer de mama: coletânea de casos / Brief psychotherapy operationalized in adaptation of women with breast cancer: case selection / Psicoterapia breve operacionalizada en la adaptación de mujeres con cáncer de mama: recopilación de casos

O objetivo deste estudo foi investigar os efeitos terapêuticos da Psicoterapia Breve Operacionalizada (PBO) na adaptação de mulheres diagnosticadas com câncer de mama e em tratamento oncológico. O câncer de mama mostra-se mobilizador de sofrimento psíquico para as mulheres tanto no diagnóstico quanto no tratamento, o que justifica identificar intervenções psicológicas adequadas para essa população. As participantes foram 17 mulheres com idade entre 30 e 65 anos. A Escala Diagnóstica Adaptativa Operacionalizada (EDAO) foi o instrumento utilizado para avaliação da adaptação em quatro setores: afetivo-relacional, produtividade, orgânico e sociocultural. Referida avaliação foi feita em três momentos: antes e após a intervenção breve, e no follow-up . A PBO foi a intervenção breve utilizada. Os resultados mostraram que o setor orgânico foi o mais comprometido, seguido do afetivo-relacional, com soluções pouquíssimo adequadas. Como foco da psicoterapia breve, a situação-problema mais recorrente se relacionava ao câncer de mama, que, na compreensão psicodinâmica, mostrou-se associada ao intenso desamparo egóico diante do adoecimento e tratamento oncológico. Na avaliação adaptativa final e follow-up , 82,4% das participantes apresentaram evolução de grupo adaptativo. Concluímos que, neste estudo, a intervenção com a PBO possibilitou efeitos terapêuticos na adaptação, reverberando na solução das situações-problema e na crise adaptativa por perda.(AU)

This study aimed to investigate the therapeutic effects of Operationalized Brief Psychotherapy (PBO) so women diagnosed with breast cancer could adapt to treatment. Breast cancer has mobilized psychological suffering for women during diagnosis and treatment, justifying the identification of the appropriate psychological interventions for this population. Participants included 17 women aged 30 to 65 years. Adaptative Operational Diagnostic Scale (EDAO) was used to evaluated adaptation in four sectors: affective-relational, productivity, organic, and sociocultural before and after a brief psychological intervention and follow-up. The PBO was used as the brief intervention. Results showed that the organic sector was the most compromised, followed by the affective-relational one, which showed very little adequate solutions. As a focus of brief psychotherapy, the most recurring problem-situation was related to breast cancer, which, in yjr psychodynamic understanding, was associated with the intense helplessness of the ego in the face of illness and treatment. In the final adaptative evaluation and follow-up, 82.4% of participants showed evolution in the adaptive group. This study concluded that the intervention with PBO enabled therapeutic effects in these participants' adaptation, reverberating in the solution of problem-situation and in the adaptive crisis by loss.(AU)

El propósito de este estudio fue investigar los efectos terapéuticos de la psicoterapia breve operacionalizada (PBO) en la adaptación de mujeres diagnosticadas con cáncer de mama y en tratamiento oncológico. El cáncer de mama moviliza sufrimiento psicológico para las mujeres tanto en el diagnóstico como en el tratamiento, lo que justifica identificar intervenciones psicológicas adecuadas para esta población. Participaron 17 mujeres de entre 30 y 65 años. El instrumento utilizado fue la Escala de Diagnóstico Adaptativo Operacionalizada (EDAO) para la evaluación adaptativa en cuatro sectores: afectivo-relacional, productividad, orgánico y sociocultural. La evaluación se realizó en tres momentos: antes, después de la intervención breve y en el seguimiento. La PBO fue la intervención breve utilizada. Los resultados mostraron que el sector orgánico fue el más comprometido, seguido por el afectivo-relacional con soluciones poquísimas adecuadas. Como foco de la psicoterapia breve, la situación-problema más recurrente estuvo relacionada con el cáncer de mama, que en la comprensión psicodinámica resultó estar asociada a un intenso desamparo ante la enfermedad y el tratamiento oncológico. En la evaluación adaptativa final y el seguimiento, el 82,4% de las participantes tuvieron evolución grupal adaptativa. Se concluye que la intervención con PBO permitió efectos terapéuticos en la adaptación de estos participantes, repercutiendo en la solución de situaciones-problema y en la crisis adaptativa por pérdida.(AU)

Rectopexia laparoscópica con técnica de Orr-Loygue para el tratamiento del prolapso rectal / Laparoscopic Orr-Loygue rectopexy with mesh for the treatment of rectal prolapse

Introducción: Existen múltiples alternativas para el tratamiento quirúrgico del prolapso rectal mediante procedimientos de fijación, resección o combinados. Si bien el abordaje perineal evita el acceso a la cavidad peritoneal, se acompaña de una tasa de recidiva mayor en relación al abordaje abdominal. Descripción: Se presenta una paciente de 66 años, histerectomizada por vía laparotómica, con un prolapso rectal externo y reductible de 1 año de evolución, sin incontinencia fecal ni constipación. La endoscopia preoperatoria descartó patología colónica asociada. Abordaje laparoscópico en posición de Trendelenburg lateralizado a la derecha. Como es habitual en estos casos se observa la presencia de dolicosigma y fondo de saco de Douglas profundo y se evidencia también la cicatriz de la cesárea. El procedimiento comienza con la apertura peritoneal a nivel del promontorio y la movilización de la unión rectosigmoidea, identificando el uréter izquierdo. Se continua la disección circunferencial tras la apertura de la reflexión peritoneal hasta la altura de la cúpula vaginal. La rectopexia se realiza según la técnica de Orr-Loygue mediante la fijación de la malla por una parte a ambas caras laterales del recto y por otra al promontorio sacro con puntos de polipropileno 2-0, cuidando de no lesionar los vasos ilíacos y los uréteres. Finalmente se cierra la reflexión peritoneal con poliglactina para aislar las mallas protésicas del contenido visceral. La paciente tuvo una buena evolución postoperatoria, otorgándose el alta a las 48 h. Tras 8 meses de seguimiento se encuentra asintomática, con tránsito digestivo y continencia fecal sin alteraciones. Conclusión: El abordaje laparoscópico para el tratamiento del prolapso rectal es seguro y ofrece las ventajas de la cirugía mini-invasiva. La rectopexia con malla protésica es un procedimiento técnicamente desafiante, aunque con mejores resultados alejados. (AU)

Introduction: There are multiple alternatives for the surgical treatment of rectal prolapse through fixation, resection or combined procedures. Although the perineal approach avoids access to the peritoneal cavity, it is associated with a higher recurrence rate than the abdominal approach. Description: The video shows a 66-year-old female patient, hysterectomized by laparotomy, with a 1-year history of reduciblefull-thickness rectal prolapse, without fecal incontinence or constipation. Preoperative endoscopy ruled out associated colonic pathology. The laparoscopic approach is done with the patient placed in Trendelenburg and tilted to the right. As usual in these cases, the presence of dolichosigma and deep Douglas pouch is observed, as well as the cesarean section scar. The procedure begins with the peritoneal opening at the level of the promontory and the mobilization of the rectosigmoid junction, identifying the left ureter. Circumferential dissection is continued after opening the peritoneal reflection up to the level of the vaginal vault. Rectopexy is performed according to the Orr-Loygue technique by fixing the mesh to both lateral aspects of the rectum on one side and to the sacral promontory on the other side with 2-0 polypropylene interrupted sutures, taking care not to injure the iliac vessels and ureters. Finally, the peritoneum is closed with a running suture with polyglactin to isolate the prosthetic mesh from the visceral content. The patient had a good postoperative outcome and was discharged at 48 h. After 8 months of follow-up, she is asymptomatic and has normal colonic transit and fecal continence. Conclusion: the laparoscopic approach for the treatment of rectal prolapse is safe and offers the advantages of minimally invasive surgery. Prosthetic mesh rectopexy is a technically challenging procedure, although has better distant results. (AU)

Uso de endoprótesis para el tratamiento de enfermedades no neoplásicas de la rodilla / Use of endoprosthesis for the treatment of non-neoplastic pathologies of the knee

Introducción: Las endoprótesis son el método de elección para la reconstrucción luego de las resecciones oncológicas. Los avances en los materiales y diseños permitieron expandir las indicaciones a enfermedades no neoplásicas. Su montaje intraoperatorio simple y rápido, y su estabilidad mecánica inmediata permiten una rehabilitación y una recuperación funcional tempranas. Sin embargo, la tasa de fallas es elevada, aunque distinta de la de las enfermedades oncológicas. Las causas predominantes son diferentes. Objetivos: Analizar nuestra experiencia con el uso de endoprótesis de rodilla y compararla con los estudios publicados, evaluando los resultados funcional y radiográfico, la supervivencia del implante y las causas de su eventual falla. Materiales y Métodos: Se seleccionaron pacientes con enfermedad no neoplásica compleja de rodilla que requirieran una reconstrucción con endoprótesis. Para el examen clínico y la evaluación funcional se utilizó el puntaje de la Musculoskeletal Tumor Society, y para las fallas de los implantes, la clasificación de Henderson y cols. modificada. Resultados:Se estudiaron 12 endoprótesis, con un seguimiento promedio de 3.8 años. Se registraron 2 fallas (18%), con un tiempo promedio hasta la falla de 47.5 meses. Una fue tipo 2 (aflojamiento aséptico) y la otra, tipo 4 (infección). No hubo otras complicaciones. En la evaluación funcional, el puntaje final medio fue del 76,6%. Conclusión: Nuestros resultados respaldan el uso de endoprótesis para enfermedades complejas no neoplásicas de rodilla en pacientes cuidadosamente seleccionados, pese a ser un procedimiento quirúrgico complejo y con muchas complicaciones. Nivel de Evidencia: IV

Introduction: Endoprosthesis is the gold standard for reconstruction after oncological resections. The advances regarding its materials and designs allowed for the expansion of the indications to non-neoplastic pathologies. Its simple and fast intraoperative assembly and its immediate mechanical stability allow for early rehabilitation and functional recovery. However, the failure rate is high, although it is different from oncological pathologies. The predominant causes are varied. Objectives: To analyze our experience in the use of knee endoprosthesis and compare it with the literature, evaluating functional outcomes, radiographic outcomes, implant survival and causes of eventual failure. Materials and Methods: Patients with complex non-neoplastic knee pathology that required reconstruction with endoprosthesis were selected. Clinical history, anamnesis, physical examination, and radiographs were reviewed. For clinical examination and functional evaluation, the MusculoSkeletal Tumor Society Score (MSTS Score) was used. For implant failures, the modified Henderson et al. classification was used. Results: 12 endoprostheses were studied, with an average follow-up of 3.8 years. Failures were recorded in 2 (18%), with a mean time to failure of 47.5 months. One type 2 failure (aseptic loosening) and one type 4 failure (infection) were recorded. No other complications were noted. For the functional evaluation, the mean final score was 76.6%. Conclusion: Our results support the use of endoprostheses for complex non-neoplastic knee diseases in carefully selected patients, despite being a complex surgical procedure with many complications.Keywords: Endoprosthesis; knee; infection; complications. Level of Evidence: IV

Artroplastia total de rodilla con implante semiconstreñido. Análisis de serie de casos / Semi-constrained knee prosthesis

Introducción: Los implantes semiconstreñidos en la artroplastia total de rodilla están indicados cuando hay compromiso de la estabilidad de la rodilla, ya sea en cirugías primarias o de revisión. materiales y métodos:Se evaluó a 43 pacientes tratados con implantes de constricción condilar varo-valgo, en una misma institución, por el mismo equipo quirúrgico, entre 2015 y 2022. Resultados:Los resultados en las escalas de función WOMAC, KSS y Oxford fueron buenos/muy buenos. Los puntajes fueron menores en pacientes >75 años, si utilizaban asistencia para caminar y si tenían enfermedades previas (estadísticamente significativo). El 86% no tuvo dolor, el 91% estaba satisfecho y el 11% sufrió complicaciones. No hubo infecciones, ni cirugías de revisión. Conclusiones: Respetando las indicaciones y la técnica quirúrgica, las artroplastias totales de rodilla semiconstreñidas con constricción condilar varo-valgo logran buenos resultados a corto y mediano plazo, con una tasa baja de complicaciones, sin diferencias estadísticas en la función entre las cirugías primarias y de revisión. Nivel de Evidencia: III

Introduction: Semi-constrained implants in TKA are indicated in cases where knee stability is compromised, either in primary or revision surgeries. materials and methods:43 patients were evaluated at the same institution, treated by the same surgical team between 2015-2022, with Sigma TC3 (Johnson & JohnsonTM) implants. Results: the WOMAC, KSS function and Oxford functiona-lity scales had good/very good results. The scores were lower in patients over 75 years of age if they used gait assistance and if they had previous pathologies (statistically significant). 86% had no pain, 91% were satisfied, 11% had complications. There were no infections or revision surgeries. Conclusions: TKAs with Sigma TC3 present good outcomes in the short and medium term with a low rate of complications in this series, with no statistical differences in function between primary and revision surgeries. Level of Evidence: III

Tratamiento de defectos acetabulares tipo IIIA-B de Paprosky y discontinuidad pélvica con implantes 3D a medida: resultados a mediano plazo / Treatment of Paprosky type IIIA-B acetabular defects and pelvic discontinuity with custom 3D implants. Medium-term results

Introducción: La revisión acetabular es una cirugía particularmente desafiante cuando hay pérdida de stock óseo y defectos acetabulares extensos. Los implantes 3D pueden suplir estos defectos y adaptarse a cada circunstancia. El objetivo de este estudio fue evaluar los resultados clínicos y radiográficos en pacientes con defectos acetabulares severos tratados con implantes impresos en 3D y determinar la constricción adecuada del cotilo para cada paciente. Materiales y métodos: Se realizó un estudio retrospectivo de 10 pacientes con defectos acetabulares severos clasificados como tipo IIIA-B de Paprosky y discontinuidad pélvica que se sometieron a una cirugía con prótesis acetabular a medida impresa en 3D, a cargo del mismo equipo quirúrgico, entre 2016 y 2022. Resultados: El seguimiento medio fue de 40.5 meses. El puntaje de cadera de Harris mejoró significativamente de un promedio de 24,2 a 63,5 en el último control. No se observaron signos de aflojamiento ni migración del cotilo 3D en cuanto a la inclinación y anteversión en ningún caso, en el último control. Conclusión: Los implantes acetabulares a medida representan una solución válida para tratar defectos óseos acetabulares severos y la discontinuidad pélvica. Nivel de Evidencia: IV

Introduction: Acetabular revision is a particularly challenging surgery when there is loss of bone stock and extensive acetabular defects. 3D implants can make up for these defects and adapt to each circumstance. The objective of this study was to evaluate clinical and radiographic outcomes in patients with severe acetabular defects treated with 3D-printed implants and determine the appropriate cup constraint for each patient. Materials and methods: A retrospective study was carried out on 10 patients with severe acetabular defects classified as Paprosky type IIIA-B and pelvic discontinuity who underwent surgery with a custom 3D-printed acetabular prosthesis, carried out by the same surgery team between 2016 and 2022. Results: The average follow-up was 40.5 months. The Harris hip score improved significantly from an average of 24.2 to 63.5 at the last follow-up. No signs of loosening or migration of the 3D cup in terms of inclination and anteversion were observed in any case, at the last control. Conclusion: Custom-made acetabular implants represent a valid solution to treat severe acetabular bone defects and pelvic discontinuity. Level of Evidence: IV

Change in the pattern of frailty among socially vulnerable older adults over a 36-month period and associated factors: a follow-up study / Mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses e fatores associados: um estudo de seguimento

OBJECTIVE: To investigate changes in the frailty levels of older adults in a context of high social vulnerability. METHODS: We conducted a prospective cohort study. Data were collected from 2 surveys conducted in 2015 and 2018. The frailty phenotype and sociodemographic and health characterization instruments were used. Descriptive statistical analysis was performed, including non-parametric tests, test for equality of proportions, and multivariate multinomial logistic regression. The use of the database was authorized, and the research was approved by the Ethics Committee. RESULTS: In 2015, 346 community-dwelling older adults participated in the study. After 36 months, a final sample of 223 participants was obtained. In 2015, the prevalence of non-frail, pre-frail, and frail older adults was 13.0%, 56.5%, and 30.5%, respectively. In 2018, 22.9% were non-frail, 56.0% were pre-frail, and 21.1% were frail. Higher education and better quality of life reduced the likelihood of becoming pre-frail and frail, respectively. CONCLUSION: There was a change in the pattern of frailty among socially vulnerable older adults over a 36-month period.

OBJETIVO: Verificar alterações nos níveis de fragilidade de pessoas idosas em contexto de alta vulnerabilidade social. METODOLOGIA: Trata-se de um estudo de coorte prospectivo. Foram coletados dados de dois inquéritos realizados em 2015 e 2018. Utilizou-se o Fenótipo de Fragilidade e instrumentos de caracterização sociodemográfica e de saúde. Análises estatísticas descritivas foram realizadas, incluindo testes não-paramétricos, teste de igualdade de proporções e regressão logística multinomial multivariada. O uso do banco de dados foi autorizado, e a pesquisa foi aprovada pelo Comitê de Ética. RESULTADOS: Em 2015, 346 idosos comunitários participaram do estudo. Após o período de 36 meses, obteve-se uma amostra final de 223 participantes. Em 2015, a prevalência de não frágeis, pré-frágeis e frágeis foi de 13,0, 56,5 e 30,5%, respectivamente. Em 2018, 22,9% eram não frágeis, 56,0% pré-frágeis e 21,1% frágeis. Maior escolaridade e qualidade de vida diminuíram a probabilidade de se tornar pré-frágil e frágil, respectivamente. CONCLUSÃO: Observou-se uma mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses.

Estudio de sobrevida a largo plazo en pacientes adultos con enfermedades respiratorias crónicas atendidos por infección respiratoria aguda por coronavirus SARS-CoV-2 / Study of long-term survival in adult patients with chronic respiratory diseases treated for acute respiratory infection by coronavirus SARS-CoV-2

La enfermedad respiratoria aguda por coronavirus SARS-CoV-2 (COVID-19) se ha convertido en un grave problema de salud pública a nivel mundial. Objetivos: Examinar el uso de recursos sanitarios, riesgo de complicaciones y muerte en pacientes adultos con enfermedades respiratorias crónicas atendidos por COVID-19. Métodos: Estudio clínico descriptivo prospectivo realizado en pacientes adultos atendidos por COVID-19 en la Red de Salud UC Christus entre el 1 de abril y 31 de diciembre de 2020. Resultados: Se evaluaron 2.160 pacientes adultos, edad: 47 ± 17 años (rango: 18-100), 51,3% sexo masculino, 43,8% tenía comorbilidades, especialmente hipertensión (23,2%), diabetes (11,7%) y enfermedades respiratorias crónicas: asma (5%), EPOC (1,4%) y enfermedad pulmonar difusa (EPD: 0,8%). Los pacientes adultos con enfermedades respiratorias crónicas tuvieron mayor riesgo de hospitalización y uso de oxígeno suplementario; sin embargo, la evolución de los pacientes asmáticos y la sobrevida a los doce meses fue similar a los pacientes sin comorbilidades atendidos por COVID-19, mientras que en los pacientes con EPOC y EPD la admisión a la unidad de paciente crítico y riesgo de muerte fueron más elevados. En el análisis multivariado, los principales predictores clínicos asociados al riesgo de muerte en el seguimiento a doce meses en pacientes adultos con COVID-19 fueron la edad y admisión al hospital, mientras que el asma fue un factor protector. Conclusión: Los pacientes asmáticos tuvieron bajo riesgo de complicaciones y muerte asociados a COVID-19; mientras que los pacientes con EPOC y EPD tuvieron mayor riesgo de complicaciones y muerte en el seguimiento a largo plazo.

The acute respiratory disease associated to coronavirus SARS-CoV-2 (COVID-19) has become a serious public health problem worldwide. Objectives: To examine the use of healthcare resources, risk of complications and death in adult patients with chronic respiratory diseases treated for COVID-19. Methods: Prospective descriptive clinical study conducted in adult patients treated for COVID-19 in the UC Christus Healthcare Network between April 1 and December 31, 2020. Results: 2,160 adult patients were evaluated, age: 47 ± 17 years-old (range: 18-100), 51.3% male, 43.8% had comorbidities, especially hypertension (23.2%), diabetes (11.7%), and chronic respiratory diseases: asthma (5%), COPD (1,4%) and interstitial lung disease (ILD: 0.8%). Adult patients with chronic respiratory diseases were at higher risk for hospitalization and use of supplemental oxygen; however, the evolution of asthmatic patients and survival at twelve months was similar to that of adult patients without comorbidities treated for COVID-19, while in patients with COPD and ILD admission to the critical care unit and risk of death were higher. In the multivariate analysis, the main clinical predictors associated to 12-month mortality risk in adult patients with COVID-19 were age and hospital admission, while asthma was a protective factor. Conclusion: Asthmatic patients had minor risk of complications and mortality associated with COVID-19; while patients with COPD and ILD had a significant higher risk of complications and 12-month mortality.

Significado do uso da prótese peniana de silicone no seguimento da braquiterapia pélvica / Significado do uso da prótese peniana de silicone no seguimento da braquiterapia pélvica / Meaning of the use of silicone penile prosthesis in the follow-up of pelvic brachytherapy

Objetivo: descrever o significado do uso da prótese peniana de silicone para dilatação vaginal no seguimento da braquiterapia em mulheres com câncer ginecológico. Método: pesquisa narrativa, realizada no Centro de Pesquisas Oncológicas, Brasil, com 34 mulheres, após braquiterapia pélvica, em seguimento no serviço de fisioterapia. Coleta de dados por entrevistas semiestruturadas, incluindo dados sociodemográficos, clínicos e o significado do uso da prótese peniana na dilatação vaginal, submetidas à análise de conteúdo e discutidas à luz do estudo From 'sex toy' to intrusive imposition. Resultados: o significado perpassa o exercício de dilatação vaginal; as dificuldades relacionadas às condições vaginais, doença, tratamento, dor, sexo, constrangimentos, preconceitos, falhas na educação em saúde; as motivações relacionam-se à busca por qualidade de vida, apoio dos companheiros e profissionais. Conclusão: a abordagem de possíveis barreiras emocionais, psicológicas, sociais e físicas deve ser planejada e executada para prevenção da estenose vaginal e melhor acolhimento.

Objective: to describe the meaning of the use of silicone penile prosthesis for vaginal dilation in the follow-up of brachytherapy in women with gynecological cancer. Method: narrative research conducted at the Centro de Pesquisas Oncológicas, Brazil, with 34 women after pelvic brachytherapy, under follow-up at the physical therapy service. Data collection through semi-structured interviews, including sociodemographic and clinical data and the significance of the use of penile prosthesis in vaginal dilation, submitted to content analysis and discussed in the light of the study From 'sex toy' to intrusive imposition. Results: the meaning permeates the vaginal dilation exercise; difficulties related to vaginal conditions, disease, treatment, pain, sex, constraints, prejudices, failures in health education; motivations are related to the search for quality of life, support of partners and professionals. Conclusion: the approach of possible emotional, psychological, social and physical barriers should be planned and executed for prevention of vaginal stenosis and better reception.

Objetivo: describir el significado del uso de una prótesis peneana de silicona para la dilatación vaginal posterior a la braquiterapia en mujeres con cáncer ginecológico. Método: investigación narrativa, realizada en el Centro de Pesquisas Oncológicas, Brasil, con 34 mujeres, después de braquiterapia pélvica, en seguimiento en el servicio de fisioterapia. Recopilación de datos a través de entrevistas semiestructuradas, incluyendo datos sociodemográficos y clínicos y el significado del uso de prótesis peneana en la dilatación vaginal, sometidos a análisis de contenido y discutidos a la luz del estudio From 'sex toy' to intrusive imposition. Resultados: el significado impregna el ejercicio de dilatación vaginal; dificultades relacionadas con condiciones vaginales, enfermedad, tratamiento, dolor, sexo, vergüenza, prejuicios, fallas en la educación para la salud; las motivaciones están relacionadas con la búsqueda de calidad de vida, apoyo de la pareja y profesionales. Conclusión: se debe planificar y ejecutar el abordaje de las posibles barreras emocionales, psicológicas, sociales y físicas para prevenir la estenosis vaginal y una mejor recepción.

Suspensión alta al ligamento uterosacro con suturas permanentes en el prolapso apical: seguimiento a 24 meses / High suspension to the uterosacral ligament with permanent sutures in the apical prolapse: 24-month follow-up

Introducción: El prolapso de órganos pélvico (POP) es una patología frecuente que afecta hasta el 60% de las mujeres. La fijación alta al ligamento uterosacro (FAUS) transvaginal es una alternativa para el tratamiento del prolapso apical con buenos resultados, tiempos operatorios y de recuperación acotados, además de bajas tasas de complicaciones. Objetivo: Evaluar la tasa de éxito anatómico y subjetivo en pacientes portadoras de un prolapso apical sometidas a FAUS en el Hospital de Quilpué a 24 meses de seguimiento. Materiales y método: Se realizó un estudio retrospectivo observacional descriptivo, seleccionando a todas las pacientes sintomáticas con un prolapso apical ≥ 2 de la clasificación de POP-Q, sometidas a una FAUS entre septiembre de 2014 y octubre de 2019. Los datos fueron obtenidos desde la base de datos de la unidad de uroginecología del Hospital de Quilpué, previa aprobación del comité de ética. El éxito objetivo se definió como un punto C a 1 centímetro sobre el himen y el éxito subjetivo con una escala de impresión de mejora global del paciente (PGI-I) mejor o mucho mejor y/o una escala visual analógica (EVA) mayor al 80%, a 24 meses de seguimiento. Resultados: Se incluyeron 46 pacientes. La tasa de éxito objetivo fue del 84% y de éxito subjetivo del 70%. Conclusiones: La FAUS transvaginal con suturas permanentes es una excelente alternativa para el tratamiento del prolapso apical con una tasa de éxito similar al gold standard a 24 meses de seguimiento.

Introduction: Pelvic organ prolapse (POP) is a frequent pathology that affects up to 60% of women. Transvaginal uterosacral ligament high fixation (USLs: utero-sacral ligaments) is an alternative for the treatment of apical prolapse with good results, limited operative and recovery times, as well as low rates of complications. Objective: To evaluate the anatomical and subjective success rate in patients with an apical prolapse undergoing STALUS at the Quilpué Hospital at 24 months of follow-up. Materials and method: A descriptive observational retrospective study was carried out, selecting all symptomatic patients with an apical prolapse ≥ 2 of the POP Q classification, submitted to a FAUS between September 2014 and October 2019. The data were obtained from the database of the Urogynecology Unit of the Quilpué Hospital, prior approval of the ethics committee. Objective success was defined as a C-point 1 centimeter above the hymen and subjective success with better or much better Patient Global Impression-Improvement (PGI-I) scale and/or a greater than 80% Visual Analogue Scale (VAS), at 24 months of follow-up. Results: 46 patients were included. The objective success rate was 84% and the subjective success rate was 70%. Conclusions: The transvaginal FAUS with permanent sutures is an excellent alternative for the treatment of apical prolapse with a success rate similar to the gold standard at 24 months of follow-up.

Reabsorción dentinaria interna coronaria: informe de un caso clínico / Coronary internal dentine resorption: report of a clinical case

Objetivo: La reabsorción dentinaria interna es un pro- ceso causado por la actividad odontoclástica asociada princi- palmente a la inflamación pulpar crónica y/o traumatismos, y se caracteriza por la pérdida progresiva de tejido dentinario y la posible invasión al cemento. El presente informe describe el diagnóstico y tratamiento de un molar inferior que presentó un cuadro sintomático de reabsorción dentinaria interna. Caso clínico: Un paciente de 38 años fue derivado a la consulta por presentar una zona de reabsorción interna en un segundo molar inferior. Durante el examen clínico y ra- diográfico se tomó una radiografía preoperatoria periapical con radiovisiógrafo en la que se observó la presencia de un área compatible con el diagnóstico de reabsorción dentinaria interna, el que fue posteriormente confirmado por medio de una tomografía computada de haz cónico. La imagen de la lesión se presentó como una zona radiolúcida deformante de bordes nítidos, localizada a nivel de la cámara pulpar. El tra- tamiento consistió en la extirpación de la pulpa coronaria y de la instrumentación, desinfección y obturación de los conduc- tos radiculares y la cavidad de acceso. En el control clínico y radiográfico realizado luego de 3 años se observó que el paciente estaba asintomático y las estructuras perirradiculares se encontraban dentro de los límites normales. La observación histológica del material removido de la cámara pulpar reveló la presencia de un tejido granulomatoso con numerosos vasos sanguíneos y escasos focos micro hemorrágicos. Hasta el momento, el tratamiento endodóntico es el pro- cedimiento indicado para el tratamiento de la reabsorción dentinaria interna. Se destaca la importancia de la tomografía computada de haz cónico para el diagnóstico y tratamiento temprano de las reabsorciones dentinarias internas a efectos de contar con un pronóstico favorable (AU)

Aim: Internal dentine resorption is aprocess caused by odontoclastic activity, mainly associated with chronic pulpal inflammation and/or trauma, and it'scharacterized by a pro- gressive loss of dentine tissue and the possible invasion of the cementum. This report describes the diagnosis and treatment of a lower molar that presented a symptomatic case of inter- nal dentine resorption. Clinical case: A 38-years old patient was referred to the office because of presenting an area of internal resorption in a lower second molar. During clinical and radiographic exam- ination, a periapical preoperative radiograph with radiovisio- graph was taken, in which the presence of an area compatible with the diagnosis of internal dentine resorption was observed, which was later confirmed by a cone-beam computed tomog- raphy.The image of the lesion was presented as a deforming radiolucent area with sharp edges, located at pulp chamber level. Treatment consisted of the removal of the coronary pulp and the instrumentation, disinfection and filling of the root ca- nals and the access cavity. In the clinical and radiographic control carried out 3 years after procedure, it was observed that the patient was asymptomatic and the periradicular struc- tures were within normal limits. The histological observation of the removed material from the pulp chamber revealed the presence of a granulomatous tissue with numerous blood ves- sels and scarce micro hemorrhagic focus. Until now, the endodontic treatment is the indicated pro- cedure to treat internal dentine resorption. It is necessary to highlight the importance of the cone-beam computerized to- mography for the early diagnosis and treatment of internal dentine resorptions in order to have a favorable outlook (AU)

Principais complicações da covid-19 e implicações futuras: revisão integrativa / Principales complicaciones del covid-19 y futuras implicaciones: revisión integrativa / Main complications of covid-19 and future implications: integrative review

Objetivo: sintetizar as evidências científicas quanto às principais complicações da COVID-19, ocorridas durante o período de convalescença, em pacientes adultos e idosos. Método: revisão integrativa, realizada entre março e maio de 2021 nas fontes: US National Library of Medicine National Institutes Database Search of Health, Literatura Latino Americana e do Caribe em Ciências da Saúde, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Excerpta Médica Database. Utilizou-se o Rayyanna seleção e a análise de conteúdo. Resultados: identificaram-se 833 artigos, destes, nove compuseram a amostra. As complicações são neurológicas, respiratórias, psiquiátricas, cardiovasculares, nutricionais e musculares. Conclusão: as complicações mais preponderantes da COVID-19 são caracterizadas pelos acometimentos respiratórios e neurológicos, as quais implicam no aumento de pacientes descompensados nos serviços de saúde paraprocedimentos eletivos, aumento dos gastos públicos e na incidência de parada cardíaca extra-hospitalar.

Objective: to synthesize the scientific evidence regarding the main complications of COVID-19, occurring during the period of convalescence, in adult and elderly patients. Method: integrative review, conducted between March and May 2021 in sources: US National Library of Medicine National Institutes Database Searchof Health, Latin American and Caribbean Literature in Health Sciences, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Medical Excerpt Database. Rayyan was used in the selection and content analysis. Results: 833 articles were identified, of which nine comprised the sample. The complications are neurological, respiratory, psychiatric, cardiovascular, nutritional and muscular. Conclusion: the most preponderant complications of COVID-19 are characterized by respiratory and neurological disorders, which imply an increase in decompensated patients in health services, for elective procedures, an increase in public spending and an incidence of out-of-hospital cardiac arrest.

Objetivo: sintetizar la evidencia científica sobre las principales complicaciones de la COVID-19, ocurridas durante el período de convalecencia, en pacientes adultos y ancianos. Método: revisión integrativa, realizada entre marzo y mayo de 2021 en las fuentes: US National Library of Medicine National Institutes Database Search of Health, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web de Ciencias, Base de datos Excerpta Médica. Utilizou-se o Rayyan na seleção y análise de conteúdo. Resultados: se identificaron 833 artículos, de los cuales nueve conformaron la muestra. Las complicaciones son neurológicas, respiratorias, psiquiátricas, cardiovasculares, nutricionales y musculares. Conclusión: las complicaciones más prevalentes de la COVID-19 se caracterizan por afectaciones respiratorias y neurológicas, lo que implica un aumento de pacientes descompensados en los servicios de salud para procedimientos electivos, aumento del gasto público y la incidencia de paros cardíacos extrahospitalarios.

Efectos de un programa de rehabilitación remota en atención primaria en salud, posterior al alta hospitalaria por COVID-19: estudio observacional / Effects of a remote rehabilitation program in primary health care, after hospital discharge due to COVID-19: observational study

Se ha reportado un importante daño sistémico de los pacientes afectados por COVID-19, y aún existen interrogantes sobre las secuelas a largo plazo. Surge ante esto la necesidad de plantear programas de rehabilitación de los sistemas primarios de atención, que respondan a estas necesidades. Se realizó un programa de 6 semanas de rehabilitación remota, con seguimiento y progreso semanal, posterior al alta hospitalaria por COVID-19 a 114 usuarios de 4 centros de atención primaria de la comuna de El Bosque, Santiago, R. Metropolitana. Se incluyó a pacientes de edades entre 21 y 93 años, combinando los principios del ejercicio terapéutico individualizado, una evaluación presencial previo y posterior a las 6 semanas de trabajo. Los indicadores evaluados fueron: Minimental Abreviado, 1 Minute Sit to Stand Test (1min STST), Timed Up and Go (TUG), índice de Barthel y FRAIL. Se hicieron análisis inferenciales y descriptivos y se encontraron mejoras favorables en los indicadores de condición física (TUG y 1'STST), Índice de Barthel y el Simple "FRAIL" Questionnaire Screening Tool (FRAIL). En conclusión, si bien la mayoría de los indicadores tuvieron resultados favorables, es necesario seguir estudiando herramientas de evaluación más sensibles e intervenciones específicas que se adapten a las necesidades de las personas.

Significant systemic damage has been reported in patients affected by COVID-19, and questions remain about long-term sequelae. Therefore, the need arises to propose rehabilitation programs for primary care systems that respond to these needs. A 6-week program of remote rehabilitation, with weekly follow-up and progress, after hospital discharge for COVID-19 was carried out on 114 users from 4 primary care centers in the commune of El Bosque, Santiago, Chile. The program included patients from 21 to 93 years-old, combining the principles of individualized therapeutic exercise, a face-to-face evaluation before and after 6 weeks of work. The indicators evaluated were: Abbreviated Minimental, 1 minute Sit to Stand Test (1 min STST), Timed Up and Go (TUG), Barthel index and the Simple "FRAIL" Questionnaire Screening Tool (FRAIL). Inferential and descriptive analyses were carried out and favorable improvements were found in the indicators of physical condition (TUG and 1min STST), Barthel Index and FRAIL. In conclusion, while most of the indicators had favorable results, it is required to further explore more sensitive assessment tools and targeted interventions that are tailored to people's needs.

Evolución del crecimiento de una cohorte de recién nacidos de la maternidad del Hospital Dr. Manuel Quintela con bajo peso al nacer hasta los 12 meses de edad corregida / Evolution of the growth rate of a newborn cohort with low weight at birth of up to 12 months of age of the Dr. Manuel Quintela Maternity Hospital / Evolução do crescimento de uma coorte de recém-nascidos com baixo peso ao nascer de até 12 meses de idade da Maternidade Dr. Manuel Quintela

Introducción: en Uruguay, la proporción de nacimientos con bajo peso al nacer (BPN) se mantiene cercana al 8%. En este grupo resulta un desafío conseguir un adecuado crecimiento y desarrollo enfocado a prevenir enfermedades a mediano y largo plazo. Objetivo: analizar la velocidad de crecimiento y los aspectos nutricionales de una cohorte de recién nacidos (RN) con BPN desde su egreso hospitalario y hasta los 12 meses de edad corregida (EC). Metodología: estudio descriptivo, prospectivo, de los RN con BPN de la unidad neonatal de la Maternidad del Hospital de Clínicas Dr. Manuel Quintela, entre el 1 de enero y el 31 de diciembre de 2015. Se excluyeron los portadores de malformaciones congénitas y patología quirúrgica al nacer. Se evaluó peso, longitud y perímetro craneano al egreso, y a los 5, 9 y 12 meses de EC. La velocidad del crecimiento fue analizada mediante z-score y Δz-score ajustado a EC en curvas de la OMS. Se estimó aporte nutricional en cada control y se exploraron asociaciones entre cambios en la curva de crecimiento y el grado de adecuación de la ingesta calórica estimada. Resultados: ingresaron al estudio 31 recién nacidos: con peso al nacer <1.500 g hubo 7 neonatos y ≥1.500 g 24. Edad gestacional (EG) media 32,5 semanas (rango 25-39), un término y 30 prematuros: extremos 2, muy prematuros 9, y moderados 19. En relación al peso al nacer para la EG 21 fueron adecuados (AEG), 7 pequeños (PEG) y 3 grandes (GEG). Completaron los tres controles programados 26 niños. En el primer control mantuvieron el carril de crecimiento 15 niños, descendieron 8 y aceleraron 8; en el segundo mantuvieron 9, desaceleraron 8 y aceleraron 12; y en el tercero mantuvieron 9, desaceleraron 7 y aceleraron 10. El número de niños que al final del seguimiento mantenían el mismo carril de crecimiento que al nacer, descendió a expensas de un aumento de aquellos que aceleraron el crecimiento. Al llegar al tercer control se encontró que sólo 9 niños mantuvieron el carril de crecimiento al nacer y el resto (17) cambiaron de carril, lo cual resultó en una diferencia significativa. En los 10 pacientes que aceleraron su crecimiento durante el primer año de vida, no se encontraron asociaciones entre la velocidad de crecimiento y las características energéticas de la alimentación complementaria que recibían. Conclusiones: se observaron problemas en el crecimiento de los niños con BPN durante el primer año de vida. Una proporción significativa presentaron crecimiento acelerado lo cual es un factor de riesgo para obesidad y enfermedades crónicas no transmisibles. Es necesario profundizar en las causas de estas alteraciones, en especial relacionadas con las prácticas de alimentación, para desarrollar estrategias que contribuyan a la prevención.

Introduction: in Uruguay, the proportion of low weight births (LBW) remains close to 8%. It is a challenge to achieve adequate growth and development focused on preventing diseases in the medium and long term for the case of this group. Objective: analyze the growth rate and nutritional aspects of a cohort of newborns (NB) with LBW since they were discharged from the hospital and until 12 months of corrected age (CA). Methodology: descriptive, prospective study of NBs with LBW of the neonatal ward of the Manuel Quintela Maternity Hospital, between January 1 and December 31, 2015. We excluded carriers of congenital malformations and surgical pathology at birth and assessed weight, length and cranial perimeter at discharge, and at 5, 9 and 12 months of CA. The growth rate was analyzed using z-score and Δz-score adjusted to CA in WHO curves. Nutritional contribution was estimated in each check-up and associations were explored between changes in the growth curve and the degree of adequacy of the estimated caloric intake. Results: 31 newborns participated in the test: 7 newborns had a birth weight of <1.500 g and ≥1.500 g: 24. Mean Gestational Age (GA) 32.5 weeks (range 25-39), one term and 30 preterm newborns: extreme 2, very premature 9, and moderate 19. Regarding birth weight according to gestational age, 21 were appropiate for gestational age (AGA), 7 small for gestational age (SGA) and 3 large for gestational age (LGA). The 26 children completed the 3 scheduled check-ups. In the 1st check-up, 15 children had been able to maintain the growth trend, in 8 of them it had decreased and in 8 it had accelerated; in the 2nd check-up 9 of them maintained their growth rate, 9 decreased it and 12 of the newborns increased it; and in the 3rd check-up, the trend remained steady for 9 of them , it decreased for 7 of them and it increased for 10 of them. The number of children who at the end of the follow-up maintained the same growth trend they had at birth decreased, despite the increase in the growth trend of those with a more accelerated growth. At the time of the 3rd check-up it was found that only 9 children maintained the growth trend they had at birth and the rest, (17), changed trends, which resulted in a significant gap. We did not find links life between the growth rate and the energy characteristics of the supplementary food they received in the 10 patients who had increased their growth rate in their first year of life. Conclusions: we observed problems regarding the growth rate of children with LBW during the first year of life. A significant proportion showed accelerated growth, which is a risk factor for obesity and chronic non-communicable diseases. It is necessary to research the causes of these alterations, especially regarding their feeding practices in order to develop strategies for their prevention.

Introdução: no Uruguai, a proporção de recém-nascidos com baixo peso ao nascer (LBW) permanece próxima de 8%. É um desafio alcançar um crescimento e desenvolvimento adequados focados na prevenção de doenças a médio e longo prazo nesse grupo de crianças. Objetivo: analisar a taxa de crescimento e aspectos nutricionais de uma coorte de recém-nascidos (RN) com LBW no momento da alta hospitalar e até 12 meses de idade corrigida (EC). Metodologia: estudo prospectivo de RNs com LBW da unidade neonatal da Maternidade do Hospital Dr. Manuel Quintela, entre 1º de janeiro e 31 de dezembro de 2015. Foram excluídos portadores de malformações congênitas e patologia cirúrgica ao nascer. Peso, comprimento e perímetro craniano foram avaliados no momento da alta hospitalar e aos 5, 9 e 12 meses de EC. A velocidade de crescimento foi analisada utilizando-se pontuação z e pontuação Δz ajustada ao EC das curvas da OMS. A contribuição nutricional foi estimada em cada controle e as associações entre mudanças na curva de crescimento e o grau de adequação da ingestão calórica estimada foram exploradas. Resultados: 31 recém-nascidos entraram no estudo: com peso ao nascer <1500 g havia 7 recém-nascidos e ≥1500 g: 24. Idade Gestacional Média (EG) 32,5 semanas (faixa 25-39), um termo e 30 prematuros: extremos 2, muito prematuros 9 e moderados 19. Em relação ao peso ao nascer para EG, 21 foram adequados (AEG), 7 pequenos (PEG) e 3 grandes (GEG). As 26 crianças completaram os 3 controles programados. No 1º controle, 15 crianças mantiveram a faixa de crescimento, 8 desceram e 8 aceleraram; no 2º mantiveram 9, desaceleraram 8 e aceleraram 12; e no 3º mantiveram 9, desaceleraram 7 e aceleraram 10. O número de crianças que, ao final do seguimento, manteve a mesma faixa de crescimento do que ao nascer diminuiu mesmo que houve um aumento daqueles que aceleraram o crescimento. No 3º controle foi constatado que apenas 9 crianças mantiveram a faixa de crescimento que tinham ao nascer e o resto (17) mudou de faixa, resultando numa diferença significativa. Nos 10 pacientes que aceleraram seu crescimento durante o primeiro ano de vida, não foram encontradas associações entre a velocidade de crescimento e as características energéticas da alimentação complementar que receberam. Conclusões: foram observados problemas no crescimento de crianças com LBW durante o primeiro ano de vida. Uma proporção significativa delas mostrou crescimento acelerado, que é um fator de risco para obesidade e doenças crônicas não transmissíveis. É necessário aprofundar nas causas dessas alterações, especialmente aquelas relacionadas às práticas alimentares para poder desenvolver estratégias que contribuam para a prevenção.

Text Messages to Promote Secondary Prevention after Acute Coronary Syndrome (IMPACS trial)

Abstract Background Short message service (SMS) to promote healthcare improves the control of cardiovascular risk factors, but there is a lack of evidence in low and middle-income countries, particularly after acute coronary syndromes (ACS). Objective This study aims to evaluate whether the use of SMS increases risk factor control after hospital discharge for ACS. Methods IMPACS is a 2-arm randomized trial with 180 patients hospitalized due to ACS at a tertiary hospital in Brazil. Eligible patients were randomized (1:1) to an SMS intervention (G1) or standard care (G2) upon hospital discharge. The primary endpoint was set to achieve 4 or 5 points in a risk factor control score, consisting of a cluster of 5 modifiable risk factors: LDL-C <70mg/dL, blood pressure (BP) <140/90mmHg, regular exercise (≥5 days/week, 30 minutes/session), nonsmoker status, and body mass index (BMI) <25 kg/m2] at 6 months. Secondary outcomes were components of the primary outcome plus rehospitalization, cardiovascular death, and death from any cause. Results are designated as significant if p<0.05. Results From randomized patients, 147 were included in the final analysis. Mean age was 58 (51-64) years, 74% males. The primary outcome was achieved by 12 (16.2%) patients in G1 and 15 (20.8%) in G2 (OR=0.73, 95%CI 0.32-1.70, p=0.47). Secondary outcomes were also similar: LDL-C<70 mg/dl (p=0.33), BP<140/90 mmHg (p=0.32), non-smoker (p=0.74), regular exercise (p=0.97), BMI (p=0.71), and rehospitalization (p=0.06). Death from any cause occurred in three participants (2%), including one cardiovascular death in each group. Conclusion SMS intervention did not significantly improve cardiovascular risk factor control when compared to standard care in patients discharged after ACS in Brazil.

Validation of the Grace Risk Score to Predict In-Hospital and 6-Month Post-Discharge Mortality in Patients with Acute Coronary Syndrome

Abstract Background The wide range of clinical presentations of acute coronary syndrome (ACS) makes it indispensible to use tools for risk stratification and for appropriate risks management; thus, the use of prognosis scores is recommended in the immediat clinical decision-making. Objective To validate the Global Registry of Acute Coronary Events (GRACE) score as a predictor of in-hospital and 6-month post-discharge mortality in a population diagnosed with ACS. Methods This is a prospective cohort study of consecutive patients diagnosed with ACS between May and December 2018. GRACE scores were calculated, as well as their predictive value for in-hospital and 6-month post-discharge mortality. The validity of the model was assessed by two techniques: discriminative power using the area under the receiver operating characteristic curve (AUC) and goodness-of-fit, using the Hosmer-Lemeshow (HL) test, at the 5% level of significance. Results A total of 160 patients were included, mean age 64 (±10.9) years; of which 60% were men. The risk model showed to have satisfactory ability to predict both in-hospital mortality, with an area under the curve (AUC) of 0.76 (95% confidence interval [CI], 0.57-0.95; p = 0.014), and 6-month post-discharge mortality, with AUC of 0.78 (95%CI, 0.62-0.94), p = 0.002. The HL test indicated good-fit for both models of the GRACE score. Conclusion In this study, the GRACE risk score for predicting mortality was appropriately validated in patients with ACS, with good discriminative power and goodness-of-fit. The results suggest that the GRACE score is appropriate for clinical use in our setting.

Guía para el seguimiento de pacientes pediátricos con enfermedad hepática crónica / Guidelines for the follow-up of pediatric patients with chronic liver disease

La historia natural de la enfermedad hepática crónica (EHC) se caracteriza por una fase de cirrosis compensada asintomática seguida de una fase descompensada, que se acompaña de signos clínicos evidentes, de los cuales los más frecuentes son la ascitis, las hemorragias, la encefalopatía y la ictericia. Esta guía actualizada sobre el manejo de pacientes con EHC en la edad pediátrica fue confeccionada con el propósito de mejorar la práctica clínica de estos pacientes complejos y darle herramientas al pediatra de cabecera para un seguimiento adecuado. Para ello, un grupo de expertos subrayó la importancia del inicio temprano del tratamiento etiológico en cualquier grado de enfermedad hepática y ampliaron su labor jerarquizando las complicaciones de la cirrosis: ascitis, hemorragia digestiva, infecciones, malnutrición; aspectos endocrinológicos, neurológicos, oftalmológicos y gastrointestinales; y complicaciones vasculares pulmonares y renales. Se incluyeron, además, aspectos psicosociales, así como el cuidado del adolescente en su transición a la vida adulta.

The natural history of chronic liver disease (CLD) is characterized by a phase of asymptomatic compensated cirrhosis followed by a decompensated phase, accompanied by the development of evident clinical signs, the most frequent being ascites, hemorrhages, encephalopathy and jaundice. This updated guideline on the management of pediatric patients with CLD was developed with the purpose of improving the clinical practice of these complex patients and to provide the pediatrician with tools for an adequate follow-up. To this end, a group of experts, after stressing the importance of early initiation of etiologic treatment in any degree of liver disease, expanded their work to include a hierarchy of complications of cirrhosis: ascites, gastrointestinal bleeding, infections, malnutrition, endocrinological, neurological, ophthalmological, gastrointestinal, pulmonary vascular and renal complications. Psychosocial aspects including the care of the adolescent in their transition to adult life were also included.