Pilot study using the ECHO model to enhance linkage to care for patients with hepatitis C in the custodial setting.

Prisoners in most countries have a higher prevalence of HCV than the general population, but their access to treatment is very limited. Our aim was to evaluate a pilot programme using the ECHO model to enhance linkage to care in patients with HCV in 3 Argentinean prisons between October 2018 and January 2020. All inmates were invited to participate, and data were collected through a personal interview. We then estimated HCV prevalence with dried blood spot and performed a logistic regression analysis to identify risk behaviours associated with HCV infection. Finally, HCV management was assessed and monitored through ECHO. Overall, 1141 inmates agreed to participate, representing 39.7% of the total prison population. Anti-HCV prevalence was estimated at 1.58% (CI 0.93; 2.48), being significantly higher in women 2.98% (CI 1.4;5.6) than in men 1.07% (CI 0.5; 2.0); P = .03. Patients with anti-HCV were significantly older than those who tested negative, 42.3 years (CI 37.6;47.1) vs 30.1 years (CI 30.6;31.2), P < .001, respectively. Multiple logistic regression analysis, identified age OR 1.07 (CI 1.03;1.12, P = .001), history of sexually transmitted disease OR 3.08 (CI 0.97;9.82, P = .057) and intravenous drug use OR 12.6 (CI 3.31;48.53, P < .001) as risk factors associated with anti-HCV. Treatment was initiated in all the patients with specialist physician support utilizing ECHO model. In conclusion, our pilot study reported a low prevalence of anti-HCV in the studied population. Incarceration provides an ideal opportunity for testing and treating HCV. ECHO model arises as a useful tool to support assessment and treatment for inmates with chronic HCV.

Ratio of Circulating Estrogen Receptors Beta and Alpha (ERß/ERα) Indicates Endoscopic Activity in Patients with Crohn's Disease.

BACKGROUND: Data supporting a role of female hormones and/or their receptors in inflammatory bowel disease (IBD) are increasing, but most of them are derived from animal models. Estrogen receptors alpha (ERα) and beta (ERß) participate in immune and inflammatory response, among a variety of biological processes. Their effects are antagonistic, and the net action of estrogens may depend on their relative proportions. AIM: To determine the possible association between the balance of circulating ERß and ERα (ERß/ERα) and IBD risk and activity. METHODS: Serum samples from 145 patients with IBD (79 Crohn's disease [CD] and 66 ulcerative colitis [UC]) and 39 controls were retrospectively studied. Circulating ERα and ERß were measured by ELISA. Disease activities were assessed by clinical and endoscopic indices specific for CD and UC. RESULTS: Low values of ERß/ERα ratio were directly associated with clinical (p = 0.019) and endoscopic (p = 0.002) disease activity. Further analyses by type of IBD confirmed a strong association between low ERß/ERα ratio and CD clinical (p = 0.011) and endoscopic activity (p = 0.002). The receiver operating curve (ROC) analysis showed that an ERß/ERα ratio under 0.85 was a good marker of CD endoscopic activity (area under the curve [AUC]: 0.84; p = 0.002; sensitivity: 70%; specificity: 91%). ERß/ERα ratio was not useful to predict UC activity. CONCLUSIONS: An ERß/ERα ratio under 0.85 indicated CD endoscopic activity. The determination of serum ERß/ERα might be a useful noninvasive screening tool for CD endoscopic activity.

Downhill varices: an uncommon cause of upper gastrointestinal bleeding.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. CASE REPORT: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. DISCUSSION: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.

Positive Resection Margins Detected by Standardized Study of a Pancreaticoduodenectomy Sample: Is There Any Real Impact on Long-term Survival? / Margen de resección positivo tras la aplicación de un examen estandarizado de la muestra de duodenopancreatectomía cefálica: ¿tiene un impacto real en la supervivencia a largo plazo?

INTRODUCTION: The pathological evaluation of pancreaticoduodenectomy (PD) samples and the impact of R1 resections on survival has recently been questioned. This study evaluates the introduction of a standardized pathology study protocol (PSP) and the prognosis of R1 resections after long-term follow-up. METHODS: We reviewed data from a prospectively maintained database regarding 109 periampullary tumors treated by PD from 2005 to 2013. The results of the introduction of a PSP were analysed, and the recurrence rate (RR), disease-free survival (DFS) and overall survival (OS) of the R1 resections were evaluated for each positive margin. RESULTS: The PD specimens of periampullary tumors analyzed by PSP showed a higher rate of isolated lymph nodes (17 vs. 8; P=.003), N+ (60% vs. 31%; P<.001), microvascular invasion (67% vs. 34%; P=.001) and R1 resections (42% vs. 18%; P=.010). Pancreatic adenocarcinomas with R1 resection in the PSP group were compared with R0, presenting higher percentages of vascular resections (P=.033), N+ (P=.029), lymphatic and perineural invasion (P=.047; P=.029), higher RR (P=.026), lower DFS (P=.016) and lower OS (P=.025). Invasion of the medial margin correlated with a worse prognosis. CONCLUSIONS: Our series shows an increase in R1 resection after the introduction of a PSP. Infiltration of the medial margin seems to be associated with a higher RR and a decrease in DFS and OS.

Epidemiology of Pediatric Zika Virus Infections.

BACKGROUND AND OBJECTIVE: In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases. METHODS: All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens. RESULTS: Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1-17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms. CONCLUSIONS: This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.

Enfrentamiento a la COVID-19 por los estudiantes de Ciencias Médicas en Mayabeque / Facing to COVID-19 by the students from Medical Sciences in Mayabeque

Introducción: La vigilancia epidemiológica activa es esencial para la prevención, control y detección de situaciones epidémicas. Objetivo: Caracterizar el enfrentamiento realizado a la COVID-19, por los estudiantes de Ciencias Médicas, en Mayabeque. Métodos: Se realizó un estudio descriptivo observacional prospectivo, de la pesquisa como enfrentamiento a la COVID-19 por estudiantes de Ciencias Médicas, en los once municipios de la provincia Mayabeque, desde el 23 de marzo al 23 de mayo del 2020. El universo estuvo constituido por 1 015 estudiantes de primero a quinto año, se utilizó un muestreo no probabilístico intencional por criterios de selección quedando constituida por 978. Las variables fueron: el número de educandos por carreras, promedio del total que notificaron de manera diaria el universo de viviendas y las visitadas, personas pesquisadas y total de estas con síntomas respiratorios por municipios. Resultados: El 97.5 por ciento de los estudiantes activos en la pesquisa eran de la carrera de Medicina, más del 99 por ciento de las viviendas planificadas fueron pesquisadas, en la mayoría de los municipios, en Güines y Melena del Sur se gestionaron el 59.9 por ciento y 46.1 por ciento de la población de forma respectiva, los sintomáticos respiratorios más frecuentes se detectaron en los municipios de San José de las Lajas 4.7 por ciento y San Nicolás, 4.2 por ciento. Conclusiones: La mayoría de la población de Mayabeque fue pesquisada por los estudiantes de Ciencias Médicas de la provincia. La pesquisa activa como estrategia de enfrentamiento contribuye al control de la pandemia COVID-19. Palabras clave: trabajo comunitario, pesquisa, sintomático respiratorio Descriptores servicios de salud comunitaria; agentes comunitarios de salud; infecciones del sistema respiratorio/ virología(AU)

Introduction: The active epidemiological watching is essential for the prevention, control and detection of epidemical situations. Objective: To characterize the facing to COVID-19 by the students from Medical Sciences in Mayabeque. Methods: A descriptive observational prospective study was carried out, of the inquest as the facing to COVID-19 by the students from Medical Sciences in Mayabeque, in the eleven municipalities in Mayabeque province, from March 23, to May 23, 2020. The universe was formed by 1 015 students from first to fifth year, an intentional non probabilistic sampling by selection criteria, was used formed by 978. The variables were: the number of students by careers, average of the total of those who reported the universe of housing and the visited ones, inquired people and the total of them with respiratory symptoms by municipality. Results: The 97.5 per cent of the active students in the inquest belonged to the Medicine career, more than 99 per cent of the planned housing were inquired in most of the municipalities, in Güines and Melena del Sur the 59.9 per cent and 46.1 of the population was managed in a prospective way, and the most frequent of the respiratory symptomatic patients were detected in San José de las Lajas for a 4.7 per cent and San Nicolás, 4.2 per cent. Conclusions: Most of the population in Mayabeque was inquired by the students of Medical Sciences in the province. The enquiry as a facing strategy contributes to the l control of COVID-19 pandemics. Key words: community work, inquest, respiratory symptomatic Descriptor: community health services; community health workers; respiratory tract infections/ virology (AU)

Intento suicida en edad pediátrica, un problema de salud actual / Suicide attempt pediatric age, a current health problem IDra. Mariuska González Borges

Introducción: La conducta suicida es un hecho de causas multifactoriales y un serio problema de salud pública en aumento importante a nivel mundial.Objetivo: Describir las características clínico- epidemiológicas en los niños y adolescentes ingresados por intento suicida.Métodos: Se realizó un estudio descriptivo transversal en los niños y adolescentes ingresados por intento suicida en el Hospital Materno infantil Piti Fajardo del municipio de Güines, provincia Mayabeque, desde enero del año 2018 a diciembre del 2019, para describir las variables: edad y sexo, factores predisponentes, conflictos precipitantes de la conducta suicida, método empleado, letalidad, seriedad y gravedad de las circunstancias según valoración psicológica.Resultados: El 50.9 porciento de los niños ingresados por intento suicida eran del grupo de 13 a 15 años, y el 85.1 porciento del sexo femenino, la depresión y los conflictos familiares fueron los factores de riesgo más frecuente (39.5 porciento y 50.9 porciento respectivamente). El 71.6 porciento empleó la ingestión de psicofármacos, 54.4 porciento con riesgo no letal, el 45.6 porciento con poca seriedad en la intención y gravedad nula el 47.4 porciento.Conclusiones: El intento suicida es predominante en el grupo de 13 a 15 años, del sexo femenino; la depresión es el factor de riesgo más frecuente y los conflictos familiares. El método que más se emplea es la ingestión de psicofármacos, con riesgo no letal, poca seriedad en la intención y gravedad nula(AU)

Introduction: Suicide behavior is a fact with multifactorial causes and an important increasing serious public health problem worldwide.Objective: To describe the clinical and epidemiologic characteristics in children and adolescents admitted because of suicide attempt.Methods: A descriptive cross sectional study was carried out in children and adolescents admitted because of suicide attempt at Piti Fajardo Maternity-Infant Hospital in Güines,Mayabeque province, from January, 2018 to December, 2019, to describe the variables: age and sex, predisposing factors, precipitating conflicts of the suicide behavior, the usedmethod, lethality, seriousness and danger of the circumstances according to psychologicalvaluation.Results: The 50.9 per cent of the children admitted because of suicide attempt were from the 13 to 15 age group, and the 85.1 per cent of the female sex, depression and family conflicts were the most frequent risk factors (39.5 per cent y 50.9 per cent respectively). The 71.6 per cent used ingestion of psychodrugs, 54.4 per cent with no lethal risk, the 45.6 per cent with little seriousness in the intention and with no critical conditions the 47.4 per cent.Conclusions: Suicide attempt prevails the 13 to 15 age group, the female sex; depression and family conflicts were the most frequent risk factors. The most used method is the ingestion of psycho-drugs, with no lethal risk, little seriousness in the intention and with no critical conditions(AU)

Margen de resección positivo tras la aplicación de un examen estandarizado de la muestra de duodenopancreatectomía cefálica: ¿tiene un impacto real en la supervivencia a largo plazo? / Positive Resection Margins Detected by Standardized Study of a Pancreaticoduodenectomy Sample: Is There Any Real Impact on Long-term Survival?

INTRODUCCIÓN: La evaluación patológica de las muestras de duodenopancreatectomía cefálica (DPC) y el impacto de las resecciones R1 sobre la supervivencia ha sido recientemente cuestionado. Este estudio evalúa la introducción de un protocolo de estudio anatomopatológico estandarizado (PE) y el pronóstico de las resecciones R1 después de un seguimiento a largo plazo. MÉTODOS: Se revisaron 109 tumores periampulares sometidos a DPC desde 2005 hasta 2013 a partir de una base de datos mantenida prospectivamente. Se analizaron los resultados de la introducción de un PE y se evaluaron la tasa de recurrencia (TR), la supervivencia libre de enfermedad (SLE) y la supervivencia global (SG) de la resección R1 para cada margen positivo. RESULTADOS: Las piezas de DPC de tumores periampulares analizadas mediante un PE mostraron una mayor tasa de ganglios linfáticos aislados (17 vs. 8; p = 0,003), N+ (60% vs. 31%; p < 0,001), invasión microvascular (67% vs. 34%; p = 0,001) y resecciones R1 (42% vs. 18%; p = 0,010). Se compararon los adenocarcinomas pancreáticos con resección R1 en el grupo PE con los R0, presentando mayores porcentajes de resecciones vasculares (p = 0,033), N+ (p = 0,029), invasión linfática y perineural (p = 0,047; p = 0,029), una mayor TR (p = 0,026), menor SLE (p = 0,016) y menor SG (p = 0,025). La infiltración del margen medial se relacionó con un peor pronóstico. CONCLUSIONES: Nuestra serie muestra un aumento en la resección R1 después de la introducción de un PE. La infiltración del margen medial parece asociarse con una mayor TR y una disminución de la SLE y SG

INTRODUCTION: The pathological evaluation of pancreaticoduodenectomy (PD) samples and the impact of R1 resections on survival has recently been questioned. This study evaluates the introduction of a standardized pathology study protocol (PSP) and the prognosis of R1 resections after long-term follow-up. METHODS: We reviewed data from a prospectively maintained database regarding 109 periampullary tumors treated by PD from 2005 to 2013. The results of the introduction of a PSP were analysed, and the recurrence rate (RR), disease-free survival (DFS) and overall survival (OS) of the R1 resections were evaluated for each positive margin. RESULTS: The PD specimens of periampullary tumors analyzed by PSP showed a higher rate of isolated lymph nodes (17 vs. 8; P = .003), N+ (60% vs. 31%; P < .001), microvascular invasion (67% vs. 34%; P = .001) and R1 resections (42% vs. 18%; P = .010). Pancreatic adenocarcinomas with R1 resection in the PSP group were compared with R0, presenting higher percentages of vascular resections (P = .033), N+ (P = .029), lymphatic and perineural invasion (P = .047; P = .029), higher RR (P = .026), lower DFS (P = .016) and lower OS (P = .025). Invasion of the medial margin correlated with a worse prognosis. CONCLUSIONS: Our series shows an increase in R1 resection after the introduction of a PSP. Infiltration of the medial margin seems to be associated with a higher RR and a decrease in DFS and OS

Lack of RAAS inhibition by high-salt intake is associated with arterial stiffness in hypertensive patients.

HYPOTHESIS/INTRODUCTION: The relationship between salt intake, blood pressure and RAAS activation is still controversial, being that both high- and low-salt intakes are associated with cardiovascular events in a J-shaped curve pattern. We hypothesized that different patterns of RAAS response to dietary salt intake among hypertensives could be identified, while vascular damage would be related to high-salt intake plus absence of expected RAAS inhibition. OBJECTIVE: We aim to assess the relationship between sodium intake, RAAS and vascular stiffness in hypertension. MATERIALS AND METHODS: We screened 681 hypertensive patients for urinary/plasma electrolytes, renin, aldosterone and pulse wave velocity (PWV) under their usual salt intake level. RESULTS: After applying exclusion criteria, an inverse relation between urinary sodium and RAAS was observed in the 300 remaining subjects. Additionally, four types of response were identified: 1) Low (L) sodium (S)-Low RAAS, 2) LS-High (H) SRAAS, 3) HS-Low RAAS, 4) HS-High RAAS. We found no differences in age/BP among groups, but type 4 response individuals included more females and a higher pulse wave velocity. CONCLUSIONS: We showed a) an inverse salt-RAAS relation, b) an association between HS plus high RAAS with increased PWV that could identify a higher-risk hypertensive condition.

Evaluación de dos años de diagnóstico de la neumonía adquirida en la comunidad en pacientes de edad pediátrica / Assessment of two years in the diagnosis of community-acquired pneumonia in pediatric patients

Fundamento: el diagnóstico de la neumonía adquirida en la comunidad es un problema no resuelto. Por dificultades en la interpretación de los Rayos X de tórax y sin manifestaciones clínicas en los pacientes, en muchas ocasiones se indica tratamiento antimicrobiano.Objetivo: evaluar la calidad del diagnóstico de los niños ingresados por neumonías en el servicio de enfermedades respiratorias del Hospital General Docente Aleida Fernández Chardiet, del municipio de Güines, provincia de Mayabeque.Métodos: se realizó un estudio descriptivo prospectivo longitudinal en los referidos pacientes en edad pediátrica, ingresados en el hospital antes declarado, desde enero 2014 a diciembre de 2015. El universo de estudio fue el total de los pacientes ingresados con este diagnóstico, 703.Resultados: el 73,5 por ciento de los niños fueron del sexo masculino y el 49,1 por ciento menores de un año. Al ingreso, el 59,7 por ciento presentó radiografía de tórax normal y el 56,9 por ciento no tenía signos clínicos. El engrosamiento hiliar (35 por ciento) y la técnica deficiente (29,5 por ciento) fueron las características radiológicas más frecuentes. Se retiró el tratamiento antibiótico al 62,8 por ciento de los pacientes con Rx normal y sin signos clínicos de neumonía, de éstos el 96,4 por cientoevolucionó satisfactoriamente.Conclusiones: la neumonía predominó en el menor de un año, masculino, más de la mitad con radiografía de tórax normal al ingreso y sin signos clínicos, indicativos de un diagnóstico inadecuado. Los pacientes que se les retiró tratamiento antibiótico evolucionaron satisfactoriamente(AU)

Background: the diagnosis of community-acquired pneumonia is an unresolved problem. Due to difficulties in the interpretation of chest X-rays and the lack of clinical manifestations in the patients, antimicrobial treatment is often indicated.Objective: to assess the quality of the diagnosis of children suffering from pneumonia admitted to the respiratory disease service of the AleidaFernándezChardiet General Teaching Hospital, of the municipality of Güines, province of Mayabeque.Methods: a longitudinal, prospective and descriptive study was carried out with the aforementioned pediatric patients admitted to the previously declared hospital from January 2014 to December 2015. The study universe was the total number of patients admitted with this diagnosis, 703.Results: 73,5 percent of the children were male and 49,1 percent were under one year of age. Upon admission, 59,7 percent presented normal chest X-ray and 56,9 percent had no clinical signs. Hilar thickening (35 percent) and a poor technique (29,5 percent) were the most frequent radiological features. The antibiotic treatment was suspended in 62,8 percent of the patients with normal X-ray and without clinical signs of pneumonia, out of which 96,4 percent progressed satisfactorily.Conclusions: pneumonia predominated in male children younger than one year of age; more than half of the patients had normal chest x-ray upon admission and without clinical signs, indicative of an inadequate diagnosis. Patients whose antibiotic treatment was suspended progressed satisfactorily(AU)

Caracterización de pacientes en edad pediátrica con celulitis, atendidos en la provincia de Mayabeque / Characterization of pediatric patients with cellulitis attended to in the province of Mayabeque

Fundamento: en los últimos tiempos se ha observado, a nivel mundial, un aumento en la prevalencia de Staphylococcus aureus meticilino-resistente en infecciones de piel y partes blandas, en pacientes ambulatorios, siendo la celulitis una de sus formas clínicas de presentación.Objetivo: caracterizar aspectos epidemiológicos y clínicos de los pacientes pediátricos ingresados con el diagnóstico de celulitis en el servicio de pediatría del Hospital General Docente Aleida Fernández Chardiet del municipio Güines, provincia Mayabeque, desde enero de 2014 a diciembre de 2015.Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en el referido lugar y período de tiempo. La población de estudio estuvo constituida por el total de pacientes ingresados en el servicio de pediatría, con el diagnóstico de celulitis. Se caracterizaron según grupo de edad, sexo, factor causal, procedencia, sitio anatómico, estadía, terapéutica, cultivo de secreciones y germen.Resultados: el 56,2 por ciento de los niños fueron masculinos y el 41,6 por ciento en edad de 5 a 9 años. El 36,2 por ciento con factor causal lasa piodermitis, con localización en la cabeza (52,4 por ciento). El 57,5 por ciento del tratamiento fue con cefazolina, con estadía entre uno a cuatro días para el 94,1 por ciento de los casos y procedentes de área rural (51,8 por ciento). Se obtuvo crecimiento bacteriano en el 81 por ciento.Conclusiones: se caracterizaron los niños con celulitis objeto de esta investigación. El agente causal más aislado fue el estafilococo, con buena respuesta a la cefazolina (AU)

Background: nowadays, an increase in the prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections has been observed in outpatients, with cellulitis being one of its clinical forms of presentation.Objective: to characterize epidemiological and clinical aspects of pediatric patients admitted with the diagnosis of cellulitis to the pediatric service of Aleida Fernández Chardiet General Teaching Hospital of the municipality of Güines, Mayabeque province, from January 2014 to December 2015.Methods: a descriptive, prospective and longitudinal study was carried out in the place and during the period of time herein mentioned. The study population consisted of the total number of patients admitted to the pediatric service with the diagnosis of cellulitis. They were characterized according to a ge group, sex, causal factor, origin, anatomical site, stay, therapeutics, culture of secretions and germ. causal factor was pyoderma, having its location in the head (52,4 percent). 57,5 percent of the treatment was with cefazolin, with a stay between one and four days for 94,1 percent of the cases and coming from a rural area (51,8 percent). Bacterial growth was obtained in 81 percent.Conclusions: children with cellulitis who were the subject of this research were characterized. The most isolated causal agent was staphylococcus, with a good response to cefazolin (AU)

Celulitis por cuerpo extraño / Cellulitis caused by foreign body

Las infecciones de la piel y el tejido celular subcutáneo surgen como un grupo importante de afecciones con una alta morbilidad en edades pediátricas, generalmente relacionada con traumatismo y cuerpos extraños. Se presenta el caso de una escolar femenina de seis años de edad, con síntomas y signos clínicos que sugieren celulitis en el muslo derecho; por su evolución tórpida se le realizó el estudio ultrasonográfico que confirmó el diagnóstico etiológico de una celulitis secundaria a un traumatismo, provocada por la introducción de un gran cuerpo extraño, que pasó inadvertido para la familia de la menor (AU)

Infections of the skin and subcutaneous tissue emerge as an important group of conditions with high morbidity in pediatric ages, often related to trauma and foreign bodies. This is a case of a 6-year-old school girl with clinical signs and symptoms suggestive of cellulitis in her right thigh; because of its torpid evolution, an ultrasonographic study was indicated, which confirmed the etiologic diagnosis of a cellulitis secondary to trauma, caused by the introduction of a large foreign body, which went unnoticed for the childs family (AU)

Metahemoglobinemia adquirida inducida por fármacos antipalúdicos / Acquired methemoglobinemia induced by antymalaric drugs

Clásicamente se describe cianosis como niveles de hemoglobina desoxigenada en sangre periférica por encima de 5g/dl; sin embargo se ha dejado a un lado, que dicha expresión clínica no sólo responde a esta condición, sino también a la acumulación distal de pigmentos anómalos producto de la alteración en la morfología habitual de la molécula de hemglobina o el estado químico de ésta. Por tal motivo, se presenta un interesante caso clínico en paciente masculino de 35 años de edad, quien consulta por cuadro febril agudo y diagnóstico de Paludismo por Plasmodium vivax, iniciando tratamiento antipalúdico. Posteriormente presenta, en ausencia de fiebre, cianosis peribucal y acral acompañada de disminución de la saturación a 83% por oximetría de pulso. El diagnóstico se basó en la evidencia clínica y la oximetría de pulso, el manejo terapéutico consistió en la administración de oxígeno húmedo y bolos de azul de metileno, notando franca mejoría clínica(AU)

Methemoglobinemia has traditionally been described in multiple studies. Cyanosis, and deoxygenated hemoglobin levels in peripheral blood above 5g / dL, not only responds to this condition, but also to the distal accumulation of anomalous pigments as products of an alteration in the normal morphology of the haemoglobin molecule or chemical state of this. An interesting case report is presented in a male, who after the diagnosis of Plasmodium Vivax Malaria and malaria treatment presenteded perioral the and distal cyanosis, as well as desaturation of 83% by oximetry. The diagnosis was based on clinical evidence and pulse oximetry, and therapeutic approach was based on the administration of wet oxygen and methylene blue bowling, showing marked clinical improvement(AU)

'Downhill varices': una causa poco frecuente de hemorragia digestiva alta / Downhill varices: an uncommon cause of upper gastrointestinal bleeding

Introducción: la hemorragia digestiva alta (HDA) es una entidad común en gastroenterología, pero las ‘Downhill varices’ (DHV) son una causa infrecuente de HDA, con diferente etiología de las varices esofágicas de tercio inferior y con diferentes implicaciones terapéuticas. Caso clínico: varón de 28 años de edad, con antecedentes de insuficiencia renal crónica sometido a hemodiálisis y síndrome de vena cava superior(SVCS) debido a múltiples sustituciones catéter, acude a urgencias por hematemesis secundaria a ruptura de una variz en tercio proximal de esófago, que inicialmente se trata con etanolamina. El estudio diagnóstico posterior demostró la circulación colateral secundaria al SVCS. No se pudo realizar terapia endoscópica o endovascular y el paciente finalmente se someterá a un bypass quirúrgico. Discusión: las DHV son una entidad infrecuente y la ligadura endoscópica con bandas se erige como el abordaje terapéutico apropiado para el evento hemorrágico. La terapia definitiva sigue siendo la de la causa del SVCS (AU)

Background: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but ‘Downhill Varices’ (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. Case report: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. Discussion: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS (AU)

Incidencia de factores de riesgo asociados a la anemia ferropénica en niños menores de cinco años / Incidence of risk factors associated to iron deficiency anemia in children under five

Se estima que más de 2 mil millones de personas en el mundo presentan déficit de hierro, más de la mitad está anémica y que la población infantil es más susceptible, por tener escasos depósitos y un crecimiento acelerado. Con el objetivo de identificar la presencia de factores de riesgo asociados a la anemia en niños de seis meses a cinco años de edad, en un Consultorio Médico de Familia (CMF) del municipio Güines, provincia Mayabeque, se realizó esta investigación. Se efectuó un estudio descriptivo, prospectivo, de corte transversal, del 1ro de abril al 30 de septiembre de 2013, con el universo de niños de este grupo de edad, pertenecientes al CMF No1 del Policlínico Docente Luis Li Trigent del referido municipio y provincia; y la muestra quedó conformada por 32 niños, a los que se les diagnosticó anemia. El 46,9 por ciento de los niños de seis a 23 meses de edad presentaron anemia con ligero predominio en el sexo masculino (53,1 por ciento). Los factores de riesgo asociados más frecuentes en la muestra de estudio fueron: la anemia materna, 75 por ciento; la no profilaxis a los niños con sales de hierro, 71,9 por ciento; la no lactancia materna exclusiva hasta los seis meses de edad (65,7 por ciento) y las infecciones, 81,2 por ciento. La anemia ligera fue más frecuente, 90,6 por ciento. Estos resultados permiten identificar la incidencia de factores de riesgo asociados a la anemia, paso previo para realizar acciones que los modifiquen (AU)

It is considered that more than two billion people in the world have iron deficiency, more than half are anemic, and children are the most susceptible since they have scarce depots and an accelerated growth. This research was carried out with the objective to identify the presence of risk factors associated to anemia in children from six months to five years old in a doctors office from Güines municipality, Mayabeque province. A descriptive, prospective, cross sectional study was performed from April 1 to September 30, 2013 with the universe of children in this age group, belonging to the doctors office No1 from Luis Li Trigent Polyclinic. The sample was composed of the 32 children who were diagnosed with anemia. The 46,9 percent of the children from six to 23 months of age had anemia with slight predominance in males (53,1 percent). The most frequent associated risk factors were: mothers anemia, 75 percent; not supplying prophylaxis with iron salts in support of children, 71,9 percent, the non-exclusive breastfeeding until six months of age (65,7 percent) and infections, 81,2 percent. Minor anemia was the most frequent: 90,6 percent. These results allow identifying the incidence of risk factors associated to anemia, previous step to perform actions that change them (AU)

Aspectos clínicos y epidemiológicos asociados al síndrome coqueluchoide en niños menores de cinco años / Clinical and epidemiological aspects associated to pertussis syndrome in children under five years old

El coqueluche es una enfermedad altamente contagiosa, se transmite por las gotas de saliva que son eliminadas al toser. En la actualidad en Latinoamérica constituye un importante problema de salud pública. Se realizó un estudio observacional, descriptivo de corte transversal en el Hospital General Aleida Fernández Chardiet del municipio de Guines, provincia de Mayabeque, durante los años 2012 y 2013; con el objetivo de caracterizar desde el punto de vista epidemiológico y clínico a los niños menores de cinco años de edad con síndrome coqueluchoide ingresados en este centro. La muestra estuvo constituida por los 68 pacientes de estas edades que ingresaron con el diagnóstico de síndrome coqueluchoide. Los datos fueron obtenidos de la revisión de las historias clínicas y fueron procesados mediante la estadística descriptiva. Predominaron los niños del sexo masculino, con edades comprendidas entre uno y seis meses. El principal antecedente patológico fue la presencia de infección vaginal materna por Chlamydia trachomatis en el último trimestre del embarazo (presente en el 61,70 por ciento de los casos); la mayoría no tuvo lactancia materna exclusiva durante los seis primeros meses de vida. Las manifestaciones más frecuentes fueron los accesos de tos quintosa, rubicundez y los vómitos postusígenos. El medicamento más utilizado en el tratamiento fue la azitromicina (91,2 por ciento) (AU)

Pertussis is an extremely contagious disease which is transmitted by saliva droplets that are expelled when coughing. Nowadays, it is an important health problem in Latin America. An observational, descriptive and cross sectional study was carried out at Aleida Fernández Chardiet General Hospital from Güines municipality in Mayabeque province during 2012 and 2013, with the objective to characterize, clinically and epidemiologically, children younger than 5 years old who were admitted for pertussis syndrome. The sample was composed of the 68 patients who were admitted with pertussis. The information was obtained by the revision of the health histories and was processed by means of descriptive statistics. Male children from 1 to 6 months old prevailed. The main past pathological history was the presence of maternal vaginal infection by Chlamydia trachomatis in the last trimester of pregnancy (61,70 percent); most of the infants did not have exclusive breastfeeding during the first 6 months of life. The most frequent manifestations were whooping cough attacks, ruddiness and posttussis vomits. The most used medication was azithromycin (91,2 percent) (AU)

Correlación entre la localización del depósito amiloide y las manifestaciones endoscópicas y clínicas en amiloidosis digestiva sintomática / Correlation between location of amyloid deposits and endoscopic and clinical manifestations in symptomatic gastrointestinal amyloidosis

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Calidad del diagnóstico de neumonía en el servicio de enfermedades respiratorias / Quality of the diagnosis of pneumonia in the service of respiratory diseases

Introducción: las infecciones respiratorias agudas se mantienen como un grupo importante de afecciones con alta morbilidad y mortalidad infantil y dentro de ellas las neumonías, la pandemia olvidada.Objetivo: verificar el diagnóstico de los niños ingresados por neumonías en el servicio de enfermedades respiratorias del Hospital General Docente Aleida Fernández Chardiet, del municipio de Güines.Métodos: se realizó un estudio descriptivo prospectivo de corte transversal de los pacientes ingresados con diagnóstico de neumonías en el servicio de enfermedades respiratorias del Hospital General Docente Aleida Fernández Chardiet, en el primer trimestre del 2013, tomando el universo de los pacientes ingresados con este diagnóstico 256.Resultados: el 72,8 por ceinto de los niños fueron del sexo masculino y el 48,1 por ciento menor de 1 año, el 61,7 por ciento, con radiografía de tórax normal al ingreso, el 45,6 por ciento sin signos clínicos, el 45,6 por ciento tratado con penicilina y en el 60,6 por ciento de los pacientes se retiro antibiótico y el 93,5 por ciento de ellos evolucionaron satisfactoriamente.Conclusiones: la neumonía predominó en el menor de un año, del sexo masculino, más de la mitad con radiografía de tórax Rx T normal al ingreso, el tratamiento de elección fue la penicilina, con evolución satisfactoria (AU)

Introduction: acute respiratory infections remain as an important group of diseases with high morbidity and child mortality and pneumonias are among them, the forgotten pandemic.Objective: to verify the diagnosis of children with pneumonias admitted to the service of respiratory diseases of Aleida Fernández Chardiet General Teaching Hospital of Güines municipality.Methods: a prospective, cross-sectional, descriptive study of patients admitted with a diagnosis of pneumonia in the service of respiratory diseases of Aleida Fernández Chardiet General Teaching Hospital was conducted in the first quarter of 2013 by taking the universe of patients admitted with this diagnosis 256.Results: 72,8 por ciento of children were male and 48,1 por ciento younger than 1 year, 61,7 por ciento with normal thorax radiography on admission, 45,6 por ciento without clinical signs, 45,6 por ciento penicillin treated and 60,6 por ciento of patients were withdrawn antibiotic and 93,5 por ciento of them had successful outcomes.Conclusions: pneumonia predominated in children younger than one year, male, over half with normal thorax radiography Rx T on admission, the chosen treatment was penicillin, with satisfactory outcome (AU)