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Paulo César Martins Urbano,1 Vanete Thomaz Soccol,1 Valderilio Feijó Azevedo2 1Biotechnology and Bioprocess Engineering Program, Federal University of Parana, Curitiba, Parana, Brazil; 2Hospital de Clínicas, Federal University of Parana, Curitiba, Parana, Brazil Abstract: Various criteria are necessary to assess the efficacy and safety of biological medications in order to grant companies the right to register these medications with the appropriate bodies that regulate their sale. The imminent expiration of the patents on reference biological products which block the cytokine TNF-α (tumor necrosis factor-α) raises the possibility of bringing so-called biosimilars to the market (similar to the biologicals of reference products). This occurrence is inevitable, but criteria to adequately evaluate these medications are now needed. Even among controversy, there is a demand from publications correlating the pro-apoptotic mechanism of the original TNF-α antagonists (etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol) in the treatment of rheumatoid arthritis and other diseases. In this article, the authors discuss the possibility of utilizing the pro-apoptotic effect correlated with the regulation of the anti-apoptotic proteins FLIP and NF-κB as new criteria for analyzing the pharmacodynamics of possible biosimilar TNF-α antagonists which should be submitted to regulatory agencies for evaluation. Keywords: anti-TNF drugs, rheumatoid arthritis, apoptosis, NF-κB, FLIP

Introduction: Neurological manifestations can be expressed as part of the complications of rheumatoid arthritis and COVID-19. In patients with both conditions the inflammatory process can affect other organs and organ systems. Objective: To present a female patient, with a diagnosis of rheumatoid arthritis and a history of COVID-19 in whom the diagnosis of brain fog was made. Clinical Case: Female patient, 52 years old, with a diagnosis of rheumatoid arthritis of 9 years of evolution and a history of COVID-19 4 months ago, which began with neurological manifestations consisting of disorders of memory, concentration, attention and frequent headache. Laboratory tests showed the presence of an inflammatory process; no alterations were found in the imaging studies. The diagnosis of brain fog syndrome was confirmed. The therapeutic scheme was maintained and psychological care was added. There was improvement in the clinical picture and follow-up is maintained with both specialties. Conclusions: The complexity of rheumatoid arthritis affecting joints and other organ systems is illustrated; COVID-19 also affects the neurological system, presenting brain fog as an expression of post-COVID-19 syndrome.

Introducción: en la cavidad oral existen muchos hallazgos que solo son detectados en el examen radiográfico rutinario, entre los frecuentes se encuentran el quiste dentígero, queratoquiste y ameloblastoma. Objetivo: realizar un análisis imagenológico comparativo de los hallazgos radiográficos de lesiones odontogénicas entre ellas el ameloblastoma, el quiste dentígero y el queratoquiste. Método: estudio retrospectivo en el periodo 2018 – 2023, llevado a cabo con una muestra de 146 ayudas diagnósticas de pacientes entre los 13 y 66 años que acuden a consulta privada en la ciudad de Medellín-Colombia, divididos en variables sociodemográficas, patológicas y anatómicas. Resultados: el estudio incluyó a 98 hombres y 48 mujeres, con un promedio de edad de 36 ± 5 años. El 46% de los casos diagnosticados fueron de quiste dentígero confirmados mediante estudio de histopatología, la mayoría se localizaron en la región mandibular posterior con un 50% y un 58% de los casos fueron relacionados a terceros molares. Conclusiones: a pesar de que se encuentran ampliamente descritas las características imagenológicas en la literatura, se hace relevante tener claridad con respecto a las de mayor predomino en la población, sin dejar de lado a las características clínicas e histopatológicas necesarias para determinar el manejo definitivo.

Background/objective This study aimed to explore physical literacy (PL) using the Canadian Assessment of Physical Literacy, second edition (CAPL-2), adapt it to the Spanish context and provide evidence of its validity for use in Spanish children aged 8–12.Methods A total of 280 students (150 girls, mean age 10.5±0.9 years) from Extremadura (Spain) completed the CAPL-2. Means and SDs were used to present CAPL-2 scores according to age and sex, as well as frequencies to place participants at different PL levels. Confirmatory factor analysis (CFA) was conducted to establish the best model fit for the data.Results The median PL of Spanish children was progressing, and girls had a lower PL than boys for all ages except 12 years. The results supported a four-domain model for the CAPL-2 Spanish version and reported good fit indices after CFA (χ2 per df ratio=1.118; P (χ2)=0.256; root mean square error of approximation=0.021; comparative fit index=0.987; Tuker-Lewis index=0.991; normed fit index=0.895).Conclusion The CAPL-2 model is a valid and reliable instrument for Spanish children aged 8–12. It represents the first tool that assesses PL in Spanish children, covering the domains of motivation and confidence, physical competence, knowledge and understanding, and daily behaviour. It may be relevant for all professionals related to physical activity, education and the health field.

Introducción: El estudio citológico por punción ecoguiada es rápido, confiable, mínimamente invasivo y beneficioso. Permite reducir procedimientos quirúrgicos innecesarios y clasifica a los pacientes con nódulos benignos o malignos para una intervención quirúrgica oportuna. Objetivo: Evaluar la utilidad diagnóstica, para enfermedad nodular, de la punción con aguja fina. Métodos: Estudio observacional, analítico y de corte transversal, basado en el análisis de los resultados de punción aspiración con aguja fina preoperatoria de pacientes sometidos a cirugía tiroidea en el Hospital Hipólito Unánue entre enero 2016 - diciembre 2019. Resultados: 105 pacientes cumplieron con los criterios de inclusión, de los cuales el 95 % (n= 100) fueron de sexo femenino. El rango de edad estuvo entre 13 y 82 años. Del total de pacientes en 64 la citología fue informada como benigna y en 19 como maligna. El diagnóstico citológico mostró una sensibilidad de un 60 %, especificidad de un 98,1 %, y valores predictivos positivo del 94,7 % y negativo del 81,3 %. La precisión de la prueba diagnóstica de citología fue de un 84,3 % (intervalo de confianza de 95 %: 74,7-91,4). Conclusión: La punción aspiración con aguja fina permite un diagnóstico simple, mínimamente invasivo, seguro y rentable, para lesiones tiroideas, con una alta especificidad y precisión. Sin embargo, debido a las posibilidades de resultados falsos negativos encontrados en este estudio, se recomienda que incluso los pacientes con hallazgos citológicos benignos sean sometidos a seguimiento clínico regular.

Introduction: Enteropathic spondylitis is an inflammatory, systemic and chronic disease that is characterized by affecting the digestive system and the osteomyoarticular system; The inflammatory process generates clinical manifestations that affect the functional capacity and perception of quality of life of patients. Objective: To evaluate the results of a nutritional intervention aimed at controlling the inflammatory process in patients with enteropathic spondylitis. Methods: A longitudinal observational and descriptive investigation was carried out that included as a universe 19 patients with a confirmed diagnosis of enteropathic spondylitis treated at the Andino Hospital of Chimborazo in the period between July 2022 and July 2023. The sample was made up of 17 patients. A nutritional intervention was applied for 10 months that included as a central element supplementation with foods rich in probiotics according to a scheme defined by a clinical nutrition specialist. Results: Average age of 43.51 years, predominance of the female sex (64.70%) and duration of the disease between 5 and 10 years (58.82%). All inflammation markers measured during the study improved during the patients' follow-up; At 9 months, an increase in the percentage of patients with negative C-reactive protein and fibrinogen and normal erythrocyte sedimentation rate was identified. Conclusions: The applied nutritional intervention contributed to improving serum values ??of inflammation markers in patients diagnosed with enteropathic spondylitis.

Included dental organs are associated with various jaws pathologies, among the most frequent are cysts, which are benign lesions that develop around the crowns from permanent teeth. The aim of this research is to propose a therapeutic algorithm and a treatment plan combined with two known techniques, in addition to describe clinical and radiographic findings and conservative therapeutic management. For this, gender and clinical diagnosis data were obtained from a series of 3 cases of dentigerous cyst, in which clinical, histological, radiographic characteristics and treatments used were described. In each case conservative surgical treatment was given accompanied by gauze soaked in nitrofurantoin. Because dentigerous cysts are the most common pathology associated with included dental organs, which can be detected in routine radiographic examinations, this must be corroborated with the histopathological study, allowing less invasive techniques, this work is based on a therapeutic algorithm and combined treatment plan, not only in children but also in adults, regardless of their size.

Prematurity, low birth weight, being small for gestational age (SGA), fetal growth restriction (FGR), and admission on a neonatal intensive care unit are cardiovascular risk factors. The objective of this study was to analyze the proportion of patients with cardiovascular risk factors and hypertension at 5-6 years of age, in a cohort of children born very preterm (PTN). Observational, retrospective and cross-sectional study of children born with a gestational age ≤ 32 weeks, hospitalized in a level III neonatal unit, in Portugal, in 2015-2016, currently aged 5-6 years. FGR was identified by the obstetric team. SGA neonates were classified according to Fenton 2013 growth charts. Body mass index (BMI) was classified according to the World Health Organization charts for its z-score and blood pressure (BP) according to the European Society of Hypertension (2016). Thirty patients were included, with a mean age of 5.4 ± 0.6 years, 57% female. The mean gestational age was 29.2 ± 1.9 weeks, the proportion of FGR was 20% and of SGA 20%. At 5-6 years old, 20% presented an increased BMI, 60% an increased BP, and 17% an increased BMI and BP. BMI at 5-6 years was higher in females (U = 33,000; p = 0.02) and had an inverse correlation with birth weight percentile (r = 0.382; p = 0.04) and a positive correlation with BMI percentile at discharge from neonatology (r = 0.414; p = 0.02). No significant correlations for BP were found. In a population at risk, it is essential to promote cardiovascular health, allowing early interventions and prevention.

Introducción: la biocompatibilidad es un factor decisivo para el éxito de una terapia endodoncica. Objetivo: evaluar la citotoxicidad de cinco materiales de uso endodóntico mediante la prueba de Artemia Salina. Método: se diseñó un estudio experimental in vitro, empleando Artemia salina, para evaluar la biocompatibilidad de los cementos Grossman, CaOH, AH-Plus, MTA y TheraCal-LC con observaciones a 24 y 48 horas. Resultados: los resultados indican que el cemento Grossman presenta un 100% de toxicidad a las 24 horas, mientras que los demás materiales muestran valores menores al 30%, reflejando un comportamiento biocompatible, sin embargo, a las 48 horas, CaOH y TheraCal-LC presentan una toxicidad mayor al 30%, mientras que AH-Plus y MTA continúan con valores -menores del 30%. Los datos fueron analizados con un Modelo lineal generalizado con distribución de errores binomial, un análisis de devianza, y la prueba de comparación múltiple de Fisher con corrección Bonferroni. Se hizo un análisis independiente para las 24 y 48 horas, bajo un nivel de significancia α=5%, se encontraron diferencias significativas a las 48 horas entre TheraCal-LC y AH-Plus y MTA. Conclusión: se concluye que el cemento Grossman presentó un alto grado de toxicidad, mientras que AH-Plus y MTA mostraron la mayor biocompatibilidad

Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.

Introducción: el queratoquiste hace parte de los quistes odontogénicos del desarrollo, derivado de los residuos de la lámina dental con un comportamiento biológico similar al de una neoplasia benigna. Presenta un alto grado de recidiva y agresividad, con lo que ocasiona una destrucción ósea masiva. Puede aparecer en cualquier zona de los maxilares y estar relacionado con dientes retenidos. Imagenológicamente, presenta una lesión radiolúcida multilocular o poliquística, que muestra un borde cortical delgado. Objetivos: demostrar la importancia de un diagnóstico correcto, una detección temprana y acertada, así como inferir la necesidad de utilizar la solución de Carnoy como primera línea de tratamiento, y determinar el momento oportuno para hacerlo. Presentación de caso: hombre de 34 años de edad, sin antecedentes personales relevantes. Tres años atrás había presentado una lesión radiolúcida localizada en los órganos dentarios 34 y 35, motivo por el que le realizaron endodoncia de estos y le removieron la lesión. Ocho meses después, en la tomografía Cone Beam, se evidenció una lesión hipodensa de mayor tamaño que las iniciales en la hemiarcada inferior izquierda. Conclusión: la marsupialización, enucleación más adyuvancia, así como la correcta evaluación de las características clínicas, radiográficas e histopatológicas, permitieron que se llevara a cabo un tratamiento quirúrgico más conservador sin utilizar la solución de Carnoy. Aun así, siempre se recomienda un seguimiento postoperatorio a largo plazo. Por otra parte, no se descarta el uso de solución de Carnoy en casos aislados y según el criterio del operador.

Pneumonia due to Streptococcus pneumoniae (pneumococcus) is a major cause of mortality in infants (children under 1 year of age), and pneumococcal conjugate vaccines (PCVs), delivered during the first year of life, are available since the year 2000. Given those two premises, the conclusion follows logically that favourable impact reported for PCVs in preventing pneumococcal disease should be reflected in the infant mortality rates (IMRs) from all causes. Using publicly available datasets, country-level IMR estimates from UNICEF and PCV introduction status from WHO, country-specific time series analysed the temporal relationship between annual IMRs and the introduction of PCVs, providing a unique context into the long-term secular trends of IMRs in countries that included and countries that did not include PCVs in their national immunisation programmes. PCV status was available for 194 countries during the period 1950–2020: 150 (77.3%) of these countries achieved nationwide PCV coverage at some point after the year 2000, 13 (6.7%) achieved only partial or temporary PCV coverage, and 31 (15.9%) never introduced PCVs to their population. One hundred and thirty-nine (92.7%) of countries that reported a decreasing (negative) trend in IMR, also reported a strong correlation with decreasing maternal mortality rates (MMRs), suggesting an improvement in overall child/mother healthcare. Conversely, all but one of the countries that never introduced PCVs in their national immunisation programme also reported a decreasing trend in IMR that strongly correlates with MMRs. IMRs have been decreasing for decades all over the world, but this latest decrease may not be related to PCVs.

Strongyloides stercoralis is a nematode that is characterized by causing a usually asymptomatic intestinal infection in immunocompetent individuals. However, in patients living with HIV and depending on their immune status, it can generate a hyperinfection syndrome with various complications due to dissemination to different organs. We present the case of a 30-year-old patient with a de novo diagnosis of human immunodeficiency virus infection and lymphoproliferative disease. Within the laboratory workup, the presence of Strongyloides stercoralis was documented in the bone marrow. Despite having a CD4+ T lymphocyte count greater than 400 cells/microliter and having started treatment for this condition with ivermectin, the patient died due to a septic state associated with hyperinfection syndrome, which is why this is considered an unusual case that alerts the clinician to take into account the presence of the nematode in patients living with HIV.

Introducción: Las enfermedades reumáticas y los linfomas tienen como elementos comunes la afectación del sistema inmune, específicamente los linfocitos T y B, y la presencia de infecciones virales como posible factor desencadenante. La presencia de enfermedades reumáticas aumenta el riesgo de aparición de linfomas. La COVID-19 es una enfermedad viral que afecta el sistema inmune, por lo que pudiera ser el detonante para la aparición de linfomas en pacientes con enfermedades reumáticas. Objetivo: Dar a conocer las características clínicas, epidemiológicas y de laboratorio de 2 pacientes con enfermedad reumática, historia de afectación por la COVID-19 en 3 ocasiones y manifestaciones clínicas de linfoma. Caso clínico: Se presentan 2 pacientes con diagnóstico de enfermedades reumáticas que tuvieron infecciones por SARS-CoV-2 en 3 ocasiones cada uno. Un año después del último cuadro respiratorio comenzaron con manifestaciones clínicas que permiten llegar al diagnóstico de linfoma de Hodgkin, en un paciente masculino, de 27 años de edad con artritis reumatoide y linfoma no Hodgkin y una paciente femenina, de 58 años de edad con antecedentes de artritis reumatoide y síndrome de Sjögren. Conclusiones: La COVID-19 pudo haber favorecido la aparición de linfomas en los pacientes con enfermedad reumática, sin embargo, se necesitan más estudios y evidencias para confirmar este hallazgo.

RESUMEN Introducción: El síndrome de Anton-Babinsky es un trastorno neuropsiquiátrico poco frecuente, que se manifiesta por anosognosia y ceguera cortical, debido a lesiones en las áreas visuales asociativas de la corteza occipital sin presentar afectación en la vía visual. En adultos mayores sus manifestaciones clínicas suelen ser atípicas y la valoración geriátrica integral permite orientar el diagnóstico, que se puede asociar con síndromes geriátricos. Objetivo: Describir las manifestaciones clínicas, síndromes geriátricos, paraclínicos y tratamiento de un paciente con Síndrome de Anton-Babinsky. Caso clínico: Paciente de 85 años, quien durante un postoperatorio inmediato de cirugía ocular (pterigión) presentó alteración fluctuante del estado de conciencia, alucinaciones visuales, disminución de la agudeza visual bilateral y anosognosia. La analítica sanguínea no reportó alteraciones y la tomografía computarizada de cráneo documentó isquemia occipital bilateral, se le diagnosticó síndrome de Anton-Babinsky. Conclusiones: El síndrome de Anton-Babinsky puede tener presentación atípica a través de síndromes geriátricos. La valoración geriátrica integral permite realizar un diagnóstico y manejo multicomponente oportuno con el objetivo de influir en el pronóstico tanto a corto como a largo plazo.

This study sought to investigate how different brain regions are affected by Alzheimer’s disease (AD) at various phases of the disease, using independent component analysis (ICA). The study examines six regions in the mild cognitive impairment (MCI) stage, four in the early stage of Alzheimer’s disease (AD), six in the moderate stage, and six in the severe stage. The precuneus, cuneus, middle frontal gyri, calcarine cortex, superior medial frontal gyri, and superior frontal gyri were the areas impacted at all phases. A general linear model (GLM) is used to extract the voxels of the previously mentioned regions. The resting fMRI data for 18 AD patients who had advanced from MCI to stage 3 of the disease were obtained from the ADNI public source database. The subjects include eight women and ten men. The voxel dataset is used to train and test ten machine learning algorithms to categorize the MCI, mild, moderate, and severe stages of Alzheimer’s disease. The accuracy, recall, precision, and F1 score were used as conventional scoring measures to evaluate the classification outcomes. AdaBoost fared better than the other algorithms and obtained a phenomenal accuracy of 98.61%, precision of 99.00%, and recall and F1 scores of 98.00% each.

Resumen: Introducción: la prevalencia de determinadas enfermedades entre los estudiantes de Medicina (EM) parece aumentar respecto a la población en general. Sin embargo, se trata de investigaciones puntuales sin un enfoque global para un análisis de posibles causas en profundidad. Realizamos un análisis de la literatura existente que aborda las enfermedades prevalentes en los EM y su relación con posibles factores intrínsecos. Método: se ha realizado una revisión narrativa de la literatura disponible en Medline sobre el EM, incluyendo revisiones sistemáticas, metaanálisis y estudios primarios, tanto en inglés como en español de trabajos publicados entre marzo de 2016 y marzo de 2022. Las palabras clave utilizadas han sido: «ill», «sick», «morbidity», «suffering» y «students, medical», «medical student», «medical student health». Resultados: de los 567 identificados, se seleccionaron 152 (115 de psicopatología y 37 de enfermedad física). De ellos, 38 artículos cumplieron con los criterios de inclusión. Se aprecia una elevada prevalencia de síntomas depresivos (27%) y ansiosos (28-33,8%) en los EM, mayor que en la población en general de referencia. El consumo de alcohol y tabaco presenta una alta prevalencia y predominan las enfermedades físicas relacionadas con la exposición a niveles altos de estrés, como los problemas digestivos, cardiovasculares, osteomusculares y de sequedad ocular. Conclusión: la psicopatología se encuentra ampliamente estudiada, mostrando diferencias respecto a la población en general. Las enfermedades del ámbito físico más prevalentes son propias de grupos de poblaciones con altos niveles de estrés y sedentarismo. Es necesario realizar estudios contrastados con los estudiantes del ámbito universitario con niveles similares de carga lectiva y estrés. Abstract: Introduction: The prevalence of certain medical conditions appears to be increasing in medical students (MS) in relation to the general population according to studies conducted without a global focus. In-depth analysis of the existing literature is required in order to ascertain the predisposing factors in medical students for those highly prevalent medical conditions. Method: A narrative review of the literature available on Medline on MS, including systematic reviews, meta-analyses and primary studies, both in English and Spanish of papers published between March 2016 and March 2022, was conducted. The keywords used were: ''ill'', ''Sick'', ''morbidity'', ''suffering'' and ''Students, medical'', ''medical student'', ''medical student health''. Results: Of the 567 articles identified, 152 were selected (115 psychopathology and 37 physical pathology). Of these, 38 articles met the inclusion criteria. A high prevalence of depressive symptoms (27%) and anxiety (28-33.8%) was found in MS, higher than in the general reference population. Alcohol and tobacco consumption is highly prevalent and physical pathologies related to high levels of stress exposure predominate, such as digestive, cardiovascular, musculoskeletal and dry eyes. Conclusion: Psychopathology has been extensively studied, showing differences with respect to the general population. The most prevalent physical pathologies are typical of population groups with high levels of stress and sedentary lifestyles. The need is raised for studies contrasting medical students with university students in general who have similar academic loads and stress levels.

Introducción: La enfermedad de cambios mínimos es una causa rara de síndrome nefrótico en el adulto, y su relación con el hipotiroidismo es más rara aún. Se considera que esta patología renal responde favorablemente al manejo con glucocorticoides y tiene una baja frecuencia de resistencia. Su abordaje hoy en día es objeto de investigación. Objetivo: Describir una rara etiología de síndrome nefrótico en el adulto con presentación, tratamiento y desenlace infrecuentes. Presentación del caso: Paciente femenino de 53 años quien inicia con síndrome nefrótico por enfermedad de cambios mínimos cortico-resistente y su asociación con un hipotiroidismo descontrolado, quien requiere manejo con rituximab y control de la enfermedad endocrinológica asociada, como enfermedad de base. Conclusiones: En este caso clínico se muestra como las enfermedades citadas pueden coexistir y el tratamiento en conjunto es necesario. El establecimiento de nuevas terapias en la población adulta como el rituximab podría mostrar beneficio, como en este caso. Sin embargo, aún existe la necesidad de estudios de mayor evidencia que validen firmemente la efectividad de los diferentes tratamientos en este tipo de pacientes.

Los aneurismas cerebrales en edad pediátrica son una patología poco frecuente, es importante tomarla en cuenta al evaluar pacientes pediátricos con manifestaciones clínicas características. Suelen localizarse en la circulación anterior, en pacientes masculinos con una edad media de 14.5 años. Se presenta un caso de un aneurisma cerebral del complejo comunicante anterior en un paciente masculino de 10 años de edad con clínica indicativa dada por cefalea de inicio súbito, vómitos incoercibles y disminución del estado de consciencia. Se realizó tomografía computarizada (TC) de cráneo simple donde se evidencia la presencia de hemorragia sub aracnoidea (HSA) Fisher II, se practica angiografía por TC para determinar la etiología del sangrado. El estudio confirmó la presencia de un aneurisma en el complejo comunicante anterior. Se realizó clipaje del aneurisma mediante un abordaje pterional clásico, obteniendo excelentes resultados y una recuperación satisfactoria. Es importante considerar los beneficios de la intervención endovascular como opción de tratamiento en casos semejantes. Brain aneurysms in pediatric age are a rare pathology, it is important to take it into account when evaluating pediatric patients with characteristic clinical manifestations. They usually appear in the anterior circulation, in male patients with a mean age of 14.5 years. A case of a cerebral aneurysm of the anterior communicating complex is presented in a 10-year-old male patient with indicative symptoms as sudden onset headache, incoercible vomiting, and decreased state of consciousness. A simple skull computed tomography (CT) was performed where was evidenced the presence of a subarachnoid hemorrhage (SAH) Fisher II, and a CT angiography was also performed to determine the etiology of the bleeding. The study confirmed the presence of an aneurysm in the anterior communicating complex. Clipping of the aneurysm was performed using a classic pterional approach, obtaining great results and a satisfactory recovery. It is important to consider the benefits of endovascular intervention as a treatment option in similar cases.

Abstract Background Self-limited Childhood Epilepsies are the most prevalent epileptic syndrome in children. Its pathogenesis is unknown. In this disease, symptoms resolve spontaneously in approximately 50% of patients when maturity is reached, prompting to a maturation problem. The purpose of this study was to understand the molecular bases of this disease by generating and analyzing induced pluripotent stem cell-derived neurons from a family with 7 siblings, among whom 4 suffer from this disease. Methods Two affected siblings and, as controls, a healthy sister and the unaffected mother of the family were studied. Using exome sequencing, a homozygous variant in the FYVE, RhoGEF and PH Domain Containing 6 gene was identified in the patients as a putative genetic factor that could contribute to the development of this familial disorder. After informed consent was signed, skin biopsies from the 4 individuals were collected, fibroblasts were derived and reprogrammed and neurons were generated and characterized by markers and electrophysiology. Morphological, electrophysiological and gene expression analyses were performed on these neurons. Results Bona fide induced pluripotent stem cells and derived neurons could be generated in all cases. Overall, there were no major shifts in neuronal marker expression among patient and control-derived neurons. Compared to two familial controls, neurons from patients showed shorter axonal length, a dramatic reduction in synapsin-1 levels and cytoskeleton disorganization. In addition, neurons from patients developed a lower action potential threshold with time of in vitro differentiation and the amount of current needed to elicit an action potential (rheobase) was smaller in cells recorded from NE derived from patients at 12 weeks of differentiation when compared with shorter times in culture. These results indicate an increased excitability in patient cells that emerges with the time in culture. Finally, functional genomic analysis showed a biased towards immaturity in patient-derived neurons. Conclusions We are reporting the first in vitro model of self-limited childhood epilepsy, providing the cellular bases for future in-depth studies to understand its pathogenesis. Our results show patient-specific neuronal features reflecting immaturity, in resonance with the course of the disease and previous imaging studies.

Introducción: La baja variabilidad del ritmo cardíaco (VRC) se ha asociado con desbalances autonómicos y riesgo cardiovascular en diversas poblaciones. Objetivo: Relacionar la variabilidad del ritmo cardíaco e índices antropométricos en hombres universitarios jóvenes, físicamente activos con bajo riesgo cardiometabólico. Materiales y métodos: Estudio descriptivo transversal. Participaron 10 hombres de 23,15 ± 2,91 años con un índice de masa corporal (IMC) de 25,48 ± 2,19 kg/m2 y un índice Cintura-Cadera (IC-C) de 0,81±0,02. La VRC en reposo se midió en un período de 5 minutos. Se realizó un análisis correlacional entre el IMC e IC-C con la proporción baja/alta frecuencia (LF/HF), desviación estándar de la variación instantánea de intervalos RR (SD1) y complejidad de los intervalos RR (α-1). Además, se determinó el poder estadístico (1- β) y tamaño del efecto (“d” de Cohen). Resultados: El LF/HF sólo se relaciona significativamente con el IC-C (r=0,638; p=0,047; d=0,80), mientras que SD1 y α-1 no reportaron ninguna asociación con el IMC e IC-C. Conclusiones: Existe un predominio parasimpático que sugiere un mecanismo protector sobre el tejido adiposo intraabdominal relacionado al IC-C. Se requieren otros estudios que expliquen todas las variables moduladoras de la VRC.

Introducción: El virus SARS-CoV-2 y su enfermedad COVID-19, afecta con mayor severidad a personas adultas mayores, sobre todo aquellas con multimorbilidad y fragilidad; esto debido a mecanismos fisiológicos como la inmunosenescencia o un pobre control de la actividad inflamatoria en esta población. Los estudios sobre el diagnóstico y tratamiento en estos pacientes son escasos y muchos de ellos tienen niveles de evidencia bajos. Objetivo: Describir las características clínicas y paraclínicas de una adulta mayor centenaria institucionalizada, frágil, con multimorbilidad quien sobrevive a la infección y desarrolla inmunidad en una unidad geriátrica de agudos. Presentación del caso: Centenaria institucionalizada con multimorbilidad y fragilidad con criterios de severidad de la enfermedad, quien fue manejada tempranamente y recuperada, llegando a desarrollar inmunidad. Conclusiones: El diagnóstico temprano, un manejo precoz y el abordaje geriátrico integral e interdisciplinar son indispensables para un desenlace favorable en pacientes adultos mayores con alto riesgo de progresión de enfermedad con COVID-19.

Introduction: Rheumatoid arthritis is described as an autoimmune disease in which there is a genetic pattern with alterations in the histocompatibility system; HLA DR4 being the pattern that is most frequently reported in this disease. Objective: To identify the relationship between genetic alterations and seropositivity in patients diagnosed with rheumatoid arthritis. Methods: Observational, cross-sectional and descriptive research with a universe of 157 patients diagnosed with rheumatoid arthritis, of which 113 were part of the research sample. The presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies was determined, and a genetic study was performed to identify the presence of HLA-DR3 and HLA-DR4. The non-parametric Pearson correlation test was used to determine the correlation between the genetic pattern and seropositivity. Results: Average age of 58.74 years with a predominance of female patients (72.57 %); 38.05 % presented at least one associated comorbidity. Rheumatoid factor was positive in 60.18 % of the patients, while positive anti-cyclic citrullinated peptide was identified in 41.59 % of the cases studied. Genetic pattern alterations were identified in 66.37 % of the patients; HLA DR4 was present independently in 38.67 % of the positive cases and combined with HLA DR3 in 20.66 %. Conclusion: A significant positive correlation was identified between alterations in the genetic pattern and seropositivity. The presence of genetic pattern alterations triples the risk of seropositivity in patients with rheumatoid arthritis.

Las enfermedades reumáticas son un grupo de afecciones, la mayoría de ellas con afectación inmunológica y compromiso sistémico, que generan distintos grados de discapacidad funcional y disminución de la percepción de calidad de vida de los pacientes que las padecen. Constituyen una de las primeras causas de discapacidad, de invalidez temporal y definitiva, de afectación laboral y se sitúan dentro de los 10 primeros motivos de consultas en el primer nivel de atención de salud. Los pacientes con este tipo de enfermedad han sido considerados como pacientes inmunodeprimidos lo cual no se corresponde directamente con los mecanismos de producción de la gran mayoría de las enfermedades reumáticas. En el presente reporte se abordan los mitos y realidades que engloban a las enfermedades reumáticas y la supuesta inmunosupresión que generan, desde la perspectiva etiopatogénica. El esclarecimiento de estos elementos es indispensable para poder enfrentar adecuadamente, desde el punto de vista terapéutico y de autocuidado a los pacientes con enfermedades reumáticas. Se concluye, que con base en los elementos etiopatogénicos de las enfermedades reumáticas y el análisis de la expresión de la respuesta inmunológica normal y en pacientes reumáticos, estos no pueden ser considerados como personas inmunodeprimidas. La prescripción de inmunosupresores se realiza con la finalidad de restaurar la respuesta inmunológica normal.

Las enfermedades reumáticas son un grupo de afecciones, la mayoría de ellas con afectación inmunológica y compromiso sistémico, que generan distintos grados de discapacidad funcional y disminución de la percepción de calidad de vida de los pacientes que las padecen. Constituyen una de las primeras causas de discapacidad, de invalidez temporal y definitiva, de afectación laboral y se sitúan dentro de los 10 primeros motivos de consultas en el primer nivel de atención de salud. Los pacientes con este tipo de enfermedad han sido considerados como pacientes inmunodeprimidos lo cual no se corresponde directamente con los mecanismos de producción de la gran mayoría de las enfermedades reumáticas. En el presente reporte se abordan los mitos y realidades que engloban a las enfermedades reumáticas y la supuesta inmunosupresión que generan, desde la perspectiva etiopatogénica. El esclarecimiento de estos elementos es indispensable para poder enfrentar adecuadamente, desde el punto de vista terapéutico y de autocuidado a los pacientes con enfermedades reumáticas. Se concluye, que con base en los elementos etiopatogénicos de las enfermedades reumáticas y el análisis de la expresión de la respuesta inmunológica normal y en pacientes reumáticos, estos no pueden ser considerados como personas inmunodeprimidas. La prescripción de inmunosupresores se realiza con la finalidad de restaurar la respuesta inmunológica normal.

Introduction: Risk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department. Material and Methods: Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (≥ 4 points). Results: We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA2DS2-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA2DS2-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation. Discussion: This is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department. Conclusion: The M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.

La obesidad constituye un problema de salud a nivel mundial que favorece el desarrollo de múltiples enfermedades crónicas no transmisibles. Así, se desarrolló una investigación con el objetivo de determinar la efectividad de la cirugía bariátrica como tratamiento de la obesidad en pacientes operados en el Hospital General del Instituto Ecuatoriano de Seguridad Social (IESS) de la ciudad de Riobamba, Chimborazo, Ecuador, durante el año 2019. Se realizó una investigación no experimental comparativa, para la que se recolectaron datos a partir de las historias clínicas de los usuarios en el entorno investigado. Los principales resultados mostraron un promedio de edad de 43,58 años, predominio de pacientes femeninas (60,61%) y de aquellos con presencia de comorbilidades (82,58%). El 68,94% de los pacientes presentó obesidad grado III antes de la cirugía, la mayoría presentó comorbilidades (82,59%), entre las que sobresalió la diabetes mellitus. Se concluyó que en los pacientes sometidos al procedimiento quirúrgico se produjo una reducción estadísticamente significativa de la incidencia de obesidad grado II y III, lo que evidenció la efectividad del tratamiento.

Introducción: la población geriátrica se incrementa en todo el mundo, en esta edad el organismo pierde capacidad de respuesta por los cambios fisiológicos, por lo que aumenta los riesgos de una intervención quirúrgica en esos pacientes. Objetivo: describir las complicaciones cardiovasculares trans y postoperatoria en pacientes geriátricos operados en el Hospital Provincial General Docente de Riobamba, durante el periodo 2018-2019. Metodología: investigación no experimental descriptiva transversal con enfoque cuantitativo. La población estuvo constituida por la totalidad de 257 historias clínicas de adultos mayores intervenidos quirúrgicamente, quedando una muestra de 207 pacientes mediante procedimiento aleatorio simple. Resultados: predominio de pacientes con edad entre 65 y 70 años (57%), los de género masculino (52,67%) y aquellos con comorbilidades (81,64%). El 54,11% fue intervenido de urgencia, el 72,95% tuvo un tiempo quirúrgico mayor que dos horas y el 93,24% requirió anestesia general. Conclusiones: las complicaciones cardiovasculares y las que ocurrieron durante transoperatorio resultaron más frecuentes. Los pacientes con más edad y presencia de comorbilidades tuvieron mayor incidencia en el desarrollo de complicaciones cardiovasculares asociadas con los procedimientos quirúrgicos.

IntroductionTargeted therapies for sepsis have failed to show benefit due to high variability among subjects. We sought to demonstrate different phenotypes of septic shock based solely on clinical features and show that these relate to outcome.MethodsA retrospective analysis was performed of a 1,023-subject cohort with early septic shock from the ProCESS trial. Twenty-three clinical variables at baseline were analyzed using hierarchical clustering, with consensus clustering used to identify and validate the ideal number of clusters in a derivation cohort of 642 subjects from 20 hospitals. Clusters were visualized using heatmaps over 0, 6, 24, and 72 h. Clinical outcomes were 14-day all-cause mortality and organ failure pattern. Cluster robustness was confirmed in a validation cohort of 381 subjects from 11 hospitals.ResultsFive phenotypes were identified, each with unique organ failure patterns that persisted in time. By enrollment criteria, all patients had shock. The two high-risk phenotypes were characterized by distinct multi-organ failure patterns and cytokine signatures, with the highest mortality group characterized most notably by liver dysfunction and coagulopathy while the other group exhibited primarily respiratory failure, neurologic dysfunction, and renal dysfunction. The moderate risk phenotype was that of respiratory failure, while low-risk phenotypes did not have a high degree of additional organ failure.ConclusionsSepsis phenotypes with distinct biochemical abnormalities may be identified by clinical characteristics alone and likely provide an opportunity for early clinical actionability and prognosis.

Introducción: En la halterofilia los perfiles antropométricos permiten una mejor planificación y ejecución del entrenamiento deportivo. Objetivo: Describir y comparar según sexo, el perfil antropométrico y somatotipo de levantadores de pesas federados de la región de Valparaíso, Chile. Materiales y métodos: Estudio descriptivo, transversal. Participaron 40 adultos levantadores de pesas. La evaluación antropométrica fue realizada utilizando el protocolo de medición y marcaje de la Sociedad Internacional de Avances en Cineantropometría; método pentacompartimental de Ross y Kerr y somatotipo de Heath-Carter. Se aplicó la T de Student para muestras independientes y U Mann-Whitney para comparar características antropométricas entre grupos. El poder estadístico y el tamaño efecto se calculó con “d” de Cohen. Resultados: Existen diferencias significativas entre grupos, para masa muscular relativa (p=0,003; d=0,96) y absoluta (p≤0,001; d=2,42); masa adiposa relativa (p≤0,001; d=1,46); masa ósea absoluta (p≤0,001; d=1,41); masa piel relativa (p≤0,001; d=1,96) y absoluta (p≤0,001; d=0,97); masa residual relativa (p=0,006; d=1,08) y absoluta (p≤0,001; d=2,09), mientras que la distribución del somatotipo clasifica al grupo masculino como Endo-Mesomorfo y al femenino como Mesomorfo–Endomorfo, observando diferencias significativas en el mesomorfismo (p≤0,001; d=1,48). Conclusiones: Existe un predominio del somatotipo mesomórfico, existiendo diferencias significativas en los componentes de composición corporal.

Introducción: La obesidad sarcopénica no está claramente definida, pero se entiende como la relación sinérgica entre la pérdida de masa y función muscular, con aumento de masa grasa, propio de la obesidad que se acentúa con la edad. Objetivo: Analizar los efectos del ejercicio físico y suplementación nutricional sobre la obesidad sarcopénica en adultos mayores. Materiales y métodos: Se realizó una búsqueda bibliográfica de artículos publicados entre el 2015 y 2020 en las bases de datos Medline través de Pubmed, SciELO y Google Scholar utilizando los términos Sarcopenia, Obesity, Frail Elderly, Exercise y Dietary supplements. Los artículos analizados consideraron solo revisiones narrativas o sistemáticas, con o sin metanálisis del efecto de una intervención de ejercicio y/o suplementación nutricional en adultos mayores. Resultados: Se presentan los criterios de definición y relación entre obesidad y sarcopenia abordados desde intervenciones de ejercicios físicos y nutricionales para la prevención y/o tratamiento de obesidad sarcopénica. Conclusiones: Las diferentes estrategias de ejercicio físico y suplementación nutricional, tanto separadas como combinadas, pueden prevenir y/o contrarrestar la obesidad sarcopénica en adultos mayores, puesto que impactan parámetros fundamentales como la composición corporal y el rendimiento físico asociado a la calidad de vida.

IntroductionThe absence of nursing care plans aimed at people living with HTLV-1 (PLHTLV) led us to develop and test a proposed nursing care plan based on the evaluation of 55 PLHTLV to outline interventions according to the clinical stage.MethodsAfter interviews with symptomatic patients, nursing diagnoses were made using the NANDA International Nursing Diagnoses (The International Nursing Knowledge Association). Subsequently, interventions were selected through the Classification of Nursing Interventions (NIC), and expected results were selected through the Classification of Nursing Outcomes (NOC).ResultsThe actual diagnoses included (ii) chronic pain, (iii) impaired urinary elimination, and (iv) sexual dysfunction; the health promotion diagnosis was (i) risk-prone health behavior; and the risk diagnoses were (i) risk of feeling powerless and (ii) risk of falls in adults. Nursing care must prevent the lack of adherence to monitoring, establish goals and promote family involvement. A safe home environment requires intervention for fall prevention. Full support in understanding pharmacological and non-pharmacological therapies for chronic pain is needed. Interventions allow patients with impaired urinary function to be reintroduced to society. For sexual dysfunction, it is necessary to discuss safe sex and behavioral changes. Regarding risk behaviors, it is necessary to guide the patient/family, adapt language to the education level of these individuals, and help them better accept the condition, among other guidelines.ConclusionThe development of a nursing care plan for PLHTLV is essential for preventing the rapid progression of disease and the improvement of the quality of life of PLHTLV and should be included in the multidisciplinary approach to the secondary level of prevention of HTLV-1.

IntroductionHuman T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) restricts activities of daily living (ADLs), affecting health and quality of life. Occupational therapy is used to promote independence during ADL in people living with HTLV (PLHTLV).ObjectiveTo quantify the clinical aspects, levels of functionality, performance in ADLs and occupational roles of PLHTLV and propose an occupational therapeutic intervention.MethodA cross-sectional, descriptive, observational study was designed with 40 PLHTLV monitored at two referral laboratories of the Federal University of Pará. The Evandro Chagas Research Institute Neurological Disability Scale (EIPEC-2), the Barthel Index and the Occupational Roles Identification List were applied. The G test and Fisher’s exact test (to identify associations between qualitative variables), the Mann–Whitney test (to identify associations between quantitative variables) and Pearson correlation analysis (to identify associations between the total Barthel Index and EIPEC-2 scores) were performed with Microsoft Excel and BioEstat 5.0, and the significance level was set at p ≤ 0.05.ResultsMotor aspects, the presence of spasticity, sensory aspects, and pain in the lumbar region and lower limbs were significantly (p = 0.0002) higher among symptomatic individuals, who also had more difficulties urinating, traveling up and down stairs and transferring from a chair to a bed. Being a worker, performing housework and socializing (with friends or family members) were the most affected activities among HAM patients.ConclusionThe impact of HAM on PLHTLV should include an intervention plan with occupational therapists in rehabilitation programs to create an important third-level prevention initiative, which may help achieve short-, medium-, and long-term goals. Asymptomatic PLHTLV should also be able to prevent future ADL impairment.

Dental transplantation is a surgical alternative, which consists of transplanting a tooth from one alveolus to another in the same patient, very useful when replacing lost dental organs in young patients, with a high success rate. Present advantages helpful for patients providing a vital, proprioceptive and excellent aesthetic rehabilitation, without altering adjacent teeth, additionally represents an alternative cheaper. The purpose of this case report is to show clinical sequence about surgical approach for dental autotransplantation from lower third molar on alveolus after extraction of right lower first molar, carried out without endodontic treatment. Female patient case of 15 years old with a diagnosis of extensive caries not restorable in 46 is presented. It is decided through an interdisciplinary board to carry out, treatment with an autologous transplant of right lower third molar in socket post-extraction of first lower molar from the same hemiarchate, post-surgical controls are performed for up to one year. Dental transplantation is an excellent treatment option when it comes to replacing missing teeth, since it offers multiple functional and aesthetic advantages, mainly in children and young adults.

Introducción: Actualmente, los efectos del enjuague bucal con carbohidratos sobre el rendimiento son controvertidos, algunos estudios plantean efectos ergogénicos, mientras que otros no han reportado efecto luego de suministrar enjuague bucal con carbohidratos. Objetivo: Determinar si existe evidencia científica que avale los distintos protocolos de enjuagues bucales con carbohidratos y su efecto sobre el rendimiento deportivo en carreras de ciclismo contrarreloj. Materiales y métodos: se realizó una búsqueda bibliográfica entre el 2015 y 2019 en las bases de datos Medline, Biblioteca Cochrane y Scopus utilizando los términos “Carbohydrates”, “Mouth rinse” y “Athletic performance”. Resultados: Se revisaron 96 estudios y se seleccionaron 7 en diversos grupos poblacionales, con diferentes métodos de evaluación y diversas dosis de enjuague con carbohidratos. Los resultados obtenidos fueron controversiales, en algunos casos se demostró efecto ergogénico y en otros no. Conclusiones: Los efectos de los enjuagues bucales con carbohidratos son controvertidos, por lo que no se puede asegurar que provoquen mejoras de rendimiento en carreras de ciclismo contrarreloj. Se requiere de más estudios aleatorizados controlados que logren homogeneizar e identificar los mecanismos de acción específicos mediante el cual los enjuagues bucales con carbohidratos actúan sobre distintas poblaciones de estudio.

Until recently mental diseases were treated as a whole, without any differentiation. Recent researchs have highlighted the differences between some of them, so consequently there are specific treatments for these pathologies today. The main objective of this work is to show two different diseases which in many cases are confused: depression and schizophrenia. These pathologies can have as triggers situations very diverse and that require different treatment. For the analysis, we are going to use two films: Prozac Nation (2001) by Erik Skjoldbjaerg and A beautiful mind (2001) by Ron Howard, which reflect the real experiences of two characters; the society in which they live and the environment around them, but especially focusing in the pharmacotherapy area, medications used, its correct use, the adverse effects and so on; in order to be able to decide if the vision presented by films has a formative character in these diseases.

Objective To describe the clinical characteristics and sociodemographic factors associated with COVID-19 among pregnant women in a maternal and children's hospital in Lima, Peru. Methods Quantitative observational study. The population under study consisted of pregnant women who attended an emergency room and had a COVID-19 test. These women were assessed for age, gestational age, place of origin, occupation, education, marital status, number of children, previous body mass index, gestational body mass index, tetanus vaccination, prenatal controls, and hemoglobin. After bivariate analysis, a generalized linear regression model was applied. Results We included 200 women aged between 18 and 34 years (84.5%) with a median gestational age of 36 weeks. More than half were from Lima (52.5%), most were housewives (79%), had high school education (71.9%), and had a cohabiting marital status (60%). The COVID-19 test positivity was 31.5% by rapid tests. Pregestational body mass index assessment showed that 36.7% of normal weight, 38,1% of overweight, and 30.3% of obese pregnant women had COVID-19 infection. 39.7% of patients with hemoglobin levels greater than or equal to 11 g/dL, 21.2% of patients with values between 10 and 10.9 g/dL, and 20% of patients with values between 7 and 9.9 g/dL had COVID-19 infection. The prevalence ratio (with a 95% confidence interval) found that cohabitation was associated with a lower risk of having COVID-19 infection in pregnant women (prevalence ratio: 0.41, p < 0.001). Conclusion Cohabiting pregnant women had a lower risk of COVID-19 infection compared with other marital statuses. Further research is needed to evaluate COVID-19 associated factors in pregnant women and possible sociodemographic or economic factors behind cohabiting marital status association among this population.

Resumo: Propõe-se um programa de curso sobre história da Medicina para alunos de graduação de escolas médicas, centrado no estudo da evolução epistemológica da Medicina do final do século XVIII aos nossos dias.

Abstract Background Nutritional support is essential in the care of critically ill children since malnutrition in this population is associated with increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state and augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in the PICU are fundamentally based on expert opinions, and the minimum threshold is 1.5 g/kg per day of protein, although protein needs could be higher in certain subgroups of patients. The main objectives of the present study are to examine whether the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, and retinol and improves nitrogen balance and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet. Methods A multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formulae with different protein contents. Blood and urine test, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry will be performed at the beginning of the nutrition regimen and at 24 h, 72 h and 5–7 days after initiation. The sample size for this trial is estimated to be 90 participants (about 30 participants in each group). The data analysis will be by intention to treat. Discussion This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition. Trial registration ClinicalTrials.gov identifier: NCT03901742. Registered April 1, 2019 – Retrospectively registered.

Introducción: La leche materna ha sido considerada como el alimento ideal a ser administrado de forma exclusiva en lactantes hasta los 6 meses. Su utilización se ha asociado a disminución de la morbilidad y mortalidad infantil. Objetivo: Determinar las fortalezas y debilidades que inciden en la implementación de la lactancia materna exclusiva en madres pertenecientes a la provincia de Chimborazo. Métodos: Se realizó un estudio descriptivo en 171 madres, a las cuales se les aplicó un cuestionario que permitió obtener información relacionada con sus características generales, así como las fortalezas y debilidades que influyeron en la implementación de la lactancia materna exclusiva. Resultados: Promedio de edad de 27 años; predominaron las pacientes casadas (54,38 %), con primaria terminada (46,78 %) y con un único hijo (39,19 %). El 54,38 % de las madres aplicó correctamente la lactancia materna exclusiva. La fortaleza que mayor significación presentó fue la relacionada con el mejor crecimiento de los niños (88,17 %) y la debilidad más referida fue la falta de descanso de la madre (24,36 %). Conclusiones: Existen bajos niveles de utilización de la lactancia materna exclusiva motivados por debilidades como la falta de descanso de la madre, el dolor en los pezones al lactar y la falta de información sobre lactancia materna exclusiva. Las fortalezas para su uso incluyen fundamentalmente el mejor crecimiento y desarrollo del niño, la prevención de enfermedades y la desnutrición.

Introduction: Head and neck cancer currently has the sixth highest incidence worldwide. The Human Papilloma Virus (HPV) is a small deoxyribonucleic acid (DNA) virus with more than 200 subtypes. Remarkable features have been reported in head and neck cancer according to HPV status. Histopathologically, cancer with positive HPV tends to be a poorly differentiated basaloid and keratinized histologic type tumor.Objective: To present the relationship between HPV- associated head and neck cancer (subtypes 16 and 18) in a young patient, describing the surgical approach performed; to show the results of the clinical practice taking into account the staging, the depth of the invasion, and the treatment received; and to assess the oncological outcome and the patient's satisfaction with esthetic and function.Case Presentation: A 40-year-old male patient is presented. He reports no history of smoking, but occasional alcohol intake, and the practice of oro-genital sexual habits in bisexual relationships. He also has a family history of cancer. The patient presents a localized ulceration in the lateral border of the tongue. The histopathological diagnosis indicated infiltrating large keratinizing squamous cell carcinoma.Conclusions: Associated risk factors such as smoking and alcohol consumption are decisive on the outcome of this type of cancer, so the diagnosis and progression of the disease in this group of positive HPV subjects requires a different approach from the commonly implemented one.Keywords: Neoplasia, surgery, histopathology, papillomaviridae, sexual behavior.

Introduction: Foodborne diseases constitute a health problem in the world, involving products of animal origin, vegetables, water sources, and foods ready for consumption. The problem arises because of the inadequate manipulation of food and the possibility of transmission of pathogenic microorganisms, mainly of a bacterial type.Objective: To describe the different conventional and molecular diagnostic techniques used in the food industry.Material and Methods: A search was carried though the analysis of review articles, original articles, and theses during a period of three months; these articles were written in English, Portuguese and Spanish. In their content, they demonstrated the use of conventional and molecular methodology for the identification of microorganisms in different types of food.Results: The conventional methods for the identification of these microorganisms make use of well-established protocols and norms, but require too much time for their identification and, in some cases, they provide low sensitivity and specificity. Molecular techniques are proposed as an alternative for the microbiological evaluation of food because they are fast, sensitive and reliable.Conclusions: Molecular techniques are proposed as a new and faster alternative for the detection of microorganisms, reducing the time for the emission of results from days to hours; identifying pathogenesis factors, virulence and drug resistance with only one assemblage, thus providing high sensitivity and specificity.Keywords: Pathogen, Diseases, Food, Transmission, Molecular Diagnostic Techniques.

Resumen: Objetivo: Identificar la integración de la medicina alternativa como asignatura base en la oferta académica de grado o posgrado de las carreras de Medicina y Enfermería de las universidades públicas y privadas de Perú. Diseño: Estudio documental, descriptivo, transversal. Participantes: Un total de 62 universidades peruanas entre instituciones públicas y privadas que ofertan la carrera de Medicina o Enfermería. Metodología: Se realizó una revisión completa de las mallas curriculares de las carreras de Medicina y Enfermería de las universidades peruanas, basada en la oferta académica general de grado y posgrado. Resultados: A nivel de grado, el 34% de las universidades incluyen la Medicina Alternativa como asignatura en la carrera de Medicina y el 46% en la carrera de Enfermería. Con relación al posgrado, solo el 5% de las universidades peruanas ofertan programas de cuarto nivel en esta área. Conclusiones: Existe deficiente oferta académica a nivel de grado y de posgrado relacionada con la medicina alternativa en las universidades peruanas. Abstract: Objective: To identify the integration of alternative medicine as a basic subject in undergraduate and graduate programs of the medical and nursing degrees of the public and private Peruvian universities. Design: A documental, cross-sectional descriptive study was conducted with 61 Peruvian public and private universities that offer a degree in Medicine and Nursing. Methodology: A complete review was carried out on the curriculum in the schools of Medicine and Nursing in Peruvian universities, depending on the undergraduate and graduates courses offered. Results: In undergraduate programs, 16% of universities included the subject called Alternative Medicine as part of the medical degree and 40% as part of Nursing degree, compared to posgraduate programs where only 3% of Peruvian universities offer a fourth level course in this area. Conclusions: There is a lack of academic offer in undergraduate and graduate programs related to alternative medicine in Peruvian universities. Palabras clave: Educación, Curriculum, Medicina alternativa, Universidades, Keywords: Curriculum, Education, Complementary therapies, Universities

El ameloblastoma a pesar de ser un tumor benigno es uno de los más agresivos y destructivos localmente de la región maxilofacial, siendo capaz de generar grandes deformaciones faciales en un corto lapso de tiempo, creciendo dentro del hueso sin perforarlo. La variante uniquística por ser considerada la menos agresiva permite un manejo conservador de esta patología. No es frecuente en niños y los criterios de tratamiento quirúrgico en la infancia son controversiales, debido, en parte, al riesgo de recurrencia cuando se practican métodos conservadores. Se presenta un caso inusual de ameloblastoma uniquístico localizado en la región anterior del maxilar inferior. Este tipo de lesiones se presenta mayormente en adultos jóvenes, principalmente en la segunda década de vida y en este caso se presentó en una niña de 12 años. La lesión fue manejada de manera conservadora con un seguimiento de cuatro años, siendo que ésta no presentó recidiva.

Introducción: El intento suicida es un problema de salud pública, las cifras aumentan a pesar de los programas preventivos, es necesario conocer su comportamiento en la población pediátrica y en la región. Objetivo: Caracterizar clínica y sociodemográficamente los menores de 18 años con intento suicida atendidos en el Hospital Infantil los Ángeles. Materiales y métodos: Estudio observacional, descriptivo de menores de 18 años con intento suicida (INSU) hospitalizados entre 2016 y 2017. Resultados: Se analizaron datos de 151 pacientes. Se encontró una prevalencia de 0,8 casos por mil ingresos. Falleció el 2% (3) luego de ingesta de Paraquat®. La edad promedio fue de 14,7 años, el 74% (112) fueron niñas. El 61,6% (58) de la población con intento suicida tenía un ambiente familiar disfuncional. Los problemas académicos y la depresión se presentaron con alta frecuencia. Dentro de los principales mecanismos de INSU se evidenciaron: Cutting, consumo de antidepresivos tricíclicos, acetaminofén y organofosforados. Conclusiones: La prevalencia de INSU crece aceleradamente con respecto a registros reportados en años anteriores en la misma institución; el hecho puede reflejar problemas en los programas de salud dirigidos a la promoción de la salud mental del adolescente.

Introducción: Se estima que el 86% de los pacientes receptores de un trasplante renal presentan una infección por microorganismos multirresistentes, principalmente de vías urinarias (IVU) en el postrasplante, lo cual se asocia a un mal pronóstico del injerto y del paciente. Objetivo: Describir los principales mecanismos de resistencia que se encuentran en la colonización de las vías urinarias, luego de ser sometido un paciente a un trasplante renal y algunos factores de riesgo que aumentan la probabilidad de complicaciones de este postoperatorio. Materiales y métodos: Se realizó una revisión de la literatura en bases de datos como Medline, Embase y ScienceDirect, empleando palabras claves validadas entre los años 2007 a 2017. Resultados: Los factores de riesgo asociados a la adquisición de IVU luego de un trasplante renal son sexo femenino, diabetes mellitus, anomalías de la vía urinaria e instrumentación de la uretra, los microorganismos asociados al trasplante renal son SARM (Staphylococcus aureus resistente a Meticilina) en un 20% en salas de nefrología y Escherichia coli y Klebsiella pneumonie tipo BLEE en un 30% y 28%. Conclusiones: Los mecanismos de resistencia de mayor prevalencia en trasplantes son causados por bacterias productoras de BLEE, asociados a la profilaxis postrasplante que se realiza.

Introduction: Ameloblastoma is a benign neoplasm that tends to be locally aggressive, with a high tendency to relapse. It is an odontogenic tumor of epithelial origin; 80% of cases occur at the mandibular level, both in branch and at an angle. It usually manifests during the third to fifth decade of life. The clinical characteristics are not determinants for the biological behavior or the prognosis of an ameloblastoma, even in many of the cases in which they are complemented with radiographs and/or histopathological samples. Objective: To report the surgical management of multicystic ameloblastoma in a radical way through a wide resection and placement of a reconstruction plate that functioned as a space maintainer, due to its unusual rapid growth. Case presentation: A clinical case of a male patient is described, who presents a tumor lesion in the right mandibular branch, with a clinical appearance of a multicystic, fast growing, follicular ameloblastoma, treated at Hospital Universitario del Caribe in Cartagena, Colombia. Data were provided on its clinical appearance, its rapid evolution, the histopathological findings and the therapeutic management performed. Conclusions: Due to its rapid growth, for this particular case, the most feasible option was to carry out the total resection of the lesion in order to avoid or reduce the possibility of relapse, followed by reconstruction with an osteosynthesis plate to restore the functionality of the temporomandibular joint and of the mandibular bone, without leaving aside the aesthetics of the patient.

Abstract Background Elderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment. Methods/design The purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD. Discussion The lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise. Trial registration Registro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy. Registered on 2 December 2016.

Introduction: Gitelman syndrome is a rare hereditary primary renal tubular disorder, with a prevalence of approximately 1 to 10 cases per 40 000 people. It does not have specific symptoms, so its diagnosis depends on high clinical suspicion by the treating physical and a sequential approach to hypokalemia, especially in young patients. Thus, a diagnostic algorithm is proposed at the end of this report. Case presentation: A 23-year-old woman with a history of hospitalization due to hypokalemia presented to the emergency service with intermittent cramping in her lower limbs, which was exacerbated by gastrointestinal symptoms. Laboratory tests reported the following findings: metabolic alkalosis, elevated levels of potassium, magnesium, chloride and sodium in urine, and reduced levels of calcium in urine. Thus, potassium supplementation and eplerenone administration were started, obtaining the complete resolution of symptoms. At her last follow-up appointment, the patient was asymptomatic, and her serum electrolyte levels were normal. In addition, during her hospital stay and due to the high suspicion of Gitelman syndrome, a genetic study was performed, which reported a mutation of the SCL12A3 gene, confirming the diagnosis. Conclusion: The sequential approach to a patient with recurrent hypokalemia is very important to reach an accurate diagnosis among a wide range of differential diagnoses.

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