ABSTRACT Purpose: Information is scarce regarding the comprehensive profile of patients with essential blepharospasm and hemifacial spasm in Brazil. The present study aimed to assess the clinical features of patients with these conditions, followed up in two reference centers in Brazil. Methods: The study included patients with essential blepharospasm and hemifacial spasm, followed up at the Departments of Ophthalmology at Universidade Federal de São Paulo and Universidade de São Paulo. Apart from demographic and clinical features, past stressful events related to the first symptoms (triggering event), aggravating factors, sensory tricks, and other ameliorating factors for the eyelid spasms were assessed. Results: A total of 102 patients were included in this study. Most patients were female (67.7%). Essential blepharospasm was the most frequent movement disorder [51/102 patients (50%)], followed by hemifacial spasm (45%) and Meige’s syndrome (5%). In 63.5% of the patients, the onset of the disorder was associated with a past stressful event. Ameliorating factors were reported by 76.5% of patients; 47% of patients reported sensory tricks. In addition, 87% of the patients reported the presence of an aggravating factor for the spasms; stress (51%) was the most frequent. Conclusion: Our study provides information regarding the clinical features of patients treated in the two largest ophthalmology reference centers in Brazil.

RESUMO Objetivo: Há poucos dados sobre o perfil de pacientes com blefaroespasmo essencial e espasmo hemifacial no Brasil. O objetivo deste estudo é avaliar de forma mais abrangente as características clínicas dos pacientes portadores dessas doenças acompanhados em dois centros de referência em oftalmologia no Brasil. Métodos: Pacientes com blefaroespasmo essencial e espasmo hemifacial, acompanhados nos Departamentos de Oftalmologia da Universidade Federal de São Paulo e da Universidade de São Paulo foram incluídos neste estudo. Além dos dados clínicos e demográficos, foram avaliados também a presença de eventos estressantes relacionados ao início dos sintomas (evento desencadeante), fatores agravantes, truques sensoriais, e outros fatores de melhora. Resultados: Cento e dois pacientes foram incluídos no estudo. A maior parte dos pacientes era do sexo feminino (67,7%). Blefaroespasmo essencial foi a condição mais frequente, observada em 51 (50%) dos pacientes. Espasmo hemifacial correspondia a 45% dos casos, enquanto 5% dos pacientes apresentavam a Síndrome de Meige. 63,5% dos pacientes associaram o início dos sintomas com um evento estressante prévio. 76,5% dos pacientes relataram fatores de melhora para os espasmos; 47% relataram truques sensoriais. Além disso, 87% dos pacientes relataram fatores de piora; estresse (51%) foi o mais frequente. Conclusão: Este estudo fornece informações a respeito das características clínicas dos pacientes com blefaroespasmo essencial e espasmo hemifacial acompanhados nos dois maiores centros de referência em oftalmologia do Brasil.

Abstract Background Infantile epileptic spasms syndrome (IESS) is a rare but severe condition affecting children early and is usually secondary to an identifiable brain disorder. It is related to psychomotor deterioration in childhood and epilepsy in adult life. Treatment is challenging as infantile spasms may not respond to most antiseizure medication, and relapse is frequent. Objective To evaluate the literature regarding treatment of IESS and provide a practical guidance to a healthcare system with limited resources. Methods An expert committee from the Brazilian Society of Child Neurology reviewed and discussed relevant scientific evidence in the treatment of IESS regarding the drugs available in Brazil. Results Oral prednisolone and vigabatrin are the most common drugs used as first-line therapy; they are efficient and affordable therapy as both are available in the Brazilian unified health system (SUS, in the Portuguese acronym). Intramuscular adrenocorticotropic hormone (ACTH) presents similar efficacy as oral prednisolone but has a higher cost and is not available in Brazil. Other antiseizure medications such as topiramate, levetiracetam, or benzodiazepines have limited response and are prescribed as adjuvant therapy. If the health service has nutritionists, a ketogenic diet should be implemented for those not responding to hormonal and vigabatrin treatment. Epilepsy surgery is mainly indicated for patients with focal lesions that do not respond to pharmacological therapy. Conclusion Early treatment of IESS with efficient drugs is feasible in our country. Using standard protocols increases the odds of achieving complete cessation in a shorter time and decreases relapse.

Resumo Antecedentes A síndrome do espasmo epiléptico infantil (IESS) é uma condição rara, mas grave, que afeta crianças precocemente e geralmente é secundária a um distúrbio cerebral identificável, estando relacionada a deterioração psicomotora na infância e a epilepsia na vida adulta. O tratamento é desafiador, pois os espasmos infantis podem não responder à maioria dos medicamentos anticrises e as recidivas são frequentes. Objetivo Avaliar a literatura sobre o tratamento de IESS e fornecer uma orientação prática para um sistema de saúde com recursos limitados. Métodos Um comitê de especialistas da Sociedade Brasileira de Neurologia Infantil revisou e discutiu evidências científicas relevantes no tratamento da IESS em relação aos medicamentos disponíveis no Brasil. Resultados Prednisolona oral e vigabatrina são os fármacos mais comumente usados como terapia de primeira linha; são eficientes e acessíveis, já que ambos estão disponíveis no sistema único de saúde brasileiro (SUS). O ACTH intramuscular apresenta eficácia semelhante à prednisolona oral, mas tem custo mais elevado e não está disponível no Brasil. Outros medicamentos anticonvulsivos, como topiramato, levetiracetam ou benzodiazepínicos, têm resposta limitada e são prescritos como terapia adjuvante. Se o serviço de saúde tiver nutricionista, deve-se implementar dieta cetogênica para aqueles que não respondem ao tratamento hormonal e vigabatrina. A cirurgia de epilepsia é indicada principalmente para pacientes com lesões focais que não respondem à terapia farmacológica. Conclusão O tratamento precoce da IESS com fármacos eficazes é factível em nosso meio. O uso de protocolos padronizados aumenta as chances de alcançar a cessação completa em um tempo menor e diminui a recaída.

RESUMO Objetivo: Há poucos dados sobre o perfil de pacientes com blefaroespasmo essencial e espasmo hemifacial no Brasil. O objetivo deste estudo é avaliar de forma mais abrangente as características clínicas dos pacientes portadores dessas doenças acompanhados em dois centros de referência em oftalmologia no Brasil. Métodos: Pacientes com blefaroespasmo essencial e espasmo hemifacial, acompanhados nos Departamentos de Oftalmologia da Universidade Federal de São Paulo e da Universidade de São Paulo foram incluídos neste estudo. Além dos dados clínicos e demográficos, foram avaliados também a presença de eventos estressantes relacionados ao início dos sintomas (evento desencadeante), fatores agravantes, truques sensoriais, e outros fatores de melhora. Resultados: Cento e dois pacientes foram incluídos no estudo. A maior parte dos pacientes era do sexo feminino (67,7%). Blefaroespasmo essencial foi a condição mais frequente, observada em 51 (50%) dos pacientes. Espasmo hemifacial correspondia a 45% dos casos, enquanto 5% dos pacientes apresentavam a Síndrome de Meige. 63,5% dos pacientes associaram o início dos sintomas com um evento estressante prévio. 76,5% dos pacientes relataram fatores de melhora para os espasmos; 47% relataram truques sensoriais. Além disso, 87% dos pacientes relataram fatores de piora; estresse (51%) foi o mais frequente. Conclusão: Este estudo fornece informações a respeito das características clínicas dos pacientes com blefaroespasmo essencial e espasmo hemifacial acompanhados nos dois maiores centros de referência em oftalmologia do Brasil.

ABSTRACT Purpose: Information is scarce regarding the comprehensive profile of patients with essential blepharospasm and hemifacial spasm in Brazil. The present study aimed to assess the clinical features of patients with these conditions, followed up in two reference centers in Brazil. Methods: The study included patients with essential blepharospasm and hemifacial spasm, followed up at the Departments of Ophthalmology at Universidade Federal de São Paulo and Universidade de São Paulo. Apart from demographic and clinical features, past stressful events related to the first symptoms (triggering event), aggravating factors, sensory tricks, and other ameliorating factors for the eyelid spasms were assessed. Results: A total of 102 patients were included in this study. Most patients were female (67.7%). Essential blepharospasm was the most frequent movement disorder [51/102 patients (50%)], followed by hemifacial spasm (45%) and Meige’s syndrome (5%). In 63.5% of the patients, the onset of the disorder was associated with a past stressful event. Ameliorating factors were reported by 76.5% of patients; 47% of patients reported sensory tricks. In addition, 87% of the patients reported the presence of an aggravating factor for the spasms; stress (51%) was the most frequent. Conclusion: Our study provides information regarding the clinical features of patients treated in the two largest ophthalmology reference centers in Brazil.

Abstract Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a puzzling clinical phenomenon with an unclear prognosis, characterized by evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography1. Currently, there are no guidelines for management, and many patients are discharged without a determined etiology, often meaning that optimal treatment gets postponed.We report three MINOCA case studies with main pathophysiological cardiac causes, particularly epicardial, microvascular, and non-ischemic, prompting differential management. The patients presented with acute chest pain, troponin raise, and no angiographically significant coronary disease.In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA concerning the relevant literature.MINOCA is considered to be a dynamic working diagnosis, including coronary, myocardial, and non-coronary disorders. Prospective studies and registries are needed to improve patient care and outcome.

Resumo O infarto do miocárdio com artérias coronárias não obstrutivas (MINOCA) é um fenômeno clínico intrigante e de prognóstico incerto, caracterizado pela evidência de infarto do miocárdio (IM) com artérias coronárias normais ou quase normais na angiografia1. Atualmente, não há diretrizes para o manejo e muitos pacientes recebem alta sem uma etiologia determinada, significando muitas vezes que o tratamento ideal é adiado.Relatamos três estudos de caso MINOCA com as principais causas fisiopatológicas cardíacas, particularmente epicárdicas, microvasculares e não isquêmicas, levando ao tratamento diferencial. Os pacientes apresentavam dor torácica aguda, aumento da troponina e nenhuma doença coronariana angiograficamente significativa.Neste estudo, analisamos a etiologia, diagnóstico clínico e tratamento da MINOCA em relação à literatura relevante.MINOCA é considerado um diagnóstico de trabalho dinâmico, incluindo distúrbios coronários, miocárdicos e não coronários. Estudos prospectivos e registros são necessários para melhorar o atendimento e o resultado do paciente.

ABSTRACT Introduction: Low back pain is defined as pain, muscle spasm, or stiffness between the L1 and L5 vertebrae, below the lower margin of the twelfth rib and above the upper gluteal fold, and may or may not be associated with pain radiating to the lower limbs. Objective: To determine the prevalence of low back pain in spine surgeons. Method: A non-randomized quantitative cross-sectional clinical study was carried out in a sample of 95 spine surgeons in Brazil, with the application of the Oswestry and visual analog pain scales, in addition to a structured questionnaire for the characterization of the participants. Results: Among the studied population, 69.5% were orthopedists, 30.5% were neurosurgeons, and the mean age of the sample was 46 years (±10.6), with neurosurgeons being older than orthopedists. Regarding BMI, the majority (77.8%) were overweight or obese, and seventy-six percent performed physical activity. The prevalence of low back pain was 58.9%. No relevant differences were found in the time spent weekly in surgeries between those who had low back pain and those who did not (p = 0.364). Mean pain intensity was 2.0 (SD = 2.2), statistically (p = 0.025) higher in orthopedists (2.3) when compared to neurosurgeons (1.3). Regarding the ODI score, 98.2% of the surgeons had a minimal disability (0-20%) for daily activities. Conclusion: The prevalence of low back pain in spine surgeons is high and is associated with mild inability to perform daily activities. Level Of Evidence IV; Non-Randomized Quantitative Cross-Sectional Clinical Study.

RESUMEN Introducción: La lumbalgia se define como dolor, espasmo muscular o rigidez entre las vértebras L1 y L5, por debajo del margen inferior de la duodécima costilla y por encima del pliegue glúteo superior, y puede o no asociarse a dolor irradiado a las extremidades inferiores. Objetivo: Determinar la prevalencia de dolor lumbar en cirujanos de columna. Método: Se realizó un estudio clínico transversal cuantitativo no aleatorizado en una muestra de 95 cirujanos de columna en Brasil, con la aplicación de las escalas de dolor de Oswestry y analógica visual, además de un cuestionario estructurado para la caracterización de los participantes. Resultados: Entre la población estudiada, el 69,5% eran ortopedistas y el 30,5% neurocirujanos y la edad media de la muestra fue de 46 años (±10,6), siendo los neurocirujanos mayores que los ortopedistas. En cuanto al IMC, la mayoría (77,8%) presentaba sobrepeso u obesidad y el setenta y seis por ciento realizaba actividad física. La prevalencia de dolor lumbar fue del 58,9%. No se encontraron diferencias relevantes en el tiempo dedicado semanalmente a las cirugías, entre los que tenían lumbalgia y los que no (p = 0,364). La intensidad media del dolor fue de 2,0 (DP = 2,2), siendo estadísticamente (p = 0,025) mayor en traumatólogos (2,3) que en neurocirujanos (1,3). En cuanto a la puntuación ODI, el 98,2% de los cirujanos tenían incapacidad mínima (0-20%) para las actividades diarias. Conclusión: La prevalencia de lumbalgia en cirujanos de columna es alta y se asocia a incapacidad leve para realizar las actividades cotidianas. Nivel de Evidencia IV; Estudio Clínico Transversal Cuantitativo no Aleatorizado.

RESUMO Introdução: A lombalgia é definida como dor, espasmo muscular ou rigidez entre as vértebras L1 e L5, abaixo da margem inferior da décima segunda costela e acima da prega glútea superior, e pode ou não estar associada à dor que se irradia para os membros inferiores. Objetivo: Determinar a prevalência de lombalgia em cirurgiões de coluna. Método: Foi realizado um estudo clínico transversal quantitativo não randomizado em uma amostra de 95 cirurgiões de coluna do Brasil, com aplicação das escalas Oswestry e visual analógica da dor, além de questionário estruturado para a caracterização dos participantes da pesquisa. Resultados: Dentre a população estudada, 69,5% eram ortopedistas e 30,5% eram neurocirurgiões e a idade média da amostra foi de 46 anos (±10,6), sendo que os neurocirurgiões eram mais velhos que os ortopedistas. Em relação ao IMC a maioria (77,8%) estavam com sobrepeso e obesidade e setenta e seis porcento realizavam atividade física. A prevalência de lombalgia foi de 58,9%. Não foram encontradas diferenças relevantes no tempo gasto semanalmente em cirurgias, entre quem tinha ou não lombalgia (p = 0,364). A intensidade média da dor foi de 2,0 (DP = 2,2), sendo estatisticamente (p = 0,025) maiores em ortopedistas (2,3) quando comparados aos neurocirurgiões (1,3). Em relação ao escore do ODI, 98,2% dos cirurgiões apresentaram incapacidade mínima (0-20%) para as atividades diárias. Conclusão: A prevalência de lombalgia em cirurgiões de coluna é grande e está associada com incapacidade leve para atividades cotidianas. Nível de Evidência IV; Estudo Clínico Transversal Quantitativo não Randomizado.

ABSTRACT Objective: To determine the clinical adverse events related to the use of femoral and radial artery access in patients who underwent interventional cardiology procedures in the Hospital Nacional Hipólito Unanue from 2015 to 2017. Materials and methods: A comparative, retrospective, observational and analytical study was conducted with a total of 151 medical records of patients who had clinical adverse events. Medical record review was used as data collection technique, and a data collection sheet designed by the researcher was used as instrument. The R software was used for the analysis. Results: Out of 151 cardiac catheterizations, 51.66 % were performed by a femoral artery access and 48.34 % by a radial artery access. The average age of the patients was 59.6 ± 11.3 years, out of which 39.73 % ranged between 60 and 70 years, and 73.50 % of the patients were males. The most frequent comorbidities were arterial hypertension and diabetes mellitus. Non-serious clinical adverse events occurred as a result of both vascular access procedures; however, their incidence was high. Fifty percent (50%) of the patients who underwent a femoral artery access procedure showed the following adverse events: hematoma (25.60 %), bleeding (9 %), ischemia (1.30 %), vagal response (1.30 %), pseudoaneurysm (1.30 %), a rare skin rash that looked like a burn (1.30 %) and pain (10.20 %). In contrast, 19.14 % of the patients who underwent a radial artery access procedure presented hematoma (8.21 %), bleeding (2.73 %), radial artery spasm (1.40 %) and pain (6.80 %). Conclusions: After determining the clinical adverse events, it was concluded that radial artery access is better than femoral artery access for interventional cardiology procedures.

RESUMEN Objetivo: Determinar cuáles fueron los eventos clínicos adversos relacionados con el uso del método femoral y método radial en pacientes que fueron sometidos a procedimientos de cardiología intervencionista en el Hospital Nacional Hipólito Unanue, durante el periodo 2015-2017. Materiales y métodos: La metodología fue comparativa, retrospectiva, con diseño observacional y analítico. Se trabajó con un total de 151 historias clínicas de pacientes que presentaron eventos clínicos adversos. Se empleó la revisión documental como técnica de recolección de datos, y una ficha de recolección de datos como instrumento, la cual fue diseñada por el investigador. Para realizar el análisis se utilizó el programa R. Resultados: De 151 cateterismos cardiacos, el 51,66 % se realizó por el método femoral y 48,34 %, por el método radial. Con respecto a la edad de los pacientes, el promedio fue 59,6 ±11,3 años; el 39,73 % de ellos estuvo entre el rango de 60 a 70 años; y el 73,50 % fueron pacientes del sexo masculino. En cuanto a las comorbilidades, la hipertensión arterial y la diabetes mellitus fueron las enfermedades más recurrentes entre los pacientes. Se presentaron eventos clínicos adversos relacionados con el uso de ambos métodos de acceso vascular, aunque no se consideraron graves; sin embargo, su incidencia es alta. Para la muestra del método femoral, en 50 % de los casos, se presentó hematoma (25,60 %), hemorragia (9 %), isquemia (1,30 %), reacción vagal (1,30 %), pseudoaneurisma (1,30 %), un caso raro tipo quemadura (1,30 %) y dolor (10,20 %); mientras que, en el método radial, en 19,14 % de los casos, se presentó hematoma (8,21 %), hemorragia (2,73 %), espasmo radial (1,40 %) y dolor (6,80 %). Conclusiones: Después de que se determinó cuáles eran los eventos clínicos adversos, se llegó a la conclusión de que es mejor usar el método radial en vez del método femoral para procedimientos de cardiología intervencionista.

ABSTRACT Introduction: stiff-person syndrome (SPS) is a rare immune-mediated central nervous system disorder characterized by painful contraction, stiffness and spasms affecting the axial and peripheral musculature in a progressive manner. Case report: a 47-year-old male patient, affected by stiffness and weakness in the right lower extremity, progressing in weeks to the other lower extremity and in months to the axial and proximal musculature of the four extremities; making ambulation, trunk flexion and arm movement difficult. He presented lumbar hyperlordosis and muscle spasms. Electromyography showed continuous muscle activity in agonist and antagonist muscles. Stiff person syndrome (SPS) was diagnosed. The treatment applied was immunomodulator (steroids and intravenous immunoglobulins) and symptomatic with benzodiazepines, baclofen and physical therapy, the evolution was satisfactory. Conclusions: SPS is not frequent in neurological-clinical practice, its definitive diagnosis depends on specific complementary studies, and its clinical manifestations make it detectable allowing timely management and prevention of disabilities associated with these patients.

RESUMEN Introducción: el síndrome de la persona rígida es una afectación del sistema nervioso central, inmunomediada e infrecuente, caracterizada por contracción, rigidez y espasmos dolorosos que afectan la musculatura axial y periférica de forma progresiva. Presentación de caso: se trata de un paciente masculino de 47 años de edad, afecto de rigidez y debilidad en la extremidad inferior derecha, progresa en semanas a la otra extremidad inferior y en meses a la musculatura axial y proximal de las cuatro extremidades; lo que dificulta la deambulación, la flexión del tronco y el movimiento de los brazos. Presentó hiperlordosis lumbar y espasmos musculares. La electromiografía mostró actividad muscular continua en músculos agonistas y antagonistas. Se diagnosticó síndrome de la persona rígida. El tratamiento aplicado fue inmunomodulador (esteroides e inmunoglobulinas endovenosas) y sintomático con benzodiacepinas, baclofeno y terapia física, la evolución fue satisfactoria. Conclusiones: el síndrome de la persona rígida es infrecuente en la práctica clínica neurológica, su diagnóstico definitivo depende de estudios complementarios específicos, sus manifestaciones clínicas lo hacen detectable, lo que permite el manejo oportuno y la prevención de las discapacidades asociadas a estos pacientes.

ABSTRACT Introduction: the spontaneous subarachnoid hemorrhage is the extravasation of blood into the subarachnoid spaces, its most frequent cause is the rupture of an intracranial aneurysm. Objective: to characterize clinically and epidemiologically and anatomopathologically the spontaneous subarachnoid hemorrhage in the “Arnaldo Milián Castro” Hospital during 2018. Methods: a descriptive observational study was carried out, of retrospective longitudinal cut, in the period from January to December 2018. The sample to be studied consisted of 32 patients. Results: the most affected sex was female (19, 59.4%), the predominant cause was aneurysmal (17, 53.1%), followed by arterial hypertension (18.8%), vasospasm (34.4%) and endocranial hypertension (21.9%). Conclusions: the most affected sex was female and, in relation to age, the 60 to 69 years age group was more predominant. The predominance of aneurysmal causes was determined, followed by those secondary to arterial hypertension, and the most frequently affected arteries were the middle cerebral and posterior communicating arteries. The most frequent complications were rebleeding and endocranial hypertension. The majority of patients had a fatal outcome and the aneurysmal cause predominated according to the anatomopathological report.

RESUMEN Introducción: la hemorragia subaracnoidea espontánea es la extravasación de sangre hacia los espacios subaracnoideos, su causa más frecuente es la rotura de un aneurisma intracraneal. Objetivo: caracterizar clínica y epidemiológicamente y anatomopatológicamente la hemorragia subaracnoidea espontánea en el Hospital “Arnaldo Milián Castro” durante el año 2018. Métodos: se realizó un estudio observacional descriptivo, de corte longitudinal retrospectivo, en el período comprendido entre enero y diciembre de 2018. La muestra a estudiar estuvo conformada por 32 pacientes. Resultados: el sexo más afectado fue el femenino (19, 59,4%), predominó la causa aneurismática (17, 53,1%), seguida por la hipertensión arterial (18,8%), el vaso espasmo (34,4%) y la hipertensión endocraneana (21,9%). Conclusiones: el sexo más afectado fue el femenino y, en relación con la edad, predominó el grupo de 60 a 69 años. Se determinó el predominio de la causa aneurismática, seguido por la secundaria a hipertensión arterial, y que las arterias más frecuentemente afectadas fueron la cerebral media y la arteria comunicante posterior. Las complicaciones más frecuentes fueron el resangrado y la hipertensión endocraneana. La mayoría de los pacientes tuvo un desenlace fatal y predominó la causa aneurismática según el informe anatomopatológico.

ABSTRACT Introduction: A digital literature search was carried out. Articles in Spanish and English that were significant in the subject under study were reviewed, in order to identify the theoretical references about pseudomyopia, considered apparent myopia, of acute onset. Objective: identify the most characteristic symptoms, signs and treatments in case of excess accommodation. Development: Today, with the confinement caused by the Covid 19 Pandemic and analyzing all these elements, the following question pops up: WHAT HAPPENED DURING THE CONFINEMENT WITH OUR ACCOMMODATION SYSTEM? Which represents a global challenge. In many cases, most of the time has been spent without being able to fully relax the accommodation, as I was using my vision almost all day at distances less than 6 m. The consequences of this situation, not natural for our vision, are problems such as: accommodative excess that maintained over time can generate an accommodative spasm, also called pseudomyopia, which generates blurred vision from a distance and can be confused with myopia. Conclusions: It is difficult to understand how a basic issue, so inescapably associated with the daily work of the ophthalmologist and optometrist, even more so in these times when humanity has had to experience such a complex moment, may have received so little attention in the literature, where a correct diagnosis, timely and effective visual therapy in these cases would avoid the structuring of artificial myopia.

RESUMEN Introducción: Se realizó una búsqueda en la literatura digital. Se revisaron artículos en español y en inglés que resultaron significativos de la temática en estudio, con el propósito de identificar los referentes teóricos acerca de la pseudomiopía, considerada miopía aparente, de inicio agudo. Objetivo: identificar síntomas, signos y tratamientos más característicos en caso de exceso de acomodación. Desarrollo: Hoy en día con el confinamiento producto a la Pandemia de la Covid 19 y analizando todos estos elementos nos salta la siguiente interrogante: ¿QUÉ HA PASADO DURANTE EL CONFINAMIENTO CON NUESTRO SISTEMA ACOMODATIVO? Lo que representa un reto mundial. En muchos casos se ha pasado la mayor parte del tiempo sin poder relajar la acomodación totalmente, por estar usando la visión casi todo el día a distancias menores de 6 m. Las consecuencias de esta situación, nada natural para nuestra visión, son problemas como: exceso acomodativo que mantenido en el tiempo puede generar un espasmo acomodativo, también llamado pseudomiopía, que genera visión borrosa de lejos y puede confundirse con una miopía. Conclusiones: Es difícil entender cómo un tema básico, tan ineludiblemente asociado al quehacer diario del oftalmólogo y optometrista, más aún en estos tiempos en los que la humanidad ha tenido que vivir un momento tan complejo, puede haber recibido tan poca atención en la literatura, donde un correcto diagnóstico, terapia visual oportuna y eficaz en estos casos evitaría la estructuración de la miopía artificial.

Abstract Cardiovascular disease is the leading cause of death in adults around the world. Young adult population has suffered changes in lifestyle over the decades, favoring the appearance of atherosclerosis at early ages, and as a consequence, the incidence of cardiovascular events emerges prematurely. It has been identified that most common risk factors are potentially modifiable. There is a greater prevalence of non-atherosclerotic etiologies of myocardial infarction such as spontaneous coronary dissection, congenital malformations, coronary embolism, and coronary spasm. Different angiographic findings and outcomes according to age and gender have been recognized. For this reason, we searched PubMed for published research and registries for the study of acute myocardial infarction in young patients. With this data, we carried out the present review to better understand the common findings in this group, and to compare them with older age groups.

Resumen La enfermedad cardiovascular persiste como primera causa mundial de muerte en los adultos. La población de adultos jóvenes ha cursado con cambios en el estilo de vida con el paso de las décadas, favoreciendo la aparición de ateroesclerosis en etapas más tempranas y como consecuencia la aparición de eventos cardiovasculares de manera más prematura. Se ha identificado que dentro de los factores de riesgo más comunes, la mayoría de ellos son potencialmente modificables. En comparación con adultos mayores, se ha identificado con mayor prevalencia la presencia de etiologías no ateroescleróticas de infarto de miocardio, como la disección coronaria espontánea, alteraciones anatómicas, embolia y espasmo coronarios. Los hallazgos angiográficos y desenlaces son diferentes de acuerdo con el grupo de edad y el sexo. Por dicho motivo realizamos una búsqueda en PubMed de los estudios y registros publicados para el estudio del infarto agudo de miocardio en paciente jóvenes. Con dicha información realizamos la presente revisión con el objetivo de una mejor comprensión de los hallazgos comunes en este grupo y realizar su comparación con grupos de mayor edad.

Abstract: During sedation in endoscopic procedures of the lower and upper digestive tract, it is common for ventilatory and hemodynamic complications to arise. This article presents a review of the strategies to treat and prevent the most common ventilatory complications: laryngeal spasm, apnea due to intravenous anesthetic drugs and bronchospasm. Hemodynamic complications are also reviewed: vagal reflex and acute hypotension. A management algorithm is proposed which synthesizes and schematizes the prophylactic and therapeutic measures described in the bibliography, ordering them by their priority and effectiveness, allowing to clearly identify the degree of treatment necessary and the viability of the endoscopic procedure.

Resumen: Durante la sedación en procedimientos endoscópicos del tubo digestivo alto y bajo, es frecuente que se susciten complicaciones ventilatorias y hemodinámicas. Se presenta una revisión de las estrategias para prevenir y tratar las complicaciones ventilatorias más frecuentes: espasmo laríngeo, apnea por fármacos anestésicos endovenosos y broncoespasmo. También se revisan las complicaciones hemodinámicas: reflejo vagal e hipotensión aguda. Se propone un algoritmo de manejo que sintetiza y esquematiza las medidas profilácticas y terapéuticas descritas en la literatura, ordenándolas de acuerdo a su prioridad y eficacia, permitiendo identificar con claridad el nivel de tratamiento necesario y la viabilidad del procedimiento endoscópico.

Abstract Hemifacial spasm consists of an unfrecuent movement disorder involving facial muscles, especially those from the upper half of the face. Two different clinical presentations are described. Primary hemifacial spasm is defined by a neurovascular conflict, and secondary occurs when facial nerve is damaged by a space occupying lesion. It is of special interest for the otorhinolaryngologist to get to know about this condition and to be able to acknowledge its clinical presentations due to the different therapeutical approach that may be needed for each of them. We contribute with a general vision of this entity reviewing its epidemiology and patophysiology. Furthermore, we show our experience by sharing a four-case series which we believe to illustrate the different ways of presentation as well as the alarm signs and symptoms that may be helpful in order to accomplish an accurate diagnose and treatment.

Resumen El espasmo hemifacial consiste en un infrecuente trastorno del movimiento que afecta a la musculatura inervada por el nervio facial, en especial la de la hemicara superior. Existen dos formas clínicas, una primaria en la que la causa subyacente está representada por un conflicto neurovascular, y una secundaria, en la que la alteración del nervio facial es producida por algún tipo de lesión ocupante de espacio. Resulta de especial interés para el otorrinolaringólogo conocer esta entidad y ser capaz de diferenciar ambas formas clínicas dado el diferente enfoque terapéutico que pueden requerir. Aportamos una visión general de esta patología repasando su epidemiología y fisiopatología, además, de nuestra experiencia en forma de una serie de cuatro casos que ilustran las variadas formas de presentación de esta entidad, así como los signos y síntomas de alarma que pueden ayudar a realizar un correcto diagnóstico y manejo.

ABSTRACT Introduction: High-resolution manometry is the gold standard for the study of esophageal motor disorders. Objective: A descriptive, cross-sectional research was carried out in el Centro Nacional de Cirugía de Mínimo Acceso, between September 2018 and December 2019, in 56 patients, diagnosed with esophageal motor disorder by high-resolution manometry, aged between 18 and 20 years, who gave their consent to participate in the study. Esophageal achalasia and minor peristalsis disorders were excluded. The variables included were: age, sex, manometric diagnoses and their characteristics, symptoms, types of esophagogastric junction, imaging or endoscopic diagnoses. For the analysis of the results, the percentage, measures of central tendency and Pearson's chi square of homogeneity were used, with a level of statistical significance p ≤ 0.05 and 95 % reliability. Development: Absent contractility (39,28 %), female sex (58,9 %) and dysphagia (66,07 %) predominated. The obstruction to the flow of the esophagogastric junction corresponded to the highest mean resting pressure of the lower esophageal sphincter (43,28 mmHg) and the mean integrated pressure ratio above 15 mmHg (38,88 mmHg). The hypercontractile esophagus presented mean high integrated distal contractility (5564,25 mmHg/s/cm). Rapid contractions were found in distal esophageal spasm (mean 21,4 cm/s). Conclusions: High resolution manometry was feasible to be used for the diagnosis of major esophageal motor disorders.

RESUMEN Introducción: La manometría de alta resolución es la prueba de referencia para el estudio de los trastornos motores esofágicos. Objetivo: Determinar la factibilidad de la manometría de alta resolución para el estudio de las características de los trastornos motores esofágicos. Métodos: Se realizó una investigación descriptiva, transversal, en el Centro Nacional de Cirugía de Mínimo Acceso, entre septiembre de 2018 y diciembre de 2019, en 56 pacientes cubanos con diagnóstico de trastorno motor esofágico por manometría de alta resolución, con edades entre 18 y 80 años, que dieron su consentimiento para participar en el estudio. Se excluyeron pacientes con acalasia esofágica y los trastornos menores de la peristalsis. Las variables incluidas fueron: edad, sexo, diagnósticos manométricos y sus características, síntomas, tipos de unión esofagogástrica, diagnósticos imagenológicos o endoscópicos. Para el análisis de los resultados se empleó el porcentaje, medidas de tendencia central y ji cuadrado de Pearson de homogeneidad, con un nivel de significación p ≤ 0,05 y 95 % de confiabilidad. Resultados: Predominó la contractilidad ausente (39,28 %), el sexo femenino (58,9 %) y la disfagia (66,07 %). A la obstrucción al flujo de la unión esofagogástrica correspondió la media de presión de reposo del esfínter esofágico inferior más alta (43,28 mmHg) y la media de la presión de relación integrada por encima de 15 mmHg (38,88 mmHg). El esófago hipercontráctil presentó media de contractilidad distal integrada elevada (5564,25 mmHg/s/cm). Se comprobó la existencia de contracciones rápidas en el espasmo esofágico distal (media de 21,4 cm/ s). Conclusiones: La manometría de alta resolución es factible de ser empleada para el diagnóstico de los trastornos motores esofágicos.

Abstract: Introduction: Ductus arteriosus stenting is a palliative alternative for neonates with ductal-dependent pulmonary flow. Objective: To present an alternative of arterial access for percutaneous coronary intervention in neonates. Clinical Case: A term neonate with low weight diagnosed with pulmonary atresia with intact ventricular septum and severe hypoplasia of the tricuspid valve with dependent coronary circu lation. Due to the surgical risk and femoral artery damage and the anatomy of the ductus arteriosus, a left axillary arterial puncture was decided where a 3.5-millimeter coronary stent was successfully placed. The patient developed an axillary spasm that resolved spontaneously. Conclusion: Alternati ve arterial access other than the femoral artery route is an option for neonates with high surgical risk and low birth weight.

Resumen: Introducción: El implante de stent en el conducto arterioso es una alternativa paliativa para neonatos con flujo pulmonar dependiente. Objetivo: Presentar una alternativa de acceso arterial para intervención percutánea en neonatos. Caso Clínico: Neonato a término con bajo peso, con diagnóstico de atresia pul monar con septum interventricular intacto e hipoplasia grave de la válvula tricúspide con circulación coronaria dependiente. Por el riesgo quirúrgico y de daño arterial femoral y por la anatomía del con ducto se decidió punción arterial axilar izquierda por donde se implantó exitosamente stent ductal coronario de 3,5 milímetros. Se presentó espasmo axilar que resolvió espontáneamente. Conclusión: Los accesos arteriales alternativos diferentes a la vía arterial femoral son una opción para neonatos de alto riesgo quirúrgico y bajo peso.

ABSTRACT The case report of a 13 years adolescent, with history of good health who just received immunization during the neonatal period is presented. He suffered from a wound caused by a rusty nail in the back of the right foot and he went to the Wete Hospital in Zanzibar, Tanzania, presenting muscular pains, spread spasms, sardonic laugh and trismus, reason why he was diagnosed spread tetanus. Treatment was prescribed with parenteral hydration, anti-tetanus toxin, anti-tetanus toxoide, antibiotics, sedative and total cure of this wound. After 2 months of hospitalization the patient had a favorable clinical course.

RESUMEN Se presenta el caso clínico de un adolescente de 13 años de edad, con antecedentes de buena salud, quien solo recibió inmunización durante la etapa neonatal, el cual sufrió una herida causada por un clavo enmohecido en el dorso del pie derecho y acudió al Hospital Wete de Zanzíbar, Tanzania, por presentar dolores musculares, espasmos generalizados, risa sardónica y trismo, por lo cual se le diagnosticó tétanos generalizado. Se prescribió tratamiento médico con hidratación parenteral, toxina antitetánica, toxoide tetánico, antibióticos, sedantes y curación local de dicha herida. Luego de 2 meses de hospitalización el paciente tuvo una evolución satisfactoria.