This study aims to propose a new method for derivatizing fatty acids (FAs) from human milk (HM), eliminating the lipid extraction step, and simplifying the preparation for gas chromatography with a flame ionization detection (GC-FID) analysis to quantify the FAs. The Design Expert software optimized the reaction times, concentrations, and sample amount. The proposed method (PM) was validated for lyophilized HM and results for the figures of merit for precision in relative standard deviation (RSD) (RSDintra-day 1.34-4.03% and RSDinter day 2.08 5.16%), accuracy (99.87-102.16%), and robustness are within a linear range of 3 to 38% lipids in HM samples. The atmospheric solids analysis probe tandem mass spectrometry (ASAP-MS/MS) technique confirmed the efficiency of PM by expressing the molecular composition of triacylglycerol formed by FAs from the GC-FID technique. The PM requires a small sample size and conducts derivatization directly in the sample matrix, minimizing extraction errors. (FAs HM, , (HM) step GCFID GC FID (GC-FID times concentrations amount (PM RSD (RSD RSDintraday RSDintra 1.344.03% 134403 1.34 4.03% 1 34 4 03 1.34-4.03 208 2 08 2.0 5.16%, 516 5.16% 5 16 5.16%) 99.87102.16%, 998710216 99.87 102.16% 99 87 102 (99.87-102.16%) 38 samples ASAPMS/MS ASAPMSMS ASAP MS/MS MS (ASAP-MS/MS matrix errors (HM 344 1.344.03 13440 134 1.3 403 4.03 0 1.34-4.0 20 2. 51 5.16 87102 99.87102.16% 99871021 9987 99.8 10216 102.16 9 8 10 (99.87-102.16% ASAPMS MSMS 1.344.0 1344 13 1. 40 4.0 1.34-4. 5.1 8710 99.87102.16 9987102 998 99. 1021 102.1 (99.87-102.16 1.344. 4. 1.34-4 5. 871 99.87102.1 998710 102. (99.87-102.1 1.344 1.34- 99.87102. 99871 (99.87-102. 99.87102 (99.87-102 99.8710 (99.87-10 99.871 (99.87-1 (99.87- (99.87 (99.8 (99. (99 (9 (

ABSTRACT Aging and face sagging have many causes, and various techniques are used for treatment, including noninvasive procedures, such as focused ultrasound, which uses the principle of collagen regeneration by coagulative necrosis of the dermis layers using radiofrequency, but this procedure has complications. We reported a case of a 54-year-old female patient who complained of poor visual acuity in her right eye three days after a focused ultrasound facial aesthetic procedure, with the best visual acuity of 20/60. Biomicroscopy of the right eye revealed an acute cataract with three points of fibrosis extending from the posterior to the anterior capsule. The patient underwent phacoemulsification surgery with visual rehabilitation and improved vision of 20/20. We hypothesized that the occurrence of acute cataract was related to the inappropriate use of focused ultrasound. causes treatment procedures radiofrequency complications 54yearold yearold 54 year old 2060 20 60 20/60 capsule 2020 20/20 5 206 2 6 20/6 202 20/2 20/

RESUMO: O objetivo deste relato é descrever o auxílio da elastografia por impulso de força de radiação acústica (ARFI) no diagnóstico de dois casos de tumores malignos da bainha dos nervos periféricos em canídeos. Ambos os pacientes apresentavam claudicação em membro torácico e já haviam sido tratados clinicamente por outros profissionais, sem resposta ao tratamento ou histórico de trauma. Ao exame físico, foi observada atrofia muscular em apenas um dos membros torácicos, nos dois casos. Foi realizado exame ultrassonográfico axilar. Na avaliação modo B, foi observada a presença de estrutura nodular, predominantemente hipoecogênica, heterogênea, irregular, não encapsulada e com reatividade adjacente, medindo aproximadamente 20.1 mm x 15.4 mm no primeiro caso e 18.3 mm x 10.7 mm no segundo caso. Foi realizada elastografia ARFI, demonstrando a presença de áreas de maior rigidez, com velocidade de ondas de cisalhamento média de 4.12 m/s (caso 1) e 4.35 m/s (caso 2), sugerindo malignidade. Em ambos os casos, foi realizada amputação do membro afetado e os nódulos removidos foram encaminhados para análise histopatológica, na qual se obteve o diagnóstico de tumor maligno da bainha de nervo periférico. Os métodos ultrassonográficos realizados nesses casos foram essenciais para o diagnóstico e conduta terapêutica. RESUMO ARFI (ARFI canídeos profissionais trauma físico torácicos axilar B nodular hipoecogênica heterogênea irregular adjacente 201 20 1 20. 154 15 4 15. 183 18 3 18. 107 10 7 10. rigidez 412 12 4.1 ms m s 435 35 4.3 2, 2 , 2) malignidade histopatológica periférico terapêutica 41 4. 43

ABSTRACT: This report described the use of acoustic radiation force impulse (ARFI) elastography in the diagnosis of two cases of canine malignant peripheral nerve sheath tumors. Both patients presented with lameness in the thoracic limb and no response to previous clinical treatment or trauma history. Physical examination revealed muscular atrophy in one of the thoracic limbs, in both dogs. B-mode axillary ultrasound showed the presence of a predominantly hypoechogenic, heterogeneous, irregular, nonencapsulated nodule with adjacent reactivity, measuring approximately 20.1 mm x 15.4 mm in the first case and 18.3 mm x 10.7 mm in the second. ARFI elastography was performed, showing areas of significant stiffness, with an average shear wave velocity of 4.12 m/s (case 1) and 4.35 m/s (case 2), suggesting malignancy. In both cases, the affected limb was amputated, and the tumors sent for histopathological analysis, which were; subsequently, diagnosed as malignant tumors of the peripheral nerve sheath. The ultrasonographic methods used were essential in the diagnosis and therapeutic conduct. ABSTRACT (ARFI history limbs dogs Bmode B mode hypoechogenic heterogeneous irregular reactivity 201 20 1 20. 154 15 4 15. 183 18 3 18. 107 10 7 10. second performed stiffness 412 12 4.1 ms m s 435 35 4.3 2, 2 , 2) malignancy amputated analysis subsequently conduct 41 4. 43

ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis. Purpose followup. followup follow up. up Methods 2 201 2021 demographics diagnosis acuity analyzed Results intermediate longterm long term However glaucoma formation endophthalmitis occurred plate structures tissues Conclusion highrisk high risk 202

This work aimed to incorporate the active compounds of the jambolan leaf in sunflower seed oil, in order to increase the nutritional quality of the oil. For this purpose, ultrasound-assisted extraction was conducted to establish the process conditions related to temperature, potency, solvent:sample ratio and time to obtain the enriched sunflower seed oil (ESSO). An experimental design was applied to examine the effect of variables (temperature, power, solvent:sample ratio and time) on the extraction mass yield (EMY). The application of maximum temperature, increased power, sample:solvent ratio and time resulted in higher EMY. Maximum theoretical EMY value was 35.16% (60 °C, 100%, 1:12 g mL-1 and 15 min). The characterization of the oils obtained from ESSO and sunflower seed oil (SSO) verified a higher content of flavonoids, phenolic compounds, a large proportion of active compounds, antioxidant activity, content of phytosterols, α-tocopherol and squalene, and induction time for ESSO. purpose ultrasoundassisted ultrasound assisted temperature potency solventsample solvent sample . (ESSO) (temperature power (EMY) samplesolvent 3516 35 16 35.16 60 (6 C °C 100 100% 112 1 12 1:1 mL1 mL mL- min. min min) SSO (SSO flavonoids activity phytosterols αtocopherol α tocopherol squalene (ESSO (EMY 351 3 35.1 6 ( 10 11 1: 35.

ABSTRACT: This study explored the use only of ultrasound (US) for extracting proteins from grass carp (Ctenopharyngodon idella) backbones at low temperature and examined its impact on hydrophobicity, solubility, electrophoretic profile, and sulfhydryl levels. Backbones were treated with 35 and 130 kHz for 20, 30, and 40 minutes at 14 ºC, resulting in two protein fractions: solid (TPS) and liquid (TPL). US increased yield compared to the non-sonicated fraction. TPL (35 kHz) exhibited a 16% reduction in total and free sulfhydryl levels and a 25% increase in hydrophobicity. US induced protein conformation and band intensity alterations, particularly between 25 to 100 kDa for TPL at 130 kHz and below 30 kDa for TPS at 35 kHz. This study demonstrated the efficacy of US for protein extraction from fish by-products and its capacity to modify protein characteristics, facilitating the development of innovative food products. ABSTRACT (US Ctenopharyngodon idella hydrophobicity solubility profile 3 13 20 4 1 ºC fractions (TPS TPL. . (TPL) nonsonicated non sonicated fraction (3 16 alterations 2 10 byproducts by products characteristics (TPL (

RESUMO: Este estudo explorou o uso exclusivo do ultrassom (US) para extrair proteínas das espinhas dorsais da carpa-capim (Ctenopharyngodon idella) em baixas temperaturas e examinou seu impacto na hidrofobicidade, solubilidade, perfil eletroforético e níveis de sulfidrilas. As espinhas dorsais foram tratadas com 35 e 130 kHz por 20, 30 e 40 minutos a 14 ºC, resultando em duas frações de proteínas: sólida (TPS) e líquida (TPL). O US aumentou o rendimento em comparação com a fração não sonificada. TPL (35 kHz) apresentou uma redução de 16% nos níveis totais e livres de sulfidrila e um aumento de 25% na hidrofobicidade. O US induziu alterações na conformação proteica e na intensidade das bandas, especialmente entre 25 e 100 kDa para TPL a 130 kHz e abaixo de 30 kDa para TPS a 35 kHz. Este estudo demonstrou a eficácia do US na extração e na modificação de algumas propriedades das proteínas de subprodutos de peixe, facilitando assim seu emprego no desenvolvimento de produtos alimentícios inovadores. RESUMO (US carpacapim carpa capim Ctenopharyngodon idella hidrofobicidade solubilidade sulfidrilas 3 13 20 4 1 ºC (TPS TPL. . (TPL) sonificada (3 16 bandas 2 10 peixe inovadores (TPL (

Abstract This article aims to provide an overview of the diagnostic imaging techniques currently available for the study of peripheral nerves. It focuses on reviewing the anatomy, since an adequate knowledge is essential for the correct interpretation of the images. The use of ultrasound, its indications, its use in the most common pathologies, advantages and disadvantages are discussed. The use of magnetic resonance imaging (MRI) is analyzed, including MRI neurography, which refers to an optimization of standard sequences to enhance the contrast of peripheral nerves and adjacent anatomical structures. Other techniques under development are also mentioned, such as elastography, which is shown to be a promising complementary technique to standard ultrasound, diffusion tensor imaging and tractography, discussing their future possibilities in the study of peripheral nerves.

Resumen Este artículo tiene como objetivo proporcionar una descripción general de las modalidades de diagnóstico por imágenes disponibles actualmente para el estudio de los nervios periféricos. Se enfoca en la revisión de la anatomía, por cuanto un conocimiento adecuado es fundamental para la correcta interpretación de las imágenes. Se discute el uso del ultrasonido, sus indicaciones, su uso en patologías más frecuentes, ventajas y desventajas. Se analiza el uso de la resonancia magnética (RM), incluyendo la neurografía por RM, que se refiere a una optimización de las secuencias estándar para mejorar el contraste de los nervios periféricos y estructuras anatómicas adyacentes. Se mencionan además otras técnicas en desarrollo como la elastografía, que se muestra como una prometedora técnica complementaria al ultrasonido estándar, el tensor de difusión y la tractografía, discutiendo sus posibilidades futuras en el estudio de nervios periféricos.

Abstract Introduction: The initial treatment of stenosing tenosynovitis is usually conservative. When there is no good response, it must be resolved by surgically releasing the A1 pulley, traditionally with open release (OR). However, there is the alternative of ultrasound-guided percutaneous A1 pulley release (UPAR), which has shown similar results. Objective: To evaluate the effectiveness and costs of UPAR compared to OR at our center. Method: A retrospective study was carried out in patients undergoing UPAR. Information on pain scale, mechanical symptoms (Quinnell grades), and disability (QuickDASH) was obtained before and after the procedure. The costs of UPAR and OR alternatives were evaluated. Results: A statistically significant improvement in pain, mechanical symptoms and disability was observed after the procedure. No complications were reported. UPAR was found to be 63% less expensive than the most economical OR alternative. Conclusion: UPAR is a safe and effective alternative to treat “trigger finger or thumb”, with low costs and a shorter recovery period compared to OR. UPAR should be considered as the initial treatment when other options have not been successful.

Resumen Introducción: El tratamiento inicial de la tenosinovitis estenosante suele ser conservador. Cuando no hay buena respuesta debe resolverse liberando quirúrgicamente la polea A1, tradicionalmente con liberación abierta (LA), sin embargo, existe la alternativa de la liberación percutánea de la polea A1 guiada por ultrasonido (LPAUS), que ha mostrado similares resultados. Objetivo: Evaluar la eficacia y costos de LPAUS en comparación con la LA en nuestro centro. Método: Se llevó a cabo un estudio retrospectivo en pacientes sometidos a LPAUS. Se obtuvo información sobre escala del dolor, síntomas mecánicos (grados de Quinnell) y discapacidad (QuickDASH) antes y después del procedimiento. Se evaluaron los costos de este y las alternativas de LA. Resultados: Se observó una mejora estadísticamente significativa en dolor, síntomas mecánicos y discapacidad después del procedimiento. No se informaron complicaciones. La LPAUS resultó ser un 63% menos costosa que la alternativa de LA más económica. Conclusión: La LPAUS es una alternativa segura y efectiva para tratar el «dedo o pulgar en gatillo», con bajos costos y un periodo de recuperación más corto en comparación con la LA. La LPAUS se debe considerar como tratamiento inicial cuando otras opciones no han tenido éxito.

Resumen A pesar de los beneficios bien conocidos de la anestesia raquídea (AR), esta técnica sigue siendo subutilizada entre los anestesiólogos pediátricos. De acuerdo con los datos de la Red Regional de Anestesia Pediátrica, la AR representó menos del 5% de todas las técnicas neuroaxiales. Algunos de los factores a los que se atribuye dicha subutilización son: su duración limitada, la falta de familiaridad con la técnica en niños de menor edad, y la preferencia del anestesiólogo por la anestesia general. El uso seguro y exitoso de la AR en niños implica el claro conocimiento de las diferencias anatómicas y fisiológicas entre adultos y niños, en virtud de las diferencias en las estructuras óseas, el crecimiento de la médula espinal y la fisiología del líquido cefalorraquídeo. Los reportes sobre el uso exitoso de la AR en niños para diferentes cirugías ha aumentado. La presente revisión educativa resumen la información conocida sobre AR en niños, revisiones de la literatura de la última década y ofrece sugerencias para el desarrollo de la AR en población pediátrica. Se discuten consideraciones técnicas, el papel de la ecografía, orientación sobre la dosificación, los efectos fisiológicos, aspectos no explicados del mecanismo de acción y la combinación de anestesia raquídea/caudal.

Abstract Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

Resumen La incorporación de nuevas tecnologías, como ultrasonido, J-Plasma (plasma de helio) y el Microaire (vibroliposucción), ha facilitado los procedimientos de lipoescultura consiguiendo una mayor satisfacción del paciente. Los beneficios de estas tecnologías se acompañan de bajas complicaciones reportadas; el presente caso constituye la cuarta descripción de neumomediastino secundario a la utilización de Renuvion® (J-Plasma) posterior a la extracción de grasa en brazos y muslos por medio de liposucción; esta infrecuente complicación se debe considerar diagnóstico diferencial en el estudio de presentación clínica de disnea y enfisema subcutáneo durante el posoperatorio.

Abstract The incorporation of new technologies such as ultrasound, J-Plasma (helium plasma) and MicroAire (power assited liposuction) has facilitated liposculpture procedures, resulting in greater patient satisfaction. The benefits of these technologies are accompanied by low reported complications; this case is the fourth description of pneumomediastinum secondary to the use of Renuvion® (J-Plasma) after liposuction for fat removal in the arms and thighs. This rare complication should be considered as part of the differential diagnosis during the study of clinical dyspnea and subcutaneous emphysema in the postoperative period.

Resumen Introducción: Aunque la vena subclavia ofrece ventajas significativas sobre otros abordajes para el acceso venoso central guiado por ultrasonido, no se considera la primera opción en la población pediátrica, principalmente debido a su proximidad con la pleura y la arteria subclavia. Objetivo: Evaluar las características sonoanatómicas de la vena subclavia y sus estructuras adyacentes utilizando el abordaje supraclavicular en la población pediátrica. Materiales y métodos: Estudio observacional de corte transversal durante el periodo intraoperatorio, desde junio de 2021 hasta marzo de 2022. Participaron niños ASA I, II y III sometidos a procedimientos quirúrgicos no emergentes bajo anestesia general. Se realizaron las imágenes bajo anestesia general, utilizando un transductor lineal de alta frecuencia para identificar la vena subclavia y medir características anatómicas. Resultados: Se reclutaron 67 niños, con una mediana de 6 años (RIQ 2-12 años), predominando el sexo masculino (61 %). La mediana de peso fue de 22 kg (RIQ12,2-34 kg) y la de estatura fue de 115 cm (RIQ 88-142 cm). Las mediciones del vaso mostraron una distancia media de la piel al vaso de 0,70 cm (DE: 0,18 cm) y una de la piel a la pleura de 1,31 cm (DE: 0,28 cm). El diámetro de la vena tuvo una mediana de 0,49 cm (RIQ 0,40-0,63 cm). El ángulo hipotético de aproximación al vaso presentó una media de 22,09 grados (DE: 4,37 grados), mientras que el ángulo de aproximación a la pleura fue de 39 grados (DE: 5,31 grados). No se documentó la visualización simultánea de la arteria y la vena en ninguna de las ventanas sonoanatómicas registradas. Las pruebas indicaron una diferencia promedio de 0,61 cm en la profundidad del vaso respecto a la pleura, y 16,91 grados menos en el ángulo de aproximación al vaso comparado con el ángulo pleural (p < 0,001). Conclusiones: Mediante esta técnica, el abordaje supraclavicular para punción de la vena subclavia en niños es seguro y viable, con una distancia promedio de la piel al vaso de 0,70 cm, minimizando el riesgo de punción pleural. Se requieren estudios adicionales para optimizar esta técnica en la población pediátrica.

Abstract Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

Resumen Durante la valoración preanestésica de la paciente obstétrica, es fundamental evaluar la condición cardiovascular basal de la paciente, identificar riesgos potenciales y facilitar modificaciones conductuales para desarrollar una estrategia de manejo individualizada, dirigida a minimizar las complicaciones. La ecografía cardíaca a la cabecera del paciente (POCUS) es un instrumento valioso para evaluar la morfología y la función del corazón antes de un procedimiento quirúrgico. El POCUS cardiaco no está diseñado para sustituir a la ecocardiografía transtorácica formal, que corresponde al área de anestesiología cardiovascular y a la cardiología. Sin embargo, cuando se usa en conjunto con la anamnesis, el examen físico, el electrocardiograma y los resultados de exámenes de laboratorio previos, el POCUS cardiaco es un complemento valioso dentro del arsenal diagnóstico de los anestesiólogos. Permite la visualización directa del corazón y de los grandes vasos, con beneficios adicionales de velocidad, disponibilidad y bajo riesgo para la paciente. El objetivo del presente manuscrito es explorar y describir las ventajas del POCUS cardiaco durante el periodo preanestésico en pacientes obstétricas y su valor potencial para los anestesiólogos, a través de la identificación de condiciones eventualmente peligrosas que pudieran requerir un manejo preoperatorio individualizado.

Abstract During the preanesthetic assessment of the obstetric patient, it is critical to assess the patient's cardiovascular baseline condition, identify any potential risks, and facilitate behavioral modification to develop an individualized management strategy aimed at minimizing complications. Cardiac point-of-care ultrasound (POCUS) is a valuable instrument for assessing the morphology and function of the heart prior to surgery. Cardiac POCUS is not designed to replace comprehensive transthoracic echocardiography, which is the realm of cardiovascular anesthesiology and cardiology. However, when used in conjunction with anamnesis, physical examination, electrocardiogram, and previous laboratory results, cardiac POCUS is a valuable adjunct in the diagnostic toolbox of anesthesiologists. It allows for direct visualization of the heart and great vessels, with added benefits of speed, availability, and low risk for the patient. The purpose of this manuscript is to explore and describe the advantages of cardiac POCUS in the preanesthetic period of obstetric patients and its potential value for anesthesiologists through the identification of potentially hazardous conditions that may require individualized preoperative management.

Resumen Introducción: La anestesia espinal se realiza mediante palpación de superficies para la identificación de los espacios intervertebrales lumbares. En adultos mayores el procedimiento presenta mayor dificultad debido a los cambios degenerativos de la columna vertebral asociados a la edad. Objetivo: Evaluar cuál técnica de anestesia espinal garantiza una mayor tasa de éxito entre la guiada por ultrasonido (US) y la guiada por reparos anatómicos (RA) en adultos mayores. Métodos: Estudio observacional de cohorte prospectivo en pacientes con indicación de suministro de anestesia subaracnoidea independientemente de la intervención quirúrgica, llevado a cabo en el Hospital Universitario del Valle y la Fundación Hospital San José Buga. En un lapso de 12 meses se recolectaron datos durante la realización de la punción, según decisión del anestesiólogo tratante, guiada por US vs. RA. Resultados: En total se evaluaron 80 pacientes entre hombres y mujeres, mayores de 65 años, con edad media de 78,50±9,04. El número de punciones, así como de redireccionamientos, fue significativamente menor en el grupo guiado por US. Adicionalmente, se observó que en el grupo guiado por RA, el 37,5 % no coincidía con el sitio demarcado con el espacio real de punción confirmado con US (p<0,001). Podría ser la causa de un bloqueo inadecuado o de complicaciones de la punción intradural. Conclusiones: La técnica de anestesia neuroaxial guiada por US en adultos mayores podría facilitar el bloqueo neuroaxial al primer intento de punción.

Abstract Introduction: Spinal anesthesia requires palpation of surfaces in order to identify the intervertebral spaces in the lumbar spine. In elderly individuals, the procedure is more challenging due to age-related degenerative changes in the spine. Objective: To determine which technique between ultrasound (US) guidance or the use of anatomical landmarks to guide spinal anesthesia ensures a higher success rate in elderly patients. Methods: prospective observational cohort study in patients with an indication to receive subarachnoid anesthesia, regardless of the type of surgical intervention, carried out at Hospital Universitario del Valle and Fundación Hospital San José Buga. Data were collected over a 12-month period at the time of making the puncture. The treating anesthetists were free to choose between US guidance or the use of anatomical landmarks. Results: Overall, 80 patients were assessed, including men and women over 65 years of age (mean 78.5±19.04). The number of punctures as well as needle redirections were significantly lower in the US-guided group. Additionally, in the group in which anatomical landmarks were used to guide the puncture, the marked site did not coincide with the actual puncture site confirmed with US in 37.5% of cases (p<0.001). This could result in inadequate block or complications associated with intradural puncture. Conclusions: US-guided neuroaxial anesthesia in elderly individuals could facilitate success on the first attempt.

Resumo Introdução: O uso da ultrassonografia no local de atendimento (PoCUS) tem ganhado relevância na prática médica, melhorando a capacidade diagnóstica e a segurança do paciente. Contudo, no Uruguai, o treinamento PoCUS para internistas é limitado. O objetivo é concretizar a implementação da formação PoCUS para os cursos de pós-graduação em Medicina Interna. Metodologia: Foi criado um curso-oficina dividido em módulos por sistemas e protocolos clínicos. Bibliografia e material audiovisual foram fornecidos aos participantes. Foram utilizados aparelhos de ultrassom portáteis sem fio e modelos voluntários. Foram realizados testes diagnósticos de conhecimento, avaliações clínicas objetivas estruturadas e pesquisas de satisfação. Resultados: 30 dos 32 participantes concluíram e foram aprovados no curso. A pesquisa de satisfação mostrou alta avaliação dos objetivos do curso, logística e instrutores. Houve uma melhoria estatisticamente significativa no conhecimento do PoCUS entre o pré e o pós-teste (54,72% vs. 82,5%). A avaliação final teve média de aprovação de 92%, com uma única exceção que exigiu recuperação. Discussão: A formação PoCUS em Medicina Interna é considerada valiosa, mas o seu desenvolvimento é limitado no Uruguai. A implementação de um curso estruturado demonstrou melhorias no conhecimento e elevados níveis de satisfação. Foi comparado com outros cursos de habilidades clínicas com resultados semelhantes. A curva de aprendizado para diferentes órgãos varia, destacando a necessidade de monitoramento contínuo. Conclusões: Altos níveis de satisfação dos participantes foram obtidos com resultados positivos em conhecimentos e habilidades. Acreditamos que é importante continuar investigando a curva de aprendizagem pós-curso.

Resumen: Introducción: El uso de la ultrasonografía en el punto de atención (PoCUS) ha ganado relevancia en la práctica médica, mejorando la capacidad diagnóstica y la seguridad de los pacientes. Sin embargo, en Uruguay, la formación en PoCUS para médicos internistas es limitada. El objetivo es lograr la implementación de la formación de PoCUS en los posgrados de Medicina Interna. Metodología: Se creó un curso-taller dividido en módulos por sistemas y protocolos clínicos. Se proporcionó bibliografía y material audiovisual a los participantes. Se utilizaron ecógrafos portátiles inalámbricos y modelos voluntarios. Se realizaron pruebas de conocimiento diagnósticas, evaluaciones clínicas objetivas estructuradas y encuestas de satisfacción. Resultados: 30 de los 32 participantes completaron y aprobaron el curso. La encuesta de satisfacción mostró una alta evaluación de los objetivos del curso, la logística y los instructores. Hubo una mejora estadísticamente significativa en el conocimiento de PoCUS entre el pre y post test (54.72% vs. 82.5%). La evaluación final tuvo una media de aprobación del 92%, con una sola excepción que requirió recuperación. Discusión: La formación en PoCUS en Medicina Interna es percibida como valiosa, pero su desarrollo es limitado en Uruguay. La implementación de un curso estructurado demostró mejoras en conocimientos y altos niveles de satisfacción. Se comparó con otros cursos de habilidades clínicas con resultados similares. La curva de aprendizaje para diferentes órganos varía, lo que destaca la necesidad de un seguimiento continuo. Conclusiones: Se obtuvieron altos niveles de satisfacción de los participantes con resultados de conocimientos y destrezas positivos. Creemos que es de importancia seguir investigando la curva de aprendizaje posterior al curso.

Abstract Introduction: The use of point-of-care ultrasound (PoCUS) has gained relevance in medical practice, improving diagnostic capacity and patient safety. However, in Uruguay, PoCUS training for internal medicine physicians is limited. The objective is to achieve the implementation of PoCUS training in Internal Medicine postgraduate courses. Methodology: A course-workshop was created divided into modules by clinical systems and protocols. Bibliography and audiovisual material were provided to participants. Wireless portable ultrasound machines and voluntary models were used. Diagnostic knowledge tests, structured objective clinical evaluations, and satisfaction surveys were conducted. Results: 30 of the 32 participants completed and passed the course. The satisfaction survey showed a high evaluation of the course objectives, logistics, and instructors. There was a statistically significant improvement in PoCUS knowledge between the pre and post test (54.72% vs. 82.5%). The final assessment had an average passing rate of 92%, with only one exception requiring retake. Discussion: PoCUS training in Internal Medicine is perceived as valuable, but its development is limited in Uruguay. The implementation of a structured course demonstrated improvements in knowledge and high levels of satisfaction. It was compared with other clinical skills courses with similar results. The learning curve for different organs varies, highlighting the need for continued monitoring. Conclusions: High levels of satisfaction were obtained from participants with positive knowledge and skills results. We believe that it is important to continue investigating the learning curve after the course.

Resumo: A tromboangeíte obliterante (TAO) é uma doença inflamatória segmentar, não aterosclerótica, que afeta artérias, veias e nervos de pequeno e médio calibre nas extremidades. Fumar é o fator patogênico fundamental. É apresentado o caso clínico de um jovem, tabagista, que apresenta necrose seca da 1ª, 2ª e 3ª falange da mão esquerda. A ultrassonografia Doppler arterial mostra artérias radial e ulnar esquerdas ocluídas. Excluindo outras etiologias, e com achados histopatológicos compatíveis, é feito o diagnóstico de TAO, doença rara, devendo ser suspeitada em pacientes jovens, do sexo masculino, fumantes, com história de claudicação intermitente, úlcera ou gangrena. O diagnóstico é clínico e de exclusão. A cessação do tabagismo é o pilar fundamental do tratamento.

Resumen: La tromboangeítis obliterante (TAO) es una enfermedad inflamatoria segmentaria, no aterosclerótica, que afecta a arterias, venas y nervios de pequeño y mediano calibre de las extremidades. El tabaquismo es el factor patogénico fundamental. Se presenta el caso clínico de un hombre joven, tabaquista, que presenta necrosis seca de 1era, 2da y 3era falange de mano izquierda. Ecografía doppler arterial evidencia arteria radial y cubital izquierda ocluidas. Excluidas otras etiologías, y con hallazgos histopatológicos compatibles, se realiza diagnóstico de TAO, enfermedad poco frecuente, se debe sospechar en pacientes jóvenes, de sexo masculino, tabaquistas, con historia de claudicacion intermitente, úlcera o gangrena. El diagnóstico es clínico y de exclusión. El cese del tabaco es el pilar fundamental del tratamiento.

Abstract: Thromboangiitis obliterans (TAO) is a segmental, non-atherosclerotic inflammatory disease that affects small and medium-sized arteries, veins and nerves of the extremities. Smoking is the main pathogenetic factor. We present the clinical case of a young man, a smoker, who presented dry necrosis of the 1st, 2nd and 3rd phalanx of the left hand. Arterial Doppler ultrasound showed occluded left radial and ulnar arteries. After excluding other etiologies and with compatible histopathological findings, a diagnosis of TAO was made. This disease is rare and should be suspected in young, male, smoker patients with a history of intermittent claudication, ulcer or gangrene. Diagnosis is clinical and by exclusion. Smoking cessation is the cornerstone of treatment.