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Resumen Los tumores pardos son raros y, por lo general, afectan huesos largos, pelvis y costillas. Pueden no estar incluidos en el diagnóstico diferencial inicial como manifestación de enfermedad esquelética, es pecialmente cuando se presentan en localizaciones atípicas. Comunicamos dos casos de tumores pardos orales como presentación inicial de hiperparatiroidismo primario. En el primer caso, una mujer de 44 años presentó una lesión dolorosa y sésil de 4 × 3 cm sobre el cuerpo central de la mandíbula que aumentó de tamaño progresivamente en 4 meses. El segundo caso corresponde a una mujer de 23 años que acudió por presentar una masa dolorosa y ul cerada de 2 cm en maxilar izquierdo de 3 meses de evolución, episodios de hemorragia gingival y difi cultad para respirar. Todos fueron tumores solitarios sin evidencia de linfadenopatía cervical palpable. La biopsia incisional de los tumores orales resultó en células gigantes, y las pruebas de laboratorio confirmaron el hiperparatiroidismo primario. Tras la paratiroidectomía, la histología confirmó adenoma en ambos casos. Los tumores pardos representan la etapa terminal de los procesos de remodelación ósea en el hiperparatiroidismo primario. Aunque este tipo de presentación clínica casi ha desaparecido en las últimas décadas, los tumores pardos deben ser considerados en el diagnóstico diferencial de las masas óseas orales.

Abstract Brown tumors represent the terminal stage of bone remodeling processes in primary hyperparathyroidism. Currently they are rare, and typically affect long bones, pelvis and ribs. Brown tumors may be not included in the initial differential diagnosis of bone disease, espe cially when they are present in atypical localizations. We reported two cases of oral brown tumors as the initial presentation of primary hyperparathyroidism. In the first case, a 44-year-old woman presented a painful and sessile lesion of 4x3 cm over the central body of the mandible which progressively increased in 4-month. The second case involved a 23-year-old woman who was referred with a 3-month history of a painful and ulcerated mass of 2 cm arising from left maxilla, episodes of gingival hemorrhage and difficulty of breathing. Both cases were solitary tumors with no evidence of palpable cervical lymphadenopathy. Incisional biopsy of oral tumors resul ted in giant cell and primary hyperparathyroidism was confirmed by laboratory tests. After parathyroidectomy, histology confirmed adenoma in both cases. Although this type of clinical presentation has almost disappeared in the recent decades, brown tumors should be consi dered in the differential diagnosis of bone oral masses.

Main reasons for hospital admission in patients with Parkinson’s disease and their relationship with the days of hospitalization
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Marín, Gerardo

; Torres-Pineda, Osvaldo

; Castillo-Rangel, Carlos

; Diaz Chiguer, Dylan L.

; Zarate-Calderon, Cristofer J.

; Torres-Pasillas, Juan G.

; Viveros-Martínez, Iraís

; Vásquez-Celaya, Lizbeth

; Hernández Briones, Zuleyma S.

; Vega-Quesada, Helena G.

; Vega-Quesada, Luis A.

; García-Hernández, Luis I.

Revista mexicana de neurociencia

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dec 2022, Volume 23 N. 6 Pages 195 - 201

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Objetivo: Es necesario estudiar las principales comorbilidades de la enfermedad de Parkinson que provocan este aumento de hospitalizaciones. Comparar el promedio de días de estancia hospitalaria de los pacientes con enfermedad de Parkinson más una comorbilidad contra el promedio de días de estancia hospitalaria sin esa comorbilidad e informar aquellos que fueron estadísticamente significativos. Metodología: Tomando pacientes con EP desde el Hospital “1 de octubre”, se realizó un estudio observacional, retrospectivo, transversal y analítico en el que se evaluó la relación de los días de hospitalización con y sin comorbilidades, encontrando cuáles serían las comorbilidades que se convierten en un factor de protección o riesgo de prolongar la estancia hospitalaria de los pacientes con EP y así sugerir la prioridad del tratamiento de estas condiciones. Resultados: De los 37 pacientes se encontraron 14 comorbilidades diferentes, de las cuales Hipotiroidismo (= 2), Infarto agudo de miocardio/dislipidemia (= 4), TCE (= 4), presentan una disminución en el número de días Pacientes hospitalizados con respecto a la media de pacientes que no presentan estas comorbilidades, en comparación, úlcera sacra (= 32,5) y neumonía (= 31) muestran un aumento de los días de hospitalización con respecto a la media. Conclusión: Se encontraron 14 comorbilidades en la enfermedad de Parkinson. Los pacientes con úlcera sacra y neumonía son hospitalizados por más tiempo en comparación con las diferentes comorbilidades. Se recomienda prestar especial atención y cuidado para prevenir/tratar estas patologías para reducir el número de días de hospitalización.

Abstract Objective: It is necessary to study the main comorbidities of Parkinson’s disease that causes this increase in hospitalization. The aim of the study was to compare the mean days of hospital stay of patients with Parkinson’s disease plus a comorbidity against the mean days of hospital stay without that comorbidity and to report those which were statistically significant. Methods: Taking patients with PD from “1 de octubre” Hospital, an observational, retrospective, cross-sectional, and analytical study was carried out in which the relationship of days of hospitalization with and without comorbidities was evaluated, finding which would be the comorbidities that were they become a factor of protection or risk of prolonging the hospital stay of patients with Parkinson’s disease (PD) and thus suggest the priority of treating these conditions. Results: Of the 37 patients, 14 different comorbidities were found, of which hypothyroidism (= 2), acute myocardial infarction/dyslipidemia (= 4), and traumatic brain injury (= 4) present a decrease in the number of days hospitalized patients with respect to the mean of patients who do not have these comorbidities, in comparison, sacral ulcer (= 32.5) and pneumonia (= 31) show an increase in the days of hospitalization with respect to the mean. Conclusion: Fourteen comorbidities were found in PD. Patients with sacral ulcer and pneumonia are hospitalized for a longer time compared to the different comorbidities. It is recommended to pay special attention and care to prevent/treat these pathologies to reduce the number of days of hospitalization.

https://doi.org/10.24875/rmn.22000015

Simple and fast process using hydrochloric acid for producing synthetic zinc-rich stevensite
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Carvalho, T. C.

; Michel, B. B,

; Silva-Valenzuela, M. G.

; Hildebrando, E.

; Neves, R. F.

; Valenzuela-Diaz, F. R.

Cerâmica

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sep 2022, Volume 68 N. 387 Pages 285 - 293

Abstract: En | Text: En | PDF: En

Abstract In the last decades, clays have been used in sectors such as health and cosmetics. This requires products that are increasingly pure and present homogeneous properties, hardly found in natural clays. The use of synthetic clays can be a solution. For this, it is necessary to explore techniques for their production. The main focus of this study was to synthesize a smectite clay in a simple, fast and economic way at low temperature and pressure, called static and dynamic methods. To regulate the pH of the reaction and bring it closer to the ideal synthesis conditions, two different acids were used: nitric acid (the most widely used in the literature) and hydrochloric acid (more accessible and cheaper). The results showed characteristics of uniform crystalline material with a porous structure similar to that of the smectite group. Small particle sizes of approximately 100 nm were observed by scanning electron microscopy. Stevensite clay was obtained by both synthesis methods using two different acids; the static method with hydrochloric acid stood out. The greater practicality in its development provides a more viable option for large-scale industrial production.

https://doi.org/10.1590/0366-69132022683873262

Depresión, ansiedad y estrés durante la pandemia COVID-19 en estudiantes de Odontología
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Pérez-Bejarano, Nohelia

; Gamarra-Insfrán, José

; Diaz-Reissner, Clarisse

; Adorno, Carlos G.

; Fretes-López, Vicente

; Diaz-Carbajal, Rebecca

; Adorno, Víctor R.

Revista Facultad de Odontología Universidad de Antioquia

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jun 2022, Volume 34 N. 1 Pages 6 - 13

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción: en diciembre del 2019, se reporta en el mundo un caso de neumonía causada por el coronavirus 2 (SARS-CoV-2). En Paraguay, actualmente se registraron más de 428.000 casos confirmados y más de 13.500 muertes. En ese contexto, la enseñanza ha tenido que convocarse al entorno virtual generando, en todos los niveles, modificaciones reactivas conductuales nacidas desde diversas causas: la dificultad al acceso a elementos informáticos, necesidad en diversos grados de reaprendizaje en un entorno no habitual y sobre todo la incertidumbre. El objetivo del estudio fue determinar los niveles de depresión, ansiedad y estrés durante la pandemia covid-19 en estudiantes de Odontología. Métodos: para este estudio observacional descriptivo de corte transversal se incluyeron estudiantes de grado de la Facultad de Odontología de la Universidad Nacional de Asunción, matriculados al periodo académico 2021. Se utilizó la escala de Depression, Anxiety and Stress (DASS-21) short form. Cada uno de los tres ejes (depresión, ansiedad y estrés) contiene 7 ítems, divididas en subescalas de contenido similar. Las puntuaciones fueron categorizadas en cinco grupos ordenados (normal, leve, moderada, severa y muy severa). Resultados: los estudiantes de Odontología presentaron cuadros de depresión y ansiedad, con síntomas de ansiedad moderada en un 42,58%; 1,29% presentó depresión severa. Conclusión: la mayoría de los estudiantes de Odontología presentaron cuadros de depresión y ansiedad con síntomas muy comunes, como la imposibilidad de relajarse, falta de iniciativa, irritabilidad y nervios.

Abstract Introduction: in December 2019, a case of pneumonia caused by coronavirus 2 (SARS-CoV-2) was reported in the world. Currently, Paraguay has registered more than 428,000 confirmed cases and more than 13,500 deaths. In this context, teaching has had to be transferred to the virtual environment, generating reactive behavioral modifications at all levels arising from various causes: difficulty in accessing computer elements, the need in varying degrees of relearning in an unusual environment and, above all, uncertainty. The aim of this study was to determine the levels of depression, anxiety and stress during the covid-19 pandemic in dental students. Methods: for this cross-sectional descriptive observational study, undergraduate students from the School of Dentistry of the National University of Asunción, enrolled in the academic period 2021, were included. The Depression, Anxiety and Stress (DASS-21) short form scale was used. Each of the three axes (depression, anxiety, and stress) contains 7 items, divided into subscales of similar content. The scores were categorized into five ordered groups (normal, mild, moderate, severe, and very severe). Results: dentistry students presented symptoms of depression and anxiety with symptoms of moderate anxiety in 42.58%; 1.29% presented severe depression . Conclusion: most of the dental students presented depression and anxiety with very common symptoms such as the inability to relax, lack of initiative, irritability and nervousness.

https://doi.org/10.17533/udea.rfo.v34n1a1 353 downloads

2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology
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Bautista-Molano, Wilson

; Saldarriaga-Rivera, Lina M.

; Junca-Ramírez, Alejandro

; Fernández-Aldana, Andrés R.

; Fernández-Ávila, Daniel G.

; Jaimes, Diego A.

; Jauregui, Edwin A.

; Segura-Charry, Juan S.

; Romero-Sanchez, Consuelo

; Felipe-Diaz, Oscar J.

Revista Colombiana de Reumatología

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jun 2022, Volume 29 N. 2 Pages 113 - 124

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN Introducción: La espondiloartritis axial es una enfermedad reumatológica que afecta a individuos jóvenes y tiene una gran repercusión sociolaboral. El retraso en el diagnóstico y el tratamiento se asocia con un mayor deterioro funcional y un impacto negativo en la calidad de vida, por lo que requiere un abordaje multidisciplinario. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes adultos con espondiloartritis axial. Métodos: Se configuró un grupo desarrollador, se formularon preguntas clínicas contestables, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado, minimizando el sesgo por conflictos de intereses. Se utilizó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la calidad de la evidencia, al igual que la dirección y la fortaleza de las recomendaciones. Se presentan 11 recomendaciones relacionadas con diagnóstico (n = 2), tratamiento farmacológico (n = 6), tratamiento no farmacológico (n = 2) y seguimiento (n = 1). Resultados: Se recomienda la radiografía de articulaciones sacroilíacas como primer método diagnóstico, y el uso de escalas de actividad para el seguimiento de los pacientes (ASDAS o BASDAI). Los antiinflamatorios no esteroideos son la primera opción de tratamiento; en caso de intolerancia o dolor residual se recomienda acetaminofén u opioides. En pacientes con compromiso axial se recomienda abstenerse de utilizar medicamentos antirreumáticos modificadores de la enfermedad convencionales ni glucocorticoides sistémicos o locales. En pacientes con falla a los antiinflamatorios no esteroideos, se recomienda un anti-TNFα o un anti-IL17A. En pacientes con falla a anti-TNFα, se recomienda iniciar un anti-IL17A. El ejercicio y la terapia física y ocupacional se recomiendan como parte del tratamiento. Se recomienda no utilizar las terapias no convencionales como única opción de tratamiento. Conclusiones: Este conjunto de recomendaciones proporciona una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis axial.

Abstract Introduction: Axial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. Objective: To develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondy-loarthritis. Methods: A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented. Results: Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A are recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. Conclusions: This set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.

https://doi.org/10.1016/j.rcreu.2021.08.003

Sea Turtles in the Bahía Málaga Conservation Mosaic, Colombian Pacific
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Barrientos-Muñoz, Karla G.

; Heidemeyer, Maike

; Ortega-Gordillo, Luis Fernando

; Valencia-Díaz, Miller

; Hinojosa-Romero, Carlos Andrés

; Valencia-González, Santiago

; Montaño, Héctor Javier

; Diaz granados, Maria Claudia

; Caldas, Juan Pablo

; Sevilla-Dueñas, Edward Leonardo

; Arauz, Randall

; Ramírez-Gallego, Cristian

Boletín de Investigaciones Marinas y Costeras - INVEMAR

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jun 2022, Volume 51 N. 1 Pages 117 - 136

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN Entre 2016-2020 se caracterizaron las especies y tamaños de las tortugas marinas presentes en el Mosaico de Conservación Bahía Málaga, Valle del Cauca por medio de monitoreo acuático y la entrega voluntaria por parte de los pescadores del área. El registro de individuos fue determinado mediante monitoreo acuático, que se dividió en tres fases: muestreo exploratorio, muestreo continuado, muestreo estandarizado, además de entregas voluntarias por los pescadores en sus faenas de pesca. Se emplearon 107 horas de esfuerzo para un total de 51 individuos de tortuga carey (Eretmochelys imbricata) y negra (Chelonia mydas) registradas. Estos resultados contribuyen como línea base para el conocimiento de las tortugas marinas como estrategia efectiva para la investigación y conservación de bahía Málaga.

ABSTRACT The species and sizes of sea turtles present in the Bahía Málaga Conservation Mosaic, Valle del Cauca, were characterized between 2016-2020 through aquatic monitoring and voluntary delivery by native fishermen. The registry of individuals was determined by aquatic monitoring, which was divided into three phases: exploratory sampling, continuous sampling, standardized sampling, plus voluntary deliveries by fishermen in their fishing tasks. A total of 107 hours of effort were used to detect 51 individuals of hawksbill (Eretmochelys imbricata) and black (Chelonia mydas) turtles. These results contribute as a baseline for the knowledge of sea turtles as an effective strategy for research and conservation in Bahía Málaga.

https://doi.org/10.25268/bimc.invemar.2022.51.1.1096 31 downloads

Frecuencia de la posición, inclinación y grado de dificultad quirúrgica de terceros molares mandibulares en pacientes que acuden a la Facultad de Odontología de la Universidad Nacional de Asunción
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Gamarra, José

; Diaz-Reissner, Clarisse

; Ocampos, Hugo

; Adorno, Carlos G.

; Fretes, Vicente

Memorias del Instituto de Investigaciones en Ciencias de la Salud

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apr 2022, Volume 20 N. 1 Pages 22 - 29

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT The position a mandibular third molar can adopt is unpredictable in most cases. To facilitate the analysis of the position and inclination of third molars, authors such as Pell-Gregory and Winter established a classification of these teeth to guide the most appropriate surgical technique for each situation. The objective was to determine the frequency of the position, inclination and degree of surgical difficulty in mandibular third molars. The study was descriptive, retrospective, cross-sectional, and observational. Panoramic radiographs of patients who attended the School of Dentistry of the National University of Asuncion between 2018 and 2020 were part of the study. A total of 220 panoramic radiographs were included in the study, 120 (54.5%) corresponded to women and 100 (45.4%) to men, the age group from 18 to 28 years old had the most participation with 134 (61%) radiographs. A frequency in position A class II of 141 (36.6%) was evidenced, while in terms of the inclination the mesioangular was the most frequent, 174 (45.5%) and in terms of the degree of surgical difficulty, minimal to moderate difficulty was observed. A high frequency of position A class II, mesial inclination was evidenced in all the radiographs analyzed.

RESUMEN La disposición que puede adoptar un tercer molar mandibular resulta en la mayoría de los casos impredecible. Para facilitar el análisis de la posición e inclinación de los terceros molares autores como Pell-Gregory y Winter, establecieron una clasificación de esas piezas dentarias para guiar la técnica operatoria más adecuada para cada situación. El objetivo fue determinar la frecuencia de la posición, inclinación y grado de dificultad quirúrgica en terceros molares mandibulares. El estudio fue observacional descriptivo, retrospectivo de corte transversal. Formaron parte del estudio radiografías panorámicas de pacientes que acudieron a la Facultad de Odontología UNA entre el 2018 y 2020. Un total de 220 radiografías panorámicas fueron incluidas en el estudio, 120 (54,5%) correspondían al sexo femenino y 100 (45,4%) al sexo masculino, la franja etaria de 18 a 28 años fue la de más participación con 134 (61%) radiografías. Se evidenció una frecuencia en la posición A clase II de 141 (36,6%), en cuanto a la inclinación de las piezas dentarias, la más frecuente fue la mesioangular 174 (45,5%) y en cuanto al grado de dificultad quirúrgica se observó una dificultad mínima a moderada. Se evidenció una frecuencia alta de la posición A clase II e inclinación mesial del total de las radiografías analizadas.

https://doi.org/10.18004/mem.iics/1812-9528/2022.020.01.22

O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID
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Cerci, Rodrigo Julio

; Vitola, João Vicente

; Paez, Diana

; Zuluaga, Alejandro

; Bittencourt, Marcio Sommer

; Sierra-Galan, Lilia M.

; Carrascosa, Patricia

; Campisi, Roxana

; Gutierrez-Villamil, Claudia

; Peix, Amalia

; Chambers, Duane

; Velez, Mayra Sánches

; Alvarado, Carla M. G.

; Ventura, Ana C. F.

; Maldonado, Alejandro

; Castanos, Alfredo P.

; Diaz, Teresa C.

; Herrera, Yariela

; Vasquez, Manuel C.

; Arrieta, Ana A.

; Mut, Fernando

; Hirschfeld, Cole

; Malkovskiy, Eli

; Goebel, Benjamin

; Cohen, Yosef

; Randazzo, Michael

; Shaw, Leslee J.

; Williams, Michelle C.

; Villines, Todd C.

; Better, Nathan

; Dorbala, Sharmila

; Raggi, Paolo

; Pascual, Thomas N. B.

; Pynda, Yaroslav

; Dondi, Maurizio

; Einstein, Andrew J.

Arquivos Brasileiros de Cardiologia

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apr 2022, Volume 118 N. 4 Pages 745 - 753

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

https://doi.org/10.36660/abc.20210388

2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology
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Saldarriaga-Rivera, Lina M.

; Bautista-Molano, Wilson

; Junca-Ramírez, Alejandro

; Fernández-Aldana, Andrés R.

; Fernández-Ávila, Daniel G.

; Jaimes, Diego A.

; Jáuregui, Edwin A.

; Segura-Charry, Juan S.

; Romero-Sánchez, Consuelo

; Felipe-Diaz, Oscar J.

Revista Colombiana de Reumatología

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mar 2022, Volume 29 N. 1 Pages 44 - 56

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Background: Peripheral spondylarthritis is a chronic Inflammatory disease whose clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. Objective: To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment, and monitoring of adult patients with peripheral spondyloarthritis. Methods: A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the for mal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The clinical practice guideline includes ten recommendations related to monitoring of disease activity (n = 1) and treatment (n = 9). Results: In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids are conditionally recommended. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondylarthritis associated with inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recom mended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with a bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. Conclusions: This set of recommendations provides an updated guideline on the diagnosis and treatment of peripheral spondyloarthritis.

RESUMEN Antecedentes: La espondiloartritis periférica es una patología Inflamatoria crónica cuya presentación clínica está determinada por la presencia de artritis, entesitis y/o dactilitis. Este término se utiliza indistintamente con algunos de sus subtipos como artritis psoriásica, artritis reactiva y espondiloartritis indiferenciada. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para el diagnóstico, el tratamiento y el seguimiento de pacientes adultos con espondiloartritis periférica. Métodos: Se constituyó un grupo desarrollador, se formularon preguntas clínicas, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado. Siguiendo el método de consenso formal de expertos, se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para para evaluar la calidad de la evidencia y generar las recomendaciones. La guía de práctica clínica incluye 10 recomendaciones: una sobre seguimiento de la actividad de la enfermedad y nueve sobre tratamiento. Resultados: En pacientes con espondiloartritis periférica se sugiere usar metotrexato o sulfasalazina como primera línea de tratamiento y se recomienda en forma condicional la inyección local de glucocorticoides. En los pacientes que fallan a cDMARDs, se recomienda iniciar un anti TNFα o un anti IL17A. Ante falla terapéutica a la primera línea con bDMARDs, se sugiere usar otro bDMARD o un inhibidor JAK. En pacientes con espondiloartritis periférica y enfermedad inflamatoria intestinal asociada, se recomienda iniciar tratamiento con cDMARDs; en ausencia de respuesta, se recomienda el uso de un anti TNFα sobre un anti IL-17 o un anti IL-12-23 como segunda línea de tratamiento. En pacientes con artritis psoriásica se recomienda, de forma condicional, el uso combinado de metotrexato con bDMARD para favorecer la optimización de la dosis de estos. Para evaluar la actividad de la enfermedad en artritis psoriásica, se sugiere el uso del DAPSA o MDA para el seguimiento de los pacientes. Conclusiones: Este conjunto de recomendaciones proporcionan una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis periférica.

https://doi.org/10.1016/j.rcreu.2021.07.005

10.

Progressive improvement of atrial and ventricular capture thresholds, sensing, and impedances in epicardial pacing leads in young adults undergoing Fontan conversion
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Moltedo, Jose M.

; Abello, Mauricio S.

; Doiny, David

; Falconi, Estela C.

; Diaz, Carlos J

; Majdalani, María G.

; Cannon, Bryan C.

Archivos de cardiología de México

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dec 2021, Volume 91 N. 4 Pages 439 - 443

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Objectives: Patients with univentricular hearts who require permanent pacing systems typically require placement of epicardial leads. It is frequently difficult to find a position with good thresholds due to epimyocardial fibrosis or fat. The goal of the study is to assess the progression of capture thresholds (CT), sensing parameters (P waves and R waves), and impedances (imp) of steroid eluting epicardial pacing leads in young adults who underwent Fontan conversion and a pacemaker implant. Methods: All patients undergoing Fontan conversion in two institutions were retrospectively identified. Demographic data, congenital heart defects, pacing leads used, and pacing parameters were analyzed at implant, at 6 weeks and 12 months after implant. Results: Twenty patients were identified (twelve males); mean age at conversion was 24.9 ± 5.4 years (range 18-35). Epicardial bipolar steroid eluting leads were used. The site of implant both in the atria and the ventricles varied depending on the parameters. At implant, mean atrial and ventricular impedances were 617 ± 171 W and 1061 ± 771 W, respectively, mean P wave amplitude was 2 ± 0.7 mV, and mean R wave amplitude was 12.5 ± 7.7 mV. Mean CT was 1.7 ± 0.8 V at 0.5 ms for the atrium and 2.2 ± 1.2 V at 0.5 ms for the ventricle. Ventricular CT and impedance showed an improvement within the first 12 months after implant, with four patients having a decrease in threshold of more than 2 V. Conclusion: In patients undergoing Fontan conversion, implant ventricular CT and impedances are frequently higher than expected but typically improve during follow-up. Acceptance of higher initial threshold values may be a potential strategy in this patient population.

Resumen Objetivos: Los pacientes con corazón univentricular que requieren estimulación cardíaca reciben sistemas de estimulación epicárdicos. Debido a la presencia de fibrosis o grasa epi-miocárdica es dificultoso en esta población encontrar sitios con adecuados parámetros de estimulación. El objetivo de este estudio es determinar la progresión de los umbrales de captura, los parámetros de sensado (medición de las ondas P y R) e impedancias (imp) de los catéteres epicárdicos con liberación de esteroides implantados en adultos jóvenes sometidos a cirugía de reconversión de Fontan e implante de marcapasos. Métodos: Los pacientes sometidos a cirugía de reconversión de Fontan en dos instituciones fueron analizados retrospectivamente. Los datos demográficos, el tipo de cardiopatía congénita, de catéteres de estimulación y los parámetros de estimulación fueron analizados al momento del implante, a las 6 semanas y al año. Resultados: Se identificaron 20 pacientes (12 de ellos de sexo masculino); la edad media al momento de la reconversión fue de 24.9 ± 5.4 años (rango 18-35). Se utilizaron catéteres epicárdicos bipolares de fijación pasiva y con liberación de esteroides en todos los casos. El sitio de implante en las aurículas y en los ventrículos fue variable de acuerdo a los parámetros. En el momento del implante las impedancias medias fueron 617 ± 171 W y 1061 ± 771 W respectivamente, la amplitud media de la onda P fue 2 ± 0.7 mV y la media de amplitud de la onda R fue de 12.5 ± 7.7 mV. Las medias de los umbrales de captura fueron 1.7 ± 0.8 V at 0.5 ms para los catéteres auriculares y 2.2 ± 1.2 V at 0.5 ms para los ventriculares. Los umbrales de captura y las impedancias ventriculares mostraron una mejoría en los 12 meses posteriores al implante, y en 4 pacientes esa mejoría en el umbral de captura ventricular fue mayor a 2 V. Conclusiones: En pacientes sometidos a una cirugía de reconversión de Fontan e implante de marcapasos, los umbrales de captura e impedancias ventriculares son más elevados que los esperados, pero mejoran durante el seguimiento. La aceptación de valores más elevados puede potencialmente constituir una alternativa en esta población de pacientes.

https://doi.org/10.24875/acm.20000426 10 downloads

11.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention
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Baldaçara, Leonardo

; Grudtner, Roberta R.

; da S. Leite, Verônica

; Porto, Deisy M.

; Robis, Kelly P.

; Fidalgo, Thiago M.

; Rocha, Gislene A.

; Diaz, Alexandre P.

; Meleiro, Alexandrina

; Correa, Humberto

; Tung, Teng C.

; Malloy-Diniz, Leandro

; Quevedo, João

; da Silva, Antônio G.

Brazilian Journal of Psychiatry

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oct 2021, Volume 43 N. 5 Pages 538 - 549

Abstract: En | Text: En | PDF: En

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

https://doi.org/10.1590/1516-4446-2020-1108 363 downloads

12.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment
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Baldaçara, Leonardo

; Rocha, Gislene A.

; Leite, Verônica da S.

; Porto, Deisy M.

; Grudtner, Roberta R.

; Diaz, Alexandre P.

; Meleiro, Alexandrina

; Correa, Humberto

; Tung, Teng C.

; Quevedo, João

; da Silva, Antônio G.

Brazilian Journal of Psychiatry

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oct 2021, Volume 43 N. 5 Pages 525 - 537

Abstract: En | Text: En | PDF: En

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

https://doi.org/10.1590/1516-4446-2020-0994 701 downloads

13.

Particle size and convergent electron diffraction patterns of triangular prismatic gold nanoparticles
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Fernando-Marquez, C.

; Mondragón-Galicia, G.

; Bazan-Diaz, L.

; Reyes-Gasga, J.

Revista mexicana de física

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aug 2021, Volume 67 N. 4 elocation e041005

Abstract: En | Text: En | PDF: En

Abstract Convergent beam diffraction (CBED) patterns of nanoparticles are possible. CBED of triangular prismatic shaped gold (Au) nanoparticle with focus on diffraction pattern symmetry and forbidden reflections observed along [111] and [112] zone axes are reported in this work. It is well known that the CBED patterns of nanoparticles of 30 nm or less in size only show bright kinematical discs. The dynamic contrast with Kikuchi and sharp HOLZ lines within the bright discs, as observed in CBED of volumetric materials, is well observed in particles larger of 500 nm in size. In addition, it is shown that the 1/3[422] and 1/2[311] weak forbidden reflections observed in the [111] and [112] electron diffraction patterns of these particles do not modify the symmetry of the CBED patterns, but they disappear as the size of the particle increases. The symmetry of the CBED patterns are always observed in concordance with the space group Fm3m (No. 225) of the Au unit cell. The possible explanations for observing forbidden reflections are the incomplete ABC stacking due to surface termination and the stacking faults in the fcc structure.

https://doi.org/10.31349/revmexfis.67.041005 20 downloads

14.

Stigma toward individuals with mental disorders among Brazilian psychiatrists: a latent class analysis
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da Silva, Antônio G.

; Loch, Alexandre A.

; Leal, Vanessa P.

; da Silva, Paulo R.

; Rosa, Monike M.

; Bomfim, Ozeias da C.

; Malloy-Diniz, Leandro F.

; Schwarzbold, Marcelo L.

; Diaz, Alexandre P.

; Palha, Antônio P.

Brazilian Journal of Psychiatry

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jun 2021, Volume 43 N. 3 Pages 262 - 268

Abstract: En | Text: En | PDF: En

Objective: The stigma toward individuals with mental disorders is highly prevalent, not only in the general population but among health care providers as well. The aim of this study was to identify subgroups based on stigmatizing beliefs related to psychiatric disorders among Brazilian psychiatrists, as well as to investigate their association with clinical and personality characteristics. Methods: Latent cluster analysis was used to find subgroups of cases in multivariate data according to a psychotic (schizophrenia) and a nonpsychotic disorder (attention-deficit hyperactivity disorder). The clusters for each psychiatric disorder were compared according to sociodemographic, emotional traits, and personality characteristics. Results: A total of 779 psychiatrists answered the questionnaire. Three different subgroups of stigma levels were identified regarding schizophrenia: the highest (n=202 [51.7%]), intermediate (108 [27.6%]), and the lowest (81 [20.7%]). Participants from the highest stigma group had a significantly longer time since graduation, higher anxiety-state scores, and lower positive affect. Two subgroups were identified with respect to attention-deficit hyperactivity disorder, although there were no differences between them in sociodemographic or clinical variables. Conclusion: There were more subgroups of stigmatizing beliefs regarding psychotic disorders. Individual characteristics, such as those related to trait anxiety and affect, can be associated with high stigma toward schizophrenia.

https://doi.org/10.1590/1516-4446-2020-0864 221 downloads

15.

Disincronía ventricular inducida por fármacos y taquicardiomiopatía en un neonate
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Majdalani, María G.

; Falconi, Estela C.

; Diaz, Carlos J.

; Doiny, David

; Abello, Mauricio S.

; Moltedo, José M.

Medicina (Buenos Aires)

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dec 2020, Volume 80 N. 6 Pages 726 - 728

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Ventricular dysfunction secondary to electrical and mechanical dyssynchrony in chronic right ventricular apical pacing is a well-recognized complication. There are no previous reports of pharmacologically induced dyssynchrony. A 10-day old infant with incessant supraventricular tachycardia was admitted to the neonatal intensive care unit. Therapy with oral propranolol was initiated and due to persistence of tachycardia intravenous amiodarone was administered. The patient remained predominantly in tachycardia with heart rates between 200-290 beats per minute for a week with serial echocardiograms showing preserved ventricular function. Oral flecainide was started. After 24 hours of treatment the patient developed a slower incessant wide QRS with a left bundle branch block pattern. The echocardiogram showed deterioration of left ventricular systolic function and moderate mitral regurgitation. Flecainide and propranolol were discontinued. The QRS complex narrowed and despite intermittent breakthroughs of supraventricular tachycardia, ventricular function normalized. Propranolol was restarted to achieve definitive control of the tachycardia. The presence of ventricular dyssynchrony generated by the left bundle branch block pattern secondary to pharmacological treatment with flecainide is a novel possible explanation for the development of ventricular dysfunction.

Resumen La disfunción ventricular secundaria a disincronía eléctrica y mecánica es una complicación de la estimulación ventricular desde el ápex del ventrículo derecho. No existen informes de disincronía secundaria a los efectos de fármacos antiarrítmicos. Se presenta el caso de una niña de 10 días de vida con taquicardia supraventricular incesante que se internó en terapia intensiva neonatal. Se inició tratamiento con propranolol por vía oral y ante la persistencia de la taquicardia se agregó amiodarona endovenosa. La paciente estuvo predominantemente en taquicardia con frecuencias cardíacas entre 200 y 290 latidos por minuto durante una semana a pesar del tratamiento instaurado. La función ventricular fue normal en los ecocardiogramas realizados. Se agregó flecainida por vía oral al esquema de tratamiento y luego de 24 horas presentó una taquicardia más lenta con QRS ancho e imagen de bloqueo completo de rama izquierda. Un nuevo ecocardiograma evidenció deterioro de la función ventricular izquierda e insuficiencia mitral moderada lo que motivó la suspensión de la flecainida y el propranolol. A las 24 horas de la suspensión se observó la normalización de la función ventricular a pesar de la persistencia de episodios intermitentes de taquicardia. Se reinició el propranolol logrando el control de la taquicardia. La presencia de disincronía ventricular generada por el bloqueo de rama izquierda secundario al tratamiento farmacológico con flecainida constituye una novedosa explicación posible para el desarrollo de disfunción ventricular.

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