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Resumen: El Pediatric Index of Mortality 3 (PIM3) es una escala que estima el riesgo de mortalidad en niños ingresados a Unidad de Cuidado Intensivo Pediátrico (UCIP) en la primera hora del ingreso. Objetivo: validar la escala PIM3 en población pediátrica que ingresa a UCIP en alturas sobre los 2.500 metros sobre el nivel del mar (m.s.n.m.), y evaluar si el lactato y el índice Saturación de Oxígeno/Fracción inspirada de oxígeno (SpO2/FiO2) mejoran su capacidad de predicción de mortalidad. Pacientes y Método: Estudio prospectivo multicéntrico realizado en diez UCIP de Colombia entre noviembre de 2016 y junio de 2017. Se recolectaron variables para cálculo del PIM3, lactato sérico y el índice SpO2/FiO2. Se validó su capacidad de discriminación con el área bajo la curva ROC y la calibración mediante la prueba de bondad de ajuste de Hosmer Lemeshow. Resultados: Se incluyeron 2.803 registros de admisiones, con una mortalidad global de 4,8%, y razón estandarizada de mortalidad de 1,1 (IC95%; 1,00-1,3). El PIM3 mostró una baja calibración (p < 0,001) y una adecuada discriminación para la población aplicada (ROC 0,84; IC95% 0,83-0,86). La adición de lactato sérico y SpO2/ FiO2 permitieron una buena calibración (p = 0,75), y mantuvo una alta discriminación de mortalidad (ROC 0,86; IC95% 0,84-0,87). Conclusiones: El comportamiento de la escala PIM3 tiene adecuada discriminación, pero una baja calibración en niños admitidos a UCIP sobre los 2500 m.s.n.m.. Las variables lactato y SpO2/FiO2 mejoraron su habilidad predictiva.

Abstract: The Pediatric Index of Mortality 3 (PIM3) is a scale that estimates the risk of mortality in children admitted to the Pediatric Intensive Care Unit (PICU) within the first hour of admission. Objective: to validate the PIM3 scale in pediatric population admitted to PICU at altitudes over 2,500 meters above sea level (m.a.s.l.), and to evaluate whether lactate and the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) index improve its ability to predict mortality. Patients and Method: A prospective multicenter study was carried out in 10 PICUs in Colombia between November 2016 and June 2017. Variables were collected for the calculation of PIM3, serum lactate, and SpO2/FiO2 index. Their discrimination capacity was validated with the area under the ROC curve and calibration using the Hosmer Lemeshow goodness-of-fit test. Results: 2,803 admissions were included, with an overall mortality of 4.8% and a standardized mortality ratio of 1.1 (95%CI 1.00-1.3). PIM3 showed low calibration (p < 0.001) and adequate discrimination for the studied population (ROC 0.84; 95%CI 0.83-0.86). The addition of serum lactate and SpO2/FiO2 allowed a good calibration (p = 0.75) and maintained a high discrimination of mortality (ROC 0.86; 95%CI 0.84-0.87). Conclusions: The performance of the PIM3 scale has adequate discrimination, but low calibration in children admitted to PICU at above 2500 m. a. s. l. Lactate and SpO2/FiO2 variables improved its predictive ability.

https://doi.org/10.32641/andespediatr.v94i4.4528

Escala “Pediatric Index Mortality 3” (PIM3) como predictor de mortalidad en unidades de cuidado intensivo pediátrico ubicadas a gran altitud
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López-Barón, Eliana

; Vasquez Hoyos, Pablo

; Martinez-Solarte, Mario

; Godoy, Javier

; Maya, Luis Carlos

; Perdomo Ramírez, Ivan

; Marina Mejía, Luz

; Godoy, Carol

; Pardo, Rosalba

; Roa, Juan David

; Mazzillo, Liliana

; González, Otto

; Fernández-Sarmiento, Jaime

; Izquierdo Borrero, Ledys María

; Duitama Vergara, Lorena

; Reyes, Martha

Andes pediatrica

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2023, N. ahead

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

https://doi.org/10.32641/andespediatr.v94i3.4528

Mecanismos plasmídicos de resistencia a quinolonas, betalactámicos y colistina en Salmonella enterica. Paraguay 2020-2021
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Ortiz, Flavia

; Weiler, Natalie

; Álvarez, Mercedes

; Orrego, Verónica

; Martínez, Jazmín

; Melgarejo, Nancy

; Brítez, Mariel

; Busignani, Sofía

; Martinez, Mario

; Dure, Felicita

; Riera, Esteban

; Bernis, David A.

; Acosta, Liz

; Rojas, Carolina

; Hamuy, Rossana

; Agüero, Mirna

; Casco, Mirtha

; Duarte, Ruth

; Gauto, Mirna

; Abreu, Karina

; Villalba, Antonio

; González, Marta

Memorias del Instituto de Investigaciones en Ciencias de la Salud

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2023, Volume 21 N. 1 elocation e21122313

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

RESUMEN Las bacterias son capaces de desarrollar mecanismos de resistencia a los antimicrobianos, aquellos adquiridos y transmisibles son los más significativos debido al potencial de diseminación. La aparición de Salmonella enterica con resistencia a C3aG, quinolonas y a colistina representa una amenaza progresiva. El objetivo fue determinar la resistencia a los antimicrobianos y la presencia de los mecanismos de resistencia plasmídicos a quinolonas, β-lactámicos y colistina en aislados de Salmonella provenientes de la vigilancia integrada de enteropatógenos. Fueron estudiadas 501 cepas de Salmonella spp. colectadas entre los años 2020 y 2021, por la red de enteropatógenos del Laboratorio Central de Salud Pública. Se investigó la resistencia a las C3aG, quinolonas y colistina, en aislamientos de humanos, alimentos, animales de consumo y ambiente. Las cepas estudiadas exhibieron resistencia a tetraciclina (32,5%), ácido nalidíxico (29%), ampicilina (13,2%), nitrofurantoína (11,6%), C3aG (7,2%), cotrimoxazol (5,8%), ciprofloxacina (2,2%). El 18% (90/501) presentaron resistencia trasferible por plásmidos, fueron detectados 111 genes (71 cepas con un gen, 17 cepas dos genes y 2 cepas tres genes diferentes). Qnr B: 41,1% (37/90), mcr-1: 38,9% (35/90), CMY: 23,3% (21/90), CTX-M: 16,7% (15/90) y Qnr S: 3,3% (3/90). Heidelberg fue el serovar predominante en muestras de pollo y el mayor portador de genes de resistencia de tipo CMY y mcr-1. La detección de genes en alimentos y animales de consumo, que pueden transmitirse fácilmente al ser humano es motivo de alerta y resalta la importancia de continuar fortaleciendo la vigilancia multisectorial y multidisciplinaria.

ABSTRACT Bacteria can develop antimicrobial resistance mechanisms, those acquired and transmissible being the most significant due to the potential for dissemination. The emergence of Salmonella enterica with resistance to third-generation cephalosporins, quinolones, and colistin represents a progressive threat. The objective was to determine antimicrobial resistance and the presence of plasmid resistance mechanisms to quinolones, β-lactams, and colistin in Salmonella isolates from integrated surveillance of enteropathogens. Five hundred and one strains of Salmonella spp. collected between 2020 and 2021 were studied by the enteropathogen network of the Laboratorio Central de Salud Publica (Central Public Health Laboratory). Research was conducted on the resistance to third-generation cephalosporins, quinolones, and colistin, isolated from humans, foodstuffs, animals for consumption, and the environment. The strains studied exhibited resistance to tetracycline (32.5%), nalidixic acid (29%), ampicillin (13.2%), nitrofurantoin (11.6%), third-generation cephalosporins (7.2%), cotrimoxazole (5.8%), and ciprofloxacin (2.2%). Eighteen percent (90/501) presented plasmid-transferable resistance, 111 genes were detected (71 strains with one gene, 17 strains with two genes, and 2 strains with three different genes). Qnr B: 41.1% (37/90), mcr-1: 38.9% (35/90), CMY: 23.3% (21/90), CTX-M: 16.7% (15/90), and Qnr S: 3.3% (3/90). Heidelberg was the predominant serovar in chicken samples and the largest carrier of CMY and mcr-1 resistance genes. The detection of genes in foodstuffs and animals for consumption, which can be easily transmitted to humans, is a cause for alarm and highlights the importance of continuing to strengthen multisectoral and multidisciplinary surveillance.

https://doi.org/10.18004/mem.iics/1812-9528/2023.e21122313

O PROGRAMA TRANSCIDADANIA: conquistas, representatividade e disputas narrativas
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Pinheiro, Carlos Vinícius Silva

; Martinez, Elias David Morales

Caderno CRH

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2023, Volume 36 elocation e023005

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

The temporal scope begins with the implementation of the Transcidadania Program by the Town Hall of São Paulo, from 2015 to 2022. The locus is limited to the LGBTQIA+ Citizenship Centers in the city, with a greater focus on the central region of the city, the migration focus of this population from Brazil. It follows the decentralization of the Program to other regions of the city and the exponent representativeness of transgender people in spaces of institutional power. The situational associative ethnographic methodology and discourse analysis are used because they are tools to encompass the heterogeneity of variables and make them palatable for the scientific translation of this unique and unprecedented public policy and its consequences. The aim is to show the resourcefulness of the program, in a qualitative perspective, as well as to situate, within the transition of different social political contexts, its relevance and the influences dialogued with the program and developments/social transformation. It is concluded that the narrative disputes that circulate the Transcidadania Program generate effects in the fight against precariousness and violence suffered by the trans population.

La portée temporelle commence avec la mise en œuvre du programme de transcitoyenneté par la ville de São Paulo, de 2015 à 2022. Le locus est limité aux centres de citoyenneté LGBTQIA+ de la ville, avec une plus grande concentration sur la région centrale de la ville, la migration foyer de cette population de São Paulo, Brésil. Il s’ensuit la décentralisation du Programme vers d’autres régions de la ville et la représentativité exposante des personnes transgenres dans les espaces de pouvoir institutionnel. La méthodologie ethnographique associative situationnelle et l’analyse de discours sont utilisées car elles sont des outils pour appréhender l’hétérogénéité des variables et les rendre acceptables pour la traduction scientifique de cette politique publique unique et inédite et de ses conséquences. L’objectif est de montrer l’ingéniosité du programme, dans une perspective qualitative, ainsi que de situer, dans la transition de différents contextes politiques sociaux, sa pertinence et les influences dialoguées avec le programme et les évolutions/transformations sociales. Il est conclu que les conflits narratifs qui circulent dans le programme Transcidadania génèrent des effets dans la lutte contre la précarité et la violence subies par la population trans.

O escopo temporal inicia-se com a implementação do Programa Transcidadania pela Prefeitura de São Paulo, de 2015 até 2022. O lócus limita-se aos Centros de Cidadania LGBTQIA+ da cidade, com maior foco na região central da cidade, foco migracional desta população do Brasil. Acompanha-se a descentralização do Programa para outras regiões da cidade e a expoente representatividade de pessoas transexuais em espaços de poder institucional. A metodologia etnográfica associativa situacional e análise de discurso são usadas por serem ferramentas para abarcar as heterogeneidades de variáveis e torná-las palatáveis para tradução científica desta única e inédita política pública e seus reflexos. Objetiva-se exibir a desenvoltura do programa, numa perspectiva qualitativa, bem como situar, dentro da transição de diversos contextos políticos sociais, a relevância dele e as influências dialogadas com o programa e desdobramentos/transformação social. Conclui-se que as disputas narrativas que circulam o Programa Transcidadania geram efeitos no combate da precariedade e da violência sofrida pela população trans.

https://doi.org/10.9771/ccrh.v36i0.31048

Ischemic Stroke and Acute Myocardial Infarction: Trends in in-Hospital Mortality in Brazil from 1998 to 2018
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Santos, Júlio Martinez

; Martinez, Alessandra Barboza Resende

; Silva, Emerson de Jesus

; Santana, Gustavo Roberto

; Barbosa, Romero Henrique de Almeida

; Lima, David Fernandes

; Lopes, Matheus Rodrigues

; Lopes, Johnnatas Mikael

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20220217

Abstract: En | Text: En | PDF: En

Abstract Background Ischemic stroke and acute myocardial infarction (AMI) are cardiovascular diseases with high morbidity and mortality rates in Brazil and worldwide. Their outcomes are influenced by public policies aimed at mitigating risk factors and by investments in infrastructure of emergency support and quality of hospital care. Objective To analyze the trend in the proportion of in-hospital deaths from ischemic stroke and AMI in Brazil as a way of evaluating the effectiveness of urgency and emergency services. Methods Ecological time series study using data from the Hospital Information System. The outcome was the proportion of in-hospital deaths from ischemic stroke and AMI with stratification by sex and state. Prais-Winsten regression was used to analyze the trend between 1998-2018 with α≤0,05. Results The proportion of deaths from AMI and ischemic stroke declined in the time series (p<0.001), decreasing annually by 0.17% and 0.25%, respectively. In 20 years, it reduced 43.76% (ischemic stroke) and 32.39% (AMI) in both sexes. However, the decline was more evident in the South and Southeast regions. Conclusion The reduction in hospital deaths from AMI and ischemic stroke was heterogeneous among Brazilian regions, which may be related to inequality in emergency services and hospital support.

https://doi.org/10.36660/ijcs.20220217

CFRP repair effectiveness on compressed steel tubular members with circular cutout
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Martinez, Jorge Luis

; Cyrino, Julio Cesar Ramalho

; Vaz, Murilo Augusto

; Hernández, Irving David

; Torres, Victor Daniel

; Perrut, Valber Azevedo

; Paula, Gustavo Gomes de

Latin American Journal of Solids and Structures

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2023, Volume 20 N. 2 elocation e477

Abstract: En | Text: En | PDF: En

Abstract Welding procedures for repairing corroded tubular structures are commonly used; however, composite material repairs are becoming popular since they do not use heat sources that might cause accidents. This paper provides a detailed description of the CFRP patch repair application in steel tubular members with a circular perforation originated from a prolonged corrosion process. The results of experimental tests on mid-scale unrepaired damaged and repaired steel tubes are reported. The predictions of the maximum loads recovered from a proposed numerical model lie close to the experimental observed values, justifying its usage for analysis of repaired tubular structures with circular cutouts when subjected to axial compression. Compared to unrepaired perforated tubes, the experimental results demonstrate a substantial strength recovery for repaired tubes. The value of this research for the oil and gas industry is that it demonstrates the feasibility of this kind of repair, which means reduced risk to the production unit and a shorter repair period. used however accidents process midscale mid scale reported values compression period

https://doi.org/10.1590/1679-78257357

Conmemoración centenaria, gestión política y proyectos urbanos en Pereira: 1947-1963
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CORREA RAMIREZ, JHON JAIME

; SAMACA ALONSO, GABRIEL DAVID

; MARTINEZ BOTERO, SEBASTIAN

Historia Caribe

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dec 2022, Volume 17 N. 41 Pages 241 - 268

Resumen El artículo reconstruye la dinámica política que precedió y definió la organización del primer centenario de Pereira en materia urbanística. En el marco de la modernización que experimentó el país entre los años cuarenta y sesenta, se identifican los intereses y propuestas de ciudad que formularon los principales promotores públicos y privados de la conmemoración. Aunque coexistió con los primeros pasos de la planeación urbana, las diferentes obras proyectadas se orientaron por la tensión y colaboración entre los sucesivos gobiernos locales y las entidades cívicas. La investigación se basa en documentación de la Alcaldía, el Concejo Municipal, prensa nacional y regional.

Resumo O artigo reconstrói a dinâmica política que precedeu e definiu a organização do primeiro centenário de Pereira em termos de planeamiento urbano. No âmbito da modernização que o país sofreu entre os anos 40 e 60, identifica os interesses e propostas para a cidade que formulados pelos principais promotores públicos e privados da comemoração. Embora tenha coexistido com os primeiros passos do planeamento urbano, as diferentes obras projectadas foram orientadas pela tensão e colaboração entre sucessivos governos locais e entidades cívicas. A investigação baseia-se na documentação do Gabinete do Presidente da Câmara, do Conselho Municipal, da imprensa nacional e regional.

Résumé L'article reconstruit la dynamique politique qui a précédé et a défini l'organisation du premier centenaire de Pereira en matière urbanistique. Dans le cadre de la modernisation éprouvée par le pays entre les années quarante et soixante, on identifie les intérêts et les propositions de ville formulés par les principaux promoteurs publiques et privés de la commémoration. Même si elle a coexisté avec les premiers pas de la planification urbaine, les différentes oeuvres projetées se sont orientées par la tension et la collaboration entre les gouvernements locaux qui se succédaient et les entités civiques. La recherche est basée sur des documents de la Mairie, le Conseil Municipal, la presse nationale et régionale.

Abstract The article reconstructs the political dynamics that preceded and defined the organization of the first centenary of Pereira in urban matters. Within the framework of the modernization that the country underwent between the 1940s and 1960s, the interests and city proposals formulated by the main public and private commemoration promoters are identified. Although it coexisted with the first steps of urban planning, the different projects planned were guided by the tension and collaboration among the successive local governments and civic entities. This investigation is based on documentation from the Mayor's Office, the Municipal Council, the national and regional press.

https://doi.org/10.15648/hc.41.2022.3376

Navegando por un territorio misterioso en cuanto al valor predictivo de la puntuación del SOFA: el dilema de la raza
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Lozada Martinez, Ivan David

; Hernandez Muñoz, Stefhany

; Angulo Lara, Ailyn Zenith

; Ruiz Benítez, Estefanía

; Buitrago Almanza, Cindy Stephanie

; Hernández Gallego, Jhon Alejandro

; Carreño Mancilla, Laura Cristina

; Ordóñez Veloza, Nathalia Carolina

; Reyes Triviño, Yohan Santiago

Revista de la Facultad de Medicina Humana

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oct 2022, Volume 22 N. 4 Pages 833 - 840

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

ABSTRACT Introduction: Critical syndromes are conditions that carry a high global burden of disease. Scoring systems are practical and reproducible aids that allow patients with more severe diseases to be quickly identified and admitted to intensive care and structured and aggressive therapy initiated. The Sequential Organ Failure Assessment (SOFA) score is one of the most widely used in the world, as there are several versions, and it is simple. However, with the appearance of COVID-19, several studies showed a disparity in the estimation of mortality and associated outcomes concerning race, culminating in excess of preventable mortality in certain racial groups. The constant evaluation of the performance of these scoring systems must be carried out due to definition updates, which can vary the accuracy of the predictive value. There is a very large gap in the evidence since the existing studies come from high-income countries, where the predominant racial group is Caucasians, which should draw attention to the magnitude of the problem. Based on the above, the objective of this review is to discuss evidence on the performance of scoring systems in critical care, particularly SOFA, and the impact that race has had on its predictive value.

RESUMEN Introducción: Los síndromes críticos son condiciones que acarrean una elevada carga de enfermedad a nivel global. Los sistemas de puntaje, son ayudas prácticas y reproducibles que permiten identificar de manera rápida pacientes con enfermedad más grave e ingresarlos a cuidado intensivo e iniciar terapia estructurada y agresiva. El score Sequential Organ Failure Assessment (SOFA), es uno de los más utilizados en el mundo, al existir varias versiones y ser sencillo. No obstante, con la aparición de la COVID-19, diversos estudios demostraron que existía una disparidad en cuanto a la estimación de mortalidad y desenlaces asociados, respecto a la raza, lo que culminó en un exceso de mortalidad prevenible en ciertos grupos raciales. La evaluación constante del rendimiento de estos sistemas de puntaje, debe realizarse debido a actualizaciones de definiciones, las cuales pueden variar la precisión del valor predictivo. Existe una brecha muy grande en cuanto la evidencia al respecto, puesto que los estudios existentes provienen de países de altos ingresos, donde el grupo racial predominante son los caucásicos, lo que debe llamar la atención de la magnitud del problema. Sobre la base de lo anterior, el objetivo de esta revisión consiste en discutir evidencia al respecto sobre el rendimiento de sistemas de puntuación en cuidado crítico, particularmente del SOFA y el impacto que ha tenido la raza sobre su valor predictivo.

https://doi.org/10.25176/rfmh.v22i4.5036

10.

Utilidad de la ecografía a pie de cama en la punción lumbar: un análisis del rendimiento diagnóstico basado en la evidencia disponible
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Lozada Martinez, Iván David

; Osma Ardila, Oscar Orlando

; Lamprea Ardila, Javier Alejandro

; Puerta Cervantes, Eliana Paola

; Jiménez Orduz, Andrea

; Ramírez Echavarria, Ana Carolina

; Leal Buitrago, Anderson

; Iglesias Monsalve, Julio César

; Caycedo Montiel, Daniela Margoth

Horizonte Médico (Lima)

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apr 2022, Volume 22 N. 2 elocation e1923

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

RESUMEN Los avances en la tecnología de la ciencia biomédica han permitido incrementar la tasa de éxito de las intervenciones gracias a las mejoras en seguridad y eficacia. Durante la evaluación del paciente con un trastorno neurológico agudo que requiere una punción lumbar, existen algunas condiciones que pueden dificultar la realización de este procedimiento, tales como la infección en el lugar de la punción o las anomalías óseas que puedan causar una lesión medular. El uso de la ecografía a pie de cama es una buena alternativa para acompañar a la punción debido a su capacidad para explorar estructuras que no pueden ser evaluadas mediante la exploración física. En los centros hospitalarios de baja complejidad, donde pueden existir barreras de acceso a herramientas de imagen costosas, la ecografía es una opción rentable para el abordaje de patologías urgentes. Con base en lo anterior, el objetivo de este manuscrito consiste en revisar conceptos relevantes basados en la evidencia más reciente, que están relacionados con el uso de la ecografía para la realización de la punción lumbar.

ABSTRACT Advances in biomedical technology have increased the success rate of medical procedures due to improvements in safety and efficacy. During the assessment of patients with acute neurological disorder who require a lumbar puncture, some conditions may hinder its performance, such as infection at the puncture site or bone abnormalities that may cause spinal cord injury. Bedside ultrasound is a good alternative to assist in the performance of a puncture, due to its ability to examine structures that cannot be assessed by physical examination. In primary health care centers, where there may be obstacles that prevent access to expensive imaging tools, ultrasound is a cost-effective option in the approach to urgent pathologies. In view of the foregoing, this paper aims to review important recent evidence-based concepts related to the use of ultrasound for the performance of a lumbar puncture.

https://doi.org/10.24265/horizmed.2022.v22n2.14

11.

Recomendaciones de la Asociación Colombiana de Neurología para el uso de anticuerpos monoclonales antiCGRP en la profilaxis de migraña
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Pradilla, Oscar Enrique

; Martinez, José David

; Rueda-Sánchez, Mauricio

; Sobrino, Fidel

; Jiménez, Juan Diego

; Ramírez, Sergio Francisco

; Muñoz-Cerón, Joe Fernando

; Volcy, Michel

; Guerra, Carolina

; Ramos, Marta Liliana

; Arango, Esteban

; Uribe, Bernardo

; Cavanzo, Paula

; Hernández, Natalia

Acta Neurológica Colombiana

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mar 2022, Volume 38 N. 1 Pages 1 - 22

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

ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.

https://doi.org/10.22379/24224022401 94 downloads

12.

Investigar durante el pregrado de medicina: ¿Es necesario modificar el programa curricular en Colombia?
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Guardo Carmona, Daniela

; Lozada Martinez, Ivan David

; Pérez Orozco, Daimer José

; Moscote Salazar, Luis Rafael

Acta Neurológica Colombiana

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mar 2022, Volume 38 N. 1 Pages 60 - 62

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.22379/24224022402 23 downloads

13.

Corrección de hernia de Amyand con malla y apendicetomía: reporte de caso
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Lozada Martinez, Ivan David

; Llamas Nieves, Andrés Elías

; Ospina Pérez, Christian German

; Álvarez Acuña, Ana Milena

; Ospina Pérez, Rosa María

Horizonte Médico (Lima)

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jan 2022, Volume 22 N. 1 elocation e1512

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

ABSTRACT Amyand’s hernia is defined as the presence of the vermiform appendix within an inguinal hernial sac. Less than 1 % of the world medical publications on hernias address this disease, out of which very few come from Latin America and the Caribbean. This is the case of a 78-year-old male patient who experienced signs and symptoms for approximately five months. He felt a lump in the right inguinal region which progressively increased in size. Two days prior to admission to the intensive care unit, he said his pain level was 8/10. During the right inguinal approach, the hernial sac was opened, revealing parts of the right colon, cecum and appendix with edematous changes. Therefore, the patient underwent an appendectomy and repair with polypropylene mesh.

RESUMEN La hernia de Amyand se define como la presencia de un apéndice vermiforme dentro de un saco herniario inguinal. Menos del 1 % de las publicaciones médicas sobre hernias en el mundo corresponde a este padecimiento, y los reportes en Latinoamérica y el Caribe son escasos. Este artículo describe el caso de un varón de 78 años con un cuadro clínico de cinco meses de evolución aproximadamente. El paciente refiere que sentía una masa en la región inguinal derecha de crecimiento progresivo. Luego se asoció un dolor (de escala 8/10) durante los dos días previos al ingreso en el departamento de urgencias. Durante la operación en la región inguinal derecha, se abre el saco herniario que muestra partes del colon derecho, el ciego y el apéndice (edematosos), por lo que se decide realizar una apendicectomía y la reconstrucción con una malla de polipropileno.

https://doi.org/10.24265/horizmed.2022.v22n1.11

14.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes

; Melo, Ana Karla Guedes de

; Cruz, Vítor Alves

; Souza, Viviane Angelina de

; Carvalho, Joana Starling de

; Machado, Ketty Lysie Libardi Lira

; Valadares, Lilian David de Azevedo

; Reis Neto, Edgard Torres dos

; Rezende, Rodrigo Poubel Vieira de

; Guimarães, Maria Fernanda Brandão de Resende

; Ferreira, Gilda Aparecida

; Braz, Alessandra de Sousa

; Vieira, Rejane Maria Rodrigues de Abreu

; Pinheiro, Marcelo de Medeiros

; Ribeiro, Sandra Lúcia Euzébio

; Bica, Blanca Elena Gomes Rios

; Baptista, Kátia Lino

; Costa, Izaias Pereira da

; Marques, Claudia Diniz Lopes

; Lopes, Maria Lúcia Lemos

; Martinez, José Eduardo

; Giorgi, Rina Dalva Neubarth

; Mota, Lícia Maria Henrique da

; Loures, Marcos Antônio Araújo da Rocha

; Paiva, Eduardo dos Santos

; Monticielo, Odirlei André

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Pileggi, Gecilmara Cristina Salviato

Advances in Rheumatology

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2022, Volume 62 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

https://doi.org/10.1186/s42358-022-00234-7

15.

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child
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Rassi, Alessandra Thome

; Santana, Tainara Sardeiro de

; Isaac, David Leonardo Cruvinel

; Martinez, Rafael Cardoso

; Garcia, Jose Mauricio Botto de Barros

; Ávila, Marcos Pereira de

Revista Brasileira de Oftalmologia

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2022, Volume 81 elocation e0012

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

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

https://doi.org/10.37039/1982.8551.20220012

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