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Introducción: Los carcinomas neuroendocrinos (NEC) de canal anal son neoplasias extremadamente raras, representando del 1 a 1,6% de la totalidad de los tumores neuroendocrinos (NET). Suelen ser poco diferenciados, muy agresivos y con alta tendencia a metastatizar. Caso clínico: Mujer de 52 años diagnosticada de fisura anal. Durante la esfinterotomía lateral interna (ELI) se evidencia un pólipo milimétrico aparentemente hiperplásico. Biopsia: NEC de alto grado. En el estudio de extensión se observa engrosamiento de la mucosa del canal anal que invade el esfínter interno, sin enfermedad a distancia. Se realiza amputación abdominoperineal laparoscópica donde se objetiva infiltración del tabique rectovaginal, por lo que se realiza resección y vaginoplastia. AP: NEC con estadio PT4B N2A, por lo que se indica quimioterapia adyuvante. Discusión: La presentación clínica de los NEC de canal anal es inespecífica, diferenciándose de otros tumores colorrectales en que hasta el 67% de los pacientes presentan metástasis al diagnóstico, siendo la supervivencia media de 11 meses. Si diagnosticamos un NEC localizado de forma incidental, es fundamental la celeridad en su tratamiento, dada su agresividad.

Introduction: Neuroendocrine carcinomas (NEC) of the anal canal are extremely rare neoplasms, representing 1 to 1.6% of all neuroendocrine tumors (NET). They are usually poorly differentiated, very aggressive and with a high tendency to metastasize. Clinical case: A 52-year-old woman diagnosed with anal fissure. During the LIS, an apparently hyperplastic millimetric polyp is evidenced. Biopsy: high-grade NEC. The imaging study shows thickening of the mucosa of the anal canal that invades the internal sphincter, without metastases. We performed a laparoscopic abdominoperineal amputation, and noticed an infiltration of the rectovaginal septum, so resection and vaginoplasty was performed. Pathology: NEC with stage PT4B N2A, for which adjuvant chemotherapy is indicated. Discussion: The clinical presentation of NEC of the anal canal is nonspecific, differing from other colorectal tumors in that up to 67% of patients have metastases at diagnosis, with a median survival of 11 months. When an incidentally localized NEC is diagnosed, prompt treatment is essential, given its aggressiveness.

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Shark meat is a popular protein source worldwide. However, existing national control policies for ensuring the safety and quality of shark meat are minimal. There are concerns about the sustainability of shark populations, which bioaccumulate and biomagnify potentially toxic elements at higher rates than non-predatory fish, posing a risk to human health. In this study, the contributions of essential elements to the Recommended Dietary Allowance (RDA) and potentially toxic elements to the Reference Dose (RfD) linked to shark consumption (200 g per week) were investigated for three shark species in the Central Mexican Pacific. We estimated risks and benefits for women, children, and men. Our results suggest that the three shark species are sources of Se, Co, Cr, Cu, Fe, and Zn, but poor sources of Mn for women and men aged 19-50 years. A weekly ingestion of 200 g of shark meat exceeded the RfD-As by 4-14 times and the RfD-Pb by 1.1-1.7 times for adults, indicating a potential risk to human health. The three shark species were also significant sources of potentially toxic elements for children, including Hg, Cd, Cr, and Pb. An excessive intake of Se was observed, with levels at 8.4-10.6 and 4.3-5.3 times the RDA for children aged 1-8 and 9-13 years, respectively. Although shark meat can be a good source of essential nutrients, the lack of controls in the commercialization process indicates that it should be consumed in moderation due to the potential risks associated with excessive exposure to potentially toxic elements. This caution is particularly important for children and pregnant women, who are at higher risk of health complications from consuming contaminated food.

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RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

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This case series study evaluated the survival, success rate and marginal bone remodeling of Morse taper hydrophilic implants placed for full-arch rehabilitations over a 1-year follow-up period. Ten patients in need of maxillary and/or mandibular full-arch rehabilitation were selected. Sixty-six Morse taper implants and sixty-six abutments were inserted. All implants were placed using a surgical flap approach without bone regeneration and were immediately loaded with definitive prostheses according to the passive fitting technique. The patients underwent clinical and radiographic follow-up at different postoperative periods: T0 = immediate (up to 1 month after surgery); T1 = 3-4 months after surgery; T2 = 6-8 months after surgery; and T3 = 1 year after surgery. The survival and success rate of the implants and the marginal bone remodeling were evaluated. Normal distribution of the outcomes was verified by Kolmogorov-Smirnov tests. Therefore, changes in vertical and horizontal marginal bone levels were assessed with paired t-tests. Results were considered significant for P < 0.05. Survival and success rates of 100% and 92.4%, respectively, were observed. Statistically significant vertical bone level changes were shown for all periods. From T0 to T3, there was a mean difference in vertical bone loss of -1.02 mm on the mesial surface and of -0.93 mm on the distal surface, for horizontal bone loss in the same period, it was observed mean changes of -0.14 mm on the mesial surface and -0.09 mm on the distal surface. This 1-year case series follow-up of immediate full-arch rehabilitation, using one-step hybrid passive fitting supported by four to six hydrophilic tapered implants, suggests predictability with high survival and success rates in edentulous patients.

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Resumen Objetivo: La lesión del nervio laríngeo recurrente es una grave complicación en cirugía tiroidea. El propósito del presente estudio es analizar la utilidad de la neuromonitorización vagal continua intraoperatoria en un hospital terciario. Materiales y Método: Estudio observacional, analítico y retrospectivo que recoge pacientes intervenidos de cirugía tiroidea con neuromonitorización en un período de 14 meses. La pérdida de señal se define como amplitud final nerviosa < 100 ^V, realizándose laringoscopia postquirúrgica ante la sospecha de lesión nerviosa. El análisis estadístico se realizó con el programa SPSS® V25,0, con p < 0,05. Resultados: Se incluyeron 120 pacientes intervenidos, registrándose en el 24,2% pérdida de señal. Factores de riesgo para lesión fueron bocio intratorácico (OR 5,31; IC 95% 1,56-17,99; p = 0,007), cirugía cervical previa (OR 5,76; IC 95% 0,64-51,97; p = 0,119) y patología maligna (OR 1,44; IC 95% 0,16-12,79; p = 0,743). Fue posible el cambio de estrategia quirúrgica en 7 casos. En el seguimiento posterior se cuantificó parálisis recurrencial transitoria en 27 pacientes y permanente en 4. Discusión: La neuromonitorización parece reducir la incidencia de parálisis laríngea porque aumenta la seguridad en la identificación del nervio recurrente y reduce su manipulación durante la cirugía. Conclusiones: La neuromonitorización intraoperatoria es útil para identificar el nervio laríngeo recurrente y advierte del riesgo potencial de lesión, permitiendo cambiar la estrategia quirúrgica para evitar la parálisis bilateral de cuerdas vocales.

Aim: Recurrent laryngeal nerve injury is a serious complication in thyroid surgery. The purpose of the present study is to analyze the use of intraoperative continuous vagal neuromonitoring in a tertiary hospital. Materials and Method: Observational, analytical and retrospective study that includes patients who underwent thyroid surgery with neuromonitoring in a period of 14 months. Loss of signal is defined as final nerve amplitude < 100 ^V, and postsurgical laryngoscopy is performed due to suspicion of nerve injury. Statistical analysis was performed with the SPSS® V25.0 program, with p < 0.05. Results: 120 operated patients were included, registering loss of signal in 24.2%. Risk factors for injury were intrathoracic goiter (OR 5.31; 95% CI 1.56-17.99; p = 0.007), previous cervical surgery (OR 5.76; 95% CI 0.64-51.97; p = 0.119) and malignant pathology (OR 1.44; 95% CI 0.16-12.79; p = 0.743). A change in surgical strategy was possible in 7 cases. In the subsequent follow-up, transient recurrent paralysis was quantified in 27 patients and permanent in 4. Discussion: Neuromonitoring seems to reduce the incidence of laryngeal paralysis because it increases the security in the identification of the recurrent nerve and reduces its manipulation during surgery. Conclusions: Intraoperative neuromonitoring is useful to identify the recurrent laryngeal nerve and warns of the potential risk of injury, allowing to change the surgical strategy to avoid bilateral vocal cord paralysis.

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OBJECTIVE: Bull-horn injuries (BHI) are unique and there is reduced published literature about it. We present an analysis of a 11-year BHI case series. METHOD: Study of 138 cases developed during a 11-year period with hospitalization admission greater than 24 hours with diagnosis of BHI/contusion. We classified patients in two groups: group A, patients undergoing procedures under general anaesthesia and group B undergoing procedures under local anaesthesia. Variables: age, sex, date, hospitalization length, main region affected, Comprehensive complication index (CCI, ISS, intensive care unit (ICU) admission, stay and mortality. Statistical analysis: t-Student test, ANOVA, χ2 and linear or logistic regression. RESULTS AND CONCLUSIONS: ISS was related to hospital stay, CCI, ICU admission and type of treatment applied. The comparative statistical analysis of variables between both groups determined a significant difference in age, ISS and hospitalization length, being greater in those belonging to group A. There is a more risk of undergoing surgery by increasing age, ISS and presenting the wounds in thorax-abdomen-pelvis area. CCI may be a good method of quantifying postoperatory morbidity in polytraumatized patients or in other areas besides the abdomen.

OBJETIVO: Las heridas por asta de toro (HAT) poseen características únicas y existe literatura escasa en esta área. Presentamos un análisis de 11 años de pacientes con HAT. MÉTODO: Estudio retrospectivo y analítico de 138 casos durante un periodo de 11 años, de pacientes ingresados durante más de 24 horas por HAT. Clasificamos a los pacientes en dos grupos: grupo A, sometidos a procedimientos bajo anestesia general, y grupo B, sometidos a procedimientos bajo anestesia local. Variables recogidas: edad, sexo, mes del suceso, hospitalización (días), región afectada, Comprehensive Complication Index (CCI), Injury Severity Score (ISS), ingreso y estancia en la unidad de cuidados intensivos (UCI) y mortalidad. Análisis estadístico: t de Student, ANOVA, χ2, regresión lineal y logística. RESULTADOS Y CONCLUSIONES: El ISS se relaciona directamente con la estancia hospitalaria, el CCI, el ingreso en UCI y el tratamiento recibido. Entre ambos grupos se evidenció una diferencia significativa en edad, ISS y estancia hospitalaria, siendo mayores en el grupo A. Existe un mayor riesgo de necesitar cirugía conforme aumentan la edad, el ISS y las heridas en tórax, abdomen o pelvis. El CCI puede ser un buen método para cuantificar la morbilidad posoperatoria en pacientes politraumatizados o con lesiones en otras áreas distintas del abdomen.

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BACKGROUND: Helicobacter pylori colonizes approximately half of the world's human population. Its presence in the gastric mucosa is associated with an increased risk of gastric adenocarcinoma, gastric lymphoma, and peptic ulcer disease. In Brazil, the high prevalence of H. pylori infection is a serious health problem. H. pylori virulence factors are associated with an increased risk of serious gastrointestinal disorders. The cagA gene encodes a cytotoxin-A-associated antigen (CagA) that is involved in bacterial pathogenicity. H. pylori strains carrying the cag pathogenicity island (cag-PAI) are significantly associated with severe clinical outcomes and histopathological changes. OBJECTIVE: The present study aims to investigate the prevalence of the cagA gene among H. pylori isolates from patients with different gastric pathologies. Further, the study hopes to verify its association with clinical outcomes. In addition, phylogenetic analysis was performed on cagA-positive H. pylori strains from patients with severe and non-severe diseases. METHODS: Gastric specimens were collected through a biopsy from 117 patients with different esogastroduodenal diseases. DNA was extracted from these gastric specimens and the polymerase chain reaction was performed to amplify the gene fragments corresponding to the 16S ribosomal RNA and cagA genes using specific primers. The polymerase chain reaction products of selected samples positive for cagA were sequenced. The sequences were aligned with reference sequences from the National Center for Biotechnology Information (NCBI) (Bethesda/USA), and a phylogenetic tree was constructed. RESULTS: H. pylori was detected in 65.9% (77/117) of Brazilian patients with different gastroduodenal disorders. Overall, 80.5% (62/77) of the strains were cagA-positive. The ages of patients with cagA-positive strains (15 males and 47 females) ranged from 18 to 74 years. The lesions were categorized as non-severe and severe according to the endoscopic and histopathological reports the most prevalent non-severe esogastroduodenal lesion was gastritis 54/77 (70.12%), followed by esophagitis 12/77 (15.58%) and duodenitis 12/77 (15.58%). In contrast, the most prevalent severe lesions were atrophy 7/77 (9.09%), followed by metaplasia 3/77 (3.86%) and gastric adenocarcinoma 2/77 (2.59%). Phylogenetic analyses performed with the partial sequences of the cagA gene obtained from local strains were grouped in the same clade. No differences in phylogenetic distribution was detected between severe and non-severe diseases. CONCLUSION: The cagA gene is highly prevalent among H. pylori isolates from gastric lesions in Brazilian patients. The presence of the cagA gene was not considered a marker of the severity of esogastroduodenal lesions in the present study. This is the first study to investigate the phylogenetic population structure of H. pylori strains in a Brazilian capital, which may improve our understanding of the clinical outcome of H. pylori infection.

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ABSTRACT BACKGROUND: Helicobacter pylori colonizes approximately half of the world's human population. Its presence in the gastric mucosa is associated with an increased risk of gastric adenocarcinoma, gastric lymphoma, and peptic ulcer disease. In Brazil, the high prevalence of H. pylori infection is a serious health problem. H. pylori virulence factors are associated with an increased risk of serious gastrointestinal disorders. The cagA gene encodes a cytotoxin-A-associated antigen (CagA) that is involved in bacterial pathogenicity. H. pylori strains carrying the cag pathogenicity island (cag-PAI) are significantly associated with severe clinical outcomes and histopathological changes. OBJECTIVE: The present study aims to investigate the prevalence of the cagA gene among H. pylori isolates from patients with different gastric pathologies. Further, the study hopes to verify its association with clinical outcomes. In addition, phylogenetic analysis was performed on cagA-positive H. pylori strains from patients with severe and non-severe diseases. METHODS: Gastric specimens were collected through a biopsy from 117 patients with different esogastroduodenal diseases. DNA was extracted from these gastric specimens and the polymerase chain reaction was performed to amplify the gene fragments corresponding to the 16S ribosomal RNA and cagA genes using specific primers. The polymerase chain reaction products of selected samples positive for cagA were sequenced. The sequences were aligned with reference sequences from the National Center for Biotechnology Information (NCBI) (Bethesda/USA), and a phylogenetic tree was constructed. RESULTS: H. pylori was detected in 65.9% (77/117) of Brazilian patients with different gastroduodenal disorders. Overall, 80.5% (62/77) of the strains were cagA-positive. The ages of patients with cagA-positive strains (15 males and 47 females) ranged from 18 to 74 years. The lesions were categorized as non-severe and severe according to the endoscopic and histopathological reports the most prevalent non-severe esogastroduodenal lesion was gastritis 54/77 (70.12%), followed by esophagitis 12/77 (15.58%) and duodenitis 12/77 (15.58%). In contrast, the most prevalent severe lesions were atrophy 7/77 (9.09%), followed by metaplasia 3/77 (3.86%) and gastric adenocarcinoma 2/77 (2.59%). Phylogenetic analyses performed with the partial sequences of the cagA gene obtained from local strains were grouped in the same clade. No differences in phylogenetic distribution was detected between severe and non-severe diseases. CONCLUSION: The cagA gene is highly prevalent among H. pylori isolates from gastric lesions in Brazilian patients. The presence of the cagA gene was not considered a marker of the severity of esogastroduodenal lesions in the present study. This is the first study to investigate the phylogenetic population structure of H. pylori strains in a Brazilian capital, which may improve our understanding of the clinical outcome of H. pylori infection.

RESUMO CONTEXTO: Helicobacter pylori coloniza aproximadamente metade da população humana mundial. A presença do microrganismo na mucosa gástrica está associada a um risco aumentado de adenocarcinoma gástrico, linfoma gástrico e úlcera péptica. No Brasil, a alta prevalência de infecção por H. pylori é um grave problema de saúde. Os fatores de virulência de H. pylori estão associados a risco aumentado de distúrbios gastrointestinais severos. O gene cagA codifica um antígeno associado à citotoxina A (CagA) que está envolvido na patogenicidade bacteriana. As cepas de H. pylori portadoras da ilha de patogenicidade cag (cag-PAI) estão significativamente associadas a desfechos clínicos severos e alterações histopatológicas. OBJETIVO: O presente estudo tem como objetivo investigar a prevalência do gene cagA entre isolados de H. pylori de pacientes com diferentes desordens gástricas, bem como verificar sua associação com desfechos clínicos. Além disso, a análise filogenética foi realizada em cepas de H. pylori cagA-positivas de pacientes com doenças severas e não severas. MÉTODOS: Amostras gástricas foram coletadas por meio de biópsia gástrica de 117 pacientes com diferentes doenças esogastroduodenais. O DNA foi extraído das amostras e utilizado para amplificar os fragmentos gênicos correspondentes aos genes RNA ribossomal 16S e cagA, através da reação em cadeia da polimerase. Os produtos da reação em cadeia da polimerase de amostras selecionadas positivas para cagA foram sequenciados e as sequências foram alinhadas com sequências de referência do National Center for Biotechnology Information (NCBI) (Bethesda/EUA). As análises filogenéticas foram realizadas a partir do sequenciamento e construção da árvore filogenética. RESULTADOS: H. pylori foi detectado em 65,9% (77/117) dos pacientes brasileiros com diferentes distúrbios gastroduodenais. No total, 80,5% (62/77) das cepas foram cagA-positivas. As idades dos pacientes com cepas cagA-positivas (15 homens e 47 mulheres) variaram de 18 a 74 anos. As lesões foram categorizadas como não severas e severas de acordo com o laudo endoscópico e histopatológico. A lesão esogastroduodenal não severa mais prevalente foi gastrite 54/77 (70,12%), seguida de esofagite 12/77 (15,58%) e duodenite 12/77 (15,58%). Em contraste, as lesões severas mais prevalentes foram atrofia 7/77 (9,09%), seguida de metaplasia 3/77 (3,86%) e adenocarcinoma gástrico 2/77 (2,59%). As análises filogenéticas realizadas com as sequências parciais do gene cagA obtidas de cepas locais foram agrupadas no mesmo clado. Nenhuma diferença na distribuição filogenética foi detectada entre doenças severas e não severas. CONCLUSÃO: O gene cagA é altamente prevalente entre isolados de H. pylori de lesões gástricas em pacientes brasileiros. A presença do gene cagA não foi considerada um marcador de severidade das lesões esogastroduodenais no presente estudo. Este é o primeiro estudo a investigar a estrutura filogenética da população de cepas de H. pylori em uma capital brasileira. Esses resultados irão contribuir para o entendimento sobre o desfecho clínico da infecção por H. pylori.

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Helicobacter pylori is the etiological agent of chronic gastritis, peptic ulcer, and gastric cancer. The duodenal ulcer-promoting gene dupA, which is located in the plasticity region of the H. pylori genome, is homologous to the virB gene which encodes a type IV secretion protein in Agrobacterium tumefaciens. Studies have shown associations between H. pylori dupA-positive strains and gastroduodenal diseases. However, whether dupA acts as a risk factor or protective factor in these diseases remains unclear. Therefore, in this study, we aimed to verify the presence of the dupA gene in infectious H. pylori strains in the Brazilian mid-west and to investigate its association with the clinical outcomes of patients with dyspepsia. Additionally, the phylogenetic origin of the strains was determined. Gastric biopsies from 117 patients with dyspepsia were analyzed using histological and molecular techniques. The hpx gene (16S rRNA) was used to screen for H. pylori infection, and positive samples were then subjected to dupA gene detection and sequencing. The estimated prevalence of H. pylori infection was 64.1%, with the dupA gene being detected in a high proportion of infectious strains (70.7%). Furthermore, a risk analysis revealed that for women, a dupA-positive H. pylori infection increased the chance of developing gastritis by twofold. The partial dupA sequences from isolated infectious strains in this work are similar to those of strains isolated in westerns countries. This study provides useful insights for understanding the role of the H. pylori dupA gene in disease development.

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RESUMEN Las resecciones hepáticas en dos tiempos se desarrollaron para aumentar la resecabilidad de los tumo res hepáticos en pacientes con futuro remanente hepático insuficiente. El ALPPS, descripto en 2011, ha representado un gran avance en el mundo de la cirugía hepatobiliopancreática. Esta técnica acelera la hipertrofia del futuro remanente hepático y reduce el intervalo de tiempo entre las dos cirugías en comparación con las técnicas clásicas. El ALPPS ha ganado popularidad rápidamente, con más de 1200 pacientes incluidos en el registro mundial. Los comités internacionales de expertos se han reunido en dos ocasiones con el fin de emitir recomendaciones, principalmente sobre las indicaciones, selección de pacientes y estandarización de la técnica quirúrgica. Aunque ha demostrado ser superior en términos de resecabilidad (entre el 80-100% frente al 60-90% de la hepatectomía en dos tiempos), su rápida implementación ha sido penalizada con alta morbi mortalidad en las series publicadas, que llega a alcanzar el 40% y el 9%, respectivamente. Además, la evidencia actual sobre los posibles beneficios y desventajas se basa mayoritariamente en estudios observacionales. Presentamos una revisión histórica, describiendo las diferentes modificaciones técnicas que se han lle vado a cabo desde su inicio y realizando una revisión rigurosa en términos de morbilidad, mortalidad y resultados oncológicos.

ABSTRACT Two-stage liver resections were described to increase the resectability of liver tumors in patients with insufficient future liver remnant. The ALPPS procedure, described in 2011, has represented a breakthrough in the field of hepato-pancreato-biliary surgery. This technique accelerates the hypertrophy of the future liver remnant and reduces the interval between the two surgeries compared with previous techniques. ALPPS has gained popularity rapidly, with more than 1200 patients included in the world registry. Recommendations about indications, patient selection and surgical standardization have been discussed twice in international expert meetings. Although ALPPS has proven to be superior in terms of resectability (80-100% versus 60-90% of two-stage hepatectomy), its rapid implementation has been punished with high morbidity and mortality reaching up to 40% and 9%, respectively, in the published series. The current evidence on the possible benefits and disadvantages is mainly based on observational studies. We present a historical review, describing the different technical modifications that have been carried out since its description, with a rigorous review in terms of morbidity, mortality, and oncological outcomes.

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RESUMEN Introducción: el programa nacional de Telemedicina - Electroencefalografía (EEG) representa un paso importante en el acercamiento de medios auxiliares de diagnóstico neurológicos a la población rural que debía recorrer grandes distancias realizando un gran esfuerzo económico. Objetivos: realizar un estudio descriptivo-comparativo abarcando resultados del ECG del periodo 2015-2016 y el estado actual hasta el año 2019. Establecer su utilidad como medio auxiliar de diagnóstico a distancia. Determinar fortalezas y debilidades. Metodología: descripción de EEG de hospitales del Ministerio de Salud Pública y Bienestar Social del 2015-2016, y comparación con resultados hasta el 2019 utilizando el sistema internacional 10-20, la interpretación fue realizada por el mismo equipo de neurólogos electroencefalografistas. El informe consignado en una ficha informática es devuelto al médico remitente para su implementación terapéutica. Resultados: hasta el año 2016 hubo 9 centros para la realización de EEG pero este número aumento a 18 en 2019. La cantidad de EEG realizados fue 858 hasta 2016 y 12.139 hasta 2019. Se observó aumento de solicitudes de asistencia remota y de equipos disponibles, abarcando más regiones y mayor número de pacientes. Se registró 60% de hallazgos normales, 22,8% patológicos donde los hallazgos focales con generalización secundaria representaron la mayoría. En 17% fueron devueltos por estar incompletos e inespecíficos. Conclusiones: se encontraron 188 resultados patológicos hasta 2016 y 2.747 hasta 2019. En los hallazgos patológicos, el más frecuente en ambos periodos fue la epilepsia parcial con generalización secundaria. No hubo diferencias en cuanto a sexo y grupos etarios en ambos periodos. Los desafíos constituyen la identificación de la epilepsia como entidad nosológica independiente, implementación de un sistema de teleconsultas y ampliar aún más el área de cobertura.

ABSTRACT Introduction: The national program of Telemedicine - Electroencephalography (EEG) represents an important step in the approach of auxiliary means of neurological diagnosis to the rural population that had to travel long distances making a great economic effort. Objectives: To carry out a descriptive-comparative study covering ECG results for the 2015-2016 period and the current status until 2019. To establish its usefulness as an auxiliary means of remote diagnosis. To determine strengths and weaknesses. Methodology: Description of EEG from hospitals of the Ministry of Public Health and Social Welfare from 2015-2016, and comparison with results until 2019 using the international 10-20 system, the interpretation was performed by the same team of electroencephalograph neurologists. The report recorded in a computer file was returned to the referring physician for its therapeutic implementation. Results: Until 2016, there were 9 centers to perform EEG but this number increased to 18 in 2019. The number of EEGs performed was 858 until 2016 and 12,139 until 2019. There was an increase in requests for remote assistance and available equipment, covering more regions and a greater number of patients. There were 60% normal and 22.8% pathological findings where focal findings with secondary generalization represented the majority. In 17%, the results were returned for being incomplete and unspecific. Conclusions: One hundred eighty-eight pathological results were found up to 2016 and 2,747 until 2019. In the pathological findings, the most frequent in both periods was partial epilepsy with secondary generalization. There were no differences regarding sex and age groups in both periods. The challenges are the identification of epilepsy as an independent nosological entity, implementation of a teleconsultation system and further expansion of the coverage area.

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Objetivos: Determinar la frecuencia de enfermedades autoinmunes (EAI) en pacientes con Artritis Reumatoidea (AR) y comparar la frecuencia de EAI entre pacientes con AR y sin AR ni otra EAI reumatológica. Material y Métodos: Estudio multicéntrico, observacional, analítico, retrospectivo. Se incluyeron pacientes consecutivos con AR (ACR/EULAR 2010) y como grupo control pacientes con diagnóstico inicial de Osteoartritis primaria (OA). Resultados: Se incluyeron 1549 pacientes: 831 con AR (84% mujeres, edad media 55.2 años [DE 13.6]) y 718 con OA (82% mujeres, edad media 67 años [DE 11.1]). La frecuencia de EAI en el grupo AR fue del 22% (n=183). Estos presentaron mayor frecuencia de EAI reumatológicas (9.4 vs 3.3%, p< 0.001), y menor frecuencia de EAI no reumatológicas que aquellos con OA (15.3 vs 20.5, p=0.007). La EAI reumatológica más prevalente fue el Síndrome de Sjögren, el cual fue más frecuente en el grupo AR (87.2 vs 29.2%, p< 0,001). La frecuencia de EAI reumatológicas en los pacientes con AR fue mayor en la forma erosiva (11 vs 6.8%, p=0.048). Conclusión: La frecuencia de EAI en los pacientes con AR fue del 22%, en quienes predominaron las de etiología reumatológica mientras que, las no reumatológicas predominaron en pacientes con OA.

Objectives: To determine the frequency of autoimmune diseases (AID) in Rheumatoid Arthritis (RA) patients and to compare this frequency between patients with and without RA or other rheumatologic AID. Methods: Multicenter, observational, analytical, retrospective study. Consecutive patients with diagnosis of RA (ACR/EULAR 2010) were included. Patients with initial diagnosis of primary ostearthritis (OA) were used as control group. Results: A total of 1549 patients were included: 831 RA (84% women, mean age 55.2 [±13.6]) and 718 OA (82% women, mean age 67 [± 11.1]). The frequency of AID in the RA group was 22% (n=183). RA patients showed higher frequency of rheumatologic AID (9.4 vs 3.3%, p< 0.001), and lower frequency of non-rheumatologic AID than OA patients (15.3 vs 20.5%, p= 0.007). The most prevalent rheumatic AID was Sjögren's Syndrome, which was more frequent in the AR group (87.2 vs 29.2%, p<0.001). The frequency of rheumatologic AID in RA patients was higher in those with erosive RA (11 vs 6.8%, p=0.048). Conclusion: The frequency of AID in RA patients was 22%. Rheumatologic AID were more frequent in RA patients, whereas non-rheumatologic AID prevailed in OA patients.

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RESUMEN Introducción: El Trastorno depresivo mayor (TDM) es una enfermedad multifactorial en la que, por interacción con diversas variables, se incrementa la vulnerabilidad a padecerla. Diversos modelos han explicado las interacciones, como el de diátesis-estrés. Vivir eventos estresantes no siempre lleva a la aparición del TDM, y se ha planteado que la atribución y la valoración de los eventos estresantes podrían ser un mejor predictor de la aparición de los síntomas. Objetivo: Determinar la asociación y el poder predictivo de la frecuencia y la valoración de eventos vitales estresantes en la presencia de sintomatología del TDM. Métodos: Estudio de casos y controles con 120 pacientes psiquiátricos y 120 personas de la población general. Se utilizó una entrevista clínica estructurada y el Cuestionario de Sucesos Vitales de Sandín y Chorot. Los datos se analizaron con pruebas no paramétricas y regresión logística binaria. Resultados: El grupo de casos obtuvo significativamente más altos en afecto negativo, frecuencia de eventos estresantes, nivel de estrés percibido, valoración negativa de la situación y percepción de no control. El modelo de regresión logística binaria indicó que la baja percepción de control frente al evento estresante es el factor más determinante, seguido por la evaluación negativa del evento. Conclusiones: Las atribuciones realizadas sobre los eventos estresantes son determinantes en la presentación del TDM, en especial la valoración del control percibido frente a los sucesos vitales, en concordancia con los modelos etiológicos del TDM de diátesis cognitiva al estrés.

ABSTRACT Introduction: Major depressive disorder (MDD) is a multifactorial disease in which, due to the interaction of several variables, the vulnerability of suffering from it increases. Several models, such as the diathesis-stress model, have explained these interactions. However, experiencing stressful events does not always lead to the development of MDD, and the attribution and appraisal of stressful events contributing to further development of depression symptoms has been considered as a possible explanation. Objective: To determinate the association and the predictive power of the frequency and appraisal of stressful life events to predict MDD symptomatology. Methods: Case-control study with 120 psychiatric patients and 120 people from the general population. A structured clinical interview and the life events questionnaire (Sandín and Chorcot) were used to evaluate the sample. The data were analysed with non-parametric tests and binary logistic regression. Results: The psychiatric patients reported significantly higher levels of negative affect, frequency of stressful life events, perceived stress, negative appraisal of the situation and lack of perceived control. The binary logistic regression model indicated that poor perception of control of the stressful event is the most determining factor, followed by negative evaluation of the situation. Conclusions: The attributions that are made regarding a stressful event are variables that predict MDD, specifically the assessment of the perceived control over the situation. These results concur with the aetiological models of MDD, such as the cognitive diathesis-stress model.

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La ascitis quilosa posoperatoria (AQP) se debe a acumulación de líquido rico en triglicéridos en la cavidad peritoneal tras una lesión en la cisterna del quilo o en sus afluentes. Es infrecuente verla después de una hepatectomía. Se presenta el caso de un varón de 44 años con adenocarcinoma a 16 cm del margen anal T3N1, con metástasis que ocupaba casi la totalidad del lóbulo hepático derecho. Luego de quimioterapia se realizó hepatectomía derecha, observándose al cuarto día postoperatorio líquido del drenaje endotorácico de aspecto lechoso, con triglicéridos 223 mg/dL y 77 mg/dL de triglicéridos séricos. Se inició dieta sin grasas, hiperproteica, con ácidos grasos de cadena media y octreótide (100 microgramos subcutáneos cada 8 horas), con resolución del cuadro. En conclusión, la complicación quilosa puede tratarse exitosamente con un abordaje menos agresivo, sin suprimir la ingesta oral, utilizando octreótide subcutáneo, dieta exenta de grasas, suplementada con proteínas y ácidos grasos de cadena media.

Postoperative chylous ascites is an intraperitoneal collection of lymphatic fluid enriched with long-chain triglycerides that results from injury of the cisterna chyli or its main tributaries. This complication is rare after liver resections. Here, we report on the case of a 44 year-old man with a T3N1 rectal adenocarcinoma 16 cm above the anal margin, with metastatic compromise of almost the entire right liver lobe. Following chemotherapy, he underwent right liver resection. On postoperative day four, the thoracic drain evidenced milky fluid containing triglyceride 223 mg/dL with serum triglycerides 77 mg/dL. A fat-free diet was indicated with fat-free protein supplements, medium chain triglycerides and octreotide (100 μg subcutaneously every 8 hours), with complete resolution. In conclusion, postoperative chylous complications may be treated successfully by a less aggressive approach, with oral diet, subcutaneous octreotide, fat-free diet supplemented with proteins and medium chain fatty acids.

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A instalação imediata de implantes em região estética é uma prática frequente, pois reduzir a remodelação óssea e tecidual. Os implantes com interface cone Morse apresentam resultados biológicos e estéticos satisfatórios a longo prazo, pois apresentam gap reduzido entre implante e componente protético e a interface fica distante do tecido ósseo. Este artigo tem como objetivo relatar a reabilitação estética de um incisivo central superior comprometido através da instalação de um implante cone Morse utilizando a técnica da cirurgia guiada com provisionalização imediata. Paciente com 40 anos de idade, do sexo masculino, apresentava incisivo central superior (#21) com tratamento endodôntico prévio, recessão gengival vestibular, escurecimento coronário e mobilidade. O caso clínico apresentado mostrou que, após 12 meses, resultados precisos e estéticos são possíveis de alcançar com a instalação de implantes em alvéolos pós-extração e instalação de um dente provisório imediato em regiões estéticas.

The immediate placement of implant in fresh sockets in the aesthetic area is a frequent practice as it reduces bone and tissue remodeling. Morse taper implants present satisfactory biological and aesthetic results in the long term, since they present a reduced gap between implant and prosthetic component and this interface is distant from bone. This article aims to report the aesthetic restoration of a compromised central upper incisor with the placement of a Morse taper implant using guided surgery with immediate provision. A 40-year-old male patient had a central upper incisor (#21) with previous endodontic treatment, vestibular gingival recession, coronary browning, and mobility. The clinical case presented showed that, after 12 months, precise and aesthetic results are possible to achieve with the placement of implants in post-extracting alveolus and installation of an immediate provisional tooth in esthetic regions.

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To determine completeness of fatal congenital Zika syndrome reporting in Mexico, we examined data from the Mexican National Institute of Statistics and Geography. We found that an estimated 50% more infants died from microcephaly attributable to congenital Zika syndrome during 2016-2017 than were reported by the existing surveillance system.

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O trabalho teve por objetivo avaliar a condição higiênico–sanitárias de alface e mix de vegetais (alface, acelga e cenoura) minimamente processados comercializados em oito hipermercados de Goiânia, GO. As análises mostras foram analisadas microbiologicamente: Número Mais Provável (NMP) de Coliformes Termotolerantes, com pesquisa e Escherichia coli, e pesquisa de Salmonella sp. Foi realizada ainda pesquisa de matéria estranha, por técnica de sedimentação. Apenas metades dos hipermercados possuíam hortaliças minimamente processadas próprias para consumo, as demais apresentaram contagens elevadas de microrganismos e presença de matéria estranha. As amostras de dois estabelecimentos tiveram contagens de Coliformes Termotolerantes acima de 1100 NMP/g e com presença de E. coli. Foi observada presença de matéria estranha, como parasitas e insetos, em 62,5% das amostras de alface e 25% das amostras de salada. Os parasitas encontrados foram Ascaris lumbricoides, Ancilostomídeos e Paramecium sp.

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O trabalho teve por objetivo avaliar as condições higiênico ­ sanitárias de alfaces cultivadas na região de Inhumas ­ GO, quanto à ocorrência de ovos de helmintos, cistos de protozoários e de elementos exógenos como materiais inorgânicos, restos de insetos e pelos de roedores. As amostras foram coletadas em sete diferentes hortas, envolvendo quatro ciclos de amostragem. Ovos de dois diferentes parasitas foram encontrados entre as amostras de alface estudadas. Analisando-se as características dos pontos de coleta e os resultados obtidos a partir de métodos de sedimentação e microscopia, é possível concluir que as alfaces cultivadas em Inhumas e no seu entorno não seguem padrões adequados para consumo humano, estando também em desacordo com a RDC nº 14 de 2014 ­ ANVISA, que define como parâmetro ausência de sujidades em alimentos.

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O trabalho teve por objetivo avaliar a condição higiênico–sanitárias de alface e mix de vegetais (alface, acelga e cenoura) minimamente processados comercializados em oito hipermercados de Goiânia, GO. As análises mostras foram analisadas microbiologicamente: Número Mais Provável (NMP) de Coliformes Termotolerantes, com pesquisa e Escherichia coli, e pesquisa de Salmonella sp. Foi realizada ainda pesquisa de matéria estranha, por técnica de sedimentação. Apenas metades dos hipermercados possuíam hortaliças minimamente processadas próprias para consumo, as demais apresentaram contagens elevadas de microrganismos e presença de matéria estranha. As amostras de dois estabelecimentos tiveram contagens de Coliformes Termotolerantes acima de 1100 NMP/g e com presença de E. coli. Foi observada presença de matéria estranha, como parasitas e insetos, em 62,5% das amostras de alface e 25% das amostras de salada. Os parasitas encontrados foram Ascaris lumbricoides, Ancilostomídeos e Paramecium sp.(AU)

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El ligamento falciforme es una reflexión peritoneal abdominal relacionada con la superficie anterior del hígado, que en su borde inferior libre contiene el ligamento redondo (LR); las lesiones únicas en este son infrecuentes. Presentamos un caso de metástasis única en el ligamento redondo en un paciente con antecedente de carcinoma renal de células claras. Realizamos una búsqueda bibliográfica para identificar casos similares. Nuestro paciente es un varón de 71 años con antecedente de carcinoma renal de células tratado con nefrectomía radical izquierda laparoscópica (estadio pT3a). En tomografía computarizada (TC) control a los 5 años se evidencia lesión focal en la periferia del segmento IVa, ante la sospecha de malignidad, se realiza laparotomía exploradora revisando toda la cavidad abdominal sin evidenciar otros implantes peritoneales. Se halla un nódulo de 1 cm en el ligamento redondo y se realiza su exéresis completa, con diagnóstico anatomopatológico de metástasis de células claras. El LR generalmente está afectado en casos de carcinomatosis peritoneal y solo existen dos casos publicados de metástasis únicas.

The falciform ligament is a peritoneal reflection that attaches the liver to the anterior abdominal wall; its lower edge contains the round ligament (RL). Single lesions in the RL are rare and usually correspond to perivascular epithelioid cell tumors. We present a case report of a single metastasis in the RL in a patient with clear cell renal cell carcinoma who underwent surgery five years ago. We conducted a literature review to identify similar cases and we found two case reports of single metastasis in the RL. Our patient was a 71-year-old man with a history of renal cell carcinoma who underwent left laparoscopic radical nephrectomy (stage pT3a), laparoscopic right adrenalectomy and total thyroidectomy due to multinodular goiter. The pathological examination revealed metastases of renal cell carcinoma. A computed tomography (CT) scan performed at 5-year follow-up showed a focal lesion in segment IVa with no FDG uptake in the PET scan, but as malignancy was suspected, the patient underwent exploratory laparatomy with no evidence of peritoneal implants. A 1-cm node was found in the round ligament that was completely resected. The pathological examination revealed metastatic clear cell renal cell carcinoma. The RL is involved in cases of peritoneal carcinomatosis and only two cases of single metastasis have been reported: in one patient with papillary renal cell carcinoma pT1aN0 and another one with left breast adenocarcinoma.

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