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Resumen Introducción: El pseudotumor inflamatorio ocular asociado a IgG4 es un proceso inflamatorio no neoplásico y poco frecuente con una incidencia de 0.28-1.08 por cada 100,000 personas. El diagnóstico de esta patología es de exclusión debiendo cumplir criterios histopatológicos, agrandamiento de un órgano en específico y concentraciones serias de IgG4. El tratamiento tiene como objetivo evitar las complicaciones secundarias. Caso clínico: Mujer de 54 años de edad sin patologías previas referidas, acude refiriendo que 6 meses previos presenta de forma súbita y sin causa aparente prurito a nivel de globo ocular y párpado izquierdo, además de disminución de la agudeza visual y dolor retroocular, motivo por el que acude a valoración. Al examen físico presentó movimientos oculares normales, proptosis izquierda, dolor a la palpación, hiperemia subconjuntival, opacidad corneal, ausencia de reflejo rojo y más renitente a la presión el ojo izquierdo en relación con el contralateral. Tomografía cráneo-toraco-abdominal reporta a nivel ocular izquierdo imágenes sugestivas de melanoma coroideo sin hallazgos de actividad metastásica. Se realiza enucleación de ojo izquierdo. Se envía pieza a patología la cual reporta infiltrado difuso linfoplasmocítico positivas para IgG4. Conclusión: La enfermedad por IgG4 ocular es una patología muy infrecuente de clínica inespecífica y diagnóstico complejo. Sin embargo, un abordaje rápido y correcto es fundamental para evitar complicaciones.

Abstract Introduction: IgG4-associated ocular inflammatory pseudotumor is a rare, non-neoplastic inflammatory process with an incidence of 0.28-1.08 per 100,000 people. The diagnosis of this pathology is one of exclusion, having to meet histopathological criteria, enlargement of a specific organ, and serious concentrations of IgG4. Treatment aims to avoid secondary complications. Clinical case: A 54-year-old woman with no previous reported pathologies, reports that for the past 6 months she has itching at the level of the eyeball and the left eyelid, suddenly and without apparent cause, in addition to decreased visual acuity and retro-ocular pain; this is why she asked for the evaluation. The physical examination revealed normal eye movements, left proptosis, pain on palpation, subconjunctival hyperemia, corneal opacity, absence of red reflex, and the left eye being more resistant to pressure in relation to the contralateral eye. The cranio-thoraco-abdominal tomography reported images at the left ocular level that were suggestive of choroidal melanoma without findings of metastatic activity. Enucleation of the left eye was performed. The specimen was sent to pathology which reported diffuse lymphoplasmacytic infiltrate positive for IgG4. Conclusion: Ocular IgG4 disease is a very rare pathology with non-specific symptoms and complex diagnosis. However, a quick and correct approach is essential to avoid complications.

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Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.

Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.

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Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

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Abstract Background: It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool. Objective: To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN). Methods: This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level. Results: Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474). Conclusion: Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

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Abstract Background: Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades. Objectives: To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events. Methods: This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests. Results: The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001). Conclusions: A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

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OBJECTIVES: Determine the frequency of actionable mutations in non-small cell lung cancer (NSCLC) and their correlation with overall survival (OS) and the site of metastases. METHODS: We performed a descriptive cross-sectional study at the Hospital de Especialidades Eugenio Espejo, Ecuador, between 2017 and 2020. Demographic, pathological, and molecular alterations in epidermal growth factor (EGFR), Anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), Programmed death-ligand 1 (PD-L1) expression, and clinical data detailed in patients' medical records with metastatic NSCLC were collected and analyzed. Seventy-nine stage IV patients had NSCLC; adenocarcinoma histology represents 56 (70.9%). The predominant mutation was in EGFR (22.8%); the most common variant was the deletion of exon 19 (72.2%). The most common metastatic site was in the contralateral lung (22.3%); however, this variable showed no significant correlation to the molecular markers (p=0.057). The overall survival (OS) and the status of molecular markers are not statistically significant (p=0.27). OS was better for non-mutated EGFR than for mutated EGFR (p=0.012). However, the frequency values are unrelated to contralateral lung metastasis or survival. CONCLUSIONS: Our frequency mutations are concordant with those found in other studies in Latin America. EGFR was the most common biomarker mutation, and there was a better OS in EGFR non-mutated patient.

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Introducción: La enfermedad periodontal ha sido identificada como un factor de riesgo para enfermedades del corazón. La falta de hábitos de higiene bucal asociados a factores de riesgo puede conducir al desarrollo de periodontitis, lo que conducirá a un aumento de mediadores inflamatorios en la sangre, lo que es un riesgo potencial para el desarrollo del proceso de aterosclerosis. Objetivo: Evaluar en la literatura la influencia de la enfermedad periodontal en las enfermedades cardiovasculares, especialmente en relación con la aterosclerosis. Método: Consistió en una búsqueda en libros y artículos científicos, con la utilización de palabras clave asociadas, así como artículos seleccionados en las bases de datos SciELO, PubMed, Scopus, de lo cual se obtuvieron alrededor de 40 bibliografías, que fueron decantadas a 35, de ellas el 50 % actualizadas. Resultados: estudios de metaanálisis apoyan una relación causal entre la enfermedad periodontal y la cardiopatía, lo que demuestra que el riesgo de desarrollar algunas complicaciones vasculares se encontró aumentado en pacientes con problemas periodontales. Conclusiones: Se hace relevante evaluar la relación de estas enfermedades y los mecanismos implicados, para poder elaborar medidas preventivas.

Introduction: Periodontal disease has been identified as a risk factor for heart disease. The lack of oral hygiene habits associated with risk factors can lead to the development of periodontitis, which will lead to an increase in inflammatory mediators in the blood, which is a potential risk for the development of the atherosclerosis process. Objective: To evaluate in the literature the influence of periodontal disease on cardiovascular diseases, especially in relation to atherosclerosis. Method: It consisted of a search in books and scientific articles, with the use of associated keywords, as well as selected articles in the SciELO, PubMed, Scopus databases, from which around 40 bibliographies were obtained, which were narrowed down to 35, of them 50% updated. Results: Meta-analysis studies support a causal relationship between periodontal disease and heart disease, demonstrating that the risk of developing some vascular complications was found to be increased in patients with periodontal problems. Final considerations: It is relevant to evaluate the relationship between these diseases and the mechanisms involved, in order to develop preventive measures.

Introdução: A doença periodontal tem sido apontada como fator de risco para doenças cardíacas. A falta de hábitos de higiene bucal associada a fatores de risco pode levar ao desenvolvimento de periodontite, o que levará ao aumento de mediadores inflamatórios no sangue, o que representa um risco potencial para o desenvolvimento do processo de aterosclerose. Objetivo: Avaliar na literatura a influência da doença periodontal nas doenças cardiovasculares, principalmente em relação à aterosclerose. Método: Consistiu na busca em livros e artigos científicos, com utilização de palavras-chave associadas, bem como em artigos selecionados nas bases de dados SciELO, PubMed, Scopus, dos quais foram obtidas cerca de 40 bibliografias, que foram reduzidas a 35, de eles 50% atualizados. Resultados: Estudos de meta-análise apoiam uma relação causal entre doença periodontal e doença cardíaca, demonstrando que o risco de desenvolver algumas complicações vasculares foi aumentado em pacientes com problemas periodontais. Considerações finais: É relevante avaliar a relação entre estas doenças e os mecanismos envolvidos, para desenvolver medidas preventivas.

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In Chile, children of low socioeconomic status usually attend public schools and have few opportunities to engage in healthy behaviors. This may increase their risk of overweight/obesity and low muscular fitness. Therefore, we aimed to determine the association between the school type attended with overweight/obesity-related markers and the muscular fitness of children in Chile. We included 1410 children (6-13 years old) attending public, subsidized, or private schools. Overweight/obesity-related markers included BMI Z-scores, waist circumference, and body fat percentage. Muscular fitness assessment included handgrip strength and standing long jump. The odds ratios [95% CI] of overweight/obesity, elevated waist circumference, elevated body fat, low handgrip strength, and low standing long jump were compared between school types. Compared with boys attending public schools, those attending subsidized or private schools had lower odds ratios of low handgrip strength (0.63 [0.42-0.94] and 0.44 [0.25-0.78], respectively). Girls attending subsidized schools, compared with those in public schools, had lower odds of overweight/obesity (0.63 [0.44-0.90]) and of having low handgrip strength (0.51 [0.34-0.78]). Compared with girls in public schools, those attending private schools had lower odds (vs. public schools) of overweight/obesity (0.45 [0.28-0.74]), of having elevated body fat (0.53 [0.29-0.96]), and of having low standing long jump (0.41 [0.21-0.77]). The elevated risk of overweight/obesity-related markers and lower muscular fitness in children, particularly girls, attending public schools increase their current and future disease risk. This suggests that childhood socioeconomic status plays a central role in determining disease risk. Health-promoting interventions specifically focused on children from disadvantaged contexts are required.

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Background: Previous studies have examined the "fat but fit" paradox, revealing that greater levels of physical fitness may diminish the harmful consequences of excess weight on cardiometabolic risk. Despite the above, specific information about the "fat but fit" paradox in prepuberal population is scarce. The aim of this study was to determine the relationship between cardiometabolic risk across (individual and combined) physical fitness and excess weight status and whether the "fat but fit" paradox is met in the sample of schoolchildren analyzed. Methods: A cross-sectional study was conducted including 452 children (59.1% girls), aged 7-9 years from Santiago (Chile). Physical fitness was assessed as cardiorespiratory fitness and muscular fitness. Cardiorespiratory fitness was determined by the 6-minute-walk-test and muscle strength was assessed by the handgrip and standing long jump tests. Excess weight (overweight and obesity) was computed through body mass index (z-score). Cardiometabolic risk was established by summing the z-score of the serum glucose, triglycerides, high-density lipoprotein, insulin and waist-to-height ratio. Results: Schoolchildren with high physical fitness (individual or combined) showed the lowest cardiometabolic risk mean scores (P for trend <0.001 for all physical fitness groups). Conversely, schoolchildren with low physical fitness (individual or combined) showed the highest cardiometabolic risk mean scores (P for trend <0.001 for all categories). Additionally, schoolchildren without excess weight and with high individual or combined physical fitness status exhibits lower cardiometabolic risk mean scores compared to schoolchildren with excess weight and low physical fitness status (individual or combined) (P for trend <0.001 for all physical fitness groups). A lower odd of having high cardiometabolic risk was found in schoolchildren without excess weight and with both high physical fitness (both cardiorespiratory fitness and muscular fitness) [odds ratio (OR) =0.08; 95% confidence interval (CI): 0.04 to 0.16] in comparison to those with excess weight and low physical fitness. Conclusions: Our results suggest that improvements in both fatness and aerobic fitness could be associated with lower cardiometabolic risk.

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Resumen Introducción: El SARS-CoV-2 se desconocía hasta el brote en Wuhan, China en diciembre de 2019, las características ultraestructurales de este virus con predisposición a receptores expresados en los neumocitos tipo II (CD209L y ECA2) resultan en daño alveolar difuso y un tercio de los pacientes con SARS-CoV-2 cumplen criterios de SIRA con hipoxemia severa. Tras el curso severo de la enfermedad y alta mortalidad se reportó en estudios la asociación del dímero D (DD) con casos graves y atribuyéndose al estado protrombótico de la enfermedad, contribuyendo directamente en ventilación mecánica prolongada y muerte. Objetivo principal: Determinar los diferentes niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados en la terapia intensiva. Material y métodos: Estudio transversal comparativo retrospectivo unicéntrico, se revisaron expedientes de pacientes mayores de 18 años que ingresaron a la Unidad de Cuidados Intensivos con diagnóstico de neumonía por SARS-CoV-2; se tomaron en cuenta los valores de DD al ingreso, al séptimo día y la relación PaO2/FiO2 de gasometrías arteriales. Definimos hipoxemia severa PaO2/FiO2 menor de 150 mmHg y tras prueba U de Mann-Whitney se evaluaron niveles de DD, curva de ROC y AUC para punto de cohorte de DD y la asociación con terapia de aporte de oxígeno y su desenlace con OR e IC95%. Resultados: Se estudiaron expedientes de 82 pacientes, 81.7% presentó hipoxemia severa al ingreso, y 74.4% al séptimo día; se reportó una mediana de DD de 1,410 ng/mL con hipoxemia severa y al séptimo día 2,238 ng/mL (p = 0.001). Curva ROC encontró DD 1,500 ng/mL como punto de cohorte asociado a hipoxemia severa (AUC: 0.808, IC al 95% 0.706-0.910). En escalas pronósticas reportó mayor puntuación, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), y SAPS II (67 pts, p ≤ 0.0001); así como en defunciones (81.6%, p ≤ 0.0001, OR 16.50 IC al 95% 5.472-49.80). Conclusión: Dímero D mayor y/o igual a 1,500 ng/mL se asocia con hipoxemia severa y con mayor mortalidad al séptimo día de estancia en UCI, indicándonos que el DD es un potencial marcador temprano y útil para guiar la terapéutica y evaluar el pronóstico del paciente.

Abstract Introduction: SARS-CoV-2 was unknown until the outbreak in Wuhan, China in December 2019, the ultra-structural characteristics of this virus with predisposition to receptors expressed in type II pneumocytes (CD209L and ECA2), results in diffuse alveolar damage and a third of the patients with SARS-CoV-2 meet criteria for SIRA with severe hypoxemia. After the severe course of the disease and high mortality, the association of DD with severe cases was reported in studies and attributed to the prothrombotic state of the disease, directly contributing to prolonged mechanical ventilation and death. Main objective: To determine the different levels of DD in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to intensive care. Material and methods: Cross-sectional retrospective single-center study, records of patients older than 18 years who were admitted to the intensive care unit with a diagnosis of SARS-CoV-2 pneumonia were reviewed; DD values on admission, on the seventh day and the PaO2/FiO2 ratio of arterial blood gases were considered. We defined severe hypoxemia PaO2/FiO2 less than 150 mmHg and after the Mann-Whitney U test, DD levels, ROC curve and AUC were evaluated for the DD cohort point and the association with oxygen supply therapy and its outcome with OR and HF 95%. Results: Records of 82 patients were studied, 81.7% presented severe hypoxemia on admission, and 74.4% on the seventh day; A median DD of 1,410 ng/mL was reported with severe hypoxemia and 2,238 ng/mL on the seventh day (p = 0.001). ROC curve found DD 1,500 ng/mL as a cohort point associated with severe hypoxemia (AUC: 0.808, 95% CI 0.706-0.910). On prognostic scales I report a higher score, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), and SAPS II (67 pts, p ≤ 0.0001); as well as in deaths (81.6%, p ≤ 0.0001, OR 16.50 95% CI 5.472-49.80). Conclusion: DD greater than and/or equal to 1,500 ng/mL is associated with severe hypoxemia and higher mortality on the seventh day of stay in the ICU, indicating that DD is a potential early and useful marker to guide the therapy and evaluate the prognosis of the patient.

Resumo Introdução: O SARS-CoV-2 era desconhecido até o surto em Wuhan, China, em dezembro de 2019, as características ultraestruturais desse vírus com predisposição a receptores expressos em pneumócitos tipo II (CD209L e ACE2), resultando em dano alveolar difuso e um terço dos pacientes com SARS-Cov-2 atendem aos critérios para SDRA com hipoxemia grave. Após o curso grave da doença e alta mortalidade, estudos relataram a associação do D-Di com casos graves e atribuindo-se ao estado pró-trombótico da doença, contribuindo diretamente para ventilação mecânica prolongada e óbito. Objetivo principal: Determinar os diferentes níveis de dímero-D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva. Material e métodos: Estudo transversal comparativo retrospectivo unicêntrico, foram revisados prontuários de pacientes maiores de 18 anos admitidos na unidade de terapia intensiva com diagnóstico de pneumonia por SARS-CoV-2; foram considerados os valores de D-Di na admissão, no sétimo dia e a relação PaO2/FiO2 da gasometria arterial. Definimos hipoxemia grave PaO2/FiO2 menor que 150 mmHg e após o teste U de Mann-Whitney, os níveis de D-Di, curva ROC e AUC foram avaliados para o ponto de coorte D-Di e a associação com oxigenoterapia e seu desfecho com OR e IC 95%. Resultados: Foram estudados prontuários de 82 pacientes, 81.7% com hipoxemia grave na admissão e 74.4% no sétimo dia; relatou-se um D-Di médio de 1,410 ng/mL com hipoxemia grave e 2,238 ng/mL no sétimo dia (p = 0.001). A curva ROC encontrou D-Di 1,500 ng/mL como um ponto de coorte associado à hipoxemia grave (AUC: 0.808, IC 95% 0.706-0.910). Em escalas de prognóstico, APACHE II (24 pontos, p = 0.036), SOFA (12 pts, p = 0.012) e SAPS II (67 pts, p ≤ 0.0001); bem como em óbitos (81.6%, p ≤ 0.0001, OR 16.50, IC 95% 5.472-49.80). Conclusão: O D-Di maior e/ou igual a 1,500 ng/ml está associada à hipoxemia grave e maior mortalidade no sétimo dia de internação na UTI, indicando que o D-Di é um potencial marcador precoce e útil para orientar a terapia e avaliar o prognóstico do paciente.

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Homem de 53 anos, hipertenso e portador de bronquite, admitido em um serviço de urgência no dia 15 de dezembro de 2020 devido sintomas gripais, febre e cefaleia iniciados há oito dias. Após constatação de acometimento pulmonar importante mediante tomografia computadorizada (TC) de tórax, sugestivo de infecção pelo vírus SARS-CoV2, o paciente foi internado em unidade de terapia intensiva. Foi intubado no décimo dia de internação, e, dois dias após, evoluiu com labilidade pressórica importante, recorrendo ao uso de noradrenalina e nitroprussiato, além de outros anti-hipertensivos, conforme a necessidade. O quadro predominante foi a hipertensão arterial sistêmica, manifestada principalmente com a mudança de decúbito, sendo o maior valor pressórico registrado de 240x90 mmHg. A disautonomia também se manifestou por ausência de dejeções, sudorese excessiva e espasmos musculares. A frequência cardíaca se manteve estável e dentro dos parâmetros de normalidade.A partir do trigésimo dia de internação, observou-se melhora progressiva do quadro e reestabelecimento da homeostase. Obteve alta após 59 dias de internação, sem sequelas significativas. A explicação mais razoável para o caso é o aumento da resistência vascular periférica, por ação da angiotensina II, associada à supressão do sistema parassimpático, o que explica, também, a incompetência do barorreflexo para compensação da frequência cardíaca. Adicionalmente, o paciente estava em uso de carvedilol. Este caso enfatiza o desafio diagnóstico precoce da disautonomia em pacientes críticos, devido a carência de ferramentas adequadas para uso na prática cotidiana. A estimulação vagal pode constituir opção terapêutica eficaz, mas carece de mais estudos

A 53-year-old male, hypertensive and with bronchitis, was admitted to the emergency department on December 15, 2020 due to flu-like symptoms, fever and headache that started eight days ago. After finding significant lung involvement by chest computed tomography (CT) suggestive of SARS-CoV2 virus infection, the patient was admitted to the intensive care unit. He was intubated on the tenth day of hospitalization, and, 2 days later, he evolved with significant pressure lability, using norepinephrine and nitroprusside, in addition to other antihypertensive drugs, as needed. The predominant state was hypertension, expressed mainly when there is interference from the patient's position in bed. The highest pressure value recorded was 240x90 mmHg. Dysautonomy was also manifested by the absence of stools, excessive sweating and muscle spasms. Heart rate remains stable and within normal limits. From the thirtieth day of hospitalization onwards, there was an evolution with progressive improvement and restoration of homeostasis. He was discharged after 59 days of hospitalization, without sequelae. The most reasonable explanation for the case is the increase in peripheral vascular resistance, due to the action of angiotensin II, associated with the suppression of the parasympathetic system, which also explains the incompetence of the baroreflex to compensate the heart rate. Additionally, the patient was using carvedilol. This case emphasizes the importance of tools that early identify dysautonomy, prepare the team. Vagal stimulation can be an effective therapeutic option, but further studies are needed

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INTRODUCTION: Background: the six minutes' walk test (6MWT) measures submaximal physical activity. Objective: this study determines the association of children´s nutritional status and body composition with the results of the 6MWT. Methods: a sample of 1419 Chilean children, 4 to 10 years of age, were assessed including anthropometry, body composition by validated equations, the 6MWT test, and in 50 % of the sample heart rate prior the test, at one minute into the test, and at one minute posttest with a Polar watch. Results: the distance walked ranged from 473.1 ± 47.8 meters in preschool children to 584.2 ± 65.7 meters in school children. In heart rate there was a significant difference between obese and eutrophic children. The distance walked in the 6MWT was positively associated with fat-free mass (p < 0.05) and BMI (R2 = 0.49). Body composition influences 6MWT quartile distribution, as well as nutritional status. Age and height explained 49 % of the variance (R2 = 0.42 and 0.47, respectively) in the 6MWT, and there are significant differences in this variable by sex, body composition, and nutritional status. Conclusions: body composition was associated with walking performance in children. Thus, it is important to evaluate height and body composition when assessing the six-minute walk test because of this important relationship.

INTRODUCCIÓN: Introducción: el test de la marcha de seis minutos (TM6M) mide una actividad física submáxima. Este estudio evaluó el efecto del test de la marcha sobre la composición corporal y el estado nutricional en niños. Métodos: en una muestra de 1419 niños chilenos de 4 a 10 años de edad se evaluaron la antropometría, la composición corporal por ecuaciones validadas, el TM6M y, en el 50 % de la muesta, la frecuencia cardíaca mediante un reloj Polar. Resultados: la distancia caminada varió desde 473,1 ± 47,8 metros en los niños preescolares hasta 584,2 ± 65,7 metros en los escolares. En la frecuencia cardíaca hubo una diferencia significativa entre niños obesos y eutróficos. La distancia caminada se asoció positivamente con la masa libre de grasa (R2 = 0,37) y el IMC (R2 = 0,49). Por otra parte, la composición corporal varía en función de los cuartiles de composición corporal y el estado nutricional. La edad y la altura explicaron el 49 % de la varianza de la prueba (R2 = 0,42 and 0,47, respectivamente). Existen diferencias significativas en la distancia recorrida en el TM6M en función del sexo, la composición corporal y el estado nutricional. Conclusiones: composición corporal, talla e IMC se asociaron a la distancia recorrida en el TM6M. Por tanto, se sugiere medir estas variables cuando se evalúe el test de marcha de seis minutos.

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RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

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OBJECTIVE: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. METHODS: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. RESULTS: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). CONCLUSION: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

OBJETIVO: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. MÉTODOS: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. RESULTADOS: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). CONCLUSÃO: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

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Assessing children's growth adequately is important due to the necessary prevention of adequate body composition, especially at pre-pubertal age. Simpler measurements such as anthropometry or bioimpedance, using equations validated in Caucasian children, have been demonstrated to overestimate or underestimate fat mass percentage (FM%) or fat-free mass (FFM) in Chilean children. In a sample of 424 children (198 boys and 226 girls) of 7-9 years old, the three component (3C) model was assessed, where total body water was determined by 2H dilution and body volume by air displacement plethysmography, in order to design and validate anthropometry and bioimpedance equations. The FM (%) equation specific for Chilean children was validated as (1·743 × BMI z-score) + (0·727 × triceps skinfold) + (0·385 × biceps skinfold) + 15·985, against the 3C model (R2 0·79). The new FFM equation (kg) generated was (log FFM = (0·018 × age) + (0·047 × sex) + (0·006 × weight) + (0·027 × resistance) + 2·071), with an R2 0·93 (female = 1 and male = 2). The Bland-Altman analysis shows a mean difference of 0·27 (sd 3·5) for the FM% in the whole group as well as 0·004 (sd 0·9) kg is the mean difference for the bioelectrical impedance analysis (BIA) FFM (kg) equation. The new equations for FM (%) and FFM (kg) in Chilean children will provide a simple and valid tool for the assessment of body composition in cohort studies or to assess the impact of nutritional programmes or public policies.

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Background: Given the considerable role played by Salmonella in the incidence of food poisoning around the world, surveillance of this infection is prioritized by both food producers and health care authorities. Data remains insufficient concerning the prevalence of Salmonella in poultry systems in Ecuador and in Latin America in general. Methods: In this study we evaluated the prevalence and diversity of Salmonella serovars in samples taken from 21 layer farms and backyard layers in central Ecuador during August-November 2017.   Salmonella was isolated following standardized methods (ISO 6579) and the serovar determination was carried out by PCR. Results: A significant presence of Salmonella was detected, with an incidence of 76% (95% confidence interval (CI): 58-94) in farms, 33% (95%CI: 13-53) in pooled cloacal swabs from layer hens, 33% (95%CI: 12-55) on feed samples, and 10% (95%CI: 0-22) in backyard layer feces from traditional local markets. The dominant serovars detected were S. Infantis and S. Typhimurium. Conclusions: This study forms a basis for further surveillance of Salmonella serovars in layer farms in central Ecuador.

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INTRODUCTION: Background: malnutrition is a common problem in hospitalized patients, being associated with increased morbidity, mortality and costs. Multiple factors contribute to a deficient nutritional status, making malnutrition the cause or consequence of severe diseases. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure indicated for long-term administration of enteral nutrition in patients with limited ability for oral intake who have an intact, functional gastrointestinal tract. The aim of this study was to determine the profile of patients undergoing PEG in a tertiary hospital in southern Brazil. Methods: single-center retrospective study of all patients who underwent PEG from January 1st to December 31st, 2016, in a private tertiary hospital located in southern Brazil. Data were collected retrospectively from the patients' medical records, including nutritional status, indications, complications and outcomes. Results: one hundred and thirty-three patients underwent PEG at our institution and were eligible for inclusion in the study. Median patient age was 82 years, and 57.9% were females. The main indication for PEG was dementia syndrome, followed by stroke. As much as 68.4% were diagnosed as severely malnourished and 23.0% had procedure-related complications. Conclusions: PEG tubes are being increasingly used for enteral nutrition in patients with dysphagia or inability to maintain adequate nutritional intake. The findings of the present study highlight the importance of regular nutritional risk screening by a multidisciplinary team, paying special attention to the patient's nutritional status and conditions that may place the patient at risk of developing dysphagia, with the implementation of measures to minimize malnutrition in hospitalized patients.

INTRODUCCIÓN: Introducción: la desnutrición es común en pacientes hospitalizados y se está convirtiendo en causa o consecuencia de enfermedades graves, asociándose a morbilidad, mortalidad y costos aumentados. Múltiples factores contribuyen a un estado nutricional deficiente. La gastrostomía endoscópica percutánea (PEG) es un procedimiento mínimamente invasivo para la administración de nutrición enteral en pacientes con capacidad limitada de ingesta oral que tengan el tracto gastrointestinal intacto y funcional. El objetivo de este estudio fue determinar el perfil de pacientes sometidos a PEG en un hospital terciario del sur de Brasil. Métodos: estudio retrospectivo unicéntrico de todos los pacientes sometidos a PEG del 1 de enero al 31 de diciembre de 2016 en un hospital terciario privado del sur de Brasil. Se recolectaron los datos retrospectivamente en los registros médicos, incluyendo estado nutricional, indicaciones, complicaciones y evolución. Resultados: ciento treinta y tres pacientes se sometieron a PEG en nuestra institución y fueron elegibles para el estudio. La edad mediana fue de 82 años y el 57,9% eran mujeres. Las principales indicaciones para PEG fueron demencia y accidente cerebrovascular. El 68,4% fueron diagnosticados con desnutrición grave y el 23,0% presentaron complicaciones relacionadas al procedimiento. Conclusiones: se utilizan cada vez más tubos de PEG para nutrición enteral en pacientes disfágicos o incapaces de mantener una ingesta nutricional adecuada. Nuestros hallazgos señalan la importancia del cribado para riesgo nutricional por un equipo multidisciplinario, con atención especial al estado nutricional del paciente y a condiciones que pueden ponerlo en riesgo para disfagia y la implementación de medidas para minimizar la desnutrición.

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Chile's Physical Activity Report Card graded the overall index on PA behavior with an F The Ministry of Sports is implementing since 2014 "Jardín Activo" (JA program) which recommends 3 weekly teacher-led PE lessons for preschool children, on half or full day attendance. We determined the effectiveness of the JA program (contribution to MVPA during school time) and assessed if effectiveness varied according to schedule. 596 five y olds, (50% boys) were selected from 66 schools; 52.9% attended half day and 47.1% full day. Children wore accelerometers during school time a day with and one without PE lesson (JA day/non JA day). We compared PA intensity between both these days by gender, using descriptive statistics and t-tests and determined the differential effect on PA intensity, between non JA and JA days by school schedule, using mixed models analyses We compared ß of sedentary and of MVPA by schedule with t-tests. Significant differences were found in PA intensity between both days within each gender. Minutes being sedentary were significantly less during JA days (14 and 15 min in boys and girls respectively); MVPA significantly higher in JA days (11 and 10 min respectively). % time children were sedentary and % they engaged in MVPA differed by schedule. Sedentary minutes were significantly higher (ß - 16.2 vs - 13.2) in half day, while the increase in MVPA was significantly higher (ß 12.5 vs 9.7) in full day. The JA program is effective, especially when children attend school full time.

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The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.

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RESUMO Os avanços tecnológicos que permitem dar suporte às disfunções de órgãos levaram a um aumento nas taxas de sobrevivência para a maioria dos pacientes críticos. Alguns destes pacientes sobrevivem à condição crítica inicial, porém continuam a sofrer com disfunções de órgãos e permanecem em estado inflamatório por longos períodos. Este grupo de pacientes críticos foi descrito desde os anos 1980 e teve diferentes critérios diagnósticos ao longo dos anos. Sabe-se que estes pacientes têm longas permanências no hospital, sofrem importantes alterações do metabolismo muscular e ósseo, apresentam imunodeficiência, consomem quantias substanciais de recursos de saúde, têm reduzida capacidade funcional e cognitiva após a alta, demandam uma considerável carga de trabalho para seus cuidadores, e apresentam elevadas taxas de mortalidade em longo prazo. O objetivo desta revisão foi apresentar as evidências atuais, em termos de definição, fisiopatologia, manifestações clínicas, tratamento e prognóstico da doença crítica persistente.

ABSTRACT The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.

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