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The use of negative pressure wound therapy (NPWT) throughout the entire treatment of a burn patient boosts wound healing and recovery. Hand burns require specialized management that enhances wound healing and facilitates early physical rehabilitation. Thus, this article showcases a novel idea of NPWT foam customization that boosts recovery and rehabilitation in patients with hand burns. We present two patients with hand burns treated with NPWT using a customized foam design that allowed for early rehabilitation while providing and optimized recovery. In the two cases presented, the patients required two surgical stages; in the first surgery, debridement of the burns was performed and customized NPWT with instillation was applied, and in the second surgical stage, the bed was reconstructed with partial-thickness skin grafts, which were bolstered with customized conventional NPWT. The management, reconstruction, and rehabilitation were accomplished in under 2 weeks, achieving a remarkable 100% success rate in graft integration during the acute phase on the first attempt. This highlights the effectiveness of incorporating NPWT across all burn treatment phases, expediting recovery and ensuring optimal functional outcomes for patients. Surgeons can customize different NPWT foam shapes that facilitate its use on difficult-to-treat areas, allowing for a faster recovery and better rehabilitation outcomes.
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BACKGROUND: There is evidence in the literature that the use of sensor-augmented insulin pumps in patients with high-complexity diabetes improves metabolic control. However, there is no long-term information on clinical outcomes such as hospitalization or admission to the emergency room. This study describes outcomes for metabolic control, incidence of hospitalizations, and emergency room visits in a specific population using this technology. OBJECTIVE: We aimed to assess long-term glycemic and clinical outcomes after the use of continuous subcutaneous insulin infusion and continuous glucose monitoring in people with diabetes. METHODS: A retrospective cohort study was carried out in patients with diabetes previously treated with an intensive insulin regimen at a specialized diabetes treatment center who required a sensor-augmented insulin pump due to nonoptimal glycemic control. Glycated hemoglobin, severe hypoglycemic episodes, nonsevere hypoglycemic episodes, perception of hypoglycemia, and the incidence of emergency room visits and hospitalizations before and after treatment were evaluated. RESULTS: Between January 2013 and August 2020, 74 patients with a median age of 36 (IQR 27-46) years were included in the study with a median 4 (IQR 2-7) years of follow-up. We found a statistically significant reduction in glycated hemoglobin (8.35% vs 7%; P<.001), nonsevere hypoglycemic episodes (71/74, 96% vs 62/74, 84%; P=.01), emergency room visits (42/73, 58% vs 4/62, 6%; P<.001), and hospitalizations (36/72, 50% vs 10/72, 14%; P<.001) after use of continuous subcutaneous insulin infusion. CONCLUSIONS: The use of a sensor-augmented insulin pump associated with a strict follow-up program for patients with high-complexity diabetes led to a significant and sustained reduction in glycated hemoglobin and hypoglycemic episodes, as well as in the rate of emergency room visits and hospitalizations. These results encourage the adoption of this technology in patients who do not achieve metabolic control with optimal management of diabetes.
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El presente artículo analiza, a partir de una revisión documental de planes y programas de curso de los doctorados en Educación activos en Chile, en qué medida y cómo los programas de formación de futuros investigadores en educación doctoral abordan el desafío de integrar la educación ética en su diseño curricular. Mediante un análisis temático de la documentación oficial de los programas se identificaron y analizaron diversos elementos relacionados con ética de la investigación e integridad académica abordados en la formación doctoral, su enfoque prevalente (normativo o de discernimiento ético), su orientación (propositiva o de prevención) y la profundidad con que son tratados esos aspectos. Los resultados muestran que solo un tercio de los actuales programas abordan de manera explícita la formación ética en investigación, y que, en estos casos, su abordaje tiende a subrayar aspectos más formales que de fondo, acotados fundamentalmente al cumplimiento del protocolo de consentimiento informado.
This article analyzes to what extent and how training programs for future researchers in doctoral education address the challenge of integrating ethical training in their curricular design. Based on a documentary review of course plans and postgraduate programs in education active in Chile, the explicit presence of ethical aspects and academic integrity in their training plans was examined. Through a thematic analysis of the official documentation of the programs, we identified and analyzed various elements related to research ethics and academic integrity addressed in doctoral training, their prevalent approach normative or ethical discernment, their orientation proactive or preventive and the depth with which these aspects are treated. The results show that only one-third of the current programs explicitly address ethical training in research and that in these cases, their approach tends to emphasize more formal than substantive aspects, mainly limited to compliance with the informed consent protocol.
O presente artigo analisa, a partir de uma revisão documental de planos e programas de curso dos doutorados em Educação ativos no Chile, em que medida e como os programas de formação de futuros investigadores em educação pós-graduada abordam o desafio de integrar a educação ética em seu plano curricular. Mediante uma análise temática da documentação oficial dos programas se identificaram e analisaram diversos elementos relacionados com ética da investigação e integridade acadêmica abordados na formação pós-graduada, seu enfoque prevalente (normativo ou de discernimento ético), sua orientação (propositiva ou de prevenção) e a profundidade com que são tratados esses aspectos. Os resultados mostram que só um terço dos atuais programas abordam de maneira explícita a formação ética em investigação, e que, nestes casos, sua abordagem tende a ressaltar aspectos mais formais que substanciais, limitados fundamentalmente ao cumprimento do protocolo de consentimento informado.
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Humanos , Ensino , ChileRESUMO
Introduction: Bipolar disorder (BD) is a chronically progressive mental condition, associated with a reduced quality of life and greater disability. Patient admissions are preventable events with a considerable impact on global functioning and social adjustment. While machine learning (ML) approaches have proven prediction ability in other diseases, little is known about their utility to predict patient admissions in this pathology. Aim: To develop prediction models for hospital admission/readmission within 5 years of diagnosis in patients with BD using ML techniques. Methods: The study utilized data from patients diagnosed with BD in a major healthcare organization in Colombia. Candidate predictors were selected from Electronic Health Records (EHRs) and included sociodemographic and clinical variables. ML algorithms, including Decision Trees, Random Forests, Logistic Regressions, and Support Vector Machines, were used to predict patient admission or readmission. Survival models, including a penalized Cox Model and Random Survival Forest, were used to predict time to admission and first readmission. Model performance was evaluated using accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC) and concordance index. Results: The admission dataset included 2,726 BD patients, with 354 admissions, while the readmission dataset included 352 patients, with almost half being readmitted. The best-performing model for predicting admission was the Random Forest, with an accuracy score of 0.951 and an AUC of 0.98. The variables with the greatest predictive power in the Recursive Feature Elimination (RFE) importance analysis were the number of psychiatric emergency visits, the number of outpatient follow-up appointments and age. Survival models showed similar results, with the Random Survival Forest performing best, achieving an AUC of 0.95. However, the prediction models for patient readmission had poorer performance, with the Random Forest model being again the best performer but with an AUC below 0.70. Conclusion: ML models, particularly the Random Forest model, outperformed traditional statistical techniques for admission prediction. However, readmission prediction models had poorer performance. This study demonstrates the potential of ML techniques in improving prediction accuracy for BD patient admissions.
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Background: A large research portfolio indicates that an activated renal renin-angiotensin system or a deficit on melatonin is associated with several cardiovascular pathologies. In this observational clinical study, we hypothesized that alterations in urinary melatonin or angiotensinogen levels may be altered in two common conditions, preeclampsia and gestational diabetes. Our study's primary objective was to assess melatonin and angiotensinogen as novel disease biomarkers detectable and quantifiable in the urine of pregnant women with or without pregnancy complications. Methods: This was a concurrent cohort study of pregnant women with selected obstetric pathologies (gestational diabetes, preeclampsia, hypertension and obesity with hypertension). A group of healthy controls was also included. Urinary 6-sulfatoxymelatonin and angiotensinogen were measured by sensitive and specific ELISAs in first morning void urine samples. The patients were included in the cohort consecutively, and the diagnosis was blinded at the level of urine collection. Urinary 6-sulfatoxymelatonin and angiotensinogen levels were investigated in the patients included in the cohort. Results: Urinary levels of angiotensinogen were significantly higher in the gestational diabetes [angiotensinogen/creatinine ratio median (25th, 75th): 0.11 (0.07, 0.18)] and preeclampsia [0.08 (0.06, 0.18)] groups than in those with healthy pregnancy [0.05(0.04, 0.06]; 6-sulfatoxymelatonin levels were significantly lower in the gestational diabetes [ug/h: median (25th, 75th): 0.12(0.08, 0.17)] and preeclampsia [0.12 (0.09, 0.15)] groups than in those with healthy pregnancy [0.20 (0.15, 0.27]. Neither morning void protein/creatinine ratio nor 24-h urine protein estimate were significantly different between the study groups. Conclusion: These results suggest that urinary angiotensinogen levels may indicate an intrarenal RAS activation while melatonin production appears to be defective in gestational diabetes or hypertension. An angiotensinogen/melatonin ratio is suggested as an early biomarker for identification of gestational diabetes or hypertension. This report provides a basis for the potential use of melatonin for the treatment of preeclampsia. A prospective study in a larger number of patients to determine the operative characteristics of these markers as potential diagnostic tests is justified.
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Introduction: Most hydrotherapy studies during childbirth report findings related to pain using a widespread set of subjective measures. In this study, ECG biomarkers as quantitative cardiac autonomic outcomes were used to assess the effects of warm shower hydrotherapy on laboring women during the first stage of labor. Methods: This was a prospective single-blind cohort study on stage I delivering women. Their cardiac autonomic function was assessed using heart rate variability (HRV) measures during a deep breathing test using point-of-care testing comprised of an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. Labor pain and anxiety were assessed using the Visual Analog Scale for Pain (VASP) and the Beck Anxiety Inventory (BAI). A total of 105 pregnant women in the first stage of labor who received warm shower hydrotherapy, intravenous analgesia (scopolamine + sodium dipyrone), or spinal anesthetic (bupivacaine + morphine) were enrolled. Results: In women during the first stage of labor, parasympathetic modulation reflected through RMSSD (root mean square of successive RR interval differences) was significantly reduced by hydrotherapy and intravenous analgesia (before vs. after mean rank diff. 35.73 and 65.93, respectively, p < 0.05). Overall HRV (SDNN, standard deviation of RR intervals) was significantly decreased only by intravenous analgesia (before vs. after mean rank diff. 65.43, p < 0.001). Mean heart rate was significantly increased by intravenous analgesia, while spinal anesthesia reduced it, and hydrotherapy did not alter it (before vs. after mean rank diff. -49.35*, 70.38*, -24.20 NS , respectively, *p < 0.05, NS not significant). Conclusion: This study demonstrates that warm shower therapy may impact the sympathovagal balance via parasympathetic withdrawal in women during the initial stage of labor. The findings of this study provide quantitative support for using warm shower hydrotherapy during labor via point-of-care testing. The dependability of hydrotherapy as a non-pharmacological treatment is linked to the completion of more clinical research demonstrating quantitative evidence via outcome biomarkers to support indications on stress and birth progress.
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Introducción: El ameloblastoma es un tumor odontogénico epitelial benigno con tendencia a la recurrencia local si no se elimina adecuadamente. Las alternativas reconstructivas incluyen el uso de colgajos libres microvascularizados, placas y prótesis personalizada de titanio. Objetivo: Describir un reemplazo hemimandibular con prótesis personalizada de titanio posterior a la exéresis de ameloblastoma. Presentación del caso: Mujer de 44 años de edad, que presentó un hallazgo radiográfico durante la realización de tratamiento pulporradicular del diente número 37. Al realizársele el reconocimiento físico facial mostró aumento de volumen en región geniana izquierda mientras que el examen intrabucal detectó expansión de las corticales en la arcada posteroinferior del mismo lado. Se realizó una radiografía panorámica y tomografía axial computarizada con la que se constató la presencia de imagen radiolúcida, multiloculada, en forma de "pompas de jabón" extendiéndose desde el cuerpo mandibular hasta el cóndilo del lado izquierdo. Se tomó muestra para biopsia, con la cual se constató que se trataba de ameloblastoma con patrón folicular. Se realizó abordaje cervical, segmentaria mandibular con margen de seguridad y exarticulación. Se reemplazó la porción eliminada con prótesis personalizada de titanio. Se mantuvo el chequeo posoperatorio en el que se comprobó una buena evolución. Conclusiones: La cirugía constituyó el pilar de tratamiento utilizado. Una vez realizada la resección quirúrgica se reconstruyó el defecto con prótesis personalizada de titanio, proceder de gran novedad en nuestro medio y útil para restablecer la función y estética(AU)
Introduction: Ameloblastoma is a benign tumor of odontogenic epithelium with a tendency to local recurrence if not removed appropriately. Reconstruction alternatives include the use of microvascularized free flaps, plates and customized titanium prostheses. Objective: Describe a case of mandibular replacement with a customized titanium prosthesis after ameloblastoma excision. Case presentation: A case is presented of a female 44-year-old patient who presented a radiographic finding during pulporadicular treatment of tooth 37. Facial physical examination found an increase in volume in the left genian region, and intraoral observation detected expansion of the corticals in the lower posterior arch of the same side. Panoramic radiography and computed axial tomography showed a multilocular radiolucid image resembling soap bubbles which extended from the mandibular body to the left condyle. A sample was taken for biopsy, which confirmed the diagnosis of follicular pattern ameloblastoma. Segmental mandibular surgery was performed by cervical approach with a safety margin and exarticulation. The portion removed was replaced with a customized titanium prosthesis. Post-operative control showed a good evolution. Conclusions: Surgery was the basic component of the treatment applied. Surgical resection was followed by reconstruction of the defect with a customized titanium prosthesis, a procedure of great novelty in our environment useful to restore function and esthetic appearance(AU)
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Humanos , Feminino , Adulto , Titânio/efeitos adversos , Biópsia/efeitos adversos , Ameloblastoma/diagnóstico por imagem , Tumores Odontogênicos/cirurgia , Reconstrução Mandibular/métodos , Radiografia PanorâmicaRESUMO
Tumor hypoxia and the hypoxia inducible factor-1, HIF-1, play critical roles in cancer progression and metastasis. We previously showed that hypoxia activates the endosomal GTPase Rab5, leading to tumor cell migration and invasion, and that these events do not involve changes in Rab protein expression, suggesting the participation of intermediate activators. Here, we identified ALS2, a guanine nucleotide exchange factor that is upregulated in cancer, as responsible for increased Rab5-GTP loading, cell migration and metastasis in hypoxia. Specifically, hypoxia augmented ALS2 mRNA and protein levels, and these events involved HIF-1α-dependent transcription, as shown by RNAi, pharmacological inhibition, chromatin immunoprecipitation and bioinformatics analyses, which identified a functional HIF-1α-binding site in the proximal promoter region of ALS2. Moreover, ALS2 and Rab5 activity were elevated both in a model of endogenous HIF-1α stabilization (renal cell carcinoma) and by following expression of stable non-hydroxylatable HIF-1α. Strikingly, ALS2 upregulation in hypoxia was required for Rab5 activation, tumor cell migration and invasion, as well as experimental metastasis in C57BL/6 mice. Finally, immunohistochemical analyses in patient biopsies with renal cell carcinoma showed that elevated HIF-1α correlates with increased ALS2 expression. Hence, this study identifies ALS2 as a novel hypoxia-inducible gene associated with tumor progression and metastasis.
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Esclerose Lateral Amiotrófica/genética , Carcinoma de Células Renais/genética , Fatores de Troca do Nucleotídeo Guanina/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Esclerose Lateral Amiotrófica/patologia , Animais , Carcinoma de Células Renais/patologia , Linhagem Celular Tumoral , Movimento Celular/genética , Proliferação de Células/genética , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Camundongos , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Ativação Transcricional/genética , Hipóxia Tumoral , Proteínas rab5 de Ligação ao GTP/genéticaRESUMO
RESUMEN Introducción: El carcinoma ameloblástico es una entidad rara que surge como una neoplasia primaria o a partir de un ameloblastoma preexistente. El colgajo de músculo temporal es una opción terapéutica frecuentemente empleada para la reconstrucción del defecto resultante luego de la exéresis quirúrgica. Objetivo: Presentar un caso clínico de restauración estética y funcional mediante reconstrucción con colgajo temporal de un defecto maxilar por exéresis de carcinoma ameloblástico, dada la infrecuente presentación de esta entidad. Caso clínico: Mujer de 49 años de edad, que refiere "una bola" en el paladar de 9 meses de evolución. Al examen físico facial presenta aumento de volumen en región infraorbitaria izquierda. Se realizó una tomografía axial computarizada en la que se constató la presencia de imagen hiperdensa en seno maxilar izquierdo con calcificación en su interior, produciendo lisis del hueso nasal y hueso cigomático infiltrando partes blandas. Se tomó muestra para biopsia que informó tumor de alto grado de malignidad correspondiente a carcinoma ameloblástico. En estudio radiográfico de tórax no se apreció presencia de metástasis pulmonar. Se realizó maxilarectomía de infra y mesoestructura, resección de la lesión con margen oncológico de seguridad y se reconstruyó el defecto palatino con colgajo pediculado del músculo temporal. Se indicó quimio y radioterapia como terapia adyuvante al tratamiento quirúrgico. Se mantuvo el chequeo posoperatorio mostrándose buena evolución clínica y una epitelización secundaria del músculo temporal en el área palatina con restauración de las funciones. Conclusiones: Se presentó un caso clínico de carcinoma ameloblástico, entidad patológica de escasa frecuencia. La cirugía constituyó el pilar de tratamiento utilizado. Una vez realizada la resección quirúrgica se reconstruyó el defecto palatino, utilizándose el colgajo del músculo temporal, opción útil para lograr el restablecimiento de las funciones estéticas y funcionales como la deglución y fonación(AU)
ABSTRACT Introduction: Ameloblastic carcinoma is a rare condition emerging as a primary neoplasm or from a preexisting ameloblastoma. Temporalis muscle flap is a therapeutic option frequently used for reconstruction of the defect resulting from surgical exeresis. Objective: Present a clinical case of esthetic and functional restoration by reconstruction with temporalis muscle flap of a maxillary defect caused by exeresis of an ameloblastic carcinoma. The case is presented because of the infrequent occurrence of this condition. Clinical case: A female 49-year-old patient reports "a lump" in her palate of nine months evolution. Physical examination finds an increase in volume in the left infraorbital region. Computed axial tomography was indicated, which revealed the presence of a hyperdense image in the left maxillary sinus with internal calcification causing lysis of the nasal bone and the zygomatic bone, and infiltrating soft tissue. A sample was taken for biopsy, which reported a tumor with a high degree of malignancy corresponding to ameloblastic carcinoma. Chest radiography did not show the presence of lung metastasis. Infra- and mesostructure maxillectomy was performed, the lesion was removed with a surgical safety margin, and the palatine defect was reconstructed with a pediculated temporalis muscle flap. Chemo- and radiotherapy were indicated as adjuvants to the surgical treatment. Postoperative follow-up found good clinical evolution and secondary epithelization of the temporalis muscle in the palatine area with restoration of functions. Conclusions: A clinical case was presented of ameloblastic carcinoma, a condition with a low frequency of occurrence. Surgery was the basic component of the treatment applied. Once surgical resection was performed, the palatine defect was reconstructed by means of a temporalis muscle flap, a useful option to achieve the restoration of esthetic and biological functions, such as swallowing and speech(AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Retalhos Cirúrgicos/cirurgia , Ameloblastoma/diagnóstico por imagem , Neoplasias Maxilomandibulares/patologia , Reconstrução Mandibular/métodos , Quimiorradioterapia Adjuvante/métodosRESUMO
Resumen: La sociedad postmoderna basada en un modelo neoliberal cuestiona el fuerte componente valórico característico del cuidado profesional de enfermería. Ante esta situación surge la interrogante: ¿Cómo se enfrenta la formación valórica en los estudiantes de enfermería y cómo se viven estos en la práctica del cuidado? Objetivo: Analizar qué se ha investigado en los últimos diez años sobre la formación ética en estudiantes de enfermería y en la práctica valórica de estos profesionales en una sociedad postmoderna. Metodología: Revisión sistemática mixta de carácter narrativo que considero los últimos diez años (2008-2018), incluye 76 artículos de los cuales se seleccionaron 48 para su análisis. Se revisaron las bases de datos: ProQuest, ProQuest education Database, ProQuest Religión Database, Ebsco, Cuiden, Dialnet plus, Latindex, Scielo, SCOPUS y Google académico. Conclusiones: El postmodernismo trastoca los valores profesionales, tanto en la práctica del cuidado como en la formación de los futuros profesionales, por ello se requiere fortalecer y adecuar los valores tradicionales entre la academia y la clínica, centrando la formación en el profesor como modelo de la práctica profesional.
Resumo: A sociedade pósmoderna baseada em um modelo neoliberal questiona o forte componente de valor característico do cuidado profissional de enfermagem. Diante desta situação surge a pregunta: Como se enfrente a formação de valores nos estudantes de enfermagem e como isto é vivido na prática do cuidado? Objetivo: Analisar o que se investigou nos últimos dez anos sobre a formação ética nos estudantes de enfermagem e na prática de valor destes profissionais em uma sociedade pósmoderna. Metodologia: revisão sistemática mista de caráter narrativo que considere os últimos dez anos (2008-2018), incluindo 76 artigos dos quais se selecionaram 48 para análise. Foram revisadas as bases de dados: ProQuest, ProQuest education Database, ProQuest Religión Database, Ebsco, Cuiden, Dialnet plus, Latindex, Scielo, SCOPUS e Google acadêmico. Conclusões: O postmodernismo transtorna os valores profissionais, tanto na prática do cuidado como na formação dos futuros profissionais, por isso se requer fortalecer e adequar os valores tradicionais entre a academia e a clínica, centrando a formação no professor como modelo da prática profissional
Abstract: The postmodern society based on a neoliberal model questions the strong value component characteristic of professional nursing care. Faced with this situation, the question arises: How is valuation training faced by nursing students and how are these students living in the practice of care? Objective: To analyze what has been researched in the last ten years about the ethical formation in nursing students and the value practice of these professionals in a postmodern society. Methodology: Mixed systematic review of a narrative nature that I consider the last ten years (2008-2018), includes 76 articles, of which 48 were selected for analysis. The databases were revised: ProQuest, ProQuest education Database, ProQuest Religion Database, Ebsco, Cuiden, Dialnet plus, Latindex, Scielo, SCOPUS and Google academic. Conclusions: Postmodernism upsets professional values, both in the practice of care and in the training of future professionals, for this reason it is necessary to strengthen and adapt the traditional values between the academy and the clinic, focusing the training on the teacher as a model of professional practice.
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Humanos , Sociedades , Enfermagem , Pós-Modernismo , Profissionalismo , Cuidados de Enfermagem , Valores SociaisRESUMO
Lipoma is a benign entity with a poor incidence in craniofacial region. The most frequent tumors in the maxillo pharyngeal space are those that occur in the major and minor salivary glands, with a higher incidence of pleomorphic adenoma, also consider a benign entity. The transmandibular approach offers a great advantage in terms of visibility during the surgery. Achieving a lower morbidity, due to the fact that anatomic structures of anterior (prestyloid) and posterior (retrostyloid) compartments are involved. Our case report has important implications: clinical, pathologic and surgical, with a good prognosis for life and good for function at 2 year of postoperatively without any recurrence reported.
El lipoma es una entidad benigna con pobre incidencia en la región craneofacial. Las tumoraciones más frecuentes en el espacio maxilofaríngeo son las que se presentan en glándulas salivales mayores y menores ectópicas, con mayor incidencia de adenoma pleomorfo, también considerado una entidad benigna. El abordaje transmandibular ofrece una gran ventaja en cuanto a la visibilidad durante el acto quirúrgico. Consiguiendo una menor morbilidad al estar involucradas estructuras del espacio preestíleo y retroestíleo. El caso clínico que se presenta tiene importantes implicaciones: clínicas, patológicas y quirúrgicas, con un pronóstico bueno para la vida y bueno para la función a dos años de posoperatorio, sin recidiva alguna.
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Lipoma/cirurgia , Mandíbula/cirurgia , Neoplasias Faríngeas/cirurgia , Feminino , Humanos , Lipoma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Faríngeas/diagnósticoRESUMO
Introducción: el carcinoma de células escamosas primario intraóseo es una neoplasia maligna poco frecuente. Objetivo: presentar un caso clínico de un carcinoma primario intraóseo derivado de un quiste odontogénico en las regiones del cuerpo a la rama mandibular izquierdas. Caso clínico: acude a consulta paciente masculino de 68 años quien refiere una molestia en la mandíbula. Al examen bucal se detecta expansión cortical a nivel del 37. Se realiza estudio de ortopantomografía donde se observó un área radiolúcida con borde definidos, y bajo la impresión diagnóstica de quiste residual se efectúa curetaje y estudio histopatológico, que confirma lo sospechado. Al cabo de unos 4 meses el paciente acude nuevamente refiriendo dolor muy intenso en la región del ángulo mandibular con ligera parestesia del labio inferior izquierdo que se asociaba al examen físico facial, con edema geniano bajo y submandibular, y al examen bucal con movilidad anormal ósea mandibular izquierda. Se realiza ortopantomografía donde se observa imagen radiolúcida de bordes irregulares, poco precisos, y fractura patológica mandibular. Se decide inmovilización y toma de muestra para biopsia, que informa un carcinoma epidermoide moderadamente diferenciado, por lo que se realiza tratamiento quirúrgico radical con manejo del cuello, más radioterapia y quimioterapia posoperatorias. Conclusión: la transformación en un carcinoma primario intraóseo a partir de un quiste residual es una entidad infrecuente en la región maxilofacial. El diagnóstico en el caso presentado se realizó por exclusión. La sintomatología de dolor intenso y parestesia fueron elementos clave en la sospecha diagnóstica. El enfoque oncológico mediante cirugía radical con manejo del cuello, radio y quimioterapia permitieron el control loco-regional(AU)
Introduction: primary intraosseous squamous cell carcinoma is an infrequent malignant neoplasm. Objective: present a clinical case of primary intraosseous carcinoma arising from an odontogenic cyst in body regions to the left mandibular branch. Clinical case: a 68-year-old male patient presented with discomfort in his mandible. Oral examination revealed cortical expansion at the level of 37. Orthopantomography showed a radiolucent area with definite borders. Curettage and histological testing confirmed the preliminary diagnosis of residual cyst. Some four months later the patient presented again with very intense pain in the mandibular angle region with slight paresthesia of the left lower lip area associated on physical facial examination with lower and submandibular genian edema, and on oral examination with abnormal left mandibular bone mobility. Orthopantomography revealed a radiolucent image of irregular, imprecise borders and pathological mandibular fracture. It was decided to immobilize and take a sample for biopsy, which reported moderately differentiated epidermoid carcinoma. Therefore, radical surgical treatment was performed with neck management plus postoperative radiotherapy and chemotherapy. Conclusion: evolution of a residual cyst into a primary intraosseous carcinoma is an infrequent condition in the maxillofacial region. In the case herein presented diagnosis was made by exclusion. The symptoms of intense pain and paresthesia were crucial to the preliminary diagnosis. Application of an oncological approach based on radical surgery with neck management and radio- and chemotherapy resulted in local-regional control(AU)
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Humanos , Masculino , Idoso , Carcinoma de Células Escamosas/diagnóstico , Radiografia Panorâmica/métodos , Neoplasias Maxilomandibulares , Procedimentos Cirúrgicos Bucais/métodosRESUMO
Introducción: el carcinoma de células escamosas primario intraóseo es una neoplasia maligna poco frecuente. Objetivo: presentar un caso clínico de un carcinoma primario intraóseo derivado de un quiste odontogénico en las regiones del cuerpo a la rama mandibular izquierdas. Caso clínico: acude a consulta paciente masculino de 68 años quien refiere una molestia en la mandíbula. Al examen bucal se detecta expansión cortical a nivel del 37. Se realiza estudio de ortopantomografía donde se observó un área radiolúcida con borde definidos, y bajo la impresión diagnóstica de quiste residual se efectúa curetaje y estudio histopatológico, que confirma lo sospechado. Al cabo de unos 4 meses el paciente acude nuevamente refiriendo dolor muy intenso en la región del ángulo mandibular con ligera parestesia del labio inferior izquierdo que se asociaba al examen físico facial, con edema geniano bajo y submandibular, y al examen bucal con movilidad anormal ósea mandibular izquierda. Se realiza ortopantomografía donde se observa imagen radiolúcida de bordes irregulares, poco precisos, y fractura patológica mandibular. Se decide inmovilización y toma de muestra para biopsia, que informa un carcinoma epidermoide moderadamente diferenciado, por lo que se realiza tratamiento quirúrgico radical con manejo del cuello, más radioterapia y quimioterapia posoperatorias. Conclusión: la transformación en un carcinoma primario intraóseo a partir de un quiste residual es una entidad infrecuente en la región maxilofacial. El diagnóstico en el caso presentado se realizó por exclusión. La sintomatología de dolor intenso y parestesia fueron elementos clave en la sospecha diagnóstica. El enfoque oncológico mediante cirugía radical con manejo del cuello, radio y quimioterapia permitieron el control loco-regional(AU)
Introduction: primary intraosseous squamous cell carcinoma is an infrequent malignant neoplasm. Objective: present a clinical case of primary intraosseous carcinoma arising from an odontogenic cyst in body regions to the left mandibular branch. Clinical case: a 68-year-old male patient presented with discomfort in his mandible. Oral examination revealed cortical expansion at the level of 37. Orthopantomography showed a radiolucent area with definite borders. Curettage and histological testing confirmed the preliminary diagnosis of residual cyst. Some four months later the patient presented again with very intense pain in the mandibular angle region with slight paresthesia of the left lower lip area associated on physical facial examination with lower and submandibular genian edema, and on oral examination with abnormal left mandibular bone mobility. Orthopantomography revealed a radiolucent image of irregular, imprecise borders and pathological mandibular fracture. It was decided to immobilize and take a sample for biopsy, which reported moderately differentiated epidermoid carcinoma. Therefore, radical surgical treatment was performed with neck management plus postoperative radiotherapy and chemotherapy. Conclusion: evolution of a residual cyst into a primary intraosseous carcinoma is an infrequent condition in the maxillofacial region. In the case herein presented diagnosis was made by exclusion. The symptoms of intense pain and paresthesia were crucial to the preliminary diagnosis. Application of an oncological approach based on radical surgery with neck management and radio- and chemotherapy resulted in local-regional control(AU)
Assuntos
Humanos , Masculino , Idoso , Carcinoma de Células Escamosas/diagnóstico , Radiografia Panorâmica/métodos , Neoplasias Maxilomandibulares/tratamento farmacológico , Procedimentos Cirúrgicos Bucais/métodosRESUMO
In this review of a clinical case we study the most frequent benign neoplasia of the main salivary glands. We present the case of a four-year relapse of a patient post-operated of a conservative total parotidectomy. We expose different opinions about this neoplasia, and the clinical case of a 50-year old female patient that presents a relapse to the parapharyngeal space, for which we used a trans-mandibular approach.
En esta revisión de un caso clínico se estudia la neoplasia benigna más frecuente de glándulas salivales mayores. Se presenta el caso de una recidiva a cuatro años de una paciente postoperada de parotidectomía total conservadora. Se exponen diferentes opiniones sobre esta neoplasia y el caso clínico de una paciente de 50 años de edad, la cual presenta recidiva hacia el espacio parafaríngeo, para el que se realizó un abordaje transmandibular.
Assuntos
Adenoma Pleomorfo/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Parotídeas/cirurgia , Feminino , Humanos , Mandíbula , Pessoa de Meia-Idade , FaringeRESUMO
Immigrant minorities regularly experience higher incidence and mortality rates of cancer. Frequently, a variety of social determinants create obstacles for those individuals to get the screenings they need. This is especially true for Haitian immigrants, a particularly vulnerable immigrant population in South Florida, who have been identified as having low cancer screening rates. While Haitian immigrants have some of the lowest cancer screening rates in the country, there is little existing literature that addresses barriers to cancer screenings among the population of Little Haiti in Miami-Dade County, Florida. The objective of this study was to evaluate the association between having a regular source of healthcare and adherence to recommended cancer screenings in the Little Haiti population of Miami.This secondary analysis utilized data collected from a random-sample, population-based household survey conducted from November 2011 to December 2012 among a geographic area approximating Little Haiti in Miami-Dade County, Florida. A total of 421 households identified as Haitian. The main exposure of interest was whether households possessed a regular source of care. Three separate outcomes were considered: adherence with colorectal cancer screening, mammogram adherence, and Pap smear adherence. Analysis was limited to households who met the age criteria for each outcome of interest. Bivariate associations were examined using the chi square test and Fisher exact test. Binary logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).After adjusting for the head of household's education and household insurance status, households without a regular source of care were significantly less likely to adhere with colorectal cancer screening (ORâ=â0.33; 95% CI: 0.14-0.80) or mammograms (ORâ=â0.28; 95% CI: 0.11-0.75). Households with insurance coverage gaps were significantly less likely to adhere with mammograms (ORâ=â0.40; 95% CI: 0.17-0.97) or Pap smears (ORâ=â0.28; 95% CI: 0.13-0.58).Our study explored adherence with multiple cancer screenings. We found a strong association between possessing a regular source of care and adherence with colorectal cancer screening and mammogram adherence. Targeted approaches to improving access to regular care may improve adherence to cancer screening adherence among this unique immigrant population.
Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Adulto , Idoso , Neoplasias Colorretais/diagnóstico , Feminino , Florida/epidemiologia , Haiti/etnologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Cooperação do Paciente/etnologia , Cooperação do Paciente/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
Introducción: dentro de los factores que conducen a deformidades persistentes después de traumatismos craneofaciales, se incluye el tratamiento inicial excesivamente retardado. La reconstrucción mandibular ideal proporcionará un arco dentario sólido para articularse con el maxilar y restaurar el habla, deglución, masticación y estética. Objetivo: caracterizar un caso de reconstrucción mandibular en una deformidad postraumática mandibular. Presentación del caso: paciente femenina de 49 años que solo puede alimentarse con comida licuada a partir de un trauma craneofacial recibido seis meses atrás. Se encontró al examen físico facial asimetría con aumento de la dimensión vertical del tercio inferior de la cara con incompetencia bilabial, y al bucal que se trataba de una paciente desdentada total superior y parcial inferior rehabilitada protésicamente en la arcada maxilar, con imposibilidad para el cierre bucal y con la presencia de un escalón visible en el reborde residual a altura del 45 y por distal del 37. Se llegó al diagnóstico de una deformidad postraumática por fractura mandibular bilateral. Se valoró de conjunto con la especialidad de Prótesis, y se decidió tratamiento quirúrgico encaminado a la reconstrucción mandibular mediante abordaje cervical, refractura, reubicación mandibular con fijación de la guía oclusal y colocación de placas mandibulares de carga soportada con tornillos bicorticales. Se realizó el seguimiento por consulta externa después del alta hospitalaria. La paciente refiere estar muy conforme con su aspecto estético y con la mejoría funcional alcanzada. Conclusiones: las secuelas postraumáticas se acompañan frecuentemente de daños en tejidos blandos y duros de la región facial con diferente grado de alteración estética y funcional para el paciente. Lograr restituir estos mediante la reconstrucción facial suele ser un reto profesional que puede ser mejor enfrentado mediante el tratamiento en equipo y transdisciplinario(AU)
Introduction: overly delayed initial treatment is one the factors leading to persistent deformities after craniofacial trauma. Ideal mandibular reconstruction will create a solid dental arch which will articulate with the maxilla and restore speech, swallowing, mastication and esthetics. Objective: present a case of mandibular reconstruction of a posttraumatic mandibular deformity. Case presentation: a 49-year-old female patient can only feed herself liquid food after a craniofacial trauma undergone six months before. Physical examination revealed facial asymmetry with an increase in the vertical dimension of the lower third of the face and bilabial incompetence. Oral examination, on the other hand, revealed that the patient had a totally edentulous upper dental arch and partial prosthetic rehabilitation of the maxillary arch, impossibility of oral closure, and the presence of a visible step on the residual ridge at the 45 and distal 37. Diagnosis was a posttraumatic deformity due to bilateral mandibular fracture. Evaluation was carried out in joint coordination with the prosthesis service, and it was decided to perform surgical mandibular reconstruction by cervical approach, refracture, mandibular relocation with fixation of the occlusal guide, and placement of load bearing mandibular plates with bicortical screws. Outpatient follow-up was conducted after hospital discharge. The patient states that she is very pleased with her esthetic appearance and the functional improvement achieved. Conclusions: posttraumatic sequelae are frequently accompanied by damage to soft and hard tissues of the facial region with varying degrees of esthetic and functional alteration. Restoration by means of facial reconstruction is often a professional challenge which may be best tackled with a team, transdisciplinary therapeutic approach(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Traumatismos Mandibulares/diagnóstico , Reconstrução Mandibular/métodos , Tomografia Computadorizada Espiral/métodosRESUMO
Introducción: dentro de los factores que conducen a deformidades persistentes después de traumatismos craneofaciales, se incluye el tratamiento inicial excesivamente retardado. La reconstrucción mandibular ideal proporcionará un arco dentario sólido para articularse con el maxilar y restaurar el habla, deglución, masticación y estética. Objetivo: caracterizar un caso de reconstrucción mandibular en una deformidad postraumática mandibular. Presentación del caso: paciente femenina de 49 años que solo puede alimentarse con comida licuada a partir de un trauma craneofacial recibido seis meses atrás. Se encontró al examen físico facial asimetría con aumento de la dimensión vertical del tercio inferior de la cara con incompetencia bilabial, y al bucal que se trataba de una paciente desdentada total superior y parcial inferior rehabilitada protésicamente en la arcada maxilar, con imposibilidad para el cierre bucal y con la presencia de un escalón visible en el reborde residual a altura del 45 y por distal del 37. Se llegó al diagnóstico de una deformidad postraumática por fractura mandibular bilateral. Se valoró de conjunto con la especialidad de Prótesis, y se decidió tratamiento quirúrgico encaminado a la reconstrucción mandibular mediante abordaje cervical, refractura, reubicación mandibular con fijación de la guía oclusal y colocación de placas mandibulares de carga soportada con tornillos bicorticales. Se realizó el seguimiento por consulta externa después del alta hospitalaria. La paciente refiere estar muy conforme con su aspecto estético y con la mejoría funcional alcanzada. Conclusiones: las secuelas postraumáticas se acompañan frecuentemente de daños en tejidos blandos y duros de la región facial con diferente grado de alteración estética y funcional para el paciente. Lograr restituir estos mediante la reconstrucción facial suele ser un reto profesional que puede ser mejor enfrentado mediante el tratamiento en equipo y transdisciplinario(AU)
Introduction: overly delayed initial treatment is one the factors leading to persistent deformities after craniofacial trauma. Ideal mandibular reconstruction will create a solid dental arch which will articulate with the maxilla and restore speech, swallowing, mastication and esthetics. Objective: present a case of mandibular reconstruction of a posttraumatic mandibular deformity. Case presentation: a 49-year-old female patient can only feed herself liquid food after a craniofacial trauma undergone six months before. Physical examination revealed facial asymmetry with an increase in the vertical dimension of the lower third of the face and bilabial incompetence. Oral examination, on the other hand, revealed that the patient had a totally edentulous upper dental arch and partial prosthetic rehabilitation of the maxillary arch, impossibility of oral closure, and the presence of a visible step on the residual ridge at the 45 and distal 37. Diagnosis was a posttraumatic deformity due to bilateral mandibular fracture. Evaluation was carried out in joint coordination with the prosthesis service, and it was decided to perform surgical mandibular reconstruction by cervical approach, refracture, mandibular relocation with fixation of the occlusal guide, and placement of load bearing mandibular plates with bicortical screws. Outpatient follow-up was conducted after hospital discharge. The patient states that she is very pleased with her esthetic appearance and the functional improvement achieved. Conclusions: posttraumatic sequelae are frequently accompanied by damage to soft and hard tissues of the facial region with varying degrees of esthetic and functional alteration. Restoration by means of facial reconstruction is often a professional challenge which may be best tackled with a team, transdisciplinary therapeutic approach(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Traumatismos Mandibulares/diagnóstico , Reconstrução Mandibular/métodos , Tomografia Computadorizada Espiral/métodosRESUMO
OBJECTIVE: The aim of this paper is to evaluate the effect of the DiabetIMSS program on cardiovascular risk, blood pressure and HDL cholesterol in patients with metabolic syndrome. METHODS: Quasi-experimental intervention study. Non-probabilistic convenience sampling. 35 subjects in the educational strategy one year were included. The following variables were collected: age, gender, smoking, total cholesterol, HDL cholesterol, systolic and diastolic blood pressure; cardiovascular risk calculator based on Framingham is calculated. Descriptive and inferential statistical percentages with Student t test was used. RESULTS: There was an increase in the proportion of subjects increased their subsequent figures HDL cholesterol intervention, there by generating an increase of protective factor (p < 0.05). Because of the blood pressure a marked improvement in all ranges of blood pressure (p < 0.05) was presented. CONCLUSIONS: The educational strategy for the control of diabetic patients presented a favorable performance in HDL-cholesterol and blood pressure, reducing the risk of cardiovascular patients.
Objetivo: evaluar el efecto del programa DiabetIMSS sobre el riesgo cardiovascular, la tensión arterial y colesterol-HDL en pacientes con síndrome metabólico. Métodos: estudio de intervención cuasiexperimental. Muestreo no probabilístico por conveniencia. Se incluyeron 35 sujetos que participaron en la estrategia educativa de un año de duración. Se recolectaron las siguientes variables: edad, género, tabaquismo, colesterol total, HDL, TA sistólica y diastólica; se calculó el riesgo cardiovascular con calculadora basada en Framingham. Se utilizó estadística descriptiva con porcentajes e inferencial con t de Student. Resultados: hubo una elevación de la proporción de sujetos que incrementaron sus cifras del colesterol-HDL posterior a la intervención, generando, por ende, un incremento del factor protector (p < 0.05). En razón de las cifras tensionales, se presentó una mejoría notable en todos los rangos de presión arterial (p < 0.05). Conclusiones: la estrategia educativa para el control del paciente diabético presentó un comportamiento favorable en el colesterol-HDL y tensión arterial, disminuyendo el riesgo cardiovascular de los pacientes.