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Abstract Objective To study the influence of various tunnel parameters and graft inclination angle (GIA) on the clinical and radiological outcome after anterior cruciate ligament reconstruction (ACLR) at long-term follow-up. Methods In this retrospective study, 80 patients with isolated anterior cruciate ligament (ACL) injury treated by single bundle ACLR using bone patellar tendon bone (BPTB) and hamstring (HT) autografts were evaluated clinically and radiologically at their long-term follow-up. The study population were divided into two groups based on ideal and nonideal tunnel parameters as well as ideal and nonideal GIA. The various tunnel parameters and GIA were interpreted with clinical and radiological outcome at long-term follow-up. Results Eighty patients, 36 (45%) using BPTB and 44 (55%) using HT autografts, were available to complete the study. Patients with ideal coronal tibial tunnel angle (CTTA) and coronal femoral tunnel angle (CFTA) show superior clinical outcome (pivot shift test) than nonideal CTTA and CFTA, which was found to be statistically significant (p-value < 0.038 and 0.024, respectively). Similarly, patients with ideal coronal tibial tunnel position (CTTP) show superior clinical outcome (International Knee Documentation Committee - IKDC objective) over nonideal CTTP (p-value < 0.017). All other tunnel parameters and GIA were not found to have influence on clinical outcome. None of the tunnel parameters have influenced osteoarthritis (OA) change. There was no progression of OA change in the study population at long-term follow-up after ACLR. Conclusion Ideal coronal tunnel parameters produced a better clinical outcome at long-term follow-up after ACLR. There was no progression of OA change at long-term follow-up after isolated ACLR.

Resumo Objetivo O objetivo deste estudo foi analisar a influência de vários parâmetros do túnel e do ângulo de inclinação do enxerto (GIA, do inglês graft inclination angle) nos desfechos clínicos e radiológicos da reconstrução do ligamento cruzado anterior (RLCA) no acompanhamento de longo prazo. Métodos Neste estudo retrospectivo, 80 pacientes com lesão isolada do ligamento cruzado anterior (LCA) submetidos à RLCA de feixe único com autoenxertos de tendão patelar ósseo (TPO) e isquiotibiais (IT) foram avaliados clínica e radiologicamente durante o acompanhamento em longo prazo. A população do estudo foi dividida em dois grupos com base nos parâmetros ideais ou não ideais do túnel, bem como no GIA ideal e não ideal. Os vários parâmetros do túnel e o GIA foram interpretados com os desfechos clínicos e radiológicos no acompanhamento em longo prazo. Resultados Oitenta pacientes, sendo 36 (45%) submetidos ao procedimento com autoenxertos de TPO e 44 (55%) com autoenxertos IT, puderam completar o estudo. Pacientes com ângulo do túnel tibial coronal (ATTC) e ângulo do túnel femoral coronal (ATFC) ideais apresentam resultados clínicos superiores (teste de pivot shift) do que aqueles com ATTC e ATFC não ideais, sendo a diferença estatisticamente significativa (valor de p < 0,038 e 0,024, respectivamente). Da mesma forma, pacientes com posição do túnel tibial coronal (PTTC) ideal apresentam resultado clínico superior (International Knee Documentation Committee [IKDC] objetivo) em relação àqueles com PTTC não ideal (valor de p < 0,017). Os demais parâmetros do túnel e o GIA não influenciaram o desfecho clínico. Nenhum dos parâmetros do túnel influenciou a alteração associada à osteoartrite (OA). Não houve progressão da alteração da OA na população do estudo no acompanhamento em longo prazo após a RLCA. Conclusão Os parâmetros ideais do túnel coronal produziram um melhor desfecho clínico no acompanhamento de longo prazo após a RLCA. Não houve progressão da alteração da OA no acompanhamento em longo prazo após a RLCA isolada.

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Background and Objective: To assess the relationship between adverse childhood experiences (ACE/ACEs) and epilepsy. Methods: We performed a cross-sectional retrospective cohort analysis using population-based data from the 2018 and 2019 National Survey of Children's Health to examine caregiver-reported ACE exposures and their relationship to caregiver-reported physician diagnoses of epilepsy or seizure disorder in children. ACEs elicited in the survey included questions about experience of violence, household dysfunction, and food and housing insecurity. Adjusting for age, race, and income level, we used logistic regression to test the relationships between cumulative ACE score and current seizure disorder or epilepsy diagnosis and to examine which specific ACEs were individually associated with current seizure disorder or epilepsy diagnosis. Results: The study population consisted of 59,963 participants; 52.2% were female, and 47.8% were male. Participant ages ranged from 0 to 17 years. A current diagnosis of epilepsy or seizure disorder was reported in 377 (0.63%) participants, and 22,749 (37.9%) participants had one or more ACE exposures. As the number of ACEs increased, odds of current epilepsy or seizure disorder diagnosis increased by 1.14 (95% confidence interval 1.07-1.22). Five ACE exposures demonstrated a high association with a current diagnosis of epilepsy or seizure disorder: food/housing insecurity, witnessing domestic violence, household mental illness, neighborhood violence, and parent/guardian incarceration. Discussion: Multiple ACE exposures were individually associated with reporting a diagnosis of epilepsy or seizure disorder. An increase in cumulative ACE exposures increased odds of having current diagnosis of epilepsy or seizure disorder.

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OBJECTIVES: To highlight how using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to understand the certainty in the evidence about the impact of climate change in health outcomes increases transparency. Also, how GRADE can enhance communication and decisions about adaptation and mitigation strategies. STUDY DESIGN AND SETTING: We developed a narrative review based on an assessment of exiting systematic reviews addressing the effect of climate change on health outcomes and the impact of mitigation and adaptation strategies. RESULTS: Adopting structured approaches such as GRADE to tackle the impact of climate change on health may help to (1) define the specific question to be addressed; (2) summarize the evidence in a structured way and assess uncertainty; (3) provide a systematic framework to move from evidence to action and to offer recommendations of different strength; (4) provide a systematic way to adapt recommendations to specific settings; and (5) provide a framework to assess the certainty of modeled evidence. CONCLUSION: In this article, we describe epidemiologic principles that could be used to move decision-making in climate change forward.

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OBJECTIVE: The aim of the study was to quantify the risk of incarceration of incisional hernias. BACKGROUND: Operative repair is the definitive treatment for incisional ventral hernias but is often deferred if the perceived risk of elective operation is elevated secondary to comorbid conditions. The risk of incarceration during nonoperative management (NOM) factors into shared decision making by patient and surgeon; however, the incidence of acute incarceration remains largely unknown. METHODS: A retrospective analysis of adult patients with an International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis of incisional hernia was conducted from 2010 to 2017 in 15 hospitals of a single healthcare system. The primary outcome was incarceration necessitating emergent operation. The secondary outcome was 30-, 90-, and 365-day mortality. Univariate and multivariate analyses were used to determine independent predictors of incarceration. RESULTS: Among 30,998 patients with an incisional hernia (mean age 58.1 ±â€Š15.9 years; 52.7% female), 23,022 (78.1%) underwent NOM of whom 540 (2.3%) experienced incarceration, yielding a 1- and 5-year cumulative incidence of 1.24% and 2.59%, respectively. Independent variables associated with incarceration included: age older than 40 years, female sex, current smoker, body mass index 30 or greater, and a hernia-related inpatient admission. All-cause mortality rates at 30, 90, and 365 days were significantly higher in the incarceration group at 7.2%, 10%, and 14% versus 1.1%, 2.3%, and 5.3% in patients undergoing successful NOM, respectively. CONCLUSIONS: Incarceration is an uncommon complication of NOM but is associated with a significant risk of death. Tailored decision making for elective repair and considering the aforementioned risk factors for incarceration provides an initial step toward mitigating the excess morbidity and mortality of an incarceration event.

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Abstract Introduction Anatomical variations in the sinonasal region are remarkably common and these variations may have an impact on maxillary sinus development due to their close anatomical adjacency. Objective The aim of this study was to investigate the effect of anatomical variations of the sinonasal region on the width, height, length, and volume of the maxillary sinus. Methods Cone beam computed tomography records of 120 patients were evaluated. Nasal septum deviation angle was measured for each patient and patients were divided into three groups as mild, moderate, and severe. Sinonasal variations such as nasal septum deviation direction, septal spur, concha bullosa, uncinate process pneumatization, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha and presence of septa in the maxillary sinus were registered. Cone beam computed tomography images were transferred to the SimPlant software thus right and left maxillary sinus volumes and dimensions were measured separately. Results There was a negative and statistically significant relationship between age and left maxillary sinus width (p= 0.015). The relationships between gender and maxillary sinus volumes and dimensions were statistically significant (p< 0.05). Although there were significant relationships between the nasal septum deviation severity, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha, and presence of septa and maxillary sinus dimensions; there was no significant relationship between septal spur, nasal septum deviation direction, concha bullosa, uncinate process pneumatization, and maxillary sinus dimensions. No statistically significant relationship could be determined between maxillary sinus volume and anatomical variations of the sinonasal region. Conclusion According to our findings, while certain the variations were found to affect the sinus dimensions; none of the variations was found to be related to the maxillary sinus volume.

Resumo Introdução As variações anatômicas na região nasossinusal são extremamente comuns e essas variações podem ter um impacto no desenvolvimento do seio maxilar, devido à proximidade anatômica. Objetivo Investigar o efeito das variações anatômicas da região nasossinusal na largura, altura, comprimento e volume do seio maxilar. Método Foram avaliados registros de tomografia computadorizada de feixe cônico de 120 pacientes. O ângulo de desvio do septo nasal foi medido para cada paciente e os pacientes foram divididos em três grupos: leve, moderado e grave. Foram observadas variações nasossinusais, como direção do desvio do septo nasal, esporão septal, concha bolhosa, pneumatização do processo uncinado, hipertrofia da concha média, hipertrofia da concha inferior, concha média paradoxal e presença de septos no seio maxilar. Imagens de tomografia computadorizada de feixe cônico foram transferidas para o software SimPlant e, portanto, os volumes e dimensões dos seios maxilares direito e esquerdo foram medidos separadamente. Resultados Houve uma relação negativa e estatisticamente significante entre a idade e a largura do seio maxilar esquerdo (p = 0,015). As relações entre gênero e volumes e dimensões do seio maxilar foram estatisticamente significantes (p < 0,05). Embora houvesse relações significativas entre a gravidade do desvio do septo nasal, hipertrofia da concha média, hipertrofia da concha inferior, concha média paradoxal e presença de septos e dimensões do seio maxilar, não houve relação significativa entre esporão septal, direção do desvio do septo nasal, concha bolhosa, pneumatização do processo uncinado e dimensões do seio maxilar. Nenhuma relação estatisticamente significante pôde ser determinada entre o volume do seio maxilar e as variações anatômicas da região nasossinusal. Conclusão De acordo com nossos achados, embora certas variações tenham afetado as dimensões sinusais, nenhuma das variações foi efetivamente relacionada ao volume do seio maxilar.

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Abstract: Introduction: In a scenario of a great information availability, the production of scientific knowledge in medicine has been increasingly accelerated. The way the medical professional perceives and directs their acquisition of knowledge still lacks national studies, particularly in times of easily accessible internet. Objective: To analyze the social representations of physicians working in Primary Health Care (PHC) teams about self-directed learning. Method: This is a qualitative-quantitative study based on Moscovici's Social Representations Theory, with a structural approach to Abric's Central Core Theory, conducted in three municipalities of the state of Minas Gerais, Brazil. Semi-structured interviews were conducted on the subject, which were recorded and transcribed. The freely evoked words that emerged from the inducing term "medical self-learning" were analyzed with the aid of EVOC® software through the four-quadrant chart and CHIC® software analyzed the similarity. Content analysis was performed for the participants' speeches. Results: Fifty interviews were carried out and the freely evoked words that possibly constitute the core of the representations were "knowledge", "dedication", "study", "reading", "need", contrasting "research" and "book". Conclusion: The results showed that the learners' characteristics, practice as a learning locus as opposed to theory, associated with the time barrier, define the core content of the social representation of the participating physicians. In this assessed context, PHC reinforces its importance as a scenario for medical self-learning.

Resumo: Introdução: Em um cenário de grande disponibilidade de informações, a produção de conhecimento científico em medicina tem sido cada dia mais acelerada. A forma como o profissional médico percebe e dirige sua aquisição de conhecimento ainda carece de estudos nacionais, particularmente em tempos de internet de fácil acesso. Objetivo: Este estudo teve como objetivo analisar as representações sociais de médicos atuantes em equipes da atenção primária à saúde (APS) sobre aprendizagem autodirigida. Método: Trata-se de um estudo quali-quantitativo fundamentado na Teoria das Representações Sociais de Moscovici com abordagem estrutural da Teoria do Núcleo Central de Abric, realizado em três municípios de Minas Gerais, no Brasil. Realizaram-se entrevistas semiestruturadas sobre o tema que foram gravadas e transcritas. As palavras evocadas livremente que surgiram do indutor "autoaprendizagem médica" foram analisadas com auxílio do software EVOC® por meio do quadro das quatro casas; e o software CHIC® analisou a similaridade. Para as falas dos participantes, realizou-se a análise de conteúdo. Resultado: Efetuaram-se 50 entrevistas, e as palavras evocadas livremente, que possivelmente compõem o núcleo central das representações, foram "conhecimento", "dedicação", "estudo", "leitura", "necessidade", tendo como contraste "pesquisa" e "livro". Conclusão: Os resultados demonstraram que as características do aprendiz e a prática como lócus de aprendizagem em contraposição à teoria, o qual está associado à barreira do tempo, definem o conteúdo central da representação social dos médicos participantes. Nesse contexto estudado, a APS reforça sua importância como cenário da autoaprendizagem médica.

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Resumen El objetivo fue evaluar la calidad de vida de personas con discapacidad intelectual y múltiple de 4 a 21 años a través de la Escala KidsLife validada para Colombia. Se adelantó un estudio de corte cuantitativo-explicativo, en el que participaron 220 informantes clave. Las dimensiones donde se evidenciaron puntuaciones medias más altas en calidad de vida fueron bienestar físico y bienestar emocional; contrariamente, las puntuaciones más bajas se registraron en autodeterminación e inclusión social. Se encontraron diferencias significativas de acuerdo con nivel de discapacidad, nivel de necesidades de apoyo y nivel de dependencia reconocida. Las mayores diferencias significativas correspondieron a las variables: sexo, contar con la familia y tener acceso a la escolaridad; sin embargo, las variables explicativas de la calidad de vida fueron: nivel de necesidades de apoyo, contar con el apoyo de una familia, residir en el hogar familiar y escolarización ordinaria. Se concluyó que los menores puntajes en autodeterminación e inclusión social indican la necesidad de promover la participación en actividades comunitarias de interés que sean incluyentes. De igual forma, las relaciones encontradas entre los factores sociodemográficos y la calidad de vida evidencian la necesidad de implementar intervenciones orientadas a la creación de planes de apoyo individualizados, con el fin de promover su autodeterminación y estimular los logros personales y organizacionales.

Abstract The objective of this study was to evaluate the quality of life of the persons with intellectual and multiple disabilities between 4 to 21 years through the KidsLife Scale validated for Colombia. A quantitative-explanatory study was carried out involving 220 key informants. The dimensions with higher average scores in quality of life were physical well-being and emotional well-being; conversely, the lowest scores recorded were related to self-determination and social inclusion. Significant differences were found according to: level of disability, level of support needs and level of recognized dependence. The greatest significant differences corresponded to variables such as sex, having a family and the access to schooling. However, the explanatory variables of quality of life were: level of support needs, having family support, family home residing and ordinary schooling. It was concluded that the lower scores in self-determination and social inclusion indicate the need to promote participation in community activities of interest that are inclusive. Likewise, the relationships found between sociodemographic factors and quality of life show the need to implement interventions aimed at the creation of individualized support plans in order to promote self-determination and stimulate personal and organizational achievements.

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Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del "Diario de alergias" en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.

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Resumen Introducción. La calidad de vida, como constructo multidimensional, considera aspectos físicos, sociales y culturales de las personas con discapacidad intelectual; por ello, se hace necesario contar con instrumentos adaptados y validados que permitan reconocer las necesidades específicas de esta población. Objetivo. Adaptar transculturalmente para Colombia la Escala KidsLife para personas con discapacidad intelectual. Materiales y métodos. Estudio instrumental hecho por fases: se hizo una revisión preliminar de la escala por parte de los investigadores; se comprobó la validez de contenido por juicio de siete expertos, quienes valoraron importancia, influencia, observancia y adecuación gramatical, y se realizó un estudio piloto con 30 personas para determinar confiabilidad y poder discriminativo. Resultados. En cuanto a la validez de contenido, los coeficientes de concordancia ponderados para concordancia entre jueces y concordancia de las dimensiones resultaron buenos. Respecto a la confiabilidad y poder discriminativo, se halló consistencia interna muy buena piara la escala total (alfa de Cronbach 0.95) y 52 ítems bajo poder discriminativo (p>0.1). Conclusiones. La adaptación y validez para Colombia de la Escala KidsLife permitirá fortalecer procesos de atención desde las diferentes dimensiones de calidad de vida centrados en las necesidades de la persona con discapacidad intelectual y múltiple, las familias y los profesionales de apoyo.

Abstract Introduction: Quality of life, as a multidimensional construct, comprises physical, social and cultural aspects of people with intellectual disabilities; therefore, it is necessary to have adapted and validated instruments to recognize the specific needs of this population. Objective: To make a cross-cultural adaptation for Colombia of the KidsLife Scale for people with intellectual disabilities. Materials and methods: Instrumental study done in phases. First, a preliminary review of the scale was made by the researchers; then, the validity of the content was verified by seven experts who assessed relevance, impact, compliance and grammatical adequacy; finally, a pilot study was carried out with 30 people to determine reliability and discriminative power. Results: In terms of content validity, the weighted concordance coefficients for agreement among judges and dimensional concordance were good. Regarding reliability and discriminative power, very good internal consistency was found for the whole scale (Cronbach's alpha of 0.95) and 52 items under discriminative power (p>0.1). Conclusions: The adapted and validated KidsLife Scale for Colombia will strengthen the care processes from different dimensions of quality of life, focused on the needs of the person with intellectual and multiple disabilities, families and support professionals.

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The vast majority of patients with allergic rhinitis (AR) do not receive the proper management which is recommended by the guidelines, but they frequently self-medicate. MASK (Mobile Airways Sentinel Network) is an integral part of a project that is supported by the European Union against chronic diseases and focused on active and healthy aging. MASK represents the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma), in which, by using a mobile application in a smart device, the objective is to guide the patient in the control of his/her multi-morbidity, AR and/or allergic conjunctivitis (AC) and/or asthma. The mobile app Allergy Diary by MACVIA-ARIA is free and it is available for both Android and iOS platforms. After it is downloaded to the patient's cell phone, it first requests some information about the patient's profile, allergic pathologies and medication; afterwards, through a visual analog scale, the patient is invited to determine the degree of affectation in the nose, eyes, and bronchi, and its influence on their productivity at work / school. After analyzing the data generated by filling the Allergy Diary, it became clear there is a new clinical entity: allergic rhinitis+ allergic conjunctivitis +asthma, with greater effect; in addition to a high level of self-medication: in general, the patient takes medication on days when symptoms are present. The app has already been deployed in 23 countries, including several Spanish-speaking countries.

La mayoría de los pacientes con rinitis alérgica no recibe el manejo idóneo, sino que se automedica. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS. Al descargarla al celular del paciente, a este se le piden datos de su perfil, patologías alérgicas y medicación; posteriormente, mediante una escala visual analógica se le invita a determinar el grado de afectación en nariz, ojos y bronquios y su influencia sobre su productividad laboral/escolar. Con los datos del Diario de Alergia se observa que existe un nuevo patrón de presentación: rinitis alérgica + conjuntivitis alérgica + asma, con mayor afectación, así como un alto nivel de automedicación: en general, el paciente toma medicación cuando presenta síntomas. La app se ha desplegado en 23 países, incluyendo varios países hispanohablantes.

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Early allergic sensitisation (atopy) is the first step in the development of allergic diseases such as atopic asthma later in life. Genes and pathways associated with atopy and atopic asthma in children and adolescents have not been well characterised.A transcriptome-wide association study (TWAS) of atopy and atopic asthma in white blood cells (WBCs) or whole blood was conducted in a cohort of 460 Puerto Ricans aged 9-20 years (EVA-PR study) and in a cohort of 250 Swedish adolescents (BAMSE study). Pathway enrichment and network analyses were conducted to further assess top findings, and classification models of atopy and atopic asthma were built using expression levels for the top differentially expressed genes (DEGs).In a meta-analysis of the study cohorts, both previously implicated genes (e.g. IL5RA and IL1RL1) and genes not previously reported in TWASs (novel) were significantly associated with atopy and/or atopic asthma. Top novel genes for atopy included SIGLEC8 (p=8.07×10-13), SLC29A1 (p=7.07×10-12) and SMPD3 (p=1.48×10-11). Expression quantitative trait locus analyses identified multiple asthma-relevant genotype-expression pairs, such as rs2255888/ALOX15 Pathway enrichment analysis uncovered 16 significantly enriched pathways at adjusted p<0.01, including those relevant to T-helper cell type 1 (Th1) and Th2 immune responses. Classification models built using the top DEGs and a few demographic/parental history variables accurately differentiated subjects with atopic asthma from nonatopic control subjects (area under the curve 0.84).We have identified genes and pathways for atopy and atopic asthma in children and adolescents, using transcriptome-wide data from WBCs and whole blood samples.

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The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.

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OBJECTIVE: To investigate the burden of asthma in a young adult population in urban areas of Argentina. DESIGN: A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. RESULTS: In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5). CONCLUSION: Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.

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Esta investigación tuvo como objetivo caracterizar la percepción que un grupo de mujeres internas en el Centro de Reclusión Femenino, próximas a ser liberadas, tenía acerca de la dinámica relacional de su familia de origen y la familia de elección. Entrevistamos a diez mujeres en forma individual. Encontramos que provienen de familias en las que existe una figura de autoridad dominante que suele ser la madre, y una figura paterna que es periférica o nula; es frecuente la violencia familiar y el abuso. La reclusión carcelaria acentúa la crisis familiar debido a que se trata de familias con escasos recursos económicos. La reclusión es un fenómeno que trasciende el ámbito familiar y carcelario, para plantearse como un asunto de interés para las políticas sociales de apoyo a la población carcelaria.

This research aims to characterize the perceptions among a group of female residents at a Female Detention Center that were close to being released regarding the dynamics of the relationships among their birth families and the families that later constructed. Ten women were individually interviewed. It was found that they come from families where the dominant authority figure is usually the mother while the father figure is peripheral or absent. There are often incidents of domestic violence and abuse within these families. The time in jail heightens the family crisis due to fact that these are families with low incomes. Imprisonment is a phenomenon that transcends the family and prison environments and should be considered an area of interest for social policies that support the imprisoned population.

Esta pesquisa objetivou caracterizar a percepção que um grupo de mulheres presas no Centro Feminino de Reclusão, e próximas de serem liberadas, tinha sobre a dinâmica de relação de sua família de origem e a família escolhida. Foram entrevistadas dez mulheres individualmente. Os resultados mostraram que elas vêm de famílias nas quais há uma figura de autoridade dominante, que normalmente é a mãe, e uma figura paterna, que é periférica ou nula; é frequente a violência familiar e o abuso. O encarceramento acentua a crise familiar já que se tratam de famílias com escassos recursos econômicos. A prisão é um fenômeno que transcende o âmbito familiar e carcerário e deve ser considerada como um assunto de interesse para as políticas sociais de apoio à população prisional.

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RESUMO

En esta investigación cualitativa se abordaron los procesos de atención integral a los problemas de convivencia familiar, en la Comisaria de Familia del sector Ladera en Cali, teniendo en cuenta la perspectiva de los modelos alternativos de resolución del conflicto. La Comisaría cuenta con un protocolo definido para la atención de los casos, además de una ruta de atención. De acuerdo con los Informes Anuales de Labores, en el período comprendido entre 2007 y 2011, se registró la atención de 39.189 personas, siendo más frecuentes las quejas por violencia familiar; adicionalmente, se reciben casos de alimentos, custodias y visitas de menores. La Comisaria prescribe medidas conciliatorias y de protección provisional con las que busca velar por la convivencia familiar.

This qualitative research addressed the processes of integral attention to the problems of family life, in the Family Commissioner in Cali, taking into account the perspective of alternative conflict resolution models. The Commissioner has a defined protocol for the attention of cases, in addition to a route of attention. According to annual reports of work, in the period between 2007 and 2011, the care of 39.189 people registered, being most frequent complaints it by family violence; in addition, cases of food, custody and visits by minors are received. The Commissioner prescribes conciliatory and interim protective measures which seeks to ensure the family life.

RESUMO

Objetivo: Identificar las barreras del entorno que afectan la inclusión social de una población con discapacidad motriz. Materiales y métodos: Se realizó un estudio descriptivo en el que participaron 45 adultos con discapacidad motriz de miembros inferiores. La encuesta incluyó las categorías: a) sociodemográfica, de salud y características del entorno, b) del acompañante o cuidador, c) sobre los productos de apoyo, d) actividades y participación, y e) factores ambientales. Resultados: Un 98% pertenecía a los estratos socioeconómicos 1, 2 y 3, y en su mayoría (53%) activos laboralmente, con salarios que no sobrepasan el mínimo legal vigente en Colombia. La causa principal de la discapacidad (42%) fue la violencia. El 67% tenía alguna dificultad para acceder al entorno físico, la información y la comunicación. Las mayores barreras fueron el acceso a los edificios públicos (54%) y a la educación técnica (83%). Conclusiones: Las múltiples barreras que afectan la inclusión social sugieren que se debe abordar esta problemática desde la estructura y organización social del entorno en que se desempeña la persona y no solamente desde su deficiencia. Como en otros estudios en Colombia, se corrobora la simultaneidad de pobreza, violencia y discapacidad.

Objective: Identify environmental barriers that affect social inclusion of people with motor impairment. Materials and methods: We conducted a descriptive study involving 45 adults with lower limb motor impairment. The survey included the following categories: a) socio-demographic, health and environmental characteristics, b) companion or caretaker, c) as-sistive products, d) activities and participation, and e) environmental factors. Results: 98% of the people belonged to socioeconomic strata 1, 2 and 3, and most of them (53%) are working with salaries that do not exceed the national monthly legal wage in Colombia. The main cause of disability (42%) was violence. 67% had some difficulty to access to the built environment, information and communication. The biggest barriers were access to public buildings (54%) and to technical education (83%). Conclusions: The multiple barriers that affect social inclusion suggest that this problem must be addressed from the structure and social organization of the environment in which the person is engaged and not just from his/her deficiency. As in other studies in Colombia, it is confirmed the simultaneity of poverty, violence and disability.

RESUMO

PURPOSE: Tumor markers are substances found in blood and other biological fluids if tumor is present in the body. They can be produced by tumor itself or can be results of cancer - body relation. They may be used in the follow-up of cancer patients to identify tumor recurrence. Pre-treatment levels have prognostic tool and could signalize persistence of minimal residual disease despite radical surgery. METHODS: We operated on 52 patients with upper GI malignancy (32 with gastric cancer and 20 with pancreatic cancer). Blood samples were taken before surgery and peritoneal samples immediately after laparotomy before any manipulation with tumor. All samples were examined by standard biochemical technique and the level was compared with a stage of the disease. RESULTS: Patients suffering from gastric carcinoma of stage I and II had higher level of both markers in sera then in the peritoneal cavity, however most of them were within physiological range. Patients in stage III and IV had average marker levels in the peritoneal cavity higher than in sera. Number of positive findings was increasing according to the stage of the disease. The peritoneal levels of both markers varied extremely in higher stages. In patients suffering from pancreatic carcinoma the CEA levels both in sera and peritoneal cavity were parallel but peritoneal levels were slightly higher in stages III and IV. Ca 19 - 9 was more sensitive for pancreatic cancer. The percentage of positive findings was higher in sera but the level of Ca 19 - 9 was higher in the peritoneal cavity. The number of positive findings again correlated with the stage of the disease. CONCLUSIONS: Levels of tumor markers in sera could signalize inoperability of tumor (Ca 19 - 9 in cases of pancreatic carcinoma); peritoneal levels could predict R1 resection especially in gastric cancer patients and risk of early peritoneal recurrence of the disease. Difference between the levels in the peritoneum and sera may signalize the route of dissemination (hematogenous and intraperitoneal).

OBJETIVO: Os marcadores tumorais são substâncias encontradas no sangue e outros fluidos biológicos em pacientes com doenças oncológicas. São produzidos pelo próprio tumor ou ser resultado da interação entre o tumor e o organismo. Podem ser usados no seguimento de pacientes com câncer para identificar recidiva tumoral. Os níveis pré-tratamento têm valor prognóstico e podem sinalizar persistência de doença residual mínima após cirurgia radical.. MÉTODOS: Foram operados 52 pacientes com tumores do trato gastroinstestinal superior (32 com câncer do estômago e 20 do pâncreas). Amostras sanguineas foram colhidas no préoperatório e amostras peritoneais imediatamente após a laparotomia, antes de qualquer manipulação do tumor. Todas as amostras foram examinadas bioquímicamente e os resultados foram comparados entre si e em face ao progresso da doença. RESULTADOS: Os pacientes com câncer de estômago nos estadios I e II apresentaram níveis sanguineos mais elevados de ambos os marcadores tumorais do que no peritônio, mas a maioria dos valores encontrava-se dentro dos limites fisiológicos. Já nos estadios III e IV os níveis dos marcadores tumorais foram mais elevados no peritônio do que no sangue. O número de exames positivos aumentou de acordo com o estadio da doença. Nos estádios avançados, observou-se elevada variabilidade nos níveis de ambos os marcadores analisados no peritônio. Os doentes com carcinoma de pâncreas tiveram níveis de CEA semelhantes no sangue e no peritônio, mas os níveis peritoneais foram ligeiramente mais elevados nos estadios III e IV. Ca 19 - 9 foi muito mais sensível para o câncer do pâncreas. A porcentagem de exames positivos foi mais elevada no sangue, mas o níveis do Ca19-9 foram mais elevados no peritônio.A porcentagem de exames positivos também teve correlação com o estadio da doença. CONCLUSÕES: Os níveis de marcadores tumorais no sangue podem indicar inoperabilidade do tumor. No peritônio podem indicar o tipo de ressecção, especialmente nos doentes com câncer gástrico, e o risco de recidiva peritoneal precoce. A diferença entre os níveis no peritônio e sangue podem sinalizar a via de disseminação, hematogênica ou intra-peritoneal.

Assuntos

RESUMO

PURPOSE: Tumor markers are substances found in blood and other biological fluids if tumor is present in the body. They can be produced by tumor itself or can be results of cancer - body relation. They may be used in the follow-up of cancer patients to identify tumor recurrence. Pre-treatment levels have prognostic tool and could signalize persistence of minimal residual disease despite radical surgery. METHODS: We operated on 52 patients with upper GI malignancy (32 with gastric cancer and 20 with pancreatic cancer). Blood samples were taken before surgery and peritoneal samples immediately after laparotomy before any manipulation with tumor. All samples were examined by standard biochemical technique and the level was compared with a stage of the disease. RESULTS: Patients suffering from gastric carcinoma of stage I and II had higher level of both markers in sera then in the peritoneal cavity, however most of them were within physiological range. Patients in stage III and IV had average marker levels in the peritoneal cavity higher than in sera. Number of positive findings was increasing according to the stage of the disease. The peritoneal levels of both markers varied extremely in higher stages. In patients suffering from pancreatic carcinoma the CEA levels both in sera and peritoneal cavity were parallel but peritoneal levels were slightly higher in stages III and IV. Ca 19 - 9 was more sensitive for pancreatic cancer. The percentage of positive findings was higher in sera but the level of Ca 19 - 9 was higher in the peritoneal cavity. The number of positive findings again correlated with the stage of the disease. CONCLUSIONS: Levels of tumor markers in sera could signalize inoperability of tumor (Ca 19 - 9 in cases of pancreatic carcinoma); peritoneal levels could predict R1 resection especially in gastric cancer patients and risk of early peritoneal recurrence of the disease. Difference between the levels in the peritoneum and sera may signalize the route of dissemination (hematogenous and intraperitoneal).(AU)

OBJETIVO: Os marcadores tumorais são substâncias encontradas no sangue e outros fluidos biológicos em pacientes com doenças oncológicas. São produzidos pelo próprio tumor ou ser resultado da interação entre o tumor e o organismo. Podem ser usados no seguimento de pacientes com câncer para identificar recidiva tumoral. Os níveis pré-tratamento têm valor prognóstico e podem sinalizar persistência de doença residual mínima após cirurgia radical.. MÉTODOS: Foram operados 52 pacientes com tumores do trato gastroinstestinal superior (32 com câncer do estômago e 20 do pâncreas). Amostras sanguineas foram colhidas no préoperatório e amostras peritoneais imediatamente após a laparotomia, antes de qualquer manipulação do tumor. Todas as amostras foram examinadas bioquímicamente e os resultados foram comparados entre si e em face ao progresso da doença. RESULTADOS: Os pacientes com câncer de estômago nos estadios I e II apresentaram níveis sanguineos mais elevados de ambos os marcadores tumorais do que no peritônio, mas a maioria dos valores encontrava-se dentro dos limites fisiológicos. Já nos estadios III e IV os níveis dos marcadores tumorais foram mais elevados no peritônio do que no sangue. O número de exames positivos aumentou de acordo com o estadio da doença. Nos estádios avançados, observou-se elevada variabilidade nos níveis de ambos os marcadores analisados no peritônio. Os doentes com carcinoma de pâncreas tiveram níveis de CEA semelhantes no sangue e no peritônio, mas os níveis peritoneais foram ligeiramente mais elevados nos estadios III e IV. Ca 19 - 9 foi muito mais sensível para o câncer do pâncreas. A porcentagem de exames positivos foi mais elevada no sangue, mas o níveis do Ca19-9 foram mais elevados no peritônio.A porcentagem de exames positivos também teve correlação com o estadio da doença. CONCLUSÕES: Os níveis de marcadores tumorais no sangue podem indicar inoperabilidade do tumor. No peritônio podem indicar o tipo de ressecção, especialmente nos doentes com câncer gástrico, e o risco de recidiva peritoneal precoce. A diferença entre os níveis no peritônio e sangue podem sinalizar a via de disseminação, hematogênica ou intra-peritoneal.(AU)

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RESUMO

The effects of laser etching, decontamination, and storage treatments on dentin components were studied using Fourier transform (FT)-Raman spectroscopy. Thirty bovine incisors were prepared to expose the dentin surface and then divided in two main groups based upon the decontamination process and storage procedure: autoclaved (group A, n=15) or stored in thymol aqueous solution (group B, n=15). The surfaces of the dentin slices were schematically divided into four areas, with each one corresponding to a treatment subgroup. The specimens were either etched with phosphoric acid (control subgroup) or irradiated with erbium-doped yttrium-aluminum-garnet (Er:YAG) laser (subgroups: I-80 mJ, II-120 mJ, and III-180 mJ, and total energy of 12 J). Samples were analyzed by FT-Raman spectroscopy; we collected three spectra for each area (before and after treatment). The integrated areas of five Raman peaks were calculated to yield average spectra. The areas of the peaks associated with phosphate content (P<0.001), type I collagen, and organic C-H bonds (P<0.05) were reduced significantly in group A (control). Analyses of samples irradiated with reduced laser energies did not show significant changes in the dentin components. These results suggest that thymol storage treatment is advised for in vitro study; furthermore, 12 J of Er:YAG laser energy does not affect dentin components.

Assuntos