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Background: The diagnosis and treatment of lung, colon, and gastric cancer through the histologic characteristics and genomic biomarkers have not had a strong impact on the mortality rates of the top three global causes of death by cancer. Methods: Twenty-five transcriptomic analyses (10 lung cancer, 10 gastric cancer, and 5 colon cancer datasets) followed our own bioinformatic pipeline based on the utilization of specialized libraries from the R language and DAVID´s gene enrichment analyses to identify a regulatory metafirm network of transcription factors and target genes common in every type of cancer, with experimental evidence that supports its relationship with the unlocking of cell phenotypic plasticity for the acquisition of the hallmarks of cancer during the tumoral process. The network's regulatory functional and signaling pathways might depend on the constant crosstalk with the microbiome network established in the oral-gut-lung axis. Results: The global transcriptomic network analysis highlighted the impact of transcription factors (SOX4, TCF3, TEAD4, ETV4, and FOXM1) that might be related to stem cell programming and cancer progression through the regulation of the expression of genes, such as cancer-cell membrane receptors, that interact with several microorganisms, including human T-cell leukemia virus 1 (HTLV-1), the human papilloma virus (HPV), the Epstein-Barr virus (EBV), and SARS-CoV-2. These interactions can trigger the MAPK, non-canonical WNT, and IFN signaling pathways, which regulate key transcription factor overexpression during the establishment and progression of lung, colon, and gastric cancer, respectively, along with the formation of the microbiome network. Conclusion: The global transcriptomic network analysis highlights the important interaction between key transcription factors in lung, colon, and gastric cancer, which regulates the expression of cancer-cell membrane receptors for the interaction with the microbiome network during the tumorigenic process.

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The microbiome has shown a correlation with the diet and lifestyle of each population in health and disease, the ability to communicate at the cellular level with the host through innate and adaptative immune receptors, and therefore an important role in modulating inflammatory process related to the establishment and progression of cancer. The oral cavity is one of the most important interaction windows between the human body and the environment, allowing the entry of an important number of microorganisms and their passage across the gastrointestinal tract and lungs. In this review, the contribution of the microbiome network to the establishment of systemic diseases like cancer is analyzed through their synergistic interactions and bidirectional crosstalk in the oral-gut-lung axis as well as its communication with the host cells. Moreover, the impact of the characteristic microbiota of each population in the formation of the multiomics molecular metafirm of the oral-gut-lung axis is also analyzed through state-of-the-art sequencing techniques, which allow a global study of the molecular processes involved of the flow of the microbiota environmental signals through cancer-related cells and its relationship with the establishment of the transcription factor network responsible for the control of regulatory processes involved with tumorigenesis.

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Resumen Los síndromes esclerodermiformes suelen imitar muy bien una esclerosis sistémica progresiva, y es la presencia de ampollas cutáneas en áreas fotoexpuestas con hiperpigmentación los datos diferenciales para diagnosticar una porfiria. Presentamos el caso de un varón de 48 años con fotosensibilidad, fragilidad capilar, ampollas cutáneas e hiperpigmentación asociado a esclerodactilia, con pérdida cicatrizal distal de tejido en los dedos de las manos, que simuló a la perfección una esclerosis sistémica progresiva. La analítica mostró negatividad para anticuerpos antinucleares, antitopoisomerasa y anticentrómero, con valores altos de uroporfirinas en orina. El tratamiento con flebotomías e hidroxicloquina mejoró la fotosensibilidad y la fragilidad cutánea.

Abstract Sclerodermiform syndromes usually mimic progressive systemic sclerosis very well, with the presence of skin blisters in photo-exposed areas with hyperpigmentation being the differential data for diagnosing porphyria. We present the case of a 48-year old man with photosensitivity, capillary fragility, skin blisters, and hyperpigmentation associated with sclerodactyly with distal scar tissue loss on the fingers, which perfectly simulated progressive systemic sclerosis. The analysis showed negativity for antinuclear, antitopoisomerase and anticentromere antibodies, with high levels of uroporphyrins in urine. Phlebotomy and hydroxycloquine treatment improved photosensitivity and skin fragility.

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INTRODUCTION: Plasma-measured tau phosphorylated at threonine 217 (p-tau217) is a potential non-invasive biomarker of Alzheimer's disease (AD). We investigated whether plasma p-tau217 predicts subsequent cognition and positron emission tomography (PET) markers of pathology in autosomal dominant AD. METHODS: We analyzed baseline levels of plasma p-tau217 and its associations with amyloid PET, tau PET, and word list delayed recall measured 7.61 years later in non-demented age- and education-matched presenilin-1 E280A carriers (n = 24) and non-carrier (n = 20) family members. RESULTS: Carriers had higher plasma p-tau217 levels than non-carriers. Baseline plasma p-tau217 was associated with subsequent amyloid and tau PET pathology levels and cognitive function. DISCUSSION: Our findings suggest that plasma p-tau217 predicts subsequent brain pathological burden and memory performance in presenilin-1 E280A carriers. These results provide support for plasma p-tau217 as a minimally invasive diagnostic and prognostic biomarker for AD, with potential utility in clinical practice and trials. HIGHLIGHTS: Non-demented presenilin-1 E280A carriers have higher plasma tau phosphorylated at threonine 217 (p-tau217) than do age-matched non-carriers. Higher baseline p-tau217 is associated with greater future amyloid positron emission tomography (PET) pathology burden. Higher baseline p-tau217 is associated with greater future tau PET pathology burden. Higher baseline p-tau217 is associated with worse future memory performance.

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Background: Everything that has contact with the body is also integrated as part of the individual's body image; Personal Protective Equipment (PPE) could be integrated into body image. Objective: To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel. Material and methods: A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups. Results: 147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed). Conclusions: The increase in distortions or omissions may be related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

Introducción: : todo lo que tiene contacto con el cuerpo también se integra como parte de la imagen corporal del individuo; el equipo de protección personal (EPP) podría integrarse a la imagen corporal. Objetivo: describir las características del dibujo de la figura humana como herramienta proyectiva de la imagen corporal en el personal de salud. Material y métodos: se realizó un estudio descriptivo longitudinal retrospectivo, que consistió en la recopilación y análisis de los test de dibujo de la figura humana realizado al personal de salud en la contingencia por COVID-19. Se realizó un análisis descriptivo de las variables cualitativas y un análisis inferencial con prueba de McNemar para comparar proporciones entre grupos. Resultados: se incluyeron 147 dibujos en contexto previo y sus respectivos dibujos en contexto durante la contingencia. Al comparar ambos grupos, en el contexto pandémico se observó un incremento en las distorsiones u omisiones (p = 0.013), principalmente localizadas en manos y brazos (p < 0.001). También, se observaron trazos sugerentes de aislamiento (p = 0.039), dibujos con poca definición de los ojos (p = 0.69), inclusión del EPP (p < 0.001) y omisión de nariz (p = 0.011) y boca (p < 0.001). Conclusiones: el incremento en las distorsiones u omisiones puede estar relacionado con la reconstrucción de la parte social. Seis meses posteriores al inicio de la contingencia, el 40% del personal de salud ya había incorporado el EPP a su dibujo proyectivo de imagen corporal.

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Introducción: todo lo que tiene contacto con el cuerpo también se integra como parte de la imagen corporal del individuo; el equipo de protección personal (EPP) podría integrarse a la imagen corporal. Objetivo: describir las características del dibujo de la figura humana como herramienta proyectiva de la imagen corporal en el personal de salud. Material y métodos: se realizó un estudio descriptivo longitudinal retrospectivo, que consistió en la recopilación y análisis de los test de dibujo de la figura humana realizado al personal de salud en la contingencia por COVID-19. Se realizó un análisis descriptivo de las variables cualitativas y un análisis inferencial con prueba de McNemar para comparar proporciones entre grupos. Resultados: se incluyeron 147 dibujos en contexto previo y sus respectivos dibujos en contexto durante la contingencia. Al comparar ambos grupos, en el contexto pandémico se observó un incremento en las distorsiones u omisiones (p = 0.013), principalmente localizadas en manos y brazos (p < 0.001). También, se observaron trazos sugerentes de aislamiento (p = 0.039), dibujos con poca definición de los ojos (p = 0.69), inclusión del EPP (p < 0.001) y omisión de nariz (p = 0.011) y boca (p < 0.001). Conclusiones: el incremento en las distorsiones u omisiones puede estar relacionado con la reconstrucción de la parte social. Seis meses posteriores al inicio de la contingencia, el 40% del personal de salud ya había incorporado el EPP a su dibujo proyectivo de imagen corporal.

Background: Everything that has contact with the body is also integrated as part of the individual's body image; Personal Protective Equipment (PPE) could be integrated into body image. Objective: To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel. Material and methods: A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups. Results: 147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed). Conclusions: The increase in distortions or omissions maybe related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

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Resumen: Aproximadamente hasta 5% de los pacientes afectados por la infección por SARS-CoV-2 (COVID-19) requieren estancia en la Unidad de Cuidados Intensivos. De ellos, hasta 71% presentarán Síndrome de Insuficiencia Respiratoria Progresiva Aguda (SIRPA). Colocar a los pacientes en posición prono es una técnica que ha demostrado resultados favorables en aquéllos con hipoxemia refractaria por SIRPA grave. Las Guías Americanas y Europeas actuales del manejo del COVID-19 recomiendan posición prono para mejorar la hipoxemia con resultados variables. Ésta es una técnica de bajo costo que podría mejorar el pronóstico de estos pacientes. Presentamos cinco pacientes con resultados variables en posición prono y concluimos que, al menos en esta primera muestra, hay mejoría de todos en la oxigenación, así como en la imagen radiográfica, lo cual no necesariamente se correlaciona con una mejoría global del paciente.

Abstract: Approximately, up to 5% of the patients infected with SARS-CoV-2 (COVID-19) need to be treated in the Critical Care Unit. Of all these patients, up to 71% will develop Acute Respiratory Distress Syndrome (ARDS). The technique of placing the patients in prone position has had good results in patients with refractory hypoxemia secondary to severe ARDS. The American and European guidelines recommend the use of prone position to improve sever hypoxemia of COVID-19 patients. It is a low cost technique that could improve the outcome in this patients. We present the results of 5 of our first patients with COVID-19 using prone position concluding that at least, in this first sample, there is a good response with improvement of hypoxemia as well as improvement in the chest X-ray images but we cannot conclude if it has an impact in the outcome of the patient, defined as survival or days in mechanical ventilation.

Resumo: Aproximadamente 5% dos pacientes afetados pela infecção por SARS-CoV-2 (COVID-19) necessitam de uma internação na Unidade de Terapia Intensiva. Desse modo, até 71% apresentarão Síndrome da Insuficiência Respiratória Progressiva Aguda (SIRPA). A colocação de pacientes em decúbito ventral é uma técnica que demonstrou resultados favoráveis em pacientes com hipoxemia refratária devido à SIRPA grave. As diretrizes americanas e européias atuais para o manejo do COVID-19 recomendam uma posição propensa a melhorar a hipoxemia com resultados variáveis. É uma técnica de baixo custo que poderia melhorar o prognóstico desses pacientes. Apresentamos 5 pacientes com resultados variáveis em decúbito ventral e concluímos que, pelo menos nessa primeira amostra, há uma melhora na oxigenação e na imagem radiográfica, que não necessariamente se correlaciona com uma melhora geral no paciente.

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La pandemia por la COVID-19 ocasionó que los Estados promulgaran normas específicas para mitigar el riesgo de contagio y preservar la salud de la población; se establecieron e implementaron estrategias para disminuir la vulnerabilidad y cuidar los factores económicos y sociales. En este proceso, las personas con discapacidad (PcD) agudizaron su vulnerabilidad, pues desde que se decretaron las medidas para mitigar la condición de crisis social, se han identificado varios grupos con dificultades socioeconómicas. En general, muchas de las PcD se encuentran en estos grupos, pues su condición por sí misma los sitúa en circunstancias vulnerables, como efecto de las brechas de comunicación, acceso y oportunidad para los servicios de salud bucal. Así, el objetivo de este ensayo es analizar críticamente la situación de esta población en tiempos de pandemia. Se realizó una revisión de la literatura nacional e internacional alrededor de los conceptos discapacidad y COVID-19. Se concluye que la crisis agudizó la vulnerabilidad de las PcD generada por las escasas estrategias que se han implementado para cubrir esta población de acuerdo a sus necesidades, por lo que se incrementaron las barreras físicas y comunicativas y, con ello, limitado el goce efectivo del derecho a la atención de salud en los servicios odontológicos

The COVID-19 pandemic promulgated States to enact specific regulations to mitigate the risk of contagion and preserve the health of the population; strategies were established and implemented to reduce vulnerability and take care of economic and social factors. In this process, people with disabilities (PwD) increased their vulnerability, since the measures to mitigate the condition of social crisis were decreed; several groups with socioeconomic difficulties have been identified. In general, many of the PwD are found in these groups, since their condition by itself places them in vulnerable circumstances, as a result of gaps in communication, access and opportunity for oral health services. Thus, the objective of this essay is to critically analyze the situation of this population in times of pandemic. A review of the national and international literature around the concepts of disability and COVID-19 was carried out. It is concluded that the crisis exacerbated the vulnerability of PwD generated by the few strategies that have been implemented to cover this population according to their needs, thus increasing physical and communication barriers and, with it, limited the effective enjoyment of the right to health care in dental services

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Resumen: Introducción: La obesidad es una enfermedad crónica que se relaciona de manera causal con múltiples patologías y aumento de morbilidad y mortalidad. A nivel respiratorio genera disminución de distensibilidad y volumen pulmonar, con colapso de vías aéreas; esto, junto con la limitación del diafragma, favorece el colapso pulmonar y formación de atelectasias, con disminución de oxigenación y aumento en el riesgo de infección. Métodos: Estudio retrospectivo, transversal, en pacientes con ventilación mecánica invasiva (VMI) por más de 48 horas. Se valoraron datos demográficos y de VM. Resultados: Se analizaron 50 pacientes, en dos grupos: no obesos con IMC < 30 kg/m2, y obesos con IMC ≥ 30 kg/m2, con 35 y 15 pacientes respectivamente. Se encontró diferencia en la relación PaO2/FiO2 siendo mayor en no obesos 193 ± 112 (54-415) que en obesos 116 ± 58 (41-260) p < 0.0001. Se utilizó mayor PEEP (Presión positiva al final de la espiración) en los obesos 11 ± 2.8 (5-16) cmH2O que en los no obesos 9 ± 2.4 (5-16) cmH2O p < 0.007. La mortalidad fue de 28.6% (n = 10) en no obesos y de 40% (n = 6) en obesos; no presentó diferencia estadísticamente significativa. No se encontraron diferencias en los tiempos de ventilación mecánica y de estancia en UCI e intrahospitalaria. Análisis: En este estudio no se encontró diferencia significativa en mortalidad entre pacientes obesos y no obesos, a diferencia de lo que se ha encontrado en otros estudios; aunque la diferencia fue de 12%, en el grupo de obesos, se encontró de manera inicial menor oxigenación y requirieron de mayor PEEP para ventilarse, recuperando la oxigenación a las 24 horas. Conclusiones: No se encontró diferencia en este estudio. Se requiere mayor número de pacientes para valorar efecto en mortalidad.

Abstract: Introduction: Obesity has become a chronic illness which casually relates with multiple pathologies as well as with an increase in morbidity and mortality rates. On the respiratory system, it diminishes lung compliance, and tidal volume with airway collapse. This issue along with movement limitation from the diaphragm favors lung collapse, and atelectasis appearance causing oxygenation reduction while rising the risk of infection. Methodology: Retrospective transversal assay performed on patients undergoing invasive mechanical ventilation for over 48 hours. Demographic and mechanical ventilation values are to be evaluated. Results: 50 patients were analyzed having a tow group distribution, non-obese with a Body mass index (BMI) under 30 kg/m2, and obese with a Body mass index (BMI) over 30 kg/m2, having 35 and 15 patients respectively. A difference between the relation of the values PaO2/FiO2 was found been higher in the non-obese group 193 ± 112 (54-415), while in the obese group it was 116 ± 58 (41-260) p < 0.0001. A bigger value for the Positive end-expiratory pressure (PEEP) was used in obese patients 11 ± 2.8 (5-16) cmH2O compared to the non-obese group with which the PEEP value was 9 ± 2.4 (5-16) cmH2O p < 0.007. The mortality was of 28.6% (n = 10) in the non-obese group while it was 40% (n = 6) in the obese group, no relevant statistical differences were observed. There were no differences in the ventilation time values, neither was a difference for the hospital care or the Intensive Care Unit admission times. Analysis: No significant difference was observed regarding mortality rates between obese and non-obese group, in contrast to other assays. While a 12% difference was found in the oxygenation values between the two groups, having the obese group a lower oxygenation value. Conclusion: No significant differences were found in this study. A greater number of patients would be needed to evaluate the effect on the mortality rate.

Resumo: Introdução: A obesidade é uma doença crônica que está casualmente relacionada a múltiplas patologias e aumento da morbidade e mortalidade. A nível respiratório, causa diminuição da complacência e do volume pulmonar com colapso das vias aéreas; isso, juntamente com a limitação do diafragma favorece o colapso dos pulmões e a formação de atelectasias com diminuição da oxigenação e aumento do risco de infecção. Métodos: Estudo retrospectivo, transversal com ventilação mecânica invasiva (VMI) por mais de 48 horas. Se valoraron datos demográficos y de VM. Resultados: Foram analisados 50 pacientes em 2 grupos: não obesos com IMC < 30 kg/m2, e obesos com IMC ≥ 30 kg/m2 com 35 e 15 pacientes respectivamente. Foi encontrada uma diferença na relação PaO2/FiO2, sendo maior em não obesos 193 ± 112 (54-415) do que em obesos 116 ± 58 (41-260) p < 0.0001. Utilizadou-se maior PEEP (pressão expiratória final positiva) nos obesos 11 ± 2.8 (5-16) cmH2O do que nos não obesos 9 ± 2,4 (5-16) cmH2O p < 0.007. A mortalidade foi de 28.6% (n = 10) em pacientes não-obesos e de 40% (n = 6) em obesos, não apresentando diferença estatisticamente significante. Não foram encontradas diferenças no tempo de ventilação mecânica, permanência em UTI e hospitalar. Análise: Neste estudo não foi encontrada diferença significativa na mortalidade entre pacientes obesos e não obesos, em contraste com outros estudos, embora a diferença tenha sido de 12%, no grupo de pacientes obesos inicialmente encontrou-se eles menor oxigenação e necessitaram de maior PEEP para ventilar, recuperando a oxigenação às 24 horas.

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Resumen: Introducción: La candidemia es una entidad clínica que se ha incrementado en pacientes en terapia intensiva, el inmuncompromiso y la invasión múltiple en estos pacientes los hace sujetos lábiles a la diseminación por hongos y por ende al incremento de mortalidad. El uso de puntajes para estimar el riesgo de desarrollar candidemia ha permitido iniciar de forma profiláctica antifúngicos, en su mayoría de tipo azoles; sin embargo, el crecimiento de Candida no albicans se ha incrementado, lo que genera incertidumbre acerca del beneficio que pueden tener estas medidas iniciadas en forma temprana en la mortalidad. Objetivos: Determinar si los pacientes que ingresan a la unidad de terapia intensiva que han recibido de forma profiláctica algún antifúngico del tipo azol tienen mayor incidencia en el desarrollo de especias de Candida no albicans. Métodos: Estudio retrospectivo, longitudinal y analítico. Pacientes mayores de 18 años que ingresan a la unidad de terapia intensiva con diagnóstico de sepsis. Se determinó qué pacientes han recibido de forma profiláctica azoles y de éstos quienes han desarrollado especies de Candida albicans y no albicans. Análisis estadístico: Se realizó análisis estadístico mediante T de Student para comparación de grupo y χ2 para variables categóricas. Los resultados se expresan en promedio, ±, desviación estándar y porcentajes. Se considera estadísticamente significativo si p ≤ 0.05, análisis con uso de sistema de estadística SPSS Statistics 21. Resultados: Veinticinco pacientes en periodo de dos años, edad 72 ± 13 años (45-92), 15 hombres (60%), sepsis abdominal 56% (n = 14), APACHE II 14 ± 5 (5-29) y SOFA 6 ± 3. Cultivos sin crecimiento en 16 pacientes (64%), Candida albicans 4 (16%) y no albicans en 5 (20%). Conclusiones: La incidencia de Candida no albicans en pacientes que reciben profilaxis con fluconazol es baja, sin incremento en mortalidad, por lo que consideramos que el uso de fluconazol como manejo profiláctico sigue siendo una medida adecuada en este grupo.

Abstract: Introduction: Candidemia is a clinical entity increasing in patients in intensive care unit, the inmuncompromised and multiple invasion makes them subject of fungal dissemination and increase in mortality. Use of scores to estimate the risk of developing candidemia has allowed start prophylactic antifungal azoles; however, the development of Candida albicans has not increased, generating uncertainty about the benefit that can have these measures initiated in early mortality. Objectives: To determine whether patients who received prophylactic any antifungal azole has impact on the development of Candida non-albicans in patients admitted to the intensive care unit. Methods: A retrospective, longitudinal, analytical study. Patients over 18 years enter the intensive care unit with sepsis. Determined that patients received prophylactic azoles and those who have developed Candida albicans and non-albicans. Statistical analysis: Statistical analysis was performed using Student T for comparison group and χ 2 for categorical variables. The results are expressed in average, ±, standard deviation and percentage. It is considered statistically significant if p ≤ 0.05, analysis using statistical system SPSS Statistics 21. Results: 25 patients, 2-year period, age 72 ± 13 years (45-92), 15 men (60%), abdominal sepsis 56% (n = 14), APACHE II 14 ± 5 (5-29) and SOFA 6 ± 3. Culture without growth in 16 patients (64%), Candida albicans 4 (16%) and non albicans in 5 (20%). Conclusions: The incidence of Candida albicans in patients not receiving prophylaxis with fluconazole is low, with no increase in mortality, and we believe that the use of fluconazole as prophylactic management remains an appropriate measure in this group.

Resumo: Introdução: candidemia é uma entidade clínica que tem aumentado em pacientes em cuidados intensivos, o inmuncompromiso e invasão múltipla nestes pacientes torna assunto disseminação do fungo lábil e portanto, a um aumento da mortalidade. Usando pontuação para estimar o risco de desenvolver candidemia permitiu iniciar antifúngicos profiláticos, em tipo principalmente azóis; no entanto, o crescimento de Candida albicans nenhuma aumentou, criando incerteza sobre o benefício pode ter essas medidas iniciadas na mortalidade precoce. Objetivos: Para determinar se os doentes que entra na unidade terapia que eles receberam intenso profilaticamente qualquer azole tipo antifúngico eles têm uma maior incidência no desenvolvimento de não-albicans especiarias Candida. Um estudo retrospectivo, longitudinal e analítica. pacientes idosos 18 entrar na unidade de cuidados intensivos com diagnóstico de sepse. Determinou-se que os pacientes receberam azóis e profiláticos daqueles que desenvolveram espécies de Candida albicans e não-albicans. Análise estatística: A análise estatística foi realizada utilizando t de Student para comparação de grupo e χ2 para variáveis ​​categóricas. Os resultados são. Eles expressos em média ± desvio padrão e a percentagem média. Considera-se estatisticamente se p ≤ 0,05 significativa, a análise estatística utilizando o sistema SPSS Statistics 21. Resultados: Vinte e cinco pacientes em dois anos, idade 72 ± 13 anos (45-92), 15 homens (60%), sepse abdominal 56% (n = 14), APACHE II 14 ± 5 (5-29) e SOFA 6 ± 3. Cultivos sem crescimento em 16 pacientes (64%), Cândida albicans 4 (16%) e não albicans em 5 (20%). Conclusões: A incidência de Candida albicans em pacientes que não receberam profilaxia com fluconazol é baixa, sem aumento da mortalidade, por isso consideramos que o uso de fluconazol como a gestão profilática continua a ser um medida adequada neste grupo.

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Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

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El proyecto pretende en sus inicios comprender, apelando a la etnografía como herramienta metodológica, los actuales problemas vinculados con el sistema educativo que afectan el desarrollo social en el departamento del Meta (Colombia), concretamente en los municipios Granada, Castilla la Nueva, Puerto Gaitán y Puerto López. Para lograrlo, se hizo necesario inicialmente articular la aparentemente obvia relación que existe entre educación y desarrollo, para lo cual la propuesta opta por las corrientes teóricas que desde una mirada alternativa privilegian el desarrollo humano sobre el crecimiento económico. Como elementos centrales de la recolección de información más detallada sobre esta relación se reconocen la situación social y económica de los sujetos escolares de los municipios de Granada, Castilla la Nueva, Puerto Gaitán y Puerto López (encuesta)...

O projeto pretende a princípio compreender, apelando à etnografia como ferramenta metodológica, os atuais problemas vinculados ao sistema edu-cativo que afetam o desenvolvimento social no departamento do Meta, concretamente nos municípios Granada, Castilla la Nueva, Puerto Gaitán e Puerto López. Para consegui-lo, fez-se necessário inicialmente articular a aparentemente óbvia relação que existe entre educação e desenvolvimen-to, para o qual a proposta opta pelas correntes teóricas que desde uma visão alternativa privilegiam o desenvolvimento humano sobre o cresci-mento econômico. Como elementos centrais da coleta de informação mais detalhada so-bre esta relação considera-se a situação social e econômica dos sujeitos escolares dos municípios de Granada, Castilla la Nueva, Puerto Gaitán e Puerto López (enquete), da mesma forma as entrevistas e grupos focais a sujeitos escolares de 10°-11°ano e sujeitos da comunidade acadêmica do município a partir de seus desejos e subjetividades em relação ao desenvolvimento...

The project intents to understand in the beginning, using ethnography as a methodological tool, the actual problematic connected to the educative system affecting the social development in Meta, specifically in the Muni-cipalities of Granada, Castilla la Nueva, Puerto Gaitán, and Puerto López. To achieve this, it was necessary to articulate the seemingly obvious rela-tionship between education and development. In this sense, the proposal opts for the theoretical currents that favor human development over the economic growth...

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Se presentan dificultades para lograr una cobertura efectiva de los controles de salud de los niños del barrio Villa Caracol de Bahía Blanca. El equipo de salud de la Unidad Sanitaria San Dionisio desarrolló un dispositivo denominado Controles Colectivos de Salud para Niños (CCSN). Los objetivos fueron reforzar el sentimiento de responsabilidad familiar respecto a la salud de los niños, realizar un tamizaje de niños que necesitaran un control de salud individual con urgencia y afianzar los espacios de vida personales con los que contaba cada sujeto. Se realizaron 5 jornadas de CCSN para niños de 2 a 14 años. Acudieron 101 niños, por lo que se logró una cobertura del 82,11%. Se obtuvo adherencia al dispositivo, en un espacio de recreación en el barrio, que a la vez se asoció con hábitos saludables, lo que concretó el sentimiento de responsabilidad familiar respecto a la salud de los niños.

The health team in the San Dionisio Health Center developed a device called Collective Health Checks for Children (CHCC) to minimize the difficulties arise for effective coverage of health checks of children in the neighborhood of Villa Caracol, Bahia Blanca. The objectives of the CHCC were to strengthen the sense of family responsibility for children's health, conduct a screening of children needing urgently health control and strengthen personal living spaces. There were five days of CHCC for children 2 to 14 year; 101 children were attended, achieving a coverage of 82.11%. Adhesion to the device was achieved in a recreational space in the neighborhood, which in turn was associated with healthy habits, specifying the sense of family responsibility for the health of children.

Assuntos

RESUMO

The health team in the San Dionisio Health Center developed a device called Collective Health Checks for Children (CHCC) to minimize the difficulties arise for effective coverage of health checks of children in the neighborhood of Villa Caracol, Bahia Blanca. The objectives of the CHCC were to strengthen the sense of family responsibility for children's health, conduct a screening of children needing urgently health control and strengthen personal living spaces. There were five days of CHCC for children 2 to 14 year, 101 children were attended, achieving a coverage of 82.11%. Adhesion to the device was achieved in a recreational space in the neighborhood, which in turn was associated with healthy habits, specifying the sense of family responsibility for the health of children.

Assuntos

RESUMO

The health team in the San Dionisio Health Center developed a device called Collective Health Checks for Children (CHCC) to minimize the difficulties arise for effective coverage of health checks of children in the neighborhood of Villa Caracol, Bahia Blanca. The objectives of the CHCC were to strengthen the sense of family responsibility for childrens health, conduct a screening of children needing urgently health control and strengthen personal living spaces. There were five days of CHCC for children 2 to 14 year, 101 children were attended, achieving a coverage of 82.11

. Adhesion to the device was achieved in a recreational space in the neighborhood, which in turn was associated with healthy habits, specifying the sense of family responsibility for the health of children.

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RESUMO

INTRODUCTION: The combination of methotrexate (MTX) + leflunomide (LFN) has been shown to be effective in the treatment of RA. Its safety has been questioned. OBJECTIVE: To evaluate the effectiveness and safety of the combination of MTX + LFN in patients with active RA. METHODS: This was a 24-week multicenter study, which included 88 patients with active disease despite consistent treatment with methotrexate and prednisolone. RESULTS: We included 78 women (88%) and 10 men. The age was 51.3 ± 12.4 years, and the evolution of disease was 8 ± 6.8 years. Patients had active disease, which was indicated by a median of IQR of 10.0 (7.0-13.0) for swollen and of 14.0 (18.0-10.0) for tender joints for the whole group. The ACR responses achieved at week 24 were: ACR20: 76.0%; ACR50: 67.1%; ACR70: 23.9%. There was improvement in the activity of disease: DAS-28 score: 5.8 ± 1.2 at baseline vs. 3.8 ± 1.6 at week 24 (P = 0.000). The most significant adverse event was elevation of transaminases in eight patients (26%). Eight patients were withdrawn due to adverse events: four due to the elevation of transaminases, and one each due to diabetes insipidus, rash, diabetes mellitus and osteomuscular pain. CONCLUSION: The combination of MTX + LFN is effective for treating RA in patients for whom conventional treatment has failed. Strict medical and laboratory control is to be enforced for safety.

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INTRODUÇÃO: A combinação de metotrexato (MTX) + leflunomida (LFN) demonstrou ser efetiva no tratamento da artrite reumatoide (AR), mas sua segurança tem sido questionada. OBJETIVO: Avaliar a eficácia e a segurança terapêutica da combinação de MTX + LFN em pacientes com AR ativa. MÉTODOS: Estudo multicêntrico com 24 semanas de duração envolvendo 88 pacientes com doença ativa, apesar do tratamento regular com MTX e prednisolona. RESULTADOS: Participaram do estudo 78 mulheres (88%) e 10 homens. A idade foi de 51,3 ± 12,4 anos, e o tempo de evolução da doença, 8,0 ± 6,8 anos. Os pacientes tinham doença ativa evidenciada por IQR média de 10 (7,0-13,0) nas articulações inflamadas e 14,0 (18,0-10,0) nas articulações dolorosas. As respostas ACR obtidas na semana 24 foram: ACR20: 76%; ACR50: 67,1%; e ACR70: 23,9%. Houve melhora na atividade da doença, medida pelo escore DAS-28: 5,8 ± 1,2 no início do estudo vs. 3,8 ± 1,6 na semana 24 (P = 0,000). O evento adverso mais significativo foi elevação das transaminases, ocorrida em oito (26%) pacientes. Oito pacientes descontinuaram o estudo devido a eventos adversos: quatro por elevação das transaminases, um por diabetes insípido, um por erupção cutânea, um por diabetes mellitus e um por dor osteomuscular. CONCLUSÃO: A combinação de MTX + LFN é efetiva para o tratamento de AR em pacientes que não obtiveram sucesso com o tratamento convencional. Há necessidade de rígido controle médico e laboratorial para segurança terapêutica.

INTRODUCTION: The combination of methotrexate (MTX) + leflunomide (LFN) has been shown to be effective in the treatment of RA. Its safety has been questioned. OBJECTIVE: To evaluate the effectiveness and safety of the combination of MTX + LFN in patients with active RA. METHODS: This was a 24-week multicenter study, which included 88 patients with active disease despite consistent treatment with methotrexate and prednisolone. RESULTS: We included 78 women (88%) and 10 men. The age was 51.3 ± 12.4 years, and the evolution of disease was 8 ± 6.8 years. Patients had active disease, which was indicated by a median of IQR of 10.0 (7.0-13.0) for swollen and of 14.0 (18.0-10.0) for tender joints for the whole group. The ACR responses achieved at week 24 were: ACR20: 76.0%; ACR50: 67.1%; ACR70: 23.9%. There was improvement in the activity of disease: DAS-28 score: 5.8 ± 1.2 at baseline vs. 3.8 ± 1.6 at week 24 (P = 0.000). The most significant adverse event was elevation of transaminases in eight patients (26%). Eight patients were withdrawn due to adverse events: four due to the elevation of transaminases, and one each due to diabetes insipidus, rash, diabetes mellitus and osteomuscular pain. CONCLUSION: The combination of MTX + LFN is effective for treating RA in patients for whom conventional treatment has failed. Strict medical and laboratory control is to be enforced for safety.

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Antecedentes: la investigación en salud se basa en la frecuencia de las enfermedades, la población que afecta y los costos implicados en su tratamiento. Las cifras estadísticas se basan esencialmente en pacientes hospitalizados, mas no en la consulta ambulatoria, que corresponde a la mayoría de pacientes dermatológicos. Objetivos: determinar las causas de consulta dermatológica en el Hospital Universitario San Vicente de Paúl (HUSVP) y en el Hospital Infantil de Medellín, y compararlas con otros centros. Diseño del estudio: descriptivo retrospectivo. Material y método: se revisaron los formatos RIA de la consulta dermatológica según edad, sexo y código diagnóstico según la CIE-9. Así mismo, se evaluó dicha estadística en el Hospital Pablo Tobón Uribe, el ISS y el CES. La información se tabuló y se analizó en la base de datos Excel 98 versión 5.0. Resultados: se atendieron un total de 2682 pacientes (rango de edad: 1.5 meses a 97 años, promedio: 43.13 años). El 65 por ciento de individuos pertenecieron al sexo femenino. Las principales causas de consulta fueron tumores cutáneos, eczemas, acné y psoriasis. La codificación utilizada por otras instituciones no permitió comparar las causas de consulta dermatológica.Conclusiones: los motivos de consulta dermatológica en diferentes centros de Medellín se semejan a los encontrados en otros países. Son necesarios estudios de prevalencia poblacional de enfermedades cutáneas en Colombia para el adecuado planeamiento de la inversión de recursos en la salud dermatológica y la investigación. En necesario modificar la codificación actual de las enfermedades para obtener una información estadística y epidemiológica precisa y real de las enfermedades cutáneas en nuestro medio.

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Objetivos: Determinar si dosis bajas de radiación alteran el curso natural de la neovascularización subfoveal en pacientes con degeneración macular relacionada con la edad (DMRE). Material y métodos: Se estudiaron pacientes con DMRE tipo húmeda determinándose edad, sexo, agudeza visual, transparencia del cristalino, campimetría computadorizada, extensión de la membrana por angiofloresceinografía y ultrasonido modo A y B. Se trataron con acelerador lineal de rayos X con dosis total de 1,500 cGy, fraccionada en 10 sesiones de 150 cGy, con haz de fotones de alta energía de 10 megaelectrón-volts. Seguimiento 18 meses. Resultados: Se trataron 34 pacientes con DMRE. La capacidad visual se mantuvo estable en 80 por ciento de los casos y 7 pacientes (20 por ciento) presentaron mejoría de una línea de visión, el campo visual se mantuvo estable en 82 por ciento, y el 18 por ciento mejoró; 6 pacientes mostraron un aumento en la opacidad del cristalino. El ultrasonido modo AB demostró reducción del grosor de la membrana neovascular subfoveal en un 34 por ciento (p<0,01). El área de extensión de la membrana también se redujo en 37.23 por ciento (p<0,05). Finalmente la respuesta global al tratamiento fue calificada como buena en el 55.8 por ciento y moderada para el 44.11 por ciento de los casos. Conclusión: Demostramos la utilidad de la radioterapia externa como un tratamiento alternativo para detener el crecimiento de la membrana neovascular subretiniana, manteniendo campo periférico, en pacientes con DMRE de tipo húmedo, cambiando la evolución natural de la enfermedad.

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