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Durante a pandemia da COVID-19 verificou-se aumento no tempo de uso de mídias eletrônicas (e-media) relacionado a problemas comportamentais. Este trabalho avaliou associações entre tempo de uso de e-media e problemas comportamentais/emocionais em crianças no contexto da pandemia. Contou com uma amostra de 277 responsáveis por crianças de 7-11 anos. Os instrumentos utilizados foram questionário socioeconômico, MAF-P e CBCL/6-18. As análises de correlação de Spearman apontaram associações positivas entre as e-media na MAF-P e escalas do CBCL/6-18. Os jogos adultos correlacionaram-se a 12 escalas; sites para informação/diversão foram associados a seis; apostar na internet a um; e jogos eletrônicos e ver vídeos no YouTube associaram-se a 17 escalas. Conclui-se, de modo geral, que os resultados indicam a necessidade de supervisão para acesso a e-media por crianças, considerando o número, a frequência de uso e o elevado número de problemas emocionais e comportamentais verificados no grupo estudado

A tipologia circadiana é uma dimensão comportamental associada a preferências de hábitos diários. Contudo, este estudo objetivou avaliar a qualidade de sono e a sonolência excessiva de acadêmicos de Psicologia. Participaram deste estudo quase-experimental 56 estudantes com idade entre 17 e 34 anos. Utilizaram-se como instrumentos o Índice de Qualidade de Sono de Pittsburgh (PSQI), o Questionário de Matutinidade e Vespertinidade, a Escala de Sonolência de Karolinska e a Escala de Ritmo Social Breve. Após avaliar o PSQI, todos os participantes responderam os instrumentos por um período de 14 dias consecutivos. A MANOVA mostrou diferença significativa para sonolência diária durante os dias úteis [λ=0. 81; F(4;47)=451,53; pchr(38)lt;0,05], especificamente para o horário das 21h [F(2;5)=3,03; pchr(38)lt;0,05]. Conclui-se que os estudantes possuem qualidade de sono ruim e, geralmente, tentam compensar as faltas de noites de sono durante a semana nos finais de semana

As taxas de abandono psicoterápico na infância e adolescência são altas, entretanto, são poucos os trabalhos dirigidos para essas faixas etárias. Este artigo investiga o processo terapêutico de um caso de abandono de psicoterapia psicanalítica de uma adolescente. Para tal, foram avaliadas 20 sessões da psicoterapia através do Adolescent Psychotherapy Q-Set (APQ), instrumento que descreve atitudes e comportamentos do paciente e do terapeuta, bem como das interações terapeuta/paciente nas sessões terapêuticas. A análise do APQ foi integrada aos aspectos dinâmicos da paciente e associada às anotações clínicas fornecidas pela terapeuta para a elaboração do entendimento clínico do processo. Concluiu-se que a não aquisição de insight da paciente, aliado a um estilo defensivo imaturo constituíram fatores preditivos ao abandono psicoterápico

Objetivo: Avaliar a qualidade de vida de enfermeiros de um serviço público em Sinop-MT Metodologia: Estudo transversal com 33 enfermeiros. As variáveis sociodemográficas, de qualidade de vida, do consumo alimentar e antropométricas foram obtidas através de quatro questionários autoaplicáveis. O cortisol plasmático foi coletado e avaliado por laboratório privado da região. As análises foram realizadas pelo Statistical Package for the Social Sciences e Graph Pad Prism, com nível de significância de 5%. Resultados e Conclusões: Houve predomínio de enfermeiros casados, do sexo feminino e de classe econômica A ou B. O escore de alimentação correlacionou-se positiva e significantemente com o dominio psicológico e nível de cortisol. O cortisol médio foi de 11,6 ug/dle correlacionou-se positiva e significantemente com os domínios físico, ambiente e ao escore geral de qualidade de vida. O peso corporal correlacionou-se inversa e significantemente com os domínios físico, psicológico, ambiente, o escore geral de qualidade de vida e à classe socioeconômica. Os enfermeiros possuem alto nível socioeconômico e baixa prevalência de excesso de peso. A percepção da qualidade de vida geral e nos seus quatro domínios pelos enfermeiros estudados foi regular e boa. O consumo alimentar e outros hábitos de vida apresentaram-se razoáveis, requerendo atenção por parte destes profissionais.

ABSTRACTThe aim of this study was to investigate whether culture, knowledge transfer and initiative allow for the configuration of homogeneous groups of Brazilian multinational companies’ subsidiaries – and, as a result, to propose a typology. Thus, based on a previously adapted Birkinshaw model (1999) of subsidiary initiatives tested by structural equation modeling in an earlier phase of research, it was possible to use transfer of knowledge, culture and initiative constructs scores from each sample unit to apply the clusters technique. As a result, three clusters were found – which, based on the Birkinshaw typology (1995) for classifying subsidiaries according to initiative, were defined as: (1) Reconfiguration initiative and (3) Local market initiative. Since the second group of subsidiaries could not be classified by Birkinshaw’s typology, it was called (2) Incipient initiative. Subsidiaries of the Reconfiguration initiative cluster present mainly internal initiatives, although they do identify local opportunities for applying and expanding their resources; whilst subsidiaries of Local market initiative reveal that both knowledge transfer in both directions (headquarters versus units) and culture are relevant to their initiatives, mainly external ones. Finally, subsidiaries from the Incipient Initiative cluster are units that tend to be similar in culture to Brazil, but knowledge transfer is low, indicating that international units do not know enough about the company’s business to be able to propose initiatives.RESUMOO objetivo deste estudo foi investigar se a cultura, a transferência de conhecimento e a iniciativa permitem a configuração de grupos homogêneos de subsidiárias de multinacionais brasileiras e, decorrente disto, propor uma tipologia. Para tanto, a partir de um modelo previamente adaptado de Birkinshaw (1999) e testado por meio da técnica de modelagem de equações estruturais, em uma etapa anterior da pesquisa sobre iniciativa das subsidiárias, foi possível utilizar os escores dos constructos transferência de conhecimento, cultura e iniciativa das unidades da amostra para aplicar a técnica de conglomerados. Como resultado, obtiveram-se três conglomerados que, de acordo com a tipologia desenvolvida por Birkinshaw (1995) para classificar as subsidiárias segundo a iniciativa, dois foram classificados em: (1) Iniciativa de reconfiguração e (3) Iniciativa no mercado local. Visto que as subsidiárias do conglomerado (2) não puderam ser classificadas na tipologia referenciada, foi denominado de iniciativa incipiente. As subsidiárias do conglomerado iniciativa de reconfiguração apresentam predominantemente a iniciativa interna, apesar de identificarem oportunidades locais de aplicação e ampliação dos seus recursos; em contrapartida, as subsidiárias do conglomerado iniciativa no mercado local indicam que tanto a transferência de conhecimento em ambos os sentidos (matriz versus unidades), quanto a cultura são relevantes para as iniciativas, destacando-se as iniciativas externas. Por fim, as subsidiárias do conglomerado iniciativa incipiente são unidades que tendem a apresentar culturas similares a do Brasil, mas a transferência de conhecimento é baixa, indicando que as unidades internacionais não dominam bem o negócio da corporação ao ponto de poderem propor iniciativas.RESUMENEl objetivo del estudio fue investigar si la cultura, transferencia de conocimiento e iniciativa, permiten la configuración de grupos homogéneos de subsidiarias de multinacionales brasileñas y, consecuentemente, la propuesta de una tipología. Para ello, a partir del modelo previamente adaptado de Birkinshaw (1999) y testado por la técnica de modelaje de ecuaciones estructurales, en una etapa anterior de la investigación, sobre iniciativa de las subsidiarias, fue posible utilizar los indicadores de los constructos para la transferencia del conocimiento y la cultura e iniciativa de las unidades de la muestra para aplicar la técnica de conglomerados. Como resultado, se obtuvieron tres conglomerados, fundamentados en la tipología de Birkinshaw (1995) para clasificar las subsidiarias, según esta iniciativa, dos fueron clasificados en: (1) Iniciativa de reconfiguración y (3) Iniciativa en el mercado local. Ya que las subsidiarias del conglomerado (2) no pudieron ser clasificadas en la tipología referenciada, este conglomerado fue denominado como iniciativa incipiente. Las subsidiarias del conglomerado Iniciativa de Reconfiguración presentan predominantemente iniciativa interna, a pesar de identificar oportunidades locales de aplicación y ampliación de sus recursos; en cuanto a las subsidiarias del conglomerado Iniciativa en el Mercado Local indican que tanto la transferencia de conocimiento en ambos sentidos (matriz versus unidades) como la cultura son relevantes para las iniciativas de estas, destacándose las iniciativas externas. Por último, las subsidiarias del conglomerado Iniciativa Incipiente, son unidades que tienden a presentar culturas similares a la de Brasil, pero la transferencia del conocimiento es baja, indicando que las unidades internacionales no dominan bien el negocio corporativo para poder proponer iniciativas.

Introduction: Restless legs syndrome (RLS) is a movement disorder characterized by an uncontrollable urge to move the legs in response to an unpleasant sensation. The coexistence of RLS and other sleep and mood disorders may require adjustment in the therapeutic strategy. The objective of this study was to determine the prevalence of RLS in adults studied with polysomnography and to evaluate its association with other sleep and mood disorders., Patients and Methods: Descriptive cross-sectional study. We included adults studied with polysomnography between 2015 and 2021. We collected information on their medical history, polysomnographic data and mood and sleep disorders using a self-administered written questionnaire which is part of the routine evaluation of all patients referred to this sleep unit. These variables were compared between patients with and without RLS., Results: We included 406 patients. The prevalence of RLS was 36.7% (n = 149). The presence of fatigue (45.3%), moderate to severe insomnia (38.9%) and depression (45.6%) was higher in subjects with RLS. We did not find differences regarding daytime sleepiness and anxiety symptoms. Periodic Limb Movements (PLM) was not associated with RLS (p = 0.26) and its prevalence was low., Conclusion: The prevalence of RLS in subjects studied with Polysomnography is high and it was associated with clinically significant fatigue, insomnia and depression. These symptoms should be identified in order to establish an adequate therapeutic strategy. The prevalence of periodic limb movements was low and was not linked with RLS. These findings contrast with previous publications. Therefore, it requires additional studies to clarify the cause of this variation.

People with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

Introduction: Congenital hypothyroidism (CH) is the most common cause of preventable intellectual disability in the pediatric population. Early diagnosis and treatment during the first month of life are essential to avoid delaying the neuropsychological development of these patients., Objective: to describe the social, cognitive, and psychomotor development of children with CH treated at the National Institute of Child Health (INSN) in Lima, Peru., Patients and Method: Retrospective analysis of 26 CH pa tients seen during 2012-2017 at INSN were reviewed. The aspects of neuropsychological development studied were: cognitive development (IQ), social development (social category), and psychomotor development (gait, speech, and chest control). The IQ was classified according to the result of the Weschler IV scale. An analysis was carried out with the Fisher-Freeman-Halton test to verify if there was a difference in the frequency of the variables according to the age of diagnosis and beginning of treatment., Results: Most of the patients presented a borderline IQ (38.5%), the most frequent social category was educable (88.7%), and most of the patients presented delay in developing the speech (88.5%). In the Fisher-Freeman-Halton test, there was only a statistically significant increase in the number of cases of speech delay in patients treated between 22 days and 12 months of age (c2 = 11.246, p = 0.002, V of Cramer = 0.778)., Conclusion: Neuropsychological developmental delay was more frequent in patients with CH diagnosed and treated after 21 days of age.

Hepatic Fasciola is a frequent disease in the Peruvian highlands. We present a case of hepatic Fasciola from the Andean zone of La Libertad, with symptoms of several months of evolution with pain in the right hypochondrium, jaundice and coluria. An abdominal CT scan was performed, demonstrating a liver mass probable neoplasm, and was referred to the Institute of Neoplastic Diseases. Laboratory tests were completed finding eosinophilia and variable increases in liver function tests. Fascioliasis was presented as a differential diagnosis and a Western Bloot examination was performed confirming its diagnosis. Treatment with 2 cycles of Triclabendazole was started, with a favorable clinical evolution.

Introduction: In the world, 75 million people require a wheelchair (W/C) but only between 5% and 15% of them have one. The WHO defines a W/C as adequate if it meets the needs of the user and their environment, offers appropriate seating and postural support and if it is safe and durable., Objective: The primary objective is to describe the seating, postural support and safety of W/Cs users who attend the I.Re.P kinesiology service. The secondary objective is to learn about their satisfaction with their W/Cs and related services., Subjects and Method: The subjects were W/C users who attend the I.Re.P. kinesiology service. The W/Cs were evaluated following the WHO guidelines, and the satisfaction using the QUEST 2.0 questionnaire., Results: Within 30 patients, 21 were men aged around 48.17 years. Only 1 subject had all the correct measures of safety, seating and posture adjustment. 6 had all the correct measures for an adequate seating and 5 had all the safety measures. Regarding satisfaction, high scores have been found with respect to W/C and low scores with respect to related services. All in all, the total satisfaction got mostly medium and high scores., Conclusion: Only 1 subject out of the 30 evaluated complied with all the seating, postural adjustment and safety requirements necessary to consider an adequate W/C. Most subjects reported being more satisfied with their W/C than with the related services., (Universidad Nacional de Córdoba.)

Objective: To determine if there are differences in factors favoring dysphonia in a group of preschool children with healthy voice and another with dysphonia., Method: In this research a total of 96 children between 2 and 5 years old were evaluated, of which 17 had dysphonia and 79 had a healthy voice. The presence of factors favoring dysphonia was compared between both groups, by means of a questionnaire addressed to their parents or caregivers created and validated especially for this research. Statistical analysis was performed by independent samples analysis to extract the p value., Results: The results show a significant difference in the values of the questionnaire (p=0.000) between the two groups. The 91.6% of the questions behaved differently between the groups with and without dysphonia., Conclusion: In this research, differences were found between the presence of factors favoring dysphonia in preschool children with and without dysphonia. The factors that have more differences are related to physical, environmental and psychological causes.

Introduction: Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders., Methods: We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method., Results and Conclusions: We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.

Introduction: Different interventions have been proposed to improve influenza vaccine coverage. The use of reminders, through letters, phone calls, pamphlets or technological applications, among others, has stood out among the different alternatives to increase adherence to vaccination. However, its effectiveness is not clear. In this summary, the first of a series of evaluation of reminders will address the use of a reminder sent by mail., Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method., Results and Conclusions: We identified eight systematic reviews that included 35 primary studies, of which 32 correspond to randomized trials. We concluded that a reminder sent by mail, probably increase adherence to influenza vaccination in all age groups (adult population, over 60 an under 18).

Introduction: A spinal cord injury refers to the damage suffered in the spinal cord as a result of trauma, disease or degeneration. Every person with spinal cord injury is at risk of developing pressure ulcers, and almost everyone will develop at least one ulcer due to severe pressure during his or her life., Objective: To identify the studies that detected risk factors for the development and recurrence of pressure ulcers in patients with spinal cord injury; and, if possible, synthesize the evidence to determine whether an association exists between them., Methods: A systematic search was conducted in Medline, LILACS, SciELO and Cochrane until December 4, 2018. The following studies were included: observational studies, case-control studies, and prospective or retrospective cohort studies, which provided an adjusted analysis of the risk factors associated with the development and recurrence of pressure ulcers in patients with spinal cord injury., Results: 25 articles met the eligibility criteria and were included for analysis. A total of 30 risk factors were identified: 4 were demographic factors, 8 were related to the injury, 5 belonged to medical comorbidities, 3 to nutritional factors, 9 were psychological, cognitive, contextual and social factors and 1 was related to support surface. As regards the factors, 56.67 percent of them were classified as non-modifiable., Conclusion: 30 risk factors were identified for the development and recurrence of pressure ulcers in patients with spinal cord injury. However, we were not able to synthesize the evidence due to the heterogeneity of the articles included in this review., (Universidad Nacional de Córdoba)

Introduction: Diffuse large B-cell lymphoma (DLBCL) accounts for 35% of non-Hodgkin lymphoma and its incidence increases with age. Epstein Barr virus (EBV) is widely spread worldwide. There is a 10% association between EBV and DLBCL in immunocompetent patients; this type of malignancy has a high prevalence in Latin American countries., Objective: Estimate the percentage of association between DLBCL and EBV patients, describing demographics, clinical and immunological features, as well as phenotype and clinical outcome in a high complexity healthcare institution in Colombia., Materials and Methods: This is an analytic observational study from an historical cohort. Clinical and pathological records were revised among DLBCL patients and subsequent in-situ hybridization was performed for EBV detection. A descriptive analysis of the data was carried out., Results: From 2011 to 2017, 55 DLBCL patients were identified. 16% were positive on ISH for EBV, most of which belonged to the non-germinal center B-cell immunophenotype (89%), with a nodal presentation (56%). DLBCL EBV positive was more prevalent among males (67%) and in younger patients (median of 48 years) where the mortality rate was 56%., Conclusions: DLBCL patients positive for EBV are more prone to belong to the non-germinal center B-cell immunophenotype which, according to our findings, is associated with a younger age and worse prognosis. Presently, EBER in-situ hybridization is not a part of routine tests, but we recommend its inclusion in the pathology package for DLBCL patients, as it can influence clinical outcomes., (Copyright © 2019 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015., Methods: All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorised using codes from ICD-9, CM., Results: A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit., Conclusions: Given that the great majority of Ophthalmological Emergency visits are categorised as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources., (Copyright © 2019 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Immunoglobulin G4 (IgG4)-related disease has been described in the last decade. It is a fibro-inflammatory condition capable of affecting almost every organ and diagnosis requires both clinical and paraclinical confirmation. We present the largest study to date in Colombia., Objective: To describe the clinical and histopathological characteristics of patients diagnosed with IgG4-related disease at the Fundación Valle del Lili., Methods: Observational-descriptive retrospective study. The clinical and pathological records of patients diagnosed with IgG4-related disease at the Fundación Valle del Lili were reviewed and a descriptive statistical analysis made., Results: From 2013-2016, 16 patients were diagnosed. Median age was 44 years (RIC 30-58) and 10 (62.5%) were women. The most common clinical presentation was a combination of a tumefactive mass, constitutional symptoms and site-related symptoms (43.8%) (n=7). No preference for any organ was seen. Histopathology revealed all cases had dense lymphoplasmacytic infiltrate and storiform-type fibrosis; 75% also had obliterative phlebitis. In all cases≥10 cells/HPF of IgG4+ were found and 81% had a ratio of IgG4+/IgG+>50%., Conclusion: IgG4-related disease appears to be underdiagnosed, probably due to its broad clinical spectrum as well as a low index of awareness among clinicians. We recommend that, when dense lymphoplasmacytic infiltrates, storiform-type fibrosis or obliterative phlebitis are found, immunohistochemistry for IgG and IgG4should be requested. Positive results then must be correlated with complementary studies to confirm the disease., (Copyright © 2018 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: There is a wide interindividual variability in the response to a period of exercise training. The science have reported that a minimum of participants could be non-responders for improving different health-related outcomes after training., Aim: To compare the effects of a 6-weeks exercise program on body composition, cardiovascular and metabolic outcomes patients with type 2 diabetes and hypertension., Material and Methods: Data from 23 trained subjects were used in a secondary analysis of the response to exercise. Of these, 14 were considered adherent to training and nine as non-adherent. Body mass, height, waist circumference, four skinfolds and their sum, blood pressure and plasma triglyceride levels were assessed before and after the training period., Results: Among adherent participants, significant reductions were observed in the sum of four skinfolds (30 ± 7 to 27 ± 6 mm, p ≤ 0.05), systolic blood pressure (133 ± 18 to 127 ± 20 mmHg; p ≤ 0.05) and plasma triglycerides (125 ± 58 to 102 ± 34 mg/dL; p ≤ 0.05). No changes were observed in weight or diastolic blood pressure. Among non-adherent participants, no changes of measured parameters were observed. Among adherent participants, 57% were considered as non-responders for waist circumference, 7% for the sum of skinfold thickness, 50% for systolic blood pressure, 64% for diastolic blood pressure and 57% for plasma triglycerides., Conclusions: Participants with a good adherence to a 6-weeks exercise training program experienced overall improvement in body composition, blood pressure and plasma triglycerides. The prevalence of non-responders varied considerably among measured outcomes.

The origin of 20% of ischemic strokes is a left ventricular thrombus. We report two patients with strokes originating from cardiac thrombi, treated in two different ways. A 42-year-old diabetic man admitted with a left parietal and occipital stroke. An echocardiogram showed a left ventricular thrombus. The patient was subjected to a surgical cardiac revascularization procedure and left ventricular thrombectomy. The postoperative evolution was uneventful and the patient was discharged on oral anticoagulation. On ambulatory follow up, no neurological deterioration was evidenced. A 38-year-old male admitted with an acute ischemic stroke, was subjected to thrombolysis with human plasminogen activator. An echocardiogram showed a left ventricular thrombus, considered the cause of the stroke. The patient was anticoagulated with heparin and discharged ten days after admission with oral anticoagulation. A new echocardiogram performed one month later, did not show the left ventricular thrombus.

Efforts to halt freshwater ecosystem degradation in central Mexico can benefit from using bio-monitoring tools that reflect the condition of their biotic integrity. We analyzed the applicability of two fish-based indices of biotic integrity using data from lotic and lentic systems in the Angulo River subbasin (Lerma-Chapala basin). Both independent data from our own collections during two consecutive years, and existing information detailing the ecological attributes of each species, were used to calculate indices of biological integrity for 16 sites in lotic and lentic habitats. We assessed environmental quality by combining independent evaluations water and habitat quality for each site. We found sites with poor, regular and good biotic integrity. Our study did not find sites with good environmental quality. Fish-based IBI scores were strongly and significantly correlated with scores from independent environmental assessment techniques. IBI scores were adequate at representing environmental conditions in most study sites. These results expand the area where a lotic system fish-based IBI can be used, and constitute an initial validation of a lentic system fish-based IBI. Our results suggest that these bio-monitoring tools can be used in future conservation efforts in freshwater ecosystems in the Middle Lerma Basin.

Patients with malignant liver tumors, whether primary tumors or metastases, that are not candidates for surgical treatment can benefit from different endovascular treatments with proven efficacy in local control of the disease. Correct treatment requires a careful angiographic technique and precise knowledge about the vascular anatomy afferent to the lesion. Occasionally, lesions considered relapse are actually areas that were untreated because the afferent pedicle was not adequately detected. On the other hand, some of the complications of endovascular treatments are related with material passing into non-hepatic vessels. Knowing the hepatic vascular anatomy and correctly identifying all the extrahepatic vessels will make it possible to perform safer, more efficacious treatments. In this article, we present different representative examples of extrahepatic vessels that originate in the hepatic artery., (Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.)

Introduction: Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients., Methods: Four years observational analysis of 21 NMD patients on home MI-E. Diagnosis included bulbar and non-bulbar Amyotrophic Lateral Sclerosis (ALS) and other NMD. Median age was 58 years. Only cooperative patients with unassisted baseline Peak Cough Flow (PCF) <270 L/min were included. All patients were under continuous mechanical ventilation (6 by tracheostomy). Pulmonary function before initiation of MI-E (median): FVC=0.81 L, MIP=28cmH(2)O, MEP=22 cmH(2)O and PCF=60 L/min. MI-E was performed by previously trained non-professional caregivers, with an on-call support of a trained health care professional. Patients had pulse oximetry monitorization and applied MI-E whenever SpO(2)<95%. Median follow-up was 12 months (3-41 months)., Results: Ten patients (9 ALS) used MI-E daily. Eleven patients used MI-E intermittently, during exacerbations, and in 8 patients early application of MI-E (guided by oximetry feed-back) avoided hospitalization. All tracheostomized patients used MI-E daily and more times a day than patients under NIV. Four patients (3 bulbar ALS), were hospitalized due to secretion encumbrance. MI-E was well-tolerated and there were no complications. In general, caregivers considered MI-E effective. During this period, 4 patients died, related to disease progression., Conclusions: Home MI-E is well tolerated, effective and safe if used by well trained caregivers. MI-E should be considered as a complement to mechanical ventilation., (Copyright 2009 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background: There is an association between periodontal diseases and preterm delivery., Aim: To assess the relationship between periodontal diseases, ascending bacterial infection and placental pathology with preterm delivery., Patients and Methods: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed in women with preterm labor with intact membranes, without an evident clinical cause or preterm premature rupture of membranes, without clinical chorioamnionitis or labor and a gestational age between 24 and 34 weeks. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture. Cervicovaginal infection was defined as a bacterial vaginosis or positive culture of cervix or vagina with a high neutrophil count. Ascending bacterial infection was diagnosed as the microbial invasion of the amniotic cavity by ascending bacteria or cervicovaginal infection. Corioamnionitis, funisitis or vellositis were diagnosed., Results: Fifty-nine women were included: forty-two with preterm labor with intact membranes and seventeen with preterm premature rupture of membranes. The prevalence of periodontal diseases was 93.2%. Microbial invasion of the amniotic fluid was detected in 27.1% of patients. periodontal pathogenic bacteria were isolated in 18.6% of amniotic fluid samples and 71.2% of subgingival plaque samples. The prevalence of ascending bacterial infection was 83.1% and in 72.9% of women it was associated with periodontal disease. Preterm delivery (<37 weeks) occurred in 64.4% of patients and was significantly associated with generalized periodontal disease and with the association of ascending bacterial infection and periodontal diseases. Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis., Conclusions: Generalized periodontal disease and its association with ascending bacterial infection are related to preterm delivery and placental markers of bacterial ascending infection.

Electronic database Medline, Embase, Cochrane Library and Lilacs were used to retrieve the clinical trials that will evaluate the various therapeutical options available for management of hemorrhagic dengue. Eight clinical studies were included. Supportive care and symptomatic treatment through hydration and aggressive fluid management, if hypotension develops in the course of disease, are the most important aids to improve survival. Treatment with corticosteroids such as methylprednisolone, hydrocortisone, carbazochorome sodium sulfonate (AC-17) and recombinant activated factor VII did not reduce mortality in children with hemorrhagic dengue. At present, no vaccine or effective antiviral treatment is available for the prevention or treatment of hemorrhagic dengue.

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.

Collagen types were studied in the lumbar intervertebral discs of non-chondrodystrophic dogs, 1 to 3 years old. Parts of intervertebral discs were frozen and sections were subjected to the 3-methyl-benzothiazol-2-on-hydrazone (MBTH) method, which permits differentiation of genetic types and maturation stages of collagen. The annulus fibrosus showed a blue (collagen I) and a violet colour (collagen II) at the external zone. The internal zone was more homogeneous and contained a mixture of both colours (collagen I and II). The nucleus pulposus showed only the violet colour, indicative of collagen II. Discs were also dissected at three different zones and submitted to an extraction technique to obtain collagen, then subjected to SDS-polyacrylamide gel electrophoresis and determination of spectrophotometric reactions of MBTH. Both studies demonstrated type I and type II collagens in the external and internal zones of the annulus fibrosus, but only type II in the nucleus pulposus. Collagen characterization, using this technique, would allow for evaluation in pathologic events of the intervertebral discs as well as for establishing the degree of alteration.

Atrophy of the alveolar process can be avoided by intentionally preserving dental roots in patients with ideal parodontal and pulpar health conditions. This article illustrates results with a representative case history.