Hospital Perpetuo Socorro

Ocular syphilis in the Iberian Peninsula shows a wide clinical spectrum and frequent posterior segment involvement. Most patients achieved favourable serological and visual outcomes. These findings support the effectiveness of standard therapies and highlight the need for early diagnosis, especially in high-risk populations.

Servicio de Medicina Interna. Hospital Perpetuo Socorro. Complejo Hospitalario Universitario de Badajoz. Servicio Extremeno de Salud. Badajoz, Espana e-mail: pepebarquero@yahoo.es Un varon de 84 anos, hipertenso y ex fumador (mas de 50 paquetes-ano) ingreso por incremento progresivo de su disnea, ortopnea, disminucion de la diuresis y edemas. En la radiografia de torax se observo cardiomegalia, incremento de la vascularizacion pulmonar y tres imagenes nodulares de gran tamano en el hemitorax derecho, de aspecto lenticular (Figuras 1 y 2), que aparecian bien definidas, perifericas e hipodensas. La confirmacion de la sospecha diagnostica de tumor evanescente o tumor fantasma se obtuvo al comprobar la desaparicion de las imagenes radiologicas a los 4 dias de tratamiento diuretico (Figura 3).

The recent study by Almani et al. [1] provides an important contribution to understanding risk in transcatheter aortic valve replacement (TAVR). Among nearly 300,000 patients, only 0.2% had hypertrophic obstructive cardiomyopathy (HOCM), yet this subgroup showed markedly worse in-hospital outcomes, including a threefold increase in mortality and higher rates of atrioventricular block, cardiogenic shock, and acute kidney injury. These findings remind interventional cardiologists that procedural success in TAVR depends not only on anatomical precision but also on ventricular physiology [2]. The authors appropriately highlight the hemodynamic complexity of patients with combined fixed and dynamic obstruction. These results, however, invite reflection on the importance of diagnostic precision before intervention. In daily practice, patients with left ventricular hypertrophy and aortic stenosis often fall into a diagnostic gray zone. The key question is whether the hypertrophy represents a secondary adaptation to valvular overload or an underlying cardiomyopathy. This distinction has major therapeutic implications. When hypertrophic cardiomyopathy (HCM) coexists or predominates, other strategies such as surgical septal myectomy, often combined with valve replacement, or alcohol septal ablation may offer more physiologically appropriate solutions than isolated TAVR. Accurate identification of HCM before TAVR is therefore not merely an academic concern but one that can alter the treatment pathway entirely. Multimodality imaging, particularly cardiac magnetic resonance, is essential to detect asymmetric hypertrophy, systolic anterior motion, or midventricular obstruction. Even so, imaging findings can overlap in older patients with long-standing hypertension or calcific aortic stenosis, making differentiation difficult. In such cases, complementary tools such as targeted genetic testing may refine diagnosis and guide referral toward the most appropriate therapy [3]. This approach represents a practical expression of precision medicine, where clinical and molecular information combine to ensure that the chosen intervention aligns with the underlying disease. Recent imaging studies support the biological basis of this differentiation. Chung et al. [4] demonstrated that carriers of sarcomere mutations exhibit significantly greater myocardial fibrosis than genotype-negative counterparts, with 90% showing late gadolinium enhancement compared with 60% among noncarriers (p < 0.001). Even in myocardial regions without visible enhancement, extracellular volume was higher (32.4% vs. 30.7%, p = 0.025), confirming diffuse interstitial fibrosis. This fibrotic substrate increases stiffness and reduces compliance, limiting the heart′s ability to tolerate abrupt unloading. Such pathophysiology helps explain why ventricles with hypertrophic cardiomyopathy are prone to post-TAVR collapse and instability despite technically successful implantation. Although genetic testing is not part of routine pre-TAVR evaluation, it could be selectively applied to patients with disproportionate septal thickening or dynamic gradients. Identifying a sarcomeric substrate before intervention could inform the choice between TAVR and surgical strategies or justify septal reduction before transcatheter valve replacement. Ultimately, the study by Almani et al. highlights that outcomes after TAVR depend not only on device technology but on accurate disease characterization. In patients with unexplained or asymmetric hypertrophy, comprehensive evaluation that includes consideration of hypertrophic cardiomyopathy and potential septal reduction should precede transcatheter intervention. The convergence of imaging, myocardial biology, and clinical judgment defines the future of precision-guided structural cardiology, ensuring that valve replacement treats the disease mechanism rather than its manifestation. The authors declare no conflicts of interest.

To develop a consensus among speech-language pathologists who are voice specialists regarding the criteria for recommending and using photobiomodulation in the context of vocal therapy and training. Seven speech-language pathologists, experts in voice, and with experience in using photobiomodulation in vocal therapy and training participated. The Delphi technique was used to achieve consensus from a panel of experts accessed independently in two phases of collection. In Phase 1, the experts were contacted individually and participated in an interview with 12 questions to gather opinions on the use of photobiomodulation in the investigated context. The experts' responses were used to construct a questionnaire with 55 items presented as statements. The experts were asked to analyze each item and indicate their level of agreement on a five-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of agreement among the judges and to select the final items of the consensus. Consensus was reached among the experts on 34 items investigated in this study, with a CVC ≥ 0.75. It was observed that 31 items achieved an excellent CVC (≥ 0.78), 14 items with a good CVC (0.60 ≥ CVC ≤ 0.77) and 10 items with a poor CVC (≤ 0.59). The total CVC was considered excellent, with a value of 0.78. There was a consensus among experts about the use of photobiomodulation in vocal habilitation and rehabilitation. It has the potential to improve the criteria for prescribing and using this device by speech-language pathologists. The findings may be useful to improve the criteria for prescribing and the use of this device by speech-language pathologists, in addition to subsidizing the development of future research and clinical recommendations in the area.

Abstract Background Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved. Objective To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC). Methods Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p &lt; 0.05 were considered significant. Results 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%). Conclusions Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Purpose: We aim to describe the characteristics of patients with childhood-onset craniopharyngioma and to analyze factors that impair quality of life (QoL) in this population. Methods: multicenter national study including patients treated between 2008-2022, from 2 to 25 years of age diagnosed with craniopharyngioma. QoL was assessed once during patient’s follow-up by age-adapted versions Pediatric Quality of Life Inventory (PedsQL TM) questionnaire. Results: Sixty-six patients were included. Median age at diagnosis was 5 years (IQR 3-8), while median follow-up was 7.4 years (IQR 2.8-9.7). Most craniopharyngioma were suprasellar (93.9%) and 59.7% had hypothalamic involvement (HI). All patients underwent surgery, 44.4% received radiotherapy and 23.6%, intra-cystic therapy. Most frequent long-term complications were visual deficit (72.7%) and endocrine impairment (94.5%). Patients exhibited hypothyroidism requiring hormone replacement (92.4%), hypocortisolism (80.3%), diabetes insipidus (86.4%) and/or growth hormone therapy (50%). When parents evaluated QoL, PedsQL TM median score was 53.8 points out of 100 (IQR 41-71.6). Higher scores were noted when patients assessed their own QoL [median-score 64.8 (IQR 57.3-81.8)], observing statistical-significant differences (p=0.019). QoL was impaired by repeated surgeries (r -0.44; p=0.014), HI [median-score 51.5 (IQR 39-63.8) vs 76.4 (59-84.8); p=0.001], radiotherapy [median-score 51.9 (IQR 38.1-61.3) vs 63.8 (IQR 49-82.5); p=0.02] and longer follow-up (r-0.3; p=0.01). Conclusion: In our study, most patients had significant comorbidities and low overall QoL scores, which was mainly affected by repeated surgery, radiation, and HI. The complex management of these patients requires multidisciplinary teams that can warrant the hypothalamic preservation and prompt intervention to prevent and identify sequelae.

Abstract Purpose: The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to 1) design and implement an ERP for trauma laparotomy patients; 2) assess its safety, feasibility, and efficacy; and 3) compare the outcomes of the proposed ERP with conventional practices. Methods: This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared with historical controls managed according to conventional practices. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. Results: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p&lt;0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p&lt;0.001). Conclusion: The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.

El manejo de los residuos sólidos es uno de los principales problemas ambientales, su gestión implica grandes esfuerzos para su progresiva disminución; la presente investigación se planteó analizar los componentes socioeconómicos y de la generación per cápita de los residuos sólidos en los hogares del sector Sagrado Corazón, Quevedo, se aplicó encuestas a los habitantes del sector, las variables que se utilizaron para la recolección de las muestras fueron residuos sólidos orgánicos e inorgánicos ( plásticos, vidrio, cartón). Se involucro a todos los habitantes de sector para la realización de las encuestas y recolección de las muestras. Para la caracterización de los residuos se hizo separando los residuos orgánicos e inorgánicos (plástico, vidrio, cartón) luego se procedió a su respectivo pesaje, se realizó dos muestreo en la cual dio un resultado de 2478.159 kilogramos de residuos que generan los ciudadanos lo que significa que Per cápita es igual 0.763 kg/persona/día, esto se lo calculo dividiendo el total de los residuos generados durante los dos muestreo por el número de habitantes del sector y por el número de días que se realizó el muestreo. Se evidencio que la población está dispuesta a aprender sobre el correcto manejo de los residuos que generan en sus hogares.

Objective: To know the feelings of pregnant women living with Human Immunodeficiency Virus (HIV) when facing the impossibility of breastfeeding. Method: Qualitative study based on Content Analysis, with 17 HIV-positive pregnant woman in a high-risk prenatal clinic. Results: Participants were aged of 18 and 41 years. Five thematic categories emerged: The discovery of HIV; The revelation of the impossibility of breastfeeding; The professional approach to the topic; The family relationship and, Adherence to treatment. Feelings such as deep sadness, despair, hopelessness and segregation are revived with the discovery of the impossibility of breastfeeding. Family Relationships are challenging; there is dissatisfaction with the service provided, given the insensitivity of professionals and secrecy. Concern about their unborn child’s health contributed to treatment adherence. Conclusions: The results point to the complexity of care. It is necessary to invest in the continuing education of professionals and guarantee the rights of these women, seeking to alleviate their suffering. Descriptors: Nursing; Women's Health; HIV; Breast Feeding; Feelings