Hospital Vargas

This review aims to evaluate the role of congenital urinary tract anomalies in the pathogenesis of pediatric nephrolithiasis. By examining specific structural abnormalities such as ureteropelvic junction obstruction (UPJO), horseshoe kidney, ectopic kidney, exstrophy-epispadias complex, and ureterocele, we aim to elucidate how these anomalies contribute to urinary stasis, infection, metabolic disturbances, and ultimately, stone formation in children. A narrative literature review was conducted focusing on congenital anomalies of the urinary tract and their association with pediatric stone formation. Relevant studies, case series, and case reports published in peer-reviewed journals were analyzed to explore the pathophysiological mechanisms, diagnostic approaches, and treatment strategies employed in affected pediatric populations. Urinary tract anomalies such as UPJO, horseshoe kidney, and ectopic kidneys were frequently associated with increased risk of stone formation, primarily due to urinary stasis and infection. In UPJO, a significant proportion of patients (up to 76%) also exhibited underlying metabolic abnormalities. Combined surgical approaches, such as robotic or laparoscopic pyeloplasty with simultaneous stone removal, demonstrated favorable outcomes with low complication rates. In children with exstrophy-epispadias complex and bladder augmentation, bladder stones developed in up to 22% of cases, regardless of the bowel segment used. Ureteroceles, although rare in children, can also harbor stones and pose diagnostic challenges. Minimally invasive interventions have shown promising results in these scenarios. Congenital urinary tract anomalies may increase the risk of pediatric stone formation by contributing to urinary obstruction, stasis, and metabolic derangements. While existing evidence supports this association, further prospective studies are needed to better define causality and optimize management strategies in this unique patient population.

El artículo 10 del Decreto Legislativo 1106 reconoce la autonomía del delito de lavado de activos.Existe un sector de la doctrina que interpreta tal autonomía como ‘autonomía sustantiva’, es decir, aquella que no incluye al delito previo dentro del tipo penal. Ante esta postura, el autor procederá a enfatizar la importancia del origen ilícito como elemento del tipo objetivo del delito de lavado de activos. Por lo tanto, reforzará la necesidad de que el delito previo quede identificado y acreditado en el proceso penal para poder configurar el ilícito de lavado de activos.A lo largo del texto, el autor dialogará e interpretará las normas relevantes, así como la jurisprudencia nacional para concluir que la autonomía consagrada en el artículo 10 se circunscribe únicamente a una autonomía procesal.

Introdução: A clínica médica é um ramo essencial da medicina veterinária que se concentra no diagnóstico, tratamento e prevenção de doenças em pacientes. As especializações dentro da clínica médica permitem um atendimento mais específico e detalhado em diversas áreas da saúde dos animais, aumentando a eficácia no tratamento de doenças complexas e oferecendo cuidados contínuos aos pacientes. As áreas de especialização incluem dentre outras em crescimento: cardiologia, gastroenterologia, endocrinologia, reumatologia, oftalmologia e oncologia. Objetivo: demonstrar a importância das especializações na medicina veterinária para diagnósticos mais precisos e tratamentos mais eficazes. Metodologia: O estudo baseado na revisão bibliográfica, onde foram utilizados os sites da PubMed e Scielo através de palavras-chaves como especializações, importância da especialização no diagnóstico preciso, resultando em grande numero de publicações na forma de teses e artigos científicos. Resultado: Como resultado da pesquisa foi possível observar diagnósticos mais precisos e rápidos como resultado do encaminhamento ao veterinário especialista, resultando em tratamentos personalizados facilitando a criação de planos de tratamento individualizados, melhorando a eficácia dos cuidados prestados e a redução de doenças crônicas através de medidas preventivas e maior adesão ao tratamento com a integração multidisciplinar de diversas áreas(veterinários, biólogos etc). Conclusão: A clínica médica e suas especializações desempenham um papel vital na promoção da saúde e no tratamento de doenças. A abordagem especializada permite uma atenção mais detalhada e eficaz às necessidades dos pacientes, melhorando os resultados clínicos e a qualidade de vida junto ao avanço contínuo em métodos de diagnóstico e técnicas de tratamento, com o reconhecimento pelo Conselho Regional de Medicina Veterinária de diversas especializações, tais como oncológica, dermatológica, cirúrgica, mas não se limitando a somente essas. O número exato de especialistas atualmente no Brasil pode variar de região.

Purpose This interlaboratory comparison was conducted to evaluate the performance of the Latin-American Biodosimetry Network (LBDNet) in analyzing digitized images for scoring dicentric chromosomes from in vitro irradiated blood samples. The exercise also assessed the use of weighted robust algorithms to compensate the uneven expertise among the participating laboratories. Methods Three sets of coded images obtained through the dicentric chromosome assay from blood samples irradiated at 1.5 Gy (sample A) and 4 Gy (sample B), as well as a non-irradiated whole blood sample (sample C), were shared among LBDNet laboratories. The images were captured using the Metafer4 platform coupled with the AutoCapt module. The laboratories were requested to perform triage scoring, conventional scoring, and dose estimation. The dose estimation was carried out using either their laboratory calibration curve or a common calibration curve. A comparative statistical analysis was conducted using a weighted robust Hampel algorithm and z score to compensate for uneven expertise in dicentric analysis and dose assessment among all laboratories. Results Out of twelve laboratories, one had unsatisfactory estimated doses at 0 Gy, and two had unsatisfactory estimated doses at 1.5 Gy when using their own calibration curve and triage scoring mode. However, all doses were satisfactory at 4 Gy. Six laboratories had estimated doses within 95% uncertainty limits at 0 Gy, seven at 1.5 Gy, and four at 4 Gy. While the mean dose for sample C was significantly biased using robust algorithms, applying weights to compensate for the laboratory’s analysis expertise reduced the bias by half. The bias from delivered doses was only notable for sample C. Using the common calibration curve for dose estimation reduced the standard deviation (s*) estimated by robust methods for all three samples. Conclusions The results underscore the significance of performing interlaboratory comparison exercises that involve digitized and electronically transmitted images, even when analyzing non-irradiated samples. In situations where the participating laboratories possess different levels of proficiency, it may prove essential to employ weighted robust algorithms to achieve precise outcomes.

La simulación es la técnica de replicar un proceso o situación. El objetivo de la simulación quirúrgica es transferir de manera efectiva las habilidades adquiridas en el laboratorio al quirófano, reduciendo las curvas de aprendizaje y los costos operativos. Objetivos: Describir la utilización, ventajas, desventajas, y estado actual de la práctica basada en simulación como método de enseñanza y aprendizaje para la capacitación de residentes y cirujanos en los programas de formación quirúrgica, según lo reportado en la literatura científica actual. Métodos: Se realizó una búsqueda en la literatura utilizando palabras claves. Se sintetizaron los hallazgos de cada estudio en una revisión narrativa. Resultados: La simulación quirúrgica es una herramienta educativa que confiere ventajas únicas. Permite el desarrollo de programas de formación flexibles e individualizados, enfatiza el aprendizaje basado en problemas, basado en competencias y basado en destrezas, y acelera el proceso de aprendizaje al ofrecer entornos seguros para practicar procedimientos quirúrgicos complejos. Además, respalda la retroalimentación y el análisis posterior, fomenta la formación multidisciplinaria y facilita la investigación y la innovación, mejorando en última instancia la calidad de la atención médica. Conclusiones: Las ventajas prácticas de los programas de formación estructurados han convertido a la educación basada en la simulación en un método de enseñanza factible, confiable y altamente atractivo. La simulación no solo contribuye al desarrollo profesional de los residentes, sino que también mejora la seguridad del paciente y la calidad general de los servicios de salud.

Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.

To examine the incidence of, barriers to, and institutional responses to formal reporting of experiences of identity-based harassment at an academic medical center. The authors invited 4,545 faculty and medical trainees at the University of Michigan Medical School to participate in a 2018 survey about civility and respect. This analysis focused on respondents who indicated experiencing at least 1 form of identity-based harassment (sexual harassment, gender policing harassment, heterosexist harassment, racialized sexual harassment) within the past year, perpetrated by staff, students, and faculty or by patients and patients' families. The authors assessed the incidence of formally reporting harassment to someone in authority, barriers to reporting, and institutional responses following reporting. Among the 1,288 (28.3%) respondents with usable data, 83.9% (n = 1,080) indicated experiencing harassment. Of the harassed individuals, 10.7% (114/1,067), including 13.1% (79/603) of cisgender women and 7.5% (35/464) of cisgender men, indicated they formally reported their harassment experiences. Among these reporters, 84.6% (66/78) of cisgender women and 71.9% (23/32) of cisgender men indicated experiencing positive institutional remedies. Many reporters indicated experiencing institutional minimization (42.9% [33/77] of cisgender women; 53.1% [17/32] of cisgender men) or retaliation (21.8% [17/78] of cisgender women; 43.8% [14/32] of cisgender men). Cisgender men were significantly more likely to indicate experiencing specific negative institutional responses, such as being considered a troublemaker (OR 3.56, 95% CI: 1.33-9.55). Among respondents who did not formally report harassment experiences, cisgender women were significantly more likely to cite concerns about institutional retaliation, such as being given an unfair performance evaluation or grade (OR 1.90, 95% CI: 1.33-2.70). Most respondents who experienced harassment did not formally report it to anyone in authority. Many reporters faced institutional minimization and retaliation. These findings suggest a need to reshape institutional harassment prevention and response systems in academic medicine.

A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

The present study was conducted to investigate and analyze the recent and relevant studies about primary dysmenorrhea and its pathophysiology. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, Google Scholar and the Cochrane Library for original articles written in English and in Scielo, Lantidex, Imbiomed-L, Redalyc and Google Scholar for original articles written in Spanish. The searches included the key words (Mesh): menstruation, menstrual period, menstrual cycle, dysmenorrhea, primary dysmenorrhea, inflammatory substance and inflammatory markers. Publications from January 1980 to February 2021 were reviewed. Dysmenorrhea is the most common gynecologic condition experienced by menstruating women. It is characterized by crampy lower abdominal pain that can range widely in severity, and associated to others symptoms. Its overall impact often has significant medical and psychosocial implications. The hallmark of primary dysmenorrhea is painful menses in the absence of any associated macroscopic pathologic process, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism. An excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation have been mentioned as the main cause of primary dysmenorrhea. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings. This narrative review investigated and analyzed the pathophysiology of primary dysmenorrhea and the implications of other chemical substances.