Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Coronavirus disease (COVID-19), classified as a pandemic by the World Health Organization, has affected many deaths to vulnerable populations due to its high transmission capacity. These transmission routes are by direct and indirect contact even of asymptomatic people. This article presents some considerations to take into account regarding the COVID-19 pandemic in oral health and the professional challenges of the stomatologist in state and private consultation from a perspective of the reality of Peru.Main remarks: Procedures that generate aerosols or droplets from the oral cavity increase the risk of transmission to health personnel, especially the stomatologist; since even dental emergency procedures require the use of instruments that generate possible means of contamination. The institutions related to stomatology have to establish biosafety protocols for dental emergency and routine practice to avoid generating chains of transmission. The role of the dentist in this health emergency is to follow biosafety guidelines for dental care in state and private health center.Final considerations: Dental practice is potentially risky in the COVID-19 pandemic, despite this, it is the duty of the dentist to fulfill his role as a health professional considering the biosecurity standards established by the health institutions.

En los pacientes con enfermedad renal crónica en estadio avanzado el trasplante renal es la principal medida terapéutica a implementar, sin embargo, el sistema inmune debe ser modulado para prevenir el riesgo de la perdida del injerto renal. El tratamiento inmunosupresor debe ser individualizado según el riesgo inmunológico de cada paciente; los mTOR son una alternativa que se debe considerar en los pacientes que serán sometidos a un trasplante renal, existen diferentes protocolos de uso, estas modalidades de inicio de fármaco pueden ser  desde la conversión de Novo, la conversión temprana y la tardía; cada uno aporta ventajas y desventajas al paciente trasplantado. El medicamento no está excepto a efectos secundarios a con considerar dentro de los mas destacados la dislipidemia, el retardo en la cicatrización de heridas, la Neumo iris, la proteína Roa y el riesgo de rechazo agudo humoral.

The case of a 55-year-old female with arterial hypertension and asthma, that arrived to the emergency department with an acute presentation of weakness and sensory deficit in both lower limbs is presented. Imaging studies were performed in addition to biopsy and culture of disc and vertebral body, and  spinal cord compression syndrome secondary to infectious spondylodiscitis was diagnosed.

El manejo del trauma vascular es una de los retos en cirugía de trauma. Involucra astucia de parte de los cirujanos involucrados y la capacidad de resolver prontamente y de forma definitiva la ruptura vascular. Presentamos un masculino con lesión de arteria braquial derecha, con pérdida de 2cm de tejido; el cual requirió manejo de control de daños por la ausencia de disponibilidad de cirujano vascular periférico en el centro medico u hospitales cercanos. Se describe las limitaciones técnicas y especializadas en el hospital rural en el que se manejó inicialmente la emergencia. Posterior el paciente presentó complicaciones ya descritas en la literatura. Su evolución en hospital de primer nivel involucró especialistas en vascular periférico, nefrología y cirugía plástica.

The direct influence of the educational environment on the performance of students of medical specialties affects their performance and the quality of care they provide, so instruments have been developed to evaluate it, aiming at specific strengths and weaknesses that allow, if necessary, redirect academic policies, which is relevant in quality management systems and in accreditation processes. Objective: To determine negative aspects in the perception of the educational environment of legal medicine residents of the Posgraduate Program in Forensic Medical Specialties of the University of Costa Rica, as input to establish a strategic university plan with improvement option. Material and Method: Observational, descriptive and quantitative cross-sectional study. The population were the resident doctors of the Posgraduate Program in Legal Medicine. The variables studied were: age, sex, educational environment and semester of residence. For the measurement of the educational environment, the Postgraduate Hospital Educational Environment Measure questionnaire was used in its translation into Spanish, which allows the simultaneous evaluation of three domains of perception: autonomy, teaching and social support; Its application was made in January 2020, it was self-administered, voluntary and anonymous. The analysis calculated absolute and relative frequencies, and means and standard deviation of the items and domains, as well as the global score. Results: The total population of resident doctors participated, 62.5% women and 37.5% men, 75% of them aged between 25 and 30 years old. Their perception of the educational environment was excellent in global terms, with a positive perception of autonomy, quality of teaching and a good and supportive environment, although aspects of the three domains that required correction were identified, obtaining lower scores in all domains in the second semester group that was precisely the one with the lowest performance. Discussion: The identification of aspects to be corrected requires follow-up and periodicity as they are applicable and interpretable in a given space of time. According to the results, the perception of autonomy could improve with the existence of an instruction manual for first-time resident doctors, which includes university aspects that they should know about. Improving the perception of teaching requires involving teachers, to identify coincidences and disadvantages of the teaching function and generate alternatives for improvement, which also have an impact on social support. Conclusion: This study allowed to identify deficient aspects in the educational environment of this postgraduate program, most of them located in the perception of teaching, which require the implementation of a university management plan in the short, medium and long term, which must be continuous.

Kidney stones are solid accumulations of different mineral salts incorporated into an organic matrix, which originate in the kidney or upper urinary tract. There are different types according to their main component, with calcium being the most prevalent. The incidence is higher in middle-aged men, which also have a higher risk of recurrence. Among the most important risk factors are alterations in the urinary concentration of minerals, metabolic syndrome and low water consumption. The most frequent clinical manifestations are pain, hematuria and bacteriuria; however, the majority of cases are asymptomatic. The gold  standard for diagnosis is computerized axial tomography (CAT) scan without contrast. Regarding treatment, it includes the pharmacological approach with nonsteroidal anti-inflammatory (NSAIDs) drugs and surgical management according to the type of kidney stone. Two of the most important complications are acute renal failure and chronic kidney disease, which cause significant morbidity and mortality; making prevention through proper hydration, low sodium and reduced animal protein intake and a normal calcium level diet vital for clinical management.

The adolescent population must be given integrated and adequate health care services to their own needs, considering their particular need to regulate fertility and receive adequate protection. It is therefore essential that the board spectrum of existing contraceptive method alternatives be taken into account, which are not exclusively used to prevent unwanted pregnancies but also offer additional benefits thanks to their non-contraceptive characteristics. This article evaluates key points to choose contraceptive methods and management guidelines that must be taken into consideration for the selection of the ideal individualized method, for which a systematic search of articles was carried out to support the selection. Long-term reversible contraceptives are found to be the first choice in adolescent. The nature and spontaneity in which sexual relations occur in this group age represents a new medical challenge where anticipation of contraceptive guidance is crucial, therefore the American College of Obstetricians and Gynecologists (ACOG) recommends starting reproductive consultations at an early age.

Red blood cell alloimmunization is the second most common immune cause of perinatal hemolytic disease. Even though nowadays it is a less frequent condition due to the advances in its prevention through the administration of anti-Rh gamma globulin, it continues to present with compromising clinical manifestations for the fetus as fetal hydrops and anemia. This paper presents the case of a previously sensitized pregnant woman with Rh isoimmunization and manifestations of severe anemia and hydrops. The case is approached with serial intrauterine transfusions, both technical aspects and perinatal results are described.  

Asymptomatic microhematuria (AMH) is defined as 3 or more red blood cells per field in urinary sediment microscopy in the absence of an obvious cause. The most common causes of AMH in adults are urinary tract infection, benign prostatic hyperplasia and kidney stones, however the possibility of malignancy should always be considered. For initial assessment, rule out benign causes and microscopy urinalysis is essential. The use of imaging studies for diagnosis is necessary, being the CT Urography the most recommended and for patients with a risk factor for malignancy, cystoscopy should always be performed. The follow-up varies according to whether the AMH is persistent or not and the risk factors for malignancy.