En busca del buen morir / In search of a good death

La muerte siempre ha generado desconcierto, por lo que acompañar en este proceso de final de vida conlleva un alto compromiso existencial. Si a esta difícil tarea se le agregan los condicionantes hospitalarios o legales que sufren los enfermos en su agonía, estamos ante una muerte aterradora, muy distante de una partida que pueda ser considerada amorosa. Como sabemos, la palabra "clínica" hace referencia a la práctica de atender al pie de la cama del paciente, aliviando el dolor del que está por partir; sin embargo, el "corsé legal" de la muerte está alejando al médico de aquel que debiera recibir toda su atención y sus cuidados, atándole el brazo para acompañarlo en el buen morir. Deberíamos debatir y acordar una estrategia que enriquezca la experiencia del momento final de la vida, de modo que ese conjunto acotado de pacientes pueda elegir su forma de partir. Es de un valor incalculable despertar la compasión en este tema tan importante que preocupa al ser humano desde los inicios de la civilización. Sería muy fructífero que aprovechemos la transmisión de sabiduría de siglos de antiguas culturas que han sabido cuidar con humildad la vida hasta el instante de morir. (AU)

Death has always implied confusion, so accompanying this end-of-life process entails a highexistential commitment. If we add to this difficult task the hospital or legal constraints suffered bypatients in their agony, we are facing a terrifying death, very far from a departure that can be considered a loving one. As we know, the word "clinical" refers to the practice of caring for the patient very close to the bed, alleviating the pain of whom is about to leave; however, the "legal corset" of death is separating the doctor from the one who should receive all his attention and care, preventing him from accompanying the pacient in his/her good dying. We should discuss and agree on a strategy that enriches the experience of the end of life, so that patients could choose the way to leave. It is of incalculable value to awaken compassion on this important issue that has concerned human since the beggining of civilization. It would be very fruitful if we take advantage of the enormous wisdom of ancient cultures that have humbly cared for life until the moment of death. (AU)

Viruela del Simio

Resumen La viruela del simio (MPX) es una enfermedad tropical zoonótica, endémica de algunas zonas de África, causada por el virus de la viruela del simio (MPXV); sin embargo, ya no se limita a las regiones endémicas por lo que es un patógeno con alcance global, de importancia para la salud pública. Este virus es miembro del género Orthopoxvirus (OPXV) de la familia Poxviridae. Se trasmite al estar en contacto con una persona o animal infectado o con material contaminado por el virus. El cuadro clínico es semejante a la viruela humana, pero la MPX es menos contagiosa y grave, con una tasa de letalidad inferior y la linfoadenopatía es el signo más notable. El diagnóstico es clínico-epidemiológico y se utilizan diversas técnicas de laboratorio para confirmarlo. No existe un tratamiento específico, las medidas de sostén son individuales y dependen de la evolución de la enfermedad, se utilizan los antivirales para el tratamiento de las formas graves. Se demostró que las vacunas estándar contra la viruela inducen una fuerte protección cruzada contra MPXV. Se realiza una revisión bibliográfica actualizada del tema en cuestión.

Abstract Monkeypox (MPX) is a zoonotic tropical disease, endemic to some areas of Africa, caused by the monkeypox virus (MPXV), however, it is no longer limited to endemic regions and is therefore a pathogen with global reach, of public health importance. This virus is a member of the Orthopoxvirus (OPXV) genus of the Poxviridae family. It is transmitted by being in contact with an infected person or animal or with material contaminated by the virus. The clinical picture is similar to smallpox but MPX is less contagious and severe, with a lower case fatality rate, being lymphadenopathy the most prominent sign. The diagnosis is clinical-epidemiological and various laboratory techniques are used to confirm it. There is no specific treatment, support measures are individual and depend on the evolution of the disease, antivirals are used to treat severe forms. Standard smallpox vaccines have been shown to induce strong cross-protection against MPXV. An updated review of the subject in question is carried out.

Aspectos clínicos e inmunológicos de la infección por SARS-CoV-2 / Clinical and immunological aspects of SARS-CoV-2 infection

Resumen Objetivo: describir los aspectos moleculares y celulares de la respuesta inmune frente a SARS-CoV-2; y las repercusiones clínicas, producto de mecanismos inmunes. Introducción: la aparición de una neumonía atípica en China, en diciembre de 2019, provocó un confinamiento global. El agente responsable de esta enfermedad fue nombrado por el Comité Internacional de Taxonomía de Virus como SARS-CoV-2, y la enfermedad que produce fue denominada COVID-19 por la OMS el 11 de febrero del 2020. Metodología: para este estudio descriptivo se indagó en la base de datos de Pubmed, Science, Nature, The Lancet, The New England Journal of Medicine, medRxiv y Google académico; cuyos descriptores utilizados fueron COVID-19, 2019-nCoV, SARS-CoV-2, linfocitos, anticuerpos e inmunidad; incluyendo en la revisión 130 estudios. Resultados: las manifestaciones clínicas más frecuentes que produce SARS-CoV-2 son: fiebre, tos seca y fatiga; siendo los individuos ancianos que presentan con mayor frecuencia complicaciones como el síndrome de distrés respiratorio agudo, arritmias, fallo cardíaco agudo y shock séptico. Se identificó descensos significativos de las células NK, linfocitos B, linfocitos T CD4+ y CD8+ en sangre periférica en pacientes con cuadros moderados y severos de COVID-19. Discusión: Las células NK y macrófagos se encargan de la contención y eliminación viral en las primeras etapas de la infección por SARSCoV-2. No está claro la relevancia de la respuesta humoral en la contención, y eliminación de SARS-CoV-2. La respuesta de linfocitos T citotóxicos es esencial para la completa resolución de la infección por SARS-CoV-2, ya que logran la eliminación de las células infectadas. No existe un tratamiento antiviral específico recomendado para COVID-19, y actualmente no existe vacuna disponible.

Abstract Objective: To describe the molecular and cellular aspects of the immune response against SARS-CoV-2 and the clinical repercussions resulting from inefficient immune mechanisms. Introduction: The emergence of an atypical pneumonia in China in December 2019 led to a global confinement. The agent responsible for this new disease was named SARS-CoV-2 by the International Committee on Taxonomy of viruses, and the disease it produces was named COVID-19 by the WHO on February 11, 2020. Methodology: For this descriptive study we researched the databases of Pubmed, Science, Nature, The Lancet, The New England Journal of Medicine, medRxiv and Google Scholar; which descriptors used were: COVID-19, 2019-nCoV, SARS-CoV-2, lymphocytes, antibodies and immunity; including 130 studies in the review. Results: The most common clinical manifestations produced by SARS-CoV-2 are: fever, dry cough and fatigue, being the elderly people who are mostly having complications such as acute respiratory distress syndrome, arrhythmias, acute heart failure and septic shock. Significant decreases in NK cells, B lymphocytes, CD4+ and CD8+ T lymphocytes were identified in peripheral blood in patients with moderate and severe COVID-19 conditions. Discussion: NK cells and macrophages are responsible for viral containment and elimination in the early stages of SARS-CoV-2 infection. The relevance of the humoral response in the containment and elimination of SARS-CoV-2 is unclear. The cytotoxic T lymphocyte response is essential for the complete resolution of SARS-CoV-2 infection, as they achieve the elimination of infected cells. There is no specific antiviral treatment recommended yet for COVID-19, and there is currently no vaccine available.

Extraperitoneal (RT) Renal Ectopia – Asymptomatic Case Report

Renal ectopia anatomically results from altered migration of kidneys to their normal position in the lumbar region. Few case reports have been reported in literature. Visceral-tissue variation was in form of quadratus lumborum and psoas major in place of the RT kidney. A 21 year old female with positive HCG (pregnancy test) presented for radiological (ultrasound) confirmation of cyesis, though no sonic evidence of gravidae was observed (< 5 wks GA); confirmatory ectopic kidney was diagnosed on completion of ultrasound. This report underscores the importance of imaging the RT groin and illiac region before surgical intervention thus preventing iatrogenic injury genesis. Treatment of this condition will depend on the functional capacity of the kidney, while nephrectomy is recommended for ‘static’ non-functional kidneys. Non-complicated cases and anatomic variation can be managed conservatively.

Seasonal dynamics of phytoplankton in two tropical rivers of varying size and human impact in Southeast Nigeria / Dinamica de temporada del fitoplankton en dos rios tropicales de tamaño e impacto humano variado en el sureste de Nigeria

Phytoplankton occurrence and dynamics in rivers are mainly shaped by hydrophysical conditions and nutrient availability. Phytoplankton main structuring factors have been poorly studied in West African rivers, and this study was undertaken to identify these conditions in two tropical rivers that vary in size and human impact. For this, environmental variables and phytoplankton monthly samples were collected from the middle reaches of Asu and Cross rivers during an 18 months survey from March 2005-July 2006. Phytoplankton biomass (F=11.87, p=0.003), Shannon-Weiner diversity and species richness (F=5.93, p=0.003) showed significant seasonality in Asu but not in Cross River. Data was analyzed with Canonical correspondence analysis (CCA) and showed environmental differences between the two rivers, nitrate in Asu River (5.1-15.5mg/L) was significantly higher than Cross River (0.03-1.7mg/L), while PO4 (0.2-0.9mg/L) was significantly lower in Asu River compared to Cross River (0.03-2.6mg/L) (p<0.05). Eutrophic factors (NO3) determined primarily phytoplankton dynamics in Asu River, especially during the dry season, whereas hydrophysical factors (depth, transparency and temperature) shaped phytoplankton in Cross River. Taxa indicative of an eutrophic condition, such as Euglena, Chlorella, Chlorococcus, Ceratium, Peridinium, Anabaena, Aphanizomenon, Closterium, Scenedesmus and Pediastrum spp., were frequently encountered in the shallow impounded Asu River, while riverine species, such as Frustulia rhomboids, Gyrosigma sp., Opephora martyr and Surirella splendida dominated Cross River. A succession pattern was observed in the functional groups identified: Na/MP→TB→P (rainy→dry season) was observed in Asu River, whereas MP/D predominated in Cross River for both seasons. We concluded that, if nutrients predominate hydrophysical factors in shaping phytoplankton during dry season (half of the year) then, they are as important as hydrophysical factors structuring phytoplankton during rainy season (the other half).

La existencia del fitoplancton y la dinámica de los ríos están principalmente determinados por condiciones hidrofísica y disponibilidad de nutrientes. Los principales factores de estructuración del fitoplancton han sido poco estudiados en los ríos de Africa Occidental, y este estudio fue realizado para identificar estas condiciones en dos ríos tropicales que varían en tamaño e impacto humano. Para ello, variables ambientales y muestras ambientales mensuales de fitoplancton se obtuvieron de la parte media de los ríos Asu y Cross durante un estudio de 18 meses, de Marzo-2005 a Julio-2006. La biomasa del fitoplancton (F=11.87, p=0.003), el índice de diversidad de Shannon-Weiner y la riqueza de especies (F=5.93, p=0.003), mostraron estacionalidad significativa en Asu pero no el río Cross. Los datos fueron analizados con el análisis de correspondencia canónica (CCA) y mostró diferencias ambientales entre los dos ríos, el nitrato en el río Asu (5.1-15.5mg/L) fue significativamente mayor que en el río Cross (0.03-1.7mg/L), mientras que PO4 (0.2-0.9mg/L) fue significativamente menor en el río Asu en comparación al río Cross (0.03-2.6mg/L) (p<0.05). Los factores eutróficos (NO3) determinaron principalmente la dinámica del fitplancton en el río Asu, especialmente durante la estación seca, mientras que los factores hidrofísicos (profunidad, transparencia y temperatura) conformaron el fitoplancton en el río Cross. Taxones indicadores de una condición eutrófica, como Euglena, Chlorella, Chlorococcus, Ceratium, Peridinium, Anabaena, Aphanizomenon, Closterium, Scenedesmus y Pediastrum spp fueron frecuentemente encontradas en las aguas poco profundas del río Asu, mientras que las especies fluviales, como Frustulia rhomboids, Gyrosigma sp., Opephora martyr y Surirella splendida dominaron el río Cross. Un patrón de sucesión se observó en los grupos funcionales, identificados: Na/MP→TB→P (Estacion lluviosa → estación seca), fue observado en el río Asu, mientras que MP/D predominó en el río Cross para ambas estaciones. Se concluyó que, si los nutrientes predominan los factores hidrofísicos en la conformación del fitoplancton durante la estación seca (la mitad del año), entonces, son tan importantes como los factores hidrofísicos estructurales del fitoplancton durante la temporada de lluvias (la otra mitad).

Do children with Glasgow 13/14 could be identified as mild traumatic brain injury? / Pacientes pediátricos com Glasgow 13 ou 14 podem ser identificados como traumatismo craniano leve?

OBJECTIVE: To identify in mild head injured children the major differences between those with a Glasgow Coma Scale (GCS) 15 and GCS 13/14. METHOD: Cross-sectional study accomplished through information derived from medical records of mild head injured children presented in the emergency room of a Pediatric Trauma Centre level I, between May 2007 and May 2008. RESULTS: 1888 patients were included. The mean age was 7.6±5.4 years; 93.7 percent had GCS 15; among children with GCS 13/14, 46.2 percent (p<0.001) suffered multiple traumas and 52.1 percent (p<0.001) had abnormal cranial computed tomography (CCT) scan. In those with GCS 13/14, neurosurgery was performed in 6.7 percent and 9.2 percent (p=0.001) had neurological disabilities. CONCLUSION: Those with GCS 13/14 had frequently association with multiple traumas, abnormalities in CCT scan, require of neurosurgical procedure and Intensive Care Unit admission. We must be cautious in classified children with GCS 13/14 as mild head trauma victims.

OBJETIVO: Identificar as principais diferenças entre os pacientes com Escala de Coma de Glasgow (GCS) 15 e aqueles com escore 13/14. MÉTODO: Estudo realizado por meio da revisão de prontuários médicos de crianças vítimas de traumatismo craniencefálico leve, admitidas em Centro de Urgências Pediátricas nível I, durante um ano. RESULTADOS: Incluídas 1888 vítimas; idade média de 7,6±5,4 anos; 93,7 por cento apresentaram pontuação 15 na GCS. Naqueles com pontuação 13/14, 46,2 por cento (p<0,001) sofreram traumas múltiplos e 52,1 por cento (p<0,001) apresentaram alterações na tomografia de crânio. Tratamento neurocirúrgico foi necessário em 6,7 por cento dos pacientes com GCS 13/14 e 9,2 por cento (p=0,001) apresentaram seqüelas neurológicas no momento da alta hospitalar. CONCLUSÃO: Crianças com escore 13/14 apresentam maior prevalência de traumas múltiplos, alterações na tomografia de crânio, necessidade de tratamento neurocirúrgico e internação em Unidade de Terapia Intensiva. Devemos ser cautelosos ao classificar crianças com pontuação 13/14 na GCS como vítimas de traumatismo craniano leve.

Efeito de substâncias desinfetantes na adesäo à dentina de um adesivo de quarta geraçäo / Influence of disinfectant solutions on the tensile bond strength of a fourth generation dentin bonding agent

O objetivo do presente trabalho foi avaliar a influência de diferentes substâncias de desinfecçäo cavitária na resistência à traçäo de um sistema adesivo de quarta geraçäo. Foram selecionados 40 molares humanos livres de cáries. Os dentes foram incluídos em resina acrílica e desgastados até expor dentina superficial. Os dentes foram divididos aleatoriamente em 4 grupos e assim tratados: Grupo 1 - MaOCl a 2,5 por cento por 40 segundos; Grupo 2 - clorexidina a 2 por cento por 40 segundos; Grupo 3 - flúor-fosfato acidulado a 1,23 por cento por 4 minutos; e Grupo 4 - controle. Apoós os diferentes tratamentos superficiais o sistema adesivo Scotchbond Multipurpose Plus (3M) foi aplicado na dentina, de acordo com as instruçöes do fabricante. Os corpos-de-prova foram confeccionados com resina composta Z100 (3M) utilizando uma matriz padronizada. Após armazenagem em água destilada por 24 horas, os espécimes foram submetidos ao teste de traçäo em uma máquina universal Mini Instrom. Os resultados em MPa para os diferentes grupos foram: Grupo 1 - 7,37 (ñ2,51); Grupo 2 - 11,25 (ñ4,65); Grupo 3 - 9,80 (ñ3,11); e Grupo 4 - 10,96 (ñ3,37). Os dados foram submetidos à análise estatística de variância, a qual näo permitiu detectar diferenças estatisticamente significantes entre os grupos. Foi possível concluir que as substâncias desinfetantes näo ocasionaram alteraçäo na capacidade adesiva do sistema adesivo de quarta geraçäo empregado