Osteochondritis Dissecans of the Lateral Femoral Trochlea Healing after Isolated Medial Patellofemoral Ligament Reconstruction: A Case Report

@#We report on a 12 years old female patient who had been diagnosed with patellofemoral instability – recurrent dislocation and anterior knee pain. Radiologic evaluation further revealed osteochondritis dissecans (OCD) of the lateral femoral trochlea. She underwent surgical procedure with isolated medial patellofemoral ligament reconstruction, no surgical procedure was done to the OCD lesion. Postoperatively, there was clinical improvement of patellofemoral instability, with radiological evidence of healing of the OCD lesion. Isolated realignment procedures such as medial patellofemoral ligament reconstruction may be associated with spontaneous healing of osteochondritis dissecans of the lateral femoral trochlea.

EVALUACIÓN IN VITRO DE LA CAPACIDAD ANTIMICROBIANA DEL ACEITE ESENCIAL DE ENELDO -Anethum graveolens- COMO INHIBIDOR DEL CRECIMIENTO DE Staphylococcus aureus, COLIFORMES Y HONGOS PRESENTES EN LA CARNE DE TRUCHA / IN VITRO EVALUATION OF THE ANTIMICROBIAL CAPACITY OF THE ESSENTIAL OIL OF DILL -Anethum graveolens- AS A GROWTH INHIBITOR OF Staphylococcus aureus, COLIFORMS AND FUNGI FOUND IN TROUT MEAT

El aceite esencial de eneldo tiene propiedades antimicrobianas y antifungicas, por lo que puede ser utilizado para evitar el deterioro de los alimentos. En esta investigación se evaluó la capacidad inhibitoria del aceite esencial de eneldo sobre Staphylococcus aureus, coliformes y hongos presentes en la carne de trucha (Oncorhynchus mykiss), utilizando 50 y 100 pL de aceite esencial. Se evaluaron diferentes condiciones de extracción del aceite esencial mediante el método de hidrodestilación y se logró un rendimiento máximo en base seca de 1,32% utilizando una relación 1:5 de agua y material vegetal durante 90 minutos. Al evaluar la capacidad antimicrobiana, el mayor efecto inhibitorio se obtuvo al aplicar 100 pL de aceite esencial de eneldo en cultivos de Staphylococcus aureus, coliformes fecales, coliformes totales y hongos, evidenciándose un mayor halo de inhibición para coliformes totales.

Dill essential oil has antimicrobial and antifungal properties; therefore it can be used in food to avoid deterioration. In this research, the inhibitory capacity of dill essential oil on Staphylococcus aureus, coliforms and fungi present in trout meat (Oncorhynchus mykiss) was evaluated by using 50 and 100 pL of essential oil. In addition, the different conditions of essential oil extraction were evaluated by the hydrodistillation method, yielding a maximum dry basis yield ofl.32%, using a water-plant ratio of 1:5, during 90 minutes. Antimicrobial capacity was evaluated obtaining greater inhibitory effect when applying 100 pL of dill essential oil in cultures of Staphylococcus aureus, fecal coliforms, total coliforms and fungi, evidencing a greater halo of inhibition for total coliforms.

Correlación del índice plaqueta/ bazo con el grado de várices esofágicas / Correlation between platelet/spleen index and esophageal varices degree

Resumen ANTECEDENTES: las enfermedades hepáticas crónicas en México fueron motivo de 28,904 fallecimientos durante 2012. Su principal complicación fue la hipertensión portal, manifestada por várices esofágicas (VE) que afectan a 30% de los pacientes. OBJETIVO: utilizar la correlación del índice plaqueta/bazo (IPB) con el grado de várices esofágicas como método diagnóstico no invasivo y de decisión terapéutica. MATERIAL Y MÉTODO: estudio observacional, analítico, transversal y retrospectivo, en el que se recolectaron datos de pacientes con diagnóstico de insuficiencia hepática, atendidos en el servicio de Medicina Interna del Hospital Central Norte de Petróleos Mexicanos, entre enero de 2010 y abril de 2016; se calcularon puntos de corte para conocer el grado de asociación del IPB con el grado de várices esofágicas; el patrón de referencia fue la endoscopia digestiva alta. RESULTADOS: se encontró un nivel de significación con valor p de 0.005 y Rho de Spearman de -0.425 que traduce una correlación estadísticamente significativa entre las variables en correlación con la escala de Dagradi y nivel de significación con valor p de 0.001 y Rho de Spearman de -0.492 en correlación con la escala de Baveno. Asimismo, para la escala de Baveno un IPB mayor a 0.700 se correlacionó con várices esofágicas pequeñas, en tanto que un IPB menor a 0.700 se correlacionó con várices esofágicas grandes. CONCLUSIONES: esta correlación puede ser un método no invasivo útil que permite establecer prioridad en cuanto al abordaje diagnóstico y discernir entre iniciar tratamiento farmacológico o realizar un procedimiento endoscópico.

Abstract BACKGROUND: Chronic liver diseases in Mexico were cause of 28,904 deaths in 2012. Its main complication was portal hypertension, manifested by esophageal varices (EV) occurring in 30% of patients. OBJECTIVE: To use the correlation of platelet/spleen index (PSI) with the degree of EV as a noninvasive diagnostic method and therapeutic decision. MATERIAL AND METHOD: An observational, analytical, cross-sectional and retrospective study was done in which data were collected from patients with chronic liver failure assisted at the Department of Internal Medicine of North Central Hospital Pemex, Mexico City, from January 2010 to April 2016. Cutpoints were calculated to determine the degree of association between PSI with the degree of EV; using the upper gastrointestinal endoscopy as the gold standard. RESULTS: We found a significance level with p-value of 0.005 and -0.425 Spearman Rho, defaming a statistically significant correlation between the variables in correlation to Dagradi Scale and a level of significance with p-value of 0.001 and -0.492 Spearman Rho in correlation to Baveno Scale. For Baveno scale it was observed that a PSI higher than 0.700 correlated with small EV, while a PSI lesser than 0.700 PSI correlated with large EV. CONCLUSIONS: This correlation can be a non-invasive useful method which allows to set priority in regard to diagnostic approach and to dis cern between starting drug treatment or doing endoscopic procedure.

Calidad de vida en hemodiálisis y diálisis peritoneal tras cuatro años de tratamiento / Quality of life in hemodialysis and peritoneal dialysis after four years of treatment

Resumen ANTECEDENTES: la hemodiálisis y diálisis peritoneal corrigen algunos síntomas del paciente provocando cambios en el estilo de vida. Hay estudios que demuestran mejor calidad de vida con diálisis peritoneal comparada con hemodiálisis. La escala Kidney Disease Quality of Life (KDQOL SF 36) evalúa adecuadamente la calidad de vida. OBJETIVO: demostrar mayor puntaje en la escala de calidad de vida en pacientes con diálisis peritoneal por más de cuatro años comparados con pacientes en hemodiálisis. MATERIAL Y MÉTODO: estudio observacional, transversal, descriptivo y multicéntrico, realizado del 1 de abril al 31 de mayo de 2016. Se utilizó la escala KDQOL SF 36 en pacientes en diálisis peritoneal o hemodiálisis en el Hospital Central Norte y Regional Poza Rica. Los resultados se compararon con t de Student y χ2. RESULTADOS: se observaron efectos mentales en 39.5% del grupo de diálisis peritoneal vs 47% en hemodiálisis, p 0.05; efectos físicos en 34% de diálisis peritoneal vs 35% en hemodiálisis, p 0.758; carga de la enfermedad renal en 27% en diálisis peritoneal vs 46% en hemodiálisis, p 0.03; efectos de la enfermedad renal en 61% en diálisis peritoneal vs 55% en hemodiálisis, p 0.391; síntomas en 71% en diálisis peritoneal vs 71% en hemodiálisis, p 0.893. CONCLUSIONES: en pacientes con diálisis peritoneal el puntaje es mejor que en pacientes en hemodiálisis en cuanto a efectos de la enfermedad renal. También se observó menor puntaje en pacientes en diálisis peritoneal vs hemodiálisis en carga de la enfermedad renal, área de efectos mentales, efectos físicos y área de síntomas, sin dife rencia estadística. Tampoco hubo diferencia significativa en diálisis a largo plazo (más de cuatro años) entre ambos grupos. Por tanto, el médico y el paciente deben encontrar la modalidad de diálisis que se ajuste mejor a sus necesidades y estilo de vida.

Abstract BACKGROUND: Hemodialysis (HD) and peritoneal dialysis (PD) cor rect some patient symptoms causing changes in the lifestyle. Studies show improved quality of life in PD compared with HD. The scale Kidney Disease Quality of Life (KDQOL SF 36) adequately assesses the quality of life. OBJECTIVE: To show higher scores on the scale of quality of life of patients with peritoneal dialysis (PD) for more than 4 years compared to patients on hemodialysis (HD). MATERIAL AND METHOD: An observational, transversal, descriptive, multicenter study, performed from April 1st to May 31st, 2016. The KDQOL SF 36 scale was used in PD or HD patients in North Central Hospital and Poza Rica Regional Hospital, Mexico. The results were compared with t-Student and χ2. RESULTS: Mental effects in the group of PD 39.5% vs 47% in HD, p 0.05; physical effects on DP 34% vs 35% in HD, p 0.758; burden of kidney disease on PD 27% vs 46% in HD, p 0.03; effects of kidney disease in PD 61% vs 55% in HD, p 0.391; symptoms in PD 71% vs 71% in HD, p 0.893. CONCLUSIONS: Peritoneal dialysis has better score than hemodialysis on effects of kidney disease; PD with lower score that HD in burden of kidney disease, mental effects area; in physical effects, symptoms area with no statistical difference. No significant difference in long-term dialysis (>4 years) between both groups. Therefore, the physician and patient should find dialysis modality that best fits their needs and lifestyle adjustment.

Control glucémico intensivo y sobretratamiento en pacientes mayores de 60 años con diabetes mellitus / Intensive glycemic control and overtreatment in diabetic patients older than 60 years

Resumen ANTECEDENTES: existe incremento de la prevalência de diabetes mellitus 2 y del envejecimiento. Así, los riesgos asociados con control glucémico intensivo en esta población vulnerable se incrementan. Por ello, debe considerarse la posibilidad de un sobretratamiento en estos pacientes. OBJETIVO: determinar la prevalencia de control glucémico intensivo y sobretratamiento en pacientes con diabetes mellitus tipo 2 mayores de 60 años. MATERIAL Y MÉTODO: estudio retrospectivo, transversal, observacional y analítico. De 2013 a 2015 se evaluaron pacientes mayores de 60 años de edad con diabetes mellitus tipo 2, hemoglobina glucosilada (HbAlc) <7% y administración de hipoglucemiantes. Los pacientes se clasificaron en control glucémico intensivo (HbAlc 6.6-7%) y sobretratamiento (HbAlc <6.5%). Los porcentajes de ambos grupos y sus complicaciones cardiovasculares y no cardiovasculares asociadas se compararon utilizando una prueba Z. RESULTADOS: se incluyeron 13,229 pacientes con diabetes mellitus tipo 2 mayores de 60 años; en 2013, fueron 4,381, 16% (n=701) en control glucémico intensivo y 6% (n=256) en sobretratamiento; en 2014 fueron 4,383, 16% (n=697) en control glucémico intensivo y 6% (n=252) en sobretratamiento; en 2015 fueron 4,465, 16% (n=708) en control glucémico intensivo y 6% (n=260) con sobretratamiento. El control glucémico intensivo causó 5, 3 y 1% de complicaciones durante 2013, 2014 y 2015, respectivamente. En el grupo con sobretratamiento el porcentaje de complicaciones fue de 4% en 2013 y de 6% en 2015. Se obtuvo un valor Z de -2.90 (p<0.05), mostrando mayor número en sobretratamiento. CONCLUSIONES: de la población estudiada, 16% estaba en control glucémico intensivo y 6% en sobretratamiento, con incremento significativo de complicaciones en el grupo con sobretratamiento, la hipoglucemia fue la más frecuente.

Abstract BACKGROUND: Due to increasing prevalence of type 2 diabetes mellitus (T2DM) and the overall aging of the population, the number of elderly patients with T2DM is continuously growing. Given the risks associated with intensive glycemic control of those patients, the possibility of overtreatment must be considered. OBJECTIVE: To determine the prevalence of intensive glycemic control and overtreatment in individuals >60 years with T2DM. MATERIAL AND METHOD: An observational, cross-sectional, retrospective and analytical study was done from 2013 to 2015. Individuals >60 years old with T2DM, glycated hemoglobin (HbA1c) <7%, and use of hypoglycemic agents were included. Patients were divided into two groups: intensive glycemic control (HbA1c 6.6-7%) and overtreatment (HbA1c <6.5%). Cardiovascular and non-cardiovascular complications associated with treatment were compared by Z-test. RESULTS: There were included 13,229 patients older than 60 years with T2DM; 4,381 in 2013, 16% (n=701) was classified as intensive glycemic control and 6% (n=256) as overtreatment; 4,383 in 2014, 16% (n=697) as intensive glycemic control and 6% (n=252) as over-treatment; 4,465 in 2015, 16% (n=708) as intensive glycemic control and 6% (n=260) as overtreatment. By this period, adverse outcomes were reported in 5%, 3% and 1% during 2013, 2014 and 2015, respectively; referring to intensive glycemic control group. Likewise, adverse outcomes were reported in 4% and 6% during 2013 and 2015, respectively; referring to overtreatment group. A value of Z-test -2.90 (p<0.05) was obtained, which was increased in overtreatment group. CONCLUSIONS: All data collected during the study highlights a significant increase of cardiovascular and non-cardiovascular adverse outcomes in patients with strict glycemic management, being hypoglycemia the most frequent; 16% are in intensive glycemic control and 6% in overtreatment.

Relación entre síndrome metabólico e índice neutrófilo/linfocito / Relation between metabolic syndrome and neutrophil to lymphocyte ratio

Resumen ANTECEDENTES: el síndrome metabòlico agrupa factores de riesgo de diabetes mellitus 2 y enfermedad cardiovascular: obesidad central, hiperglucemia, hipertensión arterial, hipertrigliceridemia y colesterol de alta densidad (C-HDL) reducido. La obesidad y el síndrome metabòlico son afecciones en las que sobreviene inflamación subclínica crónica, factor de riesgo independiente de enfermedad cardiovascular y aterosclerosis. El índice neutrófilo/linfocito (INL) ha surgido como un marcador pronóstico asociado con un estado proinflamatorio que refleja el equilibrio entre la respuesta inmunitaria innata y adaptativa. OBJETIVO: definir la relación entre el índice neutrófilo/linfocito (INL) elevado y el síndrome metabólico en trabajadores activos adscritos al Hospital Central Norte de PEMEX. Los objetivos secundarios fueron establecer la relación entre el índice neutrófilo/linfocito y los componentes del síndrome metabólico individualmente. MATERIAL Y MÉTODO: estudio retrospectivo, transversal y observacional en el que se evaluaron trabajadores activos de PEMEX de 18 a 65 años de edad y se clasificaron en dos grupos de acuerdo con la existencia o ausencia de síndrome metabólico y se calculó el índice neutrófilo/linfocito de cada uno. RESULTADOS: se incluyeron 334 pacientes, 155 (46%) no cumplieron criterios para síndrome metabólico y 179 (54%) sí. De los pacientes en el cuartil más alto de índice neutrófilo/linfocito (>2.12) 57 correspondieron al grupo con síndrome metabólico (p=0.000). El coeficiente de correlación biserial puntual entre índice neutrófilo/ linfocito y síndrome metabólico fue de 0.235 (p=0.000); 69 de los 235 pacientes con obesidad central estaban en el cuartil más alto de índice neutrófilo/linfocito (p=0.001). CONCLUSIONES: los hallazgos sugieren que existe una relación significativa entre la elevación del índice neutrófilo/linfocito (>2.12) y la existencia de síndrome metabólico y obesidad central.

Abstract BACKGROUND: Metabolic syndrome is a cluster of factors that increases the risk for developing type 2 diabetes mellitus and cardiovascular disease (CVD): central obesity, elevated fasting plasma glucose, arterial hypertension, raised triglycerides and reduced high-density lipoprotein cholesterol (HDL-C). Metabolic syndrome and obesity are entities in which chronic subclinical inflammation develops, an independent risk factor for atherosclerosis and CVD. Neutrophil to lymphocyte ratio (NLR) has emerged as a prognostic marker associated to a proinflammatory state, which reflects the balance between innate and adaptive immune responses. OBJECTIVE: To define the relation between an elevated NLR and the presence of metabolic syndrome in active employees that attend to PEMEX North Central Hospital. Secondary objectives were to establish the relation between NLR and each component of metabolic syndrome individually. MATERIAL AND METHOD: A retrospective, cross-sectional and observational stud was done including employees 18-65 years old and classified them into 2 groups according to metabolic syndrome criteria, NLR was calculated for every patient. RESULTS: Of 334 evaluated patients, 155 (46%) didn't meet the metabolic syndrome criteria, and 179 (54%) did. Fifty-seven patients in the highest quartile of NLR (>2.12) corresponded to the metabolic syndrome group (p=0.000). Point biserial correlation coefficient between NLR and metabolic syndrome was 0.235 (p=0.000). Sixty-nine of the 235 patients with central obesity were at the highest quartile of NLR (p=0.001). CONCLUSION: These findings suggest that there is a statistically significant relation between elevated NLR (>2.12) and presence of metabolic syndrome and central obesity.

Mejorando la respuesta patológica completa con tres esquemas diferentes de antraciclinas en densidad de dosis como primera línea en el tratamiento preoperatorio del cáncer de mama localmente avanzado / Improving the complete pathological response with three different schemes anthracyclines dose density as the first line in the preoperative treatment locally advanced breast cancer

Es un estudio prospectivo multiinstitucional que conlleva, a su vez, tres subestudios y luego se hace el metaanalisis de estos estudios piloto en pacientes con cáncer de mama localmente avanzado que reciben quimioterapia preoperatoria con antraciclinas en densidad de dosis seguido de tres esquemas diferentes, teniendo como objetivo llegar a la respuesta patológica completa (pCR). MATERIAL Y METODOS. Participaron 150 pacientes, 28 pacientes en el primer grupo (4AC+4AT), 57 pacientes en el segundo grupo (4AC+4CptT) y 65 pacientes en el tercer grupo (4AC+ 12 TXe), todos de inicio cánceres inoperables no metastásicos. RESULTADOS. En el primer grupo la RPC fue de 28 %, en el segundo grupo 20 % y en el tercer grupo 24 %, que se incrementó a 35 %, 19 %y 30 %, respectivamente, cuando solo se tabulo los datos de las pacientes que culminaron todo el tratamiento y que no presentaron progresión de enfermedad. CONCLUSIONES. En pacientes con tumores gigantes y en mds de 90 % EC III, las respuestas obtenidas son muy significativas solo con uso de quimioterapia, además de un ahorro económico importante al no usar biológicos. Con esto no se pretende ignorar la gran ayuda de los biológicos, simplemente que, para la realidad peruana, se proponen nuevas alternativas...

Is a prospective multi-institutional study involved three substudies in turn and then the meta-analysis of these pilot studies in patients with breast cancer with locally advanced receiving preoperative chemotherapy with anthracycline dose density followed by 3 different schemes, taking aim to reach the pCR. MATERIAL AND PATIENTS METHODS. 150 patients, 28 patients in the first group (4AC + 4AT), 57 patients in the second group (4CptT 4AC +) and 65 patients in the third group (4AC + I2TXe), all of them with inoperable cancers with nonmetastatic disease. RESULTS. The pCR In the first group was 28 %, in the second group 20% and in the third group 24 %, which increased to 35 %, 19 % and 30 % respectively when only the data of the patients culminating all treatment and no progression of disease was tabulated. CONCLUSIONS. Whereas these patients with giant tumors and in 90 % EC III responses obtained are significant only with use of chemotherapy, in addition to significant cost savings by not using biological agents. We not pretended ignore the evidence that the biological products help in excellent manner, but for our country this is an alternative good way...

Identificação imuno-histoquímica de VEGF e IGF-1 em ovários de cadelas no anestro e estro / Immunohistochemical identification of VEGF and IGF-1 in ovaries of bitches on anestrus and estrus

Com o objetivo de verificar a presença de VEGF e IGF-1 nos ovários de cadelas, foram realizadas análises imuno-histoquímicas do estroma cortical; teca e granulosa de folículos secundários, terciários e terciários pré-ovulatórios luteinizados; e ovócitos de folículos primários, secundários e terciários de ovários de cinco cadelas em anestro (Anest) e cinco em estro (Est). A identificação das fases do ciclo estral foi realizada por citologia vaginal associada a dosagem plasmática de progesterona. Os ovários foram submetidos a tratamento imuno-histoquímico para identificação de VEGF (anticorpo primário PU 360-UP, Biogenex, USA; diluição 1:30) e IGF-1 (anticorpo primário PabCa, Gro-Pep, Austrália; diluição 1:100). Determinou-se um índice de imunomarcação (IM), para cada tecido avaliado, pela razão entre a área positivamente marcada dividida pela área total analisada. Para os ovócitos, verificou-se imunomarcação positiva ou negativa. As comparações de IM entre tecidos foram realizadas pelo teste de Wilcoxon (diferentes tecidos em mesmo grupo) ou Mann-Whitney (mesmo tecido entre diferentes grupos), todas no nível de 5% de significância. VEGF e IGF-1 foram identificados, de forma semelhante (P>0,05), em todas as estruturas avaliadas em ambos os grupos experimentais. Conclui-se que esses fatores de crescimento estão presentes em cadelas no anestro e estro, no estroma cortical ovariano, folículos em diferentes estádios de desenvolvimento e ovócitos.(AU)

In order to verify the presence of VEGF and IGF-1 in the ovaries of bitches, immunohistochemical analyzes of the cortical stroma; theca and granulosa of secondary, tertiary and tertiary luteinized preovulatory follicles; and oocytes of primary, secondary and tertiary follicles of ovaries from five bitches in anestrous (Anest) and five in estrus (Est) was performed. The identification of the phases of the estrous cycle was performed by vaginal cytology associated with the measurement of plasma progesterone. The ovaries were treated for immunohistochemical identification of VEGF (PU 360 primary antibody-UP, Biogenex, USA, dilution 1:30) and IGF-1 (primary antibody PabCa, Gro-Pep, Australia; 1:100 dilution). The immunostaining index (MI) was determined for each tissue by the ratio of positively marked area divided by total analyzed area. For oocytes immunostaining was determined as positive or negative. Comparisons of IM between tissues were performed with the Wilcoxon test (deferent tissues in the same group) or Mann-Whitney test (same tissue between different groups), all at 5% significance level. VEGF and IGF-1 have been similarly identified (P>0.05) in all structures evaluated in both groups. It is concluded that in bitches in estrus and anestrous these growth factors are present in ovary cortical stroma, follicles at different stages of development and oocytes.(AU)

Influence of peak flow changes on the macroinvertebrate drift downstream of a Brazilian hydroelectric dam / Influência de alterações de vazão sobre a deriva de macroinvertebrados a jusante de uma barragem hidrelétrica brasileira

Successive daily peak flows from hydropower plants can disrupt aquatic ecosystems and alter the composition and structure of macroinvertebrates downstream. We evaluated the influence of peak flow changes on macroinvertebrate drift downstream of a hydroelectric plant as a basis for determining ecological flows that might reduce the disturbance of aquatic biota. The aim of this study was to assess the influence of flow fluctuations on the seasonal and daily drift patterns of macroinvertebrates. We collected macroinvertebrates during fixed flow rates (323 m3.s1 in the wet season and 111 m3.s1 in the dry season) and when peak flows fluctuated (378 to 481 m3.s1 in the wet season, and 109 to 173 m3.s1 in the dry season) in 2010. We collected 31,924 organisms belonging to 46 taxa in the four sampling periods. Taxonomic composition and densities of drifting invertebrates differed between fixed and fluctuating flows, in both wet and dry seasons, but family richness varied insignificantly. We conclude that macroinvertebrate assemblages downstream of dams are influenced by daily peak flow fluctuations. When making environmental flow decisions for dams, it would be wise to consider drifting macroinvertebrates because they reflect ecological changes in downstream biological assemblages.

Os sucessivos pulsos diários de vazão decorrentes da operação de usinas hidrelétricas podem perturbar os ecossistemas aquáticos e alterar a composição e estrutura de macroinvertebrados a jusante de barramentos. Nós avaliamos a influência de alterações de vazão sobre a deriva de macroinvertebrados a jusante de uma barragem hidrelétrica como subsídio para a determinação de vazões ecológicas que podem reduzir os distúrbios sobre a biota aquática. O objetivo deste estudo foi avaliar a influência das flutuações de vazão sobre os padrões sazonais e diários de deriva de macroinvertebrados. Nós coletamos os macroinvertebrados durante períodos de vazão fixa (323 m3.s1 na estação de chuvas e 111 m3.s1 na estação seca) e com flutuações de vazão (378 - 481 m3.s1 na estação de chuvas e 109 - 173 m3.s1 na estação seca) no ano de 2010. Foram coletados 31.924 organismos distribuídos em 46 taxa nos quatro períodos amostrais. A composição taxonômica e a densidade de invertebrados a deriva diferiram entre os períodos com vazão fixa e flutuante, tanto na estação de chuvas quanto na seca, mas a riqueza taxonômica não variou significativamente. Em conclusão, as comunidades de macroinvertebrados a jusante de barragens são influenciadas pelas flutuações diárias na vazão. Portanto, os macroinvertebrados a deriva devem ser considerados nos cálculos de vazões ambientais, pois eles claramente refletem as mudanças ecológicas nas comunidades biológicas a jusante de barragens hidrelétricas.

Efeito do enxerto ósseo corticoesponjoso na osteogênese em falha cortical ulnar de galinhas domésticas (Gallus domesticus) / Effect of cortico-cancellous bone grafting in osteogenisis of cortical ulnar failure of domestic chickens (Gallus domesticus)

O objetivo do estudo foi avaliar o efeito do enxerto ósseo corticoesponjoso na osteogênese em falha cortical ulnar de galinhas domésticas. Foram utilizadas 18 galinhas, com aproximadamente 70 semanas de idade e peso corpóreo médio de 2,5kg. Criou-se uma falha óssea na porção diafisária média da ulna em ambas as asas, sendo a direita utilizada como grupo-controle (grupo I) e a esquerda como grupo-tratado (grupo II). As aves foram subdivididas aleatoriamente em quatro subgrupos de acordo com o período de observação (14, 35, 60 e 90 dias). No grupo II, dois fragmentos ósseos da carena do esterno foram retirados, seccionados e implantados na falha óssea. Ao término do período de observação de cada subgrupo, as aves foram abatidas com tiopental sódico para realização dos exames histopatológico e radiográfico post-mortem, com classificação dos resultados em escala semiquantitativa (escore). O grupo II demonstrou osteogênese mais evidente aos 35 e 90 dias de pós-cirúrgico (P<0,05). Ao comparar os grupos I e II, sem levar-se em consideração o tempo de observação, foi possível observar que houve diferença estatística significativa (P<0,05). Conclui-se que o enxerto ósseo corticoesponjoso demonstra potencial osteogênico satisfatório na espécie estudada, entretanto retarda o tempo de remodelação óssea quando aplicado sobre falhas estáveis pequenas.

The aim of this survey was to evaluate the effect of cortico-cancellous bone grafting in osteogenesis in cortical ulnar failure in domestic chickens. Eighteen chickens weighing 2.5kg with approximately 70 weeks of age were used. A bone defect in the middle portion of the ulna shaft was created in both wings; the right wing in the control group (Group I) and the left in the treated group (Group II). The birds were randomly divided into four subgroups according to the observation period (14, 35, 60 and 90 days). In group II, two bone fragments of the keel of the sternum were removed, sectioned and implanted in the bone defects. At the end of the observation period for each subgroup, the birds were euthanaized with sodium thiopental to perform the histopathological and radiographic postmortem, with ranking of results in a semi-quantitative scale (score). Group II showed a more evident osteogenisis at 35 and 90 days after surgery (P<0.05). In comparing both groups, without time observation, there was statistical difference (P<0.05). In conclusion, the cortico-cancellous bone graft demonstrated satisfactory osteogenic potential in the specie studied, however, it delays the bone remodeling time when applied in stable small failures.

Distribution of human immunodeficiency virus type 1 subtypes in the state of Amazonas, Brazil, and subtype C identification

Few studies have reported the molecular epidemiological characterization of HIV-1 in the Northern region of Brazil. The present study reports the molecular and epidemiological characterization of 31 HIV-1 isolates from blood donors from the State of Amazonas who donated blood between April 2006 and March 2007. Serum/plasma samples from all donors were screened for HIV antibodies by ELISA and the results confirmed by Western blot analysis. Genomic DNA was extracted from the buffy coat using the Super Quik-Gene-DNA Isolation kit. Nested PCR was performed on the env, gag, and pol regions of HIV-1 using the Gene Amp PCR System 9700. Sequencing reactions were performed using the inner PCR primers and the DYEnamic™ ET Dye Terminator Kit, and phylogenetic analysis was performed using the gag, pol, and env gene sequences. We collected samples from 31 blood donors who tested positive for HIV-1 in confirmatory experiments. The male:female ratio of blood donors was 3.4:1, and the mean age was 32.4 years (range: 19 to 61 years). Phylogenetic analysis showed that subtype B is the most prevalent among Northern Brazilian HIV-1-seropositive blood donors. One HIV-1 subtype C and one circulating recombinant form (CRF_BF) of HIV-1 were identified in the State of Amazonas. This is the first study showing the occurrence of a possible "homogenous" subtype C in this region of Brazil. This finding could contribute to a better characterization of the HIV-1 strains that circulate in the country.

Asociación entre los polimorfismos de los genes de la enzima convertidora de angiotensina y los receptores AT1R y AT2R y el cáncer de mama: Estudio de casos y controles / The association between the angiotensin converter enzyme (ACE), AT1R and AT2R receptor gene polymorphisms and breast cancer: a case control

Introducción: el cáncer de mama es el segundo casos y 50 controles y se genotipificaron los tipo de cáncer más común y la quinta causa de muerte por cáncer a nivel mundial. Un candidado potencial para la etapa de quimio-prevención es el sistema renina-angiotensina en sus componentes: la enzima convertidora de la angiotensina (ECA), y los receptores de angiotensina II tipo 1 y 2 (ATIR y AT2R).Objetivo: establecer la asociación entre los de cáncer de mama en nuestra población de polimorfismos de los genes de la ECA, los estudio. receptores AT1R y AT2R y el cáncer de mama.Materiales y métodos: se incluyeron 50 casos y 50 controles y se genotipificaron los polimorfismos genéticos Resultados: el genotipo II presentó mayor frecuencia en los controles que en los casos, mientras que el genotipo ID fue más frecuente en los casos, sin diferencias estadísticamente significativas. No se encontró ningún tipo de efecto aditivo de los genotipos y el riesgo de cáncer de mama en nuestra población de estudio. Conclusiones: se ha descrito que la susceptibilidad al cáncer de mama es un fenómeno complejo, en el cual múltiples genes pueden desempeñar un papel importante. Para el caso de esta población, los polimorfismos evaluados no se asocian al cáncer de mama. Se requieren más estudios, con mayor fuerza metodológica sobre este tema, antes de proponer cambios en la práctica clínica.

Introduction: breast cancer is the second most common type of cancer and the fifth cause of death due to cancer around the world. The components of the renin-angiotensin system are potential candidates for chemoprevention therapy: the angiotensin converter enzyme (ACE) and type 1 and 2 angiotensin II receptors (AT1R and AT2R). Objective: establishing an association between ACE gene polymorphisms, AT1R and AT2R receptors and breast cancer. Materials and methods: 50 cases and 50 controls were included and their genetic polymorphisms genotyped. Results: genotype II occurred with greater frequency in controls than in the cases whilst the ID genotype had greater frequency in the cases (without having statistically significant differences). No type of additive effect of genotypes was found with the risk of breast cancer in the population being studied. Conclusions: susceptibility to breast cancer has been described as being a complex phenomenon in which many genes may play an important role. In the case of the population studied here, the polymorphisms evaluated were not associated with breast cancer. Further studies having greater methodological rigor regarding this topic are required before changes in clinical practice can be proposed.

Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

Prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas / Prevalence of fear of falling among a population of older adults and its correlation with mobility, dynamic balance, risk and history of falls

OBJETIVOS: Investigar a prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas. MÉTODOS: Estudo transversal randomizado. Participaram do estudo 147 idosos com idades entre 60 e 92 anos, sendo 94 (65,95 por cento) mulheres e 53 (36,05 por cento) homens. O medo de cair foi avaliado usando FES-I-BRASIL (FIB), a mobilidade foi avaliada por meio do teste "Timed Up and go" (TUG), o risco de quedas, por meio do "Functional Reach Test" (FRT) e o equilíbrio dinâmico, pelo teste da Marcha Tandem (MT). RESULTADOS: Cento e trinta e três (90,48 por cento) idosos relataram medo de cair em pelo menos uma atividade, e 80 (54,42 por cento) dos idosos apresentaram histórico de quedas (HQ). A correlação de Pearson demonstrou resultado significante (p<0,001) do medo de cair com MT (r=-0,44248), FRT (r=-0,51562), HQ (r=0,54069), TUG (r=0,45738) e idade (r=0,39772). CONCLUSÕES: O presente estudo identificou alta prevalência de medo de cair nos idosos da comunidade, independente do HQ, e correlação significativa do medo de cair com mobilidade, equilíbrio dinâmico, risco e HQ.

OBJECTIVES: To investigate the prevalence of fear of falling among a population of older adults and its correlation with mobility, dynamic balance, risk and history of falls. METHODS: This was a randomized cross-sectional study. The participants were 147 older adults between the ages of 60 and 92: 94 women (65.95 percent) and 53 men (36.05 percent). Fear of falling was assessed using FES-I-BRAZIL (FIB); mobility, using the "timed up and go" (TUG) test; risk of falls, using the "functional reach test" (FRT); and dynamic balance, using the "tandem gait test"(TGT). RESULTS: One hundred and thirty-three older adults (90.48 percent) reported fear of falling in at least one activity and 80 older adults (54.42 percent) had a history of falls (HF). Pearson's correlation was statistically significant (p<0.001) between fear of falling and the TGT (r=-0.44248), FRT (r=-0.51562), HF (r=0.54069), TUG (r=0.45738) and age (r=0.39772). CONCLUSIONS: The present study identified high prevalence of fear of falling among older adults in the community, independent of their history of falls, and significant correlations between fear of falling and mobility, dynamic balance, risk and history of falls.

Absence of antimutagenicity of Cochlospermum regium (Mart. and Schr.) Pilger 1924 by micronucleus test in mice

Cochlospermum regium (Mart. and Schr.) Pilger, popularly known as "algodãozinho do campo", is a medicinal plant that grows in the Cerrado of Brazil. This plant has been used in traditional medicine against various diseases such as leucorrhoea, gastritis and ulcers. It has also been effective in treating skin problems like pimples, boils and blotches. In the present study, the in vivo antimutagenicity of aqueous extract of C. regium was evaluated. The Micronucleus Test was performed in polychromatic erythrocytes from Swiss male mice treated with one of the four doses of extract of the plant (19, 38, 76 and 114 mg.kg-1 body weight), administered by intraperitonial injection (i.p.) simultaneously with cyclophosphamide (24 mg.kg-1 b.w.) or mitomycin C (4 mg.kg-1 b.w.). The cytotoxicity was evaluated by polychromatic and normochromatic erythrocytes ratio (PCE/NCE). The results showed no significant reduction of the micronucleated polychromatic erythrocytes frequency (P > 0.05). In conclusion, the data indicate that C. regium roots aqueous extract, for the conditions used, did not exhibit the antimutagenic effect.

Cochlospermum regium (Mart. & Schr.) Pilger, conhecido popularmente como "algodãozinho-do-campo", é uma planta medicinal que cresce no Cerrado brasileiro. Esta planta tem sido utilizada na medicina tradicional contra várias doenças como leucorréia, gastrites e úlceras. Esta também tem se mostrado efetiva no tratamento de doenças de pele como espinhas, furúnculos e manchas. No presente estudo, foi avaliada a antimutagenicidade do extrato aquoso de C. regium pelo Teste do Micronúcleo in vivo. Este ensaio foi realizado em eritrócitos policromáticos de camundongos machos Swiss tratados com quatro concentrações diferentes do extrato da planta (19, 38, 76 e 114 mg.kg-1 por peso corpóreo), administrado por injeção intraperitonial (i.p.) simultaneamente com ciclofosfamida (24 mg.kg-1 p.c.) ou mitomicina C (4 mg.kg-1 p.c.). A citotoxicidade foi avaliada pela razão eritrócitos policromáticos e normocromáticos (PCE/NCE). Os resultados obtidos não mostraram redução significativa da freqüência de eritrócitos policromáticos micronucleados (P > 0,05). Em conclusão, os resultados indicam que o extrato aquoso de raiz de C. regium, para as condições utilizadas, não exibiu efeito antimutagênico.

Linfoma de células B de la zona marginal extranodal del tejido linfoide asociado a mucosas (malt) primario de esófago: Presentación de un caso

El tracto gastrointestinal es la localización mas frecuente de los linfomas no Hodgkin extranodales, sin embargo, el compromiso del esófago es extremadamente raro, con una incidencia menor del 1% de todos los pacientes con linfoma. Se ha descrito con mayor frecuencia afectación secundaria del esófago como parte de un compromiso extenso de un linfoma gástrico o mediastinal. Se presenta el caso de paciente femenina, de 59 años de edad, con síntomas dispépticos de 2 meses de evolución. En la Endoscopia Digestiva Superior (EDS) se evidencia en tercio distal de esófago, lesión elevada, de 1cm de diámetro, con características similares al resto de la mucosa, móvil. La biopsia Endoscópica revela la presencia de un linfoma MALT de bajo grado confirmado por inmunohistoquímica. Se indicó tratamiento de erradicación para H pylori, y los estudios de extensión fueron normales. Posteriormente se realizó resección mucosal endoscópica, donde se observaron grupos aislados de linfocitos neoplásicos, con bordes de resección libres. Paciente con seguimiento endoscópico normal. Pocos casos han sido reportados en la literatura acerca de linfomas MALT de esófago, por lo tanto las características clínicas y biológicas de estos linfomas no están claramente establecidas. Es necesario el estudio y seguimiento de estos casos, para determinar los posibles factores de riesgo y así aplicar las medidas preventivas.

The gastrointestinal tract is the most common extra nodal site involved in Non- Hodgkin's lymphoma. However, esophageal involvement is extremely rare, accounting for less than 1% of patients with lymphoma. It has been described that esophageal involvement in lymphoma is more often a result of contiguous spread from mediastinal lymph nodes or from an extended gastric lymphoma. A 59 year old female consulted for dyspeptic symptoms. Endoscopic examination revealed a small submucosal mass, that measured 1 cm located at the lower thoracic esophagus. The biopsy reported a Malt lymphoma that was confirmed by immunohistochemistry. She received therapy for H. pylori eradication. Endoscopic mucosal resection was performed, and isolated groups of atypical lymphocytes were found, with free resection margins. Endoscopic follow up has been normal. Few cases have been reported in literature, therefore biological and clinical characteristics of MALT lymphoma of the esophagus are currently unknown, further study is needed to establish risk factors in order to be able to take preventive measures.

Linfoma no Hodgkin primario de esófago: Reporte de un caso

El Linfoma esofágico primario es un tumor muy raro, representa menos del 1% de los tumores esofágicos. Se reporta el caso un paciente con linfoma no Hodgkin localizado en esófago medio e inferior, que consulta por disfagia, siendo diagnosticado y tratado exitosamente con quimioterapia, con sobrevida de 12 meses, hasta la actualidad asintomático y sin evidencia de tumor.

SUMMARY Primary esophageal lymphoma is a very rare tumor; represents less than 1 % of all esophageal tumors. We report a case of a patient with no-Hodgkin lymphoma involving the medial and lower esophagus, presenting with dysphagia, he was treated successfully with chemotherapy, with an over all survival of 12 months. He is at the moment, asymptomatic and without evidence of tumor.

Caracterización molecular de alelos ABO*O del locus de grupo sanguíneo ABO en tres poblaciones chilenas / Molecular Characterization of ABO*O Alleles at the ABO Group Locus in Three Chilean Populations

Background: Among the allelic variants of blood groups, the molecular characterization of ABO blood group has clinical and anthropological importance. Aim: To perform a characterization of the molecular variants of the allele ABO*O of the ABO blood group. Material and methods: Eighty four subjects of Aymara origin, living in Northern Chile, 75 individuals of Huilliche origin, living in Southern Chile and 82 subjects living in Santiago (Central Chile), were studied. All individuals were of group O, homozygotes for G261- deletion, that defines O1 alleles. Mutations G188A, G261-, G542A, T646A and C771T, described for alleles O1, O1variant and G542A were determined by PCR-RFLP (polymerase chain reaction-restriction fragment lenght polymorphism). Results: Allele O1variant has frequencies of 0.65, 0.81 and 0.6 in Aymara, Huilliche and Santiago subjects, respectively. The figures for allele O1 are 0.35, 0.19 and 0.4, respectively and those for the allele with G542A mutation are 0.119, 0.113 and 0.079, respectively. Conclusions: These results are concordant with the reported higher frequency of allele O1variant in South American aboriginal populations. The frequencies of G542A allele in these Chilean individuals are lower than those described for Amazon aborigines.

Fecal androgen levels in common marmoset (Callithrix jacchus) males living in captive family groups

In captive common marmoset groups, the reproductive inhibition observed in subordinate female seems to be a result of olfactory, visual and behavioral cues from the dominant female. However, few studies have examined the relationship among adult males living in the same social group. These studies have shown that reproductive failure among peer males seems to be based on hormonal and behavioral mechanisms. New insights on sexual strategies in primates have been shown using fecal steroids, but so far no information is available for common marmoset males. In the present study, we evaluated the influence of light-dark cycle, age and reproductive condition on the profile of fecal androgens in males living in the same family group. Feces were collected from six fathers and six sons for androgen determination during the light phase of the 24-h cycle for eight days randomly distributed over a 4-week period. Androgen levels were determined by enzyme immunoassay technique. Adult sons showed higher androgen levels (166.97 ± 22.95 ng/g) than fathers (80.69 ± 44.38 ng/g) and juveniles (49.06 ± 23.15 ng/g; P < 0.05). No diurnal variation (P > 0.05) in fecal androgen profile was observed in adults or juveniles. No indication of androgen-mediated social competition between fathers and adult sons was demonstrable. These results provide basic information on fecal androgen profile useful to investigate the socioendocrinology of free-ranging common marmoset males and verify that, in contrast to daughters, the reproductive suppression of sons is not based on physiological inhibition of their gonads.

Prevalencia de los trastornos de la sexualidad en mujeres climatéricas: influencia de la menopausia y de la terapia de reemplazo hormonal / Prevalence of sexual dysfunction in climacteric women: influence of menopause and hormone replacement therapy

Background: Few trials have studied the prevalence of sexual dysfunction (SD) and related risk factors in postmenopausal women using the DSM-IV criteria. Aim: To evaluate the prevalence of SD in menopausal women and the impact of risk factors. Patients and methods: Five hundred thirty four healthy women, 40 to 64 years of age were interviewed using the Laumann test (DSM-IV). Results: Mean age was 52.4ñ5.7 years. Eighty three percent were peri or postmenopausal, 23 percent used hormonal substitution therapy and 79.2 percent were sexually active. Among sexually active women, the prevalence of SD increased along with age, from 22.2 percent at the 40-44 years old range to 66.0 percent in the 60-64 years old group. Hormone users and healthy women had a low risk for SD (Odds ratio (OR): 0.1 IC: 0.0-0.1 and OR: 0.6 IC: 0.3-0.9, respectively). The risk increased in menopausal women (OR: 3.3 IC: 1.6-6.9), those older than 49 years (OR: 3.4 IC: 1.8-6.4), those subjected to hysterectomy (OR: 3.7 IC: 1.3-10.6) or those with an impotent sexual partner (OR: 3.2 IC: 1.2-8.6). Conclusions: There is a high prevalence of SD among climacteric women. Estrogens, either endogenous or exogenous, have a positive influence on sexuality