Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Posibles mecanismos de acción de la terapia electroconvulsiva en esquizofrenia: revisión de la evidencia disponible en investigación con seres humanos / A review about the putative mechanisms of action of electroconvulsive therapy in schizophrenia in human research

Electroconvulsive therapy (ECT) has multiple uses in psychiatry, but its mechanisms of action (MA) in patients with schizophrenia (PS) are poorly understood. We synthesize and discuss the available evidence in this regard. We conducted a search for primary human studies and systematic reviews searching MA of ECT in PS published in PubMed/Medline, SciELO, PsycInfo, and the Cochrane Library, including 24 articles. Genetic findings are scarce and inconsistent. At the molecular level, the dopaminergic and GABAergic role stands out. The increase in brain derived neurotrophic factor (BDNF) after ECT, is a predictor of positive clinical outcomes, while the change in N-acetyl aspartate levels would demonstrate a neuroprotective role for ECT. This intervention would improve inflammatory and oxidative parameters, thereby resulting in a symptomatic improvement. ECT is associated with an increase in functional connectivity in the thalamus, right putamen, prefrontal cortex and left precuneus, structures that play a role in the neural default mode network. A decrease in connectivity between the thalamus and the sensory cortex and an enhanced functional connectivity of the right thalamus to right putamen along with a clinical improvement have been reported after ECT. Moreover a volumetric increase in hippocampus and insula has been reported after ECT. These changes could be associated with the biochemical pathophysiology of schizophrenia. Most of the included studies are observational or quasi-experimental, with small sample sizes. However, they show simultaneous changes at different neurobiological levels, with a pathophysiological and clinical correlation. We propose that the research on ECT should be carried out from neurobiological dimensions, but with a clinical perspective.

Análisis diferencial del desgaste laboral emocional en profesionales de atención socio-sanitaria geriátrica / Differential Analysis of Emotional Work Wear in Geriatric Socio-health Care Professionals

Resumen El síndrome deBurnouttiene un largo recorrido histórico en el ámbito público de los profesionales dedicados al cuidado de ancianos. En este estudio pretendemos conocer la influencia de diversas variables sociodemográficas sobre el desgaste laboral en profesionales de residencias públicas. La muestra está constituida por 136 trabajadores de ambos géneros y con edades comprendidas entre 18 y 60 años, que desempeñan labores de atención directa y gestión psicosocial. Los instrumentos aplicados han sido el Inventario deburnoutde Maslach & Jackson (1986), y el Cuestionario de Salud General (GHQ-28), de Goldberg & Hillier (1979). Nuestros resultados refieren la existencia de diferencias por sexo (en el cansancio emocional, así como en elburnouten general) y por tiempo de antigüedad en la profesión (concretamente en realización personal y enburnouten general). Estos resultados van a reforzar la necesidad de potenciar la resiliencia de los equipos interdisciplinares de profesionales orientados a proteger la salud de las personas trabajadoras en materia de prevención de riesgos laborales.

Abstract Burnout syndrome has had a long history in the public arena of professionals dedicated to the care of the elderly. In this study, we aim to understand the influence of various socio-demographic variables on work-related wear of professionals in public residences. The sample consists of 136 workers of both genders, aged between 18 and 60, who carry out direct care and psychosocial management tasks. The instruments applied were the burnout inventory by Maslach & Jackson (1986), and the General Health Questionnaire (GHQ-28) by Goldberg & Hillier (1979). Our results point to the existence of differences by sex in emotional fatigue as well as in burnout in general; and by work seniority (specifically, in personal fulfillment; and in burnout in general). These results will reinforce the need to strengthen the resilience of interdisciplinary professional teams aimed at protecting the health of working people in terms of occupational risk prevention.

FOXP2 and language alterations in psychiatric pathology / FOXP2 and language alterations in psychiatric pathology

Abstract Background From the first reports of the linguist Noam Chomsky it has become clear that the development of language has an important genetic component. Several reports in families have shown the relationship between language disorders and genetic polymorphisms. The FOXP2 gene has been a fundamental piece for the understanding of language development. This gene codes for a transcription factor containing a forkhead domain of DNA binding and participates in the regulation of the expression of a large number of genes involved in the embryonic development of fundamental neuronal structures needed for the development of speech and language. Objective To present an updated view of the relationship between FOXP2 and language alterations in psychiatric pathology. Method Narrative review of information reported in databases on the recent advances supporting genetic participation in language disorders of psychiatric illness. Results Update of content related to FOXP2 and its participation in language alterations in psychiatric diseases. Discussion and conclusion Advances in the genetic study of language disorders in psychiatric pathology open up new avenues of investigation that allow us to explore how language emerged and how it evolved, as well as to carry out comparative studies on the structure and functioning of genes to approach the understanding of this complex characteristic that makes us human.

Resumen Antecedentes Desde los primeros reportes del lingüista Noam Chomsky ha quedado claro que el desarrollo del lenguaje tiene un importante componente genético. Diversos reportes en familias han mostrado la relación entre los trastornos del lenguaje y ciertos marcadores genéticos. El gen FOXP2 ha sido una pieza fundamental para entender el desarrollo del lenguaje. Se trata de un gen que codifica para un factor de transcripción con un dominio forkhead de unión al DNA y que participa en la regulación de la expresión de un gran número de genes durante el desarrollo embrionario de estructuras neuronales fundamentales para el desarrollo del habla y el lenguaje. Objetivo Presentar un panorama actualizado de la relación del gen FOXP2 en las alteraciones del lenguaje en la patología psiquiátrica. Método Revisión narrativa de la información reportada en diversas bases de datos sobre los recientes avances que soportan la participación genética en las alteraciones del lenguaje presentes en enfermedades psiquiátricas. Resultados Actualización del contenido relacionado con el gen FOXP2 y su participación en las alteraciones del lenguaje en las enfermedades psiquiátricas. Discusión y conclusión Los avances en el estudio genético de las alteraciones del lenguaje en la patología psiquiátrica abren nuevos caminos de investigación que permiten explorar cómo surgió y cómo ha evolucionado el lenguaje, así como para llevar a cabo estudios comparativos sobre la estructura y el funcionamiento de genes para aproximarse al entendimiento de esta compleja característica que nos hace humanos.

Granulomatous pigmented purpuric dermatosis: report of a Latin-American case with blaschkoid distribution

Abstract Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.

Bullous pemphigoid associated with psoriasis: a good response to methotrexate

Abstract Psoriasis has been associated with various autoimmune diseases, however, its relation to bullous diseases is infrequent. Of these, bullous pemphigoid appears as the main associated entity, even though both conditions differ considerably in demographic and clinical aspects. We report the case of a 42-year-old female patient, with long-standing psoriasis who consulted due to the exacerbation of psoriatic plaques associated with generalized bullous lesions on the skin and oral mucosa, with one-week duration. With clinical signs and histopathological findings compatible with bullous pemphigoid associated with psoriasis, we decided to treat her with methotrexate 10mg a week. The patient had an excellent response after two months of treatment.

Infección por Serratia marcescens: una inusual causa de lesiones cutáneas / Serratia marcescens infection: an unusual cause of skin lesions

Serratia marcescens corresponde a un bacilo gram negativo, miembro de la familia Enterobacteriaceae. Este microorganismo tiene una alta capacidad de supervivencia en condiciones hostiles y ha sido implicado en infecciones del tracto respiratorio, vía urinaria, meningitis, endocarditis y sistema musculoesquelético. No obstante, es considerado una causa rara de infecciones cutáneas. Esta última tiene distintas presentaciones clínicas, la más frecuente es fascitis necrotizante seguida de celulitis. Los nódulos, las pápulas después de inyecciones de rellenos, las erupciones papulares diseminadas, las placas eritematosas, las pústulas y las úlceras son parte del amplio espectro de formas clínicas descritas en la literatura. Presentamos el caso de una paciente de 50 años, con historia de compromiso del estado general, lesiones cutáneas polimorfas y fiebre. Se confirmó una infección cutánea por Serratia marcescens mediante cultivos. Se destaca el polimorfismo y la coexistencia de distintas manifestaciones en una misma paciente, incluyendo celulitis, nódulo, ulceras y necrosis cutánea y la importancia del estudio microbiológico para el adecuado tratamiento antibiótico.

Serratia marcescens corresponds to gram negative bacillus, a member of the Enterobacteriaceae family. This microorganism has a high survival capacity in hostile conditions and has been implicated in respiratory tract, urinary tract, meningitis, endocarditis and musculoskeletal system infections. However, it is considered a infrequent cause of cutaneous infections. Has different clinical presentations, the most frequent is necrotizing fasciitis followed by cellulite. Nodules, papules after filler injections, disseminated papular eruption, erythematous plaques, pustules and ulcers are part of the broad spectrum of clinical forms described in the literature. We present the case of a 50 year old patient with a history of compromised general condition, polymorphic cutaneous lesions and fever. Serratia marcescens cutaneous infection was confirmed by cultures. The polymorphism and the coexistence of different manifestations in the same patient, including cellulitis, nodule, ulcers and skin necrosis, and the importance of the microbiological study for the adequate antibiotic treatment are highlighted.

Complete Colombian Caribbean loggerhead turtle mitochondrial genome: tRNA structure analysis and revisited marine turtle phylogeny / Genoma mitocondrial completo de la tortuga caguama del Caribe colombiano: análisis de la estructura del tRNA y revisión de la filogenia de las tortugas marinas / Genoma mitocondrial de tartaruga-cabeçuda do Caribe colômbiano completo: análise de estrutura de tRNA e filogenia revisada de tartarugas marinhas

Abstract The loggerhead marine turtle, Caretta caretta, is a widely distributed and endangered species that is facing critical population decline, especially in Colombian Caribbean rookeries. Mitochondrial DNA sequence data are of great importance for the description, monitoring, and phylogenetic analyses of migratory turtle populations. In this study, the first full mitochondrial genome of a loggerhead turtle nesting in the Colombian Caribbean was sequenced and analyzed. This mitochondrial genome consists of 16 362 bp with a nucleotide composition of T: 25.7 %, C: 27 %, A: 35 % and G: 12 %. Sequence annotation of the assembled molecule revealed an organization and number of coding and functional units as reported for other vertebrate mitogenomes. This Colombian loggerhead turtle (Cc-AO-C) showed a novel D-Loop haplotype consisting of thirteen new variable sites, sharing 99.2 % sequence identity with the previously reported Caribbean loggerhead CC-A1 D-Loop haplotype. All 13 protein-coding genes in the Cc-AO-C mitogenome were compared and aligned with those from four other loggerhead turtles from different locations (Florida, Greece, Peru, and Hawaii). Eleven of these genes presented moderate genetic diversity levels, and genes COII and ND5 showed the highest diversity, with average numbers of pair-wise differences of 16.6 and 25, respectively. In addition, the first approach related to t-RNAs 2D and 3D structure analysis in this mitogenome was conducted, leading to observed unique features in two tRNAs (tRNATrp and tRNALeu). The marine turtle phylogeny was revisited with the newly generated data. The entire mitogenome provided phylogenetically informative data, as well as individual genes ND5, ND4, and 16S. In conclusion, this study highlights the importance of complete mitogenome data in revealing gene flow processes in natural loggerhead turtle populations, as well as in understanding the evolutionary history of marine turtles.

Resumen La tortuga marina caguama, Caretta caretta, es una especie ampliamente distribuida pero que enfrenta una crítica reducción de su población en las colonias del Caribe colombiano. Los datos de las secuencias de DNA mitocondrial son de gran importancia para la descripción, monitoreo y análisis de la filogenia de las tortugas migratorias. En este estudio se secuenció y analizó por primera vez el genoma mitocondrial completo de la tortuga caguama que anida en el Caribe colombiano. Este genoma tiene un tamaño de 16.362 pb con una composición de nucleótidos de T: 25.7 %, C: 27 %, A: 35 % y G: 12 %. La anotación de la secuencia de la molécula reveló una organización y número de unidades codificantes y funcionales como los reportados para mitogenomas de otros vertebrados. Esta tortuga caguama colombiana (Cc-AO-C) mostró un nuevo haplotipo D-Loop que contiene trece nuevos sitios variables, que comparten el 99.2 % de identidad de secuencia con el haplotipo CC-A1 D-Loop previamente reportado para la tortuga caguama del Caribe. Los trece genes que codifican proteínas en el mitogenoma Cc-AO-C se compararon y alinearon con los de otras cuatro tortugas caguama de distintas localidades (Florida, Grecia, Perú y Hawái). Once de estos genes presentaron niveles moderados de diversidad genética, y los genes COII y ND5 mostraron las diversidades nucleotídicas más altas, con un número promedio de diferencias entre pares de secuencias de 6.6 y 25, respectivamente. Adicionalmente, se llevó a cabo la primera aproximación relacionada con el análisis de la estructura 2D y 3D de t-RNAs en este mitogenoma, lo cual condujo a la observación de características únicas en dos tRNAs (tRNATrp y tRNALeu). La filogenia de las tortugas marinas fue revisada a la luz de la nueva información mitogenómica. El mitogenoma, así como los genes individuales ND5, ND4 y 16S, proporcionan datos filogenéticamente informativos. En conclusión, este estudio resalta la importancia de los datos del mitogenoma para revelar procesos de flujo génico en las poblaciones naturales de tortuga caguama, así como para entender la historia evolutiva de las tortugas marinas.

Resumo A tartaruga marinha Caretta caretta (Cc) é uma espécie amplamente distribuída e ameaçada de extinção que enfrenta um declínio crítico da população, especialmente nas colônias do Caribe colombiano. Marcadores moleculares, como sequências de DNA mitocondrial (mtDNA), são de grande importância para a descrição, monitoramento e análise filogenética de populações migratórias de tartarugas. Este estudo mostra a obtenção e análise do genoma mitocondrial de uma tartaruga-cabeçal Cc aninhada na costa Caribe da Colômbia. O genoma mitocondrial é constituído por 16.362 pb, com uma região não codificante (D-Loop), 13 genes codificadores de proteínas (13 PCG), 22 genes tRNA e 2 rRNA (16S e 12S) e uma frequência nucleotídica de T: 25.7 % , C: 27 %, A: 35 % e G: 12,2 %, todos organizados de forma semelhante à maioria dos mitogenomos de vertebrados. Esta tartaruga Cc colombiana apresentou um novo haplótipo D-Loop com treze sítios polimórficos quando comparado ao haplótipo CC-A1.1 (96 %). Além disso, onze genes codificadores de proteínas entre as tartarugas marinhas de diferentes origens apresentaram uma diversidade genética semelhante, exceto os genes COII e ND5 que apresentaram o maior número médio de diferenças entre pares de seqüências (16.600 e 25.000, respectivamente). Aqui relatase a primeira abordagem relacionada à análise de estruturas 2D e 3D para Cc e descrevese as diferenças em dois tRNAs (tRNATrp, tRNALeu). As inferências bayesianas e os métodos de máxima verossimilhança explicam melhor a filogenia das tartarugas marinhas quando utilizamse mitogenomes completos, assim como os genes ND5, ND4 e 16S. Os genes marcadores ATP8, ND4L e ND1 apresentaram relação filogenética pouco suportada. Como conclusão, este estudo apresenta o uso de mitogenomes completos como uma alternativa para melhorar a análise filogenética em tartarugas marinhas e é a primeira análise genética de mitogenomes completos de nidificação na Colômbia.

Erythrodermic psoriasis and human immunodeficiency virus: association and therapeutic challenges

Abstract: Erythrodermic psoriasis is a rare but severe type of psoriasis that may be triggered by human immunodeficiency virus infection. We describe the case of a 65-year-old male patient with chronic psoriasis who presents an exacerbation of his condition over a period of two weeks. Because of the severity of his case and subsequent need for systemic therapy, human immunodeficiency virus enzyme immunoassay was performed and tested positive. He thus began antiretroviral therapy combined with acitretin, showing good clinical response after 8 weeks of treatment. There is little evidence regarding the management of erythrodermic psoriasis associated with HIV infection, so antiretroviral therapy and systemic retinoid remain as the first-line treatment.

Identificación y evaluación de actividad celulolítica en aislamientos nativos de Trichoderma spp obtenidos de biomasa de palma de aceite / Identification and screening of lignocellulosic activity in native isolates of Trichoderma spp., obtained from palm oil biomass

RESUMEN Se aislaron previamente ocho cepas nativas de racimos de palma de aceite en descomposición de Trichoderma sp. provenientes de la región de Cumaral, Meta, Colombia. Se utilizó la región de los ITS1-ITS4 para la identificación molecular y se determinó la actividad celulolítica (actividad sobre papel filtro) del complejo producido por las cepas utilizando residuos de palma como sustrato. Siete aislamientos nativos presentarón 100% de similaridad con hongos del género Trichoderma. Se observó para siete cepas, la presencia de las cinco anclas que identifican hongos del género Trichoderma, identificándose cuatro de los hongos nativos como Trichoderma koningiopsis (HR-04-89; HR-11-89; HR-19-89; y HR-06-89) y cuatro como Trichoderma asperellum (HR-01-89; HR-03-89; HR-16-89; HR-18-89). El bioensayo mostró que las cepas evaluadas de Trichoderma son estadísticamente significativas sobre la actividad enzimática de celulasas sobre papel filtro (p<0.05). Además, las cepas HR-01-89, HR-03-89, HR-11-89, HR-04-89 y HR-18-89 no presentaron diferencias en la actividad enzimática. La cepa Trichoderma reesei utilizada como referencia, presentó un comportamiento superior y diferente comparado con las cepas nativas. La cepa nativa HR-18-89 (Trichoderma asperellum) presentó mayores niveles de actividad enzimática, 78% del valor de la cepa referencia. Es importante identificar y evaluar cepas nativas de Trichoderma sp. con novedosas actividades biológicas que permitan degradar la celulosa recalcitrante de los racimos de palma africana.

ABSTRACT Previously, there were isolated eight native strains of Trichoderma sp. from a cluster of decomposing oil palm from Cumaral, Meta, Colombia. The ITS1-ITS4"s region was used for the molecular identification and the cellulase activity (filter paper activity) of the complex produced by strains was determined using palm waste as substrate. Seven native isolations showed between 97-100% similarity with fungi of the genus Trichoderma. It was observed for seven of the eight strains the presence of the five anchors which identify fungi of the genus Trichoderma, finding five of the native fungi such as Trichoderma koningiopsis (HR-04-89; HR-11-89; HR-19-89; y HR-06-89) four as Trichoderma asperellum (HR-01-89; HR-03-89; HR-16-89; HR-18-89). The bioassay showed that Trichoderma strains tested are statistically significant on the enzymatic activity of cellulases on filter paper (p <0.05). In addition, strains HR-01-89, HR-03-89, HR-11-89, HR-04-89 and HR-18-89 showed no differences in enzymatic activity. The reference strain used, Trichoderma reesei produce a superior and different behavior compared with the native strains. The native strain HR-18-89 (Trichoderma asperellum) had higher levels of enzyme activity, 78% of the value of the reference strain. It is important to identify and evaluate native strains of Trichoderma sp. with innovative biological activities that allow to degrade the recalcitrant cellulose of the African palm clusters.

Adenocarcinoma de uraco: presentación de dos casos / Urachal adenocarcinoma: report of two cases

OBJETIVOS: Revisión de la literatura del Adenocarcinoma de uraco y presentación de dos casos MÉTODOS/RESULTADOS: Analizamos las características epidemiológicas, clínicas y terapéuticas del Adenocarcinoma de uraco y presentamos dos casos diagnosticados y tratados en nuestro centro CONCLUSIONES: El Adenocarcinoma de uraco es una neoplasia rara, con mal pronóstico y cuyo tratamiento generalmente es la cistectomía parcial o radical con resección en bloque del uraco y el ombligo. Debido a su gravedad, debería tenerse en cuenta a la hora del diagnóstico.AU

OBJECTIVE: Literature review of Urachus adenocarcinoma and report of two cases. METHODS/RESULTS: We analyze epidemiological, clinical and therapeutic features of the Urachus adenocarcinoma and we report two cases diagnosed and treated in our institution. CONCLUSIONS: The Urachus adenocarcinoma is a rare cancer, with poor prognosis and treatment of which usually is radical or partial cystectomy with umbilicotomy and removal of the urachus in bloc. Due to its gravity, you should keep it in mind when you make a diagnosis.AU

Complicaciones y manejo de procedimientos dermatoestéticos: una actualización para el dermatólogo / Complications associated with cutaneous aesthetic procedures: an update for the dermatologist

En las últimas décadas se han desarrollado nuevas técnicas e indicaciones de los procedimientos estéticos mínimamente invasivos, presentando cada vez mejores resultados con un alto nivel de seguridad, sin embargo, estos no se encuentran exentos de complicaciones, las que pueden ser transitorias o permanentes. El conocimiento, abordaje, tratamiento y prevención de las distintas complicaciones son esenciales para los dermatólogos y cirujanos plásticos. Los procedimientos más utilizados son: administración de rellenos, peeling químicos, láser, luz pulsada intensa y ultrasonido de alta frecuencia. La siguiente revisión tiene como objetivo reconocer las principales complicaciones de estos procedimientos y su manejo.

In recent decades, new techniques and indications of minimally invasive aesthetic procedures have been developed, presenting increasingly better results with a high level of safety, however these are not exempt from complications, which may be transient or permanent. The knowledge, approach, treatment and prevention of the different complications are essential for the dermatologist and plastic surgeons. The most used procedures are the administration of fillers, chemical peels, lasers, intense pulsed light and high frequency ultrasound. The following review aims to recognize the main complications of these procedures and their management.

Análisis de haplotipos de la tortuga cabezona Caretta caretta (Testudines: Cheloniidae) en dos playas del Caribe colombiano / Analysis of haplotypes of the loggerhead turtle, Caretta caretta (Testudines: Cheloniidae), on two beaches of the Colombian Caribbean / Análise de haplotipos da tartaruga cabeçona, Caretta caretta (Testudines: Cheloniidae) em duas praias do Caribe colombiano

Resumen Introducción. La tortuga Caretta caretta habita los mares tropicales y subtropicales. Es una especie en vía de extinción que anida las playas en Colombia y hace extensas migraciones. Los haplotipos mitocondriales de esta tortuga se han utilizado para estudios de genética poblacional, filogeografía y estado de las especies con el objetivo de desarrollar planes de conservación de la especie. Objetivo. Identificar haplotipos mitocondriales en tortugas cabezonas anidantes del Caribe colombiano. Materiales y Métodos. Se recolectaron muestras de sangre periférica de esta especie en dos sitios del Caribe colombiano: Don Diego (playa de anidación) y la Isla San Martin de Pajarales (localidad de alimentación). El ADN total fue extraído a partir de las células sanguíneas, y utilizado para amplificar por PCR la región control mitocondrial (398 pb). Estos productos fueron purificados y secuenciados. Se realizó un alineamiento básico buscando regiones de similitud local entre las secuencias obtenidas y las descritas previamente para la especie. Se hicieron análisis filogenéticos utilizando los criterios de máxima parsimonia (MP) y máxima verosimilitud (ML). Resultados. Se identificaron tres haplotipos, CC-A1 y CC-A2 comúnmente encontrados en poblaciones reproductivas de México, el Mediterráneo y el sudeste de Estados Unidos, y un nuevo haplotipo CC-SM1 en la playa Don Diego (Magdalena). Los árboles filogenéticos muestran relación de una porción de los individuos anidantes y de forrajeo de las agregaciones del Caribe colombiano con las súper-agregaciones del Atlántico y el Mediterráneo, sugiriendo que estas podrían ser algunas de las fuentes importantes de individuos presentes en Colombia. Conclusiones. Es necesario estudiar una muestra más grande para poder confirmar hipótesis planteadas. Se identificó un nuevo haplotipo denominado CC-SM1. Este es el primer estudio sobre haplotipos mitocondriales de C. caretta realizado en Colombia.

Abstract Introduction. The Caretta caretta turtle inhabits tropical and subtropical seas. It is an endangered species that nests on Colombian beaches and makes long migrations. The mitochondrial haplotypes of this turtle have been used for population genetics, phylogeography and species status studies with the aim of developing species conservation plans. Objective. Identify mitochondrial haplotypes in nesting loggerhead turtles from the Colombian Caribbean. Materials and Methods. Peripheral blood samples from this species were collected in two sites of the Colombian Caribbean: Don Diego (nesting beach) and San Martin de Pajarales island (feeding ground). The total DNA was extracted from blood cells and used to amplify the mitochondrial control region by PCR (398 bp). These products were purified and sequenced. A basic alignment was performed looking for local similarity regions between the sequences obtained and those previously described for the species. Phylogenetic analyses were conducted by using the maximum parsimony (MP) and maximum likelihood (ML) criteria. Results. Three haplotypes were identified: CC-A1 and CC-A2, which are commonly found in breeding populations in Mexico, the Mediterranean and southeast U.S.; and a new haplotype, CC-SM1, on the Don Diego beach (Magdalena). The phylogenic trees show a relationship between a portion of the nesting and feeding individuals from the Colombian Caribbean aggregations and the Atlantic and Mediterranean super-aggregations, suggesting that these could be some of the important sources for individuals inhabiting Colombia. Conclusions. It is necessary to study a larger sample to be able to confirm the proposed hypotheses. A new haplotype called CC-SM1was identified. This is the first study on C. caretta mitochondrial haplotypes conducted in Colombia.

Resumo Introdução. A tartaruga Caretta caretta habita os mares tropicais e subtropicais. É uma espécie em via de extinção que enraíza as praias na Colômbia e faz extensas migrações. Os haplotipos mitocondriais desta tartaruga se há utilizado para estudos de genética populacional, fílogeografía e estado das espécies com o objetivo de desenvolver planos de conservação da espécie. Objetivo. Identificar haplotipos mitocondriais em tartarugas cabeçonas enraizada no Caribe colombiano. Materiais e Métodos. Se coletaram amostras de sangue periférica desta espécie em dois lugares do Caribe colombiano: Don Diego (praia de enraizamento) e a Ilha San Martin de Pajarales (localidade de alimentação). O DNA total foi extraído a partir das células sanguíneas, e utilizado para amplificar por PCR a região controle mitocondrial (398 pb). Estes produtos foram purificados e sequenciados. Se realizou um alinhamento básico buscando regiões de semelhança local entre as sequências obtidas e as descritas previamente para a espécie. Se fez análise filogenéticos utilizando os critérios de máxima parcimônia (MP) e máxima verossimilitude (ML). Resultados. Se identificaram três haplotipos, CC-A1 e CC-A2 comumente encontrados nas populações reprodutivas do México, o Mediterráneo e o sudeste de Estados Unidos, e um novo haplotipo CC-SM1 na praia Don Diego (Magdalena). As árvores filogenéticos mostram relação de uma porção dos indivíduos enraizados e de forragem das agregações do Caribe colombiano com as super-agregações do Atlântico e o Mediterrâneo, sugerindo que estas poderiam ser algumas das fontes importantes de indivíduos presentes na Colômbia. Conclusões. É necessário estudar uma amostra maior para poder confirmar hipótese proposta. Se identificou um novo haplotipo denominado CC-SM1. Este é o primeiro estudo sobre haplotipos mitocondriais de C. caretta realizado na Colômbia.

Utilidad de tinción de tricrómico de Masson en la cuantificación de densidad media vascular en mucosa oral normal, displasia epitelial y carcinoma oral de células escamosas / Utility of Masson's trichrome stain in the quantification of mean vascular density in normal oral mucosa, epithelial dysplasia and oral squamous cell carcinoma

RESUMEN: El objetivo de este estudio fue valuar la utilidad del uso de la tinción de Tricrómico de Masson (TM) en la cuantificación de la densidad media vascular (DMV) en Mucosa Oral Normal (MON), Displasia Epitelial Oral (DEO) y Carcinoma Oral de Células Escamosas (COCE). Estudio descriptivo de serie de casos. Se analizaron 17 muestras de MON, 15 muestras de DEO y 16 de COCE, teñidas con TM. Para determinar su utilidad, se compararon con las mismas muestras analizadas con técnica de inmunohistoquímica contra CD31. La cuantificación de la DMV se realizó en las 3 áreas de mayor vascularización de cada muestra. Se determinó la DMV según diagnóstico mediante la tinción TM e inmunohistoquímica contra CD31, y se calculó la correlación entre ambos. La DMV cuantificada con TM y contra CD31 difiere según el diagnóstico, observándose un aumento de la DMV al malignizarse el diagnóstico. No se encontraron diferencias al comparar la DMV cuantificada con TM y contra CD31. La correlación de la DMV analizado por TM y contra CD31 es significativa y moderada. La cuantificación de vasos sanguíneos es posible mediante la tinción de TM en muestras de MON, DEO y COCE, con una correlación moderada con la inmunohistoquímica contra CD31.

SUMMARY. The objective of this study was to evaluate the utility of Masson's Trichrome (TM) staining in the quantification of the mean vascular density (DMV) in samples of normal oral mucosa (MON), oral epithelial dysplasia (ODE) and oral squamous cell carcinoma (COCE). The design - a descriptive study of case series. We analyzed 17 samples of MON, 15 samples of DEO and 16 samples of COCE, stained with TM. To determine usefulness, we compared and analyzed the same samples, either stained with TM or with immunohistochemical technique against CD31. Quantification of the DMV was performed in the 3 areas of greatest vascularization in each sample. DMV was determined according to diagnosis by TM staining and immunohistochemistry against CD31, and the correlation between the two was then calculated. DMV quantified with TM and against CD31 differs according to the diagnosis, with an increase in DMV upon malignant diagnosis. No differences were found when comparing DMV quantified with TM and against CD31. The correlation of the DMV analyzed by TM and against CD31 is significant and moderate. Quantification of blood vessels is possible by TM staining in samples of MON, DEO and COCE. TM staining is moderately correlated with immunohistochemistry against CD31.

Inmunoexpresión de E-cadherina y vimentina en mucosa oral normal, displasia epitelial oral y carcinoma oral de células escamosas / Immunoexpression of E-cadherin and vimentin in normal oral mucosa, oral epithelial displasia and oral squamous cell carcinoma

El objetivo fue evaluar la inmunoexpresión de E-cadherina y Vimentina en mucosa oral normal (MON), displasia epitelial oral (DEO) y carcinoma oral de células escamosas (COCE). Se realizó un estudio descriptivo de una serie de casos analizandolos mediante técnica de inmunohistoquímica contra E-cadherina y Vimentina 16 muestras de MON, 16 de DEO y 19 de COCE. La inmunotinción fue evaluada cualitativamente considerando extensión e intensidad para E-cadherina e intensidad para Vimentina. El análisis de la extensión e intensidad de la inmunotinción de E-cadherina y Vimentina según diagnóstico reveló una asociación estadísticamente significativa (p<0,001). Siendo la expresión de E-cadherina más alta en MON, seguido por DEO y más baja en COCE, inversamente a lo que se observó con Vimentina. El presente estudio reveló la subregulación del marcador molecular E-cadherina junto con la expresión aberrante por parte de células epiteliales del marcador mesenquimal Vimentina en muestras de MON, DEO y COCE.

The aim was to evaluate the expression of E-cadherin and Vimentin in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC), in comparison with normal oral mucosa (NOM) in a descriptive case study using immunohistochemistry. A total of fifty-one (N=51) histological samples were included; as follows: n = 16 (NOM), n = 16 (OED) and n = 19 (OSCC). All samples were analyzed using immunohistochemistry against the expression of E-cadherin and Vimentin. Immunostaining was qualitatively evaluated by extent and intensity of its expression for E-cadherin and intensity for Vimentin. Extension and intensity analysis of E-cadherin and Vimentin immunostaining according to group revealed a statistically significant association (r<0.001). E-cadherin expression was found to be highest in NOM followed by OED and lowest in OSCC, inverse to what was observed with Vimentin. The present study revealed the down regulation of the molecular marker E-cadherin, suggestive of reduction in dysplastic cells on comparison to NOM cells, and aberrant expression of the mesenchymal marker Vimentin by epithelial cells in samples of NOM, OED and OSCC; questioning their value as a prognostic marker.

Difference in EGFR expression and mean vascular density in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma

To evaluate the expression of the epidermal growth factor receptor (EGFR) and mean vascular density (MVD) in normal oral mucosa (NOM), oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Material and methods: Descriptive case study. Nineteen histological samples diagnosed with NOM, 18 diagnosed with OED, and 19 with OSCC, were analyzed with immunohistochemistry against EGFR and CD31. EGFR expression was evaluated by extent and intensity of its expression in normal, dysplastic and neoplastic epithelium. MVD was determined through the detection of blood vessels by antibodies against CD31. Results: Extension of EGFR expression was highest in OSCC followed by OED and lowest in NOM, resulting in significant different between the degrees of extension (p<0.001). Intensity of EGFR was similar in NOM, OED and OSCC, without differences in its expression (p=0.533). Differences in MVD were found between NOM and OSCC groups (p<0.01), and between OED and OSCC groups (p<0.01), with no differences between NOM and OED groups (p=0.91). MVD was 21.17 +/- 4.98 in NOM, 23.40 +/- 5.77 in OED and 33.92 +/- 8.39 in OSCC. Conclusion: EGFR is expressed in normal, dysplastic or neoplastic oral epithelium. However, the extent of its expression is greater as malignancy increases. MVD varies according to the diagnosis.

Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

RESUMO A sobrevida de pacientes cirróticos críticos aumentou significantemente nos últimos anos devido a inúmeros avanços obtidos no manejo do paciente com cirrose descompensada e com insuficiência hepática aguda grave, particularmente após a incorporação na prática clínica de uma série de estratégias baseadas em evidencias com impacto reconhecido na redução de mortalidade. Com o intuito de discutir as principais evidencias disponíveis na literatura médica sobre o assunto, a Sociedade Brasileira de Hepatologia, em conjunto com a Associação de Medicina Intensiva Brasileira e a Associação Brasileira de Transplantes de Órgãos promoveu uma reunião monotemática sobre o manejo do paciente hepatopata crítico, que ocorreu em 21 de maio de 2014 na cidade do Rio de Janeiro. O relatório da reunião foi resumido no presente manuscrito com o objetivo de nortear a prática clínica de intensivistas, gastroenterologistas e hepatologistas no manejo do paciente hepatopata em ambiente de terapia intensiva.

Bilateral fracture of L5 pedicles in a patient with total disc replacement of L5-S1: a case report / Fratura bilateral de pedículos L5 em paciente com prótese de disco L5-S1: relato de caso / Fractura bilateral de pedículos L5 en paciente con prótesis de disco L5-S1: reporte de caso

Report of a rare complication - fracture of the pedicles - in a patient with total disc replacement of L5-S1, a surgical resolution, and a biomechanical explanation. To the authors' knowledge, there is only one previous report of bilateral fracture of the pedicles in the literature, as a complication in total disc replacement of the lumbar spine. In this case, no direct repair was made to the fracture site; instead intersomatic fusion was performed by the anterior approach. A 40-year-old male, a martial arts practitioner who had undergone L5-S1 (ProDisc®) disc replacement nine months earlier, with complete resolution of the preoperative symptoms and no complications, sudden pain during physical activity, without neurological symptoms. Computed axial tomography showed a fracture of the L5 pedicles and anterior luxation of the polyethylene insert. Surgery was performed by the posterior approach, with direct repair of the fractures and posterolateral fusion of L5-S1 with transpedicular screws (Schanz) and USS® internal fixator. A follow-up axial CT scan at 6 months after surgery showed complete consolidation of the fractures, and the patient was asymptomatic. Due to the alteration in weight transmission through the anterior part of the spine in the total replacement of the lumbar disc, which preserves the movement but not the absorption of forces, the pedicle becomes more susceptible to fracture. It is important to bear this complication in patients submitted to this procedure.

Relato de uma complicação rara - fratura de pedículos - em paciente com prótese de disco L5-S1, sua resolução cirúrgica e uma explicação biomecânica. Até onde os autores sabem, existe na literatura apenas um relato anterior de fratura bilateral de pedículos como complicação de substituição total de disco lombar; neste caso, não se realizou reparo direto da fratura, e sim, fusão intersomática por acesso anterior. Paciente do sexo masculino, com 40 anos de idade, praticante de artes marciais e com antecedente de prótese de disco L5-S1 (ProDisc®) há nove meses, atinge melhora completa dos sintomas pré-operatórios sem complicações, apresenta dor súbita ao realizar atividade física sem intercorrências neurológicas. Na tomografia axial computadorizada, observa-se fratura de pedículos L5 e luxação anterior do inxerto de polietileno. Realiza-se cirurgia por acesso posterior com reparo direto das fraturas e fusão posterolateral de L5-S1 com parafusos transpediculares tipo Schanz e fixador interno USS®. A TC axial de acompanhamento 6 meses depois da cirurgia mostra consolidação completa das fraturas, e o paciente está assintomático. Devido à alteração da transmissão de cargas através da parte anterior da coluna vertebral na substituição total de disco lombar, que preserva o movimento, mas não a absorção de forças, o pedículo fica mais suscetível à fratura, e é preciso considerar essa complicação em pacientes submetidos a esse procedimento.

Reporte de una rara complicación, fractura de pedículos, en un paciente con prótesis de disco L5-S1, la resolución quirúrgica y una explicación biomecánica. En el conocimiento de los autores, solo existe un reporte previo en la literatura de una fractura bilateral de pedículos como complicación de un reemplazo total de disco lumbar; en dicho caso no se realizó una reparación directa de la fractura, sino una fusión intersomática por vía anterior. Paciente masculino de 40 años de edad, practicante de artes marciales, con antecedente de prótesis de disco L5-S1 L nueve meses atrás, alcanza mejoría total de los síntomas preoperatorios sin complicaciones, presenta dolor súbito al realizar actividad física sin datos neurológicos. En la TAC se observa fractura de pedículos L5 y luxación anterior del inserto de polietileno. Se realiza cirugía por vía posterior con reparación directa de las fracturas y fusión posterolateral L5-S1 mediante tornillos transpediculares tipo Schanz y fijador interno USS®. La TAC de seguimiento a 6 meses de la cirugía muestra una consolidación completa de las fracturas y el paciente se encuentra asintomático. Debido a la alteración en la transmisión de las cargas a través de la porción anterior de la columna vertebral en el reemplazo total de disco lumbar, ya que este preserva el movimiento pero no la absorción de fuerzas, el pedículo es más susceptible a la fractura, es por ello que se debe tener en cuenta esta complicación en pacientes sometidos a dicho procedimiento.

Análisis descriptivo de 561 biopsias con diagnóstico de melanoma entre los años 2006 y 2012 en un laboratorio de dermatopatología de la región metropolitana / Descriptive analysis of 561 biopsies with melanoma diagnosis between 2006 and 2012

Durante las últimas décadas la incidencia de melanoma maligno(MM) ha aumentado en gran parte de los países del mundo. Entre los factores más importantes en el desarrollo de un MM está el fototipo del paciente y la exposición a radiación UV. Nuestro país cuenta con escasa información epidemiológica respecto a MM. En este trabajo se analiza la información disponible en las biopsias de piel con diagnóstico de MM procesadas en un laboratorio de dermatopatología en un periodo de siete años. La muestra contó con 561 biopsias, de los cuales el 60,61 por ciento correspondió a sexo femenino, la edad promedio de la muestra fue 54,14 años. Respecto a la localización de las lesiones, el 34,33 por ciento se encontró en extremidades inferiores, 25,70 por ciento en tronco, 21,68 por ciento en cabeza y cuello y 18,27 por ciento en extremidades superiores. El diagnóstico histológico fue melanoma in situ en el 52,88 por ciento de los pacientes e infiltrante en el 47,12 por ciento. Este último grupo se analizó en base al índice de Breslow, observando que el 32,68 por ciento de los pacientes se encontraba en etapa T1. Este trabajo es un aporte para el desarrollo de mayor información epidemiológica respecto a MM, pero dado que se trata de casos exclusivos del sector privado de salud, no es extrapolable a toda la población. Por esto sería de gran utilidad realizar un estudio similar en pacientes atendidos en hospitales, especialmente para revisar el espesor que tienen los melanomas al momento del diagnóstico.

During the last decades, incidence of malignant melanoma (MM) has raised in most countries of the world. Skin phototype and sun exposure are the most important factors related with the development of MM. In our country the epidemiological information in MM is scarse. In this study we analyze available information of skin biopsies with MM diagnosis processed in a dermatopathology lab in a period of 7 years. We analyzed 561 biopsies, 60,61 percent females, with average age of 54,14 years. The lesions were located on lower extremities in 34,33 percent, 25,70 percent on trunk, 21,68 percent on head and neck and 18,27 percent on upper extremities. The histologic diagnosis was in situ melanoma in the 52,88 percent cases and infiltrative melanoma in 47,12 percent cases. Of this last group 32,68 percent were on T1 stage (Breslow index). This study is contributing to the development of more epidemiological information on MM. Because all the cases belong to private practice, we cannot extrapolate the information to global population. It would be useful to replicate this study on public hospital population, with special attention on MM thickness at the diagnosis.

Hidrosadenitis supurativa (Parte II) / Suppurative hidrosadenitis (Part II)

La Hidrosadenitis Supurativa (HS) es una enfermedad inflamatoria,folicular, crónica, recurrente y debilitante de la piel, caracterizadapor la presencia de abscesos y/o nódulos recurrentes, formación de fístulas y cicatrices. Las lesiones inflamatorias son dolorosas profundas y se localizan en zonas del cuerpo que poseen glándulas sudoríparas apocrinas, principalmente en la región axilar, inguinal y anogenital. Es una patología que presenta gran retraso en laconsulta y diagnóstico, ya que la mayoría de los casos leves sonreportados tardíamente. La resolución espontánea es poco probable y la discapacidad progresiva es comúnmente experimentada. Hay gran compromiso de la calidad de vida el que se correlaciona con la gravedad de la enfermedad. En esta segunda parte revisaremos las enfermedades asociadas a HS, complicaciones y alternativas terapéuticas de tipo médico y quirúrgico.

Hidradenitis suppurativa (Hs) is a chronic inflammatory, follicular,recurrent and debilitating disease characterized by painful and recurrent nodules forming extensive, fibrous anddisfigured scars. Inflammatory lesions are painful and affect primarily the axillae, inguinal and anogenital areas. Is a late disease in being diagnosed because of late consultation andreport. Spontaneous resolution is very rare and progressive disable is common. There is great quality of life involvementand related with the severity of the disease. In this second Part associated diseases, complications, and medical and surgery treatments are discussed.