¿Debemos manejar la hiperuricemia asintomática para proteger al riñón?

Contexto: el ácido úrico es el producto final de la degradación de las purinas en los primates, en condiciones normales es un agente antioxidante endógeno y participa en varias vías fisiológicas, sin embargo, cuando los niveles séricos de urato se incrementan, estos participan en el desarrollo de diversas enfermedades. Desde el siglo XIX se conoce de la asociación entre hiperuricemia y daño renal, aunque ninguna guía de manejo recomienda el uso de fármacos hipouricemiantes en pacientes asintomáticos, en algunos casos especiales, el manejo farmacológico beneficiará a pacientes con hiperuricemia, brindando protección al riñón y disminuyendo el riesgo de desarrollar enfermedad renal terminal. Objetivo: describir la relación entre hiperuricemia y daño renal, y analizar los casos en los que el manejo de esta condición con medicamentos resultará en un beneficio para el riñón de los pacientes. Metodología: revisión de la literatura sobre la participación de la hiperuricemia en el daño renal y análisis de los artículos revisados. Resultados: el manejo de la hiperuricemia asintomática puede proteger el riñón en algunas situaciones específicas. Conclusiones: hay situaciones específicas para la disminución de los niveles séricos de ácido úrico.

Background: Uric acid is the end product of purine degradation in primates, under normal conditions it is an endogenous antioxidant agent and participates in several physiological pathways. However, when serum urate levels are increased, they participate in the development of various diseases. Since the nineteenth century, the association between hyperuricemia and kidney damage has been known. Although no management guideline recommends the use of hypouricemic drugs in asymptomatic patients, in some special cases pharmacological management will benefit patients with hyperuricemia, providing protection to the kidney and decreasing the risk of developing end-stage renal disease. Purpose: To describe the relationship between hyperuricemia and kidney damage, and to analyze the cases in which the management of this condition with medications will result in a benefit for the kidney of patients. Methodology: Review of the literature on the involvement of hyperuricemia in kidney damage, analysis of the reviewed articles. Results: Management of asymptomatic hyperuricemia may protect the kidney in some specific situations. Conclusions: There are specific situations for the decrease of serum uric acid levels.

The SISBIOTA-Diptera Brazilian Network: A long-term survey of Diptera from unexplored Brazilian Western Arc of Amazon, Cerrado, and Pantanal

ABSTRACT The SISBIOTA-BRASIL was a three-year multimillion-dollar research program of the Brazilian government to document plants and animals in endangered/understudied areas and biomes in Brazil. Distributional patterns and the historical events that generated them are extensively unknown regarding Brazilian fauna and flora. This deficiency hinders the development of conservation policies and the understanding of evolutionary processes. Conservation decisions depend on precise knowledge of the taxonomy and geographic distribution of species. Given such a premise, we proposed to research the diversity of Diptera of the Brazilian western arc of Amazon, Cerrado, and Pantanal in the states of Mato Grosso, Mato Grosso do Sul, and Rondônia. Three important biomes of the South American continent characterize these Brazilian states: Amazon forest, Cerrado (Brazilian Savannah), and Pantanal. Besides their ecological relevance, these biomes historically lack intensive entomological surveys. Therefore, they are much underrepresented in the Brazilian natural history collections and in the scientific literature, which is further aggravated by the fact that these areas are being exponentially and rapidly converted to commercial lands. Our project involved over 90 collaborators from 24 different Brazilian institutions and one from Colombia among researchers, postdocs, graduate and undergraduate students, and technicians. We processed and analyzed nearly 300,000 specimens from ~60 families of Diptera collected with a large variety of methods in the sampled areas. Here, we provide a detailed overview of the genera and species diversity of 41 families treated. Our results point to a total of 2,130 species and 514 genera compiled and identified for the three states altogether, with an increase of 41% and 29% in the numbers of species and genera known for the three states combined, respectively. Overall, the 10 most species-rich families were Tachinidae, Cecidomyiidae, Tabanidae, Psychodidae, Sarcophagidae, Stratiomyidae, Bombyliidae, Syrphidae, Tephritidae, and Asilidae. The 10 most diverse in the number of genera were Tachinidae, Stratiomyidae, Asilidae, Mycetophilidae, Syrphidae, Tabanidae, Muscidae, Dolichopodidae, Sarcophagidae, and Chloropidae. So far, 111 scientific papers were published regarding taxonomic, phylogenetic, and biogeographical aspects of the studied families, with the description of 101 new species and three new genera. We expect that additional publications will result from this investigation because several specimens are now curated and being researched by specialists.

Evaluación de Fotografías de Mujeres y Hombres en Función de su Estatus y el de su Obra / Assessment of Photographs from Women and Men Considering Their Status and that of Their Work

Resumen Aunque el sexo de una persona debería ser irrelevante para juzgar su competencia, es común que la evaluación se base en un prejuicio de género, que tiende a ser antifemenino. No obstante, ciertos factores pueden mitigar el prejuicio. El propósito del estudio fue averiguar la manifestación de un prejuicio de género manipulando además del sexo de supuestos fotógrafos, su estatus (profesional o aficionado) y el de su obra (ganadora o participante en un concurso). Los participantes (N = 397 adultos mexicanos, entre 18 y 79 años) juzgaron ocho fotografías abstractas respecto a su creatividad, calidad global e impacto emocional y a la competencia y futuro artístico del fotógrafo. Las mismas fotografías se incluyeron en una de ocho series. En cada serie cada fotografía incluyó una diferente combinación de las tres variables manipuladas. Se encontró un prejuicio antifemenino por parte de los participantes mujeres y hombres cuando tanto el autor como su obra tenían un alto estatus, independientemente del aspecto evaluado. Cuando el estatus del fotógrafo o de la fotografía fue bajo, el prejuicio fue pro-femenino o antimasculino. Aunque el estatus del fotógrafo y el de la fotografía mitigaron el prejuicio antifemenino, éste persistió cuando una mujer era tan exitosa como un hombre.

Abstract Although a third party's sex should be irrelevant in assessing her/his competence, the judgment is commonly influenced by a gender bias, which tends to be anti-feminine. However, certain factors could mitigate that bias. The purpose of the study was to find out if a gender prejudice appears if not only the sex of alleged photographers is manipulated, but also their status (professional or amateur) and that of their photograph (winner or entry in a prestigious contest). Participants (N = 397 Mexican adults, 18 to 79 years old) judged eight abstract photographs on its creativity, overall quality, and emotional impact and on the photographer's competence and artistic future. The same photographs were included in one of eight different series. In each series each photograph included a different combination of the three manipulated variables. An anti-feminine bias was found from both women and men participants when both the photographer and their work had a high status, regardless of the aspect evaluated. When the status of either the photographer or of the photograph was low, the bias was pro-feminine or anti-masculine. Although the status of the photographer and of her/his work mitigated the antifeminine prejudice, it persisted when women were as successful as men.

Actualización en lesión renal aguda inducida por contraste en pediatría

Contexto: la lesión renal aguda inducida por contraste se ha convertido en un tema de gran interés en la comunidad médica a nivel mundial, siendo la tercera causa de lesión renal aguda adquirida en el hospital. Objetivo: el presente artículo presenta una revisión de la literatura con el fin de actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica y que es sometida a procedimientos con medios de contraste. Metodología: en esta revisión narrativa de la literatura, presentamos la definición, los factores de riesgo, el enfoque clínico y las medidas preventivas de la nefropatía inducida por contraste en pediatría. Resultados: se define que hay un deterioro en la función renal aguda después de la administración del medio de contraste en donde se excluyen otras posibles etiologías y se establece una verdadera relación causal con la sustancia. Los factores de riesgo son múltiples, sin embargo, factores estrictamente relacionados en los niños no han sido establecidos en su totalidad. El abordaje de los pacientes que van a ser sometidos a estudios con medios de contraste inicia desde una historia clínica, un examen físico y unas medidas de laboratorio que permiten evaluar el estado basal de cada paciente para instaurar medidas preventivas. Por su parte, las estrategias de prevención de esta condición son múltiples, sin embargo, no existen guías basadas en la evidencia acerca de esta condición en el paciente pediátrico. Conclusiones: el artículo presenta una revisión de la literatura sobre lesión renal aguda para actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica que se somete a procedimientos con medios de contraste.

Context: Contrast-induced acute kidney injury has become a topic of great interest in the medical community worldwide, being the third cause of hospital-acquired acute kidney injury. Purpose: This article presents a review of the literature in order to update the concepts of this pathology in health personnel who are in contact with the pediatric population that undergoes procedures with contrast media. Methodology: In this narrative review of the literature, we present the definition, risk factors, clinical approach, and preventive measures of contrast-induced nephropathy in pediatrics. Results: It is defined as a deterioration in acute renal function after the administration of the contrast medium where other possible etiologies are excluded and a true causal relationship with the substance is established. The risk factors are multiple; nevertheless; Strictly related factors in children have not been fully established. The approach to patients who are going to undergo studies with contrast media begins with a clinical history, physical examination, and laboratory measurements that allow the baseline status of each patient to be evaluated in order to establish preventive measures. The prevention strategies of this condition are multiple; however, there are no evidence-based guidelines on this condition in pediatric patients. Conclusions: This article presents a review of the literature in order to update the concepts of acute kidney injury in health personnel who are in contact with the pediatric population that undergoes procedures with contrast media.

Dermatitis herpetiforme y enfermedad celíaca: del intestino a la piel / Dermatitis herpetiformis and celiac disease

Dermatitis herpetiformis is an autoimmune chronic blistering disease, considered a skin manifestation of celiac disease. Being both conditions multifactorial, they share some genetic traits and pathogenic mechanisms, which are responsible for the typical skin and gastrointestinal manifestations. In dermatitis herpetiformis, skin and other lesions heal after gluten-free diet and reappear shortly after its reintroduction to complete diet. Prevalence of celiac disease is 1% in the population, and approximately 13% of patients with the disease develop dermatitis herpetiformis. Diagnosis of celiac disease has progressively increased in recent decades, while clinical manifestations become more and more diverse. Given the current high frequency of skin lesions in celiac patients, in this review we update relevant aspects of the epidemiology, pathogenesis, clinical presentations, treatment and follow up of dermatitis herpetiformis, as a contribution to improve the management of both conditions.

Contaminación Bacteriana del Aerosol Dental con y sin Uso de una Cúpula de Acrílico en un Paciente en Pandemia COVID-19 / Bacterial Contamination of Dental Aerosol with and Without Use of an Acrylic Dome in a Patient in COVID-19 Pandemic

En la actual pandemia por COVID-19, el mundo clínico se ha visto obligado a reforzar el uso de protección en el quehacer asistencial, debido al alto grado de contagio y virulencia de este virus. En odontología, debido a la producción de aerosoles, se han suspendido las atenciones clínicas para prevenir contagios. El objetivo de esta investigación es determinar la cantidad de contaminación bacteriana, generada por el uso de aerosol con micromotor de alta velocidad, realizado por dentistas del Hospital de La Florida, Santiago de Chile. El estudio contó con 10 pacientes por box, con 2 muestras por paciente, en total 40 placas de cultivo, 20 Control, 20 Prueba y 3 Ambientales. El medio de cultivo se mantuvo por 10 minutos, ubicado en la frente del ope rador y pechera del paciente, se realizó simulación de operatoria con turbina, sin aislamiento absoluto, con y sin uso de una cúpula de acrílico, puesta en un paciente sano. Las muestras fueron analizadas macroscópicamente, incubadas a 37 ºC en una atmósfera de oxígeno por 24 horas y dióxido de Carbono a las 48 horas. 43 placas fueron positivas, observándose, en las muestras de la peche ra una diferencia no significativa (p=0,753) entre ambos grupos, con una diferencia promedio de 56,76 UFC. En las placas de la fre nte del operador, un promedio de 8.1 UFC en Box sin cúpula y 3,9 UFC en el box con cúpula, encontrándose diferencia estadísticament e significativa (p= 0,0391). Las placas ambientales 28,33 UFC en el Box con cúpula, 29 UFC en el Box control y Box sin cúpula 46, 66 UFC. Al comprobar que la cúpula de acrílico contiene eficazmente los aerosoles, corresponde utilizarlo como norma de biosegurid ad para proteger tanto al equipo dental, como a los pacientes en tiempos de pandemia contra el COVID-19.

In the current PANDEMIC for COVID- 19, the clinical world has been forced to reinforce the use of protection in healthcare, due to the high degree of contagion and virulence of this virus. In dentistry, due to the production of aerosols, clinical care has been suspended to prevent infection. The objective of this research is to determine the amount of bacterial contamination, generated by the use of high-speed micromotor aerosol, carried out by dentists at the Hospital de La Florida, Santiago, Chile. The study included 10 patients per box, with 2 samples per patient, in total 40 culture plates, 20 Control, 20 Test and 3 Environmental. The culture medium was kept for 10 minutes, located in the front of the operator and the patient's chest. Simulation of the operation with a turbine was performed, without absolute isolation, with and without the use of an acrylic dome, placed on a healthy patient. The samples were analyzed macroscopically, incubated at 37ºC in an atmosphere of oxygen for 24 hours and Carbon dioxide after 48 hours. 43 plates were positive, noting a non-significant difference (p = 0.753) between the two groups in the bib samples, with an average difference of 56.76 CFU. In the plates of the operator's forehead, an average of 8.1 CFU in the box without dome and 3.9 CFU in the box with dome, finding a statistically significant difference (p = 0.0391). The environmental plates 28.33 UFC in the Box with the dome, 29 UFC in the Control Box and the Box without dome 46.66 UFC. When verifying that the acrylic dome effectively contains aerosols, it should be used as a biosafety standard to protect both dental equipment and patients in times of pandemic against COVID-19.

Blanching of papaya: effect on osmotic dehydration and characterization of the fruit invertase / Branqueamento de mamão: efeito na desidratação osmótica e caracterização da invertase da fruta

ABSTRACT: This research evaluated the influence of blanching on osmotic dehydration in sucrose solutions of papaya of Formosa cultivar. The characterization of invertase present in the fruits was also done. Blanching possibly caused damages to the cellular structure resulting in higher water loss, sugar gain and, thus, effective diffusion coefficients than fresh papayas during osmotic dehydration. The invertase extracted from papaya pulp presented optimum temperature of 45 °C and optimum pH of 4.8. Considering the low production cost of papaya and the invertase characteristics, the fruit shows to be a potential source for the referred enzyme extraction.

RESUMO: O objetivo desse trabalho foi avaliar a influência do branqueamento na desidratação osmótica de mamão Formosa em soluções de sacarose. A caracterização da invertase presente nos frutos também foi realizada. O branqueamento possivelmente danificou a estrutura celular do vegetal resultando em maior perda de água, ganho de açúcar e, consequentemente, maior coeficiente de difusão do que os mamões frescos após a desidratação osmótica. A invertase extraída da polpa do mamão apresentou temperatura ótima de 45 °C e pH ótimo de 4.8. Considerando o baixo custo de produção do mamão e as características da invertase, essa fruta apresenta-se como potencial fonte de extração da enzima.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en paciente pediátrico con enfermedad renal crónica o lesión renal aguda asociada a COVID-19 / Colombian consensus of experts on evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2 / COVID-19 infection in pediatric patients with chronic kidney disease or acute kidney injury associated with COVID-19

resumen está disponible en el texto completo

Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.

Reporte de manejo exitoso con simvastatina y ezetimibe en alopecia areata / A report of successful management with simvastatin plus ezetimibe in alopecia areata

La alopecia areata es un tipo común de alopecia no cicatricial. Aunque la patogénesis exacta permanece sin dilucidar, se piensa que la alopecia areata tiene una etiología multifactorial en donde se interrelacionan predisposición genética y factores ambientales. En pacientes susceptibles, se han documentado que el estrés, infecciones y microtraumas disminuyen las citoquinas inmunosupresoras que normalmente mantienen el privilegio inmune del folículo piloso. Actualmente no hay terapia curativa para la alopecia areata, aunque ciertos tratamientos pueden inducir el crecimiento del cabello en un porcentaje de pacientes. Se postula que la simvastatina restablece el privilegio inmune y ezetimibe aportaría un efecto inmunomodulador y antiinflamatorio. Se presenta el caso de una mujer de 23 años con alopecia areata, exitosamente tratada con simvastatina y ezetimibe.

Alopecia areata is a common type of non-scarring alo¬pecia. Although the exact pathogenesis remains elusive, alopecia areata is thought to have a multifactorial etiology described as an interplay of genetic predisposition and environmental exposures. In patients with genetic susceptibility, stress, infection, and microtrauma have been documented to decrease immunosuppressive cytokines that generally maintain the hair follicle's immune privilege. There is currently no curative therapy for alopecia areata, although some treatments can induce hair growth in a percentage of patients. It has been postulated that simvastatin reestablishes the immune privilege, and ezetimibe would provide an immunomodulatory and anti-inflammatory effect. We report a case of a 23 years-old woman with alopecia areata successfully treated with simvastatin/ezetimibe.

Acrodermatitis continua de Hallopeau y artritis psoriática: reporte de caso / Acrodermatitis continua of Hallopeau and psoriatic arthritis: a case report

Un hombre de 44 años, previamente sano, consultó por poliartralgias asimétricas de características inflamatorias de tres meses de evolución, que comprometió pequeñas y grandes articulaciones. Poco tiempo después desarrolló pústulas periungueales sobre una base eritematosa y degeneración progresiva de la lámina ungueal del pulgar izquierdo, limitando severamente su funcionalidad. Destacó al examen físico la presencia de placas eritemato-escamosas y pustulosas bien delimitadas en el primer y tercer dedo de la mano izquierda con onicodistrofia severa, que fue un aspecto clave para establecer el diagnóstico de acrodermatitis continua de Hallopeau. Adicionalmente, se observaron otros hallazgos del espectro psoriático: parches eritematosos en el escroto, placas eritemato-escamosas con costras hemorrágicas en ambas rodillas y dactilitis. Se confirmó histológicamente el diagnóstico de psoriasis inversa, psoriasis en placas y psoriasis pustular, respectivamente y con los criterios de Classification Criteria for Psoriatic Arthritis, CASPAR, el diagnóstico de artritis psoriática.

A 44-year-old man, previously healthy, consulted for a three-month history of asymmetrical polyarthralgia with inflammatory features involving small and large joints. A few days later, he developed erythema covered by pustules in the nail folds and progressive degeneration of the nail plate of the left thumb, with severe functional limitation. The physical exam showed well-defined erythematous scaly and pustular plaques in the first and third fingers of the left hand, with severe onychodystrophy, which was a key aspect in the diagnosis of acrodermatitis continua of Hallopeau. Other signs of the psoriatic spectrum were observed: erythematous patches of the scrotum, erythematous scaly plaques with hemorrhagic crusts on both knees, and dactylitis. The diagnosis of inverse psoriasis, plaque psoriasis, and pustular psoriasis, respectively, were confirmed by histopathology and, with the CASPAR criteria, psoriatic arthritis. This case is of particular dermatological interest due to the variety of psoriatic manifestations recognized in a single patient and because of the poorly described association between acrodermatitis continua of Hallopeau with psoriatic arthritis.

Trends associated with stillbirth in a maternity hospital school in the north zone of são paulo: a cross-sectional study / Tendências associadas à natimortalidade em umamaternidadeescola na zona norte de São Paulo: um estudo transversal

Abstract Objective To evaluate conditions associated with stillbirth (SB), and possible trends related with it, in a maternity hospital school in the North zone of São Paulo. Methods An observational, cross-sectional study conducted at the Hospital Maternidade- escola de Vila Nova Cachoeirinha with 1,139 SBs in the period of 2003 to 2017. Cases of intermediate SB (ISB) (weight between 500 and 999 g) and late SB (LSB) (weight ≥ 1,000 g) were compared. We evaluated clinical data, laboratory tests, and fetal and placental studies. Data were stored in Windows Excel (Microsoft Corp., Redmond, WA, USA) worksheets, according to which graphs and tables were constructed. We used the statistical software SPSS for Windows version 18.0 (SPSS In., Chicago, IL, USA), estimating the prevalence ratio (PR) and odds ratio (OR), considering the 95% confidence interval (95% CI). Results The general SB rate was 11.9%, and the in-hospital SB rate was 2.8%. Pregnant women younger than 16 years of age were more likely to have ISB (OR 0.32, 0.15- 0.76), while patients older than 40 years old had a higher chance of LSB (PR 0.85, 0.72- 0.99). A total of 25.7% of the general population did not have prenatal care, and 77.1% of the cases presented fetal death at admission. The cases of ISB had a statistically significant association with home birth (OR 0.61, 0.46-0.80). Cesarean section was performed in 16.1% of the subjects, and misoprostol was the most used method for induction. Necropsy and placental study of the fetuses were performed, respectively, in 94.2% and 97.3% of the cases. Associated causes were not identified in 22.1% of the cases, and the main causes identified were amniotic sac infections (27.9%), fetal malformations (12.5%), placental abruption (11.2%), hypertensive syndromes (8.5%), and maternal syphilis (3.9%), the latter with an increasing trend. Conclusion Among the factors associated to SB were: hypertensive syndromes, amniotic sac infections, fetal malformations, placental abruption and syphilis. There was a growing trend in the number of cases of syphilis, which translates an alert. Diagnostic limitations justify indeterminate causes.

Resumo Objetivo Avaliar aspectos relacionados à ocorrência da condição de natimortalidade em uma maternidade-escola na zona norte de São Paulo e possíveis tendências associadas aos fatores causais. Métodos Estudo observacional, transversal, realizado no Hospital Maternidadeescola Vila Nova Cachoeirinha com 1.139 óbitos fetais (OF) no período de 2003 a 2017. Foram comparados os casos de OF intermediários (OFI) (peso entre 500 e 999 g) e OF tardios (OFT) (≥ 1,000 g). Avaliamos dados clínicos, exames laboratoriais, e estudos do feto e da placenta; estes foram armazenados em planilhas de Windows Excel (Microsoft Corp., Redmond, WA USA0, utilizando-se para avaliação estatística o programa SPSS v.18 (SPSS Inc., Chicago, IL, EUA). Foram ainda estimadas a razão de prevalência (RP) e a razão de chances (RC), com intervalo de confiança de 95% (IC 95%). Resultados Ocoeficiente de natimortalidade geral foi de 11,9% e o intra-hospitalar foi de 2,8%. Gestantes com menos de 16 anos de idade apresentaram maior chance de ter OFI (RC 0.32, 0.15-0.76) enquanto que pacientes com mais de 40 anos de idade apresentaram maior chance de OFT (RP 0,85; 0,72-0,99). Não fizeram prenatal 25,7% da população geral, sendo que em 77,1% dos casos, a morte fetal já tinha sido apresentada na internação. Os casos de OFI apresentaram associação estatisticamente significante com parto domiciliar (RC 0,42; 0,23-0,75). A cesárea foi realizada em 16,1% das pacientes, sendo o misoprostol o método mais utilizado para indução. Necropsia foi feita em 94,2% dos fetos, e 97,3% das placentas foram para estudo. As causas associadas não foram identificadas em 22,1% dos casos, sendo que as principais causas identificadas foram infecções do saco amniótico e membranas (27,9%), malformações (12,5%), descolamento prematuro de placenta (11,2%), síndromes hipertensivas (8,5%), e sífilis (3,9%), sendo esta última com uma tendência crescente. Conclusão Destacaram-se como fatores associados à natimortalidade: síndromes hipertensivas, corioamnionites, malformações fetais, descolamento placentário e sífilis. Houve tendência de aumento no número de casos de sífilis, o que traduz uma alerta. Limitações diagnósticas justificam as causas indeterminadas.

Caracterización de los pacientes cirróticos atendidos en el Hospital Eugenio Espejo durante el año 2018 / Characterization of the cirrhotic patients treated at the Eugenio Espejo Hospital during 2018

Introducción:La cirrosis hepática constituye una patología muy frecuente en nuestro medio. Los datos epidemiológicos en Ecuador son escasos, lo cualdificulta promover medidas de prevención y tratamientoadecuadas;además,existe un acceso limitado a terapias específicas,como el trasplante hepático.Objetivo: Determinarlas características sociodemográficas, etiología y complicaciones de los pacientes cirróticos, atendidos enelservicio de Gastroenterología del Hospital Eugenio Espejo, durante el año 2018. Materiales y métodos:Estudio descriptivo -transversal, realizado en 94 pacientes adultos con diagnóstico de cirrosisdurante el año 2018.Resultados:La principal causa de cirrosis es la esteatosishepáticano alcohólica(29%);superando al alcohol ya las etiologías virales.El grupo etario más frecuente es el comprendido entre los 36 a 64 años (57%).El estadio más frecuente fueChild B(46%) y el estadio clínico 4 (38%). La complicación más frecuentefuela ascitis(72%).Conclusiones:La esteatosis hepática no alcohólicaha desplazado a las demáscausasde cirrosis;por lo tanto, es primordial realizar programas para el manejo del síndrome metabólico, así como un fácil acceso a la atención por un especialista en Gastroenterología o Hepatología.

Introduction: Liver cirrhosis is a very common pathology in our environment. Epidemiological data in Ecuador are limited, which makes it difficult to promote adequate prevention and treatment measures; in addition, there is limited access to specific therapies, such as liver transplantation. Objective: we sought to determine the sociodemographic characteristics, etiology and complications of cirrhotic patients, treated in the gastroenterology service of the Eugenio Espejo Hospital, during 2018. Material and Methods: descriptive cross-sectional study, carried out in 94 patients, Results: we found that the main cause of cirrhosis is non-alcoholic hepatic steatosis (29%); overcoming alcohol and viral etiologies. The most frequent age group is between 36 and 64 years old (57%). The most frequent stage was Child B (46%) and clinicalstage 4 (38%). The most frequent complication was ascites (72%).Conclusions:Non-alcoholic hepatic steatosis has displaced the other causes of cirrhosis; therefore, it is essential to carry out programs for the management of the metabolic syndrome, as well as easy access to care by a specialist in gastroenterology or hepatology.

Hidrocistoma apocrino desafío dermatoscópico / Apocrine hydrocystoma dermoscopic challenge

Los hidrocistomas apocrinos son lesiones quísticas benignas. Clínicamente se caracterizan por ser nódulos quísticos claros o traslucidos, solitarios, en forma de cúpula, con superficie lisa. En la mayoría de los casos la localización suele ser alrededor del ojo, particularmente lateral al canto externo. Suelen ser asintomáticos, de crecimiento lento pudiendo llegar a 10 mm de diámetro o más. Presentamos un caso de un paciente con un hidrocistoma apocrino variante pigmentada.

Apocrine hydrocystomas are benign cystic lesions, clinically characterized by being clear or translucent cystic nodules, solitary, domeshaped, with a smooth surface. In most cases the location is usually around the eye, particularly lateral to the outer edge. They are usually asymptomatic, slow growing and can reach 10 mm in diameter or more. We present a case of a patient with a pigmented variant apocrine hydrocystom

Valoración ecográfica de la laringe fetal / Ultrasound evaluation of the fetal larynx

Introducción: el diagnóstico y tratamiento prenatal de múltiples enfermedades son posibles en la actualidad dado el conocimiento anatómico, el desarrollo tecnológico y la integración de varias áreas de la medicina. Objetivo: realizar la identificación ecográfica de la anatomía de la laringe fetal. Diseño: observacional descriptivo. Metodología: se realizó un estudio descriptivo en ultrasonografías de laringes fetales de 10 gestantes en la segunda mitad del embarazo, durante la ecografía morfológica; se determinó la identificación de las estructuras, tales como epiglotis, aritenoides, pliegues vocales y su movilidad, subglotis, tráquea, división traqueoesofágica, diámetro de la subglotis y de la tráquea proximal. Resultados: lamedia de la edad gestacional de los fetos evaluados fue de 26 semanas (20-34+5) 50 % de sexo femenino y 50 % masculino; se logró la visualización de todas las estructuras laríngeas en 2D en el 100% de los casos, en ningún caso de la división traqueoesofágica. El movimiento de los pliegues vocales fue fácilmente reconocible en todos los casos. Conclusiones: aunque las alteraciones congénitas laríngeas representan una baja incidencia, es fundamental el desarrollo en el conocimiento de la anatomía laríngea desde el punto de vista fetal para su diagnóstico ecográfico y posible tratamiento temprano.

Objective: Prenatal diagnosis and treatment for multiple diseases are now possible thanks to the anatomic knowledge available, the technological development and the integration of different areas of medicine; the aim of this study was to identify through ultrasound the anatomy of the fetal larynx. Design: Descriptive study. Methods: a descriptive study with ultrasounds of 10 pregnant women's fetuses' larynges during the second half of their gestation was carried out, during the morphological ultrasound structures such as the epiglottis, arytenoids, vocal folds and their movement, subglottis, trachea, tracheoesophageal division, subglottis diameter and proximal trachea were identified. Results: The fetuses' gestational age median was 26 weeks (20-34+5), 50 % females, 50 % males. The visualization of all laryngeal structures in 2D was possible in 100 % of the cases; the tracheoesophageal division was not seen in any case. The movement of the vocal folds was easily identified in all cases. Conclusions: Even though laryngeal congenital anomalies show low incidence, the development of the larynx anatomic knowledge at the fetal stage is fundamental to early diagnose diseases, anomalies and disorders through ultrasound and have the possibility of recommending early treatments.

Plantas utilizadas en la medicina tradicional de comunidades campesinas e indígenas de la Selva Zoque, Chiapas, México / Useful plants in traditional medicine of peasant and indigenous communities of Selva Zoque, Chiapas, Mexico

El objetivo fue conocer las plantas utilizadas en la medicina tradicional de cuatro comunidades de la Selva Zoque, Chiapas, México. En cada comunidad, se aplicaron 30 entrevistas semiestructuras. El listado florístico medicinal estuvo conformado por 113 especies, 96 géneros y 50 familias. Asteraceae, Fabaceae y Lamiaceae fueron las más representativas. Se obtuvieron 84 indicaciones de uso medicinal, clasificadas en 13 enfermedades, gastrointestinales, dermatológicas y respiratorias, fueron las más frecuentes. La hoja es la estructura de la planta más empleada (72%). El cocimiento es la manera más común de preparar a las plantas, y la vía oral es la forma más frecuente de administrar la medicina. El uso de plantas medicinales es resultado de la experiencia e íntimo contacto con la naturaleza que la sociedad ha acumulado por generaciones. Este saber ha permitido que sobrevivan comunidades que habitan en lugares apartados, donde hay carencias de servicios médicos.

The objective was to know the useful plants in the traditional medicine of four communities of Selva Zoque, Chiapas. In each community, 30 semi-structured interviews were applied. The medicinal floristic listing consisted of 114 species, 97 genera and 50 families. Asteraceae, Fabaceae and Lamiaceae were the most representative. There were 84 indications for medicinal use, classified in 13 diseases, gastrointestinal, dermatological and respiratory, were the most frequent. The leaf is the structure of the most used plant (72%). Cooking is the most common way to prepare plants, and the oral route is the most frequent way to administer medicine. The use of medicinal plants is the result of experience and intimate contact with nature that society has accumulated for generations. This knowledge has allowed communities that live in remote places to survive, where there are shortages of medical services.

Diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus tipo 2, prediabetes y sujetos no diabéticos / Differences in the epicardial fat thickness in patients with diabetes mellitus 2, prediabetes and nondiabetic subjects

Resumen OBJETIVO Evaluar si hay diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus 2, prediabetes y sujetos no diabéticos. MATERIAL Y MÉTODO Estudio en el que de enero a agosto de 2017 se evaluaron sujetos divididos en tres grupos: sujetos con diabetes mellitus 2, sujetos con prediabetes y sujetos no diabéticos. En todos se midió el grosor de la grasa epicárdica por ecocardiografía, siguiendo la técnica descrita por Iacobelis, con un equipo Aloka alfa 6, usando un transductor de 3.5 MHz, por dos ecocardiografistas que desconocían los datos clínicos de los pacientes. El método estadístico usado fue ANOVA. RESULTADOS Se incluyeron en el estudio 120 pacientes divididos en los tres grupos (40 pacientes cada grupo); se encontró grosor de la grasa epicárdica de 5.63 mm en el grupo de diabetes mellitus, de 4.43 mm en el grupo de prediabetes y de 4.0 mm en el grupo sin diabetes. No hubo diferencia en el grosor de la grasa epicárdica entre los grupos sin diabetes y prediabéticos (p = 0.09). Sin embargo, sí encontramos diferencia significativa entre el grupo de diabetes mellitus y los grupos prediabetes y sin diabetes (p = 0.00017). CONCLUSIÓN Los pacientes diabéticos tipo 2 tienen mayor grosor de la grasa epicárdica que los prediabéticos y los sujetos no diabéticos, lo que apoya la relación entre grasa visceral y diabetes mellitus tipo 2.

Abstract OBJECTIVE To evaluate the differences in epicardial fat thickness in subjects with type-2 diabetes, prediabetes or non-diabetic. MATERIAL AND METHOD A study was done from January to August 2017 evaluating subjects divided into 3 groups: group with type-2 diabetic patients, group with subjects with prediabetes and group with nondiabetic subjects. In all of them the epicardial fat thickness was measured with an Aloka alfa 6 equipment, by 2 cardiologists who were unaware of the clinical data. Statistical analysis was performed with ANOVA. RESULTS There were included 120 patients divided into three groups of 40 patients each. Epicardial fat thickness was of 5.63 mm in diabetes mellitus group, 4.43 mm in prediabetes group and 4 mm in nondiabetic group. We did not find difference in epicardial fat thickness between nondiabetes and prediabetes groups (p = 0.09). However, we found significantly differences in epicardial fat thickness between diabetes group and groups of prediabetes and nondiabetes (p = 0.00017). CONCLUSION Type-2 diabetic patients have greater nondiabetes than prediabetic and nondiabetic subjects; this fact supports the relationship between visceral fat and the risk of type-2 diabetes.

COMPARACIÓN DE MÉTODOS DE INOCULACIÓN DE Fusarium solani f. sp. passiflorae EN PLÁNTULAS DE MARACUYÁ (Passiflora edulis f. flavicarpa) / COMPARISON OF METHODS OF INOCULATION OF Fusarium solani f. sp. passiflorae IN SEEDLINGS OF PASSION FRUIT (Passiflora edulis f. flavicarpa)

RESUMEN El maracuyá es una especie susceptible a patógenos, como Fusarium solani f. sp. passiflorae, causante de la secadera, llegando a causar pérdidas entre 90 y 100%, en cultivos comerciales en Colombia. Debido al desconocimiento de un método de inoculación eficiente para evaluar germoplasma de maracuyá contra este patógeno, se planteó este estudio, cuyo objetivo fue comparar cuatro métodos de inoculación de F. solani f. sp. passiflorae MViRi01 en plántulas de maracuyá (Passiflora edulis f. flavicarpa), cultivadas a 29°C, con un fotoperiodo de 12h. Los tratamientos fueron: incisión en el tallo (T1), inmersión de raíces (T2), inyección en el tallo (T3) y cribado en tubos de ensayo modificado (T4). Se estimó la incidencia de la enfermedad y el periodo de incubación del hongo. Los métodos evaluados mostraron diferencias altamente significativas (P<0,001). F. solani f. sp. passiflorae infectó raíces, tallo y hojas, causando estrangulamiento ascendente y descendente del tallo. Se obtuvo 100% de incidencia de la enfermedad con los tratamientos T1 (incisión) y T4 (cribado). En T4, el periodo de incubación del hongo fue 2,4 días y en T2 (inmersión), de 19 días. La muerte de las plántulas ocurrió 12 días después de inocular los tratamientos T1 y T3 (inyección). La emisión de raíces adventicias en las plántulas se indujo inyectando el patógeno (T3). Los métodos apropiados para inocular Fusarium sp. en plántulas de maracuyá fueron el cribado en tubos de ensayo modificado y la incisión en el tallo, debido a la homogeneidad en los resultados y la replicabilidad.

SUMMARY Passionfruit is a species susceptible pathogens such as Fusarium solani f. sp. passiflorae, causal agent of Passiflora collar rot, which can cause yield losses between 90 and 100% in commercial crops in Colombia. Due to lack of knowledge of an efficient inoculation method to evaluate germplasm of passionfruit against this fungus, it was designed this study, whose objective was to compare four methods of inoculation of F. solani f. sp. passiflorae MViRi01 in passionfruit seedlings (Passiflora edulis f. flavicarpa) cultivated at 29ºC and 12-hours of photoperiod. The treatments were: stem incision (T1), root immersion (T2), stem injection (T3), and a modified test-tube screening methodology (T4). Disease incidence and incubation period of the fungus was evaluated. The assessed methods showed highly significant differences (P< 0.001). F. solani f. sp. passiflorae infected roots, stem, and leaves causing stem ascending and descending strangulation. Both T1 (incision) and T4 (screening) treatments showed 100% of disease incidence. The incubation period of the fungus in T4 was 2.4 days and in T2 (immersion) 19 days. The death of the seedlings occurred 12 days after inoculation in T1 and T3 (injection) treatments. The adventitious root sprouting in the seedlings was induced by injecting (T3) the pathogen. The most suitable methods to inoculate F. solani f. sp. passiflorae on passionfruit seedlings were the modified testtube screening methodology and the stem incision due to its homogeneity and replicability results.

Actualización en el manejo respiratorio de pacientes con enfermedades neuromusculares / Update in the respiratory management of patients with neuromuscular diseases

Resumen: Los días 24 y 25 de noviembre del 2016, en Montevideo, Uruguay, tuvo lugar un encuentro de capacitación en cuidados respiratorios no invasivos con más de 200 profesionales médicos, kinesiólogos y licenciadas de enfermería. El encuentro fue presidido por el Dr. John Bach, Director Médico del Centro de Ventilación Mecánica No Invasiva en la Escuela de Medicina de Rutgers, New Jersey en Newark, New Jersey, quien es reconocido a nivel mundial por su amplia trayectoria en estudios y trabajos publicados sobre ventilación no invasiva y enfermedades neuromusculares Los cuidados respiratorios no invasivos, combinando la asistencia ventilatoria, inicialmente nocturna y luego durante las 24 horas del día, incluso en pacientes con capacidad vital mínima, y la implementación de estrategias para asistencia de la tos y respiración glosofaríngea, han contribuido a una mejor calidad de vida y sobrevida de los pacientes con enfermedades neuromusculares. Los avances tecnológicos, la capacitación de los pacientes y sus cuidadores facilitan su estadía en el hogar sin depender de instituciones o cuidados de enfermería permanentes promoviendo su autonomía e integración. Resulta esencial que los profesionales de la salud, conozcan todas las opciones terapéuticas posibles para ofrecer a sus pacientes y sus familias, de modo que, conforme avanza la enfermedad, ellos puedan expresar sus voluntades en forma anticipada y sin apremios derivados de eventos "inesperados". Es necesario impulsar un cambio de paradigma en la forma en que los profesionales de la salud ven a estos individuos. Las recomendaciones claves de ese encuentro están resumidas en este artículo.

Summary: A November 2016 Noninvasive Ventilatory Support workshop and meeting with more than 200 medical professionals, physiotherapists, respiratory therapists and nurses took place in the city of Montevideo, Uruguay. It was conducted by Dr. John Robert Bach, Medical Director of the Center for Non-Invasive Mechanical Ventilation at Rutgers New Jersey School of Medicine in Newark, New Jersey, who is recognized worldwide for his extensive background in studies and publications on noninvasive ventilation and neuromuscular diseases. Non-invasive respiratory care which combines ventilatory support initially at night and then support continuously 24 hours per day, even in patients with minimal vital capacity combined with the implementation of specifics techniques for assisted coughing and glossopharyngeal breathing have contributed to a better quality of life and survival of patients with neuromuscular diseases. Technological advances and proper training for patients and caregivers facilitates the patient's ability to stay at home and also promotes their autonomy and integration, without them having to depend on hospice or permanent nursing care. It is essential for health care professionals to know all the therapeutic possibilities available for their patients and share with both the patients and the patient's family, so as the disease progresses it will help everyone clearly understand all options during conscious decision-making. It is necessary to promote a paradigm shift in the way health professionals approach individuals with neuromuscular diseases. The key recommendations from that meeting are summarized in this article.

Comunicación y salud: Influencia en los hábitos alimenticios en una escuela de Guayaquil, 2017 / Communication and health: influence on eating habits in a school in Guayaquil, 2017

El objetivo de esta investigación fue determinar cómo se manifiestan los procesos de comunicación y salud y su influencia en los hábitos alimenticios en los niños del 5.°, 6.°, 7.° grado de la Escuela Fiscal Mixta Blanca Goetha de Ordóñez de Guayaquil, 2017. Estos se manifiestan por tener una baja incidencia al fomentar las costumbres de alimentación como parte de las estrategias del educador. Es un diseño no experimental-transeccional, descriptivo, cuyo método utilizado es el constructivismo. Se desarrollaron ocho técnicas cualicuantitativas con una muestra no probalística por cuotas. Los resultados obtenidos del público muestral es que los niños en su mayoría prefieren degustar en su día a día todo tipo de comida chatarra ante la falta de control de los padres, quienes les proveen dinero para que compren, pero que ellos la prefieren en las afueras de la institución educativa. De la misma manera los padres se muestran ausentes ante la problemática del menor, debido a la falta de culturización alimenticia, por ello este grupo escolar opta por "alimentarse" de la forma que conoce. A partir de los hallazgos encontrados, aceptamos la hipótesis que comprueba que los niños se muestran indiferentes ante las diferentes estrategias y constantes consejos que imparte el gestor en su planificación. La recomendación es insistir con una cultura alimenticia que empiece desde la casa con una porción que influya. El propósito es lograr que los padres tomen conciencia de la forma en que nutren a sus hijos con los alimentos que no son los más adecuados para escolares en etapa de crecimiento.

The objective of this research was to determine how the communication and health processes and their influence on eating habits in children in the 5th, 6th and 7th grade of the Blanca Goetha Joint Fiscal School of Ordonez de Guayaquil, 2017. The processes of communication and health are manifested by having a low incidence in promoting eating habits as part of the strategies of the educator. It is a non-experimental-transectional, descriptive design whose method used is constructivism. Eight quantitative techniques were developed with a non-probalistic sample by quotas. The results obtained from the sample public is that the children mostly prefer to taste in their day to day all type of junk food in the absence of control of the parents, who provide money for them to buy, but that they prefer it in the outskirts of the educational institution. In the same way parents are absent in the face of the problem of the child due to lack of food culture, so this school group chooses to "feed" in the way it knows. From the findings found, we accept the hypothesis that proves that children are indifferent to the different strategies and constant advice that the manager imparts in his planning. The recommendation is to insist on a food culture that starts from the house with a portion that influences. The purpose is to make parents aware of how they nurture their children with foods that are not the most suitable for growing schoolchildren.

Caracterización de Cepas de Virus Sincitial Respiratorio en el Gran Buenos Aires y Aspectos de su Diseminación / Characterization of Respiratory Syncytial Virus Strains in the Greater Buenos Aires and Spreading Aspects

INTRODUCCIÓN: El virus sincitial respiratorio (VSR) es el agente viral más frecuente de infecciones respiratorias agudas bajas (IRAB) en la primera infancia y el mayor responsable de las hospitalizaciones en el período invernal. OBJETIVOS: Describir las características de los brotes de VSR en la Zona Sanitaria VI de la provincia de Buenos Aires, establecer la diversidad de las cepas circulantes y realizar el análisis bioinformático y filogeográfico de las secuencias de la glicoproteína G. MÉTODOS: Se estudió a pacientes pediátricos internados con presentación compatible con IRAB durante dos picos epidémicos (2014-2015) en cuatro hospitales. Se recopilaron datos clínicos, demográficos y socio-sanitarios, y se detectaron patógenos virales en aspirados nasofaríngeos de estos pacientes por inmunofluorescencia (IF), obteniéndose la secuencia del gen de la proteína G en los VSR positivos. RESULTADOS: De 1296 casos estudiados, 317 fueron positivos para algún agente viral. De ellos, 266 (84%) fueron VSR positivos. Se hallaron asociaciones significativas entre las poblaciones positivas y negativas para VSR. Una tendencia al hacinamiento y vivienda precaria en los casos VSR positivos fue reflejada en los estudios filogeográficos. CONCLUSIONES: Los datos de firma molecular permitieron trazar orígenes y vías de diseminación del VSR. Esto ayuda a señalar zonas y situaciones de vulnerabilidad, estableciendo la población primaria blanco de planes de vacunación u otras medidas profilácticas.

INTRODUCTION: The respiratory syncytial virus (RSV) is the most frequent viral agent associated to acute lower respiratory infections (ALRIs) in early childhood, being the main responsible for hospitalizations during winter. OBJECTIVES: To describe the characteristics of RSV outbreaks in the Health Area VI of Buenos Aires Province, to establish the diversity of circulating strains and to perform a bioinformatic and phylogeographic analysis of glycoprotein G sequences. METHODS: Pediatric inpatients with ALRI-compatible x|presentation during two epidemic peaks (2014-2015) were studied in four hospitals. Clinical, demographic and socio-sanitary data were collected, viral pathogens were detected by immunofluorescence (IF), and the sequence of the G protein gene was obtained in the positive RSVs. RESULTS: From 1296 cases, 317 were positive for some viral agent and 266 (84%) out of these were RSV positive. Significant associations were found among the positive and negative populations for RSV. A trend towards overcrowding and precarious housing in positive RSV cases was reflected in phylogeographic studies. CONCLUSIONS: The molecular signature data allowed tracing origins and routes of RSV dissemination. This helps identify areas and situations of vulnerability, establishing the primary target population for vaccination plans or other prophylactic measures.