Riesgo de Retención de Secreciones en Pacientes con Ventilación Mecánica Invasiva / Risk of Retention of Secretions in Patients with Invasive Mechanical Ventilation

Introducción. Los pacientes conectados a ventilación mecánica invasiva pueden presentar complicaciones respiratorias, donde la retención de secreciones es una de las más frecuentes. El drenaje y eliminación de las secreciones depende entre otras variables de los flujos respiratorios generados, donde una diferencia absoluta entre el flujo espiratorio máximo (FEM) y flujo inspiratorio máximo (FIM) menor a 17 L•min-1 o una relación FIM/FEM mayor a 0.9 favorecerían la retención de secreciones. Sin embargo, falta por determinar los flujos respiratorios resultantes y la proporción de pacientes con riesgo de retención de secreciones según estos parámetros. Objetivo. Determinar los flujos respiratorios durante la ventilación mecánica invasiva y la proporción de pacientes que se encuentra en riesgo de retención de secreciones. Métodos. Estudio descriptivo transversal desarrollado en la Unidad de Paciente Crítico Médico-Quirúrgico del "Hospital Clínico de la Red de Salud UC-CHRISTUS". Se incluyeron pacientes adultos intubados y conectados a ventilación mecánica, en quienes se determinó los flujos respiratorios resultantes y se estimó la diferencia absoluta FEM-FIM, la relación FIM/FEM y la proporción de pacientes con riesgo de retención de secreciones. Resultados. Se incluyeron 100 pacientes, 45% presentaba entre sus diagnósticos patología respiratoria. La mediana de la diferencia absoluta entre FEM y FIM fue de 6 L•min-1 (-5 - 14.5) y la mediana de la tasa FIM/FEM de 0.87 (0.7 - 1.13). Un 84% presentó una diferencia absoluta entre FEM y FIM menor a 17 L•min-1, mientras que el 46% presentó una relación FIM/FEM mayor a 0.9. Conclusión. Una alta proporción de pacientes conectados a ventilación mecánica presenta riesgo de retención de secreciones independiente de la presencia o ausencia de patología respiratoria. Se requieren futuras investigaciones para evaluar el impacto de este criterio sobre complicaciones respiratorias.

Background. Patients connected to invasive mechanical ventilation may develop respiratory complications, where retention of secretions is one of the most frequent. The drainage and elimination of the secretions depend on other variables of the respiratory flows generated, where an absolute difference between the peak expiratory flow (PEF) and peak inspiratory flow (PIF) less than 17 L•min-1 or a PIF/PEF ratio greater than 0.9 would favor secretion retention. However, it is necessary to determine the respiratory flows and the proportion of patients, with and without respiratory pathology, with a risk of secretions retention according to these parameters. Objective. Determine respiratory flows during connection to invasive mechanical ventilation and the proportion of patients with and without respiratory pathology at risk of secretions retention. Methods. A descriptive cross-sectional study was conducted in the Medical-Surgical Intensive Care Unit of the "Hospital Clínico de la Red de Salud UC-CHRISTUS". Intubated adult patients connected to mechanical ventilation were included, in whom the respiratory flows were assessed, and the absolute PEF-PIF difference, PIF/PEF ratio, and the proportion of patients with a risk of secretions retention were determined. Results. 100 patients were included, of which 45% presented among their diagnoses acute or chronic respiratory pathology. For the total number of patients, the median of the absolute difference between PEF and PIF was 6 L•min-1 (-5 - 14.5), and the median of the PIF/PEF ratio of 0.87 (0.7 - 1.13). Of the total of patients, 84% presented an absolute difference between PEF and PIF less than 17 L• min-1, while 46% presented a PIF/PEF ratio greater than 0.9. Conclusion. Considering the absolute difference between PEF-PIF and the PIF/PEF ratio, many patients present a risk of secretions retention. However, whether this is associated with severe respiratory complications in patients connected to invasive mechanical ventilation should be clarified in future research.

Mental stress induces endothelial dysfunction by AT1R-mediated redox imbalance in overweight/obese men

The main goal of this study was to determine whether oxidative imbalance mediated by AT1 receptor (AT1R) is responsible for deleterious endothelial responses to mental stress (MS) in overweight/obese class I men. Fifteen overweight/obese men (27±7 years old; 29.8±2.6 kg/m2) participated in three randomized experimental sessions with oral administration of the AT1R blocker olmesartan (40 mg; AT1R blockade) or ascorbic acid (AA; 3g) infusion or placebo [both intravenously (0.9% NaCl) and orally]. After two hours, endothelial function was determined by flow-mediated dilation (FMD) before (baseline), 30 min (30MS), and 60 min (60MS) after a five-minute acute MS session (Stroop Color Word Test). Blood was collected before (baseline), during MS, and 60 min after MS for redox homeostasis profiling: lipid peroxidation (TBARS; thiobarbituric acid reactive species), protein carbonylation, and catalase activity by colorimetry and superoxide dismutase (SOD) activity by an ELISA kit. At the placebo session, FMD significantly decreased 30MS (P=0.05). When compared to baseline, TBARS (P<0.02), protein carbonylation (P<0.01), catalase (P<0.01), and SOD (P<0.01) increased during the placebo session. During AT1R blockade, FMD increased 30 min after MS (P=0.01 vs baseline; P<0.01 vs placebo), while AA infusion increased FMD only 60 min after MS. No differences were observed during MS with the AT1R blockade and AA regarding TBARS, protein carbonylation, catalase, and SOD. AT1R-mediated redox imbalances played an important role in endothelial dysfunction to mental stress.

Tratamiento quirúrgico en estado epiléptico super refractario relacionado con malformación arterio venosa

Introducción: Las malformaciones arteriovenosas cerebrales (MAV) son un conjunto anormal de arterias y venas dilatadas del cerebro y caracterizadas por la pérdida de la organización vascular con una derivación arteriovenosa anormal. La probabilidad de ruptura de una MAV es baja, pudiendo causar déficit hasta en el 45% de los pacientes. La epilepsia puede asociarse con MAV siendo raro el estado epiléptico. La evolución a estado epiléptico refractario o estado epiléptico super refractario (EESR) es excepcional. Se presenta paciente con epilepsia asociada a MAV, con embolización y posterior complicación que evoluciona a EESR, donde se logró una resolución favorable con cirugía. Caso clínico: Paciente masculino de 70 años, con MAV temporal derecha no rota y epilepsia, libre de crisis desde el diagnóstico de ambas condiciones. Se realizó embolización logrando exclusión, pero con evolución a EESR. Tras estudio se realiza resección de MAV y resección parcial de zona de inicio de actividad epileptógena parieto-temporal. Además, se realizó una desconexión de región fronto-parietal central donde había evidencia de propagación de la actividad epiléptica. Paciente logra salir de estado crítico, con recuperación de conciencia y normalización de electroencefalogramas posquirúrgicos. A los 2 años evoluciona con epilepsia controlada (Engel IIa). Discusión y conclusiones: El abordaje quirúrgico es una opción en EESR y debe plantearse en un tiempo precoz de evolución (1-2 semanas). La cirugía se realizó para controlar EESR y fue una intervención exitosa. Esta estrategia puede lograr un cambio dramático en el pronóstico. La cirugía resectiva está indicada cuando hay evidencia etiológica en imágenes y focalidad eléctrica consistente en los estudios.

Introduction: Brain Arteriovenous Malformations (AVM) are an abnormal set of dilated arteries and veins within the brain and are characterized by loss of vascular organization with an abnormal arteriovenous shunt. The probability of AVM rupture is low, but it can cause deficits in up to 45% ofpatients. Epilepsy could be associated with AVM, and status epilepticus is rare. The evolution to refractory status epilepticus or super refractory status epilepticus (SRSE) is very rare. The objective is to present a patient with epilepsy associated with non-ruptured AVM, treated with embolization and a subsequent complication that evolves into SRSE, in which a favorable resolution was achieved after surgery Clinical case: 70-year-old male, with a diagnosis of non-ruptured right temporal AVM and epilepsy, who has been seizure free since the diagnosis, is reported. Embolization of the AVM was performed, achieving total exclusion, after the procedure presented seizures that evolved into SRSE. After investigation, an AVM resection and partial resection of the ictal onset zone on the right parieto-temporal region was performed, including a disconnection of the central fronto-parietal region, where there was evidence of propagation of ictal activity. Patient recovered from the critical condition after surgery, and also presented electrographic normalization. After 2 years, the epilepsy is well controlled (Engel IIa). Discussion and conclusions: The surgical approach is an option in SRSE, and it should be proposed early on, within a reasonable time of evolution (1-2 weeks). The active approach in this case, where the surgery was done for SRSE control, was a successful intervention. Especially when the features are consistent -there is etiological evidence in imaging and electrical focality in studies- there can be a dramatic change in the prognosis.

Síndrome Paraneoplásico: Dermatomiositis secundaria a carcinoma de vesícula biliar: Reporte de un caso / Paraneoplastic Syndrome. Dermatomyositis secondary to gallbladder carcinoma: A case report

RESUMEN La dermatomiositis paraneoplásica, y en particular vinculada a carcinoma de vesícula biliar es una entidad infrecuente, con menos de diez casos reportados a nivel mundial. Presentamos un paciente de 74 años con manifestaciones clínicas y dermatológicas asociadas a dermatomiositis, lo que impulsó a realizar estudios más específicos, los cuales permitieron diagnosticar finalmente un carcinoma de vesícula biliar. Haremos un repaso de esta patología en relación con el caso presentado, destacando la importancia del examen dermatológico completo como primer eslabón en el diagnóstico de neoplasias de órganos internos.

ABSTRACT Paraneoplastic dermatomyositis, particularly associated with gallbladder carcinoma, is an infrequent entity, with less than 10 cases reported worldwide. We present a 74-year-old patient with clinical and dermatological manifestations associated with dermatomyositis, which prompted more specific studies, to finally find gallbladder carcinoma. We will review this pathology in relation to the case presented, highlighting the importance of the complete dermatological examination as the first link in the diagnosis of neoplasms of internal organs.

Short isocapnic hyperoxia affects indices of vascular remodeling and intercellular adhesion molecules in healthy men

In preparation for tracheal intubation during induction of anesthesia, the patient may be ventilated with 100% oxygen. To investigate the impact of acute isocapnic hyperoxia on endothelial activation and vascular remodeling, ten healthy young men (24±3 years) were exposed to 5-min normoxia (21% O2) and 10-min hyperoxia trials (100% O2). During hyperoxia, intercellular adhesion molecules (ICAM-1) (hyperoxia: 4.16±0.85 vs normoxia: 3.51±0.84 ng/mL, P=0.04) and tissue inhibitor matrix metalloproteinase 1 (TIMP-1) (hyperoxia: 8.40±3.84 vs normoxia: 5.73±2.15 pg/mL, P=0.04) increased, whereas matrix metalloproteinase (MMP-9) activity (hyperoxia: 0.53±0.11 vs normoxia: 0.68±0.18 A.U., P=0.03) decreased compared to the normoxia trial. We concluded that even short exposure to 100% oxygen may affect endothelial activation and vascular remodeling.

Kinesiólogos frente a la pandemia de COVID-19: ¿Cuál es su rol? / Physiotherapists in COVID-19: what is their role?

Resumen El impacto de la pandemia por COVID-19 a nivel social, económico y sanitario no tiene precedentes. Sólo en Chile hasta el mes de julio de 2020, más de 340.000 personas han contraído la enfermedad y alrededor de 9.000 han fallecido por esta causa. Esta crisis sanitaria ha llevado a una adaptación en todo el sistema de salud y toma de medidas extraordinarias para poder cubrir dichas necesidades. El kinesiólogo como profesional de la salud constituye una pieza fundamental en la atención de estos pacientes. Su rol se ha visto reflejado en las distintas etapas de la enfermedad desde la atención primaria y urgencia hasta la atención de pacientes en la unidad de cuidados intensivos y posterior al alta hospitalaria. Además de su rol clínico asistencial, el kinesiólogo es capaz de contribuir en áreas de educación, promoción, gestión en salud e investigación científica, aspectos que podrían ser esenciales en el manejo de la pandemia. Es deber del kinesiólogo considerar esta oportunidad y asumir los múltiples desafíos derivados de la pandemia para comprometerse y otorgar respuestas a las necesidades sanitarias actuales.

The impact of the COVID-19 pandemic on the social, economic, and health levels is unprecedented. In Chile alone until July 2020, more than 340,000 people have tested positive and around 9,000 have died because of it. This health crisis has led to different adaptations in the health system and extraordinary measures have been taken to meet these needs. The physiotherapist as a health professional constitutes a fundamental piece in the care of these patients. Its role has been reflected in all disease's stages, from the emergency room to the intensive care unit and after hospital discharge. In addition to his clinical-attendance role, the physiotherapist may contribute in different areas such as education, health promotion, health management, and scientific research, aspects that could be essential in managing the pandemic. As physiotherapist responsibility, we should consider this opportunity and assume the multiple challenges derived from the pandemic to commit and provide answers to current health needs.

Frequência Alfa na meditação Gurdjieff / Alpha Frequency in Gurdjieff Meditation

Introdução: a meditação é uma prática que visa regular o estado mental e as emoções, podendo induzir a estados alterados de consciência. Dentre inúmeras técnicas de meditação, o trabalho proposto por George I. Gurdjieff, inclui práticas voltadas para o recolhimento da atenção e o equilíbrio entre a atividade do corpo, da mente e do sentimento. Estudos realizados com eletroencefalografia (EEG), avaliando o estado meditativo em geral, demonstraram um padrão cerebral caracterizado pelo aumento da amplitude dos ritmos eletroencefalográficos alfa e teta, bem como diferenças na atividade alfa entre a meditação e o relaxamento. Entretanto, isto não está caracterizado em meditadores da linha de G.I. Gurdjieff, que praticam, além de meditações sentadas, exercícios corporais acompanhados de uma música própria e exercícios de atenção durante a vida diária. Objetivo: comparar a atividade cerebral da frequência alfa durante os estágios de meditação e relaxamento e avaliar as diferenças entre as regiões frontal, central e occipital nesses dois estados, em meditadores experientes do grupo Gurdjieff, de Salvador-Bahia-Brasil. Metodologia: a coleta da atividade cerebral dos 8 voluntários foi realizada através do EEG. O protocolo de coleta adotado foi de 6 minutos de relaxamento e 12 minutos de meditação. Resultados: foi encontrado aumento significativo da potência alfa durante a meditação, quando comparada ao relaxamento. As regiões frontal e central não apresentaram diferenças entre si para a potência alfa, enquanto a região occipital apresentou aumento da potência alfa em comparação com as regiões frontal e central. Existe um aumento da densidade de alfa durante a meditação em todas as regiões cerebrais testadas, com maior densidade na região occipital. Conclusão: A frequência alfa comporta-se de forma diferente durante a meditação, comparada ao relaxamento, com um aumento da densidade de potência durante o estado meditativo em todas as regiões avaliadas, sendo a região occipital a que apresentou maior potência.

Introduction: meditation is a practice that aims to regulate the mental state and emotions, and can induce altered states of consciousness. Among numerous meditation techniques, the work proposed by George I. Gurdjieff, includes an attempt to balance activities from the body, the mind and the feelings. Studies conducted with electroencephalography (EEG), evaluating the meditative tate, demonstrated a brain pattern characterized by increased alpha and theta amplitude, as well as differences in alpha activity between meditation and relaxation. However, this is not characterized in Gurdjieff meditators, which practice beyond sitted meditations, body exercises with music, and attentional exercises during everyday life. Objective: comparing the brain activity of the alpha power during the meditation and relaxation stages and evaluate the differences between the frontal, central and occipital regions in these two states, in experienced meditators from the Gurdjieff group, in Salvador-Bahia-Brazil. Methodology: the data collection of the brain activity from 8 volunteers was performed by EEG. The collection protocol adopted was 6 minutes of relaxation and 12 minutes of meditation. Results: a significant increase in alpha power was found during meditation, when compared to relaxation. The frontal and central regions showed no differences between them for alpha power, while the occipital region showed an increase in alpha power compared to the frontal and central regions. Conclusion: the alpha frequency behaves differently during meditation, compared to relaxation, with an increase in alpha density during the meditative state in all evaluated regions, with the occipital region being the most potent.

Histoplasmosis diseminada. A propósito de un caso / Disseminated Histoplasmosis. About a case

RESUMEN La histoplasmosis es una micosis profunda causada por el hongo dimorfo Histoplasma capsulatum (H. capsulatum). Ingresa al organismo principalmente por la vía inhalatoria en forma de microconidias, las cuales se transforman en elementos levaduriformes intracelulares, y luego se diseminan por vía hemática. La primoinfección en pacientes inmunocompetentes suele ser asintomática y de resolución espontánea, pero los pacientes inmunodeprimidos generalmente pueden presentar una enfermedad diseminada con compromiso mucocutáneo con pápulas, nódulos, gomas, úlceras de fondo granulomatoso serosanguinolento y costras. Se presenta un caso clínico de un paciente diabético inmunodeprimido con infección por H. capsulatum, en el cual se realiza diagnóstico a partir de las lesiones cutáneas.

SUMMARY Histoplasmosis is a deep mycosis caused by the dimorfo fungus Histoplasma capsulatum (H. capsulatum). Which enters the body mainly through the inhalation route in the form of microconidia which are transformed into intracellular levaduriform elements, and then disseminated by blood. The primary infection in immunocompetent patients is usually asymptomatic and spontaneously resolved, but immunocompromised patients can usually present with a disseminated disease with mucocutaneous involvement, with papules, nodules, gums, granulomatous serosanguinolent fundus ulcers and scabs. A clinical case of an immunocompromised diabetic patient with H. capsulatum infection is presented, in which diagnosis is made from the skin lesions.

Carcinomas basocelulares localizados en áreas de la piel no expuesta a luz solar / Basal cell carcinomas located in areas of the skin not exposed to sunlight

RESUMEN Introducción: El carcinoma basocelular (CBC) es el cáncer humano más común. Es una neoplasia epitelial de malignidad limitada por un crecimiento lento y excepcional capacidad para dar metástasis a distancia. Es más frecuente en varones y en mayores de 40 años, foto tipos cutáneos I y II, una exposición solar intensa y prolongada, inmunosupresión y exposición a radiaciones ionizantes, ocurren de forma esporádica, aunque pueden ser hereditarios. Objetivo: Presentar un caso infrecuente de carcinoma basocelular en áreas no expuestas Presentación del caso: Paciente de 36 años, masculino, foto tipo III, sin antecedentes patológicos, medicamentosos, alérgicos y hereditarios; comerciante, sin antecedentes de exposición solar; consulta por lesión eritematosa en región antero-proximal del brazo derecho. Se observan otras dos lesiones, una en región pectoral derecha y otra en fosa ilíaca derecha; diagnóstico presuntivo CBC. Diagnóstico: Lesión 1: CBC. Lesión 2 y 3: CBC superficial. se solicita escisión quirúrgica convencional con ampliación de márgenes, la biopsia informa márgenes libres, se indican medidas de seguimiento y prevención. Conclusiones: se presenta un caso de CBC múltiples en áreas no expuestas a la radiación solar. Resulta fundamental el control y seguimiento de este paciente, pues tiene un alto riesgo de desarrollar melanoma.

ABSTRACT Introduction: Basal cell carcinoma (BCC) is the most common human cancer. It is an epithelial neoplasm of malignancy limited by slow growth and exceptional ability to metastasize at a distance. It is more frequent in men and in> 40 years, cutaneous phototypes I and II, a prolonged and intense solar exposure, immunosuppression and exposure to ionizing radiation, occur sporadically, although they can be hereditary. Objective: To present an infrequent case of basal cell carcinoma in unexposed areas Case presentation: Patient 36 years old, male, phototype III, without pathological, medicated, allergic and hereditary antecedents; merchant, not photo-exposed; consultation due to an erythematous lesion in the antero-proximal region of the right arm. Two other lesions are observed, one in the right pectoral region and the other in the right iliac fossa; presumptive diagnosis BCC. Diagnosis: Injury 1: BCC. Lesion 2 and 3: superficial BCC. conventional surgical excision with widening of margins is requested, biopsy reporting free margins, follow-up and prevention measures are indicated. Conclusions: a case with multiple CBC was presented in non-photoexposed areas without the clinic. Control and follow-up are essential given that they have a high risk of developing melanoma.

Identification of microchips through diagnostic imaging helps to determine the longevity of the golden lancehead (Bothrops insularis) in captivity / Identificação de microchips por meio de diagnóstico por imagem auxilia a determinar a longevidade da jararaca-ilhoa (Bothrops insularis) em cativeiro

As serpentes vindas da natureza e encaminhadas para centros de reabilitação ou de pesquisa têm uma idade incerta. Na natureza, esses animais, muitas vezes atingem um tamanho corpóreo menor do que os indivíduos cativos devido a uma menor frequência de alimentação. Assim, a idade de uma cobra recém-chegada da natureza é geralmente estimada com base em seu tamanho corpóreo, o qual é comparado com dados em cativeiro. A utilização dos meios de diagnóstico por imagem tem auxiliado a medicina na análise das serpentes em cativeiro, mediante avaliação da estrutura óssea, dos órgãos e de alterações. Este trabalho relata o uso de diagnóstico por imagem (radiografia e ultrassonografia) para identificar a presença de microchips e, consequentemente, estimar a idade de uma Bothrops insularis em cativeiro.(AU)

Cutaneous mycobiota of boid snakes kept in captivity / Microbiota cutânea de serpentes Boidae mantidas em cativeiro

Boids are large, constrictor snakes that feed mostly on mammals, reptiles, and birds. These animals are commonly raised as pets, and their improper handling can favor the emergence of fungal infections, which can lead to dermatological diseases that are undiagnosed in nature. Here, we isolate and identify the filamentous fungi that compose the mycobiota of the scales of boid snakes kept in captivity at the Biological Museum of the Butantan Institute. Thirty individuals of four species were evaluated: four Eunectes murinus, twelve Boa constrictor constrictor, seven Corallus hortulanus, and seven Epicrates crassus. Microbiological samples were collected by rubbing small square carpets on the snake scales. We isolated five genera of fungi: Penicillium sp. (30%), Aspergillus sp. (25%), Mucor sp. (25%), Acremonium sp. (10%), and Scopulariopsis sp. (10%). Approximately half of the snakes evaluated had filamentous fungi on the scales, but only 12% of the individuals were colonized by more than one fungal genus. We found no dermatophytes in the evaluated species. Our results provide an overview of the fungal mycobiota of the population of boids kept in the Biological Museum, allowing the identification of possible pathogens.(AU)

Boidae são serpentes grandes e constritoras, que comem normalmente mamíferos, répteis e aves. São comumente criadas como animais de estimação, e seu manuseio inadequado pode favorecer infecções fúngicas emergentes, as quais podem causar doenças dermatológicas que não são diagnosticadas na natureza. Foram isolados e identificados os fungos filamentosos da microbiota das escamas das serpentes Boidae mantidas em cativeiro no Museu Biológico do Instituto Butantan. Trinta indivíduos de quatro espécies foram avaliados: quatro Eunectes murinus, 12 Boa constrictor constrictor, sete Corallus hortulanus e sete Epicrates crassus. As amostras microbiológicas foram coletadas por fricção, em pequenos quadrados de carpete das escamas das serpentes. Isolaram-se cinco gêneros de fungos: Penicillium sp. (30%), Aspergillus sp. (25%), Mucor sp. (25%), Acremonium sp. (10%) e Scopulariopsis sp. (10%). Aproximadamente metade das serpentes avaliadas tinham fungos filamentosos nas escamas e apenas 12% dos indivíduos foram colonizados por mais de um gênero. Não foram encontrados dermatófitos nas espécies avaliadas. Os resultados mostraram uma visão geral da microbiota fúngica da população de boídeos mantidos no Museu Biológico, o que permitiu a identificação de possíveis patógenos.(AU)

Towards designing Brain-Computer Interfaces in terms of User-Profiles, Neurophysiological Factors and User Experience / Hacia el diseño de Interfaces Cerebro-Computadora en términos del Perfil del Usuario, Factores Neurofisiológico y Experiencia del Usuario

Abstract Brain-computer interfaces (BCIs) are technology in development that attempt to establish interaction between individuals and their surroundings by modulating their neural activity. One of the most common strategies to modulate neural activity is motor imagery (MI). However, research on MI-based BCIs has been mostly carried out on the system-related part, whereas the user-related part has been relatively ignored. Thus far, up to 30% of users cannot gain control of BCI, while the remaining ones reach modest performance. The exclusion of users in the system design has possibly led to this outcome. Therefore, the aim of this paper is to establish a mixed method based on interactive design principles and in line with (1) user-profile, (2) psychological and (3) neurophysiological factors, (4) BCI technical issues and (5) user-experience. Although some of these elements have been previously discussed, their integration and application are seldom considered during investigation.

Resumen Las interfaces cerebro-computadora (ICC) son tecnología en desarrollo que intenta establecer interacción entre un individuo y su entorno a través de la modulación de su actividad neuronal. Una de las estrategias más usadas para modular la actividad neuronal ha sido la imaginación motora. Sin embargo, la investigación en ICC controladas por imaginación motora ha sido desarrollada mayoritariamente en términos del sistema, donde el usuario es generalmente ignorado. A la fecha, hasta el 30% de los usuarios no pueden controlar un sistema ICC basado en imaginación motora, mientras que el resto de los usuarios alcanzan un desempeño moderado. La exclusión de los usuarios en el diseño del sistema, posiblemente ha llevado al bajo índice de adaptación entre el sistema y el usuario. En base a esta evidencia, el objetivo de este artículo es establecer un método mixto sustentado en principios de diseño interactivo y considerando cinco elementos: (1) perfil del usuario, (2) factores psicológicos y (3) neurofisiológicos, (4) factores técnicos y (5) experiencia del usuario. Aunque todos estos elementos han sido discutidos previamente, su integración y aplicación son muy poco frecuentes durante la investigación.

Clinical and cytogenetic characterization of a patient with tetrasomy 18p / Caracterización clínica y citogenética de un paciente con tetrasomía 18p

The 18p tetrasomy is a structural chromosomal abnormality with the presence of an extra isochromosome 18p, caused by a nondisjunction failure during maternal meiosis II. This additional i(18p) occurs in 1 of 180,000 live-born children worldwide, affecting males and females equally. It is characterized by craniofacial dysmorphisms; ears, nose and throat (ENT) abnormalities; musculoskeletal alterations; and global development delay. We aim to present the clinical and cytogenetic findings of a 3-year-10-month-old Latin American male with i(18p), to support the gene dosage effects, comparing his features with the ones reported in literature. This patient was product of the second pregnancy of a 39-year-old woman and the first son of a 49-year-old man. His main clinical features were microcephaly, facial dysmorphism, generalized hypotonia, and developmental delay. A blood sample of the patient was required to perform a GTG-banded karyotype and a fluorescence in situ hybridization (FISH) for chromosome 18 short arm. In addition, an SNP microarray analysis was carried out to detect genomic imbalances. Cytogenetic analysis revealed the presence of a metacentric supernumerary marker chromosome. The FISH study confirmed the origin of the marker chromosome by showing two signals for the 18p subtelomere and an intermediate signal for the 18 centromere. The microarray analysis showed a copy number gain of 18,385 Mb within the 18p.Tetrasomy tends to be a result of de novo events. The presence of the patient's isochromosome could be explained by advanced maternal age as it is known that this factor has high influence in isochromosome formation. Despite that there were no genes associated with the i(18p)'s clinical manifestations, these features are negatively correlated with dosage effects of the entire short arm. Physical and language therapy was recommended to the patient; the family received medical orientation, and awareness in family planning was raised.

La tetrasomía 18p es una anormalidad cromosómica estructural con la presencia de un isocromosoma extra 18p, causado por una no disyunción durante la meiosis materna II. Este adicional i(18p) ocurre en 1 de 180.000 niños nacidos vivos en todo el mundo, y afecta a hombres y mujeres por igual. Se caracteriza por dismorfias craneofaciales; anomalías en oídos, nariz y garganta (ENT); alteraciones musculoesqueléticas y del desarrollo global. Nuestro objetivo es presentar los hallazgos clínicos y citogenéticos de un varón latinoamericano de 3 años y 10 meses de edad con i(18p), para explicar los efectos de dosificación génica, comparando sus características con las reportadas en la literatura. Este paciente es producto del segundo embarazo de una mujer de 39 años y el primer hijo de un hombre de 49 años. Sus principales características clínicas fueron microcefalia, dismorfia facial, hipotonía generalizada y retraso global en el desarrollo. Se requirió una muestra de sangre del paciente para realizar un cariotipo con bandas GTG y una hibridación fluorescente in situ (FISH) para el análisis del brazo corto del cromosoma 18. Además, se llevó a cabo un análisis de microarreglos para detectar desequilibrios genómicos. El análisis citogenético reveló la presencia de un cromosoma supernumerario metacéntrico. Mientras que el estudio FISH confirma el origen del cromosoma marcador al mostrar dos señales para subtelómeros 18p y una señal intermedia para el centrómero 18. El análisis de microarreglos mostró una ganancia en el número de copias de 18,385 Mb dentro de la región 18p.La tetrasomía tiende a ser el resultado de eventos de novo. El isocromosoma del paciente podría explicarse por la edad materna avanzada, ya que se sabe que tiene una gran influencia en su formación. A pesar de que no hay genes asociados con las manifestaciones clínicas de i(18p), estas características están negativamente correlacionadas con los efectos de dosificación de todo el brazo corto. Se le recomendó terapia física y de lenguaje al paciente, la familia recibió orientación médica y se concientiza sobre la planificación familiar.

Diabetes Insípida inducida por el embarazo o gestacional: a propósito de un caso / Pregnancy or Gestational Diabetes Insipidus: a purpose of a case

RESUMEN Antecedentes: La incidencia de la diabetes insípida gestacional es aproximadamente 1/30.000 gestaciones. Objetivo: A propósito de un caso de diabetes insípida gestacional ocurrida en nuestra unidad, se decide comunicar y revisar la literatura referente a opciones de manejo y tratamiento del mismo. Caso clínico: Mujer de 38 años, primigesta de 32 semanas con clínica de poliuria y polidipsia con una ingesta hídrica diaria de hasta 7 litros. Tras realizar las pertinentes exploraciones complementarias y descartar otras patologías más frecuentes, se establece el diagnóstico de diabetes insípida gestacional. Conclusiones: La diabetes insípida gestacional es una entidad muy poco frecuente que puede desencadenar en un estado de deshidratación intensa con hipernatremia y su consecuente afectación neurológica. Es importante el diagnóstico precoz para evitar las complicaciones tanto a nivel materno como fetal, así como realizar un manejo multidisciplinar de esta patología.

ABSTRACT Background: The incidence of diabetes insipidus during pregnancy is approximately 1 in 30,000 pregnancies. Objective: We herein report a case of a patient with gestational diabetes insipidus occurring in our unit. We decided to communicate the case and review the literature regarding management and treatment options. Case report: A 38-year-old woman at 32 week of pregnancy with polyuria, polydipsia, and daily water intake of up to 7 liters. After performing the complementary tests and ruling out other more frequent conditions, the diagnosis of gestational diabetes insipidus was established. Conclusion: Gestational diabetes insipidus is a very rare entity that can cause a state of intense dehydration with hypernatremia and its consequent neurological impairment. Early detection is important in order to avoid complications of both mother and fetus, as well as to carry out a multidisciplinary management of this condition.

Heavy-ion induced two-neutron transfer reactions and the role of pairing / Reacciones de transferencia de dos neutrones inducidas por iones pesados y el papel del apareamiento

Abstract Heavy-ion induced two-neutron transfer reactions (18O,16O) at 84 MeV were studied on several targets up to high excitation energy of the residual nucleus thanks to the use of the MAGNEX magnetic spectrometer to detect the ejectiles. The obtained results indicate of the important role played by the nuclear paring.

Resumen Se estudiaron reacciones de transferencia de dos neutrones inducidas por iones pesados (18O, 16O) a 84 MeV en varios blancos hasta una alta energía de excitación del núcleo residual gracias al uso del espectrómetro magnético MAGNEX para detectar los residuos eyectados. Los resultados obtenidos indican el importante papel desempeñado por el apareamiento nuclear.

Haematological reference of snakes: Amazon tree boa (Corallus hortulanus, Linnaeus, 1758) and Burmenese Python (Python bivittatus, Kuhl, 1820) in captive / Parâmetros hematológicos das serpentes: suaçuboia (Corallus hortulanus, Linnaeus, 1758) e píton birmanesa (Python bivittatus, Kuhl, 1820) em cativeiro

Hematology has become important for making clinical diagnoses in snakes because maintenance techniques in captivity have been improving and increasing their life expectancy. The emergence of diseases in captivity requires the creation of parameters to understand the species in their healthy state. The possible association between the onset of neoplasia, immunosuppression, and viral infection are also important factors to consider. Thus, hematology is a fundamental tool for observing the responses of animals to diseases and treatments. The present study aims to study hematology between two species of snakes and compare the profiles observed with published results. Blood samples were collected from 16 male and female snakes: seven Corallus hortulanus from the family Boidae and nine Python bivittatus from the family Pythonidae belonging to the Biological Museum of the Butantan Institute, São Paulo, Brazil. Complete blood count results including blood smear, total erythrocyte count, leukocytes, and differential leukocyte count were evaluated. The data obtained in this study could help with the diagnosis, the treatment of snakes in captive conditions and in of nature conservation programs.(AU)

A hematologia das serpentes tem se tornado algo de grande importância para o diagnóstico clínico, visto que as técnicas de manutenção em cativeiro vêm aumentando a expectativa de vida. O surgimento de doenças em cativeiro leva à necessidade de criar parâmetros para conhecer as espécies em seu estado hígido. A possível associação entre o surgimento de neoplasias, imunossupressão e infecção viral também é um importante fator a ser considerado. Assim, a hematologia é uma ferramenta fundamental para se observarem as respostas dos animais diante das doenças e dos tratamentos. Nesse contexto, o presente estudo tem como objetivo o estudo hematológico entre duas espécies de serpentes e a comparação dos perfis encontrados com a literatura atual. Foi coletado sangue de 16 serpentes de ambos os sexos da família Boidae: sete Corallus hortulanus, e da família Pythonidae: nove Python bivittatus, pertencentes ao Museu Biológico do Instituto Butantan, São Paulo, Brasil. Foram avaliados o hemograma completo com esfregaço sanguíneo, a contagem total de eritrócitos, os leucócitos e a contagem diferencial de leucócitos. Os dados obtidos neste estudo poderão auxiliar no diagnóstico e no tratamento de serpentes em cativeiro e em programas de conservação da natureza.(AU)

Use of moxibustion as an auxiliary treatment in wound healing of the snake Eunectes murinus (anaconda): case report / Uso da moxabustão como tratamento auxiliar em ferimentos na serpente Eunectes murinus (anaconda): relato de caso

Large snakes of the Boidae family, such as Eunectes murinus, require special techniques to facilitate their care when they are sick. Thus, an acupuncture technique called moxibustion was applied that utilizes burning of the weed Artemisia vulgaris for heating at specific points on the skin without handling the animals. The objective of this case report was to describe the use of moxibustion acupuncture as an auxiliary treatment for snakes. A female, 4.0 meters long and weighing about 30 kg, belonging to a Biological Museum of the Butantan Institute, showed symptoms of weight loss, anorexia and hyperemia in the ventral region. The snake was examined and treated with ciprofloxacin antibiotics and a month showed an area of necrosis that exposed the muscles in the dorsal cranial region. The female was treated with moxibustion and application of silver sulfadiazine cream at the site of the lesion. After seven months of treatment, the animal showed signs of good healing with complete wound closure. This technique of moxibustion could be easily applied without restraint, an important detail given the size of the snake, and with successful closure of the lesion.(AU)

Grandes serpentes da família Boidae, como Eunectes murinus, requerem técnicas especiais para facilitar seus cuidados quando estão doentes. Assim, uma técnica de acupuntura, chamada de moxabustão, foi aplicada utilizando-se a queima da erva Artemisia vulgaris para aquecer pontos específicos na pele, sem manusear os animais. O objetivo deste relato de caso foi descrever o uso da acupuntura moxabustão como um tratamento auxiliar para serpentes. Uma fêmea com 4,0m de comprimento e pesando cerca de 30kg, pertencente ao Museu Biológico do Instituto Butantan, apresentou sintomas de perda de peso, anorexia e hiperemia na região ventral. A serpente foi examinada e tratada com o antibiótico ciprofloxacina e um mês depois mostrou uma área de necrose, que expôs os músculos da região dorsal cranial. A fêmea foi tratada com moxabustão e aplicação do creme de sulfadiazina de prata no local da lesão. Depois de sete meses de tratamento, o animal mostrou sinais de boa cicatrização, com fechamento completo da ferida. Essa técnica de moxabustão pode ser facilmente aplicada sem restrição, um detalhe importante dado o tamanho da serpente, e com fechamento bem-sucedido da lesão.(AU)

BICULTIVO EN BIOFLOC DE CACHAMA BLANCA -Piaractus brachypomus-Y TILAPIA NILÒTICA -Oreochromis niloticus- ALIMENTADAS CON DIETAS DE ORIGEN VEGETAL / CACHAMA -Piaractus brachypomus- AND NILE TILAPIA -Oreochromis niloticus- BICULTURE IN BIOFLOC FED DIETS OF VEGETABLE ORIGIN

Se evaluó el desempeño productivo de cachama blanca y tilapia nilótica cultivadas en biofloc y alimentadas con dietas de origen vegetal. Se cultivaron 80 peces/m³ en proporción 1:1 (cachama : tilapia), con tres niveles de proteína bruta (PB): 16% (T16), 24% (T24) y 32% (T32), en tanques de 1.000 l, con aireación permanente durante 120 días. Se estimaron parámetros de crecimiento, rendimiento, calidad de agua, costos de producción y análisis proximal de los flóculos. El oxígeno disuelto se mantuvo con saturación por encima de 100% y los compuestos nitrogenados (NO2 = 0,4-0,5 mg/l, NO3 = 0,4-0,5 mg/l, NH3 = 0,2-0,3 mg/l, TAN = 2,2-2,4 mg/l) no presentaron diferencias entre los tratamientos (P > 0,05). Los pesos finales de la cachama (173,5-196,2 g) fueron entre dos y cuatro veces los obtenidos por la tilapia (43,0-87,9 g). El mejor rendimiento del bicultivo se obtuvo con la dieta T24 (11,4 ± 1,3 kg/m³), el cual también registró el menor FCA (0,9 ± 0,3). Producir un kilogramo de pescado costó entre COP $3.148 (T24) y COP $4.445 (T32); del cual el alimento representó entre 49,2% (T16) y 63,3% (T32) y la energía, entre 10,3% (T32) y 14,2% (T16) de los costos. El análisis proximal de los flóculos registró niveles de proteína bruta (29-36% PB) adecuados para cachama y tilapia; pero con niveles bajos de lípidos (< 1,0%). El desempeño productivo y los costos de producción permiten sugerir la viabilidad que ofrece el sistema biofloc para la producción de carne de pescado con alimento de 24% PB de origen vegetal.

The productive performance of cachama and nile tilapia reared in biofloc and fed diets of vegetal origin was evaluated. In 1000L tanks with permanent aeration, were placed 80 fish/m3, in a ratio 1:1 (cachama : tilapia); fish were fed with three levels of crude protein (CP): 16% (T16), 24% (T24) and 32% (T32) for 120 days. Parameters of growth, yield, water quality, production costs and proximal analysis of the flocs were estimated. Dissolved oxygen showed saturation above 100% and nitrogen compounds (NO2 = 0.4-0.5 mg/l, NO3 = 0.4-0.5 mg/l, NH3 = 0.2-0.3 mg/l, TAN = 2.2-2.4 mg/l) showed no statistical difference between treatments (P > 0.05). The final weight of the cachama (173.5-196.2 g) were between two and four times those obtained by tilapia (43.0-87.9 g). The tilapia recorded a better daily gain of weight in T24 (0.7 g/day); while the cachama ranged between 1.2-1.3 g/day, with no significant difference between these values (P > 0.05). The best bi-culture yield was obtained in T24 diet (11.4 ± 1.3 kg/ m³), which also recorded the lowest FCA (0.9 ± 0.3). To produce one kilogram of fish cost between COP$3.148 (T24) and COP$4.445 (T32); of which the food represented between 49.2% (T16) and 63.3% (T32) and energy between 10.3% (T32) and 14.2% (T16) of total costs. Proximal analysis of the flocs recorded crude protein levels suitable (29-36% PB) for cachama and tilapia; but with low lipid levels (< 1.0%). The productive performance and the production costs allow to suggest the viability of the biofloc system for the production of fish meat with 24% CP diet of vegetal origin.

Factores determinantes en la formación de pasantes en servicio social. Construcción y validación de un instrumento / Determining factors on the formation of social service interns: Development and validation of an instrument / Fatores determinantes na formação de estagiários no serviço social. Construção e validação de um instrumento

Objetivo: Construir y validar un instrumento para evaluar los factores determinantes que contribuyen a la formación integral de los pasantes de servicio social (PSS). Metodología: El instrumento se construyó a partir de los elementos conceptuales que teóricamente se asocian a la formación integral de los PSS. El instrumento fue inicialmente puesto a consideración de un panel de expertos para determinar validez de contenido y se aplicó a estudiantes adscritos a diferentes unidades asistenciales que también son sede de los programas de servicio social, para conocer qué opinaban sobre su experiencia durante el desarrollo del programa elegido. Resultados: Después del análisis de contenido, fueron depurados algunos ítems para contar con un instrumento final conformado por 53 ítems agrupados en un apartado de la opinión general del programa de servicio social y 3 dimensiones: estructura, proceso y resultados. Se aplicó el instrumento a una muestra piloto de 16 alumnos, en la que se obtuvo una a de Cronbach global de 0.943. Conclusión: El presente instrumento favorece el seguimiento de los PSS y permite modificaciones oportunas para mejorar del desarrollo de los programas e incidir en la formación integral de los pasantes.

Objective: To develop and validate an instrument which assesses the determining factors contributing to the integral formation of interns of social service programs. Methodology: The instrument was developed on the basis of conceptual elements which are theoretically associated to the integral formation of interns in the social service. The instrument was content-validity examined by a panel of experts, and then applied to students assigned to diverse assisting units hosting the social service programs to explore the students' opinions on their experiences. Results: After the analysis of content, some items were further debugged and a final instrument of 53 items grouped into an overall opinion section and three specific dimensions: structure, process, and results, was constituted. This version of the instrument was then applied to a pilot sample of 16 alumni, obtaining a global Cronbach alpha of 0.943. Conclusion: The present instrument constitutes a supporting tool to following-up the interns during their social service, allowing timely adjustments to these programs to be made, thus, further fostering the integral formation of the interns.

Objetivo: Construir e validar um instrumento para avaliar os fatores determinantes que contribuem à formação integral dos estagiários de serviço social. (PSS). Metodologia: O instrumento construiu-se a partir dos elementos conceptuais que teoricamente associam-se à formação integral dos PSS. O instrumento foi inicialmente posto a consideração de um painel de especialistas para determinar validade de conteúdo e aplicou-se a estudantes pertencentes e diferentes unidades assistenciais que também são sede dos programas de serviço social, para conhecer que achavam sobre sua experiência durante o desenvolvimento do programa eleito. Resultados: Depois da análise de conteúdo foram depurados alguns itens para contar com um instrumento final conformado por 53 itens agrupados em um apartado da opinião geral do programa de serviço social e três dimensões: estrutura, processo e resultados. Aplicou-se o instrumento a uma amostra piloto de 16 alunos, na qual se obteve um de Cronbach global de 0.943. Conclusão: O presente instrumento favorece o seguimento do PSS e permite modificações oportunas para melhorar o desenvolvimento dos programas e incidir na formação integral dos estagiários.

Manejo endoscópico de litiasis en ureterocele / Endoscopic management of lithiasis in ureteroce

Introducción: El ureterocele corresponde a una dilatación sacular del uréter distal, la cual puede ser congénita o ectópica. Ocurren más frecuentemente en mujeres que hombres, presentándose de manera bilateral en el 10 por ciento de los casos. Su importancia radica en que son factores de riesgo tanto para infección como para la formación de cálculos. No existe consenso en el tratamiento de cálculos asociados a ureterocele, si bien el tratamiento endoscópico pareciera ser el de elección.(AU)

Introduction: The ureterocele corresponds to a saccular dilation of the distal ureter, which may be congenital or ectopic. They occur more frequently in women than men, presenting bilaterally in 10 pertcent of cases. Their importance lies in the fact that they are risk factors for both infection and stone formation. There is no consensus in the treatment of stones associated with ureterocele, although endoscopic treatment seems to be the one of choice Clinical Case: A 69-year-old patient was referred for a long-term illness characterized by repeated episodes of UTI, associated with 2 hematuria events. An imaging study was performed (UROTAC), and a large left ureterocele was documented with 3 cm stones in its interior