Análisis de confiabilidad y de constructo del instrumento FANTASTIC MEX-A para medir el estilo de vida de adultos mexicanos. Estudio piloto bicéntrico en un cuartel general y una universidad privada / Reliability and construction analysis of the FANTASTIC MEX-A instrument to measure the lifestyle of mexican adults. Bicentric pilot study in a headquarters and a private university

Resumen Objetivo: Realizar un análisis de confiabilidad y de constructo del instrumento FANTASTIC MEX-A a través de alfa de Cronbach (α) y análisis factorial exploratorio (AFE) en dos instituciones mexicanas localizadas en el estado de Guerrero: un cuartel general y una universidad privada, como un estudio piloto para determinar la factibilidad de realizarse a gran escala en adultos mexicanos. Diseño: Cuantitativo, transversal, no experimental, descriptivo. Muestreo aleatorio simple. Recolección de datos desde febrero del 2021 a noviembre del 2022. Variables: Nivel de estilo de vida (dependiente); ocupación, género, escolaridad, estado civil, tipo de familia, edad e índice de masa corporal (atributivas). Resultados: N=493, n=242, participación del 49% (NC=95%, IC=4.5%), la muestra se constituyó por 204 militares y 38 docentes-administrativos universitarios. Alfa de Cronbach=0.869 (buena), por el método de dos mitades se obtuvo para ítems nones α=0.76 y para ítems pares α=0.762, correlación rho entre mitades de 0.903 (correlación fuerte). Media de puntaje obtenido de 134.8±17.7 puntos, equivalente al 72.5%. Resultaron nueve factores con asociación teórica, que explican el 42.64% de la varianza acumulada en el AFE, 1: La protección de la salud mental e integridad física, 2: El distrés, 3: Las relaciones interpersonales afectivas, 4: El consumo de alcohol y sustancias de abuso, 5: La actividad física y la asociatividad, 6: El consumo de tabaco, 7: El sueño y la alimentación, 8: El control de salud y 9: La apariencia física. Conclusiones: A través del estadístico de Alfa de Cronbach por método de dos mitades se concluyó que el instrumento FANTASTIC MEX-A es consistente para la muestra estudiada. El AFE determinó validez de constructo para nueve factores con asociación teórica. Limitaciones: El estudio se realizó en el estado de Guerrero, México, la validación del instrumento en adultos mexicanos requiere una muestra representativa que considere sujetos de diversas regiones del país. Originalidad: No existen publicaciones que homologuen las versiones disponibles del instrumento en español. Se aporta una versión única que implicó la revisión y reconstrucción de cada ítem con ilustraciones de apoyo.

Abstract Objective: To carry out a reliability and construct analysis of the FANTASTIC MEX-A instrument through Cronbach's alpha (α) and exploratory factor analysis (EFA) in two Mexican institutions located in the state of Guerrero: a general headquarters and a private university, such as a pilot study to determine the feasibility of performing it on a large scale in Mexican adults. Design: Quantitative, cross-sectional, non-experimental, descriptive. Simple random sampling. Data collection from February 2021 to November 2022. Variables: Lifestyle level (dependent); occupation, gender, education, marital status, type of family, age and body mass index (attributive). Results: N=493, n=242, 49% participation (NC=95%, CI=4.5%), the sample consisted of 204 military personnel and 38 university teachers/administrators. Cronbach's alpha=0.869 (good), using the two-half method, α=0.76 was obtained for odd items and α=0.762 for even items, rho correlation between halves of 0.903 (strong correlation). Mean score obtained of 134.8 ± 17.7 points, equivalent to 72.5%. Nine factors with theoretical association were found, that explain 42.64% of the accumulated variance in the Exploratory Factor Analysis (EFA), 1: The protection of mental health and physical integrity, 2: Distress, 3: Affective interpersonal relationships, 4: The consumption of alcohol and substances of abuse, 5: Physical activity and associativity, 6: Tobacco consumption, 7: Sleep and diet, 8: Health control and 9: Physical appearance. Conclusions: Through the Cronbach's Alpha statistic by the two-half method, it was concluded that the FANTASTIC MEX-A instrument is consistent for the sample studied. The AFE determined construct validity for nine factors with theoretical association. Limitations: The study was conducted in the state of Guerrero, México, the validation of the instrument in Mexican adults requires a representative sample that considers subjects from various regions of the country. Originality: There are no publications that standardize the available versions of the instrument in Spanish. A unique version is provided that involved the revision and reconstruction of each item with supporting illustrations.

Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease: an observational retrospective study

ABSTRACT BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.

Association of serum levels of secreted frizzled-related protein 5 and Wnt member 5a with glomerular filtration rate in patients with type 2 diabetes mellitus and chronic renal disease: a cross-sectional study

ABSTRACT BACKGROUND: Diabetic nephropathy is a common complication of chronic kidney disease (CKD). ­Inflammation in the kidneys is crucial for promoting development and progression of this complication. Wnt member 5a (Wnt5a) and secreted frizzled-related protein 5 (Sfrp5) are proinflammatory proteins associated with insulin resistance and chronic low-grade adipose tissue inflammation. OBJECTIVE: To determine the correlation between serum Sfrp5 and Wnt5a concentrations and glomerular filtration rate in patients with type 2 diabetes mellitus and CKD. DESIGN AND SETTING: Cross-sectional, comparative and observational study in the Department of Endocrinology, Civil Hospital, Culiacán, Sinaloa, Mexico. METHODS: Eighty individuals with chronic kidney disease were recruited. Their serum Sfrp5 and Wnt5a concentrations were quantified using the enzyme-linked immunosorbent assay (ELISA) test. The statistical analysis consisted of the Mann-Whitney U test for independent samples and Spearman correlation, with statistical significance of P < 0.05. RESULTS: Serum Sfrp5 concentration continually increased through the stages of CKD progression, whereas serum Wnt5a concentration presented its highest levels in stage 3 CKD. Negative correlations between estimated glomerular filtration rate (eGFR) and serum concentrations of Sfrp5 (r = -0434, P = 0.001) and Wnt5a (r = -0481, P = 0.001) were found. CONCLUSIONS: There were negative correlations between serum Sfrp5 and Wnt5a concentrations and eGFR at each stage of CKD, with higher levels in female patients. This phenomenon suggests that Sfrp5 and Wnt5a might be involved in development and evolution towards end-stage renal disease.

Effectiveness of autologous lipoinjection into the hand to improve function in patients with scleroderma: pilot study

Background: Scleroderma is a rare disease of the tissues that is characterized for being inflammatory and developing fibrosis in the skin. Typically, this disease affects middle-aged women.Methods: A study was conducted in which 10 patients with scleroderma with involvement in the sclerotic stage were included. One of the hands was chosen randomly for treatment with fatty graft processed by Coleman technique and the other hand, physiological solution was placed. Patients were evaluated at 45 and 90 days after the procedure using the Cochin Hand Functional Scale (CHFS) questionnaire, modified Rodnan scale for the skin (mRSS), grip strength with dynamometer and measurement of fingertip to palm of hand in flexion.Results: The average of CHFS before treatment was 42.30 and 25.70 at 90 days p=0.007. The average strength in the experimental hand before treatment was 11.67 and 14.58 at 90 days p=0.007, in the control hand p=0.873. The mean finger-palm tip distance before treatment was 44.80 and from 36.00 to 90 days p=0.019, in the control hand p=0.149. There is a significant difference in the degree of severity at 90 days of the mRSS of the back of the hands p=0.011 and phalanges p=0.000 between the patients with lipoinjection and physiological solution.Conclusion: Significant improvement was observed in patients with scleroderma treated with autologous lipoinjection.

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients / Fatores epidemiológicos, clínicos e laboratoriais associados à doença renal crônica em pacientes mexicanos infectados pelo HIV

ABSTRACT Aim: To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Cross-sectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/µL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98; 95% CI: 5.5-72.2; p < 0.001). Conclusions: CKD was a frequent complication in HIV-infected patients. These findings confirm the importance of screening and the early detection of CKD, as well as the importance of identifying and treating traditional and non-traditional risk factors associated with CKD.

RESUMO Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m2, avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminúria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/µL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC.

Effect of conditioning protocols and ultrasonic application of an infiltrant resin in white spot lesions

Abstract The aim of this study was to evaluate different conditioning protocols and sonic/ultrasonic application of an infiltrant resin (IR) in artificial white spot lesions (AWSL). the V/L surfaces of 48 molars were induced to an AWSL and divided in 6 groups, according to the conditioning protocols and application technique: 15% hydrochloric acid (HA) + manual application of the IR; HA + 37% phosphoric acid (PA) + manual application of the IR; HA + ultrasonic application (U) of the IR; HA + sonic application (S) of the IR; PA+HA+S; and PA+HA+U. For the Penetration Depth (PD), the crowns were etched with HA for 120s. The IR Icon® (DMG) was applied according to the manufacturer`s instructions. The crowns were dye penetrated (0.1% red fluorophore rhodamine B isothiocyanate for 12h) and bleached with 30% hydrogen peroxide for 12 h. The discs were immersed in a 50% ethanol solution, containing 100 µM of sodium fluorescein. The PD (in µm) was measured using confocal laser scanning microscopy (20x). The bond strength (BS) was performed by michoshear test (0.5 mm/min). Data were submitted to 2-way ANOVA and Tukey (α=0.05). For BS, the interaction was not significant (p>0.05). For PD, the main factors were significant (application - p<0.001; conditioning technique - p=0.003). The ultrasonic application showed the highest PD values. PA+HA presented higher results than HA. The sonic/ultrasonic applications and the use of phosphoric acid prior to hydrochloric acid improved PD of the infiltrant resin. Conditioning protocols or application techniques did not influence BS values.

Resumo: O objetivo deste estudo foi avaliar diferentes protocolos de condicionamento e a aplicação sônica/ultrassônica de uma resina infiltrante (RI) em lesões de mancha branca produzidas artificialmente (LMBA). As superfícies vestibulares/linguais de 48 molares foram induzidas à formação de LMBA e divididas em 6 grupos, de acordo com os protocolos de condicionamento e técnica de aplicação da resina infiltrante: ácido hidroclorídrico 15% (AH) + aplicação manual da RI; AH + ácido fosfórico 37% (AF) + aplicação manual da RI; AH + aplicação ultrassônica da RI (U); AH + aplicação sônica da RI (S); AF + AH + S; e AF + AH + U. para o grau de penetração (GP), condicionou-se as coroas com AH por 120 s. A RI Icon® (DMG) foi aplicada de acordo com as instruções do fabricante. As coroas foram coradas (rodamina B 0,1% por 12 h) e clareadas com peróxido de hidrogênio 30% por 12 h. os discos foram imersos em solução de etanol 50%, contendo 100 µM de fluoresceína sódica. O GP (em µm) foi mensurado por meio de microscopia confocal a laser (20´). A resistência de união (RU) foi calculada pelo teste de microcisalhamento (0,5 mm/min). Os dados foram submetidos ao teste ANOVA 2 fatores e Tukey (α=0,05). Para RU, a interação não foi significante (p>0,05). Para GP, os fatores principais foram significantes (técnica de aplicação - p<0,001; protocolos de condicionamento - p=0,003). A aplicação U mostrou os maiores valores de GP. AF+AH demonstrou resultados superiores ao grupo AH. As aplicações sônica/ultrassônica e o uso do ácido fosfórico antes do ácido hidroclorídrico aumentaram o GP da resina infiltrante. Os protocolos de condicionamento ou as técnicas de aplicação não influenciaram os valores de RU.

Historical distribution of central nervous system tumors in the Mexican National Institute of Neurology and Neurosurgery / Distribución histórica de neoplasias del sistema nervioso central en el Instituto Nacional de Neurología y Neurocirugía de México

Abstract Objective: To determine the frequency of central nervous system (CNS) tumors in the first fifty years of the National Institute of Neurology and Neurosurgery of Mexico Manuel Velasco Suárez (Instituto Nacional de Neurología y Neurocirugía de México, INNN) from 1965 to 2014. Materials and methods: A total of 16 116 institutional records of CNS tumors were analyzed. The frequency and distribution of CNS tumors were evaluated by tumor type, patient age and patient gender. The annual relationship between CNS tumors and surgical discharges (SD) over the last 20 years was estimated. Results: The frequencies of most CNS tumors were consistent with those found worldwide, and the most common tumors were neuroepithelial tumors (33%), particularly astrocytic tumors (67%); meningeal tumors (26%); and pituitary tumors (20%). The incidence of pituitary tumors in these data was twice as high as that reported in other regions of the world, and the relationship between CNS tumors and SD was consistent over time (0.22-0.39). Conclusion: This study summarizes the largest sample of CNS tumor cases analyzed in Mexico and provides an important reference of the frequency of this tumor type in the country. This work will serve as a basis for conducting studies evaluating factors associated with the presence of CNS tumors and for identifying adequate public health interventions.

Resumen Objetivo: Determinar la frecuencia de neoplasias del sistema nervioso central (NSNC) en los primeros 50 años del Instituto Nacional de Neurología y Neurocirugía de México (INNN). Material y métodos: Se analizaron 16 116 registros institucionales de las NSNC, atendidas en el INNN de 1965 a 2014; se estimó su frecuencia y distribución por tipo de neoplasia, edad y género, y se determinó la relación anual de NSNC y egresos quirúrgicos (EQ) en un período de 20 años. Resultados: Las frecuencias de la mayoría de NSNC fueron consistentes con las encontradas a nivel mundial. Las más frecuentes fueron las neuroepiteliales (33%), entre las cuales destacaron las astrocíticas (67%); meníngeas (26%), e hipofisiarias (20%). El número de neoplasias hipofisiarias en esta serie fue dos veces mayor al reportado en otras regiones del mundo y la relación NSNC/EQ fue similar a través del tiempo (0.22-0.39). Conclusión: Ésta es la mayor serie de casos de NSNC analizados en México y proporciona un referente importante sobre la frecuencia de este tipo de neoplasias en el país. Este trabajo servirá de base para llevar a cabo estudios de los factores asociados a la presencia de NSNC e identificar intervenciones de salud pública adecuadas.

Estudio de biodisponibilidad de metformina 850 mg tabletas de liberación inmediata / Bioavalability study of Metformin 850 mg immediate-release tablets

Se desarrolló un estudio de biodisponibilidad de metformina 850 mg tabletas recubiertas de liberación inmediata elaboradas por Laboratorios Coaspharma S.A., en 12 voluntarios sanos de ambos sexos, con edades entre 18 y 26 años. Para llevarlo a cabo se validó previamente un método bioanalítico para la determinación de metformina en plasma humano por cromatografía líquida de alta resolución con detector ultravioleta (HPLC-UV), el cual resultó ser selectivo, específico, lineal, exacto y preciso, por lo tanto adecuado para el análisis de las muestras. Estas fueron recolectadas periódicamente en un lapso desde 0 a 24 horas, luego de la administración por vía oral de una única dosis de metformina 850 mg. Posteriormente se determinaron los parámetros farmacocinéticos promedio de los 12 participantes, obteniendo: área bajo la curva, desde tiempo cero hasta el último tiempo de muestreo t (AUC0--->t) 6856,89 ± 2073,8 ng.h/ml, área bajo la curva desde tiempo cero hasta tiempo infinito (AUC0--->∞) 7083,74 ± 2131,52 ng.h/ml, concentración máxima (Cmaxmax) 1299,02 ± 291,90 ng/ml, tiempo máximo (t) 2,33 ± 0,47 h, tiempo de vida media (t1/2) 2,50 ± 0,84 h y constante aparente de eliminación (Ke) de 0,31 ± 0,12 h-1. Los resultados fueron similares en todos los participantes y no se produjeron reacciones adversas.

A bioavailability study was conducted in 12 healthy volunteers of both genders, aged between 18 and 26. Previous to the study, a bioanalytical method for determination of metformin in human plasma by high performance liquid chromatography with ultraviolet detector (HPLCUV) was validated, and proved to be selective, specific, linear, accurate precise, and therefore, suitable for analysis in plasma. Samples were collected from 0 to 24 hours after the oral administration of a single dose of metformin 850 mg immediate-release coated tablets, produced by Coaspharma S.A. Laboratories. Then, average pharmacokinetic parameters of the twelve volunteers were determined: area under the curve from time zero to last sampling time t (AUC0--->t) 6856.89 ± 2073.8 ng.h/mL, area under the curve from time zero to infinite time (AUC0--->∞) 7083.74 ± 2131.52 ng.h/ml, maximum concentration (Cmax) 1299.02 ± 291.90 ng/mL, maximum time (t max) 2.33 ± 0.47 h, half-life (t1/2) 2.50 ± 0.84 h and apparent elimination constant (Ke) of 0.31 ± 0.12 h-1. These results are similar between the volunteers and no adverse effect was observed. Also, the results are in agree with those reported in literature.

Displasia tanatofórica: una reflexión bioética a partir de un caso clínico / Thanatophoric dysplasia: case-based bioethical analysis

El presente artículo muestra un caso de displasia tanatofórica, diagnosticado en el período prenatal bajo criterios ultrasonográficos. Se describe la evolución del embarazo hasta el nacimiento, así como la evolución postnatal del producto. Este reporte busca invitar a la reflexión bioética y retomar sus principios apelando a la otredad y a la dignidad humana, en particular del binomio madre e hijo y su entorno familiar. En este sentido, un diagnóstico precoz permite acompañar a los padres para afrontar el proceso evolutivo de esta patología, e incluso un desenlace fatal.

This paper presents a case report of thanatophoric displasia diagnosed in the prenatal period using ultrasound standards. The course of the case pregnancy, birth process, and postnatal period is described. This report invites bioethical analysis using its principles, appealing to human dignity, diversity and otherness, particularly in the mother-child dyad and their family. An early diagnosis allows parental support as they face the course of this condition and its potentially fatal outcome.

Esplenomegalia gigante por síndrome de Felty

Se presenta caso de mujer de 56 años de edad que consulta por esplenomegalia gigante y severa bicitopenia, secundaria a artritis reumatoide. El cuadro hematológico revirtió tras esplenectomía.

We report the case of a 56-year-old woman consulting for a giant splenomegaly and severe bicytopenia, secondary to rheumatoid arthritis. The hematological symptoms reverted after splenectomy.

Consideraciones de la antibioterapia profiláctica en cirugía / Considerations of the prophylactic antibiotherapy in surgery

Introducción: la antibioterapia profiláctica en cirugía sin lugar a dudas es un tema contradictorio y con un gran número de interpretaciones individuales y no siempre justificadas. Objetivos: Establecer las necesidades de aprendizaje sobre la profilaxis quirúrgica en el Hospital de Morón. Método: Se realizó un estudio observacional analítico, para identificar las necesidades de aprendizaje sobre la Antibioterapia profiláctica en cirugía en el Hospital General Docente Roberto Rodríguez Fernández de Morón en el periodo comprendido de enero de 2011 a enero de 2012. El universo se conformó por 50 médicos que laboran en dicho hospital y que se encuentran en relación a la actividad quirúrgica. Resultados: Se encontró que existen deficiencias en el conocimiento de la profilaxis quirúrgica al ser los ginecólogos y ortopédicos los que tienen mayor necesidad de aprendizaje. Conclusión: la profilaxis quirúrgica es un tema importante que no resulta de total conocimiento de los profesionales estudiados.

Analgesia con fentanil y morfina en el dolor por procesos oncoproliferativos / Analgesia with fentanil and morphine in the pain by oncoproliferative processes

La utilización de opioides ha sido utilizada con amplitud en el tratamiento de múltiples dolores incluidos los padecidos al final de la vida producto de un proceso oncoproliferativo. Con el objetivo de comparar la eficacia de la administración de microdosis de fentanil intradérmicas y la administración habitual de morfina en pacientes portadores de dolor terminal por cáncer, se realizó un estudio en el centro, comparativo y longitudinal, en 80 pacientes sometidos a tratamiento en esta institución distribuidos aleatoriamente en dos grupos: Grupo I (Fentanil) y Grupo II (Morfina). Se estudiaron las variables: tensión arterial (sistólica y diastólica), frecuencia cardiaca, frecuencia respiratoria, analgesia y efectos colaterales. Ambos grupos no tuvieron significancia estadística en las variables cardiorrespiratorias y en la evaluación analgésica. Los efectos colaterales (náuseas, vómitos y sedación) predominaron más en el grupo tratado con morfina. Se concluyó que la utilización de fentanil en microdosis intradérmicas resulta un tratamiento alternativo para el alivio del dolor por cáncer en pacientes con estado precario y aunque tiene un efecto analgésico menos duradero ciertamente se asocia a un menor número de complicaciones.

Necesidad de sistemas perfusores continuos en la práctica anestesiológica / Necessity of continuous perfusion systems in the anesthesiology practice

Introducción: La administración de drogas anestésicas intravenosas resulta una herramienta de vital importancia en la anestesiología moderna. Objetivos: Establecer el comportamiento hemodinámico en la cirugía mayor electiva al utilizar la anestesia total intravenosa con sistemas de perfusión continua y por bolos. Método: Se realizó un estudio descriptivo, con 76 pacientes intervenidos quirúrgicamente de cirugía mayor electiva, en el Hospital “Capitán Roberto Rodríguez Fernández” de Morón, durante el periodo mayo 2008 - mayo- 2011. Se les aplicó anestesia total intravenosa con sistemas perfusores continuos y se utilizaron los bolos habituales. Resultado: Se encontró estabilidad en los parámetros monitorizados en el grupo que utilizó los métodos perfusores continuos. Conclusión: Los sistemas perfusores continuos aseguran un efecto deseado con mínima incidencia de efectos indeseables.

Pseudocolinesterasas plasmáticas: a propósito de un caso / Plasmatic pseudocholinesterase: a case report

ntroducción: La presencia de colinesterasa plasmática inhibida, disminuida o genéticamente atípica, produce bloqueo neuromuscular prolongado con el uso de succinilcolina. Objetivos: Presentar la evolución clínica de una paciente portadora de colinesterasa plasmática, con recuperación tardía por uso de succinilcolina. Presentación del caso: Se presenta evolución clínica de paciente femenina de 24 años de edad, con antecedentes de anomalía del raquis en estudio suspendido por gestación con alteraciones sensitivas en mitosis I (MI), internada en Hospital General Provincial Docente de Morón. Por embarazo a término y desproporción céfalo pélvica para operación cesárea. Examen físico y complementarios habituales negativos. En el quirófano se le realizó inducción con kethamina: 125 mg IV; atropina 0,5 mg IV y succinilcolina: 100 mg IV. Laringoscopia gentil, intubación fácil con tubo 7. Se acopló al ventilador SERVO 900D, con fracción inspirada de oxígeno (FiO2) de 0.5. Frecuencia respiratoria (FR) 12 x min y volumen corriente (VT) de 450 ml. El mantenimiento anestésico se realizó con oxígeno, aire comprimido, midazolam 5 mg IV y fentanyl: 150 µg IV, sin necesidad de repetir dosis de relajante muscular. Transcurrida 1 hora se valoró posibilidad de estar en presencia de colinesterasa atípica. Se administró una bolsa de plasma, sin obtener respuesta. Continuó intubada y acoplada al ventilador durante 6 horas a partir de la cual se recuperó y se extubó sin dificultad. Conclusiones: Ante la administración de succinilcolina nunca se debe olvidar la posibilidad de bloqueo neuromuscular prolongado por presencia de pseudocolinesterasa, pues es una complicación a tener en consideración.

Monitoreo epidemiológico para Brucella abortus en fincas doble propósito del Municipio Machiques de Perijá, Venezuela: parte II validez y seguridad de las pruebas anillo de la leche y rosa de bengala / Epidemiologic surveillance system for Brucella abortus in dual purpose farms from Machiques de Perijá county, Venezuela: part II validity and accuracy of ring test and rose bengal test

Se evalúa la capacidad operativa de las pruebas diagnósticas: anillo de la leche (PAL), inmunoensayo enzimático indirecto (ELISA-i), rosa de bengala (RB) y ELISA competitivo (ELISA-c), utilizadas tras 5 años (2003-2007) de vigilancia epidemiológica para brucelosis bovina (Brucella abortus) en el municipio Machiques de Perijá, partiendo de la revalorización de un conjunto de muestras de leche y suero probados positivos y negativos. La garantía de diagnóstico previamente positivo fue alcanzada a través de evidencias epidemiológicas y positividad comprobada en suero sanguíneo al ensayo con antígeno buferado en placa y confirmación mediante fluorescencia polarizada (FP); sólo se consideraron negativos probados, los sueros y leches globales provenientes de animales negativos a FP que a lo largo del estudio no presentaron antecedentes serológicos alguno. Los resultados en leche muestran superioridad de ELISA-i versus PAL, en sensibilidad, 98,55 contra 56,52 por ciento; especificidad 99,41 y 98,82 por ciento; predicción positiva 98,58 y 95,12 por ciento; predicción negativa 99,49 y 84,84 por ciento; y cocientes de probabilidad. El nivel de concordancia entre los resultados y el verdadero estatus de las muestras fue también preferente para ELISA-i, 97,8 contra 55,3 por ciento. Las evidencias sobre sueros probados dejan en duda la contribución de RB en el diagnóstico, control y erradicación de la enfermedad en el área de estudio, al demostrarse valores medios de validez (169,92 versus 197,21) y seguridad (171,74 versus 197,02), además de bajos coeficientes de verosimilitud entre sus resultados. ELISA-c, en cambio, mantuvo excelente capacidad diagnóstica.

The performance of the following diagnostic tests: Milk Ring Test (MRT), Indirect Enzyme-linked Immunosorbent Assay (iELISA), Rose Bengal Test (RBT) and Competitive ELISA (cELISA) used for 5 years (2003-2007) in the epidemiological surveillance system for bovine brucellosis (Brucella abortus) in Machiques de Perijá County was evaluated. For this purpose, milk and sera samples previously assessed through the abovementioned tests were reassessed to define their true condition (true positive or true negative). Samples were considered as true positive through epidemiological findings and a positive result in Buffered Plate Antigen Test, which was confirmed through Fluorescence Polarization Assay (FPA); samples were considered as true negative only when they were taken from FPA-negative animals that did not seroconvert during the study. Results from tests in milk showed a higher performance of iELISA versus MRT, in sensibility: 98.55 and 56.52 percent; in specificity: 99.41 and 98.82 percent; in positive predictive value: 98.58 and 95.12 percent; in negative predictive value: 99.49 and 84.84 percent; and in coefficients of probability, respectively. The level of agreement between test and true status of samples was higher in iELISA: 97.8 versus 55.3 percent. Results from true positive and true negative samples warrant a reappreciation of the contribution of RBT in diagnostics, control and eradication of brucellosis in the studied area, taking into account its medium values of validity (169.92 versus 197.21) and accuracy (171.74 versus 197.02), as well as its low coefficients of probability. By contrast, cELISA showed an excellent diagnostic performance.

Characterization of cellulolytic activities of Bjerkandera adusta and Pycnoporus sanguineus on solid wheat straw medium / Caracterización de las actividades celulolíticas de Bjerkandera adusta y Pycnoporus sanguineus en un medio sólido de paja de trigo

Cellulolytic properties of two white rot fungi, Bjerkandera adusta and Pycnoporus sanguineus, cultivated on wheat straw agar medium, were characterized and compared. Optimal growing parameters for maximum enzyme production for both fungi were wheat straw medium pH 5 and 28ºC. B. adusta showed, on the 6th day of culture, carboxymethylcellulose (CMC)ase activity levels 1.6 times higher than maximal P. sanguineus activity, achieved on the 8th day. B. adusta supernatants also displayed higher activity levels towards xylan (3.6-fold) compared to those of P. sanguineus. However, enzymes from P. sanguineus were more robust resisting one hour incubation at high temperatures (up to 80ºC), and exhibiting activity and stability in pH range from 2 to 8. Cellulolytic activities, with molecular masses ranging from 25 to 90 kDa, from the two species were detected in zymograms.

Monitoreo epidemiológico para brucella abortus en fincas doble propósito del municipio machiques de perijá, Venezuela: Prevalencia, riesgo y efecto de un programa de control / Epidemiologic Surveillance System of Brucella abortus in Dual Purpose Farms of Machiques de Perijá County, Venezuela: Prevalence, Risk Factors and Control Program

Se evalúa la evolución durante 5 años (2003-2007) de la brucelosis bovina (Brucella abortus) en el municipio Machiques de Perijá. El estudio se realizó identificando en leche, tres veces por año, fincas reactivas a la prueba de anillo (PAL) y positivas a un ensayo inmuno enzimático indirecto (ELISA-i). Paralelamente, fueron analizadas muestras de sangre de la población bovina adulta, procedente de las explotaciones problemas, para identificar animales positivos a Rosa de Bengala (RB) y confirmados, por un ensayo inmuno enzimático competitivo (ELISA-c). Adicionalmente, se analizan los alcances de la enfermedad a nivel de un matadero municipal. Los resultados del monitoreo epidemiológico permiten evidenciar disminución progresiva en la ocurrencia de la problemática. Así, en el 2003, se detectó la existencia de 32,3% (209/648) de fincas reactivas a la PAL y 62,9% (404/583) positivas a ELISA-i, y se constató, la presencia y beneficio de animales positivos a RB/ELISA-c sin la identificación pertinente, lo cual repercute sobre la salud de los trabajadores. Para el 2007, se identifican 11,4% de rebaños reactivos a la PAL y 27,2% a ELISA-i; con una positividad de 0,38% (158/41630) de animales infectados según criterio diagnóstico seriado de RB/ELISA-c, aunque se demuestra sesgo importante en esa medición. Además, se identificaron 178 explotaciones (27,0%) sin evidencia de la enfermedad, que pudieran optar por una clasificación o estatus de libres de brucelosis. En el futuro próximo se hace necesario extender el monitoreo hacia fincas proveedoras de queseras artesanales, evaluar las contribuciones individuales de PAL y ELISA-i, como ensayos primarios en la vigilancia de la problemática, implementar providencias coercitivas de control y explorar nuevas técnicas diagnósticas para la identificación rápida de animales infectados. Estas medidas contribuirán, en mediano plazo, a la erradicación de esta enfermedad en esa región del país.

Bovine brucellosis (Brucella abortus) behavior in Machiques of Perijá County was evaluated for 5 years (2003-2007). The survey was undertaken through Ring Test and indirect ELISA (iELISA) performed on milk samples collected 3 times per year from farms located in Machiques de Perijá County. Moreover, serum samples from the adult bovine population of those farms were analyzed to detect reactors to Rose Bengal Test, which were subsequently confirmed by competitive ELISA (cELISA). Brucellosis prevalence was determined at a county slaughterhouse as well. Epidemiological surveillance results suggest a progressive decrease in brucellosis prevalence. In 2003, 32.3% (209/648) of farms were Ring Test reactors and 62.9% (404/583) were iELISA reactors; also, RBT/cELISA positive animals were slaughtered without having been branded adequately according to the law, which negatively affects slaughterhouse workers’ health. In 2007, 11.4% of herds were Ring Test reactors and 27.2% were iELISA reactors; 0.38% (158/41630) of animals were infected according to RBT/cELISA results, there is an important bias in this serial methodology though. Furthermore, 178 farms (27.0%) did not have reactors to the methods used in this survey, which could be candidates to a brucellosis-free status. In the near future, it would be necessary to extend the epidemiological surveillance for brucellosis to farms supplying traditional cheese making factories; to replace Ring Test for iELISA as the main test for milk; to implement compulsory control measures and to explore newer diagnostic tools for rapid identification of infected animals. These measures will contribute, in a short term, to brucellosis eradication in this region of Venezuela.

Dignidad humana, diversidad cultural y calidad de vida / Human digity, cuultural diversity, and quality of life / Digidade humana,, diversidade cultural e qualidade de vdaa

En este artículo, se propone la calidad de vida como una expresión concreta de la dignidad humana que permite superar el relativismo en la discusión bioética sobre la diversidad cultural y los límites de una concepción universalista de los derechos humanos. Después de hacer referencia al proceso mediante el cual las nociones cristianas de dignidad humana y de derecho natural fueron secularizadas, se hace examen de la conservadora crítica culturalista de Lee Kwan Yew y de la crítica comunitarista de Charles Taylor a la concepción universal de los derechos humanos. A partir de las respuestas de Thomas Pogge y de Amartya Sen a dichas críticas, finalmente se establece la relación que hay entre libertad, calidad de vida y capacidades humanas en la teoría de Sen.

In this paper quality of life is presented as a concrete expression of human dignity useful to overcome the bioethical debate relativism about cultural diversity and the limits of a universal conception of human rights. After describing the secularization process of Christian categories human dignity and natural right, Lee Kwan Yew's culturalistic criticism and Charles Taylor's communitarian criticism to universal conception of human rights are examined. From Thomas Pogge's and Amartya Sen's reactions to these criticisms, it is established the relationship between freedom, quality of life and human capabilities in Sen's theory.

Neste artigo é proposto a qualidade de vida como uma expressão concreta da dignidade humana que permite superar o relativismo na discusão bioética sobre a diversidade cultural e os limites de uma concepção universalista dos direitos humanos. Depois de fazer referência ao processo mediante o qual as noções cristianas de dignidade humana e de direito natural foram secularizadas, será feito um exame crítico culturalista de Lee Kwan yew e da crítica comunitarista de Charles Taylor à concepção universal dos direitos humanos. Apartir das respostas de Thomas Pogge e de Amartya Sen a estas críticas, fi nalmente se estabelece a relação que existe entre libertade, qualidade de vida e capacidades humanas na teoria de Sen.

Consumo de Alcohol durante el Embarazo: Múltiples Efectos Negativos en el Feto / Alcohol Consumption during Pregnancy: Many Adverse Effects on the Fetus

Los efectos de la exposición prenatal al alcohol pueden ser identificados prácticamente en todo el cuerpo, produciendo entre otros: graves anomalías neurológicas y del crecimiento, déficit cognitivo y académico, trastornos psicológicos, problemas de comportamiento y dificultades para una vida independiente, además de aumentar el riesgo de aborto espontáneo, el nacimiento prematuro y la mortinatalidad. El término trastorno del espectro alcohólico fetal es asignado a un gran conjunto de presentaciones clínicas presentes en el feto que son producidas por el consumo de alcohol en la madre durante el embarazo. El Síndrome Alcohólico fetal representa el tipo más grave de estas presentaciones, y es una afección que incapacita tanto mental como físicamente de por vida, debido a que, a pesar de la investigación sobre tratamientos actualmente no existe cura. Por último es importante saber que todos los defectos causados por la exposición prenatal al alcohol son totalmente prevenibles.

The effects of prenatal exposure to alcohol can be identified virtually the entire body, producing among other things: serious neurological abnormalities and growth, cognitive and academic deficits, psychological disorders, behavioral problems and difficulties for independent living, in addition to increasing the risk of miscarriage, premature birth and stillbirth. The term fetal alcohol spectrum disorder is assigned to a wide range of clinical presentations in the fetus are caused by alcohol consumption during pregnancy. Fetal alcohol syndrome is the most serious of these presentations, and a condition that is both mentally and physically disabled for life because even though the research on treatments currently no cure. Finally it is important to know that all the defects caused by prenatal exposure to alcohol is totally preventable.

Tres enfoques deontológicos acerca de la vida / Three deontologics approaches brings over of the life

Tres aproximaciones deontológicas a algunos problemas sobre el comienzo, el fin y la reproducción de la vida humana, así como a la preservación de la vida humana y no-humana en el planeta. Primero la deontología clásica de I. Kant y luego las deontologías contemporáneas de Hans y Jurgen Habermas.