Cáncer de mama Her2-positivo: Terapias sistémicas actuales y experiencia local

El cáncer de mama (CM) es la primera causa de muerte por cáncer en mujeres tanto a nivel mundial como en Chile. Basados en características clínicas, histológicas y moleculares, múltiples estudios han identificado cuatro subtipos básicos de CM, los cuales están asociados a estrategias de tratamiento específicas y diferenciadas. El CM HER2-positivo representa un 15%-25% de todas las neoplasias mamarias y se caracteriza por su agresividad, recurrencia temprana y mayor tendencia a presentar compromiso del sistema nervioso central. En las últimas décadas, nuevas terapias dirigidas se han posicionado como el estándar de tratamiento y han cambiado la historia natural de esta enfermedad, transformándola en una enfermedad potencialmente curable incluso en etapas avanzadas. Esta revisión busca entregar un resumen de las bases biológicas de esta enfermedad. Por otro lado, dada la aparición de un creciente número de nuevas estrategias de manejo sistémico, nos proponemos revisar sus mecanismos de acción analizando reportes de datos clínicos publicados y la experiencia de nuestro grupo.

Breast cancer (BC) is the leading cause of cancer death for women both worldwide and in Chile. Based on clinical, histological, and molecular features, studies have identified four BC subtypes that correlate with treatment sensitivity. Human Epidermal growth factor Receptor type 2-positive (HER2+) BC represents 15%-25% of newly diagnosed breast neoplasms; HER2+ BC is characterized by its aggressive behavior, early recurrence, and higher risk of brain metastasis. In recent years, HER2-targeted therapies have become the mainstay of treatment and have redefined the natural history of this subtype, reducing relapse rates for early-stage patients and increasing survival in advanced-stage patients. Herein we review novel treatment strategies and their mechanisms of action, along with clinical and real-world data. We also provide a summary of currently available treatments for this subtype and our local experience regarding the management of this disease.

Determinación de Valores de Armonía del Perfil Facial en la Población Chilena

RESUMEN: El realizar un tratamiento ortodóntico sólo en base a referencias de tejidos duros, puede llevar a resultados estéticos desfavorables, debido a la gran variabilidad que existe en los tejidos blandos que los recubren. Arnett et al. (1999) presentaron un análisis basado en los tejidos blandos y determinó normas que definen un rostro armónico. Sin embargo, éstas normas se obtuvieron de pacientes norteamericanos y puede que no reflejen los conceptos estéticos de nuestra población. El objetivo del presente trabajo fue determinar valores de armonía facial para la población chilena, utilizando el análisis cefalométrico de tejidos blandos presentado por Arnett et al., y compararlos con los valores previamente establecidos para la población caucásica. Se analizaron 200 fotografías y se clasificaron los perfiles en balanceados y no balanceados según el criterio de un grupo de especialistas. Posteriormente se analizaron las telerradiografías correspondientes a los perfiles clasificados, con el análisis cefalométrico de tejidos blandos. Los valores de las diferentes variables fueron analiza dos separadamente por sexo, clase esqueletal y biotipo facial, y se determinaron las diferencias entre las variables presentadas por Arnett et al. y las obtenidas en el presente estudio. Para ello se utilizaron pruebas de significancia estadística como el test t y otros no paramétricos. Sólo se encontró diferencias significativas en dos variables respecto de las normas sugeridas por Arnett et al., correspondientes a un menor espesor del labio inferior en ambos sexos, y una mayor prominencia del pómulo en mujeres chilenas, por lo que consideramos que los valores de armonía de Arnett et al., pueden ser también aplicados como parámetro estético para la población chilena.

ABSTRACT: Performing an orthodontic treatment based only on hard tissue references can lead to unfavorable aesthetic results due to the great variability that exists in soft tissues that cover them. In 1999, W.Arnett, presented an analysis based on soft tissues and determined norms that define a harmonious face. However, these standards that were obtained from North Americans and Chilean aesthetic concepts could be different. The aim of the study was to determine the values of facial harmony for the Chilean population, using the cephalometric analysis of soft tissues presented by Arnett, and compare them with the values previously established for the Caucasian population. In this study 200 photographs were analyzed, and the profiles were classified in balanced and unbalanced according to the criteria of a group of specialists. Subsequently, teleradiographs corresponding to the classified profiles were analyzed, with the cephalometric analysis of soft tissues. The values of the different variables were analyzed separately by sex, skeletal class and facial biotype, and the differences between the variables presented by Arnett et al., and those obtained in the present study. For this purpose, statistical significance tests such as the t test and other non- parametric tests were used. There were only significant differences in two variables: inferior lip variables in both sexes, and a greater prominence of the cheekbone in Chilean women, therefore we consider that the values of harmony of Arnett, can also be applied as an aesthetic parameter for the Chilean population.

Isquemia de extremidades inferiores secundaria a arteritis de la arteria temporal

Giant cell arteritis is more common in women older than 60 years, is associated with systemic inflammation symptoms and mainly involves the aortic arch and cranial arteries, specially the temporal artery. Symptomatic lower extremity arterial stenosis or occlusion is uncommon and can lead to limb loss. We report a 73-year-old woman presenting with a one-month history of lower extremity intermittent claudication of sudden onset. She also complained of fever, malaise, headache and weight loss. A non-invasive vascular study showed moderate femoral popliteal occlusive disease, with and abnormal ankle-brachial index (0.68 and 0.83 on right and left sides, respectively). An angio-computed tomography showed thickening of the aortic wall and severe stenosis in both superficial femoral arteries. Steroidal treatment was started, and a temporal artery biopsy was performed confirming giant cell arteritis. Six weeks after steroid therapy the patient had a complete remission of symptoms. A serologic exacerbation was subsequently treated with a humanized monoclonal antibody against the interleukin-6 receptor Tocilizumab, obtaining long time remission.

Tendinitis calcificante del longísimo del cuello / Acute calcific tendinitis of the longus colli muscles

RESUMEN La tendinitis calcificante prevertebral es una patología benigna y poco frecuente, con una incidencia anual de 0,5 casos por cada 100.000 habitantes. Se presenta un caso de una paciente de 52 años que consultó por cervicalgia, odinofagia y disfonía de 5 días de evolución. Tras una exploración otorrinolaringológica completa se sospechó ocupación del espacio retrofaríngeo, confirmada con pruebas de imagen. Ante estos hallazgos y con la sospecha de absceso retrofaríngeo, se decidió ingreso hospitalario para tratamiento intravenoso. Por discordancia entre la clínica, la TC y los hallazgos analíticos, se solicitó RM cervical, cuya imagen hizo sospechar una tendinitis aguda calcificante del longísimo del cuello. En este trabajo se ha realizado una revisión de la sintomatología, el diagnóstico y el tratamiento de esta entidad. Consideramos importante sospecharla dentro del diagnóstico diferencial de la ocupación del espacio retrofaríngeo para evitar realizar procedimientos innecesarios.

ABSTRACT Prevertebral calcific tendinitis is a benign and infrequent pathology, with an annual incidence of 0.5 cases per 100,000 habitants. We report the case of a 52-year-old woman that presented with a 5-day history of cervicalgia, odynophagia and dysphonia. Otolaryngological examination and radiological images showed occupation of the retropharyngeal space. The patient was admitted to the hospital for intravenous treatment. A cervical MRI was requested, suggesting an acute calcific tendinitis of the longus colli muscles. The authors provide a discussion of the clinical findings, diagnosis and treatment of this condition. We consider it to be an important differential diagnosis of a retropharyngeal space occupation, in order to avoid unnecessary procedures.

Parámetros genéticos para producción de leche en ganado Simmental (Bos taurus) mediante modelos genómicos y poligénicos / Genetic parameters for milk production in Simmental cattle (Bos taurus) using genomic and polygenic models

RESUMEN El objetivo de este estudio fue estimar parámetros genéticos con y sin la inclusión de parentesco genómico para la producción de leche acumulada a 60 (PL60), 150 (PL150), 210 (PL210) y 305 días (PL305) en ganado Simmental en Colombia. Un total de 2883 controles lecheros en 620 vacas de primer parto fueron utilizados. La información genómica se obtuvo a partir de 718 animales genotipados con un chip de una densidad de 30106 marcadores genéticos tipo polimorfismo de nucleótido simple (SNP). Se construyeron modelos de tipo univariado y bivariado bajo la metodología del mejor predictor lineal insesgado (BLUP) y genómico en una etapa (ssGBLUP). Los valores de heredabilidades para PL60, PL150, PL210 y PL305 variaron entre 0,20 a 0,27; 0,25 a 052; 0,30 a 0,35 y 0,20 a 0,23; respectivamente. La inclusión de parentesco genómico no aumentó las heredabilidades y tampoco la precisión de las estimaciones para las características asociadas a producción de leche. La escasez de información fenotípica y la baja conectividad genética entre la población genotipada y no genotipada podrían limitar procesos de selección genética para producción de leche a través del ssGBLUP en la población de ganado Simmental de Colombia.

ABSTRACT The aim of this study was to estimate genetic parameters with and without the inclusion of genomic relationship in cumulative milk production of Simmental cattle in Colombia for 60 (MP60), 150 (MP150), 210 (MP210) and 305 (MP305) days. A total of 2883 test records from 620 cows in first lactation were used. The genomic information was obtained from 718 animals genotyped with a commercial chip with a density of 30,106 single nucleotide polymorphism (SNP) genetic markers. Univariate and bivariate models were used under the conventional best linear unbiased predictor (BLUP) and the single step genomic BLUP (ssGBLUP) methodologies. The heritability estimate values for MP60, MP150, MP210 and MP305 ranged from 0.20 to 0.27, 0.25 to 0.52, 0.30 to 0.35 and 0.20 to 0.23, respectively. The use of the genomic relationship did not increase heritabilities nor the accuracy of estimates for milk traits. The lack of phenotypic records and the low genetic connectivity between genotyped and non-genotyped populations could limit the genetic selection procedures for milk production via the ssGBLUP in Colombian Simmental cattle.

Tuberculosis cutánea en pabellón auricular: reporte de un caso / Cutaneous tuberculosis in ear auricle: a case report

RESUMEN La tuberculosis cutánea representa menos del 2% de todos los casos de la infección por Mycobacterium tuberculosis. Su baja prevalencia, asociada a la amplia variedad en la presentación clínica de las lesiones, dificulta y retrasa el diagnóstico y, por tanto, el inicio del tratamiento. El siguiente es el caso de una paciente de 80 años, con una lesión ulcerada, crónica, en pabellón auricular izquierdo, con evolución tórpida y pobre respuesta al manejo farmacológico instaurado; con biopsia de piel que mostró reacción inflamatoria crónica y presencia de bacilos ácido-alcohol resistentes.

ABSTRACT Cutaneous tuberculosis represents less than 2% of all cases of infection with Mycobacterium tuberculosis. Its low prevalence, associated with a wide variety in clinical presentation of the lesions, hinders and delays the diagnosis and, thus, treatment initiation. The following is the case of an 80-years old, female patient with an ulcerated, chronic lesion in the left ear auricle, with a torpid evolution and poor response to established pharmacological management; with a skin biopsy that showed chronic inflammatory reaction and the presence of acid-fast bacilli.

Comparación del ordenamiento de predicciones BLUP y la respuesta a la selección en conejos cuando el efecto año-estación se considera fijo o aleatorio / Comparison of the BLUP prediction order and the response to selection in rabbits when the effect yearseason is considered to be either fixed or random

En lineas de conejos reproductivamente cerradas, criadas con generaciones discretas, existe una fuerte asociacion entre el año-estacion (AE) y los niveles de consanguinidad (F). Estudios realizados anteriormente mostraron que, cuando AE y F son considerados como efectos fijos en un modelo, la heredabilidad y la tendencia genetica se sobreestiman. El objetivo del trabajo fue investigar las consecuencias de considerar AE como fijo (M1) o aleatorio (M2) sobre la seleccion de animales. Se utilizaron 15671 registros correspondientes al numero de destetados de la linea A, del Departamento de Ciencia Animal de la Universidad Politecnica de Valencia, España. Los modelos fueron comparados en base a: los ordenamientos de los valores geneticos aditivos estimados en cada generacion y la respuesta esperada a la seleccion. Se plantearon seis escenarios segun intensidades de seleccion. En cada uno se estimo la correlacion de Spearman y se calculo el porcentaje de discordancia (D) entre los animales elegidos por M2 y no por M1. La respuesta a la seleccion para los animales escogidos por M1 o M2, fue estimada como la pendiente de la recta de regresion entre las medias de los valores geneticos predichos por M2 a traves de las generaciones. A medida que disminuyo la presion de seleccion, aumentaron las correlaciones de Spearman, disminuyendo los D. Aunque, a nivel generacion ambos estimadores no mantuvieron siempre la misma relacion. Las respuestas a la seleccion estimadas fueron similares para los animales seleccionados por M1 o M2, con lo cual no se esperan diferencias entre ambos modelos respecto a la seleccion.

In close reproductive lines of rabbits reared in discrete generations, there is a strong association between the year-season (AE) and the levels of consanguinity (F). Previous studies have shown that when AE and F were considered as fixed effects in a model, the heritability and the genetic tendency were overestimated. The objective of this work was to investigate the consequences of considering AE as either a fixed (M1) or random (M2) effect on the selection of animals. A total of 15,671 records corresponding to the number of rabbits weaned in line A, from the Department of Animal Science of the Polytechnic University of Valencia, Spain, were used. The comparison of models was based on the rankings of the estimated additive genetic values in each generation and the expected response to the selection. Six scenarios were proposed, varying in selection intensities. In each one, the Spearman correlation was estimated and the percentage of discordance (D) between the animals chosen for M2 but not for M1 was calculated. The response to selection for the animals chosen by either M1 or M2, was estimated as the slope of the regression line between the means of the genetic values predicted by M2 through generations. As the selection pressure decreased, the Spearman correlations increased, decreasing the D. However, at the generation level, both estimators did not always maintain that relationship. The estimated responses to selection were similar when the selection was based on estimated breeding values obtained by using either M1 or M2. Therefore, no differences are expected between both models with respect to selection.

Estudio cariológico de Chrysobalanus icaco (Chrysobalanacea) en Paraíso, Tabasco, México / Caryological study of Chrysobalanus icaco (Chrysobalanacea) in Paraíso, Tabasco, México

Chrysobalanus icaco es una planta que pertenece a la familia Chrysobalanaceae. En Tabasco, Mexico, esta planta se distribuye en los municipios de la costa. La finalidad de esta investigacion fue la caracterizacion cromosomica de dos fenotipos con color de fruto rosa y purpura mediante tincion convencional. Con tal fin, se recolectaron frutos maduros en la comunidad de Penjamo, Paraiso, Tabasco. Las semillas se dejaron germinar por 30 dias a una temperatura constante de 30 °C. Se utilizaron raicillas de 1,00 cm de longitud, las cuales fueron sometidas a hidrolisis acida y posterior tincion con orceina. Se fotografiaron 295 metafases y se midieron los cromosomas de 35 placas metafasicas del fenotipo purpura y 30 del fenotipo rosado. Ambos fenotipos presentaron 18 cromosomas pequenos, los cuales se ordenaron en nueve pares homologos segun su tamano relativo. No se observaron diferencias morfologicas ni numericas entre los cariotipos de ambos fenotipos. Ademas la prueba de t-Student (α=0,05) revelo que no se encuentran diferencias significativas entre los complementos cromosomicos de ambos fenotipos.

Chrysobalanus icaco is a plant that belongs to the Chrysobalanaceae family. In Tabasco, Mexico, this plant is distributed in the municipalities of the coastline. The main purpose of this research was to characterize the chromosomal structure of phenotypes with pink and purple fruits by the use of conventional staining. To this end, mature fruits were collected in the community of Penjamo, Paraiso, Tabasco. Seeds were allowed to germinate for 30 days at a constant temperature of 30° C. Roots of 1.00 cm in length were subjected to acid hydrolysis and subsequent staining with orcein. A total of 295 metaphases were photographed and chromosomes of 35 metaphases of the purple phenotype and 30 of the pink phenotype were measured. Both phenotypes presented 18 small chromosomes, which were ordered in nine homologous pairs according to their relative size. No morphological or numerical differences were observed between the karyotypes of both phenotypes. In addition, the t-Student (α=0.05) test did not reveal significant differences between the chromosomes complements of both phenotypes.

Impacto del Ácido Fólico en la Incidencia de Fisuras Labiopalatinas de la Población Occidente de la Región Metropolitana, Chile / Impact of Folic Acid on the Incidence of Cleft Lip and Palate of the Western Population of the Metropolitan Region, Chile

RESUMEN: La fisura labiopalatina ha tenido una alta frecuencia en la población chilena. A partir del 2000 se inició el programa de fortificación de la harina con ácido fólico a fin de disminuir los defectos del tubo neural. El objetivo de este estudio fue determinar el impacto que presenta la incorporación del ácido fólico en la incidencia de fisuras labiopalatinas de la población del área occidente de la Región Metropolitana. Se recopiló información a partir de las fichas clínicas de la Fundación Gantz seleccionando a los recién nacidos entre 1990 y 2009, correspondientes a las comunas del Servicio de Salud Occidente de la Región Metropolitana. Desde el 2000 hasta el 2004 se observó una disminución importante en las tasas de fisura labiopalatina, con una tasa de 0,88 fisurados por 1000 recién nacidos vivos. Posteriormente se observó un incremento a partir del 2005 hasta el 2009 llegando a una tasa de 1,52 fisurados por 1000 recién nacidos vivos. En conclusión, el efecto protector del ácido fólico se evidencia en la disminución de las tasas de los recién nacidos con fisuras durante los primeros años de su implementación. Sin embargo, posteriormente se observó un aumento de dichas tasas, lo cual podría deberse al incumplimiento de la norma.

ABSTRACT: Cleft lip and palate has had a high frequency in the Chilean population. From the year 2000 a flour fortification program with folic acid was initiated in order to reduce the defects of the neural tube. The objective of this study was to determine the impact of the incorporation of folic acid in the incidence of cleft lip and palate of the population of the western area of the Metropolitan Region. Information was collected from clinical records of the Gantz Foundation, selecting newborns from 1990 to 2009, corresponding to the districts of the western sector of the Metropolitan Region. From 2000 to 2004 there was a significant decrease in cleft lip and palate rates, with a rate of 0.88 cases per 1000 live births. Subsequently, an increase was observed from 2005 to 2009, reaching a rate of 1.52 cases per 1000 live births. In conclusion, the protective effect of folic acid is evidenced in the reduction of the rates of newborns with cleft palate during the first years of its implementation. However, an increase in these rates was subsequently observed, which could be due to noncompliance with the standard.

Caracterización genética de cuatro poblaciones de ovinos criollos de Argentina / Genetic characterization of four populations of Argentinian creole sheep

Los ovinos criollos son los fundadores de la ganadería ovina en la Argentina y han contribuido de manera sostenida al desarrollo económico, social y cultural de algunas regiones del país. A pesar de ello, es un recurso zoogenético escasamente valorizado y por ende poco estudiado. En orden de caracterizar genéticamente a los ovinos criollos argentinos, se tomaron muestras de ADN de cuatro poblaciones representativas localizadas en las provincias de Buenos Aires, Corrientes, Santiago del Estero y Salta. Estas majadas se seleccionaron por ser grupos conservados, que presentan las características fenotípicas de la raza y no registran la introducción de animales de otras razas en el sistema de reproducción. Un total de 30 marcadores microsatélites y la región D-loop del ADN mitocondrial fueron analizados. El análisis de los microsatélites permitió evidenciar una alta diversidad genética intrapoblacional (Ho= 0,676; He= 0,685; PIC= 0,713). Dicha variabilidad es explicada por diferencias entre los patrones moleculares de los individuos estudiados que pueden clasificarse en 3 grupos de poblaciones significativamente diferentes: BA, SA, SE+CO. Dado que dichas poblaciones explican muy poco de la variabilidad total (7,6%), ellas deberían considerarse perteneciente a una misma raza. El análisis del D-loop mitocondrial demostró que los individuos analizados están relacionados con el haplogrupo asiático, el cual está ampliamente distribuido en las razas españolas que son las antecesoras de la raza criolla argentina. Los resultados obtenidos en este trabajo proveerán información para establecer criterios de manejo de este recurso genético de Argentina con el fin de implementar planes de conservación, recuperación y/o mejora de los programas.

Creole sheep are the founders of sheep farming in Argentina and have contributed in a sustained way to the economic, social and cultural development of some regions of this country. However, it is a scarcely valorised and poorly studied genetic resource. In order to genetically characterize the Argentinian Creole sheep, DNA samples were taken from four representative populations located in the provinces of Buenos Aires, Corrientes, Santiago del Estero and Salta. These flocks were selected because they are considered to be conserved groups, they have the phenotypic characteristics of the creole breed and there are no records about the introduction of animals of other breeds into those systems. A total of 30 microsatellites and the D-loop region of mitochondrial DNA were analysed. Microsatellite analysis showed high level of genetic diversity within populations (Ho= 0.676; He= 0.685; PIC= 0.713). This variability is explained by differences between molecular patterns of the studied individuals, which can be classified into three significantly different population groups: BA, SA, SE+CO. Since these populations explain very little of the total variability (7.6%), it can be considered that they belong to a same race. The analysis of the mitochondrial D-loop showed that Argentinian Creole sheep have haplotypes belonging to the Asian haplogroup, which is widely distributed in the Spanish breeds, which are considered to be their ancestors. The results obtained in the present study will provide information to develop management criteria for this genetic resource in Argentina, in order to implement their conservation, recovery and/or to develop breeding programs.

Pileflebitis como causa de fiebre / Pylephlebitis as a cause of fever

Resumen La pileflebitis o trombosis séptica portal es una complicación rara pero con gran morbilidad y mortalidad de los procesos infecciosos abdominales que drenan al sistema venoso portal. Con mayor frecuencia se relaciona con la apendicitis y diverticulitis. La incidencia ha aumentado en los últimos años con la disponibilidad de pruebas de imagen, como ecografía y tomografía axial computada abdominal. Esta facilidad en el diagnóstico y sobre todo la prescripción de antibióticos han mejorado el pronóstico, aunque no hay claro consenso en cuanto al tratamiento de esta infección y la anticoagulación es un tema controvertido.

Abstract Pylephlebitis or suppurative thrombophlebitis of the portal mesenteric venous system is a rare but deadly complication of abdominal infections drained by the portal venous system. Usually, it is seen in the setting of appendicitis and diverticulitis. The incidence have been increased in the last years because of the use of modern diagnosis imaging such as ultrasonography and computed tomography scans. The more sensitive imaging techniques and the availability of antibiotics have improve the prognosis, although there is not consensus about the empiric antibiotic regimens and the anticoagulation therapy is a controversial topic.

Prediciendo la Actividad Cardíaca de la Almeja Tivela stultorum con Digoxina Utilizando Redes Neuronales Artificiales / Predicting the Cardioactivity of Tivela stultorum clam with Digoxin Using Artificial Neural Networks

Resumen: Las redes neuronales artificiales (RNA) son un método computacional extensamente utilizado para resolver problemas complejos y realizar predicciones en sistemas de relación no lineal. En este trabajo se utilizaron RNA para predecir la respuesta fisiológica obtenida al adicionar una concentración específica de digoxina a corazones de Tivela stultorum, un organismo modelo para probar fármacos cardíacos que se pretenden utilizar en humanos. Las entradas de la RNA fueron el peso, volumen, largo y ancho del corazón, la concentración de digoxina, el volumen utilizado para la dilución de digoxina, el máximo y mínimo de contracción, tiempo de llenado, y frecuencia cardíaca antes de adicionar la digoxina, las salidas fueron el máximo y mínimo de contracción, tiempo de llenado y frecuencia cardíaca esperados después de agregar digoxina al corazón. Las RNA se entrenaron, validaron y probaron con los resultados de experimentos in vivo. Para elegir la red óptima se utilizó el valor más pequeño del error medio cuadrado. Se obtuvo una correlación alta entre los valores predichos y calculados, excepto en el caso del tiempo de llenado. Se lograron obtener predicciones acertadas de la cardioactividad de la almeja T. stultorum cuando se les agrega una concentración específica de digoxina haciendo uso de RNA; esto con el fin de utilizarse como una herramienta para facilitar las pruebas en el laboratorio de los efectos de la digoxina.

Abstract: Artificial neural networks (ANN) are a computational method that has been widely used to solve complex problems and carry out predictions on nonlinear systems. Multilayer perceptron artificial neural networks were used to predict the physiological response that would be obtained by adding a specific concentration of digoxin to Tivela stultorum hearts, this organism is a model for testing cardiac drugs that pretends to be used in humans. The MLP-ANN inputs were weight, volume, length, and width of the heart, digoxin concentration and volume used for diluting digoxin, and maximum contraction, minimum contraction, filling time, and heart rate before adding digoxin, and the outputs were the maximum contraction, minimum contraction, filling time, and heart rate that would be obtained after adding digoxin to the heart. ANNs were trained, validated, and tested with the results obtained from the in vivo experiments. To choose the optimal network, the smallest square mean error value was used. Perceptrons obtained a high performance and correlation between predicted and calculated values, except in the case of the filling time output. Accurate predictions of the T. stultorum clams cardioactivity were obtained when a specific concentration of digoxin was added using ANNs with one hidden layer; this could be useful as a tool to facilitate laboratory experiments to test digoxin effects.

Frecuencia de tiña del cuerpo en un hospital del estado de Quintana Roo / Frequency of tinea corporis in a hospital in Quintana Roo state

Resumen ANTECEDENTES: las dermatofitosis son micosis superficiales causadas por un grupo de hongos parásitos de la queratina, denominados dermatofitos. Comprenden tres géneros: Trichophyton, Microsporum y Epidermophyton. Son cosmopolitas, predominan en climas cálidos y húmedos, y representan 70 a 80% de todas las micosis. OBJETIVO: identificar la frecuencia de consulta por tiña del cuerpo en una zona urbana tropical. MATERIAL Y MÉTODO: estudio descriptivo, abierto y transversal, en el que durante tres meses en 2015 se registraron todos los pacientes con diagnóstico clínico de tiña del cuerpo que asistieron a la consulta de dermatología de un hospital de segundo nivel de Playa del Carmen, Quintana Roo, México. Se registraron los datos demográficos, tiempo de evolución, topografía y factores predisponentes asociados. Se realizó examen directo en escama con hidróxido de potasio (KOH), cultivo micológico en medio de Sabouraud y examen directo del cultivo con azul de lactofenol para identificar al agente causal. RESULTADOS: de 546 consultas de dermatología general se detectaron 17 pacientes (3%) y se corroboró el diagnóstico con KOH en 14 pacientes (82%, nueve mujeres [64%]), entre éstos hubo crecimiento en el cultivo en 9 muestras (64%). Se aisló Microsporum canis en 4 (44%), Trichophyton rubrum en 4 (44%) y T. mentagrophytes en uno (11%). Los límites de edad fueron 3 y 57 años (4 niños, 28.5%). El tiempo de evolución promedio fue de 15 semanas. La localización más frecuente fueron las extremidades. Los factores predisponentes más comunes fueron el contacto con mascotas infectadas y la administración de corticoesteroides. CONCLUSIONES: la tiña del cuerpo representa 3% de la consulta de dermatología en un hospital de una zona urbana tropical. Fue más frecuente en mujeres, predominó en las extremidades y en 28.5% afectó a población pediátrica. T. rubrum y M. canis fueron los agentes causales más frecuentes.

Abstract BACKGROUND: Dermatophytosis are superficial mycosis caused by dermatophytes, a group of fungi that parasite keratin, and is composed of three genera: Trichophyton, Microsporum and Epidermophyton. They predominate on hot and humid climates, and are responsible of 70-80% of all mycosis. OBJETIVE: To identify the frequency of consultation for tinea corporis. MATERIAL AND METHOD: A descriptive, open and cross-sectional study in which, during three months in 2015, all patients with clinical diagnosis of tinea corporis that attended to the dermatology department in a second level hospital at Playa del Carmen, QR, Mexico, were registered including demographic data, such as progression time, topography and associated predisposing factors; a KOH mount was performed, as well as mycological culture in Sabouraud dextrose agar and microscopic examination of the colony with lactophenol blue to identify the causal agent. RESULTS: Out of 546 visits to the dermatology service, the diagnosis was confirmed in 17 patients (2.5%) and diagnosis was confirmed with a positive KOH mount in 14 patients (82%, nine women [64%]), and in 9 samples there was culture growth (64%). Microsporum canis and Trichophyton rubrum were isolated in 4 cases (44%) each, and Trichophyton mentagrophytes in one case (11%). Age range was 3-57 years, with four children registered (28.5%). The progression time of the disease was 15 weeks in average. The most frequent topography was the extremities. The most common predisposing factors were contact with infected pets and the administration of corticosteroids. CONCLUSIONS: Tinea corporis represents 3% of the dermatology consultation in a second level hospital in urban tropical zone. It is more frequent in female patients, affecting more frequently extremities; 28.5% were children. The isolated causal agents were M. canis and T. rubrum.

Recombinant 60-kDa heat shock protein from Paracoccidioides brasiliensis: is it a good antigen for serological diagnosis of paracoccidioidomycosis?

Paracoccidioides brasiliensis and P. lutzii are fungi that cause paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in South America. For serological diagnosis, although 43-kDa glycoprotein (gp43) is regarded as highly specific for PCM, the occurrence of false negative reactions in sera from patients infected with P. lutzii suggests that preparation with only one antigen is not recommended. Heat shock proteins are feasible alternatives as a second antigen because they are often highly immunogenic. In this study, we evaluated the usefulness of recombinant 60-kDa heat shock protein from P. brasiliensis (rPbHsp60) for the serological diagnosis of PCM. Using western blotting assay, we observed that 77.3% of the sera from PCM patients were positive to rPbHsp60, with 90.9% positivity to recombinant gp43 (rgp43). More importantly, sera from healthy subjects had 27% positivity to rPbHsp60 and none to rgp43. When rPbHsp60 was used in ELISA, we did not observe significant differences between the reactions with sera from PCM patients and healthy subjects, while the difference was clearly evident when the antigen was rgp43. Furthermore, rPbHsp60 was recognized by sera from patients with histoplasmosis, aspergillosis, sporotrichosis or tuberculosis in an ELISA test. These results show that rPbHsp60 is not a good antigen for PCM diagnosis.

Vida cotidiana del adulto mayor y la necesidad de sueño-descanso / Daily life of the elderly and the need for sleep-rest

La necesidad de sueño-descanso en el adulto mayor se encuentra seriamente comprometida debido a la presencia de trastornos del sueño, específicamente insomnio y somnolencia excesiva diurna, que en la actualidad representan un problema de salud pública. La etiología de dichos trastornos es multifactorial, ya que además del factor biológico existen otros componentes en su vida cotidiana que los agravan, tales como factores psicológicos, ambientales y económicos. En este sentido, la vida cotidiana del adulto mayor se visualiza como objeto de estudio de esta investigación en relación a la necesidad de sueño-descanso. OBJETIVO: Describir, analizar e interpretar las vivencias de la vida cotidiana del adulto mayor en relación con la necesidad de sueño-descanso. MÉTODO: Se realizó un estudio usando la técnica de investigación cualitativa, fenomenológica, exploratoria y descriptiva. Se eligieron a cinco adultos mayores que presentaran insomnio o somnolencia excesiva diurna y se les aplicó la entrevista en profundidad. El análisis de los datos fue de contenido tipo temático. RESULTADOS: Se encontraron dos categorías y tres subcategorías. 1. Prácticas del adulto mayor: a) Prácticas repetitivas, las cuales realiza de forma involuntaria el adulto mayor en su vida cotidiana, tales como establecer un horario autoimpuesto para dormir y despertar, el cual reduce la cantidad de horas recomendadas de sueño y por consecuencia la eficacia del mismo. b) Tareas agobiantes: Son actividades que realiza el adulto mayor como parte de su cotidianeidad y que responden a necesidades de terceras personas y que le generan una sensación de estrés durante el día, el cual, modifica el ciclo de sueño, presentando insomnio y cansancio emocional y mental, así como una disminución del tiempo que dedican a sí mismos. c) Actividades recreativas, que son regeneradoras de energía, ayudan a liberar el estrés y fomentan un descanso integral en el adulto mayor, sin embargo no hay una consciencia de la importancia que tiene el tiempo de ocio en la vejez, y los adultos mayores no le dan prioridad en su vida cotidiana. 2 Ansiedad nocturna, se refiere a un estado de agitación e inquietud que dificulta la conciliación y mantenimiento del sueño, propiciando la aparición de pensamientos y sentimientos negativos por problemas familiares y económicos principalmente, los cuales provocan síntomas de insomnio, afecto deprimido y somatización de enfermedades. CONCLUSIÓN: Los resultados obtenidos sugieren que el adulto mayor cae en un círculo vicioso que afecta la necesidad de sueño-descanso, pues no distribuye de manera adecuada el tiempo en su vida cotidiana, ya que realiza actividades que son generadoras de estrés que provocan un cambio en el ciclo de sueño-vigilia con la presencia de insomnio, el cual conlleva a un agotamiento y un deterioro en la realización de actividades cotidianas.

The elderly necessity of sleeping is compromised due to sleep disorders, specifically insomnia and excessive daytime sleepiness (EDS), which are currently an issue in public health. The etiology of said disorders is multifactorial because, besides the biological factor, there are other components in the everyday- life that aggravate them; such as psychological factors, environmental factors and economic factors. Considering this, the elderly everyday-life will be this research object of study in relation to the necessity of sleeping. OBJECTIVE: Describe, analyze and interpret the elderly everday-life experiences in relation to the necessity of sleeping. METHOD: The study was made using a qualitative, phenomenological, exploratory and descriptive research method. Five elderlies suffering from insomnia or EDS were chosen and interviewed. The data was analyzed using thematic analysis. RESULTS: There are two categories and three subcategories. 1. Elderly customs: a) Repetitive customs, which are done unintentionally by the elderly in their everyday-life, such as having a self-imposed schedule to sleep and wake, which, reduces the recommended amount of sleep and therefore the efficacy of it. b) Overwhelming activities, which are activities that the elderly do in their everyday-life in order to fulfil other's needs, which cause them a feeling of stress during the day that affects the sleep cycle, causing insomnia, emotional exhaustion and mental fatigue, as well as a decrease in the amount of time they spend on themselves. c) Recreational activities, which give energy, help to relieve stress and promote complete rest in the elderly. However, there is not awareness of how important this leisure time is at old age, so the elderly do not give it priority in their everyday-life. 2. Sleep anxiety, which refers to a state of turmoil and restlessness that causes problems to fall asleep and stay asleep, leading to negative thoughts and feelings, caused mainly by family and economic problems, which results in insomnia, depression and somatization. CONCLUSION: The results suggest that the elderly falls into a vicious circle that affects the necessity of sleeping. As a result of they not being able to organize their everyday-life time properly; due to the fact that they do activities that cause stress and a change in the sleep-wake cycle in conjunction with the presence of insomnia, which leads to exhaustion and deterioration in the performance of daily activities.

A Review of the Peri-Operative Management of Paediatric Burns: Identifying Adverse Events

Background. Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission; according to burn admission criteria; about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small; residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis; bleeding; issues around thermoregulation; the hypermetabolic state; nutritional and electrolyte issues; inhalation injuries and the amount of movement during procedures to wash patients; change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures.Objective. To review the peri-operative management and standard of surgical care of burnt children.Methods. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital; Cape Town; South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified.Results. There were 257 males and 301 females in this study; with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%; with an average of 23.5%. Inhalational injury was present in 11.3%; pneumonia in 13.1%; wound sepsis in 20.8%; and septicaemia in 9.7%; and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0oC. Core temperatures recorded at the start; halfway through and at completion of surgery were 36.9oC; 36.8oC and 36.5oC; respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL; respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children.Conclusion. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control; rapid blood loss; preceding respiratory illnesses and measures to reduce blood loss

Optical coherence tomography imaging of the basal ganglia: feasibility and brief review

Optical coherence tomography (OCT) is a promising medical imaging technique that uses light to capture real-time cross-sectional images from biological tissues in micrometer resolution. Commercially available optical coherence tomography systems are employed in diverse applications, including art conservation and diagnostic medicine, notably in cardiology and ophthalmology. Application of this technology in the brain may enable distinction between white matter and gray matter, and obtainment of detailed images from within the encephalon. We present, herein, the in vivo implementation of OCT imaging in the rat brain striatum. For this, two male 60-day-old rats (Rattus norvegicus, Albinus variation, Wistar) were stereotactically implanted with guide cannulas into the striatum to guide a 2.7-French diameter high-definition OCT imaging catheter (Dragonfly™, St. Jude Medical, USA). Obtained images were compared with corresponding histologically stained sections to collect imaging samples. A brief analysis of OCT technology and its current applications is also reported, as well as intra-cerebral OCT feasibility on brain mapping during neurosurgical procedures.

El cabello, fuente de información del estado de salud / The hair, source of health information

El cabello y especialmente el localizado en la cabeza provee importante información sobre posibles exposiciones ambientales y/o laborales a diferentes elementos. El pelo puede ser considerado como un producto excretor, y su estudio reflejaría el metabolismo de minerales en el cuerpo. Nuestro propósito en el presente estudio es conocer si datos existentes dan información poblacional sobre la presencia de elementos tóxicos o no a través del análisis del cabello humano. RESULTADOS: Fue analizada la información proveniente de 241 muestras de cabello, de los cuales 163 (67,6%) corresponden al sexo femenino y 78 (32,4%) al masculino. Fueron analizados 22 elementos esenciales y 17 elementos de tóxicos. Entre los elementos esenciales presentaron resultados elevados Calcio (Ca), Magnesio (Mg), Manganeso (Mn), Molibdeno (Mo), Vanadio (V), Estroncio (Sr) y Circonio (Zr); entre los elementos tóxicos tuvieron valores elevados Aluminio (Al), Arsénico (As), Bario (Ba), Bismuto (Bi), Cadmio (Cd), Níquel (Ni), Plomo (Pb), Mercurio (Mg), Plata (Ag), Estaño (Sn). CONCLUSIÓN. Nuestro estudio muestra a nivel poblacional, no individual, puntos de alerta por la carencia o exceso de algunos elementos analizados debiéndose continuar con estudios locales interdisciplinarios en los cuales exista información sobre enfermedades, hábitos alimentarios, hábitos tóxicos, actividad laboral y exposición ambiental a los diferentes elementos. (AU)

Hair, especially localized in the head, provides important information on possible environmental and/or labor exposures to different elements. Hair can be considered as an excretory product, and its study would reflect the metabolism of minerals in the body. Our purpose in this study was to determine whether existing population data provide information on the presence of toxic and non-toxic elements by analizing human hair. RESULTS: We analyzed information from 241 hair samples, of which 163 (67.6%) are from females and 78 (32.4%) are from males. There were analyzed 22 essential elements and 17 toxic elements. Among the essential elements that had elevated results there were: Calcium (CA), magnesium (Mg), manganese (Mn), molybdenum (Mo), vanadium (V), strontium (Sr) and zirconium (Zr); among the toxic elements, those with higher values were: Aluminum (Al), arsenic (As), barium (BA), bismuth (Bi), Cadmium (Cd), Nickel (Ni), lead (Pb), Mercury (Mg), silver (Ag), tin (Sn). CONCLUSION. Our study shows at population level, not individual, warning points due to the lack or excess of some elements analyzed. It is reccommended to continue the research with local interdisciplinary studies which include information on diseases, eating habits, toxic habits, work activity and environmental exposure to different elements. (AU)

Reduced expression of exocytotic proteins caused by anti-cholinesterase pesticides in Brachionus calyciflorus (Rotifera: Monogononta) / Redução da expressão de proteínas de exocitose causados por pesticidas anti-colinesterase em Brachionus calyciflorus (Rotifera: Monogononta)

AbstractThe organophosphate and carbamate pesticides methyl-parathion and carbaryl have a common action mechanism: they inhibit acetylcholinesterase enzyme by blocking the transmission of nerve impulses. However, they can alter the expression of exocytotic membrane proteins (SNARE), by modifying release of neurotransmitters and other substances. This study evaluated the adverse effects of the pesticides methyl-parathion and carbaryl on expression of SNARE proteins: Syntaxin-1, Syntaxin-4 and SNAP-23 in freshwater rotifer Brachionus calyciflorus. Protein expression of these three proteins was analyzed before and after exposure to these two pesticides by Western Blot. The expression of Syntaxin-1, Syntaxin-4 and SNAP-23 proteins in B. calyciflorussignificantly decreases with increasing concentration of either pesticides. This suggests that organophosphates and carbamates have adverse effects on expression of membrane proteins of exocytosis by altering the recognition, docking and fusion of presynaptic and vesicular membranes involved in exocytosis of neurotransmitters. Our results demonstrate that the neurotoxic effect of anticholinesterase pesticides influences the interaction of syntaxins and SNAP-25 and the proper assembly of the SNARE complex.

ResumoOs pesticidas organofosforados e carbamatos metil- paration e carbaril tem um mecanismo de ação comum: eles inibem a enzima acetilcolinesterase, bloqueando a transmissão dos impulsos nervosos. No entanto, eles podem alterar a expressão de proteínas de membrana de exocitose (SNARE), através da modificação da libertação de neurotransmissores e outras substâncias. Este estudo avaliou os efeitos adversos dos pesticidas metil- paration e carbaril sobre a expressão de proteínas SNARE: Sintaxina -1, Sintaxina-4 e SNAP-23 em rotíferos de água doce Brachionus calyciflorus. A expressão destas três proteínas foi analisada antes e depois da exposição a estes dois pesticidas por Western Blot. A expressão das proteínas Sintaxina-1, Sintaxina-4 e SNAP-23 em B. calyciflorus diminui significativamente com o aumento da concentração de ambos os pesticidas. Isto sugere que os organofosfatos e carbamatos têm efeitos adversos sobre a expressão de proteínas de membrana de exocitose, alterando o reconhecimento, de encaixe e fusão de membranas pré-sinápticas e vesiculares envolvidas na exocitose de neurotransmissores. Nossos resultados demonstram que o efeito neurotóxico de pesticidas anticolinesterásicos influencia a interação de sintaxinas e SNAP-25 e a montagem correta do complexo SNARE.

Microcirugía de hernia discal lumbar: revisión y análisis de 326 casos operados en el período 2002-2010 / Microsurgery of lumbar disc herniation: review and analysis of 326 cases operated in the period 2002-2010

Se revisan en forma retrospectiva las historias clínicas de los pacientes portadores de hernia discal lumbar sintomática, intervenidos en la Unidad de Neurocirugía del Hospital Base Osorno, Región de Los Lagos, Chile, durante el período comprendido entre los años 2002 y 2010. Se realiza un análisis demográfico así como de resultados y complicaciones.

We reviewed retrospectively the medical records of patients with symptomatic lumbar disc herniation, who underwent surgery in the Neurosurgery Unit at Osorno Hospital, Los Lagos Region, Chile, during the period between 2002 and 2010. Demographic and analysis of results and complications was performed.