Relação espacial entre o estojo córneo e a falange distal em éguas Campolina adultas com e sem obesidade / Spatial relationship between the hoof capsule and the distal phalanx in adult Campolina mares with and without obesity

A laminite endocrinopática tem acometido um número crescente de equinos com sinais de obesidade. Em um estudo recente com fêmeas jovens (até cinco anos) da raça Campolina, demonstraram-se indícios de alterações no dígito, ainda discretas, aparentemente associadas ao aumento da adiposidade. Com a hipótese de que essa associação é mais evidente em animais em faixa etária superior, o objetivo do presente estudo foi estudar éguas adultas (acima de cinco anos) da raça Campolina com e sem obesidade, avaliando-se radiograficamente a relação espacial entre estojo córneo e falange distal. Foram utilizadas 27 éguas entre seis e 14 anos de idade, sendo analisadas variáveis de adiposidade e medidas radiográficas dos cascos dos membros torácicos de equinos com escore corporal de 5 a 7/9 (grupo controle) e de 8 a 9 (grupo obeso). Foram feitas comparações entre os grupos e correlacionaram-se as variáveis de adiposidade com variáveis casco. A distância de afundamento da falange distal foi cerca de 20% superior nas éguas obesas (12,3±2,5 contra 10,2±2,2mm no grupo controle). Esse parâmetro também correlacionou (P<0,01) com vários parâmetros de adiposidade, com destaque para o escore de condição corporal (r=0,47) e a circunferência de pescoço a 75% (r=0,42). Os resultados corroboram estudos prévios que demonstraram associação entre obesidade e indícios de separação entre falange distal e estojo córneo em equinos de raças nacionais, comprovando, assim, a utilidade da avaliação radiográfica nesses animais. Em conclusão, éguas da raça Campolina com obesidade possuem alterações evidentes na relação espacial entre estojo córneo e falange distal, que se intensificam com o aumento da idade e da adiposidade.(AU)

In a recent study with young females (up to 5 years old) of the Campolina breed, there were discrete indications of alterations in the digit, apparently associated to the increase in adiposity. With the hypothesis that this association is more evident in horses in the upper age group, the objective was to study Campolina adult mares (above 5 years) with and without obesity, evaluating radiographically the spatial relationship between the horn and distal phalanx. Eighteen mares between six and fourteen years and with a body score of 5 to 7/9 (Control Group) and 8 to 9 (Obeso Group) were used. Adiposity and radiographic measurements from the forelimbs were analyzed. Comparisons were made between groups and adiposity variables were correlated with hoof variables. The sinking distance of the distal phalanx was about 20% higher in obese mares (12.3±2.5 versus 10.2±2.2mm). This parameter also correlated (P< 0.01) with several adiposity parameters, with emphasis on body score condition (r= 0.47) and neck circumference at 75% (r= 0.42). In conclusion, Campolina mares with obesity have obvious alterations in the spatial relation between the corneal and the distal phalanx, which get intense according to increases in age and adiposity.(AU)

La actividad física y el estado nutricional en médicos / Physical activity and nutritional status in doctors

Contexto: el personal médico, debido a su conocimiento sobre la salud física y los medios para mantener la misma, constituye un ejemplo para la comunidad en general de un correcto estilo de vida en base a una alimentación saludable y la realización de ejercicio, pero la realidad es que no se conocen datos sobre el grado de actividad física y la nutrición del personal sanitario y su estado físico. Objetivo: establecer la prevalencia de sobrepeso y describir el nivel de actividad física del personal médico que labora en el Hospital San Francisco del IESS, de la ciudad de Quito. Sujetos y métodos: se realizó un estudio epidemiológico descriptivo transversal para describir la prevalencia de sobrepeso del personal médico, para lo cual se utilizó el IMC, el IPAQ versión corta y un cuestionario de consumo de alimentos. Mediciones principales: actividad física, estado nutricional, adición de sal, consumo de grasas saturadas y frutas. Resultados: se estudiaron 80 profesionales médicos, de los cuales 46, ( 57,5%; IC95%: 46,57%-67,74%) son mujeres. El 86,2% de los sujetos se encuentran en el rango de edad de 30 a 50 años. La clasificación realizada según la encuesta IPAQ, demostró que la mitad de los participantes (50%; n=40; IC95%: 39,30%-60,70%) realizan una actividad física leve, también denominada "caminata", y que solo 17 (21,3%; IC: 13,71%-31,42%) de los participantes realizan actividad física vigorosa. Las mujeres caminan más que los hombres (33% vs. 18%). El 53,8% (n= 43); IC95%: 42.9 ­ 64.3% de los médicos tienen sobrepeso y obesidad. Los hombres tienen mayor sobrepeso y obesidad que las mujeres (30% vs. 24%). El 41,3 % afirmaron que si agregan sal a sus alimentos diarios. El 22.5% si consumen grasas saturadas. En relación al consumo de frutas y verduras, el 60% (n=48); IC: 49,05%-70,04% revelaron que poseen un consumo moderado y relevante de estos productos. Habría cierta relación entre el incremento de actividad física y la disminución de IMC, la mediana del IMC tiende a disminuir. Igualmente, quienes disminuyen la actividad física incrementan el peso. Conclusión: la mitad del personal médico tiene sobrepeso. Debido a factores externos adicionales, la actividad física no es un determinante único para la reducción de peso en el personal médico. (AU)

Context: due to their knowledge about physical well-being and how to achieve it, healthcare professionalought to set the example for the community in general regarding a healthy lifestyle based on eating good food and exercising. However, in real terms, there are no data available concerning the physical condition, level oactivity and nutrition of health professionals. Objective: to establish the degree of excess weight and physical activity of the medical practitioners working aIESS (National Health Service) Hospital San Francisco in Quito. Subjects and methods: This is an epidemiologic cross-sectional descriptive study aimed at defining the prevalence of excess weight of medical personnel using BMI, IPAQ (short version) and a food consumption survey. Principal measurements: physical activity, nutritional condition, added salt, consumption of saturated fats and fruits. Results: the number of medical professionals taking part was 80, out of which 46, i.e. 57.5%; IC95%: 46.57%-67.74%) are women. 86.2% of the subjects are between 30 to 50 years of age. The IPAQ classification indicated that half of the participants (50%; n=40; IC95%: 39.30%-60.70%) undertake a moderate form ophysical activity such as walking, and that just 17 (21.3%; IC: 13.71%-31.42%) of the participants perform vigorous physical workouts. Females walk more than males (33% vs. 18%). Moreover, 53.8% (n= 43); IC95%:n 42.9 ­ 64.3% health practitioners are classed as overweight or obese. The males tended to be more overweight/ obese than the females: (30% vs. 24%). Also, 41.3 % of the subjects admitted adding salt to their food daily, and 22.5% knowingly consume saturated fats. Regarding the consumption of fruits and vegetables, 60% (n=48); IC: 49.05%-70.04% revealed that they have moderate or relevant consumption of these products. There is a correlation between increased physical activity and decreased BMI whereby the average BMI tends to go down. Likewise, those participants with decreased physical activity, tended to put on weight. Conclusion: half of the medical personnel are overweight. Due to additional external influences, physicaactivity is not the only determining factor for weight loss among the medical staff analysed. (AU)

Hipertrigliceridemia asociada a sobrepeso y obesidad en médicos del hospital San Francisco del IESS, en la ciudad de Quito: una alerta para los profesionales médicos / Hypertriglyceridemia associated with overweight and obesity in doctors at the San Francisco del IESS hospital, in the city of Quito: an alert for medical professionals

Contexto: la OMS menciona que la alteración del estado nutricional será notorio en países en vías de desarrollo, en los cuales se experimentará cambios acelerados en los regímenes alimentarios y el modo de vida de su población, y será una respuesta a "la industrialización, la urbanización, el desarrollo económico y la globalización de los mercados"; en Ecuador la población aumentó el consumo de productos alimenticios de rápida disponibilidad, saturados en grasas y con un gran contenido calórico; y según estadísticas actuales en la última década en Ecuador se ha demostrado un notable cambio nutricional. Y es por eso que, al existir estos nuevos accesos se debe tomar en cuenta a la Hipertrigliceridemia como factor de riesgo a futuro de Enfermedades Crónicas No Transmisibles especialmente cardiovasculares. Objetivo: describir la tasa de prevalencia de Hipertrigliceridemia en relación con el sobrepeso y obesidad en médicos del Hospital San Francisco del IESS en la ciudad de Quito del período 2015 ­ 2016. Sujetos y métodos: Se realizó un estudio Epidemiológico Descriptivo de conjunto para describir la tasa de prevalencia de Hipertrigliceridemia y su relación con el estado nutricional del personal médico, para lo cual se utilizó el I.M.C. y nivel de triglicéridos en sangre. Mediciones principales: estado nutricional, triglicéridos. Resultados: se estudiaron 90 profesionales médicos, de los cuales el 60% IC95% 49,67 ­ 69,51% fueron mujeres con una media de edad de 37,96 ± 5,95 años y el 40% IC95% 30,49 ­ 50,33% fueron hombres de 40,94 ± 7,53 años de edad. Se observó que la prevalencia de Hipertrigliceridemia fue de 34,44% IC95% 25,45 ­ 44,72%, según el sexo fue de 22,22% IC95% 13,20 ­ 34,94% en mujeres y de 52,78% IC95% 37,01 ­ 68,01% en hombres. La prevalencia de sobrepeso y obesidad fue de 52,2% IC95% 37,76 ­ 57,98 %, por sexo fue de 42,59% IC95% 30,33 ­ 55,84% en mujeres y de 66,67% IC95% 50,33 ­ 79,79% en hombres. El 23,26% IC95% 13,15 ­ 37,74% de los 43 sujetos con sobrepeso u obesidad fueron hipertrigliceridémicos, es decir, representa una tasa de Hipertrigliceridemia de 232,6 x cada 1000 habitantes con sobrepeso. Conclusiones: 5 de cada 10 médicos tuvieron obesidad. 3 de cada 10 médicos presentaron hipertrigliceridemia. Aproximadamente la cuarta parte de los sujetos con sobrepeso y obesidad tienen hipertrigliceridemia. La hipertrigliceridemia se relaciona con el sobrepeso y la obesidad. Los profesionales de la salud tienen una alta prevalencia de hipertrigliceridemia con sobrepesou obesidad, lo que los expone a desarrollar enfermedades de riesgo cardiovascular. (AU)

Context: the World Health Organisation has mentioned that accelerated changes in the food regime and lifestyles of the population will cause noticeable alterations in the nutritional conditions of people in developing countries occurring as a response to the "industrialization, urbanisation, economic development and globalization of markets". In Ecuador, people have increased their consumption of readily available food products which are high in saturated fats and are distinctly calorific; and thus, according to current statistics, in the past ten years a noticeable nutritional shift has taken place. It is therefore imperative to consider Hypertriglyceridemia as a future risk factor for chronic non-communicable diseases, especially cardiovascular ones. Objective: to describe the rate of prevalence of Hypertriglyceridemia in relation to excess weight and obesity in doctors working for IESS (National Health Service) San Francisco Hospital in Quito during the 2015 ­ 2016 period. Subjects and methods: this is an epidemiological descriptive set of studies using BMI and triglyceride counts, aimed at describing the prevalence of Hypertriglyceridemia and its relation to the nutritional conditions of medical personnel. Main measurements: nutritional conditions, triglycerides Results: a total of 90 medical staff took part: 60% IC95% 49.67 ­ 69.51% were female with an average age of 37.96 ± 5.95 years, and 40% IC95% 30.49 ­ 50.33% were male ranging 40.94 ± 7.53 years of age. The prevalence of Hypertriglyceridemia was 34.44% IC95% 25.45 ­ 44.72%, and according to gender: 22.22% IC95% 13.20 ­ 34.94% in women and 52.78% IC95% 37.01 ­ 68.01% in men. The prevalence of excess weight and obesity was 52.2% IC95% 37.76 ­ 57.98 %: in terms of gender 42.59% IC95% 30.33 ­ 55.84% in women and 66.67% IC95% 50.33 ­ 79.79% in men. The results indicated that 23.26% IC95% 13.15 ­ 37.74% of the 43 subjects suffering excess weight or obesity are hypertriglyceridemic: this is equal to a hypertriglyceridemic rate of 232.6 x per every 1000 overweight persons. Conclusion: five of every 10 doctors are obese, and 3 out of every 10 present Hypertriglyceridemia. Approximately a quarter of the persons suffering excess weight and obesity have Hypertriglyceridemia which is a disease that is directly related to excess weight and obesity. Medical professionals have a high prevalence of Hypertriglyceridemia due to being overweight and obese, and are therefore at increased risk of developing cardiovascular disease.(AU)

Increased expression of ID2, PRELP and SMOC2 genes in patients with endometriosis

Endometriosis is a benign, estrogen-dependent disease with symptoms such as pelvic pain and infertility, and it is characterized by the ectopic distribution of endometrial tissue. The expression of the ID2, PRELP and SMOC2 genes was compared between the endometrium of women without endometriosis in the proliferative phase of their menstrual cycle and the eutopic and ectopic endometrium of women with endometriosis in the proliferative phase. Paired tissue samples from 20 women were analyzed: 10 from endometrial and peritoneal endometriotic lesions and 10 from endometrial and ovarian endometriotic lesions. As controls, 16 endometrium samples were collected from women without endometriosis in the proliferative phase of menstrual cycle. Analysis was performed by real-time polymerase chain reaction (PCR). There was no significant difference between gene expression in the endometrium of women with and without endometriosis. The ID2 gene expression was increased in the most advanced stage of endometriosis and in ovarian endometriomas, the PRELP was more expressed in peritoneal lesions, and the SMOC2 was highly expressed in both peritoneal and endometrioma lesions. Considering that the genes studied participate either directly or indirectly in cellular processes that can lead to cell migration, angiogenesis, and inappropriate invasion, it is possible that the deregulation of these genes caused the development and maintenance of ectopic tissue.

Reação de fase aguda e sua relação com o desempenho de cavalos em competição de longa distância / Acute phase reaction and its relationship with performance horses competing long distance

O exercício físico é um dos estímulos fisiológicos mais estressantes que um animal pode sofrer e, dependendo de sua intensidade, sugere-se que possa gerar uma reação mediada por proteínas de fase aguda (PFA). O objetivo deste estudo foi caracterizar a reação de fase aguda e sua relação com o desempenho de cavalos submetidos a uma competição de longa distância. O experimento foi desenvolvido durante a Marcha de Resistência anual promovida pela Associação Brasileira de Criadores de Cavalos Crioulos (ABCCC), composta por um percurso de 750km percorrido durante 15 dias. Foram avaliados 23 equinos, os quais foram divididos em dois grupos, sendo o grupo 1 composto pelos 10 primeiros colocados na competição e o grupo 2 formado pelos 13 animais que concluíram a competição em colocações inferiores ou foram desclassificados antes de terminar a prova. Efetuaram-se coletas sanguíneas em repouso (dia 0) e no último dia de competição, e foi realizado o teste de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE) para identificar as proteínas (albumina, haptoglobina, ceruloplasmina, transferrina, imunoglobulina G, imunoglobulina A, glicoproteína ácida e proteína de peso molecular de 23kDa). Os resultados demonstraram que o exercício físico imposto influenciou de forma significativa (P<0,0001) as concentrações séricas de haptoglobina, ceruloplasmina, imunoglobulina A, glicoproteína ácida e proteína de peso molecular de 23kDa. Quando comparados os resultados dos grupos estudados, observou-se que a concentração de haptoglobina após a competição foi superior no grupo de animais com baixo desempenho (grupo 2). Conclui-se que a competição de longa duração é capaz de gerar reação de fase aguda e que o monitoramento da concentração de haptoglobina pode ser um sinalizador de processo inflamatório e baixo desempenho.(AU)

Exercise is one of the most stressful physiologic stimuli that an animal might suffer, depending on its intensity it may generate a reaction mediated by acute phase proteins (APP). The aim of this study was to characterize the acute phase reaction and its relation to performance horses subjected to long distance competition. The experiment was conducted during the annual March of Resistance promoted by the Brazilian Association of Crioulo Horse Breeders (ABCCC), composed of a 750km route traveled during 15 days. 23 horses which were divided in two groups, one group composed by the 10 best placed horses and the second group consisting of 13 animals that have completed the competition in other positions or were disqualified before concluding the race were evaluated. All horses at the beginning of the competition (day 0) and on the last day of competition were subjected to collection of blood and SDS-polyacrylamide gel (SDS-PAGE) electrophoresis was used to measure APPs concentrations (albumin, ceruloplasmin, transferrin, haptoglobin, acid glycoprotein, immunoglobulin G, immunoglobulin A and a protein with molecular weight of 23 kDa). By the evaluation of the results, it was observed that exercise had a highly significant influence (P<0.0001) in the serum concentrations of the ceruloplasmin, haptoglobin, acid glycoprotein, immunoglobulin A and protein with molecular weight of 23kDa. When comparing the results of the study groups it was observed that the concentration of haptoglobin after the competition was higher in the group of animals with low performance (group 2). We conclude that the long term competition is able to generate acute phase reaction and monitoring the concentration of haptoglobin may be an indicator of inflammation and low performance.(AU)

Respuesta broncodilatadora en niños asmáticos / Bronchodilatador response in asthmatic children

In asthmatic patients the bronchodilator response (BDR) reflects airway obstruction reversibility. BDR commonly used definition of 12 percent or greater change in FEV1 from baseline offers poor sensitivity as an adjunct test in the diagnosis of asthma in children. A cutoff of 8 percent - 10 percent has significantly better sensitivity, although more research studies are needed to recommend this lower BDR value in children. A positive BDR is associated with biomarkers of inflammation, future lung function, inhaled corticosteroids response, and poor asthma control and could provide a useful tool for better monitoring asthmatic children, particularly when pre bronchodilator spirometry is in normal range.

En pacientes asmáticos la respuesta broncodilatadora (RBD) refleja la reversibilidad de la obstrucción de la vía aérea. La definición de 12 por ciento o mayor cambio en VEF1 con respecto a su basal tiene baja sensibilidad y podría llevar a un subdiagnóstico y subtratamiento de asma. La utilización de un punto de corte menor, de 8 por ciento a 10 por ciento, mejora significativamente la sensibilidad para el diagnóstico de asma en niños y podría considerarse en casos individuales, requiriéndose más estudios para recomendar su uso en niños. Una RBD positiva en niños se ha asociado con biomarcadores de inflamación, función pulmonar futura, respuesta a corticoides inhalatorios y pobre control del asma, por lo tanto podría entregar al médico una herramienta más para una mejor evaluación de los niños con asma sobre todo cuando su espirometría basal es normal.

Relação entre obesidade, insulina plasmática e posicionamento da falange distal em equinos da raça Crioula / Relationship between obesity, insulin and placement of plasma in equine distal phalanx of breed creole

Verificaram-se características radiográficas do posicionamento da falange distal em relação ao estojo córneo em equinos da raça Crioula e correlacionaram-se tais achados com sinais de obesidade e concentrações plasmáticas de insulina. Consideraram-se dois grupos com base no escore da condição corporal (ECC). A média de idade entre os grupos foi de 9,2±5,8 anos em indivíduos normais (ECC 5-7) e de 10,3±3,7 anos em obesos (ECC 8-9). Diferenças estatísticas entre grupos ocorreram para valores de peso, perímetro torácico, escore da condição corporal, escore da crista do pescoço, comprimento do pescoço, circunferência do pescoço em três regiões referentes a 25%, 50% e 75% do comprimento do pescoço e entre o posicionamento da falange distal em relação ao estojo córneo. O ângulo formado entre as superfícies dorsais de falange distal e casco (ângulo de rotação) correlacionou-se estatisticamente com ECC (r = 0,30; P=0,02) e com peso e perímetro torácico (r = 0,50; P<0,01). Quanto à concentração de insulina plasmática, foram encontradas correlações positivas com ECP (r = 0,40; P<0,01) e com ângulo de rotação (r = 0,23; P = 0,08), e correlação negativa com idade (r = -0,42; P<0,01). Em oito animais (27%) o ângulo de rotação foi maior que 2 graus; destes, 25% eram normais e 75%, obesos (P<0,05). Aparentemente, em equinos da raça Crioula, características morfométricas no casco diferiram dos padrões internacionais obtidos de outras raças. A obesidade interferiu na relação espacial da falange distal com o estojo córneo, indicando que os animais obesos dessa raça são mais propensos a desenvolver laminite.

The radiographic relationship of the distal phalanx with the hoof capsule was verified in Creole breed horses and these findings correlated with signs of obesity and insulin blood levels. Horses were divided in two groups based on their body score condition (ECC). The average age was 9.2±5.8 years in normal (ECC 5-7) and 10.3±3.7 years in the obese group (ECC 8-9). Statistical differences between groups (P<0.05) were detected for values of weight, thoracic girth, body score condition, neck score (ECP), neck length, neck circumference into three regions based on 25% (P25), 50% (P50) and 75% (P75) of the length of the neck and phalanx and hoof capsule relationship. The angle between the dorsal aspects of distal phalanx and hoof wall (rotation angle) statistically correlated with ECC (r = 0.30; P=0.02) and with weight and thoracic girth (r = 0.50; P<0.01). Plasma insulin concentrations positively correlated with ECP (r = 0.40, P <0.01) and rotation angle (r = 0.23, P = 0.08) and negatively with age (r = -0.42, P <.01). In eight animals (27%) rotation angle was greater than 2 degrees, of which 25% were normal and obese 75% (P <0.05). Apparently in Creole horses, morphometric characteristics of the hoof differ from international standards obtained from other breeds. Obesity interfered with the spatial relationship of the distal phalanx with the hoof capsule, indicating that obese animals of this breed are more likely to develop laminitis.

Placental hydroxymethylation vs methylation at the imprinting control region 2 on chromosome 11p15.5

In addition to methylated cytosines (5-mCs), hydroxymethylcytosines (5-hmCs) are present in CpG dinucleotide-enriched regions and some transcription regulator binding sites. Unlike methylation, hydroxymethylation does not result in silencing of gene expression, and the most commonly used methods to study methylation, such as techniques based on restriction enzymatic digestion and/or bisulfite modification, are unable to distinguish between them. Genomic imprinting is a process of gene regulation where only one member of an allelic pair is expressed depending on the parental origin. Chromosome 11p15.5 has an imprinting control region (ICR2) that includes a differentially methylated region (KvDMR1) that guarantees parent-specific gene expression. The objective of the present study was to determine the presence of 5-hmC at the KvDMR1 in human placentas. We analyzed 16 third-trimester normal human placentas (chorionic villi). We compared two different methods based on real-time PCR after enzymatic digestion. The first method distinguished methylation from hydroxymethylation, while the other method did not. Unlike other methylation studies, subtle variations of methylation in ICRs could represent a drastic deregulation of the expression of imprinted genes, leading to important phenotypic consequences, and the presence of hydroxymethylation could interfere with the results of many studies. We observed agreement between the results of both methods, indicating the absence of hydroxymethylation at the KvDMR1 in third-trimester placentas. To the best of our knowledge, this is the first study describing the investigation of hydroxymethylation in human placenta using a genomic imprinting model.

Hemolytic anemia presenting as hemoglobinuria from intentional paradichlorobenzene mothball ingestion

A 24-year-old Filipino male was diagnosed with hemolytic anemia when he presented with abrupt onset of anemia, hemoglobinuria, and increased bilirubins, after intentionally ingesting mothballs containing paradichlorobenzene. He was transfused with six units of packed red blood cells (PRBC) and was discharged improved. Paradichlorobenzene, a known oxidant, causes denaturation and precipitation of hemoglobin. These precipitates form Heins bodies within the erythrocytes that are removed by the reticuloendothelial system, fragmenting cells to produce hemoytic anemia from paradicholorobenzene ingestion as confirmed by the UP-National Poison Management and Control Center.

Atresia esofágica y fístula traqueoesofágica: evolución y complicaciones postquirúrgicas / Esophageal atresia and tracheoesophagic fistula: evolution and postsurgical complications

Esophageal atresia (EA) and tracheoesophageal fistula are congenital anomalies associated with respiratory and gastrointestinal morbidity. Objective: The aim of this study was to describe clinical characteristics of patients with EA and TEF during childhood, specially focused on respiratory and gastrointestinal complications. Methods: We reviewed the clinical charts from fifteen patients admitted to our hospital and who were followed locally between 1995 and 2007. Results: Gross classification distribution was: A: 0, B: 0, C: 12, D: 2, E: 1. Waterston distribution was Al: 6, B1: 1, B2: 4y C2: 4. Associated malformations to EA and TEF were 7/15. Main morbidity during the follow up period was: Recurrent pneumonia: 6/15, recurrent wheezing 12/15, tracheomalacia in 9/15 and apnea in one patient. Fistula re-opening in 3/15, Gastro esophageal reflux in 15/15 esophagic stenosis in 7/15. All patients were admitted to the hospital at least once during the follow up and in 12/15 of this were due to respiratory causes. Conclusions: EA and TEF after surgical repair have significant respiratory and gastrointestinal morbidity and frequent admission to the hospital during the first years of life.

La Atresia esofágica (AE) con o sin fístula traqueoesofágica (FTE) es una malformación congénita que se asocia a complicaciones respiratorias y digestivas. Objetivo: Describir las características de estos pacientes, su morbilidad respiratoria, digestiva y hospitalizaciones en su evolución a largo plazo. Materiales y Métodos: Se revisaron en forma retrospectiva 15 fichas de pacientes con diagnóstico de FTE evaluados por el equipo de Neumología Pediátrica de la Universidad Católica de Chile entre 1995 y 2007. Resultados: N = 15 pacientes, sexo masculino 9 diagnóstico el primer día de vida 13/15 pacientes. Clasificación de Gross: A= 0, B= 0, C= 12, D= 2, E= 1. Clasificación de Waterston Al: 6, Bl: 1, B2: 4 y C2: 4 Malformaciones asociadas: en 7/15. Complicaciones respiratorias: Neumonía recurrente 8/15, sibilancias recurrentes 12/15, Recurrencia de fístula: 3 /15 pacientes, Apnea: 1 paciente, Traqueomalacia (TM) (9/15). Complicaciones digestivas: Reflujo gastroesofágico 15/15, Estenosis esofágica: II15. Un paciente requirió cirugía de Nissen. Todos los pacientes se hospitalizaron en al menos una oportunidad y en el 12/15 la causa fue respiratoria. Conclusión: La FTE es una enfermedad de resolución quirúrgica con alta morbilidad respiratoria, digestiva y frecuentes hospitalizaciones en los primeros años de vida.

Usefulness of monofilament testing for detecting peripheral neuropathy I

BACKGROUND: The monofilament test is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in the community setting but it is unclear whether its use can be extended to patients with neuropathy that is not due to diabetes. OBJECTIVE: We aimed to determine the sensitivity and specificity of the monofilament test in detecting peripheral neuropathy, diabetic or non-diabetic, using Nerve Conduction Studies (NCS) as the gold standard. METHODS: In a health assessment activity in Marinduque, patients were assessed by a neurologist as to whether or not they have neuropathy. Monofilament testing was done using the NHANES protocol with a 10-g Semmes Weinstein monofilament. Nerve Conduction Study was used as the gold standard. RESULTS: Fourteen patients were included in the study. A positive monofilament test was found to be significantly associated with a positive NCS result (p CONCLUSION: Monofilament testing was found to be useful in detecting peripheral neuropathy in the community setting. If monofilament testing is positive, then peripheral neuropathy is ruled in. If the test is negative but the clinical suspicion is high, then NCS may be warranted. This cuts back the need for NCS to detect neuropathy in the community setting by more than half.

Temporal expression pattern of myostatin transcripts during chicken embryogenesis

No presente estudo, estimou-se a abundância dos transcritos da miostatina foi estimada durante a embriogênese de galinha por análises de RT-PCR competitiva. Níveis basais de mRNA desse gene foram detectados até o estádio HH15, enquanto acúmulos significativos nesses níveis foram observados apenas no estádio HH24, seguido por redução na abundância desses transcritos a partir do estádio HH26. Tais descobertas preliminares proporcionam informações relevantes sobre a ativação do fator de crescimento miostatina durante o desenvolvimento in ovo de aves.

Enfermedad de Rosai-Dorfman / Rosai-Dorfman Disease

En esta comunicación se presenta un caso con compromiso de ambas fosas nasales por la enfermedad de Rosai-Dorfman. En el examen clínico se constataron sendas masas tumorales que ocupaban totalmente la fosa nasal derecha y, parcialmente, la izquierda. En el estudio histológico se comprobó la presencia de proliferación de linfocitos, varios de ellos cargados de núcleos linfoides sin desintegrarse, lo que constituye la emperipolesis. Esta histología concuerda con la enfermedad de Rosai-Dorfman. Esta paciente fue tratada quirúrgicamente realizándosele un abordaje combinado mediante rinotomía lateral y resección endoscópica nasal con microdebridador. Es importante destacar que constituye el primer caso reportado en Cuba en la localización nasal.

Estridor de causa inhabitual en lactantes: descripción de 3 casos / Unusual causes of stridor in newborns: a description of 3 cases

Introducción: el estridor es un signo de obstrucción de la vía aérea superior localizado a nivel supraglótico, glótico o infraglótico. En lactantes la laringomalacia explica alrededor del 60 por ciento de los casos de estridor. Existen causas poco frecuentes pero potencialmente de riesgo vital frente a las cuales hay que mantener una alta sospecha clínica para hacer un diagnóstico precoz. Objetivo: dar a conocer nuestra experiencia en el manejo de tres pacientes con estridor atípico en el primer mes de vida. Casos clínicos: 1) Recién nacido de término, con síndrome velocardiofacial, delección 22q11, con estridor, cianosis, disfonia y dificultad respiratoria severa a las 48 horas de vida, fibrobroncoscopía (FB) a los 14 días revela membrana laríngea tipo 3. 2) RN prematuro que al mes de vida presentó estridor de intensidad rápidamente progresiva asociado a dificultad respiratoria, laringoscopía directa a los 45 días reveló hemangioma subglótico, se trató con corticoides sistémicos con mala respuesta y síndrome de Cushing, a los 84 días la FB mostró hemangioma subglótico que ocluía más del 50 por ciento del lumen. 3) RNT con estridor desde los 3 días, a los 60 días rinolaringoscopía mostró laringomalacia, a los 7 meses aumentó el estridor y aparecieron crisis de cianosis y apnea, FB reveló compresión extrínseca tercio distal de tráquea, esófagograma y resonancia nuclear magnética: anillo vascular (doble arco aórtico). Conclusiones: es importante realizar un diagnóstico específico y precoz en los casos de estridor asociado a dificultad respiratoria progresiva, crisis de cianosis, apneas y disfonía, siendo la FB un examen de alto rendimiento. La visualización de la vía aérea debe incluir la porción central y distal ya que la presencia de laringomalacia puede asociarse a otras alteraciones de la vía aérea

Un enfermo con una causa de hemoptisis masiva poco frecuente / Report of a patient with an infrequent cause oif massive hemoptysis

Se presenta un paciente con hemoptisis masiva cuya etiología no fue localizable en estudios por imágenes, yel diagnóstico definitivo de malformación vascular pulmonar (MVP) se obtuvo en el análisis anatomopatológico. Se actualizan, a propósito de este caso, las causas, las características clínicas y los procedimientos diagnósticos ante una MVP como causa de hemoptisis masiva

Derrame pleural y empiema complicado en niños: evolución y factores pronósticos / Prognostic factors in complicated pleural empyema in children

Background: Complicated pleural empyema has a torpid and longer clinical evolution, requiring in some patients surgical management. The predictive factors for surgical treatment are not well known. Aim: To search for clinical, laboratory or radiological predictors for the requirement of surgical treatment in pediatric patients with empyema. Patients and methods: A retrospective review of the charts of 108 patients hospitalized for pneumonia plus pleural effusion at the Pediatric Service of the Catholic University Hospital between January 1985 and July 2000. Results: Eighty one patients had complete radiological evaluation and pleural fluid biochemical analysis. Forty nine (60 percent) fulfilled the criteria for empyema and 32 (40 percent) for an exudate. Thirteen patients with empyema required surgery and 36 were treated medically. The mean age was 3 years (range 9 months-6 years) for the surgically treated and 4 years (range 12 months-14 years) for the non-surgical group. The male/female ratio was 5:1 in the surgical group and 1:1 for the non-surgical group. Pleural fluid cultures were positive in 21 of 79 patients. Streptococcus pneumonia was the most frequently isolated agent. No significant differences were found between groups for the average days of fever prior to the diagnosis or total days of fever, days of hospital stay, pleural fluid pH (6.8 and 7.0 respectively) and glucose (21 and 31 mg/dl respectively). No differences were either observed for pleural fluid risk factors (pH < 7 and glucose <20mgdl), the presence of extensive pleural effusions, pleural loculations or bands on pleural ultrasonography and positive Gram stain or cultures in the pleural fluid. Surgical patients required oxygen for more days than medical patients (7.7 and 5.1 days; p=0.037). Conclusions: This study failed to find predictive clinical, radiological or pleural fluid parameters, for the requirement of surgical treatment of empyema

Experiencia clínica en el manejo domiciliario de niños traqueostomizados / Clinical experience in home care of children with a tracheostomy

Background: Home care of tracheostomized children is considered a safe and low-cost alternative. Aim: To report the experience with tracheostomized children at the Pediatric Respiratory Unit of the Catholic University Hospital. Patients and methods: The records of 16 children (9 male) with tracheostomy (TQ) in home care between 1992 and 1998 were reviewed. Results: The average age at the moment of TQ was 9 months (range 1-30 months) and the postoperative hospital management period was 5 months (range 1-11 months). The average age at discharge was 13 months (range 3 to 30 months). Surgical indication were upper airway obstruction (congenital or acquired subglotic stenosis in three, upper airway malformations in one, vocal cord palsy in one and tracheobronchomalacia in one) and chronic assisted ventilation (severe tracheobronchomalacia in four, pulmonary hypoplasia in two, myopathy in one, central nervous injury in one and bronchopulmonary displasia in one). Overall rate complications were 2 per 100 tracheostomy months during home care and 8 per 100 tracheostomy months during hospital care. No tracheostomy-related deaths were observed. A parenteral education program to teach about tracheostomy management and cardiopulmonary resuscitation was carried out. Conclusions: Tracheostomized children can be safely managed at home

Asma casi fatal (NFA) / Near fatal asthma

Se presenta un paciente de 50 años de edad con diagnóstico de asma casi fatal. Como único antecedente previo de su enfermedad se constata la utilización esporádica de fenoterol, consumiendo en los últimos meses 1 canister cada 15 días, sin control médico previo. Se realiza una revisión de Asma Casi Fatal