What triggers phenological events in plants under seasonal environments? A study with phylogenetically related plant species in sympatry

Abstract In this study, we evaluated variation in vegetative and reproductive phenological events of four phylogenetically related plant species subjected to a seasonal environment. To this aim, we sampled 15 individuals of each plant species every fortnight for one year, between January and December of 2017. To assess when a given phenophase occurred more intensely in the population, the Fournier intensity index was used and the synchrony of individuals of the sample in a given phenological event was estimated using the activity index. The Rayleigh (Z) test was used to determine whether the phenological events have seasonal distribution. The relationship of abiotic factors (photoperiod, precipitation, relative humidity and temperature) with the intensity of phenophases was evaluated for each plant species using generalized linear models (GLMs). The phenophases of all plants showed a seasonal distribution pattern, as well as variation in synchrony of phenophases and specific sets of abiotic factors significantly influenced their phenophases. New leaves, for example, were produced throughout the seasons, with intense leaf fall in the dry season. Flowering periods, on the other hand, did not overlap. Indeed, species exhibited sequential flowering and asynchronous flowering among individuals. Our results suggest that the phenological patterns of four sympatric plant species are directly linked to climatic variables, but different abiotic factors affected different phenophases.

Resumo Neste estudo, avaliamos a variação nos eventos fenológicos vegetativos e reprodutivos de quatro espécies de plantas filogeneticamente relacionadas submetidas a um ambiente sazonal. Para isso, amostramos 15 indivíduos de cada espécie quinzenalmente, pelo período de um ano, entre janeiro e dezembro de 2017. Para avaliar quando uma determinada fenofase ocorreu de modo mais intenso na população foi utilizado o índice de intensidade de Fournier e a sincronia dos indivíduos da amostra em determinado evento fenológico foi estimada utilizando-se o índice de atividade. O teste de Rayleigh (Z) foi usado para determinar se os eventos fenológicos têm distribuição sazonal. A relação dos fatores abióticos (fotoperíodo, precipitação, temperatura e umidade relativa) com a intensidade das fenofases foi avaliada para cada espécie de planta usando modelos lineares generalizados (GLMs). As fenofases de todas as plantas apresentaram um padrão de distribuição sazonal, bem como variação na sincronia das fenofases e conjuntos específicos de fatores abióticos influenciaram significativamente suas fenofases. Folhas novas, por exemplo, foram produzidas ao longo das estações, com intensa queda de folhas na estação seca. Os períodos de floração, por outro lado, não se sobrepuseram. De fato, as espécies exibiram floração sequencial e floração assíncrona entre os indivíduos. Nossos resultados sugerem que os padrões fenológicos das quatro espécies de plantas simpátricas estão diretamente ligados às variáveis climáticas, mas diferentes fatores abióticos afetaram diferentes fenofases.

What triggers phenological events in plants under seasonal environments? A study with phylogenetically related plant species in sympatry / O que desencadeia eventos fenológicos em plantas em ambientes sazonais? Um estudo com espécies de plantas filogeneticamente relacionadas e em simpatria

In this study, we evaluated variation in vegetative and reproductive phenological events of four phylogenetically related plant species subjected to a seasonal environment. To this aim, we sampled 15 individuals of each plant species every fortnight for one year, between January and December of 2017. To assess when a given phenophase occurred more intensely in the population, the Fournier intensity index was used and the synchrony of individuals of the sample in a given phenological event was estimated using the activity index. The Rayleigh (Z) test was used to determine whether the phenological events have seasonal distribution. The relationship of abiotic factors (photoperiod, precipitation, relative humidity and temperature) with the intensity of phenophases was evaluated for each plant species using generalized linear models (GLMs). The phenophases of all plants showed a seasonal distribution pattern, as well as variation in synchrony of phenophases and specific sets of abiotic factors significantly influenced their phenophases. New leaves, for example, were produced throughout the seasons, with intense leaf fall in the dry season. Flowering periods, on the other hand, did not overlap. Indeed, species exhibited sequential flowering and asynchronous flowering among individuals. Our results suggest that the phenological patterns of four sympatric plant species are directly linked to climatic variables, but different abiotic factors affected different phenophases.

Neste estudo, avaliamos a variação nos eventos fenológicos vegetativos e reprodutivos de quatro espécies de plantas filogeneticamente relacionadas submetidas a um ambiente sazonal. Para isso, amostramos 15 indivíduos de cada espécie quinzenalmente, pelo período de um ano, entre janeiro e dezembro de 2017. Para avaliar quando uma determinada fenofase ocorreu de modo mais intenso na população foi utilizado o índice de intensidade de Fournier e a sincronia dos indivíduos da amostra em determinado evento fenológico foi estimada utilizando-se o índice de atividade. O teste de Rayleigh (Z) foi usado para determinar se os eventos fenológicos têm distribuição sazonal. A relação dos fatores abióticos (fotoperíodo, precipitação, temperatura e umidade relativa) com a intensidade das fenofases foi avaliada para cada espécie de planta usando modelos lineares generalizados (GLMs). As fenofases de todas as plantas apresentaram um padrão de distribuição sazonal, bem como variação na sincronia das fenofases e conjuntos específicos de fatores abióticos influenciaram significativamente suas fenofases. Folhas novas, por exemplo, foram produzidas ao longo das estações, com intensa queda de folhas na estação seca. Os períodos de floração, por outro lado, não se sobrepuseram. De fato, as espécies exibiram floração sequencial e floração assíncrona entre os indivíduos. Nossos resultados sugerem que os padrões fenológicos das quatro espécies de plantas simpátricas estão diretamente ligados às variáveis climáticas, mas diferentes fatores abióticos afetaram diferentes fenofases.

ANÁLISIS DE LA ADECUACIÓN DEL APORTE NUTRICIONAL A LA META CALÓRICA Y PROTEICA EN PACIENTES CON NUTRICIÓN ENTERAL EXCLUSIVA INTERNADOS EN UN HOSPITAL PÚBLICO PEDIÁTRICO DE ALTA COMPLEJIDAD / ANALYSIS OF ADEQUACY OF THE NUTRITIONAL CONTRIBUTION TO THE CALORIE GOAL AND PROTEIN IN PATIENTS WITH ENTERAL NUTRITION EXCLUSIVE BOARDING SCHOOLS IN A PUBLIC HOSPITAL PEDIATRIC HIGH COMPLEXITY

La malnutrición en los pacientes hospitalizados representa un importante problema sanitario asociado a una mayor tasa de complicaciones con un incremento de la morbimortalidad

Malnutrition in hospitalized patients represents a significant health problem associated with an increased rate of complications and higher morbidity and mortality

HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Infecciones por Chlamydia trachomatis en una unidad de cuidados intensivos neonatales / Chlamydia trachomatis infections in a neonatal intensive care unit

Las infecciones por Chlamydia trachomatis han aumentado su prevalencia, especialmente en jóvenes embarazadas. Esto adquiere relevancia en pediatría por el elevado riesgo de transmisión vertical al neonato y su potencial gravedad en el lactante. Estas infecciones requieren de un alto índice de sospecha, por cuadro clínico atípico y signos radiológicos inespecíficos. Los métodos diagnósticos convencionales presentan limitaciones para su detección. Las técnicas moleculares son las recomendadas por su elevada sensibilidad, especificidad y rapidez, lo cual permite una terapéutica adecuada y oportuna. En este estudio, desarrollado en una unidad de cuidados intensivos neonatales de un hospital de alta complejidad durante 12 años, se describieron las características de la población, su presentación clínica y evolución. La detección microbiológica se realizó por métodos moleculares. Se incluyeron 29 pacientes (p) con infección por C. trachomatis (3,9% del total de muestras enviadas),13 p con infección respiratoria y 16 p con compromiso ocular. La mediana de edad fue de 19 días al momento del diagnóstico y el 65% de las gestantes tenía <25 años. Veinticuatro p (83%) eran recién nacidos a término y 23 p (79%) previamente sanos. Nueve p (31%) presentaron fiebre al momento del ingreso y 12 (41%) eosinofilia. De los 13 p con enfermedad respiratoria, 9 (69%) consultaron por tos y 11 (85%) con hipoxemia, con requerimientos de oxígeno en 8 (61%), asistencia respiratoria mecánica en 3 (23%) y uno (16%) requirió ECMO. Los hallazgos radiológicos mostraron un patrón intersticial inespecífico. Nueve p (31%) presentaron coinfección y uno falleció asociado a influenza A (AU)

The prevalence of Chlamydia trachomatis infections has increased, especially among young pregnant women. This is of particular relevance in pediatrics due to the high risk of motherto-child transmission and the potential severity of the infection in infants. A high index of suspicion is required for these infections due to the atypical clinical features and non-specific radiological signs. The usefulness of conventional diagnostic methods is limited. Molecular techniques are recommended because of their high sensitivity, specificity, and speed, allowing for adequate and timely treatment. In this 12-year study conducted in a neonatal intensive care unit of a tertiary-care hospital, patient characteristics, clinical presentation, and outcome are described. Microbiological detection was performed using molecular methods. Twenty-nine patients with C. trachomatis infection (3.9% of the total samples submitted), of whom 13 had respiratory tract infection and 16 ocular involvement, were included. The median age at diagnosis was 19 days and 65% of the mothers were <25 years old. Twenty-four p (83%) were term newborns and 23 patients (79%) were previously healthy. On admission, 9 patients (31%) had fever and 12 (41%) had eosinophilia. Of the 13 patients with respiratory tract involvement, 9 (69%) consulted for cough and 11 (85%) had hypoxemia, requiring oxygen in 8 (61%), mechanical ventilation in 3 (23%), and ECMO in 1 (16%). Radiological findings showed a nonspecific interstitial pattern. Nine patients (31%) presented with coinfection, one of whom died due to an associated influenza A infection (AU)

Update on Dietary Compliance, Nutritional Status, and Neuropsychological Functioning in the Chilean Phenylketonuria cohort

Abstract Since 1992, Chile has had a Newborn Screening Program for Phenylketonuria (PKU), which currently has an incidence of 1:18,916 newborns. The objective of the current study was to describe the 2020 follow up of the Chilean PKU cohort. The variables analyzed were: nutritional status, dietary compliance and neuropsychological functioning. We conducted a descriptive cross-sectional statistical analysis. The 271 subjects with PKU had an average age of diagnosis of 17±8 days and a phenylalanine (Phe) level of 1122±546 umol/L. Approximately 80% of protein requirement came from a protein substitute. For those <18 years of age, 80% had good dietary compliance with Phe level between 120-360 umol/L and those >18 years had a median of 522 umol/L (95%CI 468 - 636). Forty-four percent of the active PKU cohort had overweight/obesity. Eighty-five percent of the cohort >4 years of age had a normal intelligence quotient (IQ) (score 80-120). We observed a negative correlation (p <0.001; 95% CI: - 0.5, -0.2) between IQ score and Phe level. The Chilean protocol and protein substitute subsidy for life, together with the follow-up and continuous education carried out by the clinical team has encouraged compliance.

Pitiriasis rubra pilaris en niños:informe de 2 casos / Pityriasis Rubra Pilaris in children: 2 case reports

RESUMEN Antecedentes: La pitiriasis rubra pilaris es una enfermedad infrecuente pápulo-escamosa crónica en la que existe un trastorno de la queratinización de la epidermis, caracterizada por pápulas foliculares hiperqueratósicas con tendencia a formar placas de coloración asalmonada, descamativas, con islas de piel sana asociadas a queratodermia palmo plantar. Presenta una distribución bimodal en la primera y sexta década de la vida, afectando a ambos sexos por igual. Su etiopatogenia es desconocida, se ha postulado una respuesta inmune anormal ante diferentes estímulos antigénicos, así como alteración del metabolismo de la vitamina A. Se ha clasificado en 6 tipos en base a su presentación, edad de inicio, curso y pronóstico, tratándose en forma tópica o sistémica. Casos clínicos: Se presentan dos casos en pacientes de 10 y 2 años de edad, con manifestaciones clínicas correspondientes al tipo juvenil circunscrito, que es el más frecuente en edad pediátrica y juvenil clásico respectivamente, con histopatología compatible y excelente respuesta al tratamiento tópico. Conclusiones: Aunque la pitiriasis rubra pilaris es una patología rara, deberá ser sospechada si el cuadro clínico es sugestivo, y si es compatible su histopatología. Debe considerarse que el tratamientotópico puede ser suficiente para lograr la resolución del cuadro.

ABSTRACT Background: Pityriasis rubra pilaris is an infrequent chronic papulosquamous disease in which there is a disorder of keratinization of the epidermis, characterized by hyperkeratotic follicular papules with a tendency to form salmon-colored, scaly plaques, with islands of healthy skin associated with palmoplantar keratoderma. It presents a bimodal distribution in the first and sixth decades of life, affecting both sexes equally. Its etiopathogenesis is unknown, an abnormal immune response has been postulated to different antigenic stimuli, as well as alteration of the metabolism of vitamin A. It has been classified into 6 types based on its presentation, age of onset, course and prognosis, being treated appropriately topical or systemic. Clinical cases: Two cases of 10 and 2 years of age are presented, with clinical manifestations corresponding to the circumscribed juvenile type, which is the most frequent in pediatric and classic juvenile age respectively, with compatible histopathology and excellent response to topical treatment. Conclusions: Although pityriasis rubra pilaris is a rare pathology, it should be suspected if the clinical picture is suggestive and its histopathology is compatible. It should be considered that topical treatment may be sufficient to achieve resolution of the condition.

Random regression models for the evaluation of the growth of goats of the Anglonubian breed / Modelos de regressão aleatória para avaliação do crescimento de caprinos da raça Anglonubiana

A total of 6593 weight records collected from 796 male and female Anglo-Nubian goats aged up to 130 days, offspring from 29 sires and 225 dams, were used to compare models and estimate genetic parameters throughout the growth curve by applying random regression models. Direct and maternal additive genetic effects and direct and maternal permanent environmental effects were included as random in the models. The contemporary groups were included as fixed effects and goat age at kidding was included as a covariable (linear and quadratic). The choice of the best model was based on the AIC, BIC and AICc criteria. Variance estimates of the four random effects increased as the animals aged. Direct heritability (h2) rose from 0.13 to 0.40 with age, whereas maternal heritability showed a low value. Genetic correlations of weight between closer ages were high. The most suitable random regression model to compare the fitting of random effects was that which employed the Legendre polynomials of quadratic order with homogeneous variance (3333-1).(AU)

Utilizaram-se 6593 pesos de 796 caprinos da raça Anglonubiana, coletados em machos e fêmeas com idade até 130 dias, descendentes de 29 reprodutores e 225 matrizes, com o objetivo de se compararem modelos e de se estimarem parâmetros genéticos ao longo da curva de crescimento com aplicação de modelos de regressão aleatória. Nos modelos, incluíram-se os efeitos genéticos aditivos diretos e maternos e os de ambiente permanente diretos e maternos como aleatórios; os grupos de contemporâneos foram incluídos como efeitos fixos, e a idade da cabra ao parto como covariável (linear e quadrática). A escolha do melhor modelo foi realizada pela avaliação dos critérios AIC, BIC e AICc. As estimativas de variâncias dos quatro efeitos aleatórios cresceram de acordo com o aumento da idade. A herdabilidade direta (h2) aumentou de 0,13 a 0,40 com a idade, e a materna apresentou baixo valor. As correlações genéticas do peso entre idades mais próximas foram altas. O modelo de regressão aleatório mais adequado ao se comparar o ajuste dos efeitos aleatórios foi o que empregou polinômios de Legendre de ordem quadrática com variância homogênea (3333-1).(AU)

Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo / Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study

Resumen Introducción: Las enterobacterias productoras de carbapenemasas (EPC) suponen un reto para la salud pública y la práctica clínica. Objetivo: Analizar la epidemiología, el tratamiento y la mortalidad en pacientes infectados por EPC. Material y Métodos: Análisis retrospectivo de 163 pacientes infectados por EPC en un hospital universitario desde julio de 2013 a octubre de 2015. Resultados: Klebsiella pneumoniae fue aislada en 95,1% de los casos, y la mayoría de las carbapenemasas pertenecían al grupo OXA-48 (93%). La adquisición fue nosocomial en 124 casos (77%), asociada a cuidados sanitarios en 30 (18,6%), y 7 (4,3%) fueron de adquisición comunitaria. Las infecciones más frecuentes fueron las del tracto urinario (48,4%) y las respiratorias (19,5%). Aproximadamente, la mitad de los pacientes recibieron monoterapia antimicrobiana. La tasa de mortalidad a los 30 días fue de 23,3%. El análisis multivariante identificó que la presencia de shock séptico al diagnóstico (OR 4,2; IC 95% 1,5-11) estaba asociada de manera independiente con mayor mortalidad en el primer mes, sin lograr identificar asociación con el tratamiento antimicrobiano inapropiado. Discusión: Son necesarios más estudios para aclarar si el tratamiento antimicrobiano de las infecciones por EPC debe ser combinado o si podría ser suficiente la monoterapia en infecciones leves.

Abstract Background: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. Objective: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. Material and Methods: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. Results: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. Discussion: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Hernia diafragmática secundaria a trauma: presentación tardía / Complicated diaphragmatic hernia: late outcome of trauma

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

Esplenectomía laparoscópica en pacientes con púrpura trombocitopénica idiopática: primera experiencia en el Hospital Regional de Arica / Laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura: first experience at the Regional Hospital of Arica

Introducción: La púrpura trombocitopénica idiopática (PTI) es una de las trombocitopenias más frecuentes en adultos. La esplenectomía corresponde a uno de sus tratamientos de segunda línea en pacientes refractarios a otras terapias médicas. Objetivo: Presentar nuestra primera experiencia en esplenectomía laparoscópica en el servicio de cirugía del Hospital Regional de Arica. Materiales y métodos: Se realizó una revisión transversal retrospectiva de pacientes con PTI a quienes se les indicó esplenectomía por falla en el tratamiento médico. Se tabularon los exámenes preoperatorios, plaquetas 24 h pre y posquirúrgicas, plaquetas al inicio del estudio (3 meses preoperatorios) y al mes del postoperatorio, complicaciones quirúrgicas y características histopatológicas. Resultados: Se realizaron 5 esplenectomías. El 100% de los pacientes presentaron mejoría a las 24 h de postoperados. Al cabo de un mes, sólo 3 de 5 pacientes tuvieron una mejoría de su trombocitopenia. No hubo complicaciones mayores como hemoperitoneo o fístulas pancreáticas. Un paciente presentó equimosis en un puerto. Conclusiones: La esplenectomía laparoscópica es una técnica factible de realizar en nuestro centro, con una tasa de complicaciones y resultados comparables con centros de mayor volumen.

Introduction: Idiopathic thrombocytopenic purpura (ITP) is one of the most common acquired thrombocytopenia in adults. Splenectomy is as second line treatment in medical refractory patients. Aim: The aim of this study is to present our first initial experience in laparoscopic splenectomy of the surgical department of Arica's local hospital. Materials and methods: This is a transversal prospective review of patients with ITP which splenectomy was performed due medical treatment failure. Preoperative blood test: platelet count at the beginning of the study, 24 h pre op, 24 h post op and a month post surgery were tabulated. Postoperative complications and histopathology characteristics were reported. Results: We performed 5 splenectomies, 100% of the patients presented a recovery platelet count at 24 h postop. In the first month only 3 patients had an improvement of their thrombocytopenia. There were no major complications, like hemoperitoneum or pancreatic leaks, only one patient presented port site ecchymosis. Conclusions: Laparoscopic splenectomy is a feasible technique in our center with a complication rate and outcomes comparable to high volume center.

Actividad antioxidante y marcha fitoquímica de los capítulos de Tagetes filifolia Lag. "pacha anís" / Antioxidant activity and phytochemical screening of capitula of Tagetes filifolia Lag. or "pacha anís"

Objetivo: Estudiar la actividad antioxidante y marcha fitoquímica de los capítulos de Tagetes filifolia Lag. "pacha anís".Materiales y métodos: Estudio de tipo experimental en el cual se empleó 5 kg de los capítulos de la planta medicinal Tagetes filifolia lag., provenientes de Junín. Se usó el método de cribado fitoquímico de Olga Lock para la marcha fitoquímica y el método DPPH para la determinación de la actividad antioxidante. Se dividió la muestra en 3 grupos: etéreo, alcohol etílico y agua destilada a concentraciones de 100, 50 y 5 µg/ml.Resultados: Se encontró fenoles en cantidades abundantes tanto en el extracto en agua destilada como en el extracto en alcohol etílico, además este último tuvo cantidades moderadas de quinonas. Por otro lado, el extracto en alcohol etílico fue el que presentó el mayor porcentaje de captación de radicales libres (91.26%) a una concentración de 100 µg/ml, similares resultados se encontró con el extracto etéreo (88.94%) y el extracto en agua destilada (75.58%).Conclusiones: Los principales componentes químicos fueron fenoles y quinonas. El mayor efecto antioxidante se obtuvo del extracto etanólico de la planta Tagetes filifolia a una concentración de 100 µg/ml.

Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery / Los carcinomas papilares de células renales tipo 1 y 2 localizados clínicamente tienen resultados de supervivencia similares después de la cirugía

Propósito Se intentó determinar la incidencia, hallazgos patológicos, factores pronósticos y resultados clínicos para pacientes con CCR papilar clínicamente localizado. Métodos Demográfico, Se recopilaron hallazgos clínicos y patológicos en todos los pacientes con CCRP sometidos a cirugía en cuatro centros médicos académicos. El punto final primario fue la supervivencia específica del cáncer (CSS). La supervivencia sin recaída (RFS) y la supervivencia general (OS) fueron puntos finales secundarios. Kaplan- Se obtuvieron estimaciones de Meier y se usaron modelos de regresión de riesgos proporcionales de Cox para evaluar predictores de mortalidad y recaída. Resultados Identificamos 626 CCPR, de los cuales 373 (60por ciento) fueron del tipo 1 y 253 (40 por ciento) fueron del tipo 2, con tres cuartas partes de todos los tumores siendo pT1. En comparación con los pacientes con tipo 1, aquellos con tipo 2 eran mayores (edad media: 63 frente a 61; (AU)

Purpose We aimed to determine incidence, pathologic fndings, prognostic factors and clinical outcomes for patients with clinically localized papillary RCC. Methods Demographic, clinical and pathologic fndings were collected on all patients with PRCC undergoing sur-gery at four academic medical centers. The primary end-point was cancer-specifc survival (CSS). Relapse-free survival (RFS) and overall survival (OS) were secondary endpoints. Kaplan­ Meier estimates were obtained, and Cox proportional hazard regression models were used to assess predictors of mortality and relapse. Results We identifed 626 PRCC, of which 373 (60 pertcent) were type 1 and 253 (40 pertcent) were type 2, with three-quar-ters of all tumors being pT1. Compared to patients with type 1, those with type 2 were older (mean age: 63 vs 61; (AU)

Comportamento ingestivo de bovinos leiteiros alimentados com farelo de crambe / Ingestive behavior of dairy catle fed crambe bran

O objetivo deste trabalho foi estudar os efeitos da utilização de farelo de crambe em substituição ao farelo de soja sobre o comportamento ingestivo de bovinos leiteiros. Foram utilizados quatro machos castrados Holandês x Zebu, fistulados no rúmen, com peso vivo médio de 664kg, distribuídos em delineamento quadrado latino 4 x 4. Os tratamentos consistiram em quatro dietas isoproteicas e isoenergéticas, formuladas com relação volumoso:concentrado 60:40 com base na matéria seca (MS). O volumoso foi composto de silagem de milho (51% MS) e feno de Tifton (49% MS), e o concentrado formulado com níveis crescentes de substituição do farelo de soja pelo farelo de crambe em 0%, 2,8%, 6,4% e 11,0% na MS da dieta. O comportamento ingestivo foi avaliado por meio do método direto de avaliação visual, em intervalos de 10 minutos, durante períodos de 24 horas. Registraram-se a frequência de alimentação, a ruminação e o ócio, bem como a posição do animal (em pé ou em decúbito). As variáveis em pé e em decúbito não diferiram entre os tratamentos, assim como os tempos gastos em alimentação, ruminação e ócio. O consumo de matéria seca e de FDN expressos em g/dia e gFDN/dia, respectivamente, a eficiência de ruminação expressa em gMS/min, a eficiência de ruminação expressa em gFDN/dia e o tempo de mastigação total não diferiram significativamente. No entanto, a eficiência de alimentação (gMS/min) variou de forma linear decrescente com a inclusão do farelo de crambe. Os períodos do dia influenciaram todas as atividades. O maior tempo de alimentação foi observado nos períodos após o fornecimento da dieta, e a maior atividade de ruminação foi verificada no período noturno. A substituição de farelo de soja por farelo de crambe não afetou o comportamento ingestivo, exceto para o parâmetro eficiência de alimentação. Nesse sentido, considerando o comportamento ingestivo, recomenda-se a substituição do farelo de soja por farelo de crambe para alimentação de bovinos leiteiros.

The aim of this work was to study the effects of the use of crambe meal replacing soy bean meal on the ingestive behavior of dairy cattle. Four male Holstein x Zebu rumen, with average live weight of 664 kg distributed in a 4x4 latin square design. The treatments consisted of four isonitrogenous and isocaloric diets, formulated with a roughage:concentrate ratio of 60:40 based on dry matter (DM). The forage was corn silage (51% DM) and Tifton grass hay (49% DM), and the concentrate was formulated with increasing levels of substitution of soy bean meal by crambe meal at 0%, 2.8%, 6.4% and 11.0% of the diet DM. The feeding behavior was evaluated using the direct method of visual assessment in 10 minute intervals during a 24 hour period. The frequency of feeding, idling time and the animal's position (standing or supine) were recorded. The variables standing and supine did not differ between treatments as well as time spent feeding, ruminating and idling times. The consumption of dry matter and NDF expressed in g/day and gNDF/day respectively, the efficiency of rumination expressed in gDM/min, the efficiency of rumination expressed in gNDF/day and the total chewing time did not differ significantly. However, the efficiency of power (gDM/min) decreased linearly with the inclusion of crambe meal. Periods of the day influenced all the activities. The longer feeding time was observed in the periods after the diet intake and greater rumination activity was observed at night. The replacement of soy bean meal by meal crambe did not affect feeding behavior, except for the feeding efficiency parameter. In this sense, considering the feeding behavior, the replacement of soy bean meal by crambe meal to feed dairy cattle is recommended.

Agenesia del lóbulo hepático derecho asociado a agenesia vesicular / Agenesis of the right hepatic lobe associated with gallbladder agenesis

Background: Anatomical abnormalities of the liver are rare and their association with gallbladder agenesis are even more uncommon. Case report: We report a 63 years old man complaining of jaundice, without pain or fever. A magnetic resonance imaging showed a right hepatic lobe agenesis associated with gallbladder agenesis. Jaundice subsided spontaneously.

Introducción: Las anomalías anatómicas del hígado son raras, la asociación a una agenesia vesicular es más infrecuente aún, siendo su diagnóstico generalmente un hallazgo. Caso clínico: Presentamos el caso de un paciente masculino de 63 años que consulta por ictericia, sin dolor ni fiebre, al cual se le realiza diagnóstico por imagen con resonancia magnética de agenesia de lóbulo hepático derecho asociado a agenesia vesicular. Dado que el paciente no tiene litiasis biliar, se decide tratamiento médico.

Silagem de capim-elefante adicionada de casca de maracujá / Elephant grass silage added to passion fruit's peel

Avaliaram-se-se as características fermentativas e químico-bromatológicas da silagem de capim-elefante contendo diferentes níveis de inclusão do coproduto da extração da polpa do maracujá, a casca de maracujá (CM). Utilizaram-se níveis crescentes de adição desse coproduto (0,0%; 12,5%; 25,0%; 37,5% e 50,0%) em relação à matéria natural do capim-elefante durante a ensilagem. As silagens foram obtidas a partir do corte da forrageira aos 150 dias de idade. O material foi ensilado em silos laboratoriais e, após 180 dias, os silos foram abertos e coletaram-se amostras para a determinação dos teores de matéria seca (MS); carboidratos solúveis (CHOS); potencial hidrogeniônico (pH); nitrogênio amoniacal em porcentagem do nitrogênio total (NNH3/NT); extrato etéreo (EE); proteína bruta (PB); proteína insolúvel em detergente neutro em porcentagem do nitrogênio total (PIDN/NT); proteína insolúvel em detergente ácido em porcentagem do nitrogênio total (PIDA/NT); fibra em detergente neutro (FDN); fibra em detergente ácido (FDA); celulose (CEL); lignina (LIG); nitrogênio insolúvel em detergente neutro (NIDN); nitrogênio insolúvel em detergente ácido (NIDA) e digestibilidade in vitro da matéria seca (DIVMS). Para a avaliação do efeito dos tratamentos, utilizou-se delineamento experimental inteiramente ao acaso, com quatro repetições, executando-se o estudo de regressão para cada variável analisada (P<0,05). De acordo com as equações de regressão, para as características fermentativas, as silagens podem ser consideradas de muito boa qualidade. Quanto às frações fibrosas da silagem, a inclusão de níveis crescentes desse coproduto contribuiu para diminuí-las, o que resultou em maior DIVMS. Os parâmetros analisados permitem concluir que a inclusão da CM in natura durante a ensilagem do capim-elefante é recomendada em todos os níveis avaliados.

We evaluated the fermentative, chemical and qualitative characteristics of elephant grass silage containing different levels of inclusion of coproduct extraction of the passion fruit pulp in nature, passion fruit peel (CM). We used increasing levels of addition of this coproduct (0.0, 12.5, 25.0, 37.5 and 50.0%) in relation to natural field of elephant grass during ensiling. The silages were obtained from the cut forage at 150 days of age. The material was ensiled in laboratory silos, and after 180 days, the silos were opened and samples were collected for determination of dry matter (DM); soluble carbohydrates (CHOS); hydrogen potential (pH); ammonia nitrogen in percentage of total nitrogen (NNH3/NT); ether extract (EE); crude protein (CP); neutral detergent insoluble protein as a percentage of total nitrogen (NDIP/NT); acid detergent insoluble protein as a percentage of total nitrogen (PIDA/NT); neutral detergent fiber (NDF); acid detergent fiber (ADF); cellulose (CEL); lignin (LIG); neutral detergent insoluble nitrogen (NDIN); acid detergent insoluble nitrogen (ADIN) and in vitro digestibility of dry matter (IVDDM). To assess the effect of the treatments we used a completely randomized design with four replications, running the regression analysis for each variable analyzed (P<0.05). According to the regression equations for the fermentative characteristics, silage can be considered very good quality. As for fiber digestibility of silage, the increasing levels of this coproduct contributed to decrease it, which resulted in higher IVDDM. The parameters analyzed showed that the inclusion of CM in nature with elephant grass silage is recommended at all levels evaluated.

Revisión narrativa de la literatura sobre manejo con medicina homeopàtica de pacientes con síntomas de gastritis / Narrative review of the literature on management with homeopathic medicine of patients with symptoms of gastritis

Las enfermedades del aparato digestivo son frecuentes y en ocasiones incapacitantes para la vida diaria y laboral. Dentro de ellas la gastritis es una de las que más incidencia tiene en el mundo entero. En gran parte de los casos la gastritis está acompañada de la infección por Helicobacter Pylori, bacteria que está relacionada con el cáncer de estómago. Los tratamientos que actualmente se llevan a cabo en la medicina tradicional, además de que son muy agresivos, todavía dejan muchas dudas sobre sus efectos secundarios y los daños que pueden llegar a provocar en el organismo, dentro de ellos el cáncer. Por eso mismo se ha visto el incremento en la utilización de las terapias alternativas para el manejo de la gastritis, dentro de ellas la homeopatía, la cual ha tenido una muy buena aceptación y resultados, pero desafortunadamente, todos estos avances no están lo suficientemente documentados. Para la realización de éste trabajo primero se hizo una Revisión Narrativa de la Literatura existente en los últimos 20 años, encontrando en las bases de datos que algunos remedios homeopáticos han demostrado resultados favorables en el manejo de la gastritis y tienen publicaciones muy interesantes en la literatura, pero la gran mayoría de remedios sólo se encuentran relacionados en las materias médicas. Sin embargo, este trabajo logró establecer los medicamentos homeopáticos útiles en la gastritis basándose en los síntomas que reportan las principales Medicinas Internas conocidas, como son las de: Harrison, Cecil y Farreras. Tomando éstos síntomas se pasaron al lenguaje repertorial homeopático, luego se realizó un ejercicio repertorial que nos revela varios remedios policrestos muy valiosos para el manejo de los síntomas de la gastritis. Además se realizó otra repertorización buscando sólo remedios pequeños, que nos pone delante de los ojos, opciones medicamentosas muy útiles que probablemente nunca habríamos pensado. Dentro de los remedios policrestos y semipolicrestos que se encontró tenían la mejor cobertura de síntomas de gastritis están: Arsenicum álbum, Nux vómica, Sulphuricumacidum, Sulphur, Magnesia carbónica, Lycopodium, KaliBichromicum, Iris Versicolor, Graphites, Crocus sativa, Carbovegetabilis, ArgentumNitricum, Bismuthum, Anacardiumorientale, Phosphorus, Plumbummetallicum, Bryonia, NatrumMuriaticum, Lachesis, China officinalis y Pulsatilla. Dentro de los pequeños remedios se encontraron en los primeros 5 lugares: ArsenicumIodatum, Tabacum, SecaleCornutum, FerrumPhosphoricum y Oxalicumacidum; los cuales son incluidos en la tabla de resultados de medicamentos para gastritis, junto con los policrestos y otros remedios de gran valor en el manejo de la gastritis. Este trabajo será de gran ayuda y motivación especialmente para los médicos que trabajamos con la homeopatía, para seguir publicando cada vez con mayor dedicación y detalle con el fin de dar a conocer todas las maravillas que la homeopatía nos demuestra día a día.

Síndrome de encefalopatía reversible posterior (PRES) asociada a eclampsia y síndrome HELLP / Posterior reversible encephalopathy syndrome (PRES) associated with eclampsia and HELLP syndrome

Es un síndrome usualmente reversible consistente en cefalea, alteración del estado mental, convulsiones y pérdida de la visión, asociado a edema cerebral de localización predominantemente posterior en estudios de imagen (1). La falta de su reconocimiento y manejo temprano puede ocasionar daños neurológicos permanentes (2). Se presenta el caso de una paciente de 29 años con 36 semanas de edad gestacional que ingresa al servicio de urgencias en estado epiléptico por eclampsia, síndrome HELLP (Hemólisis, Enzimas hepáticas elevadas, Plaquetas bajas) e imágenes hipodensas en regiones occipital y frontal en Tomografía Axial Computarizada de cráneo.

This syndrome, usually reversible, consists in symptoms like headache, altered mental status, seizures and lost of sight, associated to brain edema predominantly in posterior cerebral regions. The lack of its recognition and early management can lead to permanent neurological damage. It is presented the case of a 29 - year - old patient with 36 weeks of gestational age who arrives to the emergency room in epileptic status. She was diagnosed with eclampsia, HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and occipital hypodense images were determined by cerebral Computarized Tomography.

Comparative analysis of conventional PCR and real-time PCR to diagnose shrimp WSD

The aims of this study were to standard and optimize a qPCR protocol with FAM-BHQ1 probe, and to compare its sensitivity against TaqMan qPCR and PCR methods to diagnose shrimp WSD. The FAM-BHQ1 qPCR presented higher clinical sensitivity and showed to be a robust alternative to detect WSSV in clinical samples.

Composición, abundancia y distribución de las poblaciones de gasterópodos de importancia comercial en La Guajira, Caribe colombiano / Composition, abundance and distribution of populations of commercially important gastropods in La Guajira, Colombian Caribbean

In the continental Colombian Caribbean the conch resource exploitation and the status of snails populations has been poorly studied, which are reflected in the lack of fisheries management. This study assesses composition, population density and distribution of the gastropods species that make conch resource in La Guajira region. Underwater visual censuses for snails were performed between September-November 2009 in 145 100x4m (400m²) transects, spanning a total area of 56 920m² between Riohacha and Cabo de la Vela. The study was complemented with the evaluation of composition, abundance and size of gastropods conch found in the discarded-by-fishermen shell mounds in 13 beaches. In October 2010 another 40 transects were evaluated (16 000m²) from the Southern of Riohacha to the Camarones village (La Guajira). We found a total of 9 911 snails belonging to 12 species, the most abundant being Strombus pugilis with 8 912 individuals and an average density of 1 538.4±3 662.6 ind./ha , followed by Vasum muricatum with 374 individuals and an average density of 51.8±91.2 ind./ha. Calculating the importance value index (IVI) for both living organisms as the empty shells on beaches, shows that Turbinella angulata is the most used species by artisanal fishermen in the region. Cassis madagascariensis and Cassis tuberosa are also important snail resources in the region (as suggested by the number of empty shells found in beaches), but its densities were low. Strombus gigas, with only three living organisms found in the area, presented the lowest abundance ever found in the Colombian Caribbean (0.52±3.6 ind./ha), showing that queen conch population in La Guajira can- not support commercial exploitation. The abundance of discarded S. gigas shells on beaches suggests resource exploitation in the recent past. Results remarks the urgency of implementing management plans for snail fisheries in the region.

En el Caribe continental colombiano el aprovechamiento del recurso caracol y el estado de sus poblaciones han sido poco estudiados, esto se refleja en la carencia de un ordenamiento pesquero. Se evaluó la composición, densidad poblacional y distribución de las especies que conforman ese recurso en La Guajira. Se realizaron censos visuales entre septiembre y noviembre 2009 en 145 transectos de 100x4m (400m²), abarcando un área de 56 920m² entre Riohacha y el Cabo de la Vela. También se evaluó la composición, abundancia y talla de conchas de gasterópodos en depósitos de conchas vacías en 13 playas. En octubre 2010 se evaluaron 40 transectos más (16 000m²), desde el sur de Riohacha hasta Camarones. Se encontraron 9 911 caracoles de 12 especies, siendo Strombus pugilis el más abundante con 8 912 individuos y densidad de 1 538.4±3 662.6 ind./ha, seguido por Vasum muricatum con 374 individuos y densidad de 51.8±91.2 ind./ha. El índice de valor de importancia (IVI) de caracoles vivos y de conchas en las playas, muestran a Turbinella angulata como la especie más aprovechada por pescadores artesanales. Los resultados denotan la urgencia de realizar planes de manejo pesquero para este recurso en la región.