Lactate and pH values in newborns with a history of acute fetal distress / Valores de lactato y pH en recién nacidos con antecedente de sufrimiento fetal agudo

Abstract Background: Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD. Methods: We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2. Results: Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity. Conclusions: Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.

Resumen Introducción: El sufrimiento fetal agudo (SFA) es una condición que amerita un diagnóstico oportuno debido a que genera hipoxia, acidosis e incluso la muerte intrauterina. El objetivo de este estudio fue determinar los valores de lactato y pH en cordón umbilical en recién nacidos de término con antecedente SFA. Métodos: Se llevó a cabo un estudio transversal, en recién nacidos a término, de madres que tuvieron al menos un antecedente para SFA de tipo perinatal, neonatal o gasométrico. Se consideró morbilidad neonatal cuando presentaron Apgar al minuto ≤ 6, o requirieron maniobras avanzadas de reanimación neonatal, o ingreso a Unidad de Cuidados Intensivos Neonatales (UCIN). El punto de corte fue > 4 mmol/L para los valores de lactato y pH < 7.2. Resultados: De un total de 66 recién nacidos, el 33.3% de las madres presentaron al menos un antecedente para desarrollar SFA; el 22.7% presentó enfermedad hipertensiva del embarazo, el 13.6%, oligohidramnios, y el 63.6%, otros factores. El 28.7% requirieron maniobras avanzadas de la reanimación neonatal y el 7.5%, el ingreso a la UCIN. En la gasometría, el valor de lactato y pH para el grupo de recién nacidos con morbilidad neonatal fue de 4.726 ± 1.401 y 7.293 ± 0.056 respectivamente, versus 2.240 ± 0.318 y 7.359 ± 0.022 (p < 0.05) para el grupo sin morbilidad neonatal asociada. Conclusiones: Se observó un incremento del 25% de los valores de lactato en cordón umbilical y una disminución del 1% del pH en los recién nacidos con antecedente de SFA y morbilidad asociada.

Valor pronóstico de los niveles plasmáticos de IL13 en pacientes con artritis reumatoidea y enfermedad pulmonar intersticial: estudio de cohorte prospectiva / Prognostic value of IL13 plasmatic levels in patients with rheumatoid arthritis and interstitial lung disease: a prospective cohort study

Introducción: el objetivo de este estudio fue analizar la relación entre los valores de IL13 y su pronóstico en pacientes con artritis reumatoidea (AR) y enfermedad pulmonar intersticial (EPI). Materiales y métodos: estudio de cohorte prospectiva. Se midió IL13 en suero y se dividió la cohorte en dos grupos con la mediana de IL13 como punto de corte. Se estudió el tiempo hasta una caída de la capacidad vital forzada (CVF) mayor o igual al 5% con el método de Kaplan Meier (KM) y regresión de Cox. Resultados: se incluyeron 47 pacientes. La media (DE) de tiempo de seguimiento fue de 12,7 (12,5) meses. El estimador de KM a 15 meses fue de 0,48 (IC 95% 0,13-0,76) en el grupo con valores elevados de IL13 y de 0,86 (IC 95% 0,54-0,93) en el otro grupo (p=0,037). En el análisis de Cox multivariado los valores elevados de IL13 se asociaron con una caída de la CVF mayor o igual al 5% en el seguimiento (HR 17.64 (IC 95% 1,89-164,1) p=0,012). Conclusiones: los valores elevados de IL13 se asociaron con peor evolución funcional en esta cohorte prospectiva de pacientes con AR y EPI.

Introduction: the aim of our study was to analyze the relationship between the concentrations of IL13 in serum and the prognosis of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. Materials and methods: we conducted a prospective cohort study. We measured IL13 levels in serum. Patients were divided in two groups using the median of IL13 value as cut off point. Time to a decline of 5% or more in FVC% from basal measurement was estimated using Kaplan Meier method. Univariate and multivariate Cox models were applied. Results: we included 47 patients. The mean (SD) time of follow-up was 12.7 (12.5) months. The Kaplan Meier estimator at 15 months was 0.48 (CI 95% 0.13-0.76) in the group with higher values of IL13, and 0.86 (CI95% 0.54-0.93) in the other group (p=0.037). In the Cox multivariate analysis, the values of IL13 were significantly associated with a decline of 5% or more in FVC% in the follow-up (HR 17.64 (CI 95% 1.89-164.1) p=0.012). Conclusions: our results indicate that patients with higher values of IL13 in serum presented higher decline in FVC% during their follow-up.

Efectividad de la flexibilidad activa y pasiva en el entrenamiento de gimnasia rítmica / Efetividade da flexibilidade ativa e passiva no treino da ginástica rítmica / Effectiveness of active and passive flexibility in rhythmic gymnastics training

RESUMEN La flexibilidad es la capacidad de articular, de realizar movimientos a máxima amplitud, siendo una capacidad determinante en deportes como la Gimnasia Rítmica, por lo cual los modelos de planificación del entrenamiento deportivo priorizan su contenido como parte del proceso de dirección. Este trabajo tiene como objetivo: valorar el efecto de un entrenamiento pasivo y activo de flexibilidad en los miembros inferiores de gimnastas rítmicas de la Liga Deportiva Cantonal de Rumiñahui. El tipo de investigación utilizada es el cuasiexperimental de orden correlacional. En dicho estudio, se incluyen a 35 deportistas de gimnasia rítmica de la Liga Deportiva Cantonal de Rumiñahui (5-15 años). Se implementa un modelo de periodización de la flexibilidad en tres mesociclos, con 30 ejercicios de flexibilidad pasiva y activa, la cual se aplica en dos momentos de la preparación y un test de Split lateral y frontal. En el pretest del Split Lateral, se obtiene 1.74 cm. y en el postest 6.86 cm. (p=0.000), mientras que en el pretest del Split Frontal se obtiene 1.11 cm. y el postest 8.03 cm. (p=0.000). Los anteriores son indicativos superiores al combinar ambos métodos de flexibilidad, que los realizados aisladamente al comparar resultados con otra obra. En la investigación, se evidencian mejoras significativas en el Split Lateral y Frontal para el presente estudio. Esto confirma que la combinación de diversos métodos de entrenamiento de la flexibilidad articular puede mejorar la capacidad de forma óptima.

RESUMO A flexibilidade é a capacidade de articular, de realizar movimentos à máxima amplitude, sendo uma capacidade determinante em desportos como a ginástica rítmica, razão pela qual os modelos de planejamento do treino desportivo dão prioridade ao seu conteúdo como parte do processo de gestão. O objetivo deste trabalho é avaliar o efeito do treino de flexibilidade passivo e ativo nos membros inferiores dos ginastas rítmicos da Liga Desportiva Cantonal de Rumiñahui. O tipo de investigação utilizada é quase-experimental e correlacional. Neste estudo estão incluídos 35 ginastas rítmicos da Liga Desportiva Cantonal de Rumiñahui (5-15 anos de idade). Um modelo de periodização da flexibilidade é implementado em três mesociclos, com 30 exercícios de flexibilidade passivos e ativos, que são aplicados em dois momentos da preparação e um teste Split lateral e frontal. No pré-teste da Fenda Lateral, obtém-se 1,74 cm e no pós-teste 6,86 cm. (p=0,000), enquanto no pré-teste da fenda frontal 1,11 cm. e no pós-teste 8,03 cm. (p=0.000). Os acima referidos são indicadores superiores quando se combinam ambos os métodos de flexibilidade, do que aqueles realizados isoladamente quando se comparam resultados com outros trabalhos. Na investigação, melhorias significativas na Divisão Lateral e Frontal são evidentes no presente estudo. Isto confirma que a combinação de vários métodos de treino de flexibilidade conjunta pode melhorar de forma óptima a capacidade.

ABSTRACT Flexibility is the joint capacity to perform movements at maximum amplitude, being a determining capacity in sports such as rhythmic gymnastics, for which the sports training planning models prioritize its content as part of the management process. This paper research is aimed at assessing the effect of passive and active flexibility training on the lower limbs of rhythmic gymnasts from the Liga Deportiva Cantonal of Rumiñahui. This is a Quasi-experimental research of a correlational order, studying 35 rhythmic gymnastics athletes from the Rumiñahui Cantonal Sports League (5-15 years). A flexibility periodization model is implemented in three mesocycles, with 30 passive and active flexibility exercises, applying a lateral and frontal split test at two preparation moments. In the Lateral Split pretest, 1.74cm is achieved, and in the posttest 6.86cm (p=0.000), while in the Front Split pretest it is obtained 1.11cm, and the posttest 8.03cm (p=0.000). They are superior indicative when combining both methods of flexibility than those carried out separately when comparing results with another work. Significant improvements in the Lateral and Frontal Split are evidenced for the present research, indicating that the combination of various joint flexibility training methods can optimally improve capacity.

SARS-CoV-2 y RT-PCR en pacientes asintomáticos: resultados de una cohorte de trabajadores del Aeropuerto Internacional El Dorado de Bogotá, 2020 / SARS-CoV-2 and RT-PCR in asymptomatic patients: Results of a cohort of workers at El Dorado International Airport in Bogotá, 2020

Introducción. La pandemia de COVID-19 ha ocasionado cerca de 25 millones de casos en el mundo. Se ha descrito que los pacientes asintomáticos pueden ser fuentes de transmisión. Sin embargo, es difícil detectarlos y no es claro su papel en la dinámica de transmisión del virus, lo que obstaculiza la implementación de estrategias para la prevención. Objetivo. Describir el comportamiento de la infección asintomática por SARS-CoV-2 en una cohorte de trabajadores del Aeropuerto Internacional El Dorado "Luis Carlos Galán Sarmiento" de Bogotá, Colombia. Materiales y métodos. Se diseñó una cohorte prospectiva de trabajadores del Aeropuerto El Dorado. El seguimiento se inició en junio de 2020 con una encuesta a cada trabajador para caracterizar sus condiciones de salud y trabajo. Cada 21 días se tomó una muestra de hisopado nasofaríngeo para detectar la presencia del SARS-CoV-2 mediante reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se analizó el comportamiento del umbral del ciclo (cycle threshold) de los genes ORFlab y N según el día de seguimiento. Resultados. En los primeros tres seguimientos de la cohorte se encontró una incidencia de la infección por SARS-CoV-2 del 16,51 %. La proporción de contactos positivos fue del 14,08 %. La mediana del umbral del ciclo fue de 33,53. Conclusión. Se determinaron las características de la infección asintomática por el SARS-CoV-2 en una cohorte de trabajadores. La detección de infectados asintomáticos sigue siendo un reto para los sistemas de vigilancia epidemiológica.

Introduction: The 2019 coronavirus pandemic (COVID-19) has caused around 25 million cases worldwide. Asymptomatic patients have been described as potential sources of transmission. However, there are difficulties to detect them and to establish their role in the dynamics of virus transmission, which hinders the implementation of prevention strategies. Objective: To describe the behavior of asymptomatic SARS-CoV-2 virus infection in a cohort of workers at the El Dorado "Luis Carlos Galán Sarmiento" International Airport in Bogotá, Colombia. Materials and methods: A prospective cohort of 212 workers from the El Dorado airport was designed. The follow-up began in June, 2020. A survey was used to characterize health and work conditions. Every 21 day, a nasopharyngeal swab was taken to identify the presence of SARS-CoV-2 using RT-PCR. We analyzed the behavior of the cycle threshold (ORFlab and N genes) according to the day of follow-up. Results: In the first three follow-ups of the cohort, we found an incidence of SARS-CoV-2 infection of 16.51%. The proportion of positive contacts was 14.08%. The median threshold for cycle threshold was 33.53. Conclusion: We characterized the asymptomatic SARS-CoV-2 infection in a cohort of workers. The identification of asymptomatic infected persons continues to be a challenge for epidemiological surveillance systems.

Estenosis de canal lumbar: comorbilidades y análisis morfométrico / Lumbar canal stenosis: comorbidities and morphometric analysis

Introducción: La Estenosis de Canal Lumbar (ECL) refiere al estrechamiento central del canal raquídeo, recesos laterales o agujeros de conjunción. Comúnmente, causa lumbalgia crónica en quienes la padecen afectando gravemente su calidad de vida. Sin embargo, su pronóstico, incidencia sigue siendo incierta en nuestra región. Objetivo: El presente trabajo tiene como propósito, determinar la frecuencia local de la ECL y su relación con distintos parámetros morfométricos, comorbilidades y el cuestionario CSI. Material y Método: Se realizó un estudio prospectivo, analítico, asociativo y de corte transversal de las consultas atendidas por el servicio de Neurocirugía del Hospital Enrique Vera Barros de la ciudad de La Rioja Capital, Argentina durante el período agosto-diciembre 2018. Se aplicó el cuestionario "Central Sensitization Inventory" (CSI). Resultados: La ECL fue diagnosticada en 42.9% de hombres que consultaron por lumbalgia y en el 33.3% en el caso de las mujeres. La media de la edad de los pacientes con ECL fue 57 años. El 100% de pacientes presentaron comorbilidades, siendo la más prevalente la artrosis. La dorsopatía más asociada fue la Hernia de Disco Lumbar (27.3%). La intensidad del dolor y los diámetros antero-posterior (DAP) y laterales (DL), fueron inversamente significativos (DAP= -,813 p=0,09; DL= -,967 p=0,007). El puntaje en el CSI fue significativamente mayor en pacientes con ECL (37 vs. 24,62 pts.) (p=,028). Finalmente, la correlación entre los DAP y DL con el puntaje del CSI mostró una correlación inversa (DAP= -,733 p>0,05; DL= -,639 p>0,05). Conclusión: En nuestro estudio encontramos que la prevalencia de ECL es más alta en hombres de edad media y que presentan comorbilidades asociadas, además el análisis morfométrico del canal raquídeo se asocia con la intensidad del dolor y el puntaje en el CSI. Por lo cual estas variables podrían ser utilidad clínica al momento de decidir el manejo adecuado para pacientes con ECL.

Introduction: Lumbar Spinal Stenosis (LSS) anatomically can involve the central canal, lateral recess, neural foramen or any combination of these locations. Although, LSS has been consider a common cause of chronic low back pain. Only few studies had explored the prevalence, incidence and associated variables in non-Caucasian populations. Therefore, the aim of this study is to determine the local frequency of LSS and its relationship with different morphometric parameters, comorbidities and the Central Sensitization Inventory (CSI). Methods: A prospective, analytical, associative and cross-sectional study of patients With LSS by single academic center was carried out. Diagnoses were done by clinical and MRI assessment. Results: LSS was diagnosed in 42.9% of males and 33.3% of females who consulted for low back pain. The average age of the patients with LSS was 57 years. 100% of LSS patients presented comorbidities, the most prevalent being osteoarthritis. Lumbar Disc Hernia was associated in 27.3% of patients with LSS. Pain intensity was inversely correlated (AP= -,813 p=0,09; L= -,967 p=0,007) with anteroposterior (AP), and lateral (L) diameters. The score in the CSI was significantly higher in patients with LSS (37 vs. 24,62 pts.) (p=,028). Finally, the correlation between the AP and L diameters with the CSI score was inverse (AP= -,733 58 p>0,05; L= -,639 p>0,05). Conclusions: In our study, we found that the prevalence of LSS is higher in middle-aged men with associated comorbidities. In addition, morphometric analysis of the spinal canal is associated with pain intensity and CSI scores. Therefore, these variables could be clinical applicable when deciding the appropriate management for patients with LSS.

Investigating lead and zinc uptake and accumulation by Stipa hohenackeriana trin and rupr. in field and pot experiments / Investigação sobre a captação e acúmulo de chumbo e zinco por Stipa hohenackeriana trin. & rupr. em experimentos de campo e em vaso

This study was conducted to evaluate Pb and Zn uptake, mobility, and accumulation in Stipa hohenackeriana using field soil in pot and field experiments. Moreover, the effects of Municipal Solid Waste Compost (MSWC) (0, 1, and 2%) and Nano-Silica (NS) (0, 250, and 500 mg/kg) on Stipa biomass, Pb and Zn availability in the soil, and Pb and Zn uptake and accumulation were studied using pot experiments. Samples of soil, root, and shoots of Stipa were collected from field and greenhouse and after drying, extraction of Pb and Zn was done by acid digestion. Bio- Concentration Factor (BCF) and Translocation Factor (TF) were calculated to determine Pb and Zn phytoremediation efficiency. The amount of Zn and Pb remediation by Stipa from soil was determined by remediation factor (RF). The results of field experiments showed the Pb and Zn level decreased in the order of: soil >shoot>root. Results of the pot experiments also showed that plants grown in NS500-amended pots had 33% and 32% higher Pb in roots and shoots compared to control pots, respectively. In comparison, roots Pb concentration in pots amended with MSWC1% and MSWC2% decreased 22.4% and 1.7%, respectively. Roots and shoots Zn concentration in NS500-amended pots was 5.6% and 6.5% higher, respectively. However, root Zn concentration in treatments of MSWC1% and MSWC2% decreased 52.3% and 39.4%, respectively. Shoots Zn concentration decreased 52.5% and 40.0%, respectively. Although MSWC decreased the uptake and accumulation of Pb and Zn in Stipa roots and shoots, it improved the plant growth and consequently increased RF and soil remediation compared to the NS. Thus, it seems that applying MSWC and NS simultaneously can be a suitable strategy for the purpose of improving phytoremediation capability of Stipa in the Pb and Zn contaminated soils. In general, Stipa can be a suitable candidate for the accumulation of heavy metals, especially for Pb and Zn contaminated soils.

Este estudo foi conduzido para avaliar a absorção, mobilidade e acumulação de Pb e Zn em Stipa hohenackeriana em experiências usando solo de campo em vaso e em campo. Além disso, os efeitos do Composto Municipal de Resíduos Sólidos (MSWC) (0, 1 e 2%) e de nanopartículas de sílica (NS) (0, 250 e 500 mg/kg) na biomassa de Stipa, na disponibilidade de Pb e Zn no solo, e na absorção e acúmulo de Pb e Zn foram estudados usando experiências em vaso. Amostras de solo, raiz e brotos de Stipa foram coletadas do campo e da estufa e, após a secagem, a extração de Pb e Zn foi feita por digestão ácida. O Fator de Bioconcentração (BCF) e o Fator de Translocação (TF) foram calculados para determinar a eficiência de fitorremediação de Pb e Zn. A quantidade de remediação de Zn e Pb pela Stipa a partir do solo foi determinada pelo Fator de Remediação (RF). Os resultados das experiências de campo mostraram que o nível de Pb e Zn diminuiu na seguinte ordem: solo > broto > raiz. Os resultados das experiências em vaso também mostraram que as plantas cultivadas em vasos corrigidos com NS500 apresentaram teores de Pb 33% e 32% maiores em raízes e brotos em comparação com vasos de controle, respectivamente. Em comparação, a concentração de Pb em raízes em vasos corrigidos com MSWC1% e MSWC2% diminuiu 22,4% e 1,7%, respectivamente. A concentração de Zn em raízes e brotos em vasos corrigidos com NS500 foi de 5,6% e 6,5% maior, respectivamente. No entanto, a concentração de Zn da raiz nos tratamentos de MSWC1% e MSWC2% diminuiu 52,3% e 39,4%, respectivamente. A concentração de Zn nos brotos diminuiu 52,5% e 40,0%, respectivamente. Embora o MSWC tenha diminuído a absorção e acumulação de Pb e Zn nas raízes e brotos de Stipa, melhorou o crescimento da planta e consequentemente aumentou o RF e a remediação do solo em relação ao NS. Assim, parece que aplicar MSWC e NS simultaneamente pode ser uma estratégia adequada com o objetivo de melhorar a capacidade de fitorremediação de Stipa nos solos contaminados com Pb e Zn. Em geral, a Stipa pode ser um candidato adequado para a acumulação de metais pesados, especialmente para solos contaminados com Pb e Zn.

Hematoma retroperitoeneal posterior a histerectomía vaginal con colporrafia anterior y posterior en Bogotá (Colombia): reporte de un caso y revisión de la literatura / Retroperitoneal haematoma following vaginal hysterectomy with anterior and posterior vaginal wall repair in Bogotá, Colombia: Case report and review of the literature

Objetivo: reportar el caso de una paciente con hematoma retroperitoneal posterior a cirugía de corrección de prolapso por vía vaginal, y realizar revisión de la literatura médica sobre la anatomía del espacio retroperitoneal, la etiología, el diagnóstico, manejo y pronóstico del hematoma retroperitoneal posoperatorio en ginecología.Materiales y métodos: se presenta el caso de una paciente con prolapso vaginal estadio II, a quien se le practicó histerectomía vaginal con colporrafia anterior y posterior, quien presentó como complicación un hematoma retroperitoneal. La paciente fue intervenida en el Hospital Universitario de La Samaritana, hospital público de tercer nivel de complejidad, centro de referencia de Cundinamarca, ubicado en Bogotá (Colombia). Se realizó una búsqueda de literatura médica en las bases de dados Medline vía PubMed, Jstor y Lilacs, con terminología MeSH "hysterectomy vaginal" y "retroperitoneal hematoma". La búsqueda se limitó a los idiomas inglés y español entre los años 1980 a 2015.Resultados: se encontraron 15 artículos de los cuales 3 describen casos secundarios a procedimientos ginecológicos. La revisión final se conforma de: 4 revisiones de tema, 8 reportes de caso, 2 series de casos, 1 estudio observacional descriptivo.Conclusión: el hematoma retroperitoneal es una rara entidad que requiere de un alto índice de sospecha clínica para su diagnóstico. Existen varias herramientas diagnósticas, siendo la tomografía computarizada la de mayor utilidad. El manejo debe individualizarse a cada caso. En paciente estable se puede realizar manejo conservador con éxito o intervenciones endovasculares. Sin embargo, en pacientes inestables hemodinámicamente, la laparotomía es la conducta más recomendada.

Objective: To report the case of a patient who developed a retroperitoneal haematoma following prolapse correction surgery through the vaginal approach; and to review the medical literature relating to the anatomy of the retroperitoneal space and the aetiology, diagnosis, management and prognosis of postoperative retroperitoneal haematoma in gynaecology.Materials and methods: Case presentation of a patient with Stage II vaginal prolapse, who was undergone for vaginal hysterectomy with anterior and posterior vaginal wall repair. She had a retroperitoneal haematoma complication. The patien underwent surgery at Samaritana University Hospital, a level III public hospital and referral centre for the Cundinamarca region, located in Bogotá (Colombia). A search in the literature was conducted in the Medline database through PubMed, Jstor and Lilacs using the MeSH terms "vaginal hysterectomy" and "retroperitoneal haematoma". The search was limited to publications in English and Spanish between 1980 and 2015.Results: Overall, 15 articles were found, 3 of which describe cases secondary to gynaecological procedures. The final review consisted of 4 topic reviews, 8 case reports 2 case series and 1 observational descriptive study.Conclusion: Retroperitoneal haematoma is a rare clinical finding and diagnosis requires a high level of clinical suspicion. Several diagnostic tools are available, computed tomography being the most useful. Management has to be individualized in each case. If the patient is stable, the treatments of choice include conservative management, which can be successful, or endovascular interventions. However, in haemodynamically unstable patients, laparotomy is the most recommended treatment approach.

Intraventricular hemorrhage secondary to AVM of the septum pellucidum / Hemorragia intraventricular secundária a MAV de septum pellucidum

Arteriovenous malformations (AVMs) of the brain include congenital vascular lesions that represent about 2% of all hemorrhagic strokes. Despite the relative rarity of the disease (with a detection rate estimated at approximately 1/100.000 person-years), AVMs represent a significant neurological problem. Affected patients are mostly young and healthy. AVMs located in the medial region of the cerebral hemisphere and the limbic system comprise a special group with difficult access and consequent difficulties of resection. Furthermore, there is a high incidence of intracranial hemorrhage resulting from a complex venous drainage, sometimes directed to the superficial veins, but mostly to the deep venous system. The present case report illustrates a patient with an AVM centered on the septum pellucidum, whose initial clinical resulted from an intra-ventricular hemorrhage.

Malformações arteriovenosas (MAVs) encefálicas são lesões vasculares congênitas que representam cerca de 2% de todos os acidentes vasculares hemorrágicos. Embora se tratando de uma doença relativamente rara (com prevalência estimada em aproximadamente 1/100.000 pessoas-ano), MAVs representam um problema neurológico significativo. Os pacientes afetados são na maioria jovens e hígidos. MAVs localizadas na região medial do hemisfério cerebral e no sistema límbico correspondem a um grupo especial pela dificuldade de acesso e consequente dificuldade de ressecção. Além disso, possuem alta incidência de hemorragia intracraniana resultante de uma drenagem venosa complexa, por vezes direta às veias superficiais, mas na maioria para os sistemas venosos profundos. O caso relatado a seguir ilustra um paciente com uma MAV centrada no septum pellucidum, cuja apresentação clínica inicial resultou de uma hemorragia intraventricular.

Avaliação manométrica anorretal de mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa / Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder

RACIONAL: A manometria anorretal é método diagnóstico empregado na prática clínica para avaliação de distúrbios funcionais anorretais e do assoalho pélvico. As disfunções miccionais, anorretais e do assoalho pélvico tem sido consideradas como fatores contribuintes dos sintomas de bexiga hiperativa. OBJETIVO: Avaliar os resultados obtidos com manometria anorretal em mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa. MÉTODOS: Vinte e cinco mulheres adultas (média de idade de 45.5±11.9 anos) com diagnóstico clínico e urodinâmico de bexiga hiperativa submeteram-se à manometria anorretal e os resultados obtidos nesta avaliação foram comparados aos de um grupo controle de 18 mulheres (média de idade de 33.9 ±10.7 anos) assintomáticas do ponto de vista urinário e sem critérios clínicos para diagnóstico de bexiga hiperativa. O grupo de mulheres com bexiga hiperativa foi denominado BH e controle C. RESULTADO: Ocorreram seis (24%) casos de contração paradoxal do puborretal no grupo BH e nenhuma no Grupo C. Houve 13 (52%) ocorrências de hipertonia de repouso isolada ou associada à hipertonia de contração no Grupo BH e sete (39%) no Grupo C. A média de pressão de repouso foi de 80.1 mmHg no Grupo BH e 67.6 mmHg no Grupo C. O total de ocorrência de hipertonia de contração no Grupo BH foi de 7(28%) e 11(61%) no Grupo C. A média de pressão de contração foi de 182.2 mmHg no Grupo BH e 148.1 mmHg no Grupo. Com relação ao reflexo inibitório retoanal, a sensibilidade e a capacidade retal máxima não houve diferença estatisticamente significante entre os dois grupos. CONCLUSÃO: As mulheres com bexiga hiperativa apresentaram maior ocorrência de contração paradoxal do puborretal em relação às do grupo controle.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM:To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5±11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9±10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.

Concentración de Hg, Pb, Cd, Cr y As en hígado de Carcharhinus limbatus (Carcharhiniformes: Carcharhinidae) capturado en Veracruz, México

Concentration of Hg, Pb, Cd, Cr and As in liver Carcharhinus limbatus (Carcharhiniformes: Carcharhinidae) captured in Veracruz, Mexico. Pollution by heavy metals in marine ecosystems in the Gulf of Mexico is one of the hardest conservation issues to solve. Sharks as top predators are bioindicators of the marine ecosystem health, since they tend to bioaccumulate and biomagnify contaminants; they also represent a food source for local consumption. Thus, the objective of this study was to study the possible presence of heavy metals and a metalloid in livers of Carcharhinus limbatus. For this, a total of 19 shark livers were taken from animals captured nearby Tamihua, Veracruz, Mexico from December 2007 to April 2008. 12 out of the 19 captured sharks were males, one was an adult female, three were juvenile males, and three juvenile females. Four heavy metals (Hg, Pb, Cd, and Cr) and one metaloid (As) were analyzed in shark livers using an atomic absorption spectrophotometry with flame and hydride generator. Our results showed that the maximum concentrations found were: Hg=0.69mg/kg, Cd=0.43mg/kg, As=27.37mg/kg, Cr=0.70mg/kg. The minimum concentrations found were: As=14.91mg/kg, Cr=0.35mg/kg. The Pb could not be determined because the samples did not have the spectrophotometer minimum detectable amount (0.1mg/kg). None of the 19 samples analyzed showed above the permissible limits established by Mexican and American laws. There was a correlation between shark size and Cr and As concentration (Pearson test). The concentration of Cr and As was observed to be higher in bigger animals. There was not a significant difference in heavy metals concentration between juveniles and adults; however, there was a difference between males and females. A higher Cr concentration was found in females when compared to males. None of the samples exceed the maximum limit established by the laws of Mexico and the United States of America. Much longer studies are needed with C. limbatus and other species caught in the region, in order to determine the degree of contaminants exposure in aquatic ecosystems and to identify potential health risks to consumers.

La contaminación de los ecosistemas marinos y costeros por metales pesados en el Golfo de México es uno de los problemas que afectan a los recursos naturales del medio acuático. Los tiburones por situarse en niveles tróficos superiores de la red alimenticia acumulan y magnifican cantidades considerables de contaminantes. Por esta razón, el objetivo de este trabajo fue determinar la concentración de cuatro metales pesados (Hg, Cd, Pb y Cr) y un metaloide (As) en el tiburón punta negra (Carcharhinus limbatus) por medio de espectrofotometría de absorción atómica con flama y generador de hidruros. Se muestrearon 19 hígados de tiburones capturados cerca de Tamiahua, Veracruz entre noviembre 2007 y marzo 2008, de los cuales 12 fueron machos adultos, una hembra adulta, tres machos jóvenes y tres hembras jóvenes. Las concentraciones máximas registradas para cada metal fueron: Hg=0.69mg/ kg, Cd=0.43mg/kg, As=27.37mg/kg, Cr=0.35mg/kg. El Pb no fue detectado, no al menos la cantidad mínima de detección requerida por el espectrofotómetro de absorción atómica (0.1mg/kg). Ninguna de las muestras analizadas rebasó los límites máximos permisibles por las leyes mexicanas y americanas.

René Gerónimo Favaloro: Su trayectoria y su polémica decisión / René Gerónimo Favaloro: his trajectory and his controversial decision

Objetivo: Narrar la vida y obra de René Favaloro. Diseño: Ensayo histórico. Sede: Departamento de Investigación, Escuela de Medicina. Resultado: René Favaloro nació en la ciudad de La Plata, provincia de Buenos Aires, Argentina, el 14 de julio de 1923. De orígenes humildes pero esfuerzo persistente, con pasión y honestidad, logró ingresar a la Universidad Nacional de La Plata, a la Facultad de Ciencias Médicas, en donde se graduó en el año 1949. Pasados algunos años viajó a Estados Unidos, en donde su actividad estaría girando en torno a la cirugía de revascularización miocárdica. Él desarrolló una técnica que revolucionaria su época y que sigue vigente hasta el día de hoy. Dedicó su vida al servicio y enseñanza de la medicina. Fue un gran ser humano, preocupado por el prójimo, dejando como legado la hoy llamada Fundación Favaloro. Muere trágicamente el 29 de julio del año 2000, dejando un ejemplo de dar siempre lo mejor de sí mismo y de un esfuerzo por servir. En esta obra mostramos aspectos importantes de su vida, sus contribuciones médicas y su trágico desenlace.

Objective: To narrate the life and endeavor of René Favaloro. Design: Historical assay. Setting: Research Department, School of Medicine. Result: René Favaloro was born in the city of La Plata, province of Buenos Aires, Argentina, on July 14, 1923. Of humble origins, but through persistent effort, passion and honesty, he was able to enter Universidad de La Plata, to the School of Medical Sciences, where he graduated in 1949. After a couple of years, he traveled to the United States of America, where his activity would be addressed to myocardial revascularization surgery; he developed a technique that revolutionized his times and is still used nowadays, he dedicated his life to the service and teaching of medicine, he was a great human being, caring for the next, and left as legacy the Favaloro Foundation. He died tragically on July 29, 2000, leaving an example of always giving his best and being of service. In this writing, we describe some important aspects of his life, his medical contributions, and his tragic end.

Proyección de la disponibilidad de profesionales de la salud en Chile al 2020 / Projection of the availability of health professionals in Chile by the year 2020

En los últimos años hemos observado un consenso mundial en torno a la crisis actual de los recursos humanos para la salud y un acuerdo creciente de la urgencia de realizar un esfuerzo colectivo que aborde algunos de los problemas más apremiantes en esta materia. El objetivo de este estudio fue proyectar la disponibilidad de médicos(as) y enfermeras(os) que estarían en condiciones de ejercer en Chile al año 2020 y contrastar este escenario posible, con la demanda de profesionales que requerirá el sistema de salud nacional según estándares e indicadores de desarrollo humano. El análisis realizado permite concluir que según estándares y la experiencia internacional y considerando la actual matricula de primer año, las tasas de retención, titulación y ejercicio profesional y los factores de inmigración de profesionales, en Chile al año 2009 hay gran falencia de médicos(as) por habitante comparado con las metas de Organización Mundial de la Salud (OMS) y con la situación de países semejantes. Esta brecha seguirá existiendo al año 2020 si se mantienen las tasas antes mencionadas. Para lograr los estándares de países con desarrollo humano equivalente se requiere al menos duplicar la formación de médicos(as) en el país. Caso contrario se invidencia en la disposición de enfermeras(os), la que superará levemente lo requerido llegando a los niveles de países desarrollados el año 2020 si se mantienen las tasas antes mencionadas.

In recent years we have seen a global consensus around the current crisis of human resources for health and a growing agreement on the urgency of a collective effort to address some of the most pressing problems in this area. The aim of this study was to project the physician and nurses that would be able to practice in Chile to 2020 and contrast this scenario the demand for professionals who require the health system as standard and human development indicators. The analysis leads to the conclusion that according to international standards and experience and given the current first-year enrollment, retention rates, qualifications and professional immigration and professional factors in Chile to 2009 there is a great shortcoming of physicians per capita compared with the goals of WHO and the status of such countries. This gap will exist by 2020 if current rates above. To achieve the standards of countries with equivalent human development requires at least double the training of physicians in the country. Otherwise, if current rates above, the provision of nurses will exceed slightly what is required when Chile reach’s level of developed countries by 2020.

Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

Factores pronósticos y sobrevida de pacientes pediátricos con ependimomas / Prognostic and survival factors among pediatric patients with ependymomas

Antecedentes: El ependimoma es el tercer tumor intracraneano más frecuente en pediatría. Los factores que influyen en el pronóstico son la localización, la edad del paciente, la resección quirúrgica y el tratamiento con radioterapia. Recientemente se ha descrito la presencia de alteraciones cromosómicas en el tumor como factor de mal pronóstico. El objetivo de esta investigación fue determinar la sobrevida de pacientes pediátricos con ependimoma de acuerdo con los diferentes factores pronósticos. Métodos: Se revisaron los expedientes de pacientes pediátricos con ependimoma de 1996 a 2005. Se determinaron las alteraciones cromosómicas mediante hibridación genómica comparativa. Se calculó la sobrevida de acuerdo con el método Kaplan-Meier y prueba de log rank de acuerdo a cada factor pronóstico. Se calculó el riesgo de morir para cada factor de acuerdo con la razón de momios. Resultados: Se incluyeron 24 pacientes. La sobrevida global fue de 58.04%. La presencia de alteraciones cromosómicas, particularmente en el cromosoma 21, afectó significativamente la sobrevida. La edad menor a cinco años, la histología anaplásica, la quimioterapia diferente a ifosfamida-carboplatino-etopósido y la resección parcial aumentaron el riesgo de morir. Conclusiones: Se confirman los factores descritos anteriormente en la literatura, incluyendo alteraciones cromosómicas. Se describe un nuevo desbalance en el cromosoma 21 en 30% de los pacientes.

BACKGROUND: Ependymomas constitute the third most common intracranial tumors in children. Risk factors include age, location, extent of surgical excision, and radiation therapy. Recently, chromosomal imbalances have been described. OBJECTIVE: Determine global survival of patients with ependymomas according to different prognostic factors. METHODS: We reviewed the medical charts of every pediatric patient with ependymoma from 1996 to 2005. Genomic imbalances were determined using comparative genomic hybridization (CGH). Survival was calculated using the Kaplan and Meier method. We used the Log Rank test for each risk factor. Death risk was calculated by odds ratio (OR). RESULTS: We included 24 patients. Global survival was 58.04%. The presence of chromosomal imbalances, particularly in chromosome 21, significantly affected survival Being under 5 years of age, anaplastic histology, chemotherapy other than ICE (ifosfamida-carboplatin-etoposide) and partial resection increased the risk of death. CONCLUSIONS: Known risk factors were confirmed in our study, including chromosomal imbalances. We describe a new chromosomal imbalance in chromosome 21 among 30% of study participants.

Molecular cloning and expression of a putative crustacean hyperglycemic hormone of Litopenaeus vannamei in Pichia pastoris

Crustacean hyperglycemic hormone (CHH) is the most abundant and best studied member of the CHH/MIH/GIH neuropeptide hormone family. CHH plays a major role in controlling glucose levels in the hemolymph, and it also has significance in regulating molting, reproduction, and osmoregulation. In contrast, molt-inhibiting hormone (MIH) is responsible for maintaining animals in an intermolt stage. In this study, Liv-MIH-1 cDNA, which encodes a mature neuropeptide from the eyestalk of white shrimp, Litopenaeus vannamei, was expressed in methylotrophic yeast (Pichia pastoris KM71) under the control of an alcohol oxidase promoter. Recombinant Liv-MIH-1 was secreted into the culture medium using the á-factor prepro-sequence without Glu-Ala repeats. The expected protein, which had an apparent molecular mass of 12.1 kDa, was detected by Tricine-SDS-PAGE analysis and confirmed by Western blot. Pure recombinant Liv-MIH-1 was obtained by affinity chromatography, and N-terminal sequence analysis confirmed expression of the protein. Biological assays for CHH and MIH activity were also performed. Purified recombinant Liv-MIH-1 showed the ability to elevate the glucose level of hemolymph of L. vannamei, but molting was unaffected. Since these results are in agreement with the high structural and phylogenetic similarity that has been observed between Liv-MIH-1 and other CHH neuropeptides we propose to rename the protein Liv-CHH-SG1.

EFECTO DE DENSIDAD POBLACIONAL DE HUEVOS SOBRE VIABILIDAD Y TIEMPO DE DESARROLLO DE Drosophila melanogaster (DROSOPHILIDAE) / Effect Of Eggs Population Density On Viability And Time Of Development Of Drosophila melanogaster (Drosophilidae)

Para estimar el efecto de la densidad poblacional de huevos sobre la viabilidad huevoadulto de Drosophila melanogaster se realizaron tres tratamientos en frascos con medio de cultivo agar-banano: a densidad de 10, 50 y 90 huevos. La variable de respuesta fue la proporción de individuos adultos emergidos desde la aparición del primer imago hasta 15 días después de la siembra. Las viabilidades huevo-adulto promedio fueron 0,320, 0,338 y 0,328 para las densidades de 10, 50 y 90 huevos respectivamente. No se evidenciaron diferencias significativas entre los tres tratamientos (p>0.05). Por lo tanto, no se detectó en este estudio influencia de la densidad poblacional de huevos sobre la viabilidad huevo-adulto. Probablemente debido a que la proporción entre el número de huevos y la cantidad de medio fue suficientemente alta para no generar competencia en otros estadios del desarrollo huevo/adulto.

For estimating the effect from population density of eggs over viability egg-adult in Drosophila melanogaster, it was made three treatments in flasks with agar-banana culture media: densities of 10, 50 and 90 eggs. The effect evaluated was the adult’s proportion that emerged after 15 days of planting. The mean proportions of viability egg-adult were 0.32, 0.338 and 0.328 for the density of 10, 50 and 90 eggs respectively. Significant differences in viability were not evident (p>0.05). Consequently, it was not found effects from the eggs densities in the present study over egg-adult viability. These results probably were due to that the relation among number of eggs and quantity of culture media was not enough of a high for generate competition at another stadiums through the egg-adult development.

Pubovaginal sling with a low-cost polypropylene mesh

OBJECTIVE: The aim of this study was to present the results of pubovaginal sling with a low-cost polypropylene mesh in the treatment of stress urinary incontinence MATERIALS AND METHODS: 118 women diagnosed with stress urinary incontinence (SUI) due to urethral hypermobility or intrinsic sphincteric deficiency, treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon, were analyzed. All patients had a basic evaluation that included a medical history, physical examination, stress tests and urodynamic investigation RESULTS: The average follow up was of 42 months. Urethral hypermobility was observed in 67 percent of the cases. The process was carried out on an outpatient basis on 67 patients. Intra-operative complications included 4 vesical injuries, treated with catheterization for 3 days. There were 13 early complications, of which 8 were urinary retentions treated with vesical drainage for 1 to 3 weeks and 3 vaginal extrusions of the mesh treated with covering of the sections with mucous membrane. There was a need for 6 urethrolysis in patients who presented irritative and postoperative obstructive symptoms; 81.3 percent of the patients were considered cured, while 9.3 percent had significant improvement. Three initially unsuccessful cases required sling reconfiguration. All cases were eventually cured CONCLUSION: The construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially for patients in public health systems with low financial resources.