Hemorragia Intracerebral Imprevisible en un Hombre Joven: La Importancia de la Tomografía computarizada craneal post-mortem / Unpredictable Intracerebral Hemorrhage in a Young Male: The Importance of Post-Mortem Cranial Computed Tomography

La muerte súbita es aquella que ocurre dentro de las 24 horas posteriores al inicio de los síntomas y se caracteriza por ser clínicamente inexplicable, inesperada y repentina. Debido a la naturaleza de la muerte súbita, no es posible llegar a un diagnóstico preciso sin una autopsia. En esta comunicación breve, evaluaremos el caso de un empleado de crucero de 33 años, sin historial médico/farmacológico previo, el cual falleció súbitamente mientras reposaba en su camarote. Debido a las sospechas iniciales de una posible muerte causada por una sobredosis de cocaína, se le realizó un panel toxicológico abarcador el cual resultó negativo. Empero, una tomografía computarizada (TC) craneal sin contraste revirtió la hipótesis inicial y la autopsia neuropatológica -sorpresivamente- confirmó que la verdadera causa de muerte fue la ruptura de un aneurisma sacular desconocido en el polígono de Willis.

Sudden death occurs within 24 hours after the onset of symptoms and is characterized by being clinically inexplicable, sudden, and unexpected. Due to the nature of sudden death, it is not possible an accurate diagnosis without performing an autopsy. In this brief communication, we will evaluate the case of a 33-year-old cruise employee, with no prior medical/pharmacological history, who suddenly died while resting in his cabin. Due to initial suspicions of a possible cocaine overdose death, a comprehensive toxicology panel was performed, although yielding a negative result. A cranial computed tomography without contrast reversed the initial hypothesis and the neuropathological autopsy -surprisingly- confirmed that the true cause of death was the rupture of an unknown saccular aneurysm in the Circle of Willis.

Correlación entre el grado de neoplasia intraepitelial cervical y la expresión dual de p16 Y ki67, en biopsia de cuello uterino en el Hospital Santa Rosa de Lima-Perú año 2016 / Correlation between the degree of cervical intraepitelial neoplasis (nic) and the dual expression of p16 and ki67, in uterine neck biopsy in Santa Rosa Hospital of Lima-Peru year 2016

Objetivo: Determinar la frecuencia de coexpresión dual del p16 (INK4a) y ki67 en los diferentes grados de las neoplasias intraepiteliales cervicales (NIC) y su contribución molecular para diagnóstico y pronóstico. Material y Metodos: El diseño es descriptivo, prospectivo transversal. Se revisaron 20 biopsias de cérvix embebidas en parafina, que se encontraban en el archivo de Anatomía Patológica de un Hospital tercer nivel de Perú entre Enero y Diciembre del 2016, cuyas láminas portaobjeto fueron coloreadas con hematoxilina-eosina y reportadas como neoplasia intraepitelial (NIC) I, II, III. Se realizaron nuevos cortes histológicos de 3 micras para estudios complementarios usando la técnica de inmunohistoquímica dual. Las células con positividad para p16 mostraron tinción citoplasmática y/o nuclear de color rojizo y aquellas con positividad para ki67 mostraron coloración nuclear marrón. Resultados: Los 20 casos de neoplasia intraepitelial se dividen en: 06 casos de NIC I; 11 casos de NIC II y 03 casos de NIC III. La tinción dual para el Ki67 y p16 se realizó a los 20 casos, esto mostró una coexpresión en el 85% y ausencia de expresión dual en 15%. Se observó tinción en los diversos grados de NIC predominando el grado 1+ en un 50%. En el grado 2+ y 3+ la expresión fuerte en NIC II y NIC III respectivamente. La expresión del Ki67 se dio en todos los diferentes grados de NIC. Conclusiones: La coexpresión del Ki67 y p16 es de 85% en los diversos grados de NIC, siendo frecuente en el grupo de NIC II. (AU)

Objetive: To determine the frequency of dual coexpression of p16 (INK4a) and ki67 in the different degrees of cervical intraepithelial neoplasia (CIN) and its molecular contribution for diagnosis and prognosis. Material And Methods: the design is descriptive, prospective and cross-sectional. 20 cervix biopsies embedded in paraffin have been reviewed. These slides gathered from January 2016 to December 2016 were located in the records of Anatomical Pathology Department of a third level Hospital in Peru. The slides were stained with hematoxylin-eosin and reported as intraepithelial neoplasia (CIN) I, II, III. New histological sections of 3 microns were made for complementary studies by using dual immunohistochemistry technique. The cells with positivity for p16 showed cytoplasmic and / or nuclear reddish staining and those with positivity for ki67 showed brown nuclear coloration. Results: The 20 cases of intraepithelial neoplasia are divided into: 06 cases of CIN I; 11 cases of CIN II and 03 cases of CIN III. Dual staining for Ki67 and p16 was performed in all 20 cases. This showed coexpression in 85% and absence of dual expression in 15%. Staining was observed in the different grades of CIN, with predominance in grade 1+ ( 50%). In grade 2+ and 3+ the expression was strong in CIN II and CIN III respectively. The expression of Ki67 occurred in all the different grades of NIC. Conclusions: The coexpression of Ki67 and p16 is 85% in the different grades of CIN, being frequent in the group of CIN II. (AU)

Zika e Aedes aegypti: antigos e novos desafios / Zika and Aedes aegypti: new and old challenges

Resumo: A infecção por zika teve grande impacto não somente nas grávidas e nos recém-nascidos, mas também na saúde pública, nas ideias populares sobre o Aedes aegypti e no respeito dos direitos sociais das mulheres. O objetivo deste texto é identificar esse impacto e as mudanças históricas, sociais e sanitárias da doença e o legado do vírus zika. As intervenções de pesquisadores de diferentes disciplinas propiciam condições para investigações mais abrangentes sobre futuras ameaças epidêmicas no Brasil e na América Latina. Este diálogo ocorreu após o seminário "Aedes aegypti: antigas e novas emergências sanitárias", organizado pela Casa de Oswaldo Cruz, quando conversamos com alguns palestrantes e outros destacados pesquisadores sobre a história e os desafios do Aedes aegypti e do zika.

Abstract: Infection with the zika virus had a great impact not only on pregnant women and newborns, but also on public health, on popular ideas about Aedes aegypti and with respect to women's social rights. The objective of this paper is to identify this impact and the historical, social and health changes of the disease and the legacy of the zika virus. Interventions by researchers from different specialties foster conditions for more comprehensive investigations into future epidemic threats in Brazil and Latin America. This dialogue took place after the seminar "Aedes aegypti: past and future health emergencies," organized by the Casa de Oswaldo Cruz, when we talked with some speakers and other leading researchers about the history and challenges of Aedes aegypti and zika.

Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae

Abstract Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.

Avanços e desafios em normatização de amostras grátis de medicamentos no Brasil / Advances and challenges in standardization of free samples of drugs in Brazil

Este trabalho analisou criticamente a legislação sobre amostras grátis de medicamentos no Brasil, pontuando alguns aspectos importantes relacionados à saúde da população. Foi realizado um levantamento das leis, decretos, normas e regulamentações que norteiam o assunto. A amostra grátis é uma das estratégias de publicidade e marketing usadas pela indústria farmacêutica. Em alguns casos, a indicação de certos medicamentos é baseada em dados técnicos apresentados pelos propagandistas. Por outro lado, os médicos que buscam informações técnicas em fontes com menor influência da indústria farmacêutica indicam menos os medicamentos novos, que na maioria das vezes são mais caros. Embora tenha sido observado um avanço na normatização em relação às amostras grátis, ela ainda é incipiente. Tópicos como o prazo mínimo para sua distribuição, quantidade máxima a ser entregue a cada prescritor, seu transporte, armazenamento e cuidados com o prazo de validade deveriam ser incluídas na legislação pertinente, como ocorre em outros países. Estas discussões deveriam ser retomadas com a menor influência possível dos laboratórios farmacêuticos, seguindo critérios técnico-científicos. Portanto, é necessário que este assunto seja contextualizado nas resoluções sobre amostras grátis de medicamentos, seguindo as normas das boas práticas de fabricação...

This paper critically analyzed the legislation on free samples of medicines in Brazil, scoring some important health-related aspects of the population. A survey of laws, decrees, rules and regulations that guide the subject was conducted. The free sample is one of the advertising and marketing strategies used by the pharmaceutical industry. In some cases, the designation of certain drugs is based on technical data provided by the propagandists. On the other hand, physicians seeking technical information on sources with less influence of the pharmaceutical industry indicate fewer new drugs, which most often are more expensive. Although an improvement in standardization has been seen for free samples, it is still incipient. Topics such as the time limit for its distribution, maximum to be delivered to each prescriber, transport, storage and care of the expiration date amount should be included in the relevant legislation, as in other countries. These discussions should be resumed with the least possible influence of pharmaceutical companies, following technical and scientific criteria. Therefore, it is necessary that this matter be contextualized in resolutions on free samples of medicines, following the standards of good manufacturing practices...

A simple mathematical model to determine the ideal empirical antibiotic therapy for bacteremic patients

BACKGROUND: Local epidemiological data are always helpful when choosing the best antibiotic regimen, but it is more complex than it seems as it may require the analysis of multiple combinations. The aim of this study was to demonstrate a simplified mathematical calculation to determine the most appropriate antibiotic combination in a scenario where monotherapy is doomed to failure. METHODS: The susceptibility pattern of 11 antibiotics from 216 positive blood cultures from January 2012 to January 2013 was analyzed based on local policy. The length of hospitalization before bacteremia and the unit (ward or intensive care unit) were the analyzed variables. Bacteremia was classified as early, intermediate or late. The antibiotics were combined according to the combination model presented herein. RESULTS: A total of 55 possible mathematical associations were found combining 2 by 2, 165 associations with 3 by 3 and 330 combinations with 4 by 4. In the intensive care unit, monotherapy never reached 80% of susceptibility. In the ward, only carbapenems covered more than 90% of early bacteremia. Only three drugs combined reached a susceptibility rate higher than 90% anywhere in the hospital. Several regimens using four drugs combined reached 100% of susceptibility. CONCLUSIONS: Association of three drugs is necessary for adequate coverage of empirical treatment of bacteremia in both the intensive care unit and the ward. .

Risk factors for KPC-producing Klebsiella pneumoniae bacteremia

The molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae (KPC) has been largely investigated, but limited clinical information is available. A case-control study was performed to evaluate the risk factors for KPC bacteremia in hospitalized patients. Cases were patients with KPC bacteremia and controls were patients with non-KPC bacteremia. A total of 85 patients were included, 18 (21.2%) were KPC, and 67 (78.8%) were non-KPC (40 [59.7%] of them were extended-spectrum beta-lactamase producers). All KPC isolates were type 2 producers. These isolates belong to five distinct clones. Multivariate analysis showed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02 - 1.11; p = 0.004), presence of mechanical ventilation (OR, 11.1; 95% CI, 1.92 - 63.3; p = 0.007) and fluoroquinolone exposure during hospitalization (OR, 28.9; 95% CI, 1.85 - 454.6; p = 0.02) were independent risk factors for KPC in patients with K. pneumoniae bacteremia. Factors associated with severity of illness, such as age and mechanical ventilation, seem to be the main risks factors for KPC. Fluoroquinolones use might be a risk factor for KPC bacteremia. Further investigations on risk factors for KPC are warranted.

Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy

INTRODUCTION: The aim of this study was to determine risk factors for acquiring carbapenemresistant Pseudomonas aeruginosa bacteremia (CR-PA) and factors associated with in-hospital mortality. METHODS: Seventy-seven cases of bacteremia caused by P. aeruginosa were evaluated in a hospital with high incidence of CR-PA. Clinical and laboratorial factors, and previous use of antibiotics were also evaluated. In one analysis, CR-PA and carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia were compared. A second analysis compared patients who died with survivors. RESULTS: Among 77 P. aeruginosa bacteremia, 29 were caused by CR-PA. Admission to the intensive care unit, higher number of total leukocytes, and previous use of carbapenem were statistically associated with CR-PA. In the multivariate analysis, only previous use of carbapenem (including ertapenem) turned out to be a risk factor for CR-PA (p = 0.014). The 30-day mortality of patients with P. aeruginosa bloodstream infection was 44.8% for CS-PA and 54.2% for patients with CR-PA (p = 0.288). Chronic renal failure, admission to the intensive care unit, mechanical ventilation, and central venous catheter were risk factors for mortality. Incorrect treatment increased mortality of patients with bacteremia caused by CS-PA, but not for CR-SA. The odd ratio of mortality associated with incorrect therapy in patients with CS-PA was 3.30 (1.01-10.82; p = 0.043). The mortality of patients with bacteremia caused by CR-PA was unexpectedly similar regardless of antimicrobial treatment adequacy. CONCLUSION: Appropriate treatment for CS-PA bacteremia initiated within the first 24 hours was associated with lower mortality, but this cannot be extrapolated for CR-PA.

Estimation of genetic parameters for age at first calving and calving interval in Blanco Orejinegro (BON) breed cattle populations in Colombia / Estimación de parámetros genéticos para edad al primer parto e intervalo entre partos en poblaciones bovinas de la raza Blanco Orejinegro (BON) en Colombia / Estimação de parâmetros genéticos para idade ao primeiro parto e intervalo de partos em populações bovinas da raça Blanco Orejinegro (BON) na Colômbia

Objective: to estimate genetic parameters for age at first calving (AFC) and calving interval (CI) in 22 herds of Blanco Orejinegro cattle in Colombia. Methods: a total of 1,256 records for AFC and 3,803 for CI, obtained between years 1981 and 2010 were analyzed. The (Co) variances components were estimated by a derivative-free restricted maximum likelihood procedure in a bi-trait animal model. Results: average of AFC and CI were 1,104 ± 141 and 487 ± 147 days, respectively. Heritabilities were 0.15 and 0.13 for AFC and CI, respectively, with -0.43 genetic correlation. The herd and year of birth were included as fixed effects for the AFC, while parity number and the covariate age of dam at farrow were analyzed for CI. All the effects had a significant influence over the CI variance. Conclusions: the values obtained for these traits indicate that selection for calving interval and age at first calving may have a relatively low impact, due to the large environmental effect on the variation of both parameters in these breed populations.

Objetivo: estimar los parámetros genéticos de la edad al primer parto (EPP) y del intervalo entre partos (IEP) en 22 poblaciones bovinas de la raza criolla colombiana Blanco Orejinegro. Métodos: se utilizaron 1.256 registros para EPP y 3.803 registros de IEP, obtenidos entre los años 1981 y 2010. Los componentes de (Co) varianza fueron estimados por máxima verosimilitud restringida libre de derivadas con un modelo animal bicaracterístico. Resultados: los promedios de la EPP y del IEP fueron de 1.104 ± 141 y 487 ± 147 días, respectivamente. Las heredabilidades obtenidas en el análisis fueron de 0.15 y 0.13 para EPP e IEP, respectivamente, con una correlación genética de -0.43. Se evaluaron los efectos fijos de año de nacimiento y hato para la EPP, también fue incluido el orden de parto y la covariable edad de la vaca al parto en el análisis del IEP, los cuales todos tuvieron una influencia significativa sobre la variación de este parámetro. Conclusiones: los valores obtenidos para estas características reproductivas en el presente estudio, indican que la selección para intervalo entre parto y edad al primer parto puede tener un efecto relativamente bajo, debido al amplio efecto ambiental sobre la variación de estos dos parámetros en las poblaciones de esta raza.

Objetivo: estimar os parâmetros genéticos de idade ao primeiro parto (EPP) e do intervalo entre partos (IEP) em 22 populações bovinas da raça crioula colombiana Blanco Orejinegro. Métodos: foram utilizadas 1.256 e 3.803 dados para IPP e IEP respectivamente, obtidos entre os anos 1981 e 2010. Os componentes de (Co) variância foram estimados por máxima verossimilhança restrita livre de derivadas com um modelo animal bicaracterístico. Resultados: as médias da EPP e IEP foram 1.104 ± 141 días (36.8 ± 4.7 meses) e 487 ± 147 días (16.2 ± 4.9 meses), respectivamente. As herdabilidades obtidas nas análises foram de 0.15 e 0.13 para EPP e IEP respectivamente, com uma correlação genética de -0.43. Foram incluídos os efeitos fixos de ano de parto e rebanho para EPP, também foi analisado o efeito de ordem de parto e a covariável de idade da vaca ao parto para o IEP. Todos os efeitos incluídos na análise foram significativos sobre a variação do IEP. Conclusões: os valores obtidos no presente estúdio para estas características reprodutivas indicam que a selecção para intervalo entre parto e idade ao primeiro parto podem ter um efeito relativamente baixo, devido ao amplio efeito ambiental sobre a variação destes dois parâmetros nas populações desta raça.

Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance

BACKGROUND: Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics. METHODS: Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients > 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age. RESULTS: The female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to > 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (> 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded > 80% susceptibility in any age cohort. CONCLUSION: Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.

Growth performance of Blanco Orejinegro and Romosinuano bullocks on pasture / Desempeño de toretes de las razas criollas Blanco Orejinegro y Romosinuano en prueba de crecimiento en pastoreo / Teste de desempenho para crescimento de touros jovens das raças Blanco Orejinegro e Romosinuano avaliados a pasto

Objective: to describe the first performance test on Romosinuano (ROMO) and Blanco-Orejinegro (BON) bullocks held at the Nus Experiment Station in northeastern Antioquia (Colombia). Methods: a total of 15 commercial farms participated in the evaluation. The animals were tested under rotational grazing with three planes of nutrition and weighed every 28 days. The measured traits were daily gain, adjusted weight to 540 days, scrotal circumference, morphometric measurements at the end of the test, and carcass traits by ultrasound. Results: a “bull index” was obtained using these characteristics to select the four most outstanding bulls of each breed. Weight gain for the best Blanco-Oreginegro and Romosinuano bulls was higher than 1,000 and 890 g / animal / day, respectively. In addition, their final weight was greater than 340 kg. Animals were genotyped for variants of genes coding for carcass quality and meat, such as calpain (Capn), myostatin (MYO) and diacylglycerol acyltransferase (DGAT1). Conclusions: all Romosinuano individuals had desirable genotype for the CAPN 316 marker, which is associated with increased meat tenderness. On the other hand, Blanco- Orejinegro animals had the desirable genotype for the DGAT1 gene variant, related to fat deposition and fat content in milk. This is the first study that has been reported to select outstanding bulls in Colombian creole cattle breeds to facilitate the evaluation and use of superior genetic material.

Objetivo: el presente trabajo tiene por objeto describir los resultados obtenidos en la primera prueba de desempeño de toretes de las razas bovinas criollas Romosinuano (ROMO) y Blanco Orejinegro (BON), realizada en la Estación Experimental el Nus, en el Nordeste Antioqueño, con la participación de 15 ganaderías comerciales. Métodos: los animales fueron mantenidos en pastoreo rotacional, con tres diferentes planos nutricionales a lo largo de la prueba. Se realizaron pesajes cada 28 días y se evaluó la ganancia diaria de peso, el peso ajustado a los 540 días, la circunferencia escrotal, medidas morfométricas de los animales al final de la prueba, y características de la canal medida por ultrasonido. Resultados: a partir de estas características se definió un índice de toro, para seleccionar los animales sobresalientes (cuatro toretes por cada raza), dichos toros superiores presentaron valores de ganancia de peso en la prueba de desempeño superiores a los 1000 gramos animal día en la raza Blanco Oreginegro y 890 gramos animal día en la raza Romosinuano, además presentaron un peso final superior a los 340 kg. Adicionalmente, los animales fueron genotipados para variantes de genes que codifican para Calpaina (CAPN), Miostatina (MYO) y Diacilglicerol Aciltransferesa (DGAT1) relacionados con la calidad de la canal y la carne. Conclusiones: se encontró que todos los individuos de la raza Romosinuano presentaron el genotipo deseable para el marcador CAPN 316, relacionado con mayor terneza de la carne, por otro lado los animales de la raza Blanco Orejinegro presentaron el genotipo deseable para la variante del gen DGAT1, relacionado con deposición grasa y contenido de grasa en la leche. Este es el primer trabajo que se realiza para seleccionar toros sobresalientes en las razas criollas colombianas y permitirá la evaluación y uso de material genético de calidad superior.

Objetivo: este trabalho tem por objetivo descrever os resultados obtidos no primeiro teste de desempenho de touros jovens das raças crioulas Blanco Orejinegro (BON) e Romosinuano (ROMO), realizada na estação experimental El Nus, localizada no nordeste do departamento de Antioquia. Métodos: o teste teve a participação de 15 fazendas de produtores comerciais. Os animais foram mantidos em pastagem rotacional com três diferentes planos nutricionais ao longo do teste. Realizaram-se pesagens a cada 28 dias e avaliou-se o ganho diário de peso, o peso ajustado aos 540 dias, a circunferência escrotal, medidas morfométricas dos animais ao final do teste, e características da carcaça medidas por ultra-som. A partir destas características definiou-se um índice de touro, para selecionar os bois destacados (quatro touros novos por cada raça). Resultados: os touros superiores apresentaram ganhos de peso no teste de desempenho acima de 1000 gramas por cada animal ao dia na raça Blanco Orejinegro e 890 gramas na raça Romosinuano, além disto, apresentaram um peso final superior aos 340 kg. Adicionalmente, os animais foram genotipados para as variantes genéticas que codificam para a Calpaina (CAPN), miostatina (MYO), e Diacilglicerol Aciltransferase (DGAT1) relacionados com a qualidade da carcaça e da carne. Conclusões: encontrou-se que todos os indivíduos da raça Romosinuano apresentaram o genótipo desejável para o marcador CAPN316, relacionado com maior maciez da carne. De outro lado, os animas da raça Blanco Orejinegro apresentaram o genótipo desejável para a variante do gene DGAT1, relacionado coma deposição de gordura e o conteúdo de gordura no leite. Esta é a primeira pesquisa que se realiza para selecionar touros destacados nas raças crioulas colombianas e permitirá a avaliação e o uso de material genético de qualidade superior.

Funcionamiento familiar, creencias e inteligencia emocional en pacientes con trastorno obsesivo-compulsivo y sus familiares / Family functioning, beliefs regarding illness and emotional intelligence in patients with Obsessive Compulsive Disorder and in their relatives

Mental health problems, specifically mental disorders, develop from a complex system and not from a single cause. Obsessive-compulsive disorder (OCD) affects more than 2% of the population and generally the course of the illness is insidious and chronic. When functioning adequately, family constitutes a very important resource to face health problems and to help to improve the patient's life quality. This is the reason why it is important to underline the relevance of a stable, good functioning of the family system aimed at attaining an optimal development of all its members. Such development may be hindered by the family's incapability to modify functioning patterns at crucial moments when they are trapped in a series of inadaptable interactions which prevent to give specific solutions to the problems that are appearing, and when reporting, within a context of expressed emotion, an emotional over-involvement and high levels of hostility and criticism towards the member with OCD. Family accommodation is a phenomenon typical of families where the identified patient exerts a control based on aggressiveness when his/her wishes are not rewarded within the group. There are very few researches on the functioning of families of patients diagnosed with obsessive-compulsive disorder. Generally, these researches are related with the partially negative effects that the interactions have on the behavior of patients and their relatives by preventing or hindering the development of the subject's system. The accordance between the patient's emotional regulation or emotional intelligence and their relatives has not been studied. On the other hand, the knowledge of the beliefs that relatives hold regarding the illness may be related with the functioning of the group as a family, whereas beliefs will provide consistency to family life because they provide continuity between past, present and future. They are also a way to address new and ambiguous situations such as mental illness. This is the reason why getting to know these family systems may allow elaborating more specific and effective intervention programs for groups and families. Objective To determine the family types through a member identified with obsessive-compulsive disorder; to compare the emotional intelligence profile between patients and relatives according to the perceived type of family; to compare the relatives' beliefs toward the illness according to the perceived type of family. Material and methods A sample of patients and their families with obsessive-compulsive disorder was obtained from those who were sent by the doctor in charge of their treatment to participate in a model of group therapy for OCD, consisting of cognitive behavioral theory, practices and psychoeducation. During the first session patients and their relatives answered the following instruments: Family Adjustment and Cohesion scales (FACES-II) by Olson, Profile of Emotional Intelligence (PIEMO) by Cortés et al., Beck Inventory of Anxiety. Relatives answered too the Beliefs and Attributions Questionnaire by Salorio et al. In addition, data on family structure was complied. The sample was constituted by 48 patients and 61 relatives. All instruments were self-applied. Once that the type was obtained according to the Olson's circumflex model, the emotional profile, the anxious and the depressive symptoms were compared through factorial 2x3 ANOVA. Beliefs and attributions were compared through simple ANOVA. Results Three types of families were determined as follows: high cohesion with chaotic standards for expressing emotions and ideas; high cohesion with a rigid expression of ideas and emotions; low cohesion with a little expression of ideas and emotions. Different profiles of emotional intelligence were found not only for patients but also for relatives, in each family type. Families with high cohesion and high adjustment appear as most emotionally intelligent, less anxious and depressed, and with beliefs more attuned to reality. This type of family function was the less frequent. For beliefs and illness attributions, it was observed that comprehension of the disorder increases in proportion to a higher family adaptation, while the tendency of family members to experience feelings of guilt either towards themselves or towards the patient is decreased. As a result, the perception of experiencing the patient's illness as a nuisance disappears. With regard to the results of the Beck scales, family members perceived a high cohesion and low adaptation had higher scores for depression and anxiety. In patients who show high levels of depression and anxiety perceive family functioning as a rigid structure, with little prospect of change and interaction that prevents growth (high cohesion, low adaptation), and in those perceived isolation, without significant emotional ties with other family members and with the rigidity that prevents problem situations. Conclusions The results obtained are congruent with Olson's statements in regard to family functioning in the specific case of obsessive- compulsive disorder; these findings permit to understand the family dynamics which may typify the symptoms in the identified patients, and also to explain the adjustment situation described in literature. Family intervention is justified, stressing the handling of emotions as an important element to be considered in order to obtain higher therapeutic benefits for the patient. This study found differences in adjustment between patients and their families, do not perceive the need for flexibility in the operation of the system to find solutions that do not perpetuate and sustain interactions that reinforce symptoms. As for depression and anxiety, similar levels in either condition may be observed, thus confirming the close relationship between both. It was found that in patients and relatives, higher levels of family adaptation correspond to lower levels of depressive and anxious symptoms. One of the first approaches to the dynamics of these systems must be headed towards the family systems of beliefs, as the ideas that family members hold regarding the importance of their participation in the whole process of the illness has an impact in its course. Many families have rigid systems that make them more vulnerable to the fluctuations that this illness presents since for their members it is important and decisive to have control over the ailment. Families with flexible systems of beliefs are more prone to experience losses with a feeling of acceptance and therefore it is easier for them to let their members to implement changes in their functioning, thus compensating and overcoming their limitations. In this sense it is important to attain a therapeutic collaboration relationship that may create within the family a sense of realistic control and may help also to put into action the system's capabilities to promote improvement. This idea allows for openness in the system that may lead it to consider that there are more efficient operational measures that those applied to date.

Los problemas de salud mental y específicamente los trastornos mentales se desarrollan a partir de un complejo sistema biopsicosocial y difícilmente se puede identificar una causa única. El trastorno obsesivo compulsivo (TOC) afecta a más de 2% de la población y en general el curso de la enfermedad es insidioso y crónico. La familia es un importante recurso para enfrentar los problemas de salud y facilitar el mejoramiento de la calidad de vida del paciente, cuando su funcionamiento es adecuado. Existen pocas investigaciones realizadas sobre el funcionamiento de las familias de pacientes diagnosticados con trastorno obsesivo-compulsivo. Generalmente estas investigaciones están relacionadas con los efectos potencialmente negativos que dichas interacciones tienen en las conductas de pacientes y familiares que impiden u obstaculizan el desarrollo del sistema y de los individuos. La concordancia de la regulación emocional o inteligencia emocional de los pacientes y sus familiares no ha sido estudiada. Por otra parte el conocimiento de las creencias sobre la enfermedad por parte de los familiares puede estar relacionado con el funcionamiento del grupo como familia. Es por ello que el conocimiento de estos sistemas familiares podrá permitir estructurar programas de intervención grupal o familiar más específicos y eficaces. Objetivo Determinar la tipología de las familias con un miembro identificado con trastorno obsesivo compulsivo, comparando tres aspectos: 1) El perfil de inteligencia emocional entre pacientes y familiares según el tipo de familia percibido. 2) La ansiedad y depresión entre pacientes y familiares según el tipo de familia percibido y 3) Las creencias de los familiares hacia la enfermedad según el tipo de familia percibido. Material y métodos Se obtuvo una muestra de pacientes y sus familiares con trastorno obsesivo compulsivo (TOC) los que fueron enviados por su médico tratante a participar en el modelo terapéutico grupal para TOC, que consiste en Teoría y Técnicas cognitivo conductuales y psicoeducativas. Durante la primera sesión los pacientes y sus familiares acompañantes contestaron los siguientes instrumentos: Escala de cohesión y adaptación familiar (FACES-II) de Olson et al., Perfil de Inteligencia Emocional (PIEMO 2000) de Cortés et al., Inventario de Ansiedad de Beck, Inventario de depresión de Beck. Los familiares contestaron además el Cuestionario de Creencias y Atribuciones sobre la enfermedad de Salorio et al. Además se recabaron datos sobre la estructura familiar. La muestra se conformó por 48 pacientes y 61 familiares. Todos los instrumentos fueron autoaplicados. Una vez obtenida la tipología según el modelo circumplejo de Olson se compararon el perfil emocional y los síntomas ansiosos y depresivos por medio de ANOVA factorial 2x3. Las creencias y atribuciones se compararon por medio de ANOVA simple. Resultados Se determinaron tres tipos de familia: 1. Las de alta cohesión con lineamientos caóticos para la expresión de emociones e ideas. 2. Las de alta cohesión con rigidez en la expresión de ideas y emociones y 3. Las de baja cohesión con escasa expresión de ideas y emociones. Se encontraron perfiles de inteligencia emocional diferentes tanto para pacientes como para familiares en cada uno de los tipos de familia. Las familias con alta cohesión y adaptación se manifiestan como las más inteligentes emocionalmente, menos ansiosas y deprimidas y con creencias más apegadas a la realidad. Sin embargo, este grupo fue el menos frecuente. Conclusiones Los resultados obtenidos son coherentes con los planteamientos de Olson en relación al funcionamiento de las familias. En el caso específico del trastorno obsesivo-compulsivo estos hallazgos permiten entender la dinámica familiar que pudiera caracterizar el mantenimiento de la sintomatología en los pacientes identificados. La intervención familiar es un elemento importante a considerar para obtener mayores beneficios terapéuticos para el paciente.

Os hospices e os programas de voluntariado para o câncer / Hospices and volunteer cancer programs

Entrevista com o cirurgião Marcos Fernando de Oliveira Moraes,presidente da Fundação do Câncer no Rio de Janeiro, entidade privadaque apóia pesquisas e ações de controle da doença e funciona emparceria com o Instituto Nacional do Câncer, do qual foi diretor-geral.Narra suas atividades de médico e gestor, aborda a importância daprevenção e do diagnóstico precoce e apresenta dados sobre a mudançade hábitos, como o de fumar em público. Enfatiza a recenteorganização do primeiro hospice na cidade, “um lugar para onde aspessoas vão para aproveitar da melhor maneira possível o resto de vidaque têm”. Atenta para a importância dos programas de voluntariado,fundamentais para o tratamento mais humanizado da doença.

Interview with the surgeon Marcos Fernando de Oliveira Moraes, chairman ofRio de Janeiro’s Cancer Foundation, a private organization that provides supportfor cancer research and control initiatives, in partnership with the NationalCancer Institute (Instituto Nacional do Câncer, or Inca), of which Moraes wasdirector general. Dr. Moraes narrates his activities as a physician andadministrator, addresses the importance of prevention and early diagnosis, andpresents data on changing habits, like smoking in public. He highlights therecent creation of the city’s first hospice, “a place where people go to spend theremainder of their lives as well as they can.” He stresses the importance ofvolunteer programs, which are essential to providing more humanizedtreatment.

As transformações no tratamento cirúrgico dos cânceres: das grandes incisões nos anos 1970 aos cortes quase invisíveis de hoje / Changes in the surgical treatment of cancers: from the large incisions of the 1970s to today's nearly invisible cuts

O médico e cirurgião amazonense João Bosco Botelho mostra astransformações ocorridas no diagnóstico e no tratamento do câncernas últimas décadas, ressaltando que até os anos 1970, quando existiaapenas o raio X e a planigrafia, a ideia dominante era a da cirurgiaradical, para retirar o tumor com margem de segurança. As imagenscongeladas (ultrassom, tomografia computadorizada, ressonânciamagnética, cintilografias) e as dinâmicas em tempo real (endoscopias)foram determinantes para as mudanças nas cirurgias – com incisões queficam quase invisíveis – e também na rádio e quimioterapia. O médicodestaca ainda que esse desenvolvimento da tecnologia médicaacompanhou o movimento social, quando se iniciou a valorização doscorpos como templos invioláveis.

João Bosco Botelho, medical surgeon from the state of Amazonas, talks aboutthe changes that have taken place in the diagnosis and treatment of cancer inrecent decades. He calls special attention to the fact that the only options untilthe 1970s were X-rays and planigraphies, and the prevailing idea was radicalsurgery to remove the tumor with some margin of safety. Frozen images likeultrasounds, CT scans, MRIs, and scintigraphies along with real-timetechniques like endoscopies were decisive in changing not only how surgery wasperformed (now with nearly invisible incisions) but also radiation treatmentand chemotherapy. The surgeon likewise underscores how the development ofmedical technology kept pace with social trends, as bodies began to betransformed into sacred temples.