La cuestión del afrontamiento cadavérico en anatomía y la necesidad de una educación inclusiva / The question of coping with the cadavera in anatomy and the need for an inclusive education

El material cadavérico (MC) humano en la cursada de Anatomía de la carrera de Medicina es el recurso didáctico más antiguo y completo para la enseñanza. Este elemento conlleva importantes significaciones y múltiples atravesamientos (legales, éticos, procedimentales, culturales) que, a partir de la mitad del siglo XX tuvo cuestionamientos y posicionamientos pedagógicos antagónicos en cuanto a su uso. Su utilización genera reacciones emocionales en los estudiantes, a veces negativas, que son procesadas por los mecanismos de defensa y las estrategiasde afrontamiento con que el sujeto cuente. Cuando éstos son sobrepasados puede aparecer un cortejo sindromático que constituye el afrontamiento cadavérico negativo, el cual es un factor que ubica al alumno en un estado de vulnerabilidad con alteraciones en lo académico. Consideramos necesario para este grupo de estudiantes, como para aquellos en su proceso de afrontamiento, estrategias didácticas que los secunden en el proceso y tiendan a una educación inclusiva para que el afrontamiento cadavérico negativo no sea causal de deserción o riesgosidad.

SUMMARY: The human cadaveric material (CM) in the course of Anatomy of the Medicine career is the oldest and most complete didactic resource for teaching. This element carries important meanings and multiple crossings (legal, ethical, procedural, cultural) that, from the middle of the 20th century, had questions and antagonistic pedagogical positions regarding its use. Its use generates emotional reactions in students, often negative, which are processed by the defense mechanisms and coping strategies available to the subject. When these are exceeded, a syndromic courtship may appear that constitutes negative cadaveric coping, which is a factor that places the student in a state of vulnerability with academic alterations. We consider it necessary for this group of students, as well as for those in their coping process, didactic strategies that support them in the process and tend to an inclusive education so that negative cadaverous coping is not a cause of desertion or risk.

Alterations in pro- and anti-inflammatory mediators are involved in microvascular dysfunction in postmenopausal women with type 2 diabetes mellitus

Evidence has shown that women with type 2 diabetes mellitus (T2DM) have a greater risk of cardiovascular complications compared with men, but this sex difference is not clearly understood. This study assessed the microvascular function and circulatory biomarkers in postmenopausal women (PMW) with T2DM compared with diabetic men and their non-diabetic counterparts. Sixty participants were divided into nondiabetic PMW, PMW with T2DM, non-diabetic men, and diabetic men. Microvascular function was assessed using non-invasive equipment (EndoPAT®) and reported as reactive hyperemia index (RHI). Anthropometric and cardiovascular parameters were also measured. Two-way ANOVA was performed using sex (women or men) and T2DM (non-diabetic and diabetic) as the two factors. RHI impairment (1.97±0.14) was detected in diabetic PMW compared with women without T2DM (2.5±0.13) accompanied by lower adiponectin levels (T2DM: 9.3±1.2 and CTL: 13.8±1.8 ug/mL, P<0.05). An increase in the Nε-carboxymethyllysine (CML), nitrate/nitrite, and C-reactive protein (CRP) levels were observed in diabetic PMW compared to the other groups. Although a poor glycemia control was seen in diabetic men, neither RHI nor circulatory biomarkers were affected by T2DM. Multiple linear regression stratified by sex and T2DM identified some variables with RHI only in PMW with T2DM: HbA1c (P=0.003), body mass index (P=0.029), CML (P=0.032), and CRP (P=0.006). Diabetic PMW were more susceptible to the deleterious effects of hyperglycemia than men, showing microvascular dysfunction with high levels of pro-inflammatory mediators (CML and CRP) and a lower adiponectin concentration.

Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE) / 대한뇌졸중학회지

Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Colecistitis enfisematosa: Manejo satisfactorio por vía laparoscópica / Emphysematour cholecystitis: satisfactory outcome by laparoscopically managment

La colecistitis enfisematosa es una rara forma de presentación de la colecistitis aguda. Es causada por isquemia vascular y se caracteriza por la presencia de gas en la pared, en la luz o en ambas, la cual puede evolucionar a un cuadro de extrema urgencia asociada a una alta tasa de morbilidad y mortalidad. Se presenta un caso de un paciente con un cuadro de dolor abdominal con síntomas gastrointestinales y signos de respuesta inflamatoria sistémica con diagnóstico presuntivo de colecistitis enfisematosa que se realizó una colecistectomía laparoscopia de urgencia, con una adecuada evolución postoperatoria

Emphysematous cholecystitis is an uncommon variant of acute cholecystitis. It is caused by a vascular ischemia and characterized by the presence of gas in the wall, in the lumen, or in both. It can evolve into a life-threatening condition associated with a high rate of morbidity and mortality. We present a case of a patient who presented with abdominal pain, gastrointestinal symptoms, and signs of a systemic inflammatory response with a presumptive diagnosis of emphysematous cholecystitis. An emergency laparoscopic cholecystectomy was performed, with an adequate postoperative evolution

Tratamiento de la desregulación emocional en hospitales del área metropolitana de Buenos Aires: una encuesta a profesionales / Treatment of emotional dysregulation in hospitals of the metropolitan area of Buenos Aires: a survey to practitioners

Resumen El proceso de regulación emocional está siendo foco de gran cantidad de investigaciones en la actualidad. Se estima que se encuentra asociada al desarrollo y mantenimiento del 75 % de los trastornos mentales del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM, por sus siglas en inglés). En esta línea se han estado estudiando en los últimos años, a nivel global, protocolos transdiagnósticos que tienen, como foco de tratamiento, dicho proceso. El objetivo de este estudio consistió en explorar la familiaridad de los profesionales de la salud mental, de hospitales públicos del área metropolitana de Buenos Aires, con el constructo de la desregulación emocional y los protocolos diseñados para el tratamiento de pacientes con dichas características. A su vez, se buscó conocer el grado de acercamiento de los profesionales clínicos a las investigaciones sobre psicoterapias. A estos fines, se diseñó un cuestionario con 40 preguntas de respuestas abiertas y opción múltiple que fue completado por 75 profesionales (psicólogos y psiquiatras) de hospitales públicos del área metropolitana de Buenos Aires. La mayoría reportó conocer el constructo de desregulación emocional, pero al pedirles que conceptualicen un caso diseñado para este estudio muy pocos utilizaron el constructo. En cuanto a los protocolos transdiagnósticos diseñados para intervenir en la desregulación emocional, son muy poco implementados. Por su parte, menos de la mitad reportó haber leído investigaciones empíricas. Los cursos elegidos para continuar la formación son en su mayoría psicoanalíticos y la participación en congresos internacionales es escasa. Se propone la necesidad de fomentar el uso de intervenciones basadas en evidencia en hospitales públicos y la divulgación de protocolos transdiagnósticos con evidencia para la desregulación emocional.

Abstract A substantial amount of evidence regarding comorbidity among mental disorders has been accumulated during the last years. Moreover, it has been identified that there is a great variability within nosological categories. These limitations of categorical systems lead to the development of the transdiagnostic paradigm which contemplates the existence of underlying processes common to different diagnoses. The process of emotional regulation is currently the focus of many investigations. It is estimated that it is associated with the development and maintenance of 75 % of DSM mental disorders. Emotional dysregulation is being studied particularly as a common factor in depression and anxiety, the two most prevalent disorders in Argentina. Related to this, transdiagnostic protocols aiming this process have been studied in the last years at a global level. The Unified Protocol has been developed by Barlow from a transdiagnostic perspective aiming to offer an evidence-based intervention that could be faithfully used in heterogeneous groups. It was created for emotional disorders with a specific focus on emotional dysregulation, contemplating comorbidity and heterogeneity. This makes the Unified Protocol a proper and valid intervention for the most prevalent disorders in Argentina. The objective of this study was to explore the familiarity of mental health practitioners, of public hospitals in the metropolitan area of ​​Buenos Aires, with the emotional dysregulation construct and protocols designed for the treatment of patients with these characteristics. Moreover, the degree in which clinicians approach psychotherapy research was evaluated. For this purpose, a cross-sectional descriptive study was carried on. A questionnaire was designed with 40 questions (25 with closed answer and 15 with short open answer) that investigated five thematic areas: demographic characteristics, therapeutic approach, knowledge about the emotional dysregulation construct and treatment protocols, knowledge about the transdiagnostic paradigm and approach to empirical research. The questionnaire was completed by 75 practitioners (psychologists and psychiatrists) from public hospitals of the metropolitan area of Buenos Aires. After analyzing the results, it can be said that the most prominent theoretical framework from which practitioners work in public hospitals is psychoanalysis. The most prevalent diagnoses are anxiety and depression and comorbidity is frequent (M = 2.23, SD = .707). When studying the familiarity to the construct of emotional dysregulation, it was observed that even though most of them reported knowing the emotional dysregulation construct (89.3 %), when asked to conceptualize a person with intense and long-lasting emotional distress and difficulty in controlling their behavior and recognizing their emotions, very few mentioned difficulties in the regulation of emotions (13.51 %). Individual format treatment was the most chosen by psychologists for patients with these characteristics (69 %). Psychiatrists reported pharmacotherapy as the most chosen treatment (87.5 %). Group format is not frequently used. In regards to transdiagnostic protocols designed to intervene in emotional dysregulation, they are very poorly implemented. Dialectical Behavioral Therapy was reported to be known by 80 % of the sample, but used by 33.9 %, while the Unified Protocol was referred to be known by 34.7 % and used by 7.69 % of them. On the other hand, the gap between clinical practice and research seems to be wide. Less than half of the practitioners reported reading empirical research (44 %). And the transdiagnostic paradigm is known by 46.7 % of practitioners. When asked to mention the most influential authors in their practice, Freud and Lacan (classical psychoanalytic authors) were mentioned by the majority. The courses chosen to continue their training are mostly psychoanalytic and participation in international congresses is low (10.45 %). These results show the need to look for ways to encourage the use of evidence-based interventions in public hospitals and specifically the dissemination of transdiagnostic protocols with evidence for emotional dysregulation, being emotional disorders the most prevalent.

Stereological quantification of extraocular muscles in humans / Cuantificación estereológica de músculos extraoculares en humanos

SUMMARY: The aim of this study is to quantify muscular and connective tissue volumes of extraocular muscles (EOM) in humans with no ophthalmological disease using stereology. EOM from five cadaveric non-strabismic humans were obtained. The number of muscle fibers in 5,000 µm2 and volume density (Vv) of muscle and collagen were measured using stereology. Comparisons between antagonist EOM were conducted using Wilcoxon signed rank test for paired samples. A secondary analysis examining differences between pairs of EOM was also conducted. Bilateral tests were performed, and significance was set at 0.05. The horizontal rectus muscles (medial and lateral rectus) had the highest Vv of muscle and the lowest Vv of collagen. The inferior rectus muscle tended to have a fewer number of fibers per 5,000 µm2 than the rest of the EOM. However, these differences did not reach statistical significance. This is the first published study describing the normal histology of human EOM using stereology. Our investigation, through the quantification of the proportion of muscle and collagen tissue, as well as the number of muscle fibers in 5,000 µ2, establishes normal stereological parameters for EOM of humans without ophthalmological disease.

RESUMEN: El objetivo de este estudio es cuantificar el volumen de tejido muscular y conectivo de los músculos extraoculares en humanos sin enfermedad oftalmológica conocida utilizando estereología. Los músculos extraoculares fueron obtenidos de cinco cadáveres humanos sin estrabismo. El número de fibras musculares en 5.000 µm2 y la densidad de volumen (Vv) de músculo y colágeno fueron medidas usando estereología. Las comparaciones entre músculos extraoculares antagonistas se realizaron a través de la prueba de los rangos con signo de Wilcoxon para muestras pareadas. Un análisis secundario examinando diferencias entre pares de músculos extraoculares también fue llevado a cabo. Se realizaron pruebas bilaterales y la significancia fue fijada en 0,05. Los músculos rectos horizontales (recto medial y lateral) tuvieron el mayor Vv de músculo y el menor Vv de colágeno. El músculo recto inferior tuvo la tendencia a poseer menos número de fibras por 5.000 µm2 que el resto de los músculos extraoculares. No obstante, estas diferencias no llegaron a ser estadísticamente significativas. Este es el primer estudio publicado describiendo la histología normal de los músculos extraoculares usando estereología. Nuestra investigación, a través de la cuantificación de la proporción de tejido de músculo y colágeno, así como el número de fibras musculares en µm2, establece parámetros estereológicos normales para músculos extraoculares en humanos sin enfermedad oftalmológica.

Colgajo dorsolateral versus colgajo en isla mediopalmar radial para el tratamiento de lesiones traumáticas distales del pulgar. Evaluación clínica / Dorsolateral flap vs. radial midpalmar island flap in the treatment of traumatic distal thumb injuries. Clinical evaluation

Objetivo: Evaluar clínicamente a pacientes con lesiones distales combinadas del pulgar tratados mediante colgajo dorsolateral o colgajo en isla mediopalmar radial. Materiales y Métodos: Se comparó retrospectivamente a 20 pacientes (14 hombres y 6 mujeres; promedio de edad 35 años) con lesiones traumáticas combinadas distales del pulgar, operados por dos cirujanos, con técnicas diferentes. Los pacientes no tenían antecedentes quirúrgicos y el seguimiento mínimo fue de 24 meses. Se evaluaron el resultado subjetivo usando el índice de satisfacción, la escala analógica visual para dolor y el puntaje QuickDASH, y el resultado objetivo mediante el test de discriminación de 2 puntos, el tiempo quirúrgico promedio y la necesidad de reeducación espacial digital. Resultados: La media desde el ingreso hasta el alta laboral fue de 7 semanas (rango 6-8). Resultados promedio posoperatorios: escala analógica visual 01/10, ambos grupos. Grupo con colgajo dorsolateral: índice de satisfacción 97%, test de discriminación de 2 puntos 4 mm, puntaje QuickDASH 2,5; tiempo quirúrgico 45 min, sin necesidad de reeducación espacial digital. Grupo con colgajo en isla mediopalmar radial: índice de satisfacción 92%, test de discriminación de 2 puntos 6 mm, puntaje QuickDASH 8, tiempo quirúrgico 60 min; 4 pacientes requirieron reeducación espacial digital. Conclusión: Los colgajos dorsolateral y en isla mediopalmar radial resultaron eficaces en el tratamiento de lesiones traumáticas distales del pulgar, aunque el colgajo dorsolateral tuvo mejores puntajes de evaluación objetiva y requirió menos tiempo quirúrgico. Nivel de Evidencia: III

Objective: To clinically evaluate patients with combined distal thumb lesions treated by a dorsolateral flap or radial midpalmar island flap. Materials and Methods: We retrospectively compared 20 patients (14 males and 6 females, averaging 35 years) with combined distal thumb traumatic lesions, who were operated on by two surgeons using different techniques. Patients had no previous surgical history and a minimum follow-up period of 24 months. Subjective outcome was evaluated by satisfaction index (SI), visual analogue scale (VAS), and QuickDASH score. Objective outcome was evaluated by two-point discrimination test (TPDT), average surgical time (ST), and need for digital spatial reeducation (DSR). Results: Time from admission to medical discharge averaged 7 weeks (range, 6-8). Average postoperative results: VAS for pain, 01/10 (both groups); IS, 97% vs. 92% (dorsolateral flap group vs. radial midpalmar island flap); TPDT, 4 mm vs. 6 mm; QuickDASH, 2.5 vs. 8; ST, 45 minutes vs. 60 minutes; need for DSR, 0 vs. 4 cases. Conclusion: Both the dorsolateral flap and the radial midpalmar island flap techniques were effective in the treatment of distal thumb traumatic lesions, although the dorsolateral flap achieved better objective evaluation scores and required less ST. Level of Evidence: III

Ludoaprendizaje en anatomía: impacto en las concepciones culturales y el afrontamiento cadavérico desde la neurociencia cognitiva / Playbased learning in anatomy: impact on cultural conceptions and cadaveric affronting from cognitive neuroscience

El jugar fue resignificado por Huizinga como un recurso didáctico y se lo denominó "ludoaprendizaje", "aprendizaje mediado por el juego" o "técnicas lúdicas". Diversos autores estudiaron su aplicación en distintos contextos fue desarrollado como estrategia didáctica por los impulsores de la Escuela Nueva. Distintos autores (Brunner, Frebel, Decroly, Montessori, Cossettini y Freire) han analizado sus proyecciones pedagógicas y resaltaron el valor formativo e impacto en las estrategias cognitivas para la resolución de problemas, desarrollar la atención y memoria, así como elemento motivador y de creatividad. El objetivo es evaluar el impacto de esta intervención didáctica en las concepciones culturales y conceptuales referidas al material cadavérico durante el TP y su afrontamiento. Realizamos un sstudio observacional y transversal mediante una encuesta aplicada a 658 alumnos (año 2016=198; año 2017= 228; año 2018= 232) que incluyó la Escala de ansiedad ante la muerte de Temple -EAM- modificada, preguntas poblacionales (edad, sexo, lugar de nacimiento, situación en la materia, aspectos laborales, estudios previos, motivaciones en relación con la elección de la carrera) y se indagaron términos asociados a los conceptos "material cadavérico" y "pieza anatómica" con la técnica de listados libres de Bernard y la técnica de montones para investigar concepciones culturales e imaginarios y grupos de dimensiones conceptuales. Dado que la arquitectura de la Cátedra divide a los alumnos en 2 salones distintos, para evaluar diferencias con la inclusión de actividades lúdicas en un grupo. Los resultados fueron procesados con pruebas de estadística descriptiva e inferencial (SPSS para dicho análisis y realización de dendogramas), para análisis de los términos Visual Anthropac Freelists versión: 1.0.1.36 y Visual Anthropac Pilesorts versión: 1.0.2.60. El presente trabajo cumple con los reparos ético-legales y normativos vigentes. Observamos que los términos "material cadavérico" y "pieza anatómica" se asociaron con repugnancia, asco, miedo y elemento de estudio, principalmente. En el grupo de alumnos con técnicas lúdicas se objetivó menor cantidad de términos negativos, así como dimensiones conceptuales más relacionadas con el material como recurso instruccional didáctico y no como factor de distrés. En conclusión, la implementación de técnicas lúdicas en la didáctica del proceso enseñanza y aprendizaje con material cadavérico en la materia Anatomía se asoció con un menor impacto negativo en los términos asociados y dimensiones conceptuales referidos al material cadavérico. Dicho impacto tiene injerencia en el contexto de la enseñanza y se asociaría con la disminución de factores negativos en el afrontamiento cadavérico.

The act of playing is as ancient as humanity itself, yet Huizinga was the one who re-signified the concept of "ludic" as a didactive resource related to culture. Play-based learning was developed as a didactic strategy by the forerunners of the New School. Several Authors (Brunner, Frebel, Decroly, Montessori, Cossettini and Freire) have analyzed its pedagogy projections and stressed the impact and formative value in the cognitive strategies involved in problem solving tasks, attention and memory development, as well it's motivational and creativity elements. The object of the present work is to evaluate the impact of these didactic interventions in the cultural and conceptual conceptions of the students related to cadaveric material in the course of practical working during anatomy classes. Observational and transversal study through a questionnaire applied to 658 medical students (2016, n = 198; 2017, n= 228; 2018 n=232) which included a Modified Templer Death Anxiety Scale, population questions (age, gender, place of birth, situation regarding the subject, work-related aspects, former studies, motivations related to career choice). Terminology related to "cadaveric material" and "anatomic piece" was investigated with Bernard's free-listing and lot-drawing techniques in order to investigate cultural and imaginary conceptions and groups of conceptual dimensions. The class structure divides the students in two different ckassrooms, in order to evaluate difference with the inclusion of play-based activities in one of them. The results were processed using tests of descriptive and inferencial statistics (SPSS and dendrogram making), to evaluate the terminological analysis, Visual Anthropac Freelists versión: 1.0.1.36 and Visual Anthropac Pilesorts versión: 1.0.2.60. The present research takes into account all current ethical and legal norms. It has been observed that terms such as "cadaveric material" and "anatomic piece" were associated mainly with repugnancy, disgust, fear and study material. It was observed, in the group of student using play based techniques, a lesser number of negative terminology, as well as conceptual dimensions related with the material as a didactic and instructional resource instead of a distress factor. In conclusion the implementation of play-based techniques in the learning process of the Anatomy coursework was positively associated with a lesser negative impact in both associated terminology and in conceptual dimensions related to cadaveric material. Such an impact is of particular importance in the context of teaching and it would relate with the decrease of negative factors in cadaveric affronting.

Diversidad de especies de micobacterias no tuberculosas aisladas en ambientes acuáticos de la ciudad de General Pico, La Pampa, Argentina / Species diversity of non-tuberculous mycobacteria isolated from aquatic environments of General Pico city, Province of La Pampa (Argentina)

Las micobacterias no tuberculosas (MNT) no solo se estudian por su importancia como patógenos oportunistas, sino también por sus aplicaciones en biotecnología y biorremediación. Nuestro objetivo fue determinar la presencia de micobacterias en los distintos hábitats acuáticos de la ciudad de General Pico (provincia de La Pampa), así como su diversidad. Los porcentajes de muestras positivas a micobacterias fueron los siguientes: 37,5% en el sistema de distribución de agua de red, 32,6% en el acuífero que abastece dicho sistema, 36,8% en el agua proveniente de las precipitaciones, 53,1% en los humedales del área de influencia, 80% en los natatorios cubiertos y 33,3% en las fuentes decorativas ubicadas en plazas públicas. De los 90 aislamientos de MNT obtenidos el 8,9% no logró ser identificado a nivel de especie con los métodos utilizados, que incluyeron pruebas fenotípicas y métodos moleculares. Las especies más frecuentemente aisladas fueron Mycobacterium fortuitum y Mycobacterium gordonae. Algunas especies identificadas han sido reportadas en casos de micobacteriosis en nuestro país, entre ellas M. fortuitum, M. gordonae, M. intracellulare, M. vaccae, M. lentiflavum y M. nonchromogenicum. No se aislaron MNT en muestras de agua de red con concentraciones de cloro activo residual mayores de 0,8mg/l, mientras que en los natatorios la presencia de hasta 1,5mg/l de cloro activo residual no fue una limitante para la proliferación de estos microorganismos. Se puede considerar que la incidencia de micobacterias en los ambientes acuáticos de General Pico es cercana al 35%, y que la presencia de estos microorganismos y su diversidad se ve afectada por el contacto con el hombre y sus actividades, como así también por la existencia de vida animal.

Non-tuberculous mycobacteria (NTM) are studied not only for their importance as emerging opportunistic pathogens but also for their applications in biotechnology and bioremediation. Our aim was to determine the occurrence and diversity of mycobacteria in different aquatic habitats of General Pico city, Province of La Pampa. The percentage of samples with positive cultures for mycobacteria were the following: 37.5% recovered from the water supply distribution system; 32.6% from the aquifer that supplies water to the distribution system; 36.8% from rain water; 53.1% from the two wetlands in the area of influence; 80% from indoor swimming pools; and 33.3% from water fountains in downtown public squares. Of the 90 NTM isolates, 8.9% could not be identified at the species level with any of the used methods, phenotypic tests and molecular methods. Mycobacterium fortuitum and Mycobacterium gordonae were the most frequently isolated species. Some of the identified species such as, M. fortuitum, M. gordonae, M. intracellulare, M. vaccae, M. lentiflavum and M. nonchromogenicum, have been reported in cases of mycobacteriosis in Argentina. Mycobacteria with values higher than 0.8mg/ml of residual active chlorine were not recovered from the drinking water supply network, whereas in the swimming pools the presence of up to 1.5 mg/l was not a constraint. Based on our results, the presence of mycobacteria in aquatic environments is close to 35% and their occurrence and diversity is affected both by contact with man and his activities as well as by the existence of animal life.

Ansiedad y afrontamiento cadavérico en alumnos de anatomía / Anxiety and cadaveric coping in anatomy students

En estudios preliminares describimos la importancia clínica e impacto pedagógico del estudio con material cadavérico (MC) en alumnos de Anatomía y hallamos un significativo uso de sustancias psicoactivas (SP), principalmente recursantes y/o alumnos con actividades laborales. La forma de afrontamiento cadavérico (AfC) es un factor de distrés asociado con síntomas (asco, vómitos, alteraciones del sueño), con uso de SP e interfiere el proceso educativo. El objetivo fue evaluar la ansiedad en alumnos con afrontamiento cadavérico negativo. Estudio observacional y transversal mediante encuesta a 740 alumnos que incluyó: Escala de Ansiedad ante la muerte -EAM-, Escala de Ansiedad de Hamilton, preguntas sobre SP y se investigaron términos asociados a conceptos ("material cadavérico", "pieza anatómica"). En alumnos con "afrontamiento cadavérico negativo" (AfCN) (EAM<15, miedo alto/medio con MC y reacciones físicas) se aplicó la Escala de Ansiedad de Hamilton. Se aplicaron parámetros estadísticos, significación p<0,05 y requisitos ético-legales. Objetivamos alta y sostenida prevalencia de alumnos con AfCN, que presentaron mayor puntaje de ansiedad y prevalencia de uso de SP (los ansiolíticos con mayor prevalencia que las sustancias excitatorias); se registró correlación entre cantidad de SP y grado de reacciones negativas (r=0,86). La ansiedad psíquica fue mayor y se asoció con el grado de miedo. Ratificamos alta prevalencia de AfCN que se asoció con mayor nivel de ansiedad y uso de SP, principalmente ansiolíticos. Los síntomas de ansiedad se asociaron con las dimensiones conceptuales registradas y tienen impacto en el proceso de enseñanza-aprendizaje.

In preliminary studies we describe the clinical importance and pedagogical impact of the study with cadaverous material (MC) in Anatomy students and we found a significant using of psychoactive substances (SP), mainly repeating students and/or students with work activities. The form of cadaveric coping (AfC) is a factor of distress associated with symptoms (disgust, vomiting, sleep disturbances), with the use of SP and interferes with the educational process. The objective was to evaluate the anxiety in students with negative cadaveric coping. Observational and cross-sectional study by means of a survey of 740 students that included: Anxiety Scale against death -EAM-, Hamilton Anxiety Scale, questions about SP, and terms related to concepts ("cadaverous material", "anatomical piece") were investigated. In students with "negative cadaveric coping" (AfCN) (EAM <15, high / medium fear with CM and physical reactions) the Hamilton Anxiety Scale was applied. Statistical parameters, significance p <0.05 and ethical-legal requirements were applied. We aimed at high and sustained prevalence of students with AfCN, who presented higher scores of anxiety and prevalence of SP use (anxiolytics with higher prevalence than excitatory substances); correlation was recorded between the amount of SP and the degree of negative reactions (r = 0.86). The psychic anxiety was greater and was associated with the degree of fear. We confirmed a high prevalence of AfCN that was associated with a higher level of anxiety and use of SP, mainly anxiolytics. The symptoms of anxiety were associated with the registered conceptual dimensions and have an impact on the teachinglearning process.

Antiplasmodial evaluation of Anacardium occidentale and alkyl-phenols

Abstract The ethanol crude extract from cashew (Anacardium occidentale L. Anacardiaceae) displayed significant antiplasmodial activity (IC50 0.577 µg/ml). Liquid chromatography-high resolution Mass spectrometry analysis was performed to identify the main compounds existing in the ethanol extract. The occurrence of anacardic acids, cardols, and 2-methylcardols derivatives was confirmed in the extract. The IC50 obtained, when the main isolated compounds were evaluated in Plasmodium falciparum D6 strain, ranged from 5.39 µM to >100 µM. Tested here for the first time, the data showed that cardol triene 1 (IC50 = 5.69 µM) and 2-methylcardol triene 4 (IC50 = 5.39 µM) demonstrated good antimalarial activity. In conclusion, Anacardium occidentale nuts presented relevant biological potential, and further studies should be considered.

Ideas para desarrollar una psicoterapia congruente con las características culturales argentinas: aplicando el modelo de la consonancia cultural / Ideas to develop a psychotherapy congruent with argentinian cultural characteristics:applygin the cultural match model

Muchos modelos psicoterapéuticos estudian al individuo en ausencia de su contexto y características culturales. Lamentablemente, esta carencia limita la eficacia de estos modelos psicoterapéuticos en la Argentina. Estas deficiencias son particularmente pronunciadas en la medida que estos modelos difieren de las características típicas de la Argentina. En este trabajo describimos el modelo de la consonancia cultural para incluir la contribución de las variables culturales y el contexto cultural para la generación de una psicoterapia con apoyo empírico que refleje las características argentinas. Para lograr este fin comenzamos por describir tres características típicas de la Argentina. Luego presentamos dos ejemplos clínicos que describen cómo beneficiarse de las variables culturales y el contexto cultural en el proceso psicoterapéutico. Concluimos con algunas ideas para implementar adaptaciones de tratamientos psicológicos al contexto local argentino

Many psychotherapeutic models study the individual in the absence of their cultural characteristics and contexts. Unfortunately, this lack of information limits the effectiveness of these psychotherapeutic models in Argentina. These deficiencies are particularly pronounced since these models are based on settings that differ from the typical characteristics of Argentina. In this work, we describe the cultural match model that includes the contribution of cultural variables, and the cultural context. Our aim is to generate an empirically supported psychotherapy that reflects the Argentinian background. To achieve this goal, we begin by describing three typical characteristics of Argentina. We then present two concrete clinical examples that illustrate how to benefit from the cultural variables and the cultural context in the psychotherapeutic process. We conclude with some ideas to implement adaptations of psychological treatments to the local Argentinian context

Rehabilitación vestibular de la Enfermedad de Meniere en el estadio tardío: Reporte de un caso / Vestibular rehabilitation of Meniere's Disease in its chronic stage: A case report

La enfermedad de Meniere (EM), se caracteriza por ataques fluctuantes de vértigos, hipoacusia y acúfenos. Una vez que se controlan los síntomas agudos, la rehabilitación vestibular es una alternativa de tratamiento efectiva. Se presenta el caso de una mujer de 46 años con EM en la fase crónica que presenta persistencia de vértigo postural e inestabilidad de la marcha, quien fue intervenida con maniobras de reposición y rehabilitación vestibular con ejercicios de adaptación y sustitución, ejercicios de habituación del equilibrio vestibular y de control postural. Se obtuvo una respuesta favorable, con desaparición del vértigo posicional, disminución significativa de la inestabilidad y gran mejoría en su calidad de vida. No se puede llegar a conclusiones con un solo caso, sin embargo, es importante el abordaje integral en el tratamiento de pacientes con EM. (AU)

Meniere's disease presents fluctuating attacks of dizziness, hearing loss and tinnitus. Once acute symptoms are controlled, vestibular rehabilitation is an effective treatment alternative. We present the case of a 46-year-old woman with Meniere's disease in the chronic phase, who presented persistent postural vertigo and gait instability and who was treated with repositioning maneuvers, along with vestibular rehabilitation with adaptation, substitution and habituation exercises, vestibular balance and postural control. A favorable response is achieved, with the disappearance of positional vertigo, a significant decrease in instability and a great improvement in her quality of life. No conclusions can be drawn from a single case; however, a comprehensive approach is important in the treatment of patients with MS. (AU)

Associação à positividade da Lawsonia intracellularis com a expressão clínico-patológica da infecção em suínos da região metropolitana de Bucaramanga (Santander, Colômbia) / Association to positivity of Lawsonia intracellularis with the clinical and pathologic expression of infection in swine from the metropolitan area of Bucaramanga (Santander, Colombia)

Porções de íleo terminal foram coletados de 100 suínos com sinais de doença gastrointestinal na área metropolitana de Bucaramanga, a fim de se estudar a eficiência do diagnóstico de enteropatia proliferativa suína (PPE) pela técnica de PCR aninha (PCRa) empregando sequências específicas (primers) para L. intracellularis: 16S ARN região (270pb) e sua correlação com achados clínicos e patológicos. Todas as amostras foram processadas para se determinar a associação entre positividade por PCR, os sinais clínicos, os achados de necropsia e as lesões histológicas. Cinquenta e seis por cento das amostras foram positivas para L. intracellularis pela PCRa. Só 2% exibiram resultados positivos pela técnica Warthin-Starry. Trinta e um de 100 animais com sinais de anorexia resultaram positivos para PCRa (P>0,05). Não houve associação (P<0,05) entre diarreia e queda no crescimento, bem como associação (P<0,05) entre achados anatomopatológicos e histológicos com PCRa positivas.(AU)

Fragments of terminal ileum were collected from 100 pigs at slaughter from Bucaramanga Metropolitan Area (Santander, Colombia), to study the efficacy of the diagnosis of porcine proliferative enterophaty (PPE) through the technique of nested polymerase chain reaction (PCRa), employing specific sequences (primers) for L. intracellularis: 16S ARN region (270pb) and his correlation with clinic and pathological findings. All samples were processed by standard histological methods and stained with a Warthin-Starry technique. All samples were processed to determinate the association between positive PCRa results, clinical signs and necropsy findings. 56% of the 100 samples were positive for L. intracellularis through PCRa technic. Only 2% exhibited positive results through Warthin-Starry technique. A total of 31 (100) animals with anorexic symptoms were associated with positive results from PCRa (P>,05). No associations (P<0.05) were observed between diarrhea and delayed growth. No associations (P<0.05) were observed between anatomopathological and histological findings with positive PCRa.(AU)

Uso de drogas de diseño en fiestas electrónicas: aspectos clínicos, neuropsiquiátricos, epidemiológicos y de intervención prehospitalaria / Use of designer drugs in electronic parties: clinical, neuropsychiatric, epidemiological and prehospital intervention aspects

Introducción: Las llamadas "fiestas electrónicas" permitieron la generalización del uso de drogas de diseño (DdD) para disminuir el cansancio, las inhibiciones y aumentar la empatía entre los asistentes. Objetivo: Presentar los resultados de prevalencia, aspectos neuropsiquiátricos, clínicos y epidemiológicos del uso de DdD en fiestas electrónicas. Material y método: Realizamos un estudio de campo, observacional y transversal, mediante encuesta estandarizada, normatizada y anónima para consignar parámetros clínicos y neuropsiquiátricos en 138 asistentes a fiestas electrónicas que mediante demanda espontánea o requerida por terceros fueron evaluados por médicos y refirieron consumo de DdD. Se aplicaron parámetros estadísticos y se cumplieron normas éticas. Resultados: Objetivamos un alto consumo de alcohol, con alta prevalencia de uso comórbido con otras sustancias de diseño como el éxtasis y GHB. Los consumidores de GHB presentaron disminución de parámetros clínicos con un síndrome inhibitorio, en contraste con los valores aumentados en usuarios de éxtasis. Conclusión: La diferencia en las manifestaciones clínico-neuropsiquiátricas tienen sustento en aspectos neurobiológicos del mecanismo de acción y condicionan el tratamiento prehospitalario.

Introduction: The so-called "electronic parties" allowed the widespread use of designer drugs (DOD) to reduce fatigue, inhibitions and increase empathy among participants. Objective: To present the results of prevalence, neuropsychiatric, clinical and epidemiological aspects of the use of DoD in electronic parties. Material and Methods: We conducted a field study, observational and transversal, through standardized, Normatized and anonymous survey to record clinical and neuropsychiatric parameters 138 attendees electronic parties that by spontaneous or required by third application were evaluated by physicians and reported consumption of DOD. Statistical parameters were applied and ethical standards were met. Results: We objectify a high consumption of alcohol, with high prevalence of comorbid use design with other substances like ecstasy and GHB. GHB consumers had decreased clinical parameters with an inhibitory syndrome, in contrast to the values increased in users of ecstasy. Conclusions The difference in clinical and neuropsychiatric manifestations have support in neurobiological aspects of the mechanism of action and determine the prehospital treatment.

Tratamiento quirúrgico de las fracturas mediodiafisarias desplazadas de clavícula mediante placas precontorneadas con técnica mininvasiva / Surgical treatment of clavicle displaced midshaft fractures with pre-contoured plates using mini invasive technique (MIPO)

Introducción: Las fracturas mediodiafisarias de clavícula representan hasta el 10% de las fracturas del esqueleto. El tratamiento conservador brinda buenos resultados con baja incidencia de complicaciones. Sin embargo, en trazos desplazados, multifragmentarios o con deformidad significativa, se debe considerar la cirugía. El propósito de esta serie retrospectiva es exponer nuestra experiencia en el tratamiento de fracturas cerradas, desplazadas y mediodiafisarias de clavícula con placas precontorneadas mediante la técnica MIPO, describir la técnica y los resultados funcionales preliminares. Materiales y Métodos: Serie retrospectiva de 13 pacientes (11 varones [84,6%] y 2 mujeres [15,4%]), media de la edad: 31 años, con fracturas diafisarias cerradas desplazadas de clavícula de tipo 2B de Robinson (Edimburgo), tratadas mediante reducción y osteosíntesis con placas precontorneadas con MIPO, entre abril de 2010 y noviembre de 2013. Seguimiento promedio: 13 meses (rango 11-25). Se realizaron controles radiográficos y tomografías computarizadas, valorando la funcionalidad mediante las escalas de Constant-Murley modificada, QuickDASH y el dolor con la escala analógica visual. Resultados: El tiempo promedio hasta la cirugía fue de 8 días; la cirugía duró 35 minutos y el tiempo de internación posoperatoria fue de 1.28 días. La consolidación clínico-radiológica se registró en una media de 15.2 semanas. El puntaje promedio de Constant-Murley modificado fue 88; el de QuickDASH, 26,9 y la escala analógica visual arrojó un valor de 0,3. No hubo complicaciones sistémicas ni cosméticas. Conclusión: La osteosíntesis mínimamente invasiva en fracturas cerradas mediodiafisarias desplazadas de clavícula representó una técnica reproducible con un tiempo quirúrgico reducido y puntajes funcionales aceptables, sin complicaciones de relevancia. Nivel de Evidencia: IV

Introduction: Midshaft clavicular fractures represent up to 10% of skeleton fractures. Conservative treatment usually provides good results with low incidence of complications. However, surgical treatment should be considered in displaced, multifragmentary fractures or cases with significant deformity. The purpose of this retrospective case series is to report our experience in the treatment of closed and displaced midshaft clavicular fractures with pre-contoured plates using MIPO technique, to describe the technique and report preliminary functional results. Methods: Retrospective series of 13 patients (11 males [84.6%] and 2 females [15.4%], mean age: 31 years), with closed and displaced midshaft clavicle fractures classified as type 2B according to Robinson (Edinburgh) treated by reduction and internal fixation with pre-contoured plates osteosynthesis using minimally invasive technique (MIPO) between April 2010 and November 2013. Mean follow-up: 13 months (range 11-25). Radiographic and tomographic controls were carried out to assess function using modified Constant-Murley scale, QuickDASH Questionnaire and the visual analogue scale to evaluate pain. Results: Average time to surgery was 8 days, surgical time: 35 minutes, days in hospital after surgery: 1.28. Clinical and radiological consolidation was recorded at 15.2 weeks on average. The average modified Constant-Murley score was 88, QuickDASH 26.9 and visual analogue scale 0.3. No systemic or cosmetic complications were recorded. Conclusion: Minimally invasive plate osteosynthesis (MIPO) in displaced and closed midshaft clavicle fractures represented a reproducible technique with reduced surgical time and acceptable functional scores. Level of Evidence: IV

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

ABSTRACT Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them.

High Intensity Interval Training Increases Natural Killer Cell Number and Function in Obese Breast Cancer-challenged Mice and Obese Women

High intensity interval training (HIIT) boosts natural killer (NK) cell number and activity in normal weight breast cancer patients; however, whether this occurs in obese individuals is not well established. The goal of this study was to determine whether HIIT effectively boosts NK cells as a therapeutic strategy against breast cancer in an obese mouse model and in overweight/obese women. Diet induced female C57Bl/6 obese mice were assigned to undergo HIIT for four weeks or remain sedentary. Female participants were subjected to a six weeks HIIT protocol. HIIT mice acclimatized to treadmill running were subsequently injected with 5 × 105 polyoma middle T (MT) breast cancer cells intravenously. NK cell number and activation were monitored using flow cytometry, and tumor burden or lipid content evaluated from histological lung and liver tissues, respectively. In both mice and humans, circulating NK cell number and activation (CD3−NK1.1+CD27+ and CD3−CD56+, respectively) markedly increased immediately after HIIT. HIIT obese mice had reduced lung tumor burden compared to controls following MT challenge, and had diminished hepatic lipid deposition despite minimal body weight loss. Our findings demonstrate that HIIT can benefit obese individuals by enhancing NK cell number and activity, reducing tumor burden, and enhancing metabolic health.

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente / Treatment of genitourinary syndrome of menopause by CO2 fractional laser: an emerging therapeutic option

Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.

Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

Utilidad farmacoclínica de los antidepresivos ISRS en la impulsividad y la agresividad / Utility of SSRI antidepressants in the treatment of impulsivity and aggression

Introducción: Estudios preliminares sobre neurobiología de la agresividad impulsiva destacaron el papel de la serotonina para inhibir la conducta violenta que se relacionaría con la impulsividad, pero no con la agresividad. En el ámbito carcelario las conductas agresivas e impulsivas presentan una alta prevalencia y requieren su abordaje por el equipo interdisciplinario de Salud Mental. Objetivos: Determinar la utilidad farmacoclínica de antidepresivos ISRS en el tratamiento de la impulsividad y la agresividad, y sus especificidades clínicas y poblacionales. Material y Método: Estudio observacional y transversal mediante evaluación de historias clínicas de 104 masculinos con pena privativa de la libertad. Se evaluaron psicopatológicamente y se valoraron los resultados obtenidos en 4 escalas de seguimiento clínico para impulsividad y agresividad. Al subgrupo con resultado positivo en al menos 2 escalas y en la evaluación clínica (n=30) se les indicó un ISRS (paroxetina o sertralina) a su plan farmacológico y se los reevaluaron en 2 tiempos posteriores. Se aplicaron parámetros estadísticos y se cumplimentó con requisitos ético-legales. Resultados: Al analizar las subescalas de la ABS hallamos que el parámetro de agresividad y el de desinhibición fueron los que más respondieron de forma significativa (25.96%, 21.43%; p<0.01). El análisis de la escala IRS arrojó que las subescalas de tiempo para toma de decisiones y de capacidad para diferir disminuyeron significativamente (p<0.01), mientras que la de agresividad y de paciencia/impaciencia tuvieron menor significación estadística (p<0.05). Conclusiones: Los inhibidores selectivos de recaptación de serotonina tienen eficacia y utilidad clínica en el tratamiento de pacientes con comportamientos impulsivo-agresivos con particularidades asociadas a otros fármacos, diagnóstico psicopatológico y tipo de agresividad.

Introduction: Preliminary Studies on neurobiology of impulsive aggression highlighted the role of serotonin to inhibit violent behavior that would be related to impulsivity, but not aggressive. In prisons, aggressive and impulsive behaviors have a high prevalence and require interdisciplinary team approach for Mental Health. Objectives: To determine the utility of SSRI antidepressants in the treatment of impulsivity and aggression, and its clinical and population specific. Material and method: Observational and transversal study through evaluation of medical records of 104 men in prision. Psychiatrically evaluated and the results obtained in four scales for clinical follow-up were evaluated impulsivity and aggressiveness. The subgroup with a positive result in at least 2 scales and clinical evaluation (n = 30) were prescribed an SSRI (paroxetine or ser traline) to your drug plan and the re-evaluated in two later times. Statistical parameters were applied and complied with ethical and legal requirements. Results: to analyze ABS ́s subscales we found that aggressiveness and disinhibition settings were the ones that responded significantly (25.96%, 21.43%; p<0.01). The analysis of the IRS scale showed that time for decision making scale and ability to differ subscales decreased significantly (p<0.01), while aggressiveness and patience/impatience ones had less statistical significance. Conclusions: Selective serotonin reuptake inhibitors have clinical utility and effectiveness in the treatment of patients with impulsive-aggressive behavior associated with drugs other particularities, psychopathological diagnosis and aggressive type