Características clínicas y epidemiológicas asociadas con internación en niños con COVID-19 en un hospital pediátrico de alta complejidad: Estudio de cohorte enero-marzo 2022 / Clinical and epidemiologic characteristics associated with hospital admission in children with COVID19 in a tertiary-care pediatric hospital: A January-March 2022 cohort study

Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)

Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)

Adaptación transcultural de la versión colombiana de la Escala de Soledad de UCLA en pacientes con diagnóstico de cáncer / Transcultural adaptation of the Colombian version of the UCLA Loneliness Scale in patients diagnosed with cancer

Resumen Introducción: La soledad no deseada es un constructo que se ha relacionado con desenlaces negativos en diferentes aspectos de la salud, incluidos aquellos de los pacientes con cáncer. La escala de soledad de UCLA es un instrumento ampliamente utilizado en el contexto de investigación en salud para medir dicho constructo, y en Colombia la versión 03 de dicho instrumento no se encuentra traducida, ni adaptada transculturalmente. Objetivo: Traducir y adaptar transculturalmente la escala de soledad de UCLA, versión 03 para su uso en pacientes con cáncer en Colombia. Métodos: El proceso de traducción y adaptación transcultural siguió la metodología propuesta por el grupo EORTC, con el objetivo de lograr la equivalencia semántica con la versión original de la escala disponible en inglés. Se realizó una prueba piloto con 20 pacientes colombianos diagnosticados con diferentes tipos de cáncer, que asistieron al Instituto Nacional de Cancerología de Colombia. Resultados: No hubo cambios ni en la traducción de instrucciones ni en las opciones de respuesta. En la versión conciliada se modificó el ítem UC1. En la prueba piloto, dos de 20 pacientes informaron que los ítems UC6, UC7, UC11 y UC19 deberían ser modificados y un paciente mencionó que el ítem UC8 era difícil de entender; sin embargo, no se hicieron cambios dado el bajo número de pacientes que reportaron estos hallazgos, y las sugerencias planteadas podían cambiar el sentido y la equivalencia de los ítems de la escala original. Ninguno de los ítems fue ofensivo para los pacientes. Conclusión: Se generó una versión traducida y adaptada transculturalmente para ser validada en pacientes con cáncer en Colombia.

Abstract Introduction: Unwanted loneliness is a construct that has shown relationships with different negative outcomes of health, including those of patients with cancer. In the context of health research, the UCLA loneliness scale is a widely used instrument for measuring this construct. In Colombia, the 03 version of this instrument has still not been neither translated, nor transculturally adapted. Objective: To translate and perform transcultural adaptation of the UCLA loneliness scale, version 03 for its use in patients having cancer in Colombia. Methods: The process of translation and transcultural adaptation followed the methodology proposed by the EORTC group, aimed at achieving semantic equivalence with the original version of the scale. A pilot test has been made with 20 Colombian patients diagnosed with different types of cancer, attending the Instituto Nacional de Cancerología, Colombia. Results: In the reconciliated version, item UC1 has been modified. There has been not changes neither in translation of instructions, nor in response options. In pilot testing two out of 20 patients reported that items UC6, UC7, UC11 y UC19 should be modified and one patient mentioned that item UC8 was difficult to understand; however, no changes were made taking into account the low number of patients describing similar findings, and because these suggestions could change the semantic equivalence of these items. No items were deemed offensive. Conclusion: It is available a transculturally adapted version of the UCLA loneliness scale, version 03 for its validation in patients with cancer in Colombia.

Cobalamin cbiP mutant shows decreased tolerance to low temperature and copper stress in Listeria monocytogenes

BACKGROUND: Listeria monocytogenes is a foodborne pathogen that causes listeriosis in humans. This pathogen activates multiple regulatory mechanisms in response to stress, and cobalamin biosynthesis might have a potential role in bacterial protection. Low temperature is a strategy used in the food industry to control bacteria proliferation; however, L. monocytogenes can grow in cold temperatures and overcome different stress conditions. In this study we selected L. monocytogenes List2-2, a strain with high tolerance to the combination of low temperature +copper, to understand whether the cobalamin biosynthesis pathway is part of the tolerance mechanism to this stress condition. For this, we characterized the transcription level of three cobalamin biosynthesis related genes ( cbiP , cbiB, and cysG ) and the eutV gene, a transcriptional regulator encoding gene involved in ethanolamine metabolism, in L. monocytogenes strain List2-2 growing simultaneously under two environmental stressors: low temperature (8 °C) +copper (0.5 mM of CuSO4 ×5H2O). In addition, the gene cbiP , which encodes an essential cobyric acid synthase required in the cobalamin pathway, was deleted by homologous recombination to evaluate the impact of this gene in L. monocytogenes tolerance to a low temperature (8 °C) +different copper concentrations. RESULTS: By analyzing the KEGG pathway database, twenty-two genes were involved in the cobalamin biosynthesis pathway in L. monocytogenes List2-2. The expression of genes cbiP , cbiB, and cysG, and eutV increased 6 h after the exposure to low temperature +copper. The cobalamin cbiP mutant strain List2-2Δ cbiP showed less tolerance to low temperature +copper (3 mM) than the wild type L. monocytogenes List2-2. The addition of cyanocobalamin (5 nM) to the medium reverted the phenotype observed in List2-2Δ cbiP . CONCLUSION: These results indicate that cobalamin biosynthesis is necessary for L. monocytogenes growth under stress and that the cbiP gene may play a role in the survival and growth of L. monocytogenes List2-2 at low temperature +copper.

Eventos adversos supuestamente atribuibles a la vacunación e inmunización asociados a la vacuna anti-COVID-19 Sputnik V en el personbal del hospital Juan P. Garrahan / Adverse events allegedly attributable to vaccination and immunization with the anti-COVID-19 Sputnik V vaccine in the staff of the Hospital Juan P. Garrahan

Introducción: Debido a la emergencia provocada por la pandemia por el virus SARS-CoV-2 se ha producido una crisis sanitaria global. Una vez disponibles las vacunas, se espera que jueguen un rol decisivo para el control de la enfermedad. Dichas vacunas fueron desarrolladas en tiempo récord por lo que es esencial monitorear su seguridad. Durante la Campaña de Vacunación contra COVID-19, todos los Eventos supuestamente atribuibles a vacunación e inmunización (ESAVI) debieron ser notificados al Ministerio de Salud de la Nación a través del Sistema Integrado de Información Sanitaria de Argentina (SIISA). Materiales y métodos: Se realizó un estudio observacional prospectivo desde el 04/01/2021 al 05/05/2021 en el personal del Hospital Garrahan. Se utilizaron dos métodos de vigilancia de ESAVI. La vigilancia pasiva incluyó las notificaciones voluntarias recibidas de forma telefónica y a través de un cuestionario publicado en intranet. La vigilancia activa se realizó sobre los primeros 947 trabajadores inmunizados, enviando el mismo cuestionario por WhatsApp. Resultados: Hasta el día 05/05/2021 fueron inmunizados 5056 agentes, 4865 con las dos dosis. Se notificaron 473 ESAVI. De ellos, 304 correspondían a la primera dosis y 169 a la segunda. La cantidad de notificaciones según su origen fue de 136 para la vigilancia pasiva, y 333 para la vigilancia activa. Se registraron 5 ESAVI graves; tres anafilaxias, un escotoma secundario a la hipertermia generada por la vacuna y una reacción alérgica grave. Los síntomas locales más frecuentes fueron: dolor, enrojecimiento, hinchazón e induración. Los síntomas sistémicos más frecuentes fueron: fiebre, febrícula, astenia, cefalea, mialgia, artralgia y síntomas gastrointestinales. Como tratamiento en la mayoría de los casos se utilizó paracetamol. Discusión: El presente trabajo logró recolectar un número significativo de notificaciones, brindando información útil al tratarse de una vacuna recientemente aprobada en nuestro país y el mundo. (AU)

Introduction: Due to the SARS-CoV-2 pandemic emergency, a global health crisis has occurred. Once vaccines become available, they are expected to play a decisive role in controlling the disease. These vaccines were developed in record time, and therefore it is essential to monitor their safety. During the COVID-19 Vaccination Campaign, all Events Suspected to be Attributable to Vaccination and Immunization (ESAVI) had to be notified to the National Ministry of Health through the Integrated Health Information System of Argentina (SIISA). Material and methods: A prospective observational study was conducted from 04/01/2021 to 05/05/2021 in the staff of Garrahan Hospital. Two methods of ESAVI surveillance were used. Passive surveillance included voluntary notifications received by telephone and through a questionnaire posted on intranet. Active surveillance was conducted on the first 947 immunized workers, sending the same questionnaire by WhatsApp. Results: Up to 05/05/2021, 5056 workers were immunized, of whom 4865 with two doses. A total of 473 ESAVI were reported. Of these, 304 corresponded to the first dose and 169 to the second. The number of notifications was 136 for passive surveillance and 333 for active surveillance. Five severe ESAVIs were recorded; three anaphylaxis, one scotoma secondary to vaccine-generated hyperthermia, and one severe allergic reaction. The most frequent local symptoms were: pain, redness, swelling, and induration. The most frequent systemic symptoms were: mild fever or fever, asthenia, headache, myalgia, arthralgia, and gastrointestinal symptoms. Paracetamol was used as treatment in most cases. Discussion: In the present study a significant number of notifications was collected, providing useful information on a vaccine recently approved in our country and in the world (AU)

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

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

Predicting soil CO2 emissions and sinks due to soil management factors of Brachiaria decumbens pastures using Tier 2 IPCC Methodology / Predicción de emisiones y sumideros de CO2 del suelo debido a factores de manejo del suelo de Brachiaria decumbens usando Tier 2 metodología IPCC

ABSTRACT Soil carbon sequestration refers to the process of transferring carbon dioxide (CO2) from the atmosphere into the soil. The objective of this research was to do a simulation of how soil management factors in pastures can contribute to mitigate climate change by reducing soil CO2-eq emissions due to increases of soil organic carbon.In livestock systems of Cumaral (Meta), Colombia, IPCC Tier 2 methodology was used to compare changes in soils C stocks under (a) two pasture types: Brachiaria decumbens grass pastures (B1) and Brachiaria decumbens grass pastures associated with Pueraria phaseloides legume (B2); (b) four increasing doses of CaCO?: 0, 1.1, 2.2, 3.3 tons ha-1; (c) three sources of N, P, K fertilizers: 100 kg ha-1 Urea, 200 kg ha-1 Triple Superphosphate and 100 kg ha-1 Potassium Chloride. The statistical design was a randomized complete block in factorial arrangement 2 x 4 x 3. Tukey test indicated that the inclusion of kudzú in B. decumbens pasture (B2), 2.2 and 3.3 tons CaCO3 ha-1 in both pastures, and the fertilization of B1 with Urea and B2 with Triple Superphosphate presented a greater benefit in soil C accumulation and CO2-eq emissions neutralization. Adittional cluster analysis showed that B2 liming with higher lime doses regardless of the type of fertilizer used presented major soil C stored grouped in Cluster 1. We concluded that these soil management factors should be feasible to implement in pastures, that can help offset the negative effects of global climate change on livestock systems at tropical zones.

RESUMEN El secuestro de carbono en el suelo se refiere al proceso de transferencia de dióxido de carbono (CO2) de la atmósfera al suelo. El objetivo de esta investigación fue hacer una simulación de cómo los factores de manejo del suelo en pasturas, pueden contribuir a mitigar el cambio climático al reducir las emisiones de CO2-eq del suelo debido a los aumentos de acumulación de carbono orgánico en el suelo. En sistemas ganaderos de Cumaral (Meta), Colombia, se utilizó la metodología Tier 2 del Panel Intergubernamental sobre Cambio Climático (IPCC) para comparar los cambios en las existencias de C del suelo en (a) dos tipos de pasturas: pasturas de pasto Brachiaria decumbens (Bl) y pasturas del pasto Brachiaria decumbens asociadas con leguminosa de Pueraria phaseloi-des (B2); cuatro dosis crecientes de CaCO?: 0, l.l, 2.2, 3.3 tons ha1; y (c) tres fuentes de fertiliantes N, P, K: 100 kg ha-1 Urea, 200 kg ha-1 Superfosfato triple y 100 kg ha-1 Cloruro de potasio. El diseño estadístico fue un bloques completos al azar en arreglo factorial 2 x 4 x 3. El test de Tukey indicó que la inclusión de la leguminosa en la pastura (B2), la aplicación de 2.2 y 3.3 tons CaCO3 ha-1 en ambas pasturas y la fertilización de B1 con Urea y de B2 con Superfosfato triple presentaron un mayor beneficio en la acumulación de C del suelo y la neutralización de las emisiones de CO2-eq. El análisis de cluster adicional mostró que B2 encalada con más altas dosis de cal indistintamente del tipo de fertilizante usado presentaron mayor almacenamiento de C del suelo agrupados en el Cluster 1. Nosotros concluimos que estos factores de manejo de suelos deberían ser factibles de implementar en pasturas, lo que puede ayudar a compensar los efectos negativos del cambio climático global en los sistemas ganaderos de zonas tropicales.

Osificación heterotópica de cadera asociada a pancreatitis aguda severa: reporte de un caso / Hip heterotopic ossification associated with severe acute pancreatitis: a case report

La osificación heterotópica (OH), es la formación anormal de hueso maduro dentro de tejidos blandos extra esqueléticos donde normalmente no existe tejido óseo. Varias formas de OH han sido descritas de acuerdo a su presentación clínica, localización y ocurrencia progresiva o aislada. Su presentación en pacientes sometidos a inmovilización prolongada en el contexto de coma farmacológicamente inducido, en ausencia de lesiones del sistema nervioso central, es poco habitual. Presentamos el caso de una paciente de 40 años, sexo femenino, sin antecedentes mórbidos, que presenta episodio de pancreatitis aguda grave, manejada en UCI. Producto de lo anterior, requiere coma farmacológicamente inducido por 3 meses y hospitalizaciones reiteradas y prolongadas durante los 10 meses siguientes. Durante 3 años desde la resolución de su cuadro inicial evoluciona con alteración progresiva de la marcha y rigidez de la extremidad inferior derecha, sin eventos traumáticos durante ese período. Se objetiva mediante radiografía y TAC foco de OH coxofemoral derecha. Se resuelve de forma quirúrgica y biopsia de pieza operatoria confirma el diagnóstico. La paciente logra buena recuperación posterior. NIVEL DE EVIDENCIA: IV

Heterotopic ossification (HO) is the abnormal formation of mature bone within extraskeletal soft tissues where bone does not exist. Various presentation of HO have been described according to the clinical settings and location of the lesions, and progressive or isolated occurrence. A rare form of presentation occurs in induced coma patients with long-term immobilization and without central nervous system injuries. We present the case of a 40 years old female patient, without previous morbidity, who develop a severe acute pancreatitis. The patient requires an intensive care unit management (ICU) and a 3-month pharmacology induced coma and reiterative and prolonged hospitalizations during the next 8 months. During 3 years after resolution of her base disease, patient develops a progressive step claudication and a hip rigidity in adduction and external rotation. A coxofemoral HO focus is confirmed by radiology and CT. A surgical treatment of HO was performed, and the initial diagnose confirmed by anatomic pathology after biopsy of the injury. Patient had a favorable outcome.

Experiencias perceptuales inusuales en personal de enfermería y su relación con estrés laboral, esquizotipia, absorción y empatía / Unusual perceptual experiences among nursing staff and their relation to work stress, schizoid features, absorption, and empathy / Experiências perceptuais incomuns em pessoal de enfermagem e sua relação com estresse laboral, esquizotipia, absorção e empatia

El objetivo de este estudio fue determinar la frecuencia de ciertas experiencias perceptuales inusuales en entornos hospitalarios, las denominadas Experiencias Anómalo/Paranormales con frecuencia reportadas por médicos y enfermería en el ámbito hospitalario. También, comparar el grado de estrés laboral, propensión a la esquizotipia, absorción psicológica y empatía con el paciente entre enfermera/os con experiencias y sin experiencias. Se administraron tres escalas a 344 enfermera/os de 36 hospitales y centros de salud de Buenos Aires, Argentina, que fueron agrupados entre 235 con experiencias y 109 sin experiencias. Las experiencias más comunes son sensación de presencia y/o apariciones, oír ruidos, voces o diálogos, llantos o quejas, experiencias intuitivas y extrasensoriales en relación con sus pacientes, o bien la recepción de experiencias por parte de sus propios pacientes, tales como experiencias cercanas a la muerte, prácticas de oración o intervenciones religiosas con sanaciones espontáneas, y otras experiencias anómalas relacionadas con niños. Las enfermera/os con experiencias tienden a experimentar mayor estrés laboral, sin embargo quienes quedaron en el grupo con experiencias obtuvieron una puntuación más alta en el factor Despersonalización que los del grupo sin experiencias. Asimismo, en el grupo con experiencias existió mayor absorción y tendencia a la esquizotipia, así como mayor empatía cognitiva y comprensión emocional que los de sin experiencias. Desafortunadamente, al personal de enfermería, le falta capacitación para abordar de manera adecuada el proceso de morir y el duelo, se remarca esta ausencia y se rescata la importancia del conocimiento y abordaje de estos fenómenos.

The objective of this study was to explore the frequency of certain unusual perceptual experiences within hospital environments - those denominated anomalous and paranormal experiences - which are reported by medical and nursing personnel, and to compare the degree of work stress, schizoid features tendency, absorption and empathy with the patient. Three scales were used with 344 nurses from 36 hospitals and health centers in Buenos Aires, Argentina, grouped in those who had had these unusual experiences (n = 235) and those who had not (n = 109). The related most common unusual experiences included feeling a presence, listening to noises, voices, dialogs, cries, or complaints, having extra-sensorial or intuitive feelings related to the patients, and/or their own patients feeling the same situations in addition to other death proximity, praying, and spontaneous healings related experiences, and others experiences manifested by children. Regarding the results, the nurses who had these unusual experiences, also had higher scores in the factor Depersonalization, showing more absorption and schizoid features tendency, as well as more cognitive empathy and emotional comprehension, in comparison to those nurses who had not had these unusual experiences. We believe that some nurses could be better trained in order to adequately address their patients' suffering and dying processes.

O objetivo deste estudo foi a frequência de certas experiências perceptuais incomuns em ambientes hospitalares, as denominadas Experiências Anômalo/Paranormais com frequência informadas por médicos e enfermagem no âmbito hospitalar. Também, comparar o grau de estresse laboral, propensão à esquizotipia, absorção psicológica e empatia com o paciente entre enfermeira/os com experiências e sem experiências. Administraram-se três escalas a 344 enfermeira/os de 36 hospitais e centros de saúde de Buenos Aires, Argentina, que foram agrupados entre 235 com experiências e 109 sem experiências. As experiências mais comuns são sensação de presença e/ou aparições, ouvir barulhos, vozes ou diálogos, prantos ou queixas, experiências intuitivas e extra-sensoriais em relação com seus pacientes, ou bem a recepção de tais experiências por parte de seus próprios pacientes, tais como experiências próximas à morte, práticas de oração ou intervenções religiosas com curas espontâneas, e outras experiências anômalas relacionadas com crianças. As enfermeiras/os com experiências tendem a experimentar maior estresse laboral, porém quem ficou no grupo com experiências obteve uma pontuação mais alta no fator Despersonalização que os do grupo sem experiências. Assim mesmo, no grupo com experiências existiu maior absorção e tendência à esquizotipia, assim como maior empatia cognitiva e compreensão emocional que os de sem experiências. Infelizmente, pessoal de enfermagem tem falta capacitação para tratar em forma adequada o processo de morrer e o luto, assim, se ressalta esta ausência e se resgata a importância do conhecimento a abordagem destes fenómenos.

Monitoramento e conservação genética de populações naturais de Prochilodus lineatus dos rios Pardo, Mogi-Guaçu e Tietê, São Paulo / Monitoring and conservation genetics of Prochilodus lineatus wild populations of Pardo, Mogi Guaçu and Tiete rivers, São Paulo

O objetivo do presente estudo foi determinar a diversidade e a estrutura genética de seis populações naturais de Prochilodus lineatus em usinas hidrelétricas (UHE) dos rios Pardo (UHE Limoeiro - LMO), Mogi-Guaçu (UHE Mogi-Guaçu - MOG) e Tietê (UHE Promissão - PRO, UHE Barra Bonita - BAB, UHE Nova Avanhandava - NAV e UHE Bariri - BAR). Foi encontrado um total de 47 alelos, com tamanhos entre 118pb e 330pb. Os resultados de heterozigosidade média observada (0,490 a 0,625) refletiram uma alta variabilidade genética intrapopulacional. Os valores de distância genética (0,149 a 0,773), Fst (0,006 a 0,218) e Nm (1,2 a 4,2) mostraram a presença de similaridade genética entre as populações. De acordo com a AMOVA, houve maior variação dentro das populações do que entre elas. O dendograma mostrou a formação de dois agrupamentos (LMO-PRO-MOG e BAR-BAB-NAV). Concluiu-se que as populações naturais apresentaram alta variabilidade genética, com similaridade genética entre elas, possivelmente causada pelo programa de repovoamento realizado nesses rios.(AU)

The aim of this study was to determine the genetic diversity and structure of six wild populations of Prochilodus lineatus in Hydroelectric Power Plants (HPP) of the Pardo (HPP Limoeiro - LMO), Mogi Guacu (HPP Mogi-Guaçu - MOG), and Tiete (HPP Promissão - PRO, HPP Barra Bonita - BAB, HPP Nova Avanhandava - NAV and HPP Bariri - BAR) rivers. A total of 47 alleles, ranging in size from 118bp to 330bp were found. The results of observed heterozygosity average (0.490 to 0.625) reflected a high intra-population genetic variability. The values of genetic distance (0.149 to 0.773), Fst (0.006 to 0.218), and Nm (1.2 to 4.2) showed that between the populations there is genetic similarity. According to AMOVA there was higher variation within populations than between them. The dendrogram demonstrated the formation of two groups (LMO-PRO-MOG and BAR-BAB-NAV). It was concluded that wild populations had high genetic variability with genetic similarity between them, possibly caused by the restocking program performed in these rivers.(AU)

ANÁLISIS PROXIMAL, PERFIL DE ÁCIDOS GRASOS DE LAS VíSCERAS DEL CUY (Cavia porcellus) Y SU USO POTENCIAL EN ALIMENTACIÓN ANIMAL / PROXIMATE ANALYSIS, FATTY ACID PROFILE OF GUINEA PIG (Cavia porcellus) VISCERA AND ITS POTENTIAL USE IN ANIMAL FEED

Con el fin de evaluar el valor nutritivo de materias primas no convencionales en la elaboración de concentrado animal, de bajo coste y que no compitan con la alimentación del hombre, en la presente investigación se analizó el contenido nutricional de las visceras abdominales de cuy (Cavia porcellus) y de su harina, usando análisis proximal y perfil de ácidos grasos mediante cromatografía de gases. Se compararon estos resultados con materias primas convencionales como la harina de pescado y con visceras de diversos animales. Los resultados obtenidos indican que la harina de visceras de cuy puede competir con harinas de diversas procedencias dadas sus cualidades nutricionales (58% proteína, 28% grasa, 4% cenizas); además, el alto contenido de grasa en las visceras frescas (55% base seca) está constituido principalmente ácidos grasos poliinsaturados tipo omega 3, 6 y 9, siendo relevante el contenido de ácido linolénico, ácidos grasos que en la dieta de los animales son escasos y de alto costo. Es posible concluir que los componentes nutricionales de las visceras de cuy la convierten en una materia prima promisoria en alimentación animal, estimulando asi el aprovechamiento de estos residuos.

In order to assess the nutritional value of unconventional raw materials in the production of animal feed, of low cost and that do not compete with human food, in the present work the nutritional content of abdominal guinea pig (Cavia porcellus) viscera by proximate analysis and fatty acid profile by gas chromatography were analyzed. These results were compared with conventional raw materials such as fish meal and different animal viscera. The results show that the guinea pig viscera flour can compete with animal feed of various sources given its nutritional qualities (58% protein, 28% fat, 4% ash); also the high fat content in fresh viscera (55% dry basis) are primarily composed by polyunsaturated fatty acids omega 3, 6 and 9, where was relevant the content of linolenic acid, fatty acids in the animal diet that are scarce and expensive. We conclude that given the nutritional components, the guinea pig viscera are a promising raw material for animal feed, stimulating the recycling of this waste.

Serological evaluation of bovine herpesvirus 1 and 5 in cattle-breeding systems on Colombia's high plains / Evaluación serológica de Herpesvirus bovino 1 y 5 en Sistemas de cría en la Altillanura Colombiana

ABSTRACT Objective . The aim of this study was to determine the presence of Bovine herpesvirus - 1 (BoHV-1) and Bovine herpesvirus 5 (BoHV-5) neutralizing antibodies in herds on the Colombian high plains and their correlation with the level of cross-protection against both herpesviruses. Materials and methods . This study was carried out on cattle farms located around the towns of Puerto López and Puerto Gaitán in Colombia's Meta department. Sampling was made by convenience. Twenty-three farms were involved in the study; 488 sera samples were taken by random sampling. Virus neutralization test were performed according to the protocols of the OIE. Each serum was evaluated independently for each virus, BoHV-1 and BoHV-5. Results. The serological test confirmed the presence of BoHV-1 and BoHV-5 infections in the Colombian bovine population in 100% and 73.9% respectively. However, cross-reaction for both viruses was not evident in all farms evaluated. Conclusions . Alpha-herpesviruses are amongst the most significant infectious agents affecting cattle. Bovine herpesvirus 1 (BoHV-1) is found throughout the whole world and is endemic in Colombian bovine population, whereas bovine herpesvirus 5 (BoHV-5) has limited geographical distribution, mainly being reported in South-America (Brazil and Argentina), and we also confirmed the presence of BoHV-5 in Colombia.

RESUMEN Objetivo. El objetivo de este estudio fue determinar la presencia de anticuerpos para herpesvirus bovino 1 (BoHV-1) y herpesvirus bovino 5 (BoHV-5), así como también determinar el nivel de protección cruzada contra los dos herpesvirus en hatos de la altillanura colombiana. Materiales y métodos . Este estudio se realizó en fincas ubicadas en los municipios de Puerto López y Puerto Gaitán departamento del Meta. Se realizó un muestreo por conveniencia. Se emplearon 23 fincas, donde se realizó un muestreo al azar en cada una para un total de 488 muestras. Las muestras de suero fueron analizadas mediante sero-neutralización viral empleando los protocolos de la OIE. Cada uno de los sueros fue evaluado de manera independiente para cada uno de los virus BoHV-1 y BoHV-5. Resultados. Mediante la sero-neutralización viral se confirmó la presencia de BoHV-1 y BoHV-5 en la población bovina colombiana en 100% y 73.9%, respectivamente. Sin embargo, la reactividad cruzada no fue evidente en todas las fincas evaluadas. Conclusiones. Los alfa-herpesvirus bovinos se encuentran entre los agentes infecciosos más importantes del ganado bovino. Particularmente, el herpesvirus bovino 1 (BoHV-1) presenta una distribución mundial, siendo endémico en la población bovina colombiana, mientras que el herpesvirus bovino 5 (BoHV-5), presenta una distribución geográfica limitada; reportándose principalmente en Suramérica (Brasil y Argentina), comprobándose la presencia de este en los hatos colombianos.

Consumo, digestibilidade e balanço de nitrogênio em ovinos alimentados com rações contendo torta de Crambe / Intake, digestibility and nitrogen balance in sheep fed with diets containing Crambe cake

O objetivo deste trabalho foi avaliar os efeitos da utilização de torta de crambe na ração de ovinos sobre o consumo e a digestibilidade. O delineamento experimental utilizado foi o quadrado latino 4x4 com quatro animais, quatro períodos e quatro tratamentos. Os tratamentos avaliados foram rações com 30% de silagem de sorgo e 70% de torta de crambe (30:70) e rações com 70% de silagem de sorgo e 30% de torta de crambe (70:30) em cordeiros sob consumo voluntário e controlado. Os animais que receberam a ração com a relação 30:70 consumiram mais matéria seca (MS), proteína bruta (PB), extrato etéreo (EE) por kg/dia, % PV/dia e g/kg PV0,75. A relação 30:70 proporcionou maior coeficiente de digestibilidade de MS e FDN. Os animais no regime voluntário apresentaram maior consumo de MS, PB, EE por kg/dia, % PV/dia e g/kg PV0,75. A torta de crambe apresentou coeficientes de digestibilidade superiores à silagem de sorgo, independentemente do regime de consumo. A relação 30:70 apresentou diferença para o N-ingerido e N-absorvido. A torta de crambe apresenta alta digestibilidade dos nutrientes e aceitação pelos animais quando associada à silagem de sorgo.(AU)

The aim of this study was to evaluate the effects of using crambe cake in diets for sheep on intake and digestibility. The experimental design was a 4x4 Latin square with four animals, four periods and four treatments. The treatments were diets with 30% sorghum silage and 70% crambe cake (30:70) and a diet with 70% sorghum silage and 30% crambe cake (70:30) in lambs under the voluntary and controlled intake. The animals who fed a diet with a 30:70 ratio consumed more dry matter (DM), crude protein (CP), ether extract (EE) per kg/day, %BW/day and g/kgPV0,75. The ration provided higher digestibility of DM and NDF. The animals in the voluntary regime presented higher consumption of DM, CP, EE per kg/day, %BW/day and g/kgPV0,75. The cake crambe presented digestibility coefficient higher than sorghum silage, regardless of the regime intake. The 30:70 ration presented a difference in N intake and N absorbed. The cake crambe has high nutrient digestibility and acceptance by animals when associated with sorghum silage.(AU)

Aspectos epidemiológicos, diagnósticos y de tratamiento de la toxocariasis ocular / Epidemiological aspects, diagnosis, and treatment of ocular toxocariasis

Objetivo: Analizar la epidemiología, los métodos diagnósticos y los abordajes terapéuticos de la toxocariasis ocular en el Hospital de Pediatría Juan P. Garrahan. Materiales y métodos: Se realizó un estudio observacional y descriptivo en el Servicio de Oftalmología del Hospital de Pediatría J. P. Garrahan analizándose en forma retrospectiva los pacientes con ELISA positivo para IgG anti-Toxocara canis vistos en el laboratorio de Parasitología y evaluados en el servicio de Oftalmología entre enero 2006 a junio de 2013. Resultados: Se incluyeron en el estudio 301 pacientes de los cuales 95 (31,5%), presentaron diagnóstico de toxocariasis ocular (59 niños y 36 niñas) y 206 no tuvieron afección oftálmica por Toxocara canis. El 100% de los pacientes con afección ocular por el parásito presentó algún grado de alteración de la visión. Las formas de toxocariasis ocular que se registraron son: granuloma periférico aislado en 12 pacientes (12,6%), granuloma periférico con pliegue unido a papila en 36 (37,9%), granuloma de polo posterior en 7 (7,4%), endoftalmitis crónica en 3 (3,2%), neurorretinitis subaguda unilateral difusa en 2 (2,1%), desprendimiento de retina en 23 (24,2%) y en 12 (12,6%) forma indeterminada. Conclusiones: El diagnóstico de la toxocariasis ocular en la infancia tiende a hacerse en forma tardía ya que los niños pequeños no suelen manifestar a los padres la disminución visual de un ojo siendo el motivo de consulta más frecuente el estrabismo. El diagnóstico es clínico. La forma oftalmoscópica de presentación más frecuente en nuestro estudio fue el granuloma periférico con pliegue falciforme unido a papila. Oftalmoscopicamente la toxocariasis ocular puede presentarse de formas sumamente disímiles, lo cual hace dificultoso su diagnóstico y obliga a pensar siempre en éste en un niño que presenta inflamación intraocular unilateral. El uso de antiparasitarios en nuestros pacientes fue irregular (AU)

Objective: To assess the epidemiology, diagnostic methods, and treatment approach in ocular toxocariasis at the Pediatric Hospital Juan P. Garrahan. Material and methods: An observational descriptive study was conducted at the Department of Ophthalmology of the Pediatric Hospital Juan P. Garrahan. Patients with a positive ELISA for anti-Toxocara canis IgG seen at the laboratory of parasitology and evaluated at the Department of Ophthalmology between January 2006 and June 2013 were retrospectively analyzed. Results: 301 patients were included in the study of whom 95 (31.5%) had a diagnosis of ocular toxocariasis (59 boys and 36 girls) and in 206 the eyes were not affected by toxocariasis. All patients with ocular toxocariasis had some degree of visual impairment. The forms of ocular toxocariasis found were: isolated peripheral granuloma in 12 patients (12.6%), peripheral granuloma with the fold united to the papilla in 36 (37.9%), posterior pole granuloma in 7 (7.4%), chronic endophthalmitis 3 (3.2%), diffuse unilateral subacute neuroretinitis 2 (2.1%), retinal detachment in 23 (24.2%), and an indeterminate form in 12 (12.6%). Conclusions: The diagnosis of ocular toxocariasis in childhood is often late as children are not able to report vision loss to their parents. Strabism is the most common reason for consult. The diagnosis is clinical. The most frequent ophthalmoscopic presentation was peripheral granuloma with a falciform fold attached to the papilla. Ophthalmoscopically, ocular toxocariasis may present heterogeneously, resulting in a difficult diagnosis. The disease should always be suspected in a child with unilateral intraocular inflammation. The use of antiparasitic agents was variable in our patients (AU)

Infecciones invasivas con bacteriemia por Streptococcus pneumoniae en niños: ¿qué pasó en los últimos 5 años? / Invasive infections with bacteremia due to Streptococcus pneumoniae in children: What has happened over the past 5 years?

Introducción: Las infecciones por Streptococcus pneumoniae (Spn) constituyen enfermedades de alta prevalencia y representan una de las principales causas de morbimortalidad en pediatría. La resistencia antibiótica de S. pneumoniae es variable según las características del huésped, serotipos predominantes y la circulación de clones determinados. El objetivo del estudio fue evaluar las características de los niños con infecciones invasivas con bacteriemia por Spn, la sensibilidad a los antibióticos betalactámicos (penicilina y ceftriaxona) de las cepas, los serotipos identificados y la frecuencia de los serotipos en el período pre-vacunación universal para neumococo (2008 ­ 2011) versus pos vacunal (2012 ­ 2013). Material y métodos: estudio prospectivo. Se incluyeron todos los <18 años internados con documentación de Spn en hemocultivos en el Hospital de Pediatría J. P. Garrahan en el periodo 2008-2013.Se utilizó el programa Epi info versión 3.2.2 (Epi Info 7).Resultados: se incluyeron 171 pacientes, con 52,6% de varones, mediana de edad de 31 meses (RIC 12-61); 116 niños tenían co-morbilidad asociada (67,8%). Las formas clínicas de infección más frecuentes fueron neumonía (n: 68; 39,8%), supuración pleuropulmonar en 12,3% (n:21) y fiebre sin foco clínico en 18,7% (n: 32). La mortalidad fue del 8,2% (n: 14). Todos los aislamientos de Spn fueron sensibles a la penicilina y a las cefalosporinas de tercera generación. No se identificaron Spn con sensibilidad disminuida a los betalactámicos. Los serotipos predominantes fueron el 14, 1, 6A, 7F, 12F, 19A y 23F. Se identificaron serotipos incluidos en la vacuna neumocóccica 13­ V (VNC13) en el período pre vacunal en el 71.1% (n:74) versus 59.7% (n:40) en el período pos vacunal; dicha diferencia no fue estadísticamente significativa. Conclusiones: la mayoría de los pacientes con infecciones invasivas por Spn incluidos en este estudio presentaban enfermedades subyacentes. En el periodo observado no se identificaron cepas de Spn con sensibilidad disminuida a los beta- lactámicos. Aunque la incorporación de la vacuna VNC13 es reciente, la frecuencia de identificación de serotipos incluidos en la VNC-13 disminuyó un 11,4% en relación al periodo pre vacunal (71,1% vs 59,7%) (AU)

Introduction: Infections due to Streptococcus pneumoniae (Spn) are highly prevalent diseases that account for one of the main causes of morbidity and mortality in pediatrics. Resistance to antibiotics of S. pneumoniae is variable according to host characteristics, predominant serotypes, and circulation of dominant clones. The aim of this study was to assess the characteristics of children with invasive infections and bacteremia due to Spn, sensitivity of the strains to beta-lactam antibiotics (penicillin and ceftriaxone), the identified serotypes, and the incidence of serotypes in the pre-universal vaccination for pneumococcus period (2008 ­ 2011) versus the post-vaccination period (2012 ­ 2013). Material and methods: A prospective study. All children <18 years of age with documented Spn in hemocultures admitted to the Pediatric Hospital J. P. Garrahan between 2008 and 2013 were included. Epi info 3.2.2 (Epi Info 7) was used for statistical analysis. Results: We included 171 patients, 52.6% of whom were boys, with a mean age of 31 months (IQR 12-61); 116 children had associated comorbidities (67.8%). The most common clinical manifestations of infection were pneumonia (n: 68; 39.8%), inflammatory-purulent pleuropulmonary disease (n:21; 12.3%), and fever without a clinical focus (n: 32; 18.7%). Mortality was 8.2% (n: 14). All Spn isolates were sensitive to penicillin and third-generation cephalosporins. No Spn with reduced sensitivity to beta-lactams were found. Predominant serotypes were 14, 1, 6A, 7F, 12F, 19ª, and 23F. Serotypes included in the pneumococcal vaccine 13­ V (VNC13) were identified in the pre-vaccination period in 71.1% (n:74) versus 59.7% (n:40) in the post-vaccination period; this difference was not statistically significant. Conclusions: The majority of patients with invasive infections due to Spn included in this study had underlying diseases. In the study period no strains of Spn with diminished sensitivity to beta-lactams were observed. Although the VNC13 vaccine has been recently incorporated, the incidence of identification of serotypes included in the VNC-13 vaccine has decreased 11.4% compared to the pre-vaccine period (71.1% vs 59.7%)

Reparación de perforación septal con técnica de colgajos pediculados asistida con endoscopio / Nasal septal perforation repair using pediculated graft technique assisted by endoscope

La perforación septal corresponde a la comunicación entre ambas fosas nasales por un defecto del tabique nasal. Si bien la mayoría son asintomáticas, pueden presentarse como una rinitis costrosa, obstrucción nasal, epistaxis recidivante o sibilancias nasales. Su origen es predominantemente iatrogénico o idiopático, no obstante pueden presentar diversas etiologías. Es necesario determinar esto para resolver la necesidad de cirugía y definir la técnica quirúrgica más adecuada. En el siguiente trabajo presentamos 2 casos clínicos de perforación septal manejados con la técnica de avance de colgajos de mucosa de Fairbanks modificada, interponiendo además cartílago tragal.

The septal perforation is a communication between both nostrils through a nasal septal defect. Most of these defects are asymptomatic, although some may present as crusty rhinitis, nasal obstruction, recurrent epistaxis or nasal wheeze. Its origin is predominantly iatrogenic or idiopathic; however it may have several etiologies. It's fundamental to determine the cause of the septal perforation, in order to address the need for surgery and define the most appropriate surgical technique. We report 2 cases of septal perforations which were resolved with modified Fairbanks technique interposing tragal cartilage.

Levedura de cana-de-açúcar spray dry na alimentação de suínos na fase de crescimento e terminação / Sugar cane spray dry yeast on growing and finishing pigs feeding

Foi estudado o valor nutricional (digestibilidade total e ileal) de duas leveduras spray dry (cana-de-açúcar - LEV35 e cerveja+cana-de-açúcar - LEV40) e o efeito da sua inclusão em rações para suínos na fase de crescimento e terminação. Os valores de ED (kcal/kg) da LEV35 e da LEV40 foram 3.496 e 3.901 e EM (kcal/kg) foram 3.475 e 3.862, respectivamente. Os valores de lisina, metionina+cistina e treonina digestível para a levedura de cana-de-açúcar e da levedura de cerveja+cana-de-açúcar são 2,66 e 2,64, 1,11 e 1,03, 1,95 e 1,92, respectivamente. No desempenho foram utilizados 40 suínos com peso inicial de 34,39± 7,57kg (crescimento) e de 62,45± 5,68kg (terminação), distribuídos em delineamento inteiramente casualizado com cinco níveis de inclusão (0, 5, 10, 15 e20%) da LEV35. Na fase de crescimento, houve piora do GDP e da CA com o aumento da inclusão. Na fase de terminação, porém, houve efeito quadrático para o CDR, sendo o melhor nível 3.32%. Da mesma forma, ocorreu piora linear para o GDP, CA, peso de carcaça quente, rendimento de carcaça fria e peso de pernil. Os resultados sugerem que a adição de níveis crescentes da LEV35 pode prejudicar o desempenho dos suínos.

The nutritional value of two spray dry yeast (sugar cane - SCYSD and brewer+sugar cane - BYSD) and their inclusion effects on growing and finishing pigs feeding was studied. The DE (kcal/kg) values for SCYSD and BYSD were 3.496 and 3.901 and for ME (kcal/kg) they were 3.475 and 3.862. The values of digestible lysine, methionine+cistine and threonine for SCYSD and BYSD were: 2.66 and 2.64%; 1.11 and 1.03%: 1.95 and 1.92%. 40 pigs with initial weight of 34.39±7.57kg (growing) and 62.45±5.68kg (finishing), allotted in a completely randomized design with five levels of SCYSD inclusion were used in the performance assay. In the growing phase, there was an impairing on DWG and F:G, however, in the finishing phase, DFI presented a quadratic effect, being 3.32% the best level and linear reduction of DWG, F:G, slaughter weight, hot carcass weight, cold carcass yield and ham weight. The results suggest that increasing levels of SCYSD may impair the performance of growing and finishing pigs.