Hemangioma capilar lobular: granuloma piógeno en lengua / Lobular capillary hemangioma: pyogenic granuloma of tongue

El granuloma piógeno es una lesión benigna, reactiva y multifactorial que resulta de le- siones repetitivas, microtraumatismos e irritación local en piel o mucosas y cambio hormonal. Cuando aparece en la cavidad oral tiene predilección por la encía vestibular, pero es importante que el odontólogo esté consciente y familiarizado con el hecho de que puede estar localizado en otras áreas anatómicas. Clínicamente se presenta como lesión hiperplásica altamente vascularizada, de tamaño generalmente no mayor a 2 cm, pediculada en la base o sésil y de lento crecimiento. Sin mostrar preferencia por edad o sexo, tiende a aparecer principalmente en encías, labios y mucosa oral, siendo muy pocos los casos reportados en el área lingual. Es por ello que, en este artículo, nos referimos a un caso de ubicación inusual, en conjunto con una revisión de la literatura (AU)

Pyogenic granuloma is a benign, reactive, and multifactorial lesion caused by repetitive injuries, microtrauma and local irritation on the skin or mucous membranes, and hormonal change. When it appears in the oral cavity, it has a predilection for the vestibular gingiva, but the dentist must be aware and familiar with the fact that it can be present in other anatomi- cal areas. Clinically, it is presented as a hyperplasic injury highly vascular-related, with a size generally no bigger than 2 cm, pedunculated in base or sessile, and slow in growth. Without showing any preference in age or gender, it tends to appear mainly on the gums, lips, and oral mucosae, with very few, reported cases in the lingual area. Therefore, in this study, we refer to a case of unusual localization with a literature review (AU)

Increases in alginate production and transcription levels of alginate lyase (alyA1) by control of the oxygen transfer rate in Azotobacter vinelandii cultures under diazotrophic conditions

BACKGROUND: Alginates are polysaccharides used in a wide range of industrial applications, with their functional properties depending on their molecular weight. In this study, alginate production and the expression of genes involved in polymerization and depolymerization in batch cultures of Azotobacter vinelandii were evaluated under controlled and noncontrolled oxygen transfer rate (OTR) conditions. RESULTS: Using an oxygen transfer rate (OTR) control system, a constant OTR (20.3 ± 1.3 mmol L 1 h 1 ) was maintained during cell growth and stationary phases. In cultures subjected to a controlled OTR, alginate concentrations were higher (5.5 ± 0.2 g L 1 ) than in cultures under noncontrolled OTR. The molecular weight of alginate decreased from 475 to 325 kDa at the beginning of the growth phase and remained constant until the end of the cultivation period. The expression level of alyA1, which encodes an alginate lyase, was more affected by OTR control than those of other genes involved in alginate biosynthesis. The decrease in alginate molecular weight can be explained by a higher relative expression level of alyA1 under the controlled OTR condition. CONCLUSIONS: This report describes the first time that alginate production and alginate lyase (alyA1) expression levels have been evaluated in A. vinelandii cultures subjected to a controlled OTR. The results show that automatic control of OTR may be a suitable strategy for improving alginate production while maintaining a constant molecular weight.

Barrier for Particle Dispersion Control During Mastoidectomy

Abstract Introduction The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles. Objective Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy. Methods Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. The Otorhinolaryngology Surgical Team of Walter Cantídio Hospital developed the barrier for particle dispersion presented here. Results During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent. Conclusion Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary.

Detección de la mutación de la enzima isocitrato deshidrogenasa en gliomas difusos grados II, III y IV / Detection of isocitrate dehydrogenase enzyme mutation in grades II, III and IV diffuse gliomas

Introducción. Los gliomas son las neoplasias malignas primarias más frecuentes del sistema nervioso central, asociadas con una mortalidad y morbilidad elevadas. Las mutaciones en los genes IDH1 e IDH2 de la enzima isocitrato deshidrogenasa (IDH) son clave en la tumorogénesis, y son consideradas un factor pronóstico importante en estas neoplasias. En este estudio se buscó determinar la presencia de mutaciones de los genes IDH1 e IDH2 en pacientes con diagnóstico de glioma difuso en diferentes grados, y su correlación con la sobrevida. Metodología. Se realizó un estudio descriptivo, prospectivo y retrospectivo. La población de estudio fueron pacientes entre los 18 y 45 años con diagnóstico de glioma difuso grado II, III y IV, atendidos en el Hospital San Vicente Fundación de Medellín, entre 2012 y 2017, en quienes se realizó un análisis de mutaciones en los genes IDH1 e IDH2 por secuenciación Sanger y tinción de inmunohistoquímica. Resultados. Se incluyeron 14 pacientes con edad promedio de 37 años, 57% de sexo masculino. Glioblastoma fue la neoplasia más frecuente, diagnosticada en el 42,9% de casos. Por inmunohistoquímica, 10 de los 14 (71,4%) pacientes presentaron mutación de la enzima IDH1, en tanto que 1 de los 11 (9%) pacientes en quienes se logró la secuenciación del gen IDH2, mostró mutación. En general, el 78,6% presentó mutaciones de la enzima IDH, con promedio de sobrevida de 48 meses. Conclusión. Estos hallazgos sugieren que los gliomas son un grupo heterogéneo de tumores, con gran variabilidad genética que impacta en su pronóstico y comportamiento

Introduction. Gliomas are the most common primary malignancies of the central nervous system, associated with high mortality and morbidity. Mutations in the isocitrate dehydrogenase (IDH) enzyme IDH1 and IDH2 genes, are key in tumorigenesis, and are considered an important prognostic factor in these neoplasms. This study aimed to determine the presence of IDH1 and IDH2 gene mutations in patients diagnosed with diffuse glioma in different degrees, and their correlation with survival. Methodology. A descriptive, prospective and retrospective study was conducted. The study population consisted of patients between the ages of 18 and 45 with a diagnosis of grade II, III and IV diffuse glioma, treated at the Hospital San Vicente Fundación in Medellín, between 2012 and 2017, in whom an analysis of IDH1 and IDH2 gene mutations was performed by Sanger sequencing and immunohistochemical staining. Results. Fourteen patients with a mean age of 37 years were included, 57% were male. Glioblastoma was the most frequent neoplasm, diagnosed in 42.9% of the cases. By immunohistochemistry, 10 of the 14 (71.4%) patients had a mutation of the IDH1 enzyme, while 1 of the 11 (9%) patients in whom IDH2 gene sequencing was achieved showed a mutation. In general, 78.6% had IDH enzyme mutations, with an average survival of 48 months. Conclusion. These findings suggest that gliomas are a heterogeneous group of tumors, withgreat genetic variability that impacts their prognosis and behavior

¿La tiranía de los Comités de Ética en Investigación (CEI) es una realidad? / Is the tyranny of the Ethics committees in health research a reality? / A tirania dos Comitês de Ética em Pesquisa (CEI) é uma realidade?

Propósito/Contexto. En el presente artículo se hace un análisis del rol que deben cumplir los comités de ética e investigación para proteger a los voluntarios que participan en los estudios, sin olvidar sus funciones de promoción de la investigación y generación de conocimiento como una responsabilidad social, lo cual con el tiempo se ha venido distorsionando. Metodología/Enfoque. Se realizó una revisión de la evolución de la ética en investigación, que surge como respuesta a malas prácticas que atentaron contra la dignidad humana, que obligaron a repensar la forma de investigar, con la aparición de normas internacionales, recomendaciones y reglamentación legal que promovió el consentimiento informado y la conformación de los comités de ética en investigación (CEI). Resultados/Hallazgos. Como parte de la secuencia de análisis se muestra cómo estos organismos han tomado importancia en la actualidad, al punto que en muchos sitios del planeta no se puede hacer investigación sin la aprobación de los comités. Esto va a favor de los sujetos en investigación, pero con un mal manejo y un inadecuado ejercicio de poder, pueden frenar la investigación, con un ejercicio de tiranía por parte de los CEI. Discusión/Conclusiones/Contribuciones. Este análisis se apoya en la bioética global de ten Have, que tiene en cuenta la responsabilidad y el deber de la investigación como un asunto global e intergeneracional, que debemos ejercer como ciudadanos del mundo.

Purpose/Context. In the present article is made an analysis of the role that the ethics and research committees must fulfill to protect the volunteers who participate in the studies. This without forgetting their functions on research promotion and generation of knowledge as a social responsibility, which over time has been distorted. Methodology/Approach. I review the evolution of ethics in research, which arises as a response to bad practices that undermined human dignity. That press to rethink the way we investigate, with the emergence of international standards, recommendations and legal regulations that promoted informed consent and the establishment of research ethics committees. Results/Findings. As part of sequence analysis, shows how these organisms have become important now. In many parts of the planet cannot research without the approval of the committees. This goes in favor of the subjects in the investigation, but with bad handling, and inadequate must generate an exercise of power, with tyranny. Discussion/Conclusions/Contributions. This analysis and reflection are based on the global bioethics of Henk ten Have. The author works about these and takes into account the responsibility and duty of research as a global and in-tergenerational responsibility, which we must exercise as citizens of the world.

Objetivo/Contexto. Neste artigo uma análise do papel para ser atendidas por comitês de ética e pesquisa para proteger os voluntários envolvidos no estudo, incluindo as suas funções de promoção da investigação e geração de conhecimento como uma responsabilidade social tornase, que com o tempo foi distorcido. Metodologia/Abordagem. Para isso, realizou uma análise da evolução da ética em pesquisa, que é uma resposta a más práticas que solaparam a dignidade humana, o que nos obrigou a repensar a forma de investigar, com o surgimento de padrões internacionais, recomendações e regulamentos legais ele promoveu o consentimento informado e o estabelecimento de comitês de ética em pesquisa (CEP). Resultados/Descobertas. Como parte da sequência que dá análise mostra como essas agências têm tomado importante hoje, a tal ponto que em muitos lugares do planeta não pode fazer investigação sem a aprovação dos comités. Isso vale para os sujeitos da pesquisa, mas má gestão e exercício abusivo de poder, pode retardar a investigação, com um exercício de tirania pelo CIS. Discussão/Conclusões/Contribuições. Análise é baseada em bioética global, ten Have, que leva em conta a responsabilidade eo dever de pesquisa como uma responsabilidade global e intergeracional, devemos agir como cidadãos globais.

Respiration in Azotobacter vinelandii and its relationship with the synthesis of biopolymers

Azotobacter vinelandii is a gram-negative soil bacterium that produces two biopolymers of biotechnological interest, alginate and poly(3-hydroxybutyrate), and it has been widely studied because of its capability to fix nitrogen even in the presence of oxygen. This bacterium is characterized by its high respiration rates, which are almost 10-fold higher than those of Escherichia coli and are a disadvantage for fermentation processes. On the other hand, several works have demonstrated that adequate control of the oxygen supply in A. vinelandii cultivations determines the yields and physicochemical characteristics of alginate and poly(3-hydroxybutyrate). Here, we summarize a review of the characteristics of A. vinelandii related to its respiration systems, as well as some of the most important findings on the oxygen consumption rates as a function of the cultivation parameters and biopolymer production.

Problemas éticos en la asignación de recursos escasos y cuidado intensivo en la atención de la pandemia por SARS-CoV-2 Una reflexión desde los principios, criterios, derechos y deberes / Ethical problems in the assignment of scarce resources and intensive care in SARS-CoV-2 pandemic healthcare Thoughts based on principles, criteria, rights and responsibilities

Resumen Este documento tiene como finalidad identificar algunos problemas éticos de los procesos de atención en el contexto de la pandemia por SARS-CoV-2 en Colombia, y proponer un conjunto de principios y criterios éticos que permitan a las instituciones y los trabajadores de la salud la toma de decisiones éticamente sustentables y jurídicamente factibles, con un especial enfoque en la protección del núcleo de los derechos fundamentales de pacientes y trabajadores, en un contexto extraordinario caracterizado por la inequidad estructural y la discrepancia entre la oferta y la demanda de bienes, recursos y servicios de salud, con el objetivo de mitigar el estrés moral, maximizar los beneficios derivados de la utilización de los recursos escasos y modular los riesgos éticos y jurídicos asociados.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1952).

Abstract The purpose of this document is to identify some ethical problems in healthcare processes within the context of the SARS-CoV-2 pandemic in Colombia, and propose a collection of ethical principles and criteria which will allow healthcare institutions and workers to make ethically supported and legally feasible decisions. These decisions should especially focus on protecting the core of the fundamental rights of patients and workers, in an extraordinary context characterized by structural inequity and a discrepancy between the supply and demand of healthcare goods, resources and services. Ultimately, this will mitigate moral stress, maximize the benefits derived from the use of scarce resources, and modulate the associated ethical and legal risks.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1952).

Caracterización socio-epidemiológica y evolución de la tuberculosis en la Región Metropolitana de Chile, 2005 a 2018 / Socio-epidemiological caracterization and evolution of tuberculosis in the Metropolitan Region of Chile, 2005 to 2018

Resumen Introducción: El Programa chileno de Control y Eliminación de Tuberculosis (PROCET) ha permitido reducir la mortalidad por esta enfermedad en 78%, entre los años 2004 y 2013. No obstante, luego de décadas de resultados exitosos, a partir del 2000 ocurrió un enlentecimiento en la reducción de incidencia y desde el 2014, un aumento de ésta. Objetivos: Describir la evolución socio-epidemiológica de los casos de tuberculosis (TBC), desde 2005 al 2018, estratificando según país de origen, en Servicios de Salud de la Región Metropolitana (RM). Métodos: Estudio transversal con componente ecológico. Se consideraron las variables: edad, sexo, localización de la TBC, confirmación bacteriológica, co-infección con VIH, privación de libertad, país de procedencia y efectividad de la terapia anti-tuberculosis. Resultados: Se notificaron 7.507 casos, de los cuales 75,1% fue de localización pulmonar y 65,4% bacteriológicamente demostrado. Un 19,0% de los casos pertenecieron a personas no nacidas en Chile, con un aumento de esta proporción en los últimos seis años. Las tasas de incidencia, descendientes en la primera mitad del período, exhibieron un alza a partir del 2012, alejándolas del umbral de eliminación. Se observó en 74,3% éxito en la terapia y 13,4% de muerte en los casos evaluados. Conclusiones: En los últimos años, la incidencia de TBC en la RM aumentó. Los nuevos grupos vulnerables, especialmente los migrantes, requieren con urgencia, que se implementen y refuercen estrategias como la educación, pesquisa activa y acciones de control de TBC.

Abstract Background: The Chilean Program for the Control and Elimination of Tuberculosis (PROCET) has reduced mortality from this disease by 78% between 2004 and 2013. However, after decades of successful results, starting in 2000 there was a slowdown in the reduction of incidence and since 2014, an increase in it. Aim: To describe the socio-epidemiological evolution of tuberculosis (TB) cases treated at health clinics in the Metropolitan Region (MR) of Chile from 2005 to 2018, stratifying by country of origin. Methods: Cross-sectional study with ecological components, including analyses of age, sex, TB localization, bacteriological confirmation of diagnosis, co-infection with HIV, incarceration, country of origin, and effectiveness of tuberculosis treatment. Results: A total of 7,507 TB cases were recorded during the study period; 75.1% of cases were pulmonary tuberculosis, and 65.4% were bacteriologically confirmed. Overall, 19.0% of cases involved persons born outside of Chile, with the proportion of cases in foreign-born persons increasing over the past 6 years. Incidence decreased during the first half of the study period but then began to increase after 2012, moving the country away from the threshold of elimination. A total of 74.3% of cases were treated successfully, and 13.4% expired. Conclusion: In recent years, TB incidence has increased in the MR of Chile, possibly attributable to growing populations of vulnerable groups such as immigrants. This finding suggests an urgent need to implement and reinforce strategies such as education, an active screening model and more efficient contact tracing to prevent the spread of TB.

Evolución de la coinfección por TB/VIH en la Región Metropolitana de Chile, 2005 a 2018 / Evolution of tuberculosis/HIV coinfection in Metropolitan Santiago, Chile from 2005 to 2018

Background: Tuberculosis (TB)/HIV coinfection has a high mortality rate. Aim: To describe socio-epidemiological characteristics of tuberculosis (TB)-HIV coinfection, and aspects associated with its prevalence, from 2005 to 2018. Material and Methods: Analysis of the registry of the tuberculosis control and elimination program of three public health services of metropolitan Santiago. The variables considered were: TB/HIV coinfection, age, sex, location of tuberculosis, bacteriological confirmation, incarceration, commune of residence, country of origin and effectiveness of the tuberculosis therapy. Results: We analyzed 7507 TB cases, of whom 12% corresponded to cases of coinfection. The number of coinfections doubled in the last 6 years. In 2018, 45% of coinfection cases occurred in migrants. Of the total cases evaluated, 53% were successfully treated and 28% died. Conclusions: The remarkable increase in TB/HIV coinfection, urgently demands new prevention and control strategies, aimed at the most vulnerable groups.

Estrategia de pesquisa sistemática y seguimiento prolongado revela alto número de nuevas infecciones tuberculosas en contactos adultos en la Región Metropolitana, Chile / Systematic screening of adult household contacts of patients with active pulmonary tuberculosis reveals high rates of new infections during follow-up

Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening of adult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts' follow-up are essential to detect new infections and tackle the TB epidemic in Chile.

Enfermedad de Moyamoya: Cefalea crónica y demencia progresiva asociadas a infartos cerebrales múltiples / Moyamoya disease: Chronic headache and progressive dementia associated with multiple brain strokes

Se reporta el caso de un paciente de 32 años de edad que desde los 17 y hasta la actualidad, ha experimentado cefaleas constrictivas de minutos de duración, desencadenadas por actividad o esfuerzos físicos. En los últimos siete años ha presentado progresiva declinación cognitiva y cambios acentuados de personalidad con creciente dependencia para el desarrollo de actividades elementales. A los 27 años desarrolló hemiplejía izquierda total con recuperación completa en dos semanas. Muestra asimismo episodios de estado confusional severo y conducta infantil. Los exámenes de laboratorio descartaron cardiopatía, ateroesclerosis y enfermedades autoinmunes sistémicas en el paciente. Estudios neuroimagenológicos del cerebro (TAC, Angio - TEM y RM cerebralcontrastada) pusieron en evidencia seis infartos cerebrales, en estadios subagudos y crónicos, severa estenosis de las arterias cerebrales anteriores y presencia de un microaneurisma en el segmento M de la arteria cerebral media izquierda. Una limitación del presente reporte es la ausencia de estudios con angiografía digital, debida a dificultades económicas. En conclusión, el caso corresponde a un paciente con cefalea crónica asociada a demencia progresiva, en el que estudios de neuroimágenes y pruebas neuropsicológicas sustentan el diagnóstico de deterioro cognitivo asociado a la enfermedad de Moyamoya.

The case of a 32 years old male patient who since age 17 has experienced constrictive headaches of several minutes duration, triggered by physical effort is reported. For the last seven years there, he has presented a progressive cognitive decline cognitive, and marked personality changes, having become extremely dependent even for conducting elemental activities. At the age of 27, he experienced total left hemiplegia from which he completely recovered in two weeks. He also shows severe confusional states and child-like behavior. Laboratory tests ruled out heart disease, atherosclerosis and systemic autoimmune diseases. Brain neuroimaging tests (CT, Angio - TEM and contrasted cerebral MRI) revealed the occurrence of six cerebral infarcts, in subacute and chronic stages, severe stenosis of the anterior cerebral arteries, and presence of microaneurysm in the M segment of the left middle brain artery. A limitation of this report is the absence of a study with digital angiography, due to economic difficulties. In short, the case of a patient with chronic headache associated with progressive dementia is presented, with neuroimaging and neuropsychological tests that support the diagnosis of of cognitive impairment associated with Moyamoya disease.

Independencia de los comités de ética en investigación en salud, un análisis reflexivo / Independence of ethics committees in health research, a reflexive analysis / Independência dos comitês de ética em pesquisa em saúde, uma análise reflexiva

Los errores históricos en investigación médica llevaron al mundo a la creación de los comités de ética en investigación en salud (CEI), organizaciones pluri y multidisciplinarias conformadas por profesionales de variadas competencias, especialidades y formas de pensamiento, cuya función es evaluar proyectos de investigación y su ejecución, con independencia para garantizar la protección de los participantes e integridad científica. El presente artículo realiza una reflexión sobre la independencia de los comités, que se fundamenta en las categorías independencia, libertad y autonomía, en los principios bioéticos de Beauchamp y Childress, de Maliandi y Thüer aplicados a los CEI y publicaciones que han tratado el tema. Sobre la independencia de los comités, se concluye su importancia, la cual está relacionada con los miembros de los CEI, investigadores, financiadores, entes reguladores, e instituciones a las que pertenecen los CEI ­educativas, de salud o centros de investigación públicos y privados­, con metas asociadas a investigaciones, publicaciones y contratos para evaluación de proyectos. Si bien es cierto que hay compromiso institucional de respaldo a la independencia de los CEI, es necesario revisar cómo funciona en la realidad, cómo se relaciona con dilemas bioéticos, cómo se articula con los principios de respeto a la autonomía­individualidad, justicia­universalidad, no maleficencia­conservación y beneficencia­realización con la ética convergente y cuál es el concepto de expertos que han investigado sobre el particular. Conclusión: En la actualidad no es posible garantizar la independencia de los CEI, para lo que se deben definir medidas y estrategias adicionales que la fortalezcan.

The historical errors in medical research led the world to create research ethics committees in Health (REC), pluri and multidisciplinary organizations conformed by professionals with variate skills, specializations and forms of thinking, oriented to evaluate research projects and follow-up its develop, with independence, focused to guarantee subject's protection and the safety, and scientific integrity. This article reflects about committee's independence, supported on categories independence, freedom and autonomy, Beauchamp and Childress's bioethics principles, Maliandi and Thüer, applied to REC and related publications. Regarding the independence of the committees, it's important, and its related to REC members, researchers, sponsors, regulatory entities, and institutions to which the REC belong ­educational, health organizations and governmental and private research centers­, with goals associated with research, publications and contracts to project's assessments. While it is true there is institutional commitment to support the REC's independence, its necessary review how it really works, how its relate to bioethics dilemmas, how it's articulated with the principles of respect for the autonomy-individuality, justice-universality, non-maleficence-conservation and, beneficence-realization with the convergent ethics and the concept of experts who have researched about the subject. Conclusion: At present, it is not possible to guarantee the REC's independence, for these reasons, should be defined as additional measures and strategies to strengthen its independence.

Os erros históricos na pesquisa médica forçaram o mundo a criar Comitês de Ética em Pesquisa em Saúde (CEP), que são organizações multidisciplinares conformado por profissionais de variadas habilidades, especialidades e modos de pensar, cuja função é avaliar projetos de pesquisa, e sua execução, independentemente, para garantir a proteção dos participantes e a integridade científica. Este artigo reflete sobre a independência dos comitês, com base nas categorias independência, liberdade e autonomia nos princípios bioéticos de Beauchamp e Childress, de Maliandi e Thüer, aplicados ao CEP e publicações que abordaram o tema. Quanto à independência dos comitês, conclui-se a sua importância, relacionada aos membros do CEP, pesquisadores, financiadores, entidades reguladoras e instituições pertencentes ao CEP ­ centros de pesquisa educacionais, de saúde ou públicos e privados ­, com metas associadas pesquisas, publicações e contratos para avaliação de projetos. Embora seja verdade que existe um compromisso institucional real de apoiar a independência do CEP, é necessário rever a forma como funciona na realidade, no que se refere aos dilemas bioéticos, articulados com os princípios do respeito à autonomia-individualidade, justiça-universalidade, não-maleficência - conservação e beneficência-realização com convergência ética e com o conceito de especialistas que investigaram o assunto. Conclusão: Atualmente não é possível garantir a independência do CEP, para o qual devem ser definidas medidas e estratégias adicionais para fortalecer a independência das CEP.

Histiocitosis de células de Langerhans con afectación de la órbita en un lactante: reporte de un caso / Langerhans cell histiocytosis with orbital involvement in an infant: Case report

La histiocitosis de células de Langerhans es una enfermedad poco frecuente, caracterizada por la proliferación clonal de células dendríticas mieloides CD1a positivas, asociada a un componente inflamatorio significativo. El compromiso óseo es común; en niños, las lesiones líticas más frecuentes son en la cúpula craneal y son raras las lesiones en la órbita. Se presenta a un lactante de 18 meses que consultó por edema periorbitario y proptosis del ojo derecho de dos meses de evolución. Al momento del examen físico, no se encontraron otras alteraciones. Se realizó una tomografía y una resonancia magnética, que mostraron una masa tumoral en el seno maxilar de crecimiento expansivo y erosión del techo de la órbita. La biopsia confirmó la proliferación CD1a positiva; recibió tratamiento con prednisona y vinblastina, con evolución favorable. Un tratamiento precoz puede evitar secuelas significativas en los pacientes cuando son sensibles al tratamiento. Es una entidad poco frecuente que requiere un alto índice de sospecha y un manejo multidisciplinario.

The Langerhans cell histiocytosis is a rare disease characterized by the clonal proliferation of CD1a + myeloid dendritic cells associated with a significant inflammatory component. The localized form of the disease is called eosinophilic granuloma. Bone involvement is common; in children, lytic lesions are most frequently found in the cranial dome being rare in the orbit. We present an 18-month-old infant who consulted due to periorbital edema and proptosis of the right eye, with two months of evolution. The computed tomography and the magnetic resonance imaging showed a maxillary sinus tumor mass of expansive growth and erosion of the roof of the orbit. The biopsy confirmed CD1a+ proliferation; it was treated with prednisone and vinblastine with favorable evolution. It is a rare entity that requires a high index of suspicion and multidisciplinary management. Early diagnosis and treatment leads to a favorable prognosis for the patient.

Epigenética del cáncer colorrectal / Epigenetics of Colorectal Cancer

Resumen El cáncer colorrectal (CCR) es una enfermedad con una amplia distribución geográfica, que afecta a millones de personas en el mundo. Esta neoplasia se presenta de manera esporádica en el 80% de los casos, el porcentaje restante tiene una historia familiar. Las alteraciones epigenéticas, como la metilación del ADN, modificación de las histonas y los ácidos ribonucleicos (ARN) no codificantes, están involucradas en el desarrollo de esta enfermedad. En la actualidad, estas alteraciones tienen un potencial valioso como biomarcadores para la detección temprana del CCR y se considera que podrían ser útiles para el diagnóstico y pronóstico de los individuos con CCR. El propósito de esta revisión es describir los principales mecanismos epigenéticos involucrados en el cáncer colorrectal, que tienen una función importante en el desarrollo y progresión de la enfermedad.

Abstract Colorectal cancer (CRC) has broad geographic distribution and affects millions of people throughout the world. It occurs sporadically in 80% of cases, but the rest have family histories. Epigenetic alterations such as DNA methylation and modification of histones and non-coding RNA are involved in the development of this disease. At present, these alterations have valuable potential as biomarkers for early detection of CRC and could be useful for diagnosis and determination of prognosis for individuals with CRC. The purpose of this review is to describe the main epigenetic mechanisms involved in colorectal cancer and the important roles they have in the development and progression of the disease.

Características epidemiológicas y clínicas de los pacientes con cáncer colorectal en el Hospital Médico Quirúrgico y de Oncología del ISSS en el periodo 2014 a 2015 / Epidemiological and clinical characteristics of patients with colorectal cancer at the Medical Surgical and Oncology Hospital of the ISSS in the period 2014 to 2015

Las características epidemiológicas, clínicas e histologías de los pacientes con cáncer colorectal no están bien establecidas en el Instituto Salvadoreño del Seguro Social de El Salvador; además que no se ha establecido una pauta diagnostica que permita realizar tamizaje en pacientes en riesgo y así poder detectar esta patología en fases más tempranas. Siendo este tipo de cáncer uno de los más comunes a nivel mundial, es necesario conocer su comportamiento epidemiológico, clínico e histológico en nuestra población derecho habiente, para así mediante su caracterización, investigadores futuros puedan crear estrategias para detectar personas en riesgo de padecerlo y crear un algoritmo establecido de abordaje con los recursos disponibles lograr su identificación temprana y disminuir los costos que representan el tratamiento de sus fases más avanzadas, se realizó una exhaustiva búsqueda en biblioteca de la institución y departamento de gastroenterología y oncología de guías o lineamientos acerca del diagnóstico de cáncer colorectal en el ISSS, como resultado se llegó a la conclusión que al momento en esta institución no existen guías para tamizaje y diagnóstico de cáncer colorectal. Por lo cual con el presente estudio se tiene como objetivo principal describir las características clínicas y epidemiológicas del cáncer colorectal en el Hospital Médico Quirúrgico y Oncológico del ISSS de 2014 y 2015; mediante un estudio observacional, descriptivo y transversal de los pacientes que padecieron cáncer de colon en 2014 y 2015 en el cual se revisaran sus expedientes y se extraerán datos consignados acerca de las características epidemiológicas clínicas e histológicas del cáncer colorectal