Tumor de ovario borderline: concordancia entre biopsia contemporánea y biopsia definitiva / Borderline tumor of the ovary: accuracy of intraoperative frozen section and definitive biopsy

OBJETIVO: Los tumores de ovario borderline (BOT) son un grupo de lesiones neoplásicas de origen epitelial del ovario que presentan características de tumores malignos, pero sin invasión del estroma, y se caracterizan por tener un buen pronóstico. El objetivo del estudio es determinar la concordancia diagnóstica entre biopsia contemporánea y definitiva de los BOT en nuestro centro hospitalario. MÉTODO: Se realizó un estudio analítico retrospectivo de corte transversal de las biopsias contemporáneas y definitivas de BOT en la base de datos de anatomía patológica del Hospital Padre Hurtado, entre los años 2010 y 2019. El análisis estadístico de concordancia se realizó mediante test de kappa. RESULTADOS: Se revisaron 4546 informes de biopsias entre los años 2010 y 2019. Se pesquisaron 163 tumores malignos de ovario, de los cuales 69 (42,33%) correspondieron a BOT. De estos, 39 fueron serosos (56,2%), 28 mucinosos (40,57%) y 2 (2,8%) de tipo endometrioide. El resultado de concordancia diagnóstica de BOT seroso es moderada, del 75,71% con un índice de kappa de 0,5143 (p = 0,000), y el de BOT mucinoso es débil, del 65,71% con un índice de kappa de 0,2398 (p = 0,0222). CONCLUSIONES: Los BOT corresponden a un gran porcentaje dentro de los tumores malignos del ovario, siendo el subtipo seroso el más común. La concordancia entre biopsia contemporánea y definitiva es de débil a moderada.

OBJECTIVE: Borderline ovarian tumors (BOT) are a group of neoplastic lesions of epithelial origin of the ovary that present characteristics of malignant tumors but without stromal invasion and are characterized by having a good prognosis. The objective of the study is to determine the concordance between frozen section and definitive biopsy of BOT in our hospital center. METHOD: A retrospective, cross-sectional analytical study of the frozen section and definitive BOT biopsies was performed in the pathological anatomy database of the Padre Hurtado Hospital during the years 2010 and 2019. The statistical and concordance analysis was performed using kappa tests. RESULTS: 4546 biopsy reports were reviewed during 2010 and 2018. A total of 163 malignant ovarian tumors were investigated, of which 69 (42%) corresponded to BOT. Of these, the most common subtypes were 39 (56.2%) serous, 28 (40.57%) mucinous and 2 (2.8%) endometroid. The concordance results of serous BOT is moderate, 75.71% with a kappa index of 0.5143 (p = 0.000), and mucinous BOT have fair concordance, 65.71% with a kappa index of 0.2398 (p = 0.0222). CONCLUSIONS: BOT correspond to a large percentage of malignant tumors of the ovary, with the serous subtype being the most common. The concordance between contemporary and definitive biopsy is between fair and moderate.

Educación física y salud: evaluación de la aptitud muscular y la adiposidad corporal en adolescentes escolares / Physical education and health: evaluation of muscular fitness and body fat in school adolescents

RESUMEN. La Educación Física, como asignatura escolar obligatoria, debe realizar acciones para hacer frente a los altos niveles de inactividad física, sedentarismo y obesidad en la población, destacándose en importancia, la evaluación de la aptitud física y su posterior programación del ejercicio en las escuelas. Los propósitos del estudio fueron: 1) Evaluar de manera sencilla la condición física de un curso del nivel escolar secundario (n=17), de un colegio privado de la ciudad de La Plata, provincia de Buenos Aires, Argentina. 2) Conocer y relacionar los niveles de aptitud muscular y adiposidad corporal en los alumnos. Tras la investigación, se conoció que la obesidad influye negativamente en los resultados de las evaluaciones de la aptitud muscular, como muestran otros estudios. Se pudo concluir que es posible la evaluación de la condición física de los escolares para la obtención de información valiosa en pos de la prevención de la inactividad física.

ABSTRACT. Physical Education, as a compulsory school subject, must take actions to deal with the high levels of physical inactivity, sedentary lifestyle and obesity in the population. Standing out in importance, the evaluation of physical fitness and its subsequent programming of exercise in schools. The purposes of the study were: 1) To evaluate in a simple way the physical condition of a course at the secondary school level (n = 17), of a private school in the city of La Plata, province of Buenos Aires, Argentina. 2) Know and relate the levels of muscle fitness and body fat in students. After the investigation it was known that obesity negatively influences the results of evaluations of muscular fitness, as other studies show. Concluding that it was possible to assess the physical condition of school students, in order to obtain valuable information in order to prevent physical inactivity.

Complicaciones quirúrgicas intraoperatorias en laparoscopía ginecológica en el Hospital Padre Hurtado / Intraoperative surgical complications in gynecological laparoscopy at Padre Hurtado Hospital

INTRODUCCIÓN: Actualmente la cirugía laparoscópica es el gold standard de la mayoría de las cirugías ginecológicas benignas. Se estima una tasa de complicaciones en cirugía ginecológica por laparoscopía de 3.2 por 1000 pacientes, donde alrededor del 50% ocurren al momento de la primera entrada. Existen numerosas clasificaciones de las complicaciones quirúrgicas, entre ellas, la clasificación Clavien-Dindo se centra en el tratamiento postquirúrgico y tiene como objetivo unificar criterios y hacerlas comparables entre distintos centros. OBJETIVO: Describir las complicaciones en cirugía laparoscópica ginecológica en el Hospital Padre Hurtado, destacando el subgrupo de primera entrada y su clasificación Clavien-Dindo. METODOLOGÍA: Cohorte retrospectiva que incluyó a todas las pacientes operadas por laparoscopía en el pabellón de ginecología del Hospital Padre Hurtado desde el año 2014 al 2017. Se utilizó el software SPSS statistics v25, con prueba X2 para el análisis de las variables no paramétricas y t de Student para las variables paramétrica, considerando una significación estadística con p<0,05. RESULTADOS: De las 513 cirugías laparoscópicas ginecológicas realizadas en el período evaluado, sólo el 4,3% del total de las pacientes tuvieron complicaciones. De éstas, un 9% fueron de primera entrada, y en todos los casos fueron complicaciones menores o Clavien-Dindo I y II. Hubo 2 complicaciones Clavien-Dindo >III B, lo que correspondió a un 0,39%. CONCLUSIÓN: En nuestro grupo hubo una baja incidencia de complicaciones quirúrgicas y de primera entrada lo que es comparable con otras series publicadas.

INTRODUCTION: Laparoscopic surgery is currently the gold standard of most benign gynecological surgeries. A complication rate in gynecological laparoscopy is 3.2 per 1000 patients, where around 50% occur at the time of the first entry. There are numerous classifications of surgical complications, among them, Clavien-Dindo classification focuses on post-surgical treatment and aims to unify criteria and lets compare between different centers. OBJECTIVE: To describe the complications in gynecological laparoscopic surgery at the Padre Hurtado Hospital, highlighting the first entry subgroup and Clavien-Dindo classification. METHODOLOGY: Retrospective cohort that included all gynecological laparoscopy patients in Padre Hurtado Hospital from 2014 to 2017. The SPSS statistics v25 software was used, with X2 test for the analysis of non-parametric variables and t Student for the parametric variables, considering a statistical significance with p <0.05. RESULTS: 513 gynecological laparoscopic surgeries was performed in the evaluated period, only 4.3% of the total patients had complications. Of these, 9% were first entry, and in all cases were minor complications or Clavien-Dindo I and II. There were 2 patients with Clavien-Dindo complications > III B, which corresponded to 0.39%. CONCLUSION: In our group there was a low incidence of surgical complications and first entry which is comparable with other published series.

Eficacia y seguridad de la técnica de colocación de catéter de arteria pulmonar guiado por ultrasonido / Efficiency and safety of placement of pulmonary artery catheter guided by ultrasound / Eficiência e segurança da colocação do cateter de artéria pulmonar guiado por ultrassom

Resumen: Introducción: Se ha discutido el uso de catéter en la arteria pulmonar (Swan-Ganz) por no ofrecer cambios en la mortalidad de los pacientes críticos; sin embargo, aún es una herramienta útil para monitoreo hemodinámico. Objetivo: Ofrecer una alternativa en la colocación de catéter Swan-Ganz mediante ultrasonido en menor tiempo y sin complicaciones. Material y métodos: Se realizó un estudio piloto, prospectivo, observacional, transversal y descriptivo. Se colocaron 26 pacientes con diversas patologías que ameritaban aporte aminérgico o inotrópico y catéter de arteria pulmonar. Se evaluaron los tiempos de colocación y complicaciones asociadas tras su colocación. Resultados: Se obtuvo media de 91.46 segundos de colocación (rango de 60-122 segundos) tras introducir la punta del catéter por venodisección y 0% de complicaciones en 26 pacientes. Discusión: El uso del ultrasonido ofrece un método alterno de colocación del catéter sin apoyo de fluoroscopia, curvas de monitoreo o presiones intracavitarias y reduce complicaciones. Conclusiones: La colocación de Swan-Ganz por ultrasonido es un método alterno y seguro con un tiempo medio de 91 segundos para su inserción. Se requiere una muestra mayor para determinar si es eficaz el método y quizás un estudio multicéntrico.

Abstract: Background: Use of a pulmonary artery catheter (Swan-Ganz) has been discussed because it does not offer changes in the mortality of critically ill patients; however, it is still a useful tool for hemodynamic monitoring. Objective: To offer an alternative in the placement of Swan-Ganz catheter by ultrasound in less time and without complications. Material and methods: A pilot, prospective, observational, cross-sectional and descriptive study was conducted. Placing 26 patients with various pathologies that required aminergic or inotropic delivery, a pulmonary artery catheter; evaluating placement times and associated complications after placement. Results: A mean of 91.46 seconds of placement (range of 60-122 seconds) was obtained after insertion of the tip of the catheter by venodisection and 0% of complications in 26 patients. Discussion: The use of ultrasound offers an alternate method of placement of the catheter without fluoroscopy support, monitoring curves or intracavitary pressures; and reduces complications. Conclusions: The placement of Swan-Ganz by ultrasound is an alternative and safe method for placement with an average time of 91 seconds in its insertion. A larger sample is required to determine if the method is effective and perhaps a multicenter study.

Resumo: Introdução: O uso de cateter na artéria pulmonar (Swan-Ganz) tem sido discutido por não oferecer mudanças na mortalidade de pacientes em estado crítico, no entanto, ainda é uma ferramenta útil para a monitorização hemodinâmica. Objetivo: Oferecer uma alternativa na colocação do cateter de Swan-Ganz com ultrassom em menos tempo e sem complicações. Material e métodos: Foi realizado um estudo piloto, prospectivo, observacional, transversal e descritivo. Colocando 26 pacientes com diferentes patologias que requeriam suporte aminérgico ou inotrópico e cateter de artéria pulmonar; avaliando o tempo e complicações associadas após a colocação. Resultados: Obteve-se uma média de 91.46 segundos de colocação (intervalo de 60-122 segundos) após a introdução da ponta do cateter por venodissecção e 0% de complicações em 26 pacientes. Discussão: O uso do ultrassom oferece um método alternativo de colocação do cateter sem apoio de fluoroscopia, curvas de monitoramento ou pressões intracavitárias; e reduz as complicações. Conclusões: A colocação do cateter de Swan Ganz por ultrassom é um método alternativo e seguro, com um tempo médio de 91 segundos na sua inserção. É necessária uma amostra maior para determinar se o método é eficaz e talvez um estudo multicêntrico.

Anemia Management Practice in French Hemodialysis Centers.

Objective: Evaluate the hemoglobin (Hb) target values in hemodialysis (HD) patients treated with erythropoiesis-stimulating agents (ESA). Methods: Records of anemia parameters of HD patients treated during year 2012 in 5 French dialysis centers were retrospectively analyzed. Patients were stratified into “annual Hb categories” according to their monthly mean Hb: Low Hb (< 10 g/dL), Ideal Hb (from 10 to ≤ 12 g/dL), High Hb (> 12 g/dL) if they spent ≥ 75% of time in the respective category; otherwise patients were classified as Fluctuating Hb. Results: Out of 636 evaluable patients (mean age 66.6 [SD 14.9] years; male 59.4%), 91.4% received ESA treatment and 74.2% received intravenous iron. Most patients (68.9%) belonged to the Fluctuating Hb category (Ideal 18.7%; High 9.6%; Low 2.8%). Patients in the Fluctuating category experienced more frequently ESA dose changes, transfusions, hospitalizations and comorbidities compared with patients in other Hb categories. Multinomial logistic regression identified presence of at least one comorbidity (odds-ratio [OR]=7.6), hospitalization (OR=2.2), transfusion (OR=2.9), male gender (OR=0.6) and serum ferritin ≥500 vs. <200 μg/L (OR = 0.4) as predictors of Fluctuating vs. Ideal annual Hb category. Conclusions: Only 18.7% of patients had stable Hb levels within the target range according to French and international guidelines; most had fluctuating Hb levels and few patients had a consistently low annual Hb. These findings suggest that development and implementation of improved hematologic assessment and anemia treatment strategies are needed to minimize fluctuating Hb values in HD patients.

Dispositivo auditivo totalmente implantable Carina®: revisión sistemática / Fully implantable hearing device Carina®: systematic review / Fully implantable hearing device Carina®: systematic review

Objetivos: Revisar/resumir indicaciones, resultados audiológicos y de calidad de vida del dispositivo totalmente implantable Carina®. Diseño: Revisión sistemática. Métodos: Se realizó una búsqueda sistemática de la literatura entre junio/2011 y enero/2012 en bases de datos: Medline, OVID, Embase, Pro Quest, Biblioteca Cochrane. También se revisó literatura gris (Sigle) en búsqueda de información no publicada. No hubo restricción de lenguaje o límite temporal, y se incluyeron estudios en humanos con mediciones antes/después de la intervención. Se excluyeron reportes de un caso y estudios con pacientes prelinguales. Se evaluó heterogeneidad estadística (prueba Der Simonian-Laird), y la ganancia funcional combinada (GFC) se estimó con un modelo de efectos aleatorios. Se evaluó sesgo de publicación (gráfica de embudo y prueba Eggs). Resultados: Se identificaron 155 publicaciones, 43 enfocadas en el tema de investigación; ocho cumplieron criterios de inclusión/exclusión, que reportan 110 pacientes. La GFC fue 27,24 dB [IC 95% = 21,66-32,83 dB], I2 = 85%. El reconocimiento de palabras (65 dB-SPL) se incrementó con Carina® entre 35 y 70%, y hubo mejoría en calidad de vida (escala Aphab). La complicación más frecuente fue extrusión (2,7%). Se encontró sesgo de publicación (Eggs = 0,0011). Conclusiones: Se encontró heterogeneidad clínica y bajo nivel de evidencia publicada. La GFC fue considerable con el implante…

Objectives: To review and summarize indications, audiological and quality of life (QOL) outcomes of Carina® fully implantable device. Design: Systematic review. Methods: We conducted a systematic search of literature between June/2011 and January/2012 in: Medline, OVID, Embase, ProQuest, Cochrane Library. The unpublished information gray literature databases (Sigle) were also reviewed. No language or time limit restriction. Study eligibility criteria were: human studies with measures before and after the intervention. One patient case report and prelingual patients studies were excluded. Statistical heterogeneity was assessed (Der Simonian- Laird test), random effects model as a method of synthesis of functional gain was used. Publication bias was assessed (funnel plot and Eggs test). Results: 155 publications were identified, 43 of them were focused on the research topic, eight met the inclusion/exclusion criteria and report 110 patients. The pooled functional gain was 27.24 dB [95% CI = 21.66-32.83 dB], I2 = 85%. The word recognition (65 dB-SPL) was increased between 35%-70% with Carina®. A QOL improvement was observed (APHAB scale). The most frequent complication was device extrusion (3.6%). Publication bias was found (Eggs = 0.0011). Conclusions: Clinical heterogeneity and low evidence level were found in the published literature. The pooled functional gain was considerable with the implant. …

Dispositivo auditivo totalmente implantable: estudio antes y después / Fully Implantable Hearing Device: Before-and-After Study

Objetivo: Describir la experiencia y comparar los resultados audiométricos y cambio en calidad de vida en pacientes con el dispositivo auditivo totalmente implantable Carina®. Diseño: Estudio antes y después. Métodos: El dispositivo Carina® fue implantado en pacientes con hipoacusia conductiva, mixta o neurosensorial de moderada a severa. Como método de evaluación se realizaron medidas repetidas intra-sujetos para ganancia funcional y cambios en calidad de vida. Se usó la prueba T-Student para muestras relacionadas en el análisis estadístico. Resultados: Se incluyeron 27 pacientes (edad media = 28,2±15,8 años). No se observaron diferencias significativas entre el promedio de tonos puros (PTP) de la vía ósea prequirúrgica y posquirúrgica (p > 0,05). La ganancia funcional media fue = 24,0 ± 7,9 dB; se encontró una diferencia estadísticamente significativa entre el PTP sin Carina® (62,3 ± 12,4 dB) y con Carina® (38,3 ± 11,9 dB) (p < 0,0001). Hubo una mejoría significativa en la calidad de vida con el uso del dispositivo (p < 0,05). Se presentó una explantación como única complicación mayor (3,7%). Conclusiones: Los resultados audiológicos y de cambios en calidad de vida encontrados muestran a Carina® como una opción de rehabilitación auditiva eficiente…

Objective: To describe implantation experience and compare audiometric outcomes and quality of life changes in patients with fully implantable hearing device Carina®. Design: Before-and-after study. Methods: Carina® hearing device was implanted in patients with conductive, mixed and sensorineural hearing losses. As assessment method repeated-measures withinsubjects for functional gain and quality of life changes were performed. The T-test for paired samples was used for statistical analysis. Results: 27 subjects were included (mean age = 28.2 ± 15.8). No significant differences were found between preoperative and postoperative bone conduction pure tone average (PTA) (p > 0.05). The mean functional gain was 24.0 ± 7.9 dB, significant differences between the unaided PTA (62.3 ± 12.4 dB) and aided PTA (38.3 ± 11.9 dB) were found (p < 0.0001). There was a significant improvement in quality of life with the device (p < 0.05). As a major complication, only one patient was explanted (3.7%). Conclusions: The audiological outcomes and quality of life changes show Carina® as an efficient option for hearing rehabilitation. …

Mutation in the xpsD gene of Xanthomonas axonopodis pv. citri affects cellulose degradation and virulence

The Gram-negative bacterium Xanthomonas axonopodis pv. citri, the causal agent of citrus canker, is a major threat to the citrus industry worldwide. Although this is a leaf spot pathogen, it bears genes highly related to degradation of plant cell walls, which are typically found in plant pathogens that cause symptoms of tissue maceration. Little is known on Xac capacity to cause disease and hydrolyze cellulose. We investigated the contribution of various open reading frames on degradation of a cellulose compound by means of a global mutational assay to selectively screen for a defect in carboxymethyl cellulase (CMCase) secretion in X. axonopodis pv. citri. Screening on CMC agar revealed one mutant clone defective in extracellular glycanase activity, out of nearly 3,000 clones. The insertion was located in the xpsD gene, a component of the type II secretion system (T2SS) showing an influence in the ability of Xac to colonize tissues and hydrolyze cellulose. In summary, these data show for the first time, that X. axonopodis pv. citri is capable of hydrolyzing cellulose in a T2SS-dependent process. Furthermore, it was demonstrated that the ability to degrade cellulose contributes to the infection process as a whole.

Analysis of the molecular basis of Xanthomonas axonopodis pv. citri pathogenesis in Citrus limon

Xanthomonas axonopodis pathovar citri (Xac) causes bacterial citrus canker, a serious disease of most citrus species. Xanthomonas campestris pv. campestris (Xcc) is the causal agent of black rot disease in cruciferous plants. In Xcc, cell-cell signaling is mediated by diffusible signal factor (DSF). Synthesis of DSF depends on RpfB and RpfF. DSF perception and signal transduction have been suggested to involve a two-component system comprising RpfC and RpfG. It has been proposed that these proteins participate in a signal transduction system linking changes in the environment to the synthesis of DSF and the expression of virulence genes. Although the cluster of the rpf genes in Xac has synteny with the corresponding cluster in Xcc, two genes (rpfH and rpfI) are absent in Xac. To investigate DSF-mediated regulation during Xac-Citrus limon interaction, we constructed two strains of Xac, one with a mutation in the rpfF gene, leading to an inability to produce DSF, and one with a mutation in the rpfC gene leading to an overproduction of DSF. These mutants also show decreased levels of extracellular cyclic â-(1,2)-glucans and decreased production of endoglucanase and protease extracellular enzymes. The Xac DSF-deficient rpfF and the DSF-hyper producing rpfC mutants are both severely compromised in their ability to cause canker symptoms in lemon leaves compared to the wild-type. Here we provide evidence that rpf genes in Xac are involved in controlling virulence factors mediated by DSF.