Lupus Eritematoso Sistémico y Manifestaciones en el Sistema Nervioso Central: Un desafío diagnóstico permanente: casos Clínicos / Systemic lupus erythematosus and manifestations in the Central Nervous System: a permanent diagnostic challenge. Clinical cases

La presencia de manifestaciones neuropsiquiátricas en pacientes reumatológicos trae consigo un gran desafío diagnóstico que exige una mirada amplia, desde las bases de la medicina interna, a fin de poder orientar un estudio adecuado y el tratamiento oportuno. Junto con ello, el permanente diálogo e intercambio de miradas clínicas con otras especialidades permite tener un enfoque multidisciplinario que enriquece el abordaje de estas presentaciones complejas.

The presence of neuropsychiatric manifestations in rheumatological patients brings with it a great diagnostic challenge that requires a broad view, from the foundations of internal medicine, in order to guide the appropriate study and timely treatment of these patients. Along with this, the permanent dialogue and exchange of clinical views with other specialties allows for a multidisciplinary approach that enriches the approach to these complex presentations.

Perfil epidemiológico de pacientes portadores de câncer de pele atendidos no Hospital Regional da Asa Norte/DF - Brasil / Epidemiological profile of patients with skin cancer treated at the Regional Hospital of Asa Norte/DF - Brazil

Introdução: O câncer de pele é a neoplasia mais comum na população brasileira, correspondendo a 30% de todos os tumores malignos registrados no país. Os tumores malignos não melanoma são o tipo de câncer de maior incidência e prevalência no Brasil. O carcinoma basocelular (CBC) é o mais comum, correspondendo entre 70% e 75% dos casos. O carcinoma epidermóide (CEC) responde por 20% dos casos. O objetivo é determinar o perfil epidemiológico, os tipos e subtipos encontrados nos resultados de histopatológico, a conduta cirúrgica e sua eficácia, dos pacientes com suspeita de lesão maligna de pele. Métodos: Estudo retrospectivo descritivo, baseado na análise de prontuário eletrônico de ressecção de lesões de pele suspeitas de maligna, pela equipe da Cirurgia Plástica do Hospital Regional da Asa Norte, Brasília/DF, no período de janeiro de 2012 a dezembro de 2016. Resultados: Foram submetidos à cirurgia 533 pacientes, sendo sexo feminino (51,6%), com média de idade de 68,97 anos e 84% com diagnóstico de carcinoma basocelular com subtipo sólido. As margens comprometidas atingiram 11% da amostra. As reconstruções mais prevalentes foram fechamento primário e retalhos locais. Conclusão: O perfil epidemiológico dos pacientes atendidos com lesões suspeitas de câncer de pele demonstrou prevalência em mulheres e acima de 60 anos, com história de exposição solar. A face foi o local mais acometido, sendo o nariz a topografia mais comum. O CBC é tipo mais comum e o subtipo sólido circunscrito foi o mais prevalente. O tipo de reconstrução mais utilizado foi o fechamento primário e o retalho local.

Introduction: Skin cancer is the most common neoplasm in the Brazilian population, corresponding to 30% of all malignant tumors registered in the country. Non-melanoma malignant tumors are the type of cancer with the highest incidence and prevalence in Brazil. Basal cell carcinoma (BCC) is the most common, accounting for between 70% and 75% of cases. Squamous cell carcinoma (SCC) accounts for 20% of cases. The objective is to determine the epidemiological profile, the types and subtypes found in the histopathological results, the surgical conduct and its effectiveness in patients with a suspected malignant skin lesion. Methods: A retrospective descriptive study, based on the analysis of electronic medical records for resection of skin lesions suspected of malignancy, carried out by the Plastic Surgery team at the Regional Hospital of Asa Norte, Brasília/DF, from January 2012 to December 2016. Results: 533 patients were submitted to surgery, being female (51.6%), with a mean age of 68.97 years and 84% diagnosed with basal cell carcinoma with solid subtype. The compromised margins reached 11% of the sample. The most prevalent reconstructions were primary closure and local flaps. Conclusion: The epidemiological profile of patients treated with lesions suspected of skin cancer showed prevalence in women over 60 years with a history of sun exposure. The face was the most affected site, the nose being the most common topography. BCC is the most common type, and the circumscribed solid subtype was the most prevalent. The most used type of reconstruction was primary closure and local flap.

Streptococcus pseudoporcinus: a rare cause of bacteraemia in an immune-compromised patient

Streptococcus pseudoporcinus, a ß-haemolytic Streptococcus is known to cause genital infections. Author report a rare case of Streptococcus pseudoporcinus bacteremia in an immune-compromised male patient diagnosed with acute myeloid leukemia eight months back. The organism was identified as a beta hemolytic bacterium which was catalase negative, oxidase positive and bacitracin resistant. Automated methods (VITEK-2) confirmed the organism to be Streptococcus pseudoporcinus.

Smoking Exposure and Placental Vascular Compromise: A Nationwide Population-Based Study in South Korea

PURPOSE: This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta. METHODS: A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed. RESULTS: Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18–1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18–1.47), with an adjusted attributable risk of 23.95%. CONCLUSION: The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.

Diagnosis of Nerve Root Compromise of the Lumbar Spine: Evaluation of the Performance of Three-dimensional Isotropic T2-weighted Turbo Spin-Echo SPACE Sequence at 3T

OBJECTIVE: To explore the performance of three-dimensional (3D) isotropic T2-weighted turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) sequence on a 3T system, for the evaluation of nerve root compromise by disc herniation or stenosis from central to extraforaminal location of the lumbar spine, when used alone or in combination with conventional two-dimensional (2D) TSE sequence. MATERIALS AND METHODS: Thirty-seven patients who had undergone 3T spine MRI including 2D and 3D sequences, and had subsequent spine surgery for nerve root compromise at a total of 39 nerve levels, were analyzed. A total of 78 nerve roots (48 symptomatic and 30 asymptomatic sites) were graded (0 to 3) using different MRI sets of 2D, 3D (axial plus sagittal), 3D (all planes), and combination of 2D and 3D sequences, with respect to the nerve root compromise caused by posterior disc herniations, lateral recess stenoses, neural foraminal stenoses, or extraforaminal disc herniations; grading was done independently by two readers. Diagnostic performance was compared between different imaging sets using the receiver operating characteristics (ROC) curve analysis. RESULTS: There were no statistically significant differences (p = 0.203 to > 0.999) in the ROC curve area between the imaging sets for both readers 1 and 2, except for combined 2D and 3D (0.843) vs. 2D (0.802) for reader 1 (p = 0.035), and combined 2D and 3D (0.820) vs. 3D including all planes (0.765) for reader 2 (p = 0.049). CONCLUSION: The performance of 3D isotropic T2-weighted TSE sequence of the lumbar spine, whether axial plus sagittal images, or all planes of images, was not significantly different from that of 2D TSE sequences, for the evaluation of nerve root compromise of the lumbar spine. Combining 2D and 3D might possibly improve the diagnostic accuracy compared with either one.

Psicología y política en Brasil:: ¿Psicología politizada o Psicología política?

Este artículo tiene como objetivo conocer los discursos sobre la relación entre psicología y política en Brasil, para discutir la constitución, características generales y conformación actual de la Psicología Política brasileña. Como método de investigación fue realizada una revisión bibliográfica sobre toda la literatura publicada sobre Psicología Política en Brasil. Se constató que su emergencia derivó del encuentro y debate entre dos campos independientes, de la articulación entre el campo de conocimiento y su dimensión ético-política, o sea, de la Psicología Política instituida con una Psicología politizada, de corte marxista. Concluye con una definición general de que la Psicología Política brasileña es el campo transdisciplinar de saberes resultante de la articulación entre una caja de herramientas de teorías psicosociales y un proyecto ético-político por la autonomía y transformación social. Así, a través de variados referentes teóricos, sostiene la utopía de incitar procesos de concientización y cambio en las relaciones de poder instituidas.

This article aims to know the discourses about the relationship between psychology and politics in Brazil, to discuss the constitution, general characteristics and current conformation of Brazilian Political Psychology. As a research method, we carried out a bibliographic review on all the published literature on Political Psychology in Brazil. It was found that its emergence resulted from the meeting and debate between two independent fields, from the articulation between the field of knowledge and its ethical-political dimension, that is, the Political Psychology instituted with a politicized Psychology, from a Marxist perspective. It concludes with a general definition that Brazilian Political Psychology is the transdisciplinary field of knowledge resulting from the articulation of a toolbox of psychosocial theories and an ethical-political project for autonomy and social change. Thus, through several theoretical references, it defends the utopia of inciting processes of empowerment and change in the instituted power relations.

Este artigo tem como objetivo conhecer os discursos sobre a relação entre psicologia e política no Brasil, para discutir a constituição, características gerais e conformação atual da Psicologia Política brasileira. Como método de investigação foi realizada uma revisão bibliográfica sobre toda a literatura publicada sobre Psicologia Política no Brasil. Foi constatado que sua emergência derivou do encontro e debate entre dois campos independentes, da articulação entre o campo de conhecimento e sua dimensão ético-política, ou seja, da Psicologia Política instituída com uma Psicologia politizada, de viés marxista. Conclui com uma definicáo geral de que a Psicologia Política brasileira é o campo transdisciplinar de saberes resultante da articulação de uma caixa de ferramentas de teorias psicossociais e um projeto ético-político pela autonomia e transformação social. Assim, através de diversos referenciais teóricos, defende a utopia de fomentar processos de conscientização e mudança nas relações de poder instituídas.

Airway compromise during central venous cannulation in an undiagnosed tubercular retropharyngeal abscess: A case report.

Central venous cannulation is often associated with complications during insertion even by expert’s hand and with the aid of ultrasound. We encountered a patient for central line insertion through the right internal jugular vein having a retropharyngeal abscess of tubercular origin. We accidentally punctured the abscess cavity leading to increased respiratory distress and subsequent need of intubation to the patient. This kind of complication during central line insertion has never been reported before. We intend to report such a case to alert everyone about the grave complications it can lead to and the methods to minimize them in the times ahead.

Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery

STUDY DESIGN: Prospective study. PURPOSE: To compare magnetic resonance imaging (MRI) findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patients and predict the outcome. OVERVIEW OF LITERATURE: Previous studies have reported poor neurological recovery in patients with cord hemorrhage, as compared to cord edema in spine injury patients. High canal compromise, cord compression along with higher extent of cord injury also carries poor prognostic value. METHODS: Neurological status of patients was assessed at the time of admission and discharge in as accordance with the American Spine Injury Association (ASIA) impairment scale. Mean stay in hospital was 14.11+/-5.74 days. Neurological status at admission and neurological recovery at discharge was compared with various qualitative cord findings and quantitative parameters on MRI. In 27 patients, long-term follow-up was done at mean time of 285.9+/-43.94 days comparing same parameters. RESULTS: Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion showed lesser neurological recovery, as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length values were higher in patients presenting with ASIA A impairment scale injury and showed decreasing trends towards ASIA E impairment scale injury. Patients showing neurological recovery had lower mean MCC, MSCC, and lesion length, as compared to patients showing no neurological recovery (p<0.05). CONCLUSIONS: Cord hemorrhage, higher MCC, MSCC, and lesion length values have poor prognostic value in spine injury patients.

Conceitos fundamentais dos métodos projetivos / Fundamental concepts for projective techniques

O objetivo deste artigo é colaborar para fortalecer a confiança no uso dos métodos projetivos nos processos de avaliação psicológica. As associações produzidas frente aos estímulos ambíguos são consideradas expressões da personalidade. Tendo a psicanálise como cenário principal, faremos aqui a exposição de alguns conceitos teóricos que colaboram para a interpretação dos materiais projetivos. São examinados três conceitos: a projeção e suas diferentes variações, a elaboração de fantasias e a personificação. Em seguida, são apresentados alguns métodos projetivos, discutindo-se a eficácia projetiva por meio dos desenhos e pinturas...

Fundamental concepts for projective techniques. The objective of this article is to collaborate to strengthen the trust in the use of the projective methods in processes of psychological diagnosis. The associations produced to the ambiguous materials are considered as expressions of the personality. With the psychoanalysis as the main scenery, this paper exposes some theoretical concepts that make possible the interpretation of the projective materials. In the first part of the paper, four concepts are examined: projection and their different variations, elaboration of fantasies, personification and compromise formation. Soon afterwards, some projective techniques are presented, and the effectiveness of them is illustrated through drawings and paintings...

3D finite analysis on injury mechanism of spinal cord compression / 医用生物力学

Objective To construct 3D finite element model of the thoracolumbar spinal cord, and study the mechanism of spinal cord injury caused by burst fracture through biomechanical experiments. Methods The compression simulation on burst fracture was performed using finite element technology, and the results were verified by comparing the tested models with the in vivo and in vitro experimental results. Results The strain distribution in white matter of the spinal cord was higher than that in grey matter at the initial stage of burst fracture. As the displacement of bony fragments increased, the strain distribution in grey matter increased subsequently. But when the displacement of bony fragments finally reached the maximum, the strain in white matter was higher than that in grey matter. Conclusions Traumatic severity of the spinal cord during burst fracture is dependent on the posterior encroachment, and the traumatic procedure order for ventral horn (motor function) or dorsal horn (sensory function) of cord tissue also plays an important role in the evaluation. In clinical practice, the patient’s condition can be evaluated more accurately by assessing severity of the spinal motor and sensory functions. Further understanding on strain distribution in the spinal cord during the injury may inspire new strategies for treating or preventing spinal cord injury.

Surgery for Nasal Valve Compromise / 대한이비인후과학회지

The nasal valve spans a minimal cross sectional area of the intake point inside the nose. Acting as a Starling's resistor, it plays a pivotal role in controlling the inspiratory airflow. Nasal valve compromise, better known as nasal valve dysfunction, can be suspected when the patient complains of inspiratory nasal obstruction after trauma or surgery. If the patient has a history highly suspicious of nasal valve compromise, thorough physical examinations are mandatory in order to find the exact epicenter. The deformed L-strut septum and/or upper lateral cartilage are mainly responsible for the static internal nasal valve compromise. Characteristic findings include pinching of the middle vault and an inverted V deformity. Widening the nasal valve area is the most preferred therapy to correct statically narrowed nasal valve compromise. External valve compromise, on the other hand, is dynamically collapsible in many cases as evident during respiration. Typical sign, therefore, includes an inward collapse of alar and/or lateral wall upon inhalation. Treatment strategy, in this particular case, usually involves a cartilage addition to the deficient lateral wall or alar in order to stablize and provide rigidity to the lateral wall and also resist inspiratory negative force. However, surgeons should not be confused by the collapse as it may merely reflect the collapsibility of the structure rather than a genuine epicenter of nasal obstruction. Cartilage graft with or without suturing is the best therapeutic measure for patients with either static or dynamic nasal valve compromise when tackling nasal obstruction. It also enhances the structural integrity of the nasal valve. This review focuses on the various surgical techniques used in repairing nasal valve compromise to increase patency and restore breathing with an emphasis on each specific indication.

Tratamiento de la fístula perianal en la enfermedad de Crohn a partir de una experiencia local / Treatment of perianal fistulae in Crohn´s disease: a local experience

Background: Perianal fistula (PF) may be present in 40 percent of patients with Crohn´s Disease (CD). Due to its complexity, its management should be multidisciplinary. Purpose: To describe clinical treatment in patients with CD and PF in our institution. Materials and Methods: This is a descriptive retroprospective study, using a registry of CD patients. We selected patients with PF and further characterized those patients that received their treatment at Clínica las Condes (CLC). Results: From a total of 74 patients with CD in the registry, 23 (31 percent) had PF, 61 percent male, median of 7 years of disease and half with colonic extension. Twelve patients were treated in CLC, from these, seven had concomitant proctitis. Optimal diagnostic study (magnetic resonance imaging/endorectal ultrasound plus examination under anesthetic) was performed in eleven (92 percent) patients. Ten (83 percent) patients received an optimal treatment (drainage and installation of a loose seton + start or optimization of medical therapy). Complete clinical response was achieved in more than half of the patients under optimal treatment within the first 6 months. Six (50 percent) patients had one or more recurrences of PF with similar study and management in a median of 13 months. With a median follow-up of 29 months, eight out of 12 patients had complete clinical response. There was one patient with unfavorable course who required a proctectomy and terminal diversion. Conclusion: Treatment of PF in CD is complex and in our population, the first-line treatment includes the installation of a loose seton and medical therapy to achieve clinical response even though fistulous tracts may persist.

Introducción: La fístula perianal (FP) puede presentarse hasta en 40 por ciento de los pacientes con Enfermedad de Crohn (EC). Dada su complejidad el tratamiento debe ser multidisciplinario. Objetivo: Describir el tratamiento de los pacientes portadores de EC con FP. Métodos: Estudio descriptivo, utilizando un registro de pacientes con EC. Se seleccionaron los pacientes con FP y se caracterizaron aquellos que recibieron el tratamiento en Clínica Las Condes (CLC). Resultados: De un total de 74 pacientes con EC, 23 (31 por ciento) presentaban FP asociada, 61 por ciento de sexo masculino, mediana de duración de enfermedad 7 años y la mitad con extensión colónica. Doce pacientes fueron tratados en CLC, de ellos, siete presentaban proctitis al momento de la FP. En 11 (92 por ciento) pacientes se realizó un estudio diagnóstico óptimo (resonancia magnética/ endosonografía transrrectal y exploración bajo anestesia). Diez (83 por ciento) pacientes recibieron tratamiento óptimo biasociado (drenaje e instalación de sedal no cortante + inicio u optimización de terapia médica). Siete pacientes con tratamiento óptimo presentaron mejoría clínica completa dentro de los primeros 6 meses. Seis (50 por ciento) pacientes presentaron una o más recurrencia de FP con estudio y manejo similar en una mediana de 13 meses. Con una mediana de seguimiento de 29 meses, ocho de los 12 pacientes obtuvieron mejoría clínica completa. Una paciente evolucionó desfavorablemente, requiriendo proctectomía y ostomía terminal. Conclusión: El manejo del FP en EC es complejo, en nuestra población el tratamiento biasociado (sedal + fármacos) fue de elección para lograr una mejoría clínica aun cuando persistieron los trayectos fistulosos.

Neuroblastoma congénito cervical en recién nacido: presentación de un caso / Cervical congenital neuroblastome in a newborn: presentation of a case

Los neuroblastomas congénitos cervicales son muy raros. Esta forma de cáncer infantil se forma en el tejido nervioso y por lo general suele presentarse con mayor frecuencia en las glándulas suprarrenales. Aunque puede aparecer prenatalmente, es más frecuente que se diagnostique en el primer año de vida. Son tumores agresivos con una alta mortalidad. En casi todos los casos (50-60 por ciento de los mismos), para cuando se detecta un neuroblastoma, ya se ha diseminado a otras partes del cuerpo. Se presenta un caso de recién nacido que las primeras 24 horas, muestra una historia de compromiso de vías respiratorias y digestivas asociado a una masa cervical sólida y parálisis de XII par craneal.

Cervical congenital neuroblastomes are very rare. This form of infantile cancer forms in the nervous tissue and generally it uses to appear more frequently in the suprarenal glands. Although they may appear prenatally, they are more frequent in the first year after birth. They are aggressive tumors with a high mortality. In almost all the cases (50/60 percent of them), when a neuroblastome is detected, it is already disseminated to other parts of the body. We present the case of a newborn who shows a history of respiratory and digestive tracts compromise associated to a solid cervical mass and XII cranial par paralysis during the first 24 hours after birth.

Coronary Artery Air Embolism.

Coronary artery air embolization is a rare event leading to catastrophic hemodynamic compromise within seconds after introduction of air emboli within the coronary arteries. The management of massive air embolism should be extremely quick so as to save life of the patient. We present a case of a 35-year-old, diabetic and hypothyroid female who had massive air embolism in both LAD and LCX arteries during coronary angiography, which resolved within a few minutes with prompt treatment.

Ipsilateral fracture dislocations of the hip and knee joints with fracture of acetabulum : a rare case and its management principles.

Simultaneous ipsilateral hip and knee dislocations can be a devastating injury rendering the limb useless if not treated for time. Long term results also vary because these two types of injuries are associated with complications like avascular necrosis of the femoral head, knee instability, and stiffness at both the joints. Early diagnosis and prompt reduction is must to prevent the complications. Here we report a case with such an injury with description regarding its management difficulties. The prompt reduction of dislocations was carried out to achieve good results. Our case report add to this existing literature.

Bem-estar subjetivo e comprometimento com a carreira: examinando suas relações entre professores de Ensino Superior / Subjective well-being and compromise with the faculty career: examining their relations

As mudanças pelas quais o ensino superior enfrenta no Brasil acontecem em compasso com aquelas ocorridas no cenário mais amplo do mundo do trabalho, salientando a ocupação de professor universitário como unidade de análise relevante para as investigações na área da psicologia organizacional e do trabalho. Os estudos sobre comprometimento no trabalho destacam a relação com a carreira como um foco cada vez mais significativo na vida das pessoas, cujos ambientes de trabalho estão cada vez mais incertos e mutantes. Esta pesquisa buscou examinar as associações entre o comprometimento com a carreira e o bem-estar subjetivo, em professores universitários. Realizou-se para tanto estudo transversal e quantitativo, através de questionários fechados auto-aplicáveis respondidos por 551 professores de todo o território nacional. Os principais resultados indicam altos níveis de comprometimento com a carreira, assim como a correlação positiva e significativa entre o comprometimento e o bem-estar subjetivo dos professores, confirmando as tendências apontadas na literatura internacional e ampliando o leque de associações entre o comprometimento e variáveis extra-trabalho. Estudos intensivos e qualitativos são recomendados a fim de que os significados destes vínculos indiquem as formas pelas quais as duas variáveis estão inter-relacionadas.

The changes faced by the university education in Brazil take place simultaneously with those occurred on a broader view in the world of work, especially regarding the occupation of faculty members as units of important analysis for investigations in the arena of organizational and work psychology. Studies addressing compromise with work highlight the relation with the career as a focus of continuous growing significance in the lives of individuals, which work environments are becoming increasingly uncertain and mutant. This objective of this study was to examine the associations between compromise with career and subjective well-being among faculty members. For such purpose the author carried out a quantitative cross survey using self-applicable closed-type questionnaires responded by 551 teachers throughout the national territory. The main results include the high level of compromise with the career, as well as a positive and significant correlation between the compromise and the subjective well-being of faculty members, thus confirming the trends reported by the international literature and broadening the possibilities of associations between the compromise and non-work variables. Intensive and qualitative studies are recommended in order to understand the meaning of these associations and how those two variables are correlated.

Embolia pulmonar: tratamento da fase aguda / Pulmonary embolism: acute phase treatment

O tratamento da embolia pulmonar em sua fase aguda tem como objetivos a manutenção da estabilidade clínica e a reperfusão das artérias pulmonares. Nessa fase, quando ocorre o maior número de óbitos, é fundamental que estratégias terapêuticas adequadas a cada caso sejam implementadas. A gravidade da apresentação clínica, relacionada ao grau de comprometimento vascular e ao estado cardiopulmonar prévio dos pacientes, é o principal aspecto a definir o modelo de tratamento

Treatment of pulmonary embolism in its acute phase aims at maintaining stability and clinical reperfusion pulmonary arteries. In this phase, where there is the largest number of deaths, it is essential that appropriate therapeutic strategies are implemented in each case. The severity of clinical presentation, related to the degree of vascular compromise and prior to cardiopulmonary status of patients, the main aspect is to define the model of treatment

Compromiso respiratorio en mucopolisacaridosis / Respiratory manifestations in mucopolysaccharidosis

Mucopolysaccharidosis (MPS) are part of the so-called lysosomal diseases, in which the deposit of different glycosaminoglycans, depending on the enzyme deficit, generates multi-systemic manifestations, being the respiratory system one of the most affected and associated with significant morbidity and mortality. Different types of MPS show a variable degree of organ compromise even from the early stages of life: obstruction of the upper airway of varying degree, persistent rhinorrhea, otitis media, obstructive pathology of the peripheral airway, pneumonias or other infections associated with a poor mucociliary drainage are the main manifestations presented by patients. The compromise of the neurological and musculoskeletal system also brings the compromise of the respiratory pump. From that perspective the approach must be multidisciplinary, since there are several organs and systems involved. Current therapy is directed to replace the deficient enzyme but it’s available only for some of them, which delays the progression of the disease but does not stop it, even more so there is no effect on the central nervous system, being the cognitive compromise inevitable. Bone marrow transplant is a therapy not exempt of complications, but capable of changing the progression of the disease in its early stages. Therapeutic approach is based on support measures and treatment of concurrent complications, both of which will be discussed in the following article.

Las Mucopoliscaridosis (MPS) son parte de las denominadas enfermedades lisosomales. El depósito de los distintos glicosaminoglicanos comprometidos, dependiendo del déficit enzimático, genera manifestaciones multisistémicas, en donde el sistema respiratorio es uno de los principales afectados y que se asocia con morbilidad y mortalidad significativa. Los diferentes tipos de MPS presentan un grado variable de compromiso desde etapas precoces de la vida, síntomas de obstrucción de vía aérea superior de grado variable, rinorrea persistente, otitis media, patología obstructiva de vía aérea periférica, neumonías o infecciones asociadas a un mal drenaje mucociliar son las principales manifestaciones que los pacientes presentan. El compromiso neurológico y musculo esquelético, trae consigo además el compromiso de la bomba respiratoria. Desde esa perspectiva el enfoque debe ser multidisciplinario, ya que el compromiso abarca varios órganos y sistemas. Las actuales terapias están dirigidas a reemplazar la enzima deficitaria, disponibles sólo para algunas de ellas, esto trae consigo el retardo de la evolución de la enfermedad pero no lo evita, considerando que más aun no tiene ningún efecto sobre el sistema nervioso central, por lo que el compromiso cognitivo es inevitable. El trasplante de médula es una terapia no exenta de complicaciones, pero que es capaz de cambiar la progresión de la enfermedad en las etapas precoces de ella. El enfoque terapéutico se basa en terapia de sostén y el manejo de las distintas complicaciones que se van dando, siendo éstos los ejes del siguiente artículo.

Screening Maize (Zea mays L.) Genotypes by Genetic Variability of Vegetative and Yield Traits Using Compromise Programming Technique.

The present study was made to develop a suitable procedure for selecting the most sustainable maize genotype to grow by considering genetic variability for vegetative, yield and yield components under irrigated farming. The experiment was conducted at the experimental farm, College of Agricultural studies, Sudan University of Science and Technology, Shambat, during summer seasons of 2007/08 and 2008/09, respectively. Significant variability was observed for plant height, stem diameter, number of rows per cob and ear length during the first season 2007/08 and for days to 50% flowering and 100-seed weight during the second season 2008/09. Frantic genotype scored maximum seed weight (81.0g) while Baladi had least seed weight (57.48g). Frantic genotype had maximum grain yield (0.577 ton/ha), while minimum grain yield ton/ha was recorded in Baladi (0.473 ton/ha). Data recorded for heritability showed that days to 50% flowering had maximum heritability (79.1%) while the minimum heritability (4.46%) was recorded for 100 seed weight. The present study revealed considerable amount of diversity among the tested populations which could be manipulated for further improvement in maize breeding in Sudan. However, significant differences of grain yield were observed among varieties. Due to the observed variability multi objective compromise programming technique is employed to screen these Maize (Zea mays L.) genotypes according to their vegetative and yield traits for purpose of selecting the best one that suit irrigated farming conditions of Shambat area. The study ranked the different Maize (Zea mays L.) genotypes and recommends the best alternative. Ranking of alternatives was explored in reference to selection criteria weights preferred by an agronomist, animal production specialist and nutrition scientist in comparison to equal weights.

Compromised ventilation caused by tracheoesophageal fistula and gastrointestinal endoscope undergoing removal of disk battery on esophagus in pediatric patient -A case report- / 대한마취과학회지

Ingestion of disk batteries may have serious complications such as esophageal burn, perforation, and tracheoesophageal fistula, particularly when the battery is caught in the esophagus. Proper placement of the tracheal tube is critical when tracheoesophageal fistula was occurred from esophageal impaction the battery. Endoscopy of upper gastrointestinal tract in infants and children is an important and effective tool for the diagnosis and treatment of foreign body ingestion. But upper gastrointestinal endoscopy in infant and children has very high risk of tracheal compression and airway compromise. We present a case of ventilatory compromise during insertion of the upper gastrointestinal endoscopy in 16-month-old child with tracheoesophageal fistula secondary to disk battery ingestion.