Psicopedagogia para gente grande Atendimento psicopedagógico na idade madura / Psychopedagogy for grown-ups Psychopedagogical care in the mature age

O presente estudo surgiu da observação, em nossa prática profissional, de que o adulto, para lidar com questões de aprendizagem, por diferentes motivos, pode se beneficiar de atendimento psicopedagógico. Para tanto, o levantamento de fontes, de leitura e análise bibliográfica possibilitou investigarmos as necessidades da fase madura, revisando paradigmas, suas características e peculiaridades. Ao longo do trabalho, ressaltamos o resgate e/ou fortalecimento da autonomia e autoria como personagens de grande valor, sempre tendo como alvo a qualidade de vida. O estudo nos leva, ainda, a pensar no seguinte questionamento proposto por vários autores: temos mais um estágio cognitivo além dos propostos por Piaget? Propomos também a intenção de pensar acerca das diferentes possibilidades do atendimento psicopedagógico, ampliando nosso olhar e nossa escuta.

The present study arose from the observation, in our professional practice, that the adult, to deal with learning issues, for different reasons, can benefit from psychopedagogical care. Therefore, the survey of sources of reading and bibliographic analysis made it possible to investigate the needs of the mature phase, reviewing paradigms, their characteristics and peculiarities. Throughout the work, we emphasize the rescue and/or strengthening of autonomy and authorship as characters of great value, always having as a target the quality of life. The study also leads us to think about the following question proposed by several authors: do we have one more cognitive stage in addition to those proposed by Piaget? We also propose the intention of thinking about the different possibilities of psychopedagogical care, expanding our look and our listening.

Actinomicetoma plantar en un paciente sin factores de riesgo / Plantar actinomycetoma in a patient without risk factors

Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

Vasculitis por reacción de hipersensibilidad tipo III / Vasculitis for type III hypersensitivity reaction

Los procesos inmunitarios son utilizados por el organismo para defenderse de la agresión de agentes infecciosos; no obstante, en ciertos casos, el organismo reacciona de forma inapropiada o excesiva ocasionando diversos tipos de daño tisular. Estas situaciones, que conocemos como hipersensibilidad, pueden tener aspectos positivos o negativos al poder causar ellos mismos la enfermedad. Se presenta el caso de una niña de 14 años de edad, que acude al Hospital Pediátrico Docente William Soler después de varios ingresos en otros centros de salud, donde se planteó el diagnóstico de un pie de madura. Después de varias investigaciones y con el antecedente de alergia a diferentes medicamentos, los cuadros de amigdalitis a repetición, los datos del laboratorio y la clínica que presentaba la paciente, se estableció el diagnóstico de una vasculitis por reacción de hipersensibilidad tipo III. Por las características tan atípicas del cuadro clínico de esta paciente y la dificultad para llegar a un diagnóstico es importante la presentación de este caso(AU)

The immune processes are used by the body to defend against the aggression of infectious agents; however, in certain cases, the body reacts inappropriately or excessively causing various types of tissue damage. These situations, which we know as hypersensitivity, can have positive or negative aspects by being able to cause the disease themselves. We present the case of a 14-year-old girl who attended the William Soler Pediatric Teaching Hospital after several admissions to other health centers, where the diagnosis of a mature foot was raised. After several investigations and with the history of allergy to different drugs, the recurrent tonsillitis symptoms, the laboratory data and the clinic presented by the patient, the diagnosis of a vasculitis due to type III hypersensitivity reaction was established. Because of the atypical characteristics of this patient's clinical picture and the difficulty in reaching a diagnosis, the presentation of this case is important(AU)

De leitora para leitora: o espaço da mulher madura na revista Marie Claire / From reader to reader: the experience of aging in Marie Claire

Este artigo tem por objetivo analisar algumas produções textuais da seção Eu, Leitora da revista Marie Claire redigidas por leitoras do periódico que pertençam a faixa etária dos 45 aos 65 anos. Pretende-se, também, verificar quais são as temáticas abordadas nesses textos, bem como a maneira como são desenvolvidos. Com isso, intenta-se observar a caracterização dessa categoria de mulheres e, também, do espaço destinado a elas na imprensa feminina representada pelo periódico escolhido para analise. O caminho metodológico a ser percorrido, inicialmente, e pela Analise de Conteúdo (Bardin , 2004), com a intenção de verificar quais as categorias temáticas presentes nos textos analisados. Posteriormente, utiliza-se a Analise de Discurso (Charaudeau , 2006) para a compreensão dos significados presentes nas produções verbais das leitoras. Ao termino das analises, verifica-se que as mulheres elaboram seus textos considerando três temáticas: historias de amor, historias de saúde e historias de maternidade. Observa-se, também, que a referida sessão da revista revela-se como um importante espaço para essas leitoras, as quais são mulheres maduras e compartilham suas experiências com outras leitoras.

This paper aims to analyze some textual production on “Me, the reader”, section from Marie Claire magazine written by female readers between 45 and 65 years old. It is also intending to check what issues are approached in these texts, as well as the way they are developed. In this way, the purpose is to characterize the mature woman and the space she takes up in Marie Claire. The methodology, used initially is Analysis of Content (Bardin , 2004), with the intention of verifying which issues are present in the analyzed texts. Afterwards, the Speech Analysis is used (Charaudeau , 2006) to understand the meanings present in the readers’ verbal production. At the end of the analysis,it is proved that women prepare their texts considering three themes: love stories, health care stories and motherhood stories. It is also observed that the mentioned session from the magazine proves to be an important space for these mature female readers to share their experience with other readers.

Diversidad, estructura y regeneración de la selva tropical estacionalmente seca de la Península de Yucatán, México / Diversity, structure and regeneration of the seasonally dry tropical forest of Yucatán Península, Mexico

Las selvas tropicales estacionalmente secas son consideradas como uno de los ecosistemas más amenazados en las tierras bajas de la región tropical. El objetivo de este estudio fue caracterizar la composición florística, riqueza, diversidad, estructura y regeneración de una selva tropical estacionalmente seca constituida por selva mediana, vegetación secundaria y selva baja inundable localizada en el noroeste de la Península de Yucatán, México. Se utilizó el protocolo de muestreo estandarizado propuesto por Gentry (0.1 ha por tipo de vegetación en 2007) con la finalidad de comprar los resultados obtenidos en este estudio con respecto a otras selvas estacionalmente secas en Mesoamérica. Se registraron un total de 77 especies pertenecientes a 32 familias de plantas. Fabaceae y Euphorbiaceae fueron las familias con el mayor número de especies observadas en los tres tipos de vegetación estudiados. Se observó un alto recambio de especies a nivel del paisaje (Índice de Similitud de Sorensen; 0.19-0.40). Las especies no-regenerativas fueron dominantes (50-51 %), seguida de las especies regenerativas (30-28 %) y colonizadoras (14-21 %) en los tres tipos de vegetación estudiados. Zoocoria fue el modo de dispersión comúnmente observado en el área de estudio. El 88 % de las especies observadas en el área de estudio se distribuyen en Centro América. La selva del noroeste de la Península de Yucatán compartió diversos atributos florísticos a los observados en otras selvas estacionalmente secas de Meosoamérica. Las características estructurales de la vegetación (número de individuos y área basal), así como el número de especies de lianas registradas en este estudio se asociaron a los eventos de alteración natural ocurridos recientemente en el área de estudio. Los resultados obtenidos en este estudio sugieren que la selva del noroeste de la Península de Yucatán ha sido resiliente a los eventos de alteración natural (huracanes), lo que le ha permitido mantener los valores de riqueza específica dentro del rango considerado como común para las selvas estacionalmente secas de Mesoamérica. Sin embargo, la recuperación y regeneración de la vegetación a largo plazo depende de los animales dispersores de semillas. Este estudio enfatiza en la importancia de establecer una red de áreas naturales protegidas con la finalidad de conservar tanto a la diversidad acomo a la diversidad p en las selvas estacionalmente secas de Mesoamérica.

Seasonally dry tropical forests are considered as the most endangered ecosystem in lowland tropics. The aim of this study was to characterize the floristic composition, richness, diversity, structure and regeneration of a seasonally dry tropical forest landscape constituted by mature forest, secondary forest and seasonally inundated forest located in the Northeastern part of the Yucatán Península, Mexico. We used the Gentry's standard inventory plot methodology (0.1 ha per forest type in 2007) for facilitating comparison with other Mesoamerican seasonally dry tropical forests. A total of 77 species belonging to 32 families were observed in the study area. Fabaceae and Euphorbiaceae were the families with the largest taxonomic richness in the three forest types. Low levels of p diversity were observed among forest types (0.19-0.40), suggesting a high turnover of species at landscape level. The non-regenerative species were dominant (50-51 %), followed by regenerative species (3028 %), and colonizer species (14-21 %) in the three forest types. Zoochory was the most common dispersal type in the study area. The 88 % of the observed species in the study area were distributed in Central America. Some floristic attributes of the seasonally dry tropical forest of the Yucatán Península, fall into the values reported for Mesoamerican seasonally dry tropical forests. Natural disturbances contributed to explain the high number of individuals, the low number of liana species, as well as the low values of basal area observed in this study. Our results suggested that the seasonally dry tropical forest of Yucatán Península seems to be resilient to natural disturbances (hurricane) in terms of the observed number of species and families, when compared with the reported values in Mesoamerican seasonally dry tropical forests. Nonetheless, the recovery and regeneration of vegetation in long-term depends on animal-dispersed species. This study highlights the importance of establishing multiple protected areas throughout the Mesoamerican seasonally dry tropical forest in order to conserve both "- and P- diversity.

Mycetoma at a tertiary care hospital in Saudi Arabia: Correlation of histopathological and clinical findings

Objective: To present the histopathological and clinical correlation of mycetoma among patients attending King Abdulaziz University Hospital between 1998-2013. Methods: The data of all histopathologically diagnosed mycetomas in the period between January 1998 and January 2013 were collected through a computerized database search of the anatomic pathology archives at King Abdulaziz University Hospital. The collected data were analysed. Identification of species were performed for five patients using 16S ribosomal DNA and internal transcribed spacer 2. Results: There were 19 patients with mycetoma with an average age of 44.26 years and male: female ratio of 4:1. Actinomycetoma were 63.15% and eumycetoma were 36.84%. All patients presented with the classic lesions; presenting as painless subcutaneous mass, sinuses and discharge containing grains. The swellings were of slow evolution, with preferential foot localization. Species specification performed for samples from five patients with active lesions revealed species of Actinomyces israelii and Madurella mycetomatis in respective cases. Conclusions: Actinomycetoma is more common than eumycetoma in this region. The fact that one of the patients with eumycetoma was a Saudi national raises the possibility of an indigenous species similar to Maduraella mycetomatis to be further explored for characteristics and pathogenesis. The disease has to be prioritized again and more robust and quick molecular diagnostic tools should be made available in order to save patients form disfiguring amputations.

Pie de madura: primer caso en nuestro país y breve actualización (1904-2013) / Foot of madura: first case in our country and brief update (1904-2013)

Presentamos el primer caso de pie de madura publicado en Argentina y realizamos una breve actualización de su diagnóstico y terapéutica.

We presented the first case of feet of Madura published in Argentine. We did a review of diagnostic and treatment.

Recurrent madura foot without draining sinuses: a case report.

Madura foot or mycetoma is a chronic granulomatous disease characterized by localized infection of subcutaneous tissues by actinomycetes or fungi. The recurrence rate for the disease if treated inadequately is very high. Recurrence presents with swelling and multiple discharging sinuses. This is an unusual presentation of the disease without discharging sinuses which is probable the first report of this kind in the literature. A 34 year old, male, presented with the painless, progressive swellings over right foot since 4 years. No sinuses or discharge could be found on skin surface. The postoperative recurrence rate is very high, and this can be local or distant at the regional lymph nodes. This could be due to the disease biology and behavior or inadequate surgical excision. Usually it presents with multiple sinus tracts, and granule. We reported a case with classical absence of sinus tracts in recurrent actinomycosis.

Macronutrientes en la leche madura de madres adolescentes y adultas / Macronutrients in mature milk of teenagers and adult mothers

Estudio no experimental, prospectivo y comparativo para evaluar los niveles de macronutrientes en la leche madura de madres adolescentes. Fueron analizadas 52 muestras de leche madura de madres sanas y eutróficas, divididas en 2 grupos: Grupo A n=24 constituido por la leche de madres adolescentes de 10 a 18 años y Grupo B n=28 conformado por leche de madres adultas de 19 a 35 años, quienes acompañaban a sus hijos 1 a 6 meses de edad hospitalizados desde agosto 2009 a agosto de 2010. Las muestras fueron analizadas para determinar las concentraciones de carbohidratos, lípidos y proteínas. Las características maternas de los grupo A y B respectivamente fueron; etnia mestiza el 59,4% y el 39,9%, promedio de índice de masa corporal: fue de 23,55±1,01 kg/m2 y 24,2±0,38 kg/m2. Fueron primigestas 87,5% en el A y 35,7% en el B. Edad de los niños entre 1 a 2 meses: grupo A 66,6% y grupo B 71,4%. Edad maternal: grupo A 75% tenían entre 16 y 18 años y en el B 28,5% tenían entre 19 y 21 años. En A la concentración de proteínas fue 1,8±0,7 g/100ml y en B 1,9±0,7 g/100ml. La concentración de grasas en las adolescentes fue 3,8±1,5 g/100ml y en las adultas 3,9±1,3 g/100ml. La concentración de los carbohidratos en las adolescentes fue 6,8±0,8 g/100ml y en las adultas 6,6±0,9 g/100ml, siendo P>0,05 no estadísticamente significativo en los 3 casos. La concentración de macronutrientes en la leche madura de madres adolescentes y el valor energético de la misma fue similar al de las madres adultas.

This is a comparative, prospective and non-experimental study that evaluated the level of macronutrients in teenage mothers’mature breastmilk. The sample was represented by mature milk of 52 healthy and eutrophic mothers, divided in two groups: A n=24 constituted by adolescent mothers’s milk among 10 and 18 years and B n=28 formed by adult mothers’s milk among 19 and 35 years who accompanied their children 1-6 months of age hospitalized, from august 2009 to august 2010. The samples were analyzed to determine concentrations of carbohydrates, lipids and proteins. The maternal characteristics of group A and B respectively were: mestizo ethnicity 59.4% and 39.9%, average BMI: were 23.55 ± 1.01 kg/m2 and 24.2 ± 0.38 kg/m2. Primiparous were 87.5% in A and 35.7% in B. Age of children aged 1-2 months was 66.6% (A) 71.4% (B). Maternal age: group A 75% had between 16 and 18 years and group B 28.5% were between 19 and 21 years. About macronutrient concentrations, median protein level in A was 1,8 ± 0,7 g/100ml and 1,9 ± 0,7 g/100ml for B median fat concentration in teenage group was 3,8 ± 1,5 g/100ml and in adults 3,9 ± 1,3 g/100ml. Median carbohydrates level in teenage was 6,8 ± 0,8 g/100ml and in B Group was 6,6 ± 0,9 g/100ml, being non statistically significative in all three cases. The macronutrient concentrations and energetic value in teenage mothers’s mature breastmilk were similar than the adult mother’s milk.

Utilidad del modo B guiado como técnica de medición de longitud axial en pacientes con cataratas maduras e hipermaduras en el Hospital Nacional Dos de Mayo, en el periodo de junio de 2012 a junio de 2013 / Utility of the B-mode guided as a technique for measurement of axial length in patients with mature, and hypermature cataract at the National Hospital Dos de Mayo, in the period of June 2012-June 2013

Objetivos: Determinar la utilidad y precisión de la biometría guiada por modo B como técnica de medición de longitud axial (LA) en pacientes con cataratas hipermaduras. Material y Métodos: Estudio retrospectivo, transversal con un periodo de evaluación de 1 año. Se recopilaron historias clínicas de todos los pacientes con catarata hipermadura. Se evaluó: medida de LA con modo A, modo B. guiado y refracción postoperatoria final. Los pacientes fueron divididas en dos grupos: No miopes (LA<24 mm) y Miopes (LA>=24 mm). La refracción postoperatoria alcanzada se comparó con la refracción deseada. Resultados: Las L.A. obtenidas por modo A y modo B guiado fueron, en promedio, similares: 23,99mm. ± 1,22(DE) vs. 24,14mm. ± 1,59(DE) respectivamente (p=0,061). En el análisis de sub-grupos, casi no hubo diferencia entre las LA medidas en el grupo de no miopes (p=0,947). En el grupo de miopes, la LA promedio con el modo A fue 24,94mm. ± 1,20(DE) vs. 25,28mm. ± 1,73(DE) medido con el modo B guiado. Diferencia significativa (p=0,049). El grado de concordancia de los valores medidos por ambos métodos fue moderado (coeficiente de Lin: 90,1 por ciento, p<0,001). No hubo diferencias en los valores de desviación refractiva media entre ambos métodos. (p=0,4156). Conclusiones La medición de longitud axial usando biometría guiada por modo B es similar a la realizada con biometría modo A, encontrándose una concordancia moderada. Las mediciones de longitud axial son igual de precisas para ambos métodos, tanto en miopes como en no miopes.

Purpose: To determine the usefulness and accuracy of B-mode guided biometry as a technique for axial length measurement (LA) in patients with cataracts hypermature. Material and Methods: Retrospective study, cross-sectional observational analytical evaluation period of one year. We collected the medical records of all patients diagnosed with cataract hypermature. The data evaluated were: measurement of LA by mode, THE B-mode guided and postoperative refraction end. Patients were divided into two groups: No myopic (LA<24 mm) and Myopic (LA>=24 mm). The postoperative refractive results achieved are compared with the attempted values. Results: The LA obtained by B mode guided mode and A mode were, on average, similar: 23.99 mm. ± 1.22 (DE) vs. 24.14 mm. ± 1.59 (DE), respectively (p=0.061).In the analysis of sub-groups, there was almost no difference between the LA measures Non-myopic group (p=0.947). In the myopic group, the LA average with mode A was 24.94 mm. ± 1.20 (DE) vs. 25.28 mm. ± 1.73 (DE) measured B guided mode. Significant difference (p=0.049). The degree of agreement of the values measured by both methods was moderate (Lin coefficient: 90.1 per cent, p<0.001). There was no difference in the average refractive deviation values between both methods (p=0.049). Conclusions: Axial length measurement using biometrics guided mode B is similar to that performed with biometrics mode, finding moderate agreement. Axial length measurements are equally accurate for both methods, in both, myopic and non myopic.

Concurrent mycetoma and chromomycosis.

Chromoblastomycosis and Madura foot are chronic localised mycotic infection of the skin and subcutaneous tissue that follows the implantation of the fungi through minor trauma, mainly found in persons working outdoors on bare foot. In cases where both Madura and chromoblastomycosis are present, the treatment becomes difficult with low cure rates and frequent relapses. Here, we present such a very rare case of a 38-year-old cattle farmer who presented with verrucose nodules, tumefaction and multiple discharging nodules on the left lower 1/3 rd leg and foot since last 9 years. Direct KOH mount of the verrucose tissue showed Fonsecaea pedrosoi sclerotic muriform bodies and a biopsy of one granule discharging nodule demonstrated fungal mycetoma. He was put on tab. Itraconazole 200 mg o.d. and cotrimoxazole bid for 6 months with very little improvement. The rarity of this combination is most probably due to different geographical distribution.

Variaciones en la composición proteica de la leche materna madura durante el almacenamiento por congelación / Changes in protein composition of mature breast milk during storage by freezing

Introducción: La leche materna es el alimento ideal para niños desde el nacimiento hasta los seis meses de edad. Muchas madres interrumpen la lactancia materna por diversas causas, por lo que la administración de leche materna procedente de bancos de leche surge como alternativa a ser evaluada. Objetivo: Determinar las variaciones en la composición proteica de la leche materna durante el almacenamiento bajo congelación. Materiales y Métodos: Fueron colectadas 31 muestras de leche madura de mujeres entre 17 a 35 años. Las muestras se almacenaron en congelación (–20°C), durante períodos de 15, 30, 60, y 90 días. Una alícuota de cada muestra fue analizada como control basal. La concentración de proteínas totales (g/dl) fue determinada por el método de Lowry, se transformó en g/día y calculó las calorías proteicas, considerando el consumo de 850 ml de leche. Se caracterizaron las fracciones proteicas de la leche con la técnica de electroforesis en geles de poliacrilamida (SDS-PAGE). Resultados: Los resultados mostraron una concentración proteica de 1,58 g/dl al inicio y de 1,61 g/dl a los 90 días. No se encontraron variaciones significativas al comparar el contenido de proteínas, ni en el aporte proteico y calórico de la leche durante el almacenamiento bajo congelación (P>0,05). El perfil electroforético sólo demostró variaciones en fracciones proteicas de bajo peso molecular. Conclusiones: La estabilidad de los componentes proteicos ratifica como segura la forma de almacenamiento de la leche materna humana bajo congelación por un período de 3 meses en bancos de leche.

Introduction: Breast milk is the ideal food for children from birth to age six months. For various reasons many mothers stop breastfeeding early, for which reason supply of breast milk from milk banks is an alternative that should be evaluated. Objective: To determine variations in protein composition of breast milk during frozen storage. Materials and Methods: We collected 31 samples of mature milk of women between ages 17 and 35. Samples were stored frozen (-20° C) for periods of 15, 30, 60, and 90 days. An aliquot of each sample was analyzed for baseline control. Total protein concentration (g/dl) was determined by Lowry method and protein calories as g/day were calculated based on a consumption of 850 ml of milk. Protein fractions of milk were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Results: Results showed a protein concentration of 1.58 g/dl at baseline and 1.61 g/dl at 90 days. Comparison found no significant differences in protein content or protein and calorie value of the milk during frozen storage (P>0.05). The electrophoretic profile showed changes only in low molecular weight protein fractions. Conclusions: The stability of the protein components demonstrates safe storage of frozen human milk in milk banks for a period of 3 months.

Macronutrientes en leche de madres desnutridas / Macronutrients in milk of undernourished mothers

Estudio prospectivo, no experimental y comparativo que evaluó la relación entre el estado nutricional materno y las concentraciones de macronutrientes de leche materna madura. Se estudiaron 40 muestras de madres con hijos en edades entre 15 días y 6 meses, hospitalizados en el Servicio de Emergencia Pediátrica del Hospital Universitario de Maracaibo, entre Septiembre 2006 y 2007 . Se dividieron en: Grupo A estudio (n= 20) muestras de madres con desnutrición clínica y Grupo B control (n= 20) eutróficas. Se analizaron las concentraciones de macronutrientes comparándose entre sí: grasas 3,8 ± 0,32 g/dl en el A y 5,5±1,08 g/dl en el B, estadísticamente significativo (p=0,0001); proteínas 1,8 ± 0,21 g/dl en el A y 2,4 ± 0,32 g/dl en el B, estadísticamente significativo (p=0,0001) y carbohidratos 6,06 ± 0,43 g/dl en el A y 5,7±0,45 g/dl en el B estadísticamente significativo (p= 0,0136). El valor calórico de la leche fue de 65,92 ± 16,68 Kcal/dl en el Grupo A y de 83,25 ± 9,40 Kcal/dl en el grupo control, estadísticamente significativo (p=0,0002). Las desnutridas pertenecían al grupo V de Graffar Méndez Castellano confirmando la relación entre desnutrición y pobreza. Se concluye que la concentración de grasas y proteínas, así como el valor calórico en la leche madura de este grupo de madres desnutridas son menores que en el grupo control.

In a prospective, no experimental and comparative analysis, the relationship between the mother’s nutritional conditional and their macronutrient’s concentrations was evaluated in 40 samples from mothers who had children 15 days to 6 months old, in a hospital setting at the Emergency room of the Pediatric Ward of Maracaibo’s University Hospital in Maracaibo, Venezuela in one year period. Milk from two groups of 20 mothers each was analyzed: Group A (Experimental), mothers with undernourishment and Group B (Control), mothers with adequate nutritional status. Fat content was 3.8 ± 0.32 g/dl and 5.5 ± 1.08 g/dl respectively (p = 0.0001); proteins were 1.8 ± 0.21 g/dl and 2.4 ± 0.32 g/dl respectively (p = 0.0001), and carbohydrates were 6.06 ± 0.43 g/dl and 5.7 ± 0.45 g/dl respectively (p = 0.0136). In addition, caloric value was also different: 65.92 ± 15. 16.68 kcal/l and 83.25 ± 9.4 kcal/dl (p = 0.0002). The undernourished were in the range of group V Graffar Méndez-Castellano, confirming the relationship between undernutrition and poverty. It is concluded that the proteins, fat concentrations and the caloric value in the breast milk from undernourished mothers are of lower value than the nourished well mothers.

Micetoma por Actinomadura madurae en el pie: reporte de un caso en Chile / Actinomadura madurae mycetoma of the foot: report of one case

Mycetoma is a chronic infection that affects skin, subcutaneous tissue and bone. Its etiology can be mycotic or bacterial. It affects mainly the lower extremities ofmiddie age men livingin tropical climates. We repon a 44 year-old male ¡ivingin a template zone, consulting for swelling and pain in the left foot, lasting for 10 years. Physical examination showed a swollen left foot with hyperpigmented skin and a few crustedpapules. Radiology showed an extensive bone involvement of the midfoot with several oval and radiolucid images. Magnetic resonance showed son and bone tissue involvement, with múltiple oval and low intensity images in TI and T2. The biopsy was compatible with an unspecific chronic osteomyelitis. A bacterial identification by polymerase chain reaction and sequencing in the biopsy determined the presence of an Actinomadura madurae. Treatment with cotrimoxazol was started).

Mycetoma fungal infection: multiple organisms as colonizers or pathogens?

We describe a patient with mycetoma or Madura foot, in which histopathological stains of the bone and surface cultures suggested three different organisms including Nocardia species as the cause. Criteria for the diagnosis of the organisms, differentiation between colonizer and pathogen, and significance of mixed infections are discussed.

Descrevemos um paciente com micetoma ou maduromicose de pé, no que colorações histopatológicos de osso e de culturas superficiais sugeriram três organismos diferentes, incluindo espécies de Nocardia como causador. Os critérios de diagnóstico dos organismos, a diferenciação entre colonizador e patógeno, e a significância das infecções mistas são discutidos.