Actualización en el manejo de la isquemia mesentérica aguda

La isquemia mesentérica aguda (IMA) es una emergencia médico-quirúrgica poco frecuente con alta morbimortalidad. Corresponde a una interrupción brusca del aporte sanguíneo a un segmento del intestino, produciendo isquemia, daño celular, necrosis intestinal y eventualmente la muerte. La principal etiología de este cuadro es la oclusión arterial de tipo embólica, seguida por la trombótica, no oclusiva y trombótica venosa. Es una patología infrecuente con una incidencia baja, de 12 por 100.000 habitantes en series internacionales. Su principal síntoma es el dolor abdominal tipo cólico de comienzo brusco, vómitos y diarrea, esta última sucediendo posteriormente. En el examen físico se pueden constatar signos de shock y distensión abdominal. Ante la sospecha, los pacientes hemodinámicamente inestables deben ser llevados urgentemente a laparotomía exploradora, y en aquellos estables, se debe solicitar un Angio-TC para confirmar el diagnóstico y planificar el tratamiento. Existen dos métodos para tratar esta patología: la cirugía abierta y la cirugía endovascular o mínimamente invasiva. Finalmente, con el avance de estos nuevos métodos, la tasa de mortalidad ha disminuido, significativamente, en la última década.

Acute mesenteric ischemia (AMI) is a rare medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to a sudden interruption of the blood supply to a segment of the intestine, producing ischemia, cell damage, intestinal necrosis and eventually death if it is not treated. The main etiology of this condition is embolic-type arterial occlusion, followed by thrombotic, nonocclusive, and venous thrombotic. It is an infrequent pathology with a low incidence of 12 per 100,000 inhabitants in international series. During the information collection, no data was found on the Chilean population since before 1983. Its main symptom is colicky abdominal pain with a sudden onset, vomiting and diarrhea that begins after the pain. On physical examination, signs of shock and abdominal distention may be noted. Hemodynamically unstable patients should be urgently taken to exploratory laparotomy as soon as the condition is suspected, and in stable patients, an angio-CT should be requested to confirm the diagnosis and plan treatment. There are two methods to treat this pathology, open surgery and endovascular or minimally invasive surgery. The form of therapy depends on the preoperative or intraoperative findings and the type of etiology. Finally, with the advancement of these new methods, the mortality rate has decreased in the last decade.

Spatial distribution of Brazilian bovine taurine breeds associated with climatic, physical and socioeconomic variables / [Distribuição espacial de raças taurinas bovinas brasileiras associada a variáveis climáticas, físicas e socioeconômicas]

The objective of this study was to evaluate the spatial distribution of purebred Bos taurus taurus bovine breeds raised in Brazil in association with climatic, physical and socioeconomic variables. The breeds Aberdeen Angus, Ayrshire, Braford, Brangus, Charolais, Devon, Flemish, Hereford, Pinzgauer, Shorthorn and Simental were classified according to their aptitude (milk, meat or dual-purpose). They were spatialized according to their aptitude using state and municipal information. The milk breeds were found in the states of Rio Grande do Sul and Santa Catarina, while the dual-purpose breeds were found in Minas Gerais and Rio Grande do Sul states and the beef breeds were concentrated in the southern region. Only the Aberdeen Angus meat breed showed higher dispersion in other regions. Meat and dual-purpose breeds tended to be raised in regions with lower maximum temperature, average temperature, thermal amplitude and temperature-humidity index. Dual-purpose breeds were found in municipalities with high humidity and altitude, but with a low gross domestic product, little technical guidance received from cooperatives and the government, low control of diseases and parasites, as well as low use of pasture rotation systems. The spatial distribution of Brazilian bovine taurine breeds, regardless of aptitude, was related to climatic, physical and socioeconomic factors.(AU)

O objetivo deste estudo foi avaliar a distribuição espacial de raças bovinas puras Bos taurus taurus criadas no Brasil, associadas a variáveis climáticas, físicas e socioeconômicas. As raças Aberdeen Angus, Ayrshire, Braford, Brangus, Charolês, Devon, Flamenga, Hereford, Pinzgauer, Shorthorn e Simental foram classificadas de acordo com sua aptidão (leite, carne ou duplo-propósito). Elas foram espacializadas de acordo com sua aptidão a partir de informações estaduais e municipais. As raças leiteiras foram encontradas nos estados do Rio Grande do Sul e de Santa Catarina, enquanto as raças de duplo-propósito foram encontradas nos estados de Minas Gerais e Rio Grande do Sul, e as raças de carne concentraram-se na região Sul. Apenas a raça de carne Aberdeen Angus apresentou maior dispersão nas demais regiões. As raças de carne e de duplo-propósito tendem a ser criadas em regiões com menores temperatura máxima, temperatura média, amplitude térmica e índice de temperatura e umidade. As raças de duplo-propósito foram encontradas em municípios com alta umidade e altitude, mas com baixo produto interno bruto, pouca orientação técnica recebida de cooperativas e do governo, baixo controle de doenças e de parasitas e baixo uso de sistema de rotação de pastagens. A distribuição espacial das raças taurinas bovinas brasileiras, independentemente da aptidão, foi relacionada a fatores climáticos, físicos e socioeconômicos.(AU)

Motociclista de urgência e emergência: reflexo dos desafios diários no atendimento pré-hospitalar / Urgency and emergency motorcyclist: a reflection of the daily challenges in prehospital care / Motociclista de emergencia y emergencia: reflejo de los desafíos diarios en la atención prehospitalaria

Objetivo: analisar e discutir as dificuldades, os riscos ocupacionais e os possíveis desafios e frustrações dos motociclistas que atuam no atendimento pré-hospitalar no serviço de urgência e emergência do Distrito Federal. Método: estudo descritivo e exploratório, de abordagem quantitativa, mediado por pesquisa de campo. Resultados: foram investigados dois grupos - A, com 33 profissionais, e B, com 18 profissionais. No grupo A, são 26 técnicos em enfermagem e 5 enfermeiros, com média de atuação de 10,6 anos, visto serem servidores estatutários, com idade média de 38 anos e tempo de motolância de 5,4 anos. No grupo B, todos são militares de carreira e combatentes, com média de 34,9 anos de idade, 11,2 anos de tempo de militar e de 5,1 anos de serviço de motorresgate. Conclusão: é visível que as atividades desempenhadas pelas equipes são divergentes do ponto de vista operacional e técnico. A formação do enfermeiro colaborador e educador torna-se relevante para a educação continuada dos profissionais que atuam no atendimento pré-hospitalar, sendo assim, é necessário refletir sobre as dificuldades vivenciadas no dia a dia desses profissionais e estratégias e ações precisam ser elaboradas para auxiliar no suporte de enfrentamento de seus desafios diários vivenciados

Objective: to analyze and discuss the difficulties, occupational risks and the possible challenges and frustrations of motorcyclists who work in pre-hospital care in the urgency and emergency service of the Federal District. Method: descriptive and exploratory study, with a quantitative approach, mediated by field research. Results: two groups were investigated - A, with 33 professionals, and B, with 18 professionals. In group A, there are 26 nursing technicians and 5 nurses, with an average of 10.6 years of experience, as they are statutory servants, with an average age of 38 years and a motorcycle driving time of 5.4 years. In group B, all are career soldiers and combatants, with an average of 34.9 years of age, 11.2 years of military experience and 5.1 years of motor-rescue service. Conclusion: it is visible that the activities performed by the teams are divergent from an operational and technical point of view. The training of collaborative nurses and educators becomes relevant for the continuing education of professionals working in pre-hospital care, therefore, it is necessary to reflect on the difficulties experienced in the daily lives of these professionals, also strategies and actions need to be developed to help in support of coping with their experienced daily challenges.

Objetivo: analizar y discutir las dificultades, riesgos laborales y los posibles desafíos y frustraciones de los motociclistas que laboran en la atención prehospitalaria en el servicio de urgencia y emergencia del Distrito Federal. Método: estudio descriptivo y exploratorio, con enfoque cuantitativo, mediado por investigación de campo. Resultados: se investigaron dos grupos: A, con 33 profesionales, y B, con 18 profesionales. En el grupo A, hay 26 técnicos de enfermería y 5 enfermeros, con una media de 10,6 años de experiencia, por ser servidores estatutarios, con una edad media de 38 años y un tiempo de conducción en motocicleta de 5,4 años. En el grupo B, todos son soldados y combatientes de carrera, con un promedio de 34,9 años de edad, 11,2 años de experiencia militar y 5,1 años de servicio de rescate motorizado. Conclusión: es visible que las actividades realizadas por los equipos son divergentes desde el punto de vista operativo y técnico. La formación de enfermeros y educadores colaborativos cobra relevancia para la formación continua de los profesionales que laboran en la atención prehospitalaria, por ello, es necesario reflexionar sobre las dificultades que viven en el día a día de estos profesionales, además de desarrollar estrategias y acciones para ayuda en apoyo para hacer frente a sus experimentados desafíos diarios.

Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

Membrana de látex natural de Hevea brasiliensis auxilia no processo de reparação tecidual em bovinos / Natural latex rubber from Hevea brasiliensis aids tissue repair of bovine

Feridas cutâneas em bovinos são um constante desafio clínico cirúrgico por desencadearem perdas econômicas bastante significativas. O látex proveniente da seiva da seringueira (Hevea brasiliensis) apresenta potencial terapêutico para incrementar o processo de reparação tecidual. Portanto, pretendeu-se com esse estudo avaliar o tipo de reação tecidual e os possíveis mecanismos de angiogênese desencadeados pelo implante de uma membrana de látex natural em bovinos. Para tal, foram utilizados seis bovinos da raça Nelore, submetidos ao implante subcutâneo experimental de três fragmentos de membranas de látex natural. Foram coletadas amostras de tecido e da membrana aos 15, 30 e 45 dias após a implantação, para avaliações histológicas, ultraestruturais por microscopia eletrônica de varredura e imunoistoquímicas com anticorpos antimarcador de macrófagos (MAC), CYR 61 e VEGF. O implante de látex proporcionou aumento da angiogênese e reparação tecidual em bovinos, não mediada pela expressão do VEGF e CYR 61.(AU)

Cattle wounds are a constant surgical and clinical challenge, leading to important economical losses. The latex from the sap of the rubber tree (Hevea brasiliensis) has therapeutic potential to enhance tissue repair process. Therefore, we evaluated the type of tissue reaction and possible mechanisms of angiogenesis triggered by implanting natural latex rubber in bovine species. Six Nelore bovines were subjected to subcutaneous experimental implant of three fragments of natural rubber latex membranes. Tissue and rubber membrane samples were harvested at 15, 30 and 45 days implantation for histology, scanning electron microscopy and immunohistochemical evaluation with anti macrophage marker (MAC), anti CYR 61, anti VEGF antibodies. The latex membrane estimulates tissue reaction and repair and significant angiogenesis stimuli without activating CYR 61 and VEGF pathways.(AU)

Satisfacción usuaria en urgencia oftalmológica: evaluación de la consistencia interna y validez de constructo de un instrumento aplicado en Chile / Evaluation of an instrument assessing the satisfaction of ophthalmological emergency service users in Chile

Background: Ocular trauma is a distressing condition feared by the general public. Aim: To evaluate the construct validity and internal consistency of an instrument to measure the level of user satisfaction in patients treated at an Ocular Trauma and Ophthalmological Emergency Unit. Material and Methods: A survey to measure user satisfaction was applied to patients consulting at the Ocular Trauma Unit in a public hospital on April 2014. Internal consistency and construct validity from the estimated Cronbach alpha coefficient and factor analysis were assessed. Results: Surveys answered by 138 patients aged 45 ± 15 years (93% men), were analyzed. The reliability obtained for the final questionnaire was 0.88. The factor analysis yielded four factors responsible for explaining 74.1% of the total variance, related to “quality of clinical information”, “treatment by health care personnel”, “lighting conditions, environment and noise” and “waiting time and overall assessment of service”. Conclusions: These results allow to consider the instrument as a useful and reliable tool that can be applied to ophthalmological emergency service users in Chile.

Pie diabético / Diabetic foot

The prevalence of diabetes has increased considerably, constituting a global epidemic today. Many of these patients will develop chronic complications of diabetes, including diabetic foot, which aggravates the patient’s clinical condition, decreases the quality of life and has a great socioeconomic impact. The most important action to reduce the morbidity and mortality associated with this pathology is the prevention of this complication, performing a propermetabolic management and serial control of the patient, educating about self-care of the feet. Once diabetic foot ulcer is present, the cornerstones of treatment are debridement of the wound, management of any infection, revascularization procedures when indicated, and discharge of the ulcer, all of the above in order to avoid amputation. This article intends tomake a review about the epidemiology, pathophysiology, classification, diagnosis, prevention and management of diabetic foot oriented to the primary care doctor.

Síndrome ligamento arcuato medio / Median arcuate ligament syndrome

Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.

Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.

Disección espontánea de arteria mesentérica superior / Spontaneous dissection of superior mesenteric artery

Introduction: Spontaneous dissection of the superior mesenteric artery (AMS) is a infrecuent pathology, representing the main frequency of isolated peripheral artery dissection, it is more common in males and occurs in the fifth decade of life. Materials and Methods: Retrospective cases analysis of patients with spontaneous dissection of AMS that were handled in our hospital, in last two years. Results: Two patients were diagnosed in this period, both active smoking and hypertensive pathology, appearing with severe abdominal and back pain. The diagnosis was made by CT angiogram of the abdomen and pelvis; establishing medical management of hypertension and standard heparin anticoagulation. Both patients had dissections at new imaging controls and one patient required exploratory laparotomy with bowel resection and intestinal anastomosis. Patients recovered satisfactorily and are in control. Conclusions: Spontaneous dissection of the SMA is a rare disease with uncertain evolution, it may occur in middle age of life, associated with smoking and hypertension. The suspected diagnosis is clinical and can be confirmed by CT angiography. Initial management remains conservative and occasionally is surgical.

Introducción: La Disección espontánea de la arteria mesentérica superior (AMS) es una patología infrecuente, representando la primera frecuencia de disección de arteria periférica aislada, ocurre más en varones en la quinta década de la vida. Material y Método: Casos en los últimos 2 años revisados en forma retrospectiva. Resultados: Dos pacientes fueron diagnosticados en este período, presentándose ambos por dolor abdominal y lumbar de gran intensidad al Servicio de Urgencia del hospital; ambos tabáquicos activos y con hipertensión arterial (HTA). El diagnóstico fue realizado por angioTC de abdomen y pelvis, instaurándose manejo médico de HTA y anticoagulación con heparina estándar. Los 2 pacientes presentaron nuevas disecciones en los controles imagenológicos y un paciente requirió laparotomía exploradora con resección intestinal y anastomosis por isquemia intestinal. Los pacientes evolucionaron satisfactoriamente y se encuentran en control. Conclusiones: La disección espontánea de la AMS es una enfermedad poco frecuente de evolución incierta, que ocurre en la edad media de la vida, asociada a tabaquismo e HTA, la sospecha es clínica y el diagnóstico por imágenes. El manejo inicial sigue siendo médico y ocasionalmente es quirúrgico.

Aneurisma esplénico / Splenic aneurysm

Introduction: The splenic aneurysm (AAE) is a rare disease that occurs mainly in women, being mostly asymptomatic until rupture. Clinical case: We report a case of a woman aged 65, previously healthy, who complains of pain in the left upper quadrant, two-month history, performing a CT of the abdomen showing a 4.7 cm AAE without signs of rupture. Aneurysm resection was performed with splenic preservation with no signs of complication...

Introducción: El aneurisma esplénico (AAE) es una enfermedad poco frecuente, que ocurre principalmente en mujeres, siendo en su mayoría asintomático, hasta su ruptura. Caso clínico: Presentamos el caso de una mujer de 65 años, previamente sana, que consulta por dolor en hipocondrio izquierdo, de dos meses de evolución, realizándose una tomografía de abdomen, que muestra un AAE de 4,7 cm sin signos de ruptura. Se realiza resección de aneurisma con preservación esplénica, sin signos de complicación en el postoperatorio. Aunque presenta infartos esplénicos en el control se mantiene asintomática...

Evaluación del perfil metabólico lipídico en cerdas gestantes y su relación con la nutrición fetal / Evaluation of the lipid metabolic profile and its relation with fetal nutrition in gestating sows

Objetivo. Evaluar el metabolismo lipídico de cerdas gestantes como respuesta a la modificación del nivel graso de la dieta y su efecto sobre la nutrición fetal a través de indicadores metabólicos. Materiales y métodos. Cincuenta y seis cerdas gestantes primíparas o multíparas se seleccionaron para suministrarles una dieta sin adición de grasa extra (SAp o SAm) o con adición de grasa extra (AGp o AGm). La dieta SA consistió en suministrar 3 kg/día de una dieta comercial convencional, en la dieta AG se redujo el maíz y se incluyó aceite de soya para proporcionar 20% de grasa extra. Las muestras sanguíneas se colectaron a los 85, 100, 113 días de gestación y a las 24 horas posparto, asimismo, al 50% de los lechones nacidos vivos de cada camada. Se analizaron concentraciones séricas de colesterol (CT), triglicéridos (TG), lipoproteínas de alta (HDL) y baja densidad (LDL), ácidos grasos no esterificados (NEFA) y betahidroxibutirato (BHB). Resultados. Las concentraciones séricas de HDL, LDL, CT, NEFA, BHB y TG, (p<0.01) aumentaron tanto en las cerdas primíparas como multíparas al día 100 y 113, pero disminuyeron a las 24 horas posparto. Los metabolitos sanguíneos en los lechones bajo la influencia de los dos tratamientos presentaron diferencias significativas (p<0.01). Conclusiones. No se encontró efecto de la modificación de la grasa en la dieta sobre LDL y NEFA; para los restantes indicadores se presentó diferencia en las cerdas en gestación. No se encontró correlación entre los indicadores metabólicos de las madres y los lechones.

Objective. Evaluate the lipidic metabolism of gestating sows in response to a modification in thefat level of the diet and its effect on fetal nutrition through metabolic indicators. Materials andmethods. Fifty-six first-timers or multiparous sows were selected receive a diet without addingextra fat (SAp or SAm) or with extra fat addition (AGp o AGm). The SA diet consisted in feeding aconventional commercial diet of 3 kg/day, in the AG diet the corn was reduced and soybean oil wasincluded to supply 20% extra fat. Blood samples were collected at 85, 100, 113 days of gestationand 24 hours postpartum, and on 50% of the piglets born alive per litter. Serum cholesterol (CT),triglycerides (TG), high (HDL) and low (LDL) density lipoproteins, non-esterified fatty acids (NEFA)and beta hydroxybutyrate (BHB) were analyzed. Results. The Serum concentrations of HDL, LDL,CT NEFA, BHB, and TG (p<0.01) increased in sows on days 100 and 113, but decreased at 24 hourspostpartum. Blood metabolites in piglets under the influence of both treatments showed significantdifferences (p<0.01). Conclusions. There was no statistical effect from the modification of dietaryfat on LDL and NEFA; for the remaining indicators differences were evident in pregnant sows. Therewas no correlation between metabolic indicators in mothers and piglets.

Comunicación bidireccional entre el sistema inmune y neuroendocrino a través de la hormona de crecimiento, prolactina y hepcidina / Bidirectional communication between neuroendocrine and immune systems through growth hormone, prolactin and hepcidin

Se ha planteado que la hormona de crecimiento (GH) y la Prolactina (PRL) pueden intervenir en procesos infecciosos como inmunomoduladores vía receptores específicos; revelando una conexión entre el sistema inmune y el sistema endocrino en los tejidos, donde actúan como citoquinas a través de diferentes rutas de señalización. Igualmente, la hepcidina (HAMP), hormona producida en los hepatocitos como respuesta al exceso de hierro y a estímulos inflamatorios, es considerada un enlace entre el metabolismo del mineral, la defensa del hospedero y los procesos inflamatorios, debido a su capacidad de privar del hierro a los microorganismos. Se sugiere que en un proceso infeccioso, la síntesis, secreción y regulación de GH ocurre a través de la producción de citoquinas como factor de necrosis tumoral alfa (TNF-α) e interleuquina-1 beta (IL-1β), las cuales actúan en el hipotálamo, estimulando la liberación ya sea de la hormona liberadora de somatotropina o de somatostatina; por otro lado, se ha reportado que células linfoides, incluyendo linfocitos T y B y células dendríticas, producen GH, PRL biológicamente activa con propiedades inmunoreguladoras.

It has been proposed that growth hormone (GH) and prolactin (PRL) may act as immunomodulators in infectious processes via specific receptors, revealing a connection between the immune and endocrine systems in the tissues where they act as cytokines through different signaling pathways. Similarly, hepcidin (HAMP), a hormone produced in hepatocytes in response to excess iron and inflammatory stimuli, is considered a link between mineral metabolism, host defense and inflammatory processes because of its ability to deprive microorganisms of iron. It is suggested that in an infectious process, synthesis, and regulation of GH secretion occurs through the production of cytokines such as necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β), which act in the hypothalamus by stimulating the release of either somatostatin or somatotropin hormones; on the other hand, it has been reported that lymphoid cells including T and B lymphocytes and dendritic cells produce GH, and biologically active PRL with immunoregulatory properties.

Flegmasia cerulea dolens: reporte de un caso y revisión de la literatura / Flegmasia cerulea dolens: case report and literature review

Phlegmasia Caerulea Dolens is a rare complication of deep vein thrombosis. It presents with a sudden onset of pain, swelling, discoloration and arterial compromise of the affected limb. There’s usually history of prothrombotic events such as malignancy, femoral vein catheterism, antiphospholipid syndrome, recent surgery, pregnancy, etc. Left without treatment, it can evolvein to gangrene, septic shock and death. Diagnosis usually only requires clinical appreciation.Confirmation can be done with ultrasonographic studies with doppler. Treatment can be both medical and surgically based. Medical therapy can be done with heparin and elevation of the affected limb or the use of thrombolytic, whilst surgical therapy can be either venous thrombectomy or amputation. We present the case of a 57-year old smoker, diabetic, and with systemic lupus erythematosus history female patient, that goes to the emergency room with sudden left leg pain, with cyanosis and absence of distal pulses. Besides she presented with lower respiratory symptoms. Diagnosis was confirmed with ultrasound and CT pulmonary angiography was performed showing pulmonary embolism. Medical treatment was initiated with good response.

Adolescencia prevenida: pérfil sociopsicológico del adolescente rural medido a través del inventario autodescriptivo del adolescente / Prevented adolescence: socio psychological profile of rural adolescent measured by the adolescent self-descriptive inventory

Esta investigación parte y suma sus resultados a una base de datos de estudios sobre el perfil positivo y negativo del adolescente rural en cada una de las áreas evaluadas, establecidas en la macro investigación “Adolescencia Prevenida Rural” que lleva a cabo como área de estudio la Cátedra de Psicología Experimental I y II de la UCA desde 2001.En este caso el objetivo general es describir y comparar el perfil sociopsicológico del adolescente paraguayo rural de la Zona de Chaco (Villa Hayes-Cerrito) y sus variantes en relación al sexo y edad, mediante la utilización del Inventario Autodescriptivo. La muestra seleccionada estuvo compuesta por n=89 participantes de ambos sexos siendo la misma no probabilística, intencionada y autoseleccionada. Las variables comparadas de las áreas del “Inventario Autodescriptivo” evalúan los factores de riesgo presentes en las mismas y del Perfil sociodemográfico. El diseño empleado es de tipo transversal, descriptivo-exploratorio-comparativo.Los resultados concluyen que el perfil sociopsicológico del Adolescente rural presenta factores de riesgo tanto en varones y mujeres, lo cual se debe probablemente a sus características sociodemográficas e individuales.

Giardia spp. e Cryptosporidium spp. em água de manancial superficial de abastecimento contaminada por dejetos humano e animal / Giardia spp. and Cryptosporidium spp. in a fresh water supply source contaminated with human and animal excreta and waste water

Estudou-se ocorrência de cistos de Giardia spp. e oocistos de Cryptosporidium spp. - (oo)cistos - na bacia hidrográfica do Ribeirão São Bartolomeu, localizada no município de Viçosa, MG. O estudo incluiu as populações humana e animal existentes na área da bacia, bem como no efluente de uma estação de tratamento de esgoto (ETE) e de duas instalações para suínos. Os resultados indicam presença de (oo)cistos no manancial (médias geométricas: 3,92 e 3,62 (oo)cistos/l para Giardia spp. e Cryptosporidium spp., respectivamente). Propriedades com exploração bovina foram positivas ao longo de todo período (prevalência média de propriedades positivas 36,4 por cento para Giardia spp. e 18,0 por cento para Cryptosporidium spp.). O efluente da ETE apresentou elevada concentração de cistos de Giardia spp. (média geométrica na ordem de 10(4)/l), mas não foram encontrados oocistos de Cryptosporidium spp. A ocorrência de (oo)cistos apresentou comportamento sazonal, sendo que os valores médios de (oo)cistos e de pluviosidade do trimestre de coleta revelaram bom ajuste de correlação (R²=98,3 por cento; P=0,0087 para Giardia spp. e R²=91,8 por cento; P=0,0421 para Cryptosporidium spp.). A significativa ocorrência de (oo)cistos no manancial sugere que a forma de ocupação do solo interfere na qualidade parasitológica da água bruta. Os resultados apontam para a importância de adoção de medidas preventivas, como proteção de áreas de mananciais, objetivando reduzir riscos de transmissão de protozoários via água de consumo humano.

The occurrence of Giardia spp. cysts and Cryptosporidium spp. oocysts - (oo)cysts - was studied in a watershed (São Bartolomeu Stream-SB), at Viçosa city, MG. In the studied area, characterization of animal farms and identification of sewage and animal wastes discharges were undertaken. In addition, a sewage treatment plant (STP) and effluents of two swine farms were sampled. The results presented protozoan contamination (geometric averages: 3.92 and 3.62 (oo)cysts/l for Giardia spp. and Cryptosporidium spp., respectively). Positive cattle farms were detected during all the period, and the correspondent mean prevalences were: 36.4 percent for Giardia spp. and 18.0 percent for Cryptosporidium spp. STP effluent presented high concentration of Giardia spp. (geometric average of cysts in the order of 10(4)/l). However, Cryptosporidium spp. oocysts were not detected. The results showed that (oo)cysts concentration were influenced by climate factors. Precipitation and (oo)cysts concentration data were well correlated (R²=98.3 percent; P=0.0087 for Giardia spp. and R²=91.8 percent; P=0.0421 for Cryptosporidium spp.). Cysts and oocysts levels were remarkably high in the raw water source, pointing out the role of land use in an unprotected watershed as a source of protozoa. The results demonstrate the importance of preventive measures rather than relying on, sometimes unreliable, corrective measures such as water treatment, in order to minimize human health risks.

Changes in types of muscle fibers induced by transcutaneous electrical stimulation of the diaphragm of rats

The objective of the present study was to assess the effect of transcutaneous electrical diaphragmatic stimulation (TEDS) on different types of diaphragm muscle fibers. Male Wistar rats (8-12 weeks old) were divided into 2 experimental groups (N = 8 in each group): 1) control, 2) animals submitted to TEDS [frequency = 50 Hz; T ON/T OFF (contraction/relaxation time) = 2/2 s; pulse duration = 0.4 ms, intensity = 5 mA with a 1 mA increase every 3 min for 20 min] for 7 days. After completing this treatment period, the I, IIA, IIB, and IID diaphragm muscle fibers were identified using the mATPase technique. Statistical analysis consisted of the normality, homoscedasticity and t-tests (P < 0.05). There was a 19.6 percent (P < 0.05) reduction in the number of type I fibers and a 49.7 percent increase (P < 0.05) in type IID fibers in the TEDS group compared with the control group. An important result of the present study was that electrical stimulation with surface electrodes was efficient in altering the distribution of fibers in diaphragm muscle. This therapeutic resource could be used in the treatment of respiratory muscle alterations.

Fascitis necrosante grave por Serratia marcescens: Reporte de un caso clínico / Fatal necrotizing fasciitis due to Serratia marcescens

Una paciente de 81 años con insuficiencia cardíaca crónica, fibrilación auricular y tratamiento anticoagulante, ingresó por un cuadro fulminante de dolor y celulitis en la extremidad inferior derecha de 24 horas de evolución. Sobre la zona existía una úlcera crónica de cinco meses de evolución, manejada con curaciones locales. Al ingreso, había una placa necrótica pero sin hipotensión o confusión mental. La paciente estaba febril y con taquicardia (126 por min). La evaluación reveló ausencia de leucocitosis, trombosis venosa profunda en la misma pierna e infiltrados radiológicos pulmonares en el lóbulo inferior izquierdo. En las horas siguientes aumentó el dolor, apareció secreción purulenta por la úlcera y la paciente presentó confusión, hipotensión, falla respiratoria y luego shock. La paciente recibió ciprofloxacino endovenoso y clindamicina y fue intervenida a las 15 horas de ingreso, efectuándose una amputación supracondílea. El sondeo cardíaco demostró un gasto bajo (2,3 L/min) y una resistencia vascular sistémica (2888 din.s.cm"5) y presión capilar pulmonar elevada (17 cm H(2)0), cifras compatibles con un shock cardiogénico. Evolucionó en malas condiciones y falleció de falla orgánica múltiple a las 36 horas de ingreso. Los hemocultivos demostraron crecimiento de Serratia marcescens en dos frascos. No se efectuó una necropsia y los cultivos de la secreción de la úlcera fueron negativos.

An 81 year old female patient with chronic heart failure and atrial fibrillation receiving anticoagulant therapy, was admitted with progressive pain on her right leg for the past 24 hours, associated to local erythema, edema and warmth. The lesion evolved at the same site where she presented a chronic ulcer for the previous 5 months managed only with local care. At admission a necrotic plaque on the affected site was perceived; there was no hypotension or mental confusion but signs of a deep venous thrombosis on the involved leg were found. She was febrile (37.8°C) and with tachychardia (126 per minute). Laboratory evaluation revealed normal white blood cell count and a subtherapheutic anticoagulant INR value. A chest x-ray showed infiltrates on the left lower lung lobe. On the following hours the lesion evolved with increasing pain, haemorrhagic bullae and a purulent discharge through the ulcer, with the patient developing mental deterioration, hypotension, respiratory failure and shock. The patient received intravenous ciprofloxacin and clindamycin and was operated 15 hours after admission performing an over-the knee amputation. A cardiac catheterization demonstrated a low cardiac output (2.3 L/min), and both a high systemic vascular resistance (2888 din.s.cm"5) and pulmonary capillary wedge pressure (17 cm H(2)0), results compatible with cardiogenic shock. Evolution was progressively worse and she died of multiple organic failure 36 hours after admission. Two blood culture samples grew Serratia marcescens. No necropsy was performed and cultures taken from the leg remained negative.

Caracterização de anticorpos monoclonais contra rotavírus bovino e suas aplicações como ferramenta de diagnóstico / Characterization of monoclonal antibodies against bovine rotavirus and their diagnostic applications

Anticorpos monoclonais (AcM) para rotavírus bovino foram caracterizados para sua aplicação como ferramenta de diagnóstico, utilizando-se as técnicas de isotipificação, dot-blot, western-blot, imunofluorescência indireta (IFI) e ELISA de captura. A caracterização imunoquímica demonstrou que os cinco AcM 1G5, 4F7, 1E12, 4F3 e 3C12 foram do isótipo IgG2a. Pela técnica de dot-blot, os AcM 1G5, 4F7, 1E12, 4F3 detectaram antígenos do rotavírus, em diferentes concentrações, e dois AcM (1E12 e 4F3) reconheceram proteínas virais pela técnica de western-blot. Todos os AcM reagiram positivamente na técnica de IFI em cultivo celular e foram capazes de detectar antígeno viral em amostras fecais bovinas e humanas, pela técnica de ELISA de captura. Identificaram-se dois grupos de AcM, um deles formado pelos AcM 4F7, 1E12 e 1G5, para seu possível uso na detecção de antígeno viral em fezes por meio do ELISA de captura ou dot-blot e outro pelos 4F3 e 3C12, que podem ser usados para detectar antígeno viral em culturas de células por meio de IFI.

This work was carried out to characterize and evaluate five bovine rotavirus, monoclonal antibodies (MAbs), as a diagnosis tool, by isotyping, dot-blot, western-blot, indirect immunofluorescence (IFI) and ELISA techniques. The immunochemistry characterization showed that all five MAbs (4F7, 4F3, 1G5, 1E12 and 3C12) were IgG2a isotype. The dot-blot immunoassay showed that 1G5, 4F7, 1E12 and 4F3 detected viral antigen in different concentrations and two MAbs (1E12 and 4F3) recognized viral proteins by western-blot. All MAbs detected viral antigen in bovine and human fecal samples by capture ELISA technique and viral antigen in infected MA-104 cell culture by IFI. In conclusion, two groups of Mabs were indetified: one with Mabs 4F7, 1E12 and 1G5 showed the best results to detect rotavirus antigen in fecal samples by capture ELISA or dot-blot techniques assay and other with 4F3 and 3C12 which may be used to detect rotavirus antigens in cell culture by IFI. The results showed the potential use of these MAbs as diagnosis tools in diarrheas by rotavirus in bovines.