Different gene expression profiles in subcutaneous & visceral adipose tissues from Mexican patients with obesity

Background & objectives: Obesity is a health problem that requires substantial efforts to understand the physiopathology of its various types and to determine therapeutic strategies for its treatment. The objective of this study was to characterize differences in the global gene expression profiles of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) between control patients (normal weight) and patients with obesity (IMC?30) using microarrays. Methods: Employing RNA isolated from SAT and VAT samples obtained from eight control and eight class I, II and III patients with obesity, the gene expression profiles were compared between SAT and VAT using microarrays and the findings were validated via real-time quantitative polymerase chain reaction. Results: A total of 327 and 488 genes were found to be differentially expressed in SAT and VAT, respectively (P?0.05). Upregulation of PPAP2C, CYP4A11 and CYP17A1 genes was seen in the VAT of obese individuals. Interpretation & conclusions: SAT and VAT exhibited significant differences in terms of the expression of specific genes. These genes might be related to obesity. These findings may be used to improve the clinical diagnosis of obesity and could be a tool leading to the proposal of new therapeutic strategies for the treatment of obesity.

Inocuidade micotoxicológica e viabilidade de Aspergillus spp com potencial probiótico provenientes do trato digestório bovino / Mycotoxicological safety and viability of Aspergillus spp with probiotic potential from the bovine digestive tract]

Objetivou-se, com a presente pesquisa, avaliar a viabilidade de Aspergillus spp. com potencial probiótico durante o armazenamento e diante da pressão da microbiota autóctone, bem como a tolerância aos principais ácidos graxos da fermentação ruminal. Verificou-se também a inocuidade micotoxicológica desses isolados fúngicos cultivados em meio de cultivo sólido. Foram avaliados 20 isolados de Aspergillus spp., provenientes do trato gastrointestinal de bovinos criados em Urochloa decumbens lignificada. Esses fungos foram identificados por análise de sequências do DNAr e foram selecionados por apresentarem expressivo potencial celulolítico. O método vapor de amônia foi utilizado para detecção de cepas produtoras de micotoxinas. Os isolados foram avaliados quanto à viabilidade de crescimento em fluido ruminal por até 96 horas e estocagem em condições ambientais. Observou-se que os fungos avaliados não produziram aflatoxinas e que 95% dos isolados apresentaram resistência aos ácidos ruminais. Dois isolados, selecionados a partir das análises anteriores, apresentaram viabilidade sob a pressão da microbiota autóctone e de metabólitos do ecossistema ruminal e permanecem viáveis por, no mínimo, dois anos. Conclui-se que os isolados do gênero Aspergillus selecionados nesta pesquisa apresentam características fisiológicas para serem utilizados com aditivos microbianos ou probióticos para o ambiente ruminal.(AU)

The aims in this study were to evaluate the viability of Aspergillus spp. with probiotic potential during storage, pressure of autochthonous microbiota and tolerance to the main fatty acids of ruminal fermentation. The mycotoxicological safety was also verified. Twenty isolates from the gastrointestinal tract of cattle raised in lignified Urochloa decumbens were identified by rDNA sequence analysis and were previously selected because they showed significant cellulolytic potential. The ammonia vapor method was used to detect the production of mycotoxins. The isolates were evaluated for viability of ruminal fluid growth for up to 96 hours and storage under environmental conditions. The evaluated fungi did not produce aflatoxins, and 95% of them had resistance to ruminal acids. Two isolates, selected according these tests, presented viability on autochthonous microbiota pressure and metabolites from the ruminal ecosystem and remain viable for at least two years. In this research, the selected Aspergillus spp. isolates present physiological characteristics to be used with microbial additives or probiotic.(AU)

Frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México / Frequency and factors associated with obstetric hysterectomy in a second level hospital in México

INTRODUCCION La histerectomía obstétrica es procedimiento de urgencia para resolver una situación grave, su incidencia es de 5 a 15 por cada 1000 eventos obstétricos OBJETIVO GENERAL Determinar la frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México. METODOLOGIA Estudio descriptivo, transversal y retrospectivo en el periodo de Enero de 2014 a Diciembre del 2016, se incluyeron todos los casos de histerectomía posterior a un evento obstétrico, se estudiaron: edad, paridad, vía de interrupción del embarazo, antecedente de cesárea previa, indicaciones y complicaciones de la histerectomía, ingreso al servicio de terapia intensiva y mortalidad, el análisis se realizó con estadística descriptiva. RESULTADOS Durante el periodo de estudio, se atendieron 37 308 eventos obstétricos, efectuándose histerectomía obstétrica a 153 pacientes que representan el 0.57%, es decir, una HO por cada 243 embarazos. La edad promedio de quienes se les efectuó la histerectomía fue de 34 años de edad, siendo más frecuente en el grupo de mayores de 35 años, que habían tenido dos o tres embarazos previos. El antecedente de cesárea previa fue del 69.2%. La vía de interrupción del embarazo actual fue de cesárea en el 72.1%. La principal indicación fue la atonía uterina en 51 casos (33.3%). La complicación más frecuente fue la anemia aguda en el 83%. Hubo 1 muerte materna (0.6%). CONCLUSIONES La Histerectomía obstétrica es una cirugía de urgencia, por lo que se deben de identificar durante el control prenatal los factores asociados a las principales indicaciones de esta complicación.

INTRODUCTION Obstetric Hysterectomy (OH) is an emergency procedure to solve a life threatening condition, and its incidence is 5 to 15 per 1000 obstetric events. GENERAL OBJETIVE To determine the frequency and factors related with obstetric hysterectomy at a secondary hospital in Mexico. METHODOLOGY Descriptive, cross-sectional and retrospective study from January 2014 to December 2016 including all hysterectomy cases due to an obstetric event. Factors such as Age, number of deliveries, abortions, and previous cesarean sections, admission to the Intensive care unit, surgical indications, complications and mortality because of hysterectomy were analyzed thru descriptive statistics. RESULTS 37 308 obstetric events were registered and 153 were treated with Obstetric Hysterectomy representing 0.57% of the total, meaning one OH per every 243 pregnancies. The average age of those who had a hysterectomy was 28.5 years, and the procedure had its peak at the group of age older than 35 years who had had two or more pregnancies. The history of previous cesarean section was 39.2%. In 72.1% the pregnancy was terminated with a cesarean section. The main indication for hysterectomy was Uterine Atony in 33.3% (51 cases). The most frequent complication was acute anemia in 83%. There was a maternal death (0.6%). CONCLUSIONS Obstetric Hysterectomy is an emergency surgery, there are related factors that must be identified during the prenatal control to avoid this complication.

Criaderos de Aedes aegypti en la ciudad de Asunción, Paraguay durante los años 2011-2014 / Aedes aegypti breeding site in the city of Asunción, Paraguay in the 2011-2014 periods

INTRODUCCIÓN: Las poblaciones propensas a sufrir la aparición del dengue y otras enfermedades transmitidas por el Aedes aegypti en aquellas que no cuentan con un adecuado sistema de eliminación de residuos (desechos sólidos) y el suministro de agua potable es deficiente, lo cual contribuye a la aparición de los criaderos del mosquito vector. OBJETIVO: Describir los tipos de criaderos de Aedes aegypti en la ciudad de Asunción en el periodo 2011-2014. METODOLOGÍA: Estudio observacional descriptivo sobre los criaderos registrados en la base de datos del Servicio Nacional de Erradicación del Paludismo del levantamiento larval de Aedes aegypti en Asunción en el periodo 2011-2014. Resultados: Se denotó el predominio de criaderos inservibles, representando entre el 58% y el 72% del total de criaderos positivos encontrados, seguidos de los criaderos útiles (26% y el 40%), y por último los criaderos naturales (≤2%). Los criaderos útiles, inservibles y naturales exhiben una homogeneidad en los diferentes años analizados, representada por floreros, bebedero con agua para los criaderos considerados de utilidad para el ciudadano; neumáticos usados, cubetas descartables y desechos sólidos para los criaderos inservibles y axilas de hojas en lo que respecta a criaderos naturales. CONCLUSIÓN: La información obtenida podrá optimizar las decisiones y acciones del control vectorial del Aedes aegypti en lo referente a la focalización de los criaderos y su posterior disposición final por parte de la comuna o entidades responsables.

INTRODUCTION: The populations prone to dengue and other diseases transmitted by Aedes aegypti are those that do not have an adequate waste disposal system (solid waste) and the drinking water supply is deficient, which contributes to the emergence of mosquito vector breeding containers. OBJECTIVE: To describe the types of Aedes aegypti breeding site in the city of Asunción in the 2011-2014period. METHODOLOGY: Observational descriptive study on breeding siteregistered in the database of the National Malaria Eradication Service of the larval survey of Aedes aegypti in Asunción in the 2011- 2014period. Results: There was a predominance of unusable breeding sites, representing between 58% and 72% of the total number of positive breeding, followed by the useful breeding site (26% and 40%), and finally the natural breeding sites (≤2%) . The useful, unusable and natural breeding places exhibit a homogeneity in the different years analyzed, represented by vases, drinker with water for the breeding site considered useful for people; used tires, disposable buckets and unserviceable solid waste for useless hatcheries and leaf armpits for natural breeding site. CONLCUSION: The information obtained will allow optimizing decisions and actions onAedes aegypti vector control in relation to the targeting of breeding sites and their subsequent final disposal by the commune or responsible entities.

Prevalencia y frecuencia de factores asociados a infección en pacientes mayores de 18 años con fracturas cerradas / Prevalence and frequency of factors associated with infection in patients older than 18 years with closed fractures

Resumen: Introducción: La infección de sitio operatorio (ISO) es la infección nosocomial más común y es un proceso asociado a múltiples factores, los cuales en conjunto generan una alteración que afecta directamente el bienestar del paciente. Material y métodos: Estudio de corte transversal realizado en un período de un año, el tamaño de la muestra se estableció por el total de pacientes que cumplían los criterios de inclusión; se efectuó doble tabulación de los pacientes en el programa de Excel 2013 y se analizaron los datos en Stata versión 11. Resultados: La edad promedio fue de 44.3 ± 18.8 años y la relación hombre:mujer fue 1.7:1. De las características clínicas, los miembros inferiores fueron los más afectados y 21.9% de los casos afectó el fémur. Se halló una prevalencia de 6.6%, siendo la infección profunda la más frecuente; Staphylococcus aureus se cultivó en 38.5%, de los cuales 40% fue meticilino sensible. Conclusión: La prevalencia de ISO en pacientes con fracturas cerradas en el HUS fue de 6.6%, dato elevado comparado con la literatura. Los hallazgos de este estudio permitieron establecer que la hemoglobina por debajo de 10 g/dl, la realización de transfusión, la reintervención y el riesgo quirúrgico ASA se asociaron de manera estadística a la ISO.

Abstract: Introduction: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. Material and methods: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. Results: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. Conclusion: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.

Percepción de esfuerzo durante el ejercicio: ¿Es válida su medición en la población infantil? / Perceived exertion during exercise: is their measurement valid in children?

The perceived exertion (PE) corresponds to the subjective sensation caused, in part, by the me-tabolic changes during exercise. This variable has been widely used during exercise tests and during trainingprocesses andphysical rehabilitation in healthy and chronically diseased children. Additio-nally, it has been established that the assessment of PEproperties (validity and reliability) is strongly determined by the type of scale, the applied paradigm and the cognitive development. Evidence is overwhelming in establishing the validity of this measurement in children aging from 4 years old, by using adapted scales. At 8 years-old the application of estimate-production paradigm is suggested and from 13 to 15 years-old the Borg scale 6-20 would be used. In Chile EPInfant scale has been developed for measuring childperceived exertion. This scale has shown an acceptable performance in in cremental exercise test in healthy children aged 8 to 15 years old, justifying its use. We review the assessment of PE properties in children , considering key aspects in the design of scales and cognitive development of children. Additionally, the evidence regarding the validity of the Chilean scale EPInfant in children is presented. Finally the research currently under development and its projections on this issue are discussed.

La percepción de esfuerzo (PE) corresponde a la valoración subjetiva causada, en parte, por los cambios metabólicos durante el ejercicio. Esta variable ha sido ampliamente utilizada en pruebas de ejercicio y rehabilitación física en niños sanos y con enfermedades crónicas. Adicionalmente, ha sido establecido que las propiedades de medición (validez y confiabilidad) de la PE son fuertemente determinadas por el tipo de escala, paradigma de aplicación y desarrollo cognitivo. En este contexto, ha sido demostrado que la medición de la PE es válida en niños a partir de los 4 años a través de escalas adaptadas. Desde los 8 años es factible la utilización de esta variable mediante el paradigma de estimación-producción y desde los 13 a 15 años mediante escalas de adultos v.gr. Borg 6-20. En nuestro país, ha sido desarrollada la escala de medición de esfuerzo percibido infantil (EPInfant), la cual, ha mostrado, un rendimiento aceptable durante pruebas de ejercicio incremental en niños sanos de entre 8-15 años de edad, justificando su utilización en nuestro medio. En esta revisión se discuten las propiedades de medición de la PE en población infantil, considerando aspectos esenciales en el diseño de las escalas y el desarrollo cognitivo de los niños. Adicionalmente, se presenta la evidencia existente respecto a la validez de la escala EPInfant en niños de nuestro país. Finalmente se discuten las líneas de investigación actualmente en desarrollo que determinarán las perspectivas en esta temática.

Poligrafía en niños con enfermedad neuromuscular / Polygraphy in children with neuromuscular disease

Introduction: A high prevalence of sleep-disordered breathing (SDB) has been reported in neuromuscular disease (NMD) patients. Our aim was to describe the results of sleep studies performed by overnight polygraphy in pediatric ward of a public hospital from Concepción, Chile. Additionally, we purposed to define its utility in the treatment of children with NMD. Methods: Records of NMD patients admitted at G. Grant Benavente Hospital, from 2011 to 2015 were considered. The therapeutic approaches were classified as: non invasive ventilation, surgical treatment and follow up. Results: From 36 patients initially admitted in the study 5 were excluded. Patients median age was 10 years-old (range: 0.3-19), 74% (n = 23) were males. Diagnosis were: Duchenne muscular dystrophy in 12 patients (39%), Myelomeningocele in 6 (19%), Hypotonic syndrome in 5 (16%), Miopathy in 3 (10%), Spinal muscular atrohpy in 3 (10%) and other NMD in 2 patients (6%). Median of polygraphy valid time was 7.3 h (range:4.3-10.5). Median of mean values of O2 saturation was 97% (range: 91-99%) and median of minimum O2 saturation was 90% (51-95%). Six polygraphies (19%) were normal and 25 (81%) showed some degree of SDB. From this group 60% had a mild, 28% (n = 7) had a moderate and 12% (n = 3) presented a severe SDB. Fifteen patients (65%) were under non invasive ventilation, nine (29%) of them received medical treatment and two of them (6%) surgical treatment. There was no difference between the magnitude of SDB and therapeutic approach. Moreover, no association between the severity of SDB and therapeutic approach was found. Conclusion: Polygraphy allows objective diagnosis of SDB in children with NMD and is a suitable tool to define therapeutic conducts.

Introducción: Los pacientes con enfermedades neuromusculares (ENM) presentan una alta prevalencia de trastornos respiratorios del sueño (TRS). El objetivo de este estudio fue describir los resultados de estudios poligráficos y mostrar su utilidad para el establecimiento de conductas terapéuticas en niños con ENM de un hospital público de Chile. Metodología: Se consideraron registros de PG de niños con ENM. Las conductas terapéuticas fueron clasificadas como: asistencia ventilatoria no invasiva (AVNI), cirugía y observación y seguimiento. Los resultados se expresan en mediana y rango. Los tests de Kruskal-Wallis y χ2 fueron empleados. Fue considerado significativo unp < 0,05. Resultados: Al estudio ingresan 36 pacientes, siendo excluidos 5, la mediana de edad fue 10 años (0,3-19), 74% varones. Diagnósticos: Distrofia neuromuscular de Duchenne 39% (n = 12), Mielomeningocele 19% (n = 6), Síndrome hipotónico 16% (n=5), Miopatia 10% (n = 3), Atrofia espinal 10% (n = 3), otros 6% (n = 2). El tiempo validado de la poligrafía fue 7,3 h (4,3-10,5), la mediana de la saturación de O2 promedio fue 97% (91-99) y de la saturación de O2 mínima 90% (51-95). Las poligrafías fueron normales en 6 pacientes (19%) y sugerentes de TRS en 25 (81%). Entre ellas se consideró SAHOS leve 60% (n = 15), moderado 28% (n = 7) y severo 12% (n = 3). En 20 pacientes (65%) se decidió iniciar AVNI, en 9 (29%) observación y seguimiento y en 2 (6%) tratamiento quirúrgico. No existió asociación entre la categorización de gravedad de SAHOS y conducta terapéutica. Conclusión: La poligrafía permite el diagnóstico objetivo de TRS en niños con ENM y constituye una herramienta útil para determinación de conductas terapéuticas.

Energy partitioning and methane emission by sheep fed sorghum silages at different maturation stages / Partição de energia e emissão de metano por ovinos alimentados com silagem de sorgo em diferentes estádios de maturação

Energy partitioning and methane production by sheep fed silages of three commercially available sorghum hybrids (BRS 610, BR 700 and BRS 655) harvested at three maturation stages (milk, soft dough and floury) were evaluated in open circuit respiration chambers. A complete randomized design was used in a 3 × 3 (hybrids × maturity stages) factorial arrangement, and the means were compared by the Student-Newman-Keuls (SNK) test (P<0.05). The intake of dry matter, digestible dry matter, gross energy, digestible energy and metabolizable energy were not affected by maturation stage, but were influenced by hybrid. The net energy intake was influenced by maturity and sorghum genetics. The fecal output represented the main source of energy loss, as percentage of gross energy intake (48% to 52%), followed by heat increment (10% to 19%), methane emissions (4% to 6%) and urine (1% to 2%). There were no differences (P>0.10) among the treatments for the apparent digestibility of gross energy and metabolizability (qm). An interaction (P<0.05) between sorghum hybrid and maturation stages was observed for the efficiency of metabolizable energy utilization for maintenance (km), which ranged between 0.53 and 0.78. No differences (P>0.10) among treatments occurred in the daily methane production. There is substantial genetic diversity within sorghum species, determining different nutritional values. Sorghum genetics and maturity at harvest should not be an opportunity to reduce the contribution of agriculture to methane emissions.

A partição de energia e a produção de metano por ovinos alimentados com silagens de três híbridos de sorgo comerciais (BRS 610, BR 700 e BRS 655), colhidos em três estádios de maturação (leitoso, pastoso e farináceo), foram avaliadas em câmaras respirométricas de circuito aberto. Utilizou-se delineamento inteiramente ao acaso, em arranjo fatorial 3 x 3 (híbridos x estádios de maturação), e as médias foram comparadas pelo teste Student-Newman-Keuls (SNK) (P<0,05). Os consumos de matéria seca, de matéria seca digestível, de energia bruta, de energia digestível e de energia metabolizável não foram afetados pelo estádio de maturação, mas foram influenciados pelo híbrido de sorgo. O consumo de energia líquida foi influenciado pela maturidade e pelo híbrido. As perdas de energia nas fezes representaram a principal fonte de perda energética como porcentagem do consumo de energia bruta (48% a 52%), seguida pelo incremento calórico (10% a 19%), pela emissão de metano (4% a 6%) e pela urina (1 a 2%). Não houve diferenças (P>0,10) entre os tratamentos para a digestibilidade aparente da energia bruta e para a metabolizabilidade (qm). Foi observada interação (P<0,05) entre híbrido de sorgo e estádio de maturação para eficiência de uso da energia metabolizável para mantença (Km), que variou entre 0,53 e 0,78. Não ocorreram diferenças (P>0,10) entre tratamentos na produção diária de metano. A emissão de metano em gramas por kg de matéria seca digestível e por kg de fibra em detergente neutro digestível foi inferior no estádio pastoso comparado ao estádio farináceo.

Confiabilidad de la fuerza muscular respiratoria y flujos espiratorios forzados en adolescentes sanos / Reliability of pulmonary function tests in healthy adolescents

Inspiratory and expiratory muscle strength (MIP and MEP) assessment, and peak expiratory flow (PEF) and peak cough flow (PCF) measurements are often used to assess patients with respiratory diseases. Notwithstanding, there are few reports about reliability of these measurements. The aim of this study is to determine the intra-observer reliability of MIP, MEP, PCF and PEF in healthy adolescents. The study design was test retest. A sample of students from a public school of Talcahuano (Chile) were studied. MIP, MEP, PEF and PCF were recorded twice by the same appraiser, with an interval of 8 weeks. Intraclass correlation coefficient (ICC) was used as an index of reliability. Analysis of individual differences was performed by Bland and Altman’s method and the probability of discordance between test and retest was evaluated. A p value < 0.05 was considered significant. 23 students (9 males), ageing 16.3 ± 0.5 years-old entered to the study. ICC of MIP, MEP, PEF and PCF were 0.7; 0.78; 0.86 and 0.63 respectively. Bland-Altman analysis shows that the average discrepancy between the test and retest was -5 (95% CI: 35.6 to -52.6), -9.1 (95% CI: 20.2 to -38.4), -7.8 (95% CI: 107.7 to -123.2) and -28.5 (95% CI: 131.9 to -189.1) in MIP, MEP, PEF and PCF respectively. There was no significant difference in probability of discordance between parameters with the same unit of measure. Respiratory function variables show a moderate to high level of reliability, considering eight weeks of time interval between test and retest. PEF and MEP were the variables with the best performance.

La evaluación de fuerza muscular inspiratoria (PImax) y espiratoria (PEmax), la medición del flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) son, a menudo, utilizados para el seguimiento de pacientes con enfermedades respiratorias. No obstante, son escasos los reportes acerca de sus propiedades de evaluación. El objetivo de este estudio es determinar la confiabilidad intra-observador de la PImax, PEmax, FMT y FEM, en adolescentes sanos. Se empleó un diseño test retest en que se seleccionaron adolescentes voluntarios de un colegio público de Talcahuano. PImax, PImax, FEM y FMT fueron registradas por un mismo evaluador en dos oportunidades con un intervalo de 8 semanas. Se empleó el coeficiente de correlación intraclase (CCI) como índice de confiabilidad. Mediante el método de Bland-Altman se realizó el análisis de las diferencias individuales y se evaluó la probabilidad de discordancia entre test y retest. Se consideró significativo un valor de p < 0,05. Al estudio ingresaron 23 sujetos (9 varones), edad promedio 16,3 ± 0,5 años. El CCI de PImax, PEmax, FEM y FMT fueron 0,7; 0,78; 0,86 y 0,63 respectivamente. Por su parte, el análisis de Bland-Altman muestra que el promedio de discordancia entre los tests fue -8,5 (95% IC: 35,6 a -52,6), -9,1 (95% IC: 20,2 a -38,4), -7,8 (95% IC: 107,7 a -123,2) y -28,5 (95% IC: 131,9 a -189,1) en PImax, PEmax, FEM y FMT respectivamente. No existió diferencia significativa de probabilidad de discordancia entre parámetros con igual unidad de medida. Las variables de función respiratoria muestran un nivel de confiabilidad moderado a alto, considerando 8 semanas de intervalo de tiempo entre el test y retest. Las variables con mejor rendimiento fueron FEM y PEmax.

Cinética de fermentação ruminal das silagens de três híbridos de milho comerciais em diferentes estádios de maturação / Ruminal fermentation kinetics of corn silages from three commercial hybrids at different maturation stages

Foi avaliada a cinética de fermentação ruminal in vitro de três híbridos comerciais de milho (BRS 1035, BRS 1031 e BRS 1001) colhidos em três estádios de maturidade (pastoso, farináceo e farináceo-duro). Após 96 horas de fermentação, não houve diferença na PCG entre as silagens dos híbridos colhidos nos diferentes estádios de maturidade (P>0,05). O potencial máximo de produção de gases das silagens de todos os híbridos reduziu com o avançar da maturidade da planta, sendo a variação encontrada de 259,3 a 280,0mL/g de matéria seca (MS). Os valores de tempo de colonização variaram de 0h06min a 1h54min. Para as silagens dos híbridos BRS 1035 e BRS 1001, houve aumento no tempo de colonização com o avançar da maturidade da planta. Para as silagens do híbrido BRS 1031, houve aumento dos valores de tempo de colonização quando a planta avançou do estádio pastoso para farináceo, e reduziu quando a maturidade alcançou o estádio farináceo-duro. A taxa fracional de produção de gases "µ" variou entre 0,03mL/h a 0,05mL/h. Com o avançar da maturidade fisiológica, as silagens dos híbridos BRS 1035 e BRS 1001 apresentaram aumento nos valores de µ; já para as silagens do híbrido BRS 1031, os valores de µ aumentaram quando o estádio de maturidade avançou de pastoso para farináceo, e reduziu para farináceo-duro. Os valores das degradabildades efetivas foram superiores para as silagens dos diferentes híbridos colhidas no estádio pastoso. As degradabilidades da MS com o tempo de fermentação de 96 horas variaram de 70,1 a 76,4%. A silagem do híbrido BRS 1035 apresentou melhor valor nutricional quando colhida no estádio pastoso de maturidade. Já a silagem do híbrido BRS 1031 apresentou valor nutricional superior no estádio farináceo, enquanto a silagem do híbrido BRS 1001 apresentou melhor valor nutricional no estádio farináceo-duro.

The in vitro ruminal fermentation kinetics of three commercial corn hybrids (BRS 1035, BRS 1031 and BRS 1001) harvested at three maturity stages (soft dough, floury and hard-floury) were evaluated. After 96 hours of fermentation there was no change in the cumulative gas production (GPC) among silages harvested for all hybrids (P>0.05). The silages maximal degradation potential for all hybrids decreased with advanced maturity stages, and ranged from 259.32 to 279.96mL/g of dry matter. The lag values ranged from 0h 06min to 1h 54min. For silages from the BRS 1035 and BRS 1001 hybrids, there was an increase in lag with advancing plant maturity. For silage from the BRS 1031 hybrid, the lag values increase when the plant moved of soft dough stage to floury, and was reduced to hard-floury stage. The fractional rate of gas production µ ranged from 0.0292mL/h to 0.0447mL/h. With advancing physiological maturity stages, the hybrids BRS 1035 and BRS 1001 showed an increase in the µ values, since for silage from the BRS 1031 hybrid, the value of µ increased when the maturity stage progressed from soft dough to floury, and reduced to hard-floury. The values of effective degradability were higher for silages from different hybrids harvested at soft dough. The dry matter degradability (DMD) in the fermentation time of 96 hours ranged from 70.14 to 76.40%. The silage from the BRS 1035 hybrid showed better nutritional value when harvested in the soft dough stage of maturity. The silage from the BRS 1031 hybrid showed highest nutritional value at the floury stage, while the silage from the BRS 1001 hybrid showed better nutritional value in the hard-floury stage.

El proceso de investigación y su aplicación en rehabilitación respiratoria: Segunda Parte / The research process and its application in pulmonary rehabilitation: Part 2

The initial stages of clinical research were described in an integrated manner in the first part of this review (1). The integrated approach of these stages creates the background for the design of eligibility criteria, measurement protocols and statistical analysis consistent with the general course of the research process which culminates with the drafting of the results and conclusions. The general concepts related to inclusion and exclusion criteria, sampling strategies and estimation of sample size, the characteristics of the measurement process and the steps that provide a suitable statistical analysis plan, are described in this second part. This review is expected to enhance research methodology knowledge, so as to encourage the implementation of studies with higher quality standards that would raise the scientific development of this valuable area.

En la primera parte de esta revisión (1) se describieron de manera integrada las etapas iniciales del proceso de investigación clínica. El abordaje acabado de estas etapas genera las bases para el desarrollo de criterios de elegibilidad, protocolos de medición y un plan de análisis estadístico coherente al curso general del proceso que culmina con la redacción de los resultados y conclusiones. En esta segunda parte se describen los conceptos generales relacionados con los criterios de inclusión y exclusión, estrategias de muestreo y estimación de tamaño muestral, características del proceso de medición y finalmente las etapas que contempla el plan de análisis estadístico. Se espera que este material contribuya al conocimiento en el área de la metodología de la investigación, con el propósito de incentivar la ejecución de estudios con estándares de calidad cada vez más altos, que permitan elevar el desarrollo científico de esta valiosa área disciplinar.

Efecto del entrenamiento de músculos abdominales sobre la función respiratoria en adolescentes sanos: Estudio piloto / Effect of abdominal muscle training on respiratory function in healthy adolescents: A preliminar study

The respiratory muscle training has been used to improve muscle strength and optimize the mechanism of cough. The aim of this study is to evaluate the effect of abdominal muscle training on respiratory muscle strength (MIP, MEP), peak expiratory flow (PEF) and peak cough flow (PCF) in healthy adolescents. The study design was quasi-experimental, variables of respiratory function were assessed before and after the muscle training protocol in a sample of sedentary healthy adolescents without gender restriction. The sample size calculated was 15 subjects. The training protocol consisted in 8 weeks of training divided into two stages (basic and advanced training plan) twice a week. Descriptive statistics were performed, tests for normality (Shapiro Wilk), U Mann Whitney test, Pearson coefficient and t-student test were used. Results are expressed as mean and its standard deviation. It was considered significant a p value < 0,05. Seventeen subjects (8 males and 9 females) entered to the study, all subjects performed the protocol and completed it without incidents. After completing the training protocol the sit-up test performance increased 21.7% (p = 0.0001), the MIP increase 16,5 cm H2O (17.1%) (p = 0.006), MEP increased 34.9 cm H2O (50,2 %) (p = 0.0001). Moreover, PEF increased 35.3 L/min (8.3%) (p = 0.003) and PCF increased 36.6 L/min (9,1%). There was no correlation between sit-up test performance and lung function variables. PEF showed only a moderate correlation with PCF (r = 0.6; p = 0.007) and MEP (r = 0.59; p = 0.01). We conclude that, in this sample, increases in respiratory muscle strength, PEF and PCF were observed after abdominal muscle training. No association between abdominal muscle strength and respiratory function variables was found before initiating the training protocol.

El entrenamiento muscular respiratorio ha sido utilizado para mejorar la fuerza de los músculos y optimizar el mecanismo de la tos. El objetivo de este estudio es evaluar el efecto del entrenamiento de músculos abdominales sobre la fuerza de los músculos respiratorios (Pimax, Pemax), flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) en adolescentes sanos. Este estudio es cuasi experimental, donde se evaluaron las variables de función respiratoria antes y después del protocolo de entrenamiento. La muestra estuvo integrada por adolescentes sanos sedentarios sin restricción de sexo. La muestra mínima estimada fue de 15 sujetos. El protocolo de entrenamiento consistió en 8 semanas de entrenamiento dividido en 2 etapas (plan básico y avanzado de ejercicios) dos veces por semana. Se realizó estadística descriptiva, pruebas de normalidad (Shapiro Wilk); se utilizó test U de Mann Whitney, coeficiente de correlación de Pearson y test t-student para muestras pareadas. Los resultados se expresan en promedios y desviación estándar. Se consideró significativo un valor de p < 0,05. Ingresaron al estudio 17 sujetos (8 hombres y 9 mujeres), todos los sujetos realizaron el protocolo completo. Posterior al protocolo los sujetos incrementaron en 21,7% el rendimiento del sit-up test (p=0,0001); la Pimax aumentó 16,5 cm H2O (+17,1%) (p=0.006), la Pemax aumentó 34,9 cm H2O (+50,2%) (p=0,0001). Por otra parte, el FEM aumentó 35,3 L/min (+8,3%) (p=0,003) y el FMT aumentó 36,6 L/min (+9,1%). La fuerza de músculos abdominales no muestra correlación con las variables de función respiratoria. Sólo FEM muestra correlación moderada con el FMT (r = 0,6; p = 0,007) y Pemax (r = 0,59; p = 0,01). Se concluye que, en la muestra estudiada, se observan incrementos en la fuerza muscular respiratoria, FEM y FMT luego de un protocolo de entrenamiento de músculos abdominales. No se observó asociación entre la fuerza muscular abdominal y las variables de función respiratoria antes de iniciado el protocolo.

Desempenho produtivo e perfil de ácidos graxos do leite de vacas que receberam níveis crescentes de óleo de girassol em dietas à base de capim-elefante / Productive performance and fatty acid composition of milk from dairy cows fed increasing levels of sunflower oil in elephant-grass based diets

Este experimento teve como objetivo principal avaliar as alterações no perfil de ácidos graxos do leite decorrentes do fornecimento de diferentes níveis de óleo de girassol (OG) para vacas leiteiras alimentadas com dietas completas à base de capim-elefante. Doze vacas da raça Holandesa receberam quatro níveis de OG na dieta (0; 1,3; 2,5 e 3,7% da MS) em delineamento quadrado latino 4 x 4. Não houve efeito (P>0,05) dos níveis de OG sobre o consumo de MS, a produção de leite ou os teores de sólidos do leite. Por outro lado, o perfil de ácidos graxos (AG) do leite foi amplamante modificado com a inclusão de OG na dieta, e observou-se redução (P<0,0001) dos teores dos AG de cadeia curta e média, elevação dos teores de ácido oleico (P<0,0001), dos isômeros de ácido linoleico conjugado, em especial do ácido rumênico (P<0,0001) e da relação entre os ácidos graxos hipo e hipercolesterolêmicos (P<0,0001). Apesar da maior ingestão diária de ácido linoleico (P<0,01) com o aumento do nível de OG na dieta, sua concentração na gordura do leite não foi alterada. Isso indica extensiva bio-hidrogenação ruminal deste AG no rúmen, o que é compatível com o aumento (P<0,0001) da concentração de ácido esteárico e dos AG C18:1 trans, especialmente do vacênico, na gordura do leite. Em geral, os resultados observados no presente estudo indicam que a inclusão de até 3,7% de OG em dietas completas de vacas leiteiras à base de capim-elefante promove melhoria da qualidade nutricional da gordura do leite, sem comprometimento do desempenho produtivo dos animais...

This study aimed to evaluate the effects of different levels of sunflower oil (SO) (0, 1.3, 2.5 and 3.7% of diet DM) on nutrient intake, milk production, milk composition, and fatty acid (FA) composition of milk and plasma from dairy cows fed elephant-grass based diets. Twelve Holstein cows were divided into three groups and received the dietary treatments in a 4 x 4 Latin-square design. Oleic, linoleic and α-linolenic acid intakes increased linearly (P<0.001) by adding SO to the diets. The reduction (P<0.0001) in odd and branched chain FA in milk fat from cows fed SO suggests that rumen microbial growth has been inhibited to some extent. Feeding up to 3.7% of SO in chopped elephantgrass-based diets improved the nutritional quality of milk fat, which was associated with the following changes in milk fatty acid composition: reduction (P<0.0001) of short and medium chain saturated FA contents, increase in oleic acid and rumenic acid contents (P<0.0001), and increase (P<0.0001) in hypo:hypercholesterolemic FA ratio. Overall, these results indicate that including up to 3.7% SO in elephant-grass based-diets improves the nutritional quality of milk fat from dairy cows without causing any detrimental effects on production paramaters...

El proceso de investigación y su aplicación en la rehabilitación respiratoria: primera parte / The research process and its application in pulmonary rehabilitation: Part 1

In recent years there has been a significant increase in the number of scientific articles published in the rehabilitation field, which has allowed the development of the discipline based on the paradigms of evidence-based medicine. In this sense, to avoid the distortion of the results, caused by systematic or random error, it is crucial to know the methodological elements of the research process because these factors critically affect the validity of the results obtained during clinical research. The present review deals with the initial stages of the research process in an integrated manner. These latter are: the statement of the problem; objectives, hypotheses and study design. The purpose of the review is to provide guidance for the design of future studies in the area of pulmonary rehabilitation.

En los últimos años se ha observado un incremento significativo en la cantidad de artículos científicos publicados en el campo de la rehabilitación, lo que ha permitido el desarrollo de la disciplina con un enfoque basado en los paradigmas de la medicina basada en evidencia. En este sentido, conocer los elementos metodológicos que componen el proceso de investigación es fundamental para que los resultados no sufran distorsiones producidas por error sistemático o azar, factores que afectan de manera crítica la validez de los resultados obtenidos durante la investigación clínica. En la presente revisión se aborda de manera integrada las fases iniciales del proceso de investigación, que son: el planteamiento del problema; objetivos, hipótesis y diseño de estudio. El propósito es aportar una guía para el diseño de futuros estudios en el área de la rehabilitación pulmonar.

Test de caminata de seis minutos y función pulmonar en pacientes con bronquiolitis obliterante post infecciosa / Six minute walking test and pulmonary function in patients with post infectious bronchiolitis obliterans

Introduction: Post-infectious bronchiolitis obliterans (BO) is a chronic respiratory disease that is established as a consequence of a lung infection produced by adenovirus. The clinical and radiological evidence as well as spirometric variables are the cornerstones of diagnosis; however, the functional impact of lung damage, assessed through the six minute walking test (6MWT), has been scarcely studied in this group of patients, notwithstanding it has been recommended in the Chilean guidelines. The aim of the study is to evaluate the correlation between spirometric variables and 6MWT performance in patients diagnosed with BO. Patients and Methods: Correlation study conducted in pediatric pulmonary rehabilitation program of Guillermo Grant Benavente Hospital from Concepción. Chile. Records of spirometry (FEV1, FVC, FEV1/FVC and FEF25-75) and 6MWT(Distance walked (DW), heart rate, oxygen saturation, dyspnea and leg fatigue) of 22 children and adolescents diagnosed with BO were selected. The absolute values of spirometric and 6MWT variables were compared with reference values of Knudson et al and Gatica et al respectively. Results are expressed by median and range (maximum and minimum). In the statistical analysis, normality test (Kolmogorov-Smirnov), non-parametric test (Wilcoxon, Mann-Whitney) and correlation analysis (Rho-Spearman) were done by SPSS 11.5 with significance of p < 0.05. Results: The spirometry was obstructive in all patients, advanced ventilatory limitation was found in 9 children, moderate in 4, mild in 3 and minimum in 6. The WD was 597 m (750-398), 9% below the predicted value according to age (p < 0.003). The WD was lower in those with greater severity in spirometric impairment (p = 0.012). The WD expressed as a percentage of predicted value showed a significant correlation with % FEV1 (r = 0.70, p = 0.0001), FEV1/FVC ratio (r = 0.58, p = 0.004) and FEF25-75% (r = 0.70, p = 0.0001). On the other hand only saturation at the end of 6MWT showed significant correlation with % FVC (r = 0.44, p = 0.04). Conclusion: Performance during the 6MWT was positively correlated with spirometry, validating the 6MWT as a tool to assess the functional impact of lung damage in patients with BO. Future prospective studies are needed to evaluate the correlation between lung function and exercise tolerance in these patients.

Introducción: La bronquiolitis obliterante (BO) post infecciosa es una enfermedad respiratoria crónica que se establece como secuela de una infección pulmonar principalmente por adenovirus. La evidencia clínica, espirométrica y radiológica son los pilares del diagnóstico, sin embargo, pese a estar sugerido en las actuales guías nacionales, la repercusión funcional del daño pulmonar a través del test de caminata de seis minutos (C6M) ha sido escasamente estudiado en este grupo de pacientes. El objetivo de este estudio es evaluar la correlación entre variables espirométricas y resultado del C6M en una muestra de pacientes con BO. Pacientes y Métodos: Estudio correlacional donde fueron seleccionados los registros de espirometría (VEF1, CVF, VEF1/CVF y FEF25-75) y de C6M (Distancia caminada (DC), frecuencia cardíaca, saturación de oxígeno, disnea y fatiga de piernas) de 22 niños y adolescentes con diagnóstico de BO ingresados al programa de rehabilitación respiratoria infantil del Hospital Dr. Guillermo Grant Benavente de Concepción. Los valores absolutos de las variables espirométricas y C6M se compararon con valores predichos de Knudson y Gatica respectivamente. En el análisis estadístico se realizaron pruebas de normalidad (Kolmogorov-Smirnov), de contraste (Wilcoxon y Mann-Whitney) y análisis de correlación (Rho-Spearman). Los resultados se expresan en mediana, rango máximo y mínimo. Se consideró significativo p < 0,05. Resultados: En la espirometría se encontró alteración ventilatoria obstructiva de grado avanzado en 9, moderada en 4, leve en 6 y mínima en 3 niños. La DC fue de 597 m (750-398), 9% por debajo del valor predicho para la edad (p < 0,003). La DC fue menor en aquellos con mayor grado severidad en la alteración espirométrica (p = 0,012). La DC expresada en porcentaje del valor predicho mostró una correlación significativa con % VEF1 (r = 0,70;p = 0,0001), índice VEF1/CVF (r = 0,58;p = 0,004) y % FEF25-75 (r = 0,70;p = 0,0001). Sólo la saturación al final del C6M se correlacionó significativamente con % CVF (r = 0,44; p = 0,04). Conclusión: El rendimiento durante el C6Mse correlacionó con espirometría, validando al C6M como herramienta para valorar la repercusión funcional del daño pulmonar en pacientes con BO. Futuros estudios son necesarios para confirmar esta correlación.

Valor nutricional de híbridos de sorgo em diferentes estádios de maturação / Nutritional value of hybrids of sorghum in different maturation stages

Avaliaram-se a composição bromatológica e a digestibilidade in vitro das plantas, folhas, colmos e panículas de três híbridos de sorgo (BRS 610, BR 700 e BRS 655) colhidos em três estádios de maturação (leitoso, pastoso e farináceo). O delineamento utilizado foi o inteiramente casualizado, em arranjo fatorial 3x3 (híbridos x estádios de maturação), sendo as médias comparadas pelo teste SNK (P<0,05). Os teores de matéria seca (MS) das plantas variaram de 25,73% a 43,96% e aumentaram com a maturidade. A concentração de proteína bruta (PB) das plantas manteve-se inalterada (P>0,05) entre as idades de corte para todos os híbridos. Os teores de fibra insolúvel em detergente neutro (FDN) e fibra insolúvel em detergente ácido (FDA) das plantas não foram influenciados pelo estádio de maturação. Os coeficientes de digestibilidade in vitro da MS (DIVMS) das plantas do BRS 610 não variaram com a maturidade, mas para o BR 700 e BRS 655 apresentaram redução entre o estádio leitoso e o farináceo. As variações observadas nas porcentagens de MS, PB, FDN, FDA e DIVMS das frações folha, colmo e panícula ocorreram de forma diferente entre os híbridos com o avanço da maturidade. Os híbridos BR 700 e BRS 655 devem ser ensilados no estádio leitoso, enquanto o BRS 610 pode ser colhido nos três estádios de maturação avaliados.

The nutritional value of the plants, leaves, stems and panicles of three hybrids of sorghum (BRS 610, BR 700 and BRS 655) at three maturation stages (milk, soft dough and flour) were evaluated. A complete randomized design was used in a factorial arrangement 3x3 (hybrids x ages of cut), and the means were compared by SNK (P<0.05). Dry matter contents of the plants varied from 25.73% to 43.96% and increased with maturity. The percentage of crude protein (CP) of the plants remained constant (P>0.05) among cuts for all the hybrids. The values of neutral detergent fiber (NDF) and acid detergent fiber (ADF) of the plants were not affected by maturation stages. The in vitro dry matter digestibility (IVDMD) of the plants of BRS 610 didn't change with maturity, but decreased between milk and floury stages for BR 700 and BRS 655. Differences in the percentages of DM, CP, NDF, ADF and IVDMD of the plant fractions (leaves, steam and panicle) occurred differently among hybrids with the advance of maturity. The hybrids BR 700 and BRS 655 should be ensiled at milk stage, while the BRS 610 can be harvested at the three maturation stages evaluated.

Síntomas laríngeos y laringitis posterior: ¿siempre es secundario a reflujo gastroesofágico? / Association of gastroesophageal reflux with posterior laryngitis. study of 43 patients

El reflujo gastroesofágico (RGE) ha sido asociado como causa de laringitis posterior, sin embargo, la evidencia sobre esto es controversial. El objetivo principal es establecer si los pacientes con síntomas y diagnóstico de laringitis posterior, se correlacionan con la existencia de RGE ácido patológico. Objetivo secundario es el estudio del valor predictivo de cada síntoma laríngeo para reflujo ácido patológico...

Gastroesophageal reflux (GER) is syndicated as a cause of posterior laryngitis. However the evidence for the association is weak. Aim: To determine if the presence of posterior laryngitis is associated with GER.

Granuloma reparativo central de células gigantes. Características clinicomorfologicas y diagnósticos diferenciales / Central reparative granuloma of giant cells. morphological characteristics and clinical differential diagnosis

El granuloma reparativo central de células gigantes(GRCCG) es una lesión osteolítica poco frecuente, localizadageneralmente en los huesos maxilares. Aunquesu patogenia continúa siendo controversial, se creeque se origina tras una irritación o traumatismo crónico.Se manifiesta en forma de nódulo circunscripto rojo-púrpura,de crecimiento lento e histológicamente está constituidopor células gigantes multinucleadas inmersas enuna estroma de células ovaladas y fusiformes, planteandodiagnósticos diferenciales con otras lesiones de cé-lulas gigantes.A pesar de sus características histológicas benignas, elcomportamiento de esta lesión suele ser agresivo localmente.Mujer de 31 años de edad con una lesiónosteolítica en maxilar inferior, que resultó tener un componentepredominante de células gigantes que motivóun minucioso análisis anatomopatológico y clínico delesiones de células gigantes de los maxilares, llegándoseal diagnóstico de GRCCG.En nuestro caso la edad, el sexo y la localización de lalesión se correspondieron con la bibliografía consultada.También concordó la clínica, la presentación de lalesión como única, el hallazgo de células gigantesmultinucleadas en una estroma fibrocelularvascularizada y la observación de áreas hemorrágicas ypigmento hemosiderínico. No encontramos antecedentesde irritación o traumatismo en la zona tumoral.A pesar del gran número de lesiones de células gigantesmultinucleadas de los maxilares llegamos al diagnósticode GRCCG por la clínica y los hallazgos morfológicos.Nuestra paciente no presentó signos de recurrencia hastael momento de esta comunicación.Es nuestro objetivo indicar la importancia clínico-patoló-gica del GRCCG, que obliga a plantear diagnósticosdiferenciales con todas las lesiones que en esta localizaciónpresentan células gigantes...

The central reparative granuloma giant cell (GRCCG) isa rare osteolytic lesion, usually located on the jawbone.Although its pathogenesis remains controversial, isbelieved to have originated after irritation or chronic trauma.It manifests as red-purple nodule circumscribed, slowgrowing and histologically is composed of multinucleatedgiant cells embedded in a stroma of spindle and ovalcells, suggesting differential diagnosis with other giantcell lesions.Their benign histological features, the behavior of theselesions are usually locally aggressive. Case report 31 yearsof age with an osteolytic lesion in the mandible. Thehistopathological study showed the same predominantgiant cell component, arriving after a thorough differentialanalysis and clinical pathology of giant cell lesions of thejaws, the diagnosis of GRCCG.Discussion: In our case the age, sex and location of thelesion were consistent with the literature. They alsoagreed the presentation of the lesion as unique, the findingof multinucleated giant cells in a fibrocellular stroma vascularand hemorrhagic areas observing and hemosiderinpigment. No irritation or trauma to the tumor area.Our patient had no signs of recurrence. It is our objectiveto indicate the importance of GRCCG clinicopathological,which requires raising the differential diagnosisfor all lesions in this location have giant cells, takinginto account both clinical and morphology...

Presentación clínica y detalles morfológicos de la endometriosis en apéndice cecal / Clinical and morphological features of endometriosis in appendix cecal

La endometriosis es la presencia de glándulas y estromaendometriales fuera del útero, siendo la localizaciónapendicular extremadamente rara y generalmenteasintomática, llegándose al diagnóstico incidentalmente,luego de una intervención quirúrgica por apendicitisaguda. A veces simula patologías del tracto digestivo odel aparato genital, incluyendo masas tumorales sospechosasde malignidad. Presentamos tres casos de endometriosisapendicular, dos con clínica de apendicitisaguda. En el tercero había dolor abdominal tipo cólicoen hipogastrio durante la menstruación, con imagentomográfica de tumor pericecal, demostrándose en elestudio histopatológico endometriosis tanto en apéndicececal como en ciego. En los otros dos casos, la anatomíapatológica demostró en uno apendicitis aguda juntoa la endometriosis y en el otro periapendicitis reactiva ala endometriosis. Es nuestro objetivo indicar la importanciaclínico-patológica de la endometriosis a nivel delapéndice cecal, que si bien es de baja incidencia y generalmentese halla incidentalmente, obliga a tenerla encuenta, debido a que en algunos casos puede simulardiversos procesos patológicos abdominales, especialmentetumores...

Endometriosis is the presence of endometrial glands andstroma outside the uterus, appendix location beingextremely rare and usually asymptomatic, incidentallyleading to the diagnosis, after surgery for acuteappendicitis. Sometimes simulated digestive tractdiseases or genital tract, including tumor massessuspicious of malignancy. We present three cases ofappendiceal endometriosis, two with symptoms of acute appendicitis. In the third had abdominal cramping painin lower abdomen during menstruation, with pericecaltomographic imaging of tumor, histopathologydemonstrated in the Appendix both cecal endometriosisas ceccum. In the other two cases, the pathologydemonstrated in an acute appendicitis with endometriosisand other reactive periappendicitis endometriosis. Itis our objective to indicate the clinicopathologicalsignificance of endometriosis at the appendix, whichalthough low incidence and is usually incidentally,requires it to account, because in some cases cansimulate different pathological processes abdominalespecially tumors...