Compromiso sensitivo y polineuropatía periférica como manifestación inicial de enfermedad de Creutzfeldt-Jakob. A propósito de un caso

La enfermedad de Creutzfeldt-Jakob (ECJ) es una rara enfermedad neurodegenerativa con una alta incidencia en Chile respecto del resto del mundo. El cuadro se caracteriza principalmente por desarrollo de demencia rápidamente progresiva y diversos signos neurológicos inespecíficos, siendo el más frecuente la mioclonía. El caso que se describirá a continuación destaca por las manifestaciones iniciales atípicas que presentó el paciente, tales como compromiso sensitivo en región cráneo-cérvico-dorsal y polineuropatía periférica de extremidades inferiores (EEII), lo que significó un retraso en el diagnóstico clínico de la ECJ. Es importante conocer los diferentes síntomas y signos que pueden presentarse en el cuadro clínico de ECJ, tanto típicos como aquellos menos frecuentes, para así poder dar con el diagnóstico de la enfermedad en etapas más tempranas. De igual manera, es fundamental contar con herramientas diagnósticas como la detección de proteína 14-3-3 o proteína Tau en los centros de salud de nuestro país. Esto permitiría al equipo de salud, brindar un manejo de soporte adecuado y oportuno a estos pacientes.

Creutzfeldt-Jakob disease is a rare neurodegenerative disease with a high incidence in Chile compared to the rest of the world. The condition is mainly characterized by the development of rapidly progressive dementia and various nonspecific neurological signs, the most common being myoclonus. The case that will be described below stands out for the atypical initial manifestations that the patient presented, such as sensory compromise in the cranio-cervico-dorsal region and peripheral polyneuropathy of the lower extremities, which meant a delay in the clinical diagnosis of the disease. It is important to know the different symptoms and signs that can be present in the clinical picture of CJD, both typical and those less frequent, in order to be able to diagnose the disease in earlier stages. Similarly, it is essential to have diagnostic tools such as the detection of 14-3-3 protein or Tau protein in health centers in our country. This would allow the health team to provide adequate and timely support management to these patients.

Pronación: Tecnología de enfermería que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González en la Ciudad de México / Pronation: A nursing technology that promotes wellbeing among COVID-19 patients at General Hospital Dr. Manuel Gea Gonzalez in México City

Introduction: pronation is a procedure used at the Intensive Care Unit with patients presenting Acute Respiratory Distress Syndrome (ARDS) with severe hypoxemia. Bibliographical references clearly support the application of this procedure due to the improvement it produces in oxygenation and the increased survival rate in patients. The main foundation behind this technology is that Ventral Decubitus (VD) promotes an improved redistribution of ventilation toward the dorsal regions of the lung, which are mainly collapsed during Dorsal Decubitus. Nursing staff have used this procedure because VD has proven to be a strategy with a useful and accessible impact over respiratory physiology. Objective: to analyze Pronation as a nursing technology and its promotion of COVID-19 patients' wellbeing at the General Hospital Dr. Manuel Gea González, in Mexico City. Material and methods: a nonexperimental, quantitative, cross-sectional, prolective, descriptive study to analyze pronation, as a nursing technology that promotes wellbeing in the care of COVID-19 patients at General Hospital Dr. Manuel Gea González, in Mexico City. Pronation as a nursing technology was the variable being measured. The universe was 530 nursing professionals working at the Hospital. The population and sample were 52 nursing specialists working with COVID-19 patients, representing 9.81% of the Universe. Results: as for training and experience with Pronation, 50% of the staff consider they have received sufficient training in regards to the SARS-CoV-2 virus, but they are still under training. Additionally, 84.62 % consider that Pronation promotes a remarkable recovery in the patients, with oxygen saturations between 80 to 100 %; 71.16 % believe that patients do show hemodynamic instability due to the position shift, but not in every case; and 80.77 % consider they make sure their patients do not develop pressure ulcers, given that 65.39 % practice patient hygiene and movement to prevent such ulcers. Discussion: from the interviewed staff, 50.01 % consider they have received sufficient training regarding COVID and the pronation of patients. This is consistent with Hernandez et al., who describe the need of a team trained specifically on the procedure, preferably comprised of Nurses specialized in Intensive Care. Likewise, 84.62% of staff members believe Pronation improves oxygen saturation in patients from 80% to 100%, this is contrasted with Barrantes and Vargas, who indicate that if Pronation does not result in 5% improvement in oxygen saturation, the patient must be returned to dorsal decubitus. Conclusion: ventilation in prone position is a pulmonary protective action used for over 30 years that produces an evident and continuous improvement in blood oxygenation and the respiratory physiology. Therefore, nursing specialists caring for COVID-19 patients recommend its use.

Introducción: la pronación es una maniobra utilizada en las unidades de cuidados intensivos, en pacientes que presentan síndrome de distrés respiratorio agudo (SDRA), cuando la hipoxemia es severa. Apoyada por una sólida evidencia científica, tiene impacto en la forma en que se ventila a los pacientes como parámetro de seguridad, esto aumenta la supervivencia. Objetivo: analizar la pronación, como tecnología de enfermería, que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González, en la Ciudad de México. Material y métodos: estudio de carácter cuantitativo, no experimental, transversal, prospectivo, descriptivo. Variable medida: la pronación, como tecnología de enfermería. El universo 530 profesionales de enfermería que trabajan en el hospital, muestra: 52 especialistas de enfermería que trabajan con pacientes COVID-19. Resultados: en relación a la capacitación y experiencia en pronación, el 50% del personal manifiestan que sí recibieron suficiente capacitación sobre el virus SARS-CoV-2, aunque siguen capacitándose en ésta área; el 84.62 % consideran que en la pronación, los pacientes mejoran bastante, saturando entre el 80 y 100 % de oxígeno y el 80.77 % siempre cuidan que los pacientes no tengan úlceras por presión.Discusión: el 50.01 % del personal entrevistado manifiesta que sí recibió suficiente capacitación sobre la COVID-19 para pronar a los pacientes, lo que es semejante a la investigación de Hernández GD., et al.¹ Conclusión: la ventilación en posición prono es una medida de protección pulmonar utilizada hace más de 30 años que produce una mejoría evidente y sostenida de la oxigenación de la sangre y en la fisiología respiratoria, por lo que los especialistas de enfermería que atiende pacientes COVID-19 recomiendan su aplicación, pues está asociada al aumento de probabilidad de supervivencia.

Tumores que producen metástasis óseas / Tumors that cause bone metastases

Resumen: Introducción: Una metástasis es la capacidad celular tumoral para migrar del tumor primario e implantarse en tejidos de un órgano a distancia por vía hematógena, linfática o contigüidad. Las principales causas de metástasis óseas son: cáncer de mama, próstata y pulmón. Habitualmente se da en pacientes mayores de 50 años. Existe predilección por metastatizar al esqueleto axial. Objetivo: Determinar la frecuencia de los tumores que producen metástasis óseas en nuestra institución. Material y métodos: Estudio observacional, transversal, descriptivo, para análisis retrospectivo de los casos con diagnóstico de metástasis ósea. Resultados: Ciento noventa y tres casos; 121 mujeres y 72 hombres con rango de edad de 42 a 84 años. Los cánceres asociados a metástasis ósea fueron cáncer de mama, pulmón, próstata, cervicouterino y renal; en menor proporción otros como colon, tiroides, hígado y piel. Los huesos más afectados fueron esqueleto axial: columna lumbar y dorsal; en esqueleto apendicular el fémur en la región diafisaria y en el húmero el tercio proximal. En la actualidad, no se ha logrado mejorar la efectividad de estrategias de detección oportuna, por lo que los cuadros de dolor óseo deben iniciar con un protocolo de sospecha tumoral. Conclusiones: Más de 80% de los pacientes acudieron por fractura. Todos tenían historial de dolor mayor a 12 meses sin protocolo de estudio previo.

Abstract: Introduction: A metastasis is the tumor cell capacity to migrate from the primary tumor and implant itself in tissues of an organ at a distance by hematogenous, lymphatic or contiguity. The main causes of bone metastases are: breast, prostate and lung cancer. It usually occurs in patients over 50 years of age. There is a predilection for metastasizing to the axial skeleton. Objective: To determine the frequency of tumors that produce bone metastases in our institution. Material and methods: Observational, cross-sectional, descriptive study, for retrospective analysis of the cases of patients diagnosed with bone metastases. Results: 193 cases; 121 women and 72 men with an age range of 42 to 84 years. Cancers associated with bone metastases were breast, lung, prostate, cervical and renal cancers; to a lesser extent other such as colon, thyroid, liver and skin. The most affected bones were axial skeleton: lumbar and dorsal spine, and in appendicular skeleton the femur in the diaphysiary region and in the humerus the proximal third. At present it has not been possible to improve the effectiveness of timely detection strategies, so bone pain should begin with a protocol of tumor suspicion. Conclusions: More than 80% of the patients came for fracture. All patients had a history of pain greater than 12 months with no prior study protocol.

Lesiones multiligamentarias de rodilla asociadas a ruptura de tendón rotuliano / Complex multiligament knee injury associated with patellar tendon rupture

Resumen: Introducción: La lesión multiligamentaria de la articulación de rodilla se define como el daño a dos o más ligamentos principales. Estas lesiones son poco comunes, con una incidencia de ˂ 10:10,000. Constituyen menos de 0.02% de todas las lesiones ortopédicas. Es aún menos frecuente encontrar asociación de éstas a una ruptura completa del tendón patelar, la cual se presenta con una prevalencia 2.4%. Caso clínico: Masculino de 22 años sufrió accidente de alta velocidad, con diagnóstico de lesión multiligamentaria de rodilla izquierda estadio V de Schenck asociada a ruptura completa de tendón patelar, fue tratado en un solo tiempo quirúrgico con reconstrucción ligamentaria cuatro semanas después de evento traumático. Se obtuvo a los ocho meses un puntaje de 88.5 con el formulario IKDC 2000 para la evaluación funcional subjetiva de la rodilla. Discusión: El tratamiento quirúrgico definitivo se realiza a las cuatro semanas de la lesión. Con esto se disminuye el riesgo de inestabilidad. En nuestro caso clínico el paciente se logra integrar a las actividades de su vida diaria después de ocho meses. Para validar esta técnica como efectiva o buena para su uso, se requiere un mayor número de pacientes tratados de la misma forma. Sin embargo, se sugiere contemplar como una opción de manejo. Conclusión: Lesión poco frecuente, de tratamiento quirúrgico con un pronóstico reservado.

Abstract: Introduction: Multi-ligament injury of the knee joint is defined as damage to two or more major ligaments. They are uncommon, with an incidence of ˂ 10:10,000. They constitute less than 0.02% of all orthopedic lesions. It is even less frequent to find an association of these with a complete rupture of the patellar tendon which presents with a prevalence of 2.4%. Case report: 22 year old male; he presented a high-speed accident with a diagnosis of multi-ligament left knee injury stage V of Schenck associated with complete patellar tendon rupture treated in a single surgical time with ligament reconstruction, four weeks after traumatic event. A score of 88.5 was obtained after eight months with the IKDC 2000 form for the subjective functional evaluation of the knee. Discussion: The definitive surgical treatment is performed four weeks after the injury. This reduces the risk of instability. In our clinical case, the patient is integrated into the activities of his daily life after eight months. To validate this technique as effective or good for its use, a greater number of patients treated in the same way is required. It is, however, suggested to contemplate as a management option. Conclusion: These types of lesions are infrequent with a prognosis reserved.

Caracterización clínica y angiográfica según sexo de pacientes con síndrome coronario agudo sin supradesnivel del segmento ST / Clinical and angiographic characterization according to sex of patients with acute coronary syndrome without ST segment elevation

Ischemic Heart Disease is the leading cause of death and of potential years of life lost in Chile. The most frequent acute presentation of this group of pathologies is the Acute Coronary Syndrome (ACS) without ST segment elevation. According to the literature, there is a proportion of patients with non-ST elevated ACS in which coronary angiography reveals a mild coronary lesion or even shows no detectable lesion at all. This scenario is more common in women than in men. Compared with men, women with non-ST elevated ACS are older than men and more frequently have hypertension. Furthermore, women are less likely to have previous cardiac diseases, and are less common to present serum troponin rise at admission. In Chile, there are no previous studies about the differences between sexes in this disease. The objective of this study is to determine if there are major differences between sexes in aspects like clinical and angiographic findings in patients with non-ST elevated ACS. The study used a database of 1900 consecutive patients who were submitted for coronary angiography and had been previously diagnosticated with non-ST elevated ACS, between the years 2001-2017. Clinical assessment, laboratory and angiographic results were collected and analyzed to establish major differences considering p<0,05. 69% of patients were men. When comparing, the proportion of smokers was greater in men, who also more frequently had progressive worsening of angina or treatment-resistant chest pain as clinical presentations. Furthermore, previous coronary bypass surgery, previous percutaneous coronary intervention and previous myocardial infarction were more common in men. As to women, they were older and more frequently had hypertension and/or hypothyroidism. Unstable angina as a clinical presentation was more usual than in men and electrocardiographic findings as a negative T-wave in the anterior wall, evolutive segment changes and left branch bundle block were also more common. In addition, serum troponin rise was more frequent than in men. There was no difference in risk stratification with TIMI score. When comparing angiographic findings, women had more frequently mild lesions or no lesions at all (44% in women versus 27% in men). In conclusion, clinical aspects are different in between sexes as to presence of comorbidities, cardiovascular risk factors and previous cardiovascular disease. Clinical presentation is also different, as to symptoms and as to electrocardiographic findings and laboratory exams. At last, and as evidence suggests, there is a greater proportion of women with mild coronary lesions or without lesions than in men when comparing angiographic findings. (AU)

Factores pronósticos de morbimortalidad cardiovascular en pacientes egresados con infarto agudo al miocardio seguidos por un año / Prognostic factors of cardiovascular morbidity and mortality in patients with acute myocardial infarction followed for one year

Acute myocardial infarction is one of the main causes of death in the world, this occurs in the in-hospital period as well as in the follow-up. It has been much studied what occurs in the in-hospital period, but much less what occurs in the follow-up of patients with this pathology. The objective of this study was to follow patients discharged after myocardial infarction for 1 year and analyze predictors of cardiovascular events. 1174 patients were followed for 1 year, of which 17% presented some serious cardiovascular event, associated with the presence of male sex, older age, arterial hypertension, previous history of angina, hospital treatment only pharmacological, inclusion of positive inotropes in the initial treatment and use of calcium channel blockers, factors already shown by international literature but less analyzed in our country, and furthermore, the demonstration that invasive management with coronary angioplasty or bypass surgery are protective factors of the occurrence of events in this period, which reinforces the idea of a more intensive and invasive management in patients with this pathology. (AU)

Detección de cassette cromosómico en cepas de Staphylococcus aureus resistente a meticilina aisladas en un hospital universitario de la ciudad de Maracaibo / Detection of chromosomal cassette in MRSA Staphylococcus aureus strains isolated in a University Hospital in Maracaibo City

Staphylococcus aureus resistente a meticilina, es un importante patógeno nosocomial y comunitario. El determinante genético de resistencia es el gen mecA. Se han descrito 11 tipos de SCCmec, encontrándose con frecuencia los tipos II, III en infecciones hospitalarias, y los tipos IV y V en infecciones comunitarias. La presente investigación se llevó a cabo para estudiar la distribución de los tipos de SCCmec y su relación con la Leucocidina Panton-Valentine, tipificados mediante la reacción en Cadena de la Polimerasa. Para ello se estudiaron un total de 42 cepas resistentes a meticilina portadoras del gen mecA. Veintinueve (29) cepas mostraron la presencia del cassette cromosomal tipo IV (69,05%); 30,95% presentaron el SCCmec tipo I. Un 61,95% (n=13) de las cepas fueron portadoras del SCCmec IV resultando todas positivas para el gen PVL. Cabe destacar la diseminación del cassette tipo IV en cepas intrahospitalarias portadoras de PVL, lo que es preocupante tanto para la terapéutica como para el agravamiento de las infecciones en los pacientes.

Methicillin-resistant Staphylococcus aureus is an important nosocomial and community pathogen. The genetic determinant of resistance is the mecA gene. 11 types of SCCmec have been described, with types II, III frequently found in hospital infections, and types IV and V in community infections. The present investigation was carried out to study the distribution of the SCCmec types and their relation with the Panton-Valentine Leucocidin, typified by the reaction in the Polymerase Chain. To this end, a total of 42 methicillin-resistant strains carrying the mecA gene were studied. Twenty-nine (29) strains showed the presence of type IV chromosomal cassette (69.05%); 30.95% presented SCCmec type I. A 61.95% (n= 13) of the strains were carriers of SCCmec IV, all of which were positive for the PVL gene. It is worth noting the dissemination of the type IV cassette in intrahospital strains carrying PVL, which is worrisome both for the therapeutic and for the aggravation of infections in patients.

Identificación de estructuras de infección de Phytophthora palmivora en hojas de clones de palma de aceite Elaeis guinennsis Jacq / Identification of infection structures of Phytophthora palmivora in leaves of oil palm clones Elaeis guineensis Jacq

Este trabajo investigó el modelo de interacción planta-patógeno mediante discos de hojas de clones de palma de aceite inoculados en condiciones ex situ con un aislamiento de Phytophthora palmivora. Las inoculaciones se realizaron en condiciones controladas en cámara de crecimiento. En total, seis diferentes ortets fueron evaluados en seis tiempos de infección (2, 4, 6, 12, 24 y 48 horas postinfección, o hpi). Se determinó la presencia de estructuras de patogenicidad de P. palmivora como quiste, apresorio y tubos germinativos. Los quistes fueron identificados principalmente a las 2, 4 y 6 hpi. A partir de las 48 hpi no hubo presencia de zoosporas enquistadas para ningún ortet evaluado. En cuanto a los apresorios, estos se empezaron a desarrollar a las 4 horas de realizada la inoculación (siendo las 12 y 24 hpi los tiempos de mayor registro de estas estructuras). 121 Identificación de estructuras de infección de Phytophthora palmivora en hojas de clones de palma de aceite (Elaeis guineensis Jacq.) Méndez, K. et al. Introducción La Pudrición del cogollo (pc) es una de las principales enfermedades que afecta al cultivo de palma de aceite, destruyendo plantaciones desde 1964. En Colombia la enfermedad se presenta en las cuatro zonas palmeras y ha alcanzado proporciones epidémicas (Sarria et al., 2013a, 2016). A finales de 2004 en la Zona Suroccidental se registró un incremento en el número de casos, con un crecimiento exponencial de esta enfermedad, y a partir de 2007 se vieron afectadas más de 30.000 ha de cultivos de palma de aceite. En la Zona Central un comportamiento similar de la enfermedad fue registrado para la región de Puerto Wilches (Norte de Santander) entre 2009 y 2013, periodo en el cual se perdieron más de 40.000 ha como consecuencia de una epidemia de pc (Sanz, 2016). Por su parte, los productores de la Zona Norte actualmente hacen frente a la amenaza de una expansión epidémica de la pc con síntoma de hoja clorótica, la cual da cuenta de un estado avanzado de la enfermedad. Una amplia revisión del impacto de esta enfermedad desde sus inicios se encuentra en Benítez & García (2015), Sundram & Intan-Nur (2017) y Torres et al. (2016). La enfermedad de la Pudrición del cogollo es causada por el oomiceto hemibiótrofo P. palmivora (Sarria et al., 2008, 2013). Desde su identificación como agente causal de la pc en 2008, el Centro de Investigación en Palma de Aceite (Cenipalma) ha liderado diferentes investigaciones que han dado como resultado el desarrollo de estrategias de manejo integrado del cultivo de palma, así como la descripción del patógeno por medio de inoculación en condiciones in vitro en foliolos inmaduros de palma (Martínez et al., 2013, 2014a), entre otras. En cuanto a la presencia de esta enfermedad en otros cultivos, Mohamed-Azni et al. (2017) emplearon la técnica de foliolo inmaduro, logrando infectar foliolos de palma de aceite con P. palmivora aislada proveniente de cultivos de cacao y durián. Teniendo en cuenta que actualmente no se conocen fuentes probadas de resistencia de cultivares de Elaeis guineensis a la pc, y que un ciclo de mejoramiento genético de palma puede durar más de 25 años Por su parte, los tubos germinativos se encontraron a partir de las 48 hpi únicamente. Finalmente, se pudo establecer que el patógeno logra colonizar tejidos de foliolo no lignificados de clones de palma. Además, se encontró una relación entre el número de estructuras del patógeno con el comportamiento del cultivar de la palma donor (ramet)

Plant-pathogen model interaction was studied using leaf disks of oil palm clones inoculated ex situ with a Phytophthora palmivora isolate. The inoculation process was performed under growth chamber conditions. Six ortets were evaluated at six post-inoculation times (2, 4, 6, 12, 24 y 48 hours post infection, or hpi). Pathogen's infection structures as cyst, apressorium and germinative tubes were found. Cysts were identified mainly at 2, 4 and 6 hpi. After 48 hpi there were not any cysts for the evaluated ortets. The apresoria started to develop at 4 hpi, with the highest presence of these structures at 12 and 24 hpi. Germinative tubes were found only after 48 hpi. Therefore, it was established that the pathogen can colonize no-lignified tissue of oil palm clones. Finally, we found a relation between the pathogen's structures number and the response of the ortet related to its susceptibility and resistance response. Thus, it was found that the susceptible cultivar showed the highest number of germinative tubes

Comparación de plataformas automatizadas para la genotipificación del virus del papiloma humano / Comparison of automated platforms for the HPV genotypification

Resumen OBJETIVO: comparar el desempeño operativo y la concordancia de los resultados de la genotipificación del virus del papiloma humano obtenidos en los sistemas automatizados Cobas® 4800 y BD Viper™ LT a partir de muestras de citología en base líquida. MATERIALES Y MÉTODOS: estudio retrospectivo efectuado con base en el análisis de las mujeres que asistieron a las clínicas de Salud Digna para Todos entre los meses de abril a junio de 2016 para estudio de Papanicolaou. Las muestras se almacenaron en colectores BD SurePath™ de citología en base líquida. Se emplearon los sistema Cobas® 4800 y BD Viper™ LT para la genotipificación del virus. Los resultados se analizaron con la prueba de χ2 de Pearson, y la concordancia se obtuvo por medio del índice Kappa de Cohen. RESULTADOS: se analizaron 1934 muestras de citología en base líquida en las plataformas Cobas® 4800 y BD Viper™ LT. El grado de acuerdo entre los resultados obtenidos por ambas plataformas tuvo un valor de κ = 0.832. Se observaron diferencias entre el número de resultados positivos y negativos reportados, así como en las proporciones de los distintos genotipos, sin que fueran estadísticamente significativas. CONCLUSIÓN: no existen diferencias significativas entre los resultados obtenidos para la detección del virus del papiloma humano conseguidos con las plataformas Cobas® 4800 y BD Viper™ LT. En el ámbito operativo existen diferencias significativas que deben tenerse en cuenta al momento de implementar cualquiera de estas plataformas.

Abstract OBJECTIVE: To compare operative performance and concordance of human papillomavirus genotyping results obtained on Cobas® 4800 and BD Viper™ LT automated systems from liquid-based cytology samples. MATERIALS AND METHODS: Retrospective study in 1964 women attending the clinics of Salud Digna para todos I.A.P. from April to June 2016 to perform the Papanicolaou study; samples were stored in the BD SurePath™ liquid-based cytology collectors. The Cobas® 4800 and BD Viper™ LT systems were used for virus genotyping. The results were analyzed with the Pearson χ2 test, and concordance was obtained using the Cohen Kappa index. RESULTS: 1934 of liquid-based cytology samples were analyzed on the Cobas® 4800 and BD Viper™ LT platforms. The concordance between the results obtained by both platforms was very high (κ = 0.832). Moreover, there are differences between the number of positive and negative results reported, as well as in the proportions of the different genotypes, however, these were not statistically significant. CONCLUSION: There are no significant differences between the results obtained for the detection of the human papillomavirus obtained by the Cobas® 4800 and BD Viper™ LT platforms. However, at the operational level, there are important differences that must be taken into account when implementing any of these platforms.

Leucocidina de Panton Valentine en cepas SAMR aisladas de pacientes del Hospital Universitario de Maracaibo / Panton Valentine leukocidin in MRSA strains isolated from patients at the University Hospital of Maracaibo

Staphylococcus aureus se presenta como un patógeno cada vez más importante, debido al arsenal de factores de virulencia que presenta, sumado a su elevada capacidad de generar resistencia a los antimicrobianos Los objetivos de esta investigación fueron: confirmar la resistencia a meticilina mediante la amplificación del gen mecA y detectar la presencia de los genes que codifican el factor de virulencia leucocidina de Panton Valentine (PVL). Se investigaron estos genes empleando la reacción en cadena de polimerasa (PCR). Todos los aislamientos presentaron el gen mecA, el 50% de estas cepas resultó portador del gen para PVL. El 54,17% de las muestras de pacientes pediátricos, dio positivo para esta leucocidina. El mayor porcentaje de aislamiento se encontró en muestras de piel y tejidos blandos (85,7%).

Staphylococcus aureus is an increasingly important pathogen, due to the arsenal of virulence factors which presents, in addition to its high capacity to generate antimicrobial resistance. The objectives of this research were: confirm methicillin resistance by amplification the mecA gene and the presence of genes that encode Panton Valentine leucocidin (PVL) virulence factor. These genes have been investigated using polymerase chain reaction (PCR). All isolates showed the mecA gene, 50% of these strains were carrying the gene for PVL. 54,17% of the samples from pediatric patients, yield positive for this leukocidin. The highest percentage of isolation was found in samples of skin and soft tissues (85.7%).

Producción de Enterotoxina y Biofilm en Aislamientos Clínicos de Staphylococcus aureus Resistente a Meticilina / Enterotoxin and Biofilm Production in Clinical Isolates of Methicillin-Resistant Staphylococcus aureus

S. aureus se ha convertido en un problema de salud pública, debido a la dificultad que representa el tratamiento de las infecciones causadas por SARM. El propósito de esta investigación fue determinar la producción de enterotoxinas A, B, C y D y la producción de biofilm en aislamientos de SARM. Se estudiaron 50 cepas aisladas de diferentes tipos de muestras clínicas. La detección de enterotoxinas se realizó por la técnica de aglutinación en fase reversa y la producción de biofilm mediante: agar rojo congo y el método en microplacas de cultivos celulares. La producción de enterotoxina se observó en 9 cepas (18%), siendo la enterotoxina D (64%) la más prevalente, seguida de la B (27%) y la A (9%). Se demostró una asociación significativa entre la producción de enterotoxina y el tipo de muestra de la que provenía la cepa. La producción de biofilm se constató en 30% y 98% de las cepas por los métodos de agar rojo congo y microplacas de cultivos celulares, respectivamente; sólo en 15 cepas (30%) se observó correlación de ambos ensayos, se demostró que el método en microplacas de cultivo celular es más eficaz para detectar la producción de biofilm en S. aureus.

S. aureus has become a public health problem, due to the difficulty of treating infections caused by methicillin-resistant S. aureus (MRSA). The purpose of this research was to determine the production of enterotoxins A, B, C and D and the production of biofilm in clinical isolates of MRSA. Fifty MRSA strains isolated from different types of clinical samples were studied. Detection of enterotoxins was carried out using the technique of reversed phase agglutination, while biofilm production was studied through two tests: Congo red agar and the microplate cell culture method. Enterotoxin production was observed in 9 strains (18%); enterotoxin D (64%) was the most prevalent, followed by B (27%) and A (9%). A significant association was shown between enterotoxin production capacity and the type of sample that came from the strain. Biofilm production was found in 30% and 98% of the strains using the Congo red Agar and microplate cell culture methods, respectively. A correlation of both trials was observed in only 15 strains (30%). It was shown that the microplate cell culture method is more effective for detecting biofilm production in S. aureus strains.

Sand Fly Fauna (Diptera, Pcychodidae, Phlebotominae) in DifferentLeishmaniasis- Endemic Areas of Ecuador, Surveyed by Using a Newly Named Mini-Shannon Trap

To study the sand fly fauna, surveys were performed atfour different leishmaniasis-endemic areas of Ecuador, during February 2013 andApril 2014. The conventional Shannon trap was modified and simplified to anewly named mini-Shannon trap for its multiple uses at different study sites,such as limited, forested and narrow spaces. The mini-Shannon, CDC light trapsand the protected human landing method were employed for sand fly collection.The species identification of sand flies was performed mainly based on themorphology of spermathecae and cibarium, after dissection of freshsamples.  In this study, therefore, onlyfemale samples were used for analysis. A total of1,480 female sand flies belonging to 25<i> Lutzomyia</i> species were collected. Numbers of the female sand fliescollected by each trap were 417 (28.2%) by the mini-Shannon trap, 259 (17.5%)by CDC light trap and 804 (54.3%) by human landing. The total number of sand flies per trap collected bydifferent methods was markedly affected by study sites, probably because ofdifferent species compositions at each locality. Further, as an additionalstudy, the attractiveness of sand flies against the mini-Shannon traps poweredwith LED White-light and LED Black-light, waspreliminary tested, together with CDC light trap and human landing. In the test,a total of 426 sand flies of nine <i>Lutzomyia</i> species, seven man-biting and two non-man-biting species, were collected by threecapture trials during May and June 2014 in an area endemic for leishmaniasis(La Ventura). The Black-light equipped trap was relatively superior in capturenumbers to the White-light equipped one, but no significant difference wasobserved statistically between the two traps.

Sand Fly Fauna (Diptera, Pcychodidae, Phlebotominae) in Different Leishmaniasis-Endemic Areas of Ecuador, Surveyed Using a Newly Named Mini-Shannon Trap

To study the sand fly fauna, surveys were performed at four different leishmaniasis-endemic sites in Ecuador from February 2013 to April 2014. A modified and simplified version of the conventional Shannon trap was named “mini-Shannon trap” and put to multiple uses at the different study sites in limited, forested and narrow spaces. The mini-Shannon, CDC light trap and protected human landing method were employed for sand fly collection. The species identification of sand flies was performed mainly based on the morphology of spermathecae and cibarium, after dissection of fresh samples. In this study, therefore, only female samples were used for analysis. A total of 1,480 female sand flies belonging to 25 <i>Lutzomyia</i> species were collected. The number of female sand flies collected was 417 (28.2%) using the mini-Shannon trap, 259 (17.5%) using the CDC light trap and 804 (54.3%) by human landing. The total number of sand flies per trap collected by the different methods was markedly affected by the study site, probably because of the various composition of species at each locality. Furthermore, as an additional study, the attraction of sand flies to mini-Shannon traps powered with LED white-light and LED black-light was investigated preliminarily, together with the CDC light trap and human landing. As a result, a total of 426 sand flies of nine <i>Lutzomyia</i> species, including seven man-biting and two non-biting species, were collected during three capture trials in May and June 2014 in an area endemic for leishmaniasis (La Ventura). The black-light proved relatively superior to the white-light with regard to capture numbers, but no significant statistical difference was observed between the two traps.

Características clínicas y evolutivas del tortícolis muscular congénito / Clinical characteristics and outcome of congenital muscular torticollis

El Tortícolis Muscular Congénito (TMC), es un síndrome compartamental resultado de la afectación del músculoesternocleidomastoideo asociado a malposición intrauterina. Es la tercera anomalía músculo-esquelética más conocida en la edad pediátrica. Describir la distribución de frecuencia de las variables clínicas y evolutivas del TMC. Se realizó una investigación clínica per se, transversal, descriptiva a través de la revisión de historias clínicas de pacientes con TMC atendidos porNeuropediatría y Medicina Física / Rehabilitación del Instituto Hospital Universitario Los Andes durante el lapso 2001 - 2011. Se incluyeron 16 casos: 11 femeninos; 9 de los casos con edad al ingreso de 5 meses o más. Se observó asociación de TMC con presentación podálica en la mitad de los casos y en un tercio de los mismos con cesáreas complicadas. El motivo de consulta máscomún fue la posición lateral cervical, siendo derecha en 11 casos. Fueron constantes los hallazgos de pseudo tumoración cervical, espacio hombro-cuello y ángulos de rotación cervical disminuidos. Catorce pacientes presentaron plaquiocefalia y asimetría facial. Los pacientes menores de 3 meses de edad respondieron al tratamiento rehabilitador y los de 5 meses o más al tratamiento rehabilitadorcombinado con tratamiento quirúrgico. El diagnóstico precoz de TMC y la intervención temprana podrían favorecer el pronóstico funcional del paciente y evitar el apoyo quirúrgic.

The Congenital Muscular Torticollis (CMT) is a compartmental syndrome resulting from a disturbance of thesternocleidomastoid muscle associated with an intrauterine malposition. It is the third best known muscle-skeletal anomaly in the pediatric age. To describe the frequency distribution of the CMT clinical and evolving variables. A transversaldescriptive clinical research was conducted through the review of medical records of patients with CMT from the Neuropediatric andPhysical Medicine / Rehabilitation units of the Hospital Universitario Los Andes Institute during the period 2001-2011. 16 cases, 11 female, were reviewed, 9 of which were five or more months old at admission. Association of TMC with breech presentation in half of the cases and a third of them with complicated caesarean section was observed. The most common reason for seeking consultation was the lateral cervical position, this being at the right in 11 cases. The findings of cervical pseudo tumor were constant, shoulder-neck space and cervical rotation angles were decreased. Fourteen patients presented plaquiocefalia and facial asymmetry. Patients under 3 months of age had a positive response to rehabilitation treatment and those 5 or more months old to rehabilitation treatment combined with surgical treatment. An early diagnosis of CMT and an early intervention could promote a functional prognosis of the patient and avoid surgical support.

Infertilidad tubárica e infección genital por Chlamydia trachomatis-Ureaplasma urealyticum / Genital infection and tubal infertility by Chlamydia tra-chomatis or Ureaplasma urealyticum

Objetivo: establecer la asociación entre la infertilidad tubarica y la infección cervical por Chlamydia trachomatis (CT) o Ureaplasma urealiticum (UU), en mujeres infértiles. Métodos: investigación comparativa y aplicada, con diseño de tipo no experimental, de casos y controles, contemporáneo transeccional y de campo, que incluyó 60 mujeres, separadas en dos grupos pareados de acuerdo si eran infértiles (casos) o fértiles (controles), a las cuales se les tomó una muestra de hisopado endocervical para el diagnóstico molecular de CT o UU y se les realizó una histerosalpingografía para evaluar la permeabilidad de las trompas uterinas. Resultados: se detectó una prevalencia en mujeres infértiles y fértiles de infección por CT o UU del 18 por ciento y 35 por ciento, respectivamente; siendo mayor entre las mujeres infértiles, diferencia significativa solo para UU (p<0,05). Se detectó una mayor permeabilidad tubárica en las pacientes fértiles que en las infértiles (80 por ciento vs. 40 por ciento), siendo el compromiso tubárico mayor en las pacientes infértiles (p<0,05). Al asociar el diagnóstico de CT o UU con los resultados de la histerosalpingografía se constató que la detección de uno de estos microorganismos aumentaba casi 3 o 5 veces más la probabilidad de presentar obstrucción tubárica, respectivamente, diferencias no significativas (p>0,05). Conclusión: una gran parte de las mujeres infértiles presentan infección por CT o UU, patógenos de transmisión sexual que pudiesen tener responsabilidad en el daño tubárico.

Objective: to establish the association between tubal infertility and cervical infection by Chlamydia tra-chomatis (CT) or Ureaplasma urealyticum (UU) in infertile women. Methods: a comparative, and applied research with a non-experimental, case-control, contemporary-transactional and field design, including 60 women, separated into two groups matched according whether they were infertile (cases) or fertile (controls), in which was took a sample of endocervical swabs for molecular diagnosis of cT or UU and underwent hysterosalpingography to assess the permeability of the fallopian tubes. Results: it was detected in infertile and fertile women a prevalence of CT or UU infection of 18 percent and 35 percent, respectively; being higher detection among infertile women, although this difference was significant only for UU (p <0.05). Also detected more tubal permeability in fertile patients that in infertile (80 percent vs. 40 percent), being higher in engagement tubal in infertility patients (p<0.05). By associating the diagnosis of both CT and UU with hysterosalpingography'sresults found that the diagnosis of one of these microorganisms increased almost 3 to 5 times more likely to have obstruction of the fallopian tubes, respectively; although this higher risk doesn't showed significance (p>0.05). Conclusion: a large proportion of infertile women have CT or UU infection, sexually transmitted pathogens that might have tubal damage liability.

Efectos de la variación de la intensidad de los tonos primarios sobre las amplitudes de Emisiones Otoacústicas Producto de Distorsión (EOApd) en sujetos con audición dentro de rangos de normalidad / Effects of varying the intensity of the primary tones on the amplitudes of Distortion Product Otoacoustic Emissions (OAEdp) in patients with normal hearing

Introducción: Las emisiones otoacústicas (EOA) son sonidos generados por las células ciliadas externas (CCE). Se ha visto que la generación y registro de las EOA evocadas depende de factores técnicos de evaluación como el nivel de intensidad de los tonos primarios, relación frecuencial entre los tonos, etc. Objetivos: Estudiar el efecto de la variación de la intensidad de los tonos primarios en la amplitud de la respuesta de las EOA producto de distorsión (pd) en individuos con audición normal. Material y método: Se evaluaron 35 individuos a los cuales se les midieron EOApd utilizando diferentes intensidades de tonos primarios: Intensidad baja (I1=50dBSPL e I2=50dBSPL), intensidad media (I1=55dBSPL e I2=65dBSPL) e intensidad alta (I1=70dBSPL e I2=70dBSPL). Resultados: Se observó que para tonos primarios a bajas intensidades (I1=50dBSPL e I2=50dBSPL) existe una disminución tanto en amplitud y presencia de las EOApd, mientras que para tonos primarios a intensidades mayores (I1=55dBSPL e I2=65dBSPL - I1=70dBSPL e I2=70dBSPL) se evidenció un aumento en amplitud y presencia de EOApd en los sujetos estudiados. Conclusión: Se evidencian diferencias estadísticamente significativas en la amplitud de las EOApd al variar la intensidad de los tonos primarios. Por lo cual se puede establecer que las intensidades medias-altas son las más adecuadas para la evaluación de EOApd en sujetos con audición normal.

Introduction: Otoacoustic emissions (OAE) are sounds produced by outer hair cells. The generation and recording of evoked OAE depends on technical factors such as level of intensity of primary tones, frequency relationship between the tones, etc. Aim: To study the effect of varying the intensity of primary tones in the amplitude of the response of Distortion Product OAE (DP) in individuals with normal hearing. Material and method: 35 individuals were measured using different intensities OAEdp primary tones: Low Intensity (I1= I2 =50dBSPL 50dBSPL e), Medium Intensity (11= I2 =65dBSPL 55dBSPL e) and High Intensity (I1 =70dBSPL and I2 =70dBSPL). Results: Using Low primary tones (I1 =I2 =50dBSPL 50dBSPL) there is a decrease in amplitude and presence of DPOAE, while for primary tones at higher intensities (I1 and I2 = = 55dBSPL 65dBSPL -11 =70dBSPL and I2 =70dBSPL) an increase in amplitude and presence of OAEdp in subjects with normal hearing was observed . Conclusion: There are statistically significant differences in OAEdp amplitude by varying the intensity of the primary tones. Therefore medium-high intensities are best suited for the evaluation of OAEdp in subjects with normal hearing.

Diabetes y su impacto en el territorio periodontal / Diabetes and its impact in periodontal tissues

Diabetes y enfermedad periodontal corresponden probablemente al mejor ejemplo de cómo una enfermedad sistémica puede tener un efecto en el territorio periodontal. Si bien esta asociación ha sido extensamente estudiada, muchas de las asociaciones propuestas presentan contradicciones. En la presente revisión de la literatura se analizan los siguientes tópicos relevantes para la práctica clínica en periodoncia e implantología: i) Identificación de enfermedad periodontal severa y su capacidad para diagnosticar casos de diabetes; ii) Efectos de la diabetes sobre la enfermedad periodontal; iii) Efectos de la diabetes sobre la reparación periodontal y periimplantaria; iv) Efecto del tratamiento periodontal sobre el control metabólico de la diabetes.

Diabetes and periodontal disease correspond to conditions that probably exemplify how a systemic disease may have a strong impact in the periodontium. Although this association has been studied for several years, many of these studies still show contradictory results. The present review analyses the following questions relevant for the clinician in the fields of periodontology: i) Value of the diagnosis of severe periodontitis and its capacity to identify previously un-diagnosed cases of diabetes; ii) Effects of diabetes on periodontal disease; iii) Effects of diabetes on periodontal and peri-implant tissue repair and regeneration and; iv) Effect of periodontal therapy on the metabolic control of diabetes.

Influence of fish oil in the concentration of conjugated linoleic acid and omega 6 and 3 in buffalo milk / Influência do óleo de peixe na concentração de ácido linoléico conjugado e Omega 6 e 3 no leite de búfalas

The aim of this research work was to investigate the influence of fish oil supplementation on the concentration of conjugated linoleic acid (CLA) and omega 6 and 3 in samples of buffalo milk. A total of 24 female buffaloes separated at random into three groups were fed for 49 days with: natural pasture (group I), supplemented with 70mL of fish oil (group II) and 140mL of fish oil (group III). In the experiment the concentration of CLA showed differences (P<0.05) among the three groups, with a maximum of 7.14mg/g fat in group II. No significant differences were found in omega-6 among the three groups. The highest value of 3.82mg/g fat corresponded to group I, whicht had not been supplemented with fish oil. Significant differences were observed in omega 3 (P<0.05) in groups II and III with respect to group I. The highest average value of 2.42mg/g fat was obtained in group III. The closest relationship omega 6/3 (1.37:1) was observed in group III. As a result, the diets of groups II and III, which included fish oil, increased significantly the content of CLA and omega 3 with reductions in levels of omega 6.

Estudou-se a influência da suplementação com óleo de peixe sobre a concentração dos ácidos graxos ômega 6 e 3, mostrado no leite de búfala. Foram utilizadas 24 búfalas aleatoriamente selecionadas e distribuídas em três grupos e alimentados com pastagem natural por 49 dias com: nenhum suplemento (grupo I), suplementado com 70mL de óleo de peixe (grupo II) e com 140mL de óleo de peixe (grupo III). A concentração de CLA diferiu (P<0,05) entre os três grupos, com valores máxima de até 7,14mg/g de gordura no grupo II. Não foram observadas diferenças significativas para os ácidos graxos omega 6, sendo o maior valor de 3,82mg/g de gordura no grupo I. Foi observada diferença significativa quanto aos ácidos graxos ômega 3 (P<0,05) nos grupos II e III em relação ao grupo I. O mais elevado valor, 2,42mg/g de gordura foi observado no grupo III. A relação ômega 6/3 mais estreita, 1,37:1, foi observada no grupo III. Os resultados mostram que os animais dos grupos II e III que receberam suplementação de óleo de peixe aumentou significativamente o teor de CLA e de omega 3, com diminuição de omega 6.

Hiperplasia fibrosa inflamatoria: reporte de un caso / Inflammatory fibrous hyperplasia: case report

Introducción: La Hiperplasia Fibrosa Inflamatoria es una alteración caracterizada por un agrandamiento del tejido conectivo; se considera una lesión reactiva ya que se presenta como respuesta a una irritante crónico local; es una lesión común en pacientes adolescentes y de edad adulta debido a que su etiología principal se asocia a maloclusión, al uso de aparatología protésica u ortodóntica mal ajustada, así como a la presencia de biofilm. Sin embargo, la población infantil, principalmente en dentición mixta, no está exenta de presentar esta alteración, aunque en menor proporción. Objetivo: Presentar el caso clínico de un paciente en dentición mixta que presenta una Hiperplasia Fibrosa Inflamatoria con el fin de presentar las características clínicas e histopatológicas de la lesión, enfatizando la importancia de un temprano y correcto diagnóstico. Presentación del Caso: Paciente masculino de 8 años de edad que se presenta a la clínica por presentar lesiones cariosas y malposición dental. A la exploración se observa un agrandamiento gingival localizado, en el órgano dentario 41. Se decide tomar una biopsia de la lesión para establecer el diagnóstico. Conclusión: Debido a que existen varias lesiones con características clínicas muy similares a las que presentaba el paciente, es necesario conocer los diagnósticos diferenciales, así como realizar el diagnóstico temprano de la lesión para poder llevar a cabo un tratamiento eficaz y adecuado.

Introduction: The Inflammatory Fibrous Hyperplasia (IFH) is a disorder consisting in a connective tissue overgrowth; it is considered a reactive lesion because it appears in response to a chronic and local irritant; this is a very common oral lesion in adolescents and adults, its etiology is associated with dental malocclusion, use of over-extended prosthetic and orthodontic appliances, and with the presence of biofilm (plaque). Nevertheless, child population, mainly patients in mixed dentition, are not exempt from presenting this lesion, in a lower proportion, though. Objective: The aim of this case report is to present the clinical case of a patient in mixed dentition, who displays an Inflammatory Fibrous Hyperplasia, with the purpose of showing the clinical and histopathological features of this lesion, emphasizing the importance of an early and correct diagnosis. Case Report: A 8 year-old male patient, was referred to the Pediatric Dentistry Clinic of the Division of Post-graduate studies and Research, of the School of Dentistry, UNAM, for showing decay lesions and dental malposition. Clinical examination revealed a localized gingival over-growth associated to the teeth 41. It was decided to take a biopsy of the lesion to establish the final diagnosis. Conclusion: Because there are numerous lesions with pretty similar clinical features to the ones the patient presented, it is imperative and essential to know the differential diagnosis of this lesion, and to achieve an early diagnosis to accomplish an effective and appropriate treatment.