Sensibilidad y especificidad de la prueba Timed Up and Go. Tiempos de corte y edad en adultos mayores / Timed up and go values in older people with and without a history of falls

Background: Timed Up and Go (TUG) is used to assess the risk of falling of older people. Aim: To evaluate the sensitivity and specificity of TUG as a predictor of falls in older adults. Material and methods: TUG was measured in 148 independent community-dwelling older adults aged 75 ± 7 years (85% women). Of these, 58 reported having a fall in the previous year. Analysis of the ROC (Receiver Operating Characteristic) curve was performed to assess the sensitivity and specificity of common cut-off times used in clinical practice. The times required to perform the TUG as quickly as possible (best fitted time) and at the usual pace (common time) were registered. Results: Participants with a history of falls had higher TUG times than their counterparts who did not fall (10.9 ± 3.9 and 9.2 ± 2.6 s, respectively). By age groups, only in the 60-69 age group the differences between those who fell and those who did not, were statistically significant (p < 0.05). A cut-off of 9s generates the better sensitivity and specificity for the test (0.60 and 0.57, respectively). For 60-69 age group the best cut-off time is 8.2s, with an increase in sensitivity and specificity to 0.73 and 0.68, respectively. Conclusions: There were differences in TUG values between participants with and without a history of falls. Determining TUG cut-off values by age groups improves the sensitivity and specificity of the test, especially in the 60-69 age range.

Absceso encefálico secundario a estafilococcemia: caso clínico / Brain abscess secondary to staphylococcemia: Case report

RESUMEN Los abscesos encefálicos son enfermedades infecciosas poco frecuentes. El Staphylococcus aureus tiene un papel importante como causa de infecciones intrahospitalaria y extrahospitalarias; la presentación más común es la infección de piel y tejidos blandos, aunque también puede afectar otros órganos, como corazón y cerebro. CASO: Una mujer de 19 años presentó artralgia de rodilla derecha, vómitos, petequias de 3 días de evolución. Se diagnosticó septicemia por S. aureus que había producido secundariamente un absceso cerebral en región parietal izquierda con sintomatología similar a un accidente cerebrovascular, por hemiparesia derecha. DISCUSION: El absceso encefálico es poco frecuente, y puede presentar sintomatología similar a una lesión vascular. Se asocia a varios factores de riesgo, y se debe tener en cuenta que hay tres mecanismos de entrada del microorganismo al sistema nervioso central. El diagnóstico en imagenológico y su tratamiento dependerá del antibiograma.

SUMMARY Brain abscesses are infrequent. Staphylococcus aureus has an important role as cause of intrahospital and extra hospital infections; the most common nosological entity is infection of soft tissues, although it can also affect other organs such as heart or brain. CASE: A 19-year-old woman presented with a 3-day course of arthralgia in the right knee, vomiting, and petechiae. S. aureus septicemia was diagnosed, presenting as an abscess with a stroke-like right hemiparesis. DISCUSSION: Brain abscesses are uncommon; presenting symptoms might be similar to a stroke. They are associated with several risk factors, three mechanisms of entry of the microorganism into the central nervous system have been recognized. The diagnosis is radiologic and its treatment will depend on the antibiogram.

Caracterización de pacientes con hepatitis C crónica tratados en un hospital de alta complejidad de Medellín / Characterization of patients with chronic hepatitis C treated in a high complexity hospital in Medellin

Resumen Introducción: la hepatitis C (HepC) representa un problema de salud pública a nivel mundial. Se estima que en Colombia la prevalencia de virus de la hepatitis C (VHC) está entre el 0,5-1 %, y asciende al 2,1 % en pacientes mayores de 50 años. La Unidad de Hepatología del Hospital Pablo Tobón Uribe (HPTU) ha sido un referente en el manejo de la HepC en Medellín y Colombia durante años. Objetivo: describir las características sociodemográficas/clínicas y los resultados en salud de los pacientes con HepC crónica atendidos en el HPTU entre 2013 y 2018. Materiales y métodos: estudio observacional, descriptivo, retrospectivo de pacientes con HepC crónica atendidos entre el 1 de enero de 2013 y el 31 de marzo de 2018. Resultados: se analizaron 108 pacientes. La edad promedio fue de 55,8 años (desviación estándar [DE] 13,7), 51,9 % eran hombres, y 78,7 % pertenecían al régimen contributivo. El mecanismo de transmisión más frecuente fue la hemotransfusión; el genotipo 1 predominó en el grupo de pacientes analizados. La efectividad de los esquemas con interferón fue del 46,9 % y de los antivirales de acción directa (AAD) del 94,6 %. La presencia de reacciones adversas a medicamentos (RAM) fue del 68,2 % en pacientes con esquemas con interferón/ribavirina y del 25,9 % en pacientes con AAD. Conclusiones: se realiza la caracterización de los pacientes atendidos en el HPTU, en quienes los AAD han mostrado mayor efectividad y seguridad en comparación con esquemas con interferón/ribavirina.

Abstract Introduction: Throughout the world hepatitis C (HepC) is a public health problem. Estimates for its prevalence in Colombia range from 0.5% to 1% but 2.1 % for patients over 50 years of age. The Hepatology Unit at the Hospital Pablo Tobón Uribe (HPTU) has been a benchmark for management of HepC in Medellín and Colombia for years. Objective: To describe sociodemographic and clinical characteristics together with health outcomes of patients with chronic HepC who were treated at the HPTU between 2013 and 2018. Materials and methods: This is an observational, descriptive and retrospective study of patients with chronic HepC, treated between January 1, 2013 and March 31, 2018. Results: One hundred and eight patients were analyzed. The average age was 55.8 years (SD 13.7), 51.9% were men, and 78.7% belonged to the contributory health care scheme. Most frequently, the disease was transmitted by blood, and genotype 1 predominated in the group of patients analyzed. The effectiveness of interferon schemes was 46.9% while that of Direct-Acting Antivirals (DAA) was 94.6%. Adverse drug reactions were found in 68.2% of patients treated with interferon/ribavirin schemes but in only 25.9% of the patients treated with DAA. Conclusions: In this group of patients treated at HPTU, DAA were safer and more effective than interferon/ribavirin schemes.

Uncinariasis: una causa poco común de hemorragia digestiva y anemia severa / Ancylostomiasis: a rare cause of gastrointestinal bleeding and severe anemia

Resumen La anemia se caracteriza por niveles bajos de hemoglobina. En Colombia, la anemia afecta al 27,7 % de la población. Las poblaciones más afectadas son los niños en edad preescolar, mujeres en edad reproductiva, embarazadas y personas de edad avanzada. Caso clínico: paciente de 58 años con cuadro clínico compatible con cor anémico, que requirió transfusión sanguínea. Mediante estudios de extensión se consideró una hemorragia digestiva por uncinariasis, por lo cual se dio un manejo antihelmíntico, con lo que tuvo buena evolución clínica y paraclínica. Discusión: hay múltiples factores de riesgo asociados con la adquisición de este parásito; se considera que esta entidad es una causa olvidada de hemorragia de vías digestivas y en algunos casos conlleva consecuencias graves como el cor anémico. El tratamiento se realiza mediante antihelmínticos, que tienen una efectividad entre el 62 % y el 92 %.

Abstract Anemia is characterized by low levels of hemoglobin. In Colombia, anemia affects 27.7% of the population. The most seriously affected populations are preschool children, women of reproductive age, pregnant women and the elderly. Clinical case: Upon admission, the 58-year-old patient was found to have a condition compatible with cardiomegaly and redistribution of blood flow and required a blood transfusion. Additional studies suggested that digestive hemorrhaging due to ancylostomiasis could be the cause. Treatment with anthelmintics was begun and had good clinical and paraclinical results. Discussion: Acquisition of this parasite, considered to be a forgotten cause of digestive bleeding, is associated with multiple risk factors. In some cases, there are severe consequences such as cardiomegaly and redistribution of blood flow. The effectiveness of treatment with anthelmintics ranges between 62% and 92%.

Diabetes mellitus asociada a pancreatitis autoinmune: caso clínico / Autoimmune pancreatitis associated with diabetes mellitus: report of one case

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.

Serological status of IBR, BVD, leucosis, Leptospira and Neospora caninum in bovine females of the department of Santander, Colombia / Estado serológico a IBR, DVB, Leucosis, Leptospira y Neospora caninum en hembras bovinas del Departamento de Santander, Colombia

Abstract Objective. To determine the serological status of bovine females for infectious bovine rhinotracheitis (IBR), bovine viral diarrhea (BVD), leucosis, Leptospira and Neospora caninum in the department of Santander, Colombia. Materials and methods. Convenience sampling was conducted on 460 cattle farms in 23 municipalities of Santander (Colombia). The collected sera were analyzed using different commercial ELISA kits following the manufacturer's instructions. Results. Seroreactive animals were found for all diseases studied, with general prevalence rates of 21.8% for leucosis, 26.1% for Leptospira, 29.7% for BVD, 48.2% for IBR and 63% for Neospora. Conclusions. The prevalence rates of the diseases analyzed in the department of Santander among the bovine population fluctuate from medium to high and thus require official control measures.

Resumen Objetivo. Conocer el estado serológico de hembras bovinas a IBR, DVB, leucosis, leptospira y Neospora caninum en el departamento de Santander, Colombia. Materiales y métodos. Se realizó un muestreo por conveniencia en 460 fincas ganaderas de 23 municipios de Santander (Colombia), los sueros colectados fueron analizados mediante diferentes kits comerciales de ELISA siguiendo las instrucciones del fabricante. Resultados. En todas las enfermedades estudiadas se encontraron animales seroreactores, correspondiendo la prevalencia general a Leucosis 21.8%, Leptospira 26.1%, DVB 29.7%, IBR 48.2% y Neospora 63%. Conclusiones. En el departamento de Santander las enfermedades analizadas se encuentran en la población bovina con prevalencias que fluctúan entre medio a alto, lo cual requiere medidas de control oficial.

Prevalencia de riesgo de apnea obstructiva del sueño en población adulta chilena / Prevalence of risk of obstructive sleep apnea in Chilean adult population

Introducción: En Chile la apnea obstructiva del sueño (AOS) es una enfermedad crónica insuficientemente reconocida, que probablemente emerge bajo condiciones epidemiológicas apropiadas. Nuestro objetivo fue estimar su prevalencia en nuestra población adulta. Pacientes y Métodos: A través de la 2ᵃ Encuesta Nacional de Salud (ENS) 2010, estimamos la prevalencia de riesgo de AOS en población ≥ 18 años de edad. Derivada del STOP-Bang Questionnaire construimos una regla de predicción clínica-RPC: ronquido habitual, somnolencia diurna, pausas respiratorias nocturnas, hipertensión arterial, IMC > 35 kg/m2, edad > 50 años, circunferencia cervical ≥ 43 cm (hombres) y ≥ 41 cm (mujeres), sexo: hombre. Según el puntaje total, el riesgo de los sujetos se clasificó como: Bajo (< 3), Medio (3-4) y Alto (≥ 5). Para obtener prevalencia e intervalos de confianza al 95%, usamos el módulo para muestras complejas del Software SPSS (v22). Resultados: Obtuvimos 5.069 registros, edad promedio: 48 ± 18 años, 60% mujeres. Una submuestra de 4.234 cumplió los criterios de la RPC. La muestra expandida (representando 11.279.865 personas) arrojó los siguientes resultados: riesgo Bajo 60,7% (CI 95%, 58-63,4), Medio 31,1% (28,7-33,6) y Alto 8,2% (7-9,5). Riesgo en hombres: Bajo 45,8% (41,7-49,9), Medio 41,1% (37,3-45,1), Alto 13,1% (11-15,5). Riesgo en mujeres: Bajo 74,6% (71,6-77,4), Medio 21,8% (19,4-24,4), Alto 3,6% (2,5-5,1). Observamos un incremento del riesgo Alto de AOS desde 0,3% (0-1,8) en el grupo etario de 18-24 años, a 22,9% (18,4-28,2) en las personas mayores de 65 años. Los hombres con la mayor prevalencia de Alto riesgo de AOS provenían de 7 de las 15 Regiones de Chile: Araucanía (24%), Aysén (21,3%), Coquimbo (18%), Maule (17,8%), Bio-Bío (17%), Arica (16,2%) y O'Higgins (15,7%). Conclusiones: La AOS es una condición prevalente en la población chilena, es mayor en hombres que en mujeres y se observó que el riesgo Alto tiende a aumentar con la edad.

Introduction: Obstructive sleep apnea (OSA) is a neglected chronic disease probably emerging under appropriate epidemiological conditions in Chile. Our goal was to estimate the prevalence of OSA risk in adult population. Patients and Methods: From the 2nd Chilean Health Survey 2010 (NHS), we estimate the prevalence of risk of OSA in population ≥ 18 years, as a derived proxy from STOPBang Questionnaire. A clinical prediction rule-CPR: habitual snoring, daytime sleepiness, nocturnal breathing pauses, blood hypertension, BMI > 35 kg/m2, age > 50 y.o., neck circumference ≥ 43 cm (men) and ≥ 41 cm (women) and male, was constructed. According to the total score subjects were classified as: Low (< 3), Medium (3-4), and High Risk (≥ 5). SPSS Software (v22) modules for complex survey was used to obtain population prevalence and 95% confidence intervals. Results: 5,069 records were obtained, mean age 48 ± 18 years, 60% women. A subsample of 4,234 fulfil the criteria per the CPR. The expanded sample (representing 11,279,865 persons), yielded the following results: Low risk 60.7% (CI 95%, 58-63.4), Medium 31.1% (28.7-33.6) and High 8.2% (7-9.5). Men with Low risk 45.8% (41.7-49.9), Medium 41.1% (37.3-45.1), High 13.1% (11-15.5). Women with Low risk 74.6% (71.6-77.4), Medium 21.8% (19.4-24.4), High 3.6% (2.5-5.1). We observed an increasing trend in High risk of OSA from 0.3% (0-1.8) in 18-24 years old group to a 22.9% (18.4-28.2) in people aged > 65 years old. Men with the highest prevalence of High risk OSA are in 7 of the 15 Regions: Araucanía (24%), Aysén (21.3%), Coquimbo (18%), Maule (17.8%), Bio-Bio (17%), Arica (16,2%) and O'Higgins (15.7%). Conclusion: OSA is a prevalent condition in Chilean Population, is higher in men than in women and a positive age trend of high risk OSA was observed.

Caracterización de eventos de hipoglicemia en pacientes diabéticos y no diabéticos atendidos en un servicio de urgencia / Hypoglycemia in an emergency room: review of 251 cases

Background Hypoglycemia is the main limitation for the achievement of glycemic goals in the treatment of diabetes. Aim To assess the incidence of hypoglycemia in an emergency department. To characterize and identify which patients are at higher risk of having it. Material and Methods We reviewed the electronic records of patients discharged from an adult emergency room with the diagnosis of hypoglycemia between May 2011 and December 2014. Age, sex, diagnosis of diabetes (DM), antidiabetic therapy, glycosylated hemoglobin, creatinine, destination at time of discharge, blood glucose, impairment of conscience, treatment of the event and predictions were recorded. Results Of 175,244 attentions analyzed, 251 in patients aged 69 ± 17 years (54% women) consulted for hypoglycemia (0.14%). Eighty one percent had a type 2 diabetes, 6% a type 1 diabetes and 12% were non-diabetic. Mean blood glucose was 44.1 mg/dl. In diabetic patients, mean glycosylated hemoglobin was 6.5%. Ninety seven percent had impairment of conscience and 77% were admitted to the hospital. Among patients without diabetes, the main comorbidity was the history of a gastric bypass surgery. In type 2 diabetes, glibenclamide used alone or with other medications was involved in 59% of the events, 87% of patients were older than 65 years with a mean glycosylated hemoglobin of 6.3% and 32% had renal failure. Conclusions The incidence of hypoglycemia was low. There were a significant number of events in older patients with type 2 diabetes mellitus and renal failure, who were treated with glibenclamide. Most of these patients had a glycosylated hemoglobin below accepted recommendations.

Factores asociados con la conversión de la colecistectomía laparoscópica a colecistectomía abierta / Factors Associated with Conversion of Laparoscopic Colecistectomy to Open Colescytectomy

Introducción: la colecistitis aguda es una inflamación de la pared vesicular. El tratamiento para esta patología es netamente quirúrgico, y la colecistectomía laparoscópica es el procedimiento de elección. Esta puede sufrir conversión intraoperatoria debido a las complicaciones propias de la intervención, los factores del paciente o los asociados con el cirujano. Objetivo: el objetivo del estudio es establecer la frecuencia y la asociación de conversiones en colecistectomía laparoscópica, basándonos en los exámenes de laboratorio hematológicos y la ecografía abdominal, así como en los factores sociodemográficos. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal, observacional y retrospectivo, durante el período comprendido entre el 1 de enero y el 3 de noviembre de 2015. Se revisaron historias clínicas con diagnóstico de patología vesicular benigna de pacientes sometidos a procedimiento quirúrgico vesicular. Resultados: al 35,5% de los pacientes se les realizó una colecistectomía laparoscópica (CL), en la que fue necesario convertir a cirugía convencional al 42,8% de los pacientes. La mayoría de los pacientes intervenidos fueron mujeres (72,8%), aunque la conversión predominó en el sexo masculino. El diagnóstico preoperatorio más frecuente fue la colelitiasis (98,3%). La edad mayor de 50 años presentó un odds ratio de 0,55, mientras que la leucocitosis presentó un odds ratio de 0,40; ambas variables fueron estadísticamente significativas (p ≤0,05). Conclusiones: se determinó que una edad mayor de 50 años y/o un valor de leucocitos mayor de 10 000 mm3 son factores de riesgo para que una colecistectomía laparoscópica falle; además, deben tenerse en cuenta los factores propios del cirujano

Acute cholecystitis is an inflammation of the vesicular wall whose treatment is purely surgical: a laparoscopic cholecystectomy is the procedure of choice. This can be converted intraoperatively due to complications of the intervention, patient factors or factors associated with the surgeon. The aim of this study was to establish the frequency and the association of conversions of laparoscopic cholecystectomies based on hematological laboratory tests and abdominal ultrasound as well as sociodemographic factors. Materials and Methods: This is a descriptive, cross-sectional, observational and retrospective study that was carried out from January 1 to November 3, 2015. Clinical histories of patients who had been with diagnosed with benign vesicular pathologies who underwent vesicular surgical procedures were reviewed. Results: Of the cases reviewed, 35.5% patients underwent laparoscopic cholecystectomies, and of these cases 42.8% of the procedures were converted to conventional surgery. The majority of the patients were women (72.8%), but conversions were most frequent among men. The most frequent preoperative diagnosis was cholelithiasis (98.3%). Age greater than 50 years presented an odds ratio of 0.55, while leukocytosis had an odds ratio of 0.40, both variables were statistically significant (P = <0.05). Conclusions: It was determined that ages over 50 years and/or a leukocyte count over 10,000 mm3 are risk factors for failure of laparoscopic cholecystectomies. In addition, factors related to the surgeon must be taken into account

Enfermedad de moyamoya: a propósito de un caso / Moyamoya disease: a case report

Resumen La enfermedad de moyamoya (EMM) es una patología crónica caracterizada por la oclusión progresiva de la vasculatura cerebral y no aterosclerótica, generando un patrón angiográfico conocido como moyamoya, que en japonés hace alusión a la apariencia en "bocanada de humo", trae como consecuencia eventos cerebrovasculares isquémicos o hemorrágicos. Tiene dos picos de presentación, uno entre los 5 y 9 años y otro entre los 45 y 49 años, con un ligero predominio en mujeres, suele ser más frecuente en individuos de origen asiático, y menos en personas de origen hispano. El tratamiento de elección es el procedimiento quirúrgico precoz y su pronóstico no es totalmente predecible. Reporte de caso: mujer de 44 años que ingresó por presentar movimiento tónico-clónicos y requirió IOT, con tomografía axial computarizada cerebral simple que mostró hematoma intraparenquimatoso izquierdo y arteriografía con patrón moyamoya. Se manejó en la unidad de Cuidados Intensivos, donde finalmente falleció.

Summary Moyamoya disease (EMM) is a chronic disease characterized by progressive occlusion of the cerebral vasculature and nonatherosclerotic, generating an angiographic pattern known as moyamoya, which in Japanese refers to the appearance "puff of smoke", results in cerebrovascular ischemic or hemorrhagic events. Presentation has two peaks, one between 5 and 9 years and another between 45 and 49 years, with a slight predominance in women over men, usually more common in individuals of Asian origin, and less in people of Hispanic origin. The treatment of choice is early surgical procedure and prognosis is not entirely predictable. Case report: 44-year-old woman presenting income tonic-clonic movement and required IOT, single computed tomography showed left cerebral intracerebral hematoma and arteriography with Moyamoya pattern. It was handled in Intensive Care Unit, where he eventually died.

Fractura subtrocantérica en niños manejada con cirugía de mínima invasión: Reporte de casos / Subtrochanteric fracture in children treated with minimally invasive surgery: case report

Resumen: Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en solo 4% de todas las fracturas de fémur; la mayoría de las lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial; existen muchas modalidades de tratamiento, como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y, finalmente, el uso de fijadores externos. La mayoría proponen que para niños menores de 10 años, se debe preferir el manejo no quirúrgico y en mayores, el manejo quirúrgico, pero la discusión se produce entre los seis y 12 años de edad, en donde está la mayor parte de la polémica. En la actualidad, en el Hospital Universitario de Santander, tratamos este tipo de fracturas mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños, con buenos resultados.

Abstract: Subtrochanteric fractures in children are rare events that occur in only 4% of all femur fractures; most injuries occur as a result of high-energy trauma, being young male patients the most affected. The management of this type of injury is controversial; there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement, and the use of external fixators. Most suggest that for children under 10 a nonoperative approach should be preferred and that older ones should be managed surgically, but it is between six and 12-year-olds that most of the controversy exists. In this article, we present the management of this entity with a proximal fracture plate using a minimally invasive technique.

Tratamiento quirúrgico de fracturas subtrocantéricas en niños / Surgical treatment of subtrochanteric fractures in children

Resumen: Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en sólo 4% de todas las fracturas de fémur, la mayoría de lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial, existen muchas modalidades de tratamiento como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y finalmente, el uso de fijadores externos. La mayoría propone que para niños menores de 10 años debe preferirse el manejo no quirúrgico y en mayores el manejo quirúrgico, pero la discusión se produce entre los 6 y 12 años de edad, período en el que radica la mayor parte de la polémica. En la actualidad tratamos este tipo de fracturas en el hospital universitario mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños con buenos resultados.

Abstract: Subtrochanteric fractures in children are rare events, occur in only 4% of all femur fractures, most injuries occur as a result of high energy trauma, being young male's patient the most affected. The management of this type of injury is controversial, there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement and external fixators. Most suggest that children under 10 should be preferred non-operative and for older than 12 surgical management is indicated, but the discussion is between 6 and 12 years old. Through this article we present the treatment of such entity with a proximal fracture plate using a minimally invasive technique.

Diagnostic Cytochrome b gene profiles for the identification of paca (Cuniculus paca) bushmeat: implications for the monitoring of illegal hunting and wildlife trade / Perfis diagnósticos do gene Citocromo b para a identificação molecular de paca (Cuniculus paca): implicações para a detecção e monitoramento de caça e comércio ilegal

Abstract Paca (Cuniculus paca Linnaeus, 1766) is the second largest rodent found in Brazil. The quality of the meat and a long tradition of hunting have contributed to the decline of the natural populations of this species. Hunting of paca is strictly prohibited in Brazil, but in spite of this restriction, no forensic tools are available for the identification of the meat. We describe an efficient method, based on single nucleotide polymorphisms of the cytochrome b gene, that can be used to differentiate biological material derived from paca from those of domestic species commonly used as sources of meat. The identification of the presence of C. paca in the samples was 100% reliable.

Resumo Paca (Cuniculus paca Linnaeus, 1766) é o segundo maior roedor brasileiro. A qualidade da carne e a forte tradição da caça de subsistência são fatores que contribuem significativamente para o declínio das populações. Apesar da proibição a caça no Brasil, no momento ainda não há ferramentas disponíveis para identificar a carne e seus produtos como prova forense. Neste trabalho propomos um método eficaz de identificação, baseado em polimorfismos de único nucleotídeo no gene Citocromo b, objetivando diferenciar material biológico de paca das espécies domésticas comumente utilizadas como alimento no Brasil. A identificação das amostras de paca foram possíveis em 100% das amostras analisadas.

Tasa de reingreso no programado en cirugía colorrectal electiva / Hospital readmission rates in complex colorrectal surgery

Background: Non programmed hospital readmission rates are a quality indicator of colorectal surgery. Aim: To analyze the causes of readmission of patients subjected to surgical procedures including intestinal anastomoses. Material and Methods: Analysis of a database of patients subjected to elective intestinal anastomoses in a period of 10 years. All non-programmed readmissions that occurred within 30 days after patient discharge were analyzed. Results: Overall non-programmed readmission rate was 7 percent and it was due to medical causes in 55 percent of patients. Nine percent of readmitted patients required a new surgical intervention. The figure among patients readmitted due to surgical causes, was 20 percent. Sixty one percent of patients were admitted at less than six days after discharge and 84 percent at less than 10 days. A non-programmed readmission duplicated the total hospitalization lapse and triplicated the rates of new surgical procedures. Conclusions: In this series of patients, the only predictor of a non-programmed readmission was the need for reoperation during the first admission.

Antecedentes: La readmisión no programada de un paciente operado es un evento frecuente en la práctica quirúrgica y se considera un indicador de calidad de la atención. El objetivo de este estudio es revisar las causas relevantes de reingreso en nuestro medio, establecer una tasa (TR) que permita una comparación prospectiva de los resultados y, eventualmente, identificar factores de riesgo modificables. Pacientes y Método: Se incluyen todos los pacientes sometidos a cirugía mayor electiva con una anastomosis intestinal en un período de 10 años. Se define como readmisión la re-hospitalización no planificada en el período de 30 días a contar del alta del paciente categorizada como causa médica o quirúrgica. Para el análisis estadístico se empleó el test de regresión logística. Resultados: La TR en la serie fue 7 por ciento (56/791), el 55 por ciento son por causa médica. La tasa de re-operación global durante el reingreso fue 9 por ciento (5/56), cifra que se eleva al 20 por ciento (5/25) en el grupo con alguna causa quirúrgica de re-admisión. El 61 por ciento de los pacientes reingresan antes de los 6 días del egreso y el 84 por ciento antes de los diez días. Un reingreso no planificado duplica el tiempo total de hospitalización (9 vs 19 días; p = 0,001) y casi triplica la tasa de reoperación (p = 0,001). Conclusión: En nuestra serie el único factor de riesgo de un reingreso fue el antecedente de una reoperación durante la cirugía índice. La TR es un indicador complejo y los factores predictivos de una re-hospitalización son motivo de controversia.

Enteroscopia total de doble balón intraoperatoria asistida por laparoscopia en el tratamiento de Síndrome de Peutz-Jeghers: reporte de un caso / A Case Report of Complete Intraoperative Double-balloon Enteroscopy Assisted by Laparoscopy to treat of Peutz-Jeghers Syndrome

El síndrome de Peutz-Jeghers se caracteriza por pólipos hamartomatosos localizados principalmente en el intestino delgado. La mayoría de estos pacientes son sometidos a múltiples resecciones endoscópicas o quirúrgicas. Este caso trata de una paciente femenina quien fue sometida a enteroscopia de doble balón intraoperatoria asistida por laparoscopia para resección de pólipos.

Conductividad iónica en nuevos compósitos (PEO)10(CF3COONa)-X% Al2O3 / Ionic conductivity of (PEO)10(CF3COONa)-X % Al2O3 composites

Se incrementó la conductividad iónica delelectrolito sólido polimérico (PEO)10CF3COONa medianteformación de nuevos compositos, adicionando partículasde óxido de aluminio (Al2O3) como relleno. Los compositosfueron preparados por disolución en solvente líquido y lacaracterización por espectroscopia de impedancias (EI)con configuración de electrodos Pt/electrolito/Pt. Reducciónde hasta dos órdenes de magnitud en la resistencia, seobservó en diagramas de Nyquist; combinando polióxido deetileno (PEO) con trifluoroacetato de sodio (CF3COONa).Al agregar partículas de Al2O3, la reducción en resistenciallego a ser hasta de tres órdenes de magnitud, a temperaturaambiente. Los gráficos de conductividad DC en función dela concentración, mostraron incremento de conductividadiónica a bajas concentraciones de alúmina. El compositoconductor iónico sintetizado mostró conductividadde 2.00x10-5 Scm-1 temperatura ambiente y 7.70x10-4Scm-1, temperatura de 383 K. Se presentó comportamientoArrhenius en dos regiones de diagramas de conductividadcon temperatura, indicando proceso térmicamenteactivado. Para altas concentraciones de Al2O3 se observócomportamiento Vogel-Tamman-Fulcher (VTF). Lasvariaciones de conductividad con concentración de Al2O3,están asociadas con número de sitios involucrados entrasporte iónico, a través de interacciones Lewis ácido–base,entre partículas de Al2O3 y especies iónicas del electrolito...

To increase the ionic conductivity of solid polymer electrolyte, (PEO)10CF3COONa, we formed newcomposites by adding alumina particles as a filler. We prepared these composites by dissolving them ina liquid solvent, and characterized them through impedance spectroscopy (IS), using a Pt/electrolyte/Ptelectrode configuration. The combination of polyethylene oxide (PEO) with sodium trifluoroacetate(CF3COONa) produced a reduction in resistance of up to two orders of magnitude in Nyquist plots, andup to three orders of magnitude when we added Al2O3 particles at room temperature. DC conductivityconcentration graphs show an increase in the ionic conductivity with low alumina concentrations. Thenew synthesized ionic conductor composite presented conductivity values of 2.00x10-5 Scm-1 at roomtemperature and of 7.70x10-4 Scm-1 at a temperature of 383 K. Two sections of the conductivity diagramsalso evidenced a temperature induced Arrhenius behavior, indicating a thermally activated process. Higherconcentrations of Al2O3 induced a Vogel-Tamman-Fulcher (VTF) behavior. Conductivity variationsproduced by Al2O3 concentration are linked to the number of sites involved in ion transport betweenAl2O3 ionic electrolyte species through Lewis acid-base interactions...

Foi Aumentada a condutividade iônica doeletrólito de polímero sólido (PEO)10CF3COONa, através daformação de um novo compósito, adicionando partículas deóxido de alumínio (Al2O3). Os compósitos foram preparadospor dissolução num solvente líquido e a caracterizaçãofoi feita por espectroscopia de impedância (EI) com aconfiguração utilizando eletrodo de platinum - Pt/eletrólito/Pt. A redução de até duas ordens de grandeza na resistênciaé observada em diagraamas de Nyquist quando se combinapoli (óxido de etileno) (PEO) com trifluoroacetato de sodioCF3COONa. Quando as partículas de Al2O3 são adicionadasao composição, é observado uma redução na resistênciade três ordens de grandeza à temperatura ambiente. Osgráficos do logaritmo da condutividade dc em função daconcentração, mostra um aumento da condutividade parabaixas concentrações de alumína. Do compósito condutorde íons sintetizado, apresenta valores de condutividade2.00x10-5 Scm-1 à temperatura ambiente e 7,70x10-4 Scm-1a uma temperatura de 383 K. Um comportamento do tipoArrhenius é apresentado em duas regiões dos diagramas decondutividade com a temperatura, indicando um processotermicamente ativado. Para concentrações elevadas deAl2O3, uma mudança de comportamento para Vogel-Tamman-Fulcher (VTF) foi observado. As variações nacondutividade com a concentração de Al2O3, está associadaa alteração do número dos sítios envolvidos no transportede íons através de interações do tipo ácido-base de Lewisentre partículas de Al2O3 e espécies iônicas...

Estudio del control metabólico en pacientes diabéticos en hemodiálisis crónica: hemoglobina glicosilada, fructosamina y glicemias capilares / Study of metabolic control in diabetic patients on chronic hemodialysis: glycated hemoglobin, fructosamine and capillary glycemia

Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.

Uso de ácido tranexámico en el postoperatorio de cirugía cardiaca / Use of tranexamic acid in postoperative cardiac surgery

El objetivo de este estudio prospectivo, doble ciego y aleatorizado fue evaluar el impacto de la administración de ácido tranexámico (AT) después de cirugía cardiaca con circulación extracorpórea en el sangrado postoperatorio. Material y Método: Durante la inducción de la anestesia los pacientes recibieron un bolo de 10 mg•kg-1 de AT, más 50 mg en el cebado de la máquina de circulación extracorpórea, seguido de una infusión continua de 1 mg•kg-1•h-1 hasta el término de la cirugía. En ese momento los pacientes fueron aleatoriamente distribuidos en 2 grupos: el grupo control recibió 10 ml•h-1 de suero fisiológico, y el grupo de estudio una dosis de 1 mg•kg-1•h-1 de AT, en ambos casos durante el trascurso de 10 horas. El objetivo primario fue observar alguna diferencia en el sangrado durante el primer día de postoperatorio. El objetivo secundario fue observar alguna diferencia en la transfusión de sangre (glóbulos rojos, plaquetas) durante el primer día del postoperatorio y en la incidencia de reoperaciones. Tanto el anestesista como el cirujano fueron ciegos a la distribución de los pacientes en cada grupo. Se utilizó el t-test para el análisis de diferencias en las medias de las variables continuas y el z-test para las proporciones. Se consideró estadísticamente significativo un valor de p < 0,05. Se efectuó análisis de regresión múltiple para encontrar variables capaces de predecir sangrado durante el primer día postoperatorio...

The objective of this prospective, double blind, randomized trial is to evaluate the impact of tranexamic acid (TA) administration after cardiac surgery with cardiopulmonary bypass in postoperative bleeding. Materials and Methods: During induction of general anesthesia, patients received a bolus of TA of 10 mg•kg-1 plus 50 mg in the CPB priming followed by a continuous infusion of 1 mg•kg-1•h-1 until the end of the surgery. Then, patients were randomly allocated into one of two groups: the isotonic saline (IS) group received 10 ml•h-1 of isotonic saline and the TA group received an infusion of 1 mg•kg-1•h-1 of TA. Both groups received their infusions for 10 hours. Primary outcome was bleeding during first postoperative day (POD1). Secondary outcomes were blood transfusion (PRBC, platelets) during POD1 and surgical re-exploration. Anesthesiologists and surgeons were blind to patient allocation. A t-test was used to analyze differences in means of continuous variables and z-test for proportions. A p value < 0.05was considered statistically significant. Multiple regression analysis was performed to find variables able to predict bleeding in the POD1. Results: 273 patients were included, there were 15 lost per group. 125 patients in the TA group and 118 patients in the IS group were analyzed. Both groups were compared in their demographics characteristics, comorbidity and lab tests and no significant differences were found. No statistically significant differences between groups in the primary and secondary outcomes were found. Multiple regression analysis establishes the variable minutes in cardiopulmonary bypass was able to predict bleeding in the POD1. Conclusions: Postoperative infusion of TA does not decrease bleeding, transfusions and re-explorations during the POD1 of cardiac surgery with cardiopulmonary bypass...