Revisión de la sedación continua en el paciente crítico. Evidencias de la efectividad de nuevos fármacos respecto a los esquemas farmacológicos tradicionales / Review of continuous sedation in the critical ill patient. Evidence of the effectiveness of new drugs compared to traditional pharmacological schemes

Introducción: La sedación es uno de los pilares fundamentales del manejo del paciente crítico internado en la Unidad de Terapia Intensiva (UTI), sobre todo en aquellos que requieren Asistencia Ventilatoria Mecánica (AVM). Los fármacos que se utilizan con este propósito tienen el objetivo de lograr un adecuado nivel de conciencia en el paciente, de forma tal que se encuentre confortable y tolere la AVM. Los esquemas de sedación utilizados se encontraban basados en Benzodiacepinas, aunque, su uso no está exento de efectos adversos. El presente estudio pretende realizar una Revisión y Síntesis de la evidencia existente sobre la efectividad y seguridad del uso de dos nuevos fármacos, Propofol y Dexmedetomidina, para sedación continua en UTI y su comparación con los esque- mas tradicionales. Los Resultados respecto a la reducción de días en UTI resultó siempre significativa a favor del uso de propofol o dexmedetomidina en comparación a benzodiacepinas; lo mismo ocurrió con los días vinculados a la AVM. Estos resultados fueron encontrados en revisiones tanto de alta calidad como moderada o baja. Sin embargo, todos los estudios tuvieron en común que la calidad de la evidencia utilizada fue baja a moderada. Según la evidencia identificada, el uso de dexmedetomidina o propofol disminuiría de manera estadísticamente significativa los días de estadía en UTI y los requerimientos de AVM en pacientes adultos. Se debe tener en cuenta que la mayoría de las Revisiones encontradas fueron de calidad baja, siendo solamente 2 (dos) de calidad alta y una moderada. Es por esto último que la recomendación del uso de sedación basada en Dexmedetomidina o Propofol es condicional, ya que la calidad de la evidencia que la soporta es baja, en la mayoría de los casos.

Introductión: Sedation is one of the fundamental pillars of the management of critically ill patients admitted to the Intensive Care Unit (ICU), especially in those who require mechanical ventilatory assistance (MVA). The drugs used for this purpose have the objective of achieving an adequate level of consciousness in the patient, so that they are comfortable and tolerate AVM. The sedation schemes used were based on Benzodiazepines, however, their use is not free of adverse effects. The present work aims to carry out a review and synthesis of the existing evidence on the effectiveness and safety of the use of two new drugs Propofol and Dexmedetomidine for continuous sedation in ICU and its comparison with traditional regimens. The results regarding the reduction of days in ICU were always significant in favor of the use of Propofol or Dexmedetomidine compared to benzodiazepines; The same happened with the days linked to the AVM. These results were found in reviews of both high and moderate or low quality. However, what they all had in common was that the quality of the evidence used was low to moderate. According to the evidence identified, the use of Dexmedetomidine or Propofol would statistically significantly reduce the days of ICU stay and AVM requirements in adult patients. It should be taken into account that most of the reviews found were of low quality, with only 2 being of high quality, and 1 of moderate quality. It is for this last reason that the recommendation for the use of sedation based on Dexmedetomidine or Propofol is conditional, since the quality of the evidence supporting it is, for the most part, low.

Bacteriemia por Enterococcus faeciumresistente a daptomicina / Daptomycin-resistant enterococcus faecium bacteremia

La aparición de cepas de enterococos resistentes a daptomicina es un tema de preocupación clínica y epidemiológica en años recientes. Se presenta el caso de un paciente de 50 años con antecedente de artritis reumatoide e inmunosupresión crónica hospitalizado en contexto de neumonía viral por COVID-19, con sobreinfección bacteriana y choque séptico, en quien se documentó en tres oportunidades diferentes aislamientos de Enterococcus faecium vancomicino-resistente VAN A y B con falla terapéutica a daptomicina, por deterioro clínico y persistencia de hemocultivos positivos. Se inició manejo con linezolid con control de la infección, negativización de hemocultivos y evolución clínica satisfactoria. Se realiza reporte del presente caso para dar a conocer la aparición de enterococos resistentes a daptomicina, la cual es una creciente preocupación epidemiológica, con el fin de realizar identificación temprana, prevenir falla terapéutica y poder conocer la epidemiología local

n recent years, the emergence of daptomycin-resistant enterococcus strains is a growing clinical and epidemio-logical topic of concern. We report the case of a 50 year old patient with an antecedent of rheumatoid arthritis and chronic immunosuppression hospitalized in the con-text of COVID-19 pneumonia with bacterial co-infection and septic shock in which a three different moments an isolate of a "vancomycin-resistant enterococcus faecium"(VRE) Van A and B that presented therapeutic failure with daptomycin was documented after clinical deterioration and persistence of positive blood cultures. Linezolid was initiated, with clinical recovery and negativization of blood cultures following the change in antibiotic treatment. This case is reported in order to expose the ever growing con-cern of daptomycin-resistant enterococcus strains in or-der to prevent therapeutic failure, make early identifica-tion and get to know the local epidemiological status.

Unusual co-infection of severe malaria by Plasmodium vivax and dengue virus in Mexico

@#Malaria and dengue fever are among the most common mosquito-borne diseases worldwide; however, reports of coinfection are rare. We present a case of severe malaria and dengue coinfection in a 16-yearold female patient presenting with fever, thrombocytopenia, pleural effusion, myopericarditis, and acute respiratory distress syndrome. Dengue infection was confirmed by the presence of immunoglobin M antibodies and nonstructural protein 1, while malaria was confirmed by the presence of Plasmodium vivax in thick and thin blood smears. This is the first report of a dengue/malaria coinfection in Mexico.

Cocaine Cravings, Borderline Personality Disorder & Attempted Homicide

@#In the 80’s, in Spain, there was a very significant increase in the population addicted to heroin use. The behaviour patterns of use and abuse of this substance also caused many drug addicts to be linked to the associated consumption of multiple toxic substances, favouring the appearance of politoxicomania. The origin of the change of model in drug use began in mid- 1987 and in the following years, ecstasy and the so-called designer drugs began to spread throughout the festival scene in the United Kingdom, Western Europe and the Iberian Peninsul. In the 90’s, new substances were introduced into society that had little to do with heroin use, shifting the link to toxic substances to these better accepted and less questioned substances, avoiding the possible problems associated with consumption in marginal environments. The normalization of the consumption of substances of abuse began to have a greater social tolerance, breaking the stigma that led to the alarm raised by heroin consumption in the 80’s. In this sense, drugs were no longer associated with marginalization, and were seen in environments considered festive and, therefore, “normal”. ASEAN Journal of Psychiatry, Vol. 22(5): July 2021: 1-4.

Identification of miRNAs linked to peanut nodule functional processes

microRNAs (miRNAs) are non-coding small RNAs that regulate gene expression at post-transcriptional level.Thousands of miRNAs have been identified in legumes, but studies about miRNAs linked to peanut nodulefunctionality are scarce. In this work we analyzed transcriptional changes in peanut nodules to identifymiRNAs involved in functional processes of these organs. We found 32 miRNAs precursors differentiallyexpressed in nodules compared with roots, and predicted the potential targets of their corresponding maturemiRNAs. Among them, 20 belong to 14 conserved miRNAs families and 12 are Arachis hypogaea-specificmiRNAs. Expression levels of 3 miRNAs (ahy-miR399, ahy-miR159 and ahy-miR3508) were confirmedexperimentally by qPCR. We also demonstrated that the expression of these miRNAs was not affected byinoculation of a biocontrol bacterium or a fungal pathogen. The catalogue of differentially expressed miRNAprecursors and the expression of the corresponding mature miRNA potential targets in the nodules of A.hypogaea obtained in this work is a database of strong candidates, including A. hypogaea-specific miRNAs, forthe regulation of the nodule functionality. The analysis of their role in this process will certainly lead to thecharacterization of essential regulators in these particular aeschynomenoid nodules.

La mujer en Cirugía: una exploración de las barreras en la carrera laboral / Women in surgery: an exploration of career barriers

Antecedentes: las cirujanas en la Argentina experimentan barreras en el ámbito laboral y personal tratando de lograr sus objetivos profesionales. El objetivo de esta investigación fue explorar las barreras que enfrentan las cirujanas en su carrera laboral en las tres principales ciudades de la República Argentina. Material y métodos: estudio exploratorio transversal. Se utilizaron encuestas anónimas a cirujanas durante un período de 6 meses. Resultados: un 59% de las cirujanas son solteras y no viven en pareja. Aquellas con hijos son las principales encargadas de la crianza. Los esposos o convivientes aparecen en tercer lugar, con un muy bajo porcentaje de responsabilidad en la tarea. En la mayoría de los espacios laborales no existe un sistema que facilite el cuidado de hijos en su trabajo. El 65% afirma haber dejado de presentar trabajos científicos luego de la maternidad. Solo un 26% de los pacientes ha rechazado sus servicios en favor de ser intervenido por un cirujano hombre. Por el contrario, un 42% de los jefes ha rechazado ser acompañado en cirugías por cirujanas. Casi un 85% de las cirujanas ha recibido comentarios alusivos a su sexualidad durante su trabajo. Conclusión: las estructuras organizacionales quirúrgicas operan como un marco normativo estructurador de prácticas y discursos que han construido, en el nivel simbólico, subjetivo e institucional, las desigualdades entre mujeres y varones en el ámbito de la actuación médica. La feminización del sector en los últimos tiempos y la salida de la mujer al ámbito laboral no implican necesariamente la equidad de género.

Background: Women surgeons in Argentina face barriers in the workplace and in their personal life when trying to achieve their professional goals. The aim of this investigation was to explore the career barriers women surgeons face in the three main cities of Argentina. Material and methods: We conducted an exploratory cross-sectional study. Anonymous surveys were administrated to women surgeons during a six-month period. Results: Among survey respondents, 59% were single and did not live with a partner. Those with children are the primary carers. Spouses or partners appear in third place, with a very low percentage of responsibility as carers. Most workplaces where female surgeons work do not have childcare facilities. Sixty-five percent of the survey respondents had not presented scientific papers after having children. Only 26 percent of patients had rejected their services in favor of a male surgeon and 42% of head surgeons had refused to be assisted by female surgeons. Almost 85% of women surgeons have received comments about their sexuality during their work. Conclusions: The organizational structures of surgery departments work as a structured regulatory framework of practices and speeches that have constructed the inequalities between women and men in the field of medical action at the symbolic, subjective and institutional level. The recent feminization of the surgical field and the entrance of women in the workplace do not necessarily imply gender equality.

A novel de novo mutation in the PURA gene associated with a new clinical finding: large brainstem

We report the case of a Caucasian Spanish boy, who showed profound neonatal hypotonia, feeding difficulties, apnea, severe developmental delay, epilepsy, bilateral convergent strabismus, poor verbal language development and a large brainstem. Whole-exome sequence uncovered a novel de novo mutation in the purine-rich element binding protein A gene (PURA; NM_005859.4:c.72del:p.(- Gly25AlafsTer53)) that encodes the transcriptional activator protein Pur-alpha (PURA). Mutations in this gene have been identified in patients with PURA syndrome, a rare disorder characterized by an early hypotonia, developmental delay, severe intellectual disability with or without epilepsy, and disability in expressive language development. Although, up to 75 cases have been identified worldwide, to the best of our knowledge, this is the first patient described with a brainstem larger than normal. In conclusion, our data expand both genetic and phenotypic spectrum associated with PURA gene mutations.

Use of subcutaneous tocilizumab to prepare intravenous solutions for COVID-19 emergency shortage: Comparative analytical study of physicochemical quality attributes / 药物分析学报

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has produced a serious emergency for global public health, placing enormous stress on national health systems in many countries. Several studies suggest that cytokine storms (interleukins) may play an important role in severe cases of COVID-19. Neutralizing key inflammatory factors in cytokine release syndrome (CRS) could therefore be of great value in reducing the mortality rate. Tocilizumab (TCZ) in its intravenous (IV) form of administration-RoActemra? 20 mg/mL (Roche)-is indicated for treatment of severe CRS patients. Preliminary in-vestigations have concluded that inhibition of IL-6 with TCZ appears to be efficacious and safe, with several ongoing clinical trials. This has led to a huge increase in demand for IV TCZ for treating severe COVID-19 patients in hospitals, which has resulted in drug shortages. Here, we present a comparability study assessing the main critical physicochemical attributes of TCZ solutions used for infusion, at 6 mg/mL and 4 mg/mL, prepared from RoActemra? 20 mg/mL (IV form) and from RoActemra? 162 mg (0.9 mL solution pre-filled syringe, subcutaneous(SC) form), to evaluate the use of the latter for preparing clinical solutions required for IV administration, so that in a situation of shortage of the IV medicine, the SC form could be used to prepare the solutions for IV delivery of TCZ. It is important to remember that during the current pandemic all the medicines are used off-label, since none of them has yet been approved for the treatment of COVID-19.

Síndrome de DiGeorge/velocardiofacial: reporte de un caso / DiGeorge/velocardiofacial syndrome: a case report

El síndrome de DiGeorge, también conocido como síndrome velocardiofacial o síndrome de deleción 22q11, se caracteriza por la ausencia congénita del timo y la glándula paratiroides. La tríada clásica de este trastorno es cardiopatía congénita, endocrinopatía con hipocalcemia e inmunodeficiencia primaria. Sin embargo, el síndrome puede exhibir múltiples alteraciones y manifestaciones clínicas pleiotrópicas que, a menudo, resultan en dismorfismo facial y alteraciones en el paladar. Clínicamente se evidencia mayor susceptibilidad a infecciones respiratorias o gastrointestinales recurrentes y, en los casos de aplasia tímica, se requiere tratamiento con antibióticos profilácticos y trasplante tímico, mientras que en los demás se hace manejo expectante. En este manuscrito se presenta el caso de un paciente masculino de 18 meses de edad, remitido al servicio de genética por presentar diversas alteraciones fenotípicas. Se describe el proceso mediante el cual se llegó al diagnóstico de síndrome de DiGeorge, a su manejo y pronóstico, y se hace una breve revisión de la literatura

DiGeorge syndrome, also known as velocardiofacial syndrome or 22q11 deletion syndrome, is characterized by the congenital absence of the thymus and the parathyroid gland. The classic triad of this disorder is congenital heart disease, endocrinopathy with hypocalcemia and primary immunodeficiency. However, the syndrome may exhibit multiple pleotropic abnormalities and clinical manifestations that often result in facial dysmorphism and changes in the palate. Clinically, a high susceptibility to recurrent respiratory or gastrointestinal infections is observed. In cases of thymic aplasia, treatment with prophylactic antibiotics and thymic transplantation is necessary, while in others, expectant management is used. This manuscript presents the case of an 18-month old male patient, referred to the genetics service due to several phenotypic alterations. The process by which the Di- George syndrome diagnosis, management and prognosis was reached, as well as a brief review of the literature, are presented.

Aspectos genómicos, transcriptómicos y del diagnóstico en el síndrome de Down / Genomic, transcriptomic, and diagnostic features of Down syndrome

El síndrome de Down es causado por la presencia de una tercera copia del cromosoma 21 y fue descrito por primera vez en 1838 por Jean-Etienne-Dominique, y más tarde por John Langdon Haydon Down en 1866, mientras trabajaba como superintendente médico en el Asilo Real de Earlswood. Desde ese momento, la comunidad científica puso grandes esfuerzos en tratar de elucidar diversos aspectos que influyen en la naturaleza de esta condición, y que determinan su incidencia y factores de riesgo. De igual manera, se ha puesto interés en los genes involucrados en esta enfermedad, la relación genotipo-fenotipo, la expresión del fenotipo, la variabilidad del material genético y las consecuencias transcripcionales que se producen al tener una tercera copia, ya sea parcial o total, del cromosoma 21. Además, se han invertido esfuerzos en identificar biomarcadores y en diseñar metodologías de diagnóstico prenatal no invasivo que sean altamente eficientes para un mejor diagnóstico del síndrome de Down, y así reducir su impacto negativo en las madres gestantes, al proveerlas de información neutral y precisa acerca de vivir con un hijo con síndrome de Down, y darles autonomía en la decisión de la continuación de su embarazo

Down syndrome is caused by the presence of a third copy of chromosome 21 and was first described by Jean-Etienne-Dominique in 1838, and later by John Langdon Haydon Down in 1866, while working as a medical superintendent in the Royal Earlswood Asylum. Since, the scientific community has placed great efforts in trying to elucidate different influencing features in the nature of this condition that determine their incidence and risk factors. In addition, especial attention has been given to the genes involved in this disease, the genotype-phenotype relationship, the expression of the phenotype, the variability of the genetic material and the transcriptional consequences that are produced by having a third copy, either partial or total, of chromosome 21. Additionally, efforts have been invested in identifying biomarkers and designing noninvasive prenatal methodologies that are highly efficient for a better diagnosis of Down syndrome, in order to reduce its negative impact in pregnant mothers, by providing them with neutral and accurate information about life with a child with Down syndrome, as well as providing the autonomy in the decision to continue their pregnancy

Determinants of early initiation of breastfeeding in Peru: analysis of the 2018 Demographic and Family Health Survey / 한국역학회지

OBJECTIVES@#Early initiation of breastfeeding (EIBF) is one of the most cost-effective strategies to reduce neonatal mortality. We sought to determine the prevalence and determinants of EIBF in Peru.@*METHODS@#We performed a cross-sectional analytical study of the 2018 Peruvian Demographic and Family Health Survey as a secondary data source. In total, 19,595 children born during the 5 years prior to the survey were included in the study. The dependent variable (EIBF status), socio-demographic variables, and pregnancy-related variables were analyzed using a multivariate logistic regression model to identify the determinants of EIBF.@*RESULTS@#The prevalence of EIBF in the study population was 49.7%. Cesarean deliveries were associated with a lower likelihood of EIBF (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.05 to 0.07) than were vaginal deliveries. Newborns born at public health centers (aOR, 1.37; 95% CI, 1.15 to 1.65) had a higher rate of EIBF than those not born at public or private health centers. Women from the jungle region (aOR, 2.51; 95% CI, 2.17 to 2.89) had higher odds of providing EIBF than those from the coast. Mothers with more than a secondary education (aOR, 0.65; 95% CI, 0.55 to 0.76) were less likely to breastfeed during the first hour of the newborn's life than women with primary or no education.@*CONCLUSIONS@#More than half of Peruvian children do not breastfeed during the first hour after birth. The major determinants of EIBF status were the delivery mode and the region of maternal residence. Strategies are needed to promote early breastfeeding practices.

Immune response in Blackbelly lambs to Haemonchus contortus and Trichostrongylus colubriformis mixed infection in a hot and humid climate

@#The main objective was to determine the immune response of Blackbelly lambs infected with Haemonchus contortus, Trichostrongylus colubriformis, or both species. In the first stage, an experimental challenge was performed with 200 infective larvae (L3)/kg body weight (BW) of H. contortus (Hct, n = 8). Additionally, eight animals were infected with 500 L3/kg BW of T. colubriformis (Tcl), eight lambs with the mixed infection at the same dose (HctTcl), and lambs without infection were the control group. In the second infection, the same lambs were reinfected with high doses: 400 L3/kg BW of Hct and 900 L3/kg BW of Tcl. The third stage consisted of a natural reinfection in grazing. Faecal samples were taken to determine the faecal egg count (FEC) of gastrointestinal nematodes (GINs). IgA was determined in serum and saliva by an indirect Enzyme-Linked Immuno Sorbent Assay (ELISA). The haematological parameters were recorded. With the first challenge, it was not possible to promote an immune response, whereas in the second infection, FEC were higher than 1000 eggs per gram of faeces (EPG) in infected animals. During the third stage, FECs were higher in lambs infected with Tcl. Eosinophils (EOS) did not show differences in the first and second stages, but during grazing the infected lambs had higher counts than the control group (P < 0.05). IgA activity values showed the same trend, and lambs infected with HctTcl had a higher response (33% of the positive standard) than groups mono-infected (16.5% and 22.6%, respectively).

Determinación de rutina y trigonelina en extractos de hojas de Bauhinia forficata subsp. pruinosa y evaluación del efecto hipoglicemiante en humanos / Determination of rutin and trigonelline in extracts of Bauhinia forficata subsp. pruinosa and hypoglycemic effect on diabetic and prediabetic patients humans

Diabetes mellitus type 2 is a metabolic disorder characterized by chronic hyperglycemia, and an important cardiovascular risk factor with a high morbidity and mortality worldwide. Phytotherapy can be an useful complement in the treatment of chronic diseases, so the hypoglycemic effect of Bauhinia forficata (L) subsp. pruinosa (Fabaceae) was evaluated, as used in Chilean traditional medicine. The content of rutin (R) and trigonelline (T) in aqueous extracts (0.15 and 1.0 percent infusions) and lyophilized extract from leaves of B. forficata were determined by HPLC. It was obtained 2.80 ugR/mL and 2.87 ugT/mL for 0.15 percent infusion, 12.48 ugR/mL and 16.24 ugT/mL for 1.0 percent infusion, and 5.70 ugR/mL and 8.14 ugT/mL for the lyophilized extract (0.1percent). Subsequently, a pilot clinical study in diabetic and prediabetic volunteers (n = 15) was performed, taking one dose of the 0.15 percent infusion, three times a day after meals, for 3 months. The results showed a significant statistically reduction in percent of HbA1c of 0.57 +/- 0.83 (p = 0.0179), suggesting that the 0.15 percent infusion of B. forficata could be useful in the prevention or complementary treatment of diabetes...

La diabetes mellitus tipo 2 es una alteración metabólica caracterizada por hiperglicemia crónica, y un importante factor de riesgo cardiovascular con elevada morbimortalidad a nivel mundial. La Fitoterapia puede ser un complemento útil en el tratamiento de enfermedades crónicas, por lo que se evaluó el efecto hipoglicemiante de Bauhinia forficata (L) subsp. pruinosa (Fabaceae), según su uso en medicina tradicional Chilena. Se determinó mediante HPLC el contenido de rutina (R) y trigonelina (T) en infusos (0.15 por ciento y 1.0 por ciento) y extracto acuoso liofilizado de las hojas de B. forficata. Se obtuvo para el infuso 0.15 por ciento = 2.80 ugR/mL y 2.87 ugT/mL, infuso 1.0 por ciento = 12.48 ugR/mL y 16.24 ugT/mL, y en el extracto liofilizado 0.1 por ciento = 5.70 ugR/mL y 8.14 ugT/mL. Posteriormente, se realizó un estudio clínico piloto en voluntarios diabéticos y prediabéticos (n = 15), tomando una dosis del infuso al 0.15 por ciento, tres veces al día después de las comidas, durante 3 meses. Los resultados mostraron una reducción estadísticamente significativa del por ciento de HbA1c de 0.57 +/- 0.83 (p = 0.0179), sugiriendo que el infuso de hojas de B. forficata (0.15 por ciento) podría ser útil en la prevención o tratamiento complementario de la diabetes...

Absceso hepático piógeno. Presentación de caso / Pyogenic Liver Abscess. A Case Report

Los abscesos hepáticos representan el 13 % de todos los abscesos abdominales y el 48 % de los viscerales; los de origen bacteriano o abscesos hepáticos piógenos son los más frecuentes. Se presenta el caso de una mujer de 34 años, mestiza, con antecedentes de haber presentado litiasis vesicular(2011), ictericia obstructiva extrahepática por litiasis coledociana(mayo de 2012), colangitis posterior a colangiopancreatografía retrógrada endoscópica y colecistectomía (agosto de 2012) por litiasis vesicular. En septiembre de 2012, comenzó a presentar diariamente fiebres altas, con escalofríos, generalmente por las tardes; sudoraciones nocturnas, inapetencia, pérdida de peso, nauseas y dolor en el cuadrante superior derecho del abdomen, a veces intenso, mantenido y molesto. La clínica, los antecedentes, la ecografía y la tomografía axial computarizada multicorte confirmaron el diagnóstico de abscesos hepáticos piógenos. Quedaron bien identificados los factores de riego que propiciaron la infección. La paciente evolucionó satisfactoriamente con tratamiento médico.

Liver abscesses account for 13% of all abdominal abscesses and 48% of those occurring in the viscera. The bacterial or pyogenic liver abscesses are the most frequent. A case of a 34-year-old woman of mixed race with history of gallstones (2011), extrahepatic obstructive jaundice caused by cholelithiasis (May 2012), cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (August 2012) due to gallstones is presented. In September 2012, she began suffering from high fever with chills every day, usually in the evenings. In addition, she presented night sweats, loss of appetite, weight loss, nausea and pain in the right upper quadrant of the abdomen which was sharp, permanent and annoying sometimes. The signs and symptoms, history, ultrasound scan and multislice computed tomography confirmed the diagnosis of pyogenic liver abscess. The risk factors leading to the infection were well-identified. The patient progressed satisfactorily with the medical treatment provided.

Técnicas de fisioterapia respiratoria y tolerancia a la actividad física en adultos mayores con enfermedad respiratoria crónica / The respiratory physiotherapy techniques and physical activity tolerance in elderly people with chronic respiratory disease

Objetivo: evaluar el efecto de la aplicación de técnicas de fisioterapia respiratoria en la tolerancia a la actividad f¡sica en pacientes adultos mayores con enfermedad respiratoria crónica. Material y métodos: estudio cuantitativo cuasiexperimental; considerando una muestra intencional de 50 pacientes asistentes al consultorio de neumolog¡a; la aplicación de fisioterapia respiratoria al grupo constó de técnicas de respiración diafragmática, respiración de labios fruncidos, tos asistida, vibroterapia y espiración forzada; evaluados con caminatas durante 6 minutos y el subir escalones, pruebas realizadas durante ocho semanas con una frecuencia de tres veces/semana siendo valorados mediante la escala de disnea de Borg, longitud caminada y número de escalones subidos; el grupo control siguió la rutina del servicio. El an lisis incluyo estad¡stica inferencial con chi cuadrado y túde Student para igualdad de medidas. Resultados: en la primera evaluación hubo diferencias significativas en longitud recorrida GC=291,0m GE=372,0m (p<0,000) y n£mero de escalones subidos GC=19.28 GE=27,56 (p<0,000), en la segunda evaluación ambas variables conservaron sus diferencias existiendo además disminución del grado de disnea moderada-severa GC=100% GE=68% (p<0,002). Conclusiones: la aplicaci¢n de las técnicas de fisioterapia respiratoria mejora significativamente la tolerancia a la actividad f¡sica en pacientes con enfermedad pulmonar crónica. Es necesario considerar la participación de la enfermera en actividades de prevención y rehabilitación en esta población, dado los cambios demográficos y epidemiológicos en la sociedad.

Objective: This study assesses the effect of applying the physiotherapy techniques in the physical activity tolerance in elderly patients witch chronic respiratory disease. Material and methods: This is a quasi experimental quantitative study, the purposive sample is 50 patients from the pneumology specialty; in addition, some respiratory physiotherapy techniques such as diaphragmatic breathing, pursed-lip breathing, quad coughing, vibrotherapy, huffing; were evaluated with six minute walk test and climbing stairs were applied to the experimental group. This routine lasted 8 weeks with a frequency of three times per week and this group was assessed through dyspnea scale of Borg, walked distance and climbed steps. Meanwhile, the control group only followed the routine service. The data analysis include statistical inference with Chi-squared test and studentïs t to contrast the equality of averages. Results: in the first examination, itïs showed important differences between the groups regarding the walked distance GC=291,0m GE=372,0m (p<0.000) and the number of climbed steps GC=19,28 GE=27,56 (p<0.000), whereas in the second one both variables maintained its differences and also the degree of degree of dyspnea moderate-severe decreased GE=100%GE=68% (P<0,002). Conclusion: applying respiratory physiotherapy techniques improves significantly the physical activity tolerance in patients with chronic pulmonary disease. It is important to consider the presence of a nurse in prevention and rehabilitation activities in this population, due to demographic and epidemiologic changes within the society.

Anhydrobiosis in bacteria: From physiology to applications.

Anhydrobiosis is a phenomenon related to the partial or total desiccation of living organisms, keeping their vital functions after rehydration. The desiccated state in prokaryotes has been widely studied, mainly due to the broad spectrum of the anhydrobiosis applications. In this review, we present the basic theoretical concepts related to anhydrobiosis, focusing on bacterial species. An update about desiccation tolerance in bacteria is given; and the general mechanisms of desiccation tolerance and desiccation damage are described. In addition, we show how the study of anhydrobiosis in prokaryotes has established the theoretical and practical basis for the development of the drying technologies. With regard to the desiccation tolerance in bacteria, although many mechanisms remain undiscovered at the molecular level, important research about the physiology of the anhydrobiotic state and its applications has been performed, and here we provide the most recent information about this subject. On the other hand, the most widely used drying technologies and their particular applications in several fields are described (e.g. medicine, agriculture and food industry). Finally, topics on the stability of desiccated bacterial cells are treated, concluding with the necessity of focusing the research on the mathematical modelling of the desiccated state in bacteria.

Evaluación del desempeño diagnóstico del medio de difusión en agar Etest para el estudio de sensibilidad a los antifúngicos / Assessment of diagnostic performance of Agar Etest for antifungal sensitivity testing

El aumento de la incidencia de las micosis profundas ha generado la necesidad de desarrollar técnicas para el estudio de la susceptibilidad in vitro a los antifúngicos. El método de microdilución en caldo es el de referencia, sin embargo métodos alternativos surgen ante la necesidad de diagnóstico en el laboratorio clínico, siendo el Etest el método de difusión en agar m s utilizado en nuestro medio. En este trabajo se evaluó el desempeño diagnóstico del Etest en comparación con la técnica de referencia y se correlacionaron las concentraciones inhibitorias mínimas (CIMs) por ambos métodos. Se estudiaron 80 cepas de Candida spp., proces ndose por Etest y por microdilución en caldo (protocolo M27-A2 del National Committee for Clinical Laboratory Standards [NCCLS]). Se probaron: anfotericina B (AB), itraconazol (ITZ) y fluconazol (FLZ). Se evaluó el desempeño diagnóstico del Etest con respecto a la metodología de referencia (EPIDAT, versión 2.0 para Windows) y se calculó la correlación mediante el coeficiente de Pearson. El Etest presentó para el ITZ una especificidad y sensibilidad diagnóstica de 44 por ciento y 92 por ciento respectivamente, valor predictivo positivo (VPP) de 60por ciento y valor predictivo negativo (VPN) de 85 por ciento. Para el FLZ la especificidad y sensibilidad fue de 85 por ciento y 12,5 por ciento, respectivamente, VPP de 45 por ciento y VPN de 49 por ciento. Para AB el Etest no captó ninguna de las cepas resistentes. Los valores predictivos fueron calculados para detectar resistencia empleando los puntos de corte del National Committee for Clinical Laboratory Standards (NCCLS). Los coeficientes de correlación fueron los siguientes: r = - 0,02 (AB), r = - 0,03 (FLZ) y r = 0,4 (ITZ). No se validó el método desde el punto de vista analítico por no existir correlación entre las CIMs obtenidas por el Etest y la técnica de referencia. De acuerdo con los resultados obtenidos, el desempeño diagnóstico de la técnica es poco confiable. Analizando el desempeño global del Etest a la luz de los conocimientos actuales no parece un método confiable para su uso en los laboratorios de an lisis clínicos.

Evaluación del medio cromógeno CHROMagar CandidaTM para la identificación de levaduras de interés médico / Assessment of CHROMagar CandidaTM to identificate yeasts of medical interest

La incidencia de las micosis ha aumentado en los últimos años, destac ndose entre ellas las candidiasis sistémicas. La especie m s frecuente es Candida albicans; ésta ha sido reemplazada en 35 por ciento por otras especies de Candida "no albicans". La criptococosis es la micosis sistémica que se encuentra en segundo lugar en frecuencia, seguida m s raramente por otras. La identificación específica de estas levaduras es un paso crucial para establecer un diagnóstico y tratamiento correcto. Los medios cromógenos resultan atractivos por la sencillez y rapidez con que establecen el diagnóstico de especie mediante el desarrollo diferencial de colonias pigmentadas; CHROMagar Candida es uno los m s difundidos en nuestro país. Los objetivos de este trabajo son determinar el desempeño diagnóstico (sensibilidad, especificidad y valor predictivo) de dicho medio con respecto a la metodología convencional y evaluar la concordancia entre ambas metodologías. Se estudiaron 127 cepas de Candida spp., 23 Cryptococcus neoformans, 8 Rhodotorula spp. y 6 Trichosporon spp. El an lisis estadístico se realizó mediante el programa EPIDAT. Los resultados obtenidos muestran un buen desempeño diagnóstico para la identificación de C. albicans. Para la identificación de especies "no albicans" el medio pierde francamente especificidad diagnóstica, destac ndose en particular los falsos positivos con C. krusei. Se concluye que este medio es confiable para la identificación de C. albicans, pero no es posible prescindir del estudio morfológico y eventualmente de otras pruebas complementarias para el diagnóstico específico, sobre todo para cepas de Candida "no albicans" y para otros géneros, dadas sus implicancias terapéuticas.

Infección urinaria en niños: evaluación imagenológica / Children urinary infection: imaging assessment

La infección del tracto urinario (ITU) es frecuente en pediatría y es considerada un marcador biológico de enfermedad anatómica o funcional del aparato urinario en niños. Se realizó un estudio prospectivo en cuatro hospitales públicos de Uruguay cuyos objetivos fueron: conocer la prevalencia de enfermedad nefrourinaria asociada; comparar resultados de la cistouretrografía miccional (CUM) realizada en dos oportunidades distintas; analizar en menores de 2 años los hallazgos centellogr ficos en relación con la presencia de "par metros sugestivos de pielonefritis aguda (PNA)"; conocer la evolución centellogr fica. A todos los niños con ITU sintom tica se les realizó ecografía renal y de vías urinarias. Se practicó CUM a menores de 5 años y a mayores de esa edad en casos seleccionados, en un primer período al mes pos ITU y en el segundo se autorizó realizarla intratratamiento. Se realizó centellograma renal en agudo a los menores de 2 años y a mayores en casos seleccionados. Se incluyeron 168 niños. De las ecografías, 21 por ciento tenían alteraciones. De las CUM, 30 por ciento fueron patológicas (26 por ciento de los varones y 32 por ciento de las niñas estudiados). En el segundo período aumentaron significativamente los estudios realizados, sin diferencia en el número ni severidad de reflujo vesicoureteral (RVU) detectados (total: 26 por ciento). La mitad de los centellogramas fueron patológicos, predominantemente im genes de PNA. En los menores de 2 años con dos o m s "par metros sugestivos de PNA" la mitad de los centellogramas fueron normales. Se destaca la importancia de evaluar anatómica y funcionalmente el aparato urinario a todos los niños desde su primer ITU.