Identification of SARS-CoV-2 in urban rodents from Southern Mexico City at the beginning of the COVID-19 pandemic

ABSTRACT Currently, there are some concerns about the situation and, in particular, about the future of the COVID-19 pandemic and the new emerging variants of SARS-CoV-2. Rodents are an example of synanthropic animals in urban environments that harbor important zoonoses. Although the molecular identification of SARS-CoV-2 in Rattus norvegicus from New York City had been reported, in other studies, urban wild rodents infected with this virus have not been found. This study aimed to molecularly identify the presence of SARS-CoV-2 in urban wild rodents from Mexico City, trapped along a water channel of a public park as part of a pest control program, at the beginning of the COVID-19 pandemic, during the fall and winter of 2020. Up to 33 Mus musculus and 52 R. norvegicus were captured and euthanized, large intestine samples with feces from the animals were obtained. RNAs were obtained and subjected to qRT-PCR for SARS-CoV-2 identification and threshold cycle (Ct) values were obtained. Four mice (12.1%) and three rats (5.8%) were positive, three rodents exhibited Ct<30. Our results on the frequency of SARS-CoV-2 in urban rats are in line with other previous reports. Thus, similar to other authors, we suggest that surveillance for the detection of SARS-CoV-2 in urban wild rodents, as sentinel animals, should be maintained.

Adaptation of the Psychological Wellbeing Scale in Mexican medical students / Adaptación de la Escala de Bienestar Psicológico en estudiantes Mexicanos de medicina

Abstract Introduction The Ryff Scale of Psychological Well-Being is the most widely used instrument for assessing the eudemonic perspective of well-being. Although it has been adapted for the Spanish population, it has not been modified for health science students in the Mexican population. Objective Adapt and obtain the psychometric properties of this scale for medical students in the Mexican population. Method The study was conducted with 1,974 undergraduate students, 1,551 from the UNAM Medicine Faculty and 423 from the La Salle University Mexican School of Medicine. The analysis was undertaken using the IBM SPSS Statistics 21 and AMOS 21 SPSS programs. Results An instrument with a robust structure derived from the exploratory and confirmatory factor analyses carried out was obtained, with satisfactory explained variance, adequate internal consistency obtained through the Cronbach's alpha coefficient, and appropriate discrimination. Discussion and conclusion Our adaptation is a suitable version for Mexican medical students with four final dimensions; purpose in life, personal rejection and self-acceptance, personal control, and personal growth.

Resumen Introducción La Escala de Bienestar Psicológico de Carol Ryff es la más utilizada para evaluar la perspectiva eudaimónica de bienestar. Si bien se ha adaptado para población española no se ha adaptado para estudiantes de ciencias de la salud de población mexicana. Objetivo Realizar adaptación y obtener propiedades psicométricas de esta escala para estudiantes de medicina de población mexicana. Método El estudio se desarrolló con 1974 estudiantes de pregrado, 1551 de la Facultad de Medicina de la UNAM y 423 de la Escuela Mexicana de Medicina de la Universidad La Salle. El análisis desarrollado se realizó mediante el programa IBM SPSS Statistics 21 y AMOS 21 de SPSS. Resultados Se obtuvo un instrumento con una estructura sólida derivada de los análisis factoriales exploratorios y confirmatorios desarrollados, con una varianza explicada satisfactoria, una consistencia interna obtenida mediante el coeficiente alfa de Cronbach adaptada y una discriminación favorable. Discusión y conclusión El artículo es una adaptación del instrumento adecuada para estudiantes de medicina mexicanos con cuatro dimensiones finales; proyecto de vida, rechazo personal y auto aceptación, control personal y crecimiento personal.

Trypanosoma cruzi DTU II coinfection with bacteria producing prolonged cutaneous lesion in a healthy young male

ABSTRACT Chagas disease (CD) is a neglected tropical disease caused by Trypanosoma cruzi and is genetically classified in six discrete typing units (DTUs). The isolates reported in Mexico are generally associated with DTU I. We presented a case of a prolonged cutaneous lesion in a Mexican man, caused by DTU II in coinfection with Bacillus velezensis and Corynebacterium sp. The patient assessment included a complete clinical history, physical exam, laboratory tests, and a skin biopsy. In the facial tissues, intracellular parasites were revealed. The PCR tests were positive for T. cruzi in tissue and blood samples. DNA satellite sequencing was correlated with the DTU II. The initial serological tests reported negative results. However, four months later, two serological tests reported positive results. These exams were performed in different health centers. Mexico is considered an endemic area for CD; nevertheless, this is just the second cutaneous case associated with a DTU different from DTU-I noted in this country. From an ecological point of view, this fact suggests a geographical expansion of DTU II and an association with atypical skin manifestations. Further studies should be conducted to understand this exciting association between DTU-II and prolonged cutaneous expression in humans.

Parto Prematuro: Tratamiento con nifedipino versus atosiban. Revisión Bibliográfica Teórica / Preterm Labor: nifedipine vs atosiban treatment. Bilbiographic theoretical review

Introducción: La amenaza de parto pretérmino es un problema de salud pública mundial y nacional. La prematuridad viene acompañada de complicaciones como inmadurez pulmonar y lesiones del sistema nervioso central, que requieren de tratamiento oportuno.Objetivo: Establecer una comparación objetiva de los resultados del tratamiento de la ame-naza de parto prematuro, mediante el uso de Nifedipina o Atosiban, realizando una revisión teórica actualizada del tema, con el propósito de ofrecer a la comunidad científica, una he-rramienta de consulta, sobre un tema frecuente y de alto riesgo materno fetal.Materiales y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos: Google Scholar, Pubmed, Wiley Online Library, Biomed, Scopus, Medes, Medline, Pro Quest, Gale, Scopus, y ScIELO, Se incluyeron artículos publicados en revistas indexadas de alto impacto, en los últimos 5 años. Se valoró la calidad de los artículos incluidos, utilizando la metodología de Sacket, y el riesgo de sesgo, según la metodología Cochrane. Resultados: Se observó un consenso entre los autores consultados en que no existen dife-rencias significativas en el efecto tocolítico de atosiban y nifedipino Conclusiones:La literatura académica parece coincidir en que la efectividad de atosiban y ni-fedipino como agentes tocolíticos es similar, con ambos medicamentos se consigue prolongar el embarazo con riesgo de parto pretérmino, que es el propósito fundamental de la tocolisis.

Background: The threat of preterm birth is a global and national public health problem. Prematurity is linked to complications such as pulmonary immaturity and central nervous system lesions, which require timely treatment. Objective: To perform an objective comparison of the results of the treatment of the threat of premature delivery, using nifedipine or atosiban, carrying out an updated theoretical review of the subject, to offer the scientific community a tool for research on a frequent subject of high maternal and fetal risk. Materials y Methods: There was a bibliographic search in specialized databases. Articles published in high impact indexed journals in the last 5 years were included. The quality of the articles included was assessed, using the Sacket methodology, and the risk of bias, accor-ding to the Cochrane methodology. Results: There was an agreement among the authors consulted there are no significant differences in the tocolytic effect of atosiban and nifedipine. Conclusions: The academic literature seems to agree that the effectiveness of atosiban and nifedipine as tocolytic agents is similar, with both drugs prolonging pregnancy with the risk of preterm delivery, which is the fundamental purpose of tocolysis.

Long-term infection passaging of Human Adenovirus 36 in monkey kidney cells

ABSTRACT Human Adenovirus 36 (HAdV-36) has been related to diverse effects on metabolism and may attenuate the lipid accumulation in kidneys with increased adiposity. Some of these effects would be related to viral persistence. However, until now, a model of persistent in vitro infection by HAdV-36 is unknown. In this study, we examined the cells of the Vero lineage to explore their permissiveness to long-term HAdV-36 infection. HAdV-36 was productively replicated in Vero cells and maintained long-term infection for up to 35 cell passages. A subculture was obtained from the cells that survived the primary infection at a low MOI (0.5). The production of the extracellular infectious virus with titers ranging from 104 to 106 TCID50/mL and DNA-bearing cells was detected. In long-term infected cells, the intracellular distribution of viral antigen was demonstrated by performing immunolocalization (IFI) and expression of cell-viral antigen in 50% of cells by flow cytometry, using anti-HAdV-36 hyperimmune rabbit serum. Furthermore, E1a and E4orf1 genes in long-term infected passages showed a decreasing trend. Our preliminary results reveal that renal epithelial monkey cells are permissive for the productive infection of HAdV-36. Vero cell culture long-term infection might be a promising model for addressing the fundamental aspects of the HAdV-36 biology that cannot reveal broadly-used cultures, which do not maintain long-term infection in primary or transformed cells.

Identification of α-L-fucosidase (ALFuc) of Blastocystis sp. subtypes ST1, ST2 and ST3

ABSTRACT Blastocystis sp. is a common intestinal microorganism. The α-L-fucosidase (ALFuc) is an enzyme long associated with the colonization of the gut microbiota. However, this enzyme has not been experimentally identified in Blastocystis cultures. The objective of the present study was to identify ALFuc in supernatants of axenic cultures of Blastocystis subtype (ST)1 ATCC-50177 and ATCC-50610 and to compare predicted ALFuc proteins of alfuc genes in sequenced STs1-3 isolates in human Blastocystis carriers. Excretion/secretion (Es/p) and cell lysate proteins were obtained by processing Blastocystis ATCC cultures and submitting them to SDS-PAGE and immunoblotting. In addition, 18 fecal samples from symptomatic Blastocystis human carriers were analyzed by sequencing of amplification products for subtyping. A complete identification of the alfuc gene and phylogenetic analysis were performed. Immunoblotting showed that the amplified band corresponding to ALFuc (~51 kDa) was recognized only in the ES/p. Furthermore, prediction analysis of ALFuc 3D structures revealed that the domain α-L-fucosidase and the GH29 family's catalytic sites were conserved; interestingly, the galactose-binding domain was recognized only in ST1 and ST2. The phylogenetic inferences of ALFuc showed that STs1-3 were clearly identifiable and grouped into specific clusters. Our results show, for the first time through experimental data that ALFuc is a secretion product of Blastocystis sp., which could have a relevant role during intestinal colonization; however, further studies are required to clarify this condition. Furthermore, the alfuc gene is a promising candidate for a phylogenetic marker, as it shows a conserved classification with the SSU-rDNA gene.

Evaluación del control metabólico de personas con diabetes mellitus tipo 2 participantes de una intervención educativa grupal. Resultados de un análisis de conglomerados / Evaluation of metabolic control of patients with type 2 diabetes mellitus participating in a group educational intervention; results of a cluster analysis

Resumen Objetivo: evaluar los resultados de una intervención educativa grupal en diabetes mellitus tipo 2 (DM2) para determinar la capacidad de las personas participantes en el control metabólico de la enfermedad. Metodología: se realizaron diferentes análisis estadísticos; a saber, un análisis de correlación y de conglomerados mediante tres procedimientos (K medias con valores estandarizados de las variables involucradas, análisis jerárquico con variables estandarizadas) y una combinación de análisis factorial con K medias. Además, se llevó a cabo un análisis de normalización para determinar la efectividad del Programa de Intervención Nutricional en Enfermedades Crónicas. Resultados: completaron la intervención educativa 702 personas con diabetes, de las cuales la mayoría son mujeres, con edades entre 40 y 64 años. Las variables que resultaron estadísticamente significativas (p<0,001) para el análisis de conglomerados fueron glicemia posprandial, glicemia en ayunas, hemoglobina glicosilada, colesterol total y triglicéridos, donde los valores promedio disminuyeron en todas las pruebas clínicas después de la intervención educativa. Por medio de la combinación del análisis factorial y el análisis de conglomerados se generaron tres grupos: DM2 control bajo, DM2 control medio y DM2 control alto. En el análisis de normalización, se determinó que la intervención educativa del Programa de Intervención Nutricional en Enfermedades Crónicas fue efectiva. Conclusión: los resultados de estudio permitirán enfocar los objetivos terapéuticos de la intervención educativa mediante acciones propias y de seguimiento del tratamiento de una manera más certera.

Abstract Objective: Evaluate the results of a group educational intervention in type 2 diabetes mellitus (DM2) to determine the capacity of the participants in the metabolic control of the disease. Methodology: Different statistical analyzes were performed: correlation and cluster analysis using three procedures (K means with standardized values of the variables involved, hierarchical analysis with standardized variables) and a combination of factor analysis with K means. In addition, a normalization analysis was carried out to determine the effectiveness of the Nutritional Intervention Program in Chronic Diseases. Results: 702 people with diabetes completed the educational intervention, of which the majority are women, ages between 40 and 64 years old. The variables that were statistically significant (p <0.001) for the cluster analysis were postprandial glycemia, fasting glycemia, glycated hemoglobin, total cholesterol and triglycerides, where the average values decreased in all the clinical tests after the educational intervention. Three groups were generated by combining factorial analysis and cluster analysis: low control DM2, medium control DM2 and high control DM2. In the normalization analysis, it was determined that the educational intervention of the Nutritional Intervention Program in Chronic Diseases was effective. Conclusion: The results of this study will allow us to focus on the therapeutic objectives of the educational intervention through our own actions and by monitoring the treatment in a more accurate way.

Resolución quirúrgica de inestabilidad anterior de rodilla en pacientes con fisis abiertas. Técnicas quirúrgicas / Surgical treatment of anterior knee instability in children with open physis. Surgical techniques

Introducción: La lesión de LCA en niños con fisis abierta va en aumento debido a una mayor participación en deportes de contacto y al diagnóstico precoz. El tratamiento conservador de este tipo de lesiones está asociado al desarrollo de lesiones secundarias condrales y meniscales por lo que, sobre la base de la bibliografía actual, su tratamiento en pacientes esqueléticamente inmaduros con inestabilidad anterior de rodilla objetiva y sintomática es quirúrgico. Materiales y métodos: en el siguiente trabajo se presenta una revisión de dieciocho pacientes esqueléticamente inmaduros con reconstrucción de LCA y un seguimiento promedio de veintiséis meses (entre doce y cincuenta y seis) evaluados con los scores Lysholm, Tegner e IKDC, y telemetrías postoperatorias con mejoría de los scores funcionales permitiendo el retorno al mismo nivel de actividad deportiva en la mayoría de los casos. Conclusión: en esta población, no se han observado cambios en la angulación del miembro intervenido en las telemetrías postoperatorias de control, ni en el desarrollo de alteraciones del crecimiento. Tipo de estudio: Serie de Casos. Nivel de evidencia: IV

Introduction: ACL injury in children with open physis is increasing due to greater participation in contact sports and early diagnosis. Conservative treatment of this type of injury is associated with the development of secondary chondral and meniscal injuries, so based on current literature the treatment of this type of injury in skeletally immature patients with objective and symptomatic anterior knee instability is surgical. Materials and methods: the following work presents a review of eighteen skeletally immature patients with ACL reconstruction and an average follow-up of twenty-six months (between twelve and fifty-six months) evaluated with the Lysholm, Tegner and IKDC scores and postoperative telemetries with improvement in functional scores allowing return at the same level of sports activity in most cases. Conclusion: in this population, no changes in the angulation of the operated limb have been observed in the postoperative control telemetries or the development of growth alterations in any case. Type of study: Case series. Level of evidence: IV

Estimación de casos de COVID-19 en países de Suramérica empleando modelos ARIMA (Autorregresivo Integrado de Promedio Móvil) / Estimation of COVID-19 cases in South American countries using ARIMA models

El objetivo principal de este trabajo es emplear modelos ARIMA para la estimación de nuevos contagios usando datos públicos disponibles para Venezuela y la región suramericana, actualmente foco principal de un segundo brote de la COVID-19. Se realiza la predicción a 30 días del número de casos de Covid-19 en países suramericanos usando los datos públicos disponibles. Se emplearon modelos ARIMA para estimar el impacto de nuevos contagios en las dinámicas de infección para Suramérica. Desde la aparición del primer caso de la nueva neumonía Covid-19 en China, esta enfermedad se ha convertido en un problema de salud pública global y representa un gran reto el control de la infección para los países de Suramérica. Al 24 de junio de 2020 un total de 1.866.090 casos han sido detectados en la región y en el caso particular de Venezuela un total de 4.365 casos. El rápido incremento en el número de casos y la alta tasa de contagios asociado con el virus han llevado al desarrollo de distintas aproximaciones matemáticas, tales como: modelos SIR, SEIR, redes neuronales y regresiones lineales que permitan predecir la probable evolución de la epidemia. Los modelos ARIMA han sido empleados con éxito en otras infecciones como influenza, malaria, SARS, entre otras. Los resultados de las estimaciones realizadas empleando estos modelos muestran que aún en la región hacen falta mayores esfuerzos que conlleven al control de la epidemia(AU)

The main objective of this work is to use ARIMA models for the estimation of new contagions using public data available for Venezuela and the South American region, currently the main focus of a second COVID19 outbreak. A 30-day prediction is made for the num-ber of Covid-19 cases in South American countries using available public data. ARIMA models were used to estimate the impact of new contagions on infection dynamics for South America Since the appearance of the first case of the new Covid-19 pneumonia in China, which has become a global public health problem and the great challenge that the infection has represented for the countries of South America to June 24, 2020, a total of 1,866,090 cases have been detected and in the particular case of Venezuela a total of 4,365 cases have been detected for the same date. The rapid increase in the number of cases and the high rate of contagion associated with the virus have led to the development of different mathematical approaches, such as: SIR, SEIR models, neural networks and linear regressions that allow predicting the probable evolution of the epidemic. The ARIMA model has been successfully used in other infections such as influenza, malaria, SARS, among others. In the following work, the 30 - day prediction of the number of Covid-19 cases in South American countries is made using public data available. The results of the estimates made using these models show that even in the region, greater efforts are needed to control the epidemic(AU)

Cartografiar los afectos y los movimientos en el aprender corporeizado de los docentes / Mapeamento de afetos e movimentos na aprendizagem corporificada dos professores / Mapping affections and movements in teachers' embodied learning

Resumen: El cuerpo es el constructo central del ámbito de la Educación Física, pero, en los últimos años, la mirada sobre el cuerpo se ha expandido, en especial, a partir de los Nuevos Materialismos que han cuestionado y desplazado el sentido del cuerpo como realidad física y cultural a la noción de corporeidad. Este concepto vincula el cuerpo a lo relacional, va más allá de lo humano y expande las zonas de proximidad entre el cuerpo y el mundo. Esta perspectiva que diluye la idea del cuerpo como entidad que se cierra en sí misma, junto a la Teoría de los Afectos, ha llevado a cuestionar una noción de cuerpo inerte que espera pasivamente la imposición de una significación construida social y culturalmente por el sujeto. Desde este enfoque hemos indagado cómo un grupo de docentes de secundaria sitúa la corporeidad en sus trayectos en torno al aprender.

Resumo: O corpo é a construção central do campo da Educação Física, mas, nos últimos anos, o olhar sobre ele expandiu-se, sobretudo dos Novos Materialismos que questionaram e deslocaram o sentido do corpo como realidade física e cultural para a noção de corporeidade. Este conceito liga o corpo ao relacional, vai além do humano e expande as zonas de proximidade entre o corpo e o mundo. Esta perspectiva que dilui a ideia do corpo como entidade que se fecha em si mesma, juntamente com a Teoria dos Afeitos, levou a questionar uma noção de corpo inerte que espera passivamente a imposição de um significado construído social e culturalmente pelo sujeito. A partir dessa abordagem, temos pesquisado como um grupo de professores do ensino secundário situa a corporeidade em seus caminhos em torno da aprendizagem.

Abstract: The body is the central construct in the field of Physical Education, but in the last few years, it has come under growing scrutiny, especially from the New Materialisms that have questioned and displaced the meaning of the body as a physical and cultural reality towards the notion of corporeality. This concept linking the body to the relational goes beyond the human and expands the areas of proximity between body and world. The perspective that dilutes the idea of the body as an entity that closes in on itself, along with the influence of the Theory of Affects, has led to challenging the notion of an inert body that passively waits for the imposition of a meaning socially and culturally constructed by the subject. Based on this approach, we have researched how a group of secondary school teachers situates corporeality in their learning paths.

Seroprevalence of human Trypanosoma cruzi infection in the North of Estado de Mexico

Abstract INTRODUCTION: Chagas disease is a neglected public health problem in Mexico; however, detailed studies to determine the seroprevalence in some states have not been performed. METHODS: A total 1,504 human serum from thirteen communities in Estado de Mexico, were analyzed with three diagnostics techniques. RESULTS: The overall seroprevalence was 9.1%, with high prevalence among people aged 51-60 years, while people aged 0-29 years were seronegative against T. cruzi. CONCLUSIONS: Our data demonstrated the seroprevalence of T. cruzi in the North of the Estado de Mexico, an area considered as non-endemic; however, epidemiological conditions necessary for natural transmission were found.

Aterosclerosis subclínica y disminución de la densidad mineral ósea en mujeres de edad mediana / Subclinical atherosclerosis and decreasing in bone´s mineral density in middle-aged women

Introducción: la aterosclerosis y la osteoporosis son enfermedades con una alta incidencia. Diversos estudios epidemiológicos han mostrado una asociación entre ambos procesos. Objetivo: describir la posible asociación entre la aterosclerosis subclínica y la disminución de la densidad mineral ósea, así como la relación de estos procesos con variables de la esfera reproductiva en mujeres de edad mediana. Métodos: se realizó un estudio descriptivo transversal con 103 mujeres que asistieron a la consulta de climaterio y osteoporosis del Instituto Nacional de Endocrinología. La aterosclerosis subclínica se diagnosticó a través del ultrasonido doppler carotídeo, y la densidad mineral ósea mediante la absorciometría dual de rayos x en columna lumbar. El test chi cuadrado de independencia, el coeficiente de correlación lineal de Pearson, la prueba t de comparación de medias y Anova, permitieron realizar el análisis estadístico. Resultados: la aterosclerosis subclínica se diagnosticó en 28 de las mujeres de edad mediana (27 por ciento), y 48 pacientes (46,6 por ciento) presentaron densidad mineral ósea disminuida (osteopenia u osteoporosis). El 57,1 por ciento de las pacientes con aterosclerosis subclínica tuvieron una densidad mineral ósea disminuida. El 70,4 por ciento de las pacientes con aterosclerosis subclínica estaban en posmenopausia; el 66,7 por ciento de las que tenían osteopenia, y el 75 por ciento de las que presentaron osteoporosis, pertenecían a la etapa posmenopáusica. Conclusiones: las mujeres de edad mediana con aterosclerosis subclínica tienen mayor frecuencia de osteopenia u osteoporosis. En aquellas con aterosclerosis subclínica y densidad mineral ósea disminuida predomina la posmenopausia. El tipo de menopausia y el tiempo de vida reproductiva no se relacionan con la aterosclerosis subclínica y la disminución de la densidad mineral ósea. Se evidencia una asociación inversa entre tiempo de posmenopausia y densidad mineral ósea(AU)

Introduction: atherosclerosis and osteoporosis are diseases with a high incidence. Several epidemiological studies have shown a relation among both processes. Objective: to describe the possible relation among subclinical atherosclerosis and the decrease of bone´s mineral density, as well as the relations of these processes with reproductive variables in middle-aged women. Methods: a cross-sectional descriptive study was conducted with 103 women who attended to the Climacteric and Osteoporosis Consultation in the National Institute of Endocrinology. Subclinical atherosclerosis was diagnosed through carotid doppler ultrasound, and bone´s mineral density by performing a dual x-ray absorptiometry in the lumbar spine. The chi square test of independence, the Pearson linear correlation coefficient, the t test for comparison of averages and Anova allowed the performance of the statistical analysis. Results: subclinical atherosclerosis was diagnosed in 28 of the middle-aged women in the study (27 percent), and 48 of them (46.6 percent) had decreased bone´s mineral density (osteopenia or osteoporosis). 57.1 percent of the patients with subclinical atherosclerosis had a decreased bone´s mineral density. 70.4 percent of the patients with subclinical atherosclerosis were in the postmenopause stage; 66.7 percent of those with osteopenia, and 75 percent of those with osteoporosis were in the postmenopausal stage. Conclusions: middle-aged women with subclinical atherosclerosis have more incidence of osteopenia or osteoporosis. In those with subclinical atherosclerosis and low bone´s mineral density, postmenopause is predominant. The type of menopause and the reproductive lifetime are not related to subclinical atherosclerosis and low bone´s mineral density. An inverse association among the postmenopausal time and bone´s mineral density is evidenced(AU)

Absceso esplénico. Revisión del tema / Splenic abscess. Review of this subject

Los abscesos esplénicos son afecciones infrecuentes, pero con alta mortalidad. En la actualidad, los cuadros de inmunosupresión han aumentado su incidencia, provocados, generalmente, por metástasis sépticas a partir de infecciones sistémicas, muy frecuentemente endocarditis bacteriana. Se presentó un paciente, con antecedente de linfangitis crónica, que ingresó con un síndrome febril prolongado de causa no precisada. Se constató la existencia de esplenomegalia muy dolorosa a la palpación y se corroboró, por ultrasonido abdominal, la presencia de una lesión hipoecogénica en un bazo aumentado de tamaño. Se aplicó antibioticoterapia, pero no se obtuvo respuesta clínica satisfactoria y se decidió la esplenectomía con la cual se logró buena respuesta clínica y evolución favorable.

Splenic abscesses are infrequent conditions but with high mortality. Currently,immunosuppression cases have increased their incidence, usually caused by septic metastases from systemic infections, very frequently by bacterial endocarditis. A patient with a history of chronic lymphangitis is presented here. This patiente showed a prolonged febrile syndrome of unknown etiology. During admission, painful splenomegaly on palpation was noted and abdominal ultrasound confirmed a hypoechoic injury in enlarged spleen. Antibiotic treatment was applied, but since no satisfactory clinical response was seen, splenectomy was decided to perform. Good and favorable clinical response was obtained.

Colecistectomía laparoscópica por un solo puerto umbilical como alternativa para el tratamiento de la litiasis vesicular / Sigle port cholecystectomy as an alternative for the treatment of vesicular lithiasis

Objetivo: Evaluar la seguridad y factibilidad de la colecistectomía laparoscópica por puerto único en los pacientes con diagnóstico de litiasis vesicular. Métodos: Entre febrero del 2011 y febrero de 2012, se evaluaron de manera prospectiva 19 pacientes que cumplieron con los criterios de inclusión, que acudieron a la consulta externa del servicio de Cirugía 1 del hospital "Dr. Miguel Pérez Carreño". Resultados: La edad media de los pacientes fue 29 años. El mayor porcentaje correspondió al sexo femenino. La media del tiempo quirúrgico fue de 77 minutos y la promedio de IMC de los pacientes fue de 24,8. Se presentaron dos complicaciones una epidermiolisis umbilical y un seroma. El 73,7% de los pacientes refirieron muy leve dolor, 21,1% dolor leve y el 5,3% presentaron dolor moderado. El 100% de los pacientes refirió estar muy satis-fecho con el procedimiento. El 100 % de los pacientes estuvo un día de hospitalizado. En tres de los 19 pacientes se colocó un trócar subxifoideo adicional y en un solo un paciente se colocaron 2 trócares adicionales. Conclusión: La colecistectomía laparoscópica por puerto único es una técnica factible, segura, reproducible con buenos resultados estéticos y dolor post operatorio leve que requiere un entrenamiento constante(AU)

Objective: To evaluate the safety and feasibility of laparoscopic cholecystectomy by single port in patients with a diagnosis of vesicular lithiasis. Methods: Between February, 2011 and February 2012, were evaluated prospectively 19 patients who met the criteria for inclusion, who attended the outpatient surgery of the hospital "Dr.Miguel Pérez Carreño". Results: The mean age of patients was 29 years old. The greatest percentage corresponded to the female sex. The average surgical time was 77 minutes and the average BMI of patients was 24,an umbilical epidermolysis and a seroma 8 presented two complications. 73.7% of the patients reported mild pain, 21.1% mild pain and 5.3% showed moderate pain. 100% of patients said they were very satisfied with the procedure. 100% of the patients were one day hospitalized. An additional trocar was placed on three of the 19 patients and 2 were placed in a single a patient additional trocar. Conclusion: Single-port laparoscopic cholecystectomy is a feasible, safe and reproducible technique with good aesthetic results and pain mild post-operative that requires constant training(AU)

Factores de riesgo y diagnóstico de la enfermedad carotídea / Risk factors and diagnosis of carotid disease

Antecedentes: La aterosclerosis carotídea acontece por etapas y se inicia con el engrosamiento de la íntima de la pared arterial hasta la formación de la placa de ateroma. La ateromatosis carotidea extracraneal origina aproximadamente el 30% de loséictus de ese territorio. Objetivo: Revisar los aspectos más relevantes de la enfermedad carotídea asociada a factores de riesgo. Desarrollo: La enfermedad carotídea es una manifestación temprana de aterosclerosis subclínica. Puede diagnosticarse desde el punto de vista clínico y con estudios de neuroimagen. Se ha confirmado una correlación anatómica de la enfermedad carotídea, con la asociación de factores de riesgo, y diferentes manifestaciones de aterosclerosis avanzada. El cuadro clínico de la enfermedad carotdíea sintomática es variable, y la frecuencia de los síntomas es proporcional al grado de estenosis. Por tanto, causara más enfermedad cerebrovascular cuando mayor sea el grado de estenosis. La evaluación clínica debe incluir: a) Examen cardiovascular completo, con auscultación del cuello; b) fundoscopia para detectar signos de embolización retiniana; c) Examen neurológico para relacionar los snítomas con el territorio isquémico afectado; y d) el empleo de la escala de la National Institute of Health Stroke (NIHSS) para evaluar el déficit neurológico y predecir la evolución. Conclusiones: La enfermedad carotidea se relaciona con factores de riesgo tradicionales y tiene valor predictivo independiente para eventos isquémicos coronario y cerebrovasculares. Es conveniente realizar un examen clínico cuidadoso y no subestimar la importancia de su detección temprana.

Background: Carotid atherosclerosis occurs by stages and begins with the thickening of the intima of the arterial wall to the formation of atherosclerotic plaque. Extracranial carotid atheroma causes approximately 30% of strokes in that territory. Objectives: To review the most relevant aspects of carotid disease associated risk factors. Development: The carotid disease is an early manifestation of subclinical atherosclerosis. Can be diagnosed from the clinical standpoint and neuroimaging studies. It has been confirmed anatomical correlation of carotid disease, the association of risk factors, and different manifestations of advanced atherosclerosis. The clinical picture of symptomatic carotid disease is variable, and the frequency of symptoms is proportional to the degree of stenosis. Therefore, it will cause more cerebrovascular disease when higher the degree of stenosis. Clinical evaluation should include: a) complete cardiovascular examination with auscultation of the neck, b) fundoscopy for signs of retinal embolization, c) neurological symptoms related to the ischemic area affected and d) the use of the scale of the National Institute of Health Stroke (NIHSS) to assess the neurological deficit and predict outcome. Conclusions: Carotid disease is related to traditional risk factors and have independent predictive value for coronary and cerebrovascular ischemic events. It is advisable to make a careful clinical examination and not underestimate the importance of early detection.

Ideais e alteridade em uma pesquisa sobre a relação dos jovens com o saber / Ideals and alterity in a research about the relationship between young people and knowledge / Ideales y alteridad en una investigación sobre la relación de los jóvenes con el saber

Em uma investigação sobre o abandono escolar no ensino secundário espanhol a partir da relação dos jovens com o saber, entrevistamos de forma semiaberta tanto jovens considerados de êxito quanto de fracasso pela escola. Nos relatos construídos conjuntamente com eles, são explicitadas os vínculos estabelecidos entre jovens e pesquisadores como também as dos pesquisadores entre si. Este artigo discute o lugar do Outro ocupado pelo grupo de pesquisadores e pelos jovens para cada pesquisador. Também debatemos o papel dos ideais dos pesquisadores nessas relações.

In a research about Spanish secondary school's dropout considering the relationship between young people and knowledge, we interviewed both young people considered as successful or as a failure by the school in a semi-open manner. In the narrations written along with the young people, the relationships between them and the researchers were made explicit as well as the ones between the researchers themselves. This paper discusses the place of the Other for each researcher occupied by the researchers' group and by the young people. We also debate the role of the researchers' ideals in these relationships.

En una investigación sobre el abandono escolar en la Educación Secundaria Obligatoria española a partir de la relación de los jóvenes con el saber, entrevistamos de forma semiabierta tanto a jóvenes considerados de éxito como de fracaso por la escuela. En los relatos construidos conjuntamente con ellos se explicitan las relaciones establecidas entre jóvenes e investigadores así como la de los investigadores entre sí. Este artículo discute el lugar del Otro ocupado por el grupo de investigadores y por los jóvenes para cada investigador. También debatimos el papel de los ideales de los investigadores en esas relaciones.

Yield and ion content in maize irrigated with saline water in a continuous or alternating system / Produtividade e teores de íons no milho irrigado com águas salinas de forma contínua ou alternada

Irrigation with water containing salt in excess can affect crop development. However, management strategies can be used in order to reduce the impacts of salinity, providing increased efficiency in the use of good quality water. The objective of this research was to study the effects of use of high salinity water for irrigation, in continuous or cyclic manner, on vegetative growth, yield, and accumulation of ions in maize plants. Two experiments were conducted during the months from October to January of the years 2008/2009 and 2009/2010, in the same area, adopting a completely randomized block design with four replications. Irrigation was performed with three types of water with electrical conductivities (ECw) of 0.8 (A1), 2.25 (A2) and 4.5 (A3) dS m-1, combined in seven treatments including the control with low salinity water (A1) throughout the crop cycle (T1). Saline waters (A2 and A3) were applied continuously (T2 and T5) or in a cyclic way, the latter being formed by six irrigations with A1 water followed by six irrigations by eitherA2 or A3 water, starting with A1 at sowing (T3 and T6) or 6 irrigations with A2 or A3 water followed by 6 irrigations with A1 water (T4 and T7) . The use of low and high salinity water resulted in lower accumulation of potentially toxic ions (Na and Cl) and improvement in the Na/K balance in the shoots of maize plants. Application of saline water in a cyclic way also allows the substitution of about 50% of water of low salinity in irrigation, without negative impacts on maize yield.

A irrigação com águas que contenham sais em excesso pode afetar de forma negativa o desenvolvimento das culturas. No entanto, estratégias de manejo devem ser utilizadas de modo a reduzir os impactos da salinidade, proporcionando aumento na eficiência do uso de água de boa qualidade. O objetivo deste trabalho consistiu em estudar os efeitos de uso de água de alta salinidade na irrigação, de forma contínua ou cíclica, sobre o crescimento vegetativo, a produtividade e o acúmulo de íons em plantas de milho. Foram realizados dois experimentos durante os meses de outubro a janeiro, em 2008/2009 e 2009/2010, na mesma área, adotando-se um delineamento experimental em blocos casualizados, com quatro repetições. A irrigação foi realizada com três tipos de água com condutividade elétrica (CEa) de 0,8 (A1), 2,25 (A2) e 4,5 (A3) dS m-1, combinadas em sete tratamentos, incluindo o controle com água de baixa salinidade (A1) durante todo o ciclo (T1). As águas salinas A2 e A3 foram aplicadas de forma contínua (T2 e T5) ou cíclica, sendo esse último manejo formado por seis irrigações com A1, seguidas de seis irrigações com A2 ou A3 (T3 e T6), iniciando com A1 na semeadura ou seis irrigações com A2 ou A3, seguidas por seis irrigações com A1 (T4 e T7). O uso cíclico de águas de baixa e alta salinidade resultou em menor absorção de íons potencialmente tóxicos (Na e Cl) e melhoria no balanço Na/K na parte aérea das plantas de milho. A aplicação de água salina de forma cíclica permitiu também a substituição de cerca de 50% de água de baixa salinidade na irrigação, sem impactos negativos sobre a produtividade do milho.

Evaluación del aprendizaje en la educación médica / Learning assessment in medical education

El propósito de este artículo es proporcionar un panorama general de la evaluación educativa en el contexto de las ciencias de la salud, específicamente en el campo de la Medicina. Para ello, se realizó una revisión del estado del arte de la evaluación, enfatizando los conceptos fundamentales en el desarrollo teórico y metodológico, así como los alcances de la evaluación educativa en la educación superior. Se enfatiza la necesidad de desarrollar instrumentos de evaluación congruentes con los perfiles de egreso de los planes y programas de estudio de la carrera de medicina y se pone en perspectiva la evaluación de la competencia médica a través de instrumentos como el Examen Clínico Objetivo Estructurado (ECOE), que por sus características es considerado como una herramienta útil en el ámbito de la evaluación de la competencia medica a nivel internacional.

The purpose of this article is to provide an overview of educational evaluation in the context of health sciences, specifically in the field of medicine. To do this, a review of the state of the art of evaluation was performed, emphasizing the fundamental concepts in theoretical and methodological development and the scope of educational evaluation in higher education. The need to develop evaluation instruments consistent with the graduate profiles according to the syllabus of medicine is highlighted, and the evaluation of medical competence through instruments such as the Objective Structured Clinical Examination (OSCE), which by its characteristics is considered as a useful tool in the field of assessment of medical competency in the international context, is also assessed.

Tumor del estroma gastrointestinal del intestino delgado / Gastrointestinal stromal tumor of small intestine

Los tumores del estroma gastrointestinal fueron catalogados originalmente como otros tumores (leiomioma, leiomioblastoma o leiomiosarcoma), debido a su apariencia histológica similar; sin embargo, los avances en la biología molecular y la inmunohistoquímica, han permitido diferenciarlos de otras neoplasias digestivas, y definirlos como una entidad clínica e histopatológica propia. Se presenta un paciente, de sexo femenino, de la raza negra, de 79 años de edad, con dolor abdominal de 3 días de evolución, que se había iniciado en fosa ilíaca derecha y luego se mantuvo en bajo vientre, acompañado de vómitos, fatiga y decaimiento. Se decide intervenir quirúrgicamente y se lleva al salón de operaciones con el diagnóstico de una apendicitis aguda, del muñón, tipo oclusiva en el anciano, sin descartar una oclusión por bridas. Al realizar laparotomía se encuentra sangre libre en cavidad que no coagula, y se observó tumor hemorrágico, pediculado, muy móvil, hacia íleon terminal. Se realiza exéresis de este, se resecan aproximadamente 5 cm de intestino delgado y se realiza sutura termino-terminal posteriormente. Se realizó amplia toillette de la cavidad peritoneal y el cierre habitual, con evolución satisfactoria, y con alta a los 7 días. Se mantiene asintomática al año y medio de operada, y la biopsia arrojó tumor de intestino delgado, de bajo grado de malignidad, de 5 cm de diámetro(AU)

The tumors of the gastrointestinal stroma were originally classified as other type of tumors (leiomyoma, leiomyobastoma or leiomyosarcoma) due to it similar histological appearance; however, the advances in the molecular biology and the immunohistochemistry have allowed its differentiation of other digestive neoplasms and to define them as an own clinical and histopathological entity. This is the case of a black female patient aged 79 presenting with abdominal pain during 3 days of evolution started in the right iliac fossa and then it remains in the low belly accompanied by vomiting, fatigue and weakness. She was operated on and is diagnosed with a stump acute appendicitis and of occlusive type en elderly without to rule out an adhesion occlusion. Carrying out the laparotomy it was found that this not-coagulating cavity was blood-free and also a stalked hemorrhagic tumor with movements towards the terminal ileum. Authors carried out its exeresis resecting approximately 5 cm of small intestine with a termino-terminal suture later. A significant cleaning of peritoneal cavity was carried out with the habitual closure achieving a satisfactory evolution with her discharge at 7 days. Patient remains asymptomatic at one a half year postoperative and biopsy yielded a 5 cm-small intestine tumor with a low grade of malignancy(AU)