Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment / Fatores de risco para falha de tratamento após vitrectomia primária sem retinopexia com introflexão escleral

ABSTRACT Objective To assess pre-operative conditions that could influence primary anatomical success rate in a cohort of patients with rhegmatogenous retinal detachments (RRD) treated with primary vitrectomy and no scleral buckling. Methods A retrospective analysis was performed in a group of patients that underwent primary pars plana vitrectomy with gas tamponade and without scleral buckling for RRD between 2014 and 2019, with a minimum follow-up of 4 months. Results 305 eyes of 301 patients were included; 59.01% eyes were phakic, 39.01% were pseudophakic and 1.96% aphakic. 13.11% of patients had proliferative vitreoretinopathy grade B and 3.28% proliferative vitreoretinopathy grade C at the time of diagnosis while 83.61% had proliferative vitreoretinopathy grade 0 or A. 53.1% had superior breaks, 15.4% inferior breaks and 31.5% a combination of both. Primary success rate was obtained in 90.82% of eyes (95%CI 87.58-94.06). 9.18% of eyes (95%CI 5.94-12.42) re-detached. In 3.27% the cause of re-detachment was proliferative vitreoretinopathy, and in the remaining 5.90% because of a new or a missed break, the leakage of a previously treated break, or an area of shallow peripheral detachment with no detectable break. Of 181 phakic eyes, 10.49% re-detached, whereas in over 126 aphakic or pseudophakic eyes 7.75% re-detached (p=0.42). 16.39% eyes of the entire cohort had preoperative grade B or C proliferative vitreoretinopathy, whereas 32.14% of re-detached eyes had preoperative grade B or C proliferative vitreoretinopathy (95%CI 17.29-46.99; p=0.02). Th eyes that re-detached after the first surgery had a mean of 2.5 (95%CI 1.86-3.13) retinal tears, against a mean of 1.87 (95%CI 1.73-2.00) retinal tears of those that did not re-detach after the first surgery (p=0.02). Conclusion We found location of breaks and lens status to be independent factors not related to a lower single operation success rate, whereas the number or size of breaks and preoperative proliferative vitreoretinopathy stages B or C were independent factors related to a higher likelihood of re-detachment.

RESUMO Objetivo Avaliar condições pré-operatórias que poderiam influenciar a taxa de sucesso anatômico primário em uma coorte de pacientes com descolamento de retina regmatogênico tratada com vitrectomia primária e sem introflexão escleral. Métodos Foi realizada uma análise retrospectiva em um grupo de pacientes submetidos a vitrectomia primária pars plana com tamponamento gasoso e sem introflexão escleral por desprendimento de retina regmatogênico entre os anos 2014 e 2019, com monitoramento mínimo de 4 meses. Resultados Foram incluídos 305 olhos de 301 pacientes; 59,01% dos olhos eram fáquicos, 39,01% eram pseudofáquicos, e 1,96% era afáquico; 13,11% dos pacientes tinham vitreorretinopatia proliferativa grau B, e 3,28%, vitreorretinopatia proliferativa grau C no momento do diagnóstico, enquanto 83,61% tinham vitreorretinopatia proliferativa grau 0 ou A; 53,1% tinham rasgaduras superiores; 15,4%, rasgaduras inferiores e 31,5%, uma combinação de ambas. A taxa de sucesso primário foi obtida em 90,82% dos olhos (IC95% 87,58-94,06); 9,18% dos olhos (IC95% 5,94-12,42) se redestacaram. Em 3,27%, a causa do redescolamento foi vitreorretinopatia proliferativa e, nos 5,90% restantes, por causa de uma ruptura nova ou perdida, o vazamento de uma ruptura previamente tratada, ou uma área de descolamento periférico superficial sem ruptura detectável. Dos 181 olhos fáticos, 10,49% redestacaram-se, enquanto em mais de 126 olhos afáquicos ou pseudofáquicos 7,75% redestacaram-se (p=0,42); 16,39% dos olhos de toda a coorte tinham vitreorretinopatia proliferativa pré-operatória grau B ou C, enquanto 32,14% dos olhos redescolados tinham vitreorretinopatia proliferativa pré-operatória grau B ou C (IC95% 17,29-46,99) (p=0,02). Os olhos que se redescolaram após a primeira cirurgia tiveram média de 2,5 (IC95% 1,86-3,13) lágrimas retinianas, contra uma média de 1,87 (IC95% 1,73-2,00) lágrima retiniana daqueles que não se redestacaram após a primeira cirurgia. (p=0,02). Conclusão A localização das rasgaduras e o status da lente são fatores independentes não relacionados a uma menor taxa de sucesso da operação, enquanto o número ou o tamanho das rasgaduras e estágios vitreorretinopatia proliferativa pré-operatórios B ou C foram fatores independentes relacionados a uma maior probabilidade de redescolamento.

Sarcoma de Kaposi en pacientes que viven con el VIH en Guinea Ecuatorial / Kaposi sarcoma in patients living with HIV in Equatorial Guinea

Introducción: El sarcoma de Kaposi es una neoplasia oportunista asociada a la inmunodepresión causada por VIH, que se relaciona con la infección por VHH tipo 8. Objetivo: Describir la presentación del sarcoma de Kaposi en personas que viven con VIH en Guinea Ecuatorial. Métodos: Se realizó un estudio descriptivo de carácter retrospectivo para identificar la prevalencia y las características epidemiológicas y clínicas del sarcoma de Kaposi en las personas que viven con VIH que acuden a las unidades de referencia para el manejo de casos en Guinea Ecuatorial. Se revisaron las historias clínicas de una muestra aleatoria y representativa de 338 pacientes del grupo que ha recibido tratamiento en las unidades de referencia para enfermedades infecciosas de Bata, desde enero de 2007 a febrero de 2012. Resultados: Se identificaron 40 pacientes diagnosticados de sarcoma de Kaposi (prevalencia del 11, 83 por ciento). La mediana de la edad al diagnóstico de sarcoma de Kaposi fue de 43 años, siendo la ratio del sexo de 1/1. La media de linfocitos CD4 al diagnóstico fue de 166 (rango 21-375) y la frecuencia de afectación oral fue de 45 por ciento. En la mayoría de los pacientes (94,6 por ciento) la observación del sarcoma de Kaposi fue anterior al inicio del tratamiento antirretroviral. Las cifras de linfocitos T CD4/mm3 inferiores a 100 aparecían sobre todo en pacientes menores de 30 años, y esto era especialmente frecuente en el grupo de mujeres (OR 11, p <0,04, Ic 95 por ciento 0,8-148). Conclusiones: El sarcoma de Kaposi es una neoplasia prevalente en personas que viven con VIH seguidas en las unidades de referencia en Guinea Ecuatorial. En mujeres menores de 30 años podría existir un diagnóstico tardío(AU)

Introduction: Kaposi sarcoma is an opportunistic neoplasm associated to the immunosuppression caused by HIV and related to infection by HHV-8. Objective: Describe the presentation of Kaposi sarcoma in people living with HIV in Equatorial Guinea. Methods: A retrospective descriptive study was conducted to identify the prevalence and the clinical and epidemiological characteristics of Kaposi sarcoma in people living with HIV attending reference units for the management of cases in Equatorial Guinea. A review was carried out of the medical records of a random sample representative of 338 patients from the group receiving treatment at Bata reference unit for infectious diseases from January 2007 to February 2012. Results: A total 40 patients diagnosed with Kaposi sarcoma were identified (prevalence of 11,83 percent). Mean age at Kaposi sarcoma diagnosis was 43 years, with a 1/1 sex ratio. The mean CD4 lymphocyte count at diagnosis was 166 (range 21-375), whereas the frequency of oral damage was 45 percent. In most patients (94.6 percent) detection of Kaposi sarcoma was prior to the start of antiretroviral therapy. CD4 T lymphocyte levels / mm3 below 100 were mainly found in patients aged under 30 years, a fact particularly frequent among women (OR 11, p< 0.04, CI 95% 0.8-148). Conclusions: Kaposi sarcoma is a neoplasm prevailing in people living with HIV who attend reference units in Equatorial Guinea. Late diagnosis could exist among women aged under 30 years(AU)

Plants and gall hosts of the Tirimbina Biological Reserve, Sarapiqui, Costa Rica: Combining field sampling with herbarium records

There has been an increasing number of inventories of gall-inducing arthropods in the Neotropics. Nonetheless, very few inventories have been carried out in areas where the flora is well documented, and records of galls from herbaria and sites outside the study area have seldom been utilized. In this study we provide a checklist of the native vascular plants of a 345 ha forest reserve in the Caribbean lowlands of Costa Rica and document which of these plants were found to harbor galls. The gall surveys were carried out between November 2013 and December 2016. We also cross-checked our plant list with the previous gall records from elsewhere in the country and searched for galls on herbarium specimens of dicots reported from the reserve. In total, we recorded 143 families and 1174 plant species, of which 401 were hosts of galls. Plant hosts of galls were found in the following non-mutually exclusive categories: 209 in our field sampling, 257 from previous records, and 158 in herbarium specimens. Of our field records of galls, 77 were new for the country, 77 were also found in the herbarium and 110 had been previously recorded in the country. Herbarium specimens and previous records are good indicators of potential gall hosts but around one quarter (40/158) of the gall records in the herbarium were ambiguous as to whether the tissue alteration was a gall or not. Plant family size was related to number of gall hosts, but most dicot families have similar proportions of gall host species. We concluded that more than a third of the native plants in the reserve are gall hosts, but this number increased to 44.93 % when only dicots were considered. Our results demonstrate the utility of providing complete plant inventories when conducting gall inventories, and of using herbarium specimens and previous galls studies to infer gall diversity in a specific area.

Los estudios relacionados con la diversidad de insectos inductores de agallas han venido aumentando en el Neotrópico. Sin embargo, pocos inventarios se han realizado en sitios donde la flora está bien documentada y los registros previos de agallas, así como información disponible de herbario, han sido subutilizados. En este estudio brindamos un inventario de las plantas nativas en una reserva de 345 ha ubicada en las tierras bajas del Caribe costarricense y documentamos cuales de estas son hospederas de agallas. El muestreo de agallas se llevó a cabo entre noviembre del 2013 y diciembre del 2016. Así mismo, comparamos nuestra lista de plantas con los registros previos de agallas encontradas en el resto del país y examinamos en herbario todas las dicotiledóneas registradas en la reserva en busca de agallas. En total, encontramos 143 familias y 1 174 especies de plantas de las cuales 401 especies fueron hospederas de agallas. Estas fueron encontradas de las siguientes categorías no mutuamente exclusivas: 209 mediante colectas de campo, 257 a partir de registros previos y 158 en material de herbario. De las plantas con agallas encontradas en el campo 77 corresponden a registros nuevos para el país, 77 fueron halladas también en herbario y 110 habían sido reportadas anteriormente en el país. El material de herbario y los registros previos demostraron ser buenos indicadores de las potenciales especies de plantas hospederas de agallas, sin embargo, alrededor de una cuarta parte (40/158) de los registros de agallas en herbario son ambiguos (difíciles de determinar si son agallas o no). El tamaño de la familia de las plantas está relacionado con la diversidad de especies de plantas hospederas de agallas, no obstante, la mayoría de las familias de dicotiledóneas tiene una proporción similar de especies hospederas de agallas. Concluimos que al menos un tercio de las especies de plantas nativas de la reserva son hospederas de agallas, pero este número incrementa a 44.93 % cuando solo se consideran las dicotiledóneas. Nuestros resultados demuestran la importancia de proveer inventarios completos de plantas cuando se realizan inventarios de agallas, así como la utilidad de examinar material de herbario y contrastar registros previos para inferir la diversidad de agallas en un sitio.

Sarcoma de Kaposi epidémico en África Subsahariana / Epidemic Kaposi sarcoma in Sub-Saharan Africa

El sarcoma de Kaposi se ha convertido en uno de los tumores más prevalentes en África tras la epidemia de VIH, que afecta de una manera similar a hombres y mujeres. El retraso diagnóstico y el limitado acceso a tratamiento antirretroviral o quimioterapia condicionan el pronóstico de los pacientes que lo padecen. En este artículo se realiza una revisión sobre la referida enfermedad, con el objetivo de describir sus aspectos más relevantes en los últimos años en África, como son su epidemiología, caractéristicas clínicas y opciones terapéuticas existentes. Este tumor es provocado por la infección por virus herpes humano tipo 8, que resulta más prevalente en las zonas rurales del continente africano. Se postula la transmisión a través de la saliva como la vía más importante de contagio en África. La inmunodepresión que causa el VIH favorece el efecto oncogénico del virus. La forma epidémica de SK se manifiesta inicialmente como lesiones hiperpigmentadas o violáceas en la piel, que pueden extenderse a linfáticos o mucosas y a nivel sistémico, principalmente a pulmón o aparato digestivo. El síndrome de reconstitución inmune sistémica puede complicar la evolución del paciente. El inicio temprano de la terapia antirretroviral resulta imprescindible. Además, el pronóstico de los pacientes mejora con la suma de tratamiento quimioterápico con doxorrubicina, vincristina, etopóxido o bleomicina principalmente(AU)

Kaposi sarcoma (KS) has become one of the most prevalent tumors in Africa after the HIV epidemic. KS affects both men and women. Diagnostic delay and limited access to antiretroviral treatment or chemotherapy have an impact on the prognosis of KS patients. A review was conducted about KS with the purpose of describing its most outstanding characteristics in recent years in Africa, such as its epidemiology, clinical features, and existing therapeutic options. This tumor is caused by infection with human herpesvirus 8, which is more prevalent in rural areas of the African continent. Transmission via saliva was found to be the most important transmission route in Africa. HIV-related immunosuppression fosters the oncogenic effect of the virus. The epidemic form of KS initially presents as hyperpigmented or violet-colored skin lesions which may extend to lymph nodes or mucosae, or systemically, mainly to the lungs or the digestive tract. Systemic immune reconstitution syndrome may complicate the patient's evolution. Early start of antiretroviral therapy is indispensable. Additionally, prognosis improves with chemotherapy with doxorubicin, vincristine, etoposide or bleomycin, mainly(AU)

Parasitoides associados com Helicoverpa armigera em áreas de refúgio de algodão, no Oeste da Bahia, Brasil

ABSTRACT: Natural biological control is one of the major causes responsible for reduction of pest population in agricultural ecosystem. However, natural biological control importance is usually minimized by not being estimated. This study reports the occurrence of Campoletis sonorensis (Cameron, 1886) (Hymenoptera: Ichneumonidae), Archytas marmoratus (Townsend, 1915) and Archytas incertus (Macquart, 1851) (Diptera: Tachinidae) associated with Helicoverpa armigera (Hübner, 1809) (Lepidoptera: Noctuidae). The rate of larval parasitism was up to 41% in structured refuge areas of cotton, without chemical control with insecticides. This study strengthens our knowledge relating to parasitoids associated with natural control of H. armigera in the American continent. In addition, it documents the rule that structured refuge areas could play as a source of natural enemies, besides their contribution to production of non-selective populations to Bt technology.

RESUMO: O controle biológico natural é um dos principais componentes responsáveis pela redução populacional de pragas em agroecossistemas. Entretanto, a importância do controle biológico natural, usualmente, é minimizada devido não ser estimada. Este estudo documenta a ocorrência de Campoletis sonorensis (Cameron, 1886) (Hymenoptera: Ichneumonidae), Archytas marmoratus (Townsend, 1915) e Archytas incertus (Macquart, 1851) (Diptera: Tachinidae) associados a Helicoverpa armigera (Hübner, 1809) (Lepidoptera: Noctuidae). A taxa de parasitismo larval foi superior a 41% em áreas de refúgio estruturado de algodão, sem uso de inseticidas químicos. Este estudo fortalece o conhecimento relacionado com os parasitoides associados ao controle natural de H. armigera no Continente Americano. Adicionalmente, documenta o efeito que áreas de refúgio estruturado podem desempenhar como fonte de inimigos naturais, além da sua contribuição para produzir insetos não expostos à tecnologia Bt.

Seedling growth and survival of five tree species in secondary forests and adjacent pastures in the montane rain forests of Southern Costa Rica / Crecimiento y supervivencia de plántulas de cinco especies de árboles en bosques secundarios y pastizales adyacentes en un bosque lluvioso montano del sur de Costa Rica

Abstract:Successful forest restoration in tropical environments is limited by the paucity of studies on the initial establishment and early survival requirements of seedlings of most native tropical tree species under disturbed conditions. Here, we evaluated the initial growth responses and the regeneration potential of seedlings of five tree species native to Costa Rica (Hasseltia floribunda, Inga densiflora, Persea americana, Tapirira mexicana and Trichilia pittieri). Seedlings were grown in secondary forests and adjacent open pastures under contrasting conditions of light availability. We quantified seedling growth, survival and herbivory from August 2010 to August 2011 on a monthly basis, and measured differences in leaf mass per area (LMA) at the end of the experiment. We found significant variation in growth responses between the understory of secondary forests and pastures. Growth in height was highest in pastures across all species, with I. densiflora, P. americana and T. mexicana showing the most striking differences. In contrast, H. floribunda and T. pittieri did not show differences in diameter growth between environments. Except for T. mexicana, herbivory increased throughout the experiment in all the species. Herbivory increased faster in pastures for H. floribunda and T. pittieri and showed higher rates in the forest understory for I. densiflora and P. americana. Seedling survival showed significant differences for all species across environments. Survival of H. floribunda and I. densiflora was higher in secondary forests, whereas the other species showed higher survival in pastures. LMA showed higher values in the pastures across all species, showing that individuals exposed to high light conditions had great photosynthetic rate and great leaf construction capacity. Due to their rapid growth and high survival, I. densiflora and T. mexicana showed great potential to restore abandoned pastures and secondary forests. Increasing our knowledge on the response of seedlings under disturbed conditions in tropical ecosystems is critical for improving the restoration of altered environments by matching the ecological amplitude of native species with specific environmental conditions. Rev. Biol. Trop. 64 (4): 1565-1583. Epub 2016 December 01.

Resumen:La restauración exitosa del bosque en ambientes tropicales está limitada por la carencia de estudios sobre los requisitos de hábitat, el establecimiento inicial, y la sobrevivencia de las plántulas de la mayoría de las especies de árboles tropicales nativos. En este estudio, evaluamos las respuestas en el crecimiento inicial y el potencial de regeneración de las plántulas de cinco especies de árboles nativos de Costa Rica (Hasseltia floribunda, Inga densiflora, Persea americana, Tapirira mexicana y Trichilia pittieri). Sembramos las plántulas en bosques secundarios y en pastizales abiertos adyacentes con condiciones de luz contrastantes. Cuantificamos el crecimiento, la supervivencia y el daño por herbivoría de las plántulas de forma mensual entre agosto 2010 y agosto 2011, y medimos las diferencias en el la masa foliar por área de la hoja al final del experimento. Existió una variación significativa en el crecimiento de las plántulas expuestas a la sombra en los bosques secundarios y aquellas que crecieron en pastizales. El crecimiento en altura fue mayor en pastizales en todas las especies; I. densiflora, P. americana y T. mexicana mostraron la mayor diferencia entre ambientes. En con- traste, H. floribunda y T. pittieri no mostraron diferencias en el crecimiento del diámetro entre ambientes. Con la excepción de T. mexicana, todas las especies mostraron un aumento en herbivoría durante el estudio. En los pastizales, el incremento de la herbivoría fue más rápido en H. floribunda y T. pittieri, mientras que para I. densiflora y P. americana fue mayor en el bosque. La sobrevivencia de plántulas fue diferente entre ambientes para todas las especies. La sobrevivencia de H. floribunda e I. densiflora fue mayor en el bosque secundario, mientras que en las demás especies hubo mayor sobrevivencia de plántulas en los pastizales. La masa foliar por área fue mayor en las plántulas que crecieron en los pastizales que en bosque secundario para todas las especies, lo que sugiere que los individuos que crecieron en condiciones de alta incidencia de luz tuvieron mayor tasa fotosintética y mayor capacidad de construcción de la hoja. Debido al rápido crecimiento y alta supervivencia I. densiflora y T. mexicana tienen gran potencial para la restauración de bosques secundarios y pastizales abandonados. Generar información sobre la respuesta de plántulas creciendo en bosques secundarios y pastizales en regeneración es crítico para mejorar los procesos de restauración de ambientes alterados. La restauración de estos bosques depende de la correspondencia entre las condiciones específicas de hábitat y la plasticidad ecológica de las especies nativas.

Molecular characterization of microbial contaminants isolated from Umbilical Cord Blood Units for transplant

ABSTRACT Disposal of Umbilical Cord Blood Units due to microbial contamination is a major problem in Cord Blood Banks worldwide as it reduces the number of units available for transplantation. Additionally, economic losses are generated as result of resources and infrastructure used to obtain such units. Umbilical Cord Blood Units that showed initial microbial contamination were subject to strains isolation, identification, and characterization by sequencing the 16S rRNA gene and Enterobacterial Repetitive Intergenic Consensus (ERIC-PCR). Moreover, tests of antimicrobial resistance/sensitivity and phenotypic activities that may play an important role in microbial infection were performed. Microbial contamination was detected in 120 Umbilical Cord Blood Units (2.31%) in the period from 2003 to 2013. The most frequently isolated strains were Enterococcus faecium, followed by Staphylococcus epidermidis, Escherichia coli, Enterococcus faecalis, Staphylococcus haemoliticus, Klebsiella pneumoniae, Enterococcus durans, Lactobacillus helveticus, Enterococcus hiriae and Roseomonas genomospecies 5. The ERIC-PCR assays revealed a wide genetic diversity in some strains although belonging to the same genus and specie, indicating different sources of contamination. Broad-spectrum penicillins, third generation cephalosporins, aminoglycosides, and fluoroquinolones showed lower inhibitory activity on the tested strains. All strains were proteolytic, 67.69% were amylase-positive, 27.6% hemolysis-positive, and 34.71% nuclease-positive. The most common sources of contamination were: vaginal flora, digestive tract, and skin flora, highlighting the need for staff training in good manufacturing practices in collection SCU since all contaminants identified are part of the microbial flora of the donors. Implications and consequences in the therapeutic use of Umbilical Cord Blood Units for transplantation contaminated by multiresistant bacteria in immunocompromised patients are discussed.

Ectima gangrenoso en pediatría / Ecthyma gangrenosum in pediatrics

Resumen El ectima gangrenoso es una infección poco frecuente de la piel, conocida con una característica lesión causada principalmente por la Pseudomoma aeruginosa, pero que también se puede presentar por otro tipo de bacterias del tipo Staphylococcus aureus o el Streptococcus beta hemolítico del grupo A ( S. beta hemolítico del grupo A), entre otros. Esta entidad se asocia frecuentemente con inmunodeficiencias primarias y secundarias. Las lesiones, clínicamente, se presentan como máculas eritematovioláceas, descamativas que rápidamente evolucionan a papulovesículas, ampollas hemorrágicas y costrosas que dejan unas úlceras profundas en sacabocado con fondo necrótico. La mortalidad es alta, entre 40 y 75% de los individuos inmunológicamente comprometidos. Se describe el caso de una niña de 5 años que inicialmente presentó varicela y luego una sobreinfección por S. aureus ocasionando un cuadro clínico de un ectima gangrenoso; al diagnóstico se llega por la clínica, cultivos y biopsias de piel. Se realizó manejo con aciclovir, clindamicina y cefepime endovenoso, con buena y rápida respuesta de la paciente.

Abstract Ecthyma gangrenosum (EG) is a rare infection of the skin, known as a characteristic lesion caused by Pseudomoma aeruginosa , but also can occur from other types of bacteria like Staphylococcus aureus or beta hemolytic group, among others. This condition is often associated with primary and secondary immunodeficiencies. The lesions present clinically as scaly, erythematous violacious macules that rapidly evolve into papule-vesicles, bleeding and crusty blisters leaving a deep punch ulcer with a necrotic base. Mortality is high, between 40% and 75% of immunologically compromised individuals. We describe the case of a girl of 5 years of age who initially presented chickenpox and then superinfection with Staphylococcus aureus, causing a clinical picture of EG. The diagnosis was reached based on symptoms, cultures and skin biopsies. Management was achieved with acyclovir, intravenous clindamycin and cefepime, with a good and quick response by the patient.

Angiomatosis cavernosa cerebral múltiple en pediatria / Cavernous angiomatosis in children

Las malformaciones vasculares intracraneanas en niños son lesiones congénitas debidas a alteraciones en el desarrollo de la red arteriocapilar. Se presentan por orden de frecuencia: malformaciones arteriovenosas, angiomas cavernosos o cavernomas, angiomas venosos y telangiectasias. Se describe el caso de un paciente de 3 años de edad con diagnostico de angiomatosis cavernosa cerebral múltiple derecha, con variadas manifestaciones clínicas, como crisis convulsivas focales complejas motoras, alteración en la marcha, hemiparesia izquierda, entre otras que están relacionadas con esta patología. Los casos descritos de angiomatosis cavernosa múltiple son en pacientes adultos, es evidente entonces que este caso clínico contribuye a una identificación en la literatura por sus características especiales de presentación clínica y manejo en pacientes pediátricos.

Intracranial vascular malformations are congenital lesions due to alterations in network development arterioca-pillary. Are presented in order of frequency, arteriovenous malformations, cavernous angiomas or cavernomas, venous angiomas and telangiectasias. This paper describe the case of a 3 year old boy diagnosed with multiple peripheral cerebral cavernous angio-matosis right with different clinical symptoms such as focal motor seizures, left hemiparesis, among others related to this pathology. Multiple cavernous angiomatosis has been described in adult patients, it is clear then that the case report contributes to the literature identifying special characteristics of clinical presentation and management in pediatric patients.

El impacto de la detección de disfunción endotelial en la aterosclerosis: estudio mediante tomografía por emisión de positrones / Impact of the detection of endothelial dysfunction in atherosclerosis: Assessment by positron emission tomography

El endotelio juega un papel importante en la regulación del líquido intracelular, la permeabilidad vascular, en la modulación del tono vascular focal y la angiogénesis. La disfunción endotelial se manifiesta por la pérdida de la capacidad del endotelio de modular el comportamiento fisiológico del lecho vascular y actualmente se considera un marcador pronóstico de la enfermedad arterial coronaria. La relevancia de estudiar la disfunción endotelial radica en que ésta se ha observado en diversas patologías como diabetes mellitas (DM), dislipidemia, hipertensión arterial sistémica, tabaquismo o en enfermedades inmunológicas como síndrome antifosfolípido y lupus eritematoso sistémico. La Tomografía por Emisión de Positrones (PET) es un método no invasivo que permite cuantificar en términos absolutos el flujo miocárdico en reposo, esfuerzo y durante la estimulación adrenérgica, siendo considerado en la actualidad el estándar de oro para valorar la función endotelial. Por lo tanto el PET es una herramienta diagnóstica muy útil en identificar a los pacientes con disfunción endotelial y en evaluar la respuesta a la terapia administrada en enfermedades que se acompañen de ésta. Permitiendo un control óptimo y prevención de eventos adversos de estas enfermedades.

The endothelium plays an important role in the regulation of the intracellular fluid, vascular permeability, and modulation of vascular focal tone and angiogenesis. Endothelial dysfunction is manifested by the loss of the endothelium ability to modulate physiology changes in its vascular bed, and actually it is considered a prognostic marker of coronary artery disease. The relevance of assessing endothelial dysfunction relies in that it has been observed in different pathologies like DM, dyslipidemia, hypertension, tabaquism and in immunologic diseases like antiphospholipid syndrome and systemic lupus. PET is a non invasive method that allows the absolute quantification of myocardial blood flow during rest, stress and adrenergic stimulation, which allows to asses endothelial function. Therefore PET is a useful diagnostic technique to identify patients with endothelial dysfunction, and in the assessment of its response to administered therapy, allowing an optimal control and prevention of secondary adverse events of these diseases.

Importancia de la detección de viabilidad miocárdica: evaluación con tomografía por emisión de positrones con 18F-FDG / Value of the assessment of myocardial viability: evaluation with positron emission tomography 18F-FDG

It used to be thought that the consequences of coronary artery disease were final, and that the prognosis of the patient was limited to the extent of the ventricular dysfunction. This paradigm changed radically when the concept of hibernating myocardium was introduced, which states the existence of tissue that can regain contractile function after being re-vascularized. This introduced a new concept in cardiology: myocardial viability. This work presents a clear example of the importance of detecting myocardial viability in selected patients, due to the impact not only in treatment but in prognosis as well. It is also emphasized that positron emission tomography (PET) is the gold standard method to detect myocardial viability.

Tomografía computada multidetector de arterias coronarias: estado del arte. Parte II: Aplicaciones clínicas / Multidetector computed tomography of coronary arteries: state of the art. Second part: clinical applications

At the beginning of the evaluation of Coronary Artery Disease (CAD), Coronary Multidetector Computed Tomography (MDCT) was exclusively used to detect calcified plaques in coronary arteries through the Calcium Score, whose value by itself is limited. Nowadays, thanks to the technological advancements, potential clinical applications, with this method, include detection of coronary arterial stenosis, assessment of coronary bridges, and evaluation of anomalous coronaries. The intraluminal coronary stent evaluation is not possible yet, but this might become possible with the new-generation scanners. At the moment, the published results seem to be promising, nonetheless, the enthusiasm generated by this method should be accompanied by adequate training, as well as by its validation and certification.