Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

The Re-Identification of Previously Unidentifiable Clinical Non-Tuberculous Mycobacterial Isolates Shows Great Species Diversity and the Presence of Other Acid-Fast Genera.

Non-tuberculous mycobacteria that cannot be identified at the species level represent a challenge for clinical laboratories, as proper species assignment is key to implementing successful treatments or epidemiological studies. We re-identified forty-eight isolates of Ziehl-Neelsen (ZN)-staining-positive "acid-fast bacilli" (AFB), which were isolated in a clinical laboratory and previously identified as Mycobacterium species but were unidentifiable at the species level with the hsp65 PCR restriction fragment length polymorphism analysis (PRA). As most isolates also could not be identified confidently via 16S, hsp65, or rpoB DNA sequencing and a nBLAST search analysis, we employed a phylogenetic method for their identification using the sequences of the 16S rDNA, which resulted in the identification of most AFB and a Mycobacterium species diversity not found before in our laboratory. Most were rare species with only a few clinical reports. Moreover, although selected with the ZN staining as AFB, not all isolates belonged to the genus Mycobacterium, and we report for the first time in Latin America the isolation of Nocardia puris, Tsukamurella pulmosis, and Gordonia sputi from sputum samples of symptomatic patients. We conclude that ZN staining does not differentiate between the genus Mycobacterium and other genera of AFB. Moreover, there is a need for a simple and more accurate tree-based identification method for mycobacterial species. For this purpose, and in development in our lab, is a web-based identification system using a phylogenetic analysis (including all AFB genera) based on 16S rDNA sequences (and in the future multigene datasets) and the closest relatives.

Ventilación mecánica invasiva en COVID-19, ¿una estrategia mortal? / Invasive mechanical ventilation in COVID-19, a deadly strategy? / Ventilação mecânica invasiva no COVID-19, uma estratégia mortal?

Resumen Desde la epidemia de poliomielitis de Copenhague en 1952, los cuidados intensivos no habían enfrentado un desafío tan importante desde el punto de vista médico y mediático como la pandemia por COVID-19, la cual ha tenido consecuencias devastadoras; una de ellas es el desborde en la capacidad de las Unidades de Cuidados Intensivos y, como resultado, la posibilidad de ofrecer ventilación mecánica ha sido insuficiente; además, las características avasallantes y rápidamente cambiantes de la información médica y no médica, al igual que la mortalidad relacionada a la enfermedad, han desarrollado una narrativa deletérea al tratamiento de estos pacientes con apoyo ventilatorio invasivo, lo que ha hecho resurgir viejas cuestiones sobre ésta como lesiones inducidas por ventilación mecánica invasiva. Todo esto ha promovido la revivificación del apoyo ventilatorio no invasivo como medida salvadora; sin embargo, como veremos en esta aproximación a la luz de la evidencia, es errónea y puede resultar deletérea no sólo para el paciente, sino también para el personal de salud que cuida de éstos.

Abstract Since the Copenhagen polio epidemic in 1952, intensive care has not faced as important a challenge from a medical and media point of view as the COVID-19 pandemic, which has had devastating consequences, one of which is the overflow in the capacity of Intensive Care Units, and as a result of the capacity to offer mechanical ventilation has been insufficient, in addition to the overwhelming and rapidly changing characteristics of medical and non-medical information, also of disease-related mortality, has developed a deleterious narrative to the treatment of these patients with invasive ventilatory support and raising old questions about this as injuries induced by invasive mechanical ventilation. All this has promoted the rise of non-invasive ventilatory support as a saving lifes strategy, however, as we will see, this approach, in scope of the evidence, is erroneous and can be hazardous not only for the patient but also for health personnel who care for them.

Resumo Desde a epidemia de poliomielite em Copenhague em 1952, a terapia intensiva não enfrenta um desafio tão importante do ponto de vista médico e midiático como a pandemia de COVID-19, que teve consequências devastadoras, sendo uma delas o transbordamento da capacidade de terapia intensiva unidades, e com isso a possibilidade de oferta de ventilação mecânica tem sido insuficiente, além das características avassaladoras e em rápida mudança das informações médicas e não médicas, bem como a mortalidade relacionada à doença, desenvolveu uma narrativa deletéria ao tratamento da esses pacientes com suporte ventilatório invasivo e ressurgiu antigas questões sobre o mesmo, como as lesões induzidas pela ventilação mecânica invasiva. Tudo isso tem promovido o renascimento do suporte ventilatório não invasivo como medida de economia, porém, como veremos, essa abordagem, à luz das evidências, é errônea e pode ser deletéria não só para o paciente, mas também para o pessoal de saúde quem cuida deles.

Biochemical basis of differential selenium tolerance in arugula (Eruca sativa Mill.) and lettuce (Lactuca sativa L.).

Selenium (Se) biofortification in crops provides a valuable strategy to enhance human Se intake. However, crops vary greatly with their capacity in tolerating and metabolizing/accumulating Se, and the basis underlying such variations remains to be fully understood. Here, we compared the effects of Se and its analog S treatments on plant growth and biochemical responses between a Se accumulator (arugula) and a non-accumulator (lettuce). Arugula exhibited an increased biomass production in comparison with untreated controls at a higher selenate concentration than lettuce (20 µM vs. 10 µM Na2SeO4), showing better tolerance to Se. Arugula accumulated 3-folds more Se and S than lettuce plants under the same treatments. However, the Se/S assimilation as assessed by ATP sulfurylase and O-acetylserine (thiol)lyase activities was comparable between arugula and lettuce plants. Approximately 4-fold higher levels of Se in proteins under the same doses of Se treatments were observed in arugula than in lettuce, indicating that Se accumulators have better tolerance to selenoamino acids in proteins. Noticeably, arugula showed 6-fold higher ascorbate peroxidase activity and produced over 5-fold more glutathione and non-protein thiols than lettuce plants, which suggest critical roles of antioxidants in Se tolerance. Taken together, our results show that the elevated Se tolerance of arugula compared to lettuce is most likely due to an efficient antioxidant defense system. This study provides further insights into our understanding of the difference in tolerating and metabolizing/accumulating Se between Se accumulators and non-accumulators.

A rare case of spinal tuberculosis due to Mycobacterium bovis. Is zoonotic tuberculosis underdiagnosed?

We report a rare presentation of Pott's disease caused by M. bovis, suggesting transmission from infected cattle, and only the second case described so far in scientific reports. Noteworthy of this case was that the strain was only isolated on Stonebrink medium, a sodium pyruvate-containing culture medium for the isolation of mycobacteria. This medium is frequently ignored in diagnostic laboratories and in the laboratory manuals of most international health organizations. In general laboratories use a culture medium that contains glycerol, a carbon substrate considered inhibitory for the growth of M. bovis. The use of glycerol-containing medium therefore likely contributes towards underestimating zoonotic tuberculosis. Our case suggests that, in order to improved surveillance efforts for zoonotic TB and increase the notification rate for M. bovis to human TB, the use of pyruvate-containing media should be promoted, particularly in developing countries with a high prevalence of bovine TB, but also through the World Health Organization' (WHO) End TB Strategy and the Roadmap for Zoonotic TB.

Case-Case Comparison of Candida auris Versus Other Candida Species Bloodstream Infections: Results of an Outbreak Investigation in Colombia.

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast that causes outbreaks in healthcare settings around the world. In 2016, clinicians and public health officials identified patients with C. auris bloodstream infections (BSI) in Colombian healthcare facilities. To evaluate potential risk factors and outcomes for these infections, we investigated epidemiologic and clinical features of patients with C. auris and other Candida species BSI. METHODS: We performed a retrospective case-case investigation in four Colombian acute care hospitals, defining a case as Candida spp. isolated from blood culture during January 2015-September 2016. C. auris BSI cases were compared to other Candida species BSI cases. Odds ratio (OR), estimated using logistic regression, was used to assess the association between risk factors and outcomes. RESULTS: We analyzed 90 patients with BSI, including 40 with C. auris and 50 with other Candida species. All had been admitted to the intensive care unit (ICU). No significant demographic differences existed between the two groups. The following variables were independently associated with C. auris BSI: ≥ 15 days of pre-infection ICU stay (OR: 5.62, CI: 2.04-15.5), evidence of severe sepsis (OR: 3.70, CI 1.19-11.48), and diabetes mellitus (OR 5.69, CI 1.01-31.9). CONCLUSION: Patients with C. auris BSI had longer lengths of ICU stay than those with other candidemias, suggesting that infections are acquired during hospitalization. This is different from other Candida infections, which are usually thought to result from autoinfection with host flora.

Identificación de Helicobacter pylori a partir de lesión aterosclerótica coronaria humana / Identification of Helicobacter pylori from human coronary aterosclerótica injury

Introducción:El principal mecanismo patogénico que subyace la génesis y desarrollo de enfermedades del sistema circulatorio es la aterosclerosis. Es un proceso patológico complejo y progresivo de la pared arterial que afecta especialmente a las arterias coronarias, cerebrales y periféricas.Actualmente se habla sobre "La hipótesis infecciosa de la aterosclerosis". La infección por Helicobacter pyloriha sido una de las más investigadas a nivel global. Objetivo:Identificar H. pyloria partir de lesiones ateroscleróticas de pacientes que acuden a los servicios de cirugía cardiovascular y angiología de la ciudad de Barranquilla.Métodos:Se realizó un estudio descriptivo de corte transversal.En una muestra de 102 participantes.Los ateromas fueron tomados por personal experto en endarterectomía y disección de vasos sanguíneos. Los especímenes fueron embebidos en solución formaldehído al 4%.Se realizó extracción de ADN a partir de ateromas. El diagnóstico molecular de H. Pylorise realizó por PCR ANIDADA, evidenciando un fragmento de 120 pb posterior a la electroforesis en gel de agarosa al 3,5% en TBE 0,5X. Resultados:Se obtuvieron 102 muestras de ateromas. Una muestra resultó positiva para H. pylori(Muestra #14; 1/102).El tejido aterosclerótico fue obtenido a partir de arteria coronaria derecha. Conclusión: La hipótesis infecciosa de la aterosclerosis ha sido uno de los principales temas de investigación a nivel mundial en las últimas décadas. La infección por H. pylori es un factorde riesgo, sin embargo, varios estudios son necesarios para poder concluir de manera más precisa.

Introduction:The main pathogenic mechanism underlying the genesis and development of diseases of the circulatory system is atherosclerosis. It is a complex and progressive pathological process of the arterial wall that affects especially the coronary, cerebral and peripheral arteries. Currently, there is talk about "The infectious hypothesis of atherosclerosis". Helicobacter pyloriinfection has been one of the most researched worldwide. Objective:To identify H. pylori from atherosclerotic lesions of patients who attend the cardiovascular and angiology services of the city of Barranquilla. Methods:A descriptive cross-sectional study was carried out. In a sample of 102 participants. The atheromas were taken by expert personnel in endarterectomy and dissection of blood vessels. The specimens were embedded in 4% formaldehyde solution. DNA extraction was performed from atheromas. The molecular diagnosis of H. pyloriwas performed by ANIDADA PCR, evidencing a 120 bp fragment after electrophoresis in a 3.5% agarose gel in 0.5X TBE. Results:102 samples of atheromas were obtained. One sample was positive for H. pylori (Sample # 14, 1/102). The atherosclerotic tissue was obtained from the right coronary artery. Conclusion:The infectious hypothesis of atherosclerosis has been one of the main research topics worldwide in recent decades. H. pyloriinfection is a risk factor, however, several studies are necessary to be able to conclude more accurately

Citicolina, ¿deberíamos seguir indicándola en ECV isquémica? / Citicolina, devemos continuar a indicá-lo nA DCbV isquemica? / Citicoline, should we continue to indicate it in ischemic CVD?

Resumen: La enfermedad cerebrovascular (ECV) isquémica es una condición médica que implica, según su grado, discapacidad importante para el paciente, además de altos costos para su tratamiento agudo y crónico, así como en el manejo de la discapacidad con alta incidencia y prevalencia a nivel mundial. Desde el punto de vista fisiopatológico, representa una catástrofe en el funcionamiento cerebral que involucra daño estructural y funcional. Se han desarrollado múltiples estrategias para el manejo de esta patología; actualmente, el estándar de oro para su manejo es el rt-PA; sin embargo, por sus características, pocos pacientes tienen acceso al mismo. Razón por la que se han desarrollado estrategias farmacológicas diversas para su manejo: la citicolina se ha usado durante años, no obstante, genera controversias dado que su utilidad, demostrada en estudios experimentales, no se ha reproducido en la práctica clínica; más aún, algunos estudios sugieren que podría empeorar el pronóstico del paciente, lo que justificaría el abandono de su uso en el tratamiento de ECV isquémica (ictus). Por tal motivo ofrecemos esta revisión del tema con el fin de brindar herramientas que permitan aclarar dicha controversia.

Abstract: Ischemic cerebrovascular disease (CVD) is a medical condition that, according to its extension, implies significant disability for the patient, as well as high costs for its acute and chronic treatment, as well in the management of disability, with high incidence and worldwide prevalence, from the physiopathological point of view represents a catastrophe in brain functioning that involves structural and functional damage. Multiple strategies have been developed for the management of this pathology, currently the gold standard for its management is the rt-PA, however, due to its characteristics, and few patients have access to it, because it various pharmacological strategies have been developed. Citicoline has been used for years, nevertheless generates controversies since its usefulness, demonstrated in experimental studies, has not been reproduced in clinical practice but some studies suggest that it could worsen the patient's prognosis, which would justify the abandonment of its use in the treatment of ischemic CVD (ictus), for this reason we offer this review of the subject in order to provide tools to clarify this controversy.

Resumo: A doença cerebrovascular (DCbV) isquêmica é uma condição clínica que de acordo com sua extensão, implica em uma significativa incapacidade para o paciente, ademais de altos custos para seu tratamento agudo e crônico, bem como no manejo da incapacidade com alta incidência e prevalência a nível mundial. Do ponto de vista fisiopatológico representa uma catástrofe no funcionamento do cérebro que envolve danos estruturais e funcionais. Múltiplas estratégias têm sido desenvolvidas para o tratamento dessa patologia, atualmente o padrão ouro para o seu manejo é o rt-PA, porém, devido às suas características, poucos pacientes têm acesso a ele, razão pela qual várias estratégias farmacológicas foram desenvolvidas, a citicolina vem sendo utilizada há anos, gera controvérsias, uma vez que sua utilidade, demonstrada em estudos experimentais não foi reproduzida na prática clínica, mas alguns estudos sugerem que ela poderia piorar o prognóstico do paciente, o que justificaria o abandono do seu uso no tratamento de DCbV isquêmica (ictus), por esse motivo oferecemos esta revisão, a fim de fornecer ferramentas para esclarecer esta controvérsia.

The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration.

BACKGROUND: Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction. AIM: To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD. METHODS: From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed. OUTCOMES: Outcome analysis was focused on penile length restoration, penile curvature correction, intra- and postoperative complications, and patient satisfaction. RESULTS: 138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55° (range = 0-90°). Mean subjective penile length loss reported was 3.2 cm (range = 1-5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6-36 months). Mean penile length gain was 3.1 cm (range = 2-5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up. CLINICAL IMPLICATIONS: The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth. STRENGTHS AND LIMITATIONS: The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up. CONCLUSIONS: The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery. Egydio PH, Kuehhas FE. The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration. J Sex Med 2018;15:261-269.

Diagnóstico molecular de infección por virus herpes simplex tipo 1 en tejido aterosclerótico humano / Molecular diagnosis of infection by herpes simplex type 1 virus in human aterosclerótico tissue

Introducción:Las enfermedades del sistema circulatorio representan uno de los mayores problemas de salud pública a nivel mundial, nacional y regional. Elmecanismo patogénico que subyace esta patología es la aterosclerosis. Existenvarios factores que favorecen la etiopatogeniade la lesión aterosclerótica.Las infecciones, juegan un papel importante.La infección por el Virus del Herpes Simplexse ha considerado como un factor de riesgo emergente. Objetivo:Realizar diagnósticomolecular de infección porVirus Herpes Simplex tipo 1 y tipo 2en tejido aterosclerótico humano.Método:Se realizó extracción de ADN viral a partir de ateromas usando el kit comercial PureGenomeTM Tissue DNA Extraction.La amplificación delmaterial genético viralse realizó porPCR en tiempo real (qPCR) con el kit comercial "Human Herpes Virus 2 (Herpes simplex type 2)UL36 region genesig Standard Kit y Human Herpes Virus 1 (Herpes simplex type 1) Capsid assembly and DNA maturation gene. Genesig Standard Kit".Resultados:En total se obtuvieron 102 muestras de ateromas, extraídas de diferentes fuentes anatómicas. Tresmuestras resultaronpositivas para VHS tipo 1(3/102).Ninguna muestra evidenció material genético para VHS tipo 2 (0/102). Conclusión:La etiopatogenia de la aterosclerosis es un proceso altamente complejo.Los virus juegan un papel importante, en especial la infección por Virus del herpes simplex tipo 1. La infección por estevirus genera cambios a nivel de las células vasculares y no vasculares, favoreciendo el acumulo de lipoproteínas de baja densidad químicamente oxidadas, importantespara la aterogénesis

Introduction:Diseases of the circulatory system represent one of the greatest public health problems worldwide, nationally and regionally. The pathogenic mechanism that underlies this pathology is atherosclerosis. There are several factors that favor the etiopathogeny of the atherosclerotic lesion. Infections play an important role. Infection with Herpes Simplex Virus has been considered as an emerging risk factor. Objective: To perform molecular diagnosis of infection by Herpes Simplex virus type 1 and type 2 in human atherosclerotic tissue. Method:Viral DNA extraction was performed from atheromas using the commercial PureGenomeTM Tissue DNA Extraction kit. The amplification of the viral genetic material was performed by real-time PCR (qPCR) with the commercial kit "Human Herpes Virus 2 (Herpes simplex type 2) UL36 region genesig Standard Kit and Human Herpes Virus 1 (Herpes simplex type 1) Capsid assembly and DNA maturation gene Genesig Standard Kit ". Results:A total of 102 samples of atheromas were obtained, extracted from different anatomicalsources. Three samples were positive for HSV type 1 (3/102). No sample showed genetic material for HSV type 2 (0/102). Conclusion:The etiopathogenesis of atherosclerosis is a highly complex process. Viruses play an important role, especially the infection by Herpes simplex virus type 1. The infection by this virus generates changes at the level of vascular and non-vascular cells, favoring the accumulation of chemically oxidized low density lipoproteins, important for the atherogenesis

Coevolution between flight morphology, vertical stratification and sexual dimorphism: what can we learn from tropical butterflies?

Occurrence patterns are partly shaped by the affinity of species with habitat conditions. For winged organisms, flight-related attributes are vital for ecological performance. However, due to the different reproductive roles of each sex, we expect divergence in flight energy budget, and consequently different selection responses between sexes. We used tropical frugivorous butterflies as models to investigate coevolution between flight morphology, sex dimorphism and vertical stratification. We studied 94 species of Amazonian fruit-feeding butterflies sampled in seven sites across 3341 ha. We used wing-thorax ratio as a proxy for flight capacity and hierarchical Bayesian modelling to estimate stratum preference. We detected a strong phylogenetic signal in wing-thorax ratio in both sexes. Stouter fast-flying species preferred the canopy, whereas more slender slow-flying species preferred the understorey. However, this relationship was stronger in females than in males, suggesting that female phenotype associates more intimately with habitat conditions. Within species, males were stouter than females and sexual dimorphism was sharper in understorey species. Because trait-habitat relationships were independent from phylogeny, the matching between flight morphology and stratum preference is more likely to reflect adaptive radiation than shared ancestry. This study sheds light on the impact of flight and sexual dimorphism on the evolution and ecological adaptation of flying organisms.

Reestenosis de la arteria coronaria descendente anterior en mujeres diabéticas / Left anterior descending coronary artery restenosis in diabetic women

Resumen Las mujeres diabéticas con la enfermedad arterial coronaria sometidas a revascularización tienen mayor riesgo de reestenosis debido a las alteraciones fisiopatológicas a nivel vascular propias de la diabetes, a la disminución del efecto protector de los estrógenos después de la menopausia y porque el calibre de sus arterias es menor que el de las no diabéticas y menor que el de los hombres. El objetivo de este artículo es comparar la tasa de reestenosis en la arteria coronaria descendente anterior en las mujeres diabéticas que se sometieron a intervención coronaria percutánea más el stent, frente a la cirugía de revascularización. Para ello se realizó una revisión de la literatura utilizando artículos publicados en bases de datos científicas, que compararan las dos técnicas, haciendo énfasis en la población diabética femenina. Encontrando que hubo una ventaja de la cirugía de revascularización sobre la intervención coronaria percutánea en los eventos de revascularización de la lesión diana (OR 0,253, IC 95% 0,092-0,703, p = 0,008) y revascularización del vaso diana (OR 0,185, 95% CI 0,079 a 0,432, p < 0,001), correspondiente a una ventaja en la presentación de evento cardiovascular y cerebrovascular (OR 0,429, CI 95% 0,254-0,723, p = 0,001). Finalmente, se hizo un análisis crítico, concluyendo que la cirugía de revascularización es la técnica de elección en las pacientes diabéticas puesto que tiene una tasa de reestenosis menor y con ello menos eventos adversos que de esta se derivan.

Abstract Women with diabetes and coronary artery disease who undergo revascularization have a higher risk of restenosis due to the pathophysiological alterations at vascular level inherent to diabetes, to the decrease of the protective effect of estrogens after menopause and to the caliber of their arteries being smaller than women without diabetes or men. The goal of this study is to compare the rate of restenosis in anterior descending coronary artery in women with diabetes who underwent percutaneous coronary intervention and the stent, compared to revascularization surgery. For that a literature review was carried out using medical articles published in scientific databases where both techniques were compared, and focusing on female population with diabetes. Results showed there was an advantage for the revascularization surgery versus percutaneous coronary intervention in the revascularization events of the target lesion (OR 0.253, IC 95% 0.092-0.703, p = 0.008) and revascularization of the target vessel (OR 0.185, 95% CI 0.079 a 0.432, p <0.001), corresponding to an advantage in the presentation of the cardiovascular and cerebrovascular event (OR 0.429, CI 95% 0.254-0.723, p = 0.001). Finally, a critical analysis was conducted, thus concluding that revascularization is the chosen technique for female patients with diabetes because of the lower restenosis rate, avoiding its adverse events.

[Sleep quality in an adult population exposed to the noise of El Dorado Airport, Bogotá, 2012]. / Calidad del sueño en una población adulta expuesta al ruido del Aeropuerto El Dorado, Bogotá, 2012.

INTRODUCTION: The airport of Bogotá lies within the city and its expansion could produce an increase in adverse effects on the health of the inhabitants of Fontibón and Engativá districts due to the noise it generates. OBJECTIVE: To determine the prevalence of sleep disturbances and associated factors among residents of Fontibón exposed to this noise. MATERIALS AND METHODS: A cross-sectional study design was used, involving a sample of 205 people aged 18 to 65, selected by means of stratified random sampling. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Descriptive statistics were carried out, as well as correlation tests between the different scales. RESULTS: A total of 60% of the residents reported poor quality sleep (PSQI>5), with a mean PSQI of 7.19 (SD=3.931), and the following pathological interruptions were found: subjective sleep quality, 27%; sleep latency, 39%; sleep duration, 33%; habitual sleep efficiency, 37%; sleep alterations, 30%; diurnal dysfunction, 40%, and use of sleeping medication, 5%. According to the Epworth Sleepiness Scale (ESS>10), 28% of residents reported daytime somnolence. Regarding the prevalence of poor quality sleep according to the Pittsburgh Sleep Quality Index, 17% of those who reported not being able to sleep because of noise associated this with air traffic. A correlation was observed between the index and the scale ( r =0.329, CI 95%: 0.20-0.44). CONCLUSIONS: Inhabitants of the district reported poor sleep quality due to exposure to noise, airport operations being one of the main generating sources. Noise mitigation strategies in the district need to be reviewed and the public health implications of the El Dorado Airport expansion should be considered.

Calidad del sueño en una población adulta expuesta al ruido del Aeropuerto El Dorado, Bogotá, 2012 / Sleep quality in an adult population exposed to the noise of El Dorado Airport, Bogotá, 2012

Introducción. El Aeropuerto de Bogotá está dentro de la ciudad y su ampliación podría representar un aumento de los efectos adversos del ruido sobre la salud de los habitantes de las localidades de Fontibón y Engativá. Objetivo. Conocer la prevalencia de los trastornos del sueño y los factores asociados en residentes de Fontibón expuestos al ruido del Aeropuerto El Dorado. Materiales y métodos. Se hizo un estudio de corte transversal con una muestra de 205 personas de 18 a 65 años de edad, seleccionada mediante muestreo aleatorio estratificado. La calidad del sueño se evaluó mediante el índice de calidad del sueño de Pittsburgh (ICSP) y la escala de somnolencia de Epworth (ESE). Se hicieron análisis estadísticos descriptivos y pruebas de correlación entre estos instrumentos. Resultados. El 60 % de los residentes informaron mala calidad del sueño según el índice de calidad del sueño de Pittsburgh (ICSP>5), con una media de 7,19 (desviación estándar, DE=3,931), y se encontraron puntuaciones patológicas así: calidad subjetiva del sueño, 27 %; latencia del sueño, 39 %; duración del sueño, 33 %; eficiencia habitual del sueño, 37 %; alteraciones del sueño, 30 %; disfunción diurna, 40 %, y uso de hipnóticos, 5 %. Según la escala de somnolencia de Epworth (ESE>10), se reportó 28 % de somnolencia diurna. Con relación a la prevalencia de la mala calidad del sueño según el índice, 17 % de quienes reportaron no dormir debido al ruido lo asoció al tráfico aéreo. Se encontró correlación entre el índice y la escala ( r =0,329, IC 95% 0,20-0,44). Conclusiones. Los habitantes de la localidad presentaron mala calidad del sueño por exposición al ruido, siendo la operación aeroportuaria una de las principales fuentes generadoras. Es necesario revisar las estrategias de mitigación de ruido en la localidad y considerar las implicaciones de la ampliación del Aeropuerto El Dorado para la salud pública.

Introduction: The airport of Bogotá lies within the city and its expansion could produce an increase in adverse effects on the health of the inhabitants of Fontibón and Engativá districts due to the noise it generates. Objective: To determine the prevalence of sleep disturbances and associated factors among residents of Fontibón exposed to this noise. Materials and methods: A cross-sectional study design was used, involving a sample of 205 people aged 18 to 65, selected by means of stratified random sampling. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Descriptive statistics were carried out, as well as correlation tests between the different scales. Results: A total of 60% of the residents reported poor quality sleep (PSQI>5), with a mean PSQI of 7.19 (SD=3.931), and the following pathological interruptions were found: subjective sleep quality, 27%; sleep latency, 39%; sleep duration, 33%; habitual sleep efficiency, 37%; sleep alterations, 30%; diurnal dysfunction, 40%, and use of sleeping medication, 5%. According to the Epworth Sleepiness Scale (ESS>10), 28% of residents reported daytime somnolence. Regarding the prevalence of poor quality sleep according to the Pittsburgh Sleep Quality Index, 17% of those who reported not being able to sleep because of noise associated this with air traffic. A correlation was observed between the index and the scale ( r =0.329, CI 95%: 0.20-0.44). Conclusions: Inhabitants of the district reported poor sleep quality due to exposure to noise, airport operations being one of the main generating sources. Noise mitigation strategies in the district need to be reviewed and the public health implications of the El Dorado Airport expansion should be considered.

Penile lengthening and widening without grafting according to a modified 'sliding' technique.

OBJECTIVE: To present the feasibility and safety of penile length and girth restoration based on a modified 'sliding' technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). PATIENTS AND METHODS: Between January 2013 and January 2014, 143 patients underwent our modified 'sliding' technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow-shaped tunical defects with Buck's fascia only. RESULTS: In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0-100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1-7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow-up was 9.7 (6-18) months. The mean (range) penile length gain was 3.1 (2-7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6-month follow-up. CONCLUSION: Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.

Distal penile shaft reconstruction and reinforcement: the "double-windsocks" technique.

INTRODUCTION: The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons. AIM: To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis. METHODS: Between August 2007 and August 2012, 69 patients underwent surgery for penile prosthesis protrusion (45 patients) or severe distal corporal fibrosis (24 patients). The mean age at the time of surgery was 56 years (range 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks"). MAIN OUTCOME MEASURES: Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. RESULTS: Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases. Neuropraxia was reported in five cases (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively. CONCLUSION: The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.

Treatments for fibrosis of the corpora cavernosa.

INTRODUCTION: Corporal fibrosis usually occurs after explantation of an infected penile prosthesis, severe penile trauma, refractory low-flow priapism, Peyronie's disease, or the chronic intracavernous injection of vasoactive drugs. METHODS: We analysed current treatmentss for penile fibrosis. We searched PubMed using the keywords 'penile corporal fibrosis', 'treatment' and 'penile fibrosis', resulting in 63 matches, of which 19 articles met the inclusion criteria. RESULTS AND CONCLUSIONS: This review covers conservative medical therapy for corporal fibrosis and surgical therapeutic methods. The roles of phosphodiesterase- 5 inhibitors and pentoxifylline are analysed. Surgical therapy includes implantation of a penile prosthesis and corporal reconstruction, and these are reviewed. Corporal fibrosis is a major problem for patients, and is associated with severe erectile dysfunction. Conservative treatment options can be applicable in the early phase, but simultaneous corporal reconstruction procedures with concomitant implantation of a penile prosthesis should be attempted in severe cases of corporal fibrosis.

Penile length and girth restoration in severe Peyronie's disease using circular and longitudinal grafting.

OBJECTIVE: To report patient outcomes and satisfaction with our technique for penile length and girth restoration in severe Peyronie's disease (PD). PATIENTS AND METHODS: Between November 2006 and November 2011, 105 men with severe PD and erectile dysfunction (ED) underwent surgical correction using our new approach. The technique consists of penile prosthesis implantation with concomitant penile lengthening and girth restoration through circular and longitudinal incisions in the tunica albuginea according to geometric principles. RESULTS: The overall patient satisfaction rate was 89.4%. The mean (sd; range) functional penile length gain was 3.6 (0.7; 2-5) cm. Patient satisfaction with penile length gain was 95.2%. Three patients (2.9%) developed retraction with residual curvature of up to 30°, but no re-operation was necessary. In one (1%) patient, the prosthesis had to be removed because of wound infection. At a mean (sd; range) follow-up of 18.2 (5.9; 6-46) months, 104 patients (99%) were able to have sexual intercourse. CONCLUSIONS: Our surgical approach for penile length and girth restoration leads to high patient satisfaction rates and excellent functional outcomes. Our surgical approach is a safe and valid therapeutic method for the treatment of severe PD associated with ED.

Edaphic and arboricolous oribatid mites (Acari; Oribatida) in tropical environments: changes in the distribution of higher level taxonomic groups in the communities of species.

We analysed the community of oribatid mites in 25 environments of northern Brazil and one in a rain forest in Peru, encompassing fauna sampled on natural and artificial (nylon-mesh bags) substrata, from primary and secondary forests, caatinga, savannahs, flooded forests, bark and epiphytes of trees, and polyculture. A hundred and forty six species are definitively identified from a total of 444 taxa. To determine changes in the community, we took as a basis of comparison the species dominance of Lower Oribatida vs. Oppioidea and Lower Oribatida vs. Poronota. Even considering the different periods in which the inventories were realized and the different sampling methodology compared, the partition of the species of Oribatid mite in larger groups shows tendencies indicating partition of species dominance among the environments studied, showing that they differed in their suitability as habitats for the Oribatid mite community, mainly in respect to the Lower Oribatida, Oppioidea and Poronota composition. These tendencies should be explored in more detail as more becomes known about the species composition in each environment.

Edaphic and arboricolous oribatid mites (Acari; Oribatida) in tropical environments: changes in the distribution of higher level taxonomic groups in the communities of species

We analysed the community of oribatid mites in 25 environments of northern Brazil and one in a rain forest in Peru, encompassing fauna sampled on natural and artificial (nylon-mesh bags) substrata, from primary and secondary forests, caatinga, savannahs, flooded forests, bark and epiphytes of trees, and polyculture. A hundred and forty six species are definitively identified from a total of 444 taxa. To determine changes in the community, we took as a basis of comparison the species dominance of Lower Oribatida vs. Oppioidea and Lower Oribatida vs. Poronota. Even considering the different periods in which the inventories were realized and the different sampling methodology compared, the partition of the species of Oribatid mite in larger groups shows tendencies indicating partition of species dominance among the environments studied, showing that they differed in their suitability as habitats for the Oribatid mite community, mainly in respect to the Lower Oribatida, Oppioidea and Poronota composition. These tendencies should be explored in more detail as more becomes known about the species composition in each environment.

Analisou-se comunidade de ácaros oribatídeos em 25 ambientes do Norte do Brasil e em uma floresta no Peru, compreendendo fauna de substratos naturais e artificiais (sacos de malha) coletada em florestas primárias, florestas secundárias, caatinga, savanas, florestas inundáveis, casca e epífitas de árvores e policultivo. Cento e quarenta e seis espécies são definitivamente identificadas de um total de 444 taxa. Foram comparadas as dominâncias de espécies de Oribatida Inferior vs. Oppioidea e Oribatida Inferior vs. Poronota para determinar as mudanças na comunidade. Mesmo considerando os diferentes períodos dos inventários e as diferentes metodologias de coleta comparadas, a partição de espécies de Oribatida em grandes grupos mostra tendências que podem ser indicadoras da partição da dominância entre os ambientes estudados, indicando que eles diferiram em suas qualidades como habitat para a comunidade de ácaros oribatídeos, principalmente no que diz respeito à composição dos Oribatida Inferiores, Oppioidea e Poronota. Essas tendências devem ser exploradas com mais detalhes à medida que se conheça mais sobre a composição das espécies em cada ambiente.