Cirugía endoscópica vs. cirugía abierta en pacientes con neoplasias nasosinusales malignas con invasión cerebral. Estudio de serie de casos / Endoscopic versus open surgery in patients with malignant sinonasal tumors and brain invasion. A case series study

Objetivos: Evaluar la efectividad, la seguridad y los costos perioperatorios del abordaje endonasal endoscópico en pacientes con tumores nasosinusales malignos con invasión cerebral. Pacientes y método: Se realizó un estudio observacional de serie de casos. Se compararon 30 pacientes con tumores nasosinusales malignos e invasión cerebral operados (2015-2017) mediante abordaje endoscópico con una serie histórica de 53 casos operados (2010-2015) mediante cirugía abierta. Se utilizó el método de emparejamiento por puntaje de propensión para controlar el efecto de factores pronósticos. Las variables de respuesta primaria fueron el control local y la supervivencia global a los tres años. Se analizaron variables de costo perioperatorio. Resultados: Después del emparejamiento se identificaron 50 pacientes (25 en cada grupo terapéutico) con edad promedio de 55 años, 62% de sexo masculino. Predominó el carcinoma de células escamosas y la invasión cerebral grado II. El control local de la enfermedad a los tres años, la supervivencia global y libre de progresión fueron superiores en el abordaje endoscópico. El abordaje endoscópico redujo el tiempo quirúrgico en 1 hora y 20 minutos y la estadía hospitalaria en 19 días en comparación con la cirugía abierta. El abordaje endoscópico mejoró la independencia funcional y redujo las complicaciones. El ahorro promedio estimado con el abordaje endoscópico fue de aproximadamente $7.355,18 por paciente. Conclusiones: El abordaje endonasal endoscópico constituye un procedimiento seguro, efectivo y más económico en los pacientes con neoplasias nasosinusales malignas e invasión cerebral (AU)

Objectives: To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumors patients. Materials and methods: This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumors patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. Results: A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 hour 20 minutes, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. Conclusions: Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion (AU)

Microhemangiomas iridianos: a propósito de un caso / Iris microhaemangiomas: presentation of a case

CASO CLÍNICO: Mujer de 74 años que acude por cuadro de visión borrosa en el ojo derecho, de 12 h de evolución, no acompañada de otra sintomatología. En la exploración biomicroscópica se observa un hipema de 3 mm en el ojo derecho y múltiples estructuras nodulares vasculares en el margen iridiano de ambos ojos. DISCUSIÓN: Los microhemangiomas vasculares iridianos son anomalías vasculares no relacionadas con la isquemia que deben ser incluidas en el diagnóstico diferencial de hipema espontáneo

CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema

[Iris microhaemangiomas: presentation of a case]. / Microhemangiomas iridianos: a propósito de un caso.

CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema.

Co-simulación del Diseño Biomecánico para un Exoesqueleto Robótico del Miembro Inferior / Co-simulation of Biomechanical Design for a Robotic Exoskeleton for the Lower Limb

Este trabajo muestra como la co-simulación incrementa las ventajas y decrementa las desventajas para el diseño del exoesqueleto. La metodología propuesta tiene tres estados: el diseño de la parte biomecánica, el diseño mecánico y el sistema de control Para el análisis biomecánico, OpenSim® resuelve el sistema musculo-esquelético e incluye modelos para diferentes condiciones que pueden ser usados en el diseño de procesos. SolidWorks® que es aplicado en diseños asistidos por computadora evalúa la parte mecánica y Matlab® resuelve el sistema de control del exoesqueleto. Esto permite conseguir un diseño personalizado, que simula los movimientos de una marcha completa cubriendo las restricciones cinemáticas para lograr un movimiento natural y las limitaciones del usuario cuando tienen algún problema para caminar. El resultado muestra como es aplicada la co-simulación para hacer un prototipo virtual, como se unen y dependen los programas uno del otro. Aunque la simulación convencional de cada programa puede ahorrar dinero y tiempo, estos no resuelven completamente los problemas de diseño del exoesqueleto; por lo tanto la co-simulación es una excelente opción para la biomecánica, la mecánica y los sistemas de control que necesitan exactitud y rapidez en cada parte del proceso de diseño.

This work shows how the co-simulation increases the advantages and decreases the drawbacks for exoskeleton design. The proposed methodology has three stages: the design of a biomechanical part, the mechanical design and the control system. For the biomechanical analysis, OpenSim ® solves the muscle-skeleton system and includes models for different conditions that can be used in the design process. SolidWorks® that is applied in assistive computer design evaluates the mechanical part of the exoskeleton and Matlab® solves the control system that takes over the exoskeleton. It allows getting a personalized design which simulates the complete walking movements, covering the kinematic restrictions to achieve a natural human movement and the user limitations when they have any problem for to walk. The results show how the co-simulation is applied to complete a virtual prototype and the programs are linked hand in hand. Although conventional simulation by one program can save money and time, it cannot solve the entire exoskeleton design problem; as a result the co-simulation is an excellent option in biomechanical, mechanical and control systems that need accurate and swift results in each part of the design process.

Antibacterial and free-radical scavenging activities of Sonoran propolis.

AIMS: To evaluate the antibacterial and free-radical scavenging (FRS) activities of propolis collected from three different areas of Sonoran Desert in northwestern Mexico [Pueblo de Alamos (PAP), Ures (UP) and Caborca (CP)]. METHODS AND RESULTS: The antibacterial and FRS activities of Sonoran propolis were determined by the broth microdilution method and the DPPH (1,1-diphenyl-2-picrylhydracyl) assay, respectively. Propolis samples had antibacterial activity against only Gram-positive bacteria. The UP sample showed the highest antibacterial activity against Staphylococcus aureus [minimal inhibitory concentration (MIC) 100 microg ml(-1)] in a concentration-dependent manner (UP > CP > PAP). Caffeic acid phenethyl ester (CAPE), a UP propolis constituent, had very high growth-inhibitory activity towards Gram-positive bacteria, particularly against S. aureus (MIC 0.1 mmol l(-1)). To our knowledge, this is the first study showing a strong antibacterial activity of CAPE against S. aureus. Additionally, propolis CP exhibited high FRS activity (86% +/- 0.3 at 100 microg ml(-1)) comparable with those of the reference antioxidants vitamin C (87.4% +/- 1.7 at 70 micromol l(-1)) and BHT (66.07% +/- 0.76 at 140 micromol l(-1)). The propolis compounds CAPE and rutin showed high FRS activity (90.4% +/- 0.2 and 88.5% +/- 0.8 at 70 micromol l(-1), respectively). CONCLUSIONS: Sonoran propolis UP and CAPE had strong antibacterial activity against S. aureus. In addition, propolis CP showed potent FRS activity comparable with those of vitamin C and BHT. SIGNIFICANCE AND IMPACT OF THE STUDY: The strong antibacterial and antioxidant properties of Sonoran propolis and some of its constituents support further studies on the clinical applications of this natural bee product against S. aureus and several oxidative damage-related diseases.

Mating asymmetry and the direction of evolution in the Hawaiian cricket genus Laupala.

Based on studies from native Hawaiian Drosophila, a model was proposed to explain sexual isolation and mating asymmetry, from which one could potentially infer the 'direction of evolution'. We examined sexual isolation between allopatric cricket species of the genus Laupala, another endemic Hawaiian insect with an elaborate mating system, to begin to explore the nature of sexual isolation and mating asymmetry in closely related Hawaiian organisms. We studied sexual isolation and mating asymmetry in two contrasts. First, an inter-island comparison, including L. makaio from the older island of Maui and L. paranigra from the younger island of Hawaii, and second, an intra-island (Hawaii) comparison, including L. nigra from the older volcano of Mauna Kea and L. paranigra with a primary distribution on the younger volcanoes of Mauna Loa and Kilauea. We used a 'no-choice' experimental design, pairing individual males and females in homospecific or heterospecific combinations. Several behavioural aspects of courtship (proportion of male singing, latency to male singing, production of spermatophores and courtship initiation speed) were quantified as well as the success or failure of matings. We demonstrate asymmetry in sexual isolation between reciprocal combinations of L. makaio and L. paranigra. This result is examined in light of the differences in courtship behaviour manifest in the experiments with these two species. We did not find evidence of asymmetry in sexual isolation between L. nigra and L. paranigra, although differences in courtship initiation speed were evident between reciprocal combinations of these two species. In addition to the geological argument that species on older islands and older volcanoes give rise to species on younger islands and younger volcanoes, we discuss phylogenetic evidence consistent with these biogeographic hypotheses of relationships among the focal taxa. The patterns of asymmetrical sexual isolation and mating asymmetry are consistent with those found in the native Hawaiian Drosophila.

[Detection of mental health problems in childhood]. / Detección de problemas de salud mental en la infancia.

OBJECTIVE: To validate the Report Questionnaire for children (RQC) in order to estimate the prevalence of childhood psychiatric disorders in Mexico. MATERIAL AND METHODS: The RQC was applied by random selection to parents of children in a specialized care service, in a general practice setting and in schools, during an urban household survey within the National Mental Health Survey (NMHS) conducted in 1988. The sample size of adults participating in the NMHS was 2,025. Fifty-two percent (1,068) reported having a child between 3 to 12 years old living in the household. The data collection instrument was applied to the oldest children in that range. The weighted mean was used for analysis and the unbiased prevalence was estimated using the formula proposed by Rogan and Gladen; predictive values were computed using a Bayesian expression. RESULTS: The estimated prevalence of mental health disorders for children aged 3 to 12 years old was between 16.4% and 20.7%. The Positive Predictive Value of the instrument ranged between 46.6% and 76.1%, depending of the cut-off points: one or more positive items in the questionnaire or two or more. The Negative Predictive Value (NPV) ranged between 91.6% and 99.2%. CONCLUSIONS: The estimates are very similar to those reported in different countries and the NPV supports the reliability of the estimates and the potential uses of the instrument for the early detection of childhood psychiatric disorders.

[Flour of hard bean (Phaseolus vulgaris) in the preparation of bread]. / Harina de frijol endurecido (Phaseolus vulgaris L.) en la preparación de pan.

In order to utilize hardened beans, we proposed to find the method most indicated for the preparation of bean flour to determine their nutritional value, and to make bread of high industrial, nutritional quality, and good sensory characteristics, using blends of bean and wheat flours. Two types of flour were prepared, testing four soaking temperatures (22, 30, 40 and 50 degrees C) and two methods to remove the testa (under moist and dry conditions). At laboratory level, the dry testa removal method gave the best flour yields (mean = 85.8%) and the highest protein content (mean = 23.7%). Comparison between soaking temperature at 30 and 50 degrees C was not significant (alpha = 0.05). At pilot plant level, with soaking at 50 degrees C the flour yields were 58.0% for moist testa removal (H1) and 74.0% for dry removal (H2), with a protein content of 22.6% for H1 and 23.0% for H2. The H1 and H2 flours were added to wheat flour at 5, 10 and 15% for bread making. The addition of 5.0% gave breads with similar protein content and sensory characteristics to those of the control, wheat. A diet based on bean-flour bread resulted in greater weight gains than that with casein for gold hamsters. The study also demonstrated the importance of heat-treating of the bean flours, because when flour without previous heat treatment was administered, the animals lost weight and died. This effect was overcome by the process of baking the flours at 140 degrees C for four hours.

Harina de frijol endurecido (Phaseolus vulgaris L.) en la preparación de pan / Flour of hard bean (Phaseolus vulgaris) in the bread preparation

Con el propósito de utilizar el frijol endurecido, se propuso la búsqueda del método indicado para obtener harinas de frijol, determinar su valor nutritivo y elaborar panes con mezclas de harina de frijol y trigo de buena calidad industrial, nutricional, y sensorial. Se elaboraron dos tipos de harina, ensayándose cuatro temperaturas de remojo (22, 30, 40 y 50§C) y dos métodos de separación de testa (húmedo y seco). A nivel de laboratorio la separación de testa en seco proporcionó los mejores rendimientos harineros (x = 85.8%) y el más alto contenido proteínico (x = 23.7%). La comparación entre las temperaturas de remojo de 30 y 50§C respecto al rendimiento de harina no fueron significativas (* = 0.05). A nivel de planta piloto, con el remojo de 50§C los rendimientos harineros fueron de 58.0% para la separación de testa en húmedo (H1) y 74.0% para la separación en seco (H2), con porcentajes de proteína de 22.6% y 23.0% para H2. Para elaborar el pan de caja se adicionaron 5, 10 y 15% de harinas H1 y H2 a la de trigo, encontrando que la mezcla con 5.0% de H1 presentaba una buena calidad panadera, proteínica y sensorial, semejante al pan control, de ...

[Evaluation and use of polyethylene glycol in constipated patients]. / Evaluación y uso del polietilen glicol en pacientes constipados.

We evaluated the efficiency of polyethylene glycol at low dosage for the treatment of chronic constipation. A prospective, randomized, double blind study was performed in 34 patients (32 female, 2 male) with the following inclusion criteria: age between 20-60 years, history of more than 5 years of constipation and no lower endoscopic findings of infections or malignancies. The solution was administered in a fasting state at the rate of 0.5 liters daily during 8 days. Patients were divided in 2 groups. Group 1 received placebo during the first week and PEG during the 2nd. week. Group 2 received PEG solution during the first week and placebo during the 2nd. A mean of 5.53 bowel movements was observed after placebo and 12.13 after PEG in group 1 (p < 0.005). A mean of 13.56 bowel movements were observed in group 2 after PEG and 7.73 after placebo (p < 0.001). Decreased consistency of the stools was seen after PEG in both groups (p < 0.001). According to our findings, low doses of PEG were useful and safe in the treatment of constipation, with few side effects.

The adverse effects of utilizing altitude-inappropriate fetal growth curves.

Some newborn nurseries located near sea level are utilizing the Denver (high altitude) fetal growth curve to identify and screen infants at high risk for hypoglycemia and/or polycythemia: small for gestational age (SGA) and large for gestational age (LGA) infants. It has been shown that this curve may underestimate the number of SGA infants. Neonates at high risk for these conditions may therefore go undetected and unscreened. To investigate this possibility, we evaluated the risk for hypoglycemia and polycythemia in 354 newborn infants, comparing a high altitude with a sea level fetal growth curve. Polycythemia was more common in SGA than in LGA and appropriate for gestational age (AGA) infants. By changing from a high altitude to a sea level curve in our sea level population, we were able to detect several hypoglycemia and/or polycythemic infants that would have been missed. No hypoglycemic LGA infants were missed that would not have been screened for other medical indications. If newborn nursery screening for hypoglycemia and polycythemia is to be performed only in high-risk infants (ie, LGA and SGA), an altitude-appropriate fetal growth curve should be used.

Tracheoesophageal fistula: diagnosis with CT.

A baby with two lower cervical tracheoesophageal fistulas was evaluated with a barium esophagram and computerized tomography (CT). The esophagram identified both fistulas. Axial CT demonstrated the esophageal attachment of the upper fistula and completely displayed the lower fistula. A change in caliber of the esophagus from a collapsed to a distended state marked the site of the fistulas.