[Intravenous lines in transfusion and their medical devices]. / Les voies d'abord transfusionnelles et leurs dispositifs médicaux.

Treatment by blood transfusion first requires an intravenous cannula. Professionals remember the optimal diameter for transfusion (16 to 18G). Practices differ according to the department concerned. Neonatology and paediatric wards use precision filters and put in fine cannulas (24G) with the constraint that this restricts transfusion flow rate. In haematology and oncology departments, the state of the patient's veins has to be considered when administering chemotherapy which may be toxic for vascular endothelium and the implantation of a venous port by a critical care anaesthetist may be suggested. Emergency departments use central venous catheters, blood warmers and, exceptionally, intraosseous infusion which is now being used again. Haemodialysis requires repeated vascular access making the creation of arteriovenous fistula necessary. We wanted to have an overview of all the different techniques potentially used in the departments of a health institution. These medical devices are managed by the pharmacies in our institutions.

Malformaciones del oído externo y medio en pediatría: características clínico audiológicas y tratamiento / External and middle ear malformations in pediatrics: Clinical and audiological features and treatment

Objetivo: Describir las características clínicas y audiológicas de los pacientes que presentan malformaciones del oído externo y medio. Detallar la intervención con procesadores de conducción ósea y los distintos implantes como tratamiento para niños con hipoacusia auditiva moderada conductiva o mixta debido a este tipo de anomalías congénitas. Material y métodos: Se realizó un estudio prospectivo, longitudinal y observacional de 223 pacientes consecutivos con malformación auricular bilateral o unilateral atendidos en una primera consulta o en seguimiento desde octubre de 2013 hasta noviembre de 2014. Los datos a analizar de estos pacientes incluyeron: edad, sexo, existencia de otras malformaciones o síndromes asociados, uni o bilateralidad de la malformación, clasificación de la misma en grados, características del conducto auditivo externo, del nervio facial y la existencia de colesteatoma. Se realizaron evaluaciones audiológicas adecuadas para la edad madurativa del paciente. Se describen los distintos tratamientos realizados (procesadores de conducción ósea con vincha o implante). Resultados: 33% (73/223) presentó malformación auricular bilateral, con una mediana de edad de 2 años (rango 1-14 años). El 67%, (150/223)) presentó malformación auricular unilateral: 49/150 en el lado izquierdo; 101/150 en el lado derecho, con una mediana de edad de 7 años, (rango 1-16 años). El 43% (96/223) sexo femenino y el 57% por ciento (127/223) sexo masculino. El 31% (23/73) de los niños con malformación bilateral y el 16% (24/150) de los niños con malformación unilateral presentaban síndromes congénitos. Con respecto al grado de malformación, 56% de los pacientes presentaron malformación auricular grado III/IV, 28% malformación grado II y 16% malformación grado I. En el 68% de los casos presentaban atresia de conducto auditivo externo, 20% estenosis severa y 12% estenosis leve con malformación de oído medio. El 3,5% de los pacientes (5/223) tenía parálisis facial. El 4,5% de los pacientes (8/223) presentó colesteatoma en un conducto auditivo externo con estenosis severa. Se diagnosticó hipoacusia conductiva o mixta moderada en el 98,6% de los oídos con malformación. El 1,4% presentó hipoacusia neurosensorial. Dieciocho niños con malformación bilateral menores de 18 meses de vida fueron equipados con dispositivos de conducción ósea con vincha. En cuatro de estos pacientes los dispositivos provistos fueron bilaterales. En los niños mayores de cinco años se indicó cirugía de implante en 14 casos. En casos unilaterales se indicó procesador de sonido con vincha en seis niños menores de 18 meses de vida. Cinco de ellos ya han sido proporcionados y la están utilizando. En niños mayores de cinco años se indicó cirugía con implantes osteointegrados en 6 casos (AU)

Objective: To describe the clinical and audiological features of patients presenting with external and middle ear malformations. To detail the intervention with bone conduction processors and different implants in the treatment of children with moderate conductive or mixed hearing loss, conductive or mixed due to this type of congenital anomalies. Material and methods: A longitudinal, prospective, observational study was conducted in 223 consecutive patients with bilateral or unilateral aural malformations seen at the first visit or in follow-up between October 2013 and November 2014. The following data were analyzed: age, sex, associated malformations or syndromes, uni- or bilaterality of the malformation, classification of the malformation, characteristics of the external ear canal, the facial nerve, and presence of cholesteatoma. Adequate audiological evaluations for age were performed. The different management options are described (bone conduction devices with headband or implant). Results: 33% (73/223) presented with a bilateral ear malformation at a median age of 2 years (range, 1-14 years); 67% (150/223)) had a unilateral ear malformation: 49/150 on the left side and 101/150 on the right side, at a median age of 7 years (range, 1-16 years). Overall, 43% (96/223) were female and 57% (127/223) were male. Of all the children, 31% (23/73) with a bilateral malformation and 16% (24/150) with unilateral malformation had congenital syndromes. Regarding the degree of malformation, 56% of the patients had a grade III/IV ear malformation, 28% a grade II malformation, and 16% a grade I malformation; 68% of the cases had external ear canal atresia, 20% severe stenosis, and 12% mild stenosis with a middle ear malformation; 3.5% of patients (5/223) had facial paralysis; 4.5% (8/223) had cholesteatoma in the external ear canal with severe stenosis. Moderate conductive or mixed hearing loss was diagnosed in 98.6% of the ears with malformation. Sensorineural hearing loss was observed in 1.4%. Eighteen children with bilateral malformation under 18 months of age were fitted with a bone conduction device with a headband. Four of these patients needed bilateral devices. In 14 children over five years of age, implant surgery was indicated. In six children under 18 months of age with a unilateral malformation, a sound processor with headband was indicated. Five of them have already been fitted with the device. mplantation of a bone-anchored hearing aid was indicated in six children over five years of age (AU)

Actualización en la prevalencia de trastornos del equilibrio en pediatría / Update on the prevalence of balance disorders in pediatrics

Las alteraciones del equilibrio son una causa muy común de consulta en pacientes adultos pero mucho menos habitual en la población pediátrica. Cuando esta sintomatología aparece en los niños genera gran preocupación, tanto en los padres, como en los profesionales consultados. Objetivo: Exponer nuestra casuística en alteraciones del equilibrio en pacientes pediátricos y enunciar las patologías prevalentes dividiendo la muestra en grupos etarios. Materiales y Métodos: Se realizó un estudio retrospectivo, observacional, descriptivo y transversal. Se incluyeron pacientes entre 1 y 17 años que consultaron al servicio de otorrinolaringología de un Hospital Pediátrico de alta complejidad entre junio de 2014 y junio de 2017. Resultados: Se incluyeron en el estudio 247 pacientes entre 1 y 17 años; 123/247 (49%) niñas y 124/247 (51%) varones. La mediana de edad fue de 9 años. Los síntomas más frecuentes en la consulta fueron: vértigo (63/247); cefaleas (44/247) y la asociación de vértigo + cefaleas (43/247). Las patologías prevalentes fueron: cefaleas 55/247; cerebelitis aguda 30/247; vértigo paroxístico benigno de la Infancia 21/247; migraña vestibular 21/247. Conclusiones: Ante la presencia de un niño con alteraciones del equilibrio, es muy importante la historia clínica y un minucioso examen otoneurológico pensando en cada prueba qué área o sistema estamos evaluando y dónde estaría localizada la lesión (vía vestíbulo-ocular; vía vestíbulo-espinal, etc.). Es importante diferenciar, dado que es la causa de consulta más frecuente, que no todo paciente que presenta cefaleas y síntomas vestibulares asociados tiene como diagnóstico una migraña vestibular (AU)

Balance disorders are a common reason for consultation in adult patients but are much less frequent in children. When children present with these symptoms it causes great concern, both in the parents and in the professionals consulted. Objective: To present our series of pediatric patients with balance disturbance and to describe the different underlying disorders dividing the patients according to age. Material and methods: A retrospective, observational, descriptive and cross-sectional study was conducted. Patients between 1 and 17 years of age who consulted at the Department of Otolaryngology at a tertiary care hospital between June 2014 and June 2017 were included. Results: 247 patients between 1 and 17 years of age were included in the study; 123/247 (49%) girls and 124/247 (51%) males. Median age was 9 years. The most frequent symptoms at consultation were: Vertigo (63/247); Headaches (44/247), and an association of vertigo + headaches (43/247). The most common diagnosis were: headaches 55/247; acute cerebellitis 30/247; benign paroxysmal vertigo of childhood 21/247; vestibular migraine 21/247. Conclusions: In a child with a balance disorder, the diagnostic interview and a thorough oto-neurological examination are important considering what area or system is evaluated in each test and where the lesion may be located (vestibulo-ocular tract; vestibulo-spinal tract, etc.). Differentiation is important as, considering is the most frequent reason for consultation, not every patient who presents with headache associated with vestibular symptoms has vestibular migraine (AU)

Pólipo y/o granuloma aural en niños. Estudio prospectivo en 75 casos / Aural polyp and/or granuloma in children. A prospective study of 75 cases

En otorrinolaringología (ORL) infantil es habitual el hallazgo de pólipos y granulomas de oído en niños que consultan especialmente por otorrea de evolución prolongada. El pólipo y/o granuloma aural es una masa de carácter inflamatorio, que ocupa parte de la luz del conducto auditivo externo, generalmente pediculado, de aspecto congestivo, a veces friable y fácilmente sangrante, cuyo origen generalmente es a nivel de la mucosa del oído medio. Con el objetivo de describir las características clínicas, otológicas, bacteriológicas e histopatológicas de los pólipos y granulomas de oído diagnosticados en un servicio de ORL pediátrico se realizó un estudio prospectivo, descriptivo, observacional y longitudinal. Se estudió a la población pediátrica con diagnóstico de pólipo y/o granuloma aural en su primera consulta en el servicio de ORL del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Se incluyeron 75 pacientes en el estudio, evaluados consecutivamente desde el 02 de diciembre 2013 y hasta 30 enero del 2015, con una edad media: 93 meses (rango 2­180). Se realizó otomicroscopía y, en los casos de granulomas y pólipos accesibles, se realizó toma de muestra para estudio bacteriológico e histopatológico y evaluaciones audiológicas y radiológicas con tomografía computarizada (TC) en los casos necesarios. Se indicó el tratamiento médico o quirúrgico adecuado a cada patología. El motivo de consulta principal fue la otorrea como único síntoma en el 81,33% de los casos y, en menor porcentaje, asociada a otros síntomas. Tiempo medio de evolución de los síntomas: 13,5 meses (rango 1-96). No se pudo extraer material en el 20% de los pacientes. Se tomaron muestras para estudio de 60/75 granulomas óticos accesibles. El informe anatomo-patológico fue: granuloma o pólipo inflamatorio en el 50%, tejido epidermoide compatible con colesteatoma en el 41,7%, tuberculosis (TBC) en 3,3%, granuloma por cuerpo extraño en 1,7%, histiocitosis de células de Langerhans (HCL) en 3,3% muestras de pólipos. Se realizó estudio bacteriológico en 57/75 casos. Se desarrollaron gérmenes en 52/57 cultivos. El 32,7% (17/52) fueron cultivos polimicrobianos. Dos casos desarrollaron Mycobacterium tuberculosis. Se observó velamiento de caja, ático o mastoides con erosión ósea en el 46,2% (24/52) de los casos evaluados con TC. Diagnóstico final: colesteatoma 39 pacientes, OMA con pólipo de Scheibe o complicada con mastoiditis 16, OMC simple granulomatosa 13, TBC 2, HCL 2, otitis externa y celulitis en conducto auditivo externo 2 y granuloma a cuerpo extraño 1. Conclusiones: es importante obtener el diagnóstico histológico y microbiológico de los pólipos aurales en niños precozmente para excluir neoplasia u otras enfermedades granulomatosas específicas y evitar cirugías que pueden provocar secuelas al no estar indicadas en el tratamiento adecuado de ciertos tumores e infecciones (AU)

In pediatric otolaryngology (ENT) ear polyps and granulomas are a common finding in children who consult especially for prolonged otorrhea. The aural polyp and/or granuloma is an inflammatory mass occupying part of the lumen of the external auditory canal. It is usually pedunculated, congestive, sometimes friable, and may bleed easily. Its origin is usually at the level of the mucosa of the middle ear. With the aim to describe the clinical, otological, bacteriological, and histopathological features of ear polyps and granulomas diagnosed in a Department of pediatric ENT, a longitudinal, prospective, descriptive, observational study was conducted. Pediatric patients diagnosed with an aural polyp and/or granuloma at the first visit at the Department of ENT of Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" were studied. Seventy-five patients were included in the study, evaluated consecutively from December 2, 2013 to January 30, 2015; Mean age was 93 months (range 2 ­ 180). Otomicroscopy was performed and, in cases of accessible granulomas and polyps, a sample was taken for bacteriological and histopathological study. Audiological and radiological evaluations with computed tomography (CT scan) were performed when necessary. Appropriate medical or surgical treatment was indicated accordingly. The main reason for the consultation was otorrhea as the only symptom in 81.33% of cases and, in a lesser percentage, associated with other symptoms. Mean time from symptom onset to diagnosis: 13.5 months (range 1-96). No sample could be harvested in 20% of patients. Samples were taken for study of 60/75 accessible ear granulomas. Pathology report was: Inflammatory granuloma or polyp in 50%, epidermoid tissue compatible with cholesteatoma in 41.7%, tuberculosis (TBC) in 3.3%, granuloma due to a foreign body in 1.7%, and Langerhans cell histiocytosis (LHC) in 3.3% of the samples of polyps. Bacterial cultures, performed in 57/75 cases, were positive in 52/57. Polymicrobial microorganisms were found in 32.7% (17/52). Mycobacterium tuberculosis was found in two cases. Opacification of the antrum, attic, and mastoid cavities with bone erosion was observed in 46.2% (24/52) of the cases evaluated with CT. Final diagnosis: Cholesteatoma in 39 patients, OMA with a Scheibe polyp or complicated with mastoiditis in 16, simple granulomatous OMC in 13, TBC in 2, LHC in 2, external otitis and cellulitis in the external ear canal in 2, and granuloma due to a foreign body in 1. Conclusions: Histological and microbiological diagnosis of aural polyps in children should be obtained early to rule out neoplasia other granulomatous diseases to avoid surgery that may cause sequelae and is not the adequate management of certain tumors and infections (AU)

Fibroangioma nasofaríngeo juvenil. Experiencia en 89 pacientes / Juvenile nasopharyngeal angiofibroma. An experience of 89 patients

El fibroangioma nasojuvenil (FANJ) es un tumor benigno, localmente invasivo, que se presenta en varones púberes y adolescentes. Se manifiesta clínicamente por insuficiencia ventilatoria nasal progresiva y epistaxis. Con el objetivo de describir las características clínico quirúrgicas se realizó un estudio observacional, retrospectivo, transversal de los FANJ intervenidos quirúrgicamente en el período enero 2000 a diciembre 2017 en el Hospital de Pediatría Juan P. Garrahan. Resultados: se incluyeron 89 pacientes con diagnóstico de fibroangioma nasojuvenil intervenidos quirúrgicamente. El 71% de los pacientes menores de 14 años. El síntoma predominante fue epistaxis en el 91% de los casos. El 80,1% (72/89) estaban incluidos en los estadios III y IV de Chandler presentando digitaciones a fosa pterigomaxilar y senos paranasales. El 29,2% (26/89) de los casos presentaba invasión a endocráneo. En el 96% (86/89) se realizó embolización prequirúrgica de las ramas nutricias del tumor. Los abordajes quirúrgicos más utilizados fueron: la vía transantral en el 43,8% (39/89), abordaje de Le Fort 1 en el 21,3% (19/89), endoscópico en el 12,3% (11/89), abordaje combinado con neurocirugía en el 12,3% (11/89) de los pacientes. La recurrencia fue de 33,7% y no hubo pacientes fallecidos. Conclusiones: El fibroangioma nasojuvenil es una patología tumoral que requiere para su resolución un equipo multidisciplinario en instituciones con infraestructura de alta complejidad. El abordaje quirúrgico debe seleccionarse de acuerdo a la localización y extensión tumoral, la efectividad de la embolización previa, la edad del paciente y la experiencia del equipo quirúrgico (AU)

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, locally invasive tumor, occurring in pubertal and adolescent males. Clinically the tumor manifests with progressive nasal obstruction and epistaxis. With the aim to describe the clinical and surgical features, an observational, retrospective, cross-sectional study was conducted in patients with JNA who underwent surgery at Hospital de Pediatría Juan P. Garrahan between January 2000 and December 2017. Results: Overall, 89 patients diagnosed with JNA who underwent surgery were included; 71% were under 14 years of age. The main symptom was epistaxis occurring in 91% of the cases. Of all patients, 80.1% (72/89) were in Chandler stages III and IV with extension into the pterygomaxillary fossa and paranasal sinuses. Intracranial invasion was found in 29.2% (26/89) of the cases. In 96% (86/89), preoperative embolization of the feeding branches of the tumor was performed. The most commonly used surgical approaches were: The transantral approach in 43.8% (39/89), Le Fort 1 in 21.3% (19/89), endoscopic approach in 12.3% (11/89), and an approach combined with neurosurgery in 12.3% (11/89) of patients. Recurrence rate was 33.7% and none of the patients died. Conclusions: Management of JNA a multidisciplinary team at a tertiary care institution. The surgical approach should be selected according to tumor location and extension, effectiveness of previous embolization, the patient age, and expertise of the surgical team (AU)

Amigdalo adenoidectomía en pacientes con comobilidades / Adenotonsillectomy in patients with comorbidities

La adenoamigdalectomía es una de las cirugías más frecuentemente realizadas en los pacientes menores de 15 años. Es considerada una cirugía de mediana complejidad. No está exenta de riesgos y sus indicaciones deben ser muy bien evaluadas: la obstrucción de la vía aérea superior causada por hiperplasia y las infecciones bacterianas recurrentes son las indicaciones más frecuentes de amigdalectomía, y adenoidectomía. Objetivo: Describir las características clínico-epidemiológicas de la población a quien se le practica adeno-amigdalectomía portadores de hipertrofia amigdalina y vegetaciones adenoideas (HAVA) en el Hospital J.P Garrahan, sus complicaciones y el tiempo de estadía hospitalaria. Materiales y métodos: estudio descriptivo, observacional, retrospectivo y transversal, con revisión de Historias clínicas de los pacientes adeno-amigdalectomizados entre Enero 2015 a Marzo 2016. Resultados: Se realizó amigdalectomía y/o adenoidectomía en 68 pacientes. 36 masculinos, 32 femeninos. 93% (63/68) presentaban comorbilidades. El 7% (5/68) eran niños previamente sanos. Promedio de edad: 12,5 años (rango 1-16 años), mediana de edad 6 años. Tipos de comorbilidades: síndromes genéticos 18/63, antecedente de transplantes sólidos o alogénicos de médula ósea 12/63, obesidad 6/68, patología de base con compromiso muscular 4/63, patologías hematológicas 2/63, pacientes neurológicos 12/63, otros 9/63. Presentó sangrado en el postoperatorio inmediato 1/68. El tiempo de internación promedio fue de 3 días (AU)

Adenotonsillectomy is one of the most frequently performed surgeries in patients under 15 years of age. It is considered an intermediate surgery that is not devoid of risks and its indications should be well evaluated. Upper airway obstruction caused by hyperplasia and recurrent bacterial infections are the most common indications for tonsillectomy and adenoidectomy. Objective: To describe the clinical and epidemiological features of a series of patients who underwent adenotonsillectomy at Hospital J. P. Garrahan because of tonsillar hypertrophy and adenoid vegetation (THAV) assessing complications and the time of hospital stay. Material and methods: A descriptive, observational, retrospective and cross-sectional study was conducted consisting of a review of the clinical charts of patients who underwent adenotonsillectomy between January 2015 and March 2016. Results: Tonsillectomy and/or adenoidectomy was performed in 68 patients. 36 male, 32 female. Overall, 93% (63/68) presented with comorbidities; 7% (5/68) were previously healthy children. Mean age: 12.5 years (range, 1-16 years), median age: 6 years. Type of comorbidity: genetic syndromes 18/63, history of solid organ or allogeneic bone marrow transplantation 12/63, obesity 6/68, underlying muscular disorder 4/63, hematological disorders 2/63, neurological disorders 12/63, others 9/63. One patient had a hemorrhage in the immediate postoperative period 1/68. Mean hospital stay was 3 days (AU)

¿Qué es un implante coclear? / What is a cochlear implant?

La hipoacusia representa un importante problema de salud. La dificultad de oír y comunicarse es frustrante para las personas provocando aislamiento social, baja autoestima y muchas veces se acompaña de depresión. Según la Organización Mundial de la Salud (OMS), hoy en día se estima que 360 millones de personas en el mundo viven con pérdida auditiva incapacitante. En Argentina nacen aproximadamente 700.000 chicos por año; de estos, entre 1 y 3 de cada mil tienen hipoacusia. La discapacidad auditiva constituye el 18 por ciento de las discapacidades en el país, la cual se reparte en un 86,6 por ciento de dificultad auditiva y un 13,4 por ciento de sordera. El implante coclear es un producto sanitario implantable activo, de alta tecnología y precisión, encaminado a restablecer la audición de aquellas personas que padezcan una sordera causada por la destrucción de las células ciliadas de la cóclea, estimulando directamente las células ganglionares (nervio auditivo) mediante señales eléctricas encargadas de transmitir la información codificada al cerebro. Hay que recordar que, al ser una prótesis, no cura definitivamente la sordera. Hay muy pocas tecnologías sanitarias que se hayan desarrollado tan rápidamente como el Implante Coclear (AU)

Hearing loss is a major health problem. Difficulties in hearing and communicating are frustrating leading to social isolation, low self-esteem and are often associated with depression. According to the World Health Organization (WHO), currently it is estimated that 360 million people in the world live with disabling hearing loss. In Argentina, approximately 700,000 children are born per year; of these, between 1 and 3 each 1,000 have hearing loss. Hearing impairment accounts for 18 percent of disabilities in the country, of which 86.6% consists of hearing loss and 13.4% of deafness. The cochlear implant is a high-technology and high-precision active implantable device aimed at restoring the hearing in individuals who suffer from deafness caused by the destruction of the ciliated cells of the cochlea, directly stimulating the ganglion cells (auditory nerve) through electrical signals that transmit codified information to the brain. It is important to consider that, being a prosthesis, it does not definitively cure deafness. There are very few technological health devices that have been developed as rapidly as the cochlear implant (AU)

Insights into the genome and proteome of Sphingomonas paucimobilis strain 20006FA involved in the regulation of polycyclic aromatic hydrocarbon degradation.

In order to study the mechanisms regulating the phenanthrene degradation pathway and the intermediate-metabolite accumulation in strain S. paucimobilis 20006FA, we sequenced the genome and compared the genome-based predictions to experimental proteomic analyses. Physiological studies indicated that the degradation involved the salicylate and protocatechuate pathways, reaching 56.3% after 15 days. Furthermore, the strain degraded other polycyclic aromatic hydrocarbons (PAH) such as anthracene (13.1%), dibenzothiophene (76.3%), and fluoranthene. The intermediate metabolite 1-hydroxy-2-naphthoic acid (HNA) accumulated during phenanthrene catabolism and inhibited both bacterial growth and phenanthrene degradation, but exogenous-HNA addition did not affect further degradation. Genomic analysis predicted 126 putative genes encoding enzymes for all the steps of phenanthrene degradation, which loci could also participate in the metabolism of other PAH. Proteomic analysis identified enzymes involved in 19 of the 23 steps needed for the transformation of phenanthrene to trichloroacetic-acid intermediates that were upregulated in phenanthrene cultures relative to the levels in glucose cultures. Moreover, the protein-induction pattern was temporal, varying between 24 and 96 h during phenanthrene degradation, with most catabolic proteins being overexpressed at 96 h-e. g., the biphenyl dioxygenase and a multispecies (2Fe-2S)-binding protein. These results provided the first clues about regulation of expression of phenanthrene degradative enzymes in strain 20006FA and enabled an elucidation of the metabolic pathway utilized by the bacterium. To our knowledge the present work represents the first investigation of genomic, proteomic, and physiological studies of a PAH-degrading Sphingomonas strain.

Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial.

The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12 months (p value = 0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12 months (p value = 0.0003) and between pre-therapy and 12 months (p value = 0.0215). There were not significant differences between the two groups in terms of survival time (p value = 0.883), while the pain level in MWA group was significantly less than in RFA group (1.79 < 3.25, p value = 0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.

Draft Whole-Genome Sequence of Sphingobium sp. 22B, a Polycyclic Aromatic Hydrocarbon-Degrading Bacterium from Semiarid Patagonia, Argentina.

Sphingobium sp. 22B is a polycyclic aromatic hydrocarbon-degrading strain isolated from Patagonia, Argentina, with capabilities to withstand the environmental factors of that semiarid region. The draft genome shows the presence of genes related with responses to carbon starvation and drying environmental conditions.

Infection by Paramphistomidae trematodes in cattle from two agricultural regions in NW Uruguay and NW Spain.

The analysis of infection by Paramphistomidae trematodes was conducted in two agricultural regions with different knowledge on this parasitosis. Faecal and blood samples were collected from 374 cattle in Salto (NW Uruguay) where there is a lack of information about paramphistomosis. A total of 429 cattle from Galicia (NW Spain), an area with previous records of infection by gastric flukes, were sampled. Diagnostics of trematodosis was developed by using a copromicroscopic probe and an ELISA with excretory/secretory antigens collected from adult Calicophoron daubneyi (Paramphistomidae) specimens. Results were evaluated according intrinsic and extrinsic factors. In the Uruguay, the percentage of cattle passing Paramphistomidae-eggs by faeces was 7% (95% Confidence Interval 5, 10). A significantly higher prevalence of paramphistomosis in the Hereford × Angus cattle (OR=3.5) was recorded, as observed for the oldest ruminants (>3.5 years). An overall seroprevalence of 29% (25, 34) was obtained by ELISA, with the highest values in the Friesians (OR=3), the youngest bovines (<2.5 years) and dairy cattle (Friesians). Twenty-six percent (22, 30) of the cattle from Spain passed eggs by faeces, and cattle aged 2.5-7 years reached significant highest prevalences. By means of the ELISA, a percentage of 55 cattle (50, 59) had antibodies against the gastric fluke, and the highest seroprevalence was observed among the bovines under 6 years. It is concluded that paramphistomosis is on the increase in cattle from NW Spain, partly due to the absence of an effective treatment against the trematode. There is a need for reducing the risk of infection by Paramhistomidae spp. in cattle from Uruguay, especially by improving their management to avoid exposure to the gastric trematode. Further studies are in progress for identifying the species of Paramphistomidae affecting ruminants in Uruguay.

Daño celular en una población infantil potencialmente expuesta a pesticidas / Cell damage in a pediatric population potentially exposed to pesticides

Los pesticidas pueden producir efectos agudos o crónicos en la salud humana. Muchos de ellos pueden provocar daño en el material genético. Esta modificación en la información genética se ha relacionado con un alto riesgo de padecer cáncer. El objetivo del presente trabajo es indagar el daño en el material genético de una población infantil expuesta potencialmente a pesticidas en el ambiente. El diseño metodológico fue de tipo observacional y transversal. Participaron en el estudio 48 niños expuestos potencialmente a pesticidas y 46 niños no expuestos. Se obtuvo muestra de la mucosa bucal para determinar daño en el material genético a través de la frecuencia de micronúcleos (MN). Se encontró en el grupo expuesto potencialmente a pesticidas un promedio mayor de micronúcleos (5,1±2,9 vs 1,8±2,0; p<0,0001), un promedio mayor de células binucleadas, (3,5±2,7 vs 1,4±1,4; p<0,0001), mayor frecuencia de cariorrexis (18,2±18,4 vs 5,8±18,4; p<0,004) y picnosis (24,8± 18,0 vs 17,1±8,3; p<0,03). El 40% (19/47) de los niños expuestos potencialmente a pesticidas tuvieron un tiempo de exposición de 6 años. Esta investigación aporta evidencias de daño genético en la población expuesta potencialmente a pesticidas en el ambiente.

Pesticides can cause acute or chronic effects on human health. Many pesticides can cause damage to genetic material. These changes in genetic information have been associated with an increased risk of cancer. The objective of this study is to investigate damage to genetic material in a population of children potentially exposed to pesticides in the environment. The study design was observational and cross sectional. We studied 48 children potentially exposed to pesticides and 46 unexposed children. Samples of the oral mucosa were obtained to determine damage to genetic material using micronucleus frequency (MN).Higher average micronucleus counts were found in the group potentially exposed to pesticides (5.1±2.9 vs. 1.8±2.0, p <0.0001), along with a higher average of binucleate cells (3.5±2.7 vs. 1.4±1.4 p <0.0001), higher frequency of karyorrhexis (18.2±18.4 vs. 5.8± 18.4, p <0.004) and pyknosis (24.8±18.0 vs. 17.1±8.3; p <0.03).Of the children potentially exposed to pesticides, 40% (19/47) had an exposure time of 6 years. This study provides evidence of genetic damage in the population potentially exposed to pesticides in the environment.

Malformaciones congénitas asociadas a agrotóxicos / Congenital malformations associated with pesticides

Estudiar la asociación entre la exposición a pesticidas y malformaciones congénitas en neona nacidos en el Hospital Regional de Encarnación Itapúa- Paraguay.

Ribosomal RNA characterization in the leech Hirudo medicinalis.

In the present study the ribosomal RNA of the leech Hirudo medicinalis has been characterized at the aim of identifying possible analogies with other invertebrates. Upon electrophoresis on denaturating gels, ribosomal RNA fraction of H. medicinalis exhibited a remarkable thermal instability by dissociating into two hydrogen-bonded components when heated at 60 degrees C, at variance with the behaviour of the rat rRNA, which does not show this process. This result suggests a functional role in leech ribosome organisation that requires deeper structural studies.

Manejo de la hiperbilirrubinemia neonatal por pediatras que realizan atención inmediata del recién nacido / Management of neonatal hyperbilirubinemia by pediatricians providing immediate care of the newborn

El objerivo fue evaluar el conocimiento de las normas recomendadas por la AAP sobre el manejo de la hiperbilirrubinemia en recién nacidos de término y casi término. Se aplicó encuesta en la ciudad de Asunción y el área metropolitana, a pediatras y neonatólogos que realizan atención inmediata del recién nacido, y a residentes en formaón de diferentes centros de atención del área metropolitana durante el mes de agosto del año 2004 e incluyó a profesionales de práctica hospitalaria y privada. Resultados: El 24,4 porcientos (ptos) eran residentes en formación; el 38,6 ptos refirió haber realizado 2 o más años de residencia en neonatología; según los años de recibido el 60 ptos tenían 10 años o menos de recibido y el 41 ptos tenían 10 o más años de recibido. Las respuestas correctas en más del 80 ptos de la pobalción encuestada están referidas a la recomendación de seguir con lactancia materna si está ictérico y sin deshidratación en 92,1 ptos; la edad en horas del RN como el mejor criterio para interpretar los valores de bilirrubina (Bna) en 98,4 ptos; cuando descienda el 30 porcientos del valor inicial de bilirrubina para la suspensión de fototerapia en RN sin ictericia hemolítica en 90,4 ptos. Las respuestas correctas en menos del 80 ptos hacen relación a la conducta ante un RN con menos de 24 horas de vida y bilirrubina de 5,5 mg/dl 28 ptos; el control del RN ictérico sano entre las 48-72 horas del alta 57,5 ptos; el dosaje de bilirrubina total sola y no las fracciones 0,8 ptos; considerar que los primeros 4 días es el periodo de mayor riesgo de desarrollar encefalopatía o hiperbilirrubinemia severa 14,5 ptos; recomendar tubos fluorescentes verdes o azules 33 ptos; significado apropiado de luminoterapia intensiva 71 ptos; considerar la Bna total sola para indicar la fototerapia 19,4 ptos; el control de Bna entre las 4-8hs de fototerapia intensiva 70 ptos; la suspensión de la luz para la alimentación durante la fototerapia convencional 63 ptos; conocer otro tratamiento además de la exanguinotransfusión y luminoterapia para tratar la hiperbilirrubinemia 43 ptos; conocer cómo medir la dosis de radiación 14 ptos; conocimiento de factores de riesgo de 12 ptos; la alimentación frecuente (8-12 veces al día) para prevenir la hiperbilirrubinemia 30 ptos. Conclusión: Escaso nivel de adhesión a las guías recomendadas por la AAP; no hubo diferencias significativas al comparar las repuestas entre pediatras, neonatólogos y según año de recibido

Psychological aspects of drug intolerance.

A consecutive unselected series of 50 patients suffering from drug intolerance was evaluated by allergological and psychological tests. We wanted to verify the existence of a correlation between some psychological characteristics (hysteria, depression and Ego Integrity), and some clinical aspects (number and type of episodes, severity and probability of the reactions). We confirmed the prevalence of female sex in these disorders, particularly in middle-aged married women. The mean score of hysteria in the whole sample was lightly higher than normal. Moreover a relevant number of subjects (24%) scored higher than the cut off for clinical depression, with a significant difference in comparison to the overall prevalence of depression in the general population. Finally, the analysis of clinical variables considered in our patients showed that subjects with a history of less serious reactions and unlikely reactions scored higher in depression and hysteria scales. The importance of psychological evaluation of drug intolerance patients is discussed and confirmed.

Season- and latitude-dependent effects of simulated twilights on circadian entrainment.

Groups of Syrian hamsters were exposed to LD cycles with twilight transitions and photoperiods simulating natural lighting conditions at the summer solstice (SS), equinox, and winter solstice (WS) at 41 degrees N and at the winter solstice at the Arctic Circle (WS 66 degrees N) but with daytime illuminance truncated at 10 lux (LD-twilight). Separate groups were kept under matching rectangular cycles (LD-rectangular). The inclusion of twilights affected several circadian parameters in a season-and latitude-dependent manner. The most striking difference was in the timing of activity onsets, which followed dusk in the presence of twilights but were more closely related to dawn (lights-on) in their absence. Activity offsets and midpoints were also earlier in LD-twilight than in LD-rectangular, with the differences being most pronounced under WS 66 degrees N. In LD-twilight, longer nights resulted in earlier offsets and midpoints, but in LD-rectangular, midpoints were later under long than under short nights while offsets did not vary significantly. In LD-twilight, activity duration (alpha) increased monotonically with increasing nighttime duration, but in LD-rectangular, alpha was shorter under WS 66 degrees N than under WS conditions. These effects of season and latitude observed in LD-twilight were similar to those reported in animals exposed to natural illumination, while those observed in LD-rectangular differed in several respects. The presence of twilights also resulted in lower day-to-day variability in activity onset times (greater precision), supporting the earlier conclusion that twilights increase the strength of the LD zeitgeber. Free-running periods in constant darkness (DD) were shorter in LD-twilight than in LD-rectangular, especially under WS 66 degrees N, raising the possibility that the effects of twilights on the timing of the entrained activity rhythm reflect their effects on the period of that rhythm. Increasing daytime illuminance to 100 lux (WS conditions only) resulted in earlier activity offsets and midpoints and a shorter alpha but had no effect on activity onsets or on subsequent period in DD. These results indicate that exposure to low twilight illuminances alone can account for several of the documented differences between the effects of natural and rectangular light cycles on circadian entrainment.