Factores de riesgo cardiovascular en pacientes geriátricos atendidos en el centro de salud INNFA / Cardiovascular risk factors in geriatric patients attended at the INNFA health center / Factores de risco cardiovascular em doentes geriátricos atendidos no centro de saúde do INNFA

Los llamados factores de riesgo cardiovascular conductuales, como la dieta inadecuada, sedentarismo, el consumo excesivo de alcohol y el tabaquismo, aumentan la probabilidad de ataque cardíaco y accidente cerebrovascular, incluso cuando coexisten en personas sin padecimientos previos. Objetivo fue identificar los factores de riesgo cardiovascular en pacientes geriátricos del Centro de salud INNFA, en Macas, Ecuador. Metodología: Investigación con enfoque cuantitativo, diseño no experimental, alcance descriptivo, de corte transversal, empleó una muestra de 40 pacientes geriátricos atendidos en el Centro de Salud referido, la técnica para la recolección de datos fue la encuesta y el instrumento un cuestionario de riesgos cardiovasculares. La muestra de estudio se caracterizó por el predominio del sexo femenino y edades entre 60 y 69 años en los pacientes, condiciones socio-económicas que pueden incrementar el riesgo cardiovascular como como nivel educativo básico y la remuneración menor a un salario básico unificado. Conclusión: La mayoría de los pacientes presentaban dos o más factores de riesgo y entre estos predominaron la hipertensión arterial, hipercolesterolemia, sobrepeso, consumo excesivo de bebidas alcohólicas y la diabetes mellitus.

The so-called behavioral cardiovascular risk factors, such as inadequate diet, sedentary lifestyle, excessive alcohol consumption, and smoking, increase the probability of heart attack and stroke, even when they coexist in persons with no previous conditions. The objective was to identify cardiovascular risk factors in geriatric patients at the INNFA health center in Macas, Ecuador. Methodology: Research with a quantitative approach, non-experimental design, descriptive scope, cross-sectional, used a sample of 40 geriatric patients attended at the referred health center, the technique for data collection was the survey and the instrument was a cardiovascular risk questionnaire. The study sample was characterized by the predominance of female sex and age between 60 and 69 years in patients, socio-economic conditions that may increase cardiovascular risk such as basic education level and remuneration lower than a unified basic salary. Conclusion: Most of the patients had two or more risk factors and among these, arterial hypertension, hypercholesterolemia, overweight, excessive consumption of alcoholic beverages and diabetes mellitus predominated.

Os chamados factores de risco cardiovascular comportamentais, como a alimentação inadequada, o sedentarismo, o consumo excessivo de álcool e o tabagismo, aumentam a probabilidade de enfarte do miocárdio e de acidente vascular cerebral, mesmo quando coexistem em pessoas sem patologias prévias. O objetivo foi identificar os factores de risco cardiovascular em pacientes geriátricos do centro de saúde INNFA em Macas, Equador. Metodologia: Investigação com abordagem quantitativa, desenho não experimental, âmbito descritivo, transversal, com uma amostra de 40 pacientes geriátricos atendidos no referido centro de saúde, a técnica de recolha de dados foi um inquérito e o instrumento foi um questionário de risco cardiovascular. A amostra do estudo caracterizou-se pelo predomínio do sexo feminino e idade entre 60 e 69 anos, condições socioeconómicas que podem aumentar o risco cardiovascular como o nível de escolaridade básico e remuneração inferior a um salário base unificado. Conclusão: A maioria dos pacientes apresentava dois ou mais fatores de risco e, dentre estes, predominaram a hipertensão arterial, a hipercolesterolemia, o excesso de peso, o consumo excessivo de bebidas alcoólicas e o diabetes mellitus.

Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study.

Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques.

Odontoma compuesto como causa de retención dentaria. Presentación de dos casos clínicos / Odontoma compound as a cause of toothretention. Presentation of two clinical cases

RESUMEN Los odontomas son entidades odontogénicas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas. Por lo inusual del hecho el objetivo de nuestro trabajo fue presentar un caso de gemelos dicigóticos bivitelinos masculinos de 10 años de edad con presencia de retención dentaria del incisivo central superior derecho en ambos niños causado por la presencia de un odontoma compuesto, cuyo diagnóstico se corrobora clínica e histológicamente La lesión se aprecia como una zona radiolúcida bien definida en la que en su interior se ve una estructura radiopaca similar a un diente. Los odontomas fueron extirpados quirúrgicamente y se realizó una ventana quirúrgica en la zona donde se encontró el incisivo central superior para después enlazarlo y llevarlo al arco ortodóncicamente.

ABSTRACT Odontogenic entities noontimes are mixed, made by a mixture of odontogenic epithelial cells and differentiated mesenchymal. It made unusual aim of our study was to present a case of fraternal dizygotic male 10 years of age with the presence of dental retention upper right central incisor in both children caused by the presence of a compound odontoma, whose diagnosis is confirmed clinically and histologically the lesion is seen as a well-defined radiolucent area which is inside a structure similar to a tooth radiopaque. Odontomas were surgically removed and underwent surgical window in the area where they found the upper central incisor and then link it and take it to the orthodontic arch.

Odontoma compuesto como causa de retención dentaria. Presentación de dos casos clínicos / Odontoma compound as a cause of tooth retention. Presentation of two clinical cases

Los odontomas son entidades odontogénicas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas. Por lo inusual del hecho el objetivo de nuestro trabajo fue presentar un caso de gemelos dicigóticosbivitelinos masculinos de 10 años de edad con presencia de retención dentaria del incisivo central superior derecho en ambos niños causado por la presencia de un odontoma compuesto, cuyo diagnóstico se corrobora clínica e histológicamente. La lesión se aprecia como una zona radiolúcida bien definida en la que en su interior se ve una estructura radiopaca similar a un diente. Los odontomas fueron extirpados quirúrgicamente y se realizó una ventana quirúrgica en la zona donde se encontró el incisivo central superior para después enlazarlo y llevarlo al arco ortodóncicamente(AU)

Odontogenic entities noontimes are mixed, made by a mixture of odontogenic epithelial cells and differentiated mesenchymal. It made unusual aim of our study was to present a case of fraternal dizygotic male 10 years of age with the presence of dental retention upper right central incisor in both children caused by the presence of a compound odontoma, whose diagnosis is confirmed clinically and histologically the lesion is seen as a well-defined radiolucent area which is inside a structure similar to a tooth radiopaque. Odontomas were surgically removed and underwent surgical window in the area where they found the upper central incisor and then link it and take it to the orthodontic arch(EU)

Antimicrobial susceptibility of 6 antimicrobial agents in Helicobacter pylori clinical isolates by using EUCAST breakpoints compared with previously used breakpoints / Sensibilidad de aislamientos clínicos de Helicobacter pylori a seis antimicrobianos utilizando los criterios EUCAST y comparando los resultados con criterios utilizados anteriormente

INTRODUCTION: The aim of this study was to determine the differences in percentage resistance in H. pylori clinical isolates using EUCAST breakpoints compared with previously used breakpoints. MIC value distribution in H. pylori clinical isolates was also studied. METHODS: Susceptibility to amoxicillin, tetracycline, metronidazole, clarithromycin, rifampicin and levofloxacin was performed by E-test in 824 H. pylori clinical isolates. EUCAST and previous breakpoints defined resistance as follows: MIC > 0.12 mg/L and ≥ 2 mg/L for amoxicillin, > 8 mg/L and ≥ 8 mg/L for metronidazole, > 0.5 mg/L and ≥ 1 mg/L for clarithromycin, >1mg/L and ≥ 32 mg/L for rifampicin, and > 1 mg/L and ≥ 4 mg/L for tetracycline and >1mg/L levofloxacin. RESULTS: Overall resistance rate by EUCAST and by previous breakpoints was 8.5% and 3.2% for amoxicillin, 0.6% and 0.1% for tetracycline, 39.2% and 39.7% for metronidazole, 51.2% and 51.2% for clarithromycin, 32% and 3.1% for rifampicin, and 6.7% and 6.7% for levofloxacin. CONCLUSIONS: When using the different breakpoints for antimicrobial susceptibility testing, similar results were found with most antibiotics tested (tetracycline, metronidazole, clarithromycin, and levofloxacin), except for amoxicillin and rifampicin

INTRODUCCIÓN: El objetivo de este estudio era determinar las diferencias en el porcentaje de resistencia de aislamientos clínicos de H. pylori usando los puntos de corte de EUCAST comparado con los puntos de corte usados anteriormente. También se estudió la distribución de los valores de CMI en los aislamientos de H. pylori. MÉTODOS: La sensibilidad de amoxicilina, tetraciclina, metronidazol, claritromicina, rifampicina y levo-floxacina se determinó mediante E-test en 824 aislamientos clínicos de H. pylori. Los puntos de corte utilizados fueron EUCAST: CMI > 0,12 mg/L para amoxicilina, > 8 mg/L para metronidazol, >0,5mg/L para claritromicina y > 1 mg/L para rifampicina, tetraciclina y levofloxacina. Los puntos de corte que se habían utilizado antes de EUCAST fueron: CMI ≥ 2 mg/L para amoxicilina, ≥ 8 mg/L para metronidazol, ≥ 1 mg/L para claritromicina, ≥ 32 mg/L para rifampicina, ≥ 4 mg/L para tetraciclina y > 1 mg/L para levofloxacina. RESULTADOS: La resistencia global con los puntos de corte EUCAST y con los puntos de corte anteriores fue: 8,5% y 3,2% para amoxicilina, 0,6% y 0,1% para tetraciclina, 39,2% y 39,7% para metronidazol, 51,2% y 51,2% para claritromicina, 32% y 3,1% para rifampicina y 6,7% y 6,7% para levofloxacina. CONCLUSIÓN: A pesar de la utilización de diferentes puntos de corte, se obtuvieron resultados de resistencia similares para la mayoría de los antibióticos probados (tetraciclina, metronidazol, claritrnnñomicina, y levofloxacino), con la única excepción de amoxicilina y rifampicina

Antimicrobial susceptibility of 6 antimicrobial agents in Helicobacter pylori clinical isolates by using EUCAST breakpoints compared with previously used breakpoints.

INTRODUCTION: The aim of this study was to determine the differences in percentage resistance in H. pylori clinical isolates using EUCAST breakpoints compared with previously used breakpoints. MIC value distribution in H. pylori clinical isolates was also studied. METHODS: Susceptibility to amoxicillin, tetracycline, metronidazole, clarithromycin, rifampicin and levofloxacin was performed by E-test in 824 H. pylori clinical isolates. EUCAST and previous breakpoints defined resistance as follows: MIC >0.12mg/L and ≥2mg/L for amoxicillin, >8mg/L and ≥8mg/L for metronidazole, >0.5mg/L and ≥1mg/L for clarithromycin, >1mg/L and ≥32mg/L for rifampicin, and >1mg/L and ≥4mg/L for tetracycline and >1mg/L levofloxacin. RESULTS: Overall resistance rate by EUCAST and by previous breakpoints was 8.5% and 3.2% for amoxicillin, 0.6% and 0.1% for tetracycline, 39.2% and 39.7% for metronidazole, 51.2% and 51.2% for clarithromycin, 32% and 3.1% for rifampicin, and 6.7% and 6.7% for levofloxacin. CONCLUSIONS: When using the different breakpoints for antimicrobial susceptibility testing, similar results were found with most antibiotics tested (tetracycline, metronidazole, clarithromycin, and levofloxacin), except for amoxicillin and rifampicin.

Characterization of the Gastric Microbiota in a Pediatric Population According to Helicobacter pylori Status.

BACKGROUND: Helicobacter pylori colonizes the human stomach of approximately 50% of the world's population, and increases the risk of several gastric diseases. The goal of this study is to compare the gastric microbiota in pediatric patients with and without H. pylori colonization. METHODS: We studied 51 children who underwent gastric endoscopy because of dyspeptic symptoms (18 H. pylori positive and 33 negative). Gastric biopsies were obtained for rapid urease test, culture, histology and DNA extraction. H. pylori was quantified by quantitative polymerase chain reaction and the gastric microbiome studied by V4-16S ribosomal RNA gene high-throughput sequencing. RESULTS: Bacterial richness and diversity of H. pylori-positive specimens were lower than those of negative, and both groups were clearly separated according to beta diversity. Taxonomic analysis confirmed that H. pylori-positive subjects had a higher relative abundance of Helicobacter genus (66.3%) than H. pylori-negative subjects (0.45%). Four phyla (proteobacteria, bacteroidetes, firmicutes and actinobacteria) accounted for >97% of all reads in both groups. Within proteobacteria, gamma- and betaproteobacteria were the most abundant for H. pylori-negative patients, whereas epsilonproteobacteria was for H. pylori positive. H. pylori-positive patients were associated with low body mass index. In the group of underweight patients (body mass index, <18.5), there were 46.1% of H. pylori-positive patients compared with 24% in the nonunderweight group (P = 0.049). Patients with active superficial gastritis in H. pylori-positive patients had the lowest alpha diversity (P = 0.035). CONCLUSIONS: We characterized the gastric microbiota for the first time in children with and without H. pylori and observed that when H. pylori is present, it tends to dominate the microbial community. In the H. pylori-negative patients, there was more relative abundance of gammaproteobacteria, betaproteobacteria, bacteroidia and clostridia classes and a higher bacterial richness and diversity.

Rabdomiosarcoma mediastínico diagnosticado mediante punción aspiración guiada por ecografía endobronquial / Mediastinal rhabdomyosarcoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

El rabdomiosarcoma es una neoplasia mesenquimal maligna y, además, es la segunda neoplasia cardiaca después del angiosarcoma, y su incidencia global es inferior al 0,07%. Otras denominaciones que se le han dado son rabdomioblastoma, miosarcoma y rabdomioma maligno. Habitualmente la clínica de presentación es inespecífica, y el diagnóstico se alcanza con el estudio histológico e inmunohistoquímico de la lesión obtenida mediante biopsia intracavitaria o bien abierta. Presentamos el caso de un paciente de 35 años, con clínica de disnea y alteraciones electrocardiográficas al que se le diagnostica de un rabdomiosarcoma mediante una ultrasonografía endobronquial (EBUS). Revisada la bibliografía existente este es el primer caso descrito de diagnóstico de rabdomiosarcoma mediante la punción de una adenopatía mediastínica por EBUS (AU)

Rhabdomyosarcoma is a malignant mesenchymal neoplasm with an incidence of less than than 0.07%, although it is the second most frequent cardiac neoplasia after cardiac angiosarcoma. It has also been named rhabdomyoblastoma, myosarcoma and malignant rhabdomyoma. Its clinical presentation is usually non-specific and histological and immunohistochemical studies of the lesion obtained by intracavitary or open biopsy are required for diagnosis. We report a case of a 35 year old patient, with dyspnea and electrocardiographic changes, diagnosed with rhabdomyosarcoma by endobronchial ultrasound (EBUS). To our knowledge, this is the first case of a rhabdomyosarcoma diagnosed by puncturing a mediastinal adenopathy using EBUS (AU)

Clasificación inmunofenotípica de 3 casos de adenomas hepatocelulares. Diagnóstico diferencial con hiperplasia nodular focal / Immunophenotypic classification of 3 cases of hepatocellular adenoma. Differential diagnosis with focal nodular hyperplasia

El descubrimiento de los cambios moleculares de los adenomas ha dado lugar a un renovado interés en este tipo de tumor. En la última edición de la OMS de los tumores del tracto gastrointestinal (2010) se incluyen 4 tipos de adenomas hepáticos, bien caracterizados inmunohistoquímicamente, genotípicamente y fenotípicamente, en los que tienen un papel importante los antecedentes clínicos y su comportamiento morfológico para determinar el posterior riesgo de malignidad, fundamentalmente en aquellos con mutación de la b-catenina. La presencia de esteatosis, inflamación y cambios vasculares, unidos a la respuesta frente a la FABP, el amiloide sérico A y la glutamina sintetasa nos permite clasificarlos en 4 grupos: con mutación de HNF1A (H-HCA), con mutación de b-catenina (b-HCA), inflamatorios (IHCA) y sin marcadores. La ausencia de expresión frente al glypican 3, el HSP 70 y el mapeo perivenular frente a la glutamina sintetasa ayuda a excluirlos frente a los hepatocarcinomas bien diferenciados. En este trabajo describimos el comportamiento clínico, morfológico e inmunofenotípico de 3 casos de pacientes diagnosticados de adenomas hepáticos en un período de 2 años (AU)

Interest in adenomas has been renewed by the discovery of the molecular changes in these tumors. The latest World Health Organization publication on gastrointestinal tract tumors (2010) includes four types of hepatic adenomas, which are well characterized immunohistochemically, genotypically and phenotypically. In these tumors, medical history and morphological behavior play an important role in determining the risk of malignancy, mainly in adenomas with a b-catenin mutation. The presence of steatosis, inflammation, vascular changes linked to response to L-FABP, serum amyloid A, and glutamyl synthetase help to classify these tumors into four groups: hepatocellular adenomas with the HNF1A mutation (H-HCA), those with the b-catenin mutation (b-HCA), inflammatory HCA (IHCA), and HCA without markers. The absence of glypican 3 expression, HSP 70 and perivenular mapping of glutamyl synthetase helps to distinguish these tumors from well differentiated hepatocellular carcinoma. We describe the clinical, morphological and immunophenotypic features of three patients diagnosed with hepatic adenomas in a 2-year period (AU)

[Immunophenotypic classification of 3 cases of hepatocellular adenoma. Differential diagnosis with focal nodular hyperplasia]. / Clasificación inmunofenotípica de 3 casos de adenomas hepatocelulares. Diagnóstico diferencial con hiperplasia nodular focal.

Interest in adenomas has been renewed by the discovery of the molecular changes in these tumors. The latest World Health Organization publication on gastrointestinal tract tumors (2010) includes four types of hepatic adenomas, which are well characterized immunohistochemically, genotypically and phenotypically. In these tumors, medical history and morphological behavior play an important role in determining the risk of malignancy, mainly in adenomas with a b-catenin mutation. The presence of steatosis, inflammation, vascular changes linked to response to L-FABP, serum amyloid A, and glutamyl synthetase help to classify these tumors into four groups: hepatocellular adenomas with the HNF1A mutation (H-HCA), those with the b-catenin mutation (b-HCA), inflammatory HCA (IHCA), and HCA without markers. The absence of glypican 3 expression, HSP 70 and perivenular mapping of glutamyl synthetase helps to distinguish these tumors from well differentiated hepatocellular carcinoma. We describe the clinical, morphological and immunophenotypic features of three patients diagnosed with hepatic adenomas in a 2-year period.

Detection of Helicobacter pylori and clarithromycin resistance in gastric biopsies of pediatric patients by using a commercially available real-time polymerase chain reaction after NucliSens semiautomated DNA extraction.

UNLABELLED: The aim of this study was to evaluate a commercially available kit, MutaREAL Helicobacter pylori (Inmundiagnostik, Bensheim, Germany) real-time polymerase chain reaction (PCR), for detection of H. pylori infection and point mutations in the 23S rRNA genes responsible for clarithromycin resistance in gastric biopsies. METHODS: Gastric biopsies were obtained by endoscopy from pediatric patients with gastric symptoms, cultured according to standard microbiologic procedures, and clarithromycin resistance was determined by E-test. DNA extraction was performed by NucliSens platform with the NucliSens magnetic extraction reagents (bioMérieux, Marcy-l'Etoile, France) according to the manufacturer's instructions. MutaREAL kit was used according to manufacturer recommendations in a LightCycler (Roche Diagnostics Gmbh, Mannheim, Germany) for the detection of H. pylori infection and clarithromycin susceptibility. RESULTS: Amplification was positive for H. pylori in 62 and negative in 44 biopsies out of 106 biopsies. All negative biopsies were positive for human beta-globin gene. This real-time PCR assay showed sensitivity of 93.33% (negative predictive value, 90.90%) and specificity of 86.95% (positive predictive value, 90.32%) for H. pylori detection. Clarithromycin resistance was detected in 26 cases by PCR with a sensitivity and specificity of 90.62 and 95.83, respectively. CONCLUSIONS: MutaREAL kit was able to detect H. pylori and its clarithromycin susceptibility with high efficacy. This method is quicker than culture and is suitable to be done in 1 h after DNA extraction. The new system of automatic extraction will lead to reduction in the total time.

El proceso de atención de enfermería y características farmacológicas de los medicamentos broncodilatadores / The nursing care process and the pharmacological characteristics of bronchodilators

Por la frecuencia del asma bronquial como problema de salud, la importancia de los broncodilatadores en su tratamiento sintomático, y la necesidad de incorporar el proceso de atención de enfermería al trabajo diario de estos profesionales para incrementar la calidad de los servicios de salud, decidimos realizar una revisión de los aspectos farmacológicos de mayor importancia clínica de los broncodilatadores. Ello va dirigido a brindar una base de conocimientos sobre estos fármacos que permita una vinculación con el proceso de atención de enfermería, y contribuir a mejorar la asistencia médica al paciente asmático en los diferentes niveles de atención de nuestro sistema sanitario. Las características de los broncodilatadores se insertan de manera práctica en las diferentes etapas del proceso, incluyendo la educación paciente-familia(AU)

El proceso de atención de enfermería y características farmacológicas de los medicamentos broncodilatadores / The nursing care process and the pharmacological characteristics of bronchodilators

Por la frecuencia del asma bronquial como problema de salud, la importancia de los broncodilatadores en su tratamiento sintomático, y la necesidad de incorporar el proceso de atención de enfermería al trabajo diario de estos profesionales para incrementar la calidad de los servicios de salud, decidimos realizar una revisión de los aspectos farmacológicos de mayor importancia clínica de los broncodilatadores. Ello va dirigido a brindar una base de conocimientos sobre estos fármacos que permita una vinculación con el proceso de atención de enfermería, y contribuir a mejorar la asistencia médica al paciente asmático en los diferentes niveles de atención de nuestro sistema sanitario. Las características de los broncodilatadores se insertan de manera práctica en las diferentes etapas del proceso, incluyendo la educación paciente-familia.

Características citopatológicas del carcinoma de células acinares (CCA) de glándula salival. A propósito de cuatro observaciones / Cytological characteristics of acinic cell carcinoma (ACC) diagnosed by fi ne-needle aspiration biopsy (FNAB). A study of four cases

Objetivo: Presentar las características citopatológicas del carcinomaacinar (CCA), así como su correlación cito-histológica, comentando los problemas de diagnóstico diferencial de esta entidad en base a cuatro observaciones estudiadas mediante PAAF.Casos clínicos: Dos varones de 52 y 53 años, una mujer de 79 años, y una niña de 12 años que presentaron tumoraciones localizadas en territorio parotídeo (casos 1, 2 y 4), y a nivel laterocervical (caso 3). En tres pacientes, la PAAF fue, junto a los estudios de imagen,la primera aproximación diagnóstica; correspondiendo el caso 3 a una punción de adenopatías laterocervicales metastásicas en una paciente con antecedentes de CCA de parótida. Hallazgos citológicos: Las extensiones citológicas mostraron abundante celularidad tumoral dispuesta en pequeñas placas monocapa, formando estructuras acinares, o como células aisladas. Es de destacar la abundancia de núcleos desnudos en el fondo de los frotis, y la ausencia de grasa y de epitelio ductal. Las células poseían núcleos monomorfos redondeados u ovales, nucleólo poco evidente y abundante citoplasma granular ofinamente vacuolado. Discusión: La PAAF proporciona información esencial en la actuación diagnóstico-terapeútica de las tumoraciones de laglándula salival, resultando esta metodología muy sensibleen su eficacia diagnóstica. La identificación de los CCA frecuentemente presenta dificultades, debido a la gran similitud citológica de las células tumorales con el componente acinar normal propio de la glándula salival. El diagnóstico diferencial se plantea, fundamentalmente, con carcinomas de células claras,con carcinomas mucoepidermoides, con el tumor de Warthiny con los oncocitomas. Nuestras observaciones confirman la validez de la PAAF en una primera aproximación diagnóstica de estas lesiones tumorales accesibles a la punción directa

Objective: To present the cytopathological characteristics of a cinic cell carcinoma (ACC) as well as its cyto-histological correlation, commenting on the differential diagnostic problems of this entity based on four observations studied using fine-needle aspiration biopsy (FNAB).Clinical Cases: Two males of 52 and 53 years of age, one 79 year-old woman and a girl of 12 years of age, who presented tumors located in the parotid area (cases 1, 2 and 4) and at the laterocervical level (case 3).In 3 patients, the FNAB was, together with the image studies,the first diagnostic indication; case 3 corresponding to a puncture of metastatic laterocervical adenopathies in a patient with a history of parotid ACC. Cytological findings: The cytologic smears revealed abundant tumoral cellularity arranged in small monolayered sheets,forming acinar structures or isolated cells. The abundance of bare nuclei at the background of the smears, and the absence of adipose tissue and ductal epithelium are highlighted. The cells possessed round or oval monomorphic nuclei, few nucleoli and abundant granular or finely vacuolate cytoplasm. Discussion: FNAB provides essential information on the diagnostic-therapeutic management of salivary gland tumors; this methodology is highly sensitive in its diagnostic efficacy. The diagnosis of ACCs frequently presents difficulties, owing to the great cytologic similarity of the tumor cells with the normal acinar component of the salivary gland. The differential diagnosis is considered, fundamentally, with clear cell carcinomas, mucoepidermoid carcinomas, Warthin`s tumor, and oncocytomas. Our observations confirm the validity of FNAB in a first diagnostic approximation for those lesions accessible to direct puncture

Cytological characteristics of acinic cell carcinoma (ACC) diagnosed by fine-needle aspiration biopsy (FNAB). A study of four cases.

OBJECTIVE: To present the cytopathological characteristics of acinic cell carcinoma (ACC) as well as its cyto-histological correlation, commenting on the differential diagnostic problems of this entity based on four observations studied using fine-needle aspiration biopsy (FNAB). CLINICAL CASES: Two males of 52 and 53 years of age, one 79 year-old woman and a girl of 12 years of age, who presented tumors located in the parotid area (cases 1, 2 and 4) and at the laterocervical level (case 3). In 3 patients, the FNAB was, together with the image studies, the first diagnostic indication; case 3 corresponding to a puncture of metastatic laterocervical adenopathies in a patient with a history of parotid ACC. CYTOLOGICAL FINDINGS: The cytologic smears revealed abundant tumoral cellularity arranged in small monolayered sheets, forming acinar structures or isolated cells. The abundance of bare nuclei at the background of the smears, and the absence of adipose tissue and ductal epithelium are highlighted. The cells possessed round or oval monomorphic nuclei, few nucleoli and abundant granular or finely vacuolate cytoplasm. DISCUSSION: FNAB provides essential information on the diagnostic-therapeutic management of salivary gland tumors; this methodology is highly sensitive in its diagnostic efficacy. The diagnosis of ACCs frequently presents difficulties, owing to the great cytologic similarity of the tumor cells with the normal acinar component of the salivary gland. The differential diagnosis is considered, fundamentally, with clear cell carcinomas, mucoepidermoid carcinomas, Warthin s tumor, and oncocytomas. Our observations confirm the validity of FNAB in a first diagnostic approximation for those lesions accessible to direct puncture.

Clarithromycin resistance among Helicobacter pylori strains isolated from children: prevalence and study of mechanism of resistance by PCR-restriction fragment length polymorphism analysis.

Clarithromycin and metronidazole resistance was 29.1 and 23.9%, respectively, in 96 Helicobacter pylori strains obtained from pediatric patients. No resistance to amoxicillin was observed. Resistance according to patients' ages to clarithromycin and metronidazole was 45.4 and 18.2% in 22 patients from 4 to 8 years old, 30.2 and 20.7% in 53 patients from 9 to 13 years old, and 9.5 and 38.1% in 21 patients from 14 to 18 years old, respectively. The A2143G mutation was the most prevalent (82.1%) among clarithromycin-resistant strains.

[Microbiological factors that influence the eradication of Helicobacter pylori in adults and children]. / Factores microbiológicos que afectan a la erradicación de Helicobacter pylori en población adulta y pediátrica.

AIM: To study microbiological factors of Helicobacter pylori, such as antimicrobial susceptibility and virulence, which affect the eradication of the microorganism in gastric mucosa of adult and pediatric patients. METHODS: Fifty-five H. Pylori strains were isolated from culture of biopsy specimens from 39 adult and 16 pediatric patients. Antibiotic susceptibility was determined by agar dilution and study of virulence factors (cagA gene and alleles s1 and s2 of the vacA gene) by PCR. Outcome of treatment with amoxicillin (AMX), clarithromycin (CLR) and omeprazole was assessed by the urea breath test. We studied the relation of minimum inhibitory concentration (MIC) of AMX and CLR and presence of virulence factors with eradication of the microorganism.Results. The eradication rate was 69% (38/55), 71.7% in adults and 62.5% in children. Resistance to CLR and AMX was 14.5% and 0%, respectively. Overall eradication rates with respect to the variables studied were: 75% and 53% in strains with AMX MICs of < or = 0.01 6mg/L and > or = 0.032 mg/L (range < or = 0.008-0.5) (p > 0.05), 79% and 12% in strains with clarithromicina MICs of < 1 mg/L and > or = 1mg/L (range # 0.008-64) (p < 0.05), 79% and 54% in cagA+ and cagA strains (p > 0.05) and 82% and 62% in s1 and s2 strains (p > 0.05), respectively. CONCLUSIONS: H. pylori strains with higher amoxicillin and clarithromycin MICs, and cagA and vacA s2 strains were related with lower rates of eradication in both adult and pediatric populations treated with amoxicillin, clarithromycin and omeprazole.

Factores microbiológicos que afectan a la erradicación de Helicobacter pylori en población adulta y pediátrica / Microbiological factors that influence the eradication of Helicobacter pylori in adults and children

OBJETIVOS. Estudiar factores microbiológicos como la sensibilidad a antimicrobianos y factores de virulencia de Helicobacter pylori relacionados con la erradicación del microorganismo de la mucosa gástrica, tanto en población pediátrica como adulta. MÉTODOS. Se obtuvieron 55 cepas aisladas a partir del cultivo de biopsias de 16 pacientes pediátricos y de 39 adultos. La sensibilidad antibiótica se realizó mediante el método de dilución en agar y el estudio de los factores de virulencia, gen cagA y los alelos s1 y s2 del gen vacA mediante reacción en cadena de la polimerasa (PCR). El seguimiento tras el tratamiento que se instauró con amoxicilina, claritromicina y omeprazol se realizó mediante la prueba del aliento con urea marcada. Se estudió la relación entre la concentración inhibitoria mínima (CIM) a amoxicilina y claritromicina y la presencia de estos factores de virulencia con la erradicación del microorganismo. RESULTADOS. La erradicación fue del 69 por ciento (38/55), 71,7 por ciento en adultos y 62,5 por ciento en niños. La resistencia a claritromicina y amoxicilina fue 14,5 y 0 por ciento, respectivamente. Las tasas de erradicación globales en relación con las variables estudiadas fueron del 75 y 53 por ciento en cepas con CIM de amoxicilina 0,016 mg/l y CIM de amoxicilina 0,032 mg/l (intervalo 0,008-0,5) (p > 0,05), 79 y 12 por ciento en cepas con CIM de claritromicina 0,05) y 82 y 62 por ciento en cepas s1 y s2 (p > 0,05), respectivamente. CONCLUSIONES. La infección por cepas con CIM más altas a amoxicilina y claritromicina y por aislamientos cagA- y vacA s2 se relacionaron con tasas más bajas de erradicación de H. pylori, tanto en población adulta como infantil en la terapia con amoxicilina, claritromicina y omeprazol (AU)