Identification and Profiling Analysis of microRNAs in Guava Fruit (Psidium guajava L.) and Their Role during Ripening.

The guava (Psidium guajava L.) is a climacteric fruit with an accelerated post-harvest overripening. miRNAs are small RNA sequences that function as gene regulators in eukaryotes and are essential for their survival and development. In this study, miRNA libraries were constructed, sequenced and analyzed from the breaker and ripe stages of guava fruit cv. Siglo XXI. One hundred and seventy-four mature miRNA sequences from 28 miRNA families were identified. The taxonomic distribution of the guava miRNAs showed a high level of conservation among the dicotyledonous plants. Most of the predicted miRNA target genes were transcription factors and genes involved in the metabolism of phytohormones such as abscisic acid, auxins, and ethylene, as revealed through an ontology enrichment analysis. The miRNA families miR168, miR169, miR396, miR397, and miR482 were classified as being directly associated with maturation, whereas the miRNA families miR160, miR165, miR167, miR3930, miR395, miR398, and miR535 were classified as being indirectly associated. With this study, we intended to increase our knowledge and understanding of the regulatory process involved in the ripening process, thereby providing valuable information for future research on the ripening of guava fruit.

Development of a Novel, Automated High-Throughput Device for Performing the Comet Assay.

A comet assay is a trusted and widely used method for assessing DNA damage in individual eukaryotic cells. However, it is time-consuming and requires extensive monitoring and sample manipulation by the user. This limits the throughput of the assay, increases the risk of errors, and contributes to intra- and inter-laboratory variability. Here, we describe the development of a device which automates high throughput sample processing for a comet assay. This device is based upon our patented, high throughput, vertical comet assay electrophoresis tank, and incorporates our novel, patented combination of assay fluidics, temperature control, and a sliding electrophoresis tank to facilitate sample loading and removal. Additionally, we demonstrated that the automated device performs at least as well as our "manual" high throughput system, but with all the advantages of a fully "walkaway" device, such as a decreased need for human involvement and a decreased assay run time. Our automated device represents a valuable, high throughput approach for reliably assessing DNA damage with the minimal operator involvement, particularly if combined with the automated analysis of comets.

Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature.

Fractures of the anterior tibial tuberosity are uncommon, ranging from 0.4% to 2.7% of all epiphyseal lesions reported. Bilateral sequential fractures are even rarer, with less than twenty-eight cases described to date and, as such, there is very little consensus data on their treatment as a whole. We report the first two documented cases of bilateral tibial tuberosity avulsions of the anterior tubercle in Switzerland, treated by open reduction and internal fixation. Both cases were 14-year-old healthy males with no previous medical history, who both suffered extra-articular fractures after falling from a height. The first case was treated in 2012 with a four-year long clinical follow-up and full recovery. The second, treated in 2019, was clinically followed for one year with a complete recovery and has returned to sporting activity at a pre-injury level. Due to the rarity of the condition, a lack of consensus on the optimal therapy, we believe the documentation of these two cases treated by the same team may be of clinical relevance.

How did we get here and where do we go from here?: Supporting undocumented students through a pandemic.

Communities of color have been disproportionately impacted by the coronavirus disease (COVID-19) pandemic, exposing the influence of decades of policies that have under-resourced and marginalized these communities. The history of segregation and inadequate funding in education has been exacerbated by the pandemic, compounding the educational inequities already present in the United States. The intersection of this inequity alongside immigration policies over the past years have led the undocumented student population to be adversely impacted. The lack of access to health care and social safety net programs, fear of deportation, and an over reliance on technology for schooling leaves a large segment of students vulnerable for adverse academic, emotional, and social outcomes. This paper will trace the historical path of educational segregation, immigration policies, and how these led to the disproportionate impact of COVID-19 on undocumented students. It will discuss interventions for undocumented students within an antioppressive ecological framework and the ethical responsibilities that school-based mental health professionals have to support undocumented students to fulfill their highest potential, manage the emotional toll of the pandemic, and advocate for change in immigration and educational policies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Identification in silico and expression analysis of a ß-1-4-endoglucanase and ß-galactosidase genes related to ripening in guava fruit.

BACKGROUND: Guava fruit softening is a crucial process during ripening and this process involves a number of enzymes that modifies the cell wall. Two of the enzymes that regulate this process are (a) the ß-1, 4-endoglucanase 17 (BEG) which hydrolyze ß-1, 4 bonds from cellulose and hemicellulose, and (b) ß-galactosidase (BGA) that hydrolyzes pectin chains. Bioinformatics and expression analysis information on these genes is limited in guava fruit. RESULTS: A fragment of a ß-1, 4-endoglucanase 17 (PgE17), and another of a ß-galactosidase (PgGa1) were identified. These sequences have a similarity of more than 85% with those reported in the NCBI database. In the guava genome, one homologous sequence was found for PgE17 in Chr 4 and two homologous to PgGa1: one in Chr 3 and the other one in Chr 6. Putative protein PgE17 contains part of the glyco_hydro_9 domain. Putative protein PgGa1 has a part of the glyco_hydro_35 domain. Phylogenetic analysis of PgE17 and PgGa1 revealed that both are highly conserved inside the Myrtaceae family. In silico expression analysis showed that both PgE17 and PgGa1 work in a coordinated way with other cell wall modifier enzymes. Expression of these genes was found in all the guava samples analyzed. However, the highest expression was found in the fruit in the breaking and ripe states. CONCLUSIONS: A ß-1, 4-endoglucanase 17, and ß-galactosidase 1 sequences were identified. PgE17 and PgGa1 are expressed in all the plant tissues, and fruit ripening states. Although, the highest expression was on breaker and ripe states.

Relación entre APGAR al minuto y oligohidramnios en gestante a término atendidas en el hospital / Relationship between APGAR at the minute and oligohydramnios in term pregnant women treated at the hospital

Objetivo:Determinar la relación entre APGAR al minuto y la presencia de oligohidramnios en gestantes a término atendidas en el Hospital Niño Jesús de Barranquilla durante el período 2018 a 2019. Materiales y métodos:Estudio descriptivo, trasversal, retrospectivo, tipo serie de casos. Se incluyeron 203 mujeres embarazadas que fueron atendidas en el Hospital Niño Jesús, con embarazo a término y diagnostico ultrasonográfico de oligohidramnios (ILA menor o igual a 5 cm),durante los años 2018 y 2019. Se relacionaron variables sociodemográficas y gineco obstétricas con el resultado del APGAR y del ILA y se compararon los resultados utilizando Chi2 y prueba de Fisher. Resultados:El promedio de edad de las participantes fuede 23,6 años (DE+/-: 5,7); 48,8% provenían de municipios del departamento del Atlántico y 18,2% de Venezuela; 48,3% tenían un ILA de 4 a 4,9 y 8,4% tuvieron APGAR al minuto menor a 7; 4,9% tuvieron productos con bajo peso al nacer; 15,3% de los que tuvieron ILA de 1 a 3 tuvieron APGAR menor de 7, frente a 5,6% de los que tuvieron ILA de 4 a 5 (Chi2: 5,13; p: 0,024). Así mismo, 40% de las que tuvieron bajo peso al nacer presentaron APGAR <7 en contraste con 6,7% de las que tuvieron productos con peso normal(Fisher: 0,005). Conclusión: Se encontró una relación directamente proporcional entre el valor del ILA y los resultados del APGAR al minuto, y esta relación debe analizarse mediante un estudio de casos y controles. De igual forma se dedujo que el nivel inferior más seguro de líquido amniótico con el que se pueden presentar menos resultados perinatales adversos como la asfixia perinatal es con un ILA igual o mayor de 4 cm.

Objective: To determine the relationship between minute APGAR and the presence of oligohydramnios in full-term pregnant women attended at the Niño Jesús Hospital in Barranquilla during the period 2018 to 2019. Materials and methods: Descriptive, cross-sectional, retrospective study, case series type. 203 pregnant women who were treated at the Niño Jesús Hospital, with term pregnancy and ultrasound diagnosis of oligohydramnios (ILA less than or equal to 5 cm), during the years 2018 and 2019 were included. Sociodemographic and gyneco-obstetric variables were related to the APGAR and ILA and results were compared using Chi2 and Fisher's test. Results: The average age of the participants was 23.6 years (SD +/-: 5.7); 48.8% came from municipalities in the Atlántico department and 18.2% from Venezuela; 48.3% had an ILA of 4 to 4.9 and 8.4% had APGAR at one minute less than 7; 4.9% had products with low birth weight; 15.3% of those with ILA from 1 to 3 had APGAR less than 7, compared to 5.6% of those with ILA from 4 to 5 (Chi2: 5.13; p: 0.024). Likewise, 40% of those with low birth weight had APGAR <7 in contrast to 6.7% of those with normal-weight products (Fisher: 0.005). Conclusion: A directly proportional relationship was found between theILA value and the APGAR results per minute, and this relationship should be analyzed through a case-control study.Similarly, it was deduced that the safest lower level of amniotic fluid with which less adverse perinatal results can occur, such as perinatal asphyxia, is with an ILA equal to or greater than 4 cm

Modeling the potential impact of abuse-deterrent opioids on medical resource utilization.

Objectives: To extend a previously published manuscript on a model for estimating potential avoided medical events and cost savings in the US associated with the introduction of extended-release abuse-deterrent opioids and incorporate new methods of evaluating abuse deterrence using human abuse potential studies. Methods: A model was developed to estimate reductions in abuse-related events and annual savings in the US. Model inputs included: opioid abuse prevalence, abuse-deterrent opioid cost and effectiveness at deterring abuse, and opioid abuse-related events and costs. Direct (medical and drug) and indirect (work loss) cost savings (2017 US$) and abuse-related events were estimated assuming the replacement of the entire extended-release opioid market (brand and generic) by brand abuse-deterrent opioids. Results: Replacing the extended-release opioid market with abuse-deterrent opioids is estimated to lower annual abuse-related medical events by ∼13-31% (e.g. 78,000-186,000 emergency department visits) and lower annual medical costs by ∼$640 M-$1,538 M, depending on the abuse-deterrent technology (physical/chemical barrier or agonist/antagonist). Replacement of extended-release oxycodone with extended-release abuse-deterrent oxycodone is associated with the largest amount of cost savings and highest number of avoided medical events, followed by replacing extended-release morphine with an extended-release abuse-deterrent opioid. Replacement of transdermal fentanyl is associated with the smallest amount of cost savings and lowest number of avoided medical events. Conclusion: Agonist/antagonist abuse-deterrent opioid technology is associated with higher annual medical cost savings and more avoided events than physical/chemical barrier technology. Total net savings are dependent upon the abuse-deterrent opioid price relative to non-abuse-deterrent opioids.

Real-world misuse, abuse, and dependence of abuse-deterrent versus non-abuse-deterrent extended-release morphine in Medicaid non-cancer patients.

OBJECTIVE: Opioids with abuse-deterrent properties may reduce widespread abuse, misuse, and diversion of these products. This study aimed to quantify misuse, abuse, dependence, and health resource use of extended-release morphine sulfate with sequestered naltrexone hydrochloride (ER-MSN; EMBEDA®), compared with non-abuse-deterrent extended-release morphine (ERM) products in Medicaid non-cancer patients. METHODS: Administrative medical and pharmacy claims data were analyzed for 10 Medicaid states from 1 January 2015, to 30 June 2016. Patients were included if they received a prescription for ER-MSN or any oral, non-abuse-deterrent ERM. Index date was the date of first prescription for an ER-MSN or ERM. Abuse/dependence, non-fatal overdose, emergency department (ED) visits, and ED/inpatient readmissions were determined for each participant. An overall measure of misuse and abuse was also calculated. To account for differences in follow-up, all counts are expressed per 100 patient-years. RESULTS: There were 4,857 patients who received ER-MSN and 10,357 who received an ERM. The average age in the two cohorts was approximately 45 years old. From pre-index to follow-up, the number of patients per 100 patient-years with a diagnosis code indicating abuse or dependence increased by 0.91 (95% confidence interval [CI]: 0.85, 0.97) in the ER-MSN cohort and 2.23 (95% CI: 2.14, 2.32) in the ERM cohort. The number of patients per 100 patient-years with an opioid-related non-fatal overdose increased by 0.05 (95% CI: 0.04, 0.06) in the ER-MSN cohort compared with 0.11 (95% CI: 0.09, 0.13) in the ERM cohort. The opioid abuse overall composite score increased by 1.36 (95% CI: 1.24, 1.48) in the post-index period in the ER-MSN cohort compared to 3.21 (95% CI: 3.10, 3.32) in the ERM cohort. CONCLUSION: Misuse, abuse, and dependence events were numerically lower in patients receiving ER-MSN compared with those receiving ERM products.

Clinical Interpretation of Peripheral Pulse Oximeters Labeled "Not for Medical Use".

The purpose of our study was to clarify limitations of off-label use for low cost nonmedical use (NMU) pulse oximeters by primary care providers. These devices are widely marketed over the Internet and in drugstores but are not intended for medical use or reviewed by the Food and Drug Administration (FDA). Our study compared oxygen saturation (SpO2) in patients from 1 medical use (MU) pulse oximeter to 8 NMU pulse oximeters. Measured arterial oxygenation (SaO2) was compared with SpO2 when available. In patients who were normoxic (SpO2 ≥90%), all oximeters exhibited similar readings. This finding suggests that NMU pulse oximeters may be able to rule out hypoxemia in clinical settings.

Factores sociodemográficos y clínicos asociados a la supervivencia de dientes tratados endodónticamente por estudiantes de pregrado. Medellín (Colombia) / Sociodemographic and clinical factors associated to survival of endodontically treated teeth conducted by undergraduate dentistry students. Medellin (Colombia)

Resumen Objetivo: Determinar los factores sociodemográficos y clínicos asociados con la supervivencia de dientes tratados endodónticamente por estudiantes de pregrado de la Facultad de Odontología-Universidad de Antioquia (Medellín, Colombia), durante el periodo 2007-2011. Material y métodos: Estudio longitudinal retrospectivo con análisis de supervivencia por medio de las historias clínicas según los criterios de inclusión y posteriormente se examinaron a los pacientes. La supervivencia global se calculó utilizando el análisis de Kaplan-Meier, y las curvas se compararon a través del log rank test. Para el análisis multivariado se realizó el modelo de riesgos proporcionales de Cox, obteniendo la medida de asociación HR ajustada, con su intervalo de confianza al 95%. Resultados: Las variables sociodemográficas y clínicas con asociación estadísticamente significativa fueron nivel de educación, tipo de afiliación a salud, diagnóstico inicial y tipo de restauración. Los dientes que permanecen después de un tratamiento endodóntico durante los primeros tres años es del 78% y los que sobreviven por más de seis años es del 57%. La media de sobrevida de los dientes en los pacientes atendidos es de 1,959 días (error estándar de 66.9 días). El modelo multivariado mostró que la velocidad de pérdida del diente fue mayor en multirradiculares (HR 2.38; IC 95% 1.23-4.60) y en aquellos con diagnóstico inicial de absceso apical agudo (HR 27.96; IC 95% 1.84-423.09). Conclusión: Se identificaron factores sociodemográficos y clínicos asociados con la supervivencia de los dientes tratados endodónticamente, lo que permite establecer sistemas de vigilancia epidemiológica para evaluar la calidad de la atención odontológica.

Abstract Objective: To determine clinical and sociodemographic factors associated to survival of endodontically treated teeth. The present study was conducted by undergraduate students of the Faculty of Dentistry (Medellin, Colombia) during the period 2007-2011. Material and methods: Retrospective, longitudinal study with survival analysis through consultation with clinical histories according to inclusion criteria, and, further ahead, patient examination. Global survival was calculated with the use of Kaplan-Meier analysis, and curves were compared with log rank test. Cox proportional risk model was used for multivariate analysis, adjusted HR association was obtained with a 95% confidence interval. Results: Sociodemographic and clinical variables with statistically significant association were: education level, type of health affiliation, initial diagnosis and restoration type. Teeth remaining for three years after endodontic treatment were 78%, whereas 57% survived for over six years. Tooth survival mean in treated patients was 1,959 days (standard error: 66.9 days). Multivariate model showed that tooth loss speed was greater in multi-rooted teeth (HR 2.38, CI 95% 1.23-4.60) as well as in teeth with initial diagnosis of acute apical abscess (HR 27.96, CI 95%, 1.84-423.09). Conclusion: Clinical and sociodemographic factors were identified, associated to survival of endodontically treated teeth, this allowed to establish epidemiological monitoring systems in order to assess dental care quality.

Challenges Involved in the Development and Delivery of Abuse-deterrent Formulations of Opioid Analgesics.

PURPOSE: This commentary examines the development, regulatory, and reimbursement challenges facing abuse-deterrent formulation (ADF) products. METHODS: In January 2017, the Tufts Center for the Study of Drug Development convened a roundtable to explore clinical development, regulatory, and reimbursement challenges with respect to ADFs of opioid analgesics. Roundtable participants, who included a range of pharmaceutical industry and other experts, discussed multiple challenges. FINDINGS: First, several key clinical development challenges were identified and discussed. These challenges pertain to prodrug development and development of deterrents against oral abuse. Second, experts suggested that more clarity is needed from regulatory authorities regarding standards for proving ADF labeling claims and for being rewarded with 3-year data exclusivity. Similarly, given the substantial burdens associated with the development of postapproval evidence generation, experts raised the need for a consistent regulatory policy related to postapproval evidence generation for all ADFs (branded and generic). Third, despite the public health benefits of certain ADF products, current coverage and access policies impede patient access. Payer justification for restrictive policies appears to be based more on budget impact considerations than cost-effectiveness. Fourth, there remains a need to further expand the evidence base regarding clinical and cost-effectiveness as well as abuse deterrence in a real-world setting for all ADF products. IMPLICATIONS: Clinical development challenges need to be overcome with respect to novel ADF technologies, such as prodrugs and deterrents against oral abuse. More clarity is needed from regulatory authorities on labeling claims and data exclusivity eligibility with respect to ADFs. Ensuring prescriber training and awareness of various options for treating pain, including ADF products, is an important step, as is educating payers about the public health benefits of ADFs in appropriate subpopulations of pain patients. In addition, physicians may need to incorporate appropriate risk stratification methods. Finally, it is important to establish a level playing field between coverage of ADF and non-ADF products so that non-ADF products are not given preferred formulary placement.

[Smoking parental as risk factor for the development of Neonatal Respiratory Distress Syndrome]. / Tabaquismo paterno como factor de riesgo para el desarrollo de Síndrome de Distrés Respiratorio (SDR) en el recién nacido (RN).

The Respiratory Distress Syndrome (RDS) is one of the most frequent pathologies in the premature neonates and a major cause of morbidity and mortality. The objective of this study was to determine the association between parental smoking and the development of this syndrome. This study was an observational, longitudinal, retrospective, analytical, prolective type, with the neonates in the Neonatal Intensive Care Unit (NICU) of the Hospital Regional Monterrey (HRMI), who developed RDS (cases) and those that do not (controls), during the period January 2012 - April 2015, in both groups were determined the smoking habits of the father and the statistical analysis using SPSS (v. 14). The total sample was 85 RN, of which 46 developed SDR and 39 didn´t develop it, predominantly the genre male (56%). Seventy per cent of the group of parents who denied smoking, their children developed SDR, while 64% of parents who reported smoking, their children did not manifest this syndrome. The p-value was of 0.002, OR = 0.245, with 0.099 to 0.607 range. CONCLUSION: Parental smoking isn´t a risk factor for the development of RDS in the neonates, it could be considered a protective factor.

[Diagnosis and prognosis of fetal ebstein anomaly]. / Diagnóstico y pronóstico fetales de la anomalía de Ebstein.

BACKGROUND: Fetal echocardiography is possible to confirm with great certainty the diagnosis, in utero, Ebstein's anomaly, as well as determine its perinatal prognosis. OBJECTIVE: Review the experience of 16 cases diagnosed with Ebstein's anomaly, using fetal echocardiography, analyzing "forecast echocardiographic parameters" set by Pavlova, Huhta and Barre. MATERIAL AND METHOD: retrospective and descriptive analysis. We analysed echocardiographic parameters and its correlation with the perinatal development of 16 cases diagnosed with Ebstein's anomaly. RESULTS: Maternal age of our patients was 27.94 +/- 5.7 years, gestational age 31.3 +/- 3.6.) Mortality: in-utero 37.5% (n = 6), neonatal 50% (n = 8), survived 12.5% (n = 2). Cardiothoracic index 0.61 +/- 0.074, relationship foramen oval/heart atrial 0.6 +/- 0.015; obstruction to the way out of the right ventricle in 14 cases (87.5%). The deceased 81% presented degree of valvular displacement > 2.5; relationship RV/LV 2.24 +/- 0.37). CONCLUSIONS: Cardiothoracic index fetal stage > 0.55, relationship oval foramen/interatrial septum < 0.3, obstruction to the way out and a degree of valvular displacement > 2.5, absence of back flow in arteriosus ductus and a ratio RV/LV > 2 are poor prognostic factors for Ebstein's anomaly.

Late ureteral obstruction after injection of dextranomer/hyaluronic acid copolymer.

Various biological and artificial materials have been introduced for endoscopic treatment of vesicoureteral reflux. Over the past years, dextranomer combined with hyaluronic acid (Dx/Ha) has been established as the most commonly used tissue-augmenting substance for subureteral injection because of its biocompatibility. Nevertheless, the histopathologic analysis of failed Dx/Ha injections showed changes in consistency and volume of the deposit and granulomatous reactions of the adjacent tissue. We report a case of late-onset obstruction 2 years after the injection of Dx/Ha. In the current literature, this potential long-term complication is hardly mentioned.

[Fetal diagnosis and prognosis of Ebstein's anomaly]. / Diagnóstico y pronóstico fetal de la anomalía de Ebstein.

BACKGROUND: Currently fetal echocardiography may confirm the diagnosis in utero of Ebstein anomaly, as well as determine the perinatal outcome with high certainty. OBJECTIVE: To review 16 cases diagnosed with Ebstein anomaly, by fetal echocardiography, analyzing prognostic echocardiographic parameters set by Pavlova and colleagues. MATERIAL AND METHOD: A descriptive, observational, retrospective study was done in patients with fetal diagnosis of Ebstein anomaly, during January 2001 to December 2011. Echocardiographic parameters are analyzed and its correlation to perinatal evolution of 16 cases of Ebstein anomaly. RESULTS: Maternal age was of 27.94 + 5.7 years, gestational age was 31.3 +/- 3.6 weeks. In utero mortality represented 37.5% (n = 6), and neonatal mortality 50% (n = 8), two patients (12.5%) survived. Cardiothoracic index was of 0.61 +/- 0.074, ratio foramen ovale-atrial septal was of 0.6 +/- 0.015, obstruction of the outflow tract of the right ventricle was seen in 14 (87.5%) patients; 81% of the deceased had a degree of displacement valve > 2.5; ratio right ventricle-left ventricle 2.24 +/- 0.37. The umbilical vein was throbbing in 64% of the deceased, the tricuspid insufficiency was severe in 15 cases (94%, 21.62 +/- 2.82 mmHg), hydrops affected 18.7% of patients. CONCLUSIONS: The following factors are of bad prognosis in fetal stage of Ebstein anomaly: cardiothoracic index > 0.55, relative foramen ovale-atrial septal <0.3, the obstruction to the outflow tract, a degree of valve displacement > 2.5, absence of reverse flow in the duct arteriosus, ratio right ventricle-left ventricle > 2. The Ebstein anomaly diagnosed in utero has a perinatal mortality of 87.5%.

Anatomical closure technique of the nasal floor for patients with complete unilateral cleft lip and palate.

We describe a new technique for the reconstruction of the nasal floor at the same time as cheiloplasty in patients with complete unilateral cleft lip and palate. We operated on patients aged between 3 and 36 months in public secondary and tertiary level institutions. None of these patients had had a previous operation for the correction of the cleft lip or palate. The operation required the design of two mucous flaps, one lateral and one medial to the defect, to reposition the tissues anatomically and repair the congenital deficiency. Three hundred and fifty-eight patients have been treated using this technique, most of whom (n = 233, 65%) were boys, and 288 (80%) presented with a right complete unilateral cleft. Postoperative evaluation showed that 22 patients (6%) had asymmetry of the nasal base equal to or less than 1 mm, 18 (5%) had nasovestibular fistulas, and 5 (1%) required revision. We conclude that this technique greatly reduces the number of asymmetrical nasal floors and the incidence of nasovestibular fistulas.

Causas de fallecimiento por hemorragia digestiva en el Servicio de Cirugía del Hospital Docente “Miguel Enríquez”, periodo 2004 a 2006, La Habana, Cuba / Cause of death in patients with gastrointestinal bleeding, from 2004 until 2006. “Miguel Enríquez” Hospital. Havana, Cuba

Introducción: uno de los eventos más frecuentes y graves que pueden ocurrir en el aparato digestivo son las hemorragias digestivas, altas o bajas, de aquí la importancia del diagnóstico y tratamiento temprano. A pesar de los avances terapéuticos y teniendo el apoyo de los métodos endoscópicos para el diagnóstico, a veces esta entidad tiene un desenlace fatal. Objetivo: identificar las causas que con mayor frecuencia provocaron el fallecimiento de los pacientes con el diagnóstico de hemorragia digestiva en el Hospital Docente “Miguel Enríquez” de La Habana, Cuba. Materiales y métodos: se realizó un estudio retrospectivo que abarca desde enero del año 2004 hasta diciembre del 2006, revisando los reportes del comité de fallecidos y las historias clínicas de estos pacientes. Resultados: del total de fallecidos en el servicio de cirugía, el 29,3% fue por esta causa, se realizó el 77% de las necropsias, las causas más frecuentes fueron las várices esofágicas 47%, las úlceras pépticas 19,5% y las gastropatías hemorrágicas 13%. Conclusiones: las hemorragias digestivas, principalmente las altas, fueron causa frecuente de fallecimiento en este hospital. El motivo de ingreso más observado fue la hematemesis, predominaron los ancianos del sexo masculino con antecedentes patológicos personales de enfermedades crónicas.

Introduction: one of the most severe and frequent events that can affect the digestive system is gastrointestinal bleeding, hence the importance of an early diagnosis and treatment. In spite of the therapeutic advances and the support of endoscopic methods, this entity sometimes has a fatal outcome. Objective: describing the causes of death of patients with gastrointestinal bleeding in this hospital. Methods: carry out this retrospective study that spans from January of the year 2004 until December of the year 2006. It was revised the reports of the committee of deceaseds, and the histories of these patients. Results: from the total of deceased patients in this surgeryservice, 29,3% were due to this cause. We performed autopsies in 77% of these patients, and the most frequent causes of gastrointestinal bleeding were esophago gastric varices 47%, peptic ulcers 19,5% and acute erosive gastritis 13%. Conclusions: gastrointestinal bleeding was found to be a frequent cause of death in this hospital. The most commonly observed sign was hematemesis, and it was found to most commonly affect old men with a personal history of chronic illness.

Reconstruction of a degloved thumb.

We present two cases of degloving injuries of the thumb with amputation of the distal phalanx. The first one was treated with an osteocutaneous flap from the first toe, giving effective function to the thumb, and the second by a fasciocutaneous interosseous flap around the segment of the exposed thumb, with a satisfactory result.

Velopharyngeal surgery: a prospective randomized study of pharyngeal flaps and sphincter pharyngoplasties.

Residual velopharyngeal insufficiency after palatal repair varies from 10 to 20 percent in most centers. Secondary velopharyngeal surgery to correct residual velopharyngeal insufficiency in patients with cleft palate is a topic frequently discussed in the medical literature. Several authors have reported that varying the operative approach according to the findings of videonasopharyngoscopy and multiview videofluoroscopy significantly improved the success of velopharyngeal surgery. This article compares two surgical techniques for correcting residual velopharyngeal insufficiency, namely pharyngeal flap and sphincter pharyngoplasty. Both techniques were carefully planned according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. Fifty patients with cleft palate and residual velopharyngeal insufficiency were randomly divided into two groups: 25 in group 1 and 25 in group 2. Patients in group 1 were operated on by using a customized pharyngeal flap according to the findings of videonasopharyngoscopy and multiview videofluoroscopy in each case. Those in group 2 received a sphincter pharyngoplasty also customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients in both groups was not significantly different (p > 0.5). The frequency of residual velopharyngeal insufficiency after the individualized velopharyngeal surgery was not significantly different between the patient groups (12 percent versus 16 percent; p > 0.05). It seems that customized pharyngeal flaps and sphincter pharyngoplasties performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy are safe and reliable procedures for treating residual velopharyngeal insufficiency in cleft palate patients.