Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome.

OBJECTIVE: To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. METHOD: A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. RESULTS: Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. CONCLUSIONS: The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

OBJETIVO: Evaluar los resultados clínico-quirúrgicos del abordaje tipo tubular en comparación con el mini-open en la discoidectomía lumbar. El abordaje tubular promete reducir el número de días de reposo y una reincorporación más temprana a las actividades diarias y laborales. MÉTODO: Se realizó un estudio de casos y controles de pacientes operados por hernia discal mediante cirugía tubular (casos) o mini-open (controles). Las variables investigadas fueron: dolor radicular y lumbar, sexo, edad, falla en el tratamiento conservador, hernia lumbar de un solo nivel, tiempo quirúrgico, sangrado, tiempo de estancia hospitalaria, persistencia de síntomas, complicaciones, tipo de actividad ocupacional y reinserción a las actividades cotidianas. RESULTADOS: Se realizaron 100 cirugías y se crearon dos grupos, tubular y mini-open, con 50 pacientes cada uno, con hernia discal de L4-L5 o L5-S1, respectivamente. El nivel más afectado fue L4-L5 (69%). Del total de los casos, se encontró mejoría significativa (p < 0.05) a los 15 días posquirúrgicos en la escala EVA y ODI en el grupo tubular con respecto al mini-open. Ocurrieron complicaciones como infección de herida quirúrgica, durotomía y dolor persistente. CONCLUSIONES: El abordaje tubular es una opción segura y efectiva para hernias discales del segmento lumbar, y reduce los tiempos quirúrgicos, el sangrado y el tiempo de reinserción a las actividades cotidianas del paciente.

Parameters of pubertal growth spurt in children and adolescents living at high altitude in Peru

Abstract Objectives: The aim was to estimate the pubertal growth height of children and adolescents living in a high-altitude region of Peru using the Preece-Baines model 1 (1 PB). Methods: A cross-sectional study was conducted in schoolchildren from the department of Puno (Peru) between 3841 and 3874 masl. The age range was between 4 and 17 years. Standing height was evaluated. 1 PB was used to infer the mathematical and biological parameters of stature. Results: Mathematical parameters estimated by the 1 PB model reflected small residual standard error (RSE) values in both sexes (0.25 in boys and 0.27 in girls). In boys, the age at which peak velocity was reached (APHV) was estimated at 13.21 ± 0.33years. While in girls it was 9.96 ± 0.26years (p < 0.05). In general, girls reached APHV (y) 3.25 years earlier than boys. On the other hand, the growth velocity of maximum height [APHV (cm/y)] of boys was higher (6.33 ± 6.06 cm/y) relative to girls (6.06 ± 0.32 cm/y). Estimated final adult height (EFAH) in boys was reached at 166.020 ± 0.99 cm and height at maximum growth velocity (HPHV) was 153.07 ± 0.67 cm, while in girls they were significantly lower (EFAH; 153.74 ± 0.44 cm and HPHV: 139.73 ± 0.84 cm). Conclusions: This study showed that girls living in Puno at a high altitude in Peru reached APHV 3 years earlier than boys and at the same time reflected slower PHV. These results suggest that pubertal growth at high altitudes is slower in both sexes and especially in girls. Thus, modeling physical growth may be an important step in understanding the onset of puberty at different latitudes.

Parameters of pubertal growth spurt in children and adolescents living at high altitude in Peru.

OBJECTIVES: The aim was to estimate the pubertal growth height of children and adolescents living in a high-altitude region of Peru using the Preece-Baines model 1 (1 PB). METHODS: A cross-sectional study was conducted in schoolchildren from the department of Puno (Peru) between 3841 and 3874 masl. The age range was between 4 and 17 years. Standing height was evaluated. 1 PB was used to infer the mathematical and biological parameters of stature. RESULTS: Mathematical parameters estimated by the 1 PB model reflected small residual standard error (RSE) values in both sexes (0.25 in boys and 0.27 in girls). In boys, the age at which peak velocity was reached (APHV) was estimated at 13.21 ± 0.33years. While in girls it was 9.96 ± 0.26years (p < 0.05). In general, girls reached APHV (y) 3.25 years earlier than boys. On the other hand, the growth velocity of maximum height [APHV (cm/y)] of boys was higher (6.33 ± 6.06 cm/y) relative to girls (6.06 ± 0.32 cm/y). Estimated final adult height (EFAH) in boys was reached at 166.020 ± 0.99 cm and height at maximum growth velocity (HPHV) was 153.07 ± 0.67 cm, while in girls they were significantly lower (EFAH; 153.74 ± 0.44 cm and HPHV: 139.73 ± 0.84 cm). CONCLUSIONS: This study showed that girls living in Puno at a high altitude in Peru reached APHV 3 years earlier than boys and at the same time reflected slower PHV. These results suggest that pubertal growth at high altitudes is slower in both sexes and especially in girls. Thus, modeling physical growth may be an important step in understanding the onset of puberty at different latitudes.

Effects of Mono-Vacancies and Co-Vacancies of Nitrogen and Boron on the Energetics and Electronic Properties of Heterobilayer h-BN/graphene.

A study is carried out which investigates the effects of the mono-vacancies of boron (VB) and nitrogen (VN) and the co-vacancies of nitrogen (N), and boron (B) on the energetics and the structural, electronic, and magnetic properties of an h-BN/graphene heterobilayer using first-principles calculations within the framework of the density functional theory (DFT). The heterobilayer is modelled using the periodic slab scheme. In the present case, a 4 × 4-(h-BN) monolayer is coupled to a 4 × 4-graphene monolayer, with a mismatch of 1.40%. In this coupling, the surface of interest is the 4 × 4-(h-BN) monolayer; the 4 × 4-graphene only represents the substrate that supports the 4 × 4-(h-BN) monolayer. From the calculations of the energy of formation of the 4 × 4-(h-BN)/4 × 4-graphene heterobilayer, with and without defects, it is established that, in both cases, the heterobilayers are energetically stable, from which it is inferred that these heterobilayers can be grown in the experiment. The formation of a mono-vacancy of boron (1 VB), a mono-vacancy of nitrogen (1 VN), and co-vacancies of boron and nitrogen (VBN) induce, on the structural level: (a) for 1 VB, a contraction n of the B-N bond lengths of ~2.46% and a slight change in the interfacial distance D (~0.096%) with respect to the heterobilayer free of defects (FD) are observed; (b) for 1 VN, a slight contraction of the B-N of bond lengths of ~0.67% and an approach between the h-BN monolayer and the graphene of ~3.83% with respect to the FD heterobilayer are observed; (c) for VBN, it can be seen that the N-N and B-B bond lengths (in the 1 VB and 1 VN regions, respectively) undergo an increase of ~2.00% and a decrease of ~3.83%, respectively. The calculations of the Löwdin charge for the FD heterobilayer and for those with defects (1 VB, 1 VN, and VBN) show that the inclusion of this type of defect induces significant changes in the Löwdin charge redistribution of the neighboring atoms of VB and VN, causing chemically active regions that could favor the interaction of the heterobilayer with external atoms and/or molecules. On the basis of an analysis of the densities of states and the band structures, it is established that the heterobilayer with 1 VB and VBN take on a half-metallic and magnetic behavior. Due to all of these properties, the FD heterobilayer and those with 1 VB, 1 VN, and VBN are candidates for possible adsorbent materials and possible materials that could be used for different spintronic applications.

Medidas de control epidemiológico en el sector empresarial e impacto de la pandemia sobre la creación de empresas en el departamento del Magdalena Colombia / Epidemiological control measurements at the business sector and impact of pandemic on business creation in the department of Magdalena Colombia

Este trabajo se propone analizar el impacto de la pandemia por COVID-19 en los registros de creación de nuevas empresas en el departamento del Magdalena (Colombia) principalmente entre el 2019 y 2020, de la misma manera se desarrolla un análisis de las medidas de control epidemiológico a nivel nacional y a nivel departamental para comprender de mejor manera las iniciativas de contención de la COVID-19. Para el desarrollo de este trabajo, se tomaron como referencia los datos de creación de empresas de los últimos cinco años (2016 ­ 2020) en el Magdalena; así como se analizaron medidas para el control epidemiológico a nivel nacional (prevenir, mitigar, y suprimir), así como las adoptadas específicamente para el Magdalena. Entre los principales hallazgos, se encontró que, al contrastar los años 2019 y 2020, hubo una disminución del 2,6% en la creación de nuevas empresas en el departamento del Magdalena, porcentaje que representa 202 unidades productivas menos que en 2019; esta tendencia decreciente en materia de creación de empresas, venía desde 2019, año en el que hubo una caída del 0,8% en los nacimientos de nuevas empresas con respecto al 2018 -62 empresas menos-; la contundente caída en el año 2020 es un reflejo del nefasto efecto de la aparición de la COVID-19 en las dinámicas empresariales en el Magdalena; de otra parte, resaltan medidas de gestión intergremial al igual que las estrategias de apoyo financiero para dinamizar la economía en el Magdalena, así como una cronología prudente en materia de controles epidemiológicos en el Territorio(AU)

This study aims to analyze the impact of the COVID-19 pandemic on the records of the creation of new companies in the department of Magdalena (Colombia), mainly between 2019 and 2020. In the same way, an analysis of epidemiology control measures is developed at the national and departmental levels to better understand COVID-19 containment initiatives. For the development of this study, the data on business creation of the last five years (2016 - 2020) in Magdalena was taken as a reference; as well as measures for epidemiological control at the national level (prevent, mitigate, and suppress), along with those adopted specifically for Magdalena were analyzed. Among the main findings, it was found that, when comparing the years 2019 and 2020, there was a 2.6% decrease in the creation of new companies in Magdalena, a percentage that represents 202 production units less than in 2019; This downward trend in the creation of companies came from 2019, the year in which there was a 0.8% drop in the establishment of new companies compared to 2018 -62 fewer companies-; the overwhelming drop in 2020 is a reflection of the disastrous effect of the appearance of COVID-19 on business dynamics in Magdalena; On the other hand, the business associations management measures were a key important factor. Additionally, the financial support to boost the economy in Magdalena, as well as a prudent chronology - in terms of epidemiological controls in the Territory(AU)

Effects of Mono-Vacancies of Oxygen and Manganese on the Properties of the MnO2/Graphene Heterostructure.

The effects of the monovacancies of oxygen (VO) and manganese (VMn) on the structural and electronic properties of the 1T−MnO2/graphene heterostructure are investigated, within the framework of density functional theory (DFT). We found that the values of the formation energy for the heterostructure without and with vacancies of VO and VMn were −20.99 meVÅ2 , −32.11meVÅ2, and −20.81 meVÅ2, respectively. The negative values of the formation energy indicate that the three heterostructures are energetically stable and that they could be grown in the experiment (exothermic processes). Additionally, it was found that the presence of monovacancies of VO and VMn in the heterostructure induce: (a) a slight decrease in the interlayer separation distance in the 1T−MnO2/graphene heterostructure of ~0.13% and ~1.41%, respectively, and (b) a contraction of the (Mn−O) bond length of the neighboring atoms of the VO and VMn monovacancies of ~2.34% and ~6.83%, respectively. Calculations of the Bader charge for the heterostructure without and with VO and VMn monovacancies show that these monovacancies induce significant changes in the charge of the first-neighbor atoms of the VO and VMn vacancies, generating chemically active sites (locales) that could favor the adsorption of external atoms and molecules. From the analysis of the density of state and the structure of the bands, we found that the graphene conserves the Dirac cone in the heterostructure with or without vacancies, while the 1T−MnO2 monolayer in the heterostructures without and with VO monovacancies exhibits half-metallic and magnetic behavior. These properties mainly come from the hybridization of the 3d−Mn and 2p−O states. In both cases, the heterostructure possesses a magnetic moment of 3.00 µß/Mn. From this behavior, it can be inferred the heterostructures with and without VO monovacancies could be used in spintronics.

Sarcoidosis con compromiso cutáneo casuística del Servicio de Dermatología del Hospital Nacional- período 2010-2020 / Sarcoidosis with skin engagement casuistics of the National Hospital Dermatology Service - period 2010-2020

Introducción: La sarcoidosis es una enfermedad inflamatoria, granulomatosa de etiología desconocida. Puede afectar cualquier órgano siendo la afectación pulmonar la más frecuente. La piel se compromete en aproximadamente 30% de los casos, pudiendo ser inicial o único. La sarcoidosis es muy rara en el Paraguay. Objetivos: Realizar una revisión de los casos de sarcoidosis observados en el Servicio de Dermatología del Hospital Nacional en el periodo 2010-2020; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional. Resultados: Se diagnosticaron 5 casos, todas mujeres de raza blanca, con edades que oscilaban de 41 a 63 años. Las formas clínicas fueron papulosa en 3 casos, en placa 1 y mixta 1. Las lesiones cutáneas eran asintomáticas y estaban ubicadas preferentemente en rostro (4 casos). El compromiso sistémico se objetivó en las primeras consultas en 2 casos (pulmonar, ocular y ganglionar en 1 y del aparato lagrimal en otro). En todos los casos el diagnóstico se fundamentó en la correlación clínico-histológica, con el hallazgo de los granulomas sarcoides. Todos recibieron clobetasol tópico, 3 pacientes ciclos de prednisona y 2 hidroxicloroquina. La evolución fue favorable en 3 casos y 2 no volvieron a sus controles. Conclusión: La sarcoidosis con manifestaciones cutáneas es rara en nuestro Servicio, pero representa un desafío diagnóstico, que debe ser oportuno para diferenciarla de otras patologías más prevalentes en nuestro medio

Introduction: Sarcoidosis is an inflammatory, granulomatous disease of unknown etiology. It can affect any organ, lung involvement being the most frequent. The skin is compromised in approximately 30% of the cases, and can be initial or unique. Sarcoidosis is very rare in Paraguay. Objectives: To carry out a review of the sarcoidosis cases observed in the Dermatology Service of the National Hospital in the period 2010-2020; determining their demographic, clinical, laboratory and evolutionary characteristics. Materials and methods: Retrospective, descriptive and observational study. Results: 5 cases were diagnosed; all white women; with ages ranging from 41 to 63 years. The clinical forms were papular in 3 cases, in plate 1 and mixed 1. The skin lesions were asymptomatic and were preferably located on the face (4 cases). Systemic involvement was observed in the first consultations in 2 cases (pulmonary, ocular and lymph node in 1 and the lacrimal apparatus in another). In all cases the diagnosis was based on the clinical-histological correlation, with the finding of sarcoid granulomas. All received topical clobetasol, 3 patients received prednisone cycles and 2 hydroxychloroquine. The evolution was favorable in 3 cases and 2 did not return to their controls. Conclusion: Sarcoidosis with skin manifestations is rare in our Service, but it represents a diagnostic challenge that must be timely to differentiate it from other more prevalent pathologies in our setting

Estimation of Pubertal Growth Spurt Parameters in Children and Adolescents Living at Moderate Altitude in Colombia.

Objective: Knowledge of the biological parameters of pubertal growth spurt allows verification of secular changes and exploration of the timing of puberty. The aim of the study was to estimate final height, age at peak height velocity (APHV), and peak height velocity PHV (cm/y) in children and adolescents living at moderate altitude in Colombia. Methods: A cross-sectional study was designed in 2.295 schoolchildren from Bogotá (Colombia) with an age range from 5.0 to 18.9 years. Height (cm) was assessed. Preece-Baines model 1 (1PB) was used to make inferences about mathematical and biological parameters. Results: The five mathematical parameters estimated in general have reflected quality in the fit to the model, reflecting a small residual error. Final height was reached in boys at 170.8 ± 0.4 cm and in girls at 157.9 ± 0.2 cm. APHV was estimated at 12.71 ± 0.1 years in boys and 10.4 ± 0.2 years in girls. Girls reached APHV 2.2 years earlier than boys. In relation to PHV (cm/y), boys reached higher growth speed in height (7.4 ± 0.4 cm/y), and in girls it was (7.0 ± 0.2 cm/y). Conclusion: It was determined that final height was reached at 170.8 ± 0.4 cm in boys and 157.9 ± 0.2 cm in girls, and APHV (years) and PHV (cm/ye) were reached relatively early and with average peak velocity similar to Asian and Western populations. A large-scale longitudinal study is needed to confirm these findings.

Propuesta de percentiles para evaluar el crecimiento físico y la adiposidad corporal en función del estado de madurez en niños y adolescentes chilenos / Proposal of percentiles to evaluate physical growth and body adiposity as a function of maturity status in Chilean children and adolescents

Introducción: durante la infancia y la adolescencia existe una gran variabilidad individual en el crecimiento y la maduración biológica, lo que resulta en diferencias en el tamaño, la forma y la composición corporal de los niños y adolescentes de edad similar. Objetivo: proponer percentiles para evaluar el crecimiento físico y la adiposidad corporal en función del estado de madurez (EM) en niños y adolescentes chilenos. Métodos: se diseñó un estudio descriptivo (transversal) en 7292 niños y adolescentes (4214 chicos y 3084 chicas) de la región del Maule (Chile). El rango de edad oscila entre 6,0 y 17,9 años. Se evaluó el peso, la estatura y la circunferencia de la cintura (CC). Se calculó el índice de masa corporal (IMC), el índice cintura-estatura (ICE) y el EM a través de una técnica antropométrica no invasiva basada en la edad cronológica y la estatura de pie. Se utilizó el método LMS para calcular los percentiles. Resultados: el EM calculado en los chicos se observó a los 13,7 ± 0,6 APVC (años de pico de velocidad de crecimiento) y en las chicas a los 12,1 ± 0,6 APVC. Se crearon percentiles para el peso, la estatura, la CC, el IMC y el ICE. Todas las variables antropométricas se incrementan conforme el EM aumenta en APVC. Conclusión: los percentiles propuestos son una alternativa para evaluar el crecimiento físico y la adiposidad corporal en función del EM en los niños y adolescentes chilenos. Los resultados sugieren que esta técnica no invasiva puede aplicarse en contextos clínicos y epidemiológicos. (AU)

Introduction: during childhood and adolescence there is great individual variability in growth and biological maturation, resulting in differences in size, shape and body composition in children and adolescents of similar age. Objective: to propose percentiles to assess physical growth and body adiposity as a function of maturity status (SM) in Chilean children and adolescents. Methods: a descriptive (cross-sectional) study was designed in 7,292 children and adolescents (4214 boys and 3084 girls) from the Maule region (Chile). The age range was 6.0 to 17.9 years. Weight, height and waist circumference (WC) were evaluated. Body mass index (BMI), waist-height index (WHtR) and SM were calculated through a non-invasive anthropometric technique based on chronological age and standing height. The LMS method was used to calculate percentiles. Results: the SM calculated in boys was observed at 13.7 ± 0.6 APHV (years of peak growth speed) and in girls at 12.1 ± 0.6 APHV. Percentiles were created for weight, height, WC, BMI, and WHtR. All anthropometric variables increase as MS increases in PHV years. Conclusion: the proposed percentiles are an alternative to evaluate physical growth and body adiposity as a function of SM in Chilean children and adolescents. The results suggest the use of this non-invasive technique to be applied in clinical and epidemiological contexts. (AU)

[Proposal of percentiles to evaluate physical growth and body adiposity as a function of maturity status in Chilean children and adolescents]. / Propuesta de percentiles para evaluar el crecimiento físico y la adiposidad corporal en función del estado de madurez en niños y adolescentes chilenos.

INTRODUCTION: Introduction: during childhood and adolescence there is great individual variability in growth and biological maturation, resulting in differences in size, shape and body composition in children and adolescents of similar age. Objective: to propose percentiles to assess physical growth and body adiposity as a function of maturity status (SM) in Chilean children and adolescents. Methods: a descriptive (cross-sectional) study was designed in 7,292 children and adolescents (4214 boys and 3084 girls) from the Maule region (Chile). The age range was 6.0 to 17.9 years. Weight, height and waist circumference (WC) were evaluated. Body mass index (BMI), waist-height index (WHtR) and SM were calculated through a non-invasive anthropometric technique based on chronological age and standing height. The LMS method was used to calculate percentiles. Results: the SM calculated in boys was observed at 13.7 ± 0.6 APHV (years of peak growth speed) and in girls at 12.1 ± 0.6 APHV. Percentiles were created for weight, height, WC, BMI, and WHtR. All anthropometric variables increase as MS increases in PHV years. Conclusion: the proposed percentiles are an alternative to evaluate physical growth and body adiposity as a function of SM in Chilean children and adolescents. The results suggest the use of this non-invasive technique to be applied in clinical and epidemiological contexts.

INTRODUCCIÓN: Introducción: durante la infancia y la adolescencia existe una gran variabilidad individual en el crecimiento y la maduración biológica, lo que resulta en diferencias en el tamaño, la forma y la composición corporal de los niños y adolescentes de edad similar. Objetivo: proponer percentiles para evaluar el crecimiento físico y la adiposidad corporal en función del estado de madurez (EM) en niños y adolescentes chilenos. Métodos: se diseñó un estudio descriptivo (transversal) en 7292 niños y adolescentes (4214 chicos y 3084 chicas) de la región del Maule (Chile). El rango de edad oscila entre 6,0 y 17,9 años. Se evaluó el peso, la estatura y la circunferencia de la cintura (CC). Se calculó el índice de masa corporal (IMC), el índice cintura-estatura (ICE) y el EM a través de una técnica antropométrica no invasiva basada en la edad cronológica y la estatura de pie. Se utilizó el método LMS para calcular los percentiles. Resultados: el EM calculado en los chicos se observó a los 13,7 ± 0,6 APVC (años de pico de velocidad de crecimiento) y en las chicas a los 12,1 ± 0,6 APVC. Se crearon percentiles para el peso, la estatura, la CC, el IMC y el ICE. Todas las variables antropométricas se incrementan conforme el EM aumenta en APVC. Conclusión: los percentiles propuestos son una alternativa para evaluar el crecimiento físico y la adiposidad corporal en función del EM en los niños y adolescentes chilenos. Los resultados sugieren que esta técnica no invasiva puede aplicarse en contextos clínicos y epidemiológicos.

SPONTANEOUS CLOSURE OF SIMULTANEOUS IDIOPATHIC MACULAR HOLES DOCUMENTED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To report a case of spontaneous closure of simultaneous full-thickness macular hole. METHODS: Case report and literature review. RESULTS: A 67-year-old woman with small-diameter simultaneous macular holes was observed for a period of 5 months, and progression was documented with spectral-domain optical coherence tomography. Closure of right full-thickness macular hole was evidenced by 1 month and left full-thickness macular hole by 5 months. CONCLUSION: This case demonstrates possible spontaneous resolution of a condition that is usually treated surgically. A period of observation with serial imaging studies may be advised in cases of small macular holes.

Valor de las técnicas moleculares y de los factores de riesgo en el diagnóstico y evolución de la esporotricosis. A propósito de 2 casos por Sporothrix brasiliensis y S. globosa / Value of molecular techniques and risk factors in the diagnosis and evolution of sporotrichosis. About 2 cases of Sporothrix brasiliensis and S. globosa

La Esporotricosis es una micosis profunda causada por el hongo dimorfo Sporothrix schenckii, El advenimiento de técnicas moleculares como la reacción en cadena de la polimerasa ha hecho posible identificar varias especies dentro del complejo Sporothrix spp como S. brasiliensis, S. schenckii sensu stricto, S. globosa, S mexicana y S. albicans. Las diferencias son moleculares, pero también geográficas, macroscópicas, en asimilación de azúcares y crecimiento de colonias a 37º; determinando formas clínicas, evolución y respuestas terapéuticas diferentes. Comunicamos 2 casos de Esporotricosis diagnosticados en el Hospital Nacional de Paraguay, cuyos estudios de PCR del gen de la calmodulina hechos en el extranjero, determinaron ser producidos por S. brasiliensis y S. globosa respectivamente. El objetivo de la comunicación es resaltar la importancia de las técnicas moleculares para el diagnóstico preciso de la especie de Sporothrix spp, considerando los factores de riesgo asociados a la caracterización epidemiológica y a las diferencias clínico-evolutivas de los casos de esporotricosis.

Sporotrichosis is a deep mycosis caused by the dimorphic fungus Sporothrix schenckii. The advent of molecular techniques as the polymerase chain reaction has made it possible to identify several species within the Sporothrix spp complex such as S. brasiliensis, S. schenckii sensu stricto, S. globosa, S mexicana and S. albicans. The differences are molecular but also geographic, macroscopic, in sugar assimilation and colony growth at 37º, determining different clinical forms, evolution and therapeutic responses. We report 2 cases of sporotrichosis diagnosed in the National Hospital of Paraguay, whose studies of PCR of the calmodulin gene carried out abroad, determined to be produced by S. brasiliensis and S. globosa respectively. The objective of the communication is to highlight the importance of molecular techniques for the precise diagnosis of the species of Sporothrix spp, considering the risk factors associated with the epidemiological characterization and the clinical-evolutionary differences of the cases of sporotrichosis.

Infecciones mucocutáneas en pacientes con VIH/SIDA

RESUMEN Introducción: la aparición del VIH/SIDA produjo importantes cambios en varias patologías. Las enfermedades infecciosas, muchas de ellas con manifestaciones mucocutáneas, aumentaron en frecuencia, presentando evolución y respuesta al tratamiento inhabituales. El objetivo es comunicar la frecuencia y las características clínico-epidemiológicas de las infecciones mucocutáneas en pacientes con VIH/SIDA Material y métodos: estudio prospectivo, descriptivo, observacional de corte transverso. Se incluyeron pacientes de ambos sexos, mayores de 15 años, remitidos por el Programa HIV/SIDA del Hospital Nacional al Servicio de Dermatología en el período octubre 2018-octubre 2019. Resultados: se examinaron 100 pacientes con diagnóstico de VIH/SIDA, 37 presentaron infecciones mucocutáneas, de los cuales en 8 se evidenció más de una infección. Predominaron las lesiones micóticas (53%) y las virósicas (26,7%). La frecuencia de las lesiones bacterianas y parasitarias fueron 15% y 4,4% respectivamente. Los principales diagnósticos fueron candidiasis (29%), herpes simple (15,6%) y tiña corporis (11%). Conclusión: en esta serie las infecciones mucocutáneas fueron muy frecuentes (37%) predominando las micóticas, específicamente la candidiasis.

ABSTRACT Introduction: The appearance of HIV/AIDS produced important changes in various pathologies. Infectious diseases, many of them with mucocutaneous manifestations, increased in frequency, presenting unusual evolution and response to treatment. The objective is to communicate the frequency and clinical-epidemiological characteristics of mucocutaneous infections in patients with HIV / AIDS. Material and methods: Prospective, descriptive, observational, cross-sectional study. Male and female patients, older than 15 years, referred by the HIV/AIDS Program of the Hospital Nacional to the Dermatology Service in the period October 2018-October 2019 were included. Results: One hundred patients with a diagnosis of HIV/AIDS were examined, 37 presented mucocutaneous infections, and 8 of them revealed more than one infection. Fungal (53%) and viral (26.7%) lesions predominated. The frequencies of bacterial and parasitic lesions were 15% and 4.4% respectively. The main diagnoses were candidiasis (29%), herpes simplex (15.6%) and tinea corporis (11%). Conclusion: In this population, mucocutaneous infections were very frequent (37%), predominantly fungal infections, specifically candidiasis.

Conversation with Juan Carlos Negrete.

Juan Carlos Negrete is Emeritus Professor of Psychiatry, McGill University; Founding Director, Addictions Unit, Montreal General Hospital; former President, Canadian Society of Addiction Medicine; and former WHO/PAHO Consultant on Alcoholism, Drug Addiction and Mental Health.

Meta-analyses of placebo-controlled trials of acamprosate for the treatment of alcohol dependence: impact of the combined pharmacotherapies and behavior interventions study.

OBJECTIVES: : The Combined Pharmacotherapies and Behavior Interventions Study (COMBINE) reported no significant difference between acamprosate and placebo in the treatment of alcohol dependence. To evaluate the impact of COMBINE, we performed a meta-analysis of acamprosate placebo-controlled trials with the inclusion of data from COMBINE. As a secondary analysis, we added the COMBINE data to a recently published meta-analysis of naltrexone placebo-controlled trials. METHODS: : A structured literature search of major databases was performed from January 1990 to August 2007 for acamprosate placebo-controlled randomized trials. Mean differences in cumulative abstinent days (CAD) and abstinence rates (AR) from eligible studies were statistically combined to calculate point estimates and 95% CI for differences in CAD and AR. RESULTS: : Ten and 16 studies evaluating CAD and AR, respectively were suitable for statistical pooling. The findings revealed that acamprosate was superior to placebo in the mean number of CAD (P < 0.001) and AR (pooled AR = 1.58; P < 0.001). The pooled AR for naltrexone was also significant indicating a relative benefit over placebo (AR = 1.27; P < 0.001). The COMBINE trial results contributed a weight of less than 15% to the final pooled statistical outcomes for both agents. CONCLUSIONS: : The current study confirmed that acamprosate and naltrexone are both effective agents for the treatment of patients with alcohol dependence. Systematic reviews with meta-analyses of randomized controlled trials and randomized controlled trials with adequate sample sizes are in the same (highest) level of evidence. Therefore, clinicians should use both these sources of information as their foundation for selecting optimal therapy for patients with alcohol dependence.

Alterations in brain serotonin synthesis in male alcoholics measured using positron emission tomography.

BACKGROUND: A consistent association between low endogenous 5HT function and high alcohol preference has been observed, and a number of serotonergic manipulations (uptake blockers, agonists) alter alcohol consumption in animals and humans. Studies have also shown an inverse relationship between alcohol use and cerebrospinal fluid levels of serotonin metabolites, suggesting that chronic alcohol consumption produces alterations in serotonin synthesis or release. METHODS: The objective of the study was to characterize regional brain serotonin synthesis in nondepressed chronic alcoholics at treatment entry in comparison to normal nonalcoholic controls using PET and the tracer alpha-[(11)C]-methyl-L-tryptophan. RESULTS: Comparisons of the alcoholics and controls by SPM found that there were significant differences in the rate of serotonin synthesis between groups. Serotonin synthesis was significantly lower among alcoholics in Brodmann Area (BA) 9, 10, and 32. However, serotonin synthesis among the alcoholics group was significantly higher than controls at BA19 in the occipital lobe and around the transverse temporal convolution in the left superior temporal gyrus (BA41). In addition, there were correlations between regional serotonin synthesis and a quantity-frequency measure of alcohol consumption. Regions showing a significant negative correlation with QF included the bilateral rectus gyri (BA11) in the orbitofrontal area, the bilateral medial frontal area (BA6), and the right amygdala. CONCLUSIONS: Current alcoholism is associated with serotonergic abnormalities in brain regions that are known to be involved in planning, judgment, self-control, and emotional regulation.

Interpersonal group psychotherapy for comorbid alcohol dependence and non-psychotic psychiatric disorders.

Alcohol-dependent patients (N = 15) with comorbid non-psychotic psychiatric disorders were treated with Modified Interpersonal Group Therapy (MIGT) for eight weeks, 16 sessions, in a pilot intervention trial. Analysis of the group participants demonstrated that they achieved statistically significant improvements at post-treatment in four of five self-report outcome measures: number of drinking days, number of heavy drinking days, the Brief Symptom Inventory, and the Beck Depression Inventory. Furthermore, the improvements in heavy drinking days and the Brief Symptom Inventory were maintained at two and eight months post-treatment. This study yields preliminary evidence in support of MIGT as a useful treatment approach for an alcohol-dependent population with psychiatric comorbidity.

A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: changes in psychiatric symptoms and substance use.

While it is widely known that patients with schizophrenia-spectrum psychoses and co-occurring substance use disorders are more difficult to manage, there is limited data on the course of their psychiatric symptoms when they remain in treatment over time. This prospective 12-month study evaluated changes in psychiatric symptoms and substance use to ascertain if the co-existence of substance use disorders influences ratings of psychiatric symptoms at follow-up. 147 outpatients in a continuing care program were assessed at intake and followed prospectively for 12 months. Psychiatric symptoms were measured at baseline and 12-month follow-up using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAM-D). Subjective psychological distress was rated with the Brief Symptom Inventory (BSI) and quality of life by the Satisfaction with Life Domains Scale (SDLS). Drug and alcohol use was measured with the Addiction Severity Index (ASI). 50.3% of patients were diagnosed with dual disorders (DD) (current and lifetime). The most common primary substances of abuse were alcohol (35.6%) and cannabis (35.1%). DD subjects had higher baseline PANSS positive scores but experienced a greater reduction at 12 months compared to single diagnosis (SD) patients. Severity of substance abuse as measured by ASI composite scores did not decrease significantly between baseline and 12 months. DD patients with schizophrenia and related psychoses treated for their psychiatric illness showed a reduction in PANSS scores over 12 months, even when their substance use remained largely unchanged. However, co-morbidity cases continued to show higher depression and anxiety ratings. Ongoing substance abuse appears to be related to levels of depression as 62.5% of DD-current versus 34.7% of SD patients had HAM-D scores in the depressed range at 12-month follow-up. Implications for treatment are discussed.

Association between concurrent depression and anxiety and six-month outcome of addiction treatment.

OBJECTIVES: This six-month prospective study of 326 patients with substance use disorders assessed rates of depression and anxiety symptoms among patients entering addiction treatment and examined the effects of concurrent psychiatric symptoms on indicators of addiction treatment outcome. METHODS: Initial assessments included semistructured clinical interviews, the Addiction Severity Index (ASI), the Beck Depression Inventory (BDI), and the Symptom Checklist 90-Revised (SCL90-R). Patients were reassessed at six months to determine treatment outcome (abstinence status and duration of continuous abstinence). RESULTS: A majority of the sample (63 percent) had significant psychiatric symptoms at intake: 15 percent (N=49) presented with depressive symptoms, 16 percent (N=53) with anxiety symptoms, and 32 percent (N=105) with combined depressive and anxiety symptoms. Forty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients fared worse than those who were less symptomatic at intake, including those who presented with depression symptoms alone; in the latter group, 73 percent were abstinent at six months. The hierarchical regression models accounted for 22 percent of the variance in the duration of continuous abstinence, 26 percent of the variance in the frequency of drug use at six months, and 39 percent of the variance in abstinence status at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake. CONCLUSIONS: Concurrent depression or anxiety symptoms at intake had a small but significant predictive effect on addiction treatment outcome over and above factors that are clearly known to influence outcome (length of stay in treatment and initial addiction severity).