Conocimientos, actitudes y prácticas asociados a diarrea aguda en la zona norte de Bucaramanga. Estudio observacional analítico, 2014-2015 / Knowledge, attitudes and practices associated with acute diarrhea in the northern zone of Bucaramanga. An observational analytic study. 2014 to 2015

RESUMEN Introducción: la diarrea aguda y la mortalidad por diarrea continúan siendo un problema de salud pública a nivel mundial, especialmente en los países de ingreso medio o bajo. Gran parte de las enfermedades diarreicas son prevenibles mediante el acceso al agua potable y a servicios adecuados de saneamiento e higiene. Objetivo: caracterizar los conocimientos, actitudes y prácticas de cuidadores de niños menores de cinco años asociados a prevalencia de diarrea. Materiales y métodos: estudio observacional analítico de corte transversal, realizado durante el periodo 2014-2015. Se realizó un muestreo por conglomerados en la comuna norte de la ciudad de Bucaramanga y se aplicó una encuesta dirigida. Resultados: solo uno de cada diez cuidadores conoce todas las características de la diarrea aguda (cambios en la consistencia, número y duración de los síntomas) y ninguno reconoce totalmente los signos de deshidratación. El uso de remedios caseros y la creencia en causas sobrenaturales y esotéricas como causas de diarrea tuvo una alta prevalencia. La menor edad del cuidador, tener aseguramiento y mayor nivel conocimientos sobre la diarrea se asociaron a un mayor reporte de episodios de diarrea en los últimos seis meses. Conclusiones: el 49% de todos los cuidadores encuestados manifestaron que sus niños han tenido al menos un episodio de diarrea en los últimos seis meses. El nivel de conocimientos de los cuidadores es bajo. Se encontró asociación estadísticamente significativa entre la edad del cuidador, conocimiento de los síntomas diarreicos, régimen de aseguramiento y prevalencia de diarrea en menores de cinco años. MÉD.UIS. 2017;30(1):21-33.

ABSTRACT Introduction: acute diarrhea and mortality from diarrhea remains a public health problem worldwide, particularly in middle-income countries or low. Much of diarrheal diseases are preventable through access to safe water and adequate sanitation and hygiene. Objective: to characterize the knowledge, attitudes and practices of caregivers of children under five years associated with prevalence of diarrhea. Materials and methods: cross-sectional observational study, made during the period 2014-2015. Cluster sampling was conducted in the northern district of the city of Bucaramanga. A targeted survey was conducted. Results: only one in ten caregivers know all the characteristics (changes in consistency, number and duration of symptoms) of acute diarrhea. None fully recognize the signs of dehydration. The use of home remedies and belief in supernatural and esoteric causes as causes of diarrhea had a high prevalence. Caregiver younger, having higher-level assurance and knowledge on diarrhea associated with increased reporting of episodes of diarrhea in the last six months. Conclusions: 49% of all respondents report that their children caregivers have had at least one episode of diarrhea in the last six months. The level of knowledge of caregivers is low. Age of the caregiver, knowledge about diarrhea symptoms and healthcare affiliation was statistically associated with the onset of diarrhea in children up to five years. MÉD.UIS. 2017;30(1):21-33.

Constitutively active TrkB confers an aggressive transformed phenotype to a neural crest-derived cell line.

Neuroblastoma arises from sympathoadrenal progenitors of the neural crest and expression of the neurotrophin receptor TrkB and its ligand, brain-derived neurotrophic factor (BDNF), is correlated with poor prognosis. Although activated TrkB signaling promotes a more aggressive phenotype in established neuroblastoma cell lines, whether TrkB signaling is sufficient to transform neural crest-derived cells has not been investigated. To address the role of TrkB signaling in malignant transformation, we removed two immunoglobulin-like domains from the extracellular domain of the full-length rat TrkB receptor to create a ΔIgTrkB that is constitutively active. In the pheochromocytoma-derived cell line PC12, ΔIgTrkB promotes differentiation by stimulating process outgrowth; however, in the rat neural crest-derived cell line NCM-1, ΔIgTrkB signaling produces a markedly transformed phenotype characterized by increased proliferation, anchorage-independent cell growth, anoikis resistance and matrix invasion. Furthermore, expression of ΔIgTrkB leads to the upregulation of many transcripts encoding cancer-associated genes including cyclind1, twist1 and hgf, as well as downregulation of tumor suppressors such as pten and rb1. In addition, ΔIgTrkB NCM-1 cells show a 21-fold increase in mRNA for MYCN, the most common genetic marker for a poor prognosis in neuroblastoma. When injected into NOD SCID mice, control GFP NCM-1 cells fail to grow whereas ΔIgTrkB NCM-1 cells form rapidly growing and invasive tumors necessitating euthanasia of all mice by 15 days post injection. In summary, these results indicate that activated TrkB signaling is sufficient to promote the formation of a highly malignant phenotype in neural crest-derived cells.

Meningioma ventricular presentación infrecuente y revisión de la literatura / Infrequent intraventricular meningioma and review of the literature

Fundamento: Los meningiomas son tumores originados de las cubiertas aracnoideas. La localización intraventricular es rara especialmente los originados en el trígono ventricular derecho. Objetivo: Reportar un caso de localización atípica de un meningioma intracraneal. Presentación de caso: Paciente femenina de 68 años con historia de crisis convulsivas focales y cefalea de un mes de evolución. Las imágenes de Resonancia Nuclear Magnética convencionales, con secuencias en T1 y T2 axial y sagital, muestran una lesión localizada en el trígono ventricular derecho. Se realizó abordaje quirúrgico directo y excéresis total. El estudio anatomopatológico demostró un Meningioma fibroblástico. Discusión: Los meningiomas intraventriculares a nivel de trígono son infrecuentes y sólo se reportan series de pocos pacientes en la literatura. El abordaje y excéresis quirúrgica es el método de tratamiento de elección. Conclusiones: El abordaje y excéresis de meningiomas intraventriculares puede ser llevado a cabo exitosamente y en ausencia de complicaciones importantes.

Fundaments: Intraventricular meningiomas are rare often histologically benign tumors, especially those arisingfrom the right ventricular trigonal region. Objective: Report an unusual growth of intracranial meningioma. Case report: Authors present a clinical case of a 68 years old female with focal crisis and cephalea. Magnetic Resonance Imaging showed globular small hypo intense mass located in the right trigone. Surgical approach consisted in parietal craniotomy followed by dural opening and resection of the Intraventricular tumor. Post operatory evolution was adequate. Histological diagnosis was fibroblastic meningioma. Discussion: Meningiomas of the right lateral ventricule are rare and not widely reported. Surgical treatment is often successfully performed. Conclusion: Meningiomas of the lateral ventricles can be successfully diagnosed and surgically treated.

Evaluation of medical gestures based on a global performance index.

This paper presents a method to evaluate medical gestures. The objective is to objectively assess a gesture carried out by novice doctors. The proposed method is based on the study of the curvature of the 3D gesture and provide a global performance index for one manipulation. The study of the number of peaks on the curvature indicates if the gesture is smooth or not. The application is the obstetric gestures linked to the forceps use but the method can be applied to different gestures without loss of generality. Seven residents carried out 30 forceps blade placements. The results clearly show a difference between the gestures carried out. This highlights the difficulty of the gesture according to the fetal head presentation.

A method to evaluate skill transfer and acquisition of obstetric gestures based on the curvatures analysis of the position and the orientation.

This paper focuses on the gesture analysis in order to compare two human gestures. The orientations and the positions of the gestures are both taken into account and the similarity rate between two gestures is calculated. In our case, the application is in obstetrics and the aim is to evaluate forceps blade placement. The method is based on the curvature analysis of the paths during the gesture. The 3-D position paths are expressed according to their cumulated chord length and the orientation paths in the quaternion unit space. These parameterizations lead to analyze data in space independently to time as requested by physicians. After filtering data in order to minimize sensor noises, the gestures are then compared by calculating the correlation between the position and the orientation curvatures of a novice gesture and an expert one. The results clearly show that novice skills in handling forceps increase in becoming smoother and closer to the reference placement. A childbirth simulator allows novices to acquire experience without any risks, however the training have to be completed with the extraction gesture evaluation and a compulsory training period in the delivery ward.

Evaluation of obstetric gestures: an approach based on the curvature of quaternions.

This paper presents a method to evaluate a gesture carried out by a resident obstetrician by comparing it to a gesture carried out by an expert obstetrician. The studied gesture is the forceps blade placement. Resident paths were recorded on a childbirth simulator while placing forceps blades instrumented with six degrees of freedom sensors. The path is characterized by the positions and the orientations. In this paper we particularly focus on the orientations. Forceps orientations are expressed in the quaternion unit space and the curvature of quaternion path is compared by correlation to a reference defined by an expert. Residents have been trained on a simulator and their gestures are evaluated by comparing their orientation path curvatures to reference path curvatures. Quantitative results confirm the qualitative analysis, residents become more similar to the reference while training on simulator.

Evaluation of obstetric gestures: an approach based on the curvature of 3-D positions.

This paper presents a method to evaluate a gesture carried out by a resident obstetrician doctors by comparing it to a gesture carried out by an expert obstetrician doctors. The studied gesture is the forceps blade placement. Residents were recorded on a childbirth simulator while placing forceps blades. Their paths were compared in order to evaluate how similar they are to a reference path defined by an expert. The comparison method is developed with respect to expert requests: time independence and in considering the whole set of data and not only particular points. In order to respect these requests, the developed method lies on the correlation coefficient between the path curvatures. Residents have been trained on a simulator and their gestures were evaluated by comparing their path curvatures to reference path curvatures. Quantitative results confirm the qualitative analysis, residents become more similar to the reference while training on simulator.

Ulceración esofágica extensa por toma de doxiciclina / Large esophagic ulcer following doxycycline treatment

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Perinephric pseudocysts in the cat: a retrospective study and review of the literature.

Perinephric pseudocysts (PNPs) are fluid-filled fibrous sacs that surround the kidney and are not lined by an epithelium. In cats, PNPs are idiopathic, but they usually occur in association with chronic renal failure (CRF). Thirteen cats with PNPs were examined. PNPs occurred in mixed breed cats of either sex with a median age of 16 years. The PNP was palpable on physical examination and usually was interpreted as renomegaly. Clinicopathologic findings reflected CRF, and urinary tract infection was common. Rarely, a primary renal disease was diagnosed concurrent with PNPs and CRF. Diagnosis of PNPs was made by ultrasound examination and fine-needle aspiration, and treatment was by surgical removal of the PNP or ultrasound-guided drainage. Compared to previous reports of PNPs, this series of cats tended to be older and no sex predilection was found, but other findings were similar to those in the literature. Cats with PNPs may have a favorable prognosis if CRF is not severe and no other concurrent diseases are present.

[Epidemiological study on the incidence of inflammatory bowel disease in 4 Spanish areas. Spanish Group on the Epidemiological Study of Inflammatory Bowel Disease]. / Estudio epidemiológico sobre la incidencia de enfermedad inflamatoria intestinal en cuatro áreas españolas. Grupo Español para el Estudio Epidemiológico de la Enfermedad Inflamatoria Intestinal.

BACKGROUND: The incidence of inflammatory bowel disease (IBD) shows marked geographical variations. The aim of this study was to determine and compare the incidence of IBD in four Spanish areas: Sabadell (Northeast), Vigo (Northwest), Mallorca island and Motril (South). PATIENTS AND METHODS: Prospective survey based on inception cohorts over a two-years period (1 October 1991 to September 1993). Subjects were the patients resident in these areas and diagnosed of IBD according to a standard protocol for case ascertainment and definition. RESULTS: Altogether 328 cases were identified, of whom 191 were diagnosed as ulcerative colitis (UC), 135 as Crohn's disease (CD) and 2 as indeterminate colitis. The overall adjusted incidence rate per 100,000 persons between ages 15-64 years of UC and CD were respectively 9.8 and 5.2 in Sabadell, 7.7 and 5.0 in Vigo, 7.8 and 5.8 in Mallorca and 4.3 and 6.5 in Motril. The Incidence rate ratio showed no significant differences for either conditions among these areas. The global adjusted incidence rate of UC in Spanish areas (8.0; IC 95%: 6.3-9.7) was significantly lower to that of Northern European countries while that of CD (5.5; IC 95%: 4.1-6.9) was between that of Northern and Southern Europe with no significant differences. CONCLUSIONS: The incidence of IBD did not show differences among the Spanish areas, and rates are between 2 and 6 times higher than those previously reported. The incidence of UC is significantly lower than that observed in the North of Europe, while for CD the incidence is between that of Northern and Southern Europe.

Characterization of cardiac Na+/Ca(2+)-exchange by site-directed polyclonal antibodies.

Cardiac Na+/Ca(2+)-exchange is an integral membrane protein consisting of approx. 970 amino acids with as many as 12 membrane-spanning and 11 extramembranal regions (Nicoll, D.A., Lognoni, S. and Philipson, K.D. (1985) Science 250, 562-565). Based upon primary sequence information, 3 amino-acid sequences located in either extramembranal segment a or f, consisting largely of acidic amino-acids, were selected for the production of synthetic peptides. The peptides were cross-linked to carrier ovalbumin and used to generate site-directed polyclonal antibodies (sd-Ab). Western blot analysis of bovine cardiac sarcolemmal (SL) proteins demonstrated that sd-Ab against segment a and 1 against loop f recognized a 70 kDa protein and a lower molecular mass band at 55 kDa under reducing conditions. A different loop f sd-Ab failed to recognize the 70 kDa protein but did associate with a 120, 65 and 55 kDa protein under the same conditions. Under non-reducing conditions, antibodies to all three peptides recognized the 65 kDa protein. All sd-Ab were blocked by addition of their respective peptides and were not inhibited by either of the other peptides. A sd-Ab against loop f was immobilized to an affinity support matrix and used to immunoprecipitate detergent solubilized cardiac SL vesicle protein. Immunoprecipitated protein was reconstituted into proteoliposomes which demonstrated Na+/Ca(2+)-exchange activity. Immunoprecipitated protein cross-reacted with sd-Ab against all three peptides with bands at 120, 70 and 55 kDa on Western blots. Tryptic digests of native SL vesicles abolished recognition of segment a sd-Ab for SL proteins while having little or no affect on reactivity to the protein by both sd-Ab against loop f. Digestion of the SL vesicle protein with endoproteinase Arg C did not alter sd-Ab recognition. The results suggest that specific domains of the cardiac Na+/Ca(2+)-exchanger depending upon the conformation of the protein, may not be available for antibody binding. The 70 kDa polypeptide appears to include the N-terminal region of the protein and what is believed to be a large cytoplasmic extramembranal loop. Limited proteolysis by trypsin and endoproteinase Arg C yielded results consistent with the model which places the N-terminus of the protein on the extracellular surface and a large extramembranal segment (loop f) on the cytoplasmic side of the SL membrane.

[The incidence of gastric carcinoma after gastrectomy for peptic ulcer in the Vigo region. A case-control study]. / Frecuencia del carcinoma gástrico postgastrectomía para úlcera péptica en la comarca de Vigo. Estudio caso-control.

After reviewing 10,000 upper gastrointestinal endoscopies performed at the endoscopy unit of the city of Vigo over a 38 month period, we have found 485 partial gastric resections for peptic ulcer, 357 gastric carcinomas were found, of which 26 occurred after partial gastric resection for peptic ulcer. Therefore the incidence of gastric cancer in this area was 22-23/100,000. The frequency of gastric cancer after partial resective surgery was lower than expected during the first 20 years after surgery. However, thereafter a significant increase of gastric cancer occurred in those patients in which a Billroth-II but not Billroth-I procedure was used.