Loss of Lkb1 cooperates with BrafV600E and ultraviolet radiation, increasing melanoma multiplicity and neural-like dedifferentiation.

The mechanisms that work alongside BRAFV600E oncogene in melanoma development, in addition to ultraviolet (UV) radiation (UVR), are of great interest. Analysis of human melanoma tumors [data from The Cancer Genome Atlas (TCGA)] revealed that 50% or more of the samples expressed no or low amounts of serine/threonine protein kinase STK11 (also known as LKB1) protein. Here, we report that, in a mouse model, concomitant neonatal BrafV600E activation and Lkb1 tumor suppressor ablation in melanocytes led to full melanoma development. A single postnatal dose of UVB radiation had no effect on melanoma onset in Lkb1-depleted mice compared with BrafV600E-irradiated mice, but increased tumor multiplicity. In concordance with these findings and previous reports, Lkb1-null irradiated mice exhibited deficient DNA damage repair (DDR). Histologically, tumors lacking Lkb1 were enriched in neural-like tumor morphology. Genetic profiling and gene set enrichment analyses of tumor sample mutated genes indicated that loss of Lkb1 promoted the selection of altered genes associated with neural differentiation processes. Thus, these results suggest that the loss of Lkb1 cooperates with BrafV600E and UVR, impairing the DDR and increasing melanoma multiplicity and neural-like dedifferentiation.

Percepción del parto respetado en gestantes indígenas Shuar y Achuar del Cantón Taisha, año 2018-2019 / Perception of respected childbirth in pregnant indigenous shuar and achuar from canton taisha, year 2018-2019

El embarazo, parto y postparto en la mujer indígena integra un proceso de gran importancia social y cultural cargado de mitos, ritos y paradigmas. En Ecuador la etnia indígena está representada con el 35 % población general. Objetivo: Analizar la percepción sobre la preferencia del parto respetado en gestantes indígenas Shuar y Achuar que acuden a la consulta externa de la Unidad Anidada del cantón Taisha años 2018-2019. Materiales y métodos: Es un estudio con un enfoque cuali-cuantitativo; en la parte cuantitativa se utilizó un diseño bibliográfico documental- analítico y en la parte cualitativa se realizó a través de un enfoque fenomenológico analítico. Para la parte cuantitativa se recolectó la información de una matriz validada, mientras tanto, la parte cualitativa se aplicó un cuestionario semi-estructurado bajo la técnica de la entrevista. Los datos obtenidos de la matriz validada fueron codificados y procesados en el programa SPSS 2.0. Resultados: La percepción de las 119 gestantes que acudieron a la unidad Anidada Taisha en relación al lugar de atención de su parto fue 67 (56,30 %); eligieron el parto en su domicilio 50 (42,02%); en el Hospital San José de Taisha y 2 (1,68%); en la finca. De la misma manera, 72 (65,50%); prefirieron el acompañamiento por su esposo, 38 eligieron la posición en cuclillas (31,93%); finalmente 33 (27,33%); prefirieron la posición acostada. Conclusiones: Se identificó que las mujeres indígenas Shuar y Achuar que realizaron sus controles en la Unidad Anidada del cantón Taisha en el periodo 2018-2019, prefirieron las posiciones verticales cuclillas y arrodillada; además, del acompañamiento de su esposo con base a su cultura(AU)

Pregnancy, childbirth and postpartum in indigenous women integrate a process of great social and cultural importance loaded with myths, rites and paradigms. In Ecuador the indigenous ethnic group is represented with 35% general population. Objective: To analyze the perception of the preference of the respected delivery in Shuar and Achuar indigenous pregnant women who attend the outpatient clinic of the Unit Nested from Taisha canton years 2018-2019. Materials and methods: It is a study with an approach qualitative-quantitative; in the quantitative part, a documentary-analytical bibliographic design was used and in the qualitative part was carried out through an analytical phenomenological approach. for the part quantitative information was collected from a validated matrix, meanwhile, the qualitative part was applied a semi-structured questionnaire under the interview technique. The data obtained from the validated matrix were coded and processed in the SPSS 2.0 program. Results: Perception of the 119 pregnant women who attended the Nested Taisha unit in relation to the place of care of their delivery was 67 (56.30%); 50 (42.02%) chose to deliver at home; at the San Jose Hospital Taisha and 2 (1.68%); on the farm. Similarly, 72 (65.50%); preferred the accompaniment by her husband, 38 chose the squatting position (31.93%); finally 33 (27.33%); they preferred the lying position. Conclusions: It was identified that the Shuar and Achuar indigenous women who carried out their controls in the Nested Unit of the Taisha canton in the period 2018-2019, they preferred the vertical squatting and kneeling positions; In addition, the accompaniment of her husband based on your culture.(AU)

Violencia de género contra mujeres indígenas del área rural del cantón tena, año 2021 / Gender-based violence against indigenous women in the rural area of the tena Canton, year 2021

El Ecuador es un estado laico, pluricultural y multiétnico, la población indígena está representada por el 27% de la población ecuatoriana. Las mujeres indígenas, se enfrentan a diversos tipos de violencia en su vida cotidiana, la cual representa una violación de derechos humanos, civiles, políticos, justicia y vivir una vida libre de violencia. Objetivo: Analizar los factores que inciden en la violencia de género contra las mujeres indígenas del área rural del Cantón Tena. Metodología: Es un estudio con enfoque cuali-cuantitativo, en la parte cualitativa se utilizó un diseño bibliográfico documental- analítico y en la parte cualitativa se realizó a través de un enfoque fenomenológico analítico. Para la parte cuantitativa se aplicó un instrumento de recolección cuantitativa validado, mientras tanto, la parte cualitativa se aplicó un cuestionario semi estructurado bajo la técnica de la entrevista. Los datos obtenidos de la encuesta fueron codificados y procesados en el programa spss2.0. Resultados: Se evidenció que los factores sociodemográficos representaron una relación directa con la alta incidencia de violencia contra las mujeres indígenas del cantón Tena. Los datos de la prueba piloto a 30 encuestadas, período agosto- septiembre 2021, fueron: la edad 20-45 años (87,67%); estado civil unión libre (63.33%); grado de instrucción secundaria (76,67%); ocupación ama de casa (100%); procedencia rural (100%), el tipo de violencia recibida la violencia psicológica (86,67%), física (56,67%), sexual (33,33%). Conclusiones: Se identificó que la totalidad de mujeres indígenas del área rural del cantón Tena recibieron violencia por parte de sus familiares, amigos y parejas y tenían un nivel educativo bajo y pobres(AU)

Ecuador is a secular, multicultural and multi-ethnic state, the indigenous population is represented by 27% of the Ecuadorian population. Indigenous women face various types of violence in their daily life, which represents a violation of human, civil, and political rights, justice and to live a life free of violence. Objective: To analyze the factors that influence gender violence against indigenous women in the rural area of Cantón Tena. Methodology: It is a study with a qualitative-quantitative approach, in the qualitative part a documentary-analytical bibliographic design was used and in the qualitative part it was carried out through an analytical phenomenological approach. For the quantitative part, a validated quantitative collection instrument was applied, meanwhile, the qualitative part was applied a semi-structured questionnaire under the interview technique. The data obtained from the survey were coded and processed in the spss2.0 program. Results: It was evidenced that sociodemographic factors represented a direct relationship with the high incidence of violence against indigenous women in the Tena Canton. The data from the pilot test on 30 respondents, period August-September 2021, were: age 20-45 years (87.67%); free union marital status (63.33%); grade of secondary education (76.67%); housewife occupation (100%); rural origin (100%), the type of violence received: psychological (86.67%), physical (56.67%), sexual (33.33%) violence. Conclusions: It was identified that all indigenous women in the rural area of the Tena canton received violence from their relatives, friends and partners and had a low and poor educational level(AU)

Viiolencia obstétrica en el Hospital San José de Taisha, año 2020 / Obstetric violence at the San José de Taisha Hospital, year 2020

La violencia obstétrica constituye un problema de salud pública que necesita ser controlado y erradicado a nivel mundial, debido a que ha llegado a convertirse en una práctica irrespetuosa y abusiva, normalizada por los trabajadores de la salud, y representa otra forma de violencia hacia las mujeres. Dichas prácticas en las últimas décadas han venido ejecutándose de forma rutinaria durante el embarazo, el parto y el postparto, lo cual constituye una violación de derechos humanos fundamentales como el de la no discriminación y el derecho a una vida libre de violencia. Objetivo: Analizar la percepción de los profesionales de la salud acerca de la violencia obstétrica, para determinar tanto la difusión del fenómeno como el nivel de normalización de unas prácticas violentas y humillantes en profesionales de salud que se forman y actúan en el sistema nacional ecuatoriano. Se eligió como estudio de caso el Hospital San José de Taisha, en la parte amazónica del país. Metodología: La investigación es de tipo cualitativo con un diseño fenomenológico y se lleva a cabo a través de la consulta y análisis de fuentes secundarias y de entrevistas semiestructuradas a tres profesionales de la salud. Resultados. Se puso en evidencia que, aunque la violencia obstétrica ya es reconocida en su dimensión de violencia estructural y se han expedido protocolos de buenas prácticas, se pudo observar que aún persiste en los centros de salud y sigue normalizada. Conclusión: Las prácticas de violencia obstétrica se concentran en maltrato físico; maniobras inadecuadas como Kristeller, episiotomía, amniotomía y maltrato psicológico como discriminación, gritos y juicios de valor(AU)

Obstetric violence constitutes a public health problem that needs to be controlled and eradicated worldwide, because it has become a disrespectful and abusive practice, normalized by health workers, and represents another form of violence towards women. In recent decades, these practices have been routinely carried out during pregnancy, childbirth and postpartum, which constitutes a violation of fundamental human rights such as the right to non-discrimination and the right to a life free of violence. Objective: To analyze the perception of health professionals about obstetric violence, in order to determine both the diffusion of the phenomenon and the level of normalization of violent and humiliating practices in health professionals who are trained and work in the Ecuadorian national system. The Hospital San José de Taisha, in the Amazonian part of the country, was chosen as a case study. Methodology: The research is qualitative with a phenomenological design and is carried out through consultation and analysis of secondary sources and semi-structured interviews with three health professionals. The results. It became evident that, although obstetric violence is already recognized in its dimension of structural violence and protocols of good practices have been issued, it was observed that it still persists in health centers and continues to be normalized. Conclusion: Obstetric violence practices are concentrated in physical mistreatment; inadequate maneuvers such as Kristeller, episiotomy, amniotomía and psychological mistreatment such as discrimination, shouting and value judgments(AU)

Reconstrucción del ligamento cruzado anterior con autoinjerto vs aloinjerto / COMPARATION OF THE RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT WITH AUTOGRAFT VS. ALLOGRAFT

Introducción: La reconstrucción del ligamento cruzado anterior (LCA) se basa en reemplazar la ruptura del ligamento con un injerto, fijando los extremos de la tibia y fémur, mediante la colocación de un injerto, de tipo autoinjerto o aloinjerto. Objetivo general: Comparar la reconstrucción ligamentaria del cruzado anterior con autoinjerto vs aloinjerto. Material y métodos: Estudio cuasiexperimental, comparativo, longitudinal, prospectivo, heterodémico y unicéntrico, que se realizó en la consulta externa del Hospital Ángeles de Puebla, durante el periodo del 1 de noviembre a abril del 2018, evaluando en el postoperatorio inmediato y a los 9 meses con la escala de Lysholm, escala visual Análoga (EVA) y Escala de Tegner. Resultados: se analizaron a 50 pacientes, 25 pacientes se les realizó autoinjerto en el 80% menores de 29 años y el 20% mayores de 30 años, el 68% fueron del sexo masculino, 32% femenino, el 52% presentaron afectaciones en el lado derecho y el 80% fue por lesión deportiva. Los pacientes con aloinjerto fueron 25, 60% menores de 29 años y 40% mayores de 30 años, el 56% del sexo masculino, el 44% del femenino, 56% con afectación del lado izquierdo y el 60% por accidente. Se empleó la prueba estadística U de Mann Whitney para comparar la funcionalidad articular basal y a los 9 meses con la Escala Funcional de Lysholm, identificando que los pacientes con aloinjerto tuvieron mayor funcionalidad (p=0.0001), menor intensidad de dolor empleando la escala de EVA (p=0.050) y mayor nivel de actividad con la escala de Tegner, pero no significativa (p=0.148). Conclusiones: Se concluye que los pacientes con reconstrucción del ligamento cruzado anterior con aloinjerto, tuvieron mayor funcionalidad articular, evaluado por la escala de Lysholm, menor intensidad de dolor por escala EVA y se recupero el nivel de actividad física con la Escala de Tegner

Introduction: The reconstruction of the anterior cruciate ligament (ACL) is based on replacing the rupture of the ligament with a graft, fixing the ends of the tibia and the femur, by means of the placement of a graft, autograft or allograft type. Course objective: To compare the anterior cruciate ligament reconstruction with autograft vs allograft. Material and methods: Quasi-experimental, comparative, longitudinal, prospective, heterodémic and unicentric study, which was carried out in the outpatient clinic of Hospital Angeles de Puebla, during the period from November 1 to April 2018, evaluating in the immediate postoperative period and at 9 months with the Lysholm scale, Analog Visual Scale (EVA) and Tegner Scale. Results: 50 patients were analyzed, 25 patients underwent autograft in 80% in 29 years and 20% in 30 years, 68% were men, 32% women, 52% had affectations in the right side and 80% were due to injuries Sports Patients with allograft were 25, 60% younger than 29 years and 40% older than 30 years, 56% men, 44% women, 56% left side and 60% accidental. The Mann Whitney U statistical test was used to compare the baseline joint functionality and at 9 months the Lysholm Functional Scale, identifying that patients with allograft had greater functionality (p=0.0001), less pain intensity using the EVA scale (p=0.050) and higher level of activity with the Tegner scale (p=0.148) Conclusions: It is concluded that patients with reconstruction of the anterior cruciate ligament with allograft, had greater efficiency in joint functionality, evaluated by the Lysholm scale and with less pain intensity

Seasonal shifts of arbuscular mycorrhizal fungi in Cocos nucifera roots in Yucatan, Mexico.

The diversity and community structure of arbuscular mycorrhizal fungi (AMF) associated with coconut (Cocos nucifera) roots was evaluated by next generation sequencing (NGS) using partial sequences of the 18S rDNA gene and by spore isolation and morphological identification from rhizosphere soil. Root samples from six different Green Dwarf coconut plantations and from one organic plantation surrounded by tropical dry forest along the coastal sand dunes in Yucatan, Mexico, were collected during the rainy and dry seasons. In total, 14 root samples were sequenced with the Illumina MiSeq platform. Additionally, soil samples from the dry season were collected to identify AMF glomerospores. Based on a 95-97% similarity, a total of 36 virtual taxa (VT) belonging to nine genera were identified including one new genus-like clade. Glomus was the most abundant genus, both in number of VT and sequences. The comparison of dry and rainy season samples revealed differences in the richness and composition of AMF communities colonizing coconut roots. Our study shows that the main AMF genera associated with coconut tree roots in all samples were Glomus, Sclerocystis, Rhizophagus, Redeckera, and Diversispora. Based on glomerospore morphology, 22 morphospecies were recorded among which 14 were identified to species. Sclerocystis sinuosa, Sclerocystis rubiformis, Glomus microaggregatum, and Acaulospora scrobiculata were dominant in field rhizosphere samples. This is the first assessment of the composition of AMF communities colonizing coconut roots in rainy and dry seasons. It is of importance for selection of AMF species to investigate for their potential application in sustainable agriculture of coconut.

Managing urinary incontinence in older people in hospital: a best practice implementation project.

OBJECTIVES: This project aimed to improve care in managing urinary incontinence in older patients admitted to a medium-to-long-stay hospital by developing and implementing strategies to improve the compliance with best practice in managing urinary incontinence and decrease its prevalence. INTRODUCTION: Urinary incontinence (UI) is a major problem in hospitalized older people and is of great significance to public health. The application of evidence-based recommendations for this problem could be expected to improve the quality of care. METHODS: The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in healthcare practice. Participants were evaluated at baseline and at two follow-ups at three and six months after key strategies had been implemented. The location of this implementation project was the functional rehabilitation ward of a medium-to-long-stay Spanish hospital. RESULTS: In baseline audit there were four process criteria with a high level of compliance: two criteria with 35% and 44% respectively and one criterion without compliance. Action was taken to address the four barriers identified, leading to an increase in all cases except one, which was related to the characteristics of the patient. Prevalence of urinary incontinence decreased at follow-up. CONCLUSIONS: The development and implementation of strategies improved quality of care. This project obtained positive results in patient health, and the implementation of the strategies used decreased the prevalence of urinary incontinence in patients.

Stephanosporamayana (Stephanosporaceae, Russulales), a new sequestrate fungus from Yucatán Peninsula, Mexico.

Stephanosporamayana is presented as a new species from the Yucatán Peninsula, Mexico. This species is distinguished by the yellowish pileus, basidiospores with a small corona (4-6 × 1-2.5 µm), and variable size (8.0-17.0 × 6.0-11.0), thin pileus (21-40 µm) and the ecological association to lowland forest with Haematoxylumcampechianum, Gymnopodiumfloribundum, Coccolobadiversifolia, Metopiumbrownei and Pinuscaribaea. It differs from the American species of Stephanospora, like S.michoacanensis and S.chilensis, by its larger basidiospores. Descriptions, photographs and discussions are presented.

Abdomen agudo ocasionado por apendicitis aguda de probable origen tuberculoso. Informe de un caso / Acute abdomen probably caused by acute tuberculous appendicitis. A case report / Abdome agudo ocasionado por apendicite aguda tuberculosa. Informe de um caso

RESUMEN Antecedentes: la apendicitis aguda tuberculosa es una enfermedad rara, constituye de 0,001 % a 0,01 % de las formas clínicas de tuberculosis. Se presenta un caso de apendicitis aguda probablemente tuberculosa como causa de abdomen agudo quirúrgico. Caso clínico: hombre de 29 años con cuadro de dolor abdominal leve a moderado que se intensificó y localizó en el hemiabdomen derecho, claudicación, febrícula, vómito, mal estado general, leucocitosis de 11 300/µL y neutrofilia de 91 %. Se hizo apendicectomía, el reporte histopatológico fue de apendicitis aguda y la tinción de Ziehl Neelsen fue positiva. A los tres días regresó a su domicilio y no presentó complicaciones a corto ni a largo plazo. Conclusión: la apendicitis aguda tuberculosa es una entidad rara que puede ocasionar abdomen agudo; los pacientes deben recibir tratamiento medicamentoso para erradicar la causa y tener un seguimiento epidemiológico adecuado.

SUMMARY Background: Acute tuberculous appendicitis is a rare disease. It constitutes from 0.001 % to 0.01 % of the clinical forms of tuberculosis. We present cases of such disease as probably cause for surgical acute abdomen. Case report: Male aged 29 with mild to moderate diffuse abdominal pain, which intensified and localized in the right lower quadrant of the abdomen, fever, vomiting, malaise, leukocytosis (11,300/µL) and 91 % neutrophils. Appendectomy was performed, the histopathological report was acute appendicitis, Ziehl-Neelsen stain was positive. Three days later he returned home and had no short- or long term complications. Conclusion: Acute tuberculous appendicitis is a rare disease that may cause acute abdomen, patients should receive drug treatment to eradicate the cause and have proper epidemiological monitoring.

RESUMO Antecedentes: a apendicite aguda tuberculosa é uma doença rara, constitui de 0,001 % a 0,01 % das formas clínicas de tuberculose. Se apresenta um caso de apendicite aguda tuberculosa como causa de abdome agudo cirúrgico. Caso clínico: homem de 29 anos com quadro de dor abdominal leve a moderado que se intensificou e localizou no hemiabdome direito, claudicação, febrícula, vómito, mal estado em geral, leucocitose de 11 300/µL e neutrofilia de 91 %. Se fez apendicectomia, o relatório histopatológico foi de apendicite aguda e a técnica de Ziehl Neelsen foi positiva. Aos três dias regressou a seu domicílio e não apresentou complicações a curto nem a longo prazo. Conclusão: a apendicite aguda tuberculosa é uma entidade rara que pode ocasionar abdome agudo; os pacientes devem receber tratamento medicamentoso para erradicar a causa e ter um seguimento epidemiológico adequado.

[Management of ureteric colic with ketorolac and nifedipin vs. ketorolac and tamsulosin in the emergency room]. / Manejo del cólico ureteral con ketorolaco y nifedipina frente a ketorolaco y tamsulosina en el servicio de urgencias.

BACKGROUND: Ureteric colic is the most common symptom of lithiasis. It is caused by the presence of stones accumulated in the renal papillae. These stones often migrate down the ureter, causing a ureteric colic, characterized by a severe pain in the lumbar region. The aim of this study was to compare the use of ketorolac and nifedipine vs. ketorolac and tamsulosin for the medical treatment of pain caused by stones in the lower ureter. METHODS: Longitudinal study of 150 patients of 21-years or older with stones in the lower third of the ureter. 50% received ketorolac and nifedipine and the other 50%, ketorolac and tamsulosin. The Numeric Pain Rating Scale (NPRS) was used for the assessment of pain at admission and 4 and 12 hours after the treatment was administered. We used descriptive and inferential statistics (Mann-Whitney-Wilcoxon, chi-squared and Poisson regression). RESULTS: Mean age was 38.17 years; 54.7% were male and 45.3% female. NPRS mean was 9.69 (initially), 7.42 (at 4 hours) and 2.05 (at 12 hours). There were no significant differences in the initial measurement of pain between groups (p < 0.005); four and 12 hours later the pain decreased more in patients managed with ketorolac and nifedipine, p = 0.0041. There were no complications nor side effects in both treatments. CONCLUSION: The use of ketorolac and nifedipine is more effective than the use of ketorolac and tamsulosin for the management of pain caused by lower ureteral colic during the first 12 hours of treatment.

Introducción: el cólico renoureteral es la manifestación más común de la litiasis. Se trata de la presencia de cálculos en las papilas renales que frecuentemente migran hacia el uréter, ocasionando un cólico renoureteral, caracterizado por un dolor intenso en la región lumbar o en sus flancos. Se buscó comparar el uso del ketorolaco y nifedipino frente a ketorolaco y tamsulosina para el manejo del dolor ocasionado por litiasis en el tercio inferior del uréter. Métodos: estudio longitudinal en 150 pacientes mayores de 21 años con litiasis en tercio inferior del uréter. Al 50% se le administró ketorolaco y nifedipino y al otro 50% ketorolaco y tamsulosina. Se utilizó la escala numérica de dolor (END) al ingreso, a las 4 y a las 12 horas. La estadística fue descriptiva e inferencial (U de Mann-Whitney-Wilcoxon, chi cuadrada y regresión de Poisson). Resultados: la edad promedio fue 38.17 años y 54.7% de los pacientes fueron hombres. Inicialmente la END tuvo una media de 9.69, de 7.42 a las 4 horas y de 2.05 a las 12 horas. En la medición inicial del dolor no hubo diferencias significativas entre ambos grupos (p > 0.005); 4 y 12 horas después el dolor disminuyó más en los pacientes manejados con ketorolaco y nifedipino: p = 0.0041 y p = 0.000, respectivamente. No hubo complicaciones ni efectos secundarios en ambos tratamientos. Conclusión: la mancuerna ketorolaco y nifedipino es más efectiva que la del ketorolaco y la tamsulosina para el manejo del dolor del cólico renoureteral inferior durante las primeras 12 horas de tratamiento.

[Five-year survival analysis in patients with penile cancer]. / Análisis de supervivencia a cinco años en pacientes con cáncer de pene.

BACKGROUND: Short-term survival of penile cancer is poor. The objective was to describe the 5-years penile cancer survival. METHODS: Retrospective cohort study. We included patients with penile cancer managed surgically from 2010 to 2014. Descriptive statistics were used for socio-demographic variables and the Kaplan-Meier estimator for survival function. RESULTS: We studied 22 patients with a mean age of 64.95 years and a time of evolution of 25 months after the diagnosis. 68.2% of patients smoked or had human papillomavirus (HPV); they all presented phimosis; 72.7% had pain in the penis and the groin area; 81.8% had palpable lymph nodes and 45.5% lesions ≥ 3 cm; 86.3% were diagnosed in clinical stage IIIa. 59.1% underwent partial penectomy and 86.4% had squamous cell variety. 40.9% of patients died six months after the surgery. 66% of the smokers presented metastasis; all of the patients that smoked and had HPV infection had neurovascular invasion and died; 83.3% of the patients (n = 6) who underwent partial penectomy and positive lymph node dissection due to metastases died. The 5-years mortality of patients with penile cancer was 40.9%. CONCLUSION: Tobacco use and HPV increase morbidity and mortality in patients with penile cancer; lesions greater than 5 cm are more common in smokers. The size of the lesion increases with the delay in treatment.

Introducción: la sobrevida del cáncer de pene es pobre a corto plazo. El objetivo fue describir la supervivencia de pacientes con cáncer de pene a cinco años. Métodos: estudio de cohorte retrospectivo. Se incluyeron pacientes con cáncer de pene manejados quirúrgicamente durante el periodo de 2010 a 2014. La estadística fue descriptiva y se usó el estimador de Kaplan-Meier para analizar la función de supervivencia. Resultados: se estudiaron 22 pacientes, con edad media de 64.95 años y tiempo de evolución del cáncer al diagnóstico de 25 meses. El 68.2% era fumador o presentó VPH; todos tuvieron fimosis; 72.7% tuvo dolor en pene e ingle; 81.8% presentó ganglios palpables y 45.5% lesiones ≥ 3 cm. El 86.3% se diagnosticó en estadio clínico mayor de IIIa. Al 59.1% se le realizó penectomía parcial y 86.4% fue de variedad epidermoide. El 40.9% de los pacientes falleció a los seis meses después del tratamiento quirúrgico. El 66.6% de los fumadores presentó metástasis; todos los que presentaban tabaquismo más infección por VPH tuvieron invasión neurovascular y fallecieron. Al 83.3% (n = 6) de los pacientes a los que se les realizó penectomía parcial y disección ganglionar con ganglios positivos por metástasis fallecieron. La mortalidad fue de 40.9% a cinco años. Conclusión: el tabaquismo y el VPH aumentan la morbimortalidad en pacientes con cáncer de pene; las lesiones mayores de 5 cm se presentan más en fumadores. El tamaño de la lesión aumenta con la demora diagnóstica.

[Spinal tuberculosis: experience in a third level medical facility in Puebla, Mexico]. / Tuberculosis de columna vertebral: experiencia en un hospital de tercer nivel en Puebla, México.

BACKGROUND: Pott's disease or spinal tuberculosis (STB) is a serious infectious disease, caused by the migration of the bacterium Mycobacterium tuberculosis to the spine. Knowing this disease is a priority for all the physicians. The objective was to show the experience in patients with STB treated in a third level hospital in Puebla, Mexico. METHODS: Descriptive study. From January to December, 2014, we collected information of patients with STB. The variables were age, gender, length of hospital stay, affected segment of the spine, associated diseases, symptoms, diagnostic methods, type of treatment and complication. We used descriptive statistics, as well as measures of central tendency and dispersion. RESULTS: We studied 14 patients, 71.4 % male; mean age was 60.29 ± 16.54 years (33-93); the average hospital stay was 18.93 ± 9.32 days (4-34). The affected segment was thoracic in six patients (42.85%) and lumbar in eight (57.15%). Nine patients had associated diseases (64.28%) and five did not (35.7%). All patients received medical treatment and 11 surgical procedures were performed in a total of five patients (35.7%). Complications occurred in two patients (14.3%). CONCLUSIONS: STB must be managed early to avoid complications. Coordination with the first level of medical care is very important, as well as the adherence to national and international guidelines.

Introducción: La tuberculosis de la columna (TBC) es una enfermedad infecciosa grave, ocasionada por la migración de la bacteria Mycobacterium tuberculosis hacia la columna vertebral. El conocimiento de esta enfermedad es prioritario para el médico no familiar y familiar. Presentamos la experiencia en pacientes con TBC de un hospital del tercer nivel en Puebla, México. Métodos: estudio descriptivo. De enero a diciembre de 2014 recolectamos expedientes de pacientes con TBC. Las variables fueron edad, género, tiempo de estancia intrahospitalaria, enfermedades asociadas, sintomatología, métodos diagnósticos, segmento de la columna vertebral afectado, tipo de tratamiento empleado y complicaciones. Se usó estadística descriptiva, medidas de tendencia central y de dispersión. Resultados: fueron 14 pacientes (71.4% hombres); la edad promedio fue 60.29 ± 16.54 años (33-93), la estancia intrahospitalaria promedio fue de 18.93 ± 9.32 días (4-34). El segmento afectado fue el dorsal en seis pacientes (42.85%) y el lumbar en ocho (57.15%). Hubo enfermedades asociadas en nueve pacientes (64.28%). Todos los pacientes recibieron tratamiento médico. Se realizaron 11 procedimientos quirúrgicos a cinco pacientes (35.7%). Las complicaciones se presentaron en dos pacientes (14.3%). Conclusiones: La TBC debe ser manejada tempranamente para evitar complicaciones graves. La atención con el primer nivel de atención médica se debe coordinar y debemos apegarnos a lineamientos nacionales e internacionales de tratamiento.

[Chronic appendicitis due to multiple fecaliths. A case report]. / Apendicitis crónica ocasionada por fecalitos múltiples. Reporte de un caso.

BACKGROUND: The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported. CLINICAL CASE: Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis. CONCLUSIONS: The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found.

[Functional and radiological evaluation of patients with midshaft clavicle fracture surgically treated]. / Evaluación funcional y radiológica de pacientes con fractura diafisiaria de clavícula manejados quirúrgicamente.

BACKGROUND: Functional and radiographic evaluation at midshaft clavicle fractures is better with surgical than conservative management. The aim of this paper is to describe the functional and radiological evaluation of patients with midshaft clavicle fracture surgery at the Hospital de Traumatología y Ortopedia of the Instituto Mexicano del Seguro Social. METHODS: Descriptive studies, conducted during the period June 2014 to June 2015, patients undergoing surgical treatment for midshaft clavicle fracture were included. Constant-Murley and Montoya Scales were used to evaluate the functionality and radiological consolidation 6 months after the treatment. RESULTS: There were 90 patients, average age was 33.63 years, 78.9% were men, left side affected in 53.3% patients. At 6 months after surgery, functional results were excellent in 87.8% of patients, in 91% there was disappearance of fracture line regardless callus. The group of patients aged 18 and 40 years present better functional and radiographic results compared to the other groups (p <0.05). CONCLUSIONS: The management of patients with diaphyseal clavicle fracture should be surgical, ages between 18 to 40 years and between 61 to 76 years have better functional outcomes with greater consolidation of fracture line regardless of the callus.

Introducción: el manejo quirúrgico de las fracturas diafisiarias de clavícula da buenos resultados funcionales y una consolidación radiológica adecuada. El objetivo de este trabajo es describir la evaluación funcional y radiológica de los pacientes con fractura diafisiaria de clavícula operados en el Hospital de Traumatología y Ortopedia del Instituto Mexicano del Seguro Social. Métodos: estudio descriptivo, realizado durante el período de julio 2014 a junio 2015, en el que se incluyeron pacientes sometidos a tratamiento quirúrgico por fractura diafisiaria de clavícula. Se aplicaron las escalas Constant-Murley y Montoya para evaluar la funcionalidad y la consolidación radiológica a los 6 meses. Resultados: fueron 90 pacientes, con edad promedio de 33.63 años, 78.9% fueron hombres, el lado izquierdo estuvo afectado en el 53.3% de los pacientes. A los 6 meses de operados, los resultados funcionales fueron excelentes en el 87.8% de los pacientes, en el 91% hubo desaparición del trazo fracturarlo, independientemente del callo óseo. El grupo de pacientes de edades entre 18 y 40 años presentan mejores resultados funcionales y radiográficos que los otros grupos de edades (p < 0.05). Conclusiones: el manejo quirúrgico de los pacientes con fractura diafisiaria de clavícula ofrece buenos resultados funcionales y consolidación radiográfica. Las edades entre 18 a 40 años y entre 61 a 76 años tienen mejores resultados funcionales con una mayor consolidación del trazo fracturario independientemente del callo óseo.

[Evaluation of patients with humeral midshaft fractures treated with DCP plate vs. intramedullary nail UHN]. / Evaluación de los pacientes con fracturas diafisiarias de húmero tratadas con placa DCP frente a clavo centro medular UHN.

BACKGROUND: Humeral midshaft fractures should be surgically managed, so the knowledge of functionality, bone healing and pain of these treatments is required to obtain the expected results. The aim of this paper is to compare the results of patients with humeral midshaft fracture operated with intramedullary nails UHN vs. DCP plate. METHODS: Comparative study, conducted during the period of June 2014 to June 2015, in patients with humeral midshaft fracture, incidents, operated with intramedullary nails UHN vs. DCP plate. Pain, functional and radiographic assessment were conducted by Andersen, UCLA and simple X ray test, respectively. RESULTS: There were 40 patients, 57.5% with DCP plate, 67.5% male, mean age was 42.38 years, mean operative time was 73.3 minutes, side affected 50% right, 87% had complete consolidation with DCP plate against 70.6% of the patients treated with intramedullary nails UHN. Radiographic consolidation was good for both treatments, functionality and pain patients had presented no statistically significant differences in both groups (p ≥ 0.05). Complications are in the range described worldwide for both treatments. CONCLUSIONS: Both treatments are effective for humeral diaphyseal lesions, however should be cautious and try to avoid the complications that can be serious is recommended.

Introducción: las fracturas diafisiarias de húmero deben de ser manejadas quirúrgicamente, por lo que se requiere el conocimiento de la funcionalidad, consolidación ósea y dolor de estos tratamientos para poder obtener los resultados esperados. El objetivo de este trabajo es comparar la evolución de los pacientes con fractura diafisiaria de húmero operados con clavo centro medular UHN frente a aquellos operados con placa DCP. Métodos: estudio comparativo, realizado durante el periodo de junio 2014 a junio 2015, en pacientes con fractura diafisiaria de húmero, incidentes, operados con clavo UHN y placa DCP. La evaluación funcional, del dolor y la radiográfica se llevaron a cabo por las escalas UCLA, Andersen y por personal del departamento de radiodiagnóstico, respectivamente. Resultados: se seleccionaron 40 pacientes, 57.5% con placa DCP, 67.5% hombres, promedio de edad 42.38 años, tiempo quirúrgico promedio 73.3 minutos, lado afectado 50% derecho, 87% tuvieron consolidación completa con placa DCP contra 70.6% de los manejados con clavo centro medular UHN. La consolidación radiográfica fue buena para ambos tratamientos, la funcionalidad de los pacientes y el dolor presentado no tuvo diferencias estadísticamente significativas para ambos grupos (p > 0.05). Las complicaciones están en el rango descrito a nivel mundial para ambos tratamientos. Conclusiones: ambos tratamientos son eficaces para las lesiones diafisiarias del húmero, sin embargo se debe de tener precaución y tratar de evitar las complicaciones que pueden llegar a ser graves.

Síndrome de Allgrove. Informe de un caso / Allgrove syndrome. A case report

Resumen Antecedentes: El síndrome de Allgrove fue descrito en 1978; es un trastorno autosómico recesivo caracterizado por las tres A: acalasia, alacrimia e insuficiencia adrenal. El gen alterado es el AAAS, que codifica la proteína ALADIN. Caso clínico: Mujer de 17 años de edad, a los 18 meses, cursó con alacrimia que ocasionó úlceras corneales, zonas hiperpigmentadas en pliegues y niveles de hormona adrenocorticotropa (ACTH, adrenocorticotrophic hormone) en 2.1 µg/d, cortisol basal de 3.6 µg/dl. A los 5 años de edad la tomografía axial computarizada (TAC) mostró suprarrenales apenas visibles, y la electromiografía reportó neuropatía motora tipo axonal. A los 7 años inició con crisis convulsiva, disfagia a sólidos y el esofagograma baritado reportó dilatación esofágica inferior, la manometría esofágica confirmó aumento de la presión del esfínter esofágico inferior, relajación incompleta y aperistalsis del cuerpo esofágico. Se realizó cardiomiotomía de Heller y funduplicatura parcial anterior por laparoscopia, y se mostró mejoría clínica. Discusión: El síndrome de Allgrove es una enfermedad que va apareciendo durante la infancia temprana, cursa con alacrimia, acalasia e insuficiencia adrenal. Esto coincide con lo presentado en esta paciente. El tratamiento es con esteroides así como con el manejo quirúrgico de la acalasia con buenos resultados.

Abstract Background: Allgrove syndrome was described in 1978, it is an autosomal recessive disorder characterized by the triple A: Achalasia, Alacrima and Adrenal insufficiency. The AAAS is the altered gene encoding the protein ALADIN. Case report: A 17 years old female, who presented alacrima corneal ulcers at 18 month, hyperpigmentation areas, and ACTH levels in 2.1 g / d, basal cortisol of 3.6 mg/dl. At 5 years old she showed adrenal hypogenesia, electromyography reported axonal motor type neuropathy. At 7 years old, she began with seizure, dysphagia to solids, barium esophagogram reported lower esophageal dilation, esophageal manometry confirmed increased pressure of the lower esophageal sphincter, aperistalsis, and esophageal body incomplete relaxation. Heller cardiomyotomy and partial anterior fundoplication laparoscopically was performed, showing clinical improvement. Discussion: Allgrove Syndrome is a disease that will appear in early childhood, present with alacrima, achalasia and adrenal insufficiency. This coincides with what is presented in this patient; steroids are the medical treatment and achalasia must be resolved by surgery, with good results.

Colonización y estructura de la comunidad de hongos micorrízicos arbusculares en Alsophila firma (Cyatheaceae) en bosque mesófilo de montaña en Veracruz, México / Colonization and structure of arbuscular mycorrhizal fungi community in Alsophila firma (Cyatheales: Cyatheaceae) from a tropical montane cloud forest in Veracruz, México

Alsophila firma is a tree fern that is distributed mainly in tropical montane cloud forest (TMCF) and is considered as a threatened species. Arbuscular mycorrrhizal fungi (AMF) have been proposed as an alternative in rescue programs of endangered species. However, our knowledge about diversity of AMF and mycorrhizal status of the species of TMCF is limited. In Mexico TMCF shows different degrees of conservation because of fragmentation and land use change. In this study, we evaluated the level of colonization, richness and abundances of spores of AMF in three fragments with different conservation status: conserved (100 years), secondary vegetation (17 years) and disturbed. For this, soil samples and roots were collected from five individuals of A. firma per site, with at least 100m away from each other; a total of 100cm of roots were analysed per site. Root samples showed AMF and occasionally dark septate fungi (DSF) colonizations. For the overall study, 19 species of AMF were recorded: Gigaspora (7), Acaulospora (4), Glomus (4), Funneliformis (2), Sclerocystis (1) and Scutellospora (1). The dominant species in the three sites were Funneliformis geosporum and Acaulospora scrobiculata. The highest diversity (H’) and evenness (J’) (p<0.05) were found in the conserved site (H’=1.7, J’=0.66), when compared to the secondary vegetation (H’=1.5, J’=0.61), and the disturbed site (H’=0.74, J’=0.41). Statistical analysis showed that the AMF degree of colonization was significantly higher (p<0.05) in the conserved site; although, the disturbed site showed low richness and abundances of AMF, the degree of root colonization did not differ statistically (p<0.05) with the secondary vegetation site. Chao2 (Richness estimation model) showed that the number of analysed samples were sufficient to represent the structure of the AMF communities with values >90%. The present study confirmed that A. firma is a mycorrhizal species that exhibits high levels of colonization even in disturbed sites. We suggest that F. geosporum and A. scrobiculata may have the potential to inoculate the gametophyte and young sporophyte of A. firma, to support restoration programs, because of their abundances and high tolerance to disturbed sites.

Alsophila firma es un helecho arborescente que crece principalmente en bosque mesófilo de montaña (BMM) y se encuentra en la categoría de riesgo. Los hongos mico- rrízicos arbusculares (HMA) se han propuesto como una alternativa para programas de recuperación de especies nativas en peligro. Sin embargo, sabemos poco sobre la diversidad de HMA y del estatus micorrízico de las espe- cies vegetales del BMM. En México el BMM presenta diferentes grados de conservación debido a la fragmentación y el cambio de uso de suelo. Se evaluó el grado de colonización, riqueza y abundancia de esporas de los HMA presentes en fragmentos de BMM con diferente historia de manejo: conservado (100 años), en recuperación (17 años) y alterado. Se estudiaron muestras de suelo y raíces toma- das de 5 individuos de A. firma por cada sitio, con al menos 100m de distancia entre individuos. Se analizaron en total 100cm de raíz por cada sitio. Las muestras de raíz presentaron colonización principalmente de HMA y ocasionalmente por hongos septados oscuros (HSO). Se encontraron 19 especies: Gigaspora (7), Acaulospora (4), Glomus (4), Funneliformis (2), Sclerocystis (1) y Scutellospora (1). Las especies dominantes en los tres sitios fueron Funneliformis geosporum y Acaulospora scrobiculata. La mayor diversidad (H’) y equitatividad (J’) (p<0.05) se presentaron en el sitio conservado (H’=1.7; J’ 0.66) con respecto al sitio en recuperación (H’=1.5, J’ 0.61) y alterado (H’=0.74, J’=0.41). Los niveles de colonización micorrízica total de raíz fueron estadísticamente mayores (p<0.05) en el sitio conservado. Aunque el sitio alterado presenta una baja riqueza y abundancia de HMA la colonización micorrízica total de raíz no fue estadísticamente diferente (p<0.05) respecto al sitio en recuperación. El estimador Chao2 indica que las muestras analizadas reflejan la estructura general de la comunidad de HMA con valores superiores al 93%. El presente estudio confirma que A. firma es una especie micorrízica con altos niveles de colonización incluso en sitios alterados. Se sugiere que las especies F. geosporum y A. scrobiculata por su alta tolerancia a sitios alterados pueden tener potencial para inocular gametofitos y esporofitos de A. firma para incrementar la supervivencia en programas de restauración.

[Colonization and structure of arbuscular mycorrhizal fungi community in Alsophila firma (Cyatheales: Cyatheaceae) from a tropical montane cloud forest in Veracruz, México]. / Colonización y estructura de la comunidad de hongos micorrízicos arbusculares en Alsophila firma (Cyatheaceae) en bosque mesófilo de montaña en Veracruz, México.

Alsophila firma is a tree fern that is distributed mainly in tropical montane cloud forest (TMCF) and is considered as a threatened species. Arbuscular mycorrrhizal fungi (AMF) have been proposed as an alternative in rescue programs of endangered species. However, our knowledge about diversity of AMF and mycorrhizal status of the species of TMCF is limited. In Mexico TMCF shows different degrees of conservation because of fragmentation and land use change. In this study, we evaluated the level of colonization, richness and abundances of spores of AMF in three fragments with different conservation status: conserved (100 years), secondary vegetation (17 years) and disturbed. For this, soil samples and roots were collected from five individuals of A. firma per site, with at least 100 m away from each other; a total of 100 cm of roots were analysed per site. Root samples showed AMF and occasionally dark septate fungi (DSF) colonizations. For the overall study, 19 species of AMF were recorded: Gigaspora (7), Acaulospora (4), Glomus (4), Funneliformis (2), Sclerocystis (1) and Scutellospora (1). The dominant species in the three sites were Funneliformis geosporum and Acaulospora scrobiculata. The highest diversity (H') and evenness (J') (p < 0.05) were found in the conserved site (H' = 1.7, J' = 0.66), when compared to the secondary vegetation (H' = 1.5, J' = 0.61), and the disturbed site (H' = 0.74, J' = 0.41). Statistical analysis showed that the AMF degree of colonization was significantly higher (p < 0.05) in the conserved site; although, the disturbed site showed low richness and abundances of AMF, the degree of root colonization did not differ statistically (p < 0.05) with the secondary vegetation site. Chao2 (Richness estimation model) showed that the number of analysed samples were sufficient to represent the structure of the AME communities with values > 90%. The present study confirmed that A. firma is a mycorrhizal species that exhibits high levels of colonization even in disturbed sites. We suggest that F. geosporum and A. scrobiculata may have the potential to inoculate the gametophyte and young sporophyte of A. firma, to support restoration programs, because of their abundances and high tolerance to disturbed sites.

Lesión complicada por picadura del pez león (Pterois volitans) / Complicated lesions after the sting of the Lionfish (Pterois volitans)

Se presenta el caso de un buzo profesional, de la raza blanca, de 29 años de edad, con antecedentes patológicos personales de obesidad exógena grado I, quien acude al hospital con lesión complicada por picadura del pez león (Pterois volitans) en el miembro inferior izquierdo (cara anteromedial de la pierna), de 21 días de evolución, durante una actividad de corte y soldadura subacuática, en aguas turbias a una profundidad entre 4 y 5 m. Se refieren los síntomas siguientes: dolor intenso con irradiación e hipoestesia, signos de celulitis y linfangitis de evolución tórpida hacia la necrosis e infección de la herida por la aplicación incorrecta de la terapéutica médica inicial. Se indicó tratamiento médico con antibioticoterapia, analgésicos, antinflamatorios y antihistamínicos por vía oral y tratamiento quirúrgico con necrectomía, curas locales y cierre de la herida por colgajo; se adjuntó la oxigenación hiperbárica para la estimulación de la reparación, defensa y cicatrización de los tejidos lesionados. El conocimiento acerca del tema permite actuar con precaución ante las manifestaciones clínicas y sus complicaciones. La aplicación de la oxigenación hiperbárica posibilita disminuir el tiempo de evolución y la reincorporación rápida del paciente a su laborAU)

Twenty-nine years old white professional diver with personal pathological antecedents of Type I exogenous obesity who presents to the hospital with a complicated bite of lionfish (Pterois volitans) in the left lower limb (anteromedial part of the leg) of 21 days evolution. The patient was bitten during an underwater activity of cutting and welding in muddy waters at a depth between 4 and 5 meters. He reports the following symptoms: acute pain with irradiation and hypoesthesia, signs of cellulitis and lymphangitis of torpid evolution towards the necrosis and infection of the wound as a result of an incorrect initial medical therapy. Medical treatment with antibiotics, analgesics, antinflammatories and antihistamines per mouth was indicated and surgical treatment with Necrectomy, local cures and flap for wound closure was employed. Hyperbaric oxygenation for the stimulation of the repair, defense and cicatrisation of the injured tissues was included. The knowledge about this topic allows acting with caution considering the clinical manifestations and its complications. The use of hyperbaric oxygenation makes the diminishment of the time of evolution and the return of the patient to work possible(AU)