Experiencia en el tratamiento del divertículo de Meckel con abordaje abierto versus laparoscópico-asistido supraumbilical en niños / Experience in the treatment of Meckel's diverticulum with an open approach versus laparoscopic-assisted supraumbilical in children

Introducción: El divertículo de Meckel (DdM) es la malformación intestinal congénita más común diagnosticada intraoperatoriamente y requiere una resolución quirúrgica una vez conocido el diagnóstico. El presente estudio describe la experiencia en el tratamiento quirúrgico abierto y laparoscópico del DdM. Metodología: El presente estudio transversal retrospectivo, se realizó en niños tratados en el Hospital de Niños Dr. Roberto Gilbert Elizalde, Guayaquil Ecuador, en un periodo de 8 años con diagnóstico de divertículo de Meckel; se analizan variables como: edad, sexo, síntomas, diagnóstico posquirúrgico, técnica quirúrgica, estancia hospitalaria, complicaciones, resultados de biopsia, presentación clínica. Se utiliza estadística descriptiva univariada. Resultados: Se analizan 81 casos, 52 hombres (64%), 25 lactantes (31%), 23 adolescentes (28%). 50 casos (62%) se presentaron como abdomen agudo, 17 casos (21%) se presentaron como hemorragia intestinal. El DdM incidental durante una apendicitis aguda fue realizado en forma incidental en 23 casos (52%). Fueron 67 casos (83%) fueron sometidos a cirugía abierta y 14 casos (17%) fueron sometidos a cirugía combinada. Las complicaciones fueron 8/67 casos (11.9%) en cirugía abierta, y 1/14 casos (7.1%) en cirugía combinada (P=0.60). Conclusión: La resección laparoscópica de DdM no aumentó el riesgo de morbilidad o el tiempo operatorio.

Introduction: Meckel's diverticulum (MsD) is the most common congenital intestinal malformation diag-nosed intraoperatively and requires surgical resolution once the diagnosis is known. The present study de-scribes the experience in the open and laparoscopic surgical treatment of MsD. Methodology: This cross-sectional - retrospective study was carried out in children treated at the Dr. Roberto Gilbert Elizalde Children's Hospital, Guayaquil - Ecuador, for over eight years with a diagnosis of Meckel's diverticulum; variables such as age, sex, symptoms, post-surgical diagnosis, surgical technique, hospital stay, complications, biopsy results, clinical presentation are analyzed. Univariate descriptive statistics are used. Results: 81 cases were analyzed, 52 men (64%), 25 infants (31%), 23 adolescents (28%). 50 cases (62%) pre-sented as acute abdomen, and 17 cases (21%) presented as intestinal hemorrhage. Incidental MD during acute appendicitis was performed incidentally in 23 cases (52%). 67 cases (83%) underwent open surgery, and 14 (17%) underwent combined surgery. Complications were 8/67 cases (11.9%) in open surgery and 1/14 cases (7.1%) in combined surgery (P=0.60). Conclusion: Laparoscopic resection of MsD did not increase the risk of morbidity or operative time.

Significance of hepatitis B surface antigen, IgM/IgG core antibody and hepatitis B virus DNA in blood donors.

INTRODUCTION: Identification of hepatitis B virus carriers in blood donors is imperative in order to avoid transmission of the disease via blood transfusion. OBJECTIVE: To determine if blood donors with positive results for serological markers HBsAg and anti-HBc were hepatitis B virus DNA carriers. METHODS: 12,745 samples were collected from six Ecuadorian blood banks and analyzed for HBsAg, anti-HBc and anti-HBs infectious markers by automated ELISA. All samples that tested positive for one, two or all three markers were analyzed with molecular techniques to determine the presence of viral DNA. RESULTS: 27.5 % of the samples that were reactive for anti-HBc alone and 100 % of those with positive results for HbsAg and IgM/IgG anti-HBc were identified to contain hepatitis B virus DNA (p = 0.001). CONCLUSIONS: The selection of infection markers, as well as the detection methods define the results. Performing two serological and one molecular test is important in order to identify hepatitis B virus carriers and prevent its transmission.

INTRODUCCIÓN: La identificación de portadores del virus de la hepatitis B en donantes de sangre es imperativo para evitar la transmisión de la enfermedad a través de transfusiones sanguíneas. OBJETIVO: Determinar si los donantes de sangre con resultados positivos en los marcadores serológicos HbsAg y anti-HBc eran portadores del ADN del virus de la hepatitis B. MÉTODOS: Se recolectaron 12 745 muestras de seis bancos de sangre ecuatorianos, las cuales fueron analizadas con pruebas serológicas para identificar marcadores infecciosos de HBsAg, anti-HBc, anti-HBs mediante ELISA automatizada. Todas las muestras positivas para uno, dos o los tres marcadores fueron analizadas con técnica molecular para determinar la presencia del ADN viral. RESULTADOS: Se identificó que 27.5 % de las muestras reactivas solo a anti-HBc y 100 % de las muestras con resultados positivos de HBsAg/anti-HBc-IgM/IgG presentaron ADN del virus de la hepatitis B (p = 0.001). CONCLUSIONES: La elección de los marcadores de infección y los métodos de detección definen los resultados. Es importante la realización de dos pruebas serológicas y una molecular para identificar a los portadores del virus de la hepatitis B y evitar su transmisión.

Significación de los marcadores infecciosos para identificar portadores de hepatitis B en donantes de sangre / Significance of hepatitis B surface antigen, IgM/IgG core antibody and hepatitis B virus DNA in blood donors

Resumen Introducción: La identificación de portadores del virus de la hepatitis B en donantes de sangre es imperativo para evitar la transmisión de la enfermedad a través de transfusiones sanguíneas. Objetivo: Determinar si los donantes de sangre con resultados positivos de los marcadores serológicos HbsAg y anti-HBc eran portadores de ADN del virus de la hepatitis B. Métodos: Se recolectaron 12 745 muestras de seis bancos de sangre ecuatorianos, las cuales fueron analizadas con pruebas serológicas para identificar los marcadores infecciosos HBsAg, anti-HBc, anti-HBs mediante prueba ELISA automatizada. Todas las muestras positivas para uno, dos o los tres marcadores fueron analizadas con técnica molecular para determinar la presencia de ADN viral. Resultados: Se identificó que 27.5 % de las muestras reactivas solo a anti-HBc y 100 % de las muestras con resultados positivos de HBsAg/anti-HBc-IgM/IgG presentaron ADN del virus de la hepatitis B (p = 0.001). Conclusiones: La elección de los marcadores de infección y los métodos de detección definen los resultados. Es importante la realización de dos pruebas serológicas y una molecular para identificar a los portadores del virus de la hepatitis B y evitar su transmisión.

Abstract Introduction: Identification of hepatitis B virus carriers in blood donors is imperative in order to avoid transmission of the disease via blood transfusion. Objective: To determine if blood donors with positive results for serological markers HBsAg and anti-HBc were hepatitis B virus DNA carriers. Methods: 12,745 samples were collected from six Ecuadorian blood banks and analyzed for HBsAg, anti-HBc and anti-HBs infectious markers by automated ELISA. All samples that tested positive for one, two or all three markers were analyzed with molecular techniques to determine the presence of viral DNA. Results: 27.5 % of the samples that were reactive for anti-HBc alone and 100 % of those with positive results for HbsAg and IgM/IgG anti-HBc were identified to contain hepatitis B virus DNA (p = 0.001). Conclusions: The selection of infection markers, as well as the detection methods define the results. Performing two serological and one molecular test is important in order to identify hepatitis B virus carriers and prevent its transmission.

Prevalencia de anticuerpos anti-eritrocitarios en donantes voluntarios de sangre Ecuatorianos / Prevalence of anti-erythrocyte antibodies in Ecuadorian voluntary blood donors / Prevalência de anticorpos anti-eritrocitários em doadores de sangue voluntários equatorianos

El rastreo de anticuerpos anti-eritrocitarios es una de las pruebas pretransfusionales más importantes en medicina transfusional por su aporte en la prevención de reacciones adversas luego de la administración de hemocomponentes. Sin embargo, no todos los bancos de sangre ecuatorianos han incluido esta prueba en sus protocolos de trabajo. Para demostrar su importancia se realizó el presente estudio cuyo propósito fue alertar al sistema nacional de salud sobre la existencia de aloinmunización en la población de donantes de sangre. Se estableció una prevalencia de anticuerpos anti-eritrocitarios del 0,27% y se identificó una mayor frecuencia en el género femenino. Los anticuerpos identificados estuvieron relacionados con los sistemas eritrocitarios Rh (RH), Kell (KEL), Duffy (FY) y Kidd (JK). Una de las limitaciones para la inclusión de esta prueba en los bancos de sangre y servicios de medicina transfusional es el elevado costo de los reactivos y la falta de paneles de células eritrocitarias de composición homocigota y heterocigota para la identificación de anticuerpos anti-eritrocitarios nativos, situación que constituye una oportunidad para que el Ministerio de Salud Pública del Ecuador promueva mejores estrategias para la importación de reactivos, reducción de costos y disponibilidad de paneles de células.

The screening of anti-erythrocyte antibodies is one of the most important pretransfusion tests in transfusion medicine because of its contribution to the prevention of adverse reactions after the administration of blood components, however not all blood banks in Ecuador have included this test in their work protocols. This study has the purpose to alert the national health system about the existence of alloimmunization in the blood donour population. A prevalence of anti-erythrocyte antibodies of 0.27% was established, with a higher frequency being found in the female gender. The identified antibodies are related to the erythrocyte systems Rh (RH), Kell (KEL), Duffy (FY) and Kidd (JK). One of the limitations for the inclusion of this test in blood banks and transfusion medicine services is the excessive cost of serological and gel methodology reagents, and the lack of homozygous and heterozygous erythrocyte cell panels for the identification of native anti-erythrocyte antibodies. That situation constitutes an opportunity for the Ministry of Public Health of Ecuador to promote better strategies for the imports of reagents, cost reduction and availability in the country.

O rastreamento de anticorpos anti-eritrocitários é um dos testes pré-transfusão mais importantes na medicina transfusional pela sua contribuição na prevenção de reações adversas após a administração de componentes sanguíneos. No entanto, nem todos os bancos de sangue do Equador tem incluído esse teste em seus protocolos de trabalho. Para demonstrar a sua importância, foi realizado o presente estudo que teve como objetivo alertar o sistema nacional de saúde sobre a existência de aloimunização na população de doadores de sangue. Foi estabelecida uma prevalência de anticorpos anti-eritrocitários de 0,27%, identificando maior frequência no sexo feminino. Os anticorpos identificados estiveram relacionados com os sistemas eritrocitários Rh (RH), Kell (KEL), Duffy (FY) e Kidd (JK). Uma das limitações para a inclusão destes testes em bancos de sangue e serviços de medicina da transfusão é o alto custo dos reagentes, além da falta de painéis de células eritrocitárias de composição homozigótica e heterozigótica para a identificação de anticorpos anti-eritrocitários nativos, situação que constitui uma oportunidade para que o Ministério da Saúde Pública do Equador promova melhores estratégias para a importação de reagentes, redução de custos e disponibilidade de painéis de células.

Tipificación del antígeno Duffy como método indirecto para identificar individuos asintomáticos de malaria / Duffy antigen typing as an indirect method to identify asymptomatic malaria individuals

En países considerados endémicos de malaria a pesar de las estrategias realizadas anualmente para el control y erradicación de esta enfermedad existen brotes aislados de malaria debido probablemente a portadores asintomáticos, presencia de individuos con fenotipo Duffy negativo o movimientos poblacionales. El sector "50 casas" de la provincia de Esmeraldas-Ecuador reúne todas estas características por lo que el objetivo de esta investigación fue determinar la presencia del fenotipo Fy(a-b-) y su relación con el Plasmodium vivax. Se realizó una encuesta a cada miembro de las familias participantes y luego de aceptado y firmado el consentimiento informado se tomaron muestras sanguíneas para la realización de pruebas serológicas en búsqueda de anticuerpos y antígenos de P. vivax, fenotipificación del sistema Duffy y pruebas de PCR en tiempo real para la determinación de ADN de Plasmodium vivax y P. falciparum. Los resultados demostraron que existe una asociación estadísticamente significativa entre el fenotipo Duffy y malaria por P. vivax (p<0,05). Ante esta situación los organismos de control deberán proponer nuevas estrategias para la detección de portadores asintomáticos y medidas preventivas para evitar nuevos brotes de malaria, así como determinar si P. vivax ha encontrado un nuevo mecanismo de invasión en individuos portadores del fenotipo Fy(a-b-).

Despite the strategies carried out annually for the control and eradication in countries considered endemic for malaria, there are isolated outbreaks probably due to asymptomatic carriers. These involve the presence of individuals with Duffy negative phenotype or population movements. The neighbourhood "50 casas" of the province of Esmeraldas-Ecuador has all these characteristics, so the purpose of this research was to determine the presence of the Fy(a-b-) phenotype and its relationship with the Plasmodium vivax. A survey was carried out into each member of the participating families and after accepting and signing the informed consent, blood samples were taken to perform serological tests in search of antibodies and antigens of P. vivax. The phenotyping of Duffy system and real-time PCR tests for DNA determination of Plasmodium vivax and falciparum was realized. The results showed that there is a statistically significant association between the Duffy phenotype and P. vivax malaria (p<0.05). In view of this situation, the control agencies should propose new strategies for the detection of asymptomatic carriers and preventive measures to hinder new outbreaks of malaria and determine if P. vivax has found a new invasion mechanism in individuals with the Fy(a-b-) phenotype.

Nos países considerados endêmicos para malária, apesar das estratégias realizadas anualmente para o controle e erradicação desta doença existem surtos isolados de malária, resultantes provavelmente de portadores assintomáticos, presença de indivíduos com fenótipo Duffy negativo ou movimentos populacionais. O setor "50 casas" na província de Esmeraldas-Equador reúne todas essas características. Portanto o objetivo desta pesquisa foi determinar a presença de fenótipo Fy(a-b-) e sua relação com Plasmodium vivax. Foi realizada uma enquete para cada membro das famílias participantes e após a aceitação e assinatura do Consentimento informado, foram coletadas amostras de sangue para a realização de testes sorológicos em busca de anticorpos e antígenos do P. vivax. Além de testes de fenotipagem do sistema Duffy e PCR em tempo real para determinação de DNA de Plasmodium vivax e P. falciparum. Os resultados mostraram que existe uma associação estatisticamente significante entre o fenótipo Duffy e a malária por P. vivax (p<0,05). Perante está situação os órgãos de fiscalização terão que propor novas estratégias para a detecção de portadores assintomáticos e medidas preventivas para evitar novos surtos de medidas de malária bem como determinar se P. vivax tem encontrado um novo mecanismo de invasão em indivíduos portadores do fenótipo Fy(a-b-).

At-sea behavior varies with lunar phase in a nocturnal pelagic seabird, the swallow-tailed gull.

Strong and predictable environmental variability can reward flexible behaviors among animals. We used long-term records of activity data that cover several lunar cycles to investigate whether behavior at-sea of swallow-tailed gulls Creagrus furcatus, a nocturnal pelagic seabird, varied with lunar phase in the Galápagos Islands. A Bayesian hierarchical model showed that nighttime at-sea activity of 37 breeding swallow-tailed gulls was clearly associated with changes in moon phase. Proportion of nighttime spent on water was highest during darker periods of the lunar cycle, coinciding with the cycle of the diel vertical migration (DVM) that brings prey to the sea surface at night. Our data show that at-sea behavior of a tropical seabird can vary with environmental changes, including lunar phase.

Flying with the wind: scale dependency of speed and direction measurements in modelling wind support in avian flight.

BACKGROUND: Understanding how environmental conditions, especially wind, influence birds' flight speeds is a prerequisite for understanding many important aspects of bird flight, including optimal migration strategies, navigation, and compensation for wind drift. Recent developments in tracking technology and the increased availability of data on large-scale weather patterns have made it possible to use path annotation to link the location of animals to environmental conditions such as wind speed and direction. However, there are various measures available for describing not only wind conditions but also the bird's flight direction and ground speed, and it is unclear which is best for determining the amount of wind support (the length of the wind vector in a bird's flight direction) and the influence of cross-winds (the length of the wind vector perpendicular to a bird's direction) throughout a bird's journey. RESULTS: We compared relationships between cross-wind, wind support and bird movements, using path annotation derived from two different global weather reanalysis datasets and three different measures of direction and speed calculation for 288 individuals of nine bird species. Wind was a strong predictor of bird ground speed, explaining 10-66% of the variance, depending on species. Models using data from different weather sources gave qualitatively similar results; however, determining flight direction and speed from successive locations, even at short (15 min intervals), was inferior to using instantaneous GPS-based measures of speed and direction. Use of successive location data significantly underestimated the birds' ground and airspeed, and also resulted in mistaken associations between cross-winds, wind support, and their interactive effects, in relation to the birds' onward flight. CONCLUSIONS: Wind has strong effects on bird flight, and combining GPS technology with path annotation of weather variables allows us to quantify these effects for understanding flight behaviour. The potentially strong influence of scaling effects must be considered and implemented in developing sampling regimes and data analysis.