Rhino-orbital mucormycosis in a Mexican patient with COVID-19: Case report.

BACKGROUND: A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. CASE REPORT: We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien ́s progression was satisfactory. CONCLUSIONS: pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.

ANTECEDENTES: A la enfermedad por coronavirus (COVID-19) se le han atribuido diversas coinfecciones bacterianas y fúngicas, especialmente en sujetos con enfermedades preexistentes (diabetes mellitus) o en quienes han recibido altas dosis de corticosteroides. REPORTE DE CASO: Paciente masculino de 52 años, con antecedente de diabetes mellitus, quien recibió altas dosis de dexametasona y antibióticos mientras recibía atención ambulatoria por neumonía secundaria a COVID-19. La rinoscopia anterior reveló una costra necrótica, y una muestra de exudado confirmó la coexistencia de Mucor spp. Debido a la complicación del cuadro clínico, ptosis palpebral y parálisis ocular derecha, se le administró anfotericina B y fue intervenido quirúrgicamente. La evolución del paciente fue satisfactoria. CONCLUSIONES: La diabetes mellitus preexistente, el consumo de corticosteroides y antimicrobianos, además de la infección por SARS-CoV-2 son factores de riesgo asociados con la infección por Mucor spp. Es importante la detección oportuna de mucormicosis en el tratamiento de estos pacientes.

Outcome and prognostication after cardiac arrest.

The outcome after out-of-hospital cardiac arrest has historically been grim at best. The current overall survival rate of patients admitted to a hospital is approximately 10%, making cardiac arrest one of the leading causes of death in the United States. The situation is improving with the incorporation of therapeutic temperature modulation, aggressive prevention of secondary brain injury, and improved access to advanced cardiovascular support, all of which have decreased mortality and allowed for better outcomes. Mortality after cardiac arrest is often the direct result of active withdrawal of life-sustaining therapy based on the perception that neurological recovery is not possible. This reality highlights the importance of providing accurate estimates of neurological prognosis to decision makers when discussing goals of care. The current standard of care for assessing neurological status in patients with hypoxic-ischemic encephalopathy emphasizes a multimodal approach that includes five elements: (1) neurological examination off sedation, (2) continuous electroencephalography, (3) serum neuron-specific enolase levels, (4) magnetic resonance brain imaging, and (5) somatosensory-evoked potential testing. Sophisticated decision support systems that can integrate these clinical, imaging, and biomarker and neurophysiologic data and translate it into meaningful projections of neurological outcome are urgently needed.

Síndrome de Lemierre / Lemierre's Syndrome

Paciente masculino de 32 años de edad sin comorbilidades, acude a servicio de urgencias con cuadro clínico caracterizado por dolor en región cervical anterior, tos con expectoración de color marrón de mal olor y dolor torácico. Refiere como antecedente, diagnóstico de faringoamigdalitis hace un mes, para el cual recibió tratamiento antibiótico intramuscular que no especifica. Al examen físico presenta masa palpable a nivel de región cervical anterior, dolor a la palpación torácica en séptimo espacio intercostal izquierdo. A la auscultación frote pericárdico, murmullo vesicular bilateral disminuido y frote pleural. Los estudios de laboratorio demostraron leucocitosis (17230 k/ul), neutrofilia (79,25%), anemia leve (Hb 11 g/dl, Hcto 35,5%). La tomografía computarizada contrastada de tórax, demostró presencia de edema y líquido en los tejidos blandos superficiales anteriores infrahioideos del cuello por encima de la horquilla esternal, y, en la fase contrastada trombosis de la vena yugular interna izquierda

Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial.

BACKGROUND: Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests. METHODS: This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopic-endoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and re-admission. One year of follow-up was carried-on. RESULTS: At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found. CONCLUSIONS: E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications. TRIAL REGISTRATION: clinicaltrials.gov (NCT02590978).

Neurofibroma plexiforme del colédoco: una causa rara de ictericia obstructva. Reporte de caso / Plexiform Neurofibroma in the Common Bile Duct: A Rare Cause of Obstructve Jaundice. Case Report

Paciente masculino de 68 años, con ictericia obstructva quien es llevado a sala de operaciones encontrando una lesión que ocluye el 90% de la luz del tercio medio e inferior del colédoco que es reportada como un neurofbroma plexiforme del colédoco.

Male patent, 68 years old, with obstructve jaundice. Near total obstructon of common bile duct was found during laparotomy, pathology reported a plexiform neurofbroma in the common bile duct.

Actividad ictiotóxica de extractos de dos especies colombianas del género Meriania Swartz (melastomataceae) / Ichtyotoxic activity of two colombian species extracts fromthe genus Meriania Swartz (melastomataceae)

Introducción: la familia melastomataceae es la séptima más grande del reino vegetal y ha sido utilizada en la medicina tradicional para el tratamiento de algunas enfermedades. En Colombia se encuentra representada por alrededor de 62 géneros, de los cuales Meriania ha sido poco estudiado, sin presentar reportes en la literatura de sus propiedades químicas y biológicas; por lo que el estudio de sus propiedades ictiotóxicas, constituye un acercamiento en la búsqueda de sustancias activas que permitan avanzar en el conocimiento del género y en la búsqueda de compuestos promisorios con aplicaciones biológicas. Objetivo: evaluar la actividad ictiotóxica de extractos de diferente polaridad de Meriania speciosa (Bonpl.) Naudiny Merianiaquintuplinervis Naudin. Métodos: los extractos de diferente polaridad (n-hexano, acetona 70 por ciento, metanol, acetato de etilo, n-butanol y agua) de ambas especies fueron evaluados frente a peces guppy (Poecilia reticulata Peters),sometidos durante 24 h a la acción de los extractos para la cuantificación del porcentaje de actividad ictiotóxica en una escala semicuantitativa, el test de observación de FinnSandberg-Irwin y como prueba anexa se obtuvieron cortes histopatológicos, con el fin de identificar posibles lesiones generadas por los extractos vegetales. Resultados: de acuerdo con los porcentajes de actividad ictiotóxica obtenidos en este estudio, las sustancias evaluadas se clasifican como no activas, sin embargo, los resultados aportados por el test de observación indican que las sustancias afectan el sistema nervioso y generan daño hepático en el pez. Conclusiones: los extractos vegetales de las especies de Meriania estudiadas presentan comportamientos diferentes, ya que M. speciosa ejerce un efecto psicoactivo en los peces, alterándose su sistema nervioso central, mientras que M. quintuplinervis está más relacionada con un nivel de toxicidad moderado, además de provocar un efecto vasodilatador comprobado en el hígado de P. reticulata(AU)

Introduction: Melastomataceae is the seventh largest family in the plant kingdom and has been widely used in traditional medicine for the treatment of some diseases. In Colombia it is represented by around 62 genera, of which Meriania has been understudied, without presenting reports in the literature of its chemical and biological properties; so the study of their ichtyotoxic properties constitutes an approach in the search for active substances that advance knowledge of genus and in finding promising compounds with biological applications. Objetive: To evaluate the ichtyotoxic activity of extracts of different polarity of Meriania speciosa (Bonpl.) and Meriania quintuplinervis Naudin. Methods: The extracts of different polarity (n-hexane, acetone 70 percent, methanol, ethyl acetate, n-butanol and water) of both species were evaluated against guppy (Poeciliareticulata Peters), subjected for 24 h to action extracts for quantification of the percentage of ichtyotoxic activity in a semiquantitative scale and the observation Finn Sandberg-Irwintest and histopathological sections were obtained, in order to identify potential injuries from plant extracts. Results: According to ichtyotoxic activity rates obtained in this study, the evaluated substances are classified as inactive; however, the test results indicate that the substances affect the nervous system and produce liver damage in fishes. Conclusions: The plant extracts of the Meriania species studied have different behaviors, as M. speciosahas a psychoactive effect on fishes, mainly altering the central nervous system, while M. quintuplinervisis more related to a moderate level of toxicity as well as causing a vasodilator effect found in the liver of P. reticulata(AU)

Spontaneous Rupture of an Ovarian Artery Aneurysm: A Rare Postpartum Complication.

Background. Spontaneous rupture of an ovarian artery aneurysm is a rare but usually life-threatening event. It is most often associated with pregnancy or fibroids. Our case followed a normal vaginal delivery and then a delayed presentation with features similar to other less life-threatening postpartum conditions. The diagnosis could have been missed but for the meticulous and timely interventions which avoided catastrophic outcome. Case. This is a case of a multiparous woman with rupture of a left ovarian artery aneurysm, causing massive retroperitoneal hemorrhage and hematoma that required a combination of arterial embolization, percutaneous CT scan guided drainage, and surgical evacuation of the hematoma. Conclusion. Spontaneous rupture of ovarian artery should be considered as one of the differential diagnoses in the immediate postpartum period especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis, intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.

Conocimientos, actitudes y prácticas frente al uso de anticonceptivos orales de emergencia en internos de medicina del Hospital Nacional Daniel Alcides Carrión, diciembre 2014 / Knowledge, attitudes and practices against the use of emergency oral contraception in interns of medicine in the National Hospital Daniel Alcides Carrion, December 2014

Objetivo: Determinar la relación que existe entre el conocimiento nosográfico, las actitudes y las prácticas frente al uso de anticonceptivos orales de emergencia en los internos de medicina del Hospital Nacional Daniel Alcides Carrión. Diseño: Estudio descriptivo. Lugar: Hospital Nacional Daniel Alcides Carrión. Participantes: Internos de medicina que laboraron en el Hospital Nacional Daniel Alcides Carrión durante el año 2014. Intervención: Aplicación de una encuesta de conocimientos, actitudes y prácticas sobre anticoncepción de emergencia y características de filiación de los participantes. Resultados: De los 76 encuestados, el 82 por ciento presentó un nivel adecuado de conocimientos, 79 por ciento actitud adecuada y 40 por ciento prácticas adecuadas. Se encontró que si hay relación entre la actitud y las practicas frente a la anticoncepción oral. Conclusiones: No hay relación entre el nivel de conocimientos y la actitud, así como el nivel de conocimientos y las prácticas frente a la anticoncepción oral de emergencia. Sin embargo si hay relación estadísticamente significativa entre la actitud y las prácticas frente a este método anticonceptivo.

Objective: To determine the relationship between the nosographic knowledge, attitudes and practices regarding the use of emergency contraceptive pills in medicine interns of National Hospital Daniel Alcides Carrion. Design: Descriptive study. Location: National Hospital Daniel Alcides Carrion. Participants: Medicine interns who worked in the National Hospital Daniel Alcides Carrion during 2014. Intervention: Application of a survey of knowledge, attitudes and practices about emergency contraception and characteristics of affiliation of the participants. Results: Of the 76 respondents, 82 per cent had an adequate level of knowledge, 79 per cent and 40 per cent right attitude right practices. It was found that if there is relationship between attitude and practices versus oral contraception. Conclusions: There is no relationship between the level of knowledge and attitude as well as the level of knowledge and practices concerning oral emergency contraception. However, there is a statistically significant relationship between attitude and practices against birth control.

[Thyroglossal cyst and papillary carcinoma. Management proposals]. / Quiste tirogloso con carcinoma papilar de tiroides. Propuestas de manejo.

The thyroid descends through the foramen cecum leaving the thyroglossal duct, which disappears between the fifth and the tenth week of pregnancy. The lack of involution of any part of this duct results in thyroglossal cyst formation. Its diagnostic approach is made by cervical ultrasound, computed tomography and magnetic resonance imaging. Approximately 1 % of the thyroglossal cyst formation contains malignant elements, and the most reported primary tumor has been papillary carcinoma. The recommended treatment for these carcinomas is controversial and it has evolved as time goes by. From Sistrunk procedure to neck dissection with total thyroidectomy and complementary therapies, such as iodine ablation and thyroid supplements, yet there is still no consensus as to the type of surgery and postoperative management it should be used to treat this carcinoma. Therapy should be applied according to each specific case, and it should be based on histological diagnosis, the invasive character of the tumor, and the lymph node affectation. In this paper we review the literature published so far with regards to the treatment of this carcinoma.

La tiroides hace su descenso a través del foramen cecum y deja el conducto tirogloso, el cual desaparece entre la quinta y la décima semana de gestación. La falta de involución de cualquier parte de este conducto da lugar a la formación de quistes tiroglosos. Su evaluación se realiza por medio de ecografía cervical, tomografía computada y resonancia magnética. Aproximadamente el 1 % de los quistes tiroglosos contiene elementos malignos y el tumor primario que se ha documentado más ha sido el carcinoma papilar. El tratamiento recomendado para estos carcinomas es objeto de discusión; se ha usado desde la operación de Sistrunk hasta la disección cervical con tiroidectomía total y terapias complementarias como la ablación con yodo y los suplementos tiroideos; sin embargo, todavía no existe un consenso dominante en cuanto al tipo de intervención quirúrgica y su manejo postoperatorio. La terapia debe ser adaptada a cada caso, sobre el diagnóstico histológico, el carácter invasivo del tumor y la afectación de los ganglios linfáticos. En el presente escrito hemos realizado una revisión de la literatura respecto al tratamiento.

Influence of surgeon behavior on trainee willingness to speak up: a randomized controlled trial.

BACKGROUND: Our aim was to determine if a surgeon's behaviors can encourage or discourage trainees from speaking up when they witness a surgical mistake. STUDY DESIGN: A randomized clinical trial in which medical students (n = 55) were randomly assigned to an "encouraged" (n = 28) or "discouraged" (n = 27) group. Participants underwent personality tests to assess decision-making styles, and were then trained on basic tasks ("burn" then "cut") on a laparoscopic surgery simulator. After randomization, students assisted at a simulated laparoscopic salpingectomy. The senior surgeon used either an "encourage" script (eg, "Your opinion is important.") or a "discourage" script (eg, "Do what I say. Save questions for next time."). Otherwise, the surgery was conducted identically. Subsequently, a surgical mistake was made by the senior surgeon when he instructed students to cut without burning. Students were considered to have spoken up if they questioned the instruction and did not cut. Potential personality bias was assessed with two validated personality tests before simulation. Data were processed with Mann-Whitney and Fisher exact tests. RESULTS: The students in the encouraged group were significantly more likely to speak up (23 of 28 [82%] vs 8 of 27 [30%]; p < 0.001). There was no statistically significant difference between the two groups in personality traits, student training level (p = 1.0), or sex (p = 0.53). CONCLUSIONS: A discouraging environment decreases the frequency with which trainees speak up when witnessing a surgical error. The senior surgeon plays an important role in improving intraoperative communication between junior and senior clinicians and can enhance patient safety.

Quiste tirogloso como foco primario de carcinoma papilar de tiroides metastásico a cadena ganglionar yugular / Thyroglossal cyst as primary site of papillary thyroid carcinoma metastatic to jugular lymph node chain

No disponible

MODELADO Y SIMULACIÓN DE UN ROBOT TERAPÉUTICO PARA LA REHABILITACIÓN DE MIEMBROS INFERIORES / MODELING AND SIMULATION OF A THERAPEUTIC ROBOT FOR LOWER LIMBS REHABILITATION / MODELAGEM E SIMULAÇÃO DE UM ROBÔ TERAPÊUTICO DE REABILITAÇÃO DE MEMBROS INFERIORES

La rehabilitación en un sentido general tiene el objetivo de reincorporar a una persona a sus actividades de la vida cotidiana. Actualmente, un paciente que requiere de alguna rehabilitación sufre de largas esperas para ser atendido debido a la falta de personal en las clínicas y hospitales. Una alternativa para ayudar al personal médico en las terapias de rehabilitación es utilizando robots terapéuticos. Este artículo muestra el modelado y la simulación de un robot terapéutico para la rehabilitación de miembros inferiores. Se presenta el modelo cinemático y dinámico de un robot de tres grados de libertad con un efector final configurado en paralelo. Se presenta una ley de control por par calculado para el seguimiento de trayectorias planificadas. Se presentan simulaciones de ejercicios terapéuticos para cadera y rodilla realizadas en ADAMS y MATLAB para conocer el comportamiento cinemático y dinámico del robot. Los resultados obtenidos demuestran el gran potencial del robot terapéutico para asistir en la rehabilitación de miembros inferiores.

Rehabilitation in a general sense aims to reinstate a person to their activities of daily living. Currently, a patient that requires a rehabilitation suffers long waits for treatment due to lack of staff in clinics and hospitals. An alternative to assist medical staff in rehabilitation therapies is using therapeutic robots. This paper shows the modeling and simulation of a therapeutic robot for lower limb rehabilitation. The kinematic and dynamic model of a robot of three degrees of freedom with an end-effector configured in parallel is presented. A computed torque control law for a planned trajectory tracking task is presented. Simulations of therapeutic exercises for hip and knee carried out in ADAMS and MATLAB for know the kinematic and dynamic behavior of the robot are presented. The results demonstrate the great potential of the therapeutic robot to assist in the rehabilitation of lower limbs.

A reabilitação de um modo geral tem como objetivo restabelecer uma pessoa para as suas atividades de vida diária. Atualmente, um doente que necessite de alguma reabilitação sofrem com longas esperas para o tratamento devido à falta de pessoal em clínicas e hospitais. Uma alternativa para ajudar a equipe médica em terapias de reabilitação é o uso de robôs terapêuticos. Este artigo mostra o modelado e a simulação de um robô terapêutico para a reabilitação do membro inferior. Apresenta-se também Modelo cinemática e dinâmica de um robô de três graus de liberdade com uma extremidade atuante configurados em paralelo. A lei de controle para o acompanhamento calculados para par planejado trajetórias é apresentado. Simulações de exercícios terapêuticos para substituições de quadril e joelho realizadas em ADAMS e MATLAB para o comportamento cinemático e dinâmico do robô são apresentados. Os resultados demonstram o grande potencial do robô terapêutico para ajudar na reabilitação de membros inferiores.

Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata.

BACKGROUND: Positive surgical margins (PSM) are an important determinant of biochemical recurrence after radical prostatectomy (RP). We use a population-based cancer registry to evaluate PSM by stage, Gleason and prostate-specific antigen (PSA). METHODS: We identified men undergoing RP from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2007. Differences between those with and without PSM were compared with chi-squared tests. The proportion of cases with PSM were stratified by PSA and Gleason sum for both pT2 and pT3a tumours. Factors associated with PSM were analyzed using chi square and multivariate logistic regression analysis. A composite variable was used in a second multivariate analysis to display the odds ratio (OR) for a PSM for each discrete combination of PSA, Gleason score and pT stage. RESULTS: In total, 28 461 RP patients were identified and a PSM was present in 19.5%. PSM were 42% in pT3a and 16% in pT2 cases. Higher PSAs (<4.0, 4-9.9, >10) were associated with higher proportions of PSM (12%, 20% and 28%, p < 0.001). Similarly, higher Gleason scores (≤6, 3+4, 4+3, ≥8) were associated with higher PSM (12%, 22%, 27% and 33%, p < 0.001). For pT2 tumours, the proportion of PSM ranged from 8% (Gleason ≤6, PSA <4.0) to 28% (Gleason 8-10, PSA ≥10). For pT3a tumours, the PSM was higher in each Gleason/PSA strata compared to those with pT2 tumours, reaching 63% for those with pT3a, Gleason 8-10, PSA >10 disease. On multivariate analysis, stage was the largest predictor for PSM (OR 3.05, 95% confidence interval 2.81-3.30), although Gleason score and PSA remained statistically significant. CONCLUSION: In this population-based study of PSM after RP, the proportion of PSM vary significantly within different PSA and Gleason strata for organ-confined and extracapsular disease. These data can be used as a reference for urologist self-assessment.

Experiencia quirúrgica en el hiperparatiroidismo primario en el Hospital de Especialidades del Centro Médico Nacional ''La Raza'' / Surgical experience in primary hyperparathyroidism at the Specialty Hospital of the National Medical Center ''La Raza''

Objetivo: Presentar la experiencia quirúrgica en el tratamiento del hiperparatiroidismo primario. Sede: Hospital de Especialidades del Centro Médico Nacional ''La Raza''. Diseño: Ambispectivo, observacional, longitudinal, descriptivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Se realizó un estudio en el periodo comprendido de enero del 2006 a diciembre del 2010 en el Servicio de Cirugía General del Hospital de Especialidades del Centro Médico Nacional ''La Raza''. Con seguimiento mínimo de un año, se revisó el expediente y su evolución a través del tiempo, enumerando morbilidad, mortalidad, así como recurrencia o éxito quirúrgico. Resultados: Se incluyeron 119 pacientes con una edad promedio de 51.8 años, 22 hombres y 97 mujeres. La mayor frecuencia de hiperparatiroidismo primario se observó entre los pacientes de 40 y 69 años de edad. El calcio sérico promedio fue de 11.6 mg/dl al momento del diagnóstico y la media de hormona paratiroidea fue de 274 pg/ml. El hallazgo histopatológico fue de 106 adenomas (89%) y 13 hiperplasias (10.9%). Se obtuvo la curación con la primera intervención en 113 pacientes (95%), de ellos dos presentaron complicaciones agudas (1.6%) y tres crónicas (2.5%), sin mortalidad. Conclusiones: Al determinar la recurrencia del hiperparatiroidismo primario dentro de la experiencia quirúrgica en este centro hospitalario de tercer nivel y comparándolo con lo reportado en la literatura mundial, éste se encuentra dentro del promedio. La utilidad del estudio al determinar la recurrencia nos sirve para detectar factores condicionantes de la misma, además de llevar a cabo un adecuado estudio preoperatorio y selección de los pacientes.

Objective: To present the surgical experience in the treatment of primary hyperparathyroidism. Setting: Third level health care center (Specialty Hospital of the National Medical Center ''La Raza''). Design: Ambispective, observational, longitudinal, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and Methods: The study was performed from January 2006 to December 2010 in the General Surgery Service of the Specialty Hospital of the Centro Médico Nacional ''La Raza'', with a minimum follow up of one year. The clinical records were revised as well as evolution along time, assessing morbidity, mortality, recurrence or surgical success. Results: A total of 119 patients were included with an average age of 51.8 years; 22 men and 97 women. The highest frequency of primary hyperparathyroidism was observed among patients aged from 40 to 69 years. Average serum calcium was 11.6 mg/dl at the time of diagnosis, and the mean parathyroid hormone value was of 274 pg/ml. Histopathological findings included 106 adenomas (89%) and 13 hyperplasias (10.9%). Cure was obtained with the first surgery in 113 (95%) patients with two acute complications (1.6%) and three chronic ones (2.5%); no mortality was recorded. Conclusions: When determining recurrence of primary hyperparathyroidism according to surgical experience in this third level healthy care center and comparing with that reported in the worldwide literature, our result lie within the average. Determining recurrence is useful to detect its conditioning factors, aside from performing adequate preoperative study and patient selection.

Variabilidad de la frecuencia cardiaca tras tres partidos de bádminton. ¿hay diferencias por sexo? / Heart rate variability after threee badminton matches. Are there gender diferences?

Objetivos: Analizar la variabilidad de la frecuencia cardiaca (VFC) en reposo y tras 3 partidos de Bádminton consecutivos jugados en un corto periodo de tiempo (2 o 3 días) para evaluar el efecto de la fatiga acumulada y si existen diferencias entre hombres y mujeres en estas condiciones. Métodos: Hemos estudiado a 19 jugadores de Bádminton divididos en dos grupos: 11 mujeres (17,88±3,01 años) y 8 hombres (18,16±2,87 años). Se tomaron un gran número de registros iniciales en cuatro campeonatos diferentes, pero se seleccionaron para el estudio a aquellos jugadores que jugaron al menos tres partidos antes de ser eliminados del torneo. Se registró la señal cardiaca latido a latido durante 20 minutos en posición supina antes de iniciarse la competición y después de3 partidos consecutivos. El registro inicial (basal) se hizo en la habitación de los jugadores al día siguiente a su llegada a la ciudad sede y los otros tres registros se tomaron entre 15 y 25 minutos tras la finalización del partido (media 17.14 + 3, 93 minutes). Se calcularon los parámetros usuales del dominio de tiempo y los diámetros transversal (SD1) y longitudinal (SD2) del gráfico de Poincaré. Resultados: Todos los parámetros del dominio de tiempo fueron significativamente más bajos tras los partidos, respecto a la situación basal, pero sin diferencias entre los tres partidos. No se encontraron diferencias entre hombres y mujeres en ninguno de los parámetros en las cuatro situaciones. Los diámetros SD1, SD2 y la relación SD1/SD2 también tuvieron valores más bajos tras los partidos y sin diferencias entre sexos. Conclusiones: La VFC disminuye tras los partidos de Bádminton pero sin diferencias debidas al número de partidos y con los mismos cambios para hombres y mujeres (AU)

Objectives: To analyze heart rate variability (HRV) at rest and after 3 consecutive badminton matches played in a short period of time (2 or 3 days) in order to assess the effect of accumulated tiredness and if there were differences between males and females under these conditions. Methods: We have studied 19 badminton players divided into two groups: 11 females (age 17,88±3,01 years) and 8 males (age 18,16±2,87 years). In four different championships we took initial records in a large number of players, but we selected for the study to those players who played at least 3 matches before of being eliminated from the tournament. The heartbeat signal was recorded beat to beat for 20 minutes in supine position before the competition and after 3 matches. The initial record (baseline) was made at their own room one day after arriving in the host city and the another three records were made after finishing the match, between 15 and 25 minutes (average 17.14 + 3, 93 minutes).The usual parameters in the time domine as well as the transverse(SD1) and the longitudinal axis (SD2) of the Poincaré plot were calculated. Results: All parameters in time domine were significantly lower after the matches than basal but the differences between the matches were not significant. No significant differences were found between males and females in none of the parameters at the four situations. SD1, SD2 and the ratio SD1/SD2 in the Poincaré plot post-matches were lower than the baseline, but without significant gender differences. Conclusions: HRV decreases after matches but without differences due to the number of matches and these changes are the same for men and women (AU)

Determinación de la certeza diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi en pacientes con nódulo tiroideo y resultado histopatológico definitivo / Determination of the diagnostic accuracy of 99mTc sestamibi scanning in patients with thyroid nodule and a definitive histopathological report

Antecedentes La gammagrafía con tecnecio 99 (Tc99) sestamibi y la biopsia por aspiración permiten predecir de forma relativamente segura el resultado histopatológico de un nódulo tiroideo. Objetivo Determinar la utilidad diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi para detección de malignidad en pacientes con nódulo tiroideo, confirmado por resultado histopatológico definitivo posterior a tiroidectomía. Material y métodos Se estudió un total de 69 pacientes con diagnóstico de nódulo tiroideo solitario que contaban con punción por aspiración con aguja fina y que fueron sometidos a tiroidectomía total ante sospecha de cáncer con análisis patológico posterior en todos. Cincuenta y cuatro pacientes con gammagrafía tiroidea positiva para malignidad; 25 pacientes con un histopatológico final de cáncer y 29 con un histopatológico negativo al mismo. Quince pacientes con gammagrafía tiroidea negativa para neoplasia tiroidea, con 3 presentando un diagnóstico de cáncer confirmado por patología y 12 confirmados con ausencia de malignidad. Resultados En el presente estudio se realizó un análisis estadístico para determinar la certeza diagnostica del Tc99 sestamibi para detectar malignidad en los nódulos tiroideos. El estudio con gammagrafía tiroidea con Tc99 sestamibi para cáncer de tiroides, tuvo una sensibilidad de 89,28%, con una especificidad de 29,25%. El Tc99 sestamibi mostró un valor predictor positivo de 46,29% y un valor predictor negativo de 80%.ConclusionesConsideramos que la práctica de la gammagrafía tiroidea con Tc99 sestamibi debe ser una técnica diagnóstica que se utilice de forma rutinaria en todo aquel paciente con un nódulo tiroideo que presente una punción aspiración con citología tiroidea indeterminada; siendo su mayor utilidad para descartar malignidad en aquellos que presentan captación baja en el estudio de medicina nuclear (AU)

Background 99m Tc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately. Objective To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy. Material and methods A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free. Results The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%.ConclusionsWe believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan (AU)

[Determination of the diagnostic accuracy of 99mTc sestamibi scanning in patients with thyroid nodule and a definitive histopathological report]. / Determinación de la certeza diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi en pacientes con nódulo tiroideo y resultado histopatológico definitivo.

BACKGROUND: 99mTc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately. OBJECTIVE: To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy. MATERIAL AND METHODS: A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free. RESULTS: The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%. CONCLUSIONS: We believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan.

Características clínicas-epidemiológicas de niños con leucemia aguda de 0 a 15 años atendidos en el Instituto Nacional de salud del Niño del periodo 2005-2010 / Clinical and epidemiological characteristics of children with acute leukemia from 0 to 15 years treated at the National Institute of Child Health 2005-2010

Introducción: La incidencia de leucemia aguda en el Perú es de 1500 casos nuevos al año, de los cuales el 30 por ciento se presenta en pacientes pediátricos. La características clínicas-epidemiológicas son muy importantes como factores de riesgo, dándonos un pronóstico de evolución de la enfermedad. Objetivo: Describir las características clínicas-epidemiológicas de niños con Leucemia Aguda entre 0 a 15 años atendidos en el lNSN, periodo 2005-2010. Materiales y métodos: De 300 historias clínicas, se revisó 111 historias clínicas que cumplían con los criterios de inclusión, recolectamos los datos considerados como factores de riesgo elevado y las manifestaciones clínicas de ingreso. Resultados: El 46,8 por ciento fue diagnosticado de Leucemia Linfoblástica Aguda (LLA), 44,1 por ciento como Leucemia Aguda (LA) y 9 por ciento como Leucemia Mieloide Aguda (LMA). Entre los factores de riesgo elevados, el sexo que predominó fue el masculino de 1.6: 1, se notó que el 26.1 por ciento tenían un edad de 10 años a más, el 85.6 por ciento de los pacientes cursaron con el recuento leucocitario por debajo de 50, 000 células por mm3,el 62.2 por ciento presentó visceromegalia y el 63.1 por ciento adenomegalia .La manifestación clínica más frecuente fue fiebre en un 67.6 por ciento generalmente asociado a otro síntoma como diarrea, tos productiva, etc. Otros signos de ingreso frecuentes fueron palidez (57.7 por ciento) y síndrome hemorrágico (42.3 por ciento)...

Introduction: Acute Leukemia represents 30 per cent of all childhood cancers, with an incidence of 1,500 in Peru and a third of all of these affects the pediatric population. The clinical and epidemiological characteristics are very important in order to identify risk factors and to give a prognosis of the disease' outcome. Objective: To describe the clinical and epidemiological characteristics of Acute Leukemia in children between O to 15 years old who were treated in INSN, in 2007-2010. Materials and Methods: We colleded data from 111 clinical records of children with diagnosed Acute Leukemia that reached all the discemment criteria, considering risk factors and clinical manifestations in the time of admission. Results: 46,8 per cent were diagnosed with ALL, 44,1 per cent with AL and per cent with AML. In the risk factors there was a predominance by male patients of 1.6:1, patients were mostly over 10 years old, the leukocyte counts were found to be mostly under 50,000 cells in mm³, over 60 per cent presented an increased size of the spleen, Iiver and certain Iymph nodes. The most common clinical manifestation at the time of the diagnosis was fever (67.6 per cent), usually related to other symptoms such as diarrhea, cough and others. Other frecuent clinical manifestations were paleness (57.7 per cent) and hemorrhagic syndrome (42.3 per cent). A eight at the time of birth greater than 3500 grams was related to leukemia in the 50 per cent of the reviewed cases. The number of cases of leukemia in first-bom was 28.3 per cent...

Tuba, a GEF for CDC42, links dynamin to actin regulatory proteins.

Tuba is a 178kD protein containing four NH2-terminal SH3 domains, a central Dbl homology (DH) domain followed by a BAR domain, and two COOH-terminal SH3 domains. The four NH2-terminal SH3 domains bind the GTPase dynamin, a protein critical for the fission of endocytic vesicles. The DH domain functions as a CDC42-specific guanine nucleotide exchange factor and is unique among DH domains because it is followed by a BAR domain rather than a PH domain. The COOH-terminal SH3 domain binds directly to N-WASP and Ena/VASP proteins, key regulatory proteins of the actin cytoskeleton, and recruits a larger protein complex comprising additional actin regulatory factors. The properties of Tuba provide new evidence for a functional link between dynamin, endocytosis, and actin. The presence of a BAR domain, rather than a PH domain, may reflect its action at high curvature regions of the plasma membrane. Its multiple binding sites for dynamin generate an exceptionally high avidity for this GTPase and make the NH2-terminal region of Tuba a very useful tool for the one-step purification of dynamin.