Assessment of preparedness and proficiency in basic and advanced life support among nursing professionals: a cross-sectional study.

Background: Cardiac diseases are among the leading causes of death worldwide, including sudden cardiac arrest in particular. Nursing professionals are often the first to encounter these scenarios in various settings. Adequate preparation and competent knowledge among nurses significantly impact survival rates positively. Aim: To describe the state of knowledge about Basic and Advanced Life Support guidelines among Ecuadorian nursing professionals. Methodology: A nationwide, descriptive, cross-sectional study was conducted from February to April 2023 among Ecuadorian nursing professionals. Participants were invited through official social media groups such as WhatsApp and Facebook. The study utilized a self-administered online questionnaire to evaluate theoretical knowledge of Basic Life Support (BLS) and Advanced Life Support (ALS). Knowledge scores were assigned based on the number of correct answers on the tests. T-tests and one-way ANOVA were used to examine relationships between knowledge scores and demographic and academic training variables. Results: A total of 217 nursing professionals participated in the study. The majority of the participants were female (77.4%) and held a university degree (79.9%). Among them, only 44.7% claimed to have obtained a BLS training certificate at least once, and 19.4% had ALS certification. The overall BLS knowledge score (4.8/10 ± 1.8 points) was higher than the ALS score (4.3/10 ± 1.8 points). Participants who had obtained BLS certification and those who used evidence-based summaries as a source of extracurricular training achieved higher BLS and ALS knowledge scores. Conclusion: Ecuadorian nursing professionals in this study exhibited a significant deficiency in theoretical knowledge of BLS and ALS. Formal training and preparation positively impact life support knowledge. Support and inclusion of Ecuadorian nurses in training and academic preparation programs beginning at the undergraduate level are essential for promoting life support knowledge and improving outcomes.

Assessing the Proficiency in Basic and Advanced Life Support Among Physicians in Ecuador: A Cross-Sectional Study.

Purpose: Cardiorespiratory arrest's unpredictability poses a global health challenge, with gaps in physicians' life support knowledge potentially leading to poor patient outcomes, a factor yet unstudied among Ecuadorian physicians. This study aims to elucidate the state of physicians' theoretical knowledge in Ecuador based on Basic Life Support (BLS) and Advanced Life Support (ALS) guidelines. Patients and methods: A national cross-sectional online 35-questions survey was conducted between February and March 2023 using a self-administered, expert-validated questionnaire. Participants' responses were obtained through official social media groups (WhatsApp and Facebook). The survey evaluated the theoretical knowledge of BLS and ALS, with scores based on the number of correct answers out of a maximum of 10.0 points. For descriptive analysis, frequencies, percentages, means, and standard deviations (SD) were used. The T-test and one-way ANOVA were utilized to analyze the associations between knowledge levels and demographic and academic training variables of Ecuadorian doctors. Values of p < 0.05 were considered statistically significant for all analyses. Results: The survey garnered responses from 385 physicians, with a majority being female (56.6%) and possessing less than 3 years of work experience (75.1%). Of these, 71.7% and 51.9% held BLS and ALS certifications, respectively. Knowledge scores for BLS (5.8/10 ± 1.6) surpassed those for ALS (4.7/10 ± 1.8) (p < 0.001). Physicians with less than 3 years of work experience exhibited higher knowledge scores in both BLS and ALS tests (p < 0.05). Conclusion: This study revealed a notable deficiency in the theoretical knowledge of BLS and ALS among surveyed Ecuadorian physicians. Factors such as prior certification and years of work experience appeared to influence knowledge levels. Continual training and updates in life support protocols at universities and healthcare institutions are key to enhancing physicians' skills and patient outcomes.

Comparing 3 Suture Techniques After Muscle Laceration Repair.

Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.

External quality assessment program for biochemical assays of human seminal plasma: a French 6-years experience.

BACKGROUND: In 1999, despite a longstanding use, the WHO manual for the examination of human semen finally proposed to assay several biochemical components of the seminal plasma for a functional exploration of the male accessory glands. At the same time, an international effort was made to standardize laboratory tests and to increase their performance through ISO 15189 accreditation. In this setting, participation to relevant external quality assessment (EQA) schemes is an essential requirement for laboratories. To fulfil this injunction, we have organized an EQA program for seminal biochemistry using presumed commutable samples. In this study, we aimed to report an overview of the French laboratory offer, the kinds of assays used, their performance as well as their likelihood of satisfying ISO15189 requirements for EQA. RESULTS: Between 2014 and 2019, we performed seven surveys. A median of six laboratories participated to each survey giving a ratio of one laboratory per 11.2 million inhabitants. Seven biomarkers are routinely assayed but the core set shared by all laboratories comprised citrate and zinc (prostate), fructose (seminal vesicles) and α-1, 4 glucosidase (epididymis). The use of CE-IVD marked methods concerned between 0 to 75% of overall assays. According to analytical specifications, 100% of laboratories results were compliant for zinc, 75% for citrate and α-1,4 glucosidase and 67% for fructose. By combining overall data in an empirical scoring system, we identified several types of seminal biomarkers: citrate, fructose and zinc appear as good candidates for a full accreditation, α-1,4 glucosidase still presents an analytical weakness, but prostatic acid phosphatase, free L-carnitine and glycerophosphocholine cannot be accredited in the current state. CONCLUSIONS: We organized the first French EQA program for seminal biochemistry to help local laboratories to face their legal requirement to be fully accredited by 2020. It could be improved still further but it gave us an oversight on the analytic landscape. Effective methods are available for a confident biochemical exploration of prostate and seminal vesicles. However, that of epididymis appeared unexpectedly fragile. This andrological issue should be addressed by dedicated recommendations from health authorities and scientific societies.

Interleukin-17-induced neutrophil extracellular traps mediate resistance to checkpoint blockade in pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) remains a lethal malignancy with an immunosuppressive microenvironment that is resistant to most therapies. IL17 is involved in pancreatic tumorigenesis, but its role in invasive PDAC is undetermined. We hypothesized that IL17 triggers and sustains PDAC immunosuppression. We inhibited IL17/IL17RA signaling using pharmacological and genetic strategies alongside mass cytometry and multiplex immunofluorescence techniques. We uncovered that IL17 recruits neutrophils, triggers neutrophil extracellular traps (NETs), and excludes cytotoxic CD8 T cells from tumors. Additionally, IL17 blockade increases immune checkpoint blockade (PD-1, CTLA4) sensitivity. Inhibition of neutrophils or Padi4-dependent NETosis phenocopies IL17 neutralization. NMR spectroscopy revealed changes in tumor lactate as a potential early biomarker for IL17/PD-1 combination efficacy. Higher expression of IL17 and PADI4 in human PDAC corresponds with poorer prognosis, and the serum of patients with PDAC has higher potential for NETosis. Clinical studies with IL17 and checkpoint blockade represent a novel combinatorial therapy with potential efficacy for this lethal disease.

Cable equation for general geometry.

The cable equation describes the voltage in a straight cylindrical cable, and this model has been employed to model electrical potential in dendrites and axons. However, sometimes this equation might give incorrect predictions for some realistic geometries, in particular when the radius of the cable changes significantly. Cables with a nonconstant radius are important for some phenomena, for example, discrete swellings along the axons appear in neurodegenerative diseases such as Alzheimers, Parkinsons, human immunodeficiency virus associated dementia, and multiple sclerosis. In this paper, using the Frenet-Serret frame, we propose a generalized cable equation for a general cable geometry. This generalized equation depends on geometric quantities such as the curvature and torsion of the cable. We show that when the cable has a constant circular cross section, the first fundamental form of the cable can be simplified and the generalized cable equation depends on neither the curvature nor the torsion of the cable. Additionally, we find an exact solution for an ideal cable which has a particular variable circular cross section and zero curvature. For this case we show that when the cross section of the cable increases the voltage decreases. Inspired by this ideal case, we rewrite the generalized cable equation as a diffusion equation with a source term generated by the cable geometry. This source term depends on the cable cross-sectional area and its derivates. In addition, we study different cables with swelling and provide their numerical solutions. The numerical solutions show that when the cross section of the cable has abrupt changes, its voltage is smaller than the voltage in the cylindrical cable. Furthermore, these numerical solutions show that the voltage can be affected by geometrical inhomogeneities on the cable.

Características epidemiológicas de los pacientes atendidos en el programa de infecciones de transmisión sexual, Jaén y Chota 2016 / Epidemiological characteristics of patients carried out in the program of sexual transmission infections, Jaén and Chota 2016

Objetivo: Determinar las características epidemiológicas de los pacientes atendidos en el programa de infecciones de transmisión sexual en los hospitales de los distritos Jaén y Chota, enero-diciembre 2016. Material y métodos: Se revisaron las historias clínicas y libro de registro diario de los pacientes; se completó la información a una base de datos de Excel, la que posteriormente se exportó al programa SPSS 21, y el análisis estadístico entre variables se realizó utilizando el estadístico chi cuadrado. Resultados: Se encontró que los pacientes atendidos en Chota y Jaén, fueron mujeres en 90% y varones en 10%, hubo una mayor frecuencia de pacientes entre los 21 y 30 años (37,8%). Las trabajadoras sexuales representan el 37,1% de la población estudiada, y la población homosexual 4,6%. Chota aportó un 40,5% de participantes y Jaén un 59,3%. Gardnerella fue el diagnóstico más frecuente con un 43,9 %, seguido de cándida albicans con un 14,6%. El rango de edad (p<0,03) el grupo poblacional (p<0,001), el número de diagnósticos (p<0,001) y la ocupación (p<0,001) mostraron asociación con la variable ciudad de procedencia. Conclusiones: La zona de procedencia con mayor frecuencia de los pacientes atendidos en el programa de infecciones de transmisión sexual en los hospitales de los distritos Jaén y Chota 2016, es la zona urbana con un 78,6%. La ocupación con mayor frecuencia de los pacientes atendidos en el programa de infecciones de transmisión sexual en los hospitales de los distritos Jaén y Chota 2016, es la de no profesional con un 68.9%.

Fractional cable equation for general geometry: A model of axons with swellings and anomalous diffusion.

Different experimental studies have reported anomalous diffusion in brain tissues and notably this anomalous diffusion is expressed through fractional derivatives. Axons are important to understand neurodegenerative diseases such as multiple sclerosis, Alzheimer's disease, and Parkinson's disease. Indeed, abnormal accumulation of proteins and organelles in axons is a hallmark of these diseases. The diffusion in the axons can become anomalous as a result of this abnormality. In this case the voltage propagation in axons is affected. Another hallmark of different neurodegenerative diseases is given by discrete swellings along the axon. In order to model the voltage propagation in axons with anomalous diffusion and swellings, in this paper we propose a fractional cable equation for a general geometry. This generalized equation depends on fractional parameters and geometric quantities such as the curvature and torsion of the cable. For a cable with a constant radius we show that the voltage decreases when the fractional effect increases. In cables with swellings we find that when the fractional effect or the swelling radius increases, the voltage decreases. Similar behavior is obtained when the number of swellings and the fractional effect increase. Moreover, we find that when the radius swelling (or the number of swellings) and the fractional effect increase at the same time, the voltage dramatically decreases.

Frecuencia de hipoacusia y características audiométricas en pacientes con diabetes de un hospital de la ciudad de Chiclayo, Perú, 2015 / Frequency of hearing loss and audiometric characteristics of patients with diabetes in a hospital in Chiclayo city-Peru, 2015

Introducción: La diabetes es un trastorno metabólico que afecta a más de 347 millones de personas en el mundo y aproximadamente 1,1 millones en el Perú; si bien se han estudiado sus complicaciones, poco se sabe sobre su efecto en la audición. Se han planteado algunas hipótesis para intentar explicarla, sin embargo, la relación entre diabetes mellitus y la hipoacusia es motivo aún de discusión en la actualidad. Objetivos: Determinar la frecuencia de hipoacusia y las características audiométricas en pacientes con diabetes de un hospital nivel II de la Ciudad de Chiclayo durante el año 2015. Materiales y métodos: Estudio transversal descriptivo en el que se realizaron audiometrías a 185 pacientes con diabetes atendidos en el servicio de Endocrinología. Se incluyó a pacientes entre 18 y 70 años, con diagnóstico confirmado de diabetes mellitus tipo 1 y 2, que vivan en la ciudad de Chiclayo. El muestreo fue probabilístico aleatorio simple. Se excluyó a pacientes con sordera súbita, otitis media aguda o crónica, antecedente o presencia de perforación timpánica detectados durante la exploración ótica y que utilizaran material auxiliar auditivo, consumían fármacos ototóxicos, con antecedente de hipoacusia y de exposición laboral a ruido. Los datos se registraron en una ficha de audiometría convencional en la que se agregaron las variables de interés (edad, sexo, tiempo de enfermedad y otras variables clínicas). Se describieron medidas de tendencia central y de dispersión. Resultados: El 49% de los pacientes diabéticos presentaron hipoacusia, destacando la hipoacusia leve (35%), bilateral (41%) de tipo neurosensorial (45%) y con una tendencia a tonos agudos (42%). La mayoría de los pacientes con hipoacusia tuvo un tiempo de enfermedad mayor o igual a 10 años. Conclusiones: La frecuencia de hipoacusia en pacientes con diabetes es elevada en nuestro medio. Por lo general es una hipoacusia leve, de tipo neurosensorial y bilateral, independiente del tiempo de evolución. Estos datos obligan a tener un mayor énfasis en la revisión sistemática de alteraciones a nivel auditivo en los pacientes con diabetes.

Introduction: Diabetes is a metabolic disorder that affects more than 347 million people worldwide, and approximately 1.1 million in Peru. Its complications have been studied, but there is little about its effect on hearing. Although there are some hypotheses to try to explain this, the relationship between diabetes mellitus and hearing loss is still controversial. Objectives: To determine the frequency of hearing loss and the audiometric characteristics of diabetic patients in a Level II Hospital of Chiclayo City during 2015. Materials and methods: A descriptive cross-sectional study in which audiometry was performed on 185 patients with diabetes treated in the Endocrinology Department. The patients included where between 18 and 70 years, diagnosed with diabetes mellitus type 1 and 2, and lived in Chiclayo city. Simple random probability sampling was used. Those patients with sudden deafness, acute or chronic otitis media, a history or presence of tympanic perforation detected during ear examination, using hearing aid materials, on cytotoxic drugs, family history of hearing loss, and occupational exposure to noise, were excluded. Data were recorded in a conventional audiometry table in which other variables of interest (age, gender, and duration of the disease) were added. Measures of central tendency and dispersion were described. Results: Almost half (49%) of diabetic patients had hearing loss, mainly slight (35%), bilateral (41%), sensorineural (45%), and with a tendency towards higher-pitched tones (42%). Most patients with hearing loss had more than 10 years of disease. Conclusions: The frequency of hearing loss in patients with diabetes is high in our environment. It is usually a minor, sensorineural and bilateral type, independent of duration of disease. These data show that greater emphasis should be placed on the systematic review of changes in hearing levels in patients with diabetes.

A Muscular Etiology for Medial Implant Malposition Following Subpectoral Augmentation.

BACKGROUND: Implant malposition is becoming an increasingly recognized complication following subpectoral breast augmentation. Although several causes of medial malposition have been previously demonstrated, medial implant malposition secondary to unintended pectoralis muscle slips has not been previously described. OBJECTIVE: The goal of this study is to describe a form of medial implant malposition caused by pectoralis major and minor musculature vectors on the implant. METHODS: The primary investigator performed a retrospective review of all patients who underwent revisional breast surgery for the diagnosis of symmastia or medial implant malposition following subpectoral augmentation. Those patients with muscular-type etiology for medial implant malposition were identified. RESULTS: Five patients with pectoralis muscle slips causing medial implant malposition were identified. The pectoralis muscle slips were successfully diagnosed on preoperative exam and corrected with specific surgical procedures aimed at balancing surrounding forces and thus correcting malposition. CONCLUSIONS: Pectoralis muscle slips contributing to medial malposition can be found in some patients after subpectoral breast augmentation. The etiology of this deformity is unknown, but theorized to be caused by anatomic predisposition, with slips inadvertently formed during subpectoral pocket formation arising from the pectoralis minor and/or incompletely released or accessory pectoralis major muscles.

Prevalencia y factores de riesgo psicosociales de la depresión en un grupo de adultos mayores en Bogotá / Prevalence and psychosocial risk factors of depression in a group of older adults in Bogota

Introducción: la depresión es una enfermedad de alta prevalencia en adultos mayores. En Colombia su prevalencia se ha descrito entre 1,2 a 12% en mayores que viven en comunidad. Objetivo: estimar la prevalencia de depresión en un muestra de adultos mayores de Bogotá y describir los factores de riesgo psicosocial asociados. Material y métodos: se realizó un estudio de corte transversal observacional-descriptivo, en 889 adultos mayores autónomos. La depresión fue evaluada con el test de depresión geriátrica Yesavage y los factores de riesgo con la sección de acontecimientos vitales del cuestionario Predict. Resultados: el 74% de la muestra estuvo constituida por mujeres, la media de edad fue de 72,51 (DS 9,4) años y la escolaridad promedio en años fue de 7,50 (DS 5,64). Así mismo, se estimó una prevalencia de depresión del 18,6%, siendo mayor en mujeres (20%) y (18%) en sujetos entre 70 y 79 años, los adultos con baja escolaridad sumaron un 43%, y el 22% lo constituyeron personas dependientes económicamente. Por otra parte, se encontró relación entre la depresión y cinco de los factores de riesgo psicosocial conocidos como acontecimientos vitales adversos: insomnio, vivir solo, padecer enfermedades crónicas, haber sufrido una crisis económica, y la muerte de un familiar o amigo cercano en el último año. Conclusión: la prevalencia de depresión en un grupo de personas mayores de la comunidad en Bogotá es más alta que lo descrito previamente en Colombia y por la Organización Mundial de la Salud (OMS). Programas que reduzcan la soledad en la vejez y protejan a la mujer y a los mayores con menos escolaridad podrían mitigar esta condición.

Introduction: depression is one of the most prevalent diseases in the elderly. In Colombia, the prevalence of depression in this population ranges from 1,2 to 12%. Objective: to estimate the prevalence of depression in a group of independent elderly subjects in Bogota and describe the psychosocial risk factors associated with it. Material and methods: a cross-observational and descriptive study was done. The sample was constituted of 889 autonomous elderly subjects of Bogota city. Depression was assessed by applying the Test of Geriatric Depression-Yesavage-. Besides, the psychosocial risk factors were measured through the life events section, which is part of the Predict Questionnaire. Results: 74% of the sample was made up of women, the mean age was 72,51 years old (DS.9,4) and the average of education was of 7.50 years (DS.5,64). Besides, it was found a prevalence of depression of 18,6%. This prevalence was higher in the women (20%) and elderly between 70 and 79 years old (18%), adults with low education with 43% or 22% in economically dependent people. A relationship between depression and five psychosocial risk factors, known as adverse life events-insomnia, living alone, suffering a chronic disease or economic crisis or the death of the couple, a close friend or a relative. Conclusion: results showed a higher prevalence of depression in this sample in comparison to the findings yielded in previous studies developed in Colombia and the WHO. Programs that help to reduce the long lines protect women and older with less schooling ageing could mitigate the condition.

Expanded indications for the deep plane cervicofacial flap: aesthetic reconstruction of large combined temporofrontal and brow defects.

The deep plane cervicofacial (DPCF) rotation advancement flap has been well described for coverage of cheek and lower eyelid defects. The extension of this flap for coverage of complex combined temporofrontal and brow defects has not been previously described. The primary investigator (E.L.C.) performed a chart review of all 7 DPCF flaps performed for reconstructive purposes at the University of Texas Medical Branch, Galveston, Tex, from November 2011 through August 2012. Three patients with complex combined temporal and brow defects were identified. Three patients underwent coverage of complex combined temporofrontal and brow defects using the DPCF flap. Adequate coverage was provided with good skin color match. No flap loss or tip necrosis was seen, despite immediate excision of the resulting cheek standing cone deformity in 2 of the 3 patients at the time of reconstruction. All patients had suture fixation of the DPCF flap to cheek periosteum. All had none or mild lateral canthal distortion, with less than 1 mm of asymptomatic ectropion at a minimum follow-up of 4 months. The DPCF flap is a safe, effective, and reliable means to provide coverage for complex combined temporofrontal and brow defects. The deep plane elevation and musculocutaneous blood supply may improve flap mobility, viability, and resistance to tension. The standing cone deformity resulting from flap advancement can be primarily excised without risking flap necrosis. With further study, indications for the DPCF flap may include adjacent areas of the face currently being reconstructed using other means.

Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews.

BACKGROUND: Dementia includes a group of neurodegenerative disorders characterized by progressive loss of cognitive function and a decrease in the ability to perform activities of daily living. Systematic reviews of diagnostic test accuracy (DTA) focus on how well the index test detects patients with the disease in terms of figures such as sensitivity and specificity. Although DTA reviews about dementia are essential, at present there is no information about their quantity and quality. METHODS: We searched for DTA reviews in MEDLINE (1966-2013), EMBASE (1980-2013), The Cochrane Library (from its inception until December 2013) and the Database of Abstracts of Reviews of Effects (DARE). Two reviewers independently assessed the methodological quality of the reviews using the AMSTAR measurement tool, and the quality of the reporting using the PRISMA checklist. We describe the main characteristics of these reviews, including basic characteristics, type of dementia, and diagnostic test evaluated, and we summarize the AMSTAR and PRISMA scores. RESULTS: We selected 24 DTA systematic reviews. Only 10 reviews (41.6%), assessed the bias of included studies and few (33%) used this information to report the review results or to develop their conclusions Only one review (4%) reported all methodological items suggested by the PRISMA tool. Assessing methodology quality by means of the AMSTAR tool, we found that six DTA reviews (25%) pooled primary data with the aid of methods that are used for intervention reviews, such as Mantel-Haenszel and separate random-effects models (25%), while five reviews (20.8%) assessed publication bias by means of funnel plots and/or Egger's Test. CONCLUSIONS: Our assessment of these DTA reviews reveals that their quality, both in terms of methodology and reporting, is far from optimal. Assessing the quality of diagnostic evidence is fundamental to determining the validity of the operating characteristics of the index test and its usefulness in specific settings. The development of high quality DTA systematic reviews about dementia continues to be a challenge.

Anatomy of the sternal origin of the pectoralis major: implications for subpectoral augmentation.

BACKGROUND: The pectoralis major typically is manipulated for implant coverage and pocket design in subpectoral breast augmentation. An understanding of its anatomy can guide successful creation of the implant pocket. OBJECTIVES: The authors evaluated the anatomy of the sternal origin of the pectoralis major to inform surgical planning, help establish a technique for subpectoral augmentation mammaplasty, and identify the most common locations of perforators. METHODS: The sternal origins of 24 pectoralis major muscles were dissected and examined in 15 female cadavers to determine the structure and width of the pectoralis major sternal origin and its relationship to the locations of internal mammary perforators. RESULTS: The average width of the sternal origin of the pectoralis major was 7.1 mm (range, 3 mm-1.8 cm). This width decreased slightly from the second rib to the second intercostal space and then increased progressively in the caudal direction toward the fifth rib. The sternal origin terminated an average of 5.4 mm (range, 1-16 mm) from the midline, with the greatest distance at the fifth rib and large variability throughout. A row of perforators from the internal mammary artery traversed the subpectoral space an average of 2.7 cm from the midline (range, 1-3.7 cm). CONCLUSIONS: The sternal origin of the pectoralis major was thin and highly variable, suggesting that its partial release for implant medialization during subpectoral augmentation is unsafe.

Anatomic relationship of the pectoralis major and minor muscles: a cadaveric study.

BACKGROUND: Although the anatomy of the individual pectoralis major and minor muscles has been described previously, never before has the anatomic relationship between these muscles been investigated. OBJECTIVE: The authors identify the anatomic relationship of the costal origins of the pectoralis major and minor muscles. METHODS: Bilateral thoracic wall dissection was completed in 102 cadavers. In each dissection, the chest wall soft tissue was removed, and the distance between costal origins of the pectoralis major and the pectoralis minor muscles was measured. RESULTS: In 49 female and 53 male cadavers, 202 pectoralis major muscles were lifted to expose the costal origins of the pectoralis major and minor muscles. Distances between pectoralis major and pectoralis minor muscles were separated into 3 categories: less than 1 cm, between 1 and 3 cm, and greater than 3 cm. Forty-nine (24%) pectoralis muscle dissections displayed a distance of less than 1 cm between costal muscle origins. Eighty-three dissections (41%) showed an intermediate distance of between 1 and 3 cm, while the remaining 70 (35%) were over 3 cm. No significant difference was observed in these percentages with regard to sex. Ten cadavers displayed asymmetry in pectoralis muscle origin distance. Eight specimens displayed shared fibers between pectoralis major and minor muscles. CONCLUSIONS: The anatomic relationship between the costal origin of the pectoralis major and minor muscles is highly variable. Understanding this spatial relationship has important implications for cosmetic and reconstructive breast surgery.

Puntuaciones del MoCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá / MoCA and MMSE scores in patients with mild cognitive impairment and dementia in a memory clinic in Bogotá

Introducción. Diferentes pruebas neuropsicológicas permiten explorar las funciones cognitivas del adulto mayor, en un tiempo corto. En Colombia se dispone de pocos estudios sobre puntuaciones y puntos de corte para el MMSE y para el MoCA en relación al diagnóstico de deterioro cognitivo. Objetivo. Describir la distribución de las puntuaciones del MMSE y el MoCA y los puntos de corte con mejor discriminación, para el diagnóstico de deterioro cognitivo leve y demencia, en una muestra de pacientes de Bogotá. Material y métodos. Se evaluaron 248 pacientes por un equipo multidisciplinario, que consultaron a la Clínica de Memoria del HIUSJ entre 2009-2012, siguiendo un protocolo establecido. Se identificaron las puntuaciones del MoCA y MMSE, que permitieron obtener el mayor porcentaje de pacientes correctamente clasificados. Resultados. En el 70% de los pacientes con DCL y en el 69 % de los sujetos normales, se encontraron puntuaciones del MMSE inferiores o iguales a 28. En 91% de pacientes con DCL y 84% de los sujetos normales, se presentaron puntuaciones del MoCA inferiores o iguales a 25. Los pacientes con cualquier tipo de demencia, presentaron puntuaciones del MMSE inferiores o iguales a 27 e inferiores o iguales a 24 en el MoCA. Conclusión. Según el presente estudio, el tamizaje de funciones cognitivas, utilizando el MoCA, clasifica de manera más acertada que el MMSE, a los sujetos con deterioro cognitivo. Creemos que en atención primaria, estos puntos de corte del MoCA, pueden ser considerados por ahora, cuando se trate especialmente de sujetos con alta escolaridad.

Introduction. Some cognitive tests allow the evaluation of cognitive functions on the elderly in a short period of time. There are few studies in Colombia about cut-off point for the MMSE and the MoCA test. Objectives. To describe the distribution on scores on MMSE and MoCA test and the cut-off point with a better discrimination criteria for the diagnosis of mild cognitive impairment and dementia, in a sample of patients from Bogotá. Materials and methods. Two hundred forty eight patients were included in this study, being evaluated by a multidisciplinary team that followed an established protocol, on patients who attended to the Memory Clinic of HIUSJ between 2009-2012. MoCA test and MMSE scores that allow higher percentages of correctly classified patients were identified. Results. Seventy percent of patients with mild cognitive impairment and 69% of normal individuals had scores on MMSE below or equal to 28. Ninety-one percent of patients with MCI and 89% of normal patients, had scores below or equal to 25. Patients with any type of dementia had scores on MMSE below or equal to 27 and below or equal to 24 in MoCA test. Conclusion. According to the study, the screening of cognitive functions, using MoCA test, is more accurate than MMSE in patients with cognitive decline. The cut-off points, identified in our study, can be considered useful until now in primary attention, in patients with a high level of education.

Alzheimer's disease dementia guidelines for diagnostic testing: a systematic review.

Alzheimer's disease dementia (AD dementia) is one of the most common neurodegenerative diseases worldwide, with a growing incidence during the last decades. Clinical diagnosis of cognitive impairment and presence of AD biomarkers have become important issues for early and adequate treatment. We performed a systematic literature search and quality appraisal of AD dementia guidelines, published between 2005 and 2011, which contained diagnostic recommendations on AD dementia. We also analyzed diagnostic recommendations related to the use of brief cognitive tests, neuropsychological evaluation, and AD biomarkers. Of the 537 retrieved references, 15 met the selection criteria. We found that Appraisal of Guidelines Research and Evaluation (AGREE)-II domains such as applicability and editorial independence had the lowest scores. The wide variability on assessment of quality of evidence and strength of recommendations were the main concerns identified regarding diagnostic testing. Although the appropriate methodology for clinical practice guideline development is well known, the quality of diagnostic AD dementia guidelines can be significantly improved.

Biopsia por aspiración con aguja fina en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" / Fine needle aspiration biopsy at the National Children’s Hospital "Dr. Carlos Sáenz Herrera

Objetivo: Evaluar y describir la experiencia con la biopsia por aspiración con aguja fina (BAAF) en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" (HNN) de San José, Costa Rica durante los primeros 21 meses de funcionamiento de dicho servicio. Métodos: Estudio observacional y retrospectivo del material de BAAF obtenido en el HNN desde octubre de 2004 a junio de 2006 (extendidos del material, inmunofenotipo, citogenética, cultivos microbiológicos). En aquellos casos en que se realizó cirugía, se hizo correlación entre material de biopsias convencionales anteriores o posteriores y la BAAF. La evolución de los pacientes se obtuvo por medio del expediente clínico. Resultados: Se realizó un total de 142 diagnósticos en 132 pacientes. La clasificación de dichos diagnósticos fue: benigno 86 (61%), maligno 36 (25%), sospechoso 5 (3.5%), atípico 5 (3.5%); se obtuvo material insuficiente para diagnóstico en 10 (7%) de las BAAF. De los diagnósticos benignos 74 (86%) consistieron en linfadenopatía reactiva-infecciosa. Los diagnósticos malignos fueron variados, siendo el linfoma el más frecuente 14 (39%); con el linfoma de Hodgkin como el mas común 9 (25%), detectándose tanto enfermedad de novo como recurrencias. Se determino el inmunofenotipo por citometría de flujo en 17 (12%) casos y se realizó cariotipo en 2 (1.4%) casos. Conclusiones: La BAAF es un procedimiento seguro, rápido y eficaz en el diagnóstico de múltiples patologías de la población pediátrica atendida en HNN. Los dos escenarios clínicos más frecuentes en que la BAAF cumplió un rol importante fueron el diagnóstico de recurrencia del linfoma de Hodgkin y el tamizaje de linfadenopatías en niños sin historia de malignidad. En algunos casos la BAAF hace innecesaria la realización de una biopsia convencional.

Aim: To evaluate the performance of Fine Needle Aspiration Biopsy (FNAB) and describe the experience at Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" (HNN) in San José, Costa Rica during the first 21 months since introduction of this procedure. Methods: Retrospective review of all FNAB material collected at HNN from October 2004 to June 2006 (glass slides, flow cytometric analyses, cytogenetics, and cultures). When available, previous or later surgical biopsy material was also reviewed and results were correlated with FNAB. Patient followup was assessed from clinical charts. Results: A total of 142 diagnoses in 132 patients were performed. These were classified as follows: benign 86 (61%), malignant 36 (25%), suspicious 5 (3.5%), atypical 4 (3.5%). Material insufficient for diagnosis was obtained in 10 (7%) cases. Reactive-infectious lymphadenopathy comprised 74 (86%) of benign diagnoses. Most common malignant diagnosis was lymphoma. New cases and recurrences of Hodgkin’s disease were the most common specific malignancy 9 (25%) detected. Flow cytometric analysis was performed in 17 (12%) of the cases and conventional cytogenetics in 2 (1.4%). Conclusions: FNAB demonstrated to be a fast, safe and efficient diagnostic tool at HNN. Diagnosis of recurrence of Hodgkin’s lymphoma and screening of lymphadenopathies in children without history of malignancy were the two most common clinical scenarios where FNAB played an important role. FNAB can obviate the need for surgical intervention in some cases.

Conservación del palmito (Bactris gasipaes) por envasado al vacio

La política de gobiernos bolivianos se inclinó hacia el desarrollo del trópico de Cbba. Se aceleró la sustitución de cultivos de coca con cultivos con una rentabilidad sino igual parecida. Uno de estos "cultivos sustitutos" es el palmito, que con el fin de darle valor agregado y mayor tiempo de conservación se instalaron plantas de procesamiento. Este palmito procesado es en un 90

para mercados externos. en los últimos años la venta de palmito procesado a estos mercados ha sufrido severas limitaciones. Un mercado todavía no explotado es el mercado interno. Para obtener los beneficios de este mercado se debe desarrollar formas de presentación y de conservación más económicas, que mantenga el tiempo necesario las características visuales, sensoriales y fisicoquímicas del producto procesado para su comercialización y consumo. En el transcurso del trabajo de investigación se evaluó el comportamiento del palmito envasado al vacío en tres diferentes micronajes de polietileno de baja densidad, previamente sometido a tres soluciones acidulantes y en el final del proceso sometido a dos tiempos diferentes de tratamiento térmico, dando como resultado dieciocho tratamiento que fueron evaluados en forma cuantitativa como cualitativa. Después de obtener los datos y evaluarlos la combinación óptima en el desarrollo del ensayo fue la combinación de jugo de limón, polietileno de 120 micras y un tratamiento térmico de 20 minutos a temperatura de ebullición, por demostrar mejor comportamiento tanto en las variables sensoriales, en las diferentes etapas del proceso, en el tiempo de concentración y en las características microbiológicas del producto final.