Establishment of a rabbit model of different degrees of testicular torsion.

INTRODUCTION AND OBJECTIVES: Different degrees of testicular torsion result in varying degrees of testicular damage, which influences treatment options and outcomes. Therefore, establishing a testicular torsion model with different degrees is necessary for clinical diagnosis. MATERIALS AND METHODS: Rabbits were randomly divided into four groups and their spermatic cords were twisted at 0 °, 180 °, 360 °, and 720 °, respectively. Color Doppler flow imaging (CDFI) were performed to evaluate the blood supply in testicles. The twisted testicles were surgically removed at six hours post-operation and were evaluated by morphological observation and Hematoxylin and Eosin staining. RESULTS: CDFI signals were gradually decreased as the degree of testicular torsion increased, and scores of CDFI in the 360 ° and 720 ° groups were significantly decreased at postoperative six hours compared to pre-surgery. Compared to the sham, the testicle in the 180 ° group exhibited slight congestion, whereas the testicles in the 360 ° and 720 ° groups were dark red in color and had severe congestion and unrecognizable vessels. Hematoxylin and Eosin staining showed mild spermatogenic cell reduction and testicular interstitial hemorrhage in the 180 ° group. In the 360 ° and 720 ° groups, disordered seminiferous tubules, shed spermatogenic cells in tubules, inflammatory cell infiltration, and severe hemorrhage were found. In comparison with the sham, interstitial hemorrhage scores in the 360 ° and 720 ° groups were significantly higher, and scores of germinal epithelial cell thickness in the three testicular torsion groups were significantly decreased. CONCLUSIONS: Collectively, we successfully constructed a testicular torsion model with different degrees in rabbits.

Inter-observer agreement on levels of evidence in radiology articles.

Levels of evidence (LE) are established through a hierarchical classification of studies according to their design. At present, there are many heterogeneous LE classifications, and this hampers their applicability. Our study aims to identify which LE classification has the best interobserver concordance for radiology articles. For this purpose, an interobserver agreement analysis were performed on 105 original articles applying two NE scales (Oxford Center of Evidence Based Medicine (OCEBM) y National Health and Medical Research Council (NHMRC)). The inter-rater agreement of the LE assigned after reading the abstracts was good when using the OCEBM scale (K = 0.679), and somewhat lower with the NHMRC (K = 0.577 -moderate-). All differences were statistically significant (P < .000). So, in conclusion, of the two scales analysed (OCEBM and NHMRC), the OCEBM led to the strongest level of inter-rater agreement.

Donor lungs cold preservation at 10 ºC offers a potential logistic advantage in lung transplantation / La preservación fría a 10 ºC de los injertos ofrece ventajas logísticas en el trasplante pulmonar

Donor lung preservation at 10 °C appears to be an innovative and promising method that may improve transplant logistics by extending the cold ischemia time with excellent outcomes. We report the case of two lung transplants from two different donors involving the use of two different preservation methods, highlighting the benefits of using 10 °C lung storage. (AU)

La preservación pulmonar a 10 °C es una estrategia innovadora que podría mejorar la logística del trasplante pulmonar permitiendo prolongar el tiempo de isquemia fría de los injertos pulmonares con excelentes resultados. Presentamos el caso de dos trasplantes pulmonares de dos donantes diferentes empleando dos métodos de preservación distintos, recalcando los beneficios de utilizar este novedoso método de preservación a 10 °C. (AU)

Donor lungs cold preservation at 10 °C offers a potential logistic advantage in lung transplantation.

Donor lung preservation at 10 °C appears to be an innovative and promising method that may improve transplant logistics by extending the cold ischemia time with excellent outcomes. We report the case of two lung transplants from two different donors involving the use of two different preservation methods, highlighting the benefits of using 10 °C lung storage.

Cáncer de recto a nivel de la reflexión peritoneal. Exactitud de la RM preoperatoria y correlación anatomopatológica. Estudio prospectivo / Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study

Introducción Establecer la exactitud de la resonancia magnética (RM) para determinar la localización de los tumores rectales en relación con la reflexión peritoneal (RP) y su potencial afectación. Métodos Estudio prospectivo de 161 pacientes intervenidos por cáncer de recto. Las piezas quirúrgicas han sido analizadas mediante un método de doble tinción, superficie serosa con colorante naranja y grasa mesorrectal con tinta china, para comparar los resultados con la RM preoperatoria. Resultados Veintidós tumores se localizaron por encima, 65 a nivel y 74 por debajo de la RP. La RM clasificó la localización del tumor respecto a la RP de manera correcta en el 90,6% y fue capaz de detectar el 80,5% de los casos con infiltración de la RP. La RM presentó una exactitud del 92,5% para clasificar el tumor como intra o extraperitoneal. El 28,7% de los tumores por encima y a nivel de la RP presentaba anatomopatológicamente infiltración de la serosa peritoneal. Conclusiones La RM es una prueba precisa para determinar la localización de los tumores de recto en relación con la RP y su posible afectación. En el tallado macroscópico, el método de doble colorante es eficaz para determinar la afectación serosa (pT4a) y diferenciarla de la fascia mesorrectal (AU)

Introduction To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement Methods Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. Results Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. Conclusions Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface (AU)

Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study.

INTRODUCTION: To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement. METHODS: Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. RESULTS: Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. CONCLUSIONS: Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface.

Multicenter study of diffuse pleural mesothelioma. histopathological and immunohistochemical features / Estudio multicéntrico de características histopatológicas e inmunohistoquímicas del mesotelioma pleural difuso

Abstract The pathological diagnosis of diffuse pleural mesothelioma (DPM) contributes to treatment selection and clinical trials interpretation. To know its characteristics and evaluate the viability of comprehensive pathological diagnosis of DPM in Argentina we did a retrospective descriptive study of DPM cases reported from 2009 to 2018. We analyzed 398 cases corresponding to 238 (60%) men and 160 (40%) women, median age 66 years, from surgical biopsies (78%), small biopsies (16.5%) and surgical resections (5.5%). The 77% were epithelioid (E-DPM), 12% biphasic, 10% sarcomatoid, and 4 cases transitional variant. In E-DPM the main pattern was tubular in 36% and solid in 33%. There was a second pattern in 179 cases. Considering the main pattern and the second together, 48% presented tubular subtype and 48% solid subtype. Stroma, necrosis, and nuclear score showed significant differences between E-DPM and non-epithelioid mesotheliomas. Overall tumor grade was predominantly low in E-DPM, except for 42% of the solid main pattern. We recognized the transitional variant extensively in 4 cases and focally in 8. The immunohistochemical antibody panel used included pan-cytokeratin, calretinin, WT-1, cytokeratin 5, CEA and TTF-1. The expression of cytokeratin 5, calretinin and WT-1 was lower in the sarcomatoid type (43%, 87 and 37%) than in the epithelioid type (92%, 98% and 93%). This study highlights the tumor heterogeneity of DPM that shows the diagnostic difficulty, and the feasibility of evaluating histological aggressiveness in E-DPM, B-DPM and S-DPM in our country.

Resumen El diagnóstico patológico del mesotelioma pleural difuso (MPD) contribuye a la selección del tratamiento y a la interpretación de los ensayos clínicos. Para conocer sus características y evaluar la viabilidad del diagnóstico patológico de MPD en Argentina se realizó un estudio descriptivo retros pectivo de los casos de MPD informados de 2009 a 2018. Se analizaron 398 casos correspondientes a 238 (60%) hombres y 160 (40%) mujeres, mediana de edad de 66 años, a partir de biopsias quirúrgicas (78%), biopsias pequeñas (16.5%) y resecciones quirúrgicas (5.5%). El 77% fue epitelioide (E-MPD), 12% bifásicos, 10% sarcomatoides y 4 casos variante transicional. En E-MPD se encontró como patrón principal el tubular en 36% y el sólido en 33%. Hubo un segundo patrón en 179 casos. Considerando el principal y el segundo patrón en conjunto, el 48% presentó subtipo tubular y el 48% subtipo sólido. El estroma, la necrosis y el score nuclear mostraron diferencias significativas entre E-MPD y mesoteliomas no epitelioides. El grado general del tumor fue predominantemente bajo en E-MPD, a excepción del 42% del patrón principal sólido. Reconocimos la variante transicional en forma extensa en 4 casos y focalmente en 8. La expresión de citoqueratina 5, calretinina y WT-1 fue menor en el tipo sarcomatoide (43%, 87 y 37%) que en el tipo epitelioide (92%, 98% y 93%). Este estudio destaca la heterogeneidad tumoral de MPD que evidencia la dificu ltad en el diagnóstico y la viabilidad de evaluar la agresividad histológica en E-MPD, B-MPD y S-MPD en nuestro país.

Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study. / Cáncer de recto a nivel de la reflexión peritoneal. Exactitud de la RM preoperatoria y correlación anatomopatológica. Estudio prospectivo.

INTRODUCTION: To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement. METHODS: Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. RESULTS: Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. CONCLUSIONS: Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface.

Evaluación de sólidos solubles en recursos forrajeros del trópico alto en el departamento de Nariño / Evaluation of soluble solids in forage resources in the high tropics in the department of Nariño / Avaliação de sólidos solúveis em recursos forrageiros nos altos trópicos do departamento de Nariño

Resumen En los sistemas ganaderos de trópico alto colombiano, la estacionalidad forrajera, y el déficit energético de las dietas en bovinos, son las mayores limitantes para potencializar la productividad animal. El objetivo del estudio fue evaluar la concentración de sólidos solubles, en dos especies arbustivas perennes (Tithonia Diversifolia (T.d) y Sambucus Nigra (S.n), edad: 60 días (d) y dos variedades de ryegrass (Lolium perenne) Columbia y Samson (edad: 32d) en el Centro de investigación Obonuco de Agrosavia (Pasto-Nariño). Los datos fueron analizados bajo un diseño completamente al azar con arreglo de medida repetida tomando como unidad experimental las parcelas de evaluación tanto en las arbustivas como en las gramíneas. Se midió la concentración de sólidos solubles (%Ss), en tres horarios (7:30 a.m., 11:30 a.m. y 3:00 p.m.), la composición nutricional y producción de biomasa; para el análisis se utilizó el software R V. 3.5.1 a través de ANAVA y pruebas de comparación de medias (tukey<0,05). Los datos indicaron mayor concentración (p<0,05) de Ss para S.n (12,5%) en comparación con las demás especies. Los mayores valores numéricos de Ss en todas las especies se presentaron en el horario de las 3:00 p.m. y los menores a las 7:30 a.m. A nivel nutricional hubo diferencia (p<0,05) para los carbohidratos no estructurales (CNE), siendo mayores para S.n (29,5%) respecto a T.d (25,4%). La producción de biomasa (MS/t/ ha/año), fue mayor (p<0,05) para T.d (22,8 t) respecto a S.n (11,4 t). Los resultados obtenidos de Ss para los recursos forrajeros evaluados son de gran importancia para estimar el valor energético de estos forrajes en alimentación animal.

Abstract In the livestock systems of the Colombian high tropics, the seasonality of forage, and the energy deficit of the diets of cattle, are the greatest limitations to the potential of animal productivity. The objective of the study was to evaluate the concentration of soluble solids in two perennial shrub species (Tithonia diversifolia and Sambucus nigra, age: 60 days (d) and two ryegrass varieties (Lolium perenne) Columbia and Samson (age: 32 d) at the Obonuco Research Center of Agrosavia (Pasto-Nariño). The data were analyzed under a completely randomized design with a repeated measurement arrangement taking as an experimental unit the evaluation plots in both shrubs and grasses. Soluble solids concentration (%Ss), nutritional composition and biomass production were measured in three time periods (7:30 a.m., 11:30 a.m. and 3:00 p.m.). The analysis was performed using R V. 3.5.1 software through ANAVA and mean comparison tests (tukey<0.05). Data indicated higher concentration (p<0.05) of Ss for S.n (12.5%) compared to the other species. The highest numerical values of Ss in all species were presented at 3:00pm and the lowest at 7:30 a.m. At a nutritional level there was a difference (p<0.05) for non-structural carbohydrates (NSC), being higher for S.n (29.5%) than T.d (25.4%). The production of biomass (MS/t/ha/year), was higher (p<0.05) for T.d (22.8 t) with respect to S.n (11.4 t). The results obtained from Ss for the fodder resources evaluated are of great importance for estimating the energy value of these fodder products in animal feed.

Resumo Nos sistemas pecuários do alto trópico colombiano, a sazonalidade das forragens e o déficit energético das dietas do gado são as maiores limitações para o potencial de produtividade animal. O objetivo do estudo foi avaliar a concentração de sólidos solúveis em duas espécies de arbustos perenes (Tithonia diversifolia e Sambucus nigra, idade: 60 dias (d) e duas variedades de azevém (Lolium perenne) Columbia e Sansão (idade: 32 d) no Centro de Pesquisa Obonuco de Agrosavia (Pasto-Nariño). Os dados foram analisados sob um desenho completamente aleatório com um arranjo de medição repetida tomando como unidade experimental as parcelas de avaliação tanto em arbustos como em gramíneas. A concentração de sólidos solúveis (%Ss), composição nutricional e produção de biomassa foram medidas em três períodos de tempo (7:30 h, 11:30 h e 15:00 h). A análise foi realizada utilizando o software RV. 3.5.1 através do ANAVA e testes de comparação de médias (tukey<0,05). Os dados indicaram maior concentração (p<0,05) de Ss para S.n (12,5%) em comparação com as outras espécies. Os valores numéricos mais altos de Ss em todo as espécies foram apresentados às 15:00 h e os mais baixos às 7:30 h. A nível nutricional houve diferença (p<0,05) para carboidratos não estruturais (NSC), sendo maior para S.n (29,5%) do que para T.d (25,4%). A produção de biomassa (MS/t/ha/ano), foi maior (p<0,05) para T.d (22,8 t) em relação ao S.n (11,4 t). Os resultados obtidos com os Ss para os recursos forrageiros avaliados são de grande importância para estimar o valor energético desses produtos forrageiros na alimentação animal.

Uso de la evaluación en 360 grados para medir competencias en residentes de programas de postítulo de especialidades médicas: Revisión de la literatura / Use of the 360-degrees assessment tool to assess competencies in residents of postgraduate programs of medical specialties: A literature review

En distintos países, han surgido modelos educacionales que definen el marco de competencias necesarias para que todomédico espe-cialista pueda dar respuesta a los constantes cambios que está viviendo la sociedad. Para estos modelos es fundamental que cada rol y competencia sea evaluado correctamente para garantizar su óptima adquisición. Uno de los instrumentos propuestos en la literatura internacional para realizar esto es la evaluación en 360°, que además entrega una retroalimentación oportuna al residente. El objetivo de este trabajo es realizar un artículo de revisión de la literatura sobre la evaluación en 360°. La evaluación en 360º es una de las nuevas herramientas que permite dar una evaluación global de las competencias médicas en residentes de programas de especialidades a nivel de posgrado. Consiste en una pauta de observación estructurada que entrega al residente una retroalimentación desde distintos puntos de vista de su práctica cotidiana, al incluir la información obtenida de diferentes grupos de interés para el residente. Este artículo incluye aspectos relacionados con los componentes y racionalidad educacional del instrumento de evaluación, proceso de elección de los evaluadores incluyendo médicos, profesionales de la salud, personal administrativo, pacientes y familiares. Adicio-nalmente se analizan aspectos del diseño y aplicación de la evaluación en 360° o retroalimentación de múltiples fuentes.

In different countries, educational models have emerged, definning defining a competence framework needed for every medical spe-cialist to respond to the constant changes that society is experiencing. For these models, it is essential that each role and competence be evaluated correctly to guarantee their optimal acquisition. One of the instruments proposed in the international literature to do this is the 360-degree assessment, which also provides timely feedback to the resident. The 360-degree assessment is one of the new tools that allows giving a global evaluation of the medical competences in residents of specialty programs at the postgraduate level. It consists of a structured observation guide that gives the resident feedback from different points of view of their daily practice, by including the information obtained from different groups of interest for the resident. This article includes aspects related to the components and educational rationale of this assessment instrument,the selection process of examiners including medical doctors, health professions, and administrative personnel, patients and their relatives additionally, it analyzed aspects related the design and administration of the 360-degree assessment or multisource feedback

Determinación del intervalo post mortem mínimo (IPM) basado en un modelo de acumulación térmica con una cepa de Lucilia eximia (Diptera: Calliphoridae) de Costa Rica / Lucilia eximia (Diptera: Calliphoridae) as forensic indicator for the calculation of the post mortem interval in Costa Rica

RESUMEN Introducción: L. eximia es una especie de amplia distribución geográfica en Costa Rica, cuyas poblaciones son estables durante todo el año. Las características biológicas de ésta permiten concebirla como un potencial indicador forense para el cálculo del intervalo post mortem mínimo (IPM). Objetivo: Comparar el IPM calculado mediante un modelo de acumulación térmica con L. eximia (Diptera: Calliphoridae), con el IPM real en cadáveres de cerdos domésticos (Sus scrofa). Material y Métodos: Dos cadáveres de cerdo fueron expuestos en un bosque premontano húmedo tropical. A partir de dichos cadáveres se colectaron larvas de L. eximia a las 78, 144 y 192 horas posteriores al momento de muerte y se propició su desarrollo en condiciones controladas. Con los datos generados, se realizaron retroproyecciones térmicas para efectuar el cálculo del IPM. Resultados: L. eximia requirió en total 7 236,50 grados- hora acumulados (ADH) para culminar su desarrollo. Los IPM calculados mediante el modelo de acumulación térmica para los tres momentos de colecta fueron 112,56; 153,60 y 104,64 horas. Únicamente el valor intermedio no presentó diferencias estadísticamente significativas con el tiempo de muerte conocido (p>0.05). Conclusiones: El modelo de acumulación térmica en que se utilizó L. eximia brindó información precisa sobre el IPM sólo cuando se tomaron las muestras en el campo a las 144 horas, lo que perfila su utilidad para las primeras etapas de la descomposición cadavérica.

ABSTRACT Introduction: L. eximia is a species that shows a wide geographical distribution in Costa Rica, whose populations are stable throughout the year. The biological characteristics of L. eximia allow it to be considered as a potential forensic indicator for the calculation of the minimum post mortem interval (PMI). Objective: To compare the PMI calculated by a thermal accumulation model with L. eximia (Diptera: Calliphoridae), with the PMI in corpses of pigs (Sus scrofa). Methods: Two pig corpses were exposed in a tropical premontane moist forest. Larvae of L. eximia were collected from the pig carcasses at 78, 144 and 192 hours after the moment of death, and their development was promoted under controlled conditions. With the data generated, thermal back-projections were made to calculate the PMI. Results: L. eximia required a total of 7 236.50 accumulated degree hours (ADH) to complete its life cycle. The IPMs calculated by the thermal accumulation model were 112.56, 153.60, and 104.64 hours, respectively. Only the intermediate value did not present statistically significant differences with the known time of death (p>0.05). Conclusions: The thermal accumulation model using L. eximia as a forensic indicator provided accurate information about the PMI only when samples were collected at 144 hours, which indicates that this method may be accurate and useful during the first stages of cadaveric decomposition.

Inyección Intraarticular Única de Ácido Hialurónico en la Artrosis de Rodilla: Estudio Multicéntrico Prospectivo Abierto (ART-ONE 75) mediante Comparación Post-Hoc con Placebo.

INTRODUCCIÓN: La viscosuplementación del líquido sinovial mediante la inyección intraarticular (IA) de ácido hialurónico (AH) es un tratamiento sintomático ampliamente utilizado en la artrosis de rodilla (AR). Además de los productos diseñados para realizar inyecciones múltiples (normalmente de 3 a 5 inyecciones, en intervalos de 1 semana), se presta especial atención a los productos de una única inyección, ya que ofrecen ventajas específicas, como son un menor número de visitas al médico y de intervenciones invasivas con sus riesgos asociados. Sin embargo, aún existen dudas sobre la eficacia de estas inyecciones únicas, en comparación con los regímenes de inyecciones múltiples. MÉTODOS: Se realizó un estudio multicéntrico, abierto, prospectivo, post-mercado (ART-ONE 75) con el producto de inyección única ARTHRUM 2,5% (3 ml, 75 mg AH), en 214 pacientes que sufrían de AR. Los pacientes fueron seguidos en D30, D60, D120 y D180 (días). El perfil promedio de los pacientes en el momento de la inclusión fue de 62,9 años, 56% mujeres, grados I-III de Kellgren-Lawrence (46% KL III), IMC de 27,2 kg/m2 y 4 años desde el diagnóstico de AR. Se realizó una comparación post-hoc con una inyección IA única de placebo (326 pacientes, agrupados de 3 estudios ECA), que proporcionaron un perfil de paciente similar. RESULTADOS: el criterio principal fue la variación desde el inicio de la puntuación de la escala WOMAC A (dolor, escala 0-100) en D60, que se redujo en 28,9 (17,4) para la población por intención de tratar (ITT, por sus siglas en inglés) (199 pacientes), 28,0 (17,8) para la población por protocolo (PP) en la inclusión (175 pacientes), y en 27,7 (16,8) para la población PP al finalizar (143 pacientes).Los criterios secundarios y accesorios incluyeron WOMAC A en otras ocasiones, WOMAC B (rigidez), WOMAC C (función), calidad de vida y discapacidad en cada momento de seguimiento. Todos los índices mejoraron significativamente y continuaron mejorando al final del estudio. La evaluación terapéutica en D180 mostró que más del 75% de los pacientes se encontraban satisfechos con la reducción del dolor, la mejora de la movilidad, y la reducción de analgésicos y AINE. El porcentaje de pacientes definidos como respondedores de OMERACT-OARSI fue superior al 86%, a partir de D60 y en adelante. La tolerancia general fue buena, sin que ocurriera ningún evento adverso grave. El resultado de la comparación post-hoc para la escala WOMAC A mostró un tamaño del efecto [IC 95%] desde TE = 0,33 [0,15; 0,51] en D60 a TE = 0,65 [0,45; 0,85] en D180 (p <0,001), frente a la inyección de placebo (solución salina), lo cual es un resultado clínicamente relevante a favor de ARTHRUM 2,5%. CONCLUSIÓN: El presente estudio confirma la eficacia clínica de una única inyección IA de 3 ml de solución de AH conteniendo 75 mg de AH nativo de alto PM (> 2 MDa).

Nefropatía diabética como factor de riesgo asociado a infección del tracto urinario, servicio de medicina del hospital uldarico rocca fernández, 2011 ­ 2015 / Diabetic nephropathy as risk factor associated with urinary tract infection, medical service of the hospital uldarico rocca fernandez, 2011 - 2015

Introducción: La diabetes mellitus es una de las patologías más prevalentes, afectando hasta el 2014 a un 9% de la población mundial y en el Perú el 4.3% de la población adulta ya es diabética. Estos pacientes son más susceptibles a enfermedades infecciosas, siendo la del tracto urinario la más frecuente, considerándose complicada, lo que significa que deben recibir manejo hospitalario, conllevando a disminución de la calidad de vida de los mismos. Objetivo: Determinar si la nefropatía diabética es un factor de riesgo para la prevalencia de infección del tracto urinario en pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández. Métodos: Es un estudio observacional, analítico de corte longitudinal, tipo caso y control; la información se recolectó mediante una ficha de datos utilizando las historias clínicas de los pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández en el periodo 2011-2015. La muestra se obtuvo por muestreo probabilístico, siendo el tamaño de esta de 360, con una proporción de casos y controles 1:1. Resultados: La nefropatía diabética obtuvo un OR=8.62 (IC95% 4.78 ­ 15.57), la macroalbuminuria obtuvo un OR=5.75 (IC95% 2.99 ­ 11.06), el pH alcalino obtuvo un OR=5.42 (IC95% 3.22 - 9.13) y el control glucémico obtuvo un OR=5.44 (IC95% 3.44 - 8.88). Conclusión: La nefropatía diabética se asocia a mayor prevalencia de ITU en pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández.

Introduction: Diabetes mellitus is one of the most prevalent pathologies, affecting up to 2014 to 9% of the world population and in Peru, 4,3% of the adult population is already diabetic. These patients are more susceptible to infectious diseases, urinary tract infection are the most complicated frequently involve, these patients receive hospital treatment, decreasing their life quality. Objective: To determine if diabetic nephropathy is a risk factor for the prevalence of urinary tract infection in hospitalized patients at the Uldarico Rocca Fernandez Hospital. Methods: It is an observational, analytical study of longitudinal cut, case and control type; the information was collected through a data sheet using the medical records of patients hospitalized in the medical service of the Hospital Uldarico Rocca Fernandez in the period 2011-2015. The sample was obtained by probabilistic sampling, sample size of 360, with a proportion of cases and controls 1:1. Results: Diabetic nephropathy had an OR = 8.62 (95% CI 4.78 - 15.57), macroalbuminuria obtained an OR = 5.75 (95% CI 2.99-11.06), the alkaline pH had an OR = 5.42 (95% CI 3.22-9.13) and the Glycemic control obtained an OR = 5.44 (95% CI 3.44 - 8.88). Conclusion: Diabetic nephropathy is associated with a higher prevalence of UTI in patients hospitalized in the medical service of the Hospital Uldarico Rocca Fernandez.

Stressful Events and Executive Functioning in Adolescents with and without History of Grade Repetition / Eventos estresores y funcionamiento ejecutivo en adolescentes con y sin historia de repetición escolar

Abstract A number of studies have investigated the association between psychiatric disorders and alterations in cognitive development, academic performance, and learning ability. However, few studies have explored the relationship between stressful events and grade repetition. Therefore, the main goal of the present study was to compare the frequency of exposure to stressful events, academic performance, executive functioning, and performance on working memory tasks between adolescents with and without a history of grade repetition. This was a cross-sectional study. The sample was composed of 83 adolescents divided into two groups: (1) individuals with a history of grade repetition (n = 39) and (2) participants who had never repeated a grade (n = 44). Participants were administered tests to assess executive functions, intelligence, exposure to stressful events, and academic performance. Results showed that individuals with a history of grade repetition reported to experiencing a higher number of stressful events in adolescence, had worse academic performance, and obtained lower scores on executive functioning and working memory tasks than non-repeaters.

Resumen Varios estudios han investigado la asociación entre trastornos psiquiátricos y alteraciones en el desarrollo cognitivo, el rendimiento académico y la capacidad de aprendizaje. Sin embargo, pocos estudios han explorado la relación entre los eventos estresantes y la repetición escolar. Por lo tanto, el objetivo principal de este estudio fue comparar la frecuencia de exposición a eventos estresantes, el rendimiento académico, el funcionamiento ejecutivo y el desempeño en tareas de memoria de trabajo en los adolescentes con y sin antecedentes de repetición escolar. Se trata de un estudio transversal. La muestra estuvo constituida por 83 adolescentes, divididos en dos grupos: (1) los individuos con antecedentes de repetición escolar (n = 39) y (2) los participantes que nunca repitieron un año escolar (n = 44). Los participantes fueron sometidos a pruebas para evaluar las funciones ejecutivas, la inteligencia, la exposición a eventos estresantes y el rendimiento académico. Los resultados mostraron que los individuos con historia de repetición escolar relataron la ocurrencia de un mayor número de eventos estresantes durante la adolescencia, tuvieron un peor rendimiento académico y obtuvieron puntuaciones más bajas en las tareas de funcionamiento ejecutivo y memoria de trabajo que los que no repitieron.

[Relevance of Simpson's grading system for resections in WHO grade I meningiomas]. / Relevancia de la escala de Simpson en la resección de meningiomas de grado I de la OMS.

OBJECT: The aim of this study is to assess if the recurrence rates and recurrence/progression-free survivals (RFS) are different after Simpson's grades I, II, III and IV resections in World Health Organization (WHO) grade I meningiomas. MATERIAL AND METHODS: A retrospective review was conducted on the data of patients who underwent surgical treatment of WHO grade I meningiomas located in convexity, falx/parasagittal, and skull base (anterior/media/posterior) between June 1991 and December 2011. In Simpson's grade IV resections, surgical treatment was supplemented with radiotherapy/radiosurgery on the tumour remains. A comparison was made on the recurrence rates and RFSs between Simpson's grades I, II, III, and IV resections, both overall and in tumour subsets according to their location. RESULTS: A total of 208 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson's grades I, II, III, and IV. No significant differences were noted between the different degrees of Simpson in any of the location groups. In convexity meningiomas, the recurrence rates were 7% and 33% in Simpson's grades I and III resections, respectively (P=.131). CONCLUSIONS: It has been shown that the rates of tumour control in meningiomas are not related to Simpson grades. In falx/parasagittal and skull base meningiomas, more aggressive attempts of tumour resection must be balanced against the risks of damaging critical neurovascular structures. In convexity meningiomas, a Simpson's grade I resection should be attempted first.

[Chronic subdural haematomas in very elderly patients]. / Hematoma subdural crónico en pacientes muy ancianos.

INTRODUCTION: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. PATIENTS AND METHODS: A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. RESULTS: A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CONCLUSIONS: CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.

[The importance of master's degree and doctorate degree in general surgery]. / Importancia de la maestría y el doctorado en cirugía general.

BACKGROUND: The Doctor of Philosophy is the highest academic degree that can be obtained in universities. Graduate Education Program in Medicine in Mexico is divided into 2 major categories: Medical Specialty and Master studies/Doctor of Philosophy. The objective of this study was to demonstrate the importance of master's degrees and Doctor of Philosophy in general surgery. MATERIAL AND METHODS: A literature search in PubMed and Medline among others, from 1970 to 2015 with subsequent analysis of the literature reviews found. DISCUSSION: The physicians who conducted doctoral studies stand out as leaders in research, teaching and academic activities. Dual training with a doctorate medical specialty is a significant predictor for active participation in research projects within the best educational institutions. RESULTS: It is important to study a PhD in the education of doctors specialising in surgery, who show more training in teaching, research and development of academic activities. Currently, although there is a little proportion of students who do not finish the doctoral program, the ones who do are expected to play an important role in the future of medical scientific staff. It has been shown that most doctors with Doctor of Philosophy have wide range of career options. CONCLUSION: The importance of doctoral studies in the formation of general surgery is due to various reasons; the main one being comprehensively training physician scientists who can develop in clinical, teaching and research.

Aportes de kent a la filosofía homeopática / Contributions of kent to the homeopathic philosophy

Se estudiaron algunos de los parágrafos del Organon del Arte de Curar 5ª edición, escrito por Samuel Hahnemann, que son comentados y explicados por James Tyler Kent en su libro Filosofía Homeopática. Claramente, Kent agrega a los postulados de Hahnemann conceptos e interpretaciones propias. La finalidad es identificar y separar las ideas provenientes de Kent, de aquellas originales del descubridor de la homeopatía. Se evidencia que la orientación e interpretación dada por Kent a muchos de sus conceptos sobre homeopatía, provienen de sus conocimientos basados en las enseñanzas de Emmanuel Swedenborg, filósofo sueco. Se concluye que, aunque el aporte de Kent a la homeopatía es indudablemente valioso, y sus obras deben ser estudiadas con mucha atención, es muy importante, en nuestra misión como escuela, fijar con toda claridad los límites entre lo que nos dejó Hahnemann y lo que le agrega Kent a la homeopatía, para evitar comprensiones erróneas del legado del sabio de Meissen.

El inicio de la formación de doctores en ciencias en Santiago de Cuba: una experiencia singular / The beginning of training of doctors in sciences in Santiago de Cuba: a singular experience

A partir de la fundación de las escuelas de Medicina y Estomatología en 1962 y 1963, respectivamente, que fueran parte de la Facultad de Ciencias Médicas de la Universidad de Oriente, se inició en fecha temprana, además de la docencia de pregrado, la investigación científica en varios campos, tanto en las ciencias básicas como en las clínicas. El presente trabajo tuvo como propósito resaltar la experiencia singular del inicio de la formación de doctores en ciencias en Santiago de Cuba. Desde el año 1972 se logró implementar un plan de formación de los cuadros científicos y un programa de investigaciones, conducentes al grado científico de doctorado en la Facultad de Ciencias Médicas de Santiago de Cuba, con el apoyo de las facultades de ciencias respectivas de la Universidad de Oriente y la tutoría de varios asesores soviéticos en distintas ramas biomédicas(AU)

Since the foundation of the Medicine School and the Estomatology School in 1962 and 1963, respectively, integrating the Faculty of Medical Sciences at Oriente University, began early in date, besides the pre-degree teaching, the scientific investigation in several fields in the basic sciences as in the clinical ones. The present work was aimed at highlighting the singular experience of the beginning of training of doctors in sciences in Santiago de Cuba. Since the year 1972, it was possible to implement a professors' training plan, for scientific chairs and an investigation program conducive to the scientific degree of doctorate in the Faculty of Medical Sciences in Santiago de Cuba, having the support of the respective sciences faculties of Oriente University and the tutorship of several Soviet advisers in different biomedical branches(AU)

Influencia de la guía incisiva en personas con trastornos temporomandibulares Área Norte de Sancti Spíritus / Influence of incisive guide in temporalmandible problems Northern Area Sancti Spiritus

Fundamento: Los trastornos temporomandibulares constituyen un problema de salud mundial, su origen es multifactorial, estos pueden ser influenciados por factores como la guía incisiva, que puede determinar de una forma u otra el grado de severidad de estos trastornos. Objetivo: Describir la influencia de la guía incisiva en la aparición de los trastornos temporomandibulares. Metodología: Se realizó un estudio transversal con un diseño no experimental, a los pacientes de 15 a 59 años del área Norte de Sancti Spíritus que acudieron al servicio de Prótesis dental en la Clínica Estomatológica Docente Provincial en el período comprendido de enero 2012 a enero 2013. Se utilizaron métodos empíricos de análisis de documentos, observación, entrevista y medición; métodos estadísticos, test de Chi-cuadrado y matemáticos, análisis porcentual. Resultados: El sexo femenino fue el más afectado en 68,3 %, el rango de edad con mayor cantidad de pacientes afectados fue entre 24-32 años con un 36,6 %. Los niveles de disfunción moderado y leve fueron los de mayor frecuencia con un 43,9 % y 36,6 % respectivamente, el síntoma que predominó fue el ruido articular (78,0 %), seguido del dolor muscular (73,2 %). En los pacientes donde no hay resalte o lo tienen aumentado fue donde predominó la disfunción, al igual que los que tienen sobrepase aumentado. Conclusiones: Existe relación significativa entre la guía incisiva y los grados de trastornos temporomandibulares.

Background: Temporalmandible problems constitute a world health problem, they have multifactorial etiologies that can be influenced by factors such as incisive guide that can determine the degree of severity of these problems Objective: To describe the influence of incisive guide in the appearance of temporalmandible problems. Methodology: A transversal non experimental study was done with patients from 15 to 59 years, belonging to the northern area in Sancti Spiritus that went to the dental prostheses service in the Dental provincial Clinic form January 2012 to January 2013. Empirical methods: observation, surveys and measures, statistical methods: Chi square test and mathematical methods: perceptual analysis was used. Results: females were more affected, representing 68,3 %, the most affected range was from 24 to 32 years with 36,6 %. Moderate and slight levels of dysfunction were the most frequent with 43,9 % and 36,6 %, respectively, the most predominant symptom was articular noise with 78,0 %, followed by muscular pain with 73,2 %. Dysfunction was predominant in patients with non resaltation or increase as well as in patients with increased overpass. Conclusion: There is significant relationship between incisive guide and the degrees of temporalmandible problems.