Prevalencia de signos y síntomas de trastornos temporomandibulares en pacientes preortodóncicos / Prevalence of signs and symptoms of temporomandibular disorders in pre orthodontic patients

En el presente trabajo se realizó un estudio observacional, descriptivo, en pacientes de la Diplomatura Universitaria en Ortodoncia desarrollada en la Sociedad Odontológica de La Plata, provincia de Buenos Aires, Argentina, durante los años 2020-2022. El objetivo fue conocer y evaluar la prevalencia de trastornos temporomandibulares (TTM) entre los pacientes atendidos. Los signos y síntomas evaluados fueron dolor miofacial, presencia de ruidos articulares y medición de apertura máxima bucal. El 32,6 % de los pacientes presentaron signos y síntomas de TTM, el 17,4 % de la población estudiada manifestó dolor, el 21,7 % presentó ruidos articulares, el 6,52 % dolor y ruidos articulares, y la media de la apertura bucal máxima fue de 44,8 milímetros (mm).

In the present work an observational study was carried out in patients of the University Diploma in Orthodontics developed in The Dental Society of La Plata, Buenos Aires, Argentina, during the period 2020-2022. The objective of this work was to know and evaluate the prevalence of Temporomandibular Disorders (TMD) among the attended patients. The signs and symptoms evaluated were myofacial pain, presence of joint sounds, measurement of mouth opening. 32.6% of the patients presented signs and symptoms of TMD, 17.4% manifested pain, 21.7% presented articular noises, 6.52% presented pain and articular noises. Mean maximum mouth opening was 44.8 millimeters.

Factores de riesgo del cáncer de piel en el Área de Salud Delicias

Fundamento: el cáncer de piel tiene gran incidencia, con tendencia ascendente a nivel mundial. Estos carcinomas son prevenibles, tanto por cambios en los estilos de vida como por la detección de lesiones indicativas de transformación maligna. Objetivo: determinar los factores de riesgo del cáncer de piel en la población del consultorio número 4 del Área de Salud Delicias. Método: se realizó un estudio epidemiológico, observacional, analítico de casos y controles en el período 2017-2021. La población de estudio estuvo constituida por 13 pacientes (grupo de casos) y 26 pacientes (grupo control), para un total de 39 casos incluidos, todos mayores de 15 años. Se estudiaron las variables: edad, sexo, color de piel, ocupación, hora de exposición al sol, medio de protección, contacto con sustancias químicas. La información se obtuvo de las historias clínicas y un cuestionario, se analizó a través del cálculo porcentual, el Ji2 y el odd ratio. Resultados: predominaron los participantes mayores de 55 años (38,5 %), del sexo masculino (69,2 %). Tuvieron más riesgo de cáncer de piel: los de color de piel blanca (Ji2: 3,3; OR: 6,4; p<0,05), ocupación con exposición al sol (Ji2: 4,4; OR: 5,5 p<0,05), más de 3 años en la ocupación (Ji2: 3,3; OR: 6,4; p<0,05), expuestos después de las 11 a.m. (Ji2: 3,3; OR: 3,6 p<0,05), sin uso de medios de protección (Ji2: 7,8; OR: 14; p<0,05), contacto con productos químicos (Ji2: 7,4; OR: 8,8; p<0,05) y antecedentes familiares de cáncer (Ji2: 2,6; OR: 3; p<0,05). Conclusiones: predominaron los mayores de 55 años y los hombres, se demostró asociación estadística y causal entre el cáncer de piel y los factores de riesgo estudiados.

Background: skin cancer has a high incidence, with an upward trend worldwide. These carcinomas are preventable both by lifestyle changes and by detecting lesions indicative of malignant transformation. Objective: to determine the risk factors for skin cancer in the population of office number 4 of the Delicias Health Area. Method: an epidemiological, observational, analytical study of cases and controls was carried out in the period 2017-2021. The study population consisted of 13 patients (case group) and 26 patients (control group), for a total of 39 cases included, all over 15 years of age. The variables were studied: age, sex, skin color, occupation, time of exposure to the sun, means of protection, contact with chemical substances. The information was obtained from the medical records and a questionnaire, it was analyzed through the percentage calculation, the Chi2 and the odd ratio. Results: participants older than 55 years (38.5 %), male sex (69.2 %) predominated. They had a higher risk of skin cancer: those with white skin color (Chi2: 3.3; OR: 6.4; p<0.05), occupation with sun exposure (Chi2: 4.4; OR: 5, 5 p<0.05), more than 3 years in the occupation (Chi2: 3.3; OR: 6.4; p<0.05), exposed after 11 a.m. (Chi2: 3.3; OR: 3.6 p<0.05), without use of protective means (Chi2: 7.8; OR: 14; p<0.05), contact with chemical products (Chi2: 7.4; OR: 8.8; p<0.05) and a family history of cancer (Chi2: 2.6; OR: 3; p<0.05). Conclusions: those over 55 years of age and men predominated, a statistical and causal association was demonstrated between skin cancer and the risk factors studied.

[Monkeypox and exudative pharyngitis in Argentina]. / Viruela símica y faringitis exudativa en Argentina.

Since May 2022, monkeypox cases have been reported in non-endemic countries with different characteristics from the traditional description of the disease, predominantly in men who have sex with men, with possible sexual transmission and with no documentation of mortality to date. We report what would be the first patient diagnosed in Argentina with no travel nexus to countries with viral circulation. Young, bisexual man, on antiretroviral HIV pre-exposure prophylaxis, whose presentation was exudative pharyngitis with no other documented aetiology and lymphadenopathy that progressed to necrosis, presence of characteristic asynchronous lesions on the face, neck, abdomen, extremities, and genitals, in a total of no more than 25. Polymerase-chain-reaction assay of samples from skin lesions, fauces exudate and semen were positive for monkeypox. Pharyngeal involvement with the presence of exudate after ruling out other infections could be a rarity for the epidemic form of the disease. The finding of the virus in semen, already reported in other publications, is still not enough to confirm the sexual route as a form of transmission. In conclusion: Our case warns about other possible forms of presentation of epidemic monkeypox and the need to increase the level of suspicion for its early detection as a strategy to prevent dissemination and protect vulnerable groups. Even more information is required to determine the sexual transmission of this disease.

Desde mayo de 2022 se han notificado casos de viruela símica en países no endémicos con características diferentes a la descripción tradicional de la enfermedad, predominio en población de hombres que tienen sexo con hombres, posible transmisión sexual y ausencia de mortalidad a la fecha. Reportamos el que sería el primero diagnosticado en Argentina sin nexo de viaje a países con circulación viral. Se trata de un hombre joven, bisexual, en profilaxis antirretroviral de pre-exposición al HIV, cuya forma de presentación fue faringitis exudativa sin otra etiología documentada y adenopatías que evolucionaron a la necrosis, presencia de lesiones asincrónicas características en cara, cuello, abdomen, extremidades y genitales. El diagnóstico fue por detección de ADN viral por reacción en cadena de la polimerasa en lesiones de piel, exudado de fauces y semen. El compromiso faríngeo con presencia de exudado luego del descarte de otras infecciones, podría ser una rareza para la forma epidémica de la enfermedad. El hallazgo del virus en semen ya reportado en otras publicaciones no es suficiente aún para confirmar la vía sexual como forma de trasmisión. En conclusión, nuestro caso alerta sobre otras posibles formas de presentación de la viruela símica epidémica y la necesidad de aumentar el nivel de sospecha para su detección precoz, como estrategia para evitar la diseminación y proteger a grupos vulnerables. Se requiere aún más información para determinar la transmisión sexual de esta enfermedad.

Viruela símica y faringitis exudativa en Argentina / Monkeypox and exudative pharyngitis in Argentina

Resumen Desde mayo de 2022 se han notificado casos de viruela símica en países no endémicos con características diferentes a la descripción tradicional de la enfermedad, predominio en población de hombres que tienen sexo con hombres, posible transmisión sexual y ausencia de mortalidad a la fecha. Reporta mos el que sería el primero diagnosticado en Argentina sin nexo de viaje a países con circulación viral. Se trata de un hombre joven, bisexual, en profilaxis antirretroviral de pre-exposición al HIV, cuya forma de presentación fue faringitis exudativa sin otra etiología documentada y adenopatías que evolucionaron a la necrosis, presencia de lesiones asincrónicas características en cara, cuello, abdomen, extremidades y genitales. El diagnóstico fue por detección de ADN viral por reacción en cadena de la polimerasa en lesiones de piel, exudado de fauces y semen. El compromiso faríngeo con presencia de exudado luego del descarte de otras infecciones, podría ser una rareza para la forma epidémica de la enfermedad. El hallazgo del virus en semen ya reportado en otras publica ciones no es suficiente aún para confirmar la vía sexual como forma de trasmisión. En conclusión, nuestro caso alerta sobre otras posibles formas de presentación de la viruela símica epidémica y la necesidad de aumentar el nivel de sospecha para su detección precoz, como estrategia para evitar la diseminación y proteger a grupos vulnerables. Se requiere aún más información para determinar la transmisión sexual de esta enfermedad.

Abstract Since May 2022, monkeypox cases have been reported in non-endemic countries with different charac teristics from the traditional description of the disease, predominantly in men who have sex with men, with possible sexual transmission and with no documentation of mortality to date. We report what would be the first patient diag nosed in Argentina with no travel nexus to countries with viral circulation. Young, bisexual man, on antiretroviral HIV pre-exposure prophylaxis, whose presentation was exudative pharyngitis with no other documented aetiology and lymphadenopathy that progressed to necrosis, presence of characteristic asynchronous lesions on the face, neck, abdomen, extremities, and genitals, in a total of no more than 25. Polymerase-chain-reaction assay of samples from skin lesions, fauces exudate and semen were positive for monkeypox. Pharyngeal involvement with the presence of exudate after ruling out other infections could be a rarity for the epidemic form of the disease. The finding of the virus in semen, already reported in other publications, is still not enough to confirm the sexual route as a form of transmission. In conclusion: Our case warns about other possible forms of presentation of epidemic monkeypox and the need to increase the level of suspicion for its early detection as a strategy to prevent dissemination and protect vulnerable groups. Even more information is required to determine the sexual transmission of this disease.

Live Birth Rate Following Bed Rest Versus Early Mobilization After Embryo Transfer: A Systematic Review And Meta-Analysis.

Embryo transfer (ET) is the final step of in vitro fertilization (IVF). Different strategies have been proposed to increase the likelihood of implantation, such as post-transfer bed rest. The objective of this manuscript was to compare the clinical outcomes of embryo transfers after IVF of patients offered rest vs. early ambulation. The patient, intervention, comparison, and outcome(s) (PICO) model was used to select the study population, which included women/couples submitted to IVF and prescribed bed rest or early ambulation. Only studies including live birth (LB) as an outcome were included (www.crd.york.ac.uk/PROSPERO/CRD42020188716) A systematic search for studies was conducted on MEDLINE, ClinicalTrials.gov, PubMed, and the Cochrane Library. A librarian coordinated the searches in May 2020, which considered articles published since 1995. All original peer-reviewed articles in English were included, regardless of study design. The search retrieved 27 citations, of which 14 were eligible for full-text analysis and four accepted for inclusion. The studies included data on 21,598 patients/cycles (rest: 20,138; early ambulation: 1,460). Patients prescribed bed rest had an LB rate of 43.6% vs. 52.5% in the individuals not offered bed rest. The meta-analysis yielded an odds ratio of 0.77 (95% CI 0.5-1.2), which means patients on bed rest were 23% less likely to have a LB; nevertheless, this difference was not statistically significant. Considering that there is no difference between the two strategies, there is no evidence to recommend bed rest after embryo transfer.

Association of ovarian stimulation and embryonic aneuploidy in in vitro fertilization cycles with preimplantation genetic testing: A narrative systematic review.

The impact of gonadotropins used for COS on the rate of embryo aneuploidy in patients without the negative effects of age as a confounding factor, is still a subject of lively debate. We ran a systematic search for studies in MEDLINE, PubMed, Google Scholar and the Cochrane Library. A librarian coordinated the search in December of 2020. We included all original peer-reviewed papers in English, irrespective of study-design. There were no restrictions concerning method of amplification or platform used to analyze the amplified DNA. We used the PICO model to select the study population. We included women/couples submitted to COS for IVF with the intention to genetically analyze her/their embryos through PGT. The primary outcome was the rate of aneuploidy. We used the Newcastle-Ottawa scale (NOS) score to evaluate the quality of the studies included. The search yielded 73 citations, and 14 were eligible for analysis, which included data on 4805 cycles. Media quality NOS score was 8. Although it has been demonstrated that natural cycles are associated with aneuploidy, it does seem that more robust stimulations are indeed associated with a higher proportion of aneuploidy. Nevertheless, a higher response is associated with an increased number of euploid embryos available for transfer, which translates into more embryo-transfer cycles with a prospective higher cumulative live birth rate. Further evidence is needed to ascertain if there is a negative impact of COS, especially at the cellular level.

Validez por juicio de expertos de un instrumento audiovisual de consistencias de alimentos y viscosidad de líquidos (NutriDis®) adaptados para personas con disfagia / Validity by experts judgment of an audiovisual tool of food textures and thickness of liquids (NutriDis®) adapted for people with dysphagia

Resumen Introducción: las dificultades en la comprensión de las indicaciones sobre las dietas de textura modificada según la severidad de la disfagia por parte de pacientes y sus cuidadores, influyen negativamente en la adherencia y aumentan la morbimortalidad de los pacientes. La explicación escrita o verbal, no sería suficiente requiriendo recursos adicionales basados en imágenes y/o la realización de demostraciones prácticas. Por lo mencionado, se diseñó el instrumento audiovisual NutriDis®. Objetivos: determinar la validez aparente, de contenido y la factibilidad de un instrumento audiovisual basado en los descriptores de la "International Dysphagia Diet Standardisation Initiative" (IDDSI). Materiales y método: se utilizó la técnica Delphi por juicio de expertos, incluyendo a nutricionistas, kinesiólogos y fonoaudiólogos. En la primera ronda participaron 19 expertos y 9 en la segunda. Se determinó el grado de acuerdo entre éstos, a través del coeficiente V de Aiken para cada nivel de IDDSI y a nivel global. Resultados: el instrumento resultó presentar validez de contenido y el grado de acuerdo global aumentó entre la primera y la segunda ronda desde 90,8 a 94,1%, clasificándose como adecuado. El nivel IDDSI 4 presentó el máximo acuerdo e IDDSI 1 el menor. Conclusiones: según la opinión de expertos en el área, la herramienta audiovisual NutriDis®, presentó una validez de contenido adecuada en promedio y calificado globalmente como excelente por la mayoría. Se destaca que el instrumento es inédito, representando un gran desafío su desarrollo.

Abstract Introduction: patients and caregivers find it difficult to understand the indications of modified texture diets following dysphagia severity, and this negatively influences adherence and increases patient morbidity and mortality. The written or verbal explanation would not be enough, and additional resources based on images and / or the realization of practical demonstrations are required. As a result, the NutriDis® audiovisual tool was designed. Objectives: to determine the apparent and content validity and feasibility of an audiovisual tool based on the descriptors of the "International Dysphagia Diet Standardization Initiative" (IDDSI). Materials and method: the Delphi technique was used following experts judgment, including nutritionists, speech therapists and kinesiologists. 19 experts participated in the first round and 9 in the second. The degree of agreement among them was determined through Aiken's V coefficient for each level of IDDSI and also at global level. Results: the tool turned out to be valid and the degree of global agreement increased between the first and second rounds from 90, 8 % to 94,1%, classifying as adequate. Level IDDSI 4 presented the highest agreement and IDDSI 1 the lowest. Conclusions: according to the opinion of experts in the area, the NutriDis® audiovisual tool presented an adequate content validity on average and was globally rated as excellent by the majority. It is highlighted that the tool is unprecedented and its development represented a great challenge.

Ruxolitinib in severe COVID-19: Results of a multicenter, prospective, single arm, open-label clinical study to investigate the efficacy and safety of ruxolitinib in patients with COVID-19 and severe acute respiratory syndrome

Introduction: COVID-19 morbimortality is mainly associated with development of severe acute respiratory syndrome (SARS), which has been related to an augmented immune response of the host with elevated circulating cytokines. Methods: In this prospective, multicenter, single arm (compared with a historical control), add-on, experimental phase 2 study, ruxolitinib 5 mg BID was added to standard of care in COVID-19 patients. Main objective was to determine efficacy and safety of ruxolitinib in patients with COVID-19-related SARS. Results: Even though we could not show a significant reduction of COVID-19 pneumonia patients requiring intensive care unit admission and mechanical ventilation (primary endpoint), a trend to a lower mortality rate in critical ill patients receiving ruxolitinib was reported. Administered ruxolitinib dose had to be increased according to protocol in 32% of patients, without additional toxicity. Conclusion: Side effects profile was manageable, and no direct organ injury was caused by the study drug. Ruxolitinib had a fast anti-inflammatory effect, and one-third of patients felt well immediately after starting treatment.

Introducción: La morbimortalidad por COVID-19 se asocia principalmente con el síndrome respiratorio agudo severo (SARS), relacionado con una respuesta inmunitaria aumentada del huésped con aumento de los niveles circulantes de citoquinas. Métodos: En este estudio prospectivo, multicéntrico, de un solo brazo (en comparación con un control histórico), en fase 2, se agregó ruxolitinib 5 mg dos veces al día al estándar de tratamiento en pacientes con COVID-19. El objetivo principal fue determinar la eficacia y seguridad de ruxolitinib en pacientes con SARS relacionado con COVID-19. Resultados: aunque no fue posible demostrar una reducción significativa de la proporción de pacientes con neumonía por COVID-19 que requerían ingreso en la unidad de cuidados intensivos y ventilación mecánica (criterio de valoración principal), se observó una tendencia a una menor tasa de mortalidad en los pacientes críticos que recibieron ruxolitinib. La dosis de ruxolitinib administrada tuvo que aumentarse de acuerdo con el protocolo en el 32% de los pacientes, sin toxicidad adicional. Conclusión: El perfil de efectos secundarios fue manejable y el fármaco en estudio no causó lesiones orgánicas directas. El ruxolitinib tuvo un efecto antiinflamatorio rápido y un tercio de los pacientes manifestó bienestar inmediatamente después de comenzar el tratamiento.

Cognitive Behavioral Approach to Treat Obesity: A Randomized Clinical Trial.

Our aim was to analyze and compare the effects of three different long-term treatments on anthropometric profiles, eating behaviors, anxiety and depression levels, and quality of life of groups of adults with obesity. Methods: The 43 participants in the study were randomly assigned to one of three groups: the education and health group (EH, n = 12), which received lectures on health topics; the physical exercise group (PE, n = 13), which underwent physical training; and the interdisciplinary therapy plus cognitive behavioral therapy (IT + CBT) (n = 18) group, which received physical training, nutritional advice, and physical and psychological therapy. Results: Total quality of life increased significantly in the EH group (△ = 2.00); in the PE group, body weight significantly decreased (△ = -1.42) and the physical domain of quality of life improved (△ = 1.05). However, the most significant changes were seen in the IT + CBT group, in which the anthropometric profile improved; there were an increase in quality of life in all domains (physical, psychological, social, and environmental), an improvement in eating behaviors [Dutch Eating Behavior Questionnaire (DEBQ), total △ = -8.39], and a reduction in depression [Beck Depression Inventory (BDI), △ = -10.13). Conclusion: The IT + CBT program was more effective than the PE and EH programs. Clinical Trial Registration Number: NCT02573688.

Effects of functional training and 2 interdisciplinary interventions on maximal oxygen uptake and weight loss of women with obesity: a randomized clinical trial.

Our aim was to analyze and compare functional training, interdisciplinary therapy, and interdisciplinary education on cardiorespiratory fitness (CF) and anthropometric characteristics of women with obesity. Forty-four women (age = 39.7 ± 5.9 years, body mass index (BMI) = 35.5 ± 2.8 kg/m2) completed 30 weeks of intervention randomly assigned to 3 groups: functional training (FT) (n = 14), interdisciplinary therapy (IT) (n = 19), and interdisciplinary education (IE) (n = 11). The FT group participated in the training program (3/week), the IT group received the same training intervention plus nutrition (1/week) and psychology advice (1/week) and physical therapy (1/week). The IE group participated in interdisciplinary lectures on topics related to health promotion (1/month). CF (ergospirometry), anthropometry, and body composition (electrical bioimpedance) were measured pre-intervention (Pre) and post-intervention (Post). CF increased (p ≤ 0.05) significantly (Pre vs. Post) in the FT (7.5%) and IT (10.8%) groups, but not in the IE group (1.8%). Body mass (BM), BMI, relative fat mass, and waist circumference significantly (p ≤ 0.05) decreased (Pre vs. Post) in IT (-4.4%, -4.4%, -2.3%, and -5.1%, respectively). The IE group showed a significant decrease in BM (-3.7%), BMI (-3.7%), and waist circumference (-3.5%), whereas the FT group promoted significant decrease in waist circumference (-3.4%). In conclusion, functional training increased CF but only interdisciplinary interventions improved the anthropometric profile of women with obesity. Novelty Interdisciplinary therapy provided more comprehensive adaptations in women with obesity, including morphological variables and CF. Functional training increased CF but reduced only abdominal obesity. Interdisciplinary education provided benefits on morphological variables, but it does not increase CF.

Aportaciones de la Psicología a la comunicación en el ámbito sanitario

Este trabajo tiene como objetivo central, analizar el contexto de la comunicación interpersonal en la relación profesional sanitario-enfermo desde el ámbito de la Intervención Psicológica. Parece imprescindible incorporar a las áreas clínicas-asistenciales la formación necesaria en Técnicas y Protocolos sobre cómo informar y comunicarse con los pacientes en situaciones clínicas cotidianas, y en particular en la transmisión de malas noticias en temas generales de salud, y, específicamente en Servicios hospitalarios como los de Urgencias y Oncología. La formación en técnicas de Counseling es vital para estos profesionales que deberán paliar y potenciar las reacciones psicológicas e interpersonales que se suceden en la relación sanitario-enfermo, de ahí que se haga imprescindible la formación en los contextos universitarios para que los futuros profesionales tenga la capacidad de potenciar habilidades comunicativas que produzcan mayor bienestar personal y social, incrementando el grado de eficacia y eficiencia del Sistema Sanitario

The main objective of this work is to analyze the context of interpersonal communication in the healthcare professional-sick professional relationship from the field of Psychological Intervention. It seems essential to incorporate into the clinical-care areas the necessary training in Techniques and Protocols on how to inform and communicate with patients in everyday clinical situations, and in particular in the transmission of bad news in general health issues, and specifically in Hospital Services such as the Emergency and Oncology. The training in Counseling techniques is vital for these professionals who will have to alleviate and strengthen the psychological and interpersonal reactions that take place in the health-sick relationship, hence the need for training in university contexts so that future professionals have the ability to enhance communication skills that produce greater personal and social well-being, increasing the efficiency and effectiveness of the Health System

Manifestaciones mucocutáneas de intoxicación por metotrexato / 4pp Mucocutaneous manifestations of methotrexate toxicity

El metotrexato es un antimetabolito análogo al ácido fólico que inhibe competitivamente la enzima dihidrofolato reductasa y timidilato sintetasa, indispensables para la síntesis de ADN y ARN. Se utiliza ampliamente en dermatología y sus efectos adversos en la piel y mucosas son variados, incluyendo reacciones leves y graves. Las erosiones y úlceras cutáneas como manifestación de citotoxicidad por metotrexato son infrecuentes y representarían un signo cutáneo temprano de pancitopenia por toxicidad medular secundaria a dicha droga. En la mayoría de los casos existen enfermedades cutáneas previas a la ulceración, principalmente psoriasis. En ausencia de dermatitis subyacente, la presencia de ulceraciones es excepcional. Se presentan ocho casos de pacientes con signos cutáneos de intoxicación por metotrexato, con y sin dermatosis previas. En la mayoría hubo asociación de mucositis y compromiso medular. Se recomiendan pautas de tratamiento.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.

[4pp Mucocutaneous manifestations of methotrexate toxicity]. / Manifestaciones mucocutáneas de intoxicación por metotrexato.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.

Intervención neuropsicológica en un caso de retardo mental asociado a síndrome de Down / Neuropsychological Rehabilitation on mental retardation associated with Down's syndrome

Dentro de la población afectada de retraso mental, el síndrome de Down (SD) constituyen uno de los grupos más estudiados y es una de las causas genéticas más comunes, ocurriendo con gran frecuencia. Esta condición es el resultado de una anormalidad de los cromosomas, esta desviación en el desarrollo de las células resulta en la producción de 47 cromosomas en lugar de 46 que se consideran normales. El cromosoma adicional cambia totalmente el desarrollo ordenado del cuerpo y cerebro, produciendo alteraciones evidentes tanto físicas como cognitivas que afectan la capacidad adaptativa. El objetivo de este artículo es presentar el caso de una paciente con SD y mostrar los resultados de la aplicación de un programa de intervención neuropsicológica centrado en el fortalecimiento del factor primario, como eje para facilitar el funcionamiento sistémico. Se presenta la valoración previa a la intervención, el contenido del programa de intervención con los ejemplos de ejecuciones de la paciente, una valoración posterior y un análisis comparativo. La discusión se centra en la importancia de la identificación del mecanismo neurofisiológico primario que desorganiza la actividad, como eje fundamental para lograr efectos positivos en actividades de tipo voluntario mediante el lenguaje como regulador...

Within the affected population in mental retardation, Down syndrome (DS) is one of the most studied and is one of the most common genetic causes, occurring with great frequency. This condition is the result of an abnormality of chromosomes, a deviation in the development of cells results in production of 47 chromosomes instead of 46 which are considered normal. The extra chromosome changes the orderly development of the body and brain, causing both physical and obvious alterations that affect cognitive adaptive capacity. The aim of this paper is to present the case of a patient with SD and display the results of the application of a neuropsychological intervention program focused on strengthening the primary factor, as an axis to facilitate systemic functioning. It comes pre assessment, the content of the intervention program with examples of executions of the patient, after a review and comparative analysis. The discussion focuses on the importance of identifying the primary neurophysiological mechanism that disrupts the activity, as the linchpin for achieving positive effects on activities of a volunteer through language as a regulator...

Pseudomonas guariconensis sp. nov., isolated from rhizospheric soil.

We isolated a bacterial strain designated PCAVU11(T) in the course of a study of phosphate-solubilizing bacteria occurring in rhizospheric soil of Vigna unguiculata (L.) Walp. in Guárico state, Venezuela. The 16S rRNA gene sequence had 99.2 % sequence similarity with respect to the most closely related species, Pseudomonas taiwanensis, and 99.1 % with respect to Pseudomonas entomophila, Pseudomonas plecoglossicida and Pseudomonas monteilii, on the basis of which PCAVU11(T) was classified as representing a member of the genus Pseudomonas. Analysis of the housekeeping genes rpoB, rpoD and gyrB confirmed the phylogenetic affiliation and showed sequence similarities lower than 95 % in all cases with respect to the above-mentioned closest relatives. Strain PCAVU11(T) showed two polar flagella. The respiratory quinone was Q9. The major fatty acids were 16 : 0 (25.7 %), 18 : 1ω7c (20.4 %), 17 : 0 cyclo (11.5 %) and 16 : 1ω7c/15 : 0 iso 2-OH in summed feature 3 (10.8 %). The strain was oxidase-, catalase- and urease-positive, the arginine dihydrolase system was present but nitrate reduction, ß-galactosidase production and aesculin hydrolysis were negative. Strain PCAVU11(T) grew at 44 °C and at pH 10. The DNA G+C content was 61.5 mol%. DNA-DNA hybridization results showed values lower than 56 % relatedness with respect to the type strains of the four most closely related species. Therefore, the results of genotypic, phenotypic and chemotaxonomic analyses support the classification of strain PCAVU11(T) as representing a novel species of the genus Pseudomonas, which we propose to name Pseudomonas guariconensis sp. nov. The type strain is PCAVU11(T) ( = LMG 27394(T) = CECT 8262(T)).

Caracterización neuropsicológica en niños con diagnóstico de trastorno específico de aprendizaje en Cali, Colombia / Neuropsychological characteristics of children with specific learning disorders from Cali, Colombia

El objetivo de este estudio fue comparar las funciones cognitivas en niños con antecedente de Trastorno Específico de Aprendizaje (TEA) en colegios privados de la ciudad de Cali, Colombia con un grupo control (GC). La muestra estuvo conformada por 37 sujetos con TEA y 28 sujetos en el grupo control (GC), de estrato socioeconómico medio-alto. La edad promedio fue de 9 años y la escolaridad de 4°. Los instrumentos utilizados para selección de los grupos fueron el Cuestionario de problemas de aprendizaje CEPA, subescalas de la Mini entrevista neuropsiquiátrica internacional para niños y adolescentes (M.I.N.I.- N-A), la Escala de inteligencia de Wechsler para niños WISC-R y subescalas de lectura, escritura y aritmética de la Batería de Evaluación Neuropsicológica Infantil (ENI). Las funciones Cognitivas, fueron evaluadas con subescalas de la ENI. Los resultados muestran diferencias estadísticamente significativas (p≤0.05) entre las medianas de funciones cognitivas de atención, memoria (codificación y evocación), comprensión del lenguaje, habilidades construccionales, espaciales y funciones ejecutivas. En conclusión, los niños con TEA presentan alteraciones neuropsicológicas subyacentes, que interfieren en el desempeño de tareas escolares. Convencionalmente se hacen intervenciones en lectura, escritura y cálculo, y no en sus prerrequisitos, por tanto, los resultados sugieren que se debe orientar la intervención a la estimulación de los procesos cognitivos comprometidos y no al síntoma específico.

The objective of this study was to compare the cognitive functions of children with a background of Specific Learning Disorder (SLD) with a control group (CG) in private schools in the city of Cali, Colombia. The sample consisted of 37 subjects with SLD and 28 subjects in the control group (CG), from medium-high socioeconomic status. The mean age was 9 years old, and the average level of education was 4th grade. The instruments used for selecting the groups were the Learning Difficulties Questionnaire (CEPA), subscales of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), Wechsler Intelligence Scale for Children WISC-R, and subscales of reading, writing and arithmetic of the Batería de Evaluación Neuropsicológica Infantil (ENI) [Child neuropsychological assessment battery]. Cognitive functions were assessed with subscales of the ENI. The results show statistically significant differences (p ≤ 0.05) between the medians of cognitive functions of attention, memory (codification and evocation), language comprehension, constructional abilities, spatial and executive functions. In conclusion, children with SLD have underlying neuropsychological alterations that interfere with the performance of homework. Usually, interventions are made in reading, writing and arithmetic and not in their prerequisites, therefore, the results suggest that the intervention should be directed to the stimulation of cognitive processes involved and not the specific symptom.

Alteraciones cognoscitivas después de un trauma craneoencefálico / Cognitive impairment after traumatic brain injury / Alterações cognitivas após um traumatismo crânio-encefálico

Colombia carece de estudios sobre las características neuropsicológicas de personas que sufren un Trauma Craneoencefálico (TCE), a pesar de ser un problema de salud pública y la primera causa de incapacidad y muerte. Estudios previos han demostrado que el TCE genera alteraciones cognoscitivas en mayor medida en la atención y en la memoria, las cuales, a su vez, afectan la vida diaria de los pacientes. El objetivo de este estudio fue describir las funciones cognitivas que pueden verse afectadas como consecuencia de un TCE. Se evaluó un total de 30 pacientes, con edad promedio de 34 años y antecedentes de TCE de por lo menos seis meses de evolución; nueve de ellos presentaban un TCE leve; diez, una condición moderada, y once, una lesión cerebral severa; la escolaridad promedio era de nueve años, y no presentaban antecedentes neurológicos y/o psiquiátricos. Se aplicó la evaluación neuropsicológica breve en español (NEUROPSI), el Trail Making Test A y B (TMTA-TMTB), el Test de Clasificación de Tarjetas de Wisconsin (WCST), la Figura Compleja de Rey, el Test de Aprendizaje Audioverbal de Rey y el Stroop Test. Los resultados mostraron puntuaciones inferiores a la media en todas las pruebas y en los tres grupos de TCE, evidenciándose una disminución en los procesos de evocación de memoria verbal y visual, atención, lenguaje y funciones ejecutivas. En conclusión, el TCE afecta la mayoría de las funciones cognitivas, alterándolas de manera diferencial, y en algunos casos sin que ello esté relacionado con la severidad del TCE. Estos hallazgos son de gran importancia debido a las implicaciones que se presentan en el proceso de rehabilitación ofrecido a estos pacientes, el cual no sólo debe limitarse a la condición física.

Colombia lacks studies on the neuropsychological characteristics of people who suffer a traumatic brain injury (TBI), despite this being a public health problem and the leading cause of disability and death. Previous studies have shown that TBI generates further cognitive impairment in attention and memory, which, in turn, affect the daily lives of patients. The aim of this study was to describe the cognitive functions that may be affected as a result of TBI. A total of 30 patients, mean age 34 years and a history of TBI of at least 6 months duration participated in the study; 9 of them had mild head injury; 10 had a moderate condition and 11 had severe TBI; their average schooling was 9 years and they had no history of previous neurological and / or psychiatric problems. The brief neuropsychological assessment in Spanish (NEUROPSI) was carried out, along with the application of the Trail Making Test A and B (TMTA-TMTB), the Wisconsin Card Sorting Test (WCST), the Figura Compleja de Rey, the Test de Aprendizaje Audioverbal de Rey and the Stroop Test. Results showed below average scores in all tests and in the three groups of TBI, detecting a decrease in the processes of evocation of verbal and visual memory, attention, language and executive functions. In conclusion, TBI affects most cognitive functions, differentially altering them and in some cases without this being related to the severity of TBI. These findings are important due to their implications for the rehabilitation process offered to these patients which should not be limited to the physical condition.

Colômbia não tem realizado estudos sobre as características neuropsicológicas de pessoas que sofrem um traumatismo crânio-encefálico (TCE), apesar de ser um problema de saúde pública e principal causa de incapacidade e morte. Estudos anteriores demonstraram que o TCE gera mais comprometimento cognitivo de atenção e memória que, por sua vez, afeta a vida diária dos pacientes. O objetivo deste estudo foi descrever as funções cognitivas que podem ser afetados como resultado de TCE. Foram avaliados 30 pacientes de idade média 34 anos e uma história de TCE, pelo menos, de seis meses de evolução. Nove pacientes tinham um leve traumatismo craniano; dez apresentavam condição moderada; e onze sofriam lesão cerebral grave. A escolaridade média foi 9 anos, e não tinham história neurológica ou psiquiátrica. Aplicou-se avaliação neuropsicológica breve em espanhol (NEUROPSI), o Trail Making Test A e B (TMTA-TMTB), o Teste de Wisconsin Card Sorting (WCST), a Figura Complexa de Rey, o Teste de Aprendizagem Audioverbal de Rey e o Stroop Test. Os resultados mostraram pontuações abaixo da média em todos os testes e nos três grupos de TCE, mostrando uma diminuição nos processos de evocação de memória verbal e visual, atenção, linguagem e funções executivas. Em conclusão, o TCE afeta a maioria das funções cognitivas e as altera diferencialmente. Em alguns casos, sem relacionar-se com a gravidade do TCE. Essas descobertas são importantes porque influenciam no processo de reabilitação oferecido a esses pacientes, o que não deve ser limitado à condição física.

Efecto de un programa de intervención en atención para pacientes con trauma craneoencefálico moderado / Effect of an intervention program in patients with moderate traumatic brain injury

El trauma craneoencefálico [TCE] es la causa más frecuente de daño cerebral, cuyas secuelas a nivel cognitivo conllevan a alteraciones en la atención. El estudio tuvo como objetivo evaluar los efectos de un programa de intervención en la atención en pacientes con TCE Moderado. El programa se aplicó a 3 hombres con escolaridad promedio de 9 años, con una media de 31,6 años de edad y un Glasgow entre 9-12 puntos; sin antecedentes neurológicos o psiquiátricos. Se incluyeron paciente con una media de 100 en la Evaluación Neuropsicológica Breve en Español [Neuropsi]; que tenían fallas en tareas de atención, memoria y funciones motoras. Para la evaluación pre y post de la atención, se aplicó el test de clasificación de tarjetas del Wisconsin [WCST], el Trail Making Test A y B [TMTA-TMTB], Stroop Test [STROOP], y el Test de Cancelación de Letras [Letter CancelationTest]. Fue un estudio cuasi - experimental con un diseño Pre y Post para un sólo grupo; el efecto de la intervención fue evaluado por la diferencia entre las medidas Pre y Post. Se encontraron cambios estadísticamente significativos en el WCST en un paciente. Sin embargo, cualitativamente todos los pacientes mejoraron los tiempos de reacción e implementaron herramientas cognitivas como la planificación, la categorización y la clasificación.

Brain Trauma Injury [BTI], is the most common cause of brain injury which consequences, in a cognitive level, leads to attention disorders. The aim of this study is to evaluate the effect of a BTI intervention program in the attention of patients who have a moderated BTI. This program was applied to 3 men with an average of 9 years of education, with a media of 31, 6 years old, a Glasgow result between 9 to 12 points, and no neurological nor psychiatric antecedents. Also, the Brief Neuropsychological Test Battery [Neuropsi], was applied as a sift, in which, the patients obtained a media of 100, finding errors in the attention, memory and motor skills tasks. The instruments used to determine the pre and post evaluation in the attention function were: the Wisconsin Card Sorting Test [WCST], the Trail Making Test A and B [TMTA-TMTB], the Stroop task and the Letter Cancellation Test. This research was quasi-experimental with a design of only one group; the efficacy of the intervention was evaluated through the difference between the pre and post media, once the program was applied. After the intervention, there were found changes statistically significant in the WCST in just one patient. However, all patients improved their reaction time and carried out cognitive tools such as planning, categorization and classifying.

Effectiveness of protected areas in mitigating fire within their boundaries: case study of Chiapas, Mexico.

Since the severe 1982-1983 El Niño drought, recurrent burning has been reported inside tropical protected areas (TPAs). Despite the key role of fire in habitat degradation, little is known about the effectiveness of TPAs in mitigating fire incidence and burned areas. We used a GPS fire database (1995-2005) (n=3590 forest fires) obtained from the National Forest Commission to compare fire incidence (number of fires) and burned areas inside TPAs and their surrounding adjacent buffer areas in Southern Mexico (Chiapas). Burned areas inside parks ranged from 2% (Palenque) to 45% (Lagunas de Montebello) of a park's area, and the amount burned was influenced by two severe El Niño events (1998 and 2003). These two years together resulted in 67% and 46% of the total area burned in TPAs and buffers, respectively during the period under analysis. Larger burned areas in TPAs than in their buffers were exclusively related to the extent of natural habitats (flammable area excluding agrarian and pasture lands). Higher fuel loads together with access and extinction difficulties were likely behind this trend. A higher incidence of fire in TPAs than in their buffers was exclusively related to anthropogenic factors such as higher road densities and agrarian extensions. Our results suggest that TPAs are failing to mitigate fire impacts, with both fire incidence and total burned areas being significantly higher in the reserves than in adjacent buffer areas. Management plans should consider those factors that facilitate fires in TPAs: anthropogenic origin of fires, sensitivity of TPAs to El Niñio-droughts, large fuel loads and fuel continuity inside parks, and limited financial resources. Consideration of these factors favors lines of action such as alternatives to the use of fire (e.g., mucuna-maize system), climatic prediction to follow the evolution of El Niño, fuel management strategies that favor extinction practices, and the strengthening of local communities and ecotourism.

Repeated swim stress increases pain-induced expression of c-Fos in the rat lumbar cord.

We have previously demonstrated that repeated swim stress produces a long-lasting cutaneous hyperalgesia in rats. We have now looked at c-Fos expression in the spinal lumbar cord of male Sprague-Dawley rats subjected to 10-20 min daily sessions of forced swimming for 3 consecutive days. Control rats were subjected to sham swimming or were completely naive. Forty-eight hours later, nociception was assessed by recording for 90 min the nociceptive behavior evoked the injection of 1% formalin in the hind paw. Thirty min later, the rats' spinal cords were removed for c-Fos immunocytochemistry. Total pain scores were 45% higher in swim stressed rats compared to control animals due an increased nociceptive behavior during last 70 min of the recording period. In addition, the number of c-Fos-immunoreactive nuclei was 40% higher in the lumbar ipsilateral dorsal horn (L4-L5) of swim stressed rats than in controls, being the highest relative increase, relative to the control groups, observed in laminae III-IV, followed by laminae V-VI, with the smallest difference in laminae I-II. c-Fos expression in the contralateral dorsal horn was higher in swim stressed rats than in sham and nai;ve rats. In the absence of a nociceptive stimulus, a low level of c-Fos expression was observed mainly in laminae I, II, V, and VI, being higher in swim stressed rats than in sham rats. These findings suggest that repeated inescapable and uncontrollable stress could induce a sensitization and activation of sensory neurons at the spinal level.