Analysis of the airflow features and ventilation efficiency of an Ultra-Clean-Air operating theatre by qDNS simulations and experimental validation.

Ultra-Clean-Air (UCA) operating theatres aim to minimise surgical instrument contamination and wound infection through high flow rates of ultra-clean air, reducing the presence of Microbe Carrying Particles (MCPs). This study investigates the airflow patterns and ventilation characteristics of a UCA operating theatre (OT) under standard ventilation system operating conditions, considering both empty and partially occupied scenarios. Utilising a precise computational model, quasi-Direct Numerical Simulations (qDNS) were conducted to delineate flow velocity profiles, energy spectra, distributions of turbulent kinetic energy, energy dissipation rate, local Kolmogorov scales, and pressure-based coherent structures. These results were also complemented by a tracer gas decay analysis following ASHRAE standard guidelines. Simulations showed that contrary to the intended laminar regime, the OT's geometry inherently fosters a predominantly turbulent airflow, sustained until evacuation through the exhaust vents, and facilitating recirculation zones irrespective of occupancy level. Notably, the occupied scenario demonstrated superior ventilation efficiency, a phenomenon attributed to enhanced kinetic energy induced by the additional obstructions. The findings underscore the critical role of UCA-OT design in mitigating MCP dissemination, highlighting the potential to augment the design to optimise airflow across a broader theatre spectrum, thereby diminishing recirculation zones and consequently reducing the propensity for Surgical Site Infections (SSIs). The study advocates for design refinements to harness the turbulent dynamics beneficially, steering towards a safer surgical environment.

Asociación Linfoma-Tuberculosis ganglionar: Un reto diagnóstico y terapéutico

La tuberculosis, una enfermedad infectocontagiosa, de amplia distribución mundial constituye en una de las causas de morbi-mortalidad más frecuentes en países subdesarrollados. Por otra parte, el linfoma de Hodgkin, una neoplasia linfoide maligna, poco frecuente, tiende a tener un diagnóstico diferencial amplio, incluyendo la tuberculosis extrapulmonar. Se presenta el caso de un paciente masculino de 10 años, procedente de un área endémica para tuberculosis, con cuadro de un mes de evolución de aumento de volumen abdominal, asociado a fiebre vespertina y pérdida de peso, tratado inicialmente como cuadro gastroentérico, sin embargo, con múltiples estudios se logró documentar Tuberculosis ganglionar y Linfoma de Hodgkin clásico en su variante esclerosis nodular en estadio IV b, constituyéndose en un reto diagnóstico y terapéutico.   (provisto por Infomedic International)

Tuberculosis, an infectious disease with a wide global distribution, constitutes one of the most frequent causes of morbidity and mortality in underdeveloped countries. On the other hand, Hodgkin lymphoma, a rare lymphoid malignancy, tends to have a wide differential diagnosis, including extrapulmonary tuberculosis. We present the case of a 10-year-old male patient, from an endemic area for tuberculosis, with a one-month history of increased abdominal volume, associated with evening fever and weight loss, initially treated as gastroenteric symptoms, however , with multiple studies it was possible to document lymph node tuberculosis and classical Hodgkin lymphoma in its variant nodular sclerosis in stage IV b, constituting a diagnostic and therapeutic challenge. (provided by Infomedic International)

Reconstruction of a Distal Humeral Fracture with Articular Bone Loss Using Osteochondral Allograft: A Case Report.

CASE: A 31-year-old right-hand-dominant man sustained an open left distal humerus fracture resulting in a complete loss of the lateral column involving 30% of the articular surface and the lateral collateral ligament complex. Reconstructive surgery was conducted in 2 stages, beginning with articulated external elbow fixation followed by reconstruction with a fresh osteochondral allograft. Outcomes were satisfactory with no elbow pain or instability, and osseointegration was demonstrated in radiographs. CONCLUSION: The technique described in this report can be a viable option for treating young patients with a severe distal humerus fracture complicated and can provide favorable clinical and radiological outcomes.

Clay exfoliation method as a route to obtain mesoporous catalysts for CO2 methanation.

A unique method for obtaining a mesoporous catalytic support through the exfoliation of a montmorillonite is reported. This method consisted of the intercalation of Na-clay with Al-Keggin species and polyvinyl alcohol followed by microwave irradiation. The mesoporous support was employed to prepare Ni-catalysts which were used in the natural gas synthesis through CO2 methanation. The synthesis method was validated confirming the clay exfoliation and the main formation of mesopores. Also, the Ni-catalysts have mainly weak basic surface properties lower than 38 µmol.g-1, and containing Ni0 nanoparticles with sizes between 9 and 12 nm which were thermally stable after reduction and methanation reaction. The catalyst with 5% Ni wt. gave conversions between 50 and 80% with temperatures ranging from 200 to 300 °C and selectivities of 100% towards the formation of CH4 without coke formation. The (3 and 5% Ni) Ni-catalysts are stable up to 8 h at 400 °C in the methanation reaction maintaining 100% of selectivity.•Mesoporous catalytic supports are obtained through a unique clay exfoliation method (Al-keggin, PVA, and microwaves).•(3% and 5% wt.) Ni-mesoporous catalysts are thermally stable and Ni0 nanoparticles between 9 and 12 nm are achieved.•5%wt. Ni-catalyst have no deactivation up to 8 h at 400 °C and displays unprecedented performance at low temperatures in CO2-methanation with 100% of selectivity.

Yellow fever surveillance suggests zoonotic and anthroponotic emergent potential.

Yellow fever is transmitted by mosquitoes among human and non-human primates. In the last decades, infections are occurring in areas that had been free from yellow fever for decades, probably as a consequence of the rapid spread of mosquito vectors, and of the virus evolutionary dynamic in which non-human primates are involved. This research is a pathogeographic assessment of where enzootic cycles, based on primate assemblages, could be amplifying the risk of yellow fever infections, in the context of spatial changes shown by the disease since the late 20th century. In South America, the most relevant spread of disease cases affects parts of the Amazon basin and a wide area of southern Brazil, where forest fragmentation could be activating enzootic cycles next to urban areas. In Africa, yellow fever transmission is apparently spreading from the west of the continent, and primates could be contributing to this in savannas around rainforests. Our results are useful for identifying new areas that should be prioritised for vaccination, and suggest the need of deep yellow fever surveillance in primates of South America and Africa.

Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America.

Background: Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. Objective: To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. Method: Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. Results: A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. Conclusions: In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.

A simple and effective 1D-element discrete-based method for computational bone remodeling.

In-silico models applied to bone remodeling are widely used to investigate bone mechanics, bone diseases, bone-implant interactions, and also the effect of treatments of bone pathologies. This article proposes a new methodology to solve the bone remodeling problem using one-dimensional (1D) elements to discretize trabecular structures more efficiently for 2D and 3D domains. An Euler integration scheme is coupled with the momentum equations to obtain the evolution of material density at each step. For the simulations, the equations were solved by using the finite element method, and two benchmark tests were solved varying mesh parameters. Proximal femur and calcaneus bone were selected as study cases given the vast research available on the topology of these bones, and compared with the anatomical features of trabecular bone reported in the literature. The presented methodology has proven to be efficient in optimizing topologies of lattice structures; It can predict the trend of formation patterns of the main trabecular groups from two different cancellous bones (femur and calcaneus) using domains set up by discrete elements as a starting point. Preliminary results confirm that the proposed approach is suitable and useful in bone remodeling problems leading to a considerable computational cost reduction. Characteristics similar to those encountered in topological optimization algorithms were identified in the benchmark tests as well, showing the viability of the proposed approach in other applications such as bio-inspired design.

Epidemiological Indicators of SARS-CoV-2 (COVID-19) and Vaccination Effectiveness on the Report of Positive Cases in the Colombian Army.

The description of the epidemiological indicators of SARS-CoV-2 (COVID-19), such as the mortality rate (MR), the case fatality rate (CFR), and the attack rate (AR), as well as the geographical distribution and daily case reports, are used to evaluate the impact that this virus has had within the Colombian Army and its health system. As military forces around the world represent the force that defends sovereignty, independence, the integrity of the national territory, and the constitutional order, while maintaining migration controls in blocked border areas during this critical pandemic times, they must carry out strict epidemiological surveillance to control the situation among the servicemen. Up to date, the Colombian Army has faced a very high attack rate (AR = 8.55%) due, among others, to living conditions where active military personnel share bedrooms, bathrooms, and dining facilities, which facilitate the spread of the virus. However, being a mainly young and healthy population, the MR was 1.82 deaths/1,000 ha, while the CFR = 2.13% indexes consistently low if compared with those values reported for the national population. In addition, the effectiveness of vaccination is shown in daily cases of COVID-19, where, for the third peak, the active military population presented a decrease of positive patients compared to the dynamics of national transmission and the total population of the military forces (active, retired, and beneficiaries).

Estudio multicéntrico retrospectivo de los aspectos epidemiológicos, clínicos y terapéuticos de la enfermedad de Kawasaki en niños de Panamá

Resumen Antecedentes: La enfermedad de Kawasaki (EK) representa la principal causa de cardiopatía pediátrica adquirida en muchos países; sin embargo, hay pocos estudios publicados en Latinoamérica. Objetivo: Describir la epidemiología, los aspectos clínicos y el tratamiento de EK en niños en Panamá como parte del estudio de vigilancia de REKAMLATINA-2 en Latinoamérica. Pacientes y Métodos: Estudio retrospectivo, descriptivo, de pacientes internados con diagnóstico de EK, atendidos en tres hospitales pediátricos de Panamá del 1-enero-2009 al 31-diciembre-2013. Resultados: Se analizaron 111 pacientes, 61(54,9%) eran hombres. Todos fueron hospitalizados, siendo la media de hospitalización de 5,8 (4-7) días. La mediana de edad al ingreso fue de 28,9 (12-38) meses. Un 63,9% recibió antimicrobianos recientemente por otros posibles diagnósticos. Recibieron inmunoglobulina intravenosa (IGIV) 105 (94,6%) pacientes; de éstos, 10 (9,5%) fueron resistentes. Un 11,7% tuvo alteraciones cardiovasculares en el ECO inicial, de las cuales las lesiones coronarias se detectaron en 3 (2,9%) pacientes. Conclusiones: Los datos sugieren que EK en Panamá tiene una incidencia cercana a 2,05 x 100,000 bajo 15 años de edad y una frecuencia 2,6 veces mayor bajo 3 años de edad. Se observó un alto porcentaje de uso de antimicrobianos ambulatoriamente antes de la confirmación diagnóstica, lo cual sugiere reconocimiento tardío de EK en Panamá.

Abstract Background: Kawasaki disease (KD) is the leading cause of pediatric acquired heart disease in many countries, however, there are few published studies from Latin America (LA). Aim: To describe the epidemiology, clinical aspects, and treatment of KD in children from Panama as part of the REKAMLATINA-2 in LA. Methods: Retrospective descriptive review of hospitalized patients diagnosed with KD, attended at three main pediatric hospitals of Panama from January-1-2009 to December-31-2013. Results: 111 patients were analyzed, 61(54.9 %) were male. All children were hospitalized, and had a mean length of hospitalization of 5.8 (4-7) days. Median age at admission was 28.9 (12-38) months. Prior to KD final diagnosis, 63.9% patients received antibiotics for other presumed diagnoses. 105 (94.6%) patients received IGIV, 10 (9.5%) were resistant. On initial echocardiogram, 11.7% of cardiovascular complications were reported, of which coronary artery lesions (CALs) were detected in 3 (2.9 %) patients. Conclusion: The data suggest that KD in Panama has an incidence of about 2.05 x 100,000 in children under 15 years of age, and with a frequency 2.6 times higher in children under 3 years. A high rate of antibiotic misuse on outpatient prior to diagnostic confirmation was observed, suggesting KD unawareness and late recognition in Panamá.

[Multicenter retrospective study about the epidemiological, clinical and therapeutic aspects of Kawasaki disease in children from Panama]. / Estudio multicéntrico retrospectivo de los aspectos epidemiológicos, clínicos y terapéuticos de la enfermedad de Kawasaki en niños de Panamá.

BACKGROUND: Kawasaki disease (KD) is the leading cause of pediatric acquired heart disease in many countries, however, there are few published studies from Latin America (LA). AIM: To describe the epidemiology, clinical aspects, and treatment of KD in children from Panama as part of the REKAMLATINA-2 in LA. METHODS: Retrospective descriptive review of hospitalized patients diagnosed with KD, attended at three main pediatric hospitals of Panama from January-1-2009 to December-31-2013. RESULTS: 111 patients were analyzed, 61(54.9 %) were male. All children were hospitalized, and had a mean length of hospitalization of 5.8 (4-7) days. Median age at admission was 28.9 (12-38) months. Prior to KD final diagnosis, 63.9% patients received antibiotics for other presumed diagnoses. 105 (94.6%) patients received IGIV, 10 (9.5%) were resistant. On initial echocardiogram, 11.7% of cardiovascular complications were reported, of which coronary artery lesions (CALs) were detected in 3 (2.9 %) patients. CONCLUSION: The data suggest that KD in Panama has an incidence of about 2.05 x 100,000 in children under 15 years of age, and with a frequency 2.6 times higher in children under 3 years. A high rate of antibiotic misuse on outpatient prior to diagnostic confirmation was observed, suggesting KD unawareness and late recognition in Panamá.

High temperature CO2 capture of hydroxyapatite extracted from tilapia scales / Captura de CO2 a altas temperaturas, de hidroxiapatitas extraídas de escamas de tilapia / Captura de CO2 a altas temperaturas por hidroxiapatita extraída de escamas de tilápia

Abstract Hydroxyapatite (HAp) was obtained from tilapia scales by two extraction methods: direct calcination and acid-base treatment. The physicochemical characteristics of the obtained HAps were evaluated by thermogravimetric analysis, X-ray fluorescence, X-ray diffraction, scanning electron microscopy, surface area, infrared spectroscopy, and basicity measurement at 298 K by CO2 -pulse titration. Furthermore, the CO2 capture capacity of the solids at high temperature was also determined. Both methods showed the presence of a HAp phase although significant differences in the properties of the solids were found. The HAp obtained by direct calcination, exhibited a lower crystallinity and a greater surface area and basicity than the HAp obtained by the acid-base treatment. These features were correlated with the solid's CO2 capture capacity. In this work, CO2 capture capacity values for HAp yielded by calcination ranged from 2.5 to 3.2 mg CO2 /g captured at 973 K, and for the acid-base treatment-derived HAp, CO2 capture capacity values between 1.2 to 2.5 mg CO2 /g were recorded. These results reveal the potential of HAps extracted from tilapia scales as solids with high CO2 capture capacity, thermal stability, and capture/release cycles reversibility.

Resumen Se obtuvo hidroxiapatita (HAp) de escamas de tilapia por dos métodos de extracción: calcinación directa y tratamiento ácido-base. Las características fisicoquímicas de las HAps obtenidas fueron evaluadas por análisis termogravimétrico, fluorescencia de rayos X, difracción de rayos X, microscopía electrónica de barrido, área superficial, espectroscopia infrarroja y medición de basicidad a 298 K por titulación por pulso de CO2. Adicionalmente, se determinó la capacidad de captura de CO2 de los sólidos a alta temperatura. Ambos métodos mostraron la presencia de una fase de HAp, aunque se encontraron diferencias significativas en las propiedades de los sólidos. La HAp obtenida por calcinación directa exhibió una menor cristalinidad y una mayor área superficial y basicidad que la HAp obtenida con el tratamiento acido-base. Estas características se correlacionaron con la capacidad de captura de CO2 del sólido. En este trabajo, los valores de captura del CO2 con la HAp producidos por calcinación oscilaron entre 2.5 to 3.2 mg CO2/g capturado a 973 K, y con la HAp derivada del tratamiento ácido-base, se registraron valores de captura entre 1.2 to 2.5 mg CO2/g. Estos resultados revelan el potencial de HAps extraídos de escamas de tilapia como sólidos con una alta capacidad de captura de CO2, estabilidad térmica y reversibilidad de los ciclos de captura/liberación.

Resumo A hidroxiapatita (HAp) foi obtida a partir da escama de tilapia usando dois métodos de extração: calcinação direta e tratamento ácido-base. As características físico-químicas das hidroxiapatitas foram avaliadas por análise termogravimétrica, fluorescência de raios-X, difração de raios-X, microscopia eletrônica de varredura, área superficial, espectroscopia de infravermelho e medição de basicidade a 298 K por titulação de pulso de CO2. Além disso, determinou-se a capacidade de captura de CO2 dos sólidos a alta temperatura. Os dois métodos mostraram a presença da fase HAp, no entanto, diferenças significativas foram encontradas nas propriedades dos sólidos, sendo a HAp obtida por calcinação direta a que apresentou menor cristalinidade, maior área superficial e basicidade, características que foram correlacionadas com a capacidade de captura de CO2. Foram encontrados valores entre 2.5 a 3.2 mg CO2/g capturado a 973 K para a HAp obtida por calcinação e, entre 1.2 a 2.5 mg CO2/g para a HAp obtida por tratamento ácido-base. Isto revelou o potencial de HAp's extraídas da escama de tilapia como sólidos com alta capacidade de captura de CO2, estabilidade térmica e reversibilidade na liberação de CO2.

Partial removal and detoxification of Malachite Green and Crystal Violet from laboratory artificially contaminated water by Pleurotus ostreatus / Eliminación parcial y desintoxicación de Verde Malaquita y Cristal Violeta del laboratorio con agua contaminada artificialmente por Pleurotus ostreatus / Extração e desintoxicação de Verde Malaquita e Cristal Violeta de água contaminada artificialmente em laboratório por Pleurotus ostreatus

Abstract The triphenylmethane Malachite Green (MG) and Crystal Violet (CV) dyes are cationic dyes and mix with domestic wastewater when dumped; increasing, among others, the chemical and biological oxygen demand and can cause acute toxicity at different trophic levels. Promoting the removal (decolorization) of MG and CV, and laccase activity (54.8 ± 8.9 and 30.6 ± 2.9 UL-1 respectively) by using P. ostreatus viable biomass needed parameters such as pH (4.5 and 6.0), temperature (25 to 30 °C), stirring speed (120 rpm), percentage of inoculum (2% v/v), and dye concentration (20 and 10 mg L-1). In adsorption studies, it was showed that an acidic pH favors the adsorption of both dyes and the model of pseudo-second order describes best the phenomenon of adsorption. Finally, the germination index (GI), using Lactuca sativa seeds for the initial dyes solutions, was < 50%; demonstrating its high phytotoxic effect. When dye solutions were treated with viable biomass, the GI increased, leaving open the possibility to perform future research to determine if the aqueous solutions, post-treated with P. ostreatus, could be used in treatments that generate less toxic water which could be used in processes that do not require potable water.

Resumen Los colorantes trifenilmetánicos Verde Malaquita (MG) y Crystal Violeta (CV) son catiónicos y al ser vertidos se mezclan con aguas residuales domésticas, incrementando, entre otros, la demanda química y biológica de oxígeno; pudiendo causar toxicidad aguda en diferentes niveles tróficos. En este estudio se encontró que los parámetros pH (4,5 y 6,0), temperatura (25 y 30 °C), velocidad de agitación (120 r.p.m.), porcentaje de inóculo (2 % v/v) y concentración de colorante (20 y 10 mgL-1), presentaron un efecto significativo (p < 0.05) para favorecer la remoción (decoloración) de MG y CV, así como la actividad lacasa (54,76 ± 8,91 y 30,59 ± 2,89 UL-1 respectivamente) al utilizar biomasa viable de P. ostreatus. En los estudios de adsorción se evidenció que pH ácidos favorecen la adsorción de ambos colorantes y que el modelo de Pseudo-segundo orden describe mejor el fenómeno de quimisorción. Finalmente los índices de germinación (IG) empleando semillas de Lactuca sativa, para los colorantes iniciales fueron < 50 %; demostrando su efecto fitotóxico elevado. Cuando las soluciones de colorantes fueron tratadas con biomasa viable, el IG aumentó, dejando abierta la puerta para la realización de investigaciones futuras con la intensión de determinar si las soluciones acuosas, postratadas con P ostreatus, pueden ser utilizadas en tratamientos que generen aguas menos tóxicas y que estas puedan ser empleadas en otros procesos que no requieran agua potable.

Resumen Os corantes de tipo trifenilmetano Verde Malaquita (VM) e Cristal Violeta (CV) são corantes catiônicos e se misturam com águas residuais domésticas quando descartadas; aumentando, entre outros, as demandas químicas e biológicas de oxigênio, podendo causar toxicidade aguda em diferentes níveis tróficos. Promoveu-se a remoção (descoloração) de VM e CV, e atividade da lacase (54.8 ± 8.9 e 30.6 ± 2.9 UL-1 respectivamente) utilizando como parâmetros necessários para a biomassa viável de P. ostreatus como pH (4,5 e 6,0), temperatura (25 a 30 °C), velocidade de agitação (120 RPM), porcentagem de inócuo (2 % v/v), e concentração de corante (20 e 10 mg L-1). Em estudos de absorção, se demonstrou que um pH mais ácido favorece a absorção de ambos corantes e o modelo de pseudo-segunda ordem descreve melhor o fenômeno da absorção. Finalmente, o índice de germinação (IG), utilizando sementes de Lactuca sativa para as soluções iniciais dos corantes, foi < 50 %; demonstrando assim seu alto efeito fitotóxico. Quando as soluções de corante foram tratadas com a biomassa viável, o IG aumentou, deixando em aberto a possibilidade de realizar futuras investigações para determinar se as soluções aquosas, tratadas com P. ostreatus, poderiam ser utilizadas em tratamentos que gerem águas menos tóxicas, que poderia ser utilizada em processos que não requerem água potável.

Clinical and Parasitological Features of Patients with American Cutaneous Leishmaniasis that Did Not Respond to Treatment with Meglumine Antimoniate.

BACKGROUND: American cutaneous leishmaniasis (ACL) is a complicated disease producing about 67.000 new cases per year. The severity of the disease depends on the parasite species; however in the vast majority of cases species confirmation is not feasible. WHO suggestion for ACL produced by Leishmania braziliensis, as first line treatment, are pentavalent antimonial derivatives (Glucantime or Sodium Stibogluconate) under systemic administration. According to different authors, pentavalent antimonial derivatives as treatment for ACL show a healing rate of about 75% and reasons for treatment failure are not well known. METHODS: In order to characterise the clinical and parasitological features of patients with ACL that did not respond to Glucantime, a cross-sectional observational study was carried out in a cohort of 43 patients recruited in three of the Colombian Army National reference centers for complicated ACL. Clinical and paraclinical examination, and epidemiological and geographic information were recorded for each patient. Parasitological, histopathological and PCR infection confirmation were performed. Glucantime IC50 and in vitro infectivity for the isolated parasites were estimated. RESULTS: Predominant infecting Leishmania species corresponds to L. braziliensis (95.4%) and 35% of the parasites isolated showed a significant decrease in in vitro Glucanatime susceptibility associated with previous administration of the medicament. Lesion size and in vitro infectivity of the parasite are negatively correlated with decline in Glucantime susceptibility (Spearman: r = (-)0,548 and r = (-)0,726; respectively). CONCLUSION: A negative correlation between lesion size and parasite resistance is documented. L. braziliensis was found as the main parasite species associated to lesion of patients that underwent treatment failure or relapse. The indication of a second round of treatment in therapeutic failure of ACL, produced by L. braziliensis, with pentavalent antimonial derivatives is discussable.

Infecciones necrotizantes de tejidos blandos: Mionecrosis por Clostridium

Las infecciones necrotizantes de los tejidos blandos varían en su presentación clínica, pero en general son de curso grave y alta mortalidad. El cuadro clínico incluye: fiebre, celulitis, edema, crepitación, bulas, necrosis y sepsis; con frecuencia existe un antecedente traumático o quirúrgico. Como hallazgo operatorio se encuentra necrosis de la piel y tejido subcutáneo, con o sin mionecrosis. El tratamiento debe ir dirigido a compensar el estado general de los pacientes aunado al temprano desbridamiento y remoción de tejido necrótico y contaminado y cobertura antibiótica de amplio espectro. Se expone el caso clínico de un paciente indígena de 2 años, sin antecedentes patológicos previos que desarrolló un proceso compatible con una infección necrotizante de partes blandas (INPB) en miembro superior e inferior izquierdo. Se realizó de urgencia una fasciotomía de miembro superior Derecho y desarticulación de cadera izquierda y se instauró tratamiento antibiótico con meropenem y vancomicina, sesiones con oxígenos hiperbárico.

Necrotizing soft tissue infections vary in their clinical presentation, but are generally severe course and high mortality. The clinical picture includes fever, cellulitis, edema, crepitus, bullae, necrosis and sepsis; there is often a traumatic or surgical history. As surgical finding is necrosis of the skin and subcutaneous tissue, with or without myonecrosis. Treatment should be directed to compensate the general state of patients coupled with early debridement and removal of necrotic tissue and contaminated and broad-spectrum antibiotics.The clinical case of an patient two years, without previous pathological antecedents who developed a process compatible with necrotizing soft tissue infection into upper and lower left limb is exposed. Performed emergency fasciotomy of right upper limb and left hip disarticulation and antibiotic treatment was started with meropenem and vancomycin, hyperbaric oxygen sessions.

Desafío diagnóstico

Masculino de 6 meses de edad, con historia de fiebre alta, no cuantificada, manejada ambulatoriamente con antipirético, asociada a evacuaciones aguadas, amarillas, sin moco, ni sangre, no fétidas que aparecen al segundo día de iniciado el cuadro clínico. Consulta en Centro de Salud y se prescribe antihistamínico, Ceftriaxona IM, y continuar antipirético. Luego de la segunda dosis de antibiótico intramuscular presenta exantema generalizado, sin cambios en su sintomatología, pero asociado a hiporexia e irritabilidad por lo que acude al Cuarto de Urgencias hospitalario a los once días de evolución. Se realiza punción lumbar a que muestra pleocitosis con predominio de mononucleares y proteinorraquia, y se hospitaliza. Examen Físico Positivo: Paciente irritable, febril (39ºC), inyección conjuntival bilateral, adenopatías cervicales, axilares e inguinales, bilaterales de 0.8 cms, labios hipéremicos y agrietados, con lengua aframbuesada, edema en ambos pies. Eritema perianal. Durante su estadía en sala presenta exfoliación en colgajos periungueales de manos y pies. Exámenes de laboratorios: PCR mayor de 9 mg/dl, hemograma con leucocitosis (31000cel/mm3) con neutrofilia, trombocitosis (1303000) y anemia de 5.6 g/dl. VIH, VDRL, CMV, Mycoplasma y panel viral en moco nasal negativos.

Evaluación de un método de extracción y purificación de DNA a partir de tejido muscular fijado en formaldehido de cadáveres no identificados / Evaluation of a method of extracting and purifying DNA from muscle tissue fixed in formaldehyde unidentified bodies / Avaliação de um método de extracção e purificação de ADN a partir de tecido muscular fixado em formaldeído corpos não identificados

La obtención de DNA humano en buena cantidad y alta pureza a partir de tejido muscular fijado en Formaldehido no tamponado es de suma importancia en la amplificación por la Reacción en Cadena de la Polimerasa (PCR) para su aplicación en estudios de identificación y filiación genética. En este estudio se evaluó la eficiencia del Kit QIAampR DNA FFPE TISSUE y una modificación del mismo basado en lavados con PBS y el tiempo de digestión con proteinasa K, frente a la cantidad y calidad de este ácido nucléico. Las diferencias fueron significativas entre los tiempos de acción con la proteinasa K (PK) en relación a la cantidad y en la pureza producto de los lavados del tejido muscular previa extracción. Estos resultados proporcionan una pauta para el diseño de experimentos de acuerdo con el efecto de la fijación, optimizando recursos humanos e insumos.

Obtaining human DNA in large quantity and high purity from muscle tissue fixed in formaldehyde unbuffered is of utmost importance in amplification by Chain Reaction (PCR) for application in identification studies and genetic affiliation. In this study, the efficiency of DNA FFPE TISSUE QIAampR Kit and a modification thereof based washes with PBS and the time of digestion with proteinase K, compared to the amount and quality of the nucleic acid were evaluated. Differences were significant between the exposure times with proteinase K (PK) in relation to the quantity and purity of the product prior washings muscle tissue extraction. These results provide a guideline for the design of experiments according to the effect of fixing, optimizing human resources and inputs.

A obtenção de DNA humano em grande quantidade e de alta pureza a partir de tecido muscular fixado em formol não tamponado é de extrema importância para a amplificação por Reacção em Cadeia (PCR), para sua aplicação em estudos de identificação e filiação genética. Neste estudo, a eficácia do kit QIAampR DNA FFPE TISSUE e uma modificação do processo por lavagens com PBS e o tempo de digestão com proteinase K, em comparação com a quantidade e a qualidade do ácido nucléico desta base. As diferenças foram significativas entre os tempos de exposição com proteinase K em relação à quantidade e pureza produto das lavagens do tecido muscular extraída previamente. Estes resultados fornecem uma diretriz para o desenho de experimentos de acordo com o efeito de fixação, otimizando recursos humanos e insumos.

Decrease in Hospitalizations for Pneumonia in Children under Five Years of Age in an Indian Reservation in Panama after the Introduction of the Heptavalent Pneumococcal Conjugate Vaccine (PCV7).

This study quantifies the impact of Heptavalent-Pneumococcal Conjugate Vaccine (PCV7) in Panama on indigenous children younger than 5 years old, based on clinical pneumonia cases. This study demonstrates a significant 41.2% reduction in hospitalizations and 38.6% reduction in referrals for pneumonia following the introduction of PCV7. Burden of disease from pneumonia appears reduced in the ≤12-month- and 13-to-24-month-old groups.

Remoción de colorantes sintéticos mediante el proceso Fentonheterogéneo usando Fe2O3 soportado en carbón activado obtenido a partir de residuos de rosas / Removal of synthetic dyes by Fenton process using activated carbon-supported Fe2O3 obtained from rose remnants

Se estudió la remoción de colorantes negro reactivo 5 ycristal violeta, mediante la reacción Fenton empleando catalizadoresde Fe2O3 (0-10% m/m de Fe) soportados en carbón activadoobtenido a partir de residuos de rosas. El carbón activado fueobtenido por pirólisis a 500 ºC (1h) seguido de activación con NaOH(1:2 en peso). El soporte fue caracterizado empleando diferentestécnicas químicas y físicas. Los catalizadores de Fe fueron sintetizadosmediante impregnación incipiente. Los tratamientos Fenton y deadsorción fueron realizados en un reactor Batch, concentración de 10mgL-1 de los colorantes, 0,25 mgmL-1 de catalizador, pH=3,7, 20±2ºC, 750 rpm y presión atmosférica. El carbón activado empleadocomo soporte presentó alta basicidad, presencia de grupos polares ensuperficie, alto contenido de cenizas (22,85%) y de oxígeno (43,93%)y fue mayoritariamente microporoso con un área superficial BETde 520 m2g-1. La máxima remoción lograda para el negro reactivo 5se obtuvo con el catalizador de 3% Fe (98,33%) luego de 180 min.mientras que para el cristal violeta se obtuvo con el catalizador de1% de Fe (63,95%) después de 180 min. La remoción mediante eltratamiento Fenton fue dependiente del contenido de Fe, tamaño departícula del sitio activo y del tipo de colorante. La remoción de negroreactivo 5 alcanzó un máximo con 3% de Fe mientras que para elcristal violeta disminuyó con el incremento del contenido de Fe. Eltratamiento planteado en el presente trabajo es promisorio para laeliminación de colorantes sintéticos presentes en aguas contaminadas...

Fe2O3-catalysts (0-10% m/mof Fe) supported on activated carbon obtained fromrose remnants were used to study the removal of dyesreactive black 5 and crystal violet by the Fenton reaction.The activated carbon was obtained from pyrolysis at 500°C (1h) followed by activation with NaOH (1:2 wt.). Thesupport was classified using several chemical and physicaltechniques. Fe-catalysts were synthesized by incipientimpregnation. Fenton and adsorption treatments wereperformed in a batch reactor, concentration of dye of10 mgL-1, 0.25 mgmL-1 catalyst, pH = 3.7, 20 ± 2 ° C,750 rpm and atmospheric pressure. The activated carbonused as support showed high basicity, presence of polargroups on the surface, high ash content (22.85%) andoxygen (43.93%) and was mostly of the microporoustype with a BET surface area of 520 m2g-1. The maximumdiscoloration achieved for black reactive 5 was obtainedwith the catalyst of 3% Fe (98.33%) after 180 min. whilefor the crystal violet it was obtained with the catalyst of1% Fe (63.95%) after 180 min. Discoloration by Fentontreatment is dependent on the Fe content, the particlesize of the active site and the type of dye. The removalof reactive black 5 reached a maximum at 3% Fe whilethe crystal violet decreased by increasing Fe content. Thetreatment proposed in this paper is promising for theremoval of synthetic dyes present in contaminated water...

Se estudo a remoção de corantes violeta de cristal e reativopreto 5 pela reação de Fenton utilizando diferentes concentraçõesdos catalisadores de Fe2O3 (0-10% m/m de Fe) suportados em carvãoativado obtido a partir de resíduos de rosas. O carvão ativado foiobtido por pirólise a 500 °C (1h) seguido por ativação com NaOH(1:2 em peso). O suporte foi caracterizado utilizando diferentestécnicas químicas e físicas. Os catalisadores de Fe foram sintetizadospor impregnação incipiente. Os tratamentos de adsorçao e de Fentonforam realizados num reator batch, com concentração de 10 mgL-1de corante, 0,25 mgmL-1 de catalisador, em pH = 3,7, 20 ± 2 °C,750 rpm e pressão atmosférica. O carvão ativado usado comosuporte mostrou basicidade elevada, a presença de grupos polaresna superfície, elevado teor de cinzas (22,85%) e oxigênio (43,93%) efoi principalmente microporoso com uma área de superfície BET de520 m2g-1. O valor máximo obtido para a descoloração reativo preto5 foi obtido com o catalisador de 3% Fe (98,33%) após 180 min.Enquanto para o violeta de cristal foi obtido com o catalisador de 1%Fe (63,95%) após 180 min. A descoloração por tratamento de Fentoné dependente do teor de Fe, tamanho de partícula do sítio ativo e dotipo de corante. A remoção de preto reativo 5 atinge um máximo emFe3%, enquanto que para o violeta de cristal diminui com o aumentodo teor de Fe. O tratamento proposto neste trabalho é promissorpara a remoção de corantes sintéticos presentes na água contaminada...

Impacto del serotipo 5 en la enfermedad invasora por Streptococcus pneumoniae en la población pediátrica ingresada en el Hospital Materno Infantil José Domingo de Obaldía

La vigilancia de la enfermedad invasora por Streptococcus pneumoniae permite detectar los cambios geográficos y cronológicos en los serotipos circulantes y en la sensibilidad antimicrobiana, monitorizando además el impacto de las vacunas sobre la enfermedad. Objetivos: Describir los serotipos aislados y la sensibilidad antimicrobiana en los pacientes pediatrics hospitalizados con enfermedad invasora por Streptococcus pneumoniae. Describir la enfermedad invasora por Streptococcus pneumoniae y sus complicaciones clínicas asociadas. Metodología: Estudio retrospectivo, longitudinal, incluye pacientes pediátricos hospitalizados en el Hospital Materno Infantil José Domingo de Obaldía en el periodo de enero de 2010 a junio de 2011; los cuales se cursaron con enfermedad invasora por Streptococcus pneumoniae como etiología en este periodo. El diagnóstico microbiológico se realizó por coaglutinación en líquidos corporales y cultivo del microorganismo. La cepa se aisló en el laboratorio de microbiología y se tipificó en el Laboratorio Central. La enfermedad invasora fue definida por el cuadro clínico y el aislamiento de Streptococcus pneumoniae de un sitio previamente estéril. Variables analizadas: edad, sexo, procedencia, sitio de infección, complicaciones, tiempo hospitalario, mortalidad, ingreso a UCI, anemia, VIH , letalidad. Resultados: Se revisaron 25 expedientes de pacientes con enfermedad invasora y aislamiento de Streptococcus pneumoniae. Dos fueron excluidos. 20 pacientes fueron menores de 5 años y 3 mayores de 5 años. 11 varones y 12 niñas. El 91% fueron indigenas. El 60.8% procedía de la Comarca Ngöbe Buglé. Promedio hospitalario 25.3 días, rango 1-93 días. 60.8% ingresó con enfermedad grave a la UCIP; 92.8% ameritó ventilación mecánica y 78.5% presentó choque. 34%(8) cursó con compromiso de SNC y el 30% (7) bacteriemia. Se tipificaron 14 cepas , el (78.5%) fue serotipo 5. Todos los aislados fueron sensibles a penicilina. 31% (5) resistentes a TMP/SMX. El 74% de los casos tenia hemoglobina menor de 10 g y solamente 3 habían completado su vacunación con PCV-7. Todo fueron VIH negativo. 30% de los pacientes fallecieron. Conclusiones: En los caso evaluados encontramos un predominio del Streptococcus pneumoniae tipo 5 en el 78.5% de los casos. Los serotipos 24F, 18C y 4 fueron aislados en 1 caso cada uno; el 100% fue sensible a penicilina. La población más afectada fue la raza indígena y los menores de 5 años. El SNC y respiratorio fueron los sitios primarios de infección. El 61% ingreso con enfermedad grave y el 30% falleció.

The monitoring of the invading disease by S. pneumoniae allows detecting geographic and temporary changes in antimicrobial sensitivity, besides monitoring the impact of the vaccines on the disease. Objectives: To describe to the isolate serotypes and antimicrobial sensitivy of Streptococcus pneumoniae to associate invasive disease in the pediatric patients hospitalized. Besides clinical manifestations and complications. Methods: Retrospective, longitudinal study. Pediatrics patients hospitalized in the Maternal Hospital in January 2010 to June 2011; in which Streptococcus pneumoniae was isolated as etiology of invasive disease. The microbiological diagnosis for Streptococcus pneumoniae was realized with coaglutination and culture of body fluids. The strain was isolated in the microbiology laboratory and it was typified in the Central Laboratory in Panama City. An invasive disease was defined by clinical manifestations and the isolation of Streptococcus pneumoniae of a previously sterile site. Analyzes variables: age, sex, origins, site of infection, complications, hospital time, death, admission to UCI, anemia , HIV, lethality. Results: 25 files with Streptococcus pneumoniae isolation and invasive disease were reviewed. Two were excluded. 20 patients were younger than 5 years and 3 oldest of 5 years. 11 were boys and 12 girls. 91% were indigenous. 60.8% came from Comarca Ngöbe Bugle. Hospital average 25, 3 days with range 1-93 days. 60.8% had serious disease and went to the UCIP; 92.8% need mechanical ventilation and 78.5% suffering shock. 34% (8) presented with commitment respiratory and SNC simultaneously. 70% (20) patients with pneumonia presented pleural effusion. 21,7% pericardial effusion and 30% (7) bacteremia. 14 isolate were typified, serotype 5 (78.5%). All were sensible to penicillin; TMP/SMX resistant 31% (5). 74% had hemoglobin less than 10 g and only 3 had completed their vaccination with PCV-7. All were HIV negative. 30% lethality. Conclusions: Streptococcus pneumoniae serotype 5 were strains predominance in the 78.5%. Others as 24 F, 18C and 4, 1 case of each serotypes; 100% were sensible to penicillin. The people more affected was indigenous race and the younger than 5 years. The respiratory and SNC were the primary infections sites. 61% come with serious illness and 30% died.

Modelo computacional preliminar de la formación de la superficie cerebral / Preliminary computation form of the cerebral surface development

La corteza cerebral es una lámina gris, formada por cuerpos de neuronas, que cubre los hemisferios cerebrales y cuyo grosor varía de 1,25 mm en el lóbulo occipital a 4 mm en el lóbulo anterior. Debido a los numerosos pliegues que presenta, la superficie cerebral es unas 30 veces mayor que la superficie del cráneo. Estos pliegues forman las circunvoluciones cerebrales, surcos y fisuras y delimitan áreas con funciones determinadas, divididas en cinco lóbulos. La formación de las circunvoluciones puede variar entre individuos y constituyen una característica importante de la formación del cerebro. Estos patrones se pueden representar, de forma matemática, como patrones de Turing. En este artículo se desarrolla un modelo fenomenológico que describe la formación de los patrones de las circunvoluciones que ocurren en la corteza cerebral mediante ecuaciones de reacción difusión con parámetros en el espacio de Turing. Para estudiar la formación de patrones se resuelven varios ejemplos numéricos sobre geometrías simplificadas de un cerebro. Para la solución numérica se utilizó el método de los elementos finitos en conjunto con el método de Newton-Raphson. Los ejemplos numéricos muestran que el modelo puede representar la formación de los pliegues de la corteza cerebral y reproducir patologías de la formación de las circunvoluciones, tales como polimicrogiria y lisencefalia.

Cerebral cortex is a gray layer including neuron bodies covering the cerebral hemispheres and whose thickness fluctuates from 1.25 mm in the occipital lobule to 4 mm in the anterior lobule. Due to the many folds present, la cerebral surface is a thirty times greater than the cranial surface. These folds create the cerebral convolutions, grooves and fissures defining areas with determined functions, divided into five lobules. La convolutions formation may to vary among subjects and are an important characteristic of brain formation. These patterns may be represented in a mathematical way like Turing patterns. The aim of present paper was to design a phenomenological model describing the formation of convolutions patterns occurring in the cerebral cortex by means of diffusion reaction equations with parameters in the Turing space. To study la formation of patterns it is necessary to solve some numerical examples on simplified geometries of a brain. For numerical solution authors used the finite elements method together with the Newton-Raphson method. The numerical examples demonstrate that this model may to represent the folds formation in the cerebral cortex and to reproduce pathologies of the convolutions formation, such as the polymicrogyria and lissencephalous.