Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique / Abordaje torácico anterior infraclavicular para el acceso a las vértebras torácicas superiores: reporte de un caso y descripción de una nueva técnica quirúrgica

Abstract: Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA «C¼ spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Resumen: Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA «C¼, tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique.

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA "C", tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

[Comparison of treatment with plates for distal tibia fractures]. / Comparación del tratamiento con placas en fractura de tibia distal.

INTRODUCTION: Currently the surgical treatment of fractures of extraarticular distal tibia is controversial for the multiple techniques and materials of osteosynthesis, the Minimally Invasive Percutaneous Techniques (MIPO) allow us to preserve the periosteal circulation, crucial point in the natural processes of convalescence of the patient, so this technique takes relevance in our study. OBJECTIVE: To observe that this approach to fractures of the distal tibia has fewer complications and better functional result than fixation with open technique. MATERIAL AND METHODS: A longitudinal, ambispective and analytical study was conducted in the period from July 2018 to September 2019 in patients with closed fracture of the extraarticular distal tibia in patients over 18 years of age without previously diagnosed musculoskeletal comorbidities, the calculation was performed with the WinPEPI program (Programs for Epidemiologists for Windows) version 11.43 based on the study by Paul Toogooda et al (2018) with a confidence interval of 95% a minimum total of 20 patients for each group. Measures of central tendency, correlations between technique and variable were used. RESULTS: Two groups of 20 patients were analyzed comparing MIPO vs conventional technique in a period of 6 months postsurgical evaluating risk of infection, wound dehiscence, radiographic bone consolidation, joint functionality and demographic data; showing positive statistical superiority for MIPO technique. CONCLUSION: Relevant data were obtained in favor of MIPO with bone consolidation and higher functional score at six months.

INTRODUCCIÓN: Actualmente el tratamiento quirúrgico de fracturas de tibia distal extraarticular es controversial por las múltiples técnicas y materiales de osteosíntesis, las técnicas Mínimo Invasivo Percutánea (MIPO) nos permiten preservar la circulación perióstica, punto crucial en los procesos naturales de convalecencia del paciente, por ello esta técnica es de gran relevancia en nuestro estudio. OBJETIVO: Observar que este abordaje de fracturas de tibia distal tiene menos complicaciones y mejor resultado funcional que la fijación con técnica abierta. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo longitudinal, ambispectivo y analítico en el período de Julio de 2018 a Septiembre de 2019 en pacientes adultos con fractura cerrada de tibia distal extraarticular sin comorbilidades, el cálculo se realizó con el programa WinPEPI (Programs for Epidemiologists for Windows) versión 11.43 basado en el estudio de Paul Toogooda, con un intervalo de confianza de 95% se obtuvo un total mínimo de 20 pacientes por cada grupo. Se usaron medidas de tendencia central, correlaciones entre técnica y variable. RESULTADOS: Se analizaron dos grupos de 20 pacientes comparando la técnica MIPO vs. la convencional en un período de seis meses postquirúrgico evaluando riesgo de infección, dehiscencia de herida, consolidación ósea radiográfica, funcionalidad articular y datos demográficos, mostrando superioridad estadística positiva para la técnica MIPO. CONCLUSIONES: Se obtuvieron datos relevantes a favor de MIPO con consolidación ósea y mayor puntaje funcional articular a los seis meses.

Mediastinal lipoblastoma in paediatrics. / Lipoblastoma mediastínico en pediatría.

OBJECTIVE: To describe two cases of mediastinal lipoblastoma, an infrequent and little-known patho logy, which is extremely rare in the mediastinum, with no cases reported in our country. CLINICAL CASES: Two case reports. Both patients were boys younger than three years, in which a mediastinal mass was found incidentally on a chest x-ray. The study was complemented with a CT scan and with a thoracoscopic biopsy in one of the cases. Complete resection of the tumor was achieved in both patients through thoracotomy. One of the patients presented Claude Bernard Horner syndrome as a complication from surgery, which resolved spontaneously after two years and the second case had no complications. CONCLUSION: Mediastinal lipoblastoma is a very rare pathology. Descriptions found in existing literature are similar to the cases presented in this article. We can conclude that mediastinal lipoblastomas in pediatrics present a very similar pattern and presentation, having a good prognosis if complete resection is achieved. Also, it is essential to distinguish it from its differential diagnoses in order to rule out malignancy.

Lipoblastoma mediastínico en pediatría / Mediastinal lipoblastoma in paediatrics

Resumen: Objetivo: Describir dos casos de lipoblastoma mediastínico, patología de baja incidencia y poco conocida, siendo aún más infrecuente en mediastino, sin haber reportes descritos en nuestro país. Casos Clínicos: 2 pacientes, ambos de sexo masculino, menores de 3 años, en los que se encontró como ha llazgo incidental una masa mediastínica en una radiografía de tórax. El estudio se complementó con una tomografía computada y en uno de los pacientes con una biopsia toracoscópica. En ambos se logró ex tirpación completa de la lesión vía toracotomía, siendo apoyado vía toracoscópica previa a la extracción de la lesión en uno de ellos. Uno de los pacientes evolucionó con Síndrome de Claude Bernard Horner el cual resolvió de manera espontánea luego de dos años y el segundo caso no presentó complicaciones. Conclusiones: el lipoblastoma mediastínico es una patología muy poco frecuente, las descripciones de la literatura se asemejan a los casos expuestos en este artículo, concluyendo que presentan un patrón muy similar entre ellos. Teniendo un pronóstico favorable si se logra la resección completa y siendo fundamental diferenciarlo de sus diagnósticos diferenciales para descartar malignidad.

Abstract: Objective: To describe two cases of mediastinal lipoblastoma, an infrequent and little-known patho logy, which is extremely rare in the mediastinum, with no cases reported in our country. Clinical Cases: Two case reports. Both patients were boys younger than three years, in which a mediastinal mass was found incidentally on a chest x-ray. The study was complemented with a CT scan and with a thoracoscopic biopsy in one of the cases. Complete resection of the tumor was achieved in both patients through thoracotomy. One of the patients presented Claude Bernard Horner syndrome as a complication from surgery, which resolved spontaneously after two years and the second case had no complications. Conclusion: Mediastinal lipoblastoma is a very rare pathology. Descriptions found in existing literature are similar to the cases presented in this article. We can conclude that mediastinal lipoblastomas in pediatrics present a very similar pattern and presentation, having a good prognosis if complete resection is achieved. Also, it is essential to distinguish it from its differential diagnoses in order to rule out malignancy.

The Male Warrior Hypothesis: Testosterone-related Cooperation and Aggression in the Context of Intergroup Conflict.

The Male Warrior Hypothesis (MWH) establishes that men's psychology has been shaped by inter-group competition to acquire and protect reproductive resources. In this context, sex-specific selective pressures would have favored cooperation with the members of one's group in combination with hostility towards outsiders. We investigate the role of developmental testosterone, as measured indirectly through static markers of prenatal testosterone (2D:4D digit ratio) and pubertal testosterone (body musculature and facial masculinity), on both cooperation and aggressive behavior in the context of intergroup conflict among men. Supporting the MWH, our results show that the intergroup conflict scenario promotes cooperation within group members and aggression toward outgroup members. Regarding the hormonal underpinnings of this phenomenon, we find that body musculature is positively associated with aggression and cooperation, but only for cooperation when context (inter-group competition) is taken into account. Finally, we did not find evidence that the formidability of the group affected individual rates of aggression or cooperation, controlling for individual characteristics.

Presence of the p.L456V polymorphism in Cuban patients clinically diagnosed with Wilson's disease. / Polimorfismo p.L456V, presencia en pacientes cubanos con diagnóstico clínico presuntivo de la enfermedad de Wilson.

INTRODUCTION AND AIMS: Wilson's disease is characterized by the accumulation of copper in different organs, mainly affecting the liver, brain, and cornea, and is caused by mutations in the ATP7B gene. More than 120 polymorphisms in the ATP7B gene have been reported in the medical literature. The aim of the present study was to identify the conformational changes in the exon 3 region of the ATP7B gene and detect the p.L456V polymorphism in Cuban patients clinically diagnosed with Wilson's disease. MATERIAL AND METHODS: A descriptive study was conducted at the Centro Nacional de Genética Médica and the Instituto Nacional de Gastroenterología within the time frame of 2007-2012 and included 105 patients with a clinical diagnosis of Wilson's disease. DNA extraction was performed through the salting-out method and the fragment of interest was amplified using the polymerase chain reaction technique. The conformational shift changes in the exon 3 region and the presence of the p.L456V polymorphism were identified through the Single-Strand Conformation Polymorphism analysis. RESULTS: The so-called b and c conformational shift changes, corresponding to the p.L456V polymorphism in the heterozygous and homozygous states, respectively, were identified. The allelic frequency of the p.L456V polymorphism in the 105 Cuban patients that had a clinical diagnosis of Wilson's disease was 41% and liver-related symptoms were the most frequent in the patients with that polymorphism. CONCLUSION: The p.L456V polymorphism was identified in 64 Cuban patients clinically diagnosed with Wilson's disease, making future molecular study through indirect methods possible.

Cardioprotective strategies preserve the stability of respiratory chain supercomplexes and reduce oxidative stress in reperfused ischemic hearts.

Electron leakage from dysfunctional respiratory chain and consequent superoxide formation leads to mitochondrial and cell injury during ischemia and reperfusion (IR). In this work we evaluate if the supramolecular assembly of the respiratory complexes into supercomplexes (SCs) is associated with preserved energy efficiency and diminished oxidative stress in post-ischemic hearts treated with the antioxidant N-acetylcysteine (NAC) and the cardioprotective maneuver of Postconditioning (PostC). Hemodynamic variables, infarct size, oxidative stress markers, oxygen consumption and the activity/stability of SCs were compared between groups. We found that mitochondrial oxygen consumption and the activity of respiratory complexes are preserved in mitochondria from reperfused hearts treated with both NAC and PostC. Both treatments contribute to recover the activity of individual complexes. NAC reduced oxidative stress and maintained SCs assemblies containing Complex I, Complex III, Complex IV and the adapter protein SCAFI more effectively than PostC. On the other hand, the activities of CI, CIII and CIV associated to SCs assemblies were preserved by this maneuver, suggesting that the activation of other cardioprotective mechanisms besides oxidative stress contention might participate in maintaining the activity of the mitochondrial respiratory complexes in such superstructures. We conclude that both the monomeric and the SCs assembly of the respiratory chain contribute to the in vivo functionality of the mitochondria. However, although the ROS-induced damage and the consequent increased production of ROS affect the assembly of SCs, other levels of regulation as those induced by PostC, might participate in maintaining the activity of the respiratory complexes in such superstructures.

Structure and piezo-ferroelectricity relationship study of (K0.5Na0.5)0.985La0.005NbO3 epitaxial films deposited on SrTiO3 by sputtering.

This work demonstrates that the rf-sputtering technique, combined with appropriate heat treatments, is potentially effective to develop new materials and devices based on oxide-interface and strain engineering. We report a study of the structural-physical properties relationship of high crystalline quality, highly oriented and epitaxial thin films of the lead-free (K0.5Na0.5)0.985La0.005NbO3 (KNNLa) compound which were successfully deposited on Nb-doped SrTiO3 substrates, with orientations [100] (NSTO100) and [110] (NSTO110). The crystalline growth and the local ferroelectric and piezoelectric properties were evaluated by piezoresponse force microscopy combined with transmission electron microscopy and texture analysis by X-ray diffraction. Conditioned by the STO surface parameters, in the KNNLa films on NSTO100 coexist a commensurate [001]-tetragonal phase and two incommensurate [010]-monoclinic phases; while on NSTO110 the KNNLa films grew only in an incommensurate [101]-monoclinic phase. Both samples show excellent out-of-plane polarization switching patterns consistent with 180° domains walls; while for KNNLa/NSTO100 ferroelectric domains grow with the polarization pointing down, for KNNLa/NSTO110 they prefer to grow with the polarization pointing up. Comparing with previous reports on epitaxial KNN films, we find our samples to be of very high quality regarding their crystalline growth with highly ordered ferroelectric domains arrangements and, consequently, great potential for domain engineering.

Synthesis and Complete Antimicrobial Characterization of CEOBACTER, an Ag-Based Nanocomposite.

The antimicrobial activity of silver nanoparticles (AgNPs) is currently used as an alternative disinfectant with diverse applications, ranging from decontamination of aquatic environments to disinfection of medical devices and instrumentation. However, incorporation of AgNPs to the environment causes collateral damage that should be avoided. In this work, a novel Ag-based nanocomposite (CEOBACTER) was successfully synthetized. It showed excellent antimicrobial properties without the spread of AgNPs into the environment. The complete CEOBACTER antimicrobial characterization protocol is presented herein. It is straightforward and reproducible and could be considered for the systematic characterization of antimicrobial nanomaterials. CEOBACTER showed minimal bactericidal concentration of 3 µg/ml, bactericidal action time of 2 hours and re-use capacity of at least five times against E. coli cultures. The bactericidal mechanism is the release of Ag ions. CEOBACTER displays potent bactericidal properties, long lifetime, high stability and re-use capacity, and it does not dissolve in the solution. These characteristics point to its potential use as a bactericidal agent for decontamination of aqueous environments.

Abordaje posteromedial y colocación de placa en fractura de meseta tibial con fragmento posterior / Posteromedial approach and plating for a tibial plateau fracture with a posterior fragment

Antecedentes: Las fracturas de meseta tibial representan 1% de todas las fracturas, de éste, 10% corresponde a la meseta medial. El espectro de lesiones va desde fracturas no desplazadas hasta fracturas devastadoras del platillo tibial completo que requieren manejo quirúrgico extenso. Literatura en cirugía ortopédica sugiere que los resultados funcionales y radiográficos positivos dependen del tipo de abordaje, la calidad de la reducción y el tipo de implante utilizado. Material y métodos: Reporte de casos ambispectivo; comprendió de siete pacientes con fractura de meseta tibial medial y fragmento posterior a los cuales se les colocó placa posterior luego del abordaje posteromedial en un período de tiempo entre Agosto 2012 y Agosto 2013. Se utilizó la clasificación de Khan para estadificar la fractura. Se evaluó el resultado funcional y radiográfico mediante escala de Rasmussen. Se realizó estadística de frecuencias y descriptiva. Resultados: Se midió el dolor utilizando la escala visual análoga (EVA), encontrando un mínimo de dos puntos y un máximo de cuatro puntos. La flexión osciló entre 40º y 110º con un déficit de extensión mínimo de 15º y máximo de 40º. La deformidad en varo se presentó en cuatro sujetos, la deformidad en valgo en tres. Conclusiones: El abordaje posteromedial y la colocación de placa posterior en fracturas de meseta tibial presentan arcos de movilidad adecuados para la función, así como un bajo grado de dolor. La angulación en varo se presenta en pacientes con fractura de ambos platillos tibiales.

Background: Tibial plateau fractures account for 1% of all fractures. Ten percent of them involve the medial plateau. The spectrum of lesions ranges from undisplaced fractures to devastating fractures involving the entire tibial plateau, which warrant extensive surgical management. The orthopedic surgery literature suggests that positive functional and radiographic results depend on the type of approach, the quality of reduction and the type of implant used. Material and methods: Ambispective case report: seven patients were enrolled, with fracture of the medial tibial plateau and a posterior fragment. A posterior plate was placed after a posteromedial approach, between August 2012 and August 2013. Fractures were staged according to the Khan classification. Functional and radiographic results were assessed using the Rasmussen scale. Frequency and descriptive statistics were used. Results: Pain was measured using a visual analog scale (VAS), with scores ranging from two to four. Flexion ranged between 40º and 110º, with a minimum extension deficit of 15º and a maximum of 40º. Four subjects had varus deformity, three had valgus deformity. Conclusions: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. Varus angulation occurs in patients with bilateral tibial plateau fractures.

Escherichia coli-induced temporal and differential secretion of heat-shock protein 70 and interleukin-1ß by human fetal membranes in a two-compartment culture system.

INTRODUCTION: Escherichia coli is recognized as an etiological bacteria associated with chorioamnionitis and the preterm premature rupture of fetal membranes. This pathological condition induces pro-inflammatory cytokines and degradative metalloproteinases, which are considered biological markers secreted in an acute stage of infection. Heat-shock proteins (HSPs) are an important component of the innate immunity response and are found in different pathological conditions. They have not been previously measured in human fetal membranes in response to infectious conditions. We hypothesized that the choriodecidual tissue and amniotic epithelium secreted temporal and differential Hsp-60, Hsp-70, and interleukin (IL)-1ß mediated by E. coli infection. METHODS: Fetal membranes were mounted in a two-compartment culture system and infected with two passes of live E. coli at different doses (10², 104, 105, and 106 colony-forming units (CFU)/mL) and intervals of incubation (3, 6, and 24 h). The culture medium was collected, and Hsp-60, Hsp-70, and IL-1ß were assessed using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: After 3 and 6 h of infection, E. coli induced an increase in Hsp-70 secretion in the choriodecidual tissue. However, after 24 h of incubation, Hsp-70 was downregulated and we observed an increase in IL-1ß secretion. By contrast, E. coli induced a lower Hsp-60 secretion in the amnion compared to Hsp-70. DISCUSSION: Human fetal membranes responded actively to E. coli infection, with an increase in Hsp-70 during the first hours of infection. After 24 h, there was an increase in the liberation of IL-1ß.

[Posteromedial approach and plating for a tibial plateau fracture with a posterior fragment]. / Abordaje posteromedial y colocación de placa en fractura de meseta tibial con fragmento posterior.

BACKGROUND: Tibial plateau fractures account for 1% of all fractures. Ten percent of them involve the medial plateau. The spectrum of lesions ranges from undisplaced fractures to devastating fractures involving the entire tibial plateau, which warrant extensive surgical management. The orthopedic surgery literature suggests that positive functional and radiographic results depend on the type of approach, the quality of reduction and the type of implant used. MATERIAL AND METHODS: Ambispective case report: seven patients were enrolled, with fracture of the medial tibial plateau and a posterior fragment. A posterior plate was placed after a posteromedial approach, between August 2012 and August 2013. Fractures were staged according to the Khan classification. Functional and radiographic results were assessed using the Rasmussen scale. Frequency and descriptive statistics were used. RESULTS: Pain was measured using a visual analog scale (VAS), with scores ranging from two to four. Flexion ranged between 40° and 110°, with a minimum extension deficit of 15° and a maximum of 40°. Four subjects had varus deformity, three had valgus deformity. CONCLUSIONS: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. Varus angulation occurs in patients with bilateral tibial plateau fractures.

PKA tightly bound to human placental mitochondria participates in steroidogenesis and is not modified by cAMP.

INTRODUCTION: Protein phosphorylation plays an important role in the modulation of steroidogenesis and it depends on the activation of different signaling cascades. Previous data showed that PKA activity is related to steroidogenesis in mitochondria from syncytiotrophoblast of human placenta (HPM). PKA localization and contribution in progesterone synthesis and protein phosphorylation of HPM was assessed in this work. METHODS: Placental mitochondria and submitochondrial fractions were used. Catalytic and regulatory PKA subunits were identified by Western blot. PKA activity was determined by the incorporation of (32)P into proteins in the presence or absence of specific inhibitors. The effect of PKA activators and inhibitors on steroidogenesis and protein phosphorylation in HPM was tested by radioimmunoassay and autoradiography. RESULTS: The PKAα catalytic subunit was distributed in all the submitochondrial fractions whereas ßII regulatory subunit was the main isoform observed in both the outer and inner membranes of HPM. PKA located in the inner membrane showed the highest activity. Progesterone synthesis and mitochondrial protein phosphorylation are modified by inhibitors of PKA catalytic subunit but are neither sensitive to inhibitors of the regulatory subunit nor to activators of the holoenzyme. DISCUSSION: The lack of response in the presence of PKA activators and inhibitors of the regulatory subunit suggests that the activation of intramitochondrial PKA cannot be prevented or further activated. CONCLUSIONS: The phosphorylating activity of PKA inside HPM could be an important component of the steroidogenesis transduction cascade, probably exerting its effects by direct phosphorylation of its substrates or by modulating other kinases and phosphatases.

Frecuencia de la infección por nemátodos gastrointestinales en ovinos y caprinos de cinco municipios de Antioquia / Infection frequency of gastrointestinal nematode in goats and sheep of five municipalities in Antioquia

Objetivo. Determinar la frecuencia de infección por nemátodos gastrointestinales en ovinos y caprinos de apriscos de algunos municipios de Antioquia. Materiales y métodos. Estudio descriptivo de corte realizado entre febrero y junio del 2011 en muestras de materia fecal de 84 caprinos y 11 ovinos distribuidos entre 2 y 132 meses de edad en 6 apriscos de Antioquia. Se determinó el recuento de huevos por gramo de heces (hpg) usando la técnica de Mcmaster, y para obtención del estadio larvario 3, la técnica de Corticelli y Lai. Para la identificación del género de las larvas se emplearon claves taxonómicas de nemátodos gastrointestinales de ovinos y caprinos. Se calcularon la frecuencia y asociación entre los datos epidemiológicos y la infección por tricostrongilidos mediante la prueba de independencia de Chi cuadrado, y prueba de contraste U de Mann-Whitney. Resultados. La frecuencia de infección fue 86.6% y los nemátodos con mayor prevalencia fueron Haemonchus contortus (66.3%), Oesophagostomum spp., (38.9%), Trichostrongylus spp., (34.7%) y Ostertagia spp., (24.2%). Se encontró una diferencia estadísticamente significativa entre la proporción de infectados y no infectados según la raza. Conclusiones. Existen diferencias entre la frecuencia de infección de las razas Camuro, La mancha y Toggenburg, en comparación con otras razas de los mismos apriscos. Esta variación puede relacionarse con procesos de resistencia, reponiéndose a la infección, sobre los cuales se hace necesaria la realización de investigaciones enfocadas al estudio de mecanismos de acción en ovinos y caprinos de Antioquia.

Objective. To determine the frequency of gastrointestinal nematode infection in goat and sheep folds of some municipalities of Antioquia. Materials and methods. A cross-sectional descriptive study was carried out between February and June 2011 in fecal samples of 84 goats and 11 sheep between 2 and 132 months of age in six folds in Antioquia. The number of eggs per gram of feces (epg) was determined using the McMaster technique, and the 3rd larval stage was obtained by means of Corticelli and Lai technique. For larval gender identification, gastrointestinal nematode taxonomical keys for goats and sheep were used. Tricostrongilides infection frequency and its association with epidemiological data was measured by means of chi-square test and comparison of proportions by column with Z test and U of Mann-Whitney contrast test. Results. Nematode infection frequency was 86.6% and Haemonchus contortus (66.3%), Oesophagostomum spp (38.9%), Trichostrongylus spp (34.7%) and Ostertagia spp. (24.2%) were the most prevalent nematodes. A statistically significant difference was found between infected and non-infected proportion per animal breed. Conclusions. There are differences between infection frequencies in Camuro, La mancha and Toggenburg breeds compared with other breeds in the same folds. These differences can be related with resistance and/or recovering from infection, but more research focused in mechanisms of action in goats and sheep of Antioquia is necessary.

[Risk factors for ventricular peritoneal shunt infection in pediatric patients from the hospital Carlos Van Buren]. / Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren.

Hydrocephalus is a common problem in Neurosurgery and Neurology. The usual treatment is the installation of a Ventricular Peritoneal Shunt (VPS). Infection is the most frequent and serious complication. With the aim to identify risk factors associated with infection in the post surgery of VPS in pediatric patients from Carlos Van Buren Hospital a case control study between 1998-2008 was done. Cases were patients with VPS infection reported to the Department of Nosocomial Infections. Results in contingency tables were analyzed to determine Odds Ratio. 264 surgical procedures were studied in 207 patients with 53 infections reported in 26 patients. Significant risk factors were: history of prior ventriculitis, VPS dysfunction and prior external ventricular shunt, concurrent infections at the time of surgery and a neurosurgeon without the specialty of pediatric neurosurgery. We concluded that antibiotic prophylaxis was not an important factor in preventing infection and the neurosurgeon experience is relevant to the development of VPS infections.

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren / Risk factors for ventricular peritoneal shunt infection in pediatric patients from the hospital Carlos Van Buren

Hydrocephalus is a common problem in Neurosurgery and Neurology. The usual treatment is the installation of a Ventricular Peritoneal Shunt (VPS). Infection is the most frequent and serious complication. With the aim to identify risk factors associated with infection in the post surgery of VPS in pediatric patients from Carlos Van Buren Hospital a case control study between 1998-2008 was done. Cases were patients with VPS infection reported to the Department of Nosocomial Infections. Results in contingency tables were analyzed to determine Odds Ratio. 264 surgical procedures were studied in 207 patients with 53 infections reported in 26 patients. Significant risk factors were: history of prior ventriculitis, VPS dysfunction and prior external ventricular shunt, concurrent infections at the time of surgery and a neurosurgeon without the specialty of pediatric neurosurgery. We concluded that antibiotic prophylaxis was not an important factor in preventing infection and the neurosurgeon experience is relevant to the development of VPS infections.

La hidrocefalia es un problema común en neurocirugía y neurología. Su tratamiento habitual es la instalación de una válvula derivativa ventrículo peritoneal (DVP) cuya complicación más grave y frecuente es la infección. Con el propósito de identificar los factores de riesgo de infección post-operatoria en pacientes con DVP del Hospital Carlos Van Buren (HCVB), se realizó un estudio caso-control en la población pediátrica con DVP instalada entre 1998 y 2008. Los casos fueron pacientes con una infección de DVP notificada en el Departamento de Infecciones Intrahospitalarias (IIH), y controles los que no presentaron infección. Se analizaron los resultados en tablas de contingencia para determinar los Odds Ratio correspondientes. Se estudiaron 264 procedimientos quirúrgicos, 207 pacientes y 53 infecciones notificadas en 26 enfermos. Los factores de riesgo significativos fueron el antecedente de ventriculitis previa, disfunción de DVP previa, derivativa ventricular externa previas, infecciones concomitantes al momento de la cirugía, y que el neurocirujano no tuviera la especialidad en neurocirugía pediátrica. Se concluyó que la profilaxis antimicrobiana no fue un factor importante en la prevención de infecciones y que la experiencia del neurocirujano es relevante en el desarrollo de infecciones de DVP.

Mitochondrial heat shock protein participates in placental steroidogenesis.

The human placenta, which does not express the StAR protein, synthesizes large amounts of progesterone. The rate-limiting step for steroidogenesis is the transport of cholesterol which is divided into two steps: 1) cholesterol flux from cytoplasm to outer membrane mitochondria, and 2) cholesterol transport from outer to inner mitochondrial membrane. The proteins mediating placental cholesterol influx have not been clearly identified. We investigated the proteins involved in the transport of cholesterol in syncytiotrophoblast mitochondria from human placenta. Two proteins, one of 30 kDa, and another of 60 kDa, were identified using anti-MLN64 antibodies. The 30 kDa protein corresponds to a fragment of MLN64, and the 60 kDa protein was identified as a heat shock protein. During steroidogenesis, mitochondria released MLN64 protein to supernatant. When this supernatant was added to fresh isolated mitochondria, progesterone synthesis increased; a similar result was obtained with the addition of the recombinant MLN64-START protein. In the presence of flurescein-5-maleimide or N-ethyl-maleimide, the mitochondrial synthesis of progesterone was inhibited in a dose-dependent fashion without changes in mitochondrial respiration. 2D-electrophoretic pattern showed that flurescein-5-maleimide- fluorescence was associated with HSP60. Both MLN64 and HSP60 were identified in mitochondrial contact sites. The results suggest that HSP60 is involved in the steroidogenic metabolism of human placenta. A tight association between MLN64 and HSP60 is suggested for cholesterol transport in the human placenta.

Brote de queratoconjuntivitis epidémica en un Servicio de Oftalmología / A nosocomial outbreak of epidemic keratoconjunctivitis

We describe a nosocomial outbreak of keratoconjunctivitis at the Ophthalmology Clinic in Hospital Carlos Van Buren, that affected 150 patients, during August and September of 2006. This outbreak was concomitant with a community outbreak produced by the same agent in the city of Valparaiso that affected 681 other patients. Although adenovirus was not isolated in the nosocomial cases, positive cultures were obtained from community cases, so the diagnosis was based on clinical and epidemiological criteria. The infection rate within the Clinic patients was 5.2 percent considering the population that attended the Clinic in this period. The evaluation of patient care practices showed that common risk factors among affected cases were measurement of ocular tension with a tonometer in the Ophthalmology Clinic (without disinfection of the tonometer between patients), contamination of work surfaces (equipment, furniture), and poor compliance of hand hygiene. Control measures adopted were cleaning, disinfection of tonometer, equipment and work surfaces, and reinforcement of hand hygiene measures. With these measures, it was possible to control the nosocomial outbreak, despite the continued outpatient care of community-acquired cases.

Se describe un brote nosocomial de queratoconjun-tivitis epidémica en la Policlínica de Oftalmología del Hospital Carlos Van Burén, que afectó a 150 pacientes, durante los meses de agosto y septiembre de 2006. Este brote se presentó en el contexto de un brote en la ciudad de Valparaíso que afectó a otros 681 pacientes. Aun cuando no se logró aislar adenovirus (ADV) en los casos nosocomiales, se aisló ADV en pacientes del brote comunitario, por lo que el diagnóstico de los casos nosocomiales se basó en criterios clínicos y epidemiológicos. La tasa de ataque del brote nosocomial fue de 5,2 por ciento considerando la población consultante del período. La evaluación de prácticas de atención directa mostró que los factores de riesgo de los casos serían la medición de la tensión ocular mediante tonómetro en la Policlínica de Oftalmología (sin desinfección del tonómetro entre paciente y paciente), contaminación de superficies de trabajo (equipos, mobiliario) y bajo cumplimiento de la higienización de manos. Las medidas de control fueron limpieza, desinfección del tonómetro, equipos y superficies de trabajo, junto a reforzamiento de lavado de manos. Con estas medidas se logró controlar el brote intrahospitalario a pesar de mantenerse las consultas provenientes del brote en la comunidad.

Contribution of potassium in human placental steroidogenesis.

The role of K(+) on steroidogenesis in isolated mitochondria from the human placenta was explored. Cholesterol uptake and progesterone synthesis were stimulated by K(+), and by the further addition of ATP. In the presence of glibenclamide or quinine (inhibitors of the K(+) channel mito-K(ATP)), the synthesis of progesterone was improved, indicating that K(+) acts outside the mitochondria. Valinomycin, a K(+)-ionophore, inhibited mitochondrial steroidogenesis only in the absence of K(+). The mitochondrial K(+) channel in human placental mitochondria is formed by the subunit Kir 6.1 which was detected by Western blot with polyclonal antibodies. These results suggest that K(+) contributes placental mitochondrial steroidogenesis facilitating cholesterol uptake and intermembrane translocation through a mechanism non-dependent of the transport of K(+) inside the mitochondria.