ClO-driven degradation of graphene oxide: new insights from DFT calculations.

We present an extensive investigation using density functional theory (DFT) calculations on various model graphene oxide (GO) nanostructures interacting with chlorine monoxide ClO, aiming to understand the role of this highly oxidizing species in C-C bond breakage and the formation of significant holes on GO sheets. During its function, the myeloperoxidase (MPO) enzyme abundantly generates chlorine-oxygen-containing species and their presence has been identified as the cause of degradation in carbon nanotubes of diverse sizes, morphologies, and chemical compositions, both in in vivo and in vitro samples. Notably, Kurapati et al. (Small, 2015, 11, 3985-3994) demonstrated efficient degradation of single GO monolayers through MPO catalysis, though the exact degradation mechanism remains unclear. In our study, we discover that breaking C-C bonds in a single graphene oxide sheet is achievable through a simple mechanism involving the dissociation of two ClO molecules that are chemically attached as nearest neighbor species but bonded to opposite sides of the GO layer (up/down configuration). Two new carbonyl oxygens appear on the surface and the Cl atoms can be transferred to the carbon layer or as physisorbed species near the GO surface. Relatively small energy barriers are associated with these molecular events. Continuing this process on neighboring sites leads to the presence of larger holes on the GO surface, accompanied by an increase in carbonyl species on the carbon network, consistent with X-ray photoelectron spectroscopy measurements. Indeed, the distribution of oxygen functionalities is found to be crucial in defining the damage pattern induced in the carbon layer. We emphasize the important role played by the local charge distribution in the stability or instability of chemical bonds, as well as in the energy barriers and reaction pathways. Finally, we explore the possibility of achieving chlorination of GO following MPO exposure. The here-reported predictions could be the root cause of the experimentally observed low stability of individual GO sheets during the MPO catalytic cycle.

Miocarditis inducida por Clozapina: Revisión y protocolo de Screening

Clozapina, el gold standard en esquizofrenia refractaria, presenta algunos efectos adversos que ocasionalmente pueden ser graves. Entre ellos, la miocarditis precoz es un efecto cardiovascular severo poco frecuente que puede aparecer en las primeras 4-6 semanas. Las cifras de incidencia oscilan entre el 0,015-0.188% en el mundo, siendo más altas en Australia. La etiología es desconocida, postulándose hipersensibilidad mediada por Ig E; hipereosinofilia y hiperadrenergia. Múltiples investigaciones avalan a la ecocardiografía como una de las técnicas más útiles para el diagnóstico. La biopsia endomiocárdica es definitoria pero no viable. Existen, asimismo, criterios de RNM indicativos de inflamación miocárdica. Para facilitar el diagnóstico, se han propuesto criterios clínicos y analíticos de screening (hemograma, ECG, CK, PCR, troponinas). En caso de sospecha de miocarditis, el cese de clozapina y el tratamiento de soporte es la actitud a seguir, habitualmente con buenos resultados.

Although Clozapine is the gold standard treatment in resistant-schizophrenia, severe or even life-threatening adverse effects must be taked into account. Early myocarditis, a severe but unusual cardiovascular effect, can appear in the first 4-6 weeks of initiation. Incidence rates of myocarditis are about 0,015-0,188% around the world, being more elevated in Australia. Aethiology is unknown, suggesting Ig E mediated hipersensibility, hiperaeosinophilia and hiperadrenergy. Echocardiography seems to be one of the most helpful tools for diagnosing myocarditis. Endomyocardial biopsy is definitive, but not usually available. A role for cardiac magnetic resonance imaging (MRI) also has been proposed (findings of inflammation). In order to make an early diagnosis, several screening-criteria, considering clinical and laboratory ones, have been proposed: aeosinophylia, creatininkinase, C Reactive Proteine, troponin, and EKG. If we suspected clozapine-induced myocarditis, the drug must be removed and support medical treatment must be indicated.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study.

BACKGROUND AND OBJECTIVE: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. METHODS: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. RESULTS: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non-ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. CONCLUSIONS: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died.

In vitro and in vivo development of domestic cat embryos generated by in vitro fertilization after eCG priming and oocyte in vitro maturation.

The objective of this study was to evaluate, in the domestic cat, the effect of ovarian stimulation with eCG prior to oocyte in vitro maturation (priming) on in vitro and in vivo development after in vitro fertilization (IVF). For this purpose, oocyte donors were either 1) treated with a single dose of 200 IU eCG four days before oocyte recovery (eCG group), or, 2) given no treatment before oocyte recovery (control group). Ovaries of both groups were collected by ovariohysterectomy (OVH) and cumulus-oocyte complexes (COCs) were recovered by slicing. Immature COCs from both groups were matured in vitro (IVM) for 26-28 h. IVF was done with refrigerated epididymal sperm. After 24 h co-incubation, presumptive zygotes were cultured in vitro for eight days. The rates of cleavage, morulae, blastocyst development and hatching were estimated. Some blastocysts were stained for total cell counting and others were used for gene expression analysis of pluripotency (OCT4, SOX2 and NANOG) and differentiation markers (CDX2 and GATA6). Additionally, to evaluate in vivo development, embryos from the eCG group were transferred at Day 5 and Days 7 or 8 of IVC to synchronized cat recipients. The results showed that, eCG priming increased significantly the rate of blastocyst development as compared to the control group (37.9 and 25.6%, respectively) (P < 0.05). No differences were observed in total cell number of blastocysts and hatching blastocysts (mean ± SD) between the eCG and control groups (420.6 ± 193.6 and 347.0 ± 237.1, respectively) (P > 0.05). In the gene expression analysis, blastocysts generated in the eCG group had higher expression of OCT4 than blastocysts from the control group (P < 0.05). However, no significant differences were observed in the relative expression of SOX2, NANOG, CDX2 and GATA6 (P > 0.05). Additionally, six embryo transfer (ET) procedures were done, three with Day 5 embryos and three with Day 7 or 8 embryos. Recipients from both ET groups delivered live kittens. The total pregnancy rate was 4/6 (67%), meanwhile the live birth rate was 2/6 (33%). In conclusion, eCG priming improved the rate of blastocyst development in vitro and increased relative expression of OCT4. These results demonstrate that eCG priming of oocytes donors before IVM improves oocyte competence, enhance in vitro embryo development and allows live births of healthy offspring after ET.

Educación prenatal e inicio de la lactancia materna: Revisión de la literatura / Prenatal education and the commencement of breastfeeding: A literature review / Educação pré-natal e início do aleitamento materno: revisão da literatura

Introducción: Las recomendaciones universales para la alimentación infantil incluyen la lactancia materna (LM) exclusiva durante los primeros 6 meses de vida y posteriormente alimentación complementaria hasta los 2 años, así como la importancia del inicio de la lactancia en la primera hora de vida. Metodología: Búsqueda sistemática en diversas bases de datos del área de la salud cuyo objetivo fue determinar la influencia de la educación prenatal impartida, en general por los profesionales de la salud y en particular por la matrona, en la decisión de optar por la LM. Resultados y discusión: El éxito de la LM depende de la información y del apoyo proporcionado a la familia. Influye negativamente en su instauración y mantenimiento la falta de información y apoyo, las prácticas sanitarias inadecuadas y la escasa formación de los profesionales. Contribuye positivamente haber sido atendida por una matrona durante el embarazo. Existe evidencia, con categoría A, de que las clases prenatales realizadas por matronas aumentan la prevalencia, la duración y la exclusividad de la lactancia, así como el establecimiento de la lactancia al alta hospitalaria tras el parto. Se recomienda, con un grado B, proporcionar a los padres información sobre lactancia en las clases prenatales. No hay diferencias significativas en cuanto a los motivos por los cuales se abandona la lactancia entre las mujeres que realizaron educación prenatal con las que no la realizaron. Conclusiones: La educación maternal realizada por matronas desde la primera visita prenatal es un factor protector en el inicio y mantenimiento de la LM y debe incluir explicaciones sobre los beneficios que comporta y guías sencillas para resolver dudas y complicaciones.

Introduction: The recommendations on child nourishment include starting maternal breastfeeding within the first hour of life, and continuing it, exclusively, during the first 6 months of life; thereafter, a complementary diet can be included. Methodology: A systematic search in diverse databases related to the health area was conducted with the objective of determining the influence of prenatal education provided, in general by the health professionals, and in particular by midwives, on the mothers' decision to breastfeed. Results and discussion: The success of maternal breastfeeding depends on the information and the support provided to her family. Barriers to breastfeeding include the lack of information and support, the inadequate sanitary practices, and the poor preparation of the health professionals. Promoters to breastfeeding include having been assisted by a midwife during the partum. There is category-A evidence, that prenatal classes given by midwives, and the early establishment of maternal breastfeeding -following the partum- both increment the prevalence, duration, and exclusivity of breastfeeding. There were no significant differences related to the motives of abandoning breastfeeding among women who had prenatal education and who did not. Conclusions: The maternal education provided by midwives from the first prenatal visit is a promoting factor to establishing and maintaining breastfeeding. In general, prenatal education should include explanations of the benefits of breastfeeding, as well as simple guidelines related to the possible doubts.

Introdução: As recomendações universais para a alimentação infantil incluem o aleitamento materno (AM) exclusivo durante os primeiros 6 meses de vida e posteriormente alimentação complementar até os dois anos, assim como a importância do início do aleitamento na primeira hora de vida. Metodologia: Busca sistemática em diversas bases de dados da área de saúde, cujo objetivo foi determinar a influência da educação pré-natal ensinada, en geral pelos profissionais da saúde e em particular pela parteira, na decisão de optar pelo AM. Resultados e discussão: O sucesso do AM depende da informação e o apoio proporcionado à família. Influi negativamente em sua instauração e na manutenção pela falta de informação e apoio, as práticas sanitárias inadequadas e a escassa formação dos profissionais. Influi positivamente ter sido atendida por uma parteira durante a gravidez. Existe evidência, com categoria A, de que as aulas pré-natais realizadas por parteiras aumentam a prevalência, duração e exclusividade do aleitamento. Assim como o estabelecimento do aleitamento após a alta hospitalar trás o parto. Recomenda-se, com um grau B, proporcionar aos pais informação sobre aleitamento nas aulas pré-natais. Não há diferenças significativas quanto aos motivos pelos quais se abandona o aleitamento entre as mulheres que realizaram educação pré-natal com as que não. Conclusões: A educação materna realizada por parteiras desde a primeira visita pré-natal é um fator protetor no início e de manutenção do AM e deve incluir explicações sobre os benefícios que proporciona e guias simples para resolver dúvidas e complicações.

[Long-term effect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study]. / Efecto a largo plazo del policosanol en la recuperacion funcional de pacientes con ictus isquemico no cardioembolico: estudio de un año.

INTRODUCTION: Stroke is a leading cause of mortality and disability. Policosanol has been effective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects. PATIENTS AND METHODS: Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modified Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months. RESULTS: Policosanol + aspirine decreased significantly mean mRS from the first interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs <= 1. Policosanol + aspirine increased significantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin. CONCLUSIONS: Long-term (12 months) administration of policosanol + aspirin given after suffering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity.

TITLE: Efecto a largo plazo del policosanol en la recuperacion funcional de pacientes con ictus isquemico no cardioembolico: estudio de un año.Introduccion. El ictus es una causa principal de mortalidad y discapacidad. El policosanol ha sido eficaz en modelos de isquemia cerebral. Este estudio investiga si el tratamiento a largo plazo con policosanol, añadido a la terapia con acido acetilsalicilico (AAS), dentro de los 30 dias posteriores a un ictus, es mejor que el placebo + AAS en la recuperacion de los pacientes. Pacientes y metodos. Estudio aleatorizado, doble ciego, controlado con placebo. Se incluyeron 80 pacientes (edad media: 69 años) que sufrieron un ictus en los 30 dias previos y con una puntuacion de 2-4 en la escala de Rankin modificada (mRS). Se distribuyeron aleatoriamente en dos grupos y recibieron policosanol + AAS o placebo + AAS durante 12 meses. Resultados. El tratamiento con policosanol + AAS disminuyo significativamente la puntuacion en la mRS desde el primer control intermedio (1,5 meses). El efecto del tratamiento incluso mejoro con la terapia a largo plazo. El numero de pacientes que alcanzaron valores de mRS menores o iguales a 1 fue superior en el grupo de policosanol + AAS (87,5%) que en el de placebo + AAS (0%). El tratamiento con policosanol + AAS aumento significativamente el indice de Barthel, disminuyo el colesterol LDL y aumento el colesterol HDL frente a placebo + AAS. Conclusiones. El tratamiento a largo plazo (12 meses) con policosanol + AAS fue mas efectivo que el tratamiento con placebo + AAS en la recuperacion funcional de los pacientes despues de sufrir un ictus isquemico no cardioembolico de moderada gravedad.

Time resolved spectroscopy of infrared emitting Ag2S nanocrystals for subcutaneous thermometry.

We report a systematic investigation on the temperature dependence of fluorescence decay dynamics of infrared emitting colloidal Ag2S nanocrystals (NCs) with different surface coatings. The drastic lifetime reduction in the biological temperature range (20-50 °C) makes Ag2S NCs outstanding candidates for high sensitivity subcutaneous lifetime-based thermal sensing in the second biological window (1000-1400 nm). Indeed, the lifetime thermal sensitivity of Ag2S NCs has been found to be as large as 3-4% °C-1 at an operating wavelength of 1250 nm. Their application for lifetime-based luminescence nanothermometry has been demonstrated through simple ex vivo experiments specially designed to elucidate the magnitude of subcutaneous thermal gradients. Experimental data were found to be in excellent agreement with numerical simulations.

Prevalencia del síndrome metabólico en pre-eclampsia / Metabolic syndrome prevalence in preeclampsia

OBJETIVO: Determinar la prevalencia del síndrome metabólico (SM) en mujeres embarazadas con preeclampsia, Hospital Materno Infantil de la Caja Nacional de Salud, La Paz-Bolivia. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal de 181 mujeres embarazadas durante un periodo de 22 meses. Se determinó el índice de masa corporal (IMC) y la presión arterial sistémica en el brazo derecho. El diagnóstico de SM fue realizado de acuerdo con el consenso de la IDF y NCEP ATP III; de los 5 criterios para diagnóstico de SM, se excluyó la circunferencia abdominal debido al cambio fisiológico del útero. Los datos fueron procesados con paquetes estadísticos SPSS 15.0 y Epi Info 3.5. Los resultados fueron correlacionados con tablas de contingencia 2 x 2 y evaluados con la prueba del Chi cuadrado. RESULTADOS: De las 181 mujeres embarazadas con pre-eclampsia, 49.7% presentaron SM, 80.1% hipertrigliceridemia, 60.9% colesterol HDL menor a 50 mg/ dl, 19.2% glucemia mayor a 110 mg/dl y 75.6% de IMC mayor a 25. Se encontró asociaciones estadísticamente significativas entre SM/preeclampsia y IMC mayor a 25/preeclampsia (X²:12,83, p<0,05). CONCLUSIONES: La prevalencia de SM en mujeres con preeclampsia es alta, existe una asociación estadísticamente significativa entre ambas variables.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) in pregnant women with preeclampsia at Materno Infantil Hospital, Caja Nacional de Salud in La Paz-Bolivia. MATERIAL AND METHODS: It was conducted an observational, descriptive and transversal study in 181 pregnant patients over a period of 22 months. Body mass index (BMI) and systemic blood pressure on rightarm were measured. MS diagnosis was based on the IDF and NCEP ATP III consensus, considering 5 criteria of MS diagnosis, it was excluded waist circumference due to the uterine physiological changes. All data were processed with SPSS 15.0 and Epi Info 3.5 statistical packages. Results were correlated with 2x2 contingency tables and evaluated with the chi-square test. RESULTS: Pregnant women displayed a 49.7% of metabolic syndrome, 80.1% hypertriglyceridemia, 60.9% HDL cholesterol less than 50 mg/dl, 19.2% of glucose higher than 110 mg/dl and 75.6% of BMI higher than 25. Statistically significant associations between SM/preeclampsia and BMI over 25/ preeclampsia (J² 12, 83, p<0, 05) were found. CONCLUSIONS: There is a higher prevalence of metabolic syndrome in women with preeclampsia, stating a statistically significant relationship between variables.

Ameloblastoma maxilar superior: presentación de caso clínico / Upper maxillary ameloblastoma: report of a clinical case

El ameloblastoma es una entidad patológica benigna de origen odontogénico, de alta agresividad local, lo que ha sido un punto de controversia en la literatura científica. Se presenta un caso clínico, con ubicación en maxilar superior con diagnóstico de ameloblastoma sólido multiquístico. Se evalúa el caso, su posibilidad de tratamiento, revisando las características clínicas y anatomopatológicas de laentidad, basándose en una búsqueda bibliográfica.

Ameloblastoma is a benign pathological entity of odontogenic origin, very aggressive at a local level, which has become a controversial issuein cientific literature. A clinic case is presented, located in the superior maxilla diagnosed as a solid multicystic ameloblastoma. The case isevaluated, its ways of treatment, the clinical and anatomopathological characteristics of the entity with an intensive bibliographical researc.

Malformación congénita de la vía aérea pulmonar o malformación adenomatoidea quística congénita: Serie clínica de 16 pacientes / Congenital pulmonary airway malformation or congenital cystic adenomatoid malformation

Objective: To describe 16 patients treated for a congenital pulmonary anomaly named congenital pulmonary airway malformation (CPAM) or congenital cystic adenomatoid malformation (CCAM) in Roberto del Río children S Hospital. Methods: We retrospectively analyzed the medical records of patienes who had had surgery for CPAM/CCAM from January 2000 to July 2014. Results: We found 16 cases, 9 of them were males. Nine had surgery within the first year of life (5 of them within 3 weeks of life). According to Stocker 's classification CPAM/CCAM was type 1 in 9 patients, and type 2 in 7. Diagnosis was based on antenatal ultrasonography s (n = 10), persistent abnormalities in Chest X-Ray (n = 4), recurrent pneumonia (n = 1) and incidental radiological findings (n = 1). Computed Tomography (CT) was performed in 13 patients, CT angiography in 2 and only chest x-ray in one. The lesions were located in right upper lobe (3), right middle lobe (2), right lower lobe (4), left upper lobe (4) and left lower lobe (3). One patient had pectus excavatum and another one had ventricuar septal defect. They all had open thoracotomy with lobectomy of the affected area. Postoperatively was uneventful except for transient lobar atelectasis in 2 patients. There was no mortality. Conclusions: We emphasize the early diagnosis and good outcome of our patients treated which this disease. Our findings are consistent with those that has been reported in the literature.

Objetivo: Describir los pacientes tratados por malformación congénita de la vía aérea pulmonar (MCVAP) o malformación adenomatoidea quística congénita (MAQC) en el Hospital de niños Roberto del Río desde el año 2000 hasta el segundo semestre de 2014. Métodos: Revisión retrospectiva de fichas clínicas. Resultados: 16pacientes, 9 hombres. Se operaron antes del año de vida 9 pacientes (5 de ellos antes de las 3 semanas de vida). Tipo de MCVAP (según clasificación de Stocker) tipo 1 fue 9/16 y tipo 2 fueron 7/16. La sospecha diagnóstica fue en base a diagnóstico prenatal 10/16, imagen radiológica persistente 4/16, neumonías repetidas 1/16 y hallazgo radiológico 1/16. Estudio imagenológico: Tomografia computada (TC) 13/16, Angio-TC 2/16y radiografía de tórax 1/16. Ubicación: lóbulo superior derecho 3/16, lóbulo medio 2/16, lóbulo inferior derecho 4/16, lóbulo superior izquierdo 4/16, lóbulo inferior izquierdo 3/16. Comorbilidad: ninguna 14/16, pectus excavatum 1/16, comunicación interventricular 1/16. Tratamiento quirúrgico: en todos los pacientes se realizó lobectomía total del lóbulo afectado por vía abierta. Evolución postoperatoria: Buena 14/16, atelectasia 2/16. No se registró mortalidad. Conclusiones: Se destaca el diagnóstico precoz y buena evolución de nuestros pacientes concordantes con la literatura.

Simulation of risk of tuberculosis infection in healthcare workers in hospitals of an intermediate incidence country.

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3-47·7] and 44% (95% CI 36·4-51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3-49·0) and 36% (95% CI 27·9-44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

Cuidado de enfermería para la familia del paciente crítico desde la teoría de la comprensión facilitada / Critical patient's family nursing care from the facilitated sensemaking theory

Introducción: La estancia de un ser querido en la unidad de cuidados intensivos es para la familia una experiencia estresante, traumática y desagradable que se relaciona con enfrentarse a una situación de salud cercana a la muerte, el sufrimiento, la ruptura de roles y el desconocimiento. En este contexto, intervenciones realizadas para que la familia entienda lo que está pasando y lo que debe hacer fomentan la sensación de tranquilidad, confort, seguridad; favorece la adaptación y previene resultados psicológicos adversos. Objetivo: Elaborar una propuesta de gestión que permita desde la teoría brindar cuidado de calidad y excelencia a la familia de los pacientes en cuidado crítico. Metodología: Análisis y aplicación de la teoría de la comprensión facilitada desde la perspectiva del Sistema Conceptual-Teórico-Empírico y el modelo de marco lógico. Resultado: Se presenta un plan de cuidados de enfermería que, hecho desde la teoría de la comprensión facilitada y las taxonomías NANDA, NIC, NOC, muestra aspectos inherentes a la valoración, resultados e intervenciones de cuatro diagnósticos prioritarios de las posibles situaciones más frecuentes que la familia debe enfrentar cuando un ser querido está en una condición crítica de su salud. Conclusión: Un plan de cuidados estandarizado basado en la teoría de la comprensión facilitada es una estrategia de aplicación del conocimiento de enfermería que (1) consolida un modelo de atención integral que favorece la visibilidad, continuidad, eficiencia, calidad y excelencia del cuidado, y (2) disminuye la hostilidad que para los familiares de los pacientes genera la experiencia del cuidado intensivo.

Introduction: The admission of a loved one into an intensive care ward is a very tense, traumatic, and disagreeable experience for the family, and is associated with a challenge to near death situations, suffering, role rupture and even ignorance. Within this context, nursing interventions, in order that the family may have a better understanding of the situation and what they should do. They should also promote the feelings of tranquility, security, comfort, and favor the adaptation, thus preventing adverse psychological results. Objective: To design a management proposal which, based on this theory, could allow giving care of quality and excellence to the families of patients in critical status. Methodology: Analysis and establishment of the facilitated sensemaking theory from the perspective of the Theoretical-Empirical-Conceptual system, and the logical frame model. Results: A nursing care plan is presented which, formulated from the facilitated sensemaking theory and the NANDA, NIC, NOC taxonomies, shows issues related to the assessment, results, and interventions in four priority evaluations of the possible more frequent situations which the family must face when a loved one is in a critical health status. Conclusion: A standardized care plan based on the facilitated sensemaking theory is a strategy to implement nursing knowledge that: 1) consolidates an integral care model which favors the visibility, continuity, efficiency, and excellence of care; 2) reduces the hostility experience by the patient's family from the intensive care situation.

[Acute portal thrombosis and gas in the liver: a report of two cases]. / Trombosis portal aguda y gas intrahepático: a propósito de dos casos.

The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.

Trombosis portal aguda y gas intrahepático: a propósito de dos casos / Acute portal thrombosis and gas in the liver: a report of two cases

La presencia de gas portal intrahepático en adultos es un fenómeno multifactorial en el que se comparten factores inflamatorios y protrombóticos sistémicos, frecuente en pacientes con cirrosis hepática avanzada y raro en individuos con hígado sano, sin embargo la presencia de focos inflamatorios abdominales y estados de hipercoagulabilidad secundaria a la respuesta inflamatoria sistémica la hace más frecuente, sus manifestaciones son inespecíficas y variables según la gravedad del cuadro. Presentamos dos pacientes con sintomatología inespecífica y estudios imagenológicos que reportaron gas portal intrahepático, uno secundario a enfermedad diverticular y otro a abscesos hepáticos que evolucionaron favorablemente con tratamiento quirúrgico, antibiótico y anticoagulante.

The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.

Protein-losing enteropathy in a dog with lymphangiectasia, lymphoplasmacytic enteritis and pancreatic exocrine insufficiency.

This is a report of seven-year-old male Akita mixed dog, with protein-losing enteropathy (PLE). He had a history of chronic vomiting and diarrhea with anorexia/hyporexia. Previously he suffered acute abdomen about eight months prior to this visit. Our dog showed uncommon combination of diseases that could cause PLE since it was affected by inflammatory bowel disease (IBD), intestinal lymphangiectasia (IL), and exocrine pancreatic insufficiency (EPI). The dog had most of the abnormalities found in IL, as well as hypoalbuminemia, hyperglobulinemia, lymphopenia, hypocalcemia, and hypercholesterolemia. During endoscopy exam, we found changes characteristic of IL such as irregular small white spots. We took biopsies from stomach, duodenum, and cecum. These biopsies showed infiltration by lymphocytes and plasmatic cells in the lamina propria also, the duodenal biopsies showed moderate dilation of the lymphatic vessels. The patient had 2.1 µg/mL of TLI, this result was compatible with EPI. We assume that the first pathology in this animal was IBD, which caused chronic pancreatitis (CP) that in turn progressed to EPI. It is also possible that IL was secondary to IBD. We have reported for the first time the correlation of IBD and EPI in dogs. This should change our approach to treating chronic diarrhea in dogs. Therefore, we propose that dogs diagnosed with EPI should also be subjected to endoscopy and intestinal biopsy. Similarly, to rule out secondary EPI, TLI should be measured routinely in dogs with IBD.

Hiperplasia fibrosa inflamatoria: reporte de un caso / Inflammatory fibrous hyperplasia: case report

Introducción: La Hiperplasia Fibrosa Inflamatoria es una alteración caracterizada por un agrandamiento del tejido conectivo; se considera una lesión reactiva ya que se presenta como respuesta a una irritante crónico local; es una lesión común en pacientes adolescentes y de edad adulta debido a que su etiología principal se asocia a maloclusión, al uso de aparatología protésica u ortodóntica mal ajustada, así como a la presencia de biofilm. Sin embargo, la población infantil, principalmente en dentición mixta, no está exenta de presentar esta alteración, aunque en menor proporción. Objetivo: Presentar el caso clínico de un paciente en dentición mixta que presenta una Hiperplasia Fibrosa Inflamatoria con el fin de presentar las características clínicas e histopatológicas de la lesión, enfatizando la importancia de un temprano y correcto diagnóstico. Presentación del Caso: Paciente masculino de 8 años de edad que se presenta a la clínica por presentar lesiones cariosas y malposición dental. A la exploración se observa un agrandamiento gingival localizado, en el órgano dentario 41. Se decide tomar una biopsia de la lesión para establecer el diagnóstico. Conclusión: Debido a que existen varias lesiones con características clínicas muy similares a las que presentaba el paciente, es necesario conocer los diagnósticos diferenciales, así como realizar el diagnóstico temprano de la lesión para poder llevar a cabo un tratamiento eficaz y adecuado.

Introduction: The Inflammatory Fibrous Hyperplasia (IFH) is a disorder consisting in a connective tissue overgrowth; it is considered a reactive lesion because it appears in response to a chronic and local irritant; this is a very common oral lesion in adolescents and adults, its etiology is associated with dental malocclusion, use of over-extended prosthetic and orthodontic appliances, and with the presence of biofilm (plaque). Nevertheless, child population, mainly patients in mixed dentition, are not exempt from presenting this lesion, in a lower proportion, though. Objective: The aim of this case report is to present the clinical case of a patient in mixed dentition, who displays an Inflammatory Fibrous Hyperplasia, with the purpose of showing the clinical and histopathological features of this lesion, emphasizing the importance of an early and correct diagnosis. Case Report: A 8 year-old male patient, was referred to the Pediatric Dentistry Clinic of the Division of Post-graduate studies and Research, of the School of Dentistry, UNAM, for showing decay lesions and dental malposition. Clinical examination revealed a localized gingival over-growth associated to the teeth 41. It was decided to take a biopsy of the lesion to establish the final diagnosis. Conclusion: Because there are numerous lesions with pretty similar clinical features to the ones the patient presented, it is imperative and essential to know the differential diagnosis of this lesion, and to achieve an early diagnosis to accomplish an effective and appropriate treatment.

Toxicity of medicinal plants used in traditional medicine in Northern Peru.

ETHNOPHARMACOLOGICAL RELEVANCE: The plant species reported here are traditionally used in Northern Peru for a wide range of illnesses. Most remedies are prepared as ethanol or aqueous extracts and then ingested. The aim of this study was to evaluate the potential toxicity of these extracts. MATERIALS AND METHODS: The toxicity of ethanolic and water extracts of 341 plant species was determined using a brine-shrimp assay. RESULTS: Overall 24% of the species in water extract and 76% of the species in alcoholic extract showed elevated toxicity levels to brine-shrimp. Although in most cases multiple extracts of the same species showed very similar toxicity values, in some cases the toxicity of different extracts of the same species varied from non-toxic to highly toxic. CONCLUSIONS: Traditional preparation methods take different toxicity levels in aqueous and ethanol extracts into account when choosing the appropriate solvent for the preparation of a remedy.

Periodontal disease in gestational and type 1 diabetes mellitus pregnant women.

OBJECTIVE: The present study evaluated the relationship between periodontal disease and its clinical variables in Brazilian non-diabetic pregnant women (C), gestational diabetes mellitus (GDM), or type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS: A periodontal exam was performed in one hundred and sixty-one pregnant women (GDM:80; T1DM:31; C:50) by a single-blinded calibrated examiner who recorded plaque index (PI), gingival index (GI), bleeding index (BI), gingival margin location (GM), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and tooth mobility index (MI). The medical variables were age, pregestational body mass index (pre-BMI), fasting plasma glucose (FPG), and glycated hemoglobin (HbA(1c) ). RESULTS: The GI, GM, PD, CAL, BOP, and MI were significantly higher (P < 0.01) among GDM and T1DM than for C. The PI was higher in GDM and similar between C and T1DM. The Adjusted Final Model for medical variables to evaluate the effects of groups on periodontal parameters confirmed these results. CONCLUSIONS: The presence of periodontal disease was significantly higher in Brazilian diabetic pregnancies (GDM and T1DM) when compared to non-diabetic pregnant women (C). The degree of periodontal disease was similar between the GDM and T1DM groups. Age, pregestational BMI, and HbA(1c) were factors related to CAL development in these two types of diabetes mellitus.

Relación entre motivación y hábitos de estudio en alumnos de la carrera de psicología de una universidad privada de Asunción / Relation between motivation and habits of study in students of the career of psychology of a private university of Asunción

La presente investigación es de tipo descriptivo correlacional, de corte transversal y el método utilizado es el cuantitativo. Tiene el objetivo de describir la relación existente entre Motivación y Hábitos de estudio en alumnos de la carrera de Psicología de una Universidad Privada de Asunción. La muestra está compuesta por 129 estudiantes seleccionados a través de un muestreo estratificado y de participación voluntaria. Los instrumentos aplicados son el Inventario de Métodos y Hábitos de Estudio de Álvarez de TEA Ediciones y un cuestionario prediseñado para el efecto. El análisis y procesamiento de los datos aplicó técnicas de estadística descriptiva e inferencial. Los principales hallazgos demuestran que hay poca relación entre Motivación y Hábitos de Estudio, sin embargo no por eso queda rechazada la hipótesis.

This is a descriptive correlational and cross-sectional study and the method used is the quantitative one. It aims to describe the relationship between motivation and study habits in Psychology students attending a private university in Asuncion. The sample consists of 129 students selected through a stratified sampling and voluntary participation. The instruments used are "Methods and habits Inventory Study" of TEA Edition Alvarez and a pre-designed questionnaire for this purpose. The analysis and data processing techniques applied descriptive and inferential statistics. The main findings from the study show that there is little relationship between motivation and study habits, but that does not mean that the hypothesis is rejected.