Enfermedad de Fox-Fordyce: reporte de un caso / Fox-Fordyce disease: a case report

Resumen La enfermedad de Fox-Fordyce (EFF) es un trastorno inflamatorio crónicopoco frecuente de las glándulas apocrinas. Afecta comúnmente a mujeres entre los 13-35 años. Su etiopatogenia es multifactorial. Se caracteriza por pápulas foliculares pruriginosas dispuestas en zonas que contienen las glándulas mencionadas. Se presenta el caso clínico de una paciente de 30 años, con pápulas foliculares en axilas compatibles con enfermedad de Fox-Fordyce. El propósito deeste trabajo es presentar una entidad infrecuente y brindar una revisión bibliográfica repasando los diagnósticos diferenciales y las opciones terapéuticas disponibles.

Abstract Fox-Fordyce disease (FFD) is a rare chronic inflammatory disorder of the apocrine glands. It commonly affects women between 13-35 years. Its etiopathogenesis is multifactorial. This disorder is characterized by pruritic follicular papules arranged in areas containing the aforementioned glands. We reporta clinical case of a 30-year-old female patient, with follicular papules on armpits compatible with Fox-Fordyce disease. The purpose of this paper is to report a uncommon entity while providing a bibliographical revision highlighting the differential diagnoses and their available therapeutic options.

Adverse reactions to the injection of face and neck aesthetic filling materials: a systematic review.

BACKGROUND: Adverse reactions, caused during the inflammation and healing process, or even later, can be induced by the injection of dermal filler and can present a variety of clinical and histological characteristics. In this study we aimed to review the adverse reactions associated with the injection of aesthetic filling materials in the face and neck. MATERIAL AND METHODS: The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies published that mentioned adverse reactions in patients with aesthetic filling materials in the face or neck were included. Risk of bias was assessed using the Joanna Briggs Institute appraisal tool. After a 2-step selection process, 74 studies were included: 51 case reports, 18 serial cases, and five cohorts. RESULTS: A total of 303 patients from 20 countries were assessed. Lesions were more prevalent in the lip (18%), nasolabial folds (13%), cheeks (13%), chin (10%), submental (8%), glabella (7%), and forehead (6%). Histopathological analysis revealed a foreign body granuloma in 87.1% of the patients, 3% inflammatory granuloma, 3% lipogranuloma, 2.3% xanthelasma-like reaction, 1% fibrotic reaction, 0.7% amorphous tissues, 0.7% xanthelasma, 0.3% sclerosing lipogranuloma, 0.3% siliconoma, and 0.3% foreign body granuloma with scleromyxedema. In addition, two patients displayed keratoacanthoma and two others displayed sarcoidosis after cutaneous filling. The most commonly used materials were silicone fillers (19.7%), hyaluronic acid (15.5%), and hydroxyethyl methacrylate/ethyl methacrylate suspended in hyaluronic acid acrylic hydrogel (5.6%). All patients were treated, and only 12 had prolonged complications. CONCLUSIONS: There is evidence that adverse reaction can be caused by different fillers in specific sites on the face. Although foreign body granuloma was the most common, other adverse lesions were diagnosed, exacerbating systemic diseases. In this way, we reinforce the importance of previous systemic evaluations and histopathological analyses for the correct diagnosis of lesions.

Factores asociados con complicaciones mediatas en pacientes postoperados de fracturas transtrocantéricas con sistema de tornillo dinámico de cadera de 135o / Factors associated with mediate complications in postoperative patients with transtrochanteric fractures with 135o dynamic hip screw system

Resumen: Introducción: Las fracturas transtrocantéricas representan 50% de las fracturas del fémur proximal con mayor incidencia en pacientes mayores de 65 años. El objetivo del estudio es evaluar la asociación de factores ortopédicos con la presencia de complicaciones mediatas en pacientes geriátricos postoperados de fracturas transtrocantéricas con sistema de tornillo dinámico de cadera (DHS, por sus siglas en inglés) de 135o. Material y métodos: Estudio retrospectivo, analítico. Evaluamos pacientes mayores de 65 años con fracturas transtrocantéricas tratados con DHS de 135o. Analizamos radiografías prequirúrgicas, postquirúrgicas a tres y seis meses. Realizamos un análisis descriptivo de las características poblacionales, análisis de comparación de medias (U de Mann Whitney) y de proporciones (χ2), análisis de correlación y un modelo de regresión logística para determinar el grado de asociación de los factores con complicaciones mediatas. Resultados: Evaluamos 92 pacientes con edad promedio de 83 ± 6.7 años. Evidenciamos complicaciones ortopédicas mediatas en 8.7%, considerando como la más frecuente el cut-out (5.4%). En el análisis de correlación el índice punta ápex > 25 tiene correlación débil (r = 0.372), mientras que el índice punta ápex modificado al calcar > 27 posee correlación moderada (r = 0.528). El ángulo cérvico-diafisario lateral > 20o tiene correlación alta (r = 0.7). En el análisis de regresión este último se asoció con presencia de complicaciones ortopédicas mediatas (OR 4.93, IC 1.2-15.81, p = 0.000). Conclusiones: Se observó correlación entre factores como el índice punta ápex > 25, índice punta ápex modificado al calcar > 27 y ángulo cérvico-diafisario lateral > 20o con presencia de complicaciones, destacando este último como el factor que presenta asociación con diferencias estadísticamente significativas.

Abstract: Introduction: Transtrochanteric fractures represent 50% of proximal femur fractures, with a higher incidence in patients older than 65 years. The objective of the study is to evaluate the association of orthopedic factors with the presence of mediate complications in post-operative geriatric patients for transtrochanteric fractures with the 135o dynamic hip screw (DHS) system. Material and methods: Retrospective, analytical study. We evaluated patients older than 65 years with transtrochanteric fractures treated with 135o DHS. We analyzed pre-surgical, post-surgical, and 3 and 6-month radiographs. We performed a descriptive analysis of the population characteristics, comparison analysis of means (Mann-Whitney U) and proportions (chi square), correlation analysis, and a logistic regression model to determine the degree of association of the factors with mediate complications. Results: We evaluated 92 patients with a mean age of 83 ± 6.7 years. We evidenced mediate orthopedic complications in 8.7%; considering as the most frequent the cut-out (5.4%). In the correlation analysis, the peak apex index > 25 has a weak correlation (r = 0.372), the peak apex index modified to calcar > 27 moderate correlation (r = 0.528). The lateral cervico-diaphyseal angle > 20° has a high correlation (r = 0.7). In the regression analysis, the latter was associated with the presence of mediate orthopedic complications (OR 4.93, CI 1.2-15.81, p = 0.000). Conclusions: A correlation was observed between factors such as tip apex index > 25, tip apex index modified to calcar > 27 and cervical-lateral diaphyseal angle > 20o with the presence of complications, highlighting the latter as the factor that presents association with statistically significant differences.

Vasculopatía Livedoide, la punta del témpano: a propósito de un caso / Livedoid vasculopathy, the tip of the iceberg: a case report

Resumen La vasculopatía livedoide (VL), es una enfermedad vascular oclusiva que afecta la microvasculatura, se caracteriza por ser recurrente y no inflamatoria. Su incidencia es de 1/100.000 casos por habitantes, afectando en su mayoría a mujeres de edad media. Su patogenia se desconoce, pero se destaca el componente trombótico de la misma, causado por un estado de hipercoagulabilidad, que conduce a la oclusión vascular, debiendo distinguirse una forma primaria y una secundaria.Clínicamente se observan úlceras dolorosas a nivel maleolar que evolucionan progresivamente a una cicatrización atrófica, blanquecina nacarada y estrellada característica.Presentamos un caso clínico en un varón con múltiples comorbilidades y difícil tratamiento, el cual requirió un trabajo multidisciplinario.

Abstract Livedoid vascular disease (VL), is an occlusive vascular disease that affects the microvasculature, is characterized by being recurrent and non-inflammatory. Its incidence is 1 / 100,000 cases per inhabitant, affecting mostly middle-aged women. Its pathogenesis is unknown, but its thrombotic component stands out, caused by a state of hypercoagulability, which leads to vascular occlusion, and a primary and secondary form must be distinguished. Clinically, painful ulcers are observed at the malleolar level, progressing progressively to characteristic atrophic, pearly whitish and starry healing. We present a clinical case in a male with multiple comorbidities and difficult management, which required multidisciplinary work.

Rol de la apoptosis en la sepsis / The role of apoptosis in sepsis

RESUMEN La sepsis es una entidad potencialmente mortal a causa de la disfunción multiorgánica que genera una respuesta alterada del huésped frente a la infección y que culmina, luego de varios procesos, en un estado de inmunosupresión. Hoy en día, existen varias estrategias de manejo de la sepsis para disminuir el impacto multisistémico y mejorar la supervivencia, pero ninguna ha mostrado una clara eficacia. Es por esto que los últimos estudios se centran en aclarar y buscar alternativas terapéuticas basadas en el análisis de la fisiopatología molecular, con la finalidad de entrar en un periodo tardío de inmunosupresión continúa, conocida también como parálisis inmune. La apoptosis es un mecanismo molecular y fisiológico, cuya homeostasis es alterada en presencia de sepsis y que elimina células clave de la inmunidad innata y adaptativa, lo que conlleva a un mayor riesgo de infección secundaria, muchas veces fatal. Varios estudios post mortem han confirmado que la apoptosis de las células inmunes inducida por sepsis es un factor protagonista en la génesis de la inmunosupresión relacionada a la sepsis. Se cree que las estrategias terapéuticas dirigidas a regular la apoptosis podrían mejorar la supervivencia. Este es un artículo de revisión que describirá el rol fisiopatológico del fenómeno apoptótico en la sepsis y su repercusión en la evolución de esta entidad.

ABSTRACT Sepsis is a life-threatening entity caused by a multiorgan dysfunction that generates a dysregulated host response to infection and, after several processes, results in immunosuppression. Today, there are several sepsis management strategies to reduce its multisystemic effect and improve survival, but none of them have shown clear efficacy. Therefore, latest studies focus on clarifying and seeking therapeutic alternatives based on the analysis of the molecular pathophysiology of sepsis, in order to enter a late period of continuous immunosuppression also known as immunoparalysis. Apoptosis is a molecular and physiological mechanism, whose homeostasis is altered by the presence of sepsis. It causes the elimination of key cells of innate and adaptive immunity, which leads to an increased risk of-and often fatal- secondary infection. Several postmortem studies have confirmed that sepsis-induced immune cell apoptosis is a leading factor in the genesis of sepsis-related immunosuppression. It is believed that therapeutic strategies aimed at regulating apoptosis could improve survival. This review article describes the pathophysiological role of the apoptotic phenomenon in sepsis and its effect on the evolution of this entity.

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection / Intervenciones no farmacéuticas para la contención, mitigación y supresión del COVID-19

Abstract Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.

Resumen Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19. Objetivo: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud. Métodos: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión. Resultados: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.

Calcificación vascular arterial detectada en radiografía panorámica digital / Vascular arterial calcification detected in digital panoramic radiography

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Pénfigo vulgar refractario a tratamientos convencionales, con respuesta positiva a Rituximab: presentación de 5 casos / Positive Outcome in Treatment of Patients with Pemphigus Vulgaris Refractory to Conventional Treatments: A Report of Five Cases

Resumen El pénfigo vulgar es una enfermedad ampollar crónica de etiología autoinmune, en la cual el diagnóstico y tratamiento precoz disminuye la morbimortalidad de los pacientes. Actualmente se utilizan corticosteroides de primera línea asociados a inmunosupresores. Sin embargo,se ha visto que el uso de Rituximab como terapéutica de primera elección en los países desarrollados ha disminuido las reacciones adversas, con lo que mejora la calidad de vida de los pacientes. Se presentan cinco pacientes con diagnóstico de pénfigo vulgar refractario a tratamientos convencionalesque requirieron tratamiento con Rituximab.

Abstract Pemphigus vulgaris is an autoimmune chronic blistering disease. Its early diagnosis and treatment help reduce patient mortality and morbidity. Corticosteroids associated with immunosuppressants remain the standard treatment for pemphigus vulgaris. However, the use of Rituximab as first-line therapy in developed countries has been effective in reducing adverse effects improving the quality of life of patients. We report five patients with a diagnosis of pemphigus vulgaris refractory to conventional treatments requiring treatment with Rituximab.

Difteria en Venezuela: análisis de las manifestaciones clínicas y evolución de una serie de casos

Objetivo: Analizar las manifestaciones clínicas y evolución de los casos sospechosos o confirmados de Difteria en Venezuela. Materiales y Métodos: Se realizó un estudio prospectivo, observacional, descriptivo, longitudinal y multicentrico en los estados Anzoátegui, Bolívar, Carabobo, Distrito Capital, Lara, Mérida, Miranda y Zulia, se siguieron 48 pacientes sospechosos o confirmados para difteria y se describieron sus características clínicas. Resultados: 54,2 % fueron de sexo femenino, 2 de ellas embarazadas, 1 de ellas falleció. La localización más frecuente de lesiones fue la faríngea, sin embargo se observaron otras como la tonsilar, laringotraqueal, nasal y cutánea. Todos los pacientes recibieron antibióticos pero solo 32 toxina antidiftérica. Solo 11 pacientes tenían esquema vacunal completo y 18 presentaron complicaciones. El 18,8 % de la muestra falleció y el resto egresó sin secuelas. Conclusiones: El brote de difteria en Venezuela sigue activo, las cifras de pacientes afectados invitan a implementar estrategias de control a través de la inmunización de susceptibles, erradicación de portadores asintomáticos, diagnóstico temprano, reporte obligatorio, atención y manejo adecuado de los infectados.

Objective: To analize the clinical manifestations and evolution of suspected or confirmed cases of Diphtheria in Venezuela. Methods: A prospective, observational, descriptive, longitudinal and multicentric study was conducted in the Venezuelan's states of Anzoategui, Bolivar, Carabobo, Capital District, Lara, Merida, Miranda and Zulia. The time 1 of the investigation was at the hospital admission and the final time was at discharge. During the hospitalization, the follow-up was performed. Results: 48 patients were followed and all of them had suspected or confirmed Diphtheria. 45,5 % were men and 54.2 % were female, 2 of them were pregnant, and 1 of them died. The most frequent location of lesions was the pharyngeal, however other location were observed such as tonsillar, laryngotracheal, nasal and cutaneous. All patients received antibiotics but only 32 diphtheria antitoxin. Only 11 patients had a complete vaccination scheme and 18 (36 %) had complications. 18.8 % of the sample died and the rest withdrew without sequelae. Conclusions: The diphtheria outbreak in Venezuela is still active, the number of affected patients invite to implement strategies of control through the immunization of susceptibles, eradication of asymptomatic carriers, early diagnosis, mandatory reporting, care and adequate management of the infected.

Rol del laboratorio en el diagnóstico del hiperaldosteronismo primario / Laboratory Role in the Diagnosis of Primary Aldosteronism

El aldosteronismo primario se considera actualmente el causante de un 8 a 12 % de los casos de hipertensión arterial. El aumento de su prevalencia es consecuencia de cambios en los criterios diagnósticos. El tamizaje inicial se realiza en el laboratorio determinando la relación aldosterona/actividad de renina plasmática, para lo que se requieren estrictas condiciones preanalíticas; condiciones de reposo o deambulación, evitando interferencias de drogas terapéuticas que pueden afectar el resultado, de obtención y de conservación de la muestra, entre otras. Debido a la alta variabilidad en la medición de la actividad de renina plasmática, (radioinmunoensayo operador dependiente), se está proponiendo el uso de la relación aldosterona/concentración de renina, (donde la concentración de renina se determina por un método automatizado) aunque aún no hay consenso. El método de tamizaje es fundamental para el inicio del estudio de un paciente e influye en la prevalencia actual. Una vez establecidos los valores de corte para cada laboratorio, los pacientes con tamizajes positivos deben ser sometidos a pruebas confirmatorias, por ejemplo sobrecarga con sodio, o supresión con fludrocortisona, para evidenciar la secreción autónoma de aldosterona. Una vez confirmada se debe diferenciar la causa; las principales son adenoma productor de aldosterona e hiperplasia adrenal bilateral. El diagnóstico temprano permite el tratamiento correcto, evitando comorbilidades causadas por la hipertensión arterial (HTA) y remodelaciones vasculares y cardíacas por el exceso de aldosterona. Los tratamientos clásicos para la HTA no siempre son de utilidad en el aldosteronismo primario, por ello es importante el diagnóstico de la patología.

Primary aldosteronism is nowadays considered the cause of 8 to 12 % cases of hypertension. The increase in its prevalence is due to changes in diagnostic criteria. Initial screening is performed in the laboratory by obtaining the aldosterone to plasma renin activity ratio, for which strict preanalytical conditions are required, including; supine or upright posture; interaction of therapeutic drugs which may alter results; sample extraction and conservation, among others. Given the high variability in the measurement of plasma renin activity and its complexity (RIA), the use of the aldosterone to renin concentration ratio is proposed (where renin concentration is determined by an automated immunoassay), although no consensus has been reached in this matter. The screening method is essential to primarily identify those patients who should be further studied, and it influences the statistics on actual prevalence of primary aldosteronism. Once cutoff values have been determined for each laboratory, patients with positive screening results must be further submitted for confirmation tests, such as salt-loading test or fludrocortisone suppression test, in which the autonomous secretion of aldosterone is confirmed. Then, the cause of the excessive aldosterone production must be determined. The most common are aldosterone producing adenoma and bilateral adrenal hyperplasia. Early diagnosis allows for the correct treatment, minimizing comorbidities caused by hypertension and by vascular and cardiac remodelation due to the excess of aldosterone. Classic treatment for hypertension is not always useful in patients with primary aldosteronism; this is why it is important to know how to diagnose the underlying pathology.

Estudio epidemiológico de la mortalidad materna en la provincia de Entre Ríos: desnudando inequidades / Epidemiological study of maternal mortality in Entre Ríos's province revealing inequalities

INTRODUCCIÓN Es importante abordar la mortalidad infantil con la perspectiva de un análisis en el contexto, como indicador útil para la gestión local. OBJETIVOS Describir los perfiles de mortalidad en menores de 5 años en la provincia de Tucumán y caracterizar su relación con la oferta de los servicios públicos de salud y los factores socioeconómicos en el trienio 2009-2011. MÉTODOS Se realizó un estudio ecológico de la mortalidad de menores de 5 años durante 2009-2011 en las unidades poblacionales político-administrativas más pequeñas de la provincia de Tucumán. Variable dependiente defunción de menores de cinco años. Variables independientes peso al nacer, edad al morir, mes de ocurrencia, criterios de reducibilidad y edad, grado de instrucción y situación conyugal materna. Se calculó la proporción de muertes para cada categoría y la tasa de mortalidad específica con factor de amplificación por 1 000 nacidos vivos (NV). Se compararon mediante intervalos de confianza al 95%. RESULTADOS Se analizaron 1 339 fallecimientos en menores de 5 años y 88 610 NV en el trienio 2009-2011. El 69,01% (924) de las defunciones ocurrieron en establecimientos públicos de salud. La muerte domiciliaria en 1-4 años fue del 17,46%. El 66,02% de las defunciones correspondieron a la etapa neonatal precoz. Hubo criterios de reducibilidad en el 18,89% de las muertes neonatales y en el 75,38% de las posneonatales. La razón de tasa de mortalidad de <5 años entre las localidades agrupadas con mayor y con menor tasa fue de 9,09. Hubo heterogeneidad en la distribución proporcional de NV, defunciones infantiles, defunciones evitables y muertes domiciliarias entre localidades con mayor tasa de mortalidad de <5 años y con mayor número de muertes de <5 años. DISCUSIÓN ara definir las brechas poblacionales, es necesario ampliar el análisis del impacto de los cambios sociales, considerando patrones culturales propios en las unidades más pequeñas asociadas a un gobierno local.

Effect of image resolution manipulation in rearfoot angle measurements obtained with photogrammetry

The aim of this study was to investigate the influence of image resolution manipulation on the photogrammetric measurement of the rearfoot static angle. The study design was that of a reliability study. We evaluated 19 healthy young adults (11 females and 8 males). The photographs were taken at 1536 pixels in the greatest dimension, resized into four different resolutions (1200, 768, 600, 384 pixels) and analyzed by three equally trained examiners on a 96-pixels per inch (ppi) screen. An experienced physiotherapist marked the anatomic landmarks of rearfoot static angles on two occasions within a 1-week interval. Three different examiners had marked angles on digital pictures. The systematic error and the smallest detectable difference were calculated from the angle values between the image resolutions and times of evaluation. Different resolutions were compared by analysis of variance. Inter- and intra-examiner reliability was calculated by intra-class correlation coefficients (ICC). The rearfoot static angles obtained by the examiners in each resolution were not different (P > 0.05); however, the higher the image resolution the better the inter-examiner reliability. The intra-examiner reliability (within a 1-week interval) was considered to be unacceptable for all image resolutions (ICC range: 0.08-0.52). The whole body image of an adult with a minimum size of 768 pixels analyzed on a 96-ppi screen can provide very good inter-examiner reliability for photogrammetric measurements of rearfoot static angles (ICC range: 0.85-0.92), although the intra-examiner reliability within each resolution was not acceptable. Therefore, this method is not a proper tool for follow-up evaluations of patients within a therapeutic protocol.

Cáncer gástrico precoz: reporte de un caso / Early gastric cancer: report a case

El adenocarcinoma gástrico, representa entre 90% y 95% de todas las neoplasias malignas gástricas, siendo de los más comunes del mundo y más frecuente en Japón, en nuestro país el cáncer gástrico es la primera causa de mortalidad por tumores malignos de las vías digestivas con 37%, seguido de los tumores hepatobiliares y colon. Su incidencia ha aumentado en pacientes menores de 40 años, la mayoría de nuestros pacientes se diagnostican en estadios avanzados. Presentamos el caso de un paciente masculino de 42 años quien ingresó con un cuadro de hemorragia digestiva superior y en shock hipovolémico, que luego de su estabilización y posterior estudio se diagnosticó un adenocarcinoma moderadamente diferenciado precoz, quien recibió el tratamiento oncológico adecuado

The gastric carcinoma represent the 90% to 95% of all malignant gastric neoplasia, is one of the most common in the world and most frequent in Japan, in our country the gastric cancer is the first cause of mortality for malignant tumors of the digestive system with a 37% of incidence follow for hepatobillary and colon cancer. His incidence is increased in patients less than 40 years old, the majority of them were diagnostic in advance disease. We presents the case of male patient of 42 years with a digestive superior hemorrhagic episode and hipovolemic shock, after his stabilization and posterior study received a diagnostic of early adenocarcinoma moderately differentiated , and him received the adequate oncology treatment

Frequência e fatores associados à infecção pelo vírus da diarreia viral bovina em bovinos leiteiros não vacinados no Estado do Maranhão

The frequency of antibodies against the bovine viral diarrhea virus (BVDv) was studied in a dairy herd of the state of Maranhão, Brazil. Blood serum samples from 920 cows not vaccinated against bovine viral diarrhea (BVD) were analyzed through the indirect ELISA method. The study was carried out on 92 dairy farms from 23 districts located in the regions of Açailândia, Bacabal, São Luiz Island, Imperatriz, and Pedreiras. The serum samples were collected from cows with or without BVDV infection symptoms and classified according to age (> 3 years, 3-7 years, and > 7 years old). An epidemiological questionnaire was applied during sample collection to elucidate the factors which could be associated with the infection. From the 920 serum samples analyzed, 65.66% (n = 604) were reagent. The antibody frequency obtained was 67.5%, 53.57%, 80%, 63.75%, and 74%, for São Luiz Island, Imperatriz, Açailândia, Pedreiras and Bacabal, respectively. In the 23 districts studied, serologically positive cows were found on 94.57% of the farms. From the variables considered as risk factors for BVDv infection, the presence of swine, lack of veterinary assistance, use of natural breeding or natural breeding with artificial insemination, and diarrhea were statistically significant (P 0.05) for association with BVDv serum-positivity. The results obtained demonstrate high levels of BVDv occurrence in the dairy cattle population of Maranhão.

A frequência de anticorpos contra o vírus da diarreia viral bovina (BVDv) foi pesquisada na bacia leiteira do Estado do Maranhão. Amostras de soro sanguíneo de 920 fêmeas bovinas não vacinadas contra a diarreia viral bovina (bovine viral diarrhea, BVD) foram analisadas pelo método de ELISA indireto. O estudo foi realizado em 92 propriedades leiteiras, pertencentes a 23 municípios localizados nas regionais de Açailândia, Bacabal, Ilha de São Luís, Imperatriz e Pedreiras. As amostras de soro foram coletadas de fêmeas com ou sem sinais clínicos de infecção pelo vírus (bovine viral diarrhea virus, BVDv) e estratificadas segundo a faixa etária (> 3 anos, entre 3 a 7 anos e > 7anos). Durante a coleta das amostras, aplicou-se questionário epidemiológico para investigar fatores que poderiam estar associados à infecção. Das 920 amostras de soro analisadas, 65,66% (n = 604) foram reagentes. Nas regionais obtiveram-se frequências de anticorpos de 67,5%, 53,57%, 80%, 63,75% e 74%, para Ilha de São Luís, Imperatriz, Açailândia, Pedreiras e Bacabal, respectivamente. Nos 23 municípios amostrados foram encontrados animais reagentes, com detecção de bovinos sorologicamente positivos em 94,57% das propriedades. Das variáveis consideradas fatores de risco para a infecção pelo BVDv, a presença de suínos, ausência de assistência veterinária, uso de monta natural ou de monta natural associada à inseminação artificial e diarréia, apresentaram significância estatística (P 0,05) associada à soropositividade para BVDv. Os resultados obtidos demonstram níveis elevados de frequência do BVDv no rebanho bovino de aptidão leiteira do Estado do Maranhão.

Fatores de risco associados à infecção pelo Herpesvírus Bovino Tipo 1 em rebanhos bovinos leiteiros da região Amazônica maranhense

This study was performed in order to determine the frequency of Bovine Herpesvirus 1 (BoHV-1), and the main factors related to the frequency of the infection in dairy cows not vaccinated against BoHV-1 from the Maranhense Amazon region, Brazil. Serum samples from 40 ranches were submitted to indirect ELISA test for detection of BoHV-1 antibodies. An epidemiological questionnaire was applied for each herd to investigate variables that could be associated with this infection. From 400 serum samples examined, 69.25% (n = 277) in 100% (n = 40) of the herds were positive for ELISA. Variables identified as risk factors such of age range of 3-7 years, absence of veterinary assistance and respiratory signs presented a statistical significance (P 0.05) associated to BoHV-1 infection. These results indicate that BoHV-1 infection is high in the region studied and that factors related to characteristics of the ranches and to the livestock management practices were associated with the risk of infection by BoHV-1.

O presente estudo teve como objetivo determinar a frequência e os fatores de risco para a infecção pelo Herpesvírus Bovino Tipo 1 (BoHV-1) em fêmeas bovinas leiteiras na região Amazônica maranhense. Amostras de soro de animais não vacinados contra o BoHV-1 e provenientes de 40 propriedades foram submetidas à técnica de ELISA indireto. Em cada propriedade avaliada, aplicou-se ainda um questionário epidemiológico para investigar os fatores de risco que poderiam estar associados à infecção pelo vírus. Das 400 amostras de soro analisadas, 69,25% (n = 277) foram reagentes com a detecção de bovinos sorologicamente positivos em 100% (n = 40) das propriedades. Dentre os fatores de risco avaliados, faixa etária entre 3 a 7 anos, ausência de assistência veterinária e sinais respiratórios apresentaram significância estatística (P 0,05) associada à infecção pelo BoHV-1. Os resultados do estudo indicam que a frequência de anticorpos contra o BoHV-1 foi elevada na região Amazônica maranhense e que os fatores relacionados às características das propriedades e ao manejo foram associados ao risco de infecção pelo BoHV-1.

New mariner elements in Anastrepha species (Diptera: Tephritidae)

Mariner-like elements (MLE) are members from class II of transposable elements also known as DNA transposons. These elements have a wide distribution among different groups of organisms, including insects, which can be explained by horizontal and vertical gene-transfer. MLE families have been described in tephritid flies and other genera. During screening for Wolbachia bacteria in fruit flies of the genus Anastrepha, we discovered two sequences related to mariner-like elements. Based on these sequences, we designed primers that allowed us to isolate and characterize two new mariner-like elements (Anmar1 and Anmar2) in Anastrepha flies. These elements, which belong to the mellifera and rosa subfamilies have a low nucleotide diversity, and are probably inactive and acquired by vertical transfer. This is the first report of mariner-like transposons in flies found in South America.

In-vitro fertilization: donor egg sharing for premature ovarian failure / Fertilización in vitro: una donante comparte un óvulo en un caso de fallo ovárico prematuro

Premature ovarian failure may be a consequence of gonadotoxic cytotoxic chemotherapy or radiation therapy for malignant or systemic disease often resulting in major quality of life concerns. This is the first reported case in the English-speaking Caribbean using in-vitro fertilization (IVF) donor egg sharing in a patient who experienced premature ovarian failure following chemotherapy and radiation for Hodgkin's disease. The donor's indication was tubal factor infertility. Both patients delivered healthy infants.

El fallo ovárico prematuro puede ser consecuencia de la quimioterapia citotóxica gonadotóxica o la terapia de radiación para alguna enfermedad maligna o sistémica, que a menudo trae consigo serios problemas para la calidad de vida. Se reporta el primer caso en el Caribe anglófono, en el que un óvulo de fertilización in vitro (FIV) de una donante, es compartido con una paciente que experimentó fallo ovárico prematuro tras ser sometida a quimioterapia y radiación a causa de la enfermedad de Hodgkin. El diagnóstico de la donante fue infertilidad por factor tubario. Ambos pacientes dieron a luz bebés saludables.

Ecology of the parasitic endohelminth community of Pseudoplatystoma fasciatum (Linnaeus, 1776) (Siluriformes: Pimelodidae) from the Aquidauana River, Pantanal, State of Mato Grosso do Sul, Brazil

This study investigated the structure and diversity of the endohelminth community and its interactions with Pseudoplatystoma fasciatum, caught in the Aquidauana River, in the State of Mato Grosso do Sul, Brazil. Ten helminth species were represented in 1,228 specimens of parasites found in the intestine and mesentery of 33 specimens of P. fasciatum. Cestodes were observed in the intestine, while nematodes Cucullanus sp. in the mesentery. Contracaecum sp. Type 1, Spatulifer rugosa and Choanoscolex abscisus showed the highest mean intensity and mean abundance and Nomimoscolex sudobin showed the highest prevalence. Simpson's index indicated dominance in the endohelminth infracommunities (C = 1.0792) and Choanoscolex abscisus was considered the central species. A clumped pattern of dispersion according to Green's index was related. 69.69% of hosts analyzed had between 2 and 5 species of endohelminths. Mean diversity was H = 0.5517 (SD = 0.4209). Two pairs of species showed significant positive association and four pairs presented significant positive correlation among abundance data. Significant negative correlations between total length and prevalence and abundance of Peltydocotyle rugosa and Nomimoscolex sudobim were found. However, no significant correlation was observed between condition factor and abundance, as well as total length and diversity. There was significant prevalence of Harriscolex kaparari in male hosts.

Neste trabalho foram descritas a estrutura e diversidade da comunidade endohelmíntica e suas interações com Pseudoplatystoma fasciatum, capturados no rio Aquidauana, MS. Foram encontrados 1.228 espécimes de helmintos, representados por dez espécies, parasitando intestino e mesentério de 33 espécimes de P. fasciatum. Todos os cestodas parasitavam o intestino e, o nematoda Cucullanus sp. foi encontrado no mesentério. Contracaecum sp. Tipo 1, Spatulifer rugosa e Choanoscolex abscisus apresentaram os maiores valores de intensidade média e abundância média, respectivamente e, juntamente com Nomimoscolex sudobim foram as mais prevalentes. O índice de Simpson indicou dominância entre as infracomunidades de endohelmintos (C = 1,0792) e Choanoscolex abscisus foi considerada espécie central. Foi observado um padrão de distribuição agregado de acordo com o índice de Green. Dos hospedeiros amostrados 69,69% continham entre duas a cinco espécies. A diversidade média encontrada foi de H = 0,5517 (DP = 0,4209). Dois pares de espécies apresentaram associações positivas significativas e quatro pares apresentaram correlações positivas significativas entre as abundâncias. Foram observadas correlações negativas significativas entre comprimento total e prevalência e abundância parasitária para Peltydocotyle rugosa e Nomimoscolex sudobim. Não houve correlação significativa entre fator de condição e abundância parasitária, comprimento total e diversidade. A prevalência de Harriscolex kaparari foi significativamente maior nos hospedeiros machos.

Necrotic skin lesion in a dog attributed to Loxosceles (brown spider) bite: a case report

Envenomations caused by Loxosceles (brown spider) have been reported throughout the world. Clinical signs associated to bites of these spiders involve dermonecrotic lesions and intense local inflammatory response, besides systemic manifestations such as intravascular hemolysis, thrombocytopenia, disseminated intravascular coagulation and acute renal failure. The present study aimed to report and to describe dermonecrotic lesions probably caused by a Loxosceles envenomation in a four year-old poodle female dog, treated at the Dermatology Service of the Veterinary Hospital of the Veterinary Medicine and Animal Husbandry School, São Paulo State University, Botucatu, Brazil. Initially, the animal presented two skin lesions with blackish aspect that evolved into ulcerative crusts. The owner reported the presence of a brown spider near the place where the animal spent most of the time. Histological examination of lesions revealed necrosis of the epidermis extending to adnexa and panniculi, which is compatible with Loxosceles bite reaction. The animal was treated with systemic antibiotic and local curatives. Lesions healed by second intention in two months.