Developmental programming-ageing effects in muscle strength of obese rat offspring in a sex-dependent manner.

Maternal obesity programs the offspring to metabolic dysfunction. However, the effects of maternal obesity on skeletal muscle programming and ageing have been little explored. To determine if maternal obesity is a detriment to the progress of age-related muscle strength loss in the offspring (F1), we evaluated the indicators of muscle strength, adiposity, and metabolism at young adult and senior adult ages of maternal obesity F1 (MOF1) males and females from a high-fat diet-induced maternal obesity model in rat. Controls were agematched siblings whose mothers were fed a standard maternal diet (CF1). Combinatorial data analysis was performed with body weight (BW), forelimb grip strength (FGS), FGS adjusted with BW, body fat, adiposity index, and serum triacylglycerols, cholesterol, glucose, insulin, and homeostatic model assessment for insulin resistance variables, to identify discriminant traits of variation among F1 groups. During ageing, maternal obesity caused glucose and cholesterol metabolic dysfunctions in male F1, whereas adiposity-associated skeletal strength loss and fatty acid alterations were present in female offspring. In conclusion, offspring programming-ageing effects due to maternal obesity impact metabolism and skeletal muscle strength loss at later ages in a sex-dependent manner.

Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study.

OBJECTIVE: To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. METHODS: Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. RESULTS: In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p=0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p=0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI]=0.02 [0.00, 0.59], p=0.03) and length of stay (HR [95% CI]=18.5 [4.39, 78.4], p<0.001). CONCLUSIONS: The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.

Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea?

Abstract Objectives: Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). Methods: This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. Results: A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. Conclusion: A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. Level of evidence: Level 3, non-randomized cohort study.

Detection of Early Ultrasonographic Markers of Cardiovascular Dysfunction in Prediabetes Patients.

BACKGROUND: Prediabetes individuals may present incipient signals of cardiovascular injury and evaluate with unfavorable outcome. The aim of this study was to identify early ultrasonographic markers of cardiac dysfunction and arterial stiffness among glucose intolerant patients compared to healthy individuals. METHODS: Cross-sectional study with the composition of two groups: Prediabetes (PD) who met the criteria for pre-diabetes and Normoglycemic (NG): presented no criteria of pre-diabetes and diabetes mellitus in all applied tests. Clinical evaluation, assessment of cardiac function by transthoracic echocardiogram, carotid intima-media thickness by carotid ultrasonographic and evaluation of arterial stiffness by SphygmoCor® device was performed. RESULTS: Eighty adults were included in this study: PD (n = 43) and NG (n = 37). PD patients were more dyslipidemic and presented early alterations in echocardiographic variables, like: peak mitral velocity E (E (cm/sec): NG 84 ± 13 vs. PD 77 ± 11, P = 0.03), E/A Tricuspid inflow (NG: 1.5 ± 0.4 vs. PD 1.3 ± 0.3, P = 0.03), Tricuspid tissue Doppler E' (E'tric (cm/sec): NG 15.2 ± 4.4 vs. PD 13.4 ± 3.2, P = 0.04) and increased arterial stiffness (Pulse Wave Velocity: PWV (m/s): NG 7.2 ± 1.5 vs. PD 7.9 ± 1.7, P = 0.03). In the regression analysis, having an impaired oral glucose test was shown to be independently associated with reduced E Mitral, even after adjusting for a set of confounding factors. CONCLUSIONS: PD patients showed early signals of an impaired cardiac function and an increased pulse wave velocity when compared with healthy individuals. These results point to treatment optimization strategies, especially when considering preventive measures for cardiovascular outcomes, like diabetic cardiomyopathy.

[Clinical profile and results of acute pancreatitis in the Intensive and Intermediate Care Unit of a general hospital]. / Perfil clínico y resultados de la pancreatitis aguda en la Unidad de Cuidados Intensivos e Intermedios de un hospital genera.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that, according to the 2012 Atlanta classification, can be mild, moderate or severe. OBJECTIVE: Describe the epidemiological, clinical, therapeutic and outcomes of patients with AP admitted to the intensive care and intermediate care unit of a general hospital and compare them with those described in the national and international literature. MATERIALS AND METHODS: Observational study of patients with AP treated over a period of 3 years. RESULTS: 59 cases were included; the female sex prevailed (54.2%), the average age was 59.3 years, the most frequent etiology was biliary (84.7%). Average entry severity scores were APACHE II of 12.4 points, SOFA of 4.9 points and Marshall modified of 2.8 points; The most frequent organ failure was respiratory (47.5%). The average stay in care was 13.9 days and in the hospital it was 23.3 days. No patients with mild or moderate AP died during their hospital stay, 6 patients with severe AP died during their hospital stay (20% of cases of severe AP). CONCLUSION: The cases of our hospital had a clinical and therapeutic profile similar to that described in the world and Latin American literature. A hospital staying was greater than that described in recent works, but our mortality was lower.

Profilaxis combinada con inmunoglobulina intravenosa y plasmaféresis en pacientes altamente sensibilizados, receptores de trasplante renal o combinado hígado-riñón: experiencia en un centro médico colombiano / Combined prophylaxis with intravenous immunoglobulin and plasmapheresis in highly sensitized patients, recipients of kidney or combined liver-kidney transplant: experience in a Colombian medical center

El trasplante renal constituye la mejor opción de tratamiento para los pacientes con enfermedad renal crónica terminal. La supervivencia del injerto es de gran importancia y puede ser afectada por factores inmunológicos o no inmunológicos; esto unido al número de pacientes en las listas de espera, hace necesario definir estrategias de manejo que permitan tener mejores resultados a largo plazo. Objetivo. Determinar las características clínicas y humorales, y los desenlaces en receptores de trasplante renal o combinado hígado-riñón, altamente sensibilizados, que recibieron profilaxis combinada con inmunoglobulina intravenosa y plasmaféresis en el Hospital San Vicente Fundación, en Colombia. Materiales y métodos. Se realizó un estudio retrospectivo, observacional, descriptivo, que incluyó los pacientes trasplantados entre el 4 de julio de 2010 y el 19 de abril de 2017. Como variables se incluyeron, entre otras, la etiología de la enfermedad renal crónica, el tipo de terapia recibida, y el tiempo en lista de espera en días. Como desenlace se evaluó la presencia de rechazo, el tipo de rechazo, la pérdida del injerto, las complicaciones y la muerte. Resultados. Del total de 25 pacientes, el 100% recibió inmunoglobulina intravenosa y el 84% plasmaféresis. El 12% presentó rechazo del injerto, todos de tipo humoral, y el 20% perdió el injerto. Discusión. A pesar de la gran variedad de protocolos propuestos en la literatura, en esta población especial no se ha establecido un protocolo óptimo de inmunosupresión. El protocolo en nuestra pequeña cohorte no tuvo un impacto negativo en el porcentaje de infecciones postrasplante ni en la pérdida del injerto renal, pero sí redujo el tiempo en las listas de espera; por lo tanto, se requieren estudios adicionales para confirmar los hallazgos encontrados en este estudio

Kidney transplantation is the best treatment option for patients with terminal chronic kidney disease, regardless of the etiology, making graft survival an important feature, which may be affected by immunological or non-immunological factors. This, added to the increasing number of patients on waiting lists, makes it necessary to define management strategies for these patients that allow better long-term results. Objectives. To determine the clinical, humoral and outcome characteristics in highly sensitized recipients of kidney and simultaneous kidneyliver transplant who received combined prophylaxis with intravenous immunoglobulin and plasmapheresis therapy in a Colombian medical center. Materials and methods. A retrospective, observational, descriptive study was carried out that included the transplanted patients between July 4, 2010 and April 19, 2017. Variables included the etiology of chronic kidney disease, the type of therapy received, and waiting time in days, among others. As outcomes, the presence of rejection, type of rejection, graft loss, complications and death were evaluated. Results. From a total of 25 patients, 100% received intravenous immunoglobulin and 84% plasmapheresis. Twelve percent presented graft rejection, all humoral, and 20% lost the graft. Discussion. Despite the great variety of protocols proposed in the literature, an optimal immunosuppression protocol has not been established for this particular population. The protocol in our small cohort did not have a negative impact on the percentage of post-transplant infections nor in the loss of the renal graft, but it did reduce waiting time; therefore, additional studies are required to confirm the findings in this study

Neumonía recurrente como manifestación de secuestro pulmonar. Presentación de caso / Recurrent Pneumonia as a Manifestation of Pulmonary Sequestration. Case Report

El secuestro pulmonar es una enfermedad congénita del tracto respiratorio que compromete el parénquima pulmonar y su vasculatura, puede dividirse en intralobar o extralobar dependiendo de su relación con la pleura visceral normal. El subtipo extralobar usualmente se diagnostica prenatalmente o en los primeros meses de vida, mientras que el intralobar se presenta en adultos jóvenes. Representa aproximadamente el 0,15-6,4 % de todas las malformaciones pulmonares congénitas y no tiene diferencias respecto al sexo con una relación 1:1. Se presenta el caso de un paciente masculino adulto medio con neumonías a repetición en quien se realizan estudios imagenológicos con hallazgos tomográficos compatibles con secuestro pulmonar intralobar en el segmento basal posterior izquierdo, con el objetivo de realizar una revisión de la literatura para plantear una discusión sobre la importancia del diagnóstico adecuado y a tiempo de esta patología. Es necesario tener una alta sospecha clínica ­se trata de una enfermedad de presentación variable­, para solicitar el estudio imagenológico más adecuado, puesto que las imágenes son las que dan el diagnóstico definitivo del secuestro pulmonar. En algunos casos, el manejo se puede realizar de manera mínimamente invasiva a cargo de radiología intervencionista, como en este caso.

Pulmonary sequestration is a congenital respiratory disease that involves the pulmonary parenchyma and its vasculature. It can be divided into intralobar or extralobar depending on its relationship with normal visceral pleura. The extralobar subtype is usually diagnosed prenatally or in the first months of life, while the intralobar occurs in young adults. It represents approximately 0.15-6.4% of all congenital lung malformations and does not show differences with respect to sex with a 1:1 ratio. We present the case of an average adult male patient with recurrent pneumonia in whom multiples imaging studies are performed, with tomographic findings compatible with intralobar pulmonary sequestration in the left posterior basal segment, with the aim of performing a literature review to raise a discussion on the importance of the proper and early diagnosis of this pathology. It is necessary to have a high clinical suspicion -it is a disease of variable presentation-, to request the most appropriate imaging study, since the images are those that give the definitive diagnosis of pulmonary sequestration. In some cases, management can be performed in a minimally invasive manner by interventional radiology, as in this case.

Efecto del extracto de alcaloides de Berberis darwinii Hook sobre respuestas celulares innatas en fagocitos murinos / Effect of the extract of Berberis darwinii Hook alkaloids on innate cellular responses in murine phagocytes

Berberis darwinii Hook es una especie que habita el sur de Chile y la Patagonia. Siendo utilizada por la etnia mapuche para el tratamiento de procesos inflamatorios, estados febriles, y dolor estomacal. El propósito del siguiente estudio fue evaluar in vitro las propiedades del extracto de alcaloides de raíz de B. darwinii sobre respuestas celulares en monocitos desde sangre periférica de rata. Los resultados de la cuantificación del extracto muestran una concentración de alcaloides totales de 1,67 mg/g y la caracterización por HPLC- MS determinó la presencia de berberina y palmatina. In vitro se observó que los extractos disminuyeron la capacidad de adhesión y la actividad fagocítica de los monocitos e inhibieron la translocación del factor nuclear NF-κB asociado a la modulación de la inflamación, pero no así la producción de anión superóxido. Estos resultados indicarían que los alcaloides totales de B. darwinii inhiben algunos mecanismos específicos de defensa celular.

Berberis darwinii Hook is a species that inhabits southern Chile and Patagonia. This is being used by the Mapuche ethnic group for the treatment of inflammatory processes, febrile states, and stomach pain. The purpose of the following study was to evaluate in vitro the properties of an alkaloid extract of B. darwinii root on cellular responses in monocytes from the rat peripheral blood. The results of the quantification of the extract showed a total alkaloid concentration of 1.67 mg/g and the characterization by HPLC-MS determined the presence of berberine and palmatine. In vitro, it was observed that the extracts decreased the adhesion capacity and phagocytic activity of the monocytes and inhibited the translocation of the nuclear factor NF-κB associated with the modulation of inflammation, but not the production of superoxide anion. These results indicate that the total alkaloids of B. darwinii inhibit some specific mechanisms of cellular defense.

Fluorosis endémica en localidades del Paraguay / Endemic fluorosis in localities of Paraguay

Es bien conocida la utilización de fluoruros en la prevención de caries, administrados en forma sistémica o aplicados en forma tópica sobre las piezas dentarias. La fluoración del agua, en países como Estados Unidos, está instalada desde 1945, con concentraciones de flúor entre 0,7 y 1,2 mg/L recomendadas por el Servicio de Salud Pública (PHS). La fluorosis dental es una condición irreversible y constituye la primera señal visible de que un niño ha sido sobreexpuesto a fluoruros8. Es producida por el consumo de altas concentraciones de flúor en el periodo de formación de los dientes, provocando deficiencia estética y biológica, lo que predispone a la aparición de caries, sensibilidad dental, maloclusión, y problemas de autoestima por la apariencia de las piezas dentarias con repercusiones en salud pública dado los altos costos de los tratamientos restauradores9,(AU)

A report of the Maquet procedure for the management of cranial cruciate ligament rupture in a dog - a case report / Técnica de Maquet tratamento da ruptura do ligamento cranial em cão - Relato de Caso

Cranial cruciate ligament rupture is the major cause of lameness and degenerative joint disease in the canine stifle. The cause of this disease is multifactorial, especially involving degenerative and inflammatory changes. Many techniques have been described for the management of this condition, and current recommendations include the use of corrective osteotomies, most recently using the Maquet (or modified Maquet) procedure. This technique is fundamentally similar to the classical tibial tuberosity advancement (TTA), but without the use of the bone plate. The main advantages of using this technique are a shorter operative time and less use of implants. The main complication of this technique is an increased risk of tibial crest fracture. This report describes the Maquet technique for the treatment of a three-year-old male West White Terrier dog with rupture of the cranial cruciate ligament. Cruciate ligament rupture was diagnosed by a positive cranial tibial drawer test. Mediolateral stifle radiography performed under anesthesia with the stifle in 135° of extension demonstrated a tibial plateau angle of 22°. A cage of six millimeters was necessary to allow advancement. The Maquet technique produced excellent post-operative results, including early weight-bearing and neutralization of the cranial tibial drawer. The consolidation time of the osteotomy was 63 days.

A ruptura do ligamento cruzado cranial em cães é a principal causa de claudicação do membro posterior e leva ao desenvolvimento da doença articular degenerativa. A causa da doença é multifatorial, principalmente alterações degenerativas e inflamatórias. Muitas técnicas já foram descritas para o seu tratamento, mas atualmente se preconiza a utilização das osteotomias corretivas, sendo a técnica de Maquet a mais recente utilizada. Essa técnica apresenta os mesmos fundamentos da técnica clássica de avanço da tuberosidade tibial, mas não é utilizado a placa. As principais vantagens do uso dessa técnica são menor tempo cirúrgico e menor uso de implantes. A principal complicação dessa técnica é a fratura da crista da tíbia. O objetivo desse trabalho é descrever o caso de um cão, macho, três anos de idade, da raça West White Terrier com ruptura do ligamento cruzado cranial e utilização da técnica de Maquet para o tratamento. O diagnóstico da ruptura foi realizado pelo teste de gaveta e tibial cranial positivos. O planejamento cirúrgico da osteotomia através da radiografia medio-lateral. Com animal anestesiado realizou-se radiografia na projeção médio-lateral em extensão de 135°, encontrando o ângulo de platô tibial em 22°. Utilizou-se um cage de seis milímetros para permitir o avanço necessário. O uso da técnica de Maquet proporcionou

Lente intraocular fáquica de cámara anterior de fijación angular / Anterior chamber phakic introcular lens with angle fixation

La emergencia de las lentes intraoculares fáquicas en las pasadas décadas mostró una nueva alternativa para las ametropías extremas. Desde el año 1950 han sido diseñados diferentes modelos de lentes intraoculares fáquicas con distintos diseños y complicaciones. Se presenta un caso con antecedente de miopía elevada, quien posterior a la colocación de una lente intraocular fáquica de cámara anterior de fijación angular presentó como complicación en el posoperatorio abundante pigmentación iridiana sobre el lente y sinequias anteriores en 360 grados. Nos motivamos a publicar este caso y de esta forma proporcionar una actualización sobre las complicaciones de la colocación de estos lentes, así como ofrecer algunas recomendaciones para detectar a tiempo los posibles riesgos de este procedimientoa(AU)

The emergence of the phakic intraocular lenses in the last decades showed a new alternative for the extreme ametropias. Since1950 different models of phakic intraoduclar lenses have been designed with different designs and complications. Here is a patient with a history of high myopia who, after having undergone the implantation of an anterior chamber phakic intraocular lens with angle fixation, presented with abundant iridian pigmentation over the lens and anterior sinechia at 360 degrees. The objectives of this report were to provide an update on the complications of the implantation of these lenses as well as making some recommendations to timely detect the possible risks of this procedure(AU)

Detection of latent tuberculosis infection among migrant farmworkers along the US-Mexico border.

BACKGROUND: Migrant farmworkers are among the highest-risk populations for latent TB infection (LTBI) in the United States with numerous barriers to healthcare access and increased vulnerability to infectious diseases. LTBI is usually diagnosed on the border using the tuberculin skin test (TST). QuantiFERON-TB Gold In-Tube (QFT-GIT) also measures immune response against specific Mycobacterium tuberculosis antigens. The objective of this study is to assess the comparability of TST and QFT-GIT to detect LTBI among migrant farmworkers on the border, as well as to examine the effects of various demographic and clinical factors on test positivity. METHODS: Participants were recruited using mobile clinics on the San Luis US-Mexico border and tested with QFT-GIT and TST. Demographic profiles and clinical histories were collected. Kappa coefficients assessed agreement between TST and QFT-GIT using various assay cutoffs. Logistic regression examined factors associated with positive TST or QFT-GIT results. RESULTS: Of 109 participants, 59 of 108 (55 %) were either TST (24/71, 34 %) or QFT-GIT (52/106, 50 %) positive. Concordance between TST and QFT-GIT was fair (71 % agreement, ĸ = 0.38, 95 % CI: 0.15, 0.61). Factors associated with LTBI positivity included smoking (OR = 1.26, 95 % CI-1.01-1.58) and diabetes/high blood sugar (OR = 0.70, 95 % CI = 0.51-0.98). DISCUSSION: Test concordance between the two tests was fair, with numerous discordant results observed. Greater proportion of positives detected using QFT-GIT may help avoid LTBI under-diagnosis. Assessment of LTBI status on the border provides evidence whether QFT-GIT should replace the TST in routine practice, as well as identifies risk factors for LTBI among migrant populations.

Síndrome cardio-facio-cutáneo: reporte de caso / Cardio-facio-cutaneous syndrome: a case report

Resumen: el síndrome cardio-facio-cutáneo es una entidad clínica y genéticamente heterogénea, perteneciente a un grupo de síndromes conocidos como RASopatías.Este trastorno es de baja prevalencia, con alrededor de 200 a 300 casos en el mundo, e incluye entre sus manifestaciones clínicas rasgos faciales dismórficos, defectos cardíacos y alteraciones cutáneas. Los hallazgos fenotípicos del síndrome cardio-facio-cutáneo que se comparten con otros síndromes y la ausencia de criteriosdiagnósticos o signos patognomónicos lo convierten en un reto diagnóstico. En este manuscrito se presenta un caso confirmado de síndrome cardio-facio-cutáneo por estudios de genética molecular en una paciente de siete años de edad, mediante el cual se exponen las principales características de esta condición.

Abstract: The cardio-facio-cutaneous syndrome is a clinically and genetically heterogeneous disorder, belonging to a group of syndromes known as RASopathies. This condition has a low prevalence, with around of 200 to 300 cases in the world, and includes dysmorphic facial features, heart defects, and skin abnormalities among its clinical manifestations. The phenotypic findings of cardio-facio-cutane1ous syndrome that are shares with other syndromes and the absence of diagnostic criteria or pathognomonic signs make it a diagnostic challenge. Here its present a confirmed case of cardio-facio-cutaneous syndrome by molecular genetic studies in one seven years old patient, through which are exposed the main characteristics of this condition.

Especies de levaduras aisladas en muestras de orina en un hospital regional de España / Isolated yeast species in urine samples in a Spanish regional hospital

La detección de candiduria en pacientes hospitalizados o inmunodeprimidos tiene una gran relevancia clínica. El objetivo de nuestro trabajo fue describir la frecuencia de aislamiento de diferentes especies significativas de levaduras en las muestras de orina procesadas en nuestro hospital en el periodo 2010-2013 y analizar su sensibilidad a los antifúngicos de uso habitual. La identificación de especies se realizó por siembra en un medio cromogénico, prueba de filamentación y sistemas automatizados (ASM Vitek y MALDI Biotyper), mientras que la sensibilidad a los antifúngicos se determinó con el sistema ASM Vitek. De los 632 aislamientos de levaduras obtenidos, 371 fueron Candida albicans y 261 especies de Candida no C. albicans. Las especies con mayor número de aislados resistentes fueron Candida glabrata y Candida krusei. Basados en nuestros resultados, consideramos que la identificación de la especie y el estudio de la sensibilidad a los antifúngicos deberían ser prácticas habituales por parte de los laboratorios cuando se aíslan especies diferentes a C. albicans

Candiduria detection in hospitalized or immunocompromised patients is of great clinical significance. The aim of our study was to describe the isolation frequency of significant species of yeasts in urine samples processed in our hospital during the period 2010- 2013, and to analyze their susceptibility to commonly used antifungal agents. Species identification was performed by seeding on a chromogenic medium, the filamentation test and automated systems (ASM Vitek and MALDI Biotyper), while susceptibility was determined using the ASM Vitek system. Of the 632 yeast isolates in urine, 371 were Candida albicans species and 261 non-C. albicans Candida spp. The species with the highest number of resistant isolates were Candida glabrata and Candida krusei. Based on the results obtained, we believe that species identification and the susceptibility study should be current practice in the laboratories when species other than C. albicans are isolated

Análisis reflexivo sobre un currículo basado en competencias en otorrinolaringología / Reflective analysis about competency-based curriculum in otolaryngology

Se presenta una reflexión argumentativa acerca de las razones para diseñar un currículo basado en competencias para la especialización en Otorrinolaringología en la Universidad Militar Nueva Granada, además se proponen algunos elementos que pueden orientar dicho currículo. Debido a la universalización de la cultura humana debemos responder a los desafíos de la globalización, conservando nuestra identidad cultural. Hay dos situaciones específicas que como docentes universitarios debemos enfrentar. La necesidad de los estudiantes de tener acceso a la movilidad interinstitucional, y la necesidad de los profesionales de poder homologar sus títulos. Un currículo basado en competencias puede responder a estas demandas de forma apropiada, ya que es uno de los modelos más difundidos en el mundo actualmente, y favorece en el estudiante la adquisición de saberes, actitudes y habilidades; que le permitirán competir en condiciones de igualdad en el mundo laboral. Se requiere el diseño de mecanismos evaluativos específicos para este modelo, que sin embargo puede continuar conservando algunas herramientas tradicionales como la presentación de casos clínicos o exámenes sobre temas específicos como anatomía. Pruebas como el Mini-CEX pueden permitir evaluar el desempeño (saber hacer) del estudiante ante una situación clínica específica.

We present an argumentative reflection about the reasons for designing a competencybased curriculum for the specialization in Otolaryngology at the Universidad Militar Nueva Granada, also we propose some elements that can guide the curriculum. Due to the universalisation of the human culture we must respond to the challenges of globalization, preserving our cultural identity. There are two specific situations we face as university professors. The need of students to have access to the interinstitutional mobility, and the need of professionals to have homologate their titles. A competency-based curriculum can meet these demands properly, since it is one of the most popular models in the world today, and helps the student in the acquisition of knowledge, attitudes and skills, which allow them to compete on equal terms in the working world. It requires the design of specific evaluative mechanisms for this model, which nevertheless can continue preserving some traditional tools such as the presentation of case reports or tests on specific topics such as anatomy. Tests such as the Mini-CEX may allow assessment of the performance (know- how) of the student to a specific clinical situation.

Fisiología coclear / Cochlear Physiology

El interés por la fisiología y patología del sistema auditivo ha crecido en los últimos años, y no sin razón, en Estados Unidos grados variables de hipoacusia afectan al doble de la población afectada por ceguera. El sistema auditivo presenta algunas características fascinantes en su funcionamiento, la cóclea de los mamíferos, por ejemplo, es capaz de responder a vibraciones de tan solo ±0,3nm, el diámetro de un átomo y de detectar estímulos en humanos de hasta 20 KHz. El propósito del órgano de la audición es transformar la energía sonora en un impulso eléctrico que se transmite por el nervio coclear hacia el Sistema Nervioso Central. Esta revisión describe la fisiología coclear haciendo énfasis en la correlación morfofisiológica subyacente, tanto a nivel celular como molecular, intentando seguir la secuencia temporal de eventos mediante la cual un estímulo acústico se traduce en una respuesta neural.

Interest in the physiology and pathology of the auditory system has grown in recent years, not unreasonably, in the United States, variable degrees of hearing loss affect twice the population affected by blindness. The auditory system has some fascinating characteristics in their function, the cochlea of mammals, for example, is able to, answer to vibrations of ± 0,3nm, the diameter of an atom and to detect stimulations in humans up to 20 KHz. The purpose of the hearing organ is to convert sound energy into an electrical impulse that is transmitted by the cochlear nerve to the central nervous system. This review describes the cochlear physiology, making emphasis on the underlying morphophysiological correlation, in a cellular and molecular level, trying to follow the temporal sequence of events, through which, an acoustic stimulus resulting in a neural response.

Endoscopic alterations in a cohort of hemodialysis patients: a cross-sectional study.

INTRODUCTION: Although the association between chronic kidney disease and dyspepsia is widely known, it remains poorly investigated. Among the types of gastric inflammation that lead to symptoms, erosive antral gastritis is the most common form. A direct correlation between the urea serum levels and the time in hemodialysis with the onset of gastric metaplasia and dyspepsia can be observed. The aim of this study was to report the endoscopic alterations found in hemodialysis patients. METHODS: This is a cross-sectional study based on the medical records of 95 patients older than 18 years who were diagnosed with chronic kidney disease. The results of endoscopies performed up to 6 months before the beginning of the study were included. RESULTS: Among the 95 studied patients, 56.84% were male, 60% were Caucasian, and 71.57% used proton pump inhibitors. The endoscopic alteration most frequently observed was erosive gastritis (77% of the cases); however, the frequency of the alteration that caused the symptoms was irrelevant. The antrum was the most common site of involvement (55.79%). CONCLUSION: Patients with chronic kidney disease often show dyspeptic symptoms. Other abnormalities are common but are not correlated with such symptoms. In conclusion, this study identified the endoscopic alterations that are most often observed in hemodialysis patients; erosive and enanthematous gastritis were the most common forms observed.

Consideraciones de la respuesta fisiológica al estrés quirúrgico / Considerations about the physiological response to surgical stress

RESUMEN Introducción: el conocimiento de la respuesta fisiológica a la agresión que produjo el trauma quirúrgico, brindó la capacidad de tratamiento efectivo en caso de complicaciones, en el paciente propuesto para cirugía electiva no cardiaca. Objetivo: caracterizar los atributos de la respuesta al estrés quirúrgico. Métodos: se realizó un estudio sistemático, cualitativo a través de la búsqueda en MedLine y Pubmed en el periodo de enero 1990 a enero 2012 con una estrategia de búsqueda validada que restringe la investigación al análisis de los estudios aleatorizados publicados para determinar los atributos correspondientes al estrés quirúrgico durante el perioperatorio. Desarrollo: la lesión hística determinó la producción de señales nerviosas aferentes, que estimuló al eje simpático-suprarrenal, así como al eje hipotálamo-hipofisario. En este aspecto fue de importancia adicional los procesos locales de la herida y los tejidos isquémicos, los cuales a través de respuestas locales y sistémicas determinaron las alteraciones metabólicas de la coagulación, la inflamación y las disfunciones del sistema inmune. Conclusiones: el estrés quirúrgico es una situación en la que existe tanto un aumento en la velocidad de generación de especies oxidantes, radicales libres y especies excitadas, como una disminución en la actividad de los sistemas de defensa, lo que resulta en mayores con centraciones, en estado estacionario, de especies activas del oxígeno. .

Introduction: Knowledge about the physiological response to the stress caused by surgical trauma determined the choice of an effective treatment for complications in a patient scheduled for elective noncardiac surgery. Objective: Characterize the response to surgical stress. Methods: A systematic qualitative study was conducted based on a search in MedLine and PubMed from January 1990 to January 2012. The validated search strategy was restricted to the analysis of published randomized studies to determine the features of perioperative surgical stress. Results: The hystic lesion triggered the generation of afferent nervous signals, which stimulated the sympathetic-suprarenal axis, as well as the hypothalamo-hypofisiary axis. Surgical wound and ischemic tissue local processes were also important, for they produced metabolic alterations in coagulation, inflammation and immune dysfunctions expressed through both local and systemic responses. Conclusions: Surgical stress is a situation characterized by an increase in the rate of generation of oxidizing species, free radicals and excited species, and a decrease in the activity of defense systems, resulting in greater concentrations of oxygen active species in a stationary state.