A Meiotic Checkpoint Alters Repair Partner Bias to Permit Inter-sister Repair of Persistent DSBs.

Accurate meiotic chromosome segregation critically depends on the formation of inter-homolog crossovers initiated by double-strand breaks (DSBs). Inaccuracies in this process can drive aneuploidy and developmental defects, but how meiotic cells are protected from unscheduled DNA breaks remains unexplored. Here we define a checkpoint response to persistent meiotic DSBs in C. elegans that phosphorylates the synaptonemal complex (SC) to switch repair partner from the homolog to the sister chromatid. A key target of this response is the core SC component SYP-1, which is phosphorylated in response to ionizing radiation (IR) or unrepaired meiotic DSBs. Failure to phosphorylate (syp-16A) or dephosphorylate (syp-16D) SYP-1 in response to DNA damage results in chromosome non-dysjunction, hyper-sensitivity to IR-induced DSBs, and synthetic lethality with loss of brc-1BRCA1. Since BRC-1 is required for inter-sister repair, these observations reveal that checkpoint-dependent SYP-1 phosphorylation safeguards the germline against persistent meiotic DSBs by channelling repair to the sister chromatid.

El logro de la convivencia pacífica: un reto en salud mental que convoca a la academia y la comunidad / The achievement of peaceful coexistence: a challenge in mental health that convokes academia and community / O sucesso da convivência pacífica: um desafio na saúde mental que convoca a academia e a comunidade

Los espacios de reflexión académica abiertos a la comunidad en general tienen como objetivo incentivar el análisis propositivo sobre temas de actualidad y el interés en el contexto de la realidad histórica y social que vive Colombia. Constituyen, además, evidencia de la proyección y responsabilidad social universi-taria, una de las razones de ser de la educación superior.La amplia gama de expresiones del conflicto interno en Colombia, así como la historia reciente de la denominada violencia política, presente durante casi seis décadas, ha ocasionado que más de cinco gene-raciones de ciudadanos hayan crecido en un contexto en el que esta se ha incorporado en la cotidianidad no solo como forma de dirimir la diferencia, sino también como instrumento para alcanzar diferentes objetivos. La perspectiva que se abre en el país con posterioridad a la firma del acuerdo de paz del Gobierno con las Fuerzas Armadas Revolucionarias de Colombia (FARC) y el inicio de conversaciones con el Ejército de Liberación Nacional (ELN) convocan a proyectar escenarios de participación en los que emerjan nuevas formas de convivencia, coexistan la diferencia y el disenso y se construyan tanto acuerdos como consensos sobre lineamientos de acción en diversos sectores.Palabras clave: salud mental; participación comunitaria; calidad de vida.

Os espaços de reflexão acadêmica abertos à comunidade em geral têm como objetivo incentivar a análise propositiva sobre temas da atualidade e o interesse no contexto da realidade histórica e social da Colômbia. Além disso, constituem evidência da projeção e responsabilidade social universitária, uma das razões de ser da educação superior.A ampla gama de expressões do conflito interno na Colômbia, assim como a história recente da deno-minada violência política, presente durante quase seis décadas, resultou em mais de cinco gerações de cidadãos crescendo em um contexto em que isto se incorporou ao cotidiano, não apenas como forma de resolver a diferença, mas também como instrumento para alcançar diferentes objetivos. A perspectiva que se abre ao país após a assinatura do acordo de paz do Governo com as Forças Armadas Revolucionárias da Colômbia (FARC), e o início das negociações com o Exército de Libertação Nacional (ELN), levam a projetar cenários de participação em que surjam novas formas de convivência, coexistam a diferença e o dissenso e se construam tanto acordos quanto consensos sobre cursos de ação em diversos setores.Palavras-chave: saúde mental; participação comunitária; qualidade de vida.

Spaces of academic reflection open to the community in general have as an objective to incentivize the purposeful analysis of current topics and the interest in the context of the historical and social reality that Colombia lives. They constitute, in addition, evidence of universities' social projection and responsibility, one of the reasons of being for higher education.The wide array of expressions of internal conflict in Colombia, as well as the recent history of the deno-minated "political violence" present during almost 6 decades, has caused more than five generations of citizens to grow in a context in which this has been incorporated in daily life not only as a way to settle differences but also as an instrument for reaching different objectives. The perspective that opens in the country after the signing of the peace deal of the Government with the "Fuerzas Armadas Revoluciona-rias de Colombia" (FARC) and the beginning of conversations with the Ejército de Liberación Nacional (ELN) convoke the projection of theaters of participation in which will emerge new forms of coexistence, with the coexisting of differences and dissent and the building of accords and consensuses about courses of action in diverse sectors.

Dimensiones de la competencia cultural en enfermería y prácticas tradicionales para el cuidado de la infancia / Cultural nursing competency and traditional care practices for children / Dimensões da competência cultural em enfermagem e práticas tradicionais para o cuidado de crianças

Según el modelo de desarrollo de competencia cultural, el acervo cultural de cada persona se expresa en prácticas tradicionales \r\norientadas a procurar bienestar. En el marco del cuidado de enfermería, es necesario conocerlas, analizarlas e incorporarlas o ajus\r\n-\r\ntarlas; no hacerlo conduce a negar e invalidar saberes culturales colectivos e individuales.\r\nCon el objetivo de identificar expresiones de las dimensiones de la competencia cultural en enfermeras, se desarrolló una inves\r\n-\r\ntigación cualitativa fenomenológica con la participación voluntaria de once enfermeras, cuya experiencia principal ha sido el \r\ncuidado de niños en diferentes ámbitos.\r\nLas voces de las entrevistadas permiten identificar en la dimensión conciencia cultural que desde el discurso y el deber ser se \r\nhace referencia al respeto; sin embargo, en la dimensión deseo cultural no se menciona el intercambio de saberes y es ambiguo \r\nel interés por comprender su significado. El conflicto entre la vivencia personal y el rol profesional es explícito. En la dimensión \r\nconocimiento cultural, el interés por buscar información, el desarrollo de habilidades para la valoración e incorporación al cuidado \r\nde enfermería es incipiente, al igual que las expresiones de sensibilidad cultural.\r\nLa investigación aporta al reconocimiento de la importancia de brindar cuidado que además de soportado en evidencia y en \r\nprácticas efectivas, sea pertinente al esquema de valores de quien lo recibe. Se requiere durante la formación implementar estra\r\n-\r\ntegias para su fortalecimiento e incorporar el componente cultural en los protocolos de atención.

According to the cultural competency development model, \r\nthe cultural heritage of each person is expressed in traditional \r\npractices designed to ensure well-being. Therefore, it is neces\r\n-\r\nsary in the context of nursing care to identify, analyze and \r\nincorporate or adjust these practices, as a failure to do so can \r\nlead to the denial and invalidation of this collective and indi\r\n-\r\nvidual cultural knowledge.\r\nIn order to identify the expressions of cultural competencies \r\nin nurses, a phenomenological qualitative research was esta\r\n-\r\nblished, with the voluntary participation of eleven nurses with \r\nexperience in the care of children in different fields.\r\nThe voices of the interviewees allow the identification of the \r\ncultural conscience dimension since the discussion and need \r\nrefer to that respect; however, in the cultural desire aspect, the \r\nexchange of information is not mentioned, and the interest \r\nin understanding its significance is ambiguous. The conflict \r\nbetween personal experience and the professional role is \r\nexplicit. Interest in searching for information, expressing cultural \r\nknowledge, developing skills for evaluation and inclusion in \r\nnursing care are emerging as expressions of cultural sensibility.\r\nThe investigation contributes to the recognition of the impor\r\n-\r\ntance of caregiving that is not only supported by evidence \r\nand effective practices, but also seeks to be relevant according \r\nto the morals and values of the individual that is being cared \r\nfor. It is required, during training, to implement strategies that \r\nstrengthen those values and seek to incorporate the cultural \r\ncomponent in protocols of attention.

Segundo o modelo de desenvolvimento de competência \r\ncultural, o acervo cultural de cada pessoa se expressa através \r\nde práticas tradicionais que buscam o bem-estar. Portanto, \r\né necessário, no contexto de cuidados de enfermagem, \r\nconhecer, analisar e incorporar ou ajustar essas práticas, sendo \r\nque sua não realização conduz à negação e invalidação de \r\nconhecimento culturais coletivos e individuais.\r\nCom o objetivo de identificar expressões das dimensões da \r\ncompetência cultural em enfermeiras, foi desenvolvida uma \r\npesquisa qualitativa fenomenológica com a participação \r\nvoluntária de onze enfermeiras, cuja experiência principal foi o \r\ncuidado de crianças em diferentes campos.\r\nAs vozes das entrevistadas permitem a identificação da \r\ndimensão consciência cultural, uma vez que a discussão e o \r\ndever se referem a ela. No entanto, no aspecto desejo cultural, \r\na troca de informações não é mencionada e o interesse na \r\ncompressão de seu significado é ambíguo. O conflito entre \r\nexperiência pessoal e o papel profissional é explícito. Na \r\ndimensão conhecimento cultural, o interesse em buscar infor\r\n-\r\nmações, o desenvolvimento de habilidades para a valorização \r\ne incorporação aos cuidados de enfermagem são emergentes, \r\nbem como as expressões de sensibilidade cultural.\r\nA pesquisa contribui para o reconhecimento da importância de \r\ncuidados, que além de serem apoiados por evidências e práticas \r\nefetivas, também sejam pertinentes ao sistema de valores de \r\nquem os recebe. É necessária, durante a formação, a implemen\r\n-\r\ntação de estratégias que fortaleçam estes valores e busquem \r\nincorporar o componente cultural aos protocolos de atenção.

Formación en competencias para la comprensión cultural en el cuidado de enfermeria / Competency training for cultural compehension in nursing care / Treinamento de habilidades para a compreensão cultural nos cuidados da enfermagem

Es lugar común reconocer la importancia de la relación interpersonal que soporta el cuidado de enfermería, pues en ella se revela \r\n"el ser y el sentir" de quien lo brinda y de quien lo recibe, y como todo acto humano cobra sentido en el contexto cultural. Conocer, \r\ninterpretar, comprender la cosmovisión del otro y la propia, es decir, desarrollar competencias para la comprensión cultural, es \r\nimperativo en salud. Se requiere profesionales que sean coautores en el relato del proceso salud-enfermedad y que armonicen de \r\nmanera creativa y participativa teoría, práctica, reflexión y experiencia. \r\nEste interés motiva la investigación \r\nModelo para el desarrollo de competencias culturales en la formación de pregrado de enfer\r\n-\r\nmería\r\n. Desde la investigación cualitativa fenomenológica se identifican, a partir de entrevistas en profundidad realizadas a \r\ndirectivas de una facultad de enfermería de Bogotá, estrategias y recomendaciones para el desarrollo de esta competencia.\r\nSe destaca la coherencia con la misión institucional como punto de anclaje en su desarrollo. La conciencia y el conocimiento \r\ncultural se incentivan a través del aprendizaje significativo y las prácticas formativas.\r\nAlcanzar los niveles de deseo y encuentro cultural y su integración con el Proceso de Atención de Enfermería, son retos que \r\nrequieren de estrategias orientadas a docentes y estudiantes desde los principios de integralidad, comunicación, complementa\r\n-\r\nriedad y flexibilidad.\r\nPara su fortalecimiento, se propone la transversalización de este componente en el plan de estudios y el desarrollo de actividades \r\nde formación específicas, que contemplen talleres, experiencias vivenciales y seminarios, inicialmente orientados a directivas y \r\ndocentes, posteriormente proyectados a estudiantes.

It is common to recognize the importance of the interpersonal \r\nrelationship that supports nursing care, because in it is revealed \r\nthe "being and feel" of who offers it and who receives it, and \r\nlike all human action it makes sense in the cultural context. \r\nKnowing, interpreting, understanding the worldview of the \r\nother and ones own, that is to say, developing competencies \r\nfor cultural comprehension, is imperative in health. Profes\r\n-\r\nsionals are needed who are co-authors in the health-disease \r\nnarrative and who creatively and actively harmonize theory, \r\npractice, reflection, and experience.\r\nThis interest motivates the \r\nModel for the development of \r\ncultural competencies in the undergraduate formation of \r\nnursing\r\n investigation. Strategies and recommendations \r\nfor the development of these competencies from a qual\r\n-\r\nitative, phenomenological investigation were identified, \r\nthrough in depth interviews to the directives in a nursing \r\ncollege in Bogota.\r\nCoherence with the institutional mission stands out as an \r\nanchor point for its development. Consciousness and cultural \r\nknowledge are incentivized through meaningful learning and \r\nformative practices. Reaching the desired level and cultural \r\nencounter and their integration with the Process of Nursing \r\nAttention are challenges that require strategies oriented \r\nat professors and students from the principles of integrity, \r\ncommunication, complementarity, and flexibility. The proposal \r\nfor its strengthening is the mainstreaming of this component \r\nin the study plan and the development of specific formation \r\nactivities, that include workshops, seminars, and life experi\r\n-\r\nences which initially are oriented at directives and professors, \r\nand later projected to students.

É lugar comum reconhecer a importância da relação inter\r\n-\r\npessoal que dá suporte aos cuidados de enfermagem, uma \r\nvez que é nela que se revela "o ser e o sentir" de quem dá e \r\nde quem recebe, e, como todo ato humano, é significativa \r\nno contexto cultural. Conhecer, interpretar, compreender \r\na cosmovisão do outro e a própria, isto é, desenvolver habi\r\n-\r\nlidades para a compreensão cultural é necessário na área da \r\nsaúde. É preciso profissionais que sejam coautores no relato do \r\nprocesso saúde-doença e que harmonizem, de maneira cria\r\n-\r\ntiva e participativa, teoria, prática, reflexão e experiência.\r\nEsse interesse motiva a pesquisa \r\nModelo para o desenvolvi\r\n-\r\nmento de habilidades culturais na formação de graduandos \r\nde enfermagem\r\n. A partir da pesquisa qualitativa fenomenoló\r\n-\r\ngica identificam-se, com base em entrevistas em profundidade \r\nrealizadas com diretrizes de uma faculdade de enfermagem de \r\nBogotá, estratégias e recomendações para o desenvolvimento \r\ndestas habilidades.\r\nDestaca-se a coerência com a missão institucional como ponto \r\nde ancoragem em seu desenvolvimento. A consciência e o \r\nconhecimento cultural são incentivados através do aprendi\r\n-\r\nzado significativo e das práticas de formação.\r\nAlcançar os níveis de desejo e encontro cultural, e sua inte\r\n-\r\ngração com o Processo de Atenção de Enfermagem, são \r\ndesafios que requerem estratégias orientadas por parte dos \r\ndocentes e dos estudantes, a partir dos princípios de integrali\r\n-\r\ndade, comunicação, complementariedade e flexibilidade.\r\nPara seu fortalecimento, propõe-se a integração deste compo\r\n-\r\nnente no plano de estudos e o desenvolvimento de atividades \r\nde formação especificas, que incluem workshops, experiências \r\nde vida e seminários orientados inicialmente para diretrizes e \r\ndocentes, posteriormente projetados para estudantes.

Cosmovisión ancestral y comprensión de los conceptos salud, cuidado y enfermería en habitantes del resguardo muisca de Chía, 2010 / Ancestral worldview and understanding of the concepts of health, care and nursing in the population of a muisca reservation in Chía, 2010

El reconocimiento, fortalecimiento y recuperación de prácticas de cuidado en culturas diversas favorece la calidad de las acciones de enfermería; el Enfoque Biopsicosocial, cultural y espiritual y la teoría Transcultural aportan a este objetivo y sirven de soporte al diseño de estrategias orientadas a preservar, adaptar y reestructurar los cuidados culturales; acciones que desde la comprensión de la salud en este grupo, se propone sean lideradas por el profesional de enfermería. La investigación descriptiva cualitativa contó con la participación voluntaria de familias y líderes muiscas reconocidos como cuidadores por la comunidad; se presenta como abordaje metodológico que posibilita reconocer la comprensión actual de los conceptos salud, cuidado y enfermería. La información recolectada mediante la observación, encuestas y entrevistas, en las categorías enunciadas, se analizó por triangulación de fuentes y de investigadores. Se identificó un marcado proceso de aculturación en las tres categorías analizadas: el concepto “cuidado” guarda mayor proximidad con la cosmovisión ancestral; la comprensión de la salud no incorpora dimensiones reconocidas ancestralmente; y, la enfermería se identifica como un “quehacer” propio del género femenino que articula las dimensiones comunicacional, afectiva y de protección próximas a lo descrito como cuidado por los líderes en salud ancestrales.

The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients.

No useful method to directly monitor the level of end organ tissue injury is currently available clinically. Gastric reactance has been proposed to measure changes in a tissue structure caused by ischemia. The purpose of this study was to assess whether gastric reactance is a reliable, clinically relevant predictor of complications and a potentially useful tool to assess hypoperfusion in cardiovascular surgery patients. The value of gastric reactance measurements, standard hemodynamic and regional perfusion variables, and scores to predict postoperative complications were compared in 55 higher risk cardiovascular surgery patients with cardiopulmonary bypass. Low frequency gastric reactance, X(L), had a significant predictive value of postoperative persistent shock requiring more than 48 h of vasopressors and associated complications, before, during and after surgery (p < 0.05). Results suggest that reactance is an earlier predictor of patients at risk than all other variables tested. Patients with a high reactance (X(L) > 26) before surgery had a significantly higher incidence of complications, higher mortality and more days in the ICU than patients with a low reactance (X(L) < 13). X(L) was found to be a reliable and clinically relevant measurement. These results justify further clinical research to explore how this information may be used to improve patient management.

Necesidades de cuidado de enfermería en soldados amputados por minas antipersona / Necessities of nursing care in soldiers amputated by antipersonal mine

En el mundo existen más de 500 millones de personas con una u otra forma de discapacidad[1]; la Organización Mundial de la Salud (OMS) sostiene que la proporción oscila entre el 10% y el 12%, del total de la población; la Organización Internacional del Trabajo (OIT) señala que de estos, 400 millones se encuentran en países en desarrollo. El Departamento Administrativo Nacional de Estadísticas (DANE) reconoce que de cada cien colombianos, seis presentan algún tipo de discapacidad permanente y que se presenta una tendencia creciente, de esta situación como consecuencia del conflicto armado. El uso de minas antipersona se constituye en una de las situaciones que además de un gran número de víctimas, genera una amplia gama de problemática social, que evidencia la necesidad de plantear estrategias para el abordaje de una situación de salud que afecta un amplio grupo poblacional, en el que los militares y sus familias son los más afectados, en respuesta a esta situación se plantea la investigación que da origen a este articulo y responde al interrogante asociado a la identificación de necesidades de cuidado de enfermería, vivenciadas por los soldados amputados por minas antipersona durante el proceso de rehabilitación. Se reconoció que en el grupo de necesidades que cobran mayor relevancia son las asociadas a la vinculación de la familia y las redes de apoyo a los procesos de rehabilitación y las que se relacionan con la importancia de incentivar la reconstrucción del proyecto de vida del soldado, que posterior a la amputación manifiesta temores, expectativas e incertidumbre frente al desempeño de los roles previos y a la necesidad de reconstruir o redimensionar, en el marco del proceso de rehabilitación, una nueva forma de relación con el entorno.

[Minimally invasive transmuscular approach for the treatment of lumbar far lateral disc herniation]. / Utilisation d'un écarteur musculaire tubulaire dans le traitement chirurgical des hernies discales lombaires extraforaminales.

BACKGROUND: The purpose of this study was to evaluate a minimally invasive surgical technique for the treatment of lumbar far lateral disc herniation. This technique combines the tubular retractor with the operative microscope. OBJECTIVE AND METHODS: This retrospective study analyzed the files of 26 patients: 15 men and 11 women. The average age was 56 years (range, 19-83 years). The most commonly operated level was L3-L4 (46%), then L4-L5 (30.5%) and finally L2-L3 (15.5%). All patients were operated under general anesthesia. The intraoperative radioscopic location was absolutely necessary. A 12-15 mm paramedian incision was made on the side of the herniation (30 mm from the medial line). We then inserted the tubular muscular retraction system followed by the 14 mm diameter working channel. Guided by operating microscope, the articular isthmus was reamed to expose the root and the disc. The disc herniation was then removed after opening and removing the inter-transverse ligament. RESULTS: The average duration of the surgery was 55 min. This operating time decreased as the surgeons gained experience. The radicular pain, estimated using the analogical visual scale, varied from seven before surgery to two during the postoperative period. All the patients were standing up the day after surgery. The average duration of the postoperative stay in the hospital was three days (range, 1-5 days). We noted no complications from the surgical procedure. The average duration of the follow-up was two years (range, 6-36 months). CONCLUSION: This technique combines the advantages of endoscopic surgery (less muscular and osseous damage) and microscope-guided surgery (three-dimensional vision) and provided good functional results in this series.

[Intramedullary spinal tuberculoma: report of one case]. / Tuberculose intramédullaire. A propos d'un cas.

Neurological symptoms of tuberculosis are rare, even if there this pathology has been on the rise for a number of years because of HIV. Intramedullary tuberculoma is an exceptional location. We report the case of a patient with no HIV or immunodepression symptoms with intramedullary tuberculoma, revealed by a clinical presentation of insidious onset of myelopathy. We will discuss the diagnosis, treatment and clinical functional follow-up. The optimal treatment seems to be a combination of microsurgical resection and antibiotic therapy.

Valoración isocinética de la prótesis de rodilla tipo Scorpio PS / Isokinetic assessment of Scorpio PS knee prosthesis

Introducción. El objetivo del estudio es valorar la función muscular en la gonartrosis avanzada utilizando parámetros isocinéticos y analizar su evolución a los 12 meses de la implantación de una prótesis total de rodilla (PTR) tipo Scorpio PS. También se comparan los resultados antes y después de la cirugía con un grupo control. Material y métodos. Se estudia una muestra de 16 pacientes con gonartrosis candidata a implante de PTR y un grupo control apareado en cuanto a sexo, edad y lateralidad. El estudio se realiza con un dinamómetro Cybex Norm II en régimen concéntrico a velocidades de 120° y 180°/segundo. Resultados. Se observaron valores significativamente menores en la flexión (peak torque a 120°/segundo, peak torque a 180°/segundo y set total work a 120°/segundo) de los pacientes gonartrósicos respecto al grupo control. El valor de la ratio a 180°/segundo y la peak torque de flexión a 180°/segundo resultaron significativamente mayores en el grupo protetizado comparado con el mismo grupo antes de la intervención. El resto de valores obtenidos no tuvieron diferencias estadísticamente significativas (p > 0,05). Discusión. Los pacientes con gonartrosis avanzada tienen un déficit significativo en la flexión pero no en la extensión respecto a un grupo de pacientes control. Los pacientes a los que se les ha implantado una PTR tipo Scorpio PS no presentan un déficit significativo de extensión ni de flexión con respecto a los controles. Los sujetos gonartrósicos no tienen diferencias significativas en cuanto a la extensión respecto a los mismos pacientes protetizados a los 12 meses

Introduction. This study aims to evaluate muscle functionality in advanced osteoarthritis of the knee using isokinetics parameters and to analyze its evolution at 12 months of the implantation of a total knee arthroplasty (TKA). Furthermore, the results were also compared before and after surgery with the control group. Material and methods. A sample of 16 patients with osteoarthritis, who could be treated with a TKA implant and a control group comparable in regards to gender sex, age and laterality, was studied. The study was conducted using a Cybex Norm dynamometer with concentric regime at speeds of 120° and 180°/ second. Results. Significantly lower values in flexion (peak torque 120°/second, peak torque 180°/second and set total work 120°/second) were observed in osteoarthritis patients in comparison with their respective control group. The values of the 180°/second ratio and the 180°/second flexion peak torque were significantly greater in the prosthetic group compared with the same group before surgery. The rest of the values obtained showed no statistically significant differences (p > 0.05). Discussion. Patients with advanced osteoarthritis have a significant deficit in flexion but not in the extension regarding the control group. Those in whom a TKA Scorpio PS implant was done had no significant deficit of extension or flexion compared to the control group. The osteoarthritis subjects do not show significant differences regarding the extension compared to the same patients at 12-month

Gastric impedance spectroscopy in elective cardiovascular surgery patients.

Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in critically ill patients. The present study characterizes human gastric impedance spectral changes under gastric hypoperfusion in patients undergoing cardiovascular surgery, and evaluates spectral differences between patients with no evidence of gastric ischemia and complications, and patients who developed ischemia and complications. Cole and Kun parameters were calculated over time to characterize changes as tissue injury progresses. Gastric ischemia was determined by air tonometry. Impedance spectroscopy spectra were obtained from 63 cardiovascular surgery patients. The recorded spectra were classified into three groups: group 1 for patients without ischemia or complications, group 2 for patients with a short period of ischemia (less than 2 h) and group 3 for patients with more than 4 h of gastric ischemia and complications. Two distinct dispersion regions of the spectra centered at about 316 Hz and 215 kHz become clearer as tissue damage develops. The average spectrum in group 3 shows a significant difference in tissue impedance at all frequencies relative to group 1. The parameters obtained for human gastric tissue show significant changes that occur at different times and at different frequencies as ischemia progresses, and could be correlated with patient outcome. This confirms our hypothesis that hypoperfusion and ischemia cause evident changes in the impedance spectra of the gastric wall. Therefore, this technology may be a useful prognostic and diagnostic monitoring tool.

Gastric Impedance Spectroscopy in Cardiovascular Surgery Patients vs. Healthy Volunteers.

Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in the critically ill. The present study evaluates spectral differences in elective cardiovascular surgery patients compared with the impedance spectra of the gastric mucosa in healthy adults. An impedance spectroscopy probe and nasogastric tube (ISP/NGT) was placed into the stomach of 77 heart surgery and 21 healthy volunteers. The recorded impedance spectra were classified into 3 groups: group 1 for healthy volunteers; group 2 for patients with neither ischemia nor complications; and group 3 for patients with ischemia and complications during the first 3 days in the recovery unit. There were statistical differences in resistance (p<0.001) and reactance (p<0.001) among the 3 groups. The results show that impedance spectra are distinct and significantly different in patients with probable ischemic mucosal injury compared to healthy subjects, and therefore this technology may be a useful prognostic and diagnostic monitoring tool.

Pesquisa de ambliopía en preescolares del Centro de Salud familiar Bernardo Leighton / Screening for amblyopia in pre-school children in the Family Health Centre, Bernardo Leighton

Introducción: La ambliopía corresponde a una disminución de la agudeza visual sin causa orgánica conocida y tiene una prevalencia estimada entre 1 a 5 por ciento de la población general. Objetivos: Cuantificar la prevalencia y determinar las causas de ambliopía en preescolares de 4 a 5 años. Material y Métodos: Se realizó examen oftalmológico completo a 94 niños derivados en forma aleatoria desde el programa control de niño sano del Centro de Salud Familiar Bernardo Leighton y se registraron la agudeza visual y refracción con mejor visión corregida, determinándose la existencia de ambliopía. Resultados: Se encontró ambliopía en 9,6 por ciento, siendo bilateral en 5,3 por ciento y asociándose principalmente a astigmatismo. El 93,3 por ciento de los ojos con agudeza visual sin corrección menor o igual a 0,5 tenían ambliopía. Conclusiones:La alta prevalencia de ambliopía encontrada hace necesario instaurar programas de screening visual para su detección precoz. Presentar agudeza visual sin corrección de 0,5 o inferior sería un factor de riesgo de esta patología.

Polimorfismo del gen de aldosa reductasa y velocidad de aparición de retinopatía en diabéticos no insulinodependientes / Aldose reductase gene polymorphism and rate of appearance of retinopathy in non insulin dependent diabetic patients

Background: Recent studies suggest that polymorphisms associated to the aldose reductase gene could be related to early retinopathy in noninsulin dependent diabetics (NIDDM). There is also new interest on the genetic modulation of coagulation factors in relation to this complication. Aim: To look for a possible relationship between the rate of appearance of retinopathy and the genotype of (AC)n polymorphic marker associated to aldose reductase gene. Patients and methods: A random sample of 27 NIDDM, aged 68.1 ñ 10.6 years, with a mean diabetes duration of 20.7 ñ 4.8 years and a mean glycosilated hemoglobin of 10.6 ñ 1.6 percent, was studied. The genotype of the (AC)n, polymorphic marker associated to the 5Õ end of the aldose reductase (ALR2) gene was determined by 32P-PCR plus sequenciation. Mutations of the factor XIII-A gene were studied by single stranded conformational polymorphism, sequenciation and restriction fragment length polymorphism. Results: Four patients lacked the (AC)24 and had a higher rate of appearance of retinopathy than patients with the (AC)24 allele (0.0167 and 0.0907 score points per year respectively, p=0.047). Both groups had similar glycosilated hemoglobin (11.7 ñ 0.2 and 10.5 ñ 1.6 percent respectively). Factor XIII gene mutations were not related to the rate of appearance of retinopathy. Conclusions: Our data suggest that the absence of the (AC)24 allele of the (AC)n polymorphic marker associated to the 5Õ end of the aldose reductase gene, is associated to a five fold reduction of retinopathy appearance rate