Frontal sulcotomy through 3D printed illuminated endoport for minimally invasive evacuation of a deep-seated intracerebral hematoma - A case report.

Spontaneous intracerebral hemorrhage carries high mortality and disability rates and usually affects deep brain structures. We have implemented a self-designed low-cost 3D-printed illuminated endoport for the surgical drainage of a deep spontaneous intracerebral hemorrhage in a patient who arrived with right hemiparesis and a GCS score of 10. A minimally invasive approach was made and our patient had a favorable functional outcome after surgery. Carrying out this approach with a low-cost 3D-printed endoport makes it possible to offer a safe and efficient treatment option to a low-income country population.

Taxonomic and Functional Diversity of Flower-Visiting Insects in Coffee Crops.

Despite the important role that flower-visiting insects play in agricultural production, none of the previous studies of coffee pollinators in Colombia have incorporated functional diversity into their analysis. Therefore, this study aimed to quantify the abundance, richness, and functional diversity of insects that visit flowers in coffee crops. Twenty-eight plots were selected among five sites in the north, center, and south of Colombia. In each plot, coffee flower insect visitors were collected and recorded on 90 trees at eight-minute intervals per tree, at three different times over three days. All sampling was carried out during two flowering events per year, over three years, resulting in a total of 1240 h of observations. Subsequently, the insects were taxonomically identified, and the number of individuals and species, as well as the diversity of the order q, were estimated. Functional diversity was also characterized in the bee community. The results: (a) 23,735 individuals belonging to 566 species were recorded; of them, 90 were bees, with the native species being the most abundant during 10:30 and 13:00 h; (b) bees formed five functional groups, with corbiculate and long-tongued non-corbiculate bees being the most abundant and occupying the largest regions of functional space; (c) potential pollinators in coffee crops are Apis mellifera, Nannotrigona gaboi, Tetragonisca angustula, Geotrigona cf. tellurica, and Partamona cf. peckolti. Coffee crops host a wide diversity of flower visitors, especially bees, which could be beneficial for productivity and contribute to the maintenance of plant species that accompany coffee cultivation.

Effect of polyethylene fiber orientation on fracture resistance of endodontically treated premolars.

STATEMENT OF PROBLEM: Polyethylene fibers have been reported to improve the fracture resistance of endodontically treated teeth, but their optimal orientation is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effects of different fiber positions and orientations on the fracture resistance of endodontically treated premolar teeth. MATERIAL AND METHODS: One hundred endodontically treated maxillary premolars were divided into 2 groups according to the cavity design, mesio-occluso-distal and occluso-buccal, and each group was divided into 5 subgroups (n=10) according to the polyethylene fiber orientation on the pulpal floor: unidirectional horizontal (from mesial to distal), unidirectional vertical (from buccal to palatal), bidirectional (buccopalatal and mesiodistal), circular (around the walls), and without fibers (control group). The cavities were restored with fiber-reinforced composite resin and conventional composite resin. All the teeth were fractured with a universal testing machine and analyzed as catastrophic failure or reparable failure. A 1-way ANOVA was used to compare fracture strength values (α=.05). RESULTS: The tested groups with different fiber orientations showed significantly higher fracture load than the control group (P<.05). No statistically significant difference was observed among the fiber orientations (P>.05). Most of the favorable fractures were occlusal to the cemento-enamel junction, and adhesive failure were seen in the mesio-occluso-distal and occluso-buccal cavities. The highest percentage of unfavorable fractures and mixed failures was observed in the control group. CONCLUSIONS: The fiber orientation pattern in the mesio-occluso-distal and occluso-buccal cavities did not differ significantly in the fracture resistance of endodontically treated maxillary premolar teeth.

SEOM-GEINO clinical guidelines for high-grade gliomas of adulthood (2022).

High-grade gliomas (HGG) are the most common primary brain malignancies and account for more than half of all malignant primary brain tumors. The new 2021 WHO classification divides adult HGG into four subtypes: grade 3 oligodendroglioma (1p/19 codeleted, IDH-mutant); grade 3 IDH-mutant astrocytoma; grade 4 IDH-mutant astrocytoma, and grade 4 IDH wild-type glioblastoma (GB). Radiotherapy (RT) and chemotherapy (CTX) are the current standard of care for patients with newly diagnosed HGG. Several clinically relevant molecular markers that assist in diagnosis and prognosis have recently been identified. The treatment for recurrent high-grade gliomas is not well defined and decision-making is usually based on prior strategies, as well as several clinical and radiological factors. Whereas the prognosis for GB is grim (5-year survival rate of 5-10%) outcomes for the other high-grade gliomas are typically better, depending on the molecular features of the tumor. The presence of neurological deficits and seizures can significantly impact quality of life.

Techno-functional properties of gluten-free pasta from hyperprotein quinoa flour.

Many consumers who are aware of the importance of good nutrition demand quality food alternatives. In particular, many of them are looking for quality, plant-based protein sources such as quinoa. The objective of this work was to evaluate the techno-functional properties of gluten-free pasta from hyperprotein quinoa flour. Pasta mixes were made from gluten-free flours, corn, rice, cassava starch, hyperprotein quinoa flour and defatted high protein quinoa flour, which were subsequently extruded. The flow rheological properties of aqueous dispersions of flour mixtures were analyzed before and after the pasting test. In addition, thermal properties were analyzed by differential scanning calorimetry and structural properties by Fourier transform infrared spectroscopy. The results showed a change of flow from dilatant (n > 1) to pseudoplastic (n < 1) after the pasting test. In addition, a positive correlation was observed between hyperprotein defatted quinoa flour and viscosity, and a negative correlation with hyperprotein quinoa flour. Regarding thermal properties, it was found that all blends showed low gelatinization enthalpy values, attributed to the high proportions of HQF and HDQF. Spectroscopic analysis showed that the extrusion did not significantly affect the native structure of the protein, by monitoring the intensities of the 1648 cm-1, 1656 cm-1 and 1667 cm-1 bands associated with the Random coil, α-helix, ß-turns secondary structures, respectively. It was possible to conclude that both hyperprotein quinoa flour and defatted hyperprotein quinoa flours have a differential influence on the techno-functional properties of pasta. The first one, tends to reduce viscosity and consistency while the second one tends to increase it. Finally, moderate temperatures during extrusion did not cause significant changes in starch and protein structures as determined by spectroscopic study.

Management of gastropleural leak by video-assisted thoracoscopy after sleeve gastrectomy.

Obesity is a major public health issue with various comorbidities. Sleeve gastrectomy has become a popular treatment for obesity, but it carries the risk of complications, particularly staple line leakage. This case study focused on a 32-year-old woman with grade II obesity and hiatal hernia who underwent laparoscopic sleeve gastrectomy. Four days after surgery, she presented with abdominal pain, revealing leakage from the gastric sleeve into the thoracic cavity. Diagnostic procedures and interventions were performed, including cavity lavage, drainage placement, and stent placement. The patient showed clinical improvement after video-assisted thoracoscopic surgery and a multidisciplinary approach involving nutrition support and antibiotics. Despite the challenges, the patient's clinical course improved, leading to discharge with no evidence of leakage on follow-up endoscopy. Careful monitoring and timely interventions are essential to manage complications in sleeve gastrectomy procedures and ensure optimal patient outcomes.

First Molecular Identification of a Goussia Parasite from a New World Invasive Blenny.

PURPOSE: Introduced or invasive fish are susceptible to new parasites but can simultaneously carry infectious parasites from their native range towards new hosts. Screening these parasites is key to address the health of fish populations and spread of diseases. METHODS: In this study, we sequenced a Coccidia parasite, for the first time from the blenny Omobranchus sewalli, introduced in the northern coast of Brazil with an Indo-Pacific origin. RESULTS: Only one individual was infected, its genetic sequence matched (over 99%) with two lineages of undetermined species, belonging to the genus Goussia, sequenced from three marine fish species (Mulloidichthys flavolineatus, Lutjanus kasmira, and Selar crumenophthalmus) in Hawaii. CONCLUSIONS: Phylogenetic analysis suggests considerable differentiation between the Goussia detected and other Goussia spp. sequenced from North Atlantic marine fish, thus we cannot exclude the possibly that this parasite was carried by O. sewalli from its native Indo-Pacific range.

A Retrospective Study of Laparoscopic Cryptorchidectomy in 19 Cats with Intra-Abdominal Testes.

Cryptorchidism is heritable in cats, and due to the pathological risk of testicular torsion, and the development of testicular neoplasia, cryptorchidectomy is the treatment of choice. For the intra-abdominal testes, a laparotomic approach is generally recommended; however, laparoscopic cryptorchidectomy in cats has been documented in a few clinical case reports. The aim of the study was to report the short-term clinical outcomes for 19 cryptorchid cats with intra-abdominal testes that underwent cryptorchidectomy with laparoscopic techniques. Medical records of client-owned sexually intact male cats that underwent laparoscopic cryptorchidectomy in different veterinary hospitals or ambulatory surgical services were reviewed. The procedure was performed in 19 cats. The average time (mean ± standard deviation, SD) for all procedures was 23 ± 6 min (range 15-35 min). The time for laparoscopic removal of a single abdominal testis was 22 ± 6 min, with 30 min for the bilateral abdominal testes. The time until hospital discharge varied depending on the surgeon's criteria, with a mean of 6 h (range 3-24 hrs). None of the cases analyzed showed any surgical complications. The results of this study suggest that laparoscopic cryptorchidectomy is an appropriate surgical procedure to treat cryptorchid cats with intra-abdominal testes, all with benefits of minimal invasion surgery.

Preliminary study of physicochemical, thermal, rheological, and interfacial properties of quinoa oil.

Background: The growing popularity of nutrient-rich foods, among which is quinoa, is due to the increasing demand for healthier choices. Oils and hydrolyzed proteins from these foods may help prevent various health issues. The objective of this work was to perform extraction from the endosperm of the grain from high-protein quinoa flour by physical means via a differential abrasive milling process and extracting the oil using an automatic auger extractor at 160°C, as well as characterizing extracted oil. Methods: Quinoa oil extraction and physicochemical characterization were carried out. Chemical and physical quality indexes of quinoa oil were established, and both characterizations were conducted based on international and Columbian standards. Thermal properties were evaluated by differential scanning calorimetry, and rheological and interfacial properties of the oil were evaluated using hybrid rheometers and Drop Tensiometers, respectively, to determine its potential for obtaining functional foods. Results: The result was 10.5 g of oil/ 100 g of endosperm, with a moisture content of 0.12%, insoluble impurities of 0.017%, peroxide index of 18.5 meq O 2/kg of oil, saponification index of 189.6 mg potassium hydroxide/g of oil, refractive index of 1.401, and a density of 0.9179 g/cm 3 at 20°C. Regarding contaminating metals, it presented 7 mg of iron/kg of oil, a value higher than previously established limits of 5 mg of iron/kg of oil. The oil contained 24.9% oleic acid, 55.3% linoleic acid, and 4% linolenic acid, demonstrating antioxidant capacity. Quinoa oil showed thermal properties similar to other commercial oils. Conclusions: The interfacial and rheological properties were suitable for the stabilization of emulsions, gels, and foams, which are important in various industrial applications and could facilitate the development of new products. The extracted quinoa oil presented similar characteristics to other commercial oils, which could make it a potential product for commercialization and application in different industries.

Quinoa Snack Production at an Industrial Level: Effect of Extrusion and Baking on Digestibility, Bioactive, Rheological, and Physical Properties.

This research aimed to produce gluten-free snacks on a pilot scale from quinoa flour. These snacks experienced an extrusion process, followed by baking. The effects of these technological processes on carbohydrate and protein digestibility, extractable phenolic compounds (EPP), hydrolyzable phenolic compounds (HPP), antioxidant capacity, and physical properties were evaluated in raw quinoa flour and extruded snacks. Extrusion increased digestible starch (RDS) from 7.33 g/100 g bs to 77.33 g /100 g bs. Resistant starch (RS) showed a variation of 2 g/100 g bs. It is noteworthy that protein digestibility increased up to 94.58 g/100 bs after extrusion and baking. These processes increased HPP content, while EPP and carotenoid content decreased. The samples showed significant differences (p < 0.05) in the antioxidant properties determined through the DPPH and ABTS methods. Values of 19.72 ± 0.81 µmol T/g were observed in snacks and 13.16 ± 0.2 µmol T/g in raw flour, but a reduction of up to 16.10 ± 0.68 µmol T/g was observed during baking. The baking process reduced the work of crispness (Wcr) from 0.79 to 0.23 N.mm, while the saturation (C*) was higher in baked ones, showing higher color intensity. The baking process did not influence the viscosity profile. The results in this study respond to the growing interest of the food industry to satisfy consumer demand for new, healthy, and expanded gluten-free snacks with bioactive compounds.

Nematicidal Screening of Aqueous Extracts from Plants of the Yucatan Peninsula and Ecotoxicity.

Active metabolites from plants are considered safer than synthetic chemicals for the control of plant-parasitic nematodes of the genus Meloidogyne. In the present work, 75 aqueous extracts (AEs) from different vegetative parts of 34 native plant species of the Yucatan Peninsula were evaluated against second-stage juveniles (J2s) of Meloidogyne incognita and M. javanica in microdilution assays. The highest mortality (M) against both Meloidogyne species was produced by the foliar AE from Alseis yucatanensis (M ≥ 94%) and Helicteres baruensis (M ≥ 77%) at 3% w/v after 72 h. Other active AEs at 3% were from the leaves of Croton itzaeus and stems of H. baruensis (M: 87-90%) on M. javanica and the stems of Annona primigenia and the leaves of Morella cerifera on M. incognita (M: 92-97%). The AEs from A. yucatanensis had the lowest LD50 against M. incognita (0.36% w/v), and against M. javanica (3.80% w/v). In an acute ecotoxicity assay of the most promising AEs using non-target earthworms (Eisenia fetida), the AE of A. yucatanensis had slight acute toxicity (LD50: 2.80% w/v), and the rest of the most active AEs were not ecotoxic. These tropical plants are potential candidates for further studies as biorational agents for controlling Meloidogyne species.

Clarifying the taxonomy of some cryptic blennies (Blenniidae) in their native and introduced range.

Omobranchus punctatus is native to the Indo-Pacific region and invasive in the Atlantic region, currently being considered one of the most widely distributed blenny species. However, recent molecular studies indicated that O. punctatus is a complex of species, with three divergent mtDNA lineages identified to date, stressing the need for a taxonomic revision. In this study, we used an integrative approach, combining morphological and genetic data, to shed light on the taxonomy and distribution of O. punctatus. Moreover, we provide the first genetic records of introduced populations in Brazil and discuss the introduction pattern of this species in this region. Morphological data shows that O. punctatus consists of at least five distinct and geographically restricted species: O. punctatus sensu stricto, O. dispar, O. sewalli, O. cf. kochi, and O. cf. japonicus. Species delimitation analyses performed using the mtDNA data available confirmed that O. punctatus sensu stricto, O. dispar and O. sewalli correspond to different species that started to diverge about 2.6 Mya. Furthermore, O. sewalli was identified as the invasive species colonizing Atlantic shores. The existence of historical oceanographic barriers, such as the emergence of the Sunda Shelf in the Eastern Indian Ocean during the Pleistocene, and the biological traits of these blennies are the most likely factors responsible for their genetic differentiation and subsequent speciation.

Trombosis de seno venoso asociada con infección por SARS-CoV-2 / Cerebral venous thrombosis associated with SARS-Cov-2 infection

RESUMEN INTRODUCCION: La trombosis del seno venoso se considera una de las causas más infrecuentes de enfermedad cerebrovascular (ECV), prevalente en la edad joven. Suele tener un inicio insidioso, lo cual dificulta su diagnóstico y el inicio oportuno del tratamiento, y se encuentra asociada con múltiples factores de riesgo, incluyendo estados de hipercoagulabilidad, como en aquellos pacientes que cursan con infección por SARS-CoV-2. REPORTE DE CASO: Se presentan dos casos clínicos de pacientes con alteraciones neurológicas, diplopia y estatus epiléptico, en quienes se documentó por medio de la sintomatologia y de estudios imagenológicos, trombosis venosas extensas de localización infrecuente, se descartaron las principales etiologías asociadas, y el único nexo asociado fue la infección por SARS-CoV-2. Ambos pacientes recibieron tratamiento con anticoagulación parenteral, al que respondieron de forma exitosa, por lo cual se logró el alta posteriormente con anticoagulación oral. DISCUSIÓN: Es imprescindible el conocimiento de esta enfermedad, asociada con una alta sospecha diagnóstica, dadas sus manifestaciones clínicas variadas y su asociación cada vez más frecuente con infección por covid-19.

ABSTRACT INTRODUCTION: Venous sinus thrombosis is considered one of the most infrequent causes of cerebrovascular disease (CVD), prevalent in young people. It usually has an insidious onset which difficult its diagnosis and timely initiation of treatment and is associated with multiple risk factors including hypercoagulable states, as in those patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection. CASE REPORT: The following are 2 clinical cases of patients with neurological alterations, diplopia, and status epilepticus, in whom extensive venous thrombosis of infrequent location was documented through symptomatology and imaging studies, ruling out the main associated etiologies, with the only associated nexus: SARS-CoV-2 infection. Both patients received treatment with parenteral anticoagulation, responding successfully and were subsequently discharged with oral anticoagulation. DISCUSSION: It is essential to be aware of this disease associated with a high diagnostic suspicion given its varied clinical manifestations and its increasingly frequent association with COVID-19 infection.

A Trypanosoma cruzi strain from southern Mexico is more virulent for male mice in part by blocking the immune response.

INTRODUCTION: Chagas disease is a neglected disease in the American continent. The southern Mexican state of Chiapas has the highest incidence rate of Chagas disease in the country. The disease, mainly caused by Tripanosoma cruzi in Mexico, is more prevalent in males than in females but the scientific basis for the sex-related tropism is not completely understood. The objective of this study was to evaluate the pathogenicity of a T. cruzi strain in mice of both sexes and to assess certain elements of the immune response in the infected animals. METHODOLOGY: Triatomines bugs were searched at Los Mezcales, Chiapas, Mexico and T. cruzi was identified by PCR and sequencing. A T. cruzi strain was isolated from the feces of triatomines bugs. Mice were infected with the strain and the virulence of the T. cruzi strain as well as the immune response against the infection was compared in male versus female mice. RESULTS: T. dimidiata was identified in all dwellings. 42.9% of the bugs were infected with T. cruzi lineage TcI. Male mice exhibited higher parasitemia than females, and developed leukopenia and lower levels of anti-T. cruzi antibodies compared to female mice. CONCLUSIONS: The identification of the T. cruzi strain in this endemic region of Mexico revealed that male mice are prone to this infectious protozoo, in addition to manifesting a deficient immune response against infection. These findings may explain the greater number of cases of Chagas disease among men in this endemic region of Latin America.

Influence of surgical site infection on oncological prognosis after curative resection for colorectal cancer: An observational single-institution study.

BACKGROUND: An exacerbated inflammatory response to post-operative infection could favor an environment in which residual viable tumor cells present in the surgical bed, bloodstream, or occult micrometastases can survive and progress to produce local or distant recurrence. In this regard, a surgical site infection (SSI) could be an important risk factor for disease progression. This study aimed to investigate the impact of SSI on long-term survival and recurrence of colorectal cancer. METHODS: Patients who underwent curative-intent resection for colorectal carcinoma between 2011 and 2013 were retrospectively analyzed. Overall and disease-free survival (DFS) and local recurrence rate for patients with and without SSI were analyzed. RESULTS: One hundred and thirty-eight patients were included in the study. Fifty-one (37%) patients showed SSI but revealed no differences in recurrence rate and overall survival compared with non-infected patients. However, the stratified analysis revealed that patients with an intra-abdominal abscess or an organ-space-infection showed a higher recurrence rate and a decreased 5-year overall and DFS. CONCLUSIONS: SSI may have an influence on the oncological prognosis and, therefore, could be considered a recurrence factor. Further multi-institutional studies are necessary to conclude a causal association.

ANTECEDENTES: Una respuesta inflamatoria exacerbada por una infección postoperatoria podría favorecer un entorno en el que células tumorales residuales viables presentes en el lecho quirúrgico, torrente sanguíneo o micrometástasis ocultas puedan sobrevivir y progresar para producir una recurrencia local o a distancia. En este sentido, una infección del sitio quirúrgico (ISQ) podría ser un factor de riesgo de progresión de la enfermedad. Este estudio tuvo como objetivo investigar el impacto de la ISQ en la supervivencia y recurrencia del cáncer colorrectal. MÉTODO: Todos los pacientes con carcinoma colorrectal sometidos a resección con intención curativa entre 2011 y 2013 fueron analizados retrospectivamente. Se analizó supervivencia global y libre de enfermedad y la tasa de recurrencia local en pacientes con cáncer colorrectal con y sin ISQ. RESULTADOS: Se incluyeron 138 pacientes. 51 (37%) sufrieron ISQ pero no mostraron diferencias en la tasa de recurrencia y supervivencia global respecto a los pacientes no infectados. Sin embargo, el análisis estratificado reveló que los pacientes con un absceso intraabdominal o una infección órgano-espacio mostraron una tasa de recurrencia más alta y una disminución en la supervivencia global y libre de enfermedad. CONCLUSIONES: La ISQ, en función de la gravedad y la respuesta inflamatoria que genera, puede influir en el pronóstico oncológico y, por lo tanto, podría considerarse un factor de recurrencia. Futuros estudios multicéntricos son necesarios para demostrar una posible asociación.

Structural Characterization and Antioxidant Capacity of Quinoa Cultivars Using Techniques of FT-MIR and UHPLC/ESI-Orbitrap MS Spectroscopy.

The existence of more of 16,000 varieties of quinoa accessions around the world has caused a disregard on their structural and phytochemical characteristics. Most of such accessions belong to cultivars settled in Colombia. The goal of this research was to evaluate the structural attributes and antioxidant capacities from six quinoa cultivars with high productive potential from central regions in Colombia. This study used middle-range infrared spectroscopy (IR-MIR) to determine the proteins, starch and lipids distinctive to quinoa grains. Ultra-high-performance liquid chromatography electrospray ionization Orbitrap, along with high-resolution mass spectrometry (UHPLC/ESI-Orbitrap MS), were also used to identify the existence of polyphenols in cultivars. The antioxidant capacity was determined through DPPH, ABTS and FRAP. The spectrums exhibited significant variances on the transmittance bands associated with 2922 cm-1, 1016 cm-1 and 1633 cm-1. Moreover, the intensity variations on the peaks from the secondary protein structure were identified, mainly on the bands associated with ß-Sheet-1 and -2, random coil α elice and ß-turns-2 and -3. Changes found in the ratios 996 cm-1/1014 cm-1 and 1041 cm-1/1014 cm-1 were associated with the crystalline/amorphous affinity. Regarding the antioxidant capacity, great differences were identified (p < 0.001) mainly through FRAP methods, while the phenolic acids and flavonoids were determined by UHPLC/ESI-Orbitrap MS techniques. The presence of apigenin and pinocembrin on grains was reported for the first time. Titicaca and Nariño were the most phytochemically diverse quinoa seeds.

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

Crossed anterior cerebral circulation in the anterior communicating artery complex, first case report with angiographic evidence.

INTRODUCTION: This case report illustrates a new variant in the anterior cerebral artery complex, identified during carotid angioplasty. CLINICAL CASE: A 50-year-old male patient diagnosed with left carotid stenosis was diagnosed and treated by a cerebral angiography. During the procedure, crossed circulation in the anterior cerebral artery was identified. The presence of this variation demanded to discard distal emboli or artery dissection. Angioplasty was performed and the patient followed up without neurological deficit. DISCUSSION: Among the most possible and prevalent variations in anterior circulation, none of them explain the phenomenon we observed. Therefore, a new variant is established. The knowledge about variants in cerebral circulation is important to rule out pathology. CONCLUSION: Cerebral diagnostic angiography has become more available and frequent because of the rising in endovascular tools to treat stroke patients. Considering this new variation and others is important to discard pathology.

P057 How Distance Between Residence and Treatment Center Impact the Outcome of Patients With Inflammatory Bowel Disease at CMN 20.

BACKGROUND: Inflammatory bowel disease (IBD) affects an estimated 1.6 million people in the United States with at least 70,000 new cases per year. In the last 15 years an increase in frequency of IBD cases from 0.30 cases per 100,000 person-years to 1.83 cases per 100,000 person-years has been reported in Mexico. Variables such as early hospitalization at diagnosis, low hemoglobin levels, high values of C-reactive protein (CRP), fecal calprotectin concentration and absence of mucosal healing during evolution define the prognosis of these patients. However, the distance a patient must travel in order to reach a specialized treatment center can become an impediment for a correct diagnosis and treatment, severely impacting the clinical outcome of such patients. METHODS: Observational, cross-sectional, retrospective study. Objective: In patients with IBD, determine the impact of distance between the residence and specialized treatment center on the general clinical outcome. Variables analyzed: sex, age, disease duration, average travel time, distance in kilometers between place of residence and specialized treatment center, Crohn´s Disease (CD) or Ulcerative Colitis (UC), and their respective severity classification scores, as well as number of hospital readmissions per year. The results were evaluated with ANOVA tests, univariate analysis had a 95% confidence index and a significant "p" determined as p < 0.05. RESULTS: The study included 66 patients (45 UC and 21 CD). Mean age 51.15± 17.5 years. The distance between residence and hospital was calculated and classified into 3 quartiles based on proximity: 750km (quartile 3). There was a higher risk among patients in the most distant quartile for the use of biological therapy (OR, 2.20; 95% CI, 0.23- 20.55) and surgery (OR, 2.76, 95% CI 0.49- 15.48). We observed a clear relationship between the number of hospital readmission and the distance quartiles with a p = 0.0047. CONCLUSION: We observed an impact between the distance of residence and specialized treatment center over the patient's clinical outcome. More readmissions, greater disease activity scores, more use of biological therapy and surgery were observed in patients who had to travel more than 750km from their home to their specialized treatment center compared to the other travel quartiles, this with a p = 0.0047.

P061 Impact of Inflammatory Bowel Disease on sleep quality in a Mexican population attended in a referral center.

BACKGROUND: Sleep disorders occur recurrently in patients with inflammatory bowel disease (IBD). The relationship between poor sleep quality and IBD activity has been subject to scarce attention. Poor sleep quality could be considered a relevant extraintestinal manifestation and a potential marker of subclinical inflammation, which could increase the severity of inflammation and the risk of relapse, however, we do not have enough information to confirm this hypothesis. Objective: Describe the impact of IBD on the quality of sleep, in patients treated in a referral hospital. METHODS: Observational, analytical, and cross-sectional study. Patients with diagnosis of IBD treated at Centro Médico Nacional "20 de Noviembre" were evaluated. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. IBD activity was measured using the Harvey-Bradshaw index for Crohn's disease (CD) and the Mayo scale for Ulcerative Colitis (UC). RESULTS: A total of 51 patients were included, the Pittsburgh Sleep Index Questionnaire (PSQI) was performed, after informed consent was signed. Patients had a mean age of 52. Fifty five percent were female, 65% had UC. Biological therapy was administered to 70.5%. In CD 89% were in remission and 11% in moderate activity. In UC 48.5% were in remission, 45.5% had mild activity and 6% had moderate activity. Eighty percent of the patients did not use hypnotic drugs. Patients with UC in remission had a bad perception of sleep quality in 68%, quite good sleep quality in 18% and very good sleep quality in 12% with a PSQI of 10.5 ± 3.2. In patients with mild activity, the perception of sleep quality was very good in 6%, quite good in 46%, quite bad in 40% and very bad in 6%, with a PSQI of 8 ± 3.7. In patients with moderate activity, 100% had a rather bad perception of sleep quality with a PSQI of 11 ± 1.4. For CD in remission the perception of sleep was quite bad in 43%, quite good in 43%, very bad in 6% and very good in 6% with a PSQI of 9 ± 4.3. In patients with moderate activity 50% had a very bad sleep quality perception and 50% a fairly good sleep quality perception with a PSQI of 14 ± 4.2. CONCLUSION: In this study a statistically significant association was obtained between PSQI and the perception of sleep reported by the patients, with a p < 0.005. Further research is still needed to better characterize sleep disturbances in this population. Due to the sample size, a prospective, randomized study is required to confirm these findings. The present analysis has no conflict of interest.