¿Supuración crónica o pseudoquiste infectado? Una complicación de la eventroplastia con malla / Chronic suppuration or infected pseudocyst? A complication of incisional hernia repair with mesh

RESUMEN Las infecciones crónicas posteriores a reparaciones de la pared abdominal pueden presentarse como colecciones que involucran a la malla y suelen obligar a su extracción, mientras que los pseudoquistes son colecciones estériles con una gruesa pared fibrótica que debe ser extirpada para lograr la curación. Presentamos una paciente de 75 años con antecedente de eventroplastia, que consultó por un tumor abdominal de 6 meses de evolución, con características imagenológicas de pseudoquiste parietal. Durante la operación se encontró una malla preperitoneal no integrada a los tejidos y rodeada de "biofilm" y líquido turbio. La prótesis se retiró fácilmente y la aponeurosis, muy engrosada, se cerró borde a borde. El posoperatorio transcurrió sin incidentes y el cultivo desarrolló estafilococo aureus sensible a trimetoprima-sufametoxazol. Seis meses después, la evolución fue favorable y sin signos de recidiva.

ABSTRACT Chronic infections after abdominal wall repairs may present as collections involving the mesh which usually require removing the mesh, while pseudocysts are sterile collections with a thick fibrotic wall that must be removed to achieve healing. We report the case of a 75-year-old female patient with a history incisional hernia repair who sought medical advice due to an abdominal tumor which appeared 6 months before consultation with imaging tests suggestive of an abdominal wall pseudocyst. Surgery revealed a preperitoneal mesh without tissue integration surrounded by biofilm and cloudy fluid. The mesh was easily removed and the edges of the thick aponeurosis were sutured. The postoperative period evolved uneventful and the fluid culture was positive for staphylococcus aureus sensitive to trimethoprim-sufamethoxazole. Six months later the patient evolved with favorable outcome without recurrence.

Diet Quality Is Associated with a High Newborn Size and Reduction in the Risk of Low Birth Weight and Small for Gestational Age in a Group of Mexican Pregnant Women: An Observational Study.

A high-quality diet during pregnancy may have positive effects on fetal growth and nutritional status at birth, and it may modify the risk of developing chronic diseases later in life. The aim of this study was to evaluate the association between diet quality and newborn nutritional status in a group of pregnant Mexican women. As part of the ongoing Mexican prospective cohort study, OBESO, we studied 226 healthy pregnant women. We adapted the Alternated Healthy Eating Index-2010 for pregnancy (AHEI-10P). The association between maternal diet and newborn nutritional status was investigated by multiple linear regression and logistic regression models. We applied three 24-h recalls during the second half of gestation. As the AHEI-10P score improved by 5 units, the birth weight and length increased (ß = 74.8 ± 35.0 g and ß = 0.3 ± 0.4 cm, respectively, p < 0.05). Similarly, the risk of low birth weight (LBW) and small for gestational age (SGA) decreased (OR: 0.47, 95%CI: 0.27-0.82 and OR: 0.55, 95%CI: 0.36-0.85, respectively). In women without preeclampsia and/or GDM, the risk of stunting decreased as the diet quality score increased (+5 units) (OR: 0.62, 95%IC: 0.40-0.96). A high-quality diet during pregnancy was associated with a higher newborn size and a reduced risk of LBW and SGA in this group of pregnant Mexican women.

Inserción laboral del cirujano joven en la Ciudad de Buenos Aires. Necesidad de reestructuración del sistema de formación del cirujano general / Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

RESUMEN Antecedentes: la formación en cirugía se mantuvo uniforme desde la instauración del modelo de re sidencias. El avance de la ciencia ha llevado a la superespecialización y un 70% de los cirujanos conti núan en formación con una especialidad posbásica. Objetivos: identificar la proporción de cirujanos que derivan horas a otra actividad y analizar la inser ción laboral del cirujano. Material y métodos: estudio prospectivo, descriptivo, de corte transversal. 1) Encuesta, 2) Registros de la Dirección General de Docencia e Investigación, 3) Concursos y Perfiles profesionales de acceso público. Resultados: sobre 435 encuestados, al finalizar la residencia, un 73,3% continuó su formación en una posbásica. Solamente un 24,7% se insertó inmediatamente en el mercado como cirujano general. En cuanto a la inserción laboral actual de aquellos que finalizaron la formación como cirujano general, apenas un 17,4% se desempeña de manera exclusiva como cirujano general. Conclusiones: la falta de confianza para actuar de manera independiente y la necesidad de completar 4 años de formación para ingresar en el campo de interés aparecen como las problemáticas para resol ver. Se propone un programa de 5 años con formato 2+3. El período de formación básica abordará en 24 meses las generalidades de la práctica quirúrgica. El segundo, de formación avanzada, desarrollará en profundidad la subespecialidad elegida. El quinto año otorgará a todos la posibilidad de actuar a modo de cirujano independiente. Planteada como una subespecialidad, la Cirugía General volvería a ser un fin en sí misma y no un medio para llegar a una subespecialidad.

ABSTRACT Background: Training in surgery has remained relatively uniform since the residency programs were introduced. The continuous advances in science have led to the progressive super-specialization of surgeons; 70% of them continue their training with a subspecialty. Objectives: The aim of this study was to identify the proportion of surgeons who dedicate hours of their practice in another activity and to analyze how surgeons enter the workforce. Material and methods: We conducted a prospective and descriptive cross-sectional study with data from a survey, records of the General Directorate of Teaching and Research, and records of competitive selection processes and professional profiles available online. Results: Of 435 survey respondents, 73.3% of the resident graduates continued postresidency training in a surgical subspecialty. Only 24.7% immediately started working in general surgery. Among the graduate trainees in general surgery, only 17.4% were exclusively dedicated to general surgery. Conclusions: The lack of confidence to perform procedures independently and the need for completing 4 years of training in the residency program in general surgery to start training in the professional field of interest, appear as the issued to be solved. We propose a 5-year program with a 2+3 model. The initial period comprises 24 months of basic training covering the general aspects of surgical practice. The second period of advanced training will provide thorough training in the subspecialty chosen. In the last year of the 5-year program trainees will have the opportunity to act as attending surgeons. General surgery, conceived as a subspecialty, would regain its status as an objective and no longer a pathway to become a subspecialist.

[High frequency of DQ8 in the celiac population of Chaco province, Argentina]. / Alta frecuencia de DQ8 en la población celiaca de la provincia del Chaco, Argentina.

BACKGROUND: There is a strong association between celiac disease (CD) and certain genes of the major histocompatibility complex (HLA). The CD specifically related alleles are those coding for HLA-DQ2 heterodimer and to a lesser degree for HLA-DQ8. OBJECTVE. The aim of this study was to evaluate the frequency of HLA-DQB1* and HLA-DRB1* alleles, haplotypes, and genotypes in patients diagnosed with CD and in control population of Chaco, in order to establish its distribution and compare it with that observed in other populations. METHODS: A total of 139 samples from patients diagnosed with CD and 119 healthy controls were typed for HLA-DQ and HLA-DR, using PCR and reverse hybridization (INNO-LiPA or Dynal). RESULTS: Comparing patients with CD vs. controls, the DQBI*0201 (P = 0.0002), DQBJ*0202 (P = 0.0046), DQBI*0302 (P = 0. 0006), DRBl *03 (P = 0.0002), DRBl *04 (P = 0.0199) and DRB1 *07 (P = 0.0062) were significantly increased, while a decrease was observed in HLA-DQB1*0301 (P = 0.0006), HLA-DQBI*0303 (P = 0.0070), DQBI*0501 (P = 0.0023), DQB1*0604 (P = 0.0140) DRB1*01 (P = 0.0023), DRB1*08 (P = 0.0165), DRB1*09 (P = 0.0362) and DRB1*16 (P = 0.0228). Within DQB1* genotypes associated with EC, 65.4% of patients had the DQB1*02 in linkage disequilibrium with DRB1*03 or DRB1*07 (DQ2), and 43.2% presented genotype DQB1*0302 in linkage disequilibrium with DRB1*04 (DQ8). Both genotypes were shared by 15.2% of them. CONCLUSIONS: We point out the high frequency of DQ8 associated with CD. Although the DQ2 is still the most common, this finding could be attributed to the Amerindian influence in our population.

Alta frecuencia de DQ8 en la población celiaca de la provincia del Chaco, Argentina. / [High frequency of DQ8 in the celiac population of Chaco province, Argentina].

BACKGROUND: There is a strong association between celiac disease (CD) and certain genes of the major histocompatibility complex (HLA). The CD specifically related alleles are those coding for HLA-DQ2 heterodimer and to a lesser degree for HLA-DQ8. OBJECTVE. The aim of this study was to evaluate the frequency of HLA-DQB1* and HLA-DRB1* alleles, haplotypes, and genotypes in patients diagnosed with CD and in control population of Chaco, in order to establish its distribution and compare it with that observed in other populations. METHODS: A total of 139 samples from patients diagnosed with CD and 119 healthy controls were typed for HLA-DQ and HLA-DR, using PCR and reverse hybridization (INNO-LiPA or Dynal). RESULTS: Comparing patients with CD vs. controls, the DQBI*0201 (P = 0.0002), DQBJ*0202 (P = 0.0046), DQBI*0302 (P = 0. 0006), DRBl *03 (P = 0.0002), DRBl *04 (P = 0.0199) and DRB1 *07 (P = 0.0062) were significantly increased, while a decrease was observed in HLA-DQB1*0301 (P = 0.0006), HLA-DQBI*0303 (P = 0.0070), DQBI*0501 (P = 0.0023), DQB1*0604 (P = 0.0140) DRB1*01 (P = 0.0023), DRB1*08 (P = 0.0165), DRB1*09 (P = 0.0362) and DRB1*16 (P = 0.0228). Within DQB1* genotypes associated with EC, 65.4

of patients had the DQB1*02 in linkage disequilibrium with DRB1*03 or DRB1*07 (DQ2), and 43.2

presented genotype DQB1*0302 in linkage disequilibrium with DRB1*04 (DQ8). Both genotypes were shared by 15.2

of them. CONCLUSIONS: We point out the high frequency of DQ8 associated with CD. Although the DQ2 is still the most common, this finding could be attributed to the Amerindian influence in our population.

Alta frecuencia de DQ8 en la población celiaca de la provincia del Chaco, Argentina / [High frequency of DQ8 in the celiac population of Chaco province, Argentina].

BACKGROUND: There is a strong association between celiac disease (CD) and certain genes of the major histocompatibility complex (HLA). The CD specifically related alleles are those coding for HLA-DQ2 heterodimer and to a lesser degree for HLA-DQ8. OBJECTVE. The aim of this study was to evaluate the frequency of HLA-DQB1* and HLA-DRB1* alleles, haplotypes, and genotypes in patients diagnosed with CD and in control population of Chaco, in order to establish its distribution and compare it with that observed in other populations. METHODS: A total of 139 samples from patients diagnosed with CD and 119 healthy controls were typed for HLA-DQ and HLA-DR, using PCR and reverse hybridization (INNO-LiPA or Dynal). RESULTS: Comparing patients with CD vs. controls, the DQBI*0201 (P = 0.0002), DQBJ*0202 (P = 0.0046), DQBI*0302 (P = 0. 0006), DRBl *03 (P = 0.0002), DRBl *04 (P = 0.0199) and DRB1 *07 (P = 0.0062) were significantly increased, while a decrease was observed in HLA-DQB1*0301 (P = 0.0006), HLA-DQBI*0303 (P = 0.0070), DQBI*0501 (P = 0.0023), DQB1*0604 (P = 0.0140) DRB1*01 (P = 0.0023), DRB1*08 (P = 0.0165), DRB1*09 (P = 0.0362) and DRB1*16 (P = 0.0228). Within DQB1* genotypes associated with EC, 65.4

of patients had the DQB1*02 in linkage disequilibrium with DRB1*03 or DRB1*07 (DQ2), and 43.2

presented genotype DQB1*0302 in linkage disequilibrium with DRB1*04 (DQ8). Both genotypes were shared by 15.2

of them. CONCLUSIONS: We point out the high frequency of DQ8 associated with CD. Although the DQ2 is still the most common, this finding could be attributed to the Amerindian influence in our population.

Functional and hypoglycemic properties of nopal cladodes (O. ficus-indica) at different maturity stages using in vitro and in vivo tests.

Nopal (Opuntia ficus-indica) cladodes are recommended for their therapeutic properties; their maturity stage may affect their biological properties. Cladodes of three maturity stages, from the same crop and location, were dehydrated and evaluated for some of their physicochemical and nutritional characteristics and antidiabetic properties. The flours of small and medium cladodes (SCF and MCF, respectively) had higher contents of dietary fiber, water absorption, swelling, and viscosity compared to those of the large cladode flour (LCF). Streptozotocin-induced diabetic rats, treated with MCF and SCF (doses of 50 mg/kg body weight), showed reduction of postprandial blood glucose on 46.0 and 23.6%, respectively (p < 0.05), in relation to the control; and LCF had no significant effect. In vitro, glucose diffusion tests showed similar ranking by the two former samples, whereas the latter was close to the control. Cladode maturity stages showed different fiber content and produced suspensions with differences in viscosity, which may affect in vitro and in vivo glucose responses.

An evaluation of the dot-ELISA procedure as a diagnostic test in an area with a high prevalence of human Toxocara canis infection.

The aim of this work was to evaluate a dot-enzyme-linked immunosorbent assay (dot-ELISA) using excretory-secretory antigens from the larval stages of Toxocara canis for the diagnosis of toxocariasis. A secondary aim was to establish the optimal conditions for its use in an area with a high prevalence of human T. canis infection. The dot-ELISA test was standardised using different concentrations of the antigen fixed on nitrocellulose paper strips and increasing dilutions of the serum and conjugate. Both the dot-ELISA and standard ELISA methods were tested in parallel with the same batch of sera from controls and from individuals living in the problem area. The best results were obtained with 1.33 µg/mL of antigen, dilutions of 1/80 for the samples and controls and a dilution of 1/5,000 for the anti-human IgG-peroxidase conjugate. All steps of the procedure were performed at room temperature. The coincidence between ELISA and dot-ELISA was 85% and the kappa index was 0.72. The dot-ELISA test described here is rapid, easy to perform and does not require expensive equipment. Thus, this test is suitable for the serological diagnosis of human T. canis infection in field surveys and in the primary health care centres of endemic regions.

An evaluation of the dot-ELISA procedure as a diagnostic test in an area with a high prevalence of human Toxocara canis infection

The aim of this work was to evaluate a dot-enzyme-linked immunosorbent assay (dot-ELISA) using excretory-secretory antigens from the larval stages of Toxocara canis for the diagnosis of toxocariasis. A secondary aim was to establish the optimal conditions for its use in an area with a high prevalence of human T. canis infection. The dot-ELISA test was standardised using different concentrations of the antigen fixed on nitrocellulose paper strips and increasing dilutions of the serum and conjugate. Both the dot-ELISA and standard ELISA methods were tested in parallel with the same batch of sera from controls and from individuals living in the problem area. The best results were obtained with 1.33 µg/mL of antigen, dilutions of 1/80 for the samples and controls and a dilution of 1/5,000 for the anti-human IgG-peroxidase conjugate. All steps of the procedure were performed at room temperature. The coincidence between ELISA and dot-ELISA was 85 percent and the kappa index was 0.72. The dot-ELISA test described here is rapid, easy to perform and does not require expensive equipment. Thus, this test is suitable for the serological diagnosis of human T. canis infection in field surveys and in the primary health care centres of endemic regions.

Cuba's National Clinical Trials Coordinating Center: emergence, evolution, and main results. Translated from the Spanish and reprinted with permission from the Revista Cubana de Farmacia. Vol. 44 No. 2 (special supplement), Apr-Jun 2010.

The rapid development of Cuba's pharmaceutical industry in the 1990s created a need for structures to ensure clinical evaluation of products before their introduction into medical practice and subsequent marketing. One of the centers founded for this purpose was the National Clinical Trials Coordinating Center. This paper summarizes the factors that motivated the creation of the Center and presents a brief history of its organizational development over the last 17 years. It also describes the main components of the system for designing and conducting clinical trials, and the most significant contributions of each toward achieving the Center's objectives.

Nasolaryngoscopic validation of a set of clinical predictors of aspiration in a critical care setting.

BACKGROUND: Aspiration is frequent in patients with acute neurologic disorders and swallowing dysfunction. Its incidence in stroke, as high as 51%, increases mortality by up to 3 times. Pneumonia, its main complication, further increases morbidity, mortality, and patient care costs. The objective of this study was to evaluate a set of bedside predictors of aspiration ["wet voice," 3-oz water swallow test, and cervical auscultation in an intensive care unit (ICU)] and compare them with nasolaryngoscopy as the gold standard. METHODS: We conducted a prospective, nonblinded study of bedside predictors of aspiration risks in 65 consecutive ICU patients with an acute neurologic disorder or a severe medical or surgical condition with decreased level of consciousness. RESULTS: Endoscopic aspiration was detected in 17 patients. Sensitivities for wet voice, 3-oz water swallow test, and cervical auscultation were 58.82%, 88.23%, and 82.35%; specificities were 78.26%, 62.50%, and 80.43%. Positive predictive values were 50%, 45.45%, and 60.86%, and negative predictive values were 83.72%, 93.75%, and 92.50%, respectively. Positive likelihood ratios were 2.70, 2.35, and 4.20, respectively. The association of 2 positive clinical predictors, wet voice and cervical auscultation or wet voice and 3-oz water swallow test, improved specificity to 92.85% and 84.61%, positive predictive values to 83.33% and 69.23%, and likelihood ratios to 10.76 and 5.85, respectively. CONCLUSIONS: Bedside clinical predictors for aspiration risks are a useful screening tool for ICU patients presenting with risk factors for this complication.

Association of vitamin D receptor polymorphisms with osteoporosis in mexican postmenopausal women.

It has been reported that Vitamin D receptor polymorphisms are associated with osteoporosis, particularly those demonstrated by the BsmI and FokI restriction enzymes. Herein we report the results of a case-control study performed in postmenopausal Mexican women. We studied 65 osteoporotic women (< or = -2.5 SD bone mineral density [BMD] of young normal females) and 57 controls (over 90% > or = -1.5 SD BMD of young normal females. Restriction enzymes BsmI and FokI were used to identify polymorphisms. Odds ratios and their 95% confidence intervals were calculated, and analysis was performed controlling for age as a covariate. The BsmI genotypes revealed a higher frequency of the bb genotype in cases than in controls, contradicting much of the literature that suggests this genotype protects females against osteoporosis. Regarding the FokI genotypes, we were unable to confirm that the FF genotype has a protective effect against osteoporosis. The inconsistencies found in the literature and the results obtained in the present work suggest to us that other genetic and nongenetic factors are involved in the occurrence of osteoporosis, confounding the results of the possible association of osteoporosis and VDR polymorphisms.