A public health approach to increase treatment of latent TB among household contacts in Brazil.

SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

¿Cómo es la calidad de vida reportada por los estudiantes de Medicina? / Quality of life scores among 411 medical students

Background: The high academic burden may hamper the quality of life of medical students. Aim: To evaluate the quality of life (QOL) for medical students attending a Chilean university. Material and Methods: Four hundred eleven medical students aged 22 ± 2 years (51% women), studying in Santiago, Chile, answered online a validated Spanish version of the WHOQOL-BREF quality of life survey (scored from 0 to 100). Overall scores were assessed for the questionnaire domains Physical health, Psychological health, Interpersonal relationships, and Environment. Results: The global scores were 65.1 for Physical health, 63.1 for Psychological health, 61.3 for Interpersonal relationships and 67.2 for Environment. Students in clinical practice, females, those with sedentary behaviors and consuming modafinil had lower Physical health scores. Students coming from outside Santiago, with sedentary behaviors and who consumed modafinil had poorer Psychological health scores. Students coming from outside Santiago, males and those with sedentary behaviors had Lower Interpersonal relationship scores. Environment scores were also lower among students who were sedentary or from outside Santiago. Conclusions: The variables that had a greater negative impact in the quality of life of these students were the transition from theoretical courses to clinical practice, being from outside Santiago, being overweight or obese and consuming modafinil. Students that were physically active had better quality of life scores.

[Quality of life scores among 411 medical students]. / ¿Cómo es la calidad de vida reportada por los estudiantes de Medicina?

BACKGROUND: The high academic burden may hamper the quality of life of medical students. AIM: To evaluate the quality of life (QOL) for medical students attending a Chilean university. MATERIAL AND METHODS: Four hundred eleven medical students aged 22 ± 2 years (51% women), studying in Santiago, Chile, answered online a validated Spanish version of the WHOQOL-BREF quality of life survey (scored from 0 to 100). Overall scores were assessed for the questionnaire domains Physical health, Psychological health, Interpersonal relationships, and Environment. RESULTS: The global scores were 65.1 for Physical health, 63.1 for Psychological health, 61.3 for Interpersonal relationships and 67.2 for Environment. Students in clinical practice, females, those with sedentary behaviors and consuming modafinil had lower Physical health scores. Students coming from outside Santiago, with sedentary behaviors and who consumed modafinil had poorer Psychological health scores. Students coming from outside Santiago, males and those with sedentary behaviors had Lower Interpersonal relationship scores. Environment scores were also lower among students who were sedentary or from outside Santiago. CONCLUSIONS: The variables that had a greater negative impact in the quality of life of these students were the transition from theoretical courses to clinical practice, being from outside Santiago, being overweight or obese and consuming modafinil. Students that were physically active had better quality of life scores.

Evaluation of the toxicity and hypoglycemic effect of the aqueous extracts of Cnidoscolus quercifolius Pohl.

Diabetes mellitus is one of the most common chronic degenerative diseases, and it is estimated to increase worldwide to around 415 million and to impact 642 million in 2040. Research shows that some plants are sources of bioactive compounds against diabetes. Thus, the objective of this work was to evaluate the oral toxicity and the hypoglycemic effect of the aqueous extract of the leaves of Cnidoscolus quercifolius Pohl. Diabetes was induced in Swiss mice with streptozotocin and the mice were treated with an aqueous extract of C. quercifolius leaves for a period of 30 days. Phytochemical analysis showed that the extract was rich in flavonoids, catechins and triterpenoid, which did not show any mortality and behavioral alterations in mice treated with 200, 1000, and 2000 mg/kg body weight of the extract for 14 days. Histopathological analysis of organs (kidney, pancreas, liver) from mice treated with the 2000 mg/kg extract revealed no architectural change. In the present study, we found a 29% reduction in glucose levels in animals receiving 200 mg/kg body weight. These results are very promising because they showed that C. quercifolius had a hypoglycemic effect and did not present oral toxicity, thus being a new source of compounds for the control of diabetes.

Contrasting HCV and HIV seroepidemiology in 11 years of blood donors screening in Brazil.

BACKGROUND: Blood donors are, in principle, healthy individuals who may be revealed as infectious for blood-borne agents by the laboratory screening process, depicting the asymptomatic burden of the disease. Therefore, monitoring hepatitis C virus (HCV)-infected donor and human immunodeficiency virus (HIV)-infected donor and associating to their demographical and behavioural characteristics may shed light on the dynamics and contemporary changes in these viruses' epidemiology. METHODS: Donors presenting repeatedly reactive HCV or HIV serology/nucleic acid testing (NAT) screening results were submitted to confirmatory testing. Confirmed positive donors were invited to return to the blood bank for notification and counselling when a follow-up sample was obtained and an interview performed to eventually disclose potential risks. HCV- or HIV-infected donors identified over 11 years of screening (2004-2015) were evaluated for demographic and behavioural parameters. RESULTS: In the period, 139 160 donations were screened, and 36 (0.025%) were found positive for HIV, stemming from 29 male and 7 female donors. Among those, eight subjects were repeat donors. A total of 95 donations were found repeatedly reactive for HCV (0.068%), obtained from 60 men and 35 women. Noticeably, in despite of a higher HCV prevalence in the donor population, the incidence of HIV among repeat donors was 10 times that of HCV (18 × 1.6/100 000 persons-year, respectively). On average, HIV-seroreactive men were found to be younger (mean = 34 years old) than women (mean = 40 years old). A total of 10 donors acknowledged sexual behaviours not previously informed, including 2 who were aware of their HIV-positive status and another 2 who admitted to be seeking HIV testing. No window period donation was verified. DISCUSSION: The majority of the HIV-infected donors are young males who deny risk factors in the interview and also ignore the confidence self-exclusion opportunity. As they may reiterate this behaviour in serial donations, use of the most sensitive laboratory testing is justified in this setting.

Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH / Perceptions about the elisa test of people diagnosed at the aids stage

Background: The delay in the diagnosis of AIDS results in higher treatment costs. Aim: To reveal the experiences of people who were diagnosed in the AIDS stage about the access to the ELISA test. Material and Methods: In depth interviews were carried out to 15 participants from public hospitals who were in the AIDS stage at the moment of the diagnosis. The main questions asked were about the motivations to take the test, the barriers found and the help received from the health care personnel. All interviews were recorded and analyzed according to Kripperdorff. Results: The three categories that emerged were the motivations to take the test, the facilitators found and the difficulties to access to the test. The main motivation was a condition of vulnerability due to the suspicion or certainty of being infected. The main facilitator was the sensation of being accepted and not discriminated. The main difficulties were the fear of having a positive test and of being discriminated and the lack of information. Conclusions: Knowing these experiences will help to improve the early detection of HIV infections.

[Frequency of menstrual disturbances in gynecology and obstetrics residents]. / Frecuencia de trastornos menstruales en residentes de ginecología y obstetricia.

OBJECTIVE: To determine the frequency of menstrual disorders in gynecology and obstetrics residents. MATERIAL AND MET HODS: All residents of the 2015-2016 academic cycle were studied. In all them the menstrual cycle characteristics such as: rhythm, duration and quantity were analyzed. For statistical analysis Mann Whitney U test and Spearman's correlation analysis were done. RESULTS: 61 residents, 18 of 2nd, 21 of 3rd and 22 of 4th year were studied. Body mass index was significantly greater in those of 4th grade when compared with those of 2nd. The waist hip ratio (WHR) was significantly smaller in those of 3rd when compared with those of 4th. The reported frequency of menstrual disturbances was 22.8%, 28.6% and 22.7% for the 2nd, 3rd and 4th years respectively. After comparing the groups, between them the total volume was greater in those of 2nd when compared with those of 3rd (p<0.009) and 4th (p<0.04) In the correlation analysis in those of 2nd grade the WHR negatively correlated with the duration of bled (p <0.483, p<0.049). In those of 3rd year the WHR positively correlated with the duration (p 0.544, p<0.024) and with the total volume (p 0.553, p<0.02 1). In those of 4th year any correlation was found. CONCLUSION: The 2nd year residents women's are more likely to suffer menstrual disorders compared with those of 3rd and 4th ear of residence.

Host and microbiota interactions are critical for development of murine Crohn's-like ileitis.

Deregulation of host-microbiota interactions in the gut is a pivotal characteristic of Crohn's disease. It remains unclear, however, whether commensals and/or the dysbiotic microbiota associated with pathology in humans are causally involved in Crohn's pathogenesis. Here, we show that Crohn's-like ileitis in Tnf(ΔARE/+) mice is microbiota-dependent. Germ-free Tnf(ΔARE/+) mice are disease-free and the microbiota and its innate recognition through Myd88 are indispensable for tumor necrosis factor (TNF) overexpression and disease initiation in this model. The epithelium of diseased mice shows no major defects in mucus barrier and paracellular permeability. However, Tnf(ΔARE/+) ileitis associates with the reduction of lysozyme-expressing Paneth cells, mediated by adaptive immune effectors. Furthermore, we show that established but not early ileitis in Tnf(ΔARE/+) mice involves defective expression of antimicrobials and dysbiosis, characterized by Firmicutes expansion, including epithelial-attaching segmented filamentous bacteria, and decreased abundance of Bacteroidetes. Microbiota modulation by antibiotic treatment at an early disease stage rescues ileitis. Our results suggest that the indigenous microbiota is sufficient to drive TNF overexpression and Crohn's ileitis in the genetically susceptible Tnf(ΔARE/+) hosts, whereas dysbiosis in this model results from disease-associated alterations including loss of lysozyme-expressing Paneth cells.

[Perceptions about the elisa test of people diagnosed at the aids stage]. / Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH.

BACKGROUND: The delay in the diagnosis of AIDS results in higher treatment costs. AIM: To reveal the experiences of people who were diagnosed in the AIDS stage about the access to the ELISA test. MATERIAL AND METHODS: In depth interviews were carried out to 15 participants from public hospitals who were in the AIDS stage at the moment of the diagnosis. The main questions asked were about the motivations to take the test, the barriers found and the help received from the health care personnel. All interviews were recorded and analyzed according to Kripperdorff. RESULTS: The three categories that emerged were the motivations to take the test, the facilitators found and the difficulties to access to the test. The main motivation was a condition of vulnerability due to the suspicion or certainty of being infected. The main facilitator was the sensation of being accepted and not discriminated. The main difficulties were the fear of having a positive test and of being discriminated and the lack of information. CONCLUSIONS: Knowing these experiences will help to improve the early detection of HIV infections.

Espondiloartritis anquilosante: revisión de hallazgos imagenológicos en la columna / Ankylosing spondyloarthritis: review of spinal imaging findings

Abstract: Introduction. Ankylosing spondyloarthritis (AS) is the most common and representative of seronegative spondyloarthropathy. It is characterised by chronic inflammation of the axial skeleton, leading to chronic back pain and progressive stiffness. It typically occurs in young patients, with symptoms often appearing with peak onset between 20 and 30 years of age, and is strongly associated with human leukocyte antigen B-27 (HLA B-27). Current imaging techniques are central in the management of these patients. The recognition of its classic imaging findings and its complications is essential for radiologists. Objectives. To present a pictorial review of the spinal imaging findings in patients with AS. Methods and materials. An analysis will be made of the spinal imaging findings in conventional radiography, CT and MRI in multiple patients from our medical centre. The most representative findings, complications, differential diagnoses, and some radiological key points will be shown.

Resumen: Introducción. La espondilitis anquilosante (EA) es la artropatía seronegativa más común y representativa. Se caracteriza por inflamación crónica del esqueleto axial, dolor referido a la columna vertebral de tipo inflamatorio y rigidez progresiva. Típicamente se manifiesta en pacientes jóvenes que inician su sintomatología entre los 20-30 años de edad y está ligada al antígeno leucocitario humano B-27 (HLA B-27). Las imágenes son fundamentales en el manejo de estos pacientes. Es deber del radiólogo reconocer los hallazgos imagenológicos presentes. Objetivos. Realizar una revisión pictográfica de hallazgos imagenológicos presentes en la columna vertebral de pacientes portadores de EA. Material y método. Análisis de las manifestaciones imagenológicas de columna más representativas de la EA en pacientes de nuestro centro en radiografía convencional, TC y RM, junto con posibles complicaciones y diagnósticos diferenciales.

Atividades antinociceptiva e antiinflamatória do extrato etanólico de Luehea divaricata / Antinociceptive and anti-inflammatory activities of Luehea divaricate ethanol extract

RESUMO Considerando os diferentes usos etnofarmacológicos apresentados pela planta Luehea divaricata, realizou-se este estudo com o objetivo de avaliar as atividades antinociceptiva e antinflamatória do extrato etanólico de suas folhas, em modelo animal, nas dosagens de 20, 40, 80 e 160 mg/Kg, por via oral. Foram realizados os seguintes testes: contorções abdominais induzidas pelo acido acético, placa quente, formalina e edema de pata induzido por carragenina. Foram utilizados camundongos Swiss (20-25 g) para os três primeiros testes e ratos Wistar (180-250 g), para o último, divididos em seis grupos de oito animais, totalizando 48 animais em cada parâmetro de avaliação. Os resultados foram analisados estatisticamente pela análise de variância a 5% de probabilidade, para verificar quais os tratamentos que diferiram entre si, e estes foram submetidos aos testes de Kruskall-Wallis e Student-Newman-Keuls. O extrato etanólico das folhas de L. divaricata (EEtOH-Ld), nas diferentes doses estudadas, apresentou significativa atividade antinociceptiva sobre a dor induzida quimicamente por injeções intraperitoneal de acido acético e intraplantar de formalina. Na dosagem de 160 mg/Kg, esse extrato apresentou ação analgésica central, aos 120 minutos de observação, no teste de placa quente e reduziu o edema de pata induzido pela administração de carragenina, uma hora após a administração do agente inflamatório, semelhante ao efeito produzido pelo fármaco padrão.

ABSTRACT Considering the different ethnopharmacological uses submitted by the plant Luehea divaricata, this study took place in order to evaluate the antinociceptive and anti-inflammatory activities of the ethanol extract of the leaves in an animal model, the dosages of 20, 40, 80 and 160 mg/kg by oral intake. The following tests were performed: writhing induced by acetic acid, hot plate, formalin, and paw edema induced by carrageenan. Swiss mice (20-25 g) were used for the first three tests and Wistar rats (180-250 g) for the last, divided into six groups, each of eight animals, totaling 48 animals for each assessment parameter. The results were statistically analyzed by analysis of variance at 5% probability to verify which treatments differ, and these were tested by Kruskal-Wallis and Student-Newman-Keuls. The ethanol extract of L. divaricataleaves (EEtOH-Ld) at the different studied doses showed significant antinociceptive activity on chemically induced pain by intraperitoneal injections of acetic acid and intraplantar formalin. At a dosage of 160 mg/kg, this extract showed a central analgesic action after 120 minutes of observation in the hot plate test and reduced action in the paw edema induced by carrageenan one hour after the administration of the inflammatory agent, similar to the effect produced by the standard drug.

Toxicidade subaguda do extrato etanólico das folhas de Myracrodruon urundeuva sobre o ciclo estral de ratas Wistar / Subacute toxicity of Myracrodruon urundeuva leave ethanolic extract and its effects on the estrous cycle of female Wistar rats

RESUMO A fitoterapia, abrangendo o uso popular e empírico de plantas medicinais no combate e prevenção de doenças, deve ser aliada a estudos científicos que comprovem a eficácia e segurança desses compostos. No Brasil, a ampla biodiversidade vegetal da região nordeste favorece o uso e estudo de plantas com potenciais terapêuticos. A Aroeira do Sertão (Myracrodruon urundeuva Allem.) é uma espécie pertencente à família Anacardiaceae, comum no semiárido, desde o Piauí até Minas Gerais. Seu uso é diverso e disseminado por todo o País, sendo indispensáveis estudos de suas potencialidades e riscos. Devido à ampla utilização da Myracrodruon Urundeuva de forma empírica, este trabalho tem por objetivo a pesquisa de efeitos tóxicos com doses repetidas do extrato etanólico de Myracrodruon urundeuva Allem. (EEMU) e sua influência no ciclo estral de ratas Wistar. No protocolo de toxicidade subaguda foram utilizadas 25 ratas Wistar, divididas em 5 grupos (n=5), tratadas com diferentes doses do EEMU (125, 250, 500 e 1000 mg/kg) e água destilada (controle) por um período de 28 dias. Nesse período foram realizadas mensurações do consumo de água e ração e avaliação comportamental. Esses animais foram avaliados diariamente quanto a fase do ciclo estral, por meio de esfregaço vaginal a fresco, sendo observada a frequência de cada fase bem como o intervalo interestro. As ratas foram anestesiadas e o sangue foi coletado para a realização dos ensaios bioquímicos. Em seguida, foram eutanasiadas para coleta e avaliação dos órgãos internos. Durante o período de avaliação, não foram observadas alterações de comportamento, nem de consumo de água ou ração. A evolução ponderal dos animais não diferiu entre os grupos tratados. A concentração sérica de ALT foi maior nos animais tratados com EEMU 1000 mg/kg. As ratas tratadas com o extrato não apresentaram alterações significativas na frequência das fases do ciclo estral bem como duração do estro e intervalo entre estros, quando comparadas ao grupo controle. Os resultados obtidos neste estudo não apontam alterações tóxicas significativas, sistêmicas ou sobre o ciclo estral, de ratas Wistar tratadas com o extrato, nas doses avaliadas, por um período de 28 dias.

ABSTRACT The herbal medicine, comprising the popular and empirical use of medicinal plants in combating and preventing diseases, should be combined with scientific studies that prove the effectiveness and safety of these compounds. In Brazil, the vast plant biodiversity of the Northeast favors the use and study of plants with therapeutic potential. Aroeira (Myracrodruon urundeuva Allem.) is a species of the Anacardiaceae family, common in the semiarid region, from Piauí to Minas Gerais. Its use is diverse and widespread throughout the country, making studies of its potential and risks necessary. Due to the wide use of Myracrodruon urundeuva in an empirical form, this paper aims to research toxic effects with repeated doses of Myracrodruon urundeuva Allem.ethanol extract (EEMU) and its influence on the estrous cycle of female Wistar rats. In a subacute toxicity protocol 35 female Wistar rats were used, divided into 5 groups (n=5) treated with different doses of EEMU (125, 250, 500 and 1000 mg/kg) and distilled water (control) for 28 days. In this period measurements of water intake, feed consumption were carried out and a behavioral assessment was performed. The estrous cycles of these animals were evaluated daily by fresh vaginal smear, it the frequency of each phase as well as the inter-estrus intervals were observed. The rats were anesthetized and blood was collected for the biochemical assays. Then they were euthanized for the collection and evaluation of internal organs. During the evaluation period, there were no observed behavioral changes nor were the water or food consumption variations. The weight gain of the animals did not differ between treatment groups. The serum ALT was higher in animals treated with EEMU 1000 mg/kg. The rats treated with the extract showed no significant changes in the frequency of the phases of the estrous cycle, estrus duration and estrus interval when compared to the control group. The results of this study do not indicate significant toxic alterations, neither systemic nor on the estrous cycle in female rats treated with the extract, at the evaluated doses, over a period of 28 days.

TNFα-dependent development of lymphoid tissue in the absence of RORγt⁺ lymphoid tissue inducer cells.

Lymphoid tissue often forms within sites of chronic inflammation. Here we report that expression of the proinflammatory cytokine tumor necrosis factor α (TNFα) drives development of lymphoid tissue in the intestine. Formation of this ectopic lymphoid tissue was not dependent on the presence of canonical RORgt(+) lymphoid tissue-inducer (LTi) cells, because animals expressing increased levels of TNFα but lacking RORgt(+) LTi cells (TNF/Rorc(gt)(-/-) mice) developed lymphoid tissue in inflamed areas. Unexpectedly, such animals developed several lymph nodes (LNs) that were structurally and functionally similar to those of wild-type animals. TNFα production by F4/80(+) myeloid cells present within the anlagen was important for the activation of stromal cells during the late stages of embryogenesis and for the activation of an organogenic program that allowed the development of LNs. Our results show that lymphoid tissue organogenesis can occur in the absence of LTi cells and suggest that interactions between TNFα-expressing myeloid cells and stromal cells have an important role in secondary lymphoid organ formation.

Attenuation of TNF-driven murine ileitis by intestinal expression of the viral immunomodulator CrmD.

Tumor necrosis factor α (TNFα) is a key pathogenic factor in Crohn's disease and rheumatoid arthritis. TNF(ΔARE) mice express high levels of TNFα and present Crohn's-like ileitis and arthritis. Alterations in the chemokine network could underline the TNF-driven ileitis. The aim of this study was to evaluate the role of TNF and chemokines in ileitis using ectromelia virus cytokine response modifier D (CrmD), a protein that binds TNFα and a limited number of chemokines. We generated transgenic mice expressing CrmD in intestinal epithelial cells (vCrmD mice) and crossed them with the TNF(ΔARE) mice to test whether CrmD could affect TNF-driven inflammatory processes. During homeostasis, only the number of B cells in the lamina propria was reduced by CrmD expression. Interestingly, CrmD expression in the intestine markedly attenuated the inflammatory infiltrates in the ileum of TNF(ΔARE) mice, but did not affect development of arthritis. Our results suggest that CrmD affects development of ileitis by locally affecting both TNF and chemokine function in the ileum.

CXCL13 expression in the gut promotes accumulation of IL-22-producing lymphoid tissue-inducer cells, and formation of isolated lymphoid follicles.

The chemokine CXCL13 is overexpressed in the intestine during inflammation. To mimic this condition, we created transgenic mice-expressing CXCL13 in intestinal epithelial cells. CXCL13 expression promoted a marked increase in the number of B cells in the lamina propria and an increase in the size and number of lymphoid follicles in the small intestine. Surprisingly, these changes were associated with a marked increase in the numbers of RORgammat(+)NKp46(-)CD3(-)CD4(+) and RORgammat(+)NKp46(+) cells. The RORgammat(+)NKp46(-)CD3(-)CD4(+) cells expressed CXCR5, the receptor for CXCL13, and other markers of lymphoid tissue-inducer cells, such as LTalpha, LTbeta, and TNF-related activation-induced cytokine (TRANCE). RORgammat(+)NKp46(-)CD3(-)CD4(+) gut LTi cells produced IL-22, a cytokine implicated in epithelial repair; and expressed the IL-23 receptor, a key regulator of IL-22 production. These results suggest that overexpression of CXCL13 in the intestine during inflammatory conditions favors mobilization of B cells and of LTi and NK cells with immunomodulatory and reparative functions.

Los valores de pH y prolactina sanguíneos se correlacionan y son menores en las mujeres que tienen un parto en comparación con las sometidas a cesárea / Blood pH and prolactin levels are lower and correlate in women with vaginal delivery in comparison with those undergoing cesarean section

Introducción El patrón multifásico de prolactina (PRL) que ocurre durante el parto no ha podido relacionarse con factores inhibidores y liberadores de PRL ya conocidos. Objetivo Determinar si hay correlación entre las concentraciones séricas de PRL y el pH sanguíneo en las pacientes que tienen un parto vaginal, en comparación con las que se someten a cesárea. Métodos Se incluyó a un total de 23 mujeres primigestas, de las que 12 tuvieron un parto eutócico y 11 se sometieron a cesárea. A todas ellas se realizaron 7 determinaciones de pH y PRL antes y después del nacimiento, a partir del inicio del segundo peíodo del trabajo de parto o la cirugía, según el caso. Resultados Los valores de PRL y pH fueron diferentes en ambos grupos (p<0,05). En el grupo de cesárea no se observaron cambios en el pH y la PRL. En el grupo de pacientes que tuvieron un parto, los valores de PRL fueron superiores a los 45min del expulsivo y en el momento de parto, comparados con los iniciales (p<0,05). Asimismo, los valores de pH fueron menores a partir de 15min del período expulsivo hasta 21min posparto (p<0,001). Se encontró una fuerte correlación entre el pH y la PRL, en el momento del parto y a los 7 y los 14min posparto (p<0,05).Discusión Se corroboró la existencia de una secreción bifásica de PRL durante el período expulsivo, la misma que se correlaciona con la disminución en los valores de pH que ocurre durante este período (AU)

Introduction The multiphasic pattern of prolactin (PRL) secretion described during vaginal delivery has not been related to the PRL-inhibiting or -liberating factors that are already known. Objective To determine whether there is a correlation between blood PRL concentrations and pH in women with vaginal delivery compared with those undergoing cesarean delivery. Methods This study included 23 primiparous women, of whom 12 had a vaginal delivery and 11 underwent cesarean delivery. In all patients, seven blood pH and PRL determinations were performed, before and after delivery, from the beginning of the second stage of labor or surgery. Results pH and PRL levels differed between the two groups (p<0.05). In the cesarean delivery group, no changes in pH or PRL concentrations were observed. In the vaginal delivery group, PRL levels were higher 45min after the onset of the second stage of labor and at delivery compared with initial values (p<0.05). Likewise, pH levels were lower 15min after the onset of the second stage until 21min after delivery (p<0.001). A strong correlation was found between pH and PRL at delivery and at 7 and 14min after delivery (p<0.05).Discussion The results of this study confirm the existence of a biphasic PRL secreting pattern during the second stage of labor. This pattern correlates with the reduction in pH levels that occurs during this period (AU)

Neurofibromatosis plexiforme: estudio con RM de dos casos clínicos y revisión de la literatura / Plexiform neurofibromatosis: MRI study of two clinical cases and review of the literature

Von Recklinghausen's disease orneurofibromatosis type 1 is a genetic disorder characterized by cutaneous lesions, skeletal malformations and some degree of mental impairment. It is common that neurofibromas appear, these are slow growing, benign tumours of the neural sheath. Plexiform neurofibromas are patognomonic ofNF 1. These are characterized by a late diagnosis when they compromise nerve function or when they have associated soft tissue deformity. They must be studied directly because they have a higher risk of malignant transformation. We present two patients that debuted with plexiform neurofibromas with a review of the literature on the subject.

La enfermedad de Von Recklinghausen o neurofibromatosis tipo 1 es una enfermedad genética caracterizada por lesiones cutáneas, malformaciones esqueléticas y algún grado de retraso mental. En el curso de la enfermedad la presencia de neurofibromas, tumores de la vaina nerviosa de comportamiento benigno y crecimiento lento es altamente probable, siendo los plexiformes patognomónicos de la enfermedad. Estos generalmente se diagnostican en estadios avanzados con compromiso de la función de los nervios involucrados o gran deformidad de partes blandas. Deben estudiarse de manera muy dirigida ya que tienen mayor riesgo de hacer una transformación maligna. Presentamos dos pacientes que debutaron con neurofibromas plexiformes, con una revisión de la literatura sobre el tema.