Phylogenomic insight into dysploidy, speciation, and plastome evolution of a small Mediterranean genus Reichardia (Cichorieae; Asteraceae).

Reichardia Roth is a small Mediterranean genus comprising ten homogeneous species with basic chromosome numbers of 7, 8, and 9. To assess the plastid genome evolution and differentiation of Reichardia species, we assembled the complete plastome sequences of seven Reichardia and two Launaea species and conducted various phylogenomic analyses comparatively with nuclear ribosomal DNA ITS sequences. Reichardia and Launaea plastomes were highly conserved in gene content and order, containing 130 genes. Plastid phylogenomic reconstruction strongly suggested that Reichardia was a sister to Launaea, and its common ancestor initially diverged into two major lineages: the first containing species with n = 8 chromosomes exclusively, and the other with n = 9, 8, and 7 chromosomes. Although the ancestral Reichardia karyotype was suggested to most likely be n = 9 from ancestral chromosome number reconstruction, the pattern of descending dysploidy indicated by the phylogenetic trees based on nuclear ribosomal DNA ITS was less evident in the trees based on the plastome. Possible reasons for these findings are discussed.

Influence of Gamification and Cooperative Work in Peer, Mixed and Interdisciplinary Teams on Emotional Intelligence, Learning Strategies and Life Goals That Motivate University Students to Study.

It is necessary to motivate university students to reduce the dropout rate in Spain, and to look for strategies that help university students acquire professional competencies; this is where gamification can be useful. The purpose of the study was to evaluate the influence of a learning methodology based on gamification and cooperative work in peers, and in mixed and interdisciplinary teams on the emotional intelligence, learning strategies, and life goals that motivate university students to learn. The sample consisted of 102 students who took a subject with a gamification-based methodology, through the Mechanics-Dynamics-Aesthetics model, in a cooperative way. The Self-Perception Scale of Personal Academic Motivation and the Trait Meta Mood Scale 24 were used. The results of the study showed an increase in learning strategies and life goals that motivated university students to study, as well as increases in emotional clarity and significantly in emotional repair. It was concluded that gamification is a positive tool for its ability to increase emotional intelligence, life goals, and learning strategies in university students' motivation to learn.

Linfoma de Hodgkin anal primario y tumor neuroendocrino intestinal sincrónicos: a propósito de un caso y revisión de la literatura / Primary rectal Hodgkin's lymphoma and synchronous small bowel neuroendocrine tumor: Case report and literature review

Resumen La localización extranodal gastrointestinal del linfoma de Hodgkin comprende el 5% de todos los linfomas. Dentro de este grupo, el linfoma anal primario representa menos del 0,05%, siendo por tanto una entidad extremadamente rara. Por otro lado, los tumores neuroendocrinos son un grupo heterogéneo de neoplasias relativamente poco frecuentes, pero de localización fundamentalmente digestiva. La asociación entre un linfoma de Hodgkin de localización anal y un tumor neuroendocrino intestinal no ha sido descrita previamente en la literatura, pero no es en absoluto raro que los tumores neuroendocrinos puedan coexistir con otro tipo de neoplasias. Los autores presentan el caso infrecuente de presentación de linfoma Hodgkin de localización anal asociado a un tumor neuroendocrino intestinal en una paciente mujer de 74 años, describiéndose la clínica, resultados de pruebas complementarias y tratamiento recibido.

Abstract Extranodal gastrointestinal Hodgkin's lymphoma comprises 5% of all lymphomas. In this group, primary rectal lymphoma represents less than 0.05%; thus, it is an extremely rare entity. On the other hand, neuroendocrine tumors are a heterogeneous group of infrequent neoplasms, mainly of digestive location. The association between a rectal Hodgkin's lymphoma and an intestinal neuroendocrine tumor has not been previously described in the literature, but it is not at all uncommon for neuroendocrine tumors to coexist with other types of neoplasms. The authors present a rare case of rectal Hodgkin's lymphoma associated with an intestinal neuroendocrine tumor in a 74-year-old female patient, describing the symptoms, complementary test results, and treatment.

Sow Thistle Chloroplast Genomes: Insights into the Plastome Evolution and Relationship of Two Weedy Species, Sonchus asper and Sonchus oleraceus (Asteraceae).

Prickly sow thistle, Sonchus asper (L.) Hill, and common sow thistle, Sonchus oleraceus L., are noxious weeds. Probably originating from the Mediterranean region, they have become widespread species. They share similar morphology and are closely related. However, they differ in their chromosome numbers and the precise relationship between them remains uncertain. Understanding their chloroplast genome structure and evolution is an important initial step toward determining their phylogenetic relationships and analyzing accelerating plant invasion processes on a global scale. We assembled four accessions of chloroplast genomes (two S. asper and two S. oleraceus) by the next generation sequencing approach and conducted comparative genomic analyses. All the chloroplast genomes were highly conserved. Their sizes ranged from 151,808 to 151,849 bp, containing 130 genes including 87 coding genes, 6 rRNA genes, and 37 tRNA genes. Phylogenetic analysis based on the whole chloroplast genome sequences showed that S. asper shares a recent common ancestor with S. oleraceus and suggested its likely involvement in a possible amphidiploid origin of S. oleraceus. In total, 79 simple sequence repeats and highly variable regions were identified as the potential chloroplast markers to determine genetic variation and colonization patterns of Sonchus species.

Linfoma MALT de localización colónica: a propósito de un caso y revisión de la literatura / Colonic MALT Lymphoma. Case report and literature review

Resumen El linfoma MALT es una forma poco frecuente de linfoma no Hodking de células B de bajo grado, que se desarrolla a expensas del tejido linfoide de las membranas mucosas. La localización más frecuente a nivel gastrointestinal es el estómago relacionando con la infección por Helicobacter pylori. El linfoma MALT colónico es una entidad extremadamente rara y cuya incidencia no supera el 5% de los casos en países asiáticos, con series porcentualmente menores al 2,5%, siendo la ubicación de este tipo de linfoma la más inusual de todo el tracto digestivo en comparación con otras neoplasias malignas que afectan al colon. Los autores exponen el caso infrecuente de presentación de linfoma tipo MALT de localización colónica en un paciente varón de 51 años, describiendo la clínica, los resultados de pruebas complementarias y el tratamiento recibido por el paciente.

Abstract MALT lymphoma is a rare form of low-grade non-Hodking B-cell lymphoma, which develops at the expense of lymphoid tissue of the mucous membranes. The most frequent location at the gastrointestinal level is the stomach related to the infection by Helicobacter pylori. Colonic MALT lymphoma is an extremely rare entity and the incidence of which does not exceed 5% of cases in Asian countries, with a series of less than 2.5%, with the location of this type of lymphoma being the most unusual of the entire digestive tract compared to other malignant neoplasms that affect the colon. The authors present the infrequent case of presentation of MALT-type lymphoma of colonic location in a 51-year-old male patient, describing the clinic, the results of complementary tests and the treatment received by the patient.

Punto de corte para el índice de adiposidad visceral en una población venezolana: resultados del Estudio de prevalencia de síndrome metabólico de Maracaibo / Optimal cutoff for visceral adiposity index in a Venezuelan population: Results from the Maracaibo City Metabolic Syndrome Prevalence Study

Aim: Visceral obesity is one of the most intensely researched cardiometabolic risk factors in recent years; nonetheless, its accurate assessment remains a challenge in regions were socioeconomic conditions hinder the widespread use of diagnostic methods for this purpose, such as imaging tests. In this setting, Visceral Adiposity Index (VAI) may be a useful tool. Thus, the objective of this study was to determine the VAI cutoff in adult population from Maracaibo City, Venezuela. Methods: This is a descriptive, cross-sectional study with multi-staged sampling; 2026 subjects of both genders aged ≥18 years were selected from this database and had their VAI calculated. In order to determine VAI cutoffs, subsamples of metabolically healthy and sick individuals were determined, with 599 and 286 subjects, respectively. Gender-specific and general ROC curves were plotted in order to identify the most suitable cutoff according to sensitivity and specificity. Results: Median VAI in the selected sample was 1.67 (0.97-2.78). The optimal cutoff was determined to be 1.91, with 70.3% sensitivity, 70.3% specificity [AUC = 0.777 (0.745-0.808)]. No differences were found between genders. Analysis by age revealed VAI to have greater predictive power among subjects aged < 30 years (cutoff: 1.53), 78.6% sensitivity, 72.8% specificity [AUC = 0.797 (0.709-0.884)]. Conclusion: We suggest a VAI cutoff of 1.9 for define dysfunctional adiposity in our population, with age being an important factor in the epidemiologic behavior of this variable, particularly in younger individuals.

Objetivo: La obesidad central es uno de los factores de riesgo cardiometabólicos emergente más evaluado durante los últimos años, sin embargo, su medición de forma precisa resulta un reto en aquellas poblaciones cuyas condiciones económicas dificultan la realización de métodos diagnósticos complejos, como pruebas de imagen. Por ello el objetivo de este estudio es determinar el punto de corte del índice de adiposidad visceral (VAI) en sujetos adultos de la ciudad de Maracaibo, Venezuela. Métodos: Se seleccionó a 2.026 individuos de ambos sexos, mayores de 18 años, de la base de datos del Estudio de prevalencia de síndrome metabólico en la ciudad de Maracaibo, un estudio descriptivo, transversal, con muestreo multietápico. El VAI se calculó para cada sexo y para la estimación del punto corte se seleccionó a 599 sujetos sanos y 286 enfermos, realizándose curvas COR para identificar el mejor valor de acuerdo con la sensibilidad y la especificidad. Resultados: El promedio de VAI en la muestra seleccionada fue 1,67 (0,97-2,78). El punto de corte fue 1,91 (70,3% de sensibilidad y 70,3% de especificidad) con AUC = 0,777 (0,745-0,808), sin diferencias en el punto de corte según sexo. En el análisis por grupos etarios la mayor capacidad predictiva fue para el grupo < 30 años con AUC = 0,797 (0,709-0,884), con un punto de corte de 1,53 (78,6% de sensibilidad y 72,8% de especificidad). Conclusión: El punto de corte indicado para VAI en nuestra población es de 1,9; considerando la edad como un factor importante en su comportamiento, especialmente en los grupos más jóvenes.

Fractura luxación de Lisfranc en un paciente con enfermedad de Hansen. Presentación de caso / Lisfranc fracture-dislocation in a patient with Hansen´s Disease. Case presentation

Introducción: Las lesiones de la articulación de Lisfranc se producen por traumas de alta energía; pero cuando se presentan en pacientes con enfermedad de Hansen y daño del sistema nervioso periférico, los traumas repetitivos de pequeña intensidad pueden conducir a este tipo de lesión. Objetivo: Presentar un caso interesante dada la asociación en un paciente con Hansen de una lesión de Lisfranc causado por un trauma de baja energía. Presentación de caso: Paciente de 64 años de edad fototipo V, con antecedentes de Hansen Lepromatoso, que por traumas repetitivos de baja intensidad y un proceso séptico sobreañadido, presentó fractura-luxación de Lisfranc del tipo divergente, se comentan los antecedentes, el cuadro clínico, los exámenes laboratorio, ultrasonidos, estudio radiológico y el tratamiento impuesto. Conclusiones: La discapacidad en manos y pies por trastornos neurológicos en pacientes con lepra lepromatosa de más de 5 años de evolución es bastante frecuente, pero asociado a luxofractura de Lisfranc de tipo divergente, por trauma de baja intensidad, no lo es, ya que este tipo de lesión normalmente se produce por traumas de alta energía(AU)

Introduction: Lisfranc joint lesions are produced by high energy traumas, but when they present in patients with Hansen´s disease and damage to the peripheral nervous system, the low intensity repeated traumas can lead to this type of lesion. Objective: To present an interesting case, given a particular association on a patient with Hansen´s disease and a Lisfranc lesion, caused by a low energy trauma. Case presentation: 64 years old Phototype V patient with antecedents of lepromatous Hansen´s disease who presented Lisfranc fracture-dislocation of a divergent type after low intensity repeated traumas, and a septic superadded process. The antecedents, clinical picture, laboratory tests, ultrasounds, radiological study, and the treatment indicated are all analyzed. Conclusions: Disability in hands and feet due to neurological disorders in patients with lepromatous leprosy of more than 5 years of evolution is very frequent, but it is not so frequent when associated to a Lisfranc fracture-dislocation of a divergent type due to low intensity trauma, because this type of lesion is normally caused by high energy traumas(AU)

Epicardial Fat: Physiological, Pathological, and Therapeutic Implications.

Epicardial fat is closely related to blood supply vessels, both anatomically and functionally, which is why any change in this adipose tissue's behavior is considered a potential risk factor for cardiovascular disease development. When proinflammatory adipokines are released from the epicardial fat, this can lead to a decrease in insulin sensitivity, low adiponectin production, and an increased proliferation of vascular smooth muscle cells. These adipokines move from one compartment to another by either transcellular passing or diffusion, thus having the ability to regulate cardiac muscle activity, a phenomenon called vasocrine regulation. The participation of these adipokines generates a state of persistent vasoconstriction, increased stiffness, and weakening of the coronary wall, consequently contributing to the formation of atherosclerotic plaques. Therefore, epicardial adipose tissue thickening should be considered a risk factor in the development of cardiovascular disease, a potential therapeutic target for cardiovascular pathology and a molecular point of contact for "endocrine-cardiology."

Population genetics of self-incompatibility in a clade of relict cliff-dwelling plant species.

The mating systems of species in small or fragmented populations impact upon their persistence. Small self-incompatible (SI) populations risk losing S allele diversity, responsible for the SI response, by drift thereby limiting mate availability and leading to population decline or SI system breakdown. But populations of relict and/or endemic species have resisted these demographic conditions over long periods suggesting their mating systems have adapted. To address a lack of empirical data on this topic, we studied the SI systems of three relict cliff-dwelling species of Sonchus section Pustulati (Asteraceae): S. masguindalii, S. fragilis and S. pustulatus in the western Mediterranean region. We performed controlled pollinations within and between individuals to measure index of SI (ISI) expression and identify S alleles in multiple population samples. Sonchus masguindalii and S. pustulatus showed strong SI (ISI = 0.6-1.0) compared to S. fragilis (ISI = 0.1-0.7). Just five S alleles were estimated for Spanish S. pustulatus and a moderate 11-15 S alleles for Moroccan S. pustulatus and S. fragilis, respectively. The fact that autonomous fruit set was generally improved by active self-pollination in self-compatible S. fragilis suggests that individuals with weak SI can show a wide range of outcrossing levels dependent on the degree of self or outcross pollen that pollinators bear. We conclude that frequent S allele dominance interactions that mask the incompatibility interactions of recessive S alleles leading to higher mate availability and partial breakdown of SI leading to mixed mating, both contribute to reproductive resilience in this group.

Physiologic Course of Female Reproductive Function: A Molecular Look into the Prologue of Life.

The genetic, endocrine, and metabolic mechanisms underlying female reproduction are numerous and sophisticated, displaying complex functional evolution throughout a woman's lifetime. This vital course may be systematized in three subsequent stages: prenatal development of ovaries and germ cells up until in utero arrest of follicular growth and the ensuing interim suspension of gonadal function; onset of reproductive maturity through puberty, with reinitiation of both gonadal and adrenal activity; and adult functionality of the ovarian cycle which permits ovulation, a key event in female fertility, and dictates concurrent modifications in the endometrium and other ovarian hormone-sensitive tissues. Indeed, the ultimate goal of this physiologic progression is to achieve ovulation and offer an adequate environment for the installation of gestation, the consummation of female fertility. Strict regulation of these processes is important, as disruptions at any point in this evolution may equate a myriad of endocrine-metabolic disturbances for women and adverse consequences on offspring both during pregnancy and postpartum. This review offers a summary of pivotal aspects concerning the physiologic course of female reproductive function.

Phylogeography of cliff-dwelling relicts with a highly narrow and disjunct distribution in the western Mediterranean.

PREMISE OF THE STUDY: The high biodiversity in the Baetic-Rifan hotspot of Mediterranean region is shaped by complex geological and climatic histories and has been a subject of recent intensive studies. However, very little is known about phylogenetic and biogeographic history of three rare and critically endangered cliff-dwelling species of Sonchus in section Pustulati in this region. METHODS: We investigated the genetic variation and phylogenetic relationships of populations based on nuclear (ITS/ETS) and plastid (3'trnL-ndhJ/psaI-accD) DNA sequences, and amplified fragment length polymorphisms (AFLPs). We performed a Bayesian relaxed molecular clock analysis with ITS data to estimate divergence times for major lineages. KEY RESULTS: ITS/ETS and AFLP phylogenies showed high concordance and contrasted with cpDNA data. The divergence between S. masguindalii and S. fragilis was dated at 5.48 Ma, between S. fragilis and S. pustulatus at 3.89 Ma, and between the Baetic and Rifan S. pustulatus at 1.18 Ma. Within each distribution area, AFLP data showed a relatively high genetic structuring and moderate genetic diversity, the latter being impoverished in the Baetic populations. CONCLUSIONS: Our results further confirm the hybrid origin of S. pustulatus, a critically endangered species. The origin and diversification of lineages appear to have occurred on the temporary land bridge that joined Iberian and North Africa during the Messinian Salinity Crisis (5.96-5.33 Ma) and the subsequent Zanclean flood that progressively refilled the Mediterranean Basin (5.33-3.60 Ma). The only Baetic populations of S. pustulatus most likely originated from the Rifan ones.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades.

The current work describes the program of the Medicine of Disasters subject that is imparted to the future physicians of the Latin American School of Medicine in Villa Clara since 2003, as an exclusive experience in the world. It consists of 120 teaching hours distributed in two rotations that are developed during the fourth and fifth years of the career, with a theoretical-practical character. Its contents are guided to the familiarization with the topic of the disasters-causing factors, their effects upon health and the dynamics of society and the communities, as well as to the incorporation of knowledge about risks and vulnerability, besides the associated procedures to diminish them; where the preparatory work with the population and the interrelation among sectors to face adversities are predominant.

Relationship between Alcohol Consumption and Components of the Metabolic Syndrome in Adult Population from Maracaibo City, Venezuela.

Introduction. Although the relationships between alcohol and disorders such as cancer and liver disease have been thoroughly researched, its effects on cardiometabolic health remain controversial. Therefore, the objective of this study was to assess the association between alcohol consumption, the Metabolic Syndrome (MS), and its components in our locality. Materials and Methods. Descriptive, cross-sectional study with randomized, multistaged sampling, which included 2,230 subjects of both genders. Two previously determined population-specific alcohol consumption pattern classifications were utilized in each gender: daily intake quartiles and conglomerates yielded by cluster analysis. MS was defined according to the 2009 consensus criteria. Association was evaluated through various multiple logistic regression models. Results. In univariate analysis (daily intake quartiles), only hypertriacylglyceridemia was associated with alcohol consumption in both genders. In multivariate analysis, daily alcohol intake ≤3.8 g/day was associated with lower risk of hypertriacylglyceridemia in females (OR = 0.29, CI 95%: 0.09-0.86; p = 0.03). Among men, subjects consuming 28.41-47.33 g/day had significantly increased risk of MS, hyperglycemia, high blood pressure, hypertriacylglyceridemia, and elevated waist circumference. Conclusions. The relationship between drinking, MS, and its components is complex and not directly proportional. Categorization by daily alcohol intake quartiles appears to be the most efficient method for quantitative assessment of alcohol consumption in our region.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades(AU)

Successful management of insulin allergy and autoimmune polyendocrine syndrome type 4 with desensitization therapy and glucocorticoid treatment: a case report and review of the literature.

Introduction. Insulin allergy is a rare complication of insulin therapy, especially in type 1 diabetes mellitus (T1DM). Key manifestations are hypersensitivity-related symptoms and poor metabolic control. T1DM, as well as insulin allergy, may develop in the context of autoimmune polyendocrine syndrome (APS), further complicating management. Case Report. A 17-year-old male patient, diagnosed with T1DM, was treated with various insulin therapy schemes over several months, which resulted in recurrent anaphylactoid reactions and poor glycemic control, after which he was referred to our Endocrinology and Immunology Department. A prick test was carried out for all commercially available insulin presentations and another insulin scheme was designed but proved unsuccessful. A desensitization protocol was started with Glargine alongside administration of Prednisone, which successfully induced tolerance. Observation of skin lesions typical of vitiligo prompted laboratory workup for other autoimmune disorders, which returned positive for autoimmune gastritis/pernicious anemia. These findings are compatible with APS type 4. Discussion. To our knowledge, this is the first documented case of insulin allergy in type 4 APS, as well as this particular combination in APS. Etiopathogenic components shared by insulin allergy and APS beg for further research in immunogenetics to further comprehend pathophysiologic aspects of these diseases.

Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth.

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.

Laparoscopic transhiatal esophagectomy and gastric pull-up in long-gap esophageal atresia: description of the technique in our first 10 cases.

The definition accepted for the largely controversial and multiple criteria condition known as long-gap esophageal atresia (LGEA) is "inability to achieve primary end-to-end anastomosis," particularly in the presence of a tracheo-esophageal fistula. In this article we report our technique of laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL) in LGEA, based on the open approach of Spitz. Differences between TEGPUL and the original technique are the absence of a pyloromyotomy, the peel-away technique, the gastric pull-up through the distal esophagus, and its extracorporeal section. We performed the technique in 10 patients: 6 girls and 4 boys. Six had esophageal atresia type III (60%), three had esophageal atresia type I (30%) and one had esophageal atresia type II (10%). Mean time in surgery was 4.43 hours (range, 3.3-7 hours). Average stay in the pediatric intensive care unit was 5.9 days (range, 3-25 days). Average time under mechanical ventilation was 4.6 days (range, 2-8 days). Average total hospital stay was 19.4 days (range, 11-40 days). Oral feeding began at 15.6 days (range, 5-30 days). We believe these steps and the early realization of the technique will reduce the morbidity and mortality among these patients and decrease the number of contraindications to gastric pull-up. Nevertheless, a valid conclusion will require more studies with a larger number of patients and longer follow-up.

Variations of lipoprotein(a) levels in the metabolic syndrome: a report from the Maracaibo City Metabolic Syndrome Prevalence Study.

BACKGROUND: Lipoprotein(a) [Lp(a)] is a known risk factor for cardiovascular disease, yet its influence on metabolic syndrome (MS) is still controversial. The purpose of this study was to assess the impact generated by this diagnosis in serum Lp(a) concentrations. MATERIALS AND METHODS: A total of 1807 subjects of both genders (55.3% women and 44.7% men) belonging to the Maracaibo City Metabolic Syndrome Prevalence Study were evaluated. Results were expressed as Mean ± SD, determining differences through Student's t-test and One-Way ANOVA test. Multiple logistic regression models were utilized for analyzing factors associated with elevated serum Lp(a) levels and MS. Total cholesterol and LDL-C were corrected according to Lp(a)-Cholesterol when necessary. RESULTS: No differences were found in Lp(a) values between genders; P = 0,292. The association between MS and the classification of Lp(a) was statistically significant (χ (2) = 28.33; P < 0,0001), with greater levels in subjects with this diagnosis. In the univariate analysis, subjects with each of the separate diagnostic criteria showed higher serum Lp(a) concentrations, except for hyperglycemia. CONCLUSIONS: Lp(a) values exhibit important variations regarding MS and each of its components. Impaired fasting glucose appeared as a protecting factor against elevated Lp(a) concentrations, whereas its association with LDL-C and hs-CRP suggests a potential pro-inflammatory role.

Onicomadesis y enfermedad Mano-Pie-Boca / Onychomadesis and Hand-Foot-Mouth disease

Introducción. La enfermedad mano-pie-boca (EMPB) es una patología infectocontagiosa de etiología vírica, relativamente frecuente en la edad pediátrica, de diagnóstico clínico y evolución autolimitada en la mayoría de los casos. Recientemente se ha descrito la observación, varias semanas después de la resolución del cuadro, de onicomadesis en uñas de dedos de la mano y/o el pie de los niños afectados. Caso clínico. Presentamos dos casos de niños que, tras un episodio de EMPB resuelto, desarrollan onicomadesis después de un período de latencia mayor a 4 semanas. En uno de ellos la afectación ungueal es en dedos de las manos y en el otro en uñas de los pies, sin antecedentes de infección, trauma o signos de inflamación respectivamente. Comentarios. La EMPB es una infección vírica causada principalmente por dos tipos de enterovirus A, el coxsackievirus A16 (CVA16) y el enterovirus 71 (EV71). Entre los años 2000 y 2009 se han reportado diversos brotes, en diferentes países, de EMPB con onicomadesis posterior. Es importante tener presente esta aso- Onicomadesi i malaltia boca-mà-peu Alejandro Novoa Correa 1, José Luis Guillén Mejías 2 1 Servei de Pediatria; 2 Secció d’Urgències. Policlínica Comarcal El Vendrell. El Vendrell (Tarragona) ciación para realizar un diagnóstico correcto, e informar a la familia de su curso benigno y autolimitado(AU)

Introduction. Hand-foot-mouth disease (HFMD) is a common childhood contagious enteroviral infection of clinical diagnosis and selflimited clinical course. The occurrence of onychomadesis in fingernails and toenails several weeks after the resolution of HFMD was reported recently. Clinical observation. We describe two children with history of HFMD who presented with onychomadesis more than 4 weeks later; the fingernails and the toenails were involved in one case each. There was no history of infection or trauma, and there were no signs of inflammation. Comments. HFMD is a viral infectious disease caused mainly by two serotypes of enterovirus species A, coxsackievirus A16 (CVA16), and enterovirus 71 (EV71). Between 2000 and 2009 several outbreaks of HFMD followed by onychomadesis have been reported in different countries. This association must be recognized in order to make the correct diagnosis, and to inform the patients and their families of the self-limited and benign course(AU)