Management of 3 Proliferating Pilar Tumors: Definition, Differential Diagnosis, and Treatment Options. / Experiencia en el manejo de 3 tumores pilares proliferantes: definición, diagnósticos diferenciales y alternativas terapéuticas.

A proliferating pilar tumor is a rare skin neoplasm that arises from the outer root sheath of a hair follicle. Presentation varies widely, as the tumor can be benign or malignant and has a high probability of recurring after excision. We report our experience managing 3 proliferating pilar tumors with different clinical presentations and pathology findings at Hospital de San José, Bogota, Colombia.

Droplet distribution and airborne bacteria in an experimental shower unit.

Although human exposure to water aerosols is common in residential showers, the droplet distribution patterns generated in showers are not well understood nor is the bacteria released during shower operation. In this study, a two-phase flow Particle Tracking Velocimetry (PTV) algorithm was successfully used to characterize the spatial spray pattern and velocity field in two experimental showers (one low-flow and one high-flow). In addition, the airborne bacteria present in the shower over nearly 5 months of controlled operation was determined for both showers. The results indicate that the droplet velocity out of the low-flow showerhead (which had fewer orifices) was significantly higher than that out of the high-flow showerhead resulting in a higher aerosol number concentration in the low-flow shower and more consistent wetting of the shower wall. Both showerheads generated droplets in the respirable range and genera of potential health concern were observed in the shower aerosols measured both prior to and following shower operation. The study provides one of the first visualizations of droplet spray patterns in residential showers and provides insight into the airborne bacteria present in showers.

Physiological changes promoted by a strobilurin fungicide in the rice-Bipolaris oryzae interaction.

Strobilurins are among the most important fungicides that are used for plant disease control worldwide. In addition to their fungicide effect, strobilurins can also improve crop physiology. Nonetheless, the impact of azoxystrobin (Az), the main marketed strobilurin, on rice physiology is still unknown. Detailed gas exchange measurements and chlorophyll a fluorescence analysis were used to examine the Az effects on the photosynthetic performance of rice plants (cultivar Metica-1) either challenged or not with Bipolaris oryzae, the causal agent of brown spot. Az impaired carbon (C) fixation in the non-inoculated plants in a manner that was not related to photochemical or biochemical limitations, but rather to decreased stomatal conductance that limited the CO2 influx into the mesophyll cells. The photosynthesis of rice plants that were not sprayed with Az dramatically decreased upon B. oryzae infection, which was chiefly governed by photochemical and biochemical limitations. The energy surplus that was caused by limited C fixation in the rice plants that were treated with Az and inoculated with B. oryzae was thermally and effectively dissipated until 72h after inoculation. In Az absence, however, this mechanism was not sufficient to prevent chronic photoinhibition to photosynthesis. The inoculated plants were not able to fully capture and exploit the collected light energy, but these constraints were greatly limited in the presence of Az. In conclusion, Az impaired the photosynthetic performance of non-infected plants by diffusive constraints, but prevented, to a greater extent, the damage to the photosynthetic apparatus during the infection process of B. oryzae.

Photosynthetic and antioxidative alterations in coffee leaves caused by epoxiconazole and pyraclostrobin sprays and Hemileia vastatrix infection.

Coffee leaf rust (CLR), caused by Hemileia vastatrix, is a major disease affecting coffee production worldwide. In this study, an in-depth analysis of the photosynthetic performance of coffee leaves challenged or not with H. vastatrix and sprayed with either epoxiconazole (EPO) or pyraclostrobin (PYR) was performed by combining chlorophyll a fluorescence images, photosynthetic pigment pools and the activities of chitinase (CHI), ß-1,3-glucanase (GLU), peroxidase (POX) and catalase (CAT). The CLR severity was higher in the control plants, but reduced in plants sprayed with both PYR and EPO. Also, the CLR severity was reduced in plants sprayed with PYR compared with plants sprayed with EPO. Plants sprayed with either EPO or PYR showed maximal photosystem II quantum efficiency (Fv/Fm) values ranging from 0.78 to 0.80, which were quite similar to those obtained with inoculated plants (values ranging from 0.74 to 0.77). The decreases in the Fv/Fm ratio values and parallel increases in the F0 values in the inoculated plants, which were not observed in the control plants (sprayed with water) and were confirmed by images of the initial fluorescence (F0) and Fv/Fm parameters in the regions of the leaf tissue containing pustules and in the asymptomatic leaf tissue, indicated that photosynthesis was negatively impacted. When effective photosystem II quantum yield (Y(II)) values approached zero with a high photosynthetic photon flux density, high values of quantum yield of regulated energy dissipation (Y(NPQ)) in association with a high carotenoid concentration were noted in the inoculated plants sprayed either with PYR or EPO. The increased CLR severity in inoculated plants in contrast to inoculated plants sprayed with either PYR or EPO was associated with greater POX activity and a reduced photosynthetic pigment concentration. POX and CAT activities were increased in inoculated plants sprayed with either EPO or PYR when compared with control plants. CHI and GLU activities were maintained at high levels in the leaves of inoculated plants, regardless of the fungicide sprayed, indicating that CHI and GLU are less important for coffee resistance against CLR. The results of the present study clearly demonstrated that plants sprayed with either EPO or PYR showed milder CLR symptoms with adequate photosynthetic performance and optimal conditioning of their antioxidant systems.

Velocity- and power-load relationships of the bench pull vs. bench press exercises.

This study compared the velocity- and power-load relationships of the antagonistic upper-body exercises of prone bench pull (PBP) and bench press (BP). 75 resistance-trained athletes performed a progressive loading test in each exercise up to the one-repetition maximum (1RM) in random order. Velocity and power output across the 30-100% 1RM were significantly higher for PBP, whereas 1RM strength was greater for BP. A very close relationship was observed between relative load and mean propulsive velocity for both BP (R2=0.97) and PBP (R2=0.94) which enables us to estimate %1RM from velocity using the obtained prediction equations. Important differences in the load that maximizes power output (Pmax) and the power profiles of both exercises were found according to the outcome variable used: mean (MP), peak (PP) or mean propulsive power (MPP). When MP was considered, the Pmax load was higher (56% BP, 70% PBP) than when PP (37% BP, 41% PBP) or MPP (37% BP, 46% PBP) were used. For each variable there was a broad range of loads at which power output was not significantly different. The differing velocity- and power-load relationships between PBP and BP seem attributable to the distinct muscle architecture and moment arm levers involved in these exercises.

Importance of the propulsive phase in strength assessment.

This study analyzed the contribution of the propulsive and braking phases among different percentages of the one-repetition maximum (1RM) in the concentric bench press exercise. One hundred strength-trained men performed a test with increasing loads up to the 1RM for the individual determination of the load-power relationship. The relative load that maximized the mechanical power output (P(max)) was determined using three different parameters: mean concentric power (MP), mean power of the propulsive phase (MPP) and peak power (PP). The load at which the braking phase no longer existed was 76.1+/-7.4% 1RM. P(max) was dependent on the parameter used: MP (54.2%), MPP (36.5%) or PP (37.4%). No significant differences were found for loads between 40-65% 1RM (MP) or 20-55% 1RM (MPP and PP), nor between P(max) (% 1RM) when using MPP or PP. P(max) was independent of relative strength, although certain tendency towards slightly lower loads was detected for the strongest subjects. These results highlight the importance of considering the contribution of the propulsive and braking phases in isoinertial strength and power assessments. Referring the mean mechanical values to the propulsive phase avoids underestimating an individual's true neuromuscular potential when lifting light and medium loads.

Correlation between serum leptin levels and insulin sensitivity in diffuse toxic goiter.

OBJECTIVE: The aim of this survey was to assess the correlation between leptin and insulin sensitivity (IS) in cases of diffuse toxic goiter. DESIGN, PATIENTS, MEASUREMENTS: This is a descriptive study on patients with diffuse toxic goiter (DTG) assessing their body mass index (BMI), serum leptin concentrations, circulating insulin (area under the curve (AuC) of insulin), average insulin level, thyroid hormones, thyroid stimulating hormone (TSH), glycemia and IS (using a hyperinsulinemic-euglycemic clamp and the homeostasis model for assessment of insulin resistance (HOMA-IR) before and after euthyroidism induced with metimazol. RESULTS: The average patient age was 35 years old (range 31-40 years), height was 157 cm (range 151-160 cm), glycemia was 4.3 +/- 0.3 mmol/L and TSH 0.1 +/- 0.1 microU/mL. Average leptin level was 11.3 +/- 2.8 ng/dL, the average insulin level was 10.13 +/- 3.7 mIU/mL and the AuC for insulin was 50.6 +/- 18 microIU x min/mL. No correlation was found between leptin and BMI, thyroid hormones and glycemia. While controlling for the BMI effect, a correlation was found between leptin and TSH (r = -0.77, p = 0.042), as well as between leptin and insulinemia (r = 0.93, r2 = 0.86, p = 0.001) independently from the state of thyroid function. There was a tendency for a high correlation between leptin and the insulin AuC (hyperthyroidism: r = 0.89, p = 0.056; euthyroidism: r = 0.99, p = 0.056). A negative correlation was found between IS and the insulin AuC (rho = -0.58, p = 0.18). There was a high tendency for correlation between leptin and IS when the BMI effect (HOMA-IR: r = 0.70, p = 0.12; PHE: r = -0.55, p = 0.26) was taken into consideration. CONCLUSIONS: There is a high tendency for a negative correlation between leptin and IS when the BMI effect is controlled. There is a high tendency for a positive correlation between leptin and insulin and TSH.

[Screening of cervix uteri cancer in female health workers. Comparative analysis of insured individuals]. / Tamizaje de cáncer cervicouterino en trabajadoras de la salud. Un análisis comparativo con derechohabientes.

OBJECTIVE: To compare epidemiological characteristics and proportion of participation in a cervical cancer screening program in both, health-care professionals and insured on a health institute's women (Group A and Group B respectively). MATERIAL AND METHODS: Through questionnaires applied to both healthcare professionals and insured on a health institute's women (n = 96 for each group) randomly selected, a cross-sectional study was performed. To analyze the results, Yates' correction for continuity, was used. RESULTS: The characteristics from A and B groups were respectively: age 35 +/- 10 vs. 41 +/- 5 years (p < 0.001), years of scholarship: 8.3 +/- 5 vs. 12.0 +/- 1 (p < 0.001), frequency of screening test in the last two years: 1.2 +/- 0.4 vs. 1.0 +/- 0.1 (p < 0.001), time elapsed from the last test: 13.6 +/- 15 vs. 12.2 +/- 13 months (p = 0.52), attendance to screening test 55 (57%) vs. 72 (75%), (p < 0.001). Reasons for not attendance to screening test were indolence 13 (14%) vs. 13 (14%) and not enough time 7 (7%) vs. 2 (2%) by both groups, A and B, respectively. CONCLUSIONS: The proportion of attendance to cervical cancer screening is higher in health-care professionals than in insured on a health institute's women. The causes for not attendance to screening are the same in both groups.

[Risk factors for cesarean section: epidemiologic approach]. / Factores de riesgo para cesárea: un enfoque epidemiológico.

The increase in frequency of cesareans that has been noted through 70's, not diminished--like it was expected--perinatal morbidity and mortality. The most important indications to cesarean are distocias, previous cesarean and fetal stress. In 1998 frequency of cesarean deliveries in our hospital was 35% of the pregnancy attended. The claim of this study was to determine risks factors to cesarean in our hospital. A case-control study was performed, selecting 165 cases (cesareans) and 328 controls (via vaginal). It was determined OR of the risks factors and atribuible fraction. Data were analyzed by X2. The most important indications to cesarean delivery were: distocias (39%, n = 64); previous cesarean (23%, n = 41) and fetal stress (11%, n = 21). There was not significative differences in age, height and rupture membrane time in both groups. History of cesarean delivery gave major risk to another surgical intervention (OR = 12.7, p = < 0.0001, atribuible fraction 92%). Nuliparous (OR = 6.6, p < 0.00000, atribuible fraction 85%), second gestation (OR = 1.8, p = 0.002) or history of abortion (OR = 1.8, p = 0.04) were factors mainly associated to cesarean delivery. We concluded that the precise 'medications of this surgical intervention specially in nuliparous or previous cesarean delivery cases must be replanteated to diminish its elevated frequency.

[Perinatal mortality 1 in Colima, Col. Case-control study]. / Mortalidad perinatal 1 en Colima, Col. Estudio de casos y controles.

UNLABELLED: Perinatal mortality 1 (PM1) includes deads occurred from 28th week of gestation to 1st week of extrauterine life. The aim of this study was to describe, from medical records, clinical-epidemiological characteristics of 19 perinatal mortality 19 cases and 36 controls occurred in 1998 at a General Hospital. RESULTS: Interruption of the fetal-placental circulation, cardiopathy and ventricular hemorrhages were the main causes of PM1. There were no differences in cases and controls about maternal age 27.6 +/- 7 vs 28.8 +/- 5 years (p = 0.52), gestational age by amenorrhea: 39.2 +/- 1.4 vs 39.0 +/- 1.4 weeks (p = 0.82) and weight: 2892 +/- 769 vs 3352 +/- 549 g (p 0.03) respectively. In our study, the risk of PM1 was increased when history of one to four parity was present (OR = 4.67, p = 0.03) and was decreased when history of nulliparity was present (OR = 0.21, p = 0.03). Ten cases of 19 were mortinates, nine were hebdomadal deads. There was no difference in their characteristics: maternal age 26.1 +/- 5 vs 29.6 +/- 8 years (p = 0.34), gestational age 37.7 +/- 3 vs 34.1 +/- 3 weeks (p = 0.05) and weight 3025 +/- 699 vs 2780 +/- 853 g (p = 0.53) respectively. Hebdomadal death occurred 44 +/- 5 hours after their born. Results demonstrate the importance of improving prenatal attention particularly on last weeks of gestation, even in normal pregnancies.

Chronic back problems among workers.

OBJECTIVES: This article examines associations between selected work- and non-work-related factors and the incidence of chronic back problems over the next two years. DATA SOURCE: The data are from the longitudinal household component of the National Population Health Survey, conducted by Statistics Canada. The analysis is based on 3,234 male and 3,129 female respondents who, in 1994/95, were aged 16 or older, employed, rated their health as good, very good or excellent, and reported no diagnosed chronic back problems. ANALYTICAL TECHNIQUES: All analyses were weighted to represent the Canadian population in 1994/95. Unadjusted cross-tabulations and multiple logistic regression were used to examine the associations between respondents' characteristics in 1994/95 and newly diagnosed chronic back problems in 1996/97. MAIN RESULTS: More than 1 million (9%) Canadian workers aged 16 or older developed chronic back problems between 1994/95 and 1996/97. Back injury, chronic stress, depression, and being aged 40 to 49 were significantly associated with subsequent chronic back problems.

A comparison of the volume and pH of gastric contents of obese and lean surgical patients.

UNLABELLED: Obese surgical patients are typically considered to be more likely than lean patients to possess high-volume and low-pH (HVLP) gastric contents after a standard preoperative fast, based on a study of a population predominately consisting of patients receiving intramuscular preoperative sedation. We revisited this issue in a study population of 256 fasted surgical patients, of which 232 received no preoperative antacid or gastric prokinetic drug. Immediately after endotracheal intubation, an 18-French sump tube was placed, and gastric contents were withdrawn. Subjects' gastric contents were defined as HVLP if they exhibited a combination of a volume > 25 mL and a pH < 2.5. Obesity was defined as a body mass index > 30. Among nonmedicated obese patients, the proportion with HVLP gastric contents was 20 of 75 (26.6%). The proportion of lean patients with HVLP gastric contents was 66 of 157 (42.0%). The difference between the HVLP proportions for these two groups was found to be significant (P < 0.05) using chi 2 analysis. Obesity seems to be associated with a significantly decreased risk of HVLP gastric contents among surgical patients with no history of gastroesophageal pathology after a normal interval of preoperative fasting. IMPLICATIONS: Previous studies have shown that obese surgical patients have a greater volume of acidic stomach contents than lean patients, despite a routine preoperative fast. We have reexamined this issue and found that among otherwise healthy, fasted, obese surgical patients, there is a lower incidence of combined high-volume, low-pH stomach contents compared with lean patients.

Reduction of transiently expressed acetylcholinesterase activity in developing thalamocortical projections does not affect the mature pattern of basal forebrain projections to visual cortex.

Experiments tested the hypothesis that acetylcholinesterase (AChE) activity, expressed transiently in developing thalamocortical projections, serves to limit the growth of basal forebrain cholinergic projections into thalamocortical recipient zones. Newborn rats were subjected to enucleation, a procedure that eliminates transient AChE activity in developing visual cortex. After 3-8 weeks survival, AChE histochemical techniques revealed no alteration in the pattern of AChE positive basal forebrain axons in visual cortex. These data indicate that transient AChE activity in developing sensory cortex does not limit ingrowth of basal forebrain cholinergic axons.

Medicamentos en un servicio de cirugía hospitalaria / Drugs in a hospital surgery service

Un estudio que se llevó a cabo en el servicio de cirugía de mujeres del Hospital Universitario del Valle en Cali, Colombia, en mayo de 1980 puso de manifiesto una utilización inadecuada de los medicamentos que ascendía al 62% del costo de los mismos. Tal uso inadecuado correspondía a robo, deterioro o pérdida, ya que los medicamentos no se devolvían a la farmacia ni se entregaban a los pacientes cuando abandonaban el servicio. Se implantaron ciertas medidas de control entre las que se destacan el empleo de un formulario único que recogía en un solo pedido todas las órdenes médicas diarias individuales para cada paciente y supervisión de los medicamentos más utilizados por parte de la enfermera jefa del servicio. En mayo y junio de 1981 se repitió un estudio similiar y se comprobó que la utilización inadecuada había descendido al 29%. Si bien esto representa una mejora existe la necesidad de establecer sistemas de control en todo el proceso de adquisición, distribución y uso de los medicamentos con el fin de que la cantidad que prescribe el médico coincida con la que despachaba la farmacia y la que se administra a los enfermos