Un hallazgo inesperado en hipocondrio derecho / An unexcepted finding in the right hypocondrium

A 90-years-old man comes to the emergency department with diffuse abdominal pain and fever three days. On physical examination, the abdomen is soft and depressible with air-fluid sound present and bilateral reductible inguinal hernias. A mass is palpated at the level of the roght hypochondrium with a positive Murphy´s sign whitout signs of peritoneal irritation. An abdominal CT with intravenous contrast is requested due to the suspicion of acute abdominal pathology, observing cholelithiasis and a markedly distended gallbladder with torsion. (AU)

Quiste complejo de mama / Complex cyst of the breast

83-year-old woman with palpable lesion on the left breast. Mammography shows a single nodule with well-defined borders, and ultrasound a complex cyst with solid areas that biopsy resulted in an encapsulated papillary breast carcinoma. Two axillary lymph nodes were affected. (AU)

Revisión de los riesgos maternos y perinatales en tiempos de COVID-19: desafíos para el rol de la Matronería / Review of maternal and perinatal risks in times of COVID-19: challenges for the role of Midwifery

INTRODUCCIÓN Y OBJETIVO Una enfermedad nueva, COVID-19, está afectando dramáticamente al mundo. Conocer los riesgos para la salud reproductiva es un imperativo para la práctica obstétrica y ginecológica. Esta investigación analiza los riesgos maternos y perinatales asociados a COVID-19, con el objetivo de identificar desafíos que la enfermedad plantea a la práctica de la matronería. MÉTODOS Revisión narrativa. Se consultaron artículos científicos de fuentes primarias indexados en las bases Scielo, Pubmed, Scope, WOS, mediante los siguientes términos de búsqueda: "embarazo" "transmisión vertical" "salud materna y perinatal", "riesgos maternos y perinatales" "lactancia materna", COVID-19", "Coronavirus". Se realizaron 3 fases de selección. Los tópicos de análisis fueron: Transmisión vertical, Riesgo materno y perinatal, Lactancia materna. RESULTADOS. En mujeres embarazadas las formas severas de COVID-19 se presentan en presencia de enfermedades crónicas. A nivel perinatal el riesgo mayor es el parto prematuro, generalmente por indicación médica y por cesárea. Aunque no hay evidencias de transmisión vertical, tampoco puede descartarse. Los riesgos neonatales se relacionan con el contagio por proximidad y con medidas restrictivas que pueden afectar la lactancia materna y la interacción madre-hija(o). CONCLUSIONES. La COVID-19 aporta varios desafíos para la práctica de la matronería: implementación de métodos de prevención del contagio a la gestante y a su entorno cercano; adecuación de la preparación al parto en caso de positividad; prevención del estrés y desgaste emocional materno desde el inicio de la gestación hasta el postparto; adecuación de cuidados al recién nacido; investigación aplicada en Latinoamérica, y evaluación de nuevos protocolos.

INTRODUCTION AND OBJECTIVE A new disease, COVID-19, is dramatically affecting the world. Knowing the risks for the reproductive health is an imperative for the obstetric and gynecological practice. This research analyzes the maternal and perinatal risks associated with COVID-19, with the aim of identifying challenges that the disease poses to the practice of midwifery. METHODS Narrative review. Scientific articles from primary sources indexed in Scielo, Pubmed, Scope, and WOS, are consulted by using the following search terms: "pregnancy" "vertical transmission" "maternal and perinatal health", "maternal and perinatal risks" "breastfeeding", COVID-19", "Coronavirus". Three selection phases were carried out. The topics of analysis were vertical transmission, maternal and perinatal risk, breastfeeding. RESULTS In pregnant women severe forms of COVID-19 occur in the presence of chronic diseases. At the perinatal level, the biggest risk is premature delivery, generally for medical indications and by cesarean section. Although there is no evidence of vertical transmission, it cannot be ruled out either. Neonatal risks are related to transmission by proximity and restrictive measures that may affect breastfeeding and mother-child interaction. CONCLUSIONS COVID-19 brings several challenges to the practice of midwifery: implementation of methods to prevent infection of the pregnant woman and her close environment; adaptation of birth preparation in case of positivity; prevention of maternal stress and emotional distress from the beginning of pregnancy to postpartum; adequacy of care for the newborn; research in Latin America, and evaluation of new protocols.

Educación en salud, práctica de actividad física y alimentación en grandes urbes: perspectiva de los usuarios / Education in health, physical practice and food in big cities: perspective of the users

Resumen Introducción: La población que vive en grandes urbes cuenta con elementos culturales que difícilmente están incorporados en las intervenciones de educación para la salud. Objetivo: Identificar los elementos clave en el diseño de estrategias culturalmente competentes para mejorar las sesiones de educación en salud, práctica de actividad física y alimentación. Metodología: Estudio cualitativo, exploratorio y descriptivo realizado en la Ciudad de México. Se utilizó la técnica de grupos focales. El guion temático incluyó: a) causas de la enfermedad, prevención y tratamiento; b) elementos para prevenir la enfermedad: dieta y actividad física; c) motivaciones para participar en una intervención que prevenga las Enfermedades Crónicas no Transmisibles desde su contexto cultural; y d) barreras y facilitadores. Las entrevistas fueron grabadas, transcritas y analizadas de acuerdo con la teoría fundamentada. Resultados: Los resultados muestran que uno de los impedimentos de mayor peso es la falta de tiempo para acudir a sesiones de educación en salud, la práctica de actividad física, la preparación y consumo de alimentos saludables. Dentro de los grupos, obesidad y sobrepeso no se perciben como un factor importante para el desarrollo de Enfermedades crónicas no trasmisibles. Se propone incorporar elementos tanatológicos y logoterapéuticos en las intervenciones con el fin de dar sentido de vida a la salud. Conclusión: Se proponen estrategias que transiten de la promoción de la salud hacia el desarrollo humano, que integren elementos de manejo efectivo del tiempo, inteligencia emocional, aumento de la autoestima y estrategias familiares de colaboración.

Abstract Introduction: The population in the large cities has cultural elements that are hardly incorporated in health education interventions. Objective: To identify the key elements for designing culturally competent strategies necessary to improve health education sessions, physical activity and food intake for people at risk of chronic non-communicable diseases (NCD). Methodology: A qualitative, exploratory and descriptive study was performed in Mexico City. Focal group technique was used. Thematic script included topics such as: a) causes of the disease, its prevention and treatment; B) elements for disease prevention: diet and physical activity; C) motivations to participate in an intervention that prevents NCD in their own cultural context; and d) Elements that do not work in an intervention to prevent NCD. The interviews were recorded, transcribed and analyzed under the fundamental theory approach. Results: Data showed that one of the most important impediments is the lack of time to attend health education sessions, physical activity and healthy foods preparation and consumption. Within the groups, obesity and weight were not perceived as an important factor for the development of NCD. We proposed to incorporate thanatological and logotherapeutic elements in the interventions in order to give live meaning to people´s health. Conclusion: Strategies are proposed to move from health promotion to human development, integrating elements of effective management of time, emotional intelligence, increased self-esteem and family strategies of collaboration.

CD38 protein deficiency induces autoimmune characteristics and its activation enhances IL-10 production by regulatory B cells.

CD38 is a transmembrane protein expressed in B lymphocytes, and is able to induce responses as proliferation, differentiation or apoptosis. Several reports propose that CD38 deficiency accelerates autoimmune processes in murine models of autoimmune diabetes, lymphoproliferation and rheumatoid arthritis. Other reports have shown elevated CD38 expression in B and T cells from patients with autoimmunity; however, the role of CD38 is still unclear in the development of autoimmunity. Recently, it has been characterized as CD1dhi CD5+ regulatory B cell subpopulation able to produce IL-10, and the loss of these cells exacerbates the autoimmunity in murine models. Here, we report that CD38-/- mice exhibited elevated titres of ANAS, anti-dsDNA autoantibodies from 12 months of age and were higher by 16 months of age and mice presented kidney damage. Interestingly, there is a reduction in the survival of CD38-/- mice compared to the WT. Furthermore, CD38 is highly expressed by CD1dhigh CD5+ regulatory B cells, and the agonistic anti-CD38 stimulus plus LPS was able to increase the percentage of this cell subset and its ability to induce IL-10 production. Together, these results suggest that CD38 could play a role in the control of autoimmune diseases through their expression on regulatory B cells.

Testicular thermoregulation, scrotal surface temperature patterns and semen quality of water buffalo bulls reared in a tropical climate.

This study evaluated the capacity of thermoregulation and its consequences on the scrotal surface temperature patterns and semen quality of buffalo bulls raised in a wet tropical climate. Eleven water buffaloes were evaluated in the rainiest, in the transitional and in the less rainy season. Air temperature and humidity were consistently high, but the animals did not show thermal stress in any season. The scrotal temperature gradient of buffalo bulls using infrared thermography was described, and three parallel and decreasing thermal bands were characterised. Sperm quality (n = 176 ejaculates) was maintained in normal parameters over the periods. Pearson's coefficients showed that sperm volume and progressive motility were negatively correlated with ocular globe, epididymal tail and minimum scrotal temperatures (p < .01). Sperm membrane integrity was negatively influenced by increases in epididymal tail and minimum scrotal temperatures (p < .01). Ocular globe temperature also showed positive correlation with rectal, spermatic cord, and epididymal tail temperatures (p < .01). Therefore, even under high temperature and humidity, the thermoregulatory system was effective in preventing heat stress and the normality of scrotal surface temperatures, spermatogenesis and sperm maturation were maintained.

The removal of arsenate from water using iron-modified diatomite (D-Fe): isotherm and column experiments.

Iron hydroxide supported onto porous diatomite (D-Fe) is a low-cost material with potential to remove arsenic from contaminated water due to its affinity for the arsenate ion. This affinity was tested under varying conditions of pH, contact time, iron content in D-Fe and the presence of competitive ions, silicate and phosphate. Batch and column experiments were conducted to derive adsorption isotherms and breakthrough behaviours (50 µg L(-1)) for an initial concentration of 1,000 µg L(-1). Maximum capacity at pH 4 and 17% iron was 18.12-40.82 mg of arsenic/g of D-Fe and at pH 4 and 10% iron was 18.48-29.07 mg of arsenic/g of D-Fe. Adsorption decreased in the presence of phosphate and silicate ions. The difference in column adsorption behaviour between 10% and 17% iron was very pronounced, outweighing the impact of all other measured parameters. There was insufficient evidence of a correlation between iron content and arsenic content in isotherm experiments, suggesting that ion exchange is a negligible process occurring in arsenate adsorption using D-Fe nor is there co-precipitation of arsenate by rising iron content of the solute above saturation.

Vagus nerve stimulation during rehabilitative training improves forelimb strength following ischemic stroke.

Upper limb impairment is a common debilitating consequence of ischemic stroke. Physical rehabilitation after stroke enhances neuroplasticity and improves limb function, but does not typically restore normal movement. We have recently developed a novel method that uses vagus nerve stimulation (VNS) paired with forelimb movements to drive specific, long-lasting map plasticity in rat primary motor cortex. Here we report that VNS paired with rehabilitative training can enhance recovery of forelimb force generation following infarction of primary motor cortex in rats. Quantitative measures of forelimb function returned to pre-lesion levels when VNS was delivered during rehab training. Intensive rehab training without VNS failed to restore function back to pre-lesion levels. Animals that received VNS during rehab improved twice as much as rats that received the same rehabilitation without VNS. VNS delivered during physical rehabilitation represents a novel method that may provide long-lasting benefits towards stroke recovery.

Enanismo tanatofórico: presentación de un caso / Thanatophoric dwarfism: a case report

El enanismo o displasia tanatofórica constituye una malformación rara del sistema esquelético que raras veces supera la etapa prenatal. Aunque se puede presentar clínicamente de dos formas diferentes, algunas alteraciones como las costillas cortas y horizontalizadas, las deformidades del tórax y los fémures cortos y encorvados son coincidentes. Se presenta un caso diagnosticado en el Centro Municipal de Genética de la Isla de la Juventud (Cuba) en el año 2010, durante la etapa prenatal y previo asesoramiento genético a los padres, se procedió a interrumpir el embarazo. Los patólogos confirmaron el diagnóstico (AU)

Thanatophoric dwarfism or dysplasia constitutes a rare malformation of the skeletal system that usually causes prenatal demise. Although there are two clinical forms, some alterations such as short and horizontal ribs, deformities of the thorax and short, curved femurs usually occur together. We describe a case of thanatophoric dwarfism prenatally diagnosed in the Municipal Center of Genetics of the Isle of Youth (Cuba). The parents were given genetic counselling and decided to interrupt the pregnancy. The diagnosis was confirmed by pathological analysis (AU)

Treatment of slaughterhouse wastewater in upflow anaerobic sludge blanket reactor.

The performance of an upflow anaerobic sludge blanket (UASB) reactor operated at ambient temperature (20.9-25.2°C) was analysed for the treatment of slaughterhouse wastewater previously pre-treated for solid separation. The experimental work was carried out in a reactor with 15 L effective volume. Four organic loads were applied and the process performance was evaluated. The COD removal rate increased with the load rise from 4 to 15 kg COD.m(-3).d(-1). Removal efficiencies of 90% were obtained with a load of 15 kg COD.m(-3).d(-1). The entrapment of suspended solids in the sludge blanket was greater in proportion during the first two stages due to the low upflow velocities used when loads of 4 and 7 kg COD.m(-3).d(-1) were evaluated. This phenomenon did not affect the structure of the biological grains or their methanogenic activity. More than 50% of the organic nitrogen was degraded, causing a 3% increase of ammonia concentration. The concentrations of the volatile fatty acids were not high and the wastewater alkalinity was enough to prevent acidification. The yield coefficient of methane production increased with the load rise, reaching 0.266 m(3)/kg COD(removed) at 15 kg COD.m(-3).d(-1) organic load. The UASB reactor is a good option for the biological treatment of pre-treated slaughterhouse wastewater. However, additional treatment is required in order to accomplish the water quality requirements in discharges to water bodies.

The conserved WW-domain binding sites in Dystroglycan C-terminus are essential but partially redundant for Dystroglycan function.

BACKGROUND: Dystroglycan (Dg) is a transmembrane protein that is a part of the Dystrophin Glycoprotein Complex (DGC) which connects the extracellular matrix to the actin cytoskeleton. The C-terminal end of Dg contains a number of putative SH3, SH2 and WW domain binding sites. The most C-terminal PPXY motif has been established as a binding site for Dystrophin (Dys) WW-domain. However, our previous studies indicate that both Dystroglycan PPXY motives, WWbsI and WWbsII can bind Dystrophin protein in vitro. RESULTS: We now find that both WW binding sites are important for maintaining full Dg function in the establishment of oocyte polarity in Drosophila. If either WW binding site is mutated, the Dg protein can still be active. However, simultaneous mutations in both WW binding sites abolish the Dg activities in both overexpression and loss-of-function oocyte polarity assays in vivo. Additionally, sequence comparisons of WW binding sites in 12 species of Drosophila, as well as in humans, reveal a high level of conservation. This preservation throughout evolution supports the idea that both WW binding sites are functionally required. CONCLUSION: Based on the obtained results we propose that the presence of the two WW binding sites in Dystroglycan secures the essential interaction between Dg and Dys and might further provide additional regulation for the cytoskeletal interactions of this complex.

Hair cells of different shapes and their placement along the frog crista ampullaris.

The list of distinguishing morphological features of hair cells includes: Type I and Type II afferent innervation, and length, shapes and arrangements of stereo- and kinocilia. We now add to this list the shapes of the hair cells themselves and their placement within the mechanosensory organ, in this case the semicircular canal. Although hair cells of the crista ampullaris of the frog are only of Type II they may now be further classified into three sub-groups according to shape: club-, cigar- and pear-shaped. The cigar- and club-shaped hair cells are each about 40% while the pear-shaped cells are about 20% of the total numbers of hair cells in the crista. The differently-shaped hair cells also distribute differently along the crista. The cigar- and club-shaped are more-or-less uniformly distributed with somewhat higher concentrations at the ends of the crista than in the center. The pear-shaped hair cells, on the other hand, are mostly concentrated toward the center of the crista. This distribution of the pear-shaped hair cells, and their shape is reminiscent of the distribution of calyceal endings (Type I hair cell) in the cristae of amniotes [Goldberg et al., Hear. Res. 49, 89-102 (1990) in Chinchilla; Fernandez et al., Soc. Neurosci. Abstr. 17, 312 (1991) in Monkey]. There are some quantitative differences between hair cells of the same shape but from different portions of the crista. For instance, pear-shaped hair cells of the center are generally of greater cross-sectional area than those of the ends.(ABSTRACT TRUNCATED AT 250 WORDS)

["Reverse reperfusion" in myocardial scintigraphy perfusion with technetium-99m isonitrile. Incidence and clinical implications]. / "Reperfusão reversa" na cintigrafia miocárdica de perfusão com tecnécio-99m isonitrila. Incidência e implicações clínicas.

PURPOSE: Evaluation of the incidence and clinical implications of perfusion defects that appear worse in the rest than the stress myocardial perfusion imaging with technetium-99m isonitrile (MIBI), similar to the reverse redistribution described with thallium-201. METHODS: The studies of 730 consecutive patients with known or suspected coronary artery disease who underwent either diagnostic or prognostic (after myocardial infarction) technetium-99mMIBI planar scans were reviewed. Usual planar images were subjective and semi-quantitative analyzed. Patients were divided in two groups according to the indication of the test. The incidence of the reverse reperfusion pattern, the correlative findings with the angiographic coronary anatomy, when available, and its clinical implications were assessed. RESULTS: Three in the 540 (0.55%) patients of the diagnostic group and 6 out of the 190 (3.15%) patients of the myocardial infarction group have shown the "reverse reperfusion" pattern, with an overall incidence of 1.23%. Perfusion defects were anterior in 2 and inferior in 1 patient of the diagnostic group, compared to 4 anterior and 2 inferior within the prognostic population patients. One patient of the diagnostic group and 4 of the prognostic group showed ST-T changes on the exercise ECG. All of them achieved at least 85% of the maximum predicted heart rate during the stress test. The only patient with the "reverse reperfusion" pattern in the diagnostic group had no coronary disease at angiography, while the 6 patients in the post myocardial infarction group have shown either an occluded (2 cases) or recanalized infarct related artery (2 cases) and remote coronary disease (2 cases). Three of them underwent successful coronary angioplasty based on clinical and laboratory evidences of ischemia. CONCLUSION: The "reverse reperfusion" with technetium 99-m MIBI is an uncommon finding and may be associated with jeopardized myocardium after infarction, although its predictive value for recanalized infarct related artery seems to be very low. It seems to provide no added value towards coronary artery disease diagnosis. Additional experience is required in selected subgroups of patients in order to clarify the clinical value of the "reverse reperfusion" pattern with the technetium-99m MIBI.

The correlated blanching of synaptic bodies and reduction in afferent firing rates caused by transmitter-depleting agents in the frog semicircular canal.

Synaptic bodies (SBs) associated with rings of synaptic vesicles and well-defined, pre- and post-synaptic membrane structures are indicators of maturity in most hair cell-afferent nerve junctions. The role of the SBs remains elusive despite several experiments showing that they may be involved in storage of neurotransmitter. Our results demonstrate that SBs of the adult posterior semicircular canal (SCC) cristae hair cells become less electron dense following incubation of the SCC with the transmitter-depleting drug tetrabenazine (TBZ). Objective quantification and comparison of the densities of the SBs in untreated and TBZ-treated frog SCC demonstrated that TBZ significantly decreased the electron density of SBs. This reduction in electron density was accompanied by a reduction in firing rates of afferent fibers innervating the posterior SCC. A second transmitter-depleting drug, guanethidine, previously shown to reduce the electron density of hair cell SBs, also reduced the firing rates of afferent fibers innervating the posterior SCC. In contrast, the electron density of dense granules (DG), similar in size and shape to synaptic bodies (SB) in hair cells, did not change after incubation in TBZ, thus indicating that granules and SBs are not similar in regard to their electron density. The role of SBs in synaptic transmission and the transmitter, if any, stored in the SBs remain unknown. Nonetheless, the association of the lessening of electron density with a reduction in afferent firing rate provides impetus for the further investigation of the SB's role in neurotransmission.

The approach to learning in a traditional medical school.

The differences existing in learning approaches of students belonging to four different classes of a traditional school of medicine in Temuco (Chile) were evaluated. Those students were being exposed to the same curricular experience, but they were in different stages of medical training by this time. At the moment of the study they were at the end of the first, third, fifth and seventh year of medical training. The assessment was done using the Lancaster Inventory of Learning Approach. It was answered by a total of 143 students (100%). The four groups showed very similar scores without significant differences between them. According to the final results the meaning orientation was predominant in all the groups. This orientation corresponded, to the deep approach to learning of Newble & Entwistle (1986). Data were assessed statistically through analysis of variance and Scheffe test for multiple comparison.

[Cineventriculography with radionuclides and intravenous dipyridamole in the prognostic evaluation after acute myocardial infarction]. / Cineventriculografia com radionuclídeos e dipiridamol venoso na avaliação prognóstica após infarto agudo do miocárdio.

PURPOSE: To evaluate safety and usefulness of dipyridamole-radionuclide ventriculography (D-RVG), soon after acute myocardial infarction (MI), in the prediction of future cardiac events. Traditionally performed tests were also compared. PATIENTS AND METHODS: Forty-one patients (4 females) with recent MI underwent rest and dipyridamole (0.58 mg/kg of body weight) radionuclide ventriculography. The criteria for a positive test for ischemia was failure to increase left ventricular ejection fraction in 0.05 from baseline value. All patients had also coronary angiography and 36 patients underwent thallium-201 scintigraphy for comparison. The mean follow-up was 16 +/- 3 months. The following findings were considered future for events: cardiac death, reinfarction, significant angina or heart failure. RESULTS: During the follow-up 18 of the 20 patients who had cardiac events had shown positive dipyridamole-RVG, as opposed to 5 of 21 event-free patients (p less than 0.01). The ventriculographic criteria for a positive test and dipyridamole left ventricular ejection fraction were the strongest predictors of those medical events (p less than 0.01 and p less than 0.001). Among the 36 patients who had thallium-201 imaging, 16 subsequently had cardiac events and the scans were positive in 82% (p less than 0.01). Twelve (29%) patients experienced reactions during dipyridamole infusion although no fatal complications were noted. CONCLUSION: Dipyridamole-RVG is relatively safe and a sensitive predictor of future cardiac events soon after acute MI, although additional experience is required before this new technique should be routinely recommended as an alternative approach.

Traditional medicine of Baja California Sur (Mexico). II.

Continuing our studies of traditional medicine, as used in rural areas of Baja California Sur, now we wish to report on the medicinal uses of 49 more plants. Some of the more complex recipes of these medicinal plants, are discussed in the present paper. The information presented here was collected in the Municipio of Los Cabos and part of the Municipio of La Paz, B.C.S., Mexico.

Comparison of gated cardiac MRI and 2D echocardiography of intracardiac neoplasms.

The gross diagnostic factors of intracardiac tumor in four patients imaged by two-dimensional echocardiography (2D echo) and magnetic resonance imaging (MRI) were compared. Three cases had left and one had a right atrial tumor, all histologically identified as myxoma. Gated cardiac MRI depicted the size, shape, and surface characteristics of the tumors more clearly than 2D echo, because MRI provides better spatial and contrast resolution. Depiction of tumor attachment was poor to good with both techniques. Both techniques were highly accurate in localizing the tumor and displaying whether it was fixed or mobile. The global field of view provided by MRI allows better definition of tumor prolapse, secondary valvular obstruction, and cardiac chamber size. This study shows that despite its early stage of development, gated cardiac MRI provides superior image quality and is complementary to 2D echo for characterization and diagnosis of intracardiac tumor.

Clinical evaluation of 360 degrees and 180 degrees data sampling techniques for transaxial SPECT thallium-201 myocardial perfusion imaging.

The most serious controversy regarding the application of transaxial SPECT technology to 201Tl myocardial perfusion imaging is the choice between 360 degrees compared with 180 degrees data sampling techniques. The present study utilized the original 360 degrees sampled raw data of 25 patients who had both SPECT 201Tl myocardial perfusion imaging and coronary angio/ventriculography for back projection reprocessing to accomplish the 360 degrees/180 degrees comparison. The results show a high incidence, 36% (9/25), of false-positive segmental perfusion abnormality and a high incidence, 24% (6/25), of moderate to severe degree of image distortion with the 180 degrees data sampled reconstructed images. These were not observed in the 360 degrees data sampled reconstructed images. The above findings confirmed our previous preliminary conclusion that even though the 180 degrees data sampling technique has the advantage of providing improved image contrast and reduction in acquisition time it is not a reliable technique and should be abandoned. The 360 degrees data sampling is the technique of choice for transaxial SPECT 201Tl myocardial perfusion imaging.