The second Mexican consensus on hepatocellular carcinoma. Part II: Treatment.

Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented.

The second Mexican consensus on hepatocellular carcinoma. Part I: Epidemiology and diagnosis.

Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this first part of the document, the topics related to epidemiology and diagnosis are presented.

Osteoporosis grave secundaria a enfermedad de Gaucher: reporte de caso / Severe osteoporosis secondary to Gaucher disease: case report

La enfermedad de Gaucher (EG) es un trastorno genético lisosomal autosómico recesivo infrecuente, que conduce a la acumulación de lípidos y disfunción en múltiples órganos. La afectación del esqueleto es uno de los hallazgos más frecuentes de la EG y una de las principales causas de dolor y reducción de calidad de vida. El compromiso esquelético incluye anomalías en el remodelado óseo con pérdida mineral ósea, adelgazamiento cortical, lesiones líticas, fracturas por fragilidad y deformidades articulares. A continuación presentamos el caso de una paciente 61 años con osteoporosis grave secundaria a EG diagnosticada en la vida adulta, con antecedente de dos hermanas con EG. La paciente refería dolores óseos y lumbago crónico desde los 53 años. El 2012 fue evaluada en policlínico de hematología por trombocitopenia y debido a sus antecedentes familiares se le solicitaron exámenes que fueron compatibles con EG. El año 2016 la densitometría ósea (DXA) de columna lumbar y cuello femoral izquierdo, que mostró una osteoporosis. Se inició tratamiento con Alendronato, Calcio y Vitamina D, pero la paciente tuvo escasa adherencia. El 2018 se inició tratamiento de su EG con Taliglucerasa α. Al año siguiente se le realizó nueva DXA que evidenció persistencia de la osteoporosis y por mantención del lumbago se le solicitó una TAC de columna lumbar que mostró fracturas por aplastamiento de cuerpos vertebrales dorsales bajos. Se derivó a endocrinología para manejo de su osteoporosis grave. A su ingreso a endocrinología la paciente persitía con dolor lumbar alto y destacaba una marcada cifosis. Se decidió retomar tratamiento con Alendronato, calcio y vitamina D, además, se le solicitó una nueva evaluación densitométrica junto a una radiografía de columna total y evaluación dental. Durante el seguimiento la paciente mantuvo niveles de vitamina D adecuados con funciones renal, hepática y tiroidea normales.

Gaucher disease (GD) is a rare autosomal recessive lysosomal genetic disorder, leading to the accumulation and dysfunction of lipids in multiple organs. Skeletal involvement is one of the most prevalent aspects of GD and one of the main causes of pain and reduced quality of life. Abnormalities of bones, which cause changes in the development and loss of bone mineral, cortical thinning, lytic lesions,fragility fractures and deformities. We present a case of a patient diagnosed with severe osteoporosis, secondary to GD diagnosed in adult life. The patient presents a disease pattern composed of bone pain and chronic low back pain since the age of 53. In 2012, she was evaluated at the hematology for thrombocytopenia and due to her family history, tests were performed to diagnose GD, which were compatible with it. In 2016 Bone Densitometry (DXA) of the lumbar spine and left femoral neck was requested, being consistent with osteoporosis. Treatment with Alendronate, Calcium and Vitamin D was started, however, there is little adherence. In 2018, treatment for Gaucher's disease was started with Taliglucerase α. The following year, DXA was performed with few changes and a CT scan of the lumbar spine was performed diagnosing crush fractures of the low dorsal vertebral bodies. She was referred to endocrinology. Upon admission to Endocrinology, it was decided to resume initial osteoporosis treatment and to perform skeletal evaluation with DXA of the lumbar spine and hips, total spine X-ray and dental evaluation. During follow-up, it maintains vitamin D at adequate levels and normal kidney, liver and thyroid functions.

Helicobacter pylori eradication in Mexico with a levofloxacin-based scheme versus standard triple therapy: Results from an open-label, randomized, noninferiority phase iiib trial. / Erradicación de Helicobacter pylori en México con un esquema basado en levofloxacina versus la triple terapia estándar: resultados de un estudio clínico de fase iiib, abierto, aleatorizado, de no inferioridad.

INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 210-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500mg, lansoprazole 30mg, and amoxicillin 1g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80mg, levofloxacin 500mg and azithromycin 500mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. MATERIALS AND METHODS: An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. RESULTS: From the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p=0.001). CONCLUSIONS: First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments. ClinicalTrials.gov identifier NCT02726269.

Transition to parenthood and mental health at 30 years: a prospective comparison of mothers and fathers in a large Brazilian birth cohort.

Parenthood represents a major biological, social and environmental life change. Mental health disorders are common in parents and impact both the parent and their offspring. However, the relationship between parenthood and mental health and the direction of these effects are poorly understood. Longitudinal data from the Pelotas 1982 birth cohort, Southern Brazil, on 3701 individuals was used to investigate the association between number of children by age 30 years and mental health disorders using DSM-IV diagnoses at age 30 years, suicidal risk and the change in symptoms using repeated measures (using the SRQ-20) from age 19 to 30 years. Mothers, but not fathers, with higher number of children by age 30 years, were at a substantially increased risk of a wide range of mental health disorders compared to women with no children. There was evidence that motherhood was associated with an increase in symptoms over time rather than higher symptoms at baseline. Younger age at first child was also a risk factor for mental health disorders. Mothers, particularly those with multiple children, are at risk of a wide range of mental health disorders. The mechanisms to explain these risks are yet to be elucidated; however, the risk of mental health disorders was not replicated in fathers, which would be expected if residual confounding explained observed associations. Thus, multiparous mothers represent a high-risk group and should be prioritised for supportive interventions.

Telemedicina como herramienta de enseñanza de la endocrinología en estudiantes de medicina / Telemedicine as a teaching tool for endocrinology in medical students

INTRODUCCIÓN: El estudiante de medicina actualmente está inmerso en una sociedad altamente tecnologizada, dónde la telemedicina podría ser utilizada como un instrumento hacia un mayor aprendizaje. OBJETIVO: El objetivo del estudio es analizar el logro de competencias y el grado de satisfacción de los estudiantes medicina con la utilización de la telemedicina como estrategia didáctica en la enseñanza de la endocrinología. MATERIAL Y MÉTODO: Estudio preexperimental, correlacional, transversal y con medición posterior a la intervención. La muestra estuvo constituida por los 40 estudiantes de tercer año de medicina (24 hombres y 16 mujeres) que realizaron su práctica de endocrinología durante el segundo semestre del 2017. Se les evaluó los logros alcanzados en las competencias a través de una escala de apreciación y se midió el grado de satisfacción con la actividad docente a través de un cuestionario validado (α de Cronbach de 0,9565). RESULTADOS: El rendimiento de los estudiantes en el módulo de teleendocrinología al evaluar las competencias de analizar, sintetizar y presentar un caso clínico teleconsultado fue de 6,1 en una escala de 1 a 7, y no se encontraron diferencias según sexo. El 90% de los estudiantes consideró muy motivadora la metodología de enseñanza basada en la telemedicina y el 82,5% consideró que esta metodología favorece la integración de los contenidos. CONCLUSIONES: La telemedicina puede ser utilizada como una herramienta para evaluar competencias académicas de endocrinología en los estudiantes de pregrado de medicina, y que estos muestran un alto grado de satisfacción con este tipo de actividad docente.

INTRODUCTION: The medical student is currently immersed in a highly technological society, where telemedicine could be used as an instrument towards greater learning. OBJECTIVE: The objective of the study is to analyze the achievement of competences and the degree of satisfaction of medical students with the use of telemedicine as a didactic strategy in the teaching of endocrinology. MATERIAL AND METHOD: Pre-experimental, correlational, cross-sectional study and measurement after the intervention. The sample consisted of 40 third-year medical students (24 men and 16 women) who performed their endocrinology practice during the second semester of 2017. They were evaluated the achievements in the competences through a scale of appreciation and The degree of satisfaction with the teaching activity was measured through a validated questionnaire (Cronbach's de 0.9565). RESULTS: The performance of the students in the teleendocrinology module when evaluating the competences of analyzing, synthesizing and presenting a teleconsultated clinical case was 6.1 on a scale of 1 to 7, and no differences were found according to sex. 90% of the students considered the teaching methodology based on telemedicine very motivating and 82.5% considered that this methodology favors the integration of the contents. CONCLUSIONS: Telemedicine can be used as a tool to evaluate endocrinology academic competences in undergraduate medical students, and that they show a high degree of satisfaction with this type of teaching activity.

Consequences of quality of reduction on osteosynthesis complications and quality of life in elderly patients with subtrochanteric fracture. / Consecuencias de la calidad de reducción sobre complicaciones en la osteosíntesis y calidad de vida en pacientes adultos de edad avanzada con fractura subtrocantérea.

OBJECTIVE: To compare results in terms of orthopaedic complications and quality of life in elderly patients with subtrochanteric fracture treated with intramedullary nailing according to fracture reduction status. PATIENTS AND METHODS: A prospective cohort study including 90 elderly patients with subtrochanteric fractures of the femur treated with a cephalomedullary nail, with a minimum 1-year follow up. The inclusion criteria were: aged 60 years or older, without severe cognitive dysfunction and independent ambulatory capability before the fracture. We defined 3different groups in relation to fracture reduction status: good, acceptable and poor, according to modified criteria from Baumgartner et al. We compared clinical and surgical characteristics and healthy quality of life, social function and mobility according to the EQ-5D, Jensen Index and Mobility Score of Parker and Palmer questionnaires. RESULTS: We found differences in time to union, better in the good reduction group (P=.002); need for open reduction, more frequent in the good reduction group (P<.001), and in postoperative complications, more frequent in the poor reduction group (P=.001). We found no significant differences between the 3groups regarding scores in quality of life, social function and mobility. CONCLUSIONS: Reduction in subtrochanteric fractures in older people is key to obtaining better clinic and surgical results, improving time to union and decreasing surgical complications. Exposure of the focus fracture seems to be a safe manoeuvre. Quality of life had substantially deteriorated n these patients, but a there was a tendency, although not statistically significant, for it to improve in patients after good surgical reduction.

Masa pancreática: una presentación inhabitual de nesidioblastosis en el adulto / Pancreatic mass: an unusual presentation of nesidioblastosis in adults

A 41-year-old woman, multiparous of 4, with personal or familiar history of diabetes, with a history of Nissen fundoplication due to pathological gastro-oesophageal reflux, is refer to an endocrinologjst during her post-operatiye follow up, 4 months after her surgery for a 14 kg weight loss in 10 months and symtomatic hypoglycemia to repetition. A positive prolonged fasting test for hypoglycemia was performed. In addition, abdominal computed axial tomography was performed, which resulted normal and endosonography, showing a lesion on the head of the pancreas. Octreoscan positive for pancreatic head focal lesion with positive somatostatin receptors compatible with insulinoma. Whipple surgery was performed where surgeon palpated pancreatic tumor, biopsy showed tissue compatible with diffuse nesidioblastosis. In the postoperative period, the patient decreased frequency and intensity of hypoglycemic episodes compared to their previous stage. Control prolonged fasting test and Octreoscan were within normal ranges. However, 4 months after surgery, the patient presented hypoglycemia of lower intensity and frequency than before surgery. Currently he remains in control with nutritionist and endocrinologist, mainly adjusting diet and with good control glycemias.

Influencia de la polución ambiental en la incidencia de fractura de cuello femoral / Influence of enviromental pollution on the femoral neck fracture incidence

It has been shown that there is an association between air pollution and cardiovascular mortality. In bone pathology, studies show that air pollution is associated with a risk of developing osteoporosis and osteoporotic fracture associated with MP2.5 and nitrogen dioxide (NO2 ). The aim of our study was to determine whether or not there is an association between air pollution and osteoporotic disease, associating the incidence of femoral neck fracture in individuals aged 50 years or more and the contamination present in the several cities. Our results showed no statistically significant association between air pollution, evaluated using PM10 and PM2.5 as indicators, and the average annual incidence of osteoporotic hip fracture, comparing the most polluted cities and the less polluted cities of Chile

Exploring DSM-5 ADHD criteria beyond young adulthood: phenomenology, psychometric properties and prevalence in a large three-decade birth cohort.

BACKGROUND: There are still uncertainties on the psychometric validity of the DSM-5 attention deficit hyperactivity disorder (ADHD) criteria for its use in the adult population. We aim to describe the adult ADHD phenotype, to test the psychometric properties of the DSM-5 ADHD criteria, and to calculate the resulting prevalence in a population-based sample in their thirties. METHOD: A cross-sectional evaluation using the DSM-5 ADHD criteria was carried out in 3574 individuals from the 1982 Pelotas Birth Cohort. Through receiver operator curve, latent and regression analyses, we obtained parameters on construct and discriminant validity. Still, prevalence rates were calculated for different sets of criteria. RESULTS: The latent analysis suggested that the adult ADHD phenotype is constituted mainly by inattentive symptoms. Also, inattention symptoms were the symptoms most associated with impairment. The best cut-off for diagnosis was four symptoms, but sensitivity and specificity for this cut-off was low. ADHD prevalence rates were 2.1% for DSM-5 ADHD criteria and 5.8% for ADHD disregarding age-of-onset criterion. CONCLUSIONS: The bi-dimensional ADHD structure proposed by the DSM demonstrated both construct and discriminant validity problems when used in the adult population, since inattention is a much more relevant feature in the adult phenotype. The use of the DSM-5 criteria results in a higher prevalence of ADHD when compared to those obtained by DSM-IV, and prevalence would increase almost threefold when considering current ADHD syndrome. These findings suggest a need for further refinement of the criteria for its use in the adult population.

Efecto del tratamiento prolongado con metformina sobre la densidad mineral ósea en las mujeres postmenopáusicas con diabetes tipo 2 / Effect of long term metformin treatment on bone mineral density in postmenopausal women with type 2 diabetes

The aim of this study was to determine whether there is a relationship between prolonged use of metformine on bone mineral density, comparing a group of patients receiving prolonged treatment with metformine and a control group with similar characteristics biodemographic. Material and Methods: A case-control study was conducted in a population of 225 postmenopausal women between 51 and 62 years of age, were divided into 2 groups, one of type 2 diabetic patients treated with 1,000-2,000 mg. of metformine for at least 5 years (n = 75) and they had an acceptable metabolic control (HbA1c < 7.5 percent), and a control group of non diabetic women (n = 150). BMD at the lumbar spine (L1-L4) and both hips were measured with DEXA. Results: The group of type 2 diabetes treated with metfornine was associated with a significantly increased bone mineral density at the lumbar spine compared with the control group (L1-L4 g/cm2 1.07 +/- 0.15 vs 0.16 +/- 0.975) (L1-L4 T score-0.68 +/- 1.06 vs -1.73 +/- 1,07) (p = 0.05).Conclusion: Prolonged therapy metformine could have an effect on the preservation of bone mineral density at the lumbar spine in women with diabetes type 2, suggesting an effect of metfornine osteoprotective in trabecular bone.

Peripheral myopization and visual performance with experimental rigid gas permeable and soft contact lens design.

PURPOSE: To evaluate the performance of two experimental contact lenses (CL) designed to induce relative peripheral myopic defocus in myopic eyes. METHODS: Ten right eyes of 10 subjects were fitted with three different CL: a soft experimental lens (ExpSCL), a rigid gas permeable experimental lens (ExpRGP) and a standard RGP lens made of the same material (StdRGP). Central and peripheral refraction was measured using a Grand Seiko open-field autorefractometer across the central 60° of the horizontal visual field. Ocular aberrations were measured with a Hartman-Shack aberrometer, and monocular contrast sensitivity function (CSF) was measured with a VCTS6500 without and with the three contact lenses. RESULTS: Both experimental lenses were able to increase significantly the relative peripheral myopic defocus up to -0.50 D in the nasal field and -1.00 D in the temporal field (p<0.05). The ExpRGP induced a significantly higher myopic defocus in the temporal field compared to the ExpSCL. ExpSCL induced significantly lower levels of Spherical-like HOA than ExpRGP for the 5mm pupil size (p<0.05). Both experimental lenses kept CSF within normal limits without any statistically significant change from baseline (p>0.05). CONCLUSIONS: RGP lens design seems to be more effective to induce a significant myopic change in the relative peripheral refractive error. Both lenses preserve a good visual performance. The worsened optical quality observed in ExpRGP was due to an increased coma-like and spherical-like HOA. However, no impact on the visual quality as measured by CSF was observed.

Apoptosis mediated by phosphatidylserine externalization in the elimination of aneuploid germ cells during human spermatogenesis.

It has been described that aneuploidies trigger cell cycle checkpoints leading to apoptosis. The aim of this study was to assess the relationship between the presence of chromosomal abnormalities and apoptosis in germ cells and in Sertoli cells. Fourteen diagnostic testicular biopsies from infertile patients were processed following a sequential methodology, which included enzymatic disaggregation, apoptotic staining, cell sorting, cell fixation, and fluorescent in situ hybridization analysis. The chromosome constitution of germ cells (interphase pre-meiotic germ cells, meiotic figures, post-reductional germ cells, and spermatozoa) and Sertoli cells was evaluated in non-sorted and flow-sorted cell populations (apoptotic and viable). The mean percentage of aneuploidy was compared between the three fractions in each cell type using a Kruskal-Wallis test. If significant results were obtained, a two-by-two Chi-squared test was performed. There were significant differences between the apoptotic fraction and the viable and non-sorted fractions in the pre-meiotic germ cells (p < 0.01). In the remaining cell types, no association between the presence of aneuploidy and apoptotic processes was observed, even in the case of post-reductional germ cells in which we detected the highest rates of aneuploidy regardless of the fraction analyzed. From our data, it can be inferred that most of the aneuploid post-reductional germ cells are efficiently removed from the testicular epithelium without differentiating into spermatozoa. Our results suggest that the elimination of aneuploid testicular epithelial cells is triggered by different mechanisms. Accordingly, the cellular elimination of aneuploid germ cells beyond the blood-testis barrier does not involve phosphatidylserine externalization.

Correlación entre las buenas prácticas de manufactura y el cumplimiento de los criterios microbiológicos en la fabricación de helados en Chile / Correlation between the good manufacturing practices and compliance with microbiological criteria in the manufacture of ice cream in Chile

The Good Manufacturing Practices (GMP) is a basic tool to obtain safe foodstuffs for human consumption. The main goal of this research was to determine the percentage of compliance with GMP in ice cream factories and its correlation with the acceptance of microbiological criteria in samples of ice cream, according to the Sanitary Chilean Food Regulation. Inspectors from the Ministerial Regional Secretariat (SEREMI) of Health Ñuble audited GMP in 40 ice cream factories and 435 microbial analyses from ice cream samples taken between the years 2005 and 2010 were analyzed. Results showed that 55.2% of samples failed in RAM (105 UFC/g) and coliform (102 UFC/g) and 4.6% for Staphylococcus aureus (102 UFC/g) and 100% for Salmonella spp. The biggest RAM was during summer with 60% rejection. Sixty seven% of inspections of GMP reached values above the minimum (70% compliance). Facilities were the best item assessed (88.4%), and training was the worst (20.3%). The correlation between the results of audits of GMP and microbiological criteria allowed proving that with a percentage equal to or greater than 80% compliance with GMP would ensure the microbiological quality of ice cream, thereby decreasing the risk for consumer health.

Las Buenas Prácticas de Manufacturas (BPM) son una herramienta básica para obtener un producto alimenticio seguro para consumo humano. El objetivo de este estudio fue determinar el porcentaje de cumplimiento de BPM y su correlación con la aceptación de criterios microbiológicos en fábricas y muestras de helados de Ñuble, Chile, de acuerdo al Reglamento Sanitario de Alimentos chilenos. Se analizaron auditorías de BPM aplicadas por fiscalizadores de Secretaría Regional Ministerial (SEREMI) de Salud Ñuble, a 40 fábricas de helados y los resultados microbiológicos de 435 muestras de helados entre los años 2005 y 2010. Se determinó que el 55,2% de las muestras no cumplieron para RAM (105 UFC/g) y coliformes (102 UFC/g) y 4,6% para Staphylococcus aureus (102 UFC/g), en cambio el 100% cumplieron para Salmonella spp. Los mayores RAM fueron en verano con 60% de rechazo. El 67% de auditorías de BPM alcanzaron valores superiores al mínimo (70% de cumplimiento), las instalaciones fue el ítem mejor evaluado (88,4%), y capacitación del personal el peor (20,3 %). La correlación entre los resultados de auditorías de BPM y criterios microbiológicos permitió comprobar que con un porcentaje igual o superior al 80% de cumplimiento de BPM se aseguraría la calidad microbiológica de helados, disminuyendo con ello el riesgo en la salud del consumidor.

Utilidad de cortes seriados en biopsias prostáticas / Utility of Seriated Sections in Prostate Biopsies

Introducción: Con el empleo rutinario del antígeno prostático específico se detectan con mayor frecuencia carcinomas focales y proliferaciones atípicas de acinos pequeños (ASAP, atypical small acinar proliferation [sigla en inglés]). El número de cortes por cilindro que debe practicarse para detectar la mayoría de ellos se desconoce. Métodos: Revisamos 250 biopsias prostáticas por sextantes en el periodo 2008-2011. El promedio de cilindros por biopsia fue de 14. En cada caso se practicaron además del corte original, con 3 niveles histológicos, otros 3 cortes con 3 niveles (total: 12 niveles). En las biopsias con lesiones focales se practicó estudio inmunohistoquímico. La frecuencia de lesiones focales se comparó con un estudio previo de 1.000 biopsias donde se realizó un solo corte con tres niveles histológicos. Se anotaron los datos clínicos y de laboratorio. Resultados: Hubo 16 lesiones focales (6,4%); 7 (2,8%) correspondieron a carcinomas focales y 9 (3,6%) a proliferaciones atípicas. En el estudio previo se encontraron 13 (1,3%) carcinomas focales y 29 (2,9%) casos con proliferaciones atípicas. Conclusiones: Hubo un aumento del 4,2 al 6,4% de lesiones focales y un incremento de carcinomas del 1,3 al 2,8%. Aunque realizar cortes adicionales rutinariamente tiene inconvenientes prácticos, podría realizarse en pacientes con alta sospecha clínica de carcinoma (en particular jóvenes) o en los que existan antecedentes de proliferaciones glandulares atípicas compatibles con carcinoma (AU)

Introduction: With the routine use of prostate specific antigen, focal carcinomas and atypical small acini proliferation (ASAP) are currently detected more frequently. The number of sections per cylinder needed to detect most of them is still unknown. Methods: We reviewed 250 sextant prostate biopsies in the 2008-2011 period. The average number of cylinders per biopsy was 14. In each case, in addition to the original sections with three histological levels, three more sections were performed with three levels (total: 12 levels). Biopsies with focal lesion were analyzed immunohistochemically. The frequency of focal lesions was compared to a previous study of 1000 biopsies in which a single section was made with three histological levels. The main clinical and laboratory data were recorded. Results: There were 16 focal lesions (6.4%). Seven (2.8%) corresponded to focal carcinomas and nine (3.6%) to atypical proliferation. In the previous study, thirteen (1.3%) focal carcinomas and 29 (2.9%) cases with atypical proliferation were found. Conclusions: There was an increase of 4.2% to 6.4% of focal lesions carcinomas increased from 1.3% to 2.8%. Making additional sections in all biopsies may have practical drawbacks. However, they could be performed in patients with high clinical suspicion of carcinoma (especially in young patients), or when there is a history of atypical glandular proliferations consistent with carcinoma in previous biopsies (AU)

La prevención de la enfermedad renal, un nuevo reto para la enfermera / Kidney disease prevention, a new challenge for nurses

En Colombia y en el mundo la transición demográfica ha traído cambios en el estado de salud. Es así como la enfermedad renal se ha ido incrementando debido al aumento de edad en la población, y a la presencia de hipertensión arterial y diabetes mellitus como enfermedades precursoras; en estas dos enfermedades la falta de detección temprana y de un tratamiento adecuado y oportuno conllevan a la aparición de la enfermedad renal, que sin un control adecuado, progresa llevando al usuario a terapias de soporte renal y su consecuente efecto negativo en la calidad de vida del usuario y su familia. Por lo anterior, las enfermeras tienen un gran reto desde la atención primaria en salud, reforzando el cuidado de enfermeria desde el empoderamiento de la salud, pasando por la promoción de la salud, la prevención de la enfermedad y la prevención de las complicaciones, y en unión con el equipo de salud, trabajar conjuntamente con el usuario y su familia, ya que de lo contrario, el cuidado de la salud será en vano.

In Colombia and the rest of the world demographic transitions have caused changes to the health of the population. Among these changes is an increase in kidney disease due to increased life expectancy; hypertension and diabetes are precursors of the disease and late or inadequate treatment of this conditions leads to kidney disease, which without proper control creates the need for renal support therapy that has a negative effect on patients and their families lifestyles.\r\nFor this reason, nurses have a great challenge in primary health care, reinforcing care with health empowerment, health promotion, disease prevention and prevention of complications. Nurses need to work together with the health care provider and the patient and family, otherwise health care services will be in vain.

[Utility of seriated sections in prostate biopsies]. / Utilidad de cortes seriados en biopsias prostáticas.

INTRODUCTION: With the routine use of prostate specific antigen, focal carcinomas and atypical small acini proliferation (ASAP) are currently detected more frequently. The number of sections per cylinder needed to detect most of them is still unknown. METHODS: We reviewed 250 sextant prostate biopsies in the 2008-2011 period. The average number of cylinders per biopsy was 14. In each case, in addition to the original sections with three histological levels, three more sections were performed with three levels (total: 12 levels). Biopsies with focal lesion were analyzed immunohistochemically. The frequency of focal lesions was compared to a previous study of 1000 biopsies in which a single section was made with three histological levels. The main clinical and laboratory data were recorded. RESULTS: There were 16 focal lesions (6.4%). Seven (2.8%) corresponded to focal carcinomas and nine (3.6%) to atypical proliferation. In the previous study, thirteen (1.3%) focal carcinomas and 29 (2.9%) cases with atypical proliferation were found. CONCLUSIONS: There was an increase of 4.2% to 6.4% of focal lesions carcinomas increased from 1.3% to 2.8%. Making additional sections in all biopsies may have practical drawbacks. However, they could be performed in patients with high clinical suspicion of carcinoma (especially in young patients), or when there is a history of atypical glandular proliferations consistent with carcinoma in previous biopsies.

The impact of maternal post-partum depression on the language development of children at 12 months.

BACKGROUND: Language is one of the most important acquisitions made during childhood. Before verbal language, a child develops a range of skills and behaviours that allow the child to acquire all communication skills. Factors such as environmental factors, socio-economic status and interaction with parents can affect the acquisition of vocabulary in children. Post-partum depression can negatively affect the first interactions with the child and, consequently, the emotional, social and cognitive development of the child. OBJECTIVE: To analyse the effect of the duration of the mother's depression on the language development of children at 12 months old. METHODS: This was a longitudinal study. The participants of this study were mothers who had received prenatal care from the Brazilian National System of Public Health in Pelotas city, State of Rio Grande do Sul, Brazil. The mothers were interviewed at two different time points: from 30 to 90 days after delivery and at 12 months after delivery; the children were also evaluated at this later time point. To diagnose maternal depression, we used the Mini International Neuropsychiatric Interview, and to assess child development, we used the language scale of the Bayley Scales of Infant Development III. RESULTS: We followed 296 dyads. Maternal depression at both time points (post partum and at 12 months) was significantly associated with the language development of infants at 12 months of age. This impact was accentuated when related to the duration of the disorder. Older women and women with more than two children were more likely to have children with poorer language development, while women who were the primary caregiver had children with higher scores on the language test. CONCLUSION: The findings indicate that maternal age, parity, primary caregiver status and duration of post-partum depression are associated with the language development of the child.

Vivencias ante la muerte e interpretaciones en torno a la utilidad del cadáver del Potencial Donante de Órganos entre Médicos Intensivistas de un Hospital de la Ciudad de Buenos Aires / Life experiences and interpretations around to the utility of the corpse of Potential Organ Donor between Intensivist Doctors of a City Hospital from Buenos Aires

Introducción: Los sentimientos mezclados impiden al médico identificar al potencial donante de órganos, de ahí que adquieren importancia las vivencias negativas ante la muerte y la noción de "no cosificación" del cuerpo. Objetivos: a) Explorar vivencias de médicos intensivistas frente a la muerte y ante el diagnóstico de muerte encefálica y b) recopilar sus opiniones en torno a la utilización del cadáver. Diseño, ámbito y participantes: Investigación cualitativa, prospectiva, descriptiva; con muestra intencional y saturada. Información recolectada mediante entrevistas en profundidad. Participaron médicos de áreas críticas de un hospital de la Cuidad Autónoma de Buenos Aires. Resultados: La muerte significó: algo ajeno al médico, de percepción clínica, el cese de funciones cerebrales, de definición legal o práctica. La muerte encefálica representó un momento de la muerte, de diagnóstico impreciso, determinado por métodos clínicos e instrumentales. Retirar el respirador mecánico bajo muerte encefálica requiere el acuerdo familiar. El cadáver se dispone según la voluntad del fallecido, de la familia y del médico; puede usarse con respeto como material biológico. El cadáver debe donarse, porque no es mercancía, aunque podría ser vendido por fines nobles; tiene valor per se, para la familia y para el sistema de salud. Verlo como bien útil no reportaría beneficios. Su manipulación no se vio como ensañamiento, y sí como ayuda para la familia. Conclusión: La muerte, aunque percibida antes de su diagnóstico, fue difícil de explicar y fue negada entre los participantes. El diagnóstico de muerte encefálica no fue unánimemente considerado certero. La disposición del cadáver podría incluir su comercio. (AU)

Background: Identification of potential organ donor is blocked by mixed feelings of physicians, thus, negative experiences with death and the idea of "no objectification" of the human body become important. Objectives: a) to explore life experiences of ICU physicians about death and diagnosis of brain death; and b) to collect their opinions about the uses of the cadaver. Design, place and participants: Qualitative, prospective and descriptive research with intentional-saturated sampling. Data collection was based on in-depth interviews. ICU physicians from a Buenos Aires City Hospital were included. Results: Death meant something stranger to physicians; it was represented as: clinical perception, cessation of brain functions, legally or practically defined. Brain death was an uncertain diagnosis conceived as a death's moment, detected by clinical and ancillary methods. Under brain death, withdrawing of mechanical ventilator requires family agreement. Disposition of the corpse depends on the will of deceased, the family or doctors; if it is respected, it can be used as biological material. The cadaver should be donated because it is not a commodity; however, others think it could be sold for noble goals. Corpse has value per se, for the family and for the health system; there would not be benefits when it is viewed as a useful good. Procedures on a cadaver were seen as family's aid and not as cruelty. Conclusion: Death, although perceived previously to be diagnosed, was difficult to explain and it was denied among the physicians. Brain death was not unanimously considered an accurate diagnosis. The disposition of cadavers could involve their trade (AU)

Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral / Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4 percent inpatients, 2.2 percent outpatients). Campylobacter prevalence in poultry was 34 percent. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3 percent of human samples and 11.8 percent of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Las aves de consumo constituyen uno de los principales reservorios y fuente de infección humana de la campilo-bacteriosis. Se analizaron 341 muestras de deposiciones, 291 humanas y 50 aviares. De las muestras, 220 de niños con síndrome diarreico agudo-SDA (183 hospitalizados y 37 consultantes ambulatorios) y 71 niños sanos. A las 23 cepas obtenidas se les realizó CIM por dilución en agar a eritromicina y ciprofloxacina, serotipificación de Penner y genotipiicación por RAPD-PCR. Se encontró Campylobacterjejuni sólo en pacientes con SDA, de ellos 5,4 por ciento ambulatorios y 2,2 por ciento hospitalizados. En aves, la prevalencia de Campylobacter spp., fue de 34 por ciento. Hubo resistencia cruzada a ácido nalidixico y ciprofloxacina en 33,3 por ciento cepas de origen humano y 11,8 por ciento animal. Las cepas humanas fueron no tipiicables por el método de Penner. Predominó entre las aves el serotipo F. Se obtuvo un total de 14 genotipos (4/5 humanos y 10/15 aviares). En conclusión, la especie predominante en aves de corral y en humanos fue C. jejuni, existiendo una alta prevalencia de cepas de origen humano y aviar resistentes a quinolonas. Los genotipos y serotipos aviares no fueron encontrados en cepas de origen humano, lo que indica que podría existir otra fuente de infección, por lo que se requiere estudiar otros reservorios.