Unraveling the gut microbiota of Mexican pinnipeds: the dominance of life histories over phylogeny.

Studying how phylogeny influences the composition and functions of microbiotas within animal hosts is essential for gaining insights into the connection between genetics, ecology, and health in the animal kingdom. However, due to limited comprehensive studies, this influence remains unclear for many wild mammals, including Mexican pinnipeds. We employed 16S rRNA gene deep-sequencing to investigate the impact of phylogeny on the gut microbiota of four pinniped species inhabiting Mexican shores: the Pacific harbor seal (Phoca vitulina richardii), the northern elephant seal (Mirounga angustirostris), the California sea lion (Zalophus californianus), and the Guadalupe fur seal (Arctocephalus philippii townsendi). Our results indicated that factors such as diets and shared life histories exerted more influence on microbiota composition than phylogeny alone. Notably, otariid species sharing similar life histories displayed greater microbiota similarity than phocids, which have distinct life histories and fewer microbiota similarities. Furthermore, harbor seals have more microbial similarities with the two otariid species than with elephant seals. Of particular concern, we observed a higher abundance of potentially pathogenic bacteria (e.g., Photobacterium damselae and Clostridium perfringens) in harbor seals and Guadalupe fur seals compared to other pinnipeds. This finding could pose health threats to these species and nearby human populations.IMPORTANCEPinnipeds in Mexico host microbial communities that remain understudied. While several factors can influence microbiota composition, the role of phylogenetic relationships among these pinnipeds remains unclear due to limited knowledge of the microbiota in certain species. This study aimed to fill this gap by characterizing the composition and function of the gut microbiota in the four pinniped species that occur in Mexico. Our analysis reveals that shared diets and life histories contribute to similarities in the composition of gut microbial communities. This study also highlights the potential differences in the metabolic capabilities and adaptations within the gut microbiota of pinnipeds. Understanding how phylogeny impacts microbial communities enhances our insights into the evolutionary dynamics of marine mammals.

Metabarcoding Used for the First Time to Identify Prey of Wild Totoaba macdonaldi.

Totoaba macdonaldi is an endangered endemic fish of the Gulf of California. Overexploitation resulted in the Mexican government banning the fishing of this species in 1975, and it being listed as endangered. However, the species is still subject to illegal fishing. Despite its conservation status, little is known about totoaba biology. The present study aimed to implement, for the first time, a metabarcoding protocol to describe the totoaba diet. Four wild totoaba individuals, seized by Mexican law enforcement agents, were dissected, and their stomach contents were collected. Three representative amplicon libraries were generated for cephalopods, chordates, and eukaryotes. After sequencing, 18 different taxa were identified, of which 11 species were recognized as prey. The totoaba were found to have consumed Pacific anchovy (Cetengraulis mysticetus), flathead grey mullet (Mugil cephalus), bigeye croaker (Micropogonias megalops), northern anchovy (Engraulis mordax), ocean whitefish (Caulolatilus princeps), milkfish (Chanos chanos), and Pacific sardine (Sardinops sagax). Members of the Euphausiidae family (krill) were also identified. This study identified up to four times more species in much fewer samples than previous studies based on morphological recognition, thus confirming metabarcoding as an effective method for studying the feeding habits of this species and one providing the tools required for further analysis of the totoaba diet.

Effect of microencapsulated inoculum of Pichia kudriavzevii on the fermentation and sensory quality of cacao CCN51 genotype.

BACKGROUND: Microencapsulated yeasts are a novel alternative as a delivery matrix for microbiological starters. This technology aims to protect the active compounds from adverse environmental conditions and prolong their useful life and could also improve the conditions of the starters for cocoa fermentation. The present study established the effective dose to apply the microencapsulated yeast Pichia kudriavzevii as a microbiological starter of fermentation and biotechnological strategy for promoting the biochemical dynamics and sensory expression of the cocoa variety CCN-51. For this, 0.5%, 1%, 2%, and 3% of microencapsulated P. kudriavzevii yeast insolated from the artisanal fermentation process of cocoa was added to the cocoa mass to be fermented and studied on a laboratory scale. RESULTS: The partial least squares regression of fermentation was related in four quartiles, comprising the hedonic judgments of the sensory evaluation with the biochemical traits of the cocoa liquor, finding a high correlation between the physicochemical variables total phenols, percentage of insufficiently fermented grains, and percentage of total acidity, with a level of bitterness and defects found in liquors with the addition of 0.5% of microencapsulated starter. The treatments with the addition of 2% and 3% of the inoculum showed a high correlation between the variables pH, total anthocyanins, cocoa, fruity and floral aromas, sweet taste, and general aroma perception. CONCLUSION: The higher presence of volatile compounds such as 2,3-butanediol associated with cocoa aroma and 1-phenyl-2-ethanol and acetophenone associated with aromatic descriptors of fruity and floral series allowed establishment in 2% of microencapsulated P. kudriavzevii yeast, comprising the effective dose for promoting the biochemical dynamics of laboratory-scale fermentation and the development of cocoa, as well as the fruity and floral aromas of cocoa CCN-51 liquor. The microencapsulation is suitable for cocoa starters. © 2023 Society of Chemical Industry.

Prevalencia y tratamiento del asma en adultos: análisis descriptivo de la encuesta nacional de salud de Chile 2016-2017 / Prevalence and treatment of asthma in adults: descriptive analysis of the Chilean National Health Survey 2016-2017

Objetivo: Describir la prevalencia de diagnóstico autorreportado de asma, comorbilidades, patrones de tratamiento y calidad de vida (CdV) autopercibida en la población chilena, utilizando datos de la Encuesta Nacional de Salud (ENS) de 2016-2017. Métodos: Se analizó la población de la ENS 2016-2017 con ≥ 15 años. Los individuos con asma fueron identificados por autorreporte. Se evaluaron variables sociodemográficas, CdV y salud (autopercepción y/o EQ-5D-3L), estado nutricional, comorbilidades y patrón de tratamiento. Resultados: La prevalencia de asma fue de 5,4% (IC 95%: 4,5-6,5). Se reportó una frecuencia casi 2 veces mayor de CdV autopercibida (6,3% [IC 95%: 3,4-11,3] frente a 3,6% [IC 95%: 2,8-4,5]) y de salud (16,4% [IC 95%: 11,4-23,1] frente a 7,7% [IC 95%: 6,6-8,9]) muy mala/mala/menos que regular en el grupo con asma en comparación con el total de individuos de la ENS. El grupo de asma tuvo mayor frecuencia de al menos algunos problemas en todos los dominios EQ-5D-3L. La comorbilidad más frecuente fue la sintomatología depresiva. El 63% de los encuestados que reconocían tener asma no recibían ningún tratamiento en el momento de la encuesta. Con mayor frecuencia el tratamiento para el asma fue prescrito por un médico general (62,4%/55,4%, medicación de rescate/controlador) y el acceso fue a través del sistema público (65,9%/82,5%, medicación de rescate/controlador). Alrededor de un tercio de la población utilizaba monoterapia con SABA (32,8%). Conclusión: La prevalencia de asma fue del 5,4% y los asmáticos relataron peor CdV y salud. Se observó una baja tasa de tratamiento y de los tratados la mayoría usaba solo medicación de rescate.

Objective: To describe diagnosed asthma prevalence, self-reported comorbidities, treatment patterns and self-perceived quality of life (QoL) in Chilean population, using National Health Survey (NHS) data from 2016-2017. Methods: 2016-2017 NHS population aged ≥ 15 years was analyzed. Asthma individuals were identified by self-report. Sociodemographic variables, QoL and health (self-perception and/or EQ-5D-3L), nutritional status, comorbidities and treatment pattern were evaluated. Results: Asthma prevalence was 5.4% (95% CI: 4.5-6.5). Compared with NHS total individuals, asthma group showed almost 2 times higher frequency of self-perceived QoL (6.3% [95% CI: 3.4-11.3] vs 3.6% [95% CI: 2.8-4.5]) and health (16.4% [95% CI: 11.4-23.1] vs 7.7% [95% CI: 6.6-8.9]) named as very bad/bad/less than regular. In addition, asthma group had a greater frequency of at least some problems in all EQ-5D-3L domains. Depressive symptoms were the most frequently observed comorbidity. 63% of respondents who acknowledged having asthma were not receiving any treatment at the time of the survey. Asthma treatment was most frequently prescribed by a general physician (62.4%/55.4%, rescue/controller medication) and the access occurs in the public system (65.9%/82.5%, rescue/controller medication). About one third of the population used SABA monotherapy (32.8%). Conclusion: Asthma prevalence was 5.4% and asthmatics reported worse QoL and health. A very low treatment rate was observed and those treated, most were under rescue medication.

Age as a primary driver of the gut microbial composition and function in wild harbor seals.

Dietary changes are the major variation cause in the composition of the gut microbiota. The short lactation phase in phocids provides an exceptional opportunity to explore the microbiota's response to a quick transition from a milk-based to a solid diet. We investigated the effects of age and sex on the gut microbiota of harbor seals in Mexico using rectal and fecal samples from pups and adults. 16S gene sequencing revealed age explains most of the observed variations in microbial composition. Individuals with frequent contact (pups-female adults) have major microbial similarities than those with little or no contact (pups-male adults). Overall, adults and females (regardless of sex and age, respectively) have a greater microbial richness; as seals grow, the core microbiome shrinks, and microbial diversity increases. We found pathways related to milk and chitin digestion in pups' microbiomes, indicating pups were transitioning to a solid diet. An enrichment of routes related to dramatic weight loss and body mass indicated higher metabolic stress in pups in late breeding season, when they are weaned and start intermittent fasting. Our findings highlight the host-microbiome interaction in harbor seals during late breeding season in response to food shifts and metabolic stress.

Síntesis en fase sólida de un neuropéptido cosmecéutico y su microencapsulación en un sistema liposomal / Solid phase synthesis of a cosmeceutical neuropeptide and its microencapsulation in a liposomal system / Síntese de fase sólida de um neuropeptídeo cosmecêutico e sua microencapsulação em um sistema lipossomal

RESUMEN Introducción: Actualmente los péptidos sintéticos se han constituido en una novedosa alternativa para el tratamiento de la piel envejecida. Acetilhexapéptido-3 (Ac-EEMQRR-NH2) ha sido utilizado para inducir reducción de líneas de expresión de manera análoga a la toxina botulínica, pero sin efectos tóxicos. Objetivo: Sintetizar el acetilhexapéptido-3 y desarrollar un sistema liposomal para su encapsulación y favorecer su paso a través de una membrana modelo. Metodología: El péptido fue obtenido mediante síntesis en fase sólida (SFS) empleando la estrategia Fmoc/tBu, fue purificado y plenamente caracterizado. El sistema liposomal con acetilhexapéptido-3 encapsulado fue desarrollado mediante la formación de una emulsión con posterior inversión de fase por evaporación del solvente orgánico. Los sistemas fueron caracterizados en su tamaño, potencial zeta, eficiencia de encapsulación del neuropéptido y de manera preliminar se realizó un estudio de permeabilidad ex vivo. Resultados: Es posible sintetizar péptidos cortos con alto grado de pureza y buen rendimiento, utilizando la metodología de SFS Fmoc/tBu. De acuerdo con la caracterización, el sistema liposomal adelantado sugiere una buena estrategia para la encapsulación del acetilhexapéptido-3 y su potencial aplicación en el desarrollo un novedoso producto cosmecéutico.

SUMMARY Introduction: Currently synthetic peptides have become a novel alternative for the treatment of aging skin. Acetylhexapeptide-3 (Ac-EEMQRR-NH2) has been used to induce reduction of expression lines in a manner analogous to botulinum toxin, but without toxic effects. Aim: To synthesize acetylhexapeptide-3 and to develop a lipo-somal system for its encapsulation and favor its passage through a model membrane. Methodology: The peptide was obtained by solid phase synthesis (SFS) using the Fmoc / tBu strategy, it was purified and fully characterized. The liposomal system with encapsulated acetylhexapeptide-3 was developed by forming an emulsion with subsequent phase inversion by evaporation of the organic solvent. The systems were characterized in their size, zeta potential, neuropeptide encapsulation efficiency and a preliminary ex vivo permeability study was carried out. Results: It is possible to synthesize short peptides with a high degree of purity and good yield, using the SFS Fmoc / tBu methodology. According to the characterization, the advanced liposomal system suggests a good strategy for the encapsulation of acetylhexapeptide-3 and its potential application in the development of a novel cosmeceutical product.

RESUMO Introdução: Atualmente os peptídeos sintéticos têm se tornado uma nova alternativa para o tratamento do envelhecimento cutâneo. O acetilhexapeptídeo-3 (Ac-EEMQR-R-NH2) tem sido usado para induzir a redução das linhas de expressão de maneira análoga à toxina botulínica, mas sem efeitos tóxicos. Objetivo: Sintetizar acetilhe-xapeptídeo-3 e desenvolver um sistema lipossomal para seu encapsulamento e favorecer sua passagem por uma membrana modelo. Metodologia: O peptídeo foi obtido por síntese em fase sólida (SFS) utilizando a estratégia Fmoc / tBu, foi purificado e totalmente caracterizado. O sistema lipossomal com acetilhexapeptídeo-3 encapsulado foi desenvolvido pela formação de uma emulsão com subsequente inversão de fase por evaporação do solvente orgânico. Os sistemas foram caracterizados quanto ao tamanho, potencial zeta, eficiência de encapsulação de neuropeptídeos e um estudo preliminar de permeabilidade ex vivo foi realizado. Resultados: É possível sintetizar peptídeos curtos com alto grau de pureza e bom rendimento, utilizando a metodologia SFS Fmoc / tBu. De acordo com a caracterização, o sistema lipossomal avançado sugere uma boa estratégia para a encapsulação do acetilhexapeptídeo-3 e seu potencial aplicação no desenvolvimento de um novo produto cosmecêutico.

Homologación lingüística al idioma español, en población chilena, de la herramienta Sunnybrook Facial Grading System para evaluar parálisis facial. Estudio piloto

Resumen Introducción: La parálisis facial es una patología muy común. La escala "Sunnybrook Facial Grading System" (SFGS) se ha posicionado como una herramienta útil y confiable para su evaluación y evolución. Objetivo: Homologar lingüísticamente desde el idioma inglés al español la escala SFGS en una muestra de población chilena. Material y Método: Tres kinesiólogos chilenos con dominio comprobado del idioma inglés tradujeron la escala SFGS al español. Un comité creó una primera versión de la SFGS en español. Posteriormente, un profesional del Instituto Chileno-Británico tradujo la primera versión nuevamente al inglés (retrotraducción). El comité definió la segunda versión de la SFGS. Finalmente, los investigadores llevaron a cabo los pilotajes. Resultados: En dos pruebas piloto, veinte sujetos respondieron correctamente el total de las expresiones solicitadas. Conclusión: Esta versión de la escala SFGS homologada lingüísticamente al español puede ser aplicada a la población chilena.

Abstract Introduction: Facial paralysis is a very common pathology. The Sunnybrook Facial Grading System (SFGS) scale has positioned itself as a useful and reliable tool for its evaluation and follow up. Aim: To linguistically homologate the SFGS scale in a sample of the Chilean population from English to Spanish. Material and Method: Three Chilean kinesiologists with English proficiency translated the SFGS scale into Spanish. A committee developed a first version of the SFGS in Spanish. Subsequently, a professional from the Chilean-British Institute translated the first version back into English (back-translation). The committee defined the second version of the SFGS. Finally, the investigators carried out the pilots. Results: In two pilot tests, twenty subjects correctly answered the total of the expressions requested. Conclusion: This version of the SFGS scale linguistically homologated to Spanish can be applied to the Chilean population.

Hipertensión intracraneal idiopática asociada a nitrofurantoína. Caso clínico / Idiopathic intracranial hypertension associated with nitrofurantoin. Case report

Resumen Introducción: La Hipertensión Intracraneal Idiopática (HICI) es un síndrome neurológico caracterizado por un aumento de la presión intracraneal en ausencia de lesión estructural o hidrocefalia. Los síntomas incluyen cefalea, tinnitus pulsátil, oscurecimientos visuales transitorios y pérdida visual. Dentro de los signos destacan diplopía por parálisis del VI par, edema de papila y disminución de la agudeza visual. Los pacientes no tienen compromiso de conciencia ni signos neurológicos focales. La principal complicación es la pérdida visual que puede ser irreversible. La asociación entre HICI y nitrofurantoína (NTF) se reportó en 1974. Caso clínico: Mujer de 42 años, con sobrepeso, que desarrolló una HICI aproximadamente 18 meses posterior al inicio de nitrofurantoína profiláctica. Consultó por cefalea frontal, opresiva que aumentaba con la maniobra de Valsalva, asociada a disminución fluctuante de la agudeza visual y episodios de oscurecimiento. Al examen destacó edema de papila bilateral, sin déficit neurológico focal. La presión del líquido cefalorraquídeo (LCR) fue de 25,5 cm de agua. La resonancia magnética mostró signos de aumento de la presión del LCR, sin lesiones estructurales ni hidrocefalia. El cuadro se recuperó concomitantemente a la suspensión de la NTF y el uso de topiramato. No se constató daño visual permanente. Conclusiones: Se debe sospechar la HICI en mujeres en edad fértil con sobrepeso. Dentro de los gatillantes del síndrome destacan varios fármacos, entre ellos la NTF. El principal objetivo del tratamiento de la HICI es preservar la función visual.

Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure without a space occupying lesion or hydrocephalus. The symptoms are headache, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia caused by sixth cranial nerve paresis and papilledema with its associated loss of sensory visual function. The patient maintains an alert and oriented mental state, but has no localizing neurologic findings. The only major morbidity with IIH is visual loss. The association between IIH and nitrofurantoin was reported in 1974. Case: A 42 years old female, overweighed, who developed IIH 18 months after the start of prophylactic nitrofurantoin. She had frontal oppressive headache that increased with the Valsalva maneuver, fluctuant visual loss and transient visual obscurations. She had bilateral papilledema without localizing neurologic findings. The cerebrospinal fluid (CSF) pressure was 25.5 cm H2O. Magnetic resonance imaging showed signs of increased CSF pressure without structural lesions or hydrocephalus. IIH recovered with the withdrawal of nitrofurantoin and the use of topiramate. There was not permanent visual loss. Conclusions: It is recommendable to suspect IIH in obese women in the childbearing years. There are several drugs associated with IIH including nitrofurantoin. The main objective of treatment is to prevent visual loss.

Diarrea crónica como manifestación de un tumor neuroendocrino / Chronic diarrhea as a manifestation of a neuroendocrine tumor

Resumen Las neoplasias neuroendocrinas (Neuroendocrine Neoplasms, NEN) constituyen un grupo heterogéneo de neoplasias poco frecuentes, que se originan en las células endocrinas, con la capacidad de secretar aminas y polipéptidos hormonales. Las NEN de localización pancreática (pNEN) pueden ser funcionales o no funcionales. Las pNEN funcionales secretan hormonas como la gastrina, la insulina y el glucagón y otras menos frecuentes como el péptido intestinal vasoactivo (PIV), por lo que sus características sindromáticas dependen del péptido secretado. Los vipomas se manifiestan con diarrea crónica de características secretoras, que usualmente conducen a trastornos hidroelectrolíticos e incluso a complicaciones serias asociadas como la falla renal. A continuación, se describe el caso de un hombre de 37 años con diarrea crónica de 6 meses de evolución y frecuentes hospitalizaciones por trastornos hidroelectrolíticos, generados por hipocalemia severa y lesión renal aguda por deshidratación. Después de múltiples estudios, se considera el diagnóstico de una diarrea secretora por NEN funcional, secretora de PIV. Por tanto, se inicia una terapia empírica con octreotida y se logra controlar la diarrea, así como corregir el trastorno hidroelectrolítico. Además, se amplían los estudios, para documentar las pNEN tratadas mediante intervención quirúrgica, con respuesta clínica favorable y remisión completa de la sintomatología.

Abstract Neuroendocrine tumors (NETs) are a heterogeneous group of rare neoplasms that originate in endocrine cells with the ability to secrete amines and hormonal polypeptides. Pancreatic neuroendocrine tumors (PNETs) can be functional or non-functional. Functional PNETs secrete common hormones such as gastrin, insulin and glucagon and much less frequent hormones such as vasoactive intestinal peptide (VIP). Their characteristics depend on the peptide secreted. Vipomas are characterized by chronic diarrhea of ​​secretory characteristics that usually lead to hydroelectrolytic disorders and can lead to serious complications associated with renal failure. This article describes the case of a 37-year-old man who had suffered chronic diarrhea with frequent hospitalization for hydroelectrolytic disorders for six months due to severe hypokalemia and acute renal damage due to dehydration. After multiple studies, a diagnosis of secretory diarrhea due to a VIP secretory functional NET was considered. Empirical therapy with Octreotide was begun to control diarrhea and correct the hydroelectrolytic disorder. More studies of PNETS are being published. They have been treated surgically intervention with favorable clinical results and complete remission of symptoms.

Vivencias y expectativas de los actores sociales partícipes en evaluación del desarrollo psicomotor, en relación a las escalas EEDP y TEPSI utilizadas en la Araucanía, Chile, durante los años 2017-2018 / Vivências e expectativas dos acionistas sociais partícipes na avaliação do desenvolvimento do psicomotor, em relação às escalas EEDP e TEPSI usadas no Araucania, Chile, durante o ano 2017-2018 / Experiences and expectations of the social actors participating in the evaluation of psychomotor development, in relation to the EEDP and TEPSI scales used in la Araucania, Chile, in 2017-2018

Resumen: En Chile, la Escala de Evaluación del Desarrollo Psicomotor (EEDP) y Test de Desarrollo Psicomotor (TEPSI) son herramientas no actualizadas, que carecen de confiabilidad y validación internacional conocida; por ello se hace necesario analizar el proceso evaluativo desde los actores de salud y educación, Enfermeras y Educadoras de párvulos respectivamente. El objetivo fue develar las vivencias de estos actores sociales, partícipes en el proceso evaluativo del desarrollo psicomotor en menores de tres años, según determinantes sociales. Se trata de un estudio cualitativo exploratorio, basado en la fenomenología de Alfred Schütz, realizado en siete informantes claves, cinco enfermeras y dos educadoras de párvulos, por medio de la entrevista semiestructurada. El análisis se circunscribió a transcripción, codificación, agrupamiento en categorías y síntesis. Se develan las metacategorías: A: Dilemas e incertidumbres por nudos críticos y categorías intermedias: a) Brecha entre políticas públicas y realidad local, no favorece el desarrollo de los niños, b) Instrumentos desactualizados y descontextualizados, c) Mitos y expectativas de los padres frente a la evaluación, d) Instrumentos sin pertinencia social; y B: Expectativas y categorías intermedias: a) Actualización del marco político para un avance continuo y efectivo, b) Incorporación y empoderamiento de los padres en el proceso, c) Capacitación y perfeccionamiento de profesionales. Se concluye que es necesario la actualización de las estrategias evaluativas y disponer de instrumentos validados, actualizados, con pertinencia social y que consideren a los padres

Resumo: No Chile, as Escala de Avaliação do Desenvolvimento Psicomotor (EEDP) e Teste de Desenvolvimento Psicomotor (TEPSI) não são ferramentas atualizadas, que carecem de confiabilidade e validação internacionalmente conhecidas, por essa razão, é necessário analisar o processo de avaliação dos atores de saúde e educação, enfermeiros e educadoras de creches, respectivamente. Lo objetivo foi revelar as experiências dos atores sociais participantes, enfermeiros e educadoras de creches, no processo de avaliação do desenvolvimento psicomotor em crianças menores de 3 anos, segundo os determinantes sociais. Foi realizado um estudo qualitativo exploratório baseado na fenomenologia de Alfred Schütz, realizado em 7 informantes-chave, 5 enfermeiros e 2 educadoras de creches, por meio de entrevista semiestruturado. A análise foi limitada à transcrição; codificação; agrupamento em categorias e síntese. Dilemas e incertezas de nós críticos e categorias intermediárias: a) lacuna entre política pública e da realidade local, não favorece o desenvolvimento das crianças, b) instrumentos desatualizados e, c) Mitos descontextualizadas e expectativas dos metacategorias são revelados os pais na frente da avaliação, d) Instrumentos sem relevância social; e B: Expectativas e categorias intermediárias: a) Atualização do arcabouço político para o progresso contínuo e efetivo, b) Incorporação e empoderamento dos pais no processo, c) Treinamento e aperfeiçoamento dos profissionais. É necessário atualizar as estratégias de avaliação e validar instrumentos atualizados e de relevância social que considerem os pais

Abstract: In Chile, the Psychomotor Development Evaluation Scale (EEDP in Spanish) and the Psychomotor Development Test (TEPSI in Spanish) are outdated tools that lack international reliability and validation. It is necessary to analyze the evaluation process from the point of view of the health and education professionals, that is, nurses and early childhood educators. The purpose was to reveal the experiences of these actors in the evaluation process of psychomotor development in children under three years of age, according to social determinants. This is a qualitative exploratory study based on the Alfred Schütz phenomenology, carried out in seven key informants, five nurses and two educators, through semi-structured interviews. The analysis was limited to transcription, coding, grouping into categories and synthesis. The meta categories revealed are: A: Dilemmas and uncertainties by critical nodes and intermediate categories: a) The gap between public policies and local reality does not favor the development of children, b) Outdated and decontextualized instruments, c) Myths and expectations of the parents regarding the evaluation, d) Instruments without social relevance; and B: Expectations and intermediate categories: a) Political framework update for continuous and effective progress, b) Parents incorporation and empowerment in the process, c) Professionals training and improvement. It was concluded that it is necessary to update the evaluation strategies and have validated, updated and socially relevant instruments that include the parents

Evaluación del área de sección del nervio mediano tras la inyección intraneural o perineural / Cross-sectional area of the median nerve after intraneural vs perineural low volume administration

Introducción: Conocer la relación entre la aguja y el nervio durante el bloqueo de nervio periférico es de interés para evitar el daño neural; sin embargo, los signos de inyección intraneural no se hallan claramente establecidos. Nos propusimos determinar los cambios observados en el nervio periférico tras inyectar 1ml de solución en disposición intraneural o perineural de la aguja. Material y métodos: Se utilizaron 10 cadáveres frescos, a los cuales se les realizó bloqueo de nervio mediano ecoguiado en plano en 60 ocasiones (3 por brazo), realizando una punción intraneural (n=30) o perineural (n=30) según aleatorización previa. Tras el consenso de localización por 7 especialistas, se inyectó 1ml de solución y se evaluó el cambio en el área de sección del nervio y el desplazamiento a lo largo del mismo. Resultados: El área de sección del nervio mediano se aumentó en ambos grupos, sin embargo, el incremento fue significativamente mayor en el grupo intraneural (perineural 0,007+/-0,013 vs. intraneural 0,032+/-0,021cm2, p<0,0001). Un incremento superior al 27% del área de sección asegura una inyección intraneural en el nervio mediano según el análisis de la curva ROC. La difusión proximal y la distal se observó con mayor frecuencia en el grupo intraneural (proximal: 86 vs. 14%; p<0,0001. Distal: 43 vs. 4%; p<0,0001). Conclusiones: En base a nuestro estudio experimental concluimos que la inyección de un pequeño volumen (1ml) permite discriminar la disposición de la aguja intraneural vs. perineural en un porcentaje elevado de casos. Por ello, sugerimos que esta «dosis test» debe de considerarse en los algoritmos de seguridad si queremos reducir la incidencia de inyección intraneural

Introduction: To recognise the relationship between the needle tip and the median nerve during peripheral nerve block is of interest to avoid neural damage. However, signs of intraneural injection are not clearly established. The aim of this study was to define the changes observed in the peripheral nerve after the intraneural or perineural administration of 1ml of solution. Material and methods: Ultrasound guided median nerve blocks were performed in the forearm of 10 fresh cadavers on 60 occasions (3 per forearm). They were randomised into the intraneural (n=30) or perineural (n=30) location of the needle tip, after the consensus of location by 7 specialists. After 1ml of solution was injected an evaluation was made of the changes in the cross-sectional area of the nerve, as well as the displacement along the nerve. Results: The cross-sectional area of the median nerve was increased in both groups, however, the increase was significantly higher in the intraneural group (perineural 0.007+/-0.013cm2 vs. intraneural 0.032+/-0.021cm2, P<.0001). An increase of more than 27% of the area ensures an intraneural injection in the median nerve according to the ROC curve analysis. Both proximal and distal diffusion were observed more frequently in the intraneural group (proximal: 86% vs 14%, P<.0001, Distal: 43% vs 4%, P<.0001). Conclusions: Based on this experimental study, it is concluded that the injection of a small volume (1ml) allows to discriminate the disposition of the intraneural vs perineural needle in a high percentage of cases. Therefore, it is suggested that this "dose test" should be considered in the safety algorithms if it is required to reduce the incidence of intraneural injection

Cross-sectional area of the median nerve after intraneural vs perineural low volume administration. / Evaluación del área de sección del nervio mediano tras la inyección intraneural o perineural.

INTRODUCTION: To recognise the relationship between the needle tip and the median nerve during peripheral nerve block is of interest to avoid neural damage. However, signs of intraneural injection are not clearly established. The aim of this study was to define the changes observed in the peripheral nerve after the intraneural or perineural administration of 1ml of solution. MATERIAL AND METHODS: Ultrasound guided median nerve blocks were performed in the forearm of 10 fresh cadavers on 60 occasions (3 per forearm). They were randomised into the intraneural (n=30) or perineural (n=30) location of the needle tip, after the consensus of location by 7 specialists. After 1ml of solution was injected an evaluation was made of the changes in the cross-sectional area of the nerve, as well as the displacement along the nerve. RESULTS: The cross-sectional area of the median nerve was increased in both groups, however, the increase was significantly higher in the intraneural group (perineural 0.007±0.013cm2 vs. intraneural 0.032±0.021cm2, P<.0001). An increase of more than 27% of the area ensures an intraneural injection in the median nerve according to the ROC curve analysis. Both proximal and distal diffusion were observed more frequently in the intraneural group (proximal: 86% vs 14%, P<.0001, Distal: 43% vs 4%, P<.0001). CONCLUSIONS: Based on this experimental study, it is concluded that the injection of a small volume (1ml) allows to discriminate the disposition of the intraneural vs perineural needle in a high percentage of cases. Therefore, it is suggested that this "dose test" should be considered in the safety algorithms if it is required to reduce the incidence of intraneural injection.

[Use of complementary tests in emergencies and their relation with patient safety incidents]. / Uso de pruebas complementarias en urgencias y su relación con incidentes de seguridad.

OBJECTIVE: To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY: An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS: A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION: A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.

Fusión costal: una malformación simuladora de nódulo pulmonar solitario / No disponible

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Variz pulmonar: una malformación vascular simuladora de nódulo pulmonar solitario / No disponible

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Ultrasonografía endobronquial en el diagnóstico / No disponible

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Trombosis venosa pulmonar idiopática: un diagnóstico infrecuente / No disponible

La trombosis venosa pulmonar es una enfermedad potencialmente mortal. Este síndrome puede simular clínicamente un embolismo pulmonar arterial, pero tiene una estrategia de investigación y pronóstico distinto. La trombosis de la vena pulmonar es difícil de diagnosticar clínicamente y, por lo general, requiere una combinación de métodos diagnósticos utilizados convencionalmente. Presentamos la imagen radiológica de una trombosis venosa pulmonar en un varón de 70 años en el que la sospecha clínica inicial fue de tromboembolismo pulmonar arterial

Pulmonary vein thrombosis (PVT) represents a potentially fatal disease. This syndrome may clinically mimic pulmonary embolism but has a different investigation strategy and prognosis. Pulmonary vein thrombosis is difficult to diagnose clinically and usually requires a combination of conventionally used diagnostic modalities. We present the radiological images of a pulmonary vein thrombosis in a 70 year old patient with the initial clinical suspicion of a pulmonary artery thromboembolism

Passenger Lymphocyte Syndrome After Simultaneous Pancreas-Kidney Transplantation: A Case Report of an Unusual Cause of Alloimmune Hemolytic Anemia.

BACKGROUND: Passenger lymphocyte syndrome (PLS) is a disease in which the donor's lymphocytes produce antibodies to the red blood cell antigens of the recipient, causing alloimmune hemolysis. CASE REPORT: We report the case of a 39-year-old woman with stage V chronic kidney disease on hemodialysis secondary to poorly controlled diabetes mellitus type 1. She received a simultaneous pancreas-kidney transplant from a cadaver donor. The donor was A- and the recipient was A+ without initial complications with normal renal and pancreatic function, and her hemoglobin (Hb) level was 10.2 g/dL at discharge. Four weeks later she was admitted with acute pyelonephritis of the renal graft, with a Hb level of 7.5 g/dL, creatinine level of 0.7 mg/dL, and glucose level of 80 mg/dL. The study of anemia showed direct polyspecific direct Coombs weakly positive (w/+), presenting 2 alloantibodies against the Rh system: anti-D, anti-E. We increased Prednisone dose to 1 mg/kg/d and then decreased it in a pattern. Eight days after discharge, without transfusion, her Hb level was 9.9 g/dL and then it normalized. CONCLUSIONS: PLS is a very rare condition and should be suspected in the first few weeks after transplantation. In our case anemia was probably due to a residual population of Rh-negative donor cells in the transplanted pancreas-kidney received. It is usually a sudden onset of hemolytic anemia in patients with a solid organ transplant and different Rh or ABO lower incompatibility.

Arteria subclavia derecha aberrante con trayecto retro-tráqueo-esofágico en estudio de disnea y disfagia / No disponible

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