Infección por bartonella henselae en pacientes pediátricos. Lesión pseudotumoral de calota. Reporte de caso

Los tumores de calota en pacientes pediátricos poseen múltiples etiologías. Dentro de las causas pseudotumorales, las infecciones juegan un rol importante, siendo la osteomielitis por Bartonella henselae (Enfermedad por Arañazo de Gato) una posibilidad diagnóstica rara, pero que debe ser estudiada y descartada. Se presenta el caso de una lactante de 1 año, con lesión expansiva de calota, a nivel frontal derecho, hipervascularizada e infiltrativa. Se realizó estudio con ultrasonido, tomografía cerebral y cintigrama óseo. Se realizó resección quirúrgica completa de la lesión, con preservación de la duramadre y zona fontanelar, además de un cuidadoso trato con el seno sagital superior. Evolucionó sin complicaciones perioperatorias. El resultado de la biopsia fue compatible con proceso inflamatorio crónico, osteomielitis supurada. Tinción de Warthin Starry positiva sugerente de Bartonella henselae. Se descartó etiología tuberculosa y fúngica. Serología positiva para Bartonella henselae. La paciente completó antibioticoterapia, azitromicina y cotrimoxazol, con evolución clínica favorable.

Calvarial tumors in pediatric patients have multiple etiologies. Among the pseudotumoral causes, infections play an important role, being Bartonella henselae osteomyelitis (Cat Scratch Disease) a rare diagnostic possibility, but it should be studied and ruled out. We present the case of a 1 year old infant, with an expansive lesion of the calvaria, at right frontal level, hypervascularized and infiltrative. Ultrasound, brain tomography and bone scintigram were performed. Complete surgical resection of the lesion was performed, with preservation of the dura mater and fontanel area, in addition to a careful treatment with the superior sagittal sinus. The patient evolved without perioperative complications. The biopsy result was compatible with a chronic inflammatory process, suppurative osteomyelitis. Positive Warthin Starry stain suggestive of Bartonella henselae. Tuberculous and fungal etiology was ruled out. Positive serology for Bartonella henselae. The patient completed antibiotic therapy, azithromycin and cotrimoxazole, with favorable clinical evolution.

Factors Associated with Home Remedy Use by Adults Who Do Not Attend Health Care Facilities: Evidence from Peruvian Population-based Survey, 2019.

We estimated home remedy use (HRU) prevalence and associated factors in adults who present symptoms, disease, or accidents using the National Household Survey 2019. The estimation was performed in a population that did not access a health care facility. We conducted an analytical cross-sectional study in adults over 18 years of age. The dependent variable was HRU (Yes/No) as the main reason for not going to health care facilities. We collected these variables: age, sex, education, marital status, ethnicity, region of residence, chronic diseases or disability, and health insurance. The HRU prevalence was associated with older participants, who lived in the highlands or the jungle, belonged to Quechua or Aymara ethnic groups, and had comprehensive health insurance. In contrast, there was a lower HRU prevalence for those enrolled in private insurance. The HRU was associated with various socio-demographic factors in adults with any symptoms, illness, or accidents not attending health centers.

Evolução da utilização de espermatozoides sexados / Evolution of sexed spermatozoa utilization

A sexagem de espermatozoides tem relevante aplicação na produção animal. Várias publicações demonstram a eficiência do processo de sexagem por citometria de fluxo que separa os espermatozoides X e Y em função da mensuração do conteúdo de DNA. Importantes modificações no processo de sexagem por citometria de fluxo, tais como pressão, intensidade do laser, diluidores tem levado à diminuição dos danos nos espermatozoides e aumentado a viabilidade dos mesmos.

Spermatozoa sexing has an important application for livestock production. Results have been published worldwide that demonstrate effectiveness of the flow cytometer sexing process based on sorting sperm with differential DNA content as the X and Y sperm marker. Major improvements in the sexing sorting process as pressure, laser power, extenders had led to the decrease of sperm damage and increase of sperm viability

Evolução da utilização de espermatozoides sexados / Evolution of sexed spermatozoa utilization

A sexagem de espermatozoides tem relevante aplicação na produção animal. Várias publicações demonstram a eficiência do processo de sexagem por citometria de fluxo que separa os espermatozoides X e Y em função da mensuração do conteúdo de DNA. Importantes modificações no processo de sexagem por citometria de fluxo, tais como pressão, intensidade do laser, diluidores tem levado à diminuição dos danos nos espermatozoides e aumentado a viabilidade dos mesmos.(AU)

Spermatozoa sexing has an important application for livestock production. Results have been published worldwide that demonstrate effectiveness of the flow cytometer sexing process based on sorting sperm with differential DNA content as the X and Y sperm marker. Major improvements in the sexing sorting process as pressure, laser power, extenders had led to the decrease of sperm damage and increase of sperm viability(AU)

Extracting quasi-steady Lagrangian transport patterns from the ocean circulation: An application to the Gulf of Mexico.

We construct a climatology of Lagrangian coherent structures (LCSs)-the concealed skeleton that shapes transport-with a twelve-year-long data-assimilative simulation of the sea-surface circulation in the Gulf of Mexico (GoM). Computed as time-mean Cauchy-Green strain tensorlines of the climatological velocity, the climatological LCSs (cLCSs) unveil recurrent Lagrangian circulation patterns. The cLCSs strongly constrain the ensemble-mean Lagrangian circulation of the instantaneous model velocity, showing that a climatological velocity can preserve meaningful transport information. The quasi-steady transport patterns revealed by the cLCSs agree well with aspects of the GoM circulation described in several previous observational and numerical studies. For example, the cLCSs identify regions of persistent isolation, and suggest that coastal regions previously identified as high-risk for pollution impact are regions of maximal attraction. We also show that cLCSs are remarkably accurate at identifying transport patterns observed during the Deepwater Horizon and Ixtoc oil spills, and during the Grand LAgrangian Deployment (GLAD) experiment. Thus it is shown that computing cLCSs is an efficient and meaningful way of synthesizing vast amounts of Lagrangian information. The cLCS method confirms previous GoM studies, and contributes to our understanding by revealing the persistent nature of the dynamics and kinematics treated therein.

Lagrangian dynamical geography of the Gulf of Mexico.

We construct a Markov-chain representation of the surface-ocean Lagrangian dynamics in a region occupied by the Gulf of Mexico (GoM) and adjacent portions of the Caribbean Sea and North Atlantic using satellite-tracked drifter trajectory data, the largest collection so far considered. From the analysis of the eigenvectors of the transition matrix associated with the chain, we identify almost-invariant attracting sets and their basins of attraction. With this information we decompose the GoM's geography into weakly dynamically interacting provinces, which constrain the connectivity between distant locations within the GoM. Offshore oil exploration, oil spill contingency planning, and fish larval connectivity assessment are among the many activities that can benefit from the dynamical information carried in the geography constructed here.

Percepción de la calidad de atención médica en consultorios de la Cátedra de Medicina Familiar del Hospital de Clínicas, Asunción- Paraguay. Año 2013 / Quality of medical attention perception in the Family Medicine Service of the Clinic´s Hospital, Asuncion-Paraguay. Year 2013

Introducción: La calidad de la atención médica ha adquirido importancia en las últimas décadas en relación con el debate sobre los derechos de los pacientes y del derecho a la salud. Métodos: Estudio descriptivo, observacional, de corte transversal. La obtención de datos fue mediante una encuesta pre elaborada. Resultados: De un total de 54 pacientes que fueron encuestados en la Cátedra de Medicina Familiar, en el periodo de marzo-abril del 2013; el 60%, 32 pacientes, respondieron que el tiempo de espera para la consulta siempre es adecuado. Sobre las atenciones brindadas por personal de enfermería, el 87%, 47 pacientes, respondieron que siempre son adecuadas. En cuanto a si el Médico le explica todo lo que quiere saber de su salud, 77%, 42 pacientes respondieron que siempre el médico que le atiende le explica todo sobre su estado de salud. En cuanto a si está satisfecho con la atención recibida en el servicio, el 90%, 49 pacientes, respondieron que siempre quedan satisfechos con la atención recibida Conclusión: La percepción que tienen los usuarios encuestados acerca de la calidad de atención brindada en la cátedra, es que la mayoría está conforme con la misma y consideran adecuada el tipo de atención médica, así como el tiempo de espera para la consulta, como el tiempo de consulta. En un porcentaje elevado los pacientes encuestados recomendaría consultar en nuestro servicio. Palabras claves: Percepción; calidad; atención.

Introduction: The quality of medical care has become important in recent decades as it relates to the debate about patients' rights and the right to health. Methods: This was a descriptive, observational, cross-sectional study. Data collection was done through a pre-prepared survey. Results: Of a total of 54 patients who were surveyed in the Family Medicine Department clinics, during the period of March-April 2013, 60% (32 patients) responded that the appointment wait time is always adequate. Regarding the care provided by nursing staff, 87% (47 patients) responded that it is always adequate. As to whether the doctor explained everything the patient wanted to know about their health, 77% (42 patients) answered that the doctor who treats them always explains everything about their state of health. 90% (49 patients) of the users who were surveyed are always satisfied with the care received. Conclusion: the majority of users surveyed about quality of care received in the department are satisfied with their care and are satisfied regarding the type of medical attention, as well as the appointment wait time. A high percentage the patients surveyed would recommend consulting in our service. Key words: Perception;q uality; Attention

Molecular characterization of infectious bursal disease virus (IBDV) isolated in Argentina indicates a regional lineage.

In Argentina, classical vaccines are used to control infectious bursal disease virus (IBDV); however, outbreaks of IBDV are frequently observed. This could be due to failures in the vaccination programs or to the emergence of new strains, which would be able to break through the protection given by vaccines. Hence, genetic characterization of the viruses responsible for the outbreaks that occurred in recent years is crucial for the evaluation of the control programs and the understanding of the epidemiology and evolution of IBDV. In this study, we characterized 51 field samples collected in Argentina (previously identified as IBDV positive) through the analysis of previously identified apomorphic sequences. Phylogenetic analysis of regVP2 showed that 42 samples formed a unique cluster (Argentinean lineage), seven samples were typical classical strains (one of them was a vaccine strain), and two belonged to the very virulent lineage (vvIBDV). Interestingly, when the analysis was performed on the regVP1 sequences, the field samples segregated similarly to regVP2; thus, we observed no evidence of a reassortment event in the Argentinean samples. Amino acid sequence analysis of regVP2 showed a particular pattern of residues in the Argentinean lineage, particularly the presence of T272, P289 and F296, which had not been reported before as signature sequences for any IBDV phenotype. Notably, the residue S254, characteristic of the antigenic variant, was not present in any of the Argentinean samples.

[Functional dyspepsia and the satiety test: its usefulness in clinical practice]. / Dispepsia funcional y test de saciedad: utilidad en la práctica clínica.

INTRODUCTION: According to the Rome III Criteria, functional dyspepsia (FD) is classified as postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). On the other hand, the satiety test (ST) has been used to evaluate gastric accommodation and emptying, distinguishing healthy individuals from those with dyspepsia. AIMS: To determine whether the ST can distinguish dyspeptic individuals from healthy ones and to evaluate its usefulness in differentiating the two FD subtypes. METHODS: Adults with FD were consecutively enrolled in a cross-sectional study within the time frame of August 2011 and October 2012. Healthy subjects participated as controls. The ST consisted of the intake of a nutritional supplement (Fortisip®, Nutricia Bagó®) at a constant speed; satiety was graded at 5-minute intervals (1 to 5 points). Intake was suspended when the maximum score was reported. The total ingested volume and caloric intake was recorded and the Mann-Whitney U test was used in the statistical analysis. RESULTS: The study included 39 dyspeptic patients and 20 control individuals. The patients were predominantly women (84.6 vs. 25%; p < 0.0001) and they were similar in age (39.59 ± 13.53 vs. 34.70 ± 9.85 years) and BMI (24.32 ± 3.52 vs. 25.82 ± 3.34 kg/m2) with respect to the controls. The FD subtype percentages were PDS: 61%, EPS: 31%, and Mixed syndrome: 8%. There was a lower ingested volume and caloric intake on the part of the dyspeptic patients (185 vs. 300 ml and 277 vs. 520 Kcal, respectively. Both: P<.001). No differences in the ST were observed between the two pure dyspepsia subtypes. CONCLUSIONS: There was a difference in the ST between healthy individuals and those with dyspepsia, but the ingested volume and caloric intake in the two FD subtypes were similar.

Mechanisms of ring chromosome formation, ring instability and clinical consequences.

BACKGROUND: The breakpoints and mechanisms of ring chromosome formation were studied and mapped in 14 patients. METHODS: Several techniques were performed such as genome-wide array, MLPA (Multiplex Ligation-Dependent Probe Amplification) and FISH (Fluorescent in situ Hybridization). RESULTS: The ring chromosomes of patients I to XIV were determined to be, respectively: r(3)(p26.1q29), r(4)(p16.3q35.2), r(10)(p15.3q26.2), r(10)(p15.3q26.13), r(13)(p13q31.1), r(13)(p13q34), r(14)(p13q32.33), r(15)(p13q26.2), r(18)(p11.32q22.2), r(18)(p11.32q21.33), r(18)(p11.21q23), r(22)(p13q13.33), r(22)(p13q13.2), and r(22)(p13q13.2). These rings were found to have been formed by different mechanisms, such as: breaks in both chromosome arms followed by end-to-end reunion (patients IV, VIII, IX, XI, XIII and XIV); a break in one chromosome arm followed by fusion with the subtelomeric region of the other (patients I and II); a break in one chromosome arm followed by fusion with the opposite telomeric region (patients III and X); fusion of two subtelomeric regions (patient VII); and telomere-telomere fusion (patient XII). Thus, the r(14) and one r(22) can be considered complete rings, since there was no loss of relevant genetic material. Two patients (V and VI) with r(13) showed duplication along with terminal deletion of 13q, one of them proved to be inverted, a mechanism known as inv-dup-del. Ring instability was detected by ring loss and secondary aberrations in all but three patients, who presented stable ring chromosomes (II, XIII and XIV). CONCLUSIONS: We concluded that the clinical phenotype of patients with ring chromosomes may be related with different factors, including gene haploinsufficiency, gene duplications and ring instability. Epigenetic factors due to the circular architecture of ring chromosomes must also be considered, since even complete ring chromosomes can result in phenotypic alterations, as observed in our patients with complete r(14) and r(22).

[Phytobezoar as a cause of intestinal occlusion. Presentation of a case]. / Fitobezoar como causa de oclusión intestinal. Presentación de un caso.

Eighty per cent of the intestinal occlusions in the small bowel are the result of adhesions, neoplasms or hernias. Approximately 4.3% of bowel occlusions are due to some type of bezoar. We report an 83 years old male who presented with a clinical picture of intestinal obstruction. He underwent hand-assisted laparoscopic exploration identifying an intraluminal non-fixed mass. Enterotomy was performed and a 3 x 4 cm yellowish mass was extracted. Histological analysis demonstrated a vegetal bezoar. Laparoscopic surgery is increasing its role in the management of intestinal occlusion.

Brazilian city planners, American city planning? New perspectives on urban planning in Rio de Janeiro, 1930-1945.

This article analyses the connections between the ideas and principles of American city planning from 1920 with those articulated by Brazilian city planners in the 1930s and implemented by the administration of the City of Rio de Janeiro, then the capital of Brazil, notably during the period of the Estado Novo [The New State] from 1937 to 1945. In a period characterized by the centralization of political power and the concentration of decision-making in the hands of the president and the state, the City of Rio de Janeiro undertook a series of restructuring projects which utilized new forms of administration and organization. This article explores the links between urban planning in Brazil and the USA that were a notable feature of these projects. It examines particular requirements set down in city plans, city planning commissions and funding for urban activities, such as 'excess condemnation', by focusing upon articles and books written by four Brazilian engineers and proposals put forward by the American City Planning Institute, detailed in the proceedings of the National Conference on City Planning, in the periodical, City Planning and works by affiliated authors.

Mediastinitis necrotizante descendente / Descending necrotizing mediastinitis

Introducción: La mediastinitis necrotizante descendente (MND) requiere un manejo precoz y agresivo por su alta morbimortalidad. Objetivo: Describir características de las MND manejadas por nuestros equipo y determinar factores de riesgo de letalidad. Material y Método: Estudio descriptivo retrospectivo. Período enero 1993-junio 2004. Información de base de datos Equipo Cirugía Cardiotorácica y fichas clínicas. Se describe edad, género, características clínicas, tiempos de evolución, etiología, tratamiento quirúrgico, morbimortalidad y evolución. Para determinar factores de riesgo de letalidad se realiza el análisis multivariado de 14 factores pre, intra y postoperatorios, utilizando la prueba de regresión logística, método fordward stepwise. Resultados: 10 casos, todos masculinos. Edad promedio 42,2 años. Síntomas frecuentes: dolor en 8, disnea 7 y fiebre 6. Tiempo de evolución de síntomas-consulta promedio 5,8 días; entre consulta-diagnóstico 3 días; todos se operaron al momento del diagnóstico. El origen fue en 4 casos dental, en 3 otorrinolaringológico y en 3 no precisado. El promedio de cirugías por paciente fue 1,7 con rango 1-3. En 5 se realizó abordaje cervical simultáneo y en 4 casos traqueostomías. No necesitaron ventilación mecánica postoperatoria 9, promedio 16 días. Seis pacientes presentaron complicaciones postoperatorias, la más frecuente una insuficiencia renal aguda y neumonía en 3. Fallecieron 5 en falla orgánica múltiple. Promedio de hospitalización postoperatoria 26,1 días, rango 8-90. En el análisis multivariado se encontró como factor de riesgo de letalidad el número de unidades de hemoderivados en el postoperatorio y la necesidad de transfusión de plasma. Conclusiones: La MND presenta alta morbimortalidad. Para nuestra serie la utilización de hemoderivados en el postoperatorio seria un factor asociado a letalidad.

Mediastinitis postquirúrgica en cirugía cardíaca / Postperative mediastinitis in cardiac surgery

Introducción: La mediastinitis postquirúrgica en cirugía cardíaca (MPQCC) tiene incidencia de 1-2 por ciento, y letalidad de 8,-40 por ciento, siendo complicación temida en cirugía cardíaca. Objetivo: Describir las características de la MPQCC de nuestro equipo y determinar factores asociados a letalidad. Material y método: Estudio descriptivos-retrospectivo. Período 1993-2003. Información de base de datos del equipo y fichas clínicas. Se trataron 19 pacientes, 4 operados en otros centros por lo que no se incluyen en este análisis. Se realizaron en total 1.223 cirugías cardíacas, con 15 MPQCC (1,2 por ciento). Se describen la edad, género, tipo cirugía cardíaca, características clínicas, tiempo de evolución, manejo quirúrgico, morbimortalidad, microbiología y evolución. Se realizó un análisis multivariado de 32 factores pre, intra y postoperatorios, y se utilizó la prueba regresión logística, método forward stepwise. Resultados: 15 casos, 9 masculinos. Edad promedio 53,5 años. Síntomas y signos frecuentes: dolor 14 casos, fiebre 13, taquicardia 13, inestabilidad esternal 9. La cirugía cardíaca fue univalvular en 6, coronaria en 5, endocarditis infecciosa en 3 y bivalvular en 1. El tiempo entre la cirugía y la MPQCC fue en promedio 12,9 días. Se realizó aseo mediastínico, curetaje, cierre e instalación de irrigación en 14. Se aisló Staphylococcus aureus meticilinoresistente en 11. Presentaron complicaciones 8 pacientes y fallecieron 5. La estadía post operatoria fue en promedio 38,6 días. En el análisis multivariado se encontró como factores asociados a letalidad el tabaquismo, la enfermedad pulmonar obstructiva crónica, el uso del balón de contrapulsación aórtica, y en los postoperatorios de mediastinitis: días de ventilación mecánica, uso de hemoderivados, insuficiencia renal aguda y neumonía. Conclusiones: La MPQCC presenta alta morbimortalidad. En nuestra serie existen factores reconocibles asociados a letalidad.

Complejidad de las consultas en un servicio de urgencia con consultorio municipal adosado / Complexity of the consultations in a service of urgency with leaned municipal physicians offices

Se analizó la complejidad de las atenciones registradas durante el año 2003 en el Servicio de Urgencia del Hospital de Purranque. Para su clasificación se consideraron las acciones médicas y de enfermería necesarias para resolver la consulta de los pacientes, considerando que no son urgencia aquellas que sólo necesitaron una indicación médica o una acción clínica simple. Los resultados muestran que un 79,4 por ciento de consultas son de baja morbilidad, las cuales se concentran más en las mujeres. No existió una variación importante en las proporciones durante los meses del año ni entre los días de semana y fines de semana, lo que apoya la idea de que las soluciones primaria se centran más en calidad que en el número de atenciones. La carga de costo que significa para el hospital llega casi ser el doble de los costos de las urgencias reales. Finalmente se propone ocupar este instrumento para monitorizar los cambios que se introduzcan en la atención primaria.

Proteína C reactiva como predictor de complicaciones postoperatorias en apendicitis aguda / C reactive protein predicting post operative complications in acute appendicitis

La apendicitis aguda es una patología frecuente. Sus complicaciones se relacionan con una estadía hospitalaria prolongada y mayor gasto de recursos, por lo que nos parece relevante buscar índices predictivos de estas complicaciones para poder así establecer medidas preventivas que permitan economizar recursos y acortar la estadía postoperatoria de estos pacientes. Objetivo: Determinar si existió alguna relación entre valores anormales de PCR al ingreso y el desarrollo de complicaciones locales postoperatorias. Material y Método: Estudio descriptivo retrospectivo de una muestra aleatoria de 197 pacientes, operados de apendicitis aguda confirmadas histológicamente, entre el 01-01-1998 y el 31-12-2000 en el Hospital Las Higueras de Talcahuano, relacionando el valor de la PCR al ingreso (normal < 1 mg/I) con la aparición de complicaciones infecciosas locales postoperatoria (infección herida operatoria y/o absceso residual). Resultados: Se encontró un 14,3 por ciento de pacientes con PCR normales de los cuales ninguno presentó complicaciones postoperatorias. Un 85,7 por ciento de los pacientes presentó PCR elevada de los que un 16,6 por ciento presentó complicaciones infecciosas locales en el postoperatorio. Conclusión: Se observó una relación estadísticamente significativa (p < 0,005) entre valores elevados de PCR al ingreso, con la incidencia de complicaciones infecciosas locales postoperatorias.

La evaluación dinámica del lenguaje / The dynamic evaluation of language

En este artículo se comparan dos marcos conceptuales de evaluación: la evaluación del lenguaje usando métodos tradicionales con pruebas estandarizadas y la evaluación dinámica del lenguaje. La aplicación clínica del modelo de evaluación dinámica se describe en evaluaciones del desarrollo del lenguaje temprano, la conciencia fonológica, el vocabulario, el discurso narrativo, las asociaciones semánticas y la comprensión del lenguaje. Se presentan estrategias de evaluación específicas y de uso para la planificación de intervenciones en dos casos de estudio clínico.