[Relationship between severity of hypomimia and basic emotion recognition in Parkinson's disease]. / Relación entre la gravedad de la hipomimia y el reconocimiento de emociones básicas en la enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease is characterised by the presence of motor symptoms including hypomimia, and by non-motor symptoms including alterations in facial recognition of basic emotions. Few studies have investigated this alteration and its relationship to the severity of hypomimia. OBJECTIVE: The objective is to study the relationship between hypomimia and the facial recognition of basic emotions in subjects with Parkinson's disease. SUBJECTS AND METHODS: Twenty-three patients and 29 controls were evaluated with the test battery for basic emotion facial recognition. The patients were divided into two subgroups according to the intensity of their hypomimia. RESULTS: The comparison in battery test performance between the minimal/mild hypomimia and moderate/severe hypomimia groups was statistically significant in favour of the former group. CONCLUSIONS: This finding shows a close relationship between expression and facial recognition of emotions, which could be explained through the mechanism of motor simulation.

TITLE: Relación entre la gravedad de la hipomimia y el reconocimiento de emociones básicas en la enfermedad de Parkinson.Introducción. La enfermedad de Parkinson se caracteriza por la presencia de síntomas motores, entre los que es significativa la presencia de hipomimia, y por síntomas no motores, en los que se destaca la alteración en el reconocimiento facial de emociones básicas. Son pocos los estudios que investiguen dicha alteración relacionada con la gravedad de la hipomimia. Objetivo. El objetivo es estudiar la relación entre la hipomimia y el reconocimiento facial de emociones básicas en sujetos con enfermedad de Parkinson. Sujetos y métodos. Se evaluó a 23 pacientes y 29 controles con la batería de reconocimiento facial de emociones básicas. El grupo de pacientes se dividió en dos subgrupos según la intensidad de la hipomimia. Resultados. La comparación en el rendimiento de las pruebas de la batería entre el grupo de hipomimia mínima/leve e hipomimia moderada/grave resultó estadísticamente significativa a favor del primer grupo. Conclusiones. Este hallazgo evidencia una estrecha relación entre la expresión y el reconocimiento facial de emociones, que podría explicarse a través del mecanismo de simulación motora.

Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review.

INTRODUCTION: The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE: Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY: Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS: It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION: There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.

Hepatocellular carcinoma in Peru: A molecular description of an unconventional clinical presentation.

INTRODUCTION AND AIM: Hepatocellular carcinoma (HCC) is the third most frequent cancer of digestive tract tumors in Peru, with a high mortality rate of 17.7 per 100,000 inhabitants. A significant number of HCC cases in Peru do not follow the classic clinical epidemiology of the disease described in other parts of the world. Those patients present with a distinct transcriptome profile and a singular tumor process, suggesting a particular type of hepatocarcinogenesis in a portion of the Peruvian population. Our aim was to understand the clinical and biologic involvement of the epigenetic profile (methylation) and gene expression (transcriptome) of HCC in Peruvian patients. METHODS: HCC and liver transcriptome and DNA methylation profiles were evaluated in 74 Peruvian patients. RESULTS: When grouped by age, there was greater DNA methylation in younger patients with HCC but no differences with respect to the transcriptomic profile. A high prevalence of the hepatitis B virus (HBV) (>90%) was also observed in the younger patients with HCC. Enrichment analyses in both molecular profiles pinpointed PRC2 as an important molecular effector of that liver tumor process in Peruvian patients. CONCLUSION: HCC in Peruvian patients has a unique molecular profile, associated with the presence of HBV, as well as overall DNA hypermethylation related to undifferentiated liver cells or cellular reprogramming.

SELNET clinical practice guidelines for bone sarcoma.

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Perspective of health personnel on end-of-life care in Intensive Care Units. / Perspectiva de los profesionales de la salud sobre cuidados al final de la vida en unidades de cuidados intensivos.

OBJECTIVE: To understand for what care of the patient at the end of life and their relatives means to ICU health professionals. METHODS: Qualitative study with a Research-Action (AI) design, in two intensive care units of the city of Bogotá. Groups were formed in each unit and each group included at least six health professionals, the data collection techniques were: 4 participative assemblies and 6 clinical narratives, the data analysis was done through the preparation of the data, discovery of topics, coding and interpretation of data, relativisation and rigour of the data. RESULTS: 20 ICU workers participated, the analysis of the data revealed four thematic categories: Multidisciplinary team of the ICU facing the end-of-life process, Management of critical patients and their families at the end of life in the ICU, Communication process between the patient, family and multidisciplinary team at the end of life, Ethical aspects at the end of life in the ICU CONCLUSIONS: The professionals consider preserving quality of life during the patient's stay in the ICU a therapeutic objective. The development of evidence-based guidelines that facilitate multidisciplinary management at the end of life, customisation of care, effective communication, fulfilling the physical, emotional and spiritual needs of the person and their family and favouring the patient's right of autonomy in decision making.

Current Situation of Congenital Toxoplasmosis in Ecuador.

Congenital toxoplasmosis (CT) is a zoonosis resulting from the fetal transmission of the obligate intracellular parasite, T. gondii, transplacentally in pregnant women usually in the first trimester of pregnancy. This research consisted in the review of indexed articles made in the Ecuador in the period between the years 2012 and 2017 with prevalence studies of the aforementioned pathology. The purpose of this collection was to determine the current situation of this disease in the Ecuadorian territory and, in addition, to recognize the risk factors involved, affected age groups, signs and symptoms, diagnosis and prevalence of the infection. Among the risk factors were the consumption of raw or undercooked meat, contact with feces of young cats and climatic conditions that stimulate the spread of oocysts, among others. Most affected ages by this disease fluctuate between 20 and 30 years. In 90% of the cases, the disease is asymptomatic or it may present adenopathies, maculo papular erythema, hepatosplenomegaly and other general signs such as fever, malaise, headache and myalgias. According to studies conducted with specific populations, it was established that the causative agent remains latent in first-trimester pregnant women from the provinces of Pichincha (71.4% of 140 pregnant women), Guayas (73% of 5683) and El Oro (16% of 250). The results of this research evidenced missing information in Ecuador, finding few and isolated studies regarding to this pathology. Therefore, it is concluded that an updated research should be conducted in order to elucidate the true epidemiological situation of congenital toxoplasmosis in Ecuador.

Optimal Phase-Control Strategy for Damped-Driven Duffing Oscillators.

Phase-control techniques of chaos aim to extract periodic behaviors from chaotic systems by applying weak harmonic perturbations with a suitably chosen phase. However, little is known about the best strategy for selecting adequate perturbations to reach desired states. Here we use experimental measures and numerical simulations to assess the benefits of controlling individually the three terms of a Duffing oscillator. Using a real-time analog indicator able to discriminate on-the-fly periodic behaviors from chaos, we reconstruct experimentally the phase versus perturbation strength stability areas when periodic perturbations are applied to different terms governing the oscillator. We verify the system to be more sensitive to perturbations applied to the quadratic term of the double-well Duffing oscillator and to the quartic term of the single-well Duffing oscillator.

Nucleosome loss facilitates the chemotactic response of macrophages.

BACKGROUND: High mobility group box 1 (HMGB1) is a small nuclear protein with two functions. In the nucleus, it helps to wrap DNA around nucleosomes. When secreted, it recruits inflammatory cells and induces cytokine production. Before HMGB1 is secreted from inflammatory cells, it relocates to the cytoplasm, which partially or totally depletes cell nuclei of HMGB1. We previously showed that cells lacking HMGB1 contain 20% fewer nucleosomes and 30% more RNA transcripts levels genome-wide. OBJECTIVE: We hypothesized that the depletion of nuclear HMGB1 plays a role in inflammation that can enhance or complement the role of extracellular HMGB1. METHODS: We analysed the transcriptional profile of wild-type and Hmgb1-/- mouse embryonic fibroblasts (MEFs) as a proxy for cells that have lost HMGB1 from their nuclei. We explored the transcriptome of wild-type and Hmgb1-/- macrophages differentiated in the presence of granulocyte-macrophage colony-stimulating factor, before and after exposure to LPS/IFN-γ. In the same cells, histones and nuclear HMGB1 were quantified. RESULTS: We found that Hmgb1-/- MEFs show a transcriptional profile associated with stress and inflammation responses. Moreover, wild-type macrophages that have secreted HMGB1 because of LPS/IFN-γ exposure rapidly reduce their histone content as much as cells that genetically lack HMGB1. Importantly, unstimulated Hmgb1-/- macrophages activate transcriptional pathways associated with cell migration and chemotaxis. CONCLUSIONS: We suggest that nucleosome loss is an early event that facilitates transcriptional responses of macrophages to inflammation, particularly chemotaxis. HMGB1's dual roles in the nucleus and in the extracellular space appear to be complementary.

Uso del Clamp pélvico en un paciente pediátrico politraumatizado / Pelvic Clamp in a polytraumatized pediatric patient

Las fracturas de pelvis en pacientes pediátricos son poco comunes y difieren de su contraparte en los adultos en cuanto a etiología, tipos de fracturas y lesiones asociadas; suelen estar acompañados, además, de lesiones viscerales y hemorragias letales. Presentamos el caso de paciente femenino de 10 años, con fractura inestable de la pelvis e inestabilidad hemodinámica que fue tratada con Clamp Pélvico como medida de resucitación y control de daños en la emergencia. El manejo de las fracturas de pelvis con el Clamp Pélvico en pacientes pediátricos con inestabilidad hemodinámica "in extremis" o "borderline" es un procedimiento práctico que debe ser dominada por residentes y especialistas de Ortopedia y Traumatología de todos los hospitales de nuestro país(AU)

Pelvic fractures in pediatric patients are rare and differs from their counterparts in adults in terms of etiology, fractures types and associated injuries. Can be accompanied by visceral lesions and lethal hemorrhages. We report the case 10 years old female patient with unstable pelvic fracture and hemodynamic instability who was treated with Pelvic C-Clamp as a measure of damage control and resuscitation in the emergency. The management of fractures of the pelvis in pediatric patients with hemodynamic instability "in extremis" or "borderline" with the Pelvic C-Clamp is a practical procedure to be dominated by residents and specialists of Orthopedics and Traumatology of all hospitals in our country(AU)

Neuropatía sensitiva autonómica hereditaria tipo IIA: manifestaciones neurológicas y esqueléticas tempranas / Hereditary sensory and autonomic neuropathy type II A: Early neurological and skeletal findings

Las neuropatías sensitivas autonómicas son parte de las neuropatías periféricas y se deben a disfunción de genes involucrados en el funcionamiento de las neuronas sensoriales y autonómicas. Se conocen 6 variantes clínicas con subtipos determinados por anormalidad en 11 genes, los diferentes fenotipos varían en la edad de inicio, presencia de disautonomías y patrón de herencia, que con excepción del tipo i son autosómicas recesivas. La neuropatía sensitiva autonómica tipo II se caracteriza por déficit de la sensibilidad al dolor, temperatura y propiocepción. Puede manifestarse al nacer o iniciar entre los 10 y 20 años de edad con úlceras, mutilaciones y amputaciones acrales. En el presente estudio se describe a 3 miembros de una familia con mutación en el gen WNK1 causante de la forma IIA de esta neuropatía hereditaria

The hereditary sensory and autonomic neuropathies are genetic disorders characterized by the loss of sensation including pain, tactile and temperature. Its clinical and molecular features vary widely; the symptoms may begin from birth or be noticed in the first or second decade, with different types of complications of trauma to the extremities such as ulcers, mutilations and acral amputations. They are classified into six groups from I to VI, determined by the abnormality in eleven genes leading to phenotypic variations in the age of onset and the presence or absence of dysautonomia signs. With the exception of type I, all are autosomal recessive. The type II of these neuropathies is characterized by insensitivity to pain, heat and proprioception. We describe three members of a Mexican family with WNK1 gene mutation that caused hereditary neuropathy IIA

[Hereditary sensory and autonomic neuropathy type II A: early neurological and skeletal findings]. / Neuropatía sensitiva autonómica hereditaria tipo IIA: manifestaciones neurológicas y esqueléticas tempranas.

The hereditary sensory and autonomic neuropathies are genetic disorders characterized by the loss of sensation including pain, tactile and temperature. Its clinical and molecular features vary widely; the symptoms may begin from birth or be noticed in the first or second decade, with different types of complications of trauma to the extremities such as ulcers, mutilations and acral amputations. They are classified into six groups from I to VI, determined by the abnormality in eleven genes leading to phenotypic variations in the age of onset and the presence or absence of dysautonomia signs. With the exception of type I, all are autosomal recessive. The type II of these neuropathies is characterized by insensitivity to pain, heat and proprioception. We describe three members of a Mexican family with WNK1 gene mutation that caused hereditary neuropathy IIA.

Tratamiento de las lesiones del anillo pélvico con un fijador interno anterior: estudio experimental: presentación de resultados preliminares / Internal anterior fixator for pelvic ring injury treatment: experimental study: preliminary results presentation

La fijación externa para el tratamiento de las lesiones del anillo pélvico es una técnica bien descrita y ampliamente utilizada para la estabilización inicial de estas lesiones y en ocasiones como tratamiento definitivo. Sin embargo, se ha asociado con complicaciones como infección en el trayecto de los pines, aflojamiento aséptico, pérdida de la reducción, lesión neurológica, entre otras. Presentamos un método novedoso de fijación interna anterior para el tratamiento de las lesiones del anillo pélvico mediante el uso de tornillos pediculares espinales supra acetabulares unidos a una barra subcutánea. Se realizó un estudio experimental de tipo prueba terapéutica, en una institución de nivel IV, donde se trataron 4 pacientes desde enero a junio de 2012. Tiempo de curación, calidad y pérdida de la reducción, incidencia de complicaciones y movilidad y confort del paciente, entre otras variables, fueron evaluadas. Presentamos los resultados preliminares del tratamiento de las fracturas del anillo pélvico con esta técnica(AU)

External fixation for the treatment of pelvic ring injuries is a well described and widely used technique for initial stabilization of these injuries and sometimos as definitive treatment. However, it has been associated with complications such as infection in the path of the pins, aseptic loosening, loss of reduction, neurologic injury, among others. We present a novel method of anterior internal fixation for the treatment of pelvic ring injuries by using pedicle screw spinal supra acetabular aboye a bar attached to the skin. An experimental study was made conducted in a Level IV institution, where 4 patients were treated from January to June 2012. Healing time, quality and loss of reduction, incidence of complications and patient mobility and comfort, among other variables, were evaluated. We present preliminary results of treatment of pelvic ring fractures with this technique(AU)

Melanoma genital / Genital melanoma

El melanoma genital es un tumor raro que debe tenerse siempre en cuenta ante la aparición de una lesión pigmentada en la vulva en una paciente de edad avanzada o incluso sin lesión aparente, ante un prurito persistente y rebelde a los tratamientos habituales. El diagnóstico suele ser tardío (la biopsia orienta al mismo).El abordaje debe ser multidisciplinario (ginecología-oncología-cirugía plástica) (AU)

Genital melanoma is a rare tumor that should always be considered in an old patient with a pigmented lesion on the vulva or even in a patient without apparent injury with a persistent itching and rebellious to standard treatments. The diagnosis is usually delayed (biopsy directed to it). The approach should be multidisciplinary (gynecology-oncology, plastic surgery) (AU)

Reducción cerrada y fijación percutánea retrograda de una fractura transversa del acetábulo: reporte de un caso / Closed reduction and retrograd percutaneous fixation of transverse acetabular fracture: a case report

El tratamiento quirúrgico de la fracturas del acetábulo es uno de los retos más demandantes para el cirujano ortopedista y traumatólogo. La reducción abierta y fijación interna ha sido el método estándar para el manejo de estas fracturas. Sin embargo, se ha relacionado con muchas complicaciones. Para disminuir estos riesgos, se han desarrollado procedimientos percutáneos mínimamente invasivos. Las técnicas percutáneas son atractivas porque ofrecen estabilidad conservando el hematoma de la fractura y sin disrupción del periostio como ocurre en la técnica abierta. Se presenta el caso de un paciente masculino de 19 años quien presentó una fractura transversa de acetábulo izquierdo con fractura diafisiaria del fémur ipsilateral posterior a un accidente automovilístico. El acetábulo se resolvió mediante reducción cerrada y fijación interna con 2 tornillos retrógrados percutáneos. En vista de la reducción anatómica y la estabilidad conseguida, se indico la carga inmediata completa de la extremidad. Se presenta su resolución y evolución

The surgical treatment of acetabular fractures is one of the most demanding challenges for the orthopedic surgeon and orthopedist. Open Reduction and Internal Fixation has been the gold standard for the management of these fractures. However, it has been associated with many complications. To reduce these risks, minimally invasive percutaneous procedures have been developed. Percutaneous techniques are attractive because they offer stability and preserve the fracture hematoma without disruption of the periosteum through a formal open technique. We present a case of a 19 year old male patient who presented a left acetabular transverse fracture with ipsilateral femur shaft fractures after a car accident. It was resolved by closed reduction and internal fixation with 2 retrograde percutaneous screws. As an anatomic reduction and stability has achieved, immediate full weightbearing was indicated. Resolution and evolution is presented

Colgajo de So en reconstrucción de miembro inferior / So muscle flap in lower limb reconstruction

El tratamiento de la extremidad inferior siempre ha sido una dura prueba para el cirujano plástico. La situación anatómica de la tibia, desprovista de protección muscular en su aspecto anterior, la hace altamente vulnerable ante cualquier traumatismo de la extremidad. Toda lesión a este nivel exige un tratamiento óseo y cutáneo adecuados, que deben realizarse primariamente y en forma conjunta. En el presente trabajo describimos 3 casos de pacientes con traumatismos de extremidad inferior, fracturas acompañadas de pérdida de sustancia, en los cuales se practicaron colgajos musculares para reconstruir las partes afectadas. Estos colgajos, en primera instancia se tomaron del músculo sóleo, pero encontramos el inconveniente del grosor exagerado que presentaba la cobertura a pesar de su atrofia posterior y del defecto estético desagradable que quedaba en la zona donante. Por todo ello realizamos una variante: en lugar de tomar la mitad del músculo como indica la técnica convencional, tomamos solo un cuadrante que sobrevivió a expensas de un solo pedículo vascular dominante. El cuadrante restante sirvió para hacer menos notorio el defecto de la zona donante. Los 3 casos tuvieron éxito y los pacientes están muy satisfechos con los resultados estéticos. Presentamos una alternativa quirúrgica innovadora de Colgajo de Sóleo que se puede aplicar satisfactoriamente para la cobertura de defectos de miembro inferior, al cual hemos llamado colgajo de So (AU)

Lower limb treatment has always been a headache to the plastic surgeon. Tibial anatomy, doesn´t has frontal muscle protection and it´s vulnerable in any trauma. Every lesion in the lower limb must be treated by traumatologyst and plasticsurgeon. In this study we present 3 patients with lower limb trauma, fractures and soft tissue lost, treated with muscle flapto cover affected parts. First, we took the flaps from soleous muscle, but we had problems with flap thickness and with the disgusting defect crated in the donor site. So we have created a variety: instead of taking half of the muscle, we took just a quarter, which survived with only one dominant vessel. The other quarter improved de defect in the donor site. The 3patients were successful and they are happy with the results .We present an innovative surgical variant in muscle Soleous flap that can be useful in lower limb reconstruction, and that we have denominated So flap (AU)

Aspergilosis una micosis cutánea que debemos tener presente: a propósito de un caso / Aspergillosis a skin mycosis that we must have present: a propos of one case

Se presenta el caso de una paciente que fue vista en interconsulta por presentar lesiones en piel, acompañadas, según ecografía, de mixoma cardiaco, y además, con problemas neurológicos, por lo que fue hospitalizada. La biopsia y los resultados del cultivo de piel confirman el diagnóstico de Aspergilosis, por lo que fue tratada con anfotericina B, presentando una mejoría significativa de sus lesiones dermatológicas y de su estado general, pero luego sufre recaída de su sistema neurológico, especialmente por diseminación del Aspergillus a nivel sistémico. La paciente fallece un mes después de su hospitalización. Junto con presentar este interesante caso clínico se realiza una exhaustiva revisión bibliográfica de este tema