Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study.

INTRODUCTION: Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. AIM: To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. MATERIAL AND METHODS: A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4h over the first three days of the patients' hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. RESULTS: Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. CONCLUSIONS: Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events.

Cetoacidosis diabética como debut de diabetes mellitus inmunomediada en paciente en tratamiento con inhibidores de checkpoint / Diabetic ketoacidosis as debut of immune-mediated diabetes mellitus in a patient in treatment with immune checkpoint inhibitors

Los inhibidores de checkpoint (ICP) son anticuerpos usados en inmunoterapia contra el cáncer. Uno de sus blancos de acción es el receptor de muerte celular programada-1 (PD-1), el cual es importante para mantener la tolerancia inmunitaria. Sin embargo, este mecanismo se asocia a riesgo de eventos adversos relacionados a la inmunidad que pueden afectar a múltiples órganos incluyendo el sistema endocrino. Se describe el caso inhabitual de un paciente que a los 18 meses de terapia con ICP debutó con cetoacidosis diabética (CAD).

Immune checkpoint inhibitors consist in antibodies used in immunotherapy against cancer. One of their targets is the programmed cell death-1 (PD-1) receptor, which is important in maintaining self-tolerance. However, this mechanism is associated with a risk for immune-related adverse events potentially affecting multiple organs, including the endocrine system. We describe the unusual case of a patient who, after 18 months of treatment with an immune checkpoint inhibitor, debuted with diabetic ketoacidosis

Tratamiento quirúrgico en estado epiléptico super refractario relacionado con malformación arterio venosa

Introducción: Las malformaciones arteriovenosas cerebrales (MAV) son un conjunto anormal de arterias y venas dilatadas del cerebro y caracterizadas por la pérdida de la organización vascular con una derivación arteriovenosa anormal. La probabilidad de ruptura de una MAV es baja, pudiendo causar déficit hasta en el 45% de los pacientes. La epilepsia puede asociarse con MAV siendo raro el estado epiléptico. La evolución a estado epiléptico refractario o estado epiléptico super refractario (EESR) es excepcional. Se presenta paciente con epilepsia asociada a MAV, con embolización y posterior complicación que evoluciona a EESR, donde se logró una resolución favorable con cirugía. Caso clínico: Paciente masculino de 70 años, con MAV temporal derecha no rota y epilepsia, libre de crisis desde el diagnóstico de ambas condiciones. Se realizó embolización logrando exclusión, pero con evolución a EESR. Tras estudio se realiza resección de MAV y resección parcial de zona de inicio de actividad epileptógena parieto-temporal. Además, se realizó una desconexión de región fronto-parietal central donde había evidencia de propagación de la actividad epiléptica. Paciente logra salir de estado crítico, con recuperación de conciencia y normalización de electroencefalogramas posquirúrgicos. A los 2 años evoluciona con epilepsia controlada (Engel IIa). Discusión y conclusiones: El abordaje quirúrgico es una opción en EESR y debe plantearse en un tiempo precoz de evolución (1-2 semanas). La cirugía se realizó para controlar EESR y fue una intervención exitosa. Esta estrategia puede lograr un cambio dramático en el pronóstico. La cirugía resectiva está indicada cuando hay evidencia etiológica en imágenes y focalidad eléctrica consistente en los estudios.

Introduction: Brain Arteriovenous Malformations (AVM) are an abnormal set of dilated arteries and veins within the brain and are characterized by loss of vascular organization with an abnormal arteriovenous shunt. The probability of AVM rupture is low, but it can cause deficits in up to 45% ofpatients. Epilepsy could be associated with AVM, and status epilepticus is rare. The evolution to refractory status epilepticus or super refractory status epilepticus (SRSE) is very rare. The objective is to present a patient with epilepsy associated with non-ruptured AVM, treated with embolization and a subsequent complication that evolves into SRSE, in which a favorable resolution was achieved after surgery Clinical case: 70-year-old male, with a diagnosis of non-ruptured right temporal AVM and epilepsy, who has been seizure free since the diagnosis, is reported. Embolization of the AVM was performed, achieving total exclusion, after the procedure presented seizures that evolved into SRSE. After investigation, an AVM resection and partial resection of the ictal onset zone on the right parieto-temporal region was performed, including a disconnection of the central fronto-parietal region, where there was evidence of propagation of ictal activity. Patient recovered from the critical condition after surgery, and also presented electrographic normalization. After 2 years, the epilepsy is well controlled (Engel IIa). Discussion and conclusions: The surgical approach is an option in SRSE, and it should be proposed early on, within a reasonable time of evolution (1-2 weeks). The active approach in this case, where the surgery was done for SRSE control, was a successful intervention. Especially when the features are consistent -there is etiological evidence in imaging and electrical focality in studies- there can be a dramatic change in the prognosis.

Not all that glitters is COVID-19: a case series demonstrating the need for histopathology when skin findings accompany SARS-CoV-2 infection.

BACKGROUND: Descriptions of cutaneous findings associated with COVID-19 have not been consistently accompanied by histopathology or confirmatory testing for SARS-CoV-2. OBJECTIVE: To describe and classify the cutaneous findings with supporting histopathology of confirmed COVID-19 inpatients. METHODS: We included consecutive inpatients with a confirmed diagnosis of COVID-19 for whom a dermatology consult was requested. A skin biopsy was performed in all cases. Skin findings were classified as being compatible with a cutaneous manifestation of COVID-19 or as representing a distinct clinical entity. RESULTS: Twenty-eight patients were studied in whom thirty-one dermatologic diagnoses were made. Twenty-two of the dermatoses were compatible with a cutaneous manifestation of COVID-19; nine entities were not associated with infection by SARS-CoV-2. The most common COVID-19-associated pattern was an exanthematous presentation. In four patients, a new pattern was observed, characterized by discrete papules with varied histopathological findings including a case of neutrophilic eccrine hidradenitis. No cases of pernio-like lesions were identified. Skin findings not associated with COVID-19 represented 29% of diagnoses and included Malassezia folliculitis, tinea, miliaria and contact dermatitis. LIMITATIONS: There is no gold-standard test to distinguish between viral exanthems and drug reactions. CONCLUSION: A histopathological study is critical before attributing skin findings to a manifestation of COVID-19.

Psicosis secundaria a meningioma: revisión a propósito de un caso / Secondary psychosis due to meningioma: review about a case

Resumen Los meningiomas son los tumores primarios más frecuentes del sistema nervioso central, tienden a ser benignos y de lento crecimiento. Pueden ser asintomáticos o incluso manifestarse únicamente con síntomas psiquiátricos, incluyendo un cuadro psicótico. No existen estudios clínicos controlados randomizados que estudien la relación entre meningioma y cuadros psicóticos. La evidencia disponible se basa en series y reportes de casos. Existe una relación entre la magnitud del edema perilesional y la presencia de síntomas psicóticos. Por otra parte, el tamaño de la lesión o su localización neuroanatómica específica tendrían menor relevancia. La resección quirúrgica de la lesión, en conjunto con el manejo psiquiátrico adecuado, usualmente conduce al cese de la sintomatología psicótica. En la evaluación de pacientes con síntomas psicóticos se debe tener un elevado índice de sospecha, en particular en cuadros de reciente inicio, con manifestaciones atípicas o resistentes al tratamiento. En estos casos se recomienda un estudio con neuroimágenes. Este artículo presenta el caso de una paciente evaluada en nuestro hospital diagnosticada con un meningioma frontal izquierdo de gran tamaño, que presentó sintomatología psicótica secundaria, y se expone una revisión bibliográfica actualizada de esta asociación.

Meningiomas are the most frequent central nervous primary tumors, which tend to be benign and present a slow growth. They may be asymptomatic or present clinically just with psychiatric symptoms including a psychotic state. There are no clinical randomized controlled trials that study the relationship between meningioma and a psychotic episode. Available evidence is based on case reports and series. There is a relationship between the magnitude of perilesional edema and the presence of psychotic symptoms. On the other hand, the size of the tumor or its specific neuroanatomic location would have less relevance. Surgical resection of the tumor associated with psychiatric management usually leads to the cessation of psychotic symptoms. In the assessment of patients with psychotic symptoms, there must be a high index of suspicion, particularly in first psychotic episodes, atypical manifestations and resistance to treatment. In these cases, a neuroimaging study is recommended. This article presents the case of a patient evaluated in our hospital and diagnosed with a large left frontal meningioma with secondary psychotic symptoms, and an updated bibliographic review of this association is presented.

Intraocular pressure fluctuations in patients implanted with an implantable collamer lens (ICL V4c). Three-month follow-up. / Fluctuaciones de presión intraocular en pacientes operados con implante de implantable collamer lens (ICL V4c). Seguimiento a 3 meses.

INTRODUCTION: Fluctuating elevated intraocular pressure (IOP) is one of the complications of an implantable collamer lens (ICL), and its alteration is a predictive factor for the development of glaucoma. MATERIAL AND METHODS: A prospective, cross-sectional analytic study was conducted on patients suitable for ICL implantation. Complete clinical and biometric work-ups were performed, as well as night-time IOP curve, in supine position, with 4 determinations, in order to assess fluctuation, considering abnormal with a value higher than 5 mmHg. Patients underwent surgery with conventional technique and three months after the work-ups were repeated, including a night-time IOP curve to assess any changes in IOP fluctuations. RESULTS: A total of 31 eyes of 16 patients were studied. Mean IOP fluctuation in the preoperative assessment was 3.35 ± 2 mmHg, whereas the postoperative mean was 3.0 ± 2.2 mmHg, with the difference not being statistically significant. Visual acuity and capacity, as well as spheric equivalent did show a statistically significant improvement. There were 6 cases of complications, which were related to a higher vault and a greater ICL size. There was no relationship between these findings and the angle grade, pigment, and the level of training of the surgeon. CONCLUSIONS: The effect of an ICL on IOP fluctuations, has been studied for the first time, which was found to be not statistically significant. As in previous publications, the procedure was safe and reproducible, adding the fact that the level of training of the surgeon is not a determining factor in these findings.

The small-molecule MERTK inhibitor UNC2025 decreases platelet activation and prevents thrombosis.

Essentials Signaling by Gas6 through Tyro3/Axl/Mer receptors is essential for stable platelet aggregation. UNC2025 is a small molecule inhibitor of the Mer tyrosine kinase. UNC2025 decreases platelet activation in vitro and thrombus formation in vivo. UNC2025's anti-platelet effect is synergistic with inhibition of the ADP receptor, P2Y12 . SUMMARY: Background Growth arrest-specific protein 6 signals through the TAM (TYRO-3-AXL-MERTK) receptor family, mediating platelet activation and thrombus formation via activation of the aggregate-stabilizing αIIb ß3 integrin. Objective To describe the antithrombotic effects mediated by UNC2025, a small-molecule MERTK tyrosine kinase inhibitor. Methods MERTK phosphorylation and downstream signaling were assessed by immunoblotting. Light transmission aggregometry, flow cytometry and microfluidic analysis were used to evaluate the impact of MERTK inhibition on platelet activation and stability of aggregates in vitro. The effects of MERTK inhibition on arterial and venous thrombosis, platelet accumulation at microvascular injury sites and tail bleeding times were determined with murine models. The effects of combined treatment with ADP-P2Y1&12 pathway antagonists and UNC2025 were also evaluated. Results and Conclusions Treatment with UNC2025 inhibited MERTK phosphorylation and downstream activation of AKT and SRC, decreased platelet activation, and protected animals from pulmonary embolism and arterial thrombosis without increasing bleeding times. The antiplatelet effect of UNC2025 was enhanced in combination with ADP-P2Y1&12 pathway antagonists, and a greater than additive effect was observed when these two agents with different mechanisms of inhibition were coadministered. TAM kinase signaling represents a potential therapeutic target, as inhibition of this axis, especially in combination with ADP-P2Y pathway antagonism, mediates decreased platelet activation, aggregate stability, and thrombus formation, with less hemorrhagic potential than current treatment strategies. The data presented here also demonstrate antithrombotic activity mediated by UNC2025, a novel translational agent, and support the development of TAM kinase inhibitors for clinical applications.

Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.

BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.(1) Researchers have shown that prevalence rates in the U.S. may be as high as 1 in 68.(52) A number of studies have examined the effects of early exposure to anesthesia on brain development and subsequent impairment in neurocognitive function; yet, little is known about the possible effects of anesthetic agents on social-behavioral functioning. The association between exposure to anesthesia either in uterus, during the first years of life, or later and development of Autistic Spectrum Disorder (ASD) or its severity was determined in a retrospective population based cohort study. OBJECTIVES: Identify if children who had previous exposure to anesthesia either in uterus, first years of life during their developing brain years, or later, are at risk of developing ASD and its severe form of the disease. METHODS: Data was obtained from structured interviews administered to a sample of 515 parents/guardians distributed in two groups: ASD = 262 children diagnosed with this condition and Non-ASD: 253 children (siblings of ASD group) without diagnosis (95% confidence interval) that freely decided to participate and agreed to a consent form. Variables studied include: demographics, diagnosis and severity of ASD, exposure to anesthesia, method of childbirth, and age of exposure Children less than 2 years of age were considered into have developing brain period. Data was analyzed using Chi-square or Fisher exact test. RESULTS: In contrast to non-ASD group, most of the children within ASD group were male, 76% (p=0.0001). With regards to methods of childbirth, 64% of the ASD population were vaginal delivery (VD; Non-anesthesia exposure group) and 36% cesarean delivery (CD) compared to non-autistic population with 71% VD and 29% CD, which demonstrates no statistical difference between both groups (p=0.1113). Out of the 36% of ASD population that underwent CD, 7% were performed using general anesthesia and 93% regional anesthesia, while the 29% of the CD of non-ASD, 5% were performed using general anesthesia and 95% regional anesthesia. This reveals no statistical significance (p=0.7569) with the development of ASD and the type of anesthesia used when comparing ASD with non-ASD patients. In view of severity of autism, in VD, 56% of ASD population had mild form of the disorder, 34% moderate, and 10% severe; while CD had a 54% mild form of the disorder, 33% moderate, and 13% severe. This shows no statistical association (p=0.8069) when comparing exposure to anesthesia in uterus to subsequent severe form of ASD. Of the 262 ASD patients, 99 had exposure to anesthetics before their diagnosis, while in Non-ASD population, 110 had exposure to anesthesia, demonstrating no statistically significant association between both groups (p=0.2091). Out of 99 ASD patients exposed to anesthesia prior to their diagnosis, 72 were exposed before age 2. When compared to the 110 Non-ASD patients exposed to anesthesia, 86 had exposure during this developing brain period, which indicates no statistically significant association (p=0.4207). In addition, most of the ASD children exposed to anesthesia during developing brain were diagnosed with mild degree of the disorder when compared to ASD children without any previous exposure to anesthesia (p=0.9700) during the same period. When the exposure occurred after age 2, ASD children developed mild form of the disorder as compared with ASD children without any previous exposure to anesthesia (p=0.1699) in that period. CONCLUSIONS: Children under early exposure to anesthesia in uterus, first 2 years of life, or later are not more likely to develop neither ASD nor severe form of the disorder.

Antibodies against spotted fever group Rickettsia sp, in horses of the colombian Orinoquia / Anticuerpos contra Rickettsia sp, del grupo de las fiebres manchadas en equinos de la Orinoquía colombiana

Objective. It was determined the presence of antibodies against Rickettsia sp. of the spotted fever group, in horses of 8 municipalities of the Colombian Orinoquia. Matherials and methods. A cross-sectional study was conducted on 246 sera from apparently healthy horses and processed by the indirect immunofluorescence test (IFI). Results. General seropositivity was (2.85%; 7/246), while by municipalities the results were, Arauca (9.1%; 2/22), Saravena (5.6%; 1/18), San José del Guaviare (4.9%; 2/41), San Martín (3.8%; 1/26), Yopal (1.9%; 1/52). It was not identified the presence of antibodies in Puerto López (0/52), Puerto Gaitán (0/15) and Villavicencio (0/20). Four of the positive samples presented titles of 1:64, while the remaining 3 1:128. Conclusions. It shows the circulation of Rickettsia sp. of the Spotted Fever Group in horses in the region of the Colombian Orinoquia, suggesting the need for further studies to understand the ecoepidemiology of municipalities with presence of seropositive.

Objetivo. Determinar la presencia de anticuerpos contra Rickettsia sp. del grupo de las fiebres manchadas, en equinos de 8 municipios de la Orinoquía Colombiana. Materiales y métodos. Se realizó un estudio transversal en 246 sueros equinos provenientes de animales aparentemente sanos y procesados por la técnica de inmunofluorescencia indirecta (IFI). Resultados. La seropositividad general fue (2.85%; 7/246), por municipios la seropositividad fue Arauca (9.1%; 2/22), Saravena (5.6%; 1/18), San José del Guaviare (4.9%; 2/41), San Martín (3.8%; 1/26) y Yopal (1.9%; 1/52). No se identificó la presencia de seropositivos en Puerto López (0/52), Puerto Gaitán (0/15) y Villavicencio (0/20).Cuatro de las muestras positivas presentaron títulos de 1:64, mientras las 3 restantes de 1:128. No se encontró asociación entre los títulos serológicos con la raza, el sexo, edad y actividad zootécnica. Conclusiones. Se demuestra la circulación de Rickettsia sp. del Grupo de las Fiebres Manchadas en equinos de la región de la Orinoquía Colombiana, sugiriendo la necesidad de nuevos estudios para entender la ecoepidemiología de los municipios con presencia de reactores serológicos.

Examining Mechanisms of Pyrethroid Resistance in Eggs of Two Populations of the Chagas' Disease Vector Triatoma infestans (Hemiptera: Reduviidae).

Chagas disease is a zoonosis transmitted to man by blood-sucking triatomine bugs found in the Americas. Triatoma infestans (Klug, 1834) is the main vector of Chagas' disease in Argentina. The control of this illness relies heavily on vector control through the use of insecticide. However, resistance to pyrethroid insecticides associated with ineffective field treatments has been increasingly reported in T. infestans from Argentina and Bolivia. There are few reports on the expression and causes of resistance in eggs of resistant populations, and even fewer studies on insecticide resistance throughout embryonic development. In this study, we explore the biochemical and molecular mechanisms potentially associated with the deltamethrin resistance assessed in the developing eggs of the Argentinean (Campo Largo) and Bolivian (Entre Ríos) T. infestans populations.We found measurable activity of monooxigenases and pyrethroid esterases throughout embryonic development. The pyrethroid esterase activity grew steadily throughout development in all the studied populations and was highest in eggs 12 d old. Mean enzyme activity increased from 13.6 to 16.3 and 22.2 picomol 7-hydroxycoumarin/min (7-OHC) in eggs of 4-, 7-, and 12 d old from the susceptible reference bug colony. Mean activity of resistant populations increased from 16.0 to 25.9 picomol 7-OHC/min in eggs of 4- to 12 d old in Entre Ríos population, and from 15.9 to 28.9 picomol 7-OHC/min in Campo Largo population. Molecular analysis of susceptible and resistant developing eggs detected L1014F mutation in both resistant populations, but no L925I mutation was found in any of the studied populations.Higher esterase activity and L1014F presence justify the resistance to pyrethroid throughout developing eggs of both studied T. infestans populations. The description of resistance profiles including resistance mechanisms involved will allow a rational design of campaigns for the control of Chagas disease transmission.

Effect of Environmental Conditions and Toxic Compounds on the Locomotor Activity of Pediculus humanus capitis (Phthiraptera: Pediculidae).

In this work, we evaluated the effect of environmental variables such as temperature, humidity, and light on the locomotor activity of Pediculus humanus capitis. In addition, we used selected conditions of temperature, humidity, and light to study the effects of cypermethrin and N,N-diethyl-3-methylbenzamide (DEET) on the locomotor activity of head lice. Head lice increased their locomotor activity in an arena at 30°C compared with activity at 20°C. When we tested the influence of the humidity level, the locomotor activity of head lice showed no significant differences related to humidity level, both at 30°C and 20°C. Concerning light influence, we observed that the higher the intensity of light, the slower the movement of head lice. We also demonstrated that sublethal doses of toxics may alter locomotor activity in adults of head lice. Sublethal doses of cypermethrin induced hyperactivated responses in adult head lice. Sublethal doses of DEET evocated hypoactivated responses in head lice. The observation of stereotyped behavior in head lice elicited by toxic compounds proved that measuring locomotor activity in an experimental set-up where environmental conditions are controlled would be appropriate to evaluate compounds of biological importance, such as molecules involved in the host-parasite interaction and intraspecific relationships.

Resultados de callosotomía en adultos con diagnóstico de epilepsia refractaria y drop-attack / Callosotomy results in adults with diagnosis of refractory epilepsy and drop-attack

Introduction: For patients with refractory epilepsy patients, the sub-group characterized for seizures involving falls or drop-attack, the technique of callosotomy, as a palliative measure has been validated and used to control this type of seizures. Method: Group of 16 patients operated during period of four years, evaluated by protocol, which was performed as a palliative callosotomy crisis management technique was evaluated. Results: The observed group, 10 were males and 6 females, mean age 30 years, range between 19-46 years. Average evolution of epilepsy in 20.8 years, 14 cases crisis was starting before age 14. Major crises were TCG (generalized tonic clonic) and a tonic seizures were being 62.5 percent daily and 37.5 percent monthly, 100 percent had a history of TEC (brain trauma) and 56 percent history of status epilepticus. Was performed anterior callosotomy two thirds in 8 patients (mean follow-up 23.8 months), 6 patients complete callosotomy (average follow-up 15.5 months), and in 2 cases, two anterior thirds and then total callosotomy (1 case 22 months, and another 1 month follow-up). Seizures management fall > 50 percent in 75 percent of patients (3 cases without seizures of fall with anterior callosotomy two thirds), and for complete callosotomy, 100 percent control crisis in > 80 percent of patients (3 cases without seizures of fall was found in this group). Conclusion: The technique callosotomy as a palliative measure in the context of drop-attack or crises involving falls, in our experience with adult patients, has been a good tool in controlling this type of seizures.

Introducción: Dentro del grupo de pacientes refractarios en epilepsia, el sub-grupo caracterizado por crisis que involucran caídas o drop-attack, la técnica de callosotomía, como medida paliativa, ha sido validada y utilizada para el control de este tipo de crisis. Método: Se evaluó grupo de 16 pacientes adultos operados durante período de 4 años, evaluados por protocolo, donde se realizó callosotomía como técnica paliativa de control de crisis. Resultados: Del grupo observado, 10 fueron varones, 6 mujeres, promedio de edad 30 años, rango entre 19 a 46 años. Promedio de evolución de epilepsia de 20,8 años. En 14 casos el inicio de crisis fue antes de los 14 años. Principales crisis fueron TCG (tónico clónico generalizada) y atónicas, siendo en el 62,5 por ceinto diarias y en el 37,5 por ciento mensuales, el 100 por ceinto tenía antecedente de TEC (trauma encéfalo craneano) y en el 56 por ciento antecedente de status epiléptico. Se realizó callosotomía dos tercios anterior en 8 pacientes (seguimiento 23,8 meses promedio), 6 pacientes callosotomía total (seguimiento 15,5 meses promedio), y en 2 casos, dos tercios anterior y luego callosotomía total (1 caso 22 meses, y otro, 1 mes de seguimiento). Se encontró control de crisis de caídas > 50 por ciento en el 75 por ciento (3 casos sin crisis) de casos con callosotomía dos tercios anterior, para callosotomía completa, 100 por ciento control de crisis en > 80 por ciento (3 casos sin crisis) de este grupo. Conclusión: La técnica de callosotomía como medida paliativa en el contexto de drop-attack o crisis que involucren caídas, en nuestra experiencia en pacientes adultos, ha sido una herramienta útil en el control de este tipo de crisis.

Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.

BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.1 Researchers have shown that prevalence rates in the U.S. may be as high as 1 in 68.52 A number of studies have examined the effects of early exposure to anesthesia on brain development and subsequent impairment in neurocognitive function; yet, little is known about the possible effects of anesthetic agents on social-behavioral functioning. The association between exposure to anesthesia either in uterus, during the first years of life, or later and development of Autistic Spectrum Disorder (ASD) or its severity was determined in a retrospective population based cohort study. OBJECTIVES: Identify if children who had previous exposure to anesthesia either in uterus, first years of life during their developing brain years, or later, are at risk of developing ASD and its severe form of the disease. METHODS: Data was obtained from structured interviews administered to a sample of 515 parents/guardians distributed in two groups: ASD = 262 children diagnosed with this condition and Non-ASD: 253 children (siblings of ASD group) without diagnosis (p = 0.8069) when comparing exposure to anesthesia in uterus to subsequent severe form of ASD. Of the 262 ASD patients, 99 had exposure to anesthetics before their diagnosis, while in Non-ASD population, 110 had exposure to anesthesia, demonstrating no statistically significant association between both groups (p = 0.2091). Out of 99 ASD patients exposed to anesthesia prior to their diagnosis, 72 were exposed before age 2. When compared to the 110 Non-ASD patients exposed to anesthesia, 86 had exposure during this developing brain period, which indicates no statistically significant association (p = 0.4207). In addition, most of the ASD children exposed to anesthesia during developing brain were diagnosed with mild degree of the disorder when compared to ASD children without any previous exposure to anesthesia (p = 0.9700) during the same period. When the exposure occurred after age 2, ASD children developed mild form of the disorder as compared with ASD children without any previous exposure to anesthesia (p = 0.1699) in that period. CONCLUSIONS: Children under early exposure to anesthesia in uterus, first 2 years of life, or later are not more likely to develop neither ASD nor severe form of the disorder. INDEX WORDS: Anesthesia, Autism Spectrum Disorder, Puerto Rico. (95% confidence interval) that freely decided to participate and agreed to a consent form. Variables studied, include: demographics, diagnosis and severity of ASD, exposure to anesthesia, method of childbirth, and age of exposure. Children less than 2 years of age were considered into have developing brain period. Data was analyzed using Chi-square or Fisher exact test. RESULTS: In contrast to non-ASD group, most of the children within ASD group were male, 76% (p = 0.0001). With regards to methods of childbirth, 64% of the ASD population were vaginal delivery (VD; Non-anesthesia exposure group) and 36% cesarean delivery (CD) compared to non-autistic population with 71% VD and 29% CD, which demonstrates no statistical difference between both groups (p = 0.1113). Out of the 36% of ASD population that underwent CD, 7% were performed using general anesthesia and 93% regional anesthesia, while the 29% of the CD of non-ASD, 5% were performed using general anesthesia and 95% regional anesthesia. This reveals no statistical significance (p = 0.7569) with the development of ASD and the type of anesthesia used when comparing ASD with non-ASD patients. In view of severity of autism, in VD, 56% of ASD population had mild form of the disorder, 34% moderate, and 10% severe; while CD had a 54% mild form of the disorder, 33% moderate, and 13% severe. This shows no statistical association.

Estado de vacunación en profesionales y técnicos del equipo de salud de hospitales estatales de la Provincia de Córdoba, Argentina / Estado de vacinação em profissionais e técnicos da equipe de saúde de hospitais estaduais da província de Córdoba, Argentina / Immunization status of health professionals and technicians belonging to the health team from state hospitals of the province of Cordoba, Argentina

Objetivo: Determinar el estado de vacunación de losprofesionales y técnicos del equipo de salud de hospitalesestatales de la provincia de Córdoba respecto de lasvacunas contra la hepatitis B, la triple o doble viral, ladoble bacteriana y antiinfluenza. Métodos: Se realizóun estudio de corte transversal, sobre una muestra de844 trabajadores de hospitales públicos pertenecientesal ministerio de salud de la provincia de Córdoba,durante los años 2013 y 2014. Se aplicó un cuestionarioauto-administrado y se realizaron análisis univariadosy bivariados. Para la evaluación de factores asociadoscon la vacunación se aplicó el estadístico chi cuadrado,definiéndose un margen de error del 5% (p < 0,05)y un intervalo de confianza del 95%. Resultados: Laproporción de profesionales y técnicos con coberturasfueron: doble bacteriana 87,2%, anti hepatitis B 77,6% triple o doble viral 69,0% y antiinfluenza el 55,2%. En todas se encontró un mejor estadode vacunación entre quienes poseen mayor educación, menor antigüedad, los más jóvenes,con diferencias significativas según sexo a hepatitis B, y con menos antigüedad en la dobleviral. Conclusión: Los trabajadores estudiados poseen un estado de vacunación inferior alrecomendado internacionalmente, sin embargo resultó similar o superior al reportado endiversos países, poniendo de manifiesto que la sub-cobertura de vacunación en el personalsanitario es una problemática extendida, que debe ser priorizada por las autoridades, dadaslas implicancias para el propio trabajador y la población que atienden.

Objective: To determine the immunization status of health professionals and techniciansbelonging to the health team from state hospitals of the province of Cordoba regardingHepatitis B vaccine; Measles and Rubella vaccine; Measles, Mumps and Rubella Vaccine(MMR); Diphtheria and Tetanus vaccine (DT); and influenza (flu) vaccine. Methods:A cross sectional study was carried out on a sample of 844 workers from public hospitalsbelonging to the Ministry of Health of the province of Cordoba during the years 2013 and2014. A self administered questionnaire was used and univariate analysis and bivariateanalysis were done. For the assessment of factors associated with vaccination, chi squarestatistics was applied; a 5% margin of error was defined (p < 0.05) and a confidence intervalof 95 %. Results: The proportion of professionals and technicians with coverage was:Diphtheria and Tetanus Vaccine (DT) 87.2%, Hepatitis B vaccine 77.6%, MMR vaccineor Measles and Rubella vaccine 69.0% and influenza vaccine 55.2%. Better immunizationstatus was found among those with higher education, less seniority, and younger agewith significant differences regarding sex in hepatitis B and less seniority in Measles andRubella vaccine. Conclusion: The workers studied present an immunization status belowthe one internationally recommended. However, it is similar or higher to the level reportedin different countries, showing that the under-coverage of health professionals is an outspreadproblem that must be prioritized by the authorities, given the implications for theworkers themselves and the population they assist.

Escopo: Determinar o estado de vacinação de profissionais e técnicos da equipe de saú-de de hospitais públicos na província de Córdoba respeito de vacinas contra a hepatite B, adupla ou tríplice viral, a dupla bacteriana e a anti-gripal. Métodos: Um estudo transversalem uma amostra de 844 trabalhadores de hospitais públicos pertencentes ao Ministério daSaúde da província de Córdoba foi realizado durante os anos de 2013 e 2014.Empregou-se um questionário auto-administrado e foram realizadas análises univariadase bivariadas. Para avaliar os fatores associados à vacinação aplicou-se o chi-quadradoestatístico, definindo-se uma margem de erro de 5% (p < 0,05) e um intervalo de confiançade 95%. Resultados: A proporção de profissionais e técnicos com coberturas foia seguinte: duplo bacteriana 87,2%, anti hepatite B 77,6%, tríplice ou dupla 69,0% eanti-gripal 55,2%. Em todas foi encontrado um melhor estado de vacinação entre aquelescom maiores estudos, menor antiguidade, os mais jovens, com diferenças significativas deacordo com o sexo para a hepatite B, e com menos antiguidade na dupla viral. Conclusão:Os trabalhadores estudados têm um estado de vacinação inferior ao recomendado internacionalmente, porém, foi semelhante ou superior ao registrado em vários países, mostrandoque a insuficiente cobertura de-vacinação em profissionais de saúde é um problema generalizadoque deve ser priorizado pelas autoridades dadas as implicações para o trabalhadore para a população que ele serve.

Scientific evidence of three different insecticide-resistant profiles in Triatoma infestans (Hemiptera: Reduviidae) populations from Argentina and Bolivia.

Triatoma infestans (Klug, 1834) (Hemiptera, Reduviidae) is the main vector of Chagas disease in the southern cone South America. Chemical control to the vectors appears to be the best option to reduce the incidence of the disease. However, since 2002, high resistance to insecticides that correlated with field control failures was detected in T. infestans from Argentina and Bolivia. In this paper, we analyzed three T. infestans populations whose pyrethroid-resistance had been recently detected, and we defined at least three resistant profiles according to the toxicological and biochemical characteristics of the studied resistant populations. The resistance profiles were identified as Ti-R1, Ti-R2, and Ti-R3, corresponding to the Argentinean Acambuco, and the Bolivians Entre Ríos and Mataral. Ti-R1 exhibited nymphs and eggs with medium resistance level to deltamethrin (RR = 32.5 and 28.6; respectively). Pyrethroid-esterases played a relevant role in deltamethrin resistance. Ti-R2 exhibited nymphs with high resistance to deltamethrin (RR = 173.8) and low resistance to fipronil (RR = 12.4). Pyrethroid-esterases were involved in resistance. Moreover, eggs showed medium resistance level to deltamethrin (RR = 39.1). Ti-R3 had nymphs with low resistance to deltamethrin (RR = 17.4), and medium resistance to fipronil (RR = 66.8). Pyrethroid-esterases showed increased activity, and eggs possessed low resistance to deltamethrin (RR = 8.4). The characterization of the resistance to pyrethroid in these T. infestans populations from Argentina and Bolivia do not permit the generalization of three forms of resistance profile. So far as we appear to know, the forms of mechanisms and their frequencies reported here are selected independently, so additional sites might well show additional combinations of resistance mechanisms and their frequencies.

Lactancia materna ineficaz: prevalencia y factores asociados / Ineffective Breastfeeding: prevalence and associated factors

Introducción: Es posible evitar muertes neonatales mediante la lactancia materna desde el primer día de vida, pues la leche materna es el alimento óptimo para el lactante por su contenido nutricional necesario favorecer el crecimiento y desarrollo. Objetivo: Determinar la prevalencia y factores asociados al diagnóstico de enfermería "Lactancia materna ineficaz" en lactantes menores de 6 meses hospitalizados en una institución de tercer nivel. Metodología: Estudio de corte transversal. Se seleccionaron 108 binomios (madre e hijo) hospitalizados en una institución de tercer nivel de atención en el año 2009, se aplicó un formato validado para identificar el diagnóstico. Se realizó análisis Rasch a las variables que representan las características definitorias del diagnóstico, con el cual se creó una escala de 0 a 100 y se construyó un modelo de regresión lineal con las variables asociadas a la medida del diagnóstico. Resultados: la prevalencia del diagnóstico fue de 93,5 %, la característica definitoria más fácil de encontrar fue Incapacidad del lactante para agarrarse al pecho materno y la más difícil fue agitación y llanto del lactante dentro de la primera hora después de la lactancia materna. La regresión lineal mostró factores asociados como: género femenino, peso del lactante y necesidad de la madre de ir a orinar. Conclusión: Existe una tendencia desfavorable tanto en la prevalencia como en la duración de la lactancia materna para los lactantes hospitalizados; la promoción de la lactancia materna debe ser un trabajo interdisciplinario; modificar las normas hospitalarias favoreciendo el contacto del binomio y la puesta temprana al pecho materno. Salud UIS 2011; 43 (3): 271-279.

Introduction: neonatal deaths can be prevented by breastfeeding from the first day of life, as is the optimal food for infants by their nutritional content required for better growth and development. Objective: To determine the prevalence and associated factors with nursing diagnosis "ineffective breastfeeding" in infants under than 6 months hospitalized in a tertiary institution. Methodology: Cross sectional study. We selected 108 pairs (mother and child) hospitalized in an institution of tertiary care in 2009, we applied a validated format to identify the diagnosis. Rasch analysis was performed for variables that represent the defining characteristics of the diagnosis, which created a scale of 0 to 100 and built a linear regression model the variables associated with the extent of diagnosis. Results: Prevalence of diagnosis was 93,5 %, the defining characteristic was easier to find the infant’s inability to hold on to the breast and the hardest was shaking and crying of the infant within the first hour after breastfeeding. Linear regression was associated factors such as: female gender, weight infant and the mother need to urinate. Conclusion: There is an unfavorable trend in both the prevalence and duration of breastfeeding for infants hospitalized, promotion of breastfeeding should be an interdisciplinary, modify hospital policies favoring the contact of the binomial and the early start to the chest maternal. Salud UIS 2011; 43 (3): 271-279.

New findings of insecticide resistance in Triatoma infestans (Heteroptera: Reduviidae) from the Gran Chaco.

Chagas disease is a major health concern in Latin America, and Triatoma infestans (Klug, 1834) is responsible for the majority of cases of Chagas disease in the continent. After the discovery of deltamethrin highly resistant populations in the neighboring areas to Yacuiba (Bolivia) and Salvador Mazza (Argentina), we studied T. infestans populations north and southward, with the aim of describing the range of the resistant area. In addition, tests were conducted to describe the susceptibility to fipronil in deltamethrin-resistant populations. Tarija populations were highly resistant to deltamethrin, showing that the resistant area is greater than previously reported. Argentinean and Paraguayan populations were susceptible or presented moderate to low levels of deltamethrin resistance. Resistance to fipronil was found in Bolivian populations, although this insecticide was effective against Argentinean populations. This study shows that the Argentinean and Paraguayan populations are currently under successful control with deltamethrin. However, continuous resistance monitoring is necessary. We found that fipronil is a viable option for Argentina, whereas the resistance found in Bolivia implies that new formulations are needed to control T. infestans in Bolivia. Further research is required to find new alternatives of control in those areas that are currently suffering from high infestation rates.

Atención primaria y trastornos mentales y del comportamiento: una mirada exploratoria / Primary careand mental and behavior disorders: an exploratory view

Objetivo: Identificar la prevalencia de los problemas de comportamiento y salud mental que se relacionan con el primer nivel de atención a partir del análisis de las estadísticas de mortalidad a nivel nacional y el la provincia de Córdoba. Metodología: La fuente analizada fue la Base de Datos de Mortalidad 2005-2006 del Ministerio de Salud de la Nación. Se calcularon tasas de mortalidad bruta (TMB) y específica (TME) según sexo, edad y causa por trastornos mentales y de comportamiento (TMyC), Mortalidad proporcional (MP) y la razón de tasas para país y provincia de Córdoba. Software SPSS e InfoStat. Resultados: En el año 2005, la TMB fué similar entre país y provincia de Córdoba, mientras que la TME por causa y por sexo fueron inferiores en Córdoba. Los TMYC representaron el 0.74 % de MP en Argentina, valores similares se registraron en el 2006. Conclusión: La prevalencia de los TMyC observados en los registros de estadísticas virtuales de Argentina y provincia de Córdoba se relacionan a patologías que están incluidas como necesidades en el primer nivel de atención.

Programa piloto para pacientes beneficiarios de Fonasa, que padecen esclerosis multiple: tratamiento con inmunomoduladores en el sistema público de salud de Chile: Informe del primer año, 10 de julio 2008-30 de Junio 2009 / Pilot national treatment program for multiple sclerosis patients belonging to the public health care system of Chile (FONASA) with immunomodulating disease-modifying therapies: first year report from July 2008 to June 2009

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...

Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...