Relationships between depression, anxiety, and motivation in the real-world: Effects of physical activity and screentime.

Background: Mood and anxiety disorders are highly prevalent and comorbid worldwide, with variability in symptom severity that fluctuates over time. Digital phenotyping, a growing field that aims to characterize clinical, cognitive and behavioral features via personal digital devices, enables continuous quantification of symptom severity in the real world, and in real-time. Methods: In this study, N=114 individuals with a mood or anxiety disorder (MA) or healthy controls (HC) were enrolled and completed 30-days of ecological momentary assessments (EMA) of symptom severity. Novel real-world measures of anxiety, distress and depression were developed based on the established Mood and Anxiety Symptom Questionnaire (MASQ). The full MASQ was also completed in the laboratory (in-lab). Additional EMA measures related to extrinsic and intrinsic motivation, and passive activity data were also collected over the same 30-days. Mixed-effects models adjusting for time and individual tested the association between real-world symptom severity EMA and the corresponding full MASQ sub-scores. A graph theory neural network model (DEPNA) was applied to all data to estimate symptom interactions. Results: There was overall good adherence over 30-days (MA=69.5%, HC=71.2% completion), with no group difference (t(58)=0.874, p=0.386). Real-world measures of anxiety/distress/depression were associated with their corresponding MASQ measure within the MA group (t's > 2.33, p's < 0.024). Physical activity (steps) was negatively associated with real-world distress and depression (IRRs > 0.93, p's ≤ 0.05). Both intrinsic and extrinsic motivation were negatively associated with real-world distress/depression (IRR's > 0.82, p's < 0.001). DEPNA revealed that both extrinsic and intrinsic motivation significantly influenced other symptom severity measures to a greater extent in the MA group compared to the HC group (extrinsic/intrinsic motivation: t(46) = 2.62, p < 0.02, q FDR < 0.05, Cohen's d = 0.76; t(46) = 2.69, p < 0.01, q FDR < 0.05, Cohen's d = 0.78 respectively), and that steps significantly influenced intrinsic motivation (t(46) = 3.24, p < 0.003, q FDR < 0.05, Cohen's d = 0.94). Conclusions: Novel real-world measures of anxiety, distress and depression significantly related to their corresponding established in-lab measures of these symptom domains in individuals with mood and anxiety disorders. Novel, exploratory measures of extrinsic and intrinsic motivation also significantly related to real-world mood and anxiety symptoms and had the greatest influencing degree on patients' overall symptom profile. This suggests that measures of cognitive constructs related to drive and activity may be useful in characterizing phenotypes in the real-world.

Effects of finite counterion size and nonhomogeneous permittivity and viscosity of the solution on the electrokinetics of a concentrated salt-free colloid.

In the present work, a general model of the electrokinetics and dielectric response of a concentrated salt-free colloid is developed which includes consideration of the finite size of the counterions released by the particles to the solution, a nonhomogeneous permittivity of the solution, the existence of Born and dielectrophoretic forces acting on the counterions, and especially the fact that the solution viscosity and diffusion counterion coefficient are allowed to be functions of the local counterion concentration. These effects have recently been discussed by J. J. López-García et al. [Phys. Rev. Fluids 4, 103702 (2019)10.1103/PhysRevFluids.4.103702] in the case of dilute colloids in general electrolyte solutions. The objective of this work is to explore the new effects and their influence on the electrokinetic response of concentrated salt-free systems. Present results confirm previous findings regarding the important increases of the dc electrophoretic mobility and dc electrical conductivity, as well as huge increments of the dynamic electrophoretic mobilities at high frequencies when finite-ion-size effects were taken into account. In addition, consideration of the viscosity of the solution and of the counterion diffusion coefficient as functions of the local counterion concentration leads to a decrease of the magnitude of the previous electrokinetic results. The theory incorporates a more convenient hard-sphere hydrodynamic model to account for the nonhomogeneous viscosity of the solution than others proposed in previous works in the literature. A comparison is elaborated on between electrokinetic and dielectric responses with different levels of complexity of the theoretical model, starting from the case of pointlike counterions and following with the inclusion in sequence of additional aspects such as finite counterion size, nonhomogeneous electrical permittivity with associated Born and dielectrophoretic effects, and, finally, position-dependent viscosity and diffusion counterion coefficient, and clearly shows the influence of individual effects on the general electrokinetic response and especially the relevant role the nonhomogeneous viscosity on the dc and ac electrokientic behavior of salt-free colloids.

Exposición a radiación del cirujano de columna / Radiation exposure of the spine surgeon

Resumen: Introducción: en general, los cirujanos de columna buscan minimizar el daño a tejidos blandos empleando abordajes menos invasivos, lo que ocasiona que utilicen imágenes intraoperatorias de una manera mucho más habitual que el resto de las especialidades quirúrgicas; por lo tanto, están en mayor riesgo de exposición de radiación. Objetivo: el propósito del trabajo es analizar la cantidad de radiación a la cual está expuesto el cirujano de columna en diferentes escenarios. Material y métodos: estudio prospectivo con una fuente de datos descriptiva, longitudinal, no aleatorizada. Se llevó a cabo el estudio en el período del año 2015 al 2019; la protección radiológica consistió en chaleco plomado, protector de tiroides y lentes plomados; se usaron 10 dosímetros. Resultados: cuatro dosímetros fueron incluidos en el estudio, los otros seis fueron excluidos. Durante el estudio, un cirujano sufrió de cáncer de tiroides y otro de liposarcoma. En el grupo de protegidos se incluyeron dos cirujanos, en el grupo de protección aleatorizada se incluyó un cirujano y en el grupo sin protección se incluyó un cirujano. El dosímetro del grupo sin protección recibió mayor cantidad de radiación en todos los años, se realizó un análisis inferencial por año relacionado con el número de cirugías no encontrando correlación significativa, atribuimos este resultado a que no clasificamos el tipo de cirugía realizada por cada cirujano. Conclusión: el cirujano de columna debe de aplicar los métodos primarios de protección radiológica, ya que los cirujanos de columna sin equipo de protección reciben mayor cantidad de radiación en comparación con los protegidos.

Abstract: Introduction: in general, spine surgeons seek to minimize soft tissue damage by using less invasive approaches, which causes them to use intraoperative images much more frequently than other surgical specialties; therefore, they are at increased risk of radiation exposure. Objective: the aim of this work was to analyse the amount of radiation to which the spine surgeon is exposed in different scenarios. Material and methods: a prospective study with a descriptive, longitudinal non-randomized data source. We carried out this study in the period from 2015 to 2019, the radiologic protection consisted in lead apron, thyroid shield and leaded glasses, there were 10 badge dosimeters. Results: only 4 dosimeters were included in the study, the other six were excluded. During the study period one surgeon suffered thyroid cancer and other suffered of liposarcoma. In the protected group were two surgeons, in the group of aleatory exposition was one surgeon and in the unprotected group was one surgeon. In the study the dosimeter in the unprotected group received more amount of radiation in all the years, we did an inferential analysis per year related with the number of surgeries without significant correlation, we attribute this result because we didn't classified the type of surgery realized by each surgeon. Conclusion: we conclude that the spine surgeon must apply the primary methods of radiological protection and that the unprotected spine surgeon receives more amount of radiation in comparison of the protected ones.

Testing spatial working memory in pigs using an automated T-maze.

Pigs are an important large animal model for translational clinical research but underutilized in behavioral neuroscience. This is due, in part, to a lack of rigorous neurocognitive assessments for pigs. Here, we developed a new automated T-maze for pigs that takes advantage of their natural tendency to alternate. The T-maze has obvious cross-species value having served as a foundation for cognitive theories across species. The maze (17' × 13') was constructed typically and automated with flanking corridors, guillotine doors, cameras, and reward dispensers. We ran nine pigs in (1) a simple alternation task and (2) a delayed spatial alternation task. Our assessment focused on the delayed spatial alternation task which forced pigs to wait for random delays (5, 60, 120, and 240 s) and burdened spatial working memory. We also looked at self-paced trial latencies, error types, and coordinate-based video tracking. We found pigs naturally alternated but performance declined steeply across delays (R2 = 0.84). Self-paced delays had no effect on performance suggestive of an active interference model of working memory. Positional and head direction data could differentiate subsequent turns on short but not long delays. Performance levels were stable over weeks in diverse strains and sexes, and thus provide a benchmark for future neurocognitive assessments in pigs.

Diagnóstico de parasitosis gastrointestinal en ganado vacuno de razas carniceras con diferentes técnicas coproparasitológicas / Diagnosis of gastrointestinal parasitosis in beef cattle of butcher breeds with different coproparasitological techniques

RESUMEN Las parasitosis gastrointestinales en bovinos de producción son uno de los problemas sanitarios más importantes a nivel mundial. Estos nematodos ocasionan problemas gastroentéricos que se caracterizan clínicamente por diarrea, debilidad, hemorragias y deshidratación. Entre las parasitosis gastrointestinales causadas por nematodos en ganado bovino, se destacan las familias: Trichuridae, Trichostrongylidae, Ancylostomidae, Ascaridae y Strongyloididae. El propósito de esta investigación fue determinar la eficacia de las distintas técnicas coproparasitológicas cualitativas y cuantitativas para la detección de nematodos gastrointestinales en ganado bovino. Para este estudio se utilizaron 250 muestras de vacas de raza carnicera, divididos en diferentes grupos, para la aplicación de las técnicas coproparasitológicas de tipo cualitativo y cuantitativo, los cuales fueron escogidos específicamente teniendo en cuenta criterios de inclusión y exclusión para cada animal. Los resultados entregados por este estudio indicaron que el mayor porcentaje en la identificación de estados infectantes parasitarios fue por medio de las técnicas coproparasitologicas de tipo cualitativo, principalmente aquellas de flotación de sulfato de zinc y magnesio con un 50%.

ABSTRACT Gastrointestinal parasites in production cattle are one of the most important health problems worldwide. These nematodes cause gastroenteric problems that are clinically characterized by diarrhoea, weakness, bleeding and dehydration. Within the gastrointestinal parasites caused by nematodes in cattle, the following families stand out: Trichuridae, Trichostrongylidae, Ancylostomidae, Ascaridae and Strongyloididae. The purpose of this research was to determine the efficacy of the different qualitative and quantitative coproparasitological techniques for the detection of gastrointestinal nematodes in cattle. For this study, 250 samples of beef breed cows were used, divided into different groups, for the application of qualitative and quantitative coproparasitological techniques, which were specifically chosen taking into account inclusion and exclusion criteria for each animal. The results delivered by this study indicated that the highest percentage in the identification of parasitic infective states was through qualitative coproparasitological techniques, focused mainly on zinc and magnesium sulfate flotation techniques with 50%.

Utilidad de la tomografía computada de cavidades paranasales como evaluación otorrinolaringológica pretrasplante renal / Usefulness of computed tomography of the paranasal sinus as a kidney pre-transplant otorhinolaryngological evaluation

Resumen Introducción: El trasplante renal corresponde al tratamiento de elección para la enfermedad renal crónica. No existe un protocolo universalmente aceptado para la evaluación otorrinolaringológica del receptor del riñón a implantar, existiendo una gran heterogeneidad en su práctica. La tomografía computada de cavidades paranasales es uno de los estudios más habitualmente utilizados para descartar patologías otorrinolaringológicas que contraindiquen la intervención. Objetivo: Describir los hallazgos imagenológicos de las tomografías computadas solicitadas como evaluación pretrasplante renal. Determinar si estos hallazgos condicionaron una contraindicación para trasplante o algún cambio en el manejo del paciente. Material y Método: Estudio descriptivo de corte transversal mediante la revisión de fichas clínicas de pacientes derivados a estudio pretrasplante renal durante el año 2018 en el Hospital Carlos Van Buren. Resultados: Se obtuvo información de 40 pacientes derivados para evaluación otorrinolaringológica. El promedio de edad fue de 49 ± 11,4 años; 55% fueron mujeres. La causa más frecuente de enfermedad renal fue idiopática (70%). A 34 de 40 pacientes se les solicitó evaluación tomográfica. A cinco pacientes se les indicó corticoides intranasales y se derivó un paciente a evaluación dental. No se generó ninguna contraindicación para el trasplante renal. Discusión: Existe poca literatura sobre la utilidad de la tomografía de cavidades paranasales como estudio pretrasplante renal. En el presente estudio no se encontró ningún hallazgo que contraindicara la intervención. Conclusión: Se necesitan más estudios para poder asegurar si la evaluación otorrinolaringológica y el uso de tomografía tiene alguna implicancia en la evolución de los pacientes sometidos a trasplante renal.

Abstract Introduction: Kidney transplantation is the treatment of choice for chronic kidney disease. There is no universally accepted protocol for the otorhinolaryngological evaluation of the recipient, and there is heterogeneity in clinical practice. Computed tomography of the paranasal cavities is one of the most commonly used studies to rule out otorhinolaryngological pathologies that contraindicate the intervention. Aim: To describe the imaging findings of the computed tomographies requested as a pre-transplant evaluation. To determine if these findings determined a contraindication for transplantation or any change in the patient's management. Material and Method: Descriptive cross-sectional study by reviewing the clinical records of patients referred to a pre-kidney transplant study during 2018 at the Hospital Carlos Van Buren. Results: Information was obtained from 40 patients referred for otorhinolaryngological evaluation. The average age was 49 ± 11.4 years; 55% were women. The most common cause of kidney disease was idiopathic (70%). 34 of 40 patients had a computed tomography. Five patients received intranasal corticosteroids and one patient was referred for dental evaluation. There were no contraindications for renal transplantation. Conclusion: There is little literature on the usefulness of paranasal cavity tomography as a pre-kidney transplant study. In the present study, no finding was found that would contraindicate the intervention. More studies are needed to be able to ascertain whether the otorhinolaryngological evaluation and the use of tomography have any implications in the evolution of patients undergoing kidney transplantation.

Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico / Myocardial infarction with non-obstructive coronary artery disease. Diagnostic value of intravascular imaging and cardiac resonance

BACKGROUND: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. AIM: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. MATERIAL AND METHODS: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. RESULTS: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. CONCLUSIONS: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Posición del hueso hioides en pacientes con mordida abierta / Hyoid bone position in open bite patients

Objetivo: Evaluar la posición de hueso hioides en pacientes con mordida abierta, mediante el trazado cefalométrico del triángulo hioideo propuesto por Rocabado, Bibby y Preston. Materiales y método: Se analizaron 32 radiografías cefálicas laterales digitales, obtenidas de un centro odontológico de la ciudad de Cuenca, correspondientes a individuos de ambos sexos, entre 5 a 26 años de edad. Las telerradiografías fueron analizadas mediante el programa Nemoceph NX, donde se determinó la posición anteroposterior y vertical del hueso hioides, mediante el trazado cefalométrico del triángulo hioideo propuesto por Rocabado, Bibby y Preston, siendo el mentón, la tercera vértebra cervical y el hueso hioides las estructuras que se utilizaron para realizar dicho trazado. Resultados: Se observó una posición anterosuperior del hueso hioides en individuos con mordida abierta, con un triángulo hioideo positivo, pero no siempre, ya que en algunos de los casos se presentó un triángulo hioideo negativo. Se evidenciaron diferencias estadísticamente negativas entre hombres y mujeres en lo que respecta a la posición vertical del hueso hioides. Esta posición varió en los diferentes grupos etarios, con una posición más superior en un rango de edad menor y descendiendo conforme avanza la edad. Conclusiones: la posición del hueso hioides en pacientes con mordida abierta tiene una tendencia anterosuperior, influenciada por el sexo y la edad. En el presente estudio, casi la mitad de los pacientes presentó un triángulo hioideo positivo (59,4%) pero no en todos los casos, ya que presentaron también un triángulo hioideo negativo (40,6%) (AU)

Influence of Surface Sealants on Microleakage in Composite Restorations / Estudio de la Influencia de los Sellantes de Superficie sobre la Microfiltración en Restauraciones de Composite

ABSTRACT: Polymerization shrinkage of composites can generate stress that results in the formation of microgaps at the resin-enamel interface and marginal leakage. The aim of the present work was to evaluate the influence of surface sealants on microleakage in composite restorations. Enamel-dentin occlusal cavities were prepared in 30 non-carious upper and lower premolars. The cavities were restored with One Coat Bond SL and Brilliant New Generation (Coletene), following the manufacturers' instructions, and polished appropriately. The samples were randomly assigned to one of the following six treatment groups: Group I (Control-no sealant); Group II: Single Bond (3M/ESPE); Group III: Perma Seal (Ultradent); Group IV: Heliobond (Vivadent); Group V: Biscover LV (Bisco); Group VI: Bioforty (Biodinâmica). The samples were then immersed in 2 % aqueous methylene blue solution for 48 hours, and thermocycled 100 times from 5 ºC to 55 ºC. The obtained specimens were ground in a bucco-palatal orientation to reach the medial plane, and observed under a stereoscopic loupe at 40X. The degree of microleakage was evaluated by assessing the penetration of the dye to the tooth-restoration interface, using a 0 to 3 grading scale. The obtained data were analyzed using the Kruskal-Wallis non-parametric test. Significant differences were observed between all rebonded groups and the control group; no differences were observed among Single Bond, Perma Seal and bioforty, or between Heliobond and Biscover LV. It would seem convenient to apply a surface sealant over composite restorations to improve marginal integrity and reduce microleakage.

RESUMEN: La contracción de polimerización de los composites puede generar fuerzas que determinan la formación de microbrechas en la interfase resina-esmalte y filtración marginal. El objetivo de este trabajo fue evaluar la influencia de los sellantes de superficie, en restauraciones de composite, sobre la microfiltración. Se utilizaron 30 premolares superiores e inferiores, libres de caries, donde se realizaron preparaciones oclusales amelodentinarias que fueron obturadas con One Coat Bond SL y Brilliant New Generation (Coletene), siguiendo las indicaciones del fabricante y pulidas adecuadamente. Luego las muestras se distribuyeron aleatoriamente en seis grupos, según los materiales experimentales: Grupo I (Control), Grupo II: Single Bond (3M/ESPE), Grupo III: Perma Seal (Ultradent), Grupo IV: Heliobond (Vivadent), Grupo V: Biscover LV (Bisco), Grupo VI: bioforty (biodinámica). Posteriormente las piezas fueron sometidas a ciclaje térmico por 100 ciclos entre 5 ºC y 55 ºC, sumergidas en una solución acuosa de azul de metileno al 2 % durante 48 horas y desgastadas en sentido V-P, hasta el plano medial, para ser observadas con lupa estereoscópica a 40 X. El grado de filtración se evaluó por la penetración del colorante en la interfase diente-restauración en una escala de O a 3. Los datos obtenidos fueron analizados mediante la muestra no paramétrica de Kruskal-Wallis. Se encontraron diferencias significativas de todos los grupos con respecto al grupo control (p= 0,0167), no existiendo significación entre Single Bond, Perma Seal y bioforty ni entre Heliobond y Biscover LV. En restauraciones de composite, sería conveniente la aplicación de sellantes de superficie para mejorar la integridad marginal y disminuir la microfiltración.

Enfermedad de finkelstein: reporte de un caso / Finkelstein's disease: a case report

La enfermedad de Finkelstein es una vasculitis leucocitoclástica de pequeños vasos y de curso benigno que afecta principalmente a niños menores de 2 años y se caracteriza por manifestaciones cutáneas singulares, debido al aspecto morfológico y por la aparición súbita de sus lesiones. Característicamente no se presentan afectaciones viscerales asociadas y su típica apariencia de las lesiones cutáneascontrasta con el buen estado general de los niños afectados, presentando completa y espontánea recuperación en 1-3 semanas, sin secuelas permanentes post inflamatorias. Se informa de un lactante de 18 meses de edad, cuatro días de evolución caracterizada por múltiples lesiones tipo placas purpúricas múltiples, multiformes en cara, miembros superiores e inferiores y región glútea, asociado a edema demanos y pies. La importancia del estudio radica en la etiología desconocida, la poca frecuencia de la enfermedad y en la necesidad de un diagnóstico diferencial entre la enfermedad de Finkelstein y la Púrpura de Schõlein-Henoch (PSH) debido a sus similitudes clínicas, ya que de ello dependen varios factores; en primer lugar el diagnóstico médico, pues en vista de la poca información reportada sobre eltema y a la semejanza con la PSH se pueden hacer diagnósticos equivocados y por ende tratamientos innecesarios, por esta misma razón, se cree que hay un mayor número de casos de enfermedad de Finkelstein no diagnosticados.

Finkelstein’s disease is a leukocytoclastic vasculitis of small vessels and benign course that mainly affects children under the age of 2years and is characterized by typical cutaneous manifestations. Characteristically associated visceral affectations do not occur and thespectacular nature of the skin lesions contrasts with the general condition of the affected children, presenting complete and spontaneous recovery in 1-3 weeks, without permanent sequelae. An 18 month old infant, four days of evolution characterized by multiple typepurpuric plaques multiple, multifaceted purpuric on face, upper and lower limbs, and gluteus, associated with edema of face hands and feet. The importance of the study lies in the unknown etiology, the infrecuency of the disease, and the need for a differential diagnosisbetween disease of Finkelstein and the Henoch Shonlein Purpura (PSH) due to their clinical similarities, since it´s depends on several factors; first medical diagnosis, because in view of the limited information reported on the topic and the similarity with the PSH can makewrong diagnoses and therefore unnecessary treatments, for this same reason, believed that there is a greater number of undiagnosed casesof disease of Finkelstein.

Sialoadenitis purulenta submaxilar producida por cuerpo extraño en el conducto de Wharton / Submandibular sialoadenitis due to a foreign body in the Wharton duct

Una causa frecuente de infección crónica de la glándula submaxilar es la obstrucción de su conducto excretor que puede ser causada por litiasis, tapones de moco o a por la presencia de un cuerpo extraño. En las tres circunstancias se desarrollan cuadros de inflamación crónica del conducto (sialodoquitis) y de la glándula (sialoadenitis). Los estudios de imágenes radiográficas adecuadas son de gran utilidad para el diagnóstico, puesto que revelan el elemento obstructivo La presencia dentro del conducto salival de un cuerpo extraño es extremadamente rara. En este reporte se presenta un caso inusual de un paciente masculino de 23 años de edad que presentaba secreción purulenta debajo de la lengua y dolor crónico en la región submaxilar izquierda, de diez años de duración, donde el examen radiográfico convencional y la tomografía espiral multicorte contribuyeron al diagnóstico, identificando un mondadientes de madera alojado dentro del con ducto de Wharton. Se discute la importancia de la anamnesis y la interpretación de las imágenes en el manejo del caso.

One of the more frequent causes of submandibular sialoadenitis is the obstruction of its duct. The obstruction can be caused by lithiasis, mucus plug or a foreign body. The three circumstances produce inflammation and infection of the duct and the gland. Appropriated radiographic image techniques are very useful to demonstrate the obstructive object. The presence of a foreign body in the salivary duct is extremely rare. In this article is reported an unusual case of a 23-year-old male patient that presented purulent secre tion in the floor of the mouth and complained of chronic pain in the submandibular salivary gland, both lasting for ten years. Conventional radiographies and computed radiographs allowed to identify a wood toothpick inside the WhartonÆs duct. Data obtained during anamnesis and interpretations of radiographic findings are discussed for the adequate management of the case.

Manejo actual de la estenosis de carótida: tratamiento endovascular comparado con endarterectomía / Current management of carotid stenosis: endovascular treatment versus endarterectomy

Antiplatelet therapy used to be the only way to prevent further cerebrovascular events in patients with carotid stenosis. After publication of final results of the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET), endarterectomy was considered the best treatment option. Currently, endovascular treatment of atherosclerotic carotid artery stenosis has been established as an alternative to surgical endarterectomy. Our aim is to show the evolution of endovascular therapy in carotid stenosis, to compare outcomes between endovascular, medical and surgical treatments, and to analize the current state of endovascular therapy. It is worth underscoring that many of the studies were conducted decades ago and consequently both the endovascular technique and medical treatments used then greatly differ from current practices. Several studies agree stenting benefits patients under 70 years of age and exhibits, at least, same short-term results as endarterectomy, along with higher rate of long-term restenosis. Indication for treatment in asymptomatic patients and the use of protection systems remain an unresolved issue. A multidisciplinary team should implement an individualized treatment plan for each patient.

En estenosis carotidea, la única manera de prevenir nuevos eventos cerebrovasculares era mediante antiagregación. Después de los estudios NASCET y ECST se estableció que la endarterectomía conseguía mejores resultados. Ahora se ha establecido la terapia endovascular como alternativa. Nuestro objetivo es mostrar la evolución de la terapia endovascular en estenosis carotidea, contrastar los resultados entre tratamiento endovascular, médico y quirúrgico y exponer la situación actual de la terapia endovascular. Algunos estudios se realizaron hace décadas y tanto la técnica endovascular como los tratamientos médicos, no son comparables con los de hoy. Varios estudios coinciden en que el stenting beneficia a menores de 70 años y presenta al menos iguales resultados que la endarterectomía a corto plazo, con mayor tasa de reestenosis a largo plazo. Quedan por resolver la indicación de tratamiento en pacientes asintomáticos o la utilización de sistemas de protección. El tratamiento debe ser individualizado en un equipo multidisciplinar.

FLAVONOIDES AISLADOS DE LAS INFLORESCENCIAS DE Piper hispidum Kunth (PIPERACEAE) Y DERIVADOS ACETILADOS ISOLATED / FLAVONOIDS FROM INFLORESCENCES OF Piper hispidum Kunth (PIPERACEAE) AND ACETYLATED DERIVATIVES / DERIVATIVES FLAVONOIDES ISOLADOS DAS INFLORESCÊNCIAS DE Piper hispidum Kunth (PIPERACEAE) E DERIVADOS ACETILADOS

A partir del extracto etanílico de las inflorescencias de la especie Piper hispidum Kunth (Piperaceae) fueron aislados tres flavonoides: 5-hidroxi-7-metoxiflavanona, 5-hidroxi-4,7-dimetoxiflavanona y 2,4,6-trimetoxidihidrochalcona. De las flavanonas aisladas fueron obtenidos los derivados acetilados: 5-acetoxi- 7-metoxiflavanona y 5-acetoxi-4,7- dimetoxiflavanona. Las estructuras fueron elucidadas empleando técnicas espectrocópicas y por comparacióncon datos de literatura. Los compuestos naturales y sus derivados fueron sometidos al bioensayo de letalidad frente a Artemia salina. El flavonoide 5-hidroxi-7-metoxiflavanona presenta la mayor actividad tóxica frente a los microcrustáceos CL50 1.8 [1]g/ml.

From the ethanolic extract of the inflorescences of Piper hispidum Kunth (Piperaceae) were isolated three flavonoids 5-hydroxy-7-methoxyflavanone, 5-hydroxy-4,7-dimethoxyflavanone and 2,4,6-trimethoxydihydrochalcone. The acetylated derivatives 5-acetoxy- 7-methoxyflavanone and 5-acetoxy- 4,7- dimethoxyflavanone were synthesized from the isolated pure flavanones. Characterization was mainly achieved by spectroscopic techniques and compared with literature data. Natural compounds and derivatives were subjected to brine shrimp lethality bioassay. The most toxic compound was the flavonoid 5-hydroxy- 7-methoxyflavanone with a LC50 1,8 [1]g/ml.

A partir do extracto etanílico das inflorescancias da especie Piper hispidum Kunth (Piperaceae) foram isolados tras flavonoides: 5-hidroxi-7-metoxiflavanona, 5-hidroxi-4,7-dimetoxiflavanona y 2,4,6-trimetoxidihidrochalcona. Das flavanonas isoladas foram sintetizados os derivados acetilados 5-acetoxi-7-metoxiflavanona y 5-acetoxi-4,7-dimetoxiflavanona. As estruturas foram elucidadas empregando técnicas espectrocópicas e por comparasau com dados da literatura. Os compostos naturais e seus derivados foram submetidos a bioensaáos de letalidade frente a Artemia salina. O flavonoide 5-hidroxi-7-metoxiflavanona presenta uma major atividad toxica frente aos microcrustaceos CL50 1,8 [1]g/ml.

Longitud del canal cervical uterino como factor de riesgo de parto prematuro en pacientes sintom¨¢ticas / Cervical length as a risk factor of preterm delivery

Objetivo: Determinar si el acortamiento del cuello uterino en pacientes sintom¨¢ticas es predictor de parto prematuro en o antes de las 35 semanas y dentro de 7 d¨ªas. M¨¦todo: Se estudiaron 852 pacientes que consultaron por din¨¢mica uterina, a las que se midi¨® el cuello uterino al ingreso. Las pacientes fueron manejadas de acuerdo a las Gu¨ªas Cl¨ªnicas del Hospital. Se excluyeron las pacientes en trabajo de parto, con membranas rotas o con cerclaje. Resultados: La edad gestacional promedio al ingreso fue 31,5 semanas (rango: 24,0-34,9). Se present¨® parto prematuro a las 35 semanas o antes en 61 casos (7,2%), y dentro de los 7 d¨ªas del ingreso en 14 pacientes (1,6%). Fueron predictores independientes significativos (OR; IC95%) para un parto ¡Ü35 semanas las siguientes variables: antecedente de prematurez (2,03; 1,06-3,89), metrorragia (6,87; 2,83-16,65) y canal cervical <25 mm (3,31; 1,92-5,7). El an¨¢lisis con curvas ROC demostr¨® que el valor de corte que mejor predice un parto ¡Ü35 semanas y dentro de 7 d¨ªas de ingresada, es un cuello uterino <19,5 mm (p<0,05). Conclusiones: El acortamiento del canal cervical en pacientes sintom¨¢ticas, particularmente con un canal <20 mm, se asocia con un riesgo significativo de parto prematuro ¡Ü35 semanas y dentro de 7 d¨ªas de ingresada. La medici¨®n de canal cervical ayuda a distinguir a las pacientes en riesgo, con el fin de concentrar esfuerzos en ese grupo de embarazadas.

Objective: To determine if the shortening of cervical length (CL) in women with threatened preterm labor could predict delivery at or before 35 weeks´ gestation and within 7 days of presentation. Method: Sonographic measurement of CL was done in 852 women with singleton pregnancies presenting with painful uterine contractions. Women in labor, with ruptured membranes or those with cervical cerclage were excluded. Results: Median gestational age at presentation was 31.5 (range: 24.0-34.9) weeks and median cervical length was 31.5 (range: 3-61) mm. Delivery within 7 days occurred in 14 (1.6%) and delivery at or before 35 weeks, in 61 (7.2%) cases. Significant (OR; 95%CI) independent predictors of delivery at or before 35 weeks were vaginal bleeding (6.87; 2.83-16.65), cervical length (3.31; CI 1.92-5.70) and a history of preterm birth (2.03; 1.06-3.89). ROC curve analysis showed that a cervical length shorter than 19.5 mm (p<0.05) was the best cutoff value for predicting a delivery at or before 35 weeks´ gestation and within 7 days of presentation. Conclusions: Shortening of cervical length in threatened preterm labor, especially when shorter than 19.5 mm, is associated with a significant risk of preterm labor ¡Ü35 weeks¡¯ gestation and within 7 days of admission. Sonographic measurement of cervical length helps to recognize patients at risk for preterm birth, in order to focus interventions in that group of patients.

Alfa 1 antitrypsin and protease levels in Puerto Rican asthmatics: a pilot study

A cross-sectional pilot study was conducted on a population of 119 asthmatics who had been recruited from the Emergency Room Department of a major hospital in Ponce, Puerto Rico. The purpose of the study was to determine the frequency of the MM, MS, and SS a-i-antiprotease variants. Also, we analyzed the serum levels of the alpha-1-antiprotease inhibitor, quantified the levels of serine proteases in homes of the asthmatic volunteers, and determined whether environmental levels of proteases, regardless of their sources, had any association with either asthma symptoms or alpha-1-antiprotease inhibitor phenotypes. Our results do not support the role of the alpha-1-antiprotease as a risk factor for asthma in the study population as previously reported. Patients who had visited the ED due to asthma on 3 or more occasions had significantly higher trypsin levels than those who had done so 2 or fewer times. Of those asthmatic patients who had daily symptoms, 40had been exposed to high levels of elastase, and 33.3to trypsin. Similarly, 52.9of the patients with 2 or more hospitalizations a year had been exposed to high elastase levels, and 40.5of asthma patients who had nocturnal asthma more than 3 times a week had been exposed to high levels of elastase.

Extranodal B-cell lymphoma in a patient with atopic-like dermatitis

Atopic dermatitis is a chronic relapsing skin disease that occurs commonly during early infancy and childhood and is frequently associated to personal and family history of allergic rhinitis, asthma and/or skin disease. As a rule, it follows a benign course. We report a case of a female patient with a chronic atopic-like dermatitis who eventually developed an extranodal systemic large B-cell lymphoma during the course of her disease

Gastroplastía endoscópica antirreflujo: análisis experimental de su efecto en la presión del esfínter esofágico inferior / Antireflux endoscopic gastroplasty: experimental analysis of it effect in the inferior esophageal sphincter

El objetivo de este trabajo es evaluar en forma experimental el efecto de la cirugía endoscópica antirreflujo en la presión del esfínter esofágico inferior en perros. Se utilizó 5 perros mestizos que fueron mantenidos en ayunas por 12 horas previo procedimiento. Luego fueron pesados y anestesiados con una dosis inicial de 25 mg/kg de pentotal i.v. y bolos de 10 mg/kg según necesidad. Se introdujo una sonda perfundida de tres canales, conectada a un transductor de presión y un polígrafo Beckmann R411, determinándose la presión y ubicación del esfínter esofágico inferior (EEI). A continuación se realizó una endoscopía y se instaló un sobretubo esofágico. Se instaló el mecanismo de sutura endoscópica en un endoscopio Olympus CF-1TS2, se colocaron 2 puntos 1 cm bajo la línea Z a la derecha de la curvatura menor y luego fueron anudados para formar un pliegue. El procedimiento se repitió pero colocando los puntos a la izquierda de la curvatura. A continuación se midió nuevamente la presión del EEI con la misma técnica. Los animales fueron mantenidos con libre acceso al alimento y agua por 7 días. Después de este período fueron nuevamente anestesiados y se midió nuevamente la presión del EEI. Los resultados confirman que la gastroplastía endoscópica es capaz de aumentar en forma significativa la presión del EEI en perros