Benquerencia (La Serena - Spain) rock art: An integrated spectroscopy analysis with FTIR and Raman.

La Serena region is a large plateau with open landscapes bounded in the south by a mountain chain formed by the Benquerencia, Tiros and La Rinconada Sierras. There are more than 300 painted and engraved sites in the region. Cueva Grande, Cueva de En medio and Cueva Pequeña are three Schematic rock art shelters located in the municipality of Benquerencia de la Serena, Badajoz, Spain. Over their panels have been documented more than a hundred of painted schematic figures (anthropomorphic figures, eye-shape figures and symbols) (Neolithic - Copper Age). Paintings are monochromatic with red or black coloration. A total of 13 samples (10 red and 3 black samples) from different panels were collected and analyzed using micro-Raman spectroscopy and ATR-FTIR. Micro-Raman spectroscopy was able to characterize the main mineral component, respectively hematite for the red figures and charcoal for the black paintings. ATR-FTIR was useful to possible ochre and possible organic identification. These latest results are particularly important for understanding manufacturing processes and addressing conservation problems.

[Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients]. / Validación de las escalas de valoración de riesgo de úlceras por presión EMINA y EVARUCI en pacientes críticos.

OBJECTIVE: To contribute to the validation of the EMINA and EVAUCI scales for assessing the risk of pressure ulcers in the critical patient and compare their predictive capacity in this same context. METHOD: Prospective study from December 2012 until June 2013. SETTING: Polyvalent intensive care unit of 14 beds in a reference hospital for two sanitary areas. PATIENTS: patients of 18 years of age or older and without pressure ulcers were included. They were followed until development of a pressure ulcer of grade I or greater, medical discharge, death or 30 days. MAIN VARIABLES: presence of ulcers, daily score of the risk of developing pressure ulcers through EMINA and EVARUCI evaluation. The validity of both scales was calculated using sensitivity, specificity, and positive and negative predictive value. The level of significance was P≤0.05. RESULTS: A total of 189 patients were evaluated. 67.2% were male with a mean age of 59.4 (DE: 16,8) years old, 53 (28%) developed pressure ulcers, being the incidence rate of 41 ulcers per 1000 admission days. The mean day of diagnosis was 7.7 days (DE: 4,4) and the most frequent area was the sacrum. The sensitivity and specificity for the mean of observations was 94.34 (IC95% 87.17-100) and 33.33 (IC95% 25.01-41.66) for the EMINA scale for a risk>10 and 92.45 (IC95% 84.40-100) and 42.96 (IC95% 34.24-51.68) for the EVARUCI scale for a risk of>11. CONCLUSIONS: No differences were found in predictive capacity of both scales. For sensitivities>90%the scales show to be insufficiently specific in the pressure ulcer risk detection in critical patients.

Reporte de caso y revisión de la literatura de caso de paciente con meningoencefalitis por amebas de vida libre / Case report and literature review of a patient with meningoencephalitis from free-living amoebae

Paciente de 14 años, proveniente de Apartadó (Antioquia), remitido al Hospital Pablo Tobón Uribe de Medellín por un cuadro febril agudo asociado a deterioro rápido del estado de conciencia, decantándose posteriormente como causa de su deterioro una ameba de vida libre (Naegleria fowleri) . Las amebas de vida libre son una causa etiológica poco común de meningitis, tienen un curso fulminante y requieren de un alto índice de sospecha para hacer un tratamiento oportuno.

A 14-year-old patient from Apartado (Antioquia, Colombia) was referred to Hospital Pablo Tobon Uribe in Medellin for acute febrile illness associated with headache and rapid loss of consciousness. The etiologic agent causing this deterioration was found to be a free-living amoeba ( Naegleria fowleri ). Free-living amoebae are a rare etiology for meningoencephalitis, have a fulminant course and require a high index of suspicion for early diagnosis.

Neumonía fatal en una niña inmunocompetente, asociada a herpes simple tipo 1 / Fatal pneumonia associated to herpes simplex 1, in an immunocompetent girl

Most reported cases of lower respiratory tract infection due to herpes simplex virus type-1 (HSV-1) occurs in immunocompromised patients, however there are few cases of viral infection in inmunocompentes critically ill patients (1-3). Objective: Report the case of fatal VHS-1 pneumonia in an immunocompetent patient. Case: A ten year old girl, immunocompetent, who presents respiratory symptoms and progresses rapidly to severe hypoxemia, instability and death. Lung biopsy reported Cowdry type A inclusions and the polimerasa chain reaction (PCR) was positive for HSV-1. We discuss the clinical features, diagnosis, treatment and prognosis in critically ill immunocompetent patients with HSV-1 infection in lower respiratory tract.

La mayoría de los casos reportados de infección por el virus herpes simplex tipo-1 (VHS-1) en el tracto respiratorio inferior ocurren en pacientes inmunosuprimidos; sin embargo, se han reportado casos de aislamiento del virus en pacientes inmunocompentes en estado crítico. Objetivo: Reportar el caso de neumonía grave y fatal por VHS-1 en un paciente inmunocompetente. Caso Clínico: Paciente de 10 años, sexo femenino, inmu-nocompetente, que inicia síntomas respiratorios y progresa rápidamente a hipoxemia severa, inestabilidad y muerte. La biopsia pulmonar reportó inclusiones de Cowdry tipo A y una reacción en cadena de la polimerasa (PCR) positiva para VHS-1. Discusión: Se comenta el cuadro clínico, diagnóstico, tratamiento y pronóstico en pacientes inmunocompetentes críticamente enfermos con infección por VHS-1 en el tracto respiratorio inferior.

Gangrena de Fournier en asociación con el uso de anti-inflamatorios no esteroideos: Reporte de un caso pediátrico / An unusual presentation of Fournier's gangrene: ¿Is there a relationship with NSAID use? Pediatric case report

La gangrena de Fournier es una enfermedad amenazante para la vida, que se caracteriza por fascitis necrosante del área perineal. Afecta con mayor frecuencia a pacientes adultos con inmunosupresión y son pocos los casos reportados en la población pediátrica. El uso de fármacos anti-inflamatorios no esteroideos (AINEs) se ha asociado con fascitis necrosante, probablemente por supresión de la inmunidad durante la infección. Describimos el caso de un paciente con 6 meses de edad sin factores inmu-nosupresores, con gangrena de Fournier, probablemente asociada a la ingesta de AINEs.

Founier's gangrene is a rare but life-threatening disease characterized by necrotizing fasciitis of the perineal area. It mostly affects adult patients with an immunosuppressant factor and there are only a few cases reported in children. Use of nonsteroidal anti-inflammatory drugs has been associated with necrotizing fasciitis probably because of suppressing host immunity during infection. We describe a case of a six month old infant without im-munosuppressant factors, with Founier´s gangrene probably associated with nonsteroidal anti-inflammatory intake.

Dilation of apocrine glands. A forgotten but helpful histopathological clue to the diagnosis of axillary Fox-Fordyce disease.

Fox-Fordyce disease is a condition with protean histopathological alterations whose pathogenesis remains a mystery. Although recent studies have addressed histological changes specific of this disease, including perifollicular xanthomatosis, no attention has been given to apocrine acini dilation as an adjunct histopathological finding to the diagnosis. Moreover, although previous efforts were done to demonstrate that perifollicular foamy histiocytes harbor apocrine secretion content, this concept has not been proved to date. In this study, we report 2 cases harboring prominent dilation of apocrine coils with mucinous content. Such mucinous content showed mucin profile identical to the dermal mucin deposits in both cases. Of note, perifollicular foamy histiocytes demonstrated cytoplasmic mucin, supporting the suggestion that these cells phagocytose apocrine secretion. Although not specific, apocrine coil dilation is another histopathological feature of Fox-Fordyce disease and it may be used as a low-power magnification clue for the correct diagnosis. We also propose that the so-called perifollicular xanthomatosis may be composed of muciphages or mixed cell (muciphages/xanthomatous) population, an issue that should be further investigated in future studies.

Insuficiencia cardíaca en hospitales chilenos: resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Cardiac failure in Chilean hospitals: results of the National Registry of Heart Failure, ICARO

Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. Results: Three hundred seventy two patients aged 69±13 years old, 59 percent men, were assessed. The main etiologies of HF were ischemic in 31.6 percent, hypertensive in 35.2 percent, valvular in 14.9 percent and idiopathic in 7.4 percent. There was a history of hypertension 69 percent, diabetes in 35 percent, myocardial infarction in 22 percent, atrial fibrillation (AF) in 28 percent. The presentation form of HF was chronic decompensated in 86 percent, acute in 12 percent, refractory in 2 percent. The causes of decompensation were non compliance with diet or medical prescriptions in 28 percent, infections in 22 percent and AF 17 percent. ECG showed AF in 36 percent and left bundle branch block in 16 percent. Echocardiography was performed in 52 percent of the patients, 69 percent had left ventricular ejection fraction <40 percent. On admission, 39 percent received angiotensin converting enzyme (ACE) inhibitors, 15 percent beta-blocker, 25 percent digoxin, 16 percent spironolactone and 53 percent furosemide. The mean hospital stay was 11±10 days and mortality was 4.5 percent. Conclusions: The elderly is the age group most commonly admitted to hospital due to HF. The main etiologies were ischemic and hypertensive. The main causes for decompensations were noncompliance with diet or medical prescriptions and infections. A significant proportion had a relatively well preserved ventricular systolic function (Rev Méd Chile 2004; 132: 655-62).

Reconstrucción mamaria bilateral: experiencia de los últimos 7 años / Bilateral breast reconstruction: experience of the last 7 years

Se muestra la experiencia clínica en 11 pacientes mujeres portadoras de cáncer mamario bilateral, sometidas a reconstrucción mamaria bilateral con colgajo miocutáneo de recto abdominal bilateral (TRAM), entre abril de 1995 y diciembre de 2001. Se revisaron las fichas clínicas de las pacientes y se tabularon edad, tipo histológico del cáncer, factores de riesgo y complicaciones a corto y largo plazo. Finalmente, se realizó una evaluación subjetiva por las pacientes acerca de los resultados quirúrgicos.

Capillary leakage syndrome: a case report and a review.

Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.

Uso de la hormona de crecimiento humana en niñas con síndrome de Turner / Use of Human Growth Hormone in childs of Turner syndrome

Para evaluar el efecto de la hormona de crecimiento sobre el crecimiento de las niñas con síndrome de Turner se realizó un trabajo prospectivo enel cual se incluyeron 19 niñas. Todas consultaron por talla baja. Conclusión:la hormona de crecimineto mejora en forma significativa la velocidad de crecimiento en las niñas con síndrome de Turner. Queda por determinar el efecto de la hormona de crecimiento sobre la talla final en nuestro grupo de pacientes

[Public health as a subject for the Assembly]. / La salud publica proposito de la Asamblea.

PIP: Six Ecuadorian political figures and physicians were interviewed on their opinions concerning the problems of the health sector and possible solutions. Ecuadorians anticipate that installation of the National Assembly will lead to diagnosis and reform of societal ills. Health has not been a high priority of political leaders. Only 10% of the population has access to the social security system. Infant mortality rates are very high in the rural sierra, and nearly 70% of indigenous sierra children suffer from chronic malnutrition. The need for broad reform of the health sector has been recognized. The interview subjects agreed that reforms are needed, especially in regard to the Ecuadorian Institute of Social Security, which all agreed had become weakened by excessive political patronage and presence of unqualified political appointees. They agreed that the nation's health is deteriorating each day, but they did not always agree on how to solve the crisis. Among the themes debated were the need for improved coordination of services, increased investment in health services, redefinition of the role of public and private services, participation of the population in the construction of health policy, the need for professional administration, whether the poor should be charged for services, and whether monopolies should be permitted in the field of health care.^ieng

El colgajo fasciocutáneo radial de base distal / Radial fasciocutaneous graft of distal base

La cobertura cutánea de la mano constituye un problema complejo cuando sus estructuras óseas, articulares o tendinosas están expuestas. Presentamos nuestra experiencia con 14 colgajos fasciocutáneos radiales de base distal (CFCRBD) del antebrazo en la cirugía recosntructiva de la mano de 13 pacientes portadores de exposición osteotendinosa por heridas y quemaduras, contracturas cicatriciales postquemadura y muñones de amputación con cobertura cutánea inestable. La técnica quirúrgica consiste en el levantamiento de un colgajo fasciocutáneo radial de base distal que sigue el eje, pero no incluye la arteria radial. No hubo complicaciones en 4 casos; en 5 pacientes se observó sufrimiento isquémico superficial del borde distal del colgajo que se recuperó con tratamiento conservador y en otros 5, necrosis de espesor completo que lograron cobertura empleando secundariamente segmentos proximales del colgajo. El CFCRBD constituye una alternativa aceptable en la reconstrucción de la cobertura cutánea de la mano por la sencillez de su diseño y rápida ejecución sin requerimiento de técnica microquirúrgica. Al mismo tiempo evita las molestias de la inmovilización de los colgajos pediculados en tronco o brazo contralateral y no sacrifica vasos importantes

Fibrosarcomas inducidos por metilcolantreno (MC) tratado con el conjugado proteina C reactiva acido fólico en liposomas

La unión química covalente de la Proteina C Reactiva con el Acido Fólico forma una nueva molécula, un inmunógeno peculiar proteínico-hapténico , el mismo que es transportado al torrente circulatorio por liposomas (vesiculas fosfolípidas). Este modelo terapéutico especial y original, sería capaz de inhibir el crecimiento tumoral ocasionado por una respuesta antigénica y potencializada.

Determination of tenoxicam in plasma by high-performance liquid chromatography.

A high-performance liquid chromatographic technique with a lower detection limit for measuring tenoxicam plasma levels was standardized. Tenoxicam was extracted with dichloromethane from acidified plasma and the evaporated extracts were analysed on a reversed-phase column using a methanol-phosphate buffer mobile phase and setting ultraviolet detection at 355 nm. A reproducible calibration curve in the 5-2000 ng/ml range was obtained. The mean recovery of extraction was 98.99 +/- 4.3% and the detection limit was 5 ng/ml.

Fibroma odontogénico periférico con producción de sustancia dentinoide / Peripheral odontogenic fibroma with dentinoid substance production

Fibro-cementum bony neoplasias arise from totipotential connective tissue. The generally contain calcified structures such as bone, cement and more rarely dentin. They may be periphical or central lesions of the jaws. The WHO classifies them into six groups: Four of them correspond to cementomas; two as bony lesions. The literature on this matter reports a probable origin from periodontal issues.