Anatomic Areas of Lipoframing in Breast Surgery.

Breast lipoframing is a concept in breast surgery that encompasses the often-overlooked aspects of the mammary glands, such as the surrounding structures and adipose tissue within the thorax. By acknowledging the interplay between these components and recognizing the need for their simultaneous treatment, breast lipoframing aims to optimize surgical aesthetic outcomes. This article proposes a comprehensive definition of the surrounding mammary fat tissue by delineating the specific areas of the breast involved in the lipoframing technique. It presents a retrospective analysis of 554 female patients, revealing only one case of seroma and three cases of hematoma. Furthermore, we explore the application of liposuction as a means to effectively treat these areas and achieve superior results.

Central American and Caribbean Consensus Document for the Optimal Management of Oral Anticoagulation in Patients with Non-Valvular Atrial Fibrillation Endorsed by the Central American and Caribbean Society of Arterial Hypertension and Cardiovascular Prevention.

Atrial fibrillation (AF) is the most common arrhythmia in adults. Prevention of the ischaemic risk with oral anticoagulants (OACs) is widely recommended, and current clinical guidelines recommend direct oral anticoagulants (DOACs) as preference therapy for stroke prevention. However, there are currently no clinical practice guidelines or recommendation documents on the optimal management of OACs in patients with AF that specifically address and adapt to the Central American and Caribbean context. The aim of this Delphi-like study is to respond to doubts that may arise in the management of OACs in patients with non-valvular AF in this geographical area. A consensus project was performed on the basis of a systematic review of the literature, a recommended ADOLOPMENT-like approach, and the application of a two-round Delphi survey. In the first round, 31 recommendations were evaluated and 30 reached consensus, of which, 10 unanimously agreed. The study assessed expert opinions in a wide variety of contextualized recommendations for the optimal management of DOACs in patients with non-valvular atrial fibrillation (NVAF). There is a broad consensus on the clinical practice guideline (CPG) statements used related to anticoagulation indication, patient follow-up, anticoagulation therapy complications, COVID-19 management and prevention, and cardiac interventions.

The rostral micro-tooth morphology of blue marlin, Makaira nigricans.

Billfish rostra potentially have several functions; however, their role in feeding is unequivocal in some species. Recent work linked morphological variation in rostral micro-teeth to differences in feeding behavior in two billfish species, the striped marlin (Kajikia audax) and the sailfish (Istiophorus platypterus). Here, we present the rostral micro-tooth morphology for a third billfish species, the blue marlin (Makaira nigricans), for which the use of the rostrum in feeding behavior is still undocumented from systematic observations in the wild. We measured the micro-teeth on rostrum tips of blue marlin, striped marlin, and sailfish using a micro-computed tomography approach and compared the tooth morphology among the three species. This was done after an analysis of video-recorded hunting behavior of striped marlin and sailfish revealed that both species strike prey predominantly with the first third of the rostrum, which provided the justification to focus our analysis on the rostrum tips. In blue marlin, intact micro-teeth were longer compared to striped marlin but not to sailfish. Blue marlin had a higher fraction of broken teeth than both striped marlin and sailfish, and broken teeth were distributed more evenly on the rostrum. Micro-tooth regrowth was equally low in both marlin species but higher in sailfish. Based on the differences and similarities in the micro-tooth morphology between the billfish species, we discuss potential feeding-related rostrum use in blue marlin. We put forward the hypothesis that blue marlin might use their rostra in high-speed dashes as observed in striped marlin, rather than in the high-precision rostral strikes described for sailfish, possibly focusing on larger prey organisms.

Distinct interactions stabilize EGFR dimers and higher-order oligomers in cell membranes.

The epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase with important roles in many cellular processes as well as in cancer and other diseases. EGF binding promotes EGFR dimerization and autophosphorylation through interactions that are well understood structurally. How these dimers relate to higher-order EGFR oligomers seen in cell membranes, however, remains unclear. Here, we used single-particle tracking (SPT) and Förster resonance energy transfer imaging to examine how each domain of EGFR contributes to receptor oligomerization and the rate of receptor diffusion in the cell membrane. Although the extracellular region of EGFR is sufficient to drive receptor dimerization, we find that the EGF-induced EGFR slowdown seen by SPT requires higher-order oligomerization-mediated in part by the intracellular tyrosine kinase domain when it adopts an active conformation. Our data thus provide important insight into the interactions required for higher-order EGFR assemblies involved in EGF signaling.

Relict duck-billed dinosaurs survived into the last age of the dinosaurs in subantarctic Chile.

In the dusk of the Mesozoic, advanced duck-billed dinosaurs (Hadrosauridae) were so successful that they likely outcompeted other herbivores, contributing to declines in dinosaur diversity. From Laurasia, hadrosaurids dispersed widely, colonizing Africa, South America, and, allegedly, Antarctica. Here, we present the first species of a duck-billed dinosaur from a subantarctic region, Gonkoken nanoi, of early Maastrichtian age in Magallanes, Chile. Unlike duckbills further north in Patagonia, Gonkoken descends from North American forms diverging shortly before the origin of Hadrosauridae. However, at the time, non-hadrosaurids in North America had become replaced by hadrosaurids. We propose that the ancestors of Gonkoken arrived earlier in South America and reached further south, into regions where hadrosaurids never arrived: All alleged subantarctic and Antarctic remains of hadrosaurids could belong to non-hadrosaurid duckbills like Gonkoken. Dinosaur faunas of the world underwent qualitatively different changes before the Cretaceous-Paleogene asteroid impact, which should be considered when discussing their possible vulnerability.

Distinct interactions stabilize EGFR dimers and higher-order oligomers in cell membranes.

The epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase (RTK) with important roles in many cellular processes as well as cancer and other diseases. EGF binding promotes EGFR dimerization and autophosphorylation through interactions that are well understood structurally. However, it is not clear how these dimers relate to higher-order EGFR oligomers detected at the cell surface. We used single-particle tracking (SPT) and Förster resonance energy transfer (FRET) imaging to examine how each domain within EGFR contributes to receptor dimerization and the rate of its diffusion in the cell membrane. We show that the EGFR extracellular region is sufficient to drive receptor dimerization, but that the EGF-induced EGFR slow-down seen by SPT requires formation of higher order oligomers, mediated in part by the intracellular tyrosine kinase domain - but only when in its active conformation. Our data thus provide important insight into higher-order EGFR interactions required for EGF signaling.

Synthesis and Characterization of a pH- and Temperature-Sensitive Fe3O4-SiO2-Poly(NVCL-co-MAA) Nanocomposite for Controlled Delivery of Doxorubicin Anticancer Drug.

This work reports the synthesis, characterization, and in vitro release studies of pH- and temperature-sensitive Fe3O4-SiO2-poly(NVCL-co-MAA) nanocomposite. Fe3O4 nanoparticles were prepared by chemical coprecipitation, coated with SiO2 by the Stöber method, and functionalized with vinyl groups. The copolymer poly(N-vinylcaprolactam-co-methacrylic acid) (poly(NVCL-co-MAA)) was grafted onto the functionalized Fe3O4-SiO2 nanoparticles by free radical polymerization. XRD, FTIR, TGA, VSM, and TEM techniques were performed to characterize the nanocomposite. The release behavior of Doxorubicin (DOX) loaded in the nanocomposite at pH 5.8 and 7.4, and two temperatures, 25 and 37 °C, was studied. According to the release studies, approximately 55% of DOX is released in 72 h at pH 7.4, regardless of temperature. At pH 5.8, 78% of DOX was released in 48 h at 25 °C, and when increasing the temperature to 37 °C, more than 95 % of DOX was released in 24 h. The DOX release data treated with Zero-order, first-order, Higuchi, and Korsmeyer-Peppas models showed that Higuchi's model best fits the data, indicating that the DOX is released by diffusion. The findings suggest that the synthesized nanocomposite may be useful as a DOX carrier in biomedical applications.

Architecture Optimization of a Non-Linear Autoregressive Neural Networks for Mackey-Glass Time Series Prediction Using Discrete Mycorrhiza Optimization Algorithm.

Recurrent Neural Networks (RNN) are basically used for applications with time series and sequential data and are currently being used in embedded devices. However, one of their drawbacks is that RNNs have a high computational cost and require the use of a significant amount of memory space. Therefore, computer equipment with a large processing capacity and memory is required. In this article, we experiment with Nonlinear Autoregressive Neural Networks (NARNN), which are a type of RNN, and we use the Discrete Mycorrhizal Optimization Algorithm (DMOA) in the optimization of the NARNN architecture. We used the Mackey-Glass chaotic time series (MG) to test the proposed approach, and very good results were obtained. In addition, some comparisons were made with other methods that used the MG and other types of Neural Networks such as Backpropagation and ANFIS, also obtaining good results. The proposed algorithm can be applied to robots, microsystems, sensors, devices, MEMS, microfluidics, piezoelectricity, motors, biosensors, 3D printing, etc.

Haemosporidian parasites in the ash-breasted Sierra finch (Geospizopsis plebejus): insights from an Andean dry forest population.

Haemosporidian genera Plasmodium, Haemoproteus and Leucocytozoon, responsible for avian malarial infections, are highly diverse and have a wide range of health effects and predictors, depending on the host and its environmental context. Here, we present, for the first time, detailed information on the identity, prevalence and parasitaemia of haemosporidians and other haemoparasites that infect the ash-breasted Sierra finch, Geospizopsis plebejus, in an Andean dry forest. We study the consequences of infection in the host body and health conditions and explore the environmental and intrinsic factors that influence infection status and parasitaemia. We conducted diagnoses by cytochrome b (cytb) sequencing and morphological identification, and estimated the levels of parasitaemia based on microscopy. We identified 6 cytb lineages infecting G. plebejus. Two of them were new lineages: Haemoproteus sp. GEPLE01 and GEPLE02. We also detected Haemoproteus sp. ZOCAP08, Haemoproteus sp. AMAVIR01, Plasmodium homopolare BAEBIC02 and Plasmodium cathemerium ZONCAP15. By microscopy, we detected Haemoproteus coatneyi, Haemoproteus erythrogravidus, P. homopolare and other unidentified species of Haemoproteus, Plasmodium, Babesia sp. and 1 microfilaria. We found no evidence of Leucocytozoon. Additionally, we detected several coinfections by sequencing and microscopy. The prevalence of haemosporidian infections was high (87.7%), and the mean parasitaemia was 61.65 infected cells per 10 000 erythrocytes examined. Prevalence and parasitaemia were higher for Haemoproteus than for Plasmodium. Haemoproteus sp. AMAVIR01 showed the highest prevalence (43.1%) and mean parasitaemia (94.39/10 000 erythrocytes) and might be associated with H. coatneyi. Immature individuals showed a lower prevalence than adults, supporting previous findings.

Green Synthesis of Silver Nanoparticles Using Pecan Nut (Carya illinoinensis) Shell Extracts and Evaluation of Their Antimicrobial Activity.

Nowadays, the increase in bacteria resistant to multiple antibiotics has become a real threat to the human health, forcing researchers to develop new strategies. Silver nanoparticles (AgNPs) may be a viable solution to this problem. The green synthesis of AgNPs is considered a green, ecological and low-priced process that provides small and biocompatible nanostructures with antimicrobial activity with a potential application in medicine. In this work, pecan nut shell extracts were analyzed in order to determine their viability for the production of AgNPs. These NPs were synthesized using an extract rich in bioactive molecules, varying the reaction time and silver nitrate (AgNO3) concentration. AgNPs production was confirmed by FT-IR, UV-Vis and EDX spectroscopy, while their morphology and size were determined by transmission electron microscopy (TEM) and dynamic light scattering (DLS). The antibacterial activity of AgNPs was evaluated by the agar diffusion method against Salmonella typhi, Staphylococcus aureus and Proteus mirabilis. The results showed that it is possible to obtain nanoparticles from an extract rich in antioxidant molecules with a size between 39.9 and 98.3 nm with a semi-spherical morphology. In addition, it was shown that the reaction time and the concentration of the precursor influence the final nanoparticles size. Antimicrobial tests showed that there is greater antimicrobial inhibition against Gram-negative than Gram-positive microorganisms, obtaining inhibition zone from 0.67 to 5.67 mm.

Portación nasal de Staphylococcus aureus en el personal de salud de áreas críticas de un Hospital Pediátrico durante julio-setiembre 2018 / Nasal carriage of Staphylococcus aureus in health personnel in critical areas of a Pediatric Hospital during July-September 2018 / Transporte nasal de Staphylococcus aureus em profissionais de saúde em áreas críticas de um Hospital Pediátrico durante julho-setembro de 2018

Las infecciones intrahospitalarias (IIH) son causa de elevada morbimortalidad y representan un problema sanitario importante. El personal de salud es reservorio y potencial transmisor de los agentes etiológicos de las mismas. S. aureus es uno de los microorganismos implicados, por lo tanto es importante conocer la frecuencia de portación en el personal de salud y establecer el perfil de susceptibilidad antimicrobiana para contribuir con la elaboración de medidas de prevención incluyendo actividades educativas. Objetivo: Conocer la frecuencia de portación de S. aureus, distribución y antibiotipos de las cepas presentes en el personal sanitario del Hospital Pediátrico de Referencia (HPR). Materiales y métodos: Se realizó un estudio descriptivo durante el periodo julio-setiembre del año 2018. Se incluyeron muestras de hisopados nasales de trabajadores de la salud de distintas áreas de internación que consintieron participar en el estudio. Se excluyeron aquellos que recibieron antibióticos dentro de los 3 meses previos al estudio. Las muestras fueron sembradas en agar sangre ovina al 5% (ASO) y se incubaron a 35-37ºC en aerobiosis por 24-48 horas. La identificación de las colonias sospechosas de Staphylococcus aureus por métodos convencionales y MALDI-TOF. El patrón de resistencia antimicrobiana de S. aureus se detectó por disco-difusión. En los cultivos resistentes a meticilina (SAMR) se determinó la presencia del gen mecA y se realizó la tipificación del SCCmec por pruebas de reacción en cadena de polimerasa. Resultados: Se obtuvieron 225 hisopados a partir de 225 trabajadores, presentaron desarrollo 212. En 49 se recuperaron cultivos de S. aureus. Correspondieron a SAMR 11 de las 49 cepas, todas portaban el gen mecA. Hubo predominio en el personal de enfermería (7/11), en los servicios de hemato-oncología (3/11) y cuidados intensivos neonatales (4/11). Asociaron resistencia a macrólidos y clindamicina 8 de 11 aislamientos SAMR, a gentamicina 2 y a mupirocina uno. El SCCmec más frecuentemente identificado fue el tipo IV (7/11). Conclusiones: Los resultados muestran la presencia de cepas SAMR entre el personal de salud del CHPR y aportan información complementaria para efectuar prevención y control de las IIH, actuando sobre todo en el personal de salud encargado de la atención de pacientes susceptibles.

Hospital-acquired infections (IIH) are a cause of high morbidity and mortality and represent a major health problem. Health personnel are reservoirs and potential transmitters of their etiological agents. S. aureus is one of the microorganisms involved, therefore it is important to know the frequency of carriage in health personnel and establish the antimicrobial susceptibility profile to contribute to the development of prevention measures, including educational activities. Objective: To know the frequency of carriage of S. aureus, distribution and antibiotypes of the strains present in the health personnel of the Reference Pediatric Hospital (HPR). Materials and methods: A descriptive study was carried out during the period July-September 2018. Nasal swab samples from health workers from different hospitalization areas who agreed to participate in the study were included. Those who received antibiotics within 3 months prior to the study were excluded. The samples were seeded in 5% sheep blood agar (ASO) and incubated at 35-37ºC in aerobiosis for 24-48 hours. Identification of suspicious Staphylococcus aureus colonies by conventional methods and MALDI-TOF. The antimicrobial resistance pattern of S. aureus was detected by disc diffusion. In methicillin-resistant cultures (MRSA), the presence of the mecA gene was determined and SCCmec was typified by polymerase chain reaction tests. Results: 225 swabs were obtained from 225 workers, 212 showed development. S. aureus cultures were recovered from 49. 11 of the 49 strains corresponded to MRSA, all of them carried the mecA gene. There was a predominance in the nursing staff (7/11), in the hematology-oncology services (3/11) and neonatal intensive care (4/11). They associated resistance to macrolides and clindamycin in 8 of 11 MRSA isolates, 2 to gentamicin, and 1 to mupirocin. The most frequently identified SCCmec was type IV (7/11). Conclusions: The results show the presence of MRSA strains among the health personnel of the CHPR and provide complementary information to carry out prevention and control of IIH, acting especially on the health personnel in charge of the care of susceptible patients.

As infecções hospitalares (HII) são causa de alta morbidade e mortalidade e representam um importante problema de saúde. Os profissionais de saúde são reservatórios e potenciais transmissores de seus agentes etiológicos. O S. aureus é um dos micro-organismos envolvidos, por isso é importante conhecer a frequência de portadores em profissionais de saúde e estabelecer o perfil de suscetibilidade antimicrobiana para contribuir no desenvolvimento de medidas de prevenção incluindo atividades educativas. Objetivo: Conhecer a frequência de portadores de S. aureus, distribuição e antibiótipos das cepas presentes no pessoal de saúde do Hospital Pediátrico de Referência (HPR). Materiais e métodos: Foi realizado um estudo descritivo durante o período de julho a setembro de 2018. Foram incluídas amostras de swab nasal de profissionais de saúde de diferentes áreas de internação que concordaram em participar do estudo. Aqueles que receberam antibióticos nos 3 meses anteriores ao estudo foram excluídos. As amostras foram semeadas em 5% de ágar sangue de carneiro (ASO) e incubadas a 35-37ºC em aerobiose por 24-48 horas. Identificação de colônias suspeitas de Staphylococcus aureus por métodos convencionais e MALDI-TOF. O padrão de resistência antimicrobiana de S. aureus foi detectado por difusão em disco. Em culturas resistentes à meticilina (MRSA), a presença do gene mecA foi determinada e SCCmec foi tipificado por testes de reação em cadeia da polimerase. Resultados: 225 swabs foram obtidos de 225 trabalhadores, 212 apresentaram desenvolvimento. Culturas de S. aureus foram recuperadas de 49. 11 das 49 cepas correspondiam a MRSA, todas carregavam o gene mecA. Houve predominância na equipe de enfermagem (7/11), nos serviços de hematologia-oncologia (3/11) e de terapia intensiva neonatal (4/11). Eles associaram resistência a macrolídeos e clindamicina em 8 de 11 isolados de MRSA, 2 à gentamicina e 1 à mupirocina. O SCCmec mais frequentemente identificado foi o tipo IV (7/11). Conclusões: Os resultados mostram a presença de cepas de MRSA entre os profissionais de saúde do CHPR e fornecem informações complementares para realizar a prevenção e controle da HII, atuando principalmente sobre os profissionais de saúde responsáveis ​​pelo atendimento de pacientes suscetíveis.

Gemini and Bicephalous Surfactants: A Review on Their Synthesis, Micelle Formation, and Uses.

The use of surfactants in polymerization reactions is particularly important, mainly in emulsion polymerizations. Further, micelles from biocompatible surfactants find use in pharmaceutical dosage forms. This paper reviews recent developments in the synthesis of novel gemini and bicephalous surfactants, micelle formation, and their applications in polymer and nanoparticle synthesis, oil recovery, catalysis, corrosion, protein binding, and biomedical area, particularly in drug delivery.

Mapping the neural systems driving breathing at the transition to unconsciousness.

After falling asleep, the brain needs to detach from waking activity and reorganize into a functionally distinct state. A functional MRI (fMRI) study has recently revealed that the transition to unconsciousness induced by propofol involves a global decline of brain activity followed by a transient reduction in cortico-subcortical coupling. We have analyzed the relationships between transitional brain activity and breathing changes as one example of a vital function that needs the brain to readapt. Thirty healthy participants were originally examined. The analysis involved the correlation between breathing and fMRI signal upon loss of consciousness. We proposed that a decrease in ventilation would be coupled to the initial decline in fMRI signal in brain areas relevant for modulating breathing in the awake state, and that the subsequent recovery would be coupled to fMRI signal in structures relevant for controlling breathing during the unconscious state. Results showed that a slight reduction in breathing from wakefulness to unconsciousness was distinctively associated with decreased activity in brain systems underlying different aspects of consciousness including the prefrontal cortex, the default mode network and somatosensory areas. Breathing recovery was distinctively coupled to activity in deep brain structures controlling basic behaviors such as the hypothalamus and amygdala. Activity in the brainstem, cerebellum and hippocampus was associated with breathing variations in both states. Therefore, our brain maps illustrate potential drives to breathe, unique to wakefulness, in the form of brain systems underlying cognitive awareness, self-awareness and sensory awareness, and to unconsciousness involving structures controlling instinctive and homeostatic behaviors.

Bizarre tail weaponry in a transitional ankylosaur from subantarctic Chile.

Armoured dinosaurs are well known for their evolution of specialized tail weapons-paired tail spikes in stegosaurs and heavy tail clubs in advanced ankylosaurs1. Armoured dinosaurs from southern Gondwana are rare and enigmatic, but probably include the earliest branches of Ankylosauria2-4. Here we describe a mostly complete, semi-articulated skeleton of a small (approximately 2 m) armoured dinosaur from the late Cretaceous period of Magallanes in southernmost Chile, a region that is biogeographically related to West Antarctica5. Stegouros elengassen gen. et sp. nov. evolved a large tail weapon unlike any dinosaur: a flat, frond-like structure formed by seven pairs of laterally projecting osteoderms encasing the distal half of the tail. Stegouros shows ankylosaurian cranial characters, but a largely ancestral postcranial skeleton, with some stegosaur-like characters. Phylogenetic analyses placed Stegouros in Ankylosauria; specifically, it is related to Kunbarrasaurus from Australia6 and Antarctopelta from Antarctica7, forming a clade of Gondwanan ankylosaurs that split earliest from all other ankylosaurs. The large osteoderms and specialized tail vertebrae in Antarctopelta suggest that it had a tail weapon similar to Stegouros. We propose a new clade, the Parankylosauria, to include the first ancestor of Stegouros-but not Ankylosaurus-and all descendants of that ancestor.

Infección grave por estreptococo del grupo B en la Unidad de Cuidados Intensivos Pediátricos del Centro Hospitalario Pereira Rossell entre los años 2007 y 2017 / Serious infection due to group B Streptococcus at the Pediatric Intensive Care Unit of the Pereira Rossell Children's Hospital between 2007 and 2017 / Infecção grave causada por Estreptococo do grupo B na Unidade de Terapia Intensiva do Centro Hospitalar Pediátrico Pereira Rossell entre os anos 2007 e 2017

Introducción: el estreptococo del grupo B (EGB) es una causa frecuente de sepsis neonatal. La enfermedad precoz disminuyó su incidencia por la profilaxis antibiótica, a diferencia de la sepsis tardía, que aumentó su incidencia en los últimos años. Objetivo: conocer la incidencia de la sepsis tardía en el período 2016-2017 en el Centro Hospitalario Pereira Rossell (CHPR). El secundario, describir las características epidemiológicas y clínicas de sepsis tardía por EGB en niños ingresados a la Unidad de Cuidados Intensivos de Niños (UCIN) del CHPR en el período 2007-2017. Resultados: la incidencia calculada de sepsis tardía por EGB fue de 0,53 casos/1000 recién nacidos (RN) vivos. Entre los años 2007 y 2017 ingresaron cinco niños por sepsis tardía por EGB a la UCIN del CHPR. La presentación clínica más frecuentes fue fiebre sin foco y meningitis. Se obtuvieron tres aislamientos en sangre de EBG y tres en líquido cefalorraquídeo (dos en cultivo y otro por detección de ADN). Ninguno falleció. Los casos con meningitis presentaron alteraciones en la tomografía de cráneo. Un niño fue pretérmino. Conclusiones: la sepsis tardía se vincula a importante morbimortalidad en pediatría. No se ha establecido cuáles son los principales factores de riesgo asociados a una enfermedad grave ni las políticas para disminuir su incidencia.

Background: group B streptococcus (GBS) is a common cause of neonatal sepsis. Early disease decreased its incidence due to antibiotic prophylaxis. Late sepsis increased its incidence in recent years. Objectives: to know the incidence of late onset EGB sepsis in the period 2016-2017 at the Pereira Rossell Hospital Center (CHPR), and secondly, to describe the epidemiological characteristics and the clinical presentation of late onset sepsis due to GBS in children admitted to the Children's Intensive Care Unit (UCIN) of the CHPR in the period 2007-2017. Results: the calculated incidence of late sepsis due to GBS was 0.53 cases/1000 live newborns. Between 2007-2017, 5 children were admitted due to GBS late sepsis at the UCIN. The most frequent clinical presentation was fever without focus and meningitis. 3 isolates were obtained in EBG blood cultures and 3 in cerebrospinal fluid (2 in culture and another by DNA detection). None of them died. Cases with meningitis showed abnormalities in the brain tomography. 1 of the 5 was preterm. Conclusions: late sepsis is associated with significant morbidity and mortality in pediatric patients. The main risk factors associated with serious disease and the policies needed to reduce its incidence have not been established.

Introdução: o estreptococo do grupo B (SGB) é uma causa frequente de sepse neonatal. A doença precoce diminuiu sua incidência devido à profilaxia antibiótica, ao contrário da sepse tardia, que aumentou sua incidência nos últimos anos. Objetivo: conhecer a incidência de sepse tardia no período 2016-2017 no Centro Hospitalar Pereira Rossell (CHPR) e descrever as características epidemiológicas e clínicas da sepse tardia por SGB em crianças internadas na Unidade de Terapia Intensiva Infantil (UTIN) do CHPR no período de 2007-2017. Resultados: a incidência calculada de sepse tardia por SGB foi de 0,53 casos/1000 recém-nascidos vivos (RNs). Entre 2007-2017, 5 crianças foram internadas na UTIN do CHPR por sepse tardia devido a GBS. A apresentação clínica mais frequente foi febre sem causa e meningite. 3 isolados de EBG foram obtidos no sangue e 3 no líquido cefalorraquidiano (2 em cultura e outro por detecção de DNA). Nenhum dos pacientes morreu. Os casos com meningite apresentaram alterações na tomografia de crânio. Uma criança era pré-termo. Conclusões: a sepse tardia está associada a significativa morbimortalidade em pediatria. Os principais fatores de risco associados a uma doença grave e as políticas para reduzir sua incidência ainda não foram estabelecidas.

Current Incidence and Risk Factors of Fecal Incontinence After Acute Stroke Affecting Functionally Independent People.

Background: Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke. Methods: We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged >18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected. Results: Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14-22) vs. 5 (3-13), p < 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7-60.1) adjusted for covariates. Conclusions: At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.

Treatment and prevention of ocular motility restrictions with amniotic membrane transplantation.

We intend to investigate the indications, complications, and final results of amniotic membrane (AM) transplantation in ocular motility restrictions. Surgeons have tried to prevent restrictive adhesions between the extraocular muscles and surrounding tissues because they cause unpredictable results. AM transplantation wrapping extraocular musculature has been proposed as a technique with good results for this purpose. A search was carried out in Medline, Embase, Cochrane Library and Clinicaltrial, Lilac and Ibecs databases, using the indexed terms" amnion", "strabismus," "strabismus-subheading-surgery" and "ocular motility disorders." The only exclusion criteria were studies conducted in non-humans or studies with insufficient data on eye motility. No study was discarded for analysis because of language, age or methodology. This review includes 165 patients (223 eyes), with a mean follow-up of 11.49 months. The mean age was 21 years old, 47% were males and 57% were children. 14 studies conducted in humans were eligible: 4 single case, 8 case series, 1 cohort study and 1 randomized clinical trial. In the vast majority of these papers, use of AM transplantation to treat (12 out of 14 papers) or either to prevent (2 out of 14 papers) motility restrictions or restrictive strabismus secondary to muscular adhesions. All the studies except one presents very favorable results improving postsurgical eye motility. The cryopreservation method was more widely used, presenting a good safety profile with few adverse effects in the short and medium term. Significant improvement was reported in most patients after the use of amniotic membrane transplantation to treat or prevent ocular motility limitations. Very few complications or adverse effects were documented.

Caracterización clínica y epidemiológica del carcinoma basocelular en el Hospital Celia Sánchez Manduley, 2017- 2019 / Clinical and epidemiological characterization of basal cell carcinoma at Celia Sanchez Manduley Clinical Surgical Teaching Hospital, 2017- 2019

RESUMEN Introducción: el carcinoma basocelular representa aproximadamente de 70 a un 80 % de los cánceres cutáneos no melanoma, es un tumor maligno de origen epitelial, su crecimiento es lento y rara vez metastiza. Objetivo: caracterizar las variables clínico y epidemiológico de pacientes con carcinoma basocelular. Métodos: se realizó un estudio observacional descriptivo y transversal en 159 pacientes diagnosticados con carcinoma basocelular, atendidos en el Servicio de Maxilofacial del Hospital Clínico Quirúrgico Docente "Celia Sánchez Manduley" de Manzanillo, en el período diciembre 2017 - diciembre 2019. Se estudiaron las variables: edad, sexo, color de la piel, procedencia, localización, formas clínicas y técnica quirúrgica realizada. Se aplicó en la investigación estadística descriptiva. Resultados: el grupo más afectado fue el de la séptima década de vida (23,3 %), con un ligero predominio del sexo femenino (55,3 %). La mayoría de los pacientes con carcinoma basocelular fueron de piel blanca (54,7 %), la población rural fue la más afectada (56 %). La región nasal fue la más dañada (37,7 %), la forma clínica nodular perlada (49,7 %) fue la que predominó y la mayoría de los pacientes fueron tratados con exéresis simple (64,8 %). Conclusiones: el carcinoma basocelular predominó en las féminas, mayormente en pacientes de piel blanca, de procedencia rural y el área más dañada fue la nariz. El principal factor de riesgo de esta enfermedad es la exposición a las radiaciones ultravioletas, de ahí la importancia de la prevención y fotoprotección desde la infancia.

ABSTRACT Introduction: basal cell carcinoma represents approximately 70 to 80% of non-melanoma skin cancers, it is a malignant tumor of epithelial origin, and its growth is slow and rarely metastasizes. Objective: to characterize the clinical and epidemiological variables of patients with basal cell carcinoma. Methods: a descriptive, cross-sectional and observational study was carried out in 159 patients diagnosed with basal cell carcinoma, attended Maxillofacial Service at Celia Sánchez Manduley Clinical Surgical Teaching Hospital, Manzanillo province, from the period December 2017 - December 2019. The following variables were studied: age, sex, skin color, origin, location, clinical forms and surgical technique performed. Descriptive statistics was applied in the research. Results: the most affected group was the seventh decade of life (23,3 %), with a slight predominance of female sex (55,3 %). Most of the patients with basal cell carcinoma were white skinned (54,7 %), the rural population was the most affected (56 %). The nasal region was the most damaged (37,7 %), the nodular pearly clinical form (49,7 %) was the predominant one and most patients were treated with simple excision (64,8 %). Conclusions: basal cell carcinoma predominated in females, mostly in patients with white skin, of rural origin and the most damaged area was the nose. The main risk factor for this disease is exposure to ultraviolet radiation, hence the importance of prevention and photo-protection from childhood.

Chitosan microparticles as entrapment system for trans- cinnamaldehyde: Synthesis, drug loading, and in vitro cytotoxicity evaluation.

The ionic gelation method was used to study the effect of the crosslinking agent, sodium tripolyphosphate on average particle size (Dp) and zeta potential (ζp) of chitosan microparticles (CSMP) unloaded and loaded with trans-cinnamaldehyde (TCIN). The obtained values of Dp and ζp trend as 117.6 ±â€¯0.4 ≤ Dp ≤ 478.5 ±â€¯3.5 nm and +27.8 ±â€¯1.3 ≤ ζp ≤ +103.5 ±â€¯4.2 mV, respectively. The entrapment efficiency of TCIN in CSMP was 9.1 ±â€¯2.0% and 71.5 ±â€¯2.9% was released after 360 min (pH = 6.5) which reveals a potential anti-cancer activity in acidic environment. Cytotoxicity of TCIN in DMSO (0-50 µM) was evaluated on MDCK and HeLa cell lines and exhibited low effect at either 24 or 48 h of exposure; whereas TCIN-loaded CSMP (0-50 µM) showed, after 24 h of exposure, 67.6 ±â€¯7.0 and 64.5 ±â€¯3.9% cytotoxicity for MDCK and HeLa cell lines, respectively. At 48 h of exposure, TCIN-loaded CSMP achieved 81.1 ±â€¯0.26 and 77.9 ±â€¯4.2% cytotoxicity for MDCK and HeLa cell lines, respectively.