Multimessenger Constraints on Radiatively Decaying Axions from GW170817.

The metastable hypermassive neutron star produced in the coalescence of two neutron stars can copiously produce axions that radiatively decay into O(100) MeV photons. These photons can form a fireball with characteristic temperature smaller than 1 MeV. By relying on x-ray observations of GW170817/GRB 170817A with CALET CGBM, Konus-Wind, and Insight-HXMT/HE, we present new bounds on the axion-photon coupling for axion masses in the range 1-400 MeV. We exclude couplings down to 5×10^{-11} GeV^{-1}, complementing and surpassing existing constraints. Our approach can be extended to any feebly interacting particle decaying into photons.

Dopamine D2 receptor agonist, bromocriptine, remodels adipose tissue dopaminergic signalling and upregulates catabolic pathways, improving metabolic profile in type 2 diabetes.

BACKGROUND AND OBJECTIVES: The therapeutic effects of the dopamine D2 receptor (D2R) agonist, bromocriptine, in type 2 diabetes (T2D) have been attributed to central nervous system actions. However, peripheral dopamine directly modulates glucose uptake in insulin-sensitive tissues and lipid metabolism in adipose tissue (AT). We hypothesized that the dopaminergic system may be impaired in the adipose tissue of patients with T2D and that the therapeutic actions of bromocriptine could involve the modulation of metabolism in this tissue. METHODS: The expression of dopamine receptors was evaluated in visceral AT samples from patients with obesity and stratified in several groups: insulin sensitive (IS); insulin resistance (IR) normoglycaemic; insulin resistant prediabetic; insulin resistant diabetic, according to Ox-HOMA2IR, fasting glycaemia and HbA1c levels. T2D Goto-Kakizaki rats (GK) were fed a high-caloric diet (HCD) for five months and treated with bromocriptine (10 mg/kg/day, i.p.) in the last month. The levels of dopaminergic system mediators and markers of insulin sensitivity and glucose and lipid metabolism were assessed in the peri-epididymal adipose tissue (pEWAT) and brown (BAT) adipose tissues, liver, and skeletal muscle. RESULTS: Patients with IR presented a decreasing trend of DRD1 expression in the visceral adipose tissue, being correlated with the expression of UCP1, PPARA, and insulin receptor (INSR) independently of insulin resistance and body mass index. Although no differences were observed in DRD2, DRD4 expression was significantly decreased in patients with prediabetes and T2D. In HCD-fed diabetic rats, bromocriptine increased D1R and tyrosine hydroxylase (TH) levels in pEWAT and the liver. Besides reducing adiposity, bromocriptine restored GLUT4 and PPARγ levels in pEWAT, as well as postprandial InsR activation and postabsorptive activation of lipid oxidation pathways. A reduction of liver fat, GLUT2 levels and postprandial InsR and AMPK activation in the liver was observed. Increased insulin sensitivity and GLUT4 levels in BAT and an improvement of the overall metabolic status were observed. CONCLUSIONS: Bromocriptine treatment remodels adipose tissue and the liver dopaminergic system, with increased D1R and TH levels, resulting in higher insulin sensitivity and catabolic function. Such effects may be involved in bromocriptine therapeutic effects, given the impaired expression of dopamine receptors in the visceral adipose tissue of IR patients, as well as the correlation of D1R expression with InsR and metabolic mediators.

Technical position on milk and its derivatives in adult health and disease from the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría. / Posición técnica sobre la leche y derivados lácteos en la salud y en la enfermedad del adulto de la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Gerontología y Geriatría.

Milk is a liquid food that possesses an important quantity of highly bioavailable macronutrients. In addition, it is readily accessible, as well as relatively inexpensive. Given that the knowledge of physicians about nutrition and food composition is deficient, in general, many of the dietary interventions recommended in diverse clinical settings lack a scientific basis. The aim of the present review was to produce a technical opinion that serves as a frame of reference to best sustain recommendations for consuming milk and dairy products as daily nutrition in the adult and older adult. The effects of milk and dairy products during the pediatric stage are not addressed in the present work. The Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría jointly discussed and analyzed topics dealing with the legal designation of milk, the classification and nutritional profile of cow's milk, its nutritional characteristics, its consumption in the adult, intolerance to cow's milk, and associations of milk consumption with digestive tract alterations and other conditions. Finally, certain aspects of milk consumption in the older adult and its relation to overall health are briefly discussed.

Impact of Distinct Freezing Curves on the Quality of Ram Sperm after Thawing.

BACKGROUND: Automated equipment with customized freezing curves can be used to cryopreserve ram sperm, but none is considered a standard. OBJECTIVE: This study compared the post-thawing quality of ram sperm frozen using a conventional freezing curve and two controlled-rate curves. MATERIALS AND METHODS: Six ejaculates were collected from four rams (n = 24). In the conventional curve (110 min), sperm was cooled at -0.3 to -0.5°C min-1 until 5°C, stabilized for 60 min and exposed to liquid nitrogen (LN2) vapor for 10 min (-80°C) before submersion. The slow-customized (SC) curve (126.2 min) used a rate of -0.25°C min-1 until 5°C, stabilization for 60 min and a rate of -20°C min-1 until -120°C before immersion in LN2. Rates for the fast-customized (FC) curve (75 min) were: -0.3°C min-1 until 5°C; -3°C min-1 until -10°C; -5°C min-1 until -35°C; and -4°C min-1 until immersion in LN2 (-43°C). RESULTS: Velocity in a straight line and beat-cross frequency were lower for spermatozoa frozen with the FC than with the conventional curve (P < 0.05). The FC curve resulted in more membrane and acrosome damages than the other curves (P < 0.05). Mitochondrial membrane potential was lower with the SC than with the other curves (P < 0.05). CONCLUSION: The conventional curve was more efficient than both tested automated freezing curves. The FC curve may be an alternative to the SC curve due to the shorter processing time.

The effects of xanthan gum on equine sperm quality during cooling storage / Efeitos de xantam gum em qualidade de esperma equino durante armazenamento resfriado

This study was designed to evaluate the possible benefits of adding xanthan gum to a standard extender for equine through in vitro analyzes of sperm quality. Semen was collected four times from five different stallions (n= 20 samples) and subjected to cooled storage under different conditions: control (only standard extender) and three different concentrations of xanthan gum (0.01%, 0.12%, and 0.25%) supplemented to the extenders. Sperm parameters, such as motility, mitochondrial functionality, and membrane, acrosome, and DNA integrity were measured after 0h, 24h, 48h, and 72h of sperm storage at 5ºC. Our observations indicated that sperm motility declined with longer cooling period with the 0.25% xanthan gum supplementation group compared with the control group. Other parameters, such as mitochondrial functionality and membrane and acrosome integrity also declined for all treatments during storage; however, no differences were observed between xanthan gum and control groups. DNA integrity did not significantly change during the storage. In conclusion, the addition of xanthan gum to equine semen extender is not harmful to the sperm structure, despite reducing the sperm motility.(AU)

Esse estudo foi desenvolvido para avaliar os possíveis benefícios de acrescentar xanthan gum a um extensor padrão através de analises in vitro de qualidade de esperma. Semen foi coletado quatro vezes de cinco garanhões diferentes (n = 20 amostras) e submetido a armazenamen to resfriado em diferentes condições: controle (apenas extensor padrão) e três diferentes concentrações de xanthan gum (0,01%, 0,12% e 0,25%) suplementado aos extensores. Parâmetros dos espermatozoides, como mobilidade, funcionamento mitocondrial e integridade de membranas, acrossomos e DNA forma medidos após 0h, 24h, 48h e 72h de armazenamento a 5oC. Nossas observações indicaram que motilidade reduziu com armazenamento resfriado prolongado no grupo de 0,25% de suplementação de xanthan gum comparado ao grupo controle. Outros parâmetros, como funcionalidade mitocondrial e integridade de membrana e acrossomos também reduziu em todos os tratamentos durante o armazenamento, no entanto não foram detectadas diferenças significativas entre grupos tratados e grupo controle. Integridade de DNA não mudou significativamente durante armazenamento. Em conclusão, a adição de xanthan gum a extensor de sêmen equino não é danosa à estrutura do espermatozoide apesar de reduzir motilidade.(AU)

Metabolites related to eGFR: Evaluation of candidate molecules for GFR estimation using untargeted metabolomics.

BACKGROUND: Metabolomics can be used to identify novel metabolites related to renal function and that could therefore be used for estimating GFR. We evaluated metabolites replicated and related to eGFR in 3 studies (CKD and general population). METHODS: Metabolomics was performed by GC-MS. The Progredir Cohort (n = 454, class 3 and 4 CKD) was used as the derivation study and adjusted linear regression models on eGFR-CKDEPI were built. Bonferroni correction was applied for selecting metabolites to be independently validated in the Diabetic Nephropathy Study (n = 56, macroalbuminuric DN) and in the Baependi Heart Study (BHS, n = 1145, general population). RESULTS: In the Progredir Cohort, 72 metabolites where associated with eGFR. Of those, 11 were also significantly associated to eGFR in the DN Study and 8 in the BHS. Four metabolites were replicated and significantly associated to eGFR in all 3 studies: d-threitol, myo-inositol, 4-deoxierythronic acid and galacturonic acid. In addition, pseudouridine was strongly correlated to eGFR only in the 2 CKD populations. CONCLUSIONS: Our results demonstrate metabolites that are potential biomarkers of renal function: d-threitol, myo-inositol, 4-deoxierythronic acid, galacturonic acid and pseudouridine. Further investigation is needed to determine their performance against otherwise gold-standard methods, most notably among those with normal eGFR.

Natural coinfection by Streptococcus agalactiae and Francisella noatunensis subsp. orientalis in farmed Nile tilapia (Oreochromis niloticus L.).

Streptococcus agalactiae and Francisella noatunensis subsp. orientalis (Fno) are important pathogens for farm-raised tilapia worldwide. There are no reports of coinfection caused by S. agalactiae and Fno in fish. This study aimed to determine the aetiology of atypical mortalities in a cage farm of Nile tilapia and to characterize the genetic diversity of the isolates. Fifty-two fish were sampled and subjected to parasitological and bacteriological examination. The S. agalactiae and Fno isolates were genotyped using MLST and REP-PCR, respectively. Whole-genome sequencing was performed to confirm the MLST results. Seven fish were shown coinfected by S. agalactiae and Fno. Chronic hypoxia and a reduction in the water temperature were determined as risk factors for coinfection. Fno isolates were shown clonally related in REP-PCR. The MLST analysis revealed that the S. agalactiae isolates from seven coinfected fish were negative for the glcK gene; however, these were determined to be members of clonal complex CC-552. This is the first description of coinfection by S. agalactiae and Fno in farm-raised Nile tilapia. The coinfection was predisposed by chronic hypoxia and was caused by the main genotypes of S. agalactiae and Fno reported in Brazil. Finally, a new S. agalactiae genotype with glcK gene partially deleted was described.

New hosts and genetic diversity of Flavobacterium columnare isolated from Brazilian native species and Nile tilapia.

Flavobacterium columnare is responsible for disease outbreaks in freshwater fish farms. Several Brazilian native fish have been commercially exploited or studied for aquaculture purposes, including Amazon catfish Leiarius marmoratus × Pseudoplatystoma fasciatum and pacamã Lophiosilurus alexandri. This study aimed to identify the aetiology of disease outbreaks in Amazon catfish and pacamã hatcheries and to address the genetic diversity of F. columnare isolates obtained from diseased fish. Two outbreaks in Amazon catfish and pacamã hatcheries took place in 2010 and 2011. Four F. columnare strains were isolated from these fish and identified by PCR. The disease was successfully reproduced under experimental conditions for both fish species, fulfilling Koch's postulates. The genomovar of these 4 isolates and of an additional 11 isolates from Nile tilapia Oreochromis niloticus was determined by 16S rRNA restriction fragment length polymorphism PCR. The genetic diversity was evaluated by phylogenetic analysis of the 16S rRNA gene and repetitive extragenic palindromic PCR (REP-PCR). Most isolates (n = 13) belonged to genomovar II; the remaining 2 isolates (both from Nile tilapia) were assigned to genomovar I. Phylogenetic analysis and REP-PCR were able to demonstrate intragenomovar diversity. This is the first report of columnaris in Brazilian native Amazon catfish and pacamã. The Brazilian F. columnare isolates showed moderate diversity, and REP-PCR was demonstrated to be a feasible method to evaluate genetic variability in this bacterium.

Outbreaks and genetic diversity of Francisella noatunensis subsp orientalis isolated from farm-raised Nile tilapia (Oreochromis niloticus) in Brazil.

Francisella noatunensis subsp orientalis (FNO) is an emerging pathogen of warm water tilapia in a number of different countries. The disease caused by this bacterium in fish is characterized by a systemic granulomatous infection that causes high mortality rates during outbreaks. FNO has been previously described in Asia, Europe, and Central and North America. Its occurrence in South America has never been described. Since 2012, outbreaks of a granulomatous disease have been recorded in cage farms of Nile tilapia (Oreochromis niloticus L.) in Brazil. The current study aimed to identify the etiologic agent of recent francisellosis outbreaks at Brazilian tilapia farms, and to characterize the genetic diversity of the pathogen from farms with distinct geographic origins and without epidemiological connections. Bacteriological analysis of 44 diseased Nile tilapia collected from five cage farms in Brazil was performed during 2012 and 2013. The farms were in different locations and had no recent history of animal or biological material transport between each other. Sixty-two FNO isolates were identified on the basis of FNO-specific qPCR. The main predisposing factors for the occurrence of outbreaks on Brazilian farms were lower water temperature (<22°C) and life stage of fish, affecting mainly fry, fingerlings and young adults (live weight <100 g). The genetic diversity of the Brazilian FNO isolates was evaluated using repetitive extragenic palindromic-PCR. The isolates from different origins were shown to be clonally related. This is the first report of the occurrence and genetic diversity of FNO in South America.

[Mexican consensus on portal hypertension]. / Consenso Mexicano de Hipertensión Portal.

The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available.

Composição química e digestibilidade de partes e subprodutos de aves nas formas crua e cozida para cães / Chemical composition and digestibility of raw and cooked chicken parts for dogs

Determinou-se a composição de partes da carcaça - pescoço, dorso e pés de aves -, e sua digestibilidade, usadas para cães nas formas crua e cozida. Os animais, pesados antes e depois do período experimental, foram alimentados uma vez ao dia, com livre acesso ao alimento por uma hora. Cada animal recebeu aproximadamente 50g alimento/kg de peso. As fezes, coletadas diariamente, foram pesadas e congeladas até a realização das análises bromatológicas. Os pés apresentaram os maiores valores de proteína bruta (PB) e matéria mineral (MM), o pescoço, o maior valor de energia bruta (EB), e o dorso, os de matéria seca (MS), matéria orgânica (MO) e extrato etéreo (EE). O cozimento não alterou a composição dos alimentos, entretanto os alimentos cozidos apresentaram teores menores em PB e maiores em EE. Os coeficientes de digestibilidade da MO e da PB do pescoço aumentaram significativamente quando este foi cozido, e os valores de energia metabolizável (EM) e energia digestível (ED) diminuíram. O cozimento do dorso resultou em redução de EM e ED. Os coeficientes de digestibilidade da MS, MO e PB e a ED e EM do pé foram significativamente maiores para os pés cozidos.

In order to use an ingredient to formulate dog foods, it is ideal to the industry to know its properties including the digestibility. So, this work studied the chemical composition and the digestibility of chicken parts used to feed dogs, since they are used frequently by the dog food industry. The ingredients were raw and cooked neck, back, and feet. The animals were weighted before and after the experimental period and food was served once a day. The food was weighted before and after being served. Each animal consumed approximately 50g food/kg body weight. The feces were collected daily and freezed as well as the food until the bromatological analyses procedures. The feet had the highest values for crude protein (CP) and mineral content (MC); while the back, the highest values for dry matter (DM), organic matter (OM), and fat. Cooking had no significant effect on chemical composition of the ingredients. Considering the digestibility coefficient, OM and CP of neck had a significant increase when it was used in the cooked form; but, the metabolizable energy (ME) and the digestible energy (DE) values considerably decreased. For the back, the heat treatment resulted in a significant reduction of ME and DE and the digestibility coefficients of DM, OM, and CP, and ME, and DE of the feet were higher using the same treatment.

Physico-chemical analysis of metronidazole encapsulation processes in Eudragit copolymers and their blending with amphiphilic block copolymers.

A physico-chemical analysis of metronidazole-Eudragit copolymers L100 and RLPO (a cationic polymeric matrix with an electrophilic character) was carried out in order to explore the drug-polymer interaction and its possible effects on the encapsulation and release profiles. An oil-in-oil encapsulation procedure was designed to obtain more intimate drug-matrix mixtures and to obtain a better insight into the details of the interaction. The encapsulation efficiency obtained in these cases was high (in the range of 85-95%), but the release rates were quite rapid. Solubility and interaction between metronidazole and copolymers are discussed in detail with a view to explaining the results. Amphiphilic block copolymers of poly(ethylene)-b-(polyethylene oxide) (20, 50 and 80% PEO) were tested as a matrix for metronidazole release in order to improve drug profiles. The performance of RLPO as the matrix for drug release was improved by blending it with amphiphilic block copolymer poly(ethylene)-b-(polyethylene oxide) (20% PEO). The release mechanism of metronidazole is governed mainly by the swelling of RLPO, yielding a better fit with the second-order Schott equation.

Optimisation of MSW collection routes for minimum fuel consumption using 3D GIS modelling.

Collection of municipal solid waste (MSW) may account for more than 70% of the total waste management budget, most of which is for fuel costs. It is therefore crucial to optimise the routing network used for waste collection and transportation. This paper proposes the use of geographical information systems (GIS) 3D route modelling software for waste collection and transportation, which adds one more degree of freedom to the system and allows driving routes to be optimised for minimum fuel consumption. The model takes into account the effects of road inclination and vehicle weight. It is applied to two different cases: routing waste collection vehicles in the city of Praia, the capital of Cape Verde, and routing the transport of waste from different municipalities of Santiago Island to an incineration plant. For the Praia city region, the 3D model that minimised fuel consumption yielded cost savings of 8% as compared with an approach that simply calculated the shortest 3D route. Remarkably, this was true despite the fact that the GIS-recommended fuel reduction route was actually 1.8% longer than the shortest possible travel distance. For the Santiago Island case, the difference was even more significant: a 12% fuel reduction for a similar total travel distance. These figures indicate the importance of considering both the relief of the terrain and fuel consumption in selecting a suitable cost function to optimise vehicle routing.

Weak D type 2 is the most prevalent weak D type in Portugal.

The weak D phenotype is the most common D variant, with a frequency of 0.2-1% in Caucasian individuals. There are several weak D types, with different frequencies in European countries, which may pose serologic problems and have the potential for alloimmunization. Samples from Portuguese individuals were tested for RhD by two or three distinct monoclonal and oligoclonal antisera, in direct agglutination tests. When discrepant results were observed, samples were tested with panels of monoclonal anti-D by LISS-indirect antiglobulin test. Cases that reacted weakly with IgM but positive with IgG anti-D were analysed by PCR-sequence-specific primers and real-time PCR. Ninety-nine samples were referred after being characterized as weak D. This genotype was recognized, with a preponderance of weak D type 2 (63.6%) over type 1 (16.2%) and 3 (14.1%). The high incidence of weak D type 2 in our population is in marked contrast to studies performed in other European populations and might be due to our sample selection criteria or ethnic variation. There are advantages in genotyping serologically depressed D samples to avoid the waste of D-negative RBC units and the use of immunoglobulin in pregnant women, who have no risk of alloimmunization.

Outcome of infections caused by multiple drug-resistant bacteria in liver transplant recipients.

OBJECTIVE: To evaluate the impact of infections caused by multiple-drug-resistant (MDR) bacteria on the clinical outcome of liver transplant recipients. METHODS: Retrospective study including all episodes of bacterial infection diagnosed in patients undergoing liver transplantation from January 19, 1999, to June 30, 2002. The diagnosis of bacterial infection required microbiological documentation. Mortality associated with episodes of infection by MDR bacteria was compared to that observed after antibiotic-susceptible bacterial infections. RESULTS: Among 99 patients undergoing liver transplantation during the study period, there were 57 episodes of bacterial infections. Gram-negative bacilli were the predominant etiologic agents (76%) and Pseudomonas aeruginosa was the most frequent bacterial species found in these cases (23 isolates, 28%). Thirty-six episodes of infection (63%) were caused by MDR bacteria. Mean time after transplantation to the diagnosis of infection was 17 days. Mortality associated with episodes of MDR bacterial infections (nine deaths, 25%) was not significantly different from that observed during episodes of antibiotic-susceptible bacteria (five deaths, 24%; P =.92). CONCLUSION: These data suggest that resistance to multiple antimicrobial agents does not have an impact on the mortality associated to bacterial infections in liver transplant recipients.

Presentación infrecuente de ependimoma intracraneal: relato de caso / intracraneal infrequent presentation of ependynoma: case report

El compromiso óseo craneal asociado a tumores cerebrales primarios es de ocurrencia rara. Entre los gliomas de crecimiento lento que pueden cursar con erosión craneána están el astrocitoma, oligodendroglioma, ependimoblastoma, oligoastrocitoma, glioblastoma multiforme, meningiomas, metástasis y sarcomas. Su fisiopatología se debe probablemente a evolución lenta y localización superficial en el cerebro, lo que ocasiona elevación progresiva de la presión intracraneal. Los autores relatan un caso de ependimoma parietal posterior derecho con perforación de la duramadre y extensión extracraneal.

Quiste dermoide de la fontanela anterior en adulto: relato de caso / Anterior fontanella dermoid cyst in adult: case report

Los quístes dermoides en la región de la fontanela anterior son raros constituyendo alrededor de 0,1 porciento de todos los tumores craneales. Son tumores relacionados con el desarrollo, que aparecen frecuentemente en la región axial del neuro-eje o en la línea de fusión embriológica. Son diagnósticados y tratados por cirugía en los primeros añós de vida, razón por la cual este tipo de patologíaes raramente observada en la edad adulta. Para s diagnóstico son necesarios radiografía simple y tomografía computarizada con o sin contraste. Los autores relatan un caso de Quiste Dermoide de Inclusión Congénita (DIC) ubicado en la fontanela anterior en un paciente adulto, y discuten su aspecto histopatológico, diagnóstico diferencial y tratamiento.

Traumatísmo craneoencefálico por accidente con vehículos de dos ruedas / Head injury and accident by two wheels vehicles

En los EE.UU., el traumatísmo craneoencefálico (TCE) es la principal causa mortis entre individuos de 10 a 44 años y constituye por más del 50 por ciento de los órbitos por trauma alcanzado, por lo tanto, una importante parcela económicamente activa de la población. El uso de vehículos de dos ruedas, sea como medio de transporte, recreación o para la práctica de deportes, no está exento de accidentes, siendo el TCE relevante consecuencia de esa práctica y la principal causa de muerte e invalidez. Se realizó un estudio prospectivo de 20 pacientes atendidos en el Hospital Universitario Vírgen de la Arrixaca, Murcia, España, con diagnóstico de TCE por caída de vehículo de dos ruedas, en el período de enero a junio de 2002, utilizando un protocolo patrón, el cual fue rellenado por el autor o por el equipo del hospital. En nuestra muestra, hubo una nítida predominancia del sexo masculino (95 por ciento de los casos), siendo el grupo más afectado el de los jóvenes de 11 a 20 años, con el 65 por ciento de los casos. Hubo 17 accidentes por motocicleta y tres por bicicleta. En el primer grupo, siete (41,2 por ciento) usaban casco y entre los usuarios de bicicleta, dos (67 por ciento). En todo el muestreo, el uso de casco fue relatado por el 45 por ciento de los pacientes. La tomografía computarizada (TC) fue el método de elección para la evaluación de esos pacientes, pues es un método rápido que tiene la posibilidad de reconocer a los pacientes que necesitan intervención quirúrgica. En cuanto a las lesiones encontradas en las imágenes por TAC, el 85 por ciento del muestreo evidenció la presencia de lesiones intracraneales, siendo el hematoma subdural la más frecuente, seguido de la hemorragia subaracnoidea, la contusión cerebral y el edema cerebral. El tratamiento instituído fue conservador en la mayoría de los casos, siendo en apenas 5 pacientes (25 por ciento) necesaria la cirugía. El tiempo medio de internación fue significativamente más alto en los pacientes sometidos a tratamiento quirúrgico en relación al grupo sometido a tratamiento conservador (26,6 días y 15,3 días, respectivamente). La mortalidad fue de 10 por ciento (2 pacientes). La atención en el lugar del accidente es de importancia fundamental para reducir el número de óbitos y secuelas después del traumatísmo en general y el TEC en particular.

[Echocardiographic diagnosis of transposition of the great arteries associated with anomalous pulmonary venous connection].

We report 2 cases of transposition of the great arteries associated with anomalous pulmonary venous connection emphasizing the clinical findings, the diagnosis, and the evolution of the association. One of the patients had the anomalous pulmonary venous connection in its total infradiaphragmatic form, in the portal system, and the other patient had a partial form, in which an anomalous connection of the left superior lobar vein with the innominate vein existed. At the time of hospital admission, the patients had cyanosis and respiratory distress with clinical findings suggesting transposition of the great arteries. The diagnosis in 1 of the cases, in which the anomalous connection was partial, was established only with echocardiography, without invasive procedures that would represent risk for the patient; in the other case, in which the anomalous connection was total, the malformation was only evidenced with catheterization. The patients underwent surgery for anatomical correction of the heart disease. Only 1 patient had a good outcome.