Resección completa en dos tiempos de teratoma quístico gigante del mediastino que debuta con compromiso vital

Objetivo: Describir resolución quirúrgica de teratoma de mediastino en dos tiempos que debuta en paciente con urgencia vital. Materiales y Métodos: Revisión de caso clínico y descripción retrospectiva del manejo quirúrgico realizado. Resultados: Estudio imagenológico evidenció tumor con contenido quístico que comprometía ambos hemitórax. Dado compromiso vital del paciente, se realiza quistocentesis descompresiva en pabellón, seguido de videotoracoscopía que demuestra origen mediastínico y quistectomía parcial por toracotomía. En un segundo tiempo quirúrgico, se reseca remanente vía esternotomía media. Discusión: Los teratomas mediastínicos son extremadamente infrecuentes, reportándose 44 casos en literatura mundial, sin registros a nivel nacional. Afecta a jóvenes sanos, la mayoría asintomáticos, siendo su hallazgo tardío e incidental. El compromiso de estructuras mediastínicas y de vía aérea pueden ocasionar riesgo vital. Conclusión: La descompresión perioperatoria del contenido quístico del teratoma fue fundamental para mantener fuera de riesgo vital al paciente durante el acto quirúrgico.

Objective: To describe the successful surgical resolution of a giant teratoma of the mediastinum that presents with a vital emergency. Clinical Case: Male patient, 30 years old, with no known history, consulted for a 1-year history of dyspnea on minimal exertion, associated with weight loss without dietary restriction. Imaging study showed tumor with cystic content that compromised both hemithorax. Given the patient's vital commitment, decompressive cystocentesis was performed, followed by video-assisted thoracoscopy that showed mediastinal origin and partial cystectomy by thoracotomy. In a second surgical time, resection of the remnant was performed via median sternotomy. Discussion: Mediastinal teratomas are extremely rare, reporting 44 cases in the world literature, with no national registry. They usually affect healthy young people, most of them asymptomatic and therefore, their discovery is late and incidental. In this case, due to the compression of noble structures, perioperative cystic decompression was essential. Conclusion: Perioperative decompression of the cystic content of the teratoma was essential to maintain stable hemodynamics and subsequent surgical resection.

SARC-F and SARC-CalF Scores as Mortality Risk Factors in Older Men with Cancer: A Longitudinal Study from Peru.

OBJECTIVES: We aimed to evaluate the role of SARC-F and SARC-CalF scores as risk factors for mortality in adults over 60 years of age with cancer of the Centro Médico Naval (CEMENA) in Callao, Peru during 2012-2015. METHODS: We performed a secondary analysis of data from a prospective cohort carried out from September 2012 to February 2013 in the Geriatrics Department of CEMENA. The outcome variable was mortality at two years of follow-up, while the exposure variable was the risk of sarcopenia assessed using the SARC-F and SARC-CalF scales. We carried out Cox proportional-hazards models to assess the role of SARC-F and SARC-CalF scores as risk factors for mortality. We estimated crude (cHR) and adjusted (aHR) hazard ratios (HR) with their respective 95% confidence intervals (95%CI). Likewise, we calculated the area under the curve (AUC) of both exposure variables in relation to mortality. RESULTS: We analyzed data from 922 elderly men with cancer; 43.1% (n=397) were between 60 and 70 years old. 21.5% (n=198) and 45.7% (n=421) were at risk of sarcopenia according to SARC-F and SARC-CalF, respectively, while the incidence of mortality was 22.9% (n=211). In the adjusted Cox regression model, we found that the risk of sarcopenia measured by SARC-F (aHR=2.51; 95%CI: 1.40-2.77) and SARC-CalF (aHR=2.04; 95%CI: 1.55-4.02) was associated with a higher risk of death in older men with cancer. In the diagnostic performance analysis, we found that the AUC for mortality prediction was 0.71 (95%CI: 0.68-0.75) for SARC-F and 0.80 (95%CI: 0.78-0.82) for SARC-CalF. CONCLUSIONS: The risk of sarcopenia evaluated by SARC-F and SARC-CalF scores was associated with an increased risk of mortality in older men with cancer. Both scales proved to be useful and accessible instruments for the identification of groups at risk of mortality.

Lack of association between angiotensin-converting enzyme genotype and muscle strength in Peruvian older people.

Aging can be associated with decreasing muscle strength, and related factors are comorbidities, sex, physical activity, and possibly genetic factors. Among genetic factors the renin-angiotensin system is of interest, but data on the Peruvian population is lacking. The objective of our study was to evaluate the association of grip strength and angiotensin convertase enzyme (ACE) polymorphism in Peruvian older people. A cross-sectional study in a convenience sample of 104 participants over 60 years in Lima, Perú, with analysis of the ACE polymorphism, was performed. We studied 104 participants, 46 men (44,2%) and 58 women (55,8%), with a mean age and standard deviation (SD) of 73,7 (7,4) years, range between 60-90 years. The frequency of D/D, I/D and I/I genotypes was 12,7; 43,7 and 43,7% respectively. The genotype distribution of ACE polymorphism agreed with the Hardy-Weinberg equilibrium (p=0,746). The mean (SD) of grip strength in the D/D, I/D and I/I polymorphisms were 24,8 (7,2); 22,8 (7,2) and 23,4 (7,6) kg respectively; no significant difference was observed (p=0,41) between genetic groups. In this small convenience sample of older Peruvians, no association was found between grip strength and ACE genotype.

Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru.

BACKGROUND: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly. OBJECTIVES: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients. DESIGN, SETTING, AND PARTICIPANTS: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed. MEASUREMENTS: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). RESULTS: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90). CONCLUSIONS: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.

On the accuracy of RANS simulations with DNS data.

Simulation results conducted for incompressible planar wall-bounded turbulent flows with the Reynolds-Averaged Navier-Stokes (RANS) equations with no modeling involved are presented. Instead, all terms but the molecular diffusion are represented by the data from direct numerical simulation (DNS). In simulations, the transport equations for velocity moments through the second order (and the fourth order where the data are available) are solved in a zero-pressure gradient boundary layer over a flat plate and in a fully-developed channel flow in a wide range of Reynolds numbers using DNS data from Sillero et al. (2013), Lee & Moser (2015), and Jeyapaul et al. (2015). The results obtained demonstrate that DNS data are the significant and dominant source of uncertainty in such simulations (hereafter, RANS-DNS simulations). Effects of the Reynolds number, flow geometry, and the velocity moment order as well as an uncertainty quantification technique used to collect the DNS data on the results of RANS-DNS simulations are analyzed. New criteria for uncertainty quantification in statistical data collected from DNS are proposed to guarantee the data accuracy sufficient for their use in RANS equations and for the turbulence model validation.

Prevalencia de la intoxicación mortal por suicidios casuística de los últimos años / Prevalence of fatal poisoning suicide cases in recent years

Conocer el panorama de las muertes intencionales por intoxicación, ingresados en el Hospital Central San Cristóbal (HCSC) entre 2000 a 2004. La recolección de información realizada para el presente análisis comprendió los datos de notificación del material constituido por historias médicas del HCSC siendo el método utilizado para la recolección de datos a través de fichas individuales. La letalidad por intoxicaciones voluntarias se calculó como el número de muertes en relación con el total de muertes por intoxicaciones. Estadísticamente se utilizó revisión y análisis retrospectivo de los expedientes, así como investigación bibliográfica actualizada sobre el tema. Las variables analizadas fueron: edad, sexo, año, sustancia, vía de exposición. Fueron estudiados 110 casos de adultos muertos por intoxicación de los cuales 77 (70 por ciento) fueron de manera intencional, de esta últimas cifras(total), 70 por ciento fueron mujeres en comparación al sexo masculino, la edad predominante fue de 18 a 38 años con una media de 28. El análisis temporal indica tendencia al incremento en el número de casos en los últimos años, siendo para el año 2004 67 por ciento en comparación a los años 2001-2003, resultando consistentemente mayor por el plaguicida Organofosforados, ocupando el primer lugar con un 78 por ciento, seguido de otros plaguicidas 10 por ciento, medicamentos 7 por ciento y otras sustancias 5 por ciento la vía de exposición fue la oral en el 85 por ciento. Este estudio nos permite observar las tendencias de las muertes intencionales por intoxicación y mejorar el conocimiento de las mismas, adecuar normas de atención y establecer pautas de prevención. Las intoxicaciones en ciudades de alta densidad poblacional por exposición intencional son permanentes. Las sustancias tóxicas que causan el mayor número de muertes por intoxicación son los plaguicidas del grupo de los Organofosforados. La población desconoce la magnitud de los efectos qque puede generar.

Estudio epidemiológico comparativo del abuso sexual en adolescentes y el consumo de drogas / Comparative epidemiological study of the adolescent sexual abuse and drug use

Conocer la relación entre consumo de algunas drogas y el abuso sexual, en adolescentes de ambos sexos de una localidad estudiantil de la cuidad de San Cristóbal Estado Táchira Venezuela. Se estudiaron 763 jóvenes de un instituto docente de secundaria ubicado en el centro de la cuidad, los datos fueron obtenidos por encuestas tipo cuestionario realizadas a cada estudiante, estudiando tanto a la víctima como al agresor. De total se encontró 60 por ciento de jóvenes que tuvieron un suceso de abuso sexual, (35 por ciento del sexo femenino y 25 por ciento del sexo masculino), y 40 por ciento reportaron consumo de drogas, la prevalencia del agresor fue de 38 por ciento predominando en 55 por ciento en el sexo masculino. La edad más precoz de haber padecido de abuso sexual predominó en el sexo femenino en 58 por ciento (del total). Ambos sexos manifestaron casi por igual haber sido abusado por familiares. Estos hallazgos demuestran la relación del consumo de drogas y el abuso sexual en hombres y en mujeres, llamando la atención que en ambos sexos el agresor es intrafamiliar y en edades tempranas, lo que revela una estrecha relación causa efecto.

Theoretical study of C-H and C-F activation in CH4-nFn (n =1-4) molecules by platinum.

CASSCF followed by MRMP2 calculations have been carried out to analyze the reactions of a naked platinum atom with the fluorocarbon compounds CH(4-n)Fn (n = 1-4). For each of these interactions the potential-energy surfaces which correlate with the triplet ground state and the first excited singlet state of the free fragments were investigated for representative states evolving from different approaching modes of the reactants. For all the fluorinated fragments activation of the C-H and C-F bonds by the metal is strongly determined by the low-multiplicity channels arising from the first excited asymptote. Although stable products are predicted for insertion of the metallic atom into both the C-H and the C-F bonds of the different fluorocarbon compounds, comparison between the calculated energy barriers for reactions taking place in the same fluorinated molecule suggests in all cases a kinetic preference for the C-H bond oxidative addition to the platinum atom.

Uso de beta-bloqueantes y evolución clínica de la cardiopatía isquémica aguda / Use beta-blockate and clinical evolution of the acute ischemic heart disease

La Cardiopatía Isquémica Aguda es una patología multifactorial que, a pesar de haber disminuido en las últimas tres décadas, continúa ocupando papel relevante como problema de salud pública. Actualmente, el uso de terapia trombolítica, aspirina y beta-bloqueantes han cambiado su pronóstico. Hemos realizado el presente trabajo retrospectivo tipo caso controles, con el fin de evaluar el riesgo de presentación de complicaciones en pacientes con Cardiopatía Isquémica Aguda, en cualesquiera de sus tres formas de presentación, al no recibir Beta-Bloqueantes. del total de casos revisados, solamente pudimos ingresar al estudio, el 18.9 por ciento (103 casos). La edad promedio de 57,27 años ñ 13.09 DS, con predominio del sexo masculino. El 82.5 por ciento fueron infartos agudos. El 9.7 por ciento lesiones, y el 7.8 por ciento isquemia. Las áreas de mayor afectación miocárdica fueron la cara diafragmática y anterior. El 59.2 por ciento presentó complicaciones y sólo 33 pacientes recibieron Beta-Bloqueantes. La Odds Ratio cruda encontrada al medir el riesgo de complicación al no recibir Beta-Bloqueantes fue de 2.17 (CI:1.02-555.52,p=0.06) para todo el grupo. al no ajustarla para edad y sexo, fue de 2.05 (CI:1.21-3.48,p=0.007), y, al calcular sólo para los pacientes con infarto , fue de 1.78 (CI:1.1-3.02,p=0.09). Los Beta-Bloqueantes utilizados durante la Cardiopatía Isquémica aguda actúan como factores protectores en la aparición de complicaciones agudas, lo cual traduce en disminución de la mortalidad.

Changes in female reproductive condition following male take-overs in a colony of hamadryas and hybrid baboons.

This paper describes and discusses events observed in the Madrid colony of hamadryas and hybrid baboons, when a novel group of 3 adult males, 3 adult females and 1 unweaned infant was introduced to the resident colony comprising 12 adult females, 11 juveniles and 6 unweaned infants. Novel males took over resident adult females in any reproductive condition, and all acyclic females (i.e. lactating, pregnant and immature) exhibited a dramatic enhancement of sexual activity. Lactating females shortened their postpartum amenorrhoea periods and resumed oestrous cycles around day 14 following the introduction of the novel males, without infanticide occurring. Their return to breeding condition was not affected by the age of their current infant or the day they were taken over by the males. A female in an early stage of pregnancy aborted spontaneously and resumed oestrus on day 26. The other pregnant female significantly shortened her gestation time, delivered a viable infant on day 13, and resumed breeding activity 39 days post-partum (on day 52), while suckling her infant. A cycling female adopted and suckled a 74-day-old infant, continued showing oestrous cycles and conceived. Immature females reached menarche significantly earlier than expected and only then joined one of the newly established harem units. It is argued that the observed enhancement of sexual activity was not imposed by the males' aggressive behaviour but rather was a spontaneous female response to male novelty. This single causal factor was potent enough to override the role that nutrition and lactation normally play in the control of the females' reproductive activity. Differences in latency until the appearance of the response were probably due to the different constraints imposed by the female's current reproductive state. It was also hypothesized that when (a) sexual swellings are attractive to males, (b) novel males are especially active in the process of bonding with new females, and (c) males are important sources of coalitionary support, females might by developing sexual swellings compete more successfully against other females and attain a higher position in the female hierarchy of the newly established unit. This would have the ultimate effect of increasing their potential reproductive success. In several cases females did gain socially by coming into oestrus, but attained no immediate reproductive advantage.