Angina de Ludwig, aspectos semiológicos útiles para el diagnóstico presuntivo de una patología letal / Ludwig`s angina, useful semiologic points for the presumptive diagnosis of a lethal pathology

Resumen Mujer de 74 años consulta al servicio de urgencia por cuadro de sepsis origen aparentemente no precisado, hasta su evaluación por dermatología que describe eritema violáceo cervical anterior más una infección en cavidad bucal como puerta de entrada. Considerando la clínica y los estudios por imágenes confirmamos el diagnóstico de Angina de Ludwig, cuadro de alta morbimortalidad que puede progresar a otras complicaciones más graves. Finalmente la paciente evoluciona de manera tórpida no respondiendo a medidas realizadas de soporte y fallece. La Angina de Ludwig es una celulitis de evolución rápida y grave, muy poco frecuente, que por lo general tiene una puerta de entrada a través de infecciones de la mucosa oral, donde su sospecha obliga a iniciar terapia precoz con antibióticos, quirúrgico y soporte.

Abstract This is a 74-year-old female patient with comorbidities who consulted the emergency service due to symptoms of sepsis of apparently unspecified origin, until her evaluation by dermatology revealed mild anterior cervical violaceous erythema and probable dental infection as the portal of entry. Based on clinical and imaging findings, a diagnosis of Ludwig's angina is confirmed, a condition with high morbidity and mortality that can progress to other more severe complications. Finally, the patient had a torpid evolution, not responding to support measures, and died. Ludwig's Angina is a cellulitis of etiology, usually rapidly progressive, infrequent oral infections, where a mandatory physical examination should be considered and suspected in order to start early therapy.

Side effects of the BNT162b2 vaccine in the personnel of the Military Central Hospital.

OBJECTIVE: The pandemic disease by SARS-CoV-2 infection does not have an effective treatment. To prevent the disease, scientists developed vaccines that the clinicians use as an emergency licensed vaccine. The objective of this study was to determine the side effects in personnel vaccinated at the Military Central Hospital of Mexico with the BNT162b2 vaccine. PATIENTS AND METHODS: This study included the subjects who had received both doses of the BNT162b2 vaccine between December 2020 and February 2021. We asked about the side effects after the first and the second vaccine doses. One group had no history of COVID-19, and the second had a history of COVID-19. ANTI-SARS-CoV-2 antibodies were measured by the immunodetection technique in the second group only. RESULTS: We included 946 participants, 62% were women, and 80% were without comorbidities; 680 were included in the first group, and only 266 were in the second group. After the first dose, 77% of the first group and 86% of the second group presented some side effects. After the second dose, 84% of the first group and 89% of the second group showed some side effects. The main side effect was mild pain. All participants (126) were IgG positive, and only 26.9% were IgM positive at 17.5 days (12.8 days, 20.3 days) after the second dose. CONCLUSIONS: There is a positive correlation between side effects after the first dose in patients with a history of previous SARS-CoV-2 infection compared to those who did not. Nevertheless, this correlation is not present after the second dose. The low percentage of IgM could be related to the time interval between vaccination and sample measure.

Advances in catalytic routes for the production of carboxylic acids from biomass: a step forward for sustainable polymers.

Polymers are ubiquitously present in our daily life because they can meet a wide range of needs and fields of applications. This success, based on an irresponsible linear consumption of plastics and the access to cheap oil, is creating serious environmental problems. Two lines of actions are needed to cope with them: to adopt a circular consumption of plastics and to produce renewable carbon-neutral monomers. This review analyses the recent advances in the chemocatalytic processes for producing biomass-derived carboxylic acids. These renewable carboxylic acids are involved in the synthesis of relevant general purpose and specialty polyesters and polyamides; some of them are currently derived from oil, while others can become surrogates of petrochemical polymers due to their excellent performance properties. Polyesters and polyamides are very suitable to be depolymerised to other valuable chemicals or to their constituent monomers, what facilitates the circular reutilisation of these monomers. Different types of carboxylic acids have been included in this review: monocarboxylic acids (like glycolic, lactic, hydroxypropanoic, methyl vinyl glycolic, methyl-4-methoxy-2-hydroxybutanoic, 2,5-dihydroxypent-3-enoic, 2,5,6-trihydroxyhex-3-enoic acids, diphenolic, acrylic and δ-amino levulinic acids), dicarboxylic acids (2,5-furandicarboxylic, maleic, succinic, adipic and terephthalic acids) and sugar acids (like gluconic and glucaric acids). The review evaluates the technology status and the advantages and drawbacks of each route in terms of feedstock, reaction pathways, catalysts and economic and environmental evaluation. The prospects and the new research that should be undertaken to overcome the main problems threatening their economic viability or the weaknesses that prevent their commercial implementation have also been underlined.

Comparación del consumo de edulcorantes no nutritivos con estado nutricional en embarazadas chilenas / Comparison of non-nutritive sweetener consumption and nutritional status among pregnant Chileans

INTRODUCCIÓN: El consumo de edulcorantes no calóricos (ENC) se ha incrementado en todos los grupos etarios, sin embargo, no se ha cuantificado su ingesta en embarazadas OBJETIVO: Determinar la ingesta y comparar el consumo de ENC según el estado nutricional en embarazadas chilenas. MATERIAL Y MÉTODOS: Estudio descriptivo, se entrevistaron a embarazadas de las ciudades de Santiago y Concepción. A cada embarazada se le aplicó una encuesta de frecuencia de consumo semanal de alimentos con ENC para determinar la ingesta de ellos, y se les realizó una evaluación nutricional utilizando la información del carné de control de la embarazada. RESULTADOS: Se evaluaron 601 embarazadas, 98% consume ENC, ninguna de ellas sobrepasa la ingesta diaria admitida (IDA) para ningún ENC. Las bebidas y jugos con ENC presentan la mayor penetración de productos con ENC de la dieta. Al comparar según estado nutricional, no se encontraron diferencia en el consumo de los ENC. Al comparar solo las bebidas y jugos con ENC con ciclamato las embarazadas obesas consumen significativamente más. CONCLUSIÓN: No se observó diferencias según estado nutricional cuando se analiza de manera global, al analizar por grupos de alimentos el mayor consumo se observo en bebidas con ciclamato en las embarazadas con obesidad.

INTRODUCTION: Consumption of non-caloric sweeteners (NCS) has increased in all age groups; however, intake in pregnant women has not been quantified. OBJECTIVE: To determine the intake of NCS and compare consumption by nutritional status among pregnant Chileans. MATERIAL AND METHODS: Pregnant women from the cities of Santiago and Concepción were interviewed as part of a descriptive study. Each pregnant woman was given a frequency survey of weekly food consumption with NCS to determine intake, and a nutritional evaluation was carried out using information from the pregnant woman's check up form. RESULTS: 601 pregnant women were evaluated, 98% consumed NCS, none of them exceeded the accepted daily intake (ADI) for any NCS. Beverages and juices with NCS presented the highest proportions of NCS in the diet. When comparing nutritional status, no difference was found in the consumption of NCS. When comparing only beverages and juices with NCS, obese pregnant women consumed significantly more cyclamate compared to non-obese women. CONCLUSION: No differences according to nutritional status were observed when analyzed globally, when analyzing by food groups the highest consumption was observed in beverages with cyclamate among obese pregnant women.

Procedimiento endoscópico en la migración al recto de un dispositivo intrauterino. Reporte de un caso / Endoscopic management in the migration to rectum of an intrauterine device. Case report

Resumen ANTECEDENTES La perforación es la complicación más temida durante la aplicación de un dispositivo intrauterino; cuando esto sucede debe retirarse el dispositivo debido al potencial riesgo de perforación y obstrucción intestinal. CASO CLÍNICO Paciente de 26 años, con trastorno del ciclo menstrual y dispareunia. La radiografía abdominal mostró el dispositivo intrauterino en posición anómala. La tomografía simple de abdomen evidenció el dispositivo en la zona intraluminal del recto, en la pared anterior, a 10 cm del esfínter anal. Se extrajo el dispositivo mediante colonoscopia. Los hallazgos intraoperatorios fueron: migración del dispositivo intrauterino, a 12 cm del margen anal, con adecuada exposición del brazo vertical. La extracción del dispositivo fue exitosa, con evolución satisfactoria de la paciente pues no hubo dolor ni alteraciones intestinales. CONCLUSIÓN La colonoscopia es una técnica diagnóstica y terapéutica efectiva en pacientes con migración del dispositivo intrauterino y afectación intestinal sin perforación, incluso puede considerarse antes de recurrir a la laparoscopia o laparotomía.

Abstract BACKGROUND Perforation is the most important complication during the application of an intrauterine device, which should be removed because of the potential risk of perforation and intestinal obstruction. CASE REPORT Female patient of 26 years of age, who presents menstrual rhythm disorders as well as dyspareunia. The tomography revealed the intrauterine device in the rectum, in the anterior wall, intraluminal, and 10 cm from the anal sphincter. It was scheduled for colonoscopy and device removal. The intraoperative findings were: migration of the intrauterine device, 12 cm from the anal margin, with adequate exposure of the vertical arm. The extraction of the device was successful. The patient had a satisfactory evolution, showed no pain or intestinal alterations. CONCLUSION Colonoscopy is a study of great help in all patients in whom migration of IUD with bowel disease without perforation and related complications is suspected, since it provides diagnostic and even therapeutic support, prior to considering a laparoscopy or laparotomy.

Different Gene Expression Signatures in Children and Adults with Celiac Disease.

Celiac disease (CD) is developed after gluten ingestion in genetically susceptible individuals. It can appear at any time in life, but some differences are commonly observed between individuals with onset early in life or in adulthood. We aimed to investigate the molecular basis underlying those differences. We collected 19 duodenal biopsies of children and adults with CD and compared the expression of 38 selected genes between each other and with the observed in 13 non-CD controls matched by age. A Bayesian methodology was used to analyze the differences of gene expression between groups. We found seven genes with a similarly altered expression in children and adults with CD when compared to controls (C2orf74, CCR6, FASLG, JAK2, IL23A, TAGAP and UBE2L3). Differences were observed in 13 genes: six genes being altered only in adults (IL1RL1, CD28, STAT3, TMEM187, VAMP3 and ZFP36L1) and two only in children (TNFSF18 and ICOSLG); and four genes showing a significantly higher alteration in adults (CCR4, IL6, IL18RAP and PLEK) and one in children (C1orf106). This is the first extensive study comparing gene expression in children and adults with CD. Differences in the expression level of several genes were found between groups, being notorious the higher alteration observed in adults. Further research is needed to evaluate the possible genetic influence underlying these changes and the specific functional consequences of the reported differences.

Using Molecular Phenotyping to Guide Improvements in the Histologic Diagnosis of T Cell-Mediated Rejection.

Recognition that some lesions typical of T cell-mediated rejection (TCMR) also occur in antibody-mediated rejection requires revision of the histologic TCMR definition. To guide this process, we assessed the relative importance of various lesions and the performance of new histology diagnostic algorithms, using molecular TCMR scores as histology-independent estimates of true TCMR. In 703 indication biopsies, random forest analysis and logistic regression indicated that interstitial infiltrate (i-lesions) and tubulitis (t-lesions) were the key histologic predictors of molecular TCMR, with arteritis (v-lesions) having less importance. Histology predicted molecular TCMR more accurately when diagnoses were assigned by strictly applying the Banff rules to the lesion scores and redefining isolated v-lesion TCMR. This improved prediction from area under the curve (AUC) 0.70 with existing rules to AUC 0.80. Further improvements were achieved by introducing more categories to reflect inflammation (AUC 0.84), by summing the lesion scores (AUC 0.85) and by logistic regression (AUC 0.90). We concluded that histologic assessment of TCMR can be improved by placing more emphasis on i- and t-lesions and incorporating new algorithms for diagnosis. Nevertheless, some discrepancies between histologic and molecular diagnoses persist, partially due to the inherent nonspecificity of i- and t-lesions, and molecular methods will be required to help resolve these cases.

Anatomical Variations of the Blood Vascular System in Veterinary Medicine. The Internal Iliac Artery of the Dog. Part Two.

The aim of this study was to investigate the variability of the internal pudendal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twenty-six anatomical variations were found, thirteen occurring in more than 5% of the dogs. Anatomical variations were grouped in relation to the origin of the prostatic/vaginal arteries, middle rectal artery, urethral artery, ventral perineal and caudal rectal arteries. The chi-squared test was used to analyse differences in sex, side of the body, profile and size, and the results were considered statistically significant when P ≤ 0.05. An identical vascular pattern in both hemipelvises was found for most of the anatomical variations described.

Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog - Part Three.

The aim of this study was to analyse and describe the variability of the umbilical artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. To study the permeability of the umbilical artery, ten adult dogs, nine newborns and thirteen foetuses between 35 and 50 days of gestation were also used. In relation to the origin of the umbilical artery, six anatomical variations were found. From which five involved a cranial (n = 4) or caudal (n = 1) relocation of its origin, and in one case (n = 1), the umbilical artery arose from the median sacral artery. In eight cases, the umbilical artery gave off the prostatic (n = 1) or vaginal (n = 7) arteries. The permeability of the umbilical artery was the most significant anatomical variation: permeability was detected in 45% (106 of 232 pelvic halves) of all cases, from which 36 were males and 70 females. Interestingly, an equal vascular permeability in both hemipelvises was found for 82% of the dogs, thus additional data related to such feature of the umbilical artery was also recorded. In accordance with the statistical study, the main anatomical variations described showed significant values for gender, side of the body, size and profile variables.

Brain ischemia downregulates the neuroprotective GDNF-Ret signaling by a calpain-dependent mechanism in cultured hippocampal neurons.

The glial cell line-derived neurotrophic factor (GDNF) has an important role in neuronal survival through binding to the GFRα1 (GDNF family receptor alpha-1) receptor and activation of the receptor tyrosine kinase Ret. Transient brain ischemia alters the expression of the GDNF signaling machinery but whether the GDNF receptor proteins are also affected, and the functional consequences, have not been investigated. We found that excitotoxic stimulation of cultured hippocampal neurons leads to a calpain-dependent downregulation of the long isoform of Ret (Ret51), but no changes were observed for Ret9 or GFRα1 under the same conditions. Cleavage of Ret51 by calpains was selectively mediated by activation of the extrasynaptic pool of N-methyl-d-aspartate receptors and leads to the formation of a stable cleavage product. Calpain-mediated cleavage of Ret51 was also observed in hippocampal neurons subjected to transient oxygen and glucose deprivation (OGD), a model of global brain ischemia, as well as in the ischemic region in the cerebral cortex of mice exposed to transient middle cerebral artery occlusion. Although the reduction of Ret51 protein levels decreased the total GDNF-induced receptor activity (as determined by assessing total phospho-Ret51 protein levels) and their downstream signaling activity, the remaining receptors still showed an increase in phosphorylation after incubation of hippocampal neurons with GDNF. Furthermore, GDNF protected hippocampal neurons when present before, during or after OGD, and the effects under the latter conditions were more significant in neurons transfected with human Ret51. These results indicate that the loss of Ret51 in brain ischemia partially impairs the neuroprotective effects of GDNF.

Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog: Part One.

Traditional veterinary anatomical models describe the branches of the caudal gluteal artery as the iliolumbar, cranial gluteal, lateral caudal, satellite of the ischiatic nerve and dorsal perineal arteries. However, some classical veterinary anatomy textbooks often indicate variations the general organization of the arterial tree, without giving any pattern of origin or illustrations of the different branching. The aim of this study was to investigate the presumptive variability of the caudal gluteal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twelve anatomical variations were found, nine occurring in more than 5% of the dogs, and three in <5%. A 'long-type' internal iliac artery, which means short caudal gluteal and internal pudendal arteries, was identified, while a 'perineal trunk' was observed as an interesting arterial variation. If the caudal segment alone is taken into consideration, identical vascular patterns in both hemi-pelvises are found in 17% of the dogs. Significant statistical correlation was found for four different types of anatomic variations and gender, two types of variations and body size, one type of variation for body side and one type of variation for head shape.

Immunological fecal occult blood test vs. serum ferritin for detection of colorectal neoplasia in high risk asymptomatic population.

INTRODUCTION: Fecal occult blood tests (FOBT) (biochemical or immunological) are based on the fact that most of the polyps or cancers bleed. Anemia due to iron deficiency is a wellknown sign for colorectal cancer (CRC). Ferritin is frequently used to select candidates for colonoscopy. OBJECTIVE: To determine and compare the diagnostic value of immunological fecal occult blood test vs. ferritin for the detection of colorectal neoplasia (cancer or polyps) in high-risk patients. METHODS: A transversal prospective study at National Cancer Institute, Mexico City, in consecutive asymptomatic subjects at high risk for CRC was performed, comparing two tests (immunological against serum ferritin) with colonoscopy plus histopathology. Both tests were performed in a blindly fashion previous to colonoscopy. RESULTS: Fifty patients were included in the study; twenty-eight patients had colorectal neoplasia (21 CRC, 7 adenomas). All immunologic tests for fecaloccult blood were positive in patients with colorectal lesions (sensitivity, 98%). There was no difference between the mean ferritin levels in patients with CRC or adenomas vs. those with negative colonoscopy (p = 0.58). The cutoff point where significant relationship between serum ferritin levels and colon lesions was established was ?46 ng/mL. In anemic patients with serum ferritin levels <46 ng/mL, the test had a sensitivity 53%, specificity 86%, positive predictive value 83%, and negative predictive value of 59% (p = 0.003). CONCLUSIONS: The immunological FOBT is a better diagnostic tool than serum ferritin for screening of colonic neoplasms.

[The Latin American Psychiatrist: profile and degree of satisfaction with the specialty]. / El médico psiquiatra latinoamericano: su perfil y su grado de satisfacción con la especialidad.

OBJECTIVES: The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction. METHODS AND MATERIALS: A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey. RESULTS: A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described. CONCLUSIONS: In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries.

Improvement of small dairy producers in the central coast of Peru.

The objective of this study was to characterize a group of small dairy producers in the central coast of Peru and determine the most important limiting factors that affect animal productivity, using Participatory Rural Appraisal methodologies. The information collected during a year included biological and socio-economic characteristics. Inappropriate nutrition, management, health and reproduction were observed in most farms. The average number of animals per family was 17.3, of which 40% were bulls and growing calves. Milk production and net cash income were reduced in the summer. The feeding programme for lactating and growing females of forage exchanged for labour and purchased concentrates did not theoretically or practically meet the cows' needs. All water was carried to the site on donkeys from one kilometre distance. All cows were negative for a number of potential infectious diseases. By California Mastitis Test of routine samples 7.1% of cows had clinical mastitis and 66.1% subclinical. Taking notional labour and forage costs into account, milk production was at a loss but the farmers considered neither and were satisfied with a net cash income from milk sales three times the average agricultural wage.

Low molecular weight constituents of male mouse urine mediate the pregnancy block effect and convey information about the identity of the mating male.

Mouse urine contains a complex mixture of chemosignals including a variety of small volatile molecules that are bound to major urinary proteins. In addition to signalling maleness, male urine also conveys information about individuality, which allows recently mated female mice to distinguish the urinary chemosignals of the mating male from those of an unfamiliar male. The highly polymorphic nature of the major urinary proteins makes them a likely candidate for conveying individuality information in the context of the pregnancy block effect. This was investigated by comparing the pregnancy-blocking effectiveness of a high molecular weight urinary fraction, containing major urinary proteins, with that of a low molecular weight fraction containing volatile ligands. Not only was the high molecular weight fraction ineffective in blocking pregnancy, but it also appeared to be less important in signalling individuality than the low molecular fraction. The high molecular weight fraction was ineffective in inducing expression of the immediate early gene product egr-1 in the accessory olfactory bulb. In contrast, the low molecular weight fraction induced egr-1 expression in the mitral/tufted neurons in the anterior subregion of the accessory olfactory bulb, suggesting that they activate the V1R class of vomeronasal receptor neuron.

Histochemical identification of carbohydrate moieties in the accessory olfactory bulb of the mouse using a panel of lectins.

Lectin binding patterns in the olfactory bulb of the mouse were investigated using 12 biotinylated lectins. Three, with specificities for galactose, N-acetylgalactosamine and L-fucose, stained only the nervous and glomerular layers of the accessory olfactory bulb; four, with specificities for galactose or N-acetylglucosamine, stained these layers in both the accessory and the main olfactory bulbs; three, with specificities for N-acetylgalactosamine or L-fucose, effected general staining with little contrast between the background and the accessory olfactory bulb or other structures; the remaining two, both of them specific for mannose, stained no part of the tissue studied. In the nervous and glomerular layers of the accessory olfactory bulb six lectins stained the anterior and posterior halves with different intensities and two of these six similarly differentiated between rostral and caudal regions of the posterior half. We conclude that: (i) three lectins binding to different monosaccharides are specific stains for the vomeronasal system when used in this area of the mouse brain; (ii) it may be appropriate to distinguish three parts in the mouse accessory olfactory bulb, instead of the hitherto generally accepted two.

Retrograde labelling of mitral/tufted cells in the mouse accessory olfactory bulb following local injections of the lipophilic tracer DiI into the vomeronasal amygdala.

It has recently become apparent that there are two classes of vomeronasal receptor neurons that project to functionally separate anterior and posterior sub-regions of the mammalian accessory olfactory bulb. However, anterograde tracing of the projections from these sub-regions, in the mouse, has revealed that the processing pathways are not segregated at the level of the vomeronasal amygdala. Both sub-regions have overlapping projections to the superficial lamina of the medial and posterior medial cortical nuclei of the amygdala. However, differential projections have been found in the opossum, in which only the posterior sub-region projects to the deeper laminae of the medial amygdala. Therefore, there may be species differences in these projections that are important for the control of reproductive behaviour. This study used an alternative approach of retrogradely tracing mitral/tufted cell projections from different nuclei of the vomeronasal amygdala back to the accessory olfactory bulb of mice. Local injections of the lipophilic tracer DiI were made into the antero-dorsal and postero-ventral divisions of the medial amygdala, and into the postero-medial cortical amygdala. In each case, provided the DiI affected the superficial lamina Ia, labelled mitral/tufted cells were found distributed throughout the anterior-posterior extent of the accessory olfactory bulb. These results confirm that mitral/tufted cells of the anterior and posterior sub-regions of the accessory olfactory bulb project to both the medial and postero-medial cortical nuclei of the amygdala. There was no evidence for differential projections from the anterior and posterior sub-regions accessory olfactory bulb in mice, as has been reported to occur in other species.