Reemplazo esofágico mínimamente invasivo con tubo de Akiyama en un paciente pediátrico con quemadura esofágica / Minimally invasive esophageal replacement with Akiyama tube in a pediatric patient with esophageal burn

Introducción. La ingesta de cáusticos continúa siendo un problema de salud pública en los países en vía de desarrollo, por lo que a veces es necesario realizar un reemplazo esofágico en estos pacientes. Aún no existe una técnica estandarizada para este procedimiento. Caso clínico. Masculino de 10 años con estenosis esofágica por ingesta de cáusticos, quien no mejoró con las dilataciones endoscópicas. Se realizó un ascenso gástrico transhiatal por vía ortotópica mediante cirugía mínimamente invasiva como manejo quirúrgico definitivo .Discusión. Actualmente existen varios tipos de injertos usados en el reemplazo esofágico. La interposición colónica y gástrica son las que cuentan con mayores estudios, mostrando resultados similares. Conclusiones. La elección del tipo y posición del injerto debe ser individualizada, tomando en cuenta las características de las lesiones y la anatomía de cada paciente para aumentar la tasa de éxito.

Introduction. The ingestion of caustics continues to be a public health problem in developing countries, which is why sometimes is necessary to perform an esophageal replacement in these patients. There is still no standardized technique for this procedure. Clinical case. A 10-year-old male with esophageal stricture due to caustic ingestion, who did not improve with endoscopic dilations. A laparoscopic transhiatal gastric lift was performed orthotopically as definitive surgical management using minimally invasive surgery. Discussion. Currently there are several types of grafts used in esophageal replacement. Colonic and gastric interposition are the ones that have the most studies, showing similar results. Conclusions. Choice of type and position of the graft must be individualized, taking into account the characteristics of the lesions and anatomy of each patient, in order to increase the success rate.

Antibody titrations are critical for microflow cytometric analysis of extracellular vesicles.

Optimization of flow cytometry assays for extracellular vesicles (EVs) often fail to include appropriate reagent titrations - the most critically antibody titration is either not performed or is incomplete. Using nonoptimal antibody concentration is one of the main sources of error leading to a lack of reproducible data. Antibody titration for the analysis of antigens on the surface of EVs is challenging for a variety of technical reasons. Using platelets as surrogates for cells and platelet-derived particles as surrogates for EV populations, we demonstrate our process for antibody titration, highlighting some of the key analysis parameters that may confound and surprise new researchers moving into the field of EV research. Additional care must be exercised to ensure instrument and reagent controls are utilized appropriately. Complete graphical analysis of positive and negative signal intensities, concentration, and separation or stain index data is highly beneficial when paired with visual analysis of the cytometry data. Using analytical flow cytometry procedures optimized for cells for EV analysis can lead to misleading and nonreproducible results.

Transoral flexible laser surgery of the upper aerodigestive tract with blue laser.

PURPOSE: The introduction of fiber-guided lasers was a breakthrough in laryngology practice, opening the path for treating different pathologies with minimally invasive procedures, both in the operating room and in the office. The most recent technology in the area is the blue laser, which combines photoangiolytic and cutting properties, characteristics that make this equipment suitable for its use in upper aerodigestive tract surgery. However, there is not enough experience in this area. The authors present a case series of patients with different pharyngeal, laryngeal, and tracheal pathologies who were treated by means of transoral procedures using fiber-guided blue laser. METHODS: The surgical records of patients with different upper aerodigestive tract pathologies who were treated with fiber-guided blue laser in the operating room, under general anesthesia with jet ventilation or supraglottic ventilation using suspension laryngotracheoscopy techniques between February 2018 and March 2022 were reviewed. RESULTS: A total of 80 surgical interventions in a group of 38 patients were performed. A wide variety of procedures was executed, either using the laser alone or in combination with other techniques to treat different pathologies of the aero-digestive tract safely and effectively, with adequate functional results. CONCLUSIONS: Following all necessary precautions, blue laser is a reliable tool to perform minimally invasive surgeries in the operating room using TOFLS techniques. It can be used alone or in combination with other devices to achieve the desired goals.

Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal / Surgical complications of lymphoma with gastrointestinal involvement

Introducción. El linfoma puede afectar el tracto gastrointestinal de manera primaria o secundaria, y representa hasta el 2 % de todas las neoplasias malignas del intestino delgado y colon. El tracto gastrointestinal es la ubicación extraganglionar primaria más común en el linfoma no Hodgkin. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos académicas, con revisión de textos publicados sobre el tema en los últimos 5 años. Discusión. La presentación clínica del linfoma con compromiso gastrointestinal es inespecífica y, hasta en la mitad de los pacientes, se puede presentar de manera inicial con complicaciones que requieran manejo quirúrgico. Entre las principales se encuentran la perforación intestinal, el sangrado digestivo y la obstrucción intestinal

Introduction. Lymphoma can affect the gastrointestinal tract, primarily or secondarily, and accounts for up to 2% of all malignant neoplasms of the small intestine and colon. The gastrointestinal tract is the most common primary extranodal location in non-Hodgkin lymphoma. Methods. A literature search performed in the main academic databases, with a review of texts published on the subject in the last 5 years.Discussion. The clinical presentation of lymphoma with gastrointestinal involvement is nonspecific and, in up to half of the patients, it can present initially with complications that require surgical management. Among the main ones are intestinal perforation, digestive bleeding and intestinal obstruction.

Rainfall decrease and red deer rutting behaviour: Weaker and delayed rutting activity though higher opportunity for sexual selection.

In the last decades, climate change has caused an increase in mean temperatures and a reduction in average rainfall in southern Europe, which is expected to reduce resource availability for herbivores. Resource availability can influence animals' physical condition and population growth. However, much less is known on its effects on reproductive performance and sexual selection. In this study, we assessed the impact of three environmental factors related to climate change (rainfall, temperature and vegetation index) on Iberian red deer Cervus elaphus hispanicus reproductive timing and sexual behaviour, and their effects on the opportunity for sexual selection in the population. We measured rutting phenology as rut peak date, the intensity of male rutting activity as roaring rate, and the opportunity for sexual selection from the distribution of females among harem holding males in Doñana Biological Reserve (Southwest Spain), from data of daily observations collected during the rut over a period of 25 years. For this study period, we found a trend for less raining and hence poorer environmental conditions, which associated with delayed rutting season and decreased rutting intensity, but that appeared to favour a higher degree of polygyny and opportunity for sexual selection, all these relationships being modulated by population density and sex ratio. This study highlights how climate change (mainly rainfall reduction in this area) can alter the conditions for mating and the opportunity for sexual selection in a large terrestrial mammal.

The dark ventral patch: A bimodal flexible trait related to male competition in red deer.

Sexual signals play a central role in male-male competition in polygynous species. In red deer (Cervus elaphus), male's ventral area become dark during the rutting season due to urine spraying behaviour and retains many chemical compounds potentially revealing individual features. Here we investigate the variation in size of this trait, exploring its relationship with age and male competitive features such as antlers or body size, as well as populational level of intrasexual competition for mates. We found that the size of the dark ventral patch followed a clearly bimodal distribution, i.e. males mostly expressed the full-size trait or just developed a very small one. For these two groups of males according to trait expression, the relationships of trait size with age and antler size differed. Populational level of intrasexual competition appeared to affect the relationship between antler size and the probability of a fully developed ventral patch. These results indicate that the trait encodes information on body size, antler size, age and populational level of mate competition, thus suggesting a role in signalling male's competitive features and willingness to allocate reproductive effort within a particular season.

Social environment modulates investment in sex trait versus lifespan: red deer produce bigger antlers when facing more rivalry.

Theory predicts that the plastic expression of sex-traits should be modulated not only by their production costs but also by the benefits derived from the presence of rivals and mates, yet there is a paucity of evidence for an adaptive response of sex-trait expression to social environment. We studied antler size, a costly and plastic sex trait, and tooth wear, a trait related to food intake and longevity, in over 4,000 male Iberian red deer (Cervus elaphus hispanicus) from 56 wild populations characterized by two contrasting management practices that affect male age structure and adult sex-ratio. As a consequence, these populations exhibit high and low levels of male-male competition for mating opportunities. We hypothesized that males under conditions of low intra-sexual competition would develop smaller antlers, after controlling for body size and age, than males under conditions of high intra-sexual competition, thus reducing energy demands (i.e. reducing intake and food comminution), and as a consequence, leading to less tooth wear and a concomitant longer potential lifespan. Our results supported these predictions. To reject possible uncontrolled factors that may have occurred in the wild populations, we carried out an experimental design on red deer in captivity, placing males in separate plots with females or with rival males during the period of antler growth. Males living with rivals grew larger antlers than males living in a female environment, which corroborates the results found in the wild populations. As far as we know, these results show, for the first time, the modulation of a sexual trait and its costs on longevity conditional upon the level of intra-sexual competition.

Trombocitopenia inducida por rifampicina / Rifampicin-induced thrombocytopenia

RESUMEN La trombocitopenia inducida por rifampicina es un fenómeno de origen inmune cuya presentación es inusual pero potencialmente fatal. Se presenta el caso de un paciente inmunocomprometido y con tuberculosis diseminada quien desarrolló trombocitopenia inducida por rifampicina en las primeras 12 horas tras inicio de la terapia antituberculosa sin que mediara sensibilización previa al medicamento. Se confirmó la relación de causa-efecto al resolverse la trombocitopenia con la suspensión de la rifampicina y al reaparecer con la re-exposición al fármaco.

SUMMARY Rifampicin-induced thrombocytopenia is a rare but potentially fatal immune phenomenon. We report the case of an immunocompromised patient with disseminated tuberculosis who developed rifampicin-induced thrombocytopenia 12 hours after starting anti-tuberculous therapy without previous drug sensitization. The cause-effect relationship was confirmed when thrombocytopenia resolved with rifampicin suspension but later reappeared upon drug re-exposure.

Perfil clínico y epidemiológico de pacientes atendidos por hipertiroidismo e hipotiroidismo en el servicio de endocrinología de una institución hospitalaria de Medellín (Colombia) entre 2013 y 2015 / Clinical and epidemiological profile of patients with hyperthyroidism and hypothyroidism that receive endocrinological services from a medical institution in Medellín (Colombia) between 2013 and 2015

Objetivo: determinar el perfil epidemiológico en pacientes hipertiroideos e hipotiroideos que acudieron al servicio de endocrinología de una institución hospitalaria de Medellín (Colombia) entre 2013 y 2015.Materiales y métodos: se realizó un estudio descriptivo retrospectivo y se incluyeron todas las historias clínicas de pacientes con diagnóstico de hipertiroidismo o hipotiroidismo. Se realizó un análisis univariado con estadística descriptiva por medio de frecuencias absolutas y proporciones en el programa IBM SPSS versión 19.0. Resultados: se estudiaron 149 pacientes: 131 con hipotiroidismo y 18 con hipertiroidismo, la media de edad fue 57,8±17,8 años y 48,2±15,1 años respectivamente. La frecuencia de sexo femenino fue mayor en hipotiroideos que en hipertiroideos (86,3% versus 66,7%). Las principales etiologías en los hipotiroideos fueron el hipotiroidismo postquirúrgico 11,5% y la enfermedad de Hashimoto 5,3%,mientras que en el hipertiroidismo estuvieron la enfermedad de Graves 33,3% y tirotoxicosis 22,2%. El síntoma más frecuente en los pacientes estudiados fue el bocio con un 14,5% en los hipotiroideos versus un 38,9% en los hipertiroideos. Los antecedentes personales más frecuentes en ambos grupos de pacientes fueron hipertensión arterial y Diabetes Mellitus. Conclusión: los resultados del presente estudio son acordes a la información existente en la literatura, la presentación de patologías tiroideas es más común en el sexo femenino; y la principal etiología es cirugía y enfermedad de Graves para hipo e hipertiroidismo respectivamente..(AU)

Objective: determine the epidemiological profile of hyperthyroid and hypothyroid patients that receive endocrinological services from a medical institution in Medellin (Colombia) between 2013 and 2015. Materials and Methods: a descriptive, retrospective study was conducted and included the clinical records of patients diagnosed with hyperthyroidism or hypothyroidism. A univariate analysis was applied using descriptive statistics by means of absolute frequencies and proportions in the IBM SPSS software, version 19.0. Results: a sample of 149 patients was obtained 131 patients with hypothyroidism and 18 with hyperthyroidism, the average age was 57,8±17,8 years and 48,2±15,1 years, respectively. The frequency of female sex with hypothyroidism was greater than those patients with hyperthyroidism (86,3% versus 66,7%). Post-surgery hypothyroidism had a high prevalence 11,5% followed by the Hashimoto disease 5,3%.The principal etiologies in hyperthyroidism were Graves disease 33,3% and thyrotoxicosis 22,2%. With relation to the signs and frequent symptoms in the studied patients,the goiter was common in 14,5% of the patients with hypothyroidism versus 38,9% of those patients with hyperthyroidism. The most frequent diseases on past medical history in both groups of patients were high blood pressure and Diabetes Mellitus. Conclusion: the results of the present study are in agreement with the information existing in the literature, the presentation of thyroid pathologies is more common in the female sex; and the main etiology is surgery and Graves' disease for hypo and hyperthyroidism respectively..(AU)

Exploratory behaviour modulates the relationship between colony familiarity and helping in a cooperative bird.

Individuals within animal groups may differ in personality and degree of familiarity raising the question of how this influences their social interactions. In Iberian magpies Cyanopica cooki, a portion of first-year males engage in cooperative behaviours and dispersal, allowing addressing this question. In this study, we first investigate the relationship between colony familiarity (native versus foreign) and reproductive status (breeding versus helping) of males during 21 years. Secondly, we measure the exploratory behaviour and monitor reproductive status of a sample of individuals with different colony familiarity during 2 years. Long-term monitoring revealed that foreign individuals were more likely breeders. The analysis on the subset of individuals in which exploratory behaviour was measured revealed a mediatory effect of exploratory behaviour in the association between colony familiarity and helping behaviour. Specifically, among foreign individuals, higher explorative males were more frequently involved in helping behaviour than lower explorative ones. Conversely, among native males, breeders were more explorative than helpers. Our results suggest that aspects of personality may mediate the value of familiarity in reproductive tasks in social species.

Caracterización de pacientes sometidos a cirugía bariátrica en una clínica privada de la ciudad de Medellín, Colombia,2009-2011: estudio descriptivo / Characterization of patients undergoing bariatric surgery in a private clinic of the city of Medellin, Colombia. 2009-2011: descriptive study

Objetivo: caracterizar los pacientes sometidos a cirugía bariátrica en una clínica privada de la ciudad de Medellín, Colombia. La obesidad es definida por la Organización Mundial de la Salud como un índice de masa corporal >30Kg/m2, que junto a las enfermedades asociadas, se ha convertido en uno de los problemas más importantes de la salud pública a nivel mundial. Materiales y métodos: se realizó un estudio descriptivo retrospectivo con 1’122 historias clínicas de pacientes sometidos a cirugía bariátrica y que no tuvieran antecedente de: consumo constante de alcohol o hepatitis. Resultados: en este estudio, la edad promedio fue de 40,9 ±11,9 años (rango: 15-78) y el 77,4% fueron hombres. El 81% tuvo por cirugía el Bypass, al momento del ingreso el 56.9% tenía obesidad grado II, el perímetro abdominal de estos pacientes tuvo una media de119, 5±17, 5 cm, 274 registros tenían reporte de biopsia hepática (24,4%) de los cualessolo el 1,8% eran normales y el 98,2% tenían algún grado de infiltración grasa y otros hallazgos patológico. Únicamente el 19,7% de los pacientes realizaban ejercicio demanera rutinaria. Conclusión: contrario a lo reportado en la literatura, se halló más frecuencia de obesidad en hombres que en mujeres. Sin embargo la cirugía más frecuente y el promedio de edad se comportan similar a lo descrito en trabajos previos.

Objective: characterize the patients undergoing bariatric surgery in a private clinic ofthe city of Medellin, Colombia. Obesity is defined by the World Health Organization asa body mass index >30 Kg/m2, which has become one of the most important problems of public health around the world. Materials and Methods: the present research isa retrospective descriptive study with 1’122 clinical histories of patients undergoing bariatric surgery and without history of: constant consumption of alcohol or hepatitis. The statistical analysis was made in the program SPSS vr. 21, the qualitative variables were estimated through percentages and the quantitative were calculated though theaverage, standard deviation, and the minimum and maximum values. Results: in this study, the average age of this group was 40,9 ±11,9 years (range: 15-78), the 77,4%were men. 81% had bypass as surgery of choice, at the time of entry the 56,9% had obesity grade II, abdominal perimeter of these patients had an average of 119,5±17,5cm, 274 records had a liver biopsy report (24,4%) of which the only 1,8% were normaland the 98,2% remaining had some fatty infiltration and other pathologic findings. Only 19,7% of patients routinely performed exercise. Conclusion: contrary to what was reported in the literature, it was found more percentage of obesity in men than inwomen. How ever the average age and the most frequent surgery behave similar tothat described in previous works.

Life span and reproductive cost explain interspecific variation in the optimal onset of reproduction.

Fitness can be profoundly influenced by the age at first reproduction (AFR), but to date the AFR-fitness relationship only has been investigated intraspecifically. Here, we investigated the relationship between AFR and average lifetime reproductive success (LRS) across 34 bird species. We assessed differences in the deviation of the Optimal AFR (i.e., the species-specific AFR associated with the highest LRS) from the age at sexual maturity, considering potential effects of life history as well as social and ecological factors. Most individuals adopted the species-specific Optimal AFR and both the mean and Optimal AFR of species correlated positively with life span. Interspecific deviations of the Optimal AFR were associated with indices reflecting a change in LRS or survival as a function of AFR: a delayed AFR was beneficial in species where early AFR was associated with a decrease in subsequent survival or reproductive output. Overall, our results suggest that a delayed onset of reproduction beyond maturity is an optimal strategy explained by a long life span and costs of early reproduction. By providing the first empirical confirmations of key predictions of life-history theory across species, this study contributes to a better understanding of life-history evolution.

Síndrome de ovario poliquístico y complicaciones metabólicas: más allá del exceso de andrógenos / Polycystic ovarian syndrome and metabolic complications: beyond androgen excess

El síndrome del ovario poliquístico (SOP) es la alteración endocrinológica más común que afecta a las mujeres en edad reproductiva con estudios que reportan una prevalencia de hasta un 21%. Existen diferentes criterios de diagnóstico que describen diferentes fenotipos en las pacientes. El SOP trae grandes implicaciones en la salud femenina ya que se ha relacionado con alteraciones endocrinológicas, metabólicas y de fertilidad. Actualmente hay mayor conocimiento sobre la patogénesis de la enfermedad y se han relacionado nuevos marcadores bioquímicos tanto en mecanismos fisiopatológicos propios del SOP, como de enfermedades asociadas, permitiendo mejor identificación y manejo de esta población, lo que implica un avance para el desarrollo de posibles terapias y métodos diagnósticos más eficaces.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder, it affects mostly women of reproductive age and some studies have reported that up to 21% of women present this syndrome. There are different diagnostic criteria for PCOS that characterize these patients into one of various phenotypes. This disorder has great implications on women’s health because it has been linked to other metabolic, endocrine and fertility disorders. Due to recent investigations, there has been a surge of new information about the pathogenesis of this disease, which in turn has helped explore new biochemical markers and pathophysiological mechanisms of PCOS and associated diseases, thus allowing a clearer identification and better management of these patients. This new information can lead to a breakthrough in the development of potential therapies and more effective diagnostic methods.

Assessing the ecological condition of streams in a southeastern Brazilian basin using a probabilistic monitoring design.

Prompt assessment and management actions are required if we are to reduce the current rapid loss of habitat and biodiversity worldwide. Statistically valid quantification of the biota and habitat condition in water bodies are prerequisites for rigorous assessment of aquatic biodiversity and habitat. We assessed the ecological condition of streams in a southeastern Brazilian basin. We quantified the percentage of stream length in good, fair, and poor ecological condition according to benthic macroinvertebrate assemblage. We assessed the risk of finding degraded ecological condition associated with degraded aquatic riparian physical habitat condition, watershed condition, and water quality. We describe field sampling and implementation issues encountered in our survey and discuss design options to remedy them. Survey sample sites were selected using a spatially balanced, stratified random design, which enabled us to put confidence bounds on the ecological condition estimates derived from the stream survey. The benthic condition index indicated that 62 % of stream length in the basin was in poor ecological condition, and 13 % of stream length was in fair condition. The risk of finding degraded biological condition when the riparian vegetation and forests in upstream catchments were degraded was 2.5 and 4 times higher, compared to streams rated as good for the same stressors. We demonstrated that the GRTS statistical sampling method can be used routinely in Brazilian rain forests and other South American regions with similar conditions. This survey establishes an initial baseline for monitoring the condition and trends of streams in the region.

El semillero de investigación como una estrategia para la creación de aprendizaje autónomo en la Facultad de Medicina / Research “Seedbed” as a strategy to foment self-directed learning in the School of Medicine

La Universidad Pontificia Bolivariana asume un modelo pedagógico integrado que se entiende como una propuesta que gira en torno al estudiante como centro del proceso educativo. En dicho modelo los intereses, temas y problemas del contexto sociocultural son objetos principales de difusión; de esta manera se potencia la pedagogía como construcción de significados personales y sociales, la estructuración del currículo, el conocimiento que contribuye a la formación intelectual, social, ética y al aprendizaje significativo. Con estos parámetros, el presente documento tiene por objeto definir la influencia que puede tener la participación activa y comprometida en los semilleros de investigación, sobre la generación de aprendizaje autónomo y las competencias que la universidad tiene para difundir entre sus estudiantes para que sean afines a los requerimientos profesionales y personales del futuro.

Disposable-soma senescence mediated by sexual selection in an ungulate.

Senescence may result from an optimal balance between current reproductive investment and bodily repair processes required for future reproduction, a theoretical prediction difficult to prove especially in large, long-lived animals. Here we propose that teeth that have fixed dimensions early in life, but that wear during chewing, can be taken as a measure of total lifetime 'repair', and their wear rate as a measure of current expenditure in performance. Our approach also considers the sexual selection process to investigate the advance of senescence in males compared with females, when selection favouring competition over mates reduces the reproductive lifespan of males. We studied carcasses of 2,141 male and 739 female red deer (Cervus elaphus) of different ages, finding that male molariform teeth emerged at a far smaller size than expected from body size dimorphism. This led to higher workload, steeper wear rate and earlier depletion of male teeth than in females, in concordance with sex-specific patterns of lifetime performance and reproduction. These findings provide the empirical support for the disposable-soma hypothesis of senescence, which predicts that investment in bodily repair will decrease when the return from this investment may not be realized as a result of other causes that limit survival or reproduction.