The effect of ancillary ligands on hydrocarbon C-H bond functionalization by uranyl photocatalysts.

The aqueous uranyl dication has long been known to facilitate the UV light-induced decomposition of aqueous VOCs (volatile organic compounds), via the long-lived highly efficient, uranyl excited state. The lower-energy visible light excited uranyl ion is also able to cleave unactivated hydrocarbon C-H bonds, yet the development of this reactivity into controlled and catalytic C-H bond functionalization is still in its infancy, with almost all studies still focused on uranyl nitrate as the precatalyst. Here, hydrocarbon-soluble uranyl nitrate and chloride complexes supported by substituted phenanthroline (Ph2phen) ligands are compared to each other, and to the parent salts, as photocatalysts for the functionalization of cyclooctane by H atom abstraction. Analysis of the absorption and emission spectra, and emission lifetimes of Ph2phen-coordinated uranyl complexes demonstrate the utility of the ligand in light absorption in the photocatalysis, which is related to the energy and kinetic decay profile of the uranyl photoexcited state. Density functional theory computational analysis of the C-H activation steps in the reaction show how a set of dispersion forces between the hydrocarbon substrate and the Ph2phen ligand provide control over the H atom abstraction, and provide predictions of selectivity of H atom abstraction by the uranyl oxo of the ring C-H over the ethyl C-H in an ethylcyclohexane substrate.

Effect of tobacco use on Zenker's diverticulotomy outcomes.

OBJECTIVE: To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD). STUDY DESIGN: Single institution retrospective review. SETTING: Tertiary care academic hospital. METHODS: A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence. RESULTS: Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94). CONCLUSIONS: There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.

Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study.

Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8% and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.67 vs. mean 41.95 h), and restart of oral intake after surgery (mean 96.06 vs. mean 119.65) compared with open approach. Increased heart rate and intensive care unit length of stay were related with mortality (p 0.01 and 0.000 respectively). For morbidity, laparotomy and need and duration of ICU stay were related with any complication statistically significant (p 0.02, 0.008, 0.000 respectively). Patients with increased heart rate in the emergency room, decreased amount of intravenous fluids, need and higher length of stay in the intensive care unit, and delay in resuming oral intake after surgery appear to have poor outcomes. Laparoscopic approach seems to be a safe and feasible approach for intestinal obstruction in selected patients.

Divertículo de Meckel con tumor neuroendocrino: presentación inusual / Meckel's diverticulum with neuroendocrine tumor: unusual presentation

El divertículo de Meckel es una malformación congénita que suele presentarse como un hallazgo incidental asintomático. Puede complicarse por procesos inflamatorios o tumores, cursando con sintomatología abdominal sumamente inespecífica, lo que complica su diagnóstico oportuno. Aunque la incidencia de neoplasias malignas en estos divertículos es baja, los tumores neuroendocrinos son los más representativos. Presentamos el caso de una paciente de 72 años que consultó por dolor abdominal y deposiciones melénicas, con múltiples nódulos intrahepáticos sugestivos de tumores neuroendocrinos y hallazgo intraoperatorio incidental de diverticulitis aguda de Meckel con metástasis peridiverticular de un tumor neuroendocrino. (AU)

Meckel's diverticulum is a congenital malformation that usually presents as an incidental finding. It can be complicated by inflammatory processes or tumors, with non-specific abdominal symptoms which delay its timely diagnosis. Although the incidence of malignant neoplasms in these diver-ticula is low, neuroendocrine tumors are the most representative. We present the case of a 72-year-old female patient who consulted for abdominal pain and melenic bowel movements, with multiple intrahepatic nodules suggestive of neuroendocrine tumors and an incidental intraoperative finding of acute Meckel's diverticulitis with peridiverticular metastasis of a neuroendocrine tumor. (AU)

Redox Activity of Pyridine-Oxazoline Ligands in the Stabilization of Low-Valent Organonickel Radical Complexes.

Low-valent organonickel radical complexes are common intermediates in cross-coupling reactions and metalloenzyme-mediated processes. The electronic structures of N-ligand supported nickel complexes appear to vary depending on the actor ligands and the coordination number. The reduction products of a series of divalent (pyrox)Ni complexes establish the redox activity of pyrox in stabilizing electron-rich Ni(II)-alkyl and -aryl complexes by adopting a ligand-centered radical configuration. The reduced pyrox imparts an enhanced trans-influence. In contrast, such redox activity was not observed in a (pyrox)Ni(I)-bromide species. The excellent capability of pyrox in stabilizing electron-rich Ni species resonates with its proclivity in promoting the reductive activation of C(sp3) electrophiles in cross-coupling reactions.

Robotic Gastrectomy for Gastric Adenocarcinoma in the USA: Insights and Oncologic Outcomes in 220 Patients.

BACKGROUND: While multiple Asian and a few Western retrospective series have demonstrated the feasibility and safety of robotic-assisted gastrectomy for gastric cancer, its reliability for thorough resection, especially for locoregional disease, has not yet been firmly established, and reported learning curves vary widely. To support wider implementation of robotic gastrectomy, we evaluated the learning curve for this approach, assessed its oncologic feasibility, and created a selection model predicting the likelihood of conversion to open surgery in a US patient population. PATIENTS AND METHODS: We retrospectively reviewed data on all consecutive patients who underwent robotic gastrectomy at a high-volume institution between May 2012 and March 2019. RESULTS: Of the 220 patients with gastric cancer selected to undergo curative-intent robotic gastrectomy, surgery was completed using robotics in 159 (72.3%). The median number of removed lymph nodes was 28, and ≥ 15 lymph nodes were removed in 94% of procedures. Surgical time decreased steadily over the first 60-80 cases. Complications were generally minor: 7% of patients experienced complications of grade 3 or higher, with an anastomotic leak rate of 2% and mortality rate 0.9%. Factors predicting conversion to open surgery included neoadjuvant chemotherapy, BMI ≥ 31 kg/m2, and tumor size ≥ 6 cm. CONCLUSIONS: These findings support the safety and oncologic feasibility of robotic gastrectomy for selected patients with gastric cancer. Proficiency can be achieved by 20 cases and mastery by 60-80 cases. Ideal candidates for this approach are patients with few comorbidities, BMI < 31 kg/m2, and tumors < 6 cm.

Impact of social media on the continuous education of the general surgeon, a new experience, @Cirbosque: A Latin American example.

Social media has gained widespread recognition for its importance in the medical field. Such platforms play an important role for learning and teaching, because knowledge can be transmitted instantly and massively, and specialists in different world-wide locations can discuss experiences instantaneously. The present article presents our experience of using social media to facilitate surgical learning while encouraging leadership and global mentoring. This retrospective descriptive study was initiated at the time of the creation of our social media handle on Twitter, February 22, 2019. Since that time, we have posted 10,587 academic tweets; the monthly growth rate has been 9% (393 new followers per month). Currently, we have 4,213 followers, 11,241,000 impressions, 121,105 visits, and 121,105 mentions. We have reviewed 59 topics of interest in general surgery and 132 clinical cases in trauma, as well as in hepatobiliary, gastrointestinal, thoracic, and acute-care surgery. We have made 13 image challenges using illustrations of diagnostic and intraoperative images. Although the evidence is uncertain to promote education performed entirely through social media, we show that @Cirbosque has been effective, and the impact of this initiative on Twitter is appreciated by many surgeons worldwide, including renowned teachers in each of the topics addressed. Furthermore, the number of participants in the discussions increased each day, as did all impact indicators according to Twitter Analytics. Thus, we conclude that the educational message of @Cirbosque is having a positive effect and reaching thousands of people worldwide, suggesting that others can develop similar outreach programs in education and communication.

Non surgical management for massive gastric lipomatosis.

BACKGROUND: Gastric lipomatosis (GL) is defined as a lipomatous lesion with diffuse infiltration of the submucosal layer by adipose tissue with multiple lesions and must be differentiated from gastrointestinal lipomas, which are solitary submucosal masses composed of well-differentiated adipose tissue surrounded by a fibrous capsule. GL are uncommon, represents 5 % of gastrointestinal tract lipomas and less than 1∼3 % of all gastric tumors. CASE PRESENTATION: A 65-year-old woman, who underwent non-operatively approach by Gastric lipomatosis. Non-specific gastrointestinal symptoms and endoscopic examination ruled out the possibility of mucosal ulceration or bleeding. Endoscopic ultrasonography and abdominal CT that confirmed gastric lipomatosis. DISCUSSION: Gastric lipomas are usually small, solitary and asymptomatic, and are hence often detected incidentally, surgical management in asymptomatic patients still be a in debate. CONCLUSION: Non operative management in massive gastic lipomatosis is appropiate when the patient is asymptomatic without mucosal ulceration, regardless of the amount of gastric lipomas. Avoiding patient the morbidity of a total gastrectomy.

Endoscopic trans gastric assisted surgery for gastric tumors: Case report and description of a new surgical technique.

BACKGROUND: Minimally invasive intragastric surgery [IGS] was first described by Ohashi in 1995 for early gastric cancer, with 3 trocars placed in the gastric lumen. Prior abdominal surgery is not a contraindication to IGS while the abdominal cavity is not explored, always that exist transilumination. But conversion to laparoscopic and open surgery can be challenging owing to the insufflated stomach and/or small bowel, although gas can be easily released via the gastrostomy. CASE PRESENTATION: A 53-year-old female patient, presented with a sub epithelial gastric antrum lesion confirmed by endoscopic ultrasonography managed with surgical endoscopic percutaneous assisted transgastric technique [EPATS] using a gastrostomy tube and the endoscope. DISCUSSION: We have been developing this operation since 2018. Nevertheless, we think EPATS is worthy to master, as PEIGS can salvage the entire stomach of patients with sub epithelial lesions in the lesser curve and in the esophagogastric junction, who otherwise would have to undergo total or proximal gastrectomy. CONCLUSION: We need to perform more cases for future comparative studies with percutaneous endoscopic intragastric surgery [PEIGS] in terms of parameters as pain, inflammation, complications, stenosis, oncological results and cosmesis.

Efecto in vitro del extracto crudo de un estreptomiceto causante de sarna común de papa en Sinaloa, México / In vitro effect of the crude extract of a potato common scab streptomycete in Sinaloa, Mexico

Abstract A strain isolated from potato common scab superficial lesions in El Fuerte Valley in northern Sinaloa, Mexico, was identified by 16S rRNA and morphological methods. Moreover, the effects of the crude extract of strain V2 was evaluated on radish and potato. The isolate was similar to Streptomyces acidiscabies in its morphological properties; however, the 16S rRNA gene sequence of strain V2 was neither 100% identical to this species nor to the streptomycetes previously reported in Sinaloa, Mexico. Strain V2 did not amplify any specific PCR products for genes necl and tomA, which have been found and reported in S. acidiscabies. Strain V2 produced a PCR product for the txtAB operon, which is related to the production of thaxtomin. In vitro assays using crude thaxtomin extract and a spore suspension of the organism caused necrotic symptoms on radish and potato, which were highly virulent in potato. This study reports that Streptomyces sp. V2 has a toxigenic region (TR) that is associated with the thaxtomin gene cluster.

Resumen Se aisló una cepa de una lesión superficial de sarna común de la papa en un ejemplar procedente del Valle del Fuerte, en el norte de Sinaloa, México. La cepa fue identificada por secuenciación del gen 16S ARNr, y por sus características morfológicas. Los efectos del extracto crudo de dicha cepa, llamada V2, fue evaluado en papa y rábano. El aislado fue similar a Streptomyces acidiscabies en sus características morfológicas, pero la secuencia del gen 16S ARNr de la cepa V2 no fue 100% idéntica a la de dicha especie, ni tampoco a las de cepas identificadas dentro de este taxón previamente en Sinaloa, México. La cepa V2 no amplificó los productos específicos de PCR de los genes nec1 y tomA, los cuales sí se han reportado en S. acidiscabies. La cepa V2 amplificó el producto de PCR para del operón txtAB, relacionado con la producción de taxtomina. A través de ensayos in vitro usando un extracto crudo de taxtomina y una suspensión de esporas del organismo aislado se verificó la producción de síntomas necróticos en rábano y papa, con mayor virulencia en esta última especie. Este estudio indica que Streptomyces sp. V2 tiene una región toxigénica (TR) asociada con el cluster de genes de taxtomina.

Data on forecasting energy prices using machine learning.

This article contains the data related to the research article "Long-term forecast of energy commodities price using machine learning" (Herrera et al., 2019). The datasets contain monthly prices of six main energy commodities covering a large period of nearly four decades. Four methods are applied, i.e. a hybridization of traditional econometric models, artificial neural networks, random forests, and the no-change method. Data is divided into 80-20% ratio for training and test respectively and RMSE, MAPE, and M-DM test used for performance evaluation. Other methods can be applied to the dataset and used as a benchmark.

In vitro effect of the crude extract of a potato common scab streptomycete in Sinaloa, Mexico.

A strain isolated from potato common scab superficial lesions in El Fuerte Valley in northern Sinaloa, Mexico, was identified by 16S rRNA and morphological methods. Moreover, the effects of the crude extract of strain V2 was evaluated on radish and potato. The isolate was similar to Streptomyces acidiscabies in its morphological properties; however, the 16S rRNA gene sequence of strain V2 was neither 100% identical to this species nor to the streptomycetes previously reported in Sinaloa, Mexico. Strain V2 did not amplify any specific PCR products for genes nec1 and tomA, which have been found and reported in S. acidiscabies. Strain V2 produced a PCR product for the txtAB operon, which is related to the production of thaxtomin. In vitro assays using crude thaxtomin extract and a spore suspension of the organism caused necrotic symptoms on radish and potato, which were highly virulent in potato. This study reports that Streptomyces sp. V2 has a toxigenic region (TR) that is associated with the thaxtomin gene cluster.

Agonistas de GLP-1 más inhibidores de SGLT2. ¿Efectos cardioprotectores aditivos? / GLP-1 agonists plus SGLT2 inhibitors. Additive cardioprotective effects?

Resumen En Latinoamérica, Colombia ocupa el segundo lugar en número de pacientes con diabetes mellitus y probablemente en número de pacientes no diagnosticados. En Colombia se calculan más de 2 millones de personas con diabetes mellitus, con prevalencia de 9.6%, es la quinta causa de muerte y está entre las 10 enfermedades que motivan la asistencia clínica. Nuevos tratamientos con agonistas de GLP1 (AGLP1) e inhibidores de SGLT2 (iSGLT2) han demostrado de manera individual y por mecanismos de acción diferentes un efecto significativo en el control metabólico, en otros factores, como presión arterial, perfil lipídico, peso, así como en potencial protección renal y cardiovascular. Las guías actuales de tratamiento de la diabetes mellitus tipo 2 sugieren que en caso de persistencia de concentraciones de hemoglobina glucosilada (HA1c) fuera de metas a pesar de tratamiento dual durante tres meses, tendría lugar progresar a terapia triple. Se hizo una revisión de la bibliografía que incluyó buscadores en Pubmed, Embase y Cochrane; se incluyeron 12 artículos. Con base en esta revisión de la bibliografía, concluimos que deberían hacerse más estudios clínicos con la combinación de AGLP1 más iSGLT2 en el contexto de pacientes con diabetes mellitus tipo 2 con mal control metabólico a pesar de tratamientos duales y triples.

Abstract In South America, Colombia is secondly with number of diagnosed patients with diabetes mellitus (DM) and probably non-diagnostic patients. It has been calculated in Colombia 2 million people with diabetes mellitus, with a prevalence of 9.6% and it is the fifth position of causes of death and within the 10 causes that motivate the search for help. The new therapies with glucagon-like-1 receptors agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2i) have been shown individually and through different mechanisms of action impact on the metabolic control and other variables such as blood pressure, lipid profile, weight, renal and cardiovascular protection. Type 2 diabetes mellitus treatment guides recommend for patients with dual therapy who continue HA1c out of goals, consider triple therapy if the patient has not achieved the goals after three months. A systematic search was made that included search engines such as Pubmed, Embase and Cochrane, resulting in 12 articles. More clinical studies should be done with the combination of GLP-1 RAs and SGLT2i in the context of patients with type 2 diabetes mellitus with poor metabolic control despite dual and triple therapies.

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC. METHODS: Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated. RESULTS: A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%). CONCLUSIONS: In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Endoscopic Ultrasound as a Pretreatment Clinical Staging Tool for Gastric Cancer: Association with Pathology and Outcome.

BACKGROUND: Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established. OBJECTIVES: The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships. METHODS: A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1-2, N0) and EUS high-risk (T3-4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT. RESULTS: Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05). CONCLUSIONS: Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools.

[A school program for dengue control in Honduras: from knowledge to action]. / Un programa escolar para el control del dengue en Honduras: del conocimiento a la práctica.

The Environmental School Program (PEA, for its Spanish acronym), a dengue control initiative focused on primary schools that took place during 2005-2010 in several cities in Honduras, is described. The environmental health program was designed to increase knowledge and develop skills in the identification and control of Aedes aegypti breeding sites, as well as in water and solid waste management. The results, as measured by behavioral change and reduced larval indices, were satisfactory in the majority of the participating schools. The initiative involved not only children, but also their parents and teachers. In addition to reducing larval indices, PEA was successful in promoting community participation in environmental issues, particularly Aedes control. The inclusion of this educational content in the primary school curriculum in Honduras remains pending.

Un programa escolar para el control del dengue en Honduras: del conocimiento a la práctica / A school program for dengue control in Honduras: from knowledge to action

Se describe el Programa Escolar Ambiental (PEA), una iniciativa de control de dengue enfocada en el ámbito de la escuela -primaria durante el -período de 2005-2010 en varias ciudades de Honduras. El programa fue diseñado para generar mayor conocimiento y destreza en la identificación y el control de criaderos de Aedes aegypti dentro de un contexto de salud ambiental, que incluía además el manejo del agua y los desechos sólidos. Los resultados en él cambio de comportamiento y en la reducción de los índices larvarios fueron satisfactorios en la mayoría de las escuelas que formaron parte de la experiencia, lográndose la participación de los niños, y también de sus padres y maestros. El PEA resultó efectivo además de la reducción de los índices larvarios, en la promoción de la participación comunitaria en temas ambientales con énfasis en el control de Aedes. La inclusión de estos contenidos educativos en el currículo de educación primaria es una asignatura aún pendiente en Honduras.

The Environmental School Program (PEA, for its Spanish acronym), a dengue control initiative focused on primary schools that took place during 2005-2010 in several cities in Honduras, is described. The environmental health program was designed to increase knowledge and develop skills in the identification and control of Aedes aegypti breeding sites, as well as in water and solid waste management. The results, as measured by behavioral change and reduced larval indices, were satisfactory in the majority of the participating schools. The initiative involved not only children, but also their parents and teachers. In addition to reducing larval indices, PEA was successful in promoting community participation in environmental issues, particularly Aedes control. The inclusion of this educational content in the primary school curriculum in Honduras remains pending.

Situación epidemiológica del dengue en Honduras período 1991-2010 / Epidemiological situation of dengue in Honduras during the 1991-2010 period

El dengue es la enfermedad viral transmitida por mosquitos de más rápida diseminación en el mundo. En los últimos 50 años, la incidencia se ha incrementado más de 30 veces. En Honduras, los primeros casos se presentaron durante la epidemia de 1978. Actualmente, constituye un problema de salud pública mayor en nuestro país. Se revisa la situación epidemiológica del dengue en el periodo 1991-2010, los principales hitos alcanzados y las recomendaciones a ser aplicadas para el control del problema. Fuentes. Se realizó revisión de las estadísticas epidemiológicas sobre el dengue en Honduras publicadas por la Secretaría de Salud, publicaciones especiales de la Organización Mundial de la Salud, así como la literatura médica internacional y nacional de las últimas tres décadas. Desarrollo. El patrón epidemiológico de la fiebre del dengue en Honduras durante los últimos 32 años ha mostrado dos distintas etapas: 1) brotes epidémicos en áreas localizadas (1978-1994) y 2) circulación viral endémica o epidémica a nivel nacional con predominio de las Regiones Sanitarias Metropolitanas del Distrito Central y San Pedro Sula (1995–2010). Estas regiones han representado más del 50% de los casos de dengue del país en los últimos cuatro años. Conclusiones. Las lecciones aprendidas más relevantes en este periodo nos muestran que el control de este problema parte de un compromiso político decidido de los tomadores de decisiones, el involucramiento de los diversos sectores gubernamentales y no gubernamentales y la adopción de una campaña continua de educación en salud...

Immunosupression and infection after major surgery: a nutritional deficiency.

T cell dysfunction significantly increases susceptibility to infections and organ failure after trauma or surgery (physical injury). This coincides with a persistent drop in arginine availability, a necessary amino acid for normal T cell function. Recent data led to the identification of a novel mechanism of T cell suppression caused by the depletion of arginine through the induction of arginase 1 (ARG1) in a specialized group of immature myeloid cells, now named myeloid-derived suppressor cells (MDSC). In addition to T cell dysfunction, arginine depletion leads to the decrease in nitric oxide (NO) production. Dietary therapy containing arginine at supraphysiologic concentrations along with other components such as omega-3 fat acids, antioxidants, nucleotides, and vitamin A is associated with improvement in T cell function, NO production, and a significant decrease in infection rates. The authors propose that a pathologic decrease in arginine availability is an identifiable nutrition deficiency syndrome that worsens outcomes if left untreated.

Left ventricular volume reduction by radiofrequency heating of chronic myocardial infarction in patients with congestive heart failure.

BACKGROUND: Myocardial infarct expansion and left ventricular (LV) remodeling are integral components in the evolution of chronic heart failure and predict morbidity and mortality. Radiofrequency (RF) heating and patch placement of chronic LV aneurysms caused a sustained reduction in LV infarct area and volume in an ovine infarct model. This study evaluated the effect of RF heating and epicardial patch as an adjunct to coronary artery bypass graft on LV volumes in patients with prior myocardial infarction, evidence of akinetic/dyskinetic scar, and LV ejection fraction < or =40%. METHODS AND RESULTS: Ten patients (3 female; mean age, 64+/-11 years) scheduled for coronary artery bypass graft were enrolled (Canadian Cardiovascular Society angina class 2.1+/-1.1; New York Heart Association class 3.1+/-0.5). Intraoperative digital photography demonstrated an acute 39% reduction in infarct area (n=5; P=0.01), and transesophageal ECGs demonstrated a 16% acute reduction in LV end-diastolic volumes (n=9; P=0.002) after RF treatment. There were no intraoperative or procedure-related postoperative complications, and during an average follow-up of >180 days, there have been no safety issues. All patients had complete relief of their angina and improvement in exercise tolerance. Serial transthoracic ECGs over the 6 months of follow-up after RF treatment demonstrated persistent reductions in LV end-diastolic volume (29%; P<0.0001) and LV end-systolic volume (37%; P<0.0001) with improved ejection fraction (P<0.02). CONCLUSIONS: RF heating and patch placement in these 10 patients resulted in acute reduction in infarct area and ventricular volumes that were maintained 180 days after procedure. This technique may reduce the incidence of congestive heart failure and mortality in these patients and warrants investigation in larger clinical trials.