Positive mental health of Latin American university professors: A scientific framework for intervention and improvement.

The post-pandemic stage covid-19 has revealed overloads, ambiguities, and conflicts of teachers in the performance of new roles in hybrid classrooms that demanded an urgent adaptation, this highlighted the need for priority attention to the mental health of teachers, however, there are still insufficient studies that transcend the diagnosis and are committed to establish proposals for improvement. OBJECTIVE: This study aims to establish a proposal for the promotion of positive mental health (PMH). METHODS: The study was deployed from a qualitative approach; using an ethnomethodological design that allowed studying how teachers create meanings and sense in their work context, an appreciative interview was conducted with an affirmative theme that allowed teachers to expose their experiences that were systematized and processed with ATLAS. ti software. The application of the interview was conducted online through a Google form, during the months of February and March 2023. Three hundred university professors who experienced the pandemic in universities in Brazil, Chile, Colombia, Ecuador, Mexico, and Peru participated, based on a convenience sampling. RESULTS: The results of the deductive phase confirmed Lluch's PMH theoretical framework; however, new nuances or variations have been identified, which must be considered in the complex and dynamic nature of each PMH factor. From there, the results of the inductive phase allowed revealing emerging concepts, that is, new categories that would have the function of improving the PMH factors, which is why they have been denominated: dynamizing nuclei. PMH dynamizing nuclei are adjustment to work environment, soft skills, work-family balance, self-motivation, self-efficacy, subjective well-being, proactive strategies, engagement, resilience. CONCLUSIONS: Finally, with the results of both phases, the creation of an integrated model was generated, which was evaluated by six experts in a round of feedback, who highlighted the relevance of the findings and offered recommendations that were considered in the study. The new integrated model has revealed an interesting association, since it not only legitimizes the PMH's dynamizing cores, but also informs on which specific factor of the PMH these cores have the greatest impact, which has a high guiding value for intervention and improvement based on focused strategies.

Atypical Hemolytic Uremic Syndrome: A Nationwide Colombian Pediatric Series.

Objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes. Methods. A multicenter cohort of 27 Colombian children with aHUS were included. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on 6 patients who were suspected of having other renal diseases before aHUS diagnosis. Results. Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups showed comparable clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation, particularly in the 1 to 7 age group (P = .01). Renal biopsies were as follows: 3 had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive GN. Genetic screening was available in 6 patients and identified 2xCFHR5, 2xMCP, 1xADAMTS13/THBD, and 1xDGKE mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1 to 7 age group. The renal outcome was not significantly different regardless of age group. Conclusion. In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports.

Sex education in the eyes of primary school teachers in Novo Hamburgo, Rio Grande do Sul, Brazil.

Sex education has been included in the National Curriculum of the Brazilian Ministry of Education since 1996 as a cross-cutting theme that should be linked to the contents of each school subject in primary and high schools. This paper presents a study of the implementation of this policy in the primary schools of Novo Hamburgo, Rio Grande do Sul, Brazil, based on interviews between January 2011 and April 2012 with 82 teachers working in those schools. We found that sex education was not being taught as a cross-cutting theme in any of the schools, and that any lessons were mostly dominated by a biomedical discourse focusing primarily on the reproductive organs, fertility, pregnancy, and contraception. Sexual health and relationships and non-heterosexual sex and relationships were being neglected. Sex education was also considered a possible means of correcting or controlling sexual identities and behaviours deemed abnormal or immoral. We recommend far more discussion of how to implement the National Curriculum recommendations. We call for education courses to provide theoretical and methodological training on sex education for teachers, and recommend that the boards of educational institutions take up sex education as a priority subject. Lastly, we suggest that each school studies local sexuality-related problems and based on the findings, each teacher presents a pedagogical proposal of how to integrate sex education into the subjects they teach.

Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia.

OBJECTIVE: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. METHODS: A 12-month retrospective observational study of children under the age of 18 years who met criteria for MIS-C. RESULTS: A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40-503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2-178.7; p=0.034). Two patients had macrophage activation syndrome. CONCLUSIONS: Coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which needs to highlight the importance of early clinical suspicion.

HEMOLYTIC UREMIC SYNDROME ASSOCIATED WITH STREPTOCOCCUS PNEUMONIAE IN PEDIATRICS: A CASE SERIES.

OBJECTIVE: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. CASES DESCRIPTION: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. COMMENTS: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.

Performing an intestinal stoma with placement of an Artificial Sphincter® Intestinal Valve (VITEA): A case report.

INTRODUCTION: Intestinal stomas are created for distinct clinical conditions. They may involve the small bowel (ileostomy) or the large bowel (colostomy), depending on the objective or site of the stoma. Intestinal stomas may be temporary or permanent; they cause loss control of intestinal transit due to the absence of a sphincter that regulates its exit, provoking a continuous passage of fecal matter through the stoma. Within the environment of the ostomized patients, there are several important complications involving their quality of life. CASE PRESENTATION: The Intestinal Valve Type Artificial Sphincter (VITEA) device is placed in a patient diagnosed with cervical cancer, who has a vaginal-rectum fistula that requires a definitive colostomy. DISCUSSION: Intestinal stomas have been validated for over a century. We present the case with a similar complication rate to those described after performing a stoma with conventional open technique in terms of quality of life and cost-benefit ratio. The proportion of complications and the quality of life found in the ostomized patient with the VITEA* device is acceptable, and also eliminates the colostomy bags, providing the function of an artificial sphincter by everting the mucosa on the same device. No complications were found during the follow-up. CONCLUSIONS: The results from this proposal will allow to evaluate the safety and efficacy profile associated with a stomal bags.

Definition of an automated Content-Based Image Retrieval (CBIR) system for the comparison of dermoscopic images of pigmented skin lesions.

BACKGROUND: New generations of image-based diagnostic machines are based on digital technologies for data acquisition; consequently, the diffusion of digital archiving systems for diagnostic exams preservation and cataloguing is rapidly increasing. To overcome the limits of current state of art text-based access methods, we have developed a novel content-based search engine for dermoscopic images to support clinical decision making. METHODS: To this end, we have enrolled, from 2004 to 2008, 3415 caucasian patients and collected 24804 dermoscopic images corresponding to 20491 pigmented lesions with known pathology. The images were acquired with a well defined dermoscopy system and stored to disk in 24-bit per pixel TIFF format using interactive software developed in C++, in order to create a digital archive. RESULTS: The analysis system of the images consists in the extraction of the low-level representative features which permits the retrieval of similar images in terms of colour and texture from the archive, by using a hierarchical multi-scale computation of the Bhattacharyya distance of all the database images representation with respect to the representation of user submitted (query). CONCLUSION: The system is able to locate, retrieve and display dermoscopic images similar in appearance to one that is given as a query, using a set of primitive features not related to any specific diagnostic method able to visually characterize the image. Similar search engine could find possible usage in all sectors of diagnostic imaging, or digital signals, which could be supported by the information available in medical archives.

Pendred syndrome in two Galician families: insights into clinical phenotypes through cellular, genetic, and molecular studies.

CONTEXT: We studied two families from Galicia (northwest Spain) with Pendred syndrome (PS) and unusual thyroid phenotypes. In family A, the proposita had a large goiter and hypothyroxinemia but normal TSH and free T3 (FT3). In family B, some affected members showed deafness but not goiter. OBJECTIVE: Our objective was to identify the mutations causing PS and molecular mechanisms underlying the thyroid phenotypes. INTERVENTIONS: Interventions included extraction of DNA and of thyroid tissue. PATIENTS: Propositi and 10 members of the two families participated in the study. MAIN OUTCOME MEASURES: Main outcome measures included SLC26A4 gene analysis, deiodinase activities in thyroid tissue, and c.416-1G-->A effects on SLC26A4 splicing. In addition, a primary PS thyrocyte culture, T-PS2, was obtained from propositus B and compared with another culture of normal human thyrocytes, NT, by Western blotting, confocal microscopy, and iodine uptake kinetics. RESULTS: Proposita A was heterozygous for c.578C-->T and c.279delT, presented with goiter, and had normal TSH and FT3 but low FT4 attributable to high type 1 and type 2 iodothyronine deiodinase activities in the goiter. Propositus B bore c.279delT and a novel mutation c.416-1G-->A; some deaf relatives were homozygous for c.416-1G-->A but did not present goiter. The c.279delT mutation was associated with identical haplotype in the two families. T-PS2 showed truncated pendrin retained intracellularly and high iodine uptake with low efflux leading to iodine retention. CONCLUSIONS: c.279delT is a founder mutation in Galicia. Proposita A adapted to poor organification by increasing deiodinase activities in the goiter, avoiding hypothyroidism. Lack of goiter in subjects homozygous for c.416-1G-->A was due to incomplete penetrance allowing synthesis of some wild-type pendrin. Intracellular iodine retention, as seen in T-PS2, could play a role in thyroid alterations in PS.

Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia / Síndrome inflamatória multissistêmica em criança associada à COVID-19: experiência em um hospital pediátrico de referência na Colômbia

Abstract Objective: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. Methods: A 12-month retrospective observational study of children under the age of 18 years who met criteria for MIS-C. Results: A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40-503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2-178.7; p=0.034). Two patients had macrophage activation syndrome. Conclusions: Coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which needs to highlight the importance of early clinical suspicion.

Resumo Objetivo: Descrever as características clínicas e os diferentes fenótipos de crianças com síndrome inflamatória multissistêmica na criança temporalmente relacionada com a COVID-19 (do inglês multisystem inflammatory syndrome in children — MIS-C) e avaliar as condições de risco que favorecem a maior gravidade da doença durante um período de 12 meses em um hospital pediátrico de referência na Colômbia. Métodos: Estudo retrospectivo de 12 meses de observação de crianças menores de 18 anos que cumprem os critérios para o MIS-C. Resultados: Vinte e oito crianças foram apresentadas com os critérios do MIS-C. A idade média era de sete anos, e 54% eram do sexo masculino. Para além da febre (100%) (com início quatro dias antes da admissão), as características clínicas mais frequentes eram gastrointestinais (86%) e mucocutâneas (61%). Quatorze crianças (50%) apresentavam sintomas semelhantes aos de Kawasaki. As anomalias ecocardiográficas mais frequentes foram derrame pericárdico (64%), envolvimento valvar (68%), disfunção ventricular (39%) e anomalias coronárias (29%). Tinham linfopenia 75% das crianças. Todas tinham algum teste de coagulação anormal. A maioria recebeu imunoglobulina intravenosa (89%), glucocorticoides (82%), vasopressores (54%) e antibióticos (64%). Tiveram envolvimento mais grave 61% dos pacientes, que precisaram ser internados em unidade de terapia intensiva (mediana de quatro dias, média de seis dias); os preditores de gravidade foram pacientes com fenótipo inflamatório/ MIS-C (odds ratio — OR 26,5; intervalo de confiança — IC95% 1,4-503,7; p=0,029) e erupção cutânea (OR 14,7; IC95% 1,2-178,7; p=0,034). Dois pacientes (7%) apresentavam síndrome de ativação macrofágica. Conclusões: Alteração da artéria coronária, disfunção ventricular e internação na unidade de terapia intensiva foram frequentes, o que nos alerta sobre a importância da suspeita clínica precoce.

Hemolytic uremic syndrome associated with streptococcus pneumoniae in pediatrics: a case series / Síndrome hemolítico-urêmica associada com streptococcus pneumoniae em pediatria: série de casos

ABSTRACT Objective: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. Cases description: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. Comments: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.

RESUMO Objetivo: Descrever uma série de casos de quatro pacientes com síndrome hemolítico-urêmica por pneumococo em uma instituição de referência em Bogotá, Colômbia. Descrição dos casos: Descrevemos os casos de quatro pacientes que apresentaram sintomas respiratórios e febre. Todos estavam em estado geral regular à admissão hospitalar e necessitaram de cuidados intensivos e suporte ventilatório. Na admissão, em três dos casos foi evidenciada a complicação pleuropulmonar. Isolamento de Streptococcus pneumoniae sensível à penicilina foi realizado em todos os casos. Os quatro pacientes precisaram de transfusão sanguínea e terapia de reposição renal durante a hospitalização. Nos testes laboratoriais, observou-se anemia, trombocitopenia grave, presença de esquizócitos em esfregaço de sangue periférico e hiperazotemia. Com esse quadro, o diagnóstico foi de síndrome hemolítico-urêmica associada à infecção por S. pneumoniae. Houve recuperação progressiva da função renal em três dos quatro pacientes, que tiveram alta após 36 dias de internação hospitalar, em média. Um paciente teve complicações vasculares trombóticas, resultando em duas amputações nas extremidades, e teve alta após 99 dias de internação, com necessidade de hemodiálise em dias alternados. Comentários: A síndrome hemolítico-urêmica por Streptococcus pneumoniae é uma complicação rara, mas grave, da doença invasiva pneumocócica. A pneumonia complicada é a principal condição associada a essa entidade. Destaca-se o curto período em que esses casos foram apresentados, levando em conta a baixa incidência anual de síndrome hemolítico-urêmica.

[Metastatic collision tumour. A case report]. / Tumor metastásico de colisión. Informe de un caso.

BACKGROUND: Collision tumours are extremely rare. They are defined by the presence of two tumours of different histological origin in the same organ. CLINICAL CASE: A 71 year old female with history of a carcinoid tumour removed 20 years ago without any recurrence. The patient was admitted with intestinal occlusion symptoms secondary to a right flank abdominal tumour. An exploratory laparotomy was performed, removing the tumor and applying optimal debulking. The histopathological study reported bilateral ovary adenocarcinoma, as well as metastatic collision tumour of two histological types: well differentiated adenocarcinoma and a mixed malignant mesodermic Mullerian tumor. The patient was treated with adjuvant chemotherapy with poor results (death in 24 months). CONCLUSIONS: The presence of collision tumours is extremely rare. There are no statistics or specific treatment reported. Diagnosis is made with histopathology. At the moment, no similiar cases have been reported.

New approaches to the management of peripheral vertigo: efficacy and safety of two calcium antagonists in a 12-week, multinational, double-blind study.

OBJECTIVE: To evaluate the efficacy and safety profile of one 30-mg nimodipine oral tablet taken three times per day (one tablet with breakfast, one with lunch, and one with dinner) or one 150-mg cinnarizine verum oral capsule taken once each day with dinner for 12 weeks. STUDY DESIGN: Comparative in a double-blind, multinational pilot study. SETTING: Tertiary referral center. PATIENTS: A total of 221 patients met the study criteria; of that total, 181 adult patients completed the study, including 135 women and 46 men whose ages ranged from 20 to 80 years. INTERVENTIONS: Two calcium antagonists were used to treat vertigo (nimodipine, 89 patients; cinnarizine, 92 patients), and all patients were maintained on the same dosage regimen until they completed 12 weeks of treatment. Patients were evaluated at 2-and 4-week intervals; an additional evaluation was made at Week 14 to determine vertigo recurrence in the posttreatment period. MAIN OUTCOME MEASURES: The response was evaluated by using the vertigo severity index, a count of vertigo episodes in a given time period. Each episode is weighted according to its intensity. RESULTS: Nimodipine treatment decreased the incidence of moderate vertigo episodes by 78.8% and decreased severe vertigo episodes by 85.0%. Cinnarizine treatment decreased the incidence of moderate vertigo episodes by 65.8% and decreased severe vertigo episodes by 89.8%. Nimodipine and cinnarizine exhibited similar safety profiles. Only two patients withdrew from the study because of adverse events possibly related to the study drug. One patient withdrew from the cinnarizine group because of headache, and one patient withdrew from the nimodipine group because of lipothymia. CONCLUSION: These data confirm the marked efficacy of both nimodipine and cinnarizine in the treatment of vestibular vertigo.

Respiratory syncytial virus-associated hospitalizations in pre-mature infants in Lima, Peru.

We conducted a prospective cohort study in four hospitals in Lima, Peru in infants with a birth weight ≤ 1,500 g followed from birth hospital discharge up to 1 year of age to determine the incidence of respiratory syncytial virus (RSV) hospitalizations. We enrolled 222 infants from March of 2009 to March of 2010: 48 infants with a birth weight < 1,000 g and 174 infants with a birth weight of 1,000-1,500 g (birth weight = 1,197 ± 224 g; gestational age = 30.1 ± 2.6 weeks). There were 936 episodes of respiratory infections; the incidence of respiratory infections during the first 1 year of life was 5.7 episodes/child-years. The incidence of RSV respiratory infections that required emergency room management was 103.9 per 1,000 child-years, and the incidence of RSV hospitalizations was 116.2 per 1,000 child-years (244.9 in infants with a birth weight < 1,000 g and 88.9 in infants 1,000-1,500 g; P < 0.05). The incidence of RSV respiratory infections that required emergency management or hospitalization is high among pre-mature infants in Lima.

Valvuloplastia pulmonar en menores de 21 años / Pulmonary valvuloplasty in patients under the age of 21

Resumen Objetivo: Determinar la asociación entre la proporción de las reintervenciones en los pacientes con la estenosis valvular pulmonar y la presencia de un gradiente transvalvular pulmonar final ≥25 mm Hg en pacientes menores de 21 años. Metodología: Estudio unicéntrico observacional, tipo corte transversal de período. Población: Pacientes entre 0 meses y 21 años en quienes se realizó valvuloplastia pulmonar con balón. Análisis: Descripción del grupo y análisis en los subgrupos dados por el gradiente final transvalvular ≥25 mm Hg y la reintervención. Se realizaron pruebas chi2 de Pearson, para las variables categóricas. Para las variables continuas se realizaron pruebas U de Mann-Whitney. Se realizó una regresión logística para definir la asociación entre las variables y el desenlace a la reintervención. Resultados: En el grupo con el gradiente final ≥25 mm Hg, el 86,67% eran lactantes. Se encontró que en el grupo con el gradiente final < 25 mm Hg la mediana del gradiente inicial fue de 42 mm Hg IQ 25-75%: (34-59) en comparación con el grupo con el gradiente final ≥25 mm Hg, la mediana del gradiente inicial fue 70 mm Hg IQ 25-75%: (41-86). Al analizar los grupos por la variable reintervención, se observó que el cambio en la relación de las presiones entre el ventrículo derecho y el ventrículo izquierdo se asoció con menor necesidad de reintervención. OR 0,04; IC 95% (0,002-0,7). El tener un gradiente final después de la intervención ≥25 mm Hg se asoció a reintervención. OR 14,5; IC 95% (2,8-75). Conclusiones: Un gradiente final transvalvular pulmonar ≥25 mm Hg se asoció a mayor probabilidad de reintervención.

Abstract Motivation: To determine the association between the proportion of reoperations in patients with pulmonary valvular stenosis and the presence of a final pulmonary transvalvular gradient of ≥25 mm Hg in patients under the age of 21. Methods: Observational single-centre study, cross-sectional period type. Population: Patients between 0 months and 21 years of age who underwent balloon pulmonary valvuloplasty. Analysis: Description of the group and analysis in the subgroups given by the final transvalvular gradient of ≥25 mm Hg and reoperation. Pearson's chi-squared test was conducted for categorical variables. For the continuous variables, the Mann-Whitney U test was conducted. Logistic regression was used to define the association between variables and reoperation outcome. Results: In the group with the final gradient of ≥25 mm Hg, 86.67% were infants. The group with the final gradient of < 25 mm Hg the median of the initial gradient was 42 mm Hg IQ 25-75%: (34-59) in comparison to the group with the final gradient ≥25 mm Hg, the median of the initial gradient was 70 mm Hg IQ 25-75%: (41-86). By analysing both groups with the reoperation variable, it was observed that the change in the relationship of the pressured between the right ventricle and the left ventricle was associated with a lower need for reoperation. OR 0.04; CI 95% (0.002-0.7). Having a final gradient of ≥25 mm Hg after the surgery was associated to reoperation. OR 14.5; CI 95% (2.8-75). Conclusion: Having a final pulmonary transvalvular gradient of ≥25 mm Hg was associated to a higher probability of reoperation.

Automated dermoscopy image analysis of pigmented skin lesions.

Dermoscopy (dermatoscopy, epiluminescence microscopy) is a non-invasive diagnostic technique for the in vivo observation of pigmented skin lesions (PSLs), allowing a better visualization of surface and subsurface structures (from the epidermis to the papillary dermis). This diagnostic tool permits the recognition of morphologic structures not visible by the naked eye, thus opening a new dimension in the analysis of the clinical morphologic features of PSLs. In order to reduce the learning-curve of non-expert clinicians and to mitigate problems inherent in the reliability and reproducibility of the diagnostic criteria used in pattern analysis, several indicative methods based on diagnostic algorithms have been introduced in the last few years. Recently, numerous systems designed to provide computer-aided analysis of digital images obtained by dermoscopy have been reported in the literature. The goal of this article is to review these systems, focusing on the most recent approaches based on content-based image retrieval systems (CBIR).

Peroxisome proliferator-activated receptors: Targets for the treatment of metabolic illnesses (Review).

Peroxisome proliferator-activated receptors (PPARs) belong to a family of transcription factors of which three isotypes, PPARα, PPARδ (ß) and PPARγ, are known. These play a central role in regulating intermediate metabolism and in incidences of inflammation. In recent years, a greater understanding of their mechanisms of action and their effects, principally in the management of cardiovascular disease, has been achieved. PPAR agonists, catalysts and agents have been used since the 1990s, when it was confirmed that fibrates possess lipid modifying properties when selectively activating PPARα. In addition, thiazolidinediones, structures analogous to fibrates, showed PPARγ activity with an insulin-sensitizing effect, leading to their use in the control and even prevention of diabetes mellitus type 2. Currently, studies are oriented to the development of agents that activate multiple PPAR isoforms - not only dual (PPARα/γ), but also PPAR panagonists (α/γ/δ). The purpose of this review is to explain the mechanisms of the molecular action and the effects of PPAR agonists, and also to analyze existing and current studies concerning their use in cardiovascular and metabolic illnesses.

Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicentre, open-label, prospective study.

OBJECTIVE: To compare the bacteriological and clinical efficacy of three treatments for uncomplicated cystitis in ambulatory pre-menopausal women: ciprofloxacin 250 mg orally twice daily for 3 days, trimethoprim/sulfamethoxazole 160/800 mg orally twice daily for 7 days, and norfloxacin 400 mg orally twice daily for 7 days. MATERIALS AND METHODS: A total of 455 women were randomly assigned to three treatment groups: 151 received ciprofloxacin, 150 received trimethoprim/sulfamethoxazole, and 154 received norfloxacin. Bacteriological cure and clinical resolution were evaluated 5-9 days and 4-6 weeks after completion of treatment. RESULTS: There was no significant difference among the three treatment groups: overall efficacy ranged from 78.5% for the trimethoprim/sulfamethoxazole group, to 84.5% for the ciprofloxacin group. The highest overall incidence of drug-related adverse effects occurred in the trimethoprim/sulfamethoxazole patients. CONCLUSIONS: These data indicate that a 3 day treatment with ciprofloxacin is at least as clinically and bacteriologically effective as 7 day treatments with trimethoprim/sulfamethoxazole and norfloxacin for uncomplicated lower urinary tract infections.

Aplicaciones en ginecología de los antaganonistas de LH-RH / Ginecological applications of GNRH antagonist a review

Las modificciones a la LH-RH nativa produjeron la aparición de los análogos: agonistas cuyas aplicaciones en la medicina reproductiva han sido ampliamente estudiadas y los antagonistas de reciente estudio y aparición. Existen ciertas situaciones clínicas en las cuales lo que se necesita es una rápida supresión de la producción de las gonadotropinas endógenas, y por el efecto estimulador inicial del análogo no se logra. Los antagonistas causan una supresión inmediata de la producción de FSH y LH por un bloqueo competitivo de los receptores lo cual hace que su uso sea óptimo en los casos de inducción de ovulación más técnica de reproducción asistida. Otras de las indicaciones potenciales serían los casos en los que se requiere una supresión de la producción endógena de esteroides sexuales como el caso de la hiperplasia benigna de próstata, el cáncer de próstata y el cáncer de ovario, en los cuales ha demostrado una promisoria utilidad

Importancia de la respuesta a la inducción de ovulación y la edad en el resultado de las técnicas de reproducción asistida / Importance of the response to the ovulation induction and the age in the result of the assisted reproduction techniques

Objetivo: este estudio pretendió analizar la eficacia de las técnicas de reproducción asistida en un grupo de pacientes con una respuesta disminuida a la estimulación ovárica (tres folículos o menos al finalizar la estimulación ovárica) y correlacionarla con la edad. Materiales y métodos: se describen 966 casos de pacientes sometidas a fertilización in vitro o inyección intracitoplasmática de espermatozoides, de las cuales 100 tuvieron una respuesta pobre. Resultados: el grupo de las "pobres respondedoras" en un 80 por ciento de los casos correspondió a mujeres mayores de 35 años, siendo el 46 por ciento mayor de 40. El promedio de embriones transferidos fue 1,59 para el grupo de estudio y 3,47 para el grupo control, con una tasa de implantación de 11,34 y 12,34 respectivamente. La tasa de embarazo fue menor en el grupo de las "pobres respondedoras" (16,39 por ciento) comparado con el grupo control (29,62 por ciento). Conclusiones: los resultados sugieren que las pacientes con una respuesta pobre a la inducción de ovulación (tres folículos o menos) tienen mayor riesgo de un resultado adverso al someterse a técnicas de reproducción asistida por la poca producción de ovocitos, lo cual limita la posibilidad de seleccionar los mejores embriones para transferir y aumenta la probabilidad de obtener embriones con anomalías cromosómicas.

Teratoma nasofaringeo causante de insuficiencia respiratoria en un neonato / Nasopharyngeal teratoma causing neonatal respiratory distress

La dificultad respiratoria en la etapa neonatal suele deberse a trastornos pulmonares secundarios a inmadurez, o bien a malformaciones congénitas intratorácicas. Las masas localizadas en la región nasofaríngea son muy raras pero también pueden ocasionar dificultad respiratoria de diversos grados en este grupo de edad. Se describe el caso de un recién nacido con insuficiencia respiratoria causada por un teratoma nasofaríngeo, que se sometió a tratamiento quirúrgico con resultados exitosos