Transposase-DNA Complex Structures Reveal Mechanisms for Conjugative Transposition of Antibiotic Resistance.

Conjugative transposition drives the emergence of multidrug resistance in diverse bacterial pathogens, yet the mechanisms are poorly characterized. The Tn1549 conjugative transposon propagates resistance to the antibiotic vancomycin used for severe drug-resistant infections. Here, we present four high-resolution structures of the conserved Y-transposase of Tn1549 complexed with circular transposon DNA intermediates. The structures reveal individual transposition steps and explain how specific DNA distortion and cleavage mechanisms enable DNA strand exchange with an absolute minimum homology requirement. This appears to uniquely allow Tn916-like conjugative transposons to bypass DNA homology and insert into diverse genomic sites, expanding gene transfer. We further uncover a structural regulatory mechanism that prevents premature cleavage of the transposon DNA before a suitable target DNA is found and generate a peptide antagonist that interferes with the transposase-DNA structure to block transposition. Our results reveal mechanistic principles of conjugative transposition that could help control the spread of antibiotic resistance genes.

[Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care]. / Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego.

BACKGROUND: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. AIM: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. PATIENTS AND METHODS: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. RESULTS: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. CONCLUSIONS: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

[Elena de Cespedes: The eventful life of a XVI century surgeon]. / Elena de Céspedes. La azarosa vida de una cirujana del siglo XVI.

Throughout the history of surgery there have been exceptional cases of surgeons around the world. One of them is Elena/o of Cespedes. Born as a girl, this hermaphrodite dedicated all his life to acting as a man, doing jobs that were only for men such as a soldier, peasant, and surgeon. She was the first licensed surgeon in Spain and maybe in all Europe. She married a woman and then was tried for sodomy by the Spanish Inquisition commanded by inquisitor Lope de Mendoza. She was founded guilty and punished with 200 lashes and a 10-year service at a hospital, dressed as a woman.

[Andres Vesalio, Francisco Díaz, Miguel de Cervantes Saavedra and the birth of urology in the 16th Century]. / Andrés Vesalio, Francisco Díaz, Miguel de Cervantes Saavedra y el nacimiento de la urología en el siglo XVI.

In the sixteenth century there were great advances in science, literature, and the arts. During this century, urology as a specialty was conceived, thanks to the contributions of Andreas Vesalius, anatomist and leading physician to the court of Charles V, and Dr. Francisco Diaz, a native of Alcala de Henares, surgeon and clinician. Dr. Diaz had a close relationship with Miguel de Cervantes, who at one point in his life suffered from renal colic. In his masterpiece "Re-Printed Treaty of all diseases of the kidneys, bladder and wattles of the Cock and Urina, divided into three books," of which the first book of urology is the History of Medicine, describes in detail the clinical and therapeutic aspects of urological diseases, known as the "bad stone" and urethral strictures known as "wattles", in addition to describing the different surgical techniques and the development of new instruments for urological procedures, which include the cisorio instrument and the Speculum pudendi. For the above, Dr. Francisco Diaz is considered the father of urology.

[Ultrasonographic evaluation of the diameter of the optic nerve sheath for medication of intracranial pressure: a case report]. / Evaluación ultrasonográfica del diámetro de la vaina del nervio óptico (DVNO) para la medición de la presión intracraneana (PIC): a propósito de un caso.

The main complication associated with acute brain injury is the elevation of intracranial pressure (ICP) and it is associated with high morbidity and mortality. In these patients, multimodal neurological monitoring has emerged as a fundamental tool in the intensive care unit, with the minimally invasive trend seen in recent years. We report the case of a patient in which ICP monitoring was based on the measurement of the diameter of the optic nerve sheath (DONS), a procedure that has shown a good correlation with the ICP, as well as a high specificity, sensitivity, and low cost.

[Liver abscess syndrome with lung involvement secondary to hypermucoviscosity Klebsiella pneumoniae]. / Síndrome de absceso hepático secundario a Klebsiella pneumoniae hipermucoviscosa con involucro pulmonar.

Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging infection characterized by primary monomicrobial liver abscess, bacteremia and metastatic complications. KLAS is endemic in Taiwan but additional cases has also been described in other world regions. It's caused by strains of K. pneumonia serotype K1, rmpA, magA positive, displaying hypermucoviscosity. We present the case of a previously healthy 69 years old patient who developed fever, liver abscess,septic shock, bacteremia, and pneumonia. In cultures grew hypermucoviscous phenotype of K. pneumonia characterized by positive "string test". The patient responded favourably to antibiotic therapy with ceftriaxone, meropenem, amykacin and percutaneous drainage of the abscess. Increased awareness about this globally emerging infection by physicians could allow earlier detection and optimal treatment.

Complications of Locked Plating for Proximal Humeral Fractures in Active Patients in a Level One Trauma Center.

Background: The incidence of complications associated with locked plating of proximal humerus fractures (PHF) has been reported in up to 40% of surgeries. This study aimed to analyze the incidence and risk factors of complications and re-intervention associated with locked plating of PHF in a an young active working population. Methods: This retrospective cohort study included patients indicated for locked plating of displaced PHF at a dedicated workers' accident trauma center. The variables analyzed were patient comorbidities, fracture characteristics, and immediate radiologic surgical outcomes. Postoperative complications and risk factors were determined. Results: A total of 127 patients with a median follow-up of 31 months and a median age of 52 years were included. The complication and reintervention rates were 13.4% and 12.6%, respectively. The main cause of reintervention was post-traumatic stiffness. The incidence of other complications was 4% screw protrusion, 1.6% avascular necrosis, 1.6% varus collapse. Complications were not associated with age, comorbidity, fracture classification, bone mineral density, Hertel's risk factors, presence of calcar comminution, reduction quality, and calcar screw position. Discussion: The incidence of complications and reintervention was low. The main cause of reintervention was persistent stiffness, and no risk factors for complications were found in this study.

Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up.

Background: Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Results: Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5° ± 14.8° (range, 70°-140°) and the mean extension was -5.9° ± 7.0° (range, -20°-0°). Mean pronation and supination were 85.8° ± 11.9° (range, 45°-90°) and 86.9° ± 14.3° (range, 20°-90°), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P = 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P = 0.05), articular angle (22.5° vs. 27.7°, P = 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P = 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7° vs. 6.4°, P = 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P = 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P = 0.0219). Conclusion: The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.

[Libman-Sacks endocarditis]. / Endocarditis de Libman-Sacks.

In 1924, Libman and Sacks described valvular lesions in patients with lupus erythematosus. Libman-Sacks valvular lesions are sterile fibrinous vegetations that preferentially develop at the left-sided heart valves. Reports of their prevalence range from 53 to 74%. Libman-Sacks endocarditis is associated with disease activity and antiphospholipid antibodies titer. Echocardiography is a useful tool for documenting valvular involvement and dysfunction as well as disease progression. Transesophageal echocardiography is superior to transthoracic echocardiography in detecting Libman-Sacks endocarditis. This report describes the echocardiographic image of Libman-Sacks endocarditis in a patient with active lupus erithematosus.

Urological manifestations of the disease related to immunoglobulin G4.

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Urological manifestations of the disease related to immunoglobulin G4. / Manifestaciones urológicas de la enfermedad relacionada con la inmunoglobulina G4

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Structural and Biophysical Analysis of the Soluble DHH/DHHA1-Type Phosphodiesterase TM1595 from Thermotoga maritima.

The concentration of messenger molecules in bacterial cells needs to be tightly regulated. This can be achieved by either controlling the synthesis rate, degradation, or export by specific transporters, respectively. The regulation of the essential second messenger c-di-AMP is achieved by modulation of the diadenylate cyclase activity as well as by specific phosphodiesterases that hydrolyze c-di-AMP in the cell. We provide here structural and biochemical data on the DHH-type phosphodiesterase TmPDE (TM1595) from Thermotoga maritima. Our analysis shows that TmPDE is preferentially degrading linear dinucleotides, such as 5'-pApA, 5'-pGpG, and 5'-pApG, compared with cyclic dinucleotide substrates. The high-resolution structural data provided here describe all steps of the PDE reaction: the ligand-free enzyme, two substrate-bound states, and three post-reaction states. We can furthermore show that Pde2 from Streptococcus pneumoniae shares both structural features and substrate specificity based on small-angle X-ray scattering data and biochemical assays.

Genetic analysis of caveolin-1 and eNOS genes in colorectal cancer.

Caveolae are involved in physical compartmentalization between different groups of signaling events. Its main component, CAV1, modulates different pathways in cellular physiology. The emerging evidence pointing to the role of CAV1 in cancer led us to study whether different alleles of this gene are associated with colorectal cancer (CRC). Since one of the most characterized enzymes regulated by CAV1 is eNOS, we decided to include both genes in this study. We analyzed five SNPs in 360 unrelated CRC patients and 550 controls from the general population. Two of these SNPs were located within eNOS and three within the CAV1 gene. Although haplotype distribution was not associated with CRC, haplotype TiA (CAV1) was associated with familiar forms of CRC (p<0.05). This was especially evident in CRC antecedents and nuclear forms of CRC. If both CG (eNOS) and TiA (CAV1) haplotypes were taken together, this association increased in significance. Thus, we propose that CAV1, either alone or together with eNOS alleles, might modify CRC heritability.

Hemoperfusión en pacientes con enfermedades críticas e injuria renal aguda. Reporte de tres casos / Hemoperfusion in patients with critical diseases and acute kidney injury. Three cases report

RESUMEN La hemoperfusión es una técnica de aclaramiento extracorpóreo de moléculas de mediano y gran peso molecular, lipofílicas y de alta unión a proteínas plasmáticas, basada en el principio físico de adsorción. Puede usarse de forma aislada o combinada con otras técnicas, como hemodiálisis convencional, hemodiálisis híbrida o terapia de reemplazo renal continua. Se reportantres pacientes (dos con pancreatitis severa y unocon sepsis asociada a leptospirosis) que desarrollaron injuria renal aguda y fueron tratados mediante hemoperfusión combinada con hemodiálisis convencional en la Unidad de Cuidados Intensivos (UCI).Se evidenció depuración significativa de toxinas urémicas y citoquinas proinflamatorias, además de otras moléculas como enzimas digestivas y creatinfosfokinasa. El futuro de esta técnica adsortiva,innovadora en el tratamiento de condiciones sistémicas inflamatorias, requiere todavía de mayor evidencia para demostrar su utilidad para prevenir la mortalidad de pacientes críticos.

ABSTRACT Hemoperfusion is a technique for extracorporeal clearance of medium and large molecular weight molecules, lipophilic and highly bound to plasma proteins based on the physical principle of adsorption. It can be used in isolation or in combination with other techniques such as conventional hemodialysis, hybrid hemodialysis or continuous renal replacement therapy. Three patients (two with severe pancreatitis and one with leptospirosis-associated sepsis) in which hemoperfusion combined with conventional hemodialysisin the Intensive Care Unit are reported. All three cases developed in addition to acute kidney injury. Significant clearance of uremic toxins and proinflammatory cytokines is evident, in addition to other molecules such as digestive enzymes and creatine phosphokinase. The future of this innovative adsorptive technique in the treatment of systemic inflammatory conditions requires even more evidence to demonstrate its benefit in the mortality of critically ill patients.

Complete mitochondrial genome of Ictalurus pricei (Teleostei: Ictaluridae) and evidence of a cryptic Ictalurus species in Northwest Mexico.

The nominal Yaqui catfish, Ictalurus pricei, is a species of Ictaluridae (Siluriformes) often recorded from Northwest Mexico. Southern distribution members of the I. pricei complex in Northwest Mexico include at least one undescribed species that differs from Yaqui catfish in morphological features, herein called "Sinaloa Catfish". Sequencing of four geographical mitogenome haplotypes of Yaqui catfish and Sinaloa catfish showed geographical haplotypes of I. pricei within a clade of specific identity, close to Sinaloa catfish haplotypes. Our molecular phylogeny represents a working hypothesis supporting information on the evolutionary relationships of the Ictalurus species from Western Mexico and Western USA.

Morphometry and meristics of two species of Ictalurus (Siluriformes: Ictaluridae), native catfishes of Sierra Madre Occidental, Mexico

Introduction: Morphotypes of native catfish of the genus Ictalurus (Siluriformes: Ictaluridae) are known to occur in allopatry in the northern Sierra Madre Occidental of Mexico, with only the Yaqui catfish (Ictalurus pricei) taxonomically described. Recent genetic analysis of these morphotypes has revealed the monophyly of the I. pricei complex, which indicates Ictalurus sp. from the Culiacán River and San Lorenzo River basins as its nearest genetic relative and recognizes as an evolutionarily significant unit the Culiacán River and San Lorenzo River morphotypes. Objective: To compare the meristic and morphometric characteristics of the catfish of the Culiacán River basin with its nearest genetic relative, the Yaqui catfish, in order to determine the presence of distinctive morphological characters that support genetic evidence previously reported for these morphotypes. Methods: Catfish specimens were collected during various field expeditions (1990-2012) to remote sites of the Sierra Madre Occidental and conducted in the Yaqui River and Culiacán River basins with the purpose of morphological comparison. Forty-five morphological characters (40 morphometric and five meristic) were examined in 76 adult specimens - 52 Ictalurus sp. and 24 Ictalurus pricei. Three groups were subject to a discriminant function analysis (DFA), including two Ictalurus sp. groups from the Humaya River and Tamazula River sub-basins, representing the Culiacán River basin, and one I. pricei group representing the Yaqui River basin. The standardized measurements and meristic data of the catfish morphotypes were compared by means of DFA. Results: The DFA revealed 12 characters to be significantly different (P< 0.01) among the groups compared. The morphological characters separating the Ictalurus sp. (Culiacán River basin) from the Yaqui catfish were associated with lower anal, pelvic and pectoral fin ray numbers, shorter head and predorsal lengths, shorter longest lateral barbel and longest dorsal ray lengths and a narrower premaxilar dentary plate; and finally longer distances in Ictalurus sp. for dorsal-fin origin to last anal-fin ray base and dorsal-fin origin to posterior end of the adipose fin base. The standardized coefficients for canonical variables 1 and 2 accounted for 85.6 % and 14.4 % of the total variation, respectively. Conclusions: The distinctive morphological characters of the Ictalurus sp. found in the Culiacán River basin, combined with the known mitochondrial evidence for this morphotype, identify it as an evolutionarily significant unit that requires description as a new species based on taxonomical protocols.

Introducción: Morfotipos de bagres nativos del género Ictalurus (Siluriformes: Ictaluridae) se distribuyen de manera alopátrica en el norte de la Sierra Madre Occidental, de los cuales solo el bagre Yaqui (Ictalurus pricei) ha sido taxonómicamente descrito. Análisis genéticos recientes de esos morfotipos han revelado la monofilia del complejo I. pricei, que incluyó a Ictalurus sp. de las cuencas de los ríos Culiacán y San Lorenzo como su pariente genético más cercano, además del reconocimiento de los morfotipos de los ríos Culiacán and San Lorenzo como una unidad evolutivamente significativa. Objetivo: Comparar características merísticas y morfométricas del bagre de la cuenca del río Culiacán con su pariente genético más cercano, el bagre Yaqui, con el propósito de determinar la presencia de caracteres morfológicos distintivos en apoyo a evidencia genética previamente reportada para esos morfotipos. Métodos: Especímenes de bagres fueron recolectados durante varias expediciones de campo (1990-2012) en sitios remotos de la Sierra Madre Occidental en las cuencas de los ríos Yaqui y Culiacán para comparación morfológica. Cuarenta y cinco caracteres morfológicos (40 morfométricos y cinco merísticos) fueron examinados en 76 especímenes adultos (52 de Ictalurus sp. y 24 de Ictalurus pricei). Medidas corporales estandarizadas y datos merísticos de los morfotipos de bagres estudiados fueron comparados por medio de un análisis de función discriminante (AFD). Resultados: El AFD arrojó 12 caracteres significativamente diferentes (P< 0.01) entre los grupos comparados. Los caracteres morfológicos que distinguen al bagre del río Culiacán del bagre Yaqui, estuvieron asociados con un menor número de radios anales, pélvicos y pectorales, así como dimensiones más pequeñas para la longitud de la cabeza, longitud predorsal, longitud de la barbilla lateral más larga, longitud del radio dorsal más largo y una menor anchura de la placa dentaria premaxilar; y finalmente, dimensiones mayores en Ictalurus sp. (cuenca del río Culiacán) para distancias como origen de aleta dorsal a la base del último radio anal y origen de aleta dorsal a conexión posterior de aleta adiposa. Los coeficientes estandarizados para las variables canónicas 1 y 2 explicaron el 85.6 y 14.4 % de la variación total, respectivamente. Conclusiones: Los caracteres morfológicos distintivos de Ictalurus sp. de la cuenca del río Culiacán, en combinación con la evidencia mitocondrial conocida para este mismo morfotipo, permite reconocerlo como una unidad evolutivamente significativa y que requiere ser descrita como una especie nueva bajo los protocolos taxonómicos.

Importancia del uso adecuado del equipo de protección individual y la implementación de protocolos de seguridad perioperatorios durante la pandemia de COVID-19 / Importance of the Proper use of Personal Protective Equipment and the Implementation of Perioperative Safety Protocols During the COVID-19 Pandemic

RESUMEN El panorama que se presenta en la actualidad es un reto sin precedentes para el manejo de los pacientes quirúrgicos, la toma de decisiones y el empleo de recursos en cuanto a material y equipos de protección en el contexto de la pandemia por COVID-19. Por lo que el presente artículo pretende dar a conocer los lineamientos para el correcto actuar en el quirófano, el uso del equipo de protección individual, las indicaciones de cirugía y el mejor abordaje en el marco de esta situación. El principal objetivo de seguir estas recomendaciones es mitigar el riesgo de contagio y educar al personal de salud médico-quirúrgico para que esté preparado para hacer frente a esta pandemia.

ABSTRACT The current landscape represents an unprecedented challenge in managing surgical patients, decision-making and the use of resources such as protective equipment in the context of the COVID-19 pandemic. Therefore, the objective of this article is to provide guidelines for good conduct in the operating room, the use of personal protective equipment, suggestions for surgeries and the best approach in the context of this situation. The main objective of these recommendations is to mitigate the risk of contagion and to educate medical-surgical health personnel in how to deal with this pandemic.

Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial.

BACKGROUND AND PURPOSE: Mild alterations in temperature have prominent effects on ischemic cell injury and stroke outcome. Elevated core body temperature (CBT), even if mild, may exacerbate neuronal injury and worsen outcome, whereas hypothermia is potentially neuroprotective. The antipyretic effects of acetaminophen were hypothesized to reduce CBT. METHODS: This was a randomized, controlled clinical trial at 2 university hospitals. Patients were included if they had stroke within 24 hours of onset of symptoms, National Institutes of Health Stroke Scale (NIHSS) score > or =5, initial CBT <3 8.5 degrees C, and white blood cell count < 12 600 cells/mm(3); they were excluded if they had signs of infection, severe medical illness, or contraindication to acetaminophen. CBT was measured every 30 minutes. Patients were randomized to receive acetaminophen 650 mg or placebo every 4 hours for 24 hours. The primary outcome measure was mean CBT during the 24-hour study period; the secondary outcome measure was the change in NIHSS. RESULTS: Thirty-nine patients were randomized. Baseline CBT was the same: 36.96 degrees C for acetaminophen versus 36.95 degrees C for placebo (P=0.96). During the study period, CBT tended to be lower in the acetaminophen group (37.13 degrees C versus 37.35 degrees C), a difference of 0.22 degrees C (95% CI, -0.08 degrees C to 0.51 degrees C; P=0.14). Patients given acetaminophen tended to be more often hypothermic <36.5 degrees C (OR, 3.4; 95% CI, 0.83 to 14.2; P=0.09) and less often hyperthermic >37.5 degrees C (OR, 0.52; 95% CI, 0.19 to 1.44; P=0.22). The change in NIHSS scores from baseline to 48 hours did not differ between the groups (P=0.93). CONCLUSIONS: Early administration of acetaminophen (3900 mg/d) to afebrile patients with acute stroke may result in a small reduction in CBT. Acetaminophen may also modestly promote hypothermia <36.5 degrees C or prevent hyperthermia >37.5 degrees C. These effects are unlikely to have robust clinical impact, and alternative or additional methods are needed to achieve effective thermoregulation in stroke patients.

Lepra lepromatosa. Presentación de un caso / Lepromatous leprosy. Case presentation

La lepra, es una enfermedad infectocontagiosa de evolución crónica, producida por el Micobacterium Leprae que afecta piel y nervios periféricos. En su forma más grave también daña los órganos internos. Tan antigua como el mismo hombre, los enfermos que la padecen continúan marginados y estigmatizados como ocurría miles de años atrás. La Organización Mundial de la Salud (OMS) ha desarrollado un programa orientado a prevenir, diagnosticar oportunamente y tratarla de forma adecuada. En muchas ocasiones, los pacientes con lepra son diagnosticados en la atención secundaria, acompañados de discapacidades irreversibles por los diagnósticos tardíos. Por esta razón es oportuno presentar un caso clínico de lepra lepromatosa, diagnosticado en el área de salud (atención primaria) y en etapa temprana de la enfermedad, lo que interrumpe la cadena epidemiológica y además evita las temibles discapacidades asociadas que los llevan a ser inhabilitados sociales, con todas las afectaciones psicológicas para el paciente y su familia. Es de vital importancia seguir preparando al Equipo Básico de Salud (EBS) y Grupo Básico de Trabajo (GBT) para poder realizar diagnósticos tempranos de lepra en el nivel de atención primaria, como el expuesto en este trabajo, para así poder cumplir con el deber de erradicar la enfermedad en Cuba.

Leprosy is an infectious and contagious disease, of chronic evolution produced by Micobacterium Leprae which affects skin and nerves In its most severe form it also affects internal organs. As old as men, patients who suffer from it continue marginalized and stigmatized as it occurred thousand of years ago. World Heath Organization (WHO) has developed a program oriented  to diagnose it timely and treat it adequately. Many times patients with leprosy are diagnosed in the second health care level, accompanied by irreversible disabilities due to late diagnosis. For this reason we think it is necessary to present a case of Lepromatous Leprosy, diagnosed in the health area (primary health care) and in an early stage of the disease , which interrupts the epidemiological chain and avoids the frightening associated disabilities which end in social inability, with all the psychological effects for the patient and his family. It is of great importance to continue preparing the Health Basic Team (BHT) an d the Work Basic Group (WBG) to make early diagnosis of leprosy in the primary health care , as the one presented in this work to fulfill the duty of eradicating this disease in the country.