Tangent space functional reconfigurations in individuals at risk for alcohol use disorder.

Human brain function dynamically adjusts to ever-changing stimuli from the external environment. Studies characterizing brain functional reconfiguration are nevertheless scarce. Here we present a principled mathematical framework to quantify brain functional reconfiguration when engaging and disengaging from a stop signal task (SST). We apply tangent space projection (a Riemannian geometry mapping technique) to transform functional connectomes (FCs) and quantify functional reconfiguration using the correlation distance of the resulting tangent-FCs. Our goal was to compare functional reconfigurations in individuals at risk for alcohol use disorder (AUD). We hypothesized that functional reconfigurations when transitioning in/from a task would be influenced by family history of alcohol use disorder (FHA) and other AUD risk factors. Multilinear regression model results showed that engaging and disengaging functional reconfiguration were driven by different AUD risk factors. Functional reconfiguration when engaging in the SST was negatively associated with recent drinking. When disengaging from the SST, however, functional reconfiguration was negatively associated with FHA. In both models, several other factors contributed to the explanation of functional reconfiguration. This study demonstrates that tangent-FCs can characterize task-induced functional reconfiguration, and that it is related to AUD risk.

Complement Biosensors Identify a Classical Pathway Stimulus in Complement-Mediated Hemolytic Uremic Syndrome.

Complement-mediated hemolytic uremic syndrome (CM-HUS) is a thrombotic microangiopathy characterized by germline variants or acquired antibodies to complement proteins and regulators. Building upon our prior experience with the modified Ham (mHam) assay for ex vivo diagnosis of complementopathies, we have developed an array of cell-based complement "biosensors'' by selective removal of complement regulatory proteins (CD55 and CD59, CD46, or a combination thereof) in an autonomously bioluminescent HEK293 cell line. These biosensors can be used as a sensitive method for diagnosing CM-HUS and monitoring therapeutic complement blockade. Using specific complement pathway inhibitors, this model identifies IgM-driven classical pathway stimulus during both acute disease and in many patients during clinical remission. This provides a potential explanation for ~50% of CM-HUS patients who lack an alternative pathway "driving" variant and suggests at least a subset of CM-HUS is characterized by a breakdown of IgM immunologic tolerance. Key Points: CM-HUS has a CP stimulus driven by polyreactive IgM, addressing the mystery of why 40% of CM-HUS lack complement specific variantsComplement biosensors and the bioluminescent mHam can be used to aid in diagnosis of CM-HUS and monitor complement inhibitor therapy.

Integrating Global Citizen Science Platforms to Enable Next-Generation Surveillance of Invasive and Vector Mosquitoes.

Mosquito-borne diseases continue to ravage humankind with >700 million infections and nearly one million deaths every year. Yet only a small percentage of the >3500 mosquito species transmit diseases, necessitating both extensive surveillance and precise identification. Unfortunately, such efforts are costly, time-consuming, and require entomological expertise. As envisioned by the Global Mosquito Alert Consortium, citizen science can provide a scalable solution. However, disparate data standards across existing platforms have thus far precluded truly global integration. Here, utilizing Open Geospatial Consortium standards, we harmonized four data streams from three established mobile apps­Mosquito Alert, iNaturalist, and GLOBE Observer's Mosquito Habitat Mapper and Land Cover­to facilitate interoperability and utility for researchers, mosquito control personnel, and policymakers. We also launched coordinated media campaigns that generated unprecedented numbers and types of observations, including successfully capturing the first images of targeted invasive and vector species. Additionally, we leveraged pooled image data to develop a toolset of artificial intelligence algorithms for future deployment in taxonomic and anatomical identification. Ultimately, by harnessing the combined powers of citizen science and artificial intelligence, we establish a next-generation surveillance framework to serve as a united front to combat the ongoing threat of mosquito-borne diseases worldwide.

Correction: Stress generation, relaxation and size control in confined tumor growth.

[This corrects the article DOI: 10.1371/journal.pcbi.1009701.].

The economic vulnerability of fishing households to climate change in the south Pacific region of Colombia.

Climate change's direct and indirect effects on marine ecosystems and coastal areas mainly impact small-scale fishers, especially in developing countries, which present extreme poverty and high dependency on marine ecosystems as a source of food and sustenance for households. Understanding the vulnerability of fishing households and considering the associated socio-economic-political complexities is essential for preserving their livelihoods and maintaining their well-being. This study proposes a measure of economic vulnerability based on the capacity of fishing households in Tumaco, located on the southern Pacific coast of Colombia, to diversify their livelihoods. Different statistical procedures have been conducted to identify the most relevant strategies in reducing the economic vulnerability of households. The results indicate that reducing the vulnerability of fishing households depends on adaptation strategies such as occupational mobility, some elements of social capital, and reduced dependence on the fisheries resource. This study could constitute an input for creating public policy that guides efforts to achieve strategies for the generation of other livelihoods and the sustainability of fishing households that continue to choose fishing as their main economic activity.

Towards a Measure for Characterizing the Informational Content of Audio Signals and the Relation between Complexity and Auditory Encoding.

The accurate description of a complex process should take into account not only the interacting elements involved but also the scale of the description. Therefore, there can not be a single measure for describing the associated complexity of a process nor a single metric applicable in all scenarios. This article introduces a framework based on multiscale entropy to characterize the complexity associated with the most identifiable characteristic of songs: the melody. We are particularly interested in measuring the complexity of popular songs and identifying levels of complexity that statistically explain the listeners' preferences. We analyze the relationship between complexity and popularity using a database of popular songs and their relative position in a preferences ranking. There is a tendency toward a positive association between complexity and acceptance (success) of a song that is, however, not significant after adjusting for multiple testing.

Stress generation, relaxation and size control in confined tumor growth.

Experiments on tumor spheroids have shown that compressive stress from their environment can reversibly decrease tumor expansion rates and final sizes. Stress release experiments show that nonuniform anisotropic elastic stresses can be distributed throughout. The elastic stresses are maintained by structural proteins and adhesive molecules, and can be actively relaxed by a variety of biophysical processes. In this paper, we present a new continuum model to investigate how the growth-induced elastic stresses and active stress relaxation, in conjunction with cell size control feedback machinery, regulate the cell density and stress distributions within growing tumors as well as the tumor sizes in the presence of external physical confinement and gradients of growth-promoting chemical fields. We introduce an adaptive reference map that relates the current position with the reference position but adapts to the current position in the Eulerian frame (lab coordinates) via relaxation. This type of stress relaxation is similar to but simpler than the classical Maxwell model of viscoelasticity in its formulation. By fitting the model to experimental data from two independent studies of tumor spheroid growth and their cell density distributions, treating the tumors as incompressible, neo-Hookean elastic materials, we find that the rates of stress relaxation of tumor tissues can be comparable to volumetric growth rates. Our study provides insight on how the biophysical properties of the tumor and host microenvironment, mechanical feedback control and diffusion-limited differential growth act in concert to regulate spatial patterns of stress and growth. When the tumor is stiffer than the host, our model predicts tumors are more able to change their size and mechanical state autonomously, which may help to explain why increased tumor stiffness is an established hallmark of malignant tumors.

Quiste óseo simple en el calcáneo: reporte de un caso / Simple osseous cyst of the calcaneus a case report

Las tumoraciones óseas son patologías producto de modificaciones en la estructura del hueso y en su contenido, pueden presentarse como lesiones tumorales benignas o malignas, primitivas o metastásicas, en dependencia de varios factores: la edad de presentación, localización, velocidad de crecimiento, reacción perióstica e infiltración a estructuras vecinas. Las publicaciones demuestran que los quistes óseos simples asintomáticos y pequeños no requieren tratamiento, hasta el 25% son de resolución espontánea posterior a una fractura patológica; mientras que quistes más grandes con corteza delgada, requieren de algún tipo de intervención. Se presenta el caso de una paciente de sexo femenino de 17 años de edad, que acude por presentar dolor de moderada intensidad en talón izquierdo que se intensifica a la deambulación, con un tiempo de 2 meses de evolución, posterior a un trauma contuso en esta región. Al examen físico se evidencia dolor a la digito presión y maniobras de movilización activa-pasiva en cara lateral externa a nivel de calcáneo de pie izquierdo. Se realiza radiografía lateral simple de calcáneo izquierdo, donde se evidencia una lesión lítica circular de 3 por 3 cm que compromete la región anteroinferior de calcáneo. En conclusión, el quiste óseo simple o solitario, es una patología benigna, que, aunque no ponga en peligro la vida de la persona puede afectar seriamente la funcionalidad del pie. En la actualidad no existe un tratamiento estandarizado para el manejo de esta patología, las técnicas quirúrgicas actuales en especial el curetaje y el autoinjerto óseo resultan muy prometedoras.

Bone tumors are pathologies resulting from modifications in the bone structure and its content, they can present as benign or malignant, primitive or metastatic tumor lesions, depending on various factors: age of presentation, location, growth rate, periosteal reaction and infiltration to neighboring structures. The publications show that small, asymptomatic and small bone cysts do not require treatment, up to 25% are spontaneous resolution after a pathological fracture; while larger cysts with thin bark require some type of intervention. The case of a 17-year-old female patient is presented, who presents for presenting moderate intensity pain in the left heel that intensifies on ambulation, with a time of 2 months of evolution, after a blunt trauma in this region. On physical examination, pain from the pressure digit and active-passive mobilization maneuvers were evidenced on the external lateral aspect at the calcaneus level of the left foot. A simplelateral radiograph of the left calcaneus was performed, showing a 3 by 3 cm circular lytic lesion involving the anteroinferior region of the calcaneus. In conclusion, simple or solitary bone cyst is a benign pathology that, although it does not endanger the person's life, can seriously affect the functionality of the foot. Currently, there is no standardized treatment for the management of this pathology, current surgical techniques, especially curettage and bone autograft are very promising.

Técnica de larson original modificada para la reconstrucción del ligamento colateral lateral de la rodilla, reporte de un caso / Modified original larson technique for the knee´s lateral collateral ligament reconstruction, a case report

El ligamento colateral lateral (LCL), que forma parte de los estabilizadores de la rodilla, constituye una estructura importante dentro del complejo posterolateral de la misma (CPL), que restringe al varo, en los ángulos de flexión de esta, especialmente a los 30°, además de controlar la rotación externa. Son infrecuentes las lesiones que afectan a este complejo, etiológicamente entre el 50- 90% se asocian a otras lesiones ligamentosas con predominio del 60% de daño del ligamento cruzado posterior. La técnica de Larson se basa en la reconstrucción del LCL y del complejo poplíteo, utilizando una inserción proximal única en el epicóndilo femoral. Presentamos el caso de un paciente masculino de 28 años de edad, sin antecedentes clínicos, que acude debido a un varo forzado de la extremidad mientras realizaba actividad deportiva y tras recibir impacto directo en la región lateral interna de pantorrilla derecha, posterior a lo cual presenta dolor a los movimientos pasivos e imposibilidad a la deambulación. Además, presenta equimosis, edema, escoriaciones superficiales en cara lateral externa y dolor a la digitopresión en trayecto de ligamento colateral externo. A maniobras de exploración de rodilla: signo de bostezo en varo positivo, cepillado rotuliano positivo, hiperpresión de rotula positivo, limitación funcional a la flexión y extensión de la articulación. Esta técnica, Larson modificada, resulta como una de las más prometedoras por sus varias características, como la menos exigente y al mismo tiempo brindando resultados alentadores. Este procedimiento se fundamenta en la reconstrucción del LCL y del tendón poplíteo (TP) en conjunto, resumiéndose así la reconstrucción del Ligamento Poplíteo Peroneo (LPP) como estabilizador estático del TP, con su inserción a nivel de la cabeza del peroné en conjunto con la del LCL y la restitución de ambas inserciones en el epicóndilo femoral, tomando en cuenta la morfología del peroné y los ángulos de movimientos de la rodilla.

The lateral collateral ligament (LCL), which is part of the knee stabilizers, constitutes an important structure within the posterolateral complex of the same (CPL), which restricts the varus, in the flexion angles of this, especially at 30°, in addition to controlling external rotation. Lesions that affect this complex are infrequent, etiologically between 50-90% are associated with other ligamentous injuries with a predominance of 60% damage to the posterior cruciate ligament. The Larson technique is based on the reconstruction of the LCL and the popliteal complex, using a single proximal insertion in the femoral epicondyle. We present the case of a 28-year-old male patient, with no medical history, who attended due to a forced varus of the limb while performing sports activity and after receiving a direct impact on the internal lateral region of the right calf, after which he presented pain to passive movements and inability to ambulation. In addition, he presents ecchymosis, edema, superficial abrasions on the external lateral aspect and pain on acupressure in the course of the external collateral ligament. A knee examination maneuvers: positive varus yawn sign, positive patellar brushing, positive patella hyperpressure, functional limitation to flexion and extension of the joint. This modified Larson technique turns out to be one of the most promising due to its various characteristics, as the least demanding and at the same time providing encouraging results. This procedure is based on the reconstruction of the LCL and the popliteal tendon (PT) as a whole, thus summarizing the reconstruction of the Peroneal Popliteal Ligament (LPP) as a static stabilizer of the PT, with its insertion at the level of the head of the fibula in conjunction with the of the LCL and the restitution of both attachments in the femoral epicondyle, taking into account the morphology of the fibula and the angles of movement of the knee.

Propuesta de protocolo diagnóstico, estadificador y quirúrgico para el cáncer de endometrio / Proposal for a diagnostic, staging and surgical protocol for endometrial carcinoma

El carcinoma de endometrio es la neoplasia más frecuente del tracto genital de la mujer en el mundo occidental es una patología que va en ascenso en los países en vías de desarrollo. En general, el pronóstico de carcinoma endometrial es bueno, con una supervivencia global de alrededor del 80 %. Se pueden definir tres grupos de acuerdo al riesgo de recurrencia, en alto, medio y bajo. Se realiza revisión bibliográfica y casuística para proponer protocolo de manejo quirúrgico en pacientes con cáncer de endometrio. Se definen tres etapas durante el protocolo: clínica, patológica y quirúrgica. Se realizan recomendaciones basados en la vía de abordaje, tipo de histerectomía, lavado peritoneal, linfadenectomía, omentectomía, y cito-reducción. Se plantean situaciones especiales y la importancia del ganglio centinela. La realización de protocolos quirúrgicos para el manejo de carcinoma endometrial permite la unificación de criterios, mejora la evaluación de respuesta rapéutica y facilita revisiones y mejoras a futuro.(AU)

The endometrial carcinoma is the most common neoplasia in the genital tract of women in the western world and is a condition that is increasing in the developing countries. In general, the rognosis of endometrial carcinoma is good, with an overall survival of about 80 %. It can define three groups according to the risk of the recurrence in high, medium and low. The literature review and case mix is performed to propose the surgical management protocol in patients with endometrial cancer. Three stage the clinical, the pathological and the surgical defined for the protocol. The recommendations based on the approach, type of the ysterectomy, te peritoneal washing, the lymphadenectomy, the omentectomy, and the debulking are made. The special situations and the importance of sentinel node arise. Performing the surgical protocol for the management of endometrial carcinoma allows the unification of criteria, the improved therapeutic response assessment and facilitates future revisions and improvements.(AU)

Enfermedad de Creutzfeldt-Jakob familiar: a propósito de un caso de demencia rápidamente progresiva en Chile / Creutzfeldt-Jakob familial disease: about a rapidly progressive dementia case in Chile

La enfermedad de Creutzfeldt-Jakob (ECJ) corresponde una enfermedad por priones, la cual se manifiesta como demencia rápidamente progresiva. Dentro de sus manifestaciones clínicas puede presentar deterioro cognitivo progresivo y mioclonías, entre otros. El objetivo de este trabajo es dar a conocer la ECJ de variante familiar, mediante la presentación de un caso clínico. Presentación del caso: Paciente de 67 años, con antecedentes de familiares fallecidos por ECJ, previamente autovalente, que consulta por cuadro de 2 meses de evolución, caracterizado por deterioro cognitivo progresivo, desorientación temporo-espacial, mioclonías y apraxia ideomotora principalmente. Dentro del estudio realizado durante su hospitalización, destaca resonancia magnética de cerebro que describe hiperintensidad de señal bilateral simétrica en ganglios basales y cortezas frontales paramedianas. Además de electroencefalograma (EEG) que muestra descargas agudas de morfología trifásica. Esto junto a la clínica y exámenes complementarios permiten plantear una probable ECJ de variante familiar. Discusión: La aproximación diagnóstica a la ECJ es principalmente clínica, siendo el estudio histopatológico mediante biopsia cerebral el GOLD standard. Dentro de los estudios fundamentales que apoyan el diagnóstico de ECJ, se encuentra la resonancia magnética (RM) y EEG característicos. El diagnóstico de la variante familiar de ECJ se basa en el estudio genético del codón 200 y 129. Se expone una enfermedad no conocida de forma completa, de la cual aún no existen métodos diagnostico totalmente certeros, salvo por la biopsia. Es por esto que los aspectos clínicos son de gran relevancia para su sospecha, representando un desafío para el medico actual.

Introduction: Creutzfeldt-Jakob disease (CJD) is a prion disease, which manifests itself as a rapidly progressive dementia. Within its clinical manifestations may present progressive cognitive impairment and myoclonus, among others. The aim of this paper is to present the familal-type CJD by presenting a clinical case. Case Report: 67-year-old patient with a history of relatives who died of CJD, previously autovalent that consults for a 2 months period characterized by progressive cognitive impairment, time and space disorientation, myoclonus and ideomotor apraxia. In the study carried out during his hospitalization, he was studied with a brain magnetic resonance that describes symmetrical bilateral signal hyperintensity in basal ganglia and paramedian frontal cortex. In addition the electroencephalogram (EEG) showed acute discharges of three-phase morphology. These findings together, with the clinical manifestations and complementary tests allowed to raise a probable familial CJD. Discussion: The diagnostic approach to CJD is mainly clinical, with the GOLD standard being the histopathological study using cerebral biopsy. Among the fundamental studies that support the diagnosis of CJD are the characteristic MRI and EEG. The diagnosis of the familial type of CJD is based on a genetic study of codon 200 and 129. This case exposes a disease of which is not yet fully known which there are still no completely accurate diagnostic methods, except for the biopsy. That is why the clinical aspects are of great relevance to suspect it, representing a challenge for the current doctor.

New approaches to superovulation in the cow.

There is continuing need to simplify bovine superovulation protocols without compromising embryo production. The control of follicular wave emergence and ovulation has facilitated donor management, but the most commonly used treatment, oestradiol, cannot be used in many parts of the world and mechanical removal of the dominant follicle is difficult to apply in the field. Other alternatives include gonadotrophin-releasing hormone (GnRH) or LH, but efficacy in groups of randomly cycling animals is variable. Another alternative is to increase the response to GnRH by inducing a persistent follicle and initiating FSH treatments following GnRH-induced ovulation. The number of transferable embryos following superovulation during the first follicular wave did not differ from that achieved 4 days after oestradiol benzoate and progesterone. To further simplify superovulation, FSH has been administered as a single intramuscular injection. Superovulation of beef donors with a single intramuscular injection of Folltropin-V (Bioniche Animal Health, Belleville, ON, Canada) diluted in a slow-release formulation resulted in embryo production comparable to that obtained using the traditional twice-daily protocol. The single intramuscular injection has the potential to reduce labour and handling and may be useful when handling stress is an impediment to success. These alternatives provide ways of facilitating widespread application of embryo transfer technologies.

Angioplastía percutánea del tronco principal de la arteria coronaria izquierda / Percutaneous angioplasty of the left main coronary artery

Se describe el caso de una paciente de 38 años de edad, portadora de enfermedad arterial coronaria del tronco principal de la coronaria izquierda, la cual fue intervenida en forma percutánea con implante de una prótesis endovascular o stent sin injerto venoso o arterial previo, en forma exitosa. Después de 5 meses de seguimiento, la paciente se encuentra asintomática.

Manejo de la hemorragia subaracnoidea en pacientes ingresados en el área de Neurocirugía del hospital Dr. Teodoro Maldonado Carbo, 01 de enero al 31 de julio de 2002 / I manage of the hemorragia subaracnoidea in patients entered in the area of Neurosurgery of the Dr. Teodoro Maldonado Carbo Hospital, January 1st to July 31 of 2002

Estudio realizado en el servicio de Neurocirugía del hospital “Dr. Teodoro Maldonado Carbo” durante 1 enero-31 julio 2002. Fueron 118 pacientes ingresados de los cuales se tomaron 16 pacientes que cumplieron con los criterios de inclusión y que por tanto se constituye en universo.Tipo de estudio: retrospectivo, descriptivo.Objetivos. General:Determinar cómo se realiza el manejo de los pacientes con hemorragia subaracnoidea ingresados en el servicio de Neurocirugía.Específicos:1.- Establecer por medio de porcentajes la morbimortalidad de los pacientes que cursan con Hemorragia Subaracnoidea.2.- Determinar la influencia que ejercen los antecedentes personales y hábitos de este grupo de pacientes.Resultados: De los 16 pacientes la patología determinada se presentó el 49% en mayores de 60 años; prevaleciendo también en el sexo masculino que alcanzó el 62%. En cuanto a los pacientes con antecedentes de hipertensión arterial se destacó el 25%, aún en aquellos individuos que seguían un tratamiento adecuado. En cuanto a la etiología se destacó el trauma cráneo encefálico con un 44%, seguido de los aneurismas con un 25%. Como medio de diagnóstico, la tomografía axial computarizada, con el 81%, demostró que sigue siendo el de primera elección. El tratamiento conservador alcanzó el 75% y en nuestro universo de estudio se obtuvo 62% de mejoría y 38% curación al momento del alta hospitalaria.Conclusiones: Se logró demostrar con este estudio el adecuado y eficaz manejo intra hospitalario para con este grupo de pacientes, no sólo con el hecho del alto porcentaje en el tratamiento conservador sino también porque no existió ningún paciente fallecido en nuestro universo de estudio.

Study carried out in the Service of Neurosurgery at the Dr. Teodoro Maldonado Carbo Hospital during January 1st to 31 July 2002. They were 118 entered patients of which took 16 patients that fulfilled the approaches. Therefore the universe of our study belongs to 16 patients. Study type: retrospective, descriptive.Objectives. General: To determine like he/she is carried out the handling of the patients with Hemorragia Subaracnoidea entered in the service of Neurosurgery.Specific:1. - to settle down by means of percentages the morbimortalidad of the patients that study with Hemorragia Subaracnoidea.2. - to determine the influence that you/they exercise the personal antecedents and habits of this group of patients that have presented Hemorragia Subaracnoidea. Results: Of the 16 patients that entered with diagnosis of Hemorragia Subaracnoidea, 49% was obtained in bigger than 60 years, also prevailing in the masculine sex that reached 62%. As for the patients with antecedents of arterial Hypertension stood out even 25% in those individuals that followed an appropriate treatment. As for the etiología he/she stood out the Trauma skull encefálico with 44%, followed by the Aneurismas with 25%. Like half of diagnosis, the On-line Axial Tomografía with 81% demonstrated that it continues being the first election in this group of patient. The conservative treatment reached 75% and in our study universe it was obtained 62% of improvement and 38% cure to the hospital moment of the high one.Conclusions: It was possible to demonstrate with this study the appropriate and effective I manage hospital intra towards this group of patient, not only with the fact of the high percentage in the conservative treatment but also because any patient deceased didn't exist in our study universe.

Análisis de la mortalidad de la Sección de Medicina del Hospital Rafael Angel Calderón Guardia del 2001-2003 / Analysis of the mortality of the Department of Medicine in the Hospital Rafael Angel Calderón Guardia 2001-2003

Objetivo: Describir los patrones de mortalidad del departamento de medicina del Hospital Rafael Angel Calderón Guardia y compararla con la mortalidad general y la recolectada en la literatura mundial. Métodos: Se revisaron los certificados de defunción de pacientes internados en los diferentes servicios de la sección de medicina desde el 1ero de junio del 2001 a el 30 de junio del 2003. Resultados: Hubo 895 fallecimientos en el período de estudio, 51 por ciento fueron hombres. 20 por ciento de los pacientes tenían edades iguales o menores a 50 años, el grupo erario con mayor número de defunciones fue el de los 71 a 80 años (226 fallecimientos). Los principales diagnósticos de fallecimiento fueron, en orden : Neumonía, cardiopatía isquémica, enfermedad cerebro-vascular, shock séptico, cirrosis, insuficiencia renal, malignidades hematológicas, enfermedad obstructiva crónica, sida y embolismo pulmonar. Los servicios con mayor mortalidad fueron : Medicina Interna (41,5 por ciento), Neumología (11,7 por ciento), Cardiología (11,3 por ciento), Neurología (10 por ciento) y Gastroenterología (8 por ciento). Conclusión: La mortalidad intrahospitalaria mantiene un comportamiento muy similar comparado con la mortalidad general del país en lo que a diagnósticos y edad se refiere. Excluyendo los casos de trauma que por lo general no se ingresan a este departamento.

Azitromicina y enfermedades de transmisión sexual causadas por Chlamydia trachomatis y Neisseria gonorrhoeae / Azithromycin and sexually transmitted diseases caused by Chlamydia trachomatis and Neisseria gonorrhoeae

Objetivos: Evaluar la eficacia y seguridad de azitromicina en el tratamiento de las enfermedades de transmisión sexual (ETS) causadas por Chlamydia trachomatis y Neisseria gonorrhoeae. Diseño: estudio prospectivo, abierto, no comparativo. Ubicación: consulta externa de las instituciones que participaron. Pacientes: 50 pacientes ambulatorios con ETS comprobada por microbiología empleando prueba de ELISA para Chlamydia trachomatis y cultivos en medio selectivo para Neisseria gonorrhoeae. Intervención: tratamiento con dosis oral única de 1 gr de azitromicina. No se permitió otro antibiótico asociado. Principal Resultado a evaluar: Curación de los síntomas y erradicación microbiológica de los patógenos hallados. Resultados: predominio del sexo femenino; aún cuando era una población altamente promiscua, (incluía trabajadores sexuales) se encontraron 5 pacientes totalmente asintomáticas, con infección por Chlamydia trachomatis y una de ellas con gonococo asociado. La mayoría de los casos en ambos sexos presentaba infección por clamidia sola (83%), seguida por los casos asociados a gonococo (14%) Y un caso de infección únicamente por gonococo. Clínica: la mejoría clínica, se puede apreciar en las primeras 48 horas en la mitad de los pacientes cifra que llegó al 95% a los 7-10 días post-tratamiento. Microbiología: la erradicación se logró en el 96% de los casos, presentándose una recidiva y dos reinfecciones, todas por Chlamydia trachomatis, que curaron, fuera de protocolo a una segunda dosis. Cumplimiento: de los 50 pacientes que recibieron el tratamiento, 48 (96%) retornaron a los controles. Seguridad: 3 pacientes presentaron eventos adversos individualmente: náusea, vértigo y diarrea, todos leves y cedieron espontáneamente. Conclusiones: estandarizando el tratamiento de la ETS causadas por Chlamydia trachomatis y Neisseria gonorrhoeae con azitromicina en dosis oral única de 1 gr, con su óptimo cumplimiento y sus elevadas tasas de eficacia clínica y microbiológica podría ayudar enormemente a los servicios de salud de todo el mundo en el manejo de esta endemia.