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This study analysed the mechanisms of quinolone resistance among enterotoxigenic Escherichia coli (ETEC) in a periurban area of Lima, Peru. The susceptibility to nalidixic acid and ciprofloxacin, the role of Phe-Arg-b-Naphtylamyde inhibitable-(PAbN) efflux pumps, the presence of mutations in gyrA and parC as well as the presence of aac(6')Ib-cr, qepA, qnrA, qnrB, qnrC, qnrD, qnrVC and oqxAB were determined in 31 ETEC from previous case/control studies of children's diarrhoea. Discordances between disk diffusion, with all isolates showing intermediate or fully resistance to nalidixic acid, and minimal inhibitory concentration (MIC), with 7 isolates being below considered resistance breakpoint, were observed. Twenty-one isolates possessed gyrA mutations (19 S83L, 2 S83A). AAC(6') Ib-cr, QnrS, QnrB and QepA were found in 7, 6, 2 and 1 isolates respectively, with 3 isolates presenting 2 transferable mechanisms of quinolone resistance (TMQR) concomitantly. TMQR were more frequent among isolates with MIC to nalidixic acid ranging from 2 to 16 mg/L (p=0.03), while gyrA mutations were more frequent among isolates with nalidixic acid MIC >= 128 mg/L (p=0.0002). In summary, the mechanisms of quinolone resistance present in ETEC isolates in Peru have been described. Differences in the prevalence of underlying mechanisms associated with final MIC levels were observed. The results suggest two different evolutive strategies to survive in the presence of quinolones related to specific bacterial genetic background.
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Escherichia coli Enterotoxigênica , Quinolonas , Criança , Humanos , Escherichia coli Enterotoxigênica/genética , Ácido Nalidíxico/farmacologia , Quinolonas/farmacologia , Ciprofloxacina , Estudos de Casos e ControlesRESUMO
Household water contamination at point of use depends on human, animal and environmental factors embodying all aspects of a One Health approach. This study investigated the association between household factors, the presence of thermotolerant coliform, and the presence of antibiotic resistant bacteria in drinking water among 314 households with children under 5 in Cajamarca, Peru. This study analysed data from a baseline sampling of a randomized controlled trial, including household surveys covering household water management and factors such as household animals, as well as microbiological data from samples collected from drinking water. Data were analysed using generalized linear models. Drinking water samples collected from narrow-mouthed containers were less likely to be contaminated than samples collected from the faucet (OR = 0.55, p = 0.030) or wide mouthed containers. The presence of thermotolerant coliform was associated with owning farm birds, which increased the proportion of contamination from 42.2% to 59.1% (OR = 1.98, p = 0.017) and with animal waste observed in the kitchen area, which increased the prevalence of contamination from 51.4% to 65.6% (OR = 1.80, p = 0.024). Resistance to any antibiotic was higher among pig owners at 60%, relative to non-pig owners at 36.4% (OR = 1.97, p = 0.012) as well as households with free-roaming animals in the kitchen area at 59.6% compared to households without free-roaming animals at 39.7% (OR = 2.24, p = 0.035). Recent child antibiotic use increased the prevalence of trimethoprim-sulfamethoxazole resistance among E. coli isolates to 22.3% relative to 16.7% (OR = 3.00, p = 0.037). Overall, these findings suggest that water storage in a secure container to protect from in-home contamination is likely to be important in providing safe drinking water at point of use. In addition, transmission of thermotolerant coliform and AMR between domestic animals and human drinking water supplies is likely. Further research should explore transmission pathways and methods to support safe drinking water access in multi-species households.
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Resumen Introducción: La enfermedad de Ménière se caracteriza por crisis recurrentes de vértigo, asociado a hipoacusia y tinnitus, que pueden ser incapacitantes, y provocar estrés y ansiedad. Objetivos: Evaluar el efecto de la dexametasona transtimpánica sobre la audición y vértigo en pacientes con enfermedad de Ménière de difícil manejo. Material y Método: Se reclutó a pacientes con enfermedad de Ménière de difícil manejo médico quienes fueron tratados con tres inyecciones transt-impánicas de dexametasona (4 mg/ml). Se realizó audiometría, prueba calórica y dos encuestas de disca-pacidad (DHI y UCLA-DQ) al inicio, tres, y diez semanas posintervención, además de una entrevista a los seis meses. Resultados: Doce pacientes completaron el estudio. Se observó un aumento del promedio de umbrales auditivos hasta 11,25 dB, principalmente entre 125 y 3000 Hz a las tres semanas, y una reducción de éstos hasta 7,5 dB a las diez semanas respecto de los iniciales, principalmente entre 125 y 2000 Hz (no estadísticamente significativo). Todos los pacientes presentaron hipo-excitabilidad vestibular. Se observó una mejoría significativa en el puntaje de la encuesta UCLA-DQ posinterven-ción, manteniéndose durante todo el seguimiento. No se encontraron diferencias estadísticamente significativas en el puntaje global ni subcomponentes de la encuesta DHI. Siete de ocho pacientes reportaron que volverían a utilizar las inyecciones. Conclusión: Los corticoides transtimpánicos pueden ayudar a disminuir la discapacidad e impacto en la calidad de vida de los pacientes con enfermedad de Ménière de difícil manejo a mediano y largo plazo.
Abstract Introduction: Ménière's disease is characterized by recurrent episodes of vertigo, sensorineural hearing loss and aural fullness, which can be incapacitating and cause stress and anxiety. Aim: To assess the effect of transtympanic steroid injections on hearing and vertigo for patients suffering from intractable Ménière's disease. Material and Method: Patients with intractable Ménière's disease were recruited and treated with three transtympanic steroid injections (dexamethasone 4 mg/ml). Audiometric and vestibular assessment, and two dizziness questionnaires (DHI, UCLA-DQ) were performed upon recruitment, three weeks, and ten weeks following the transtympanic treatment. A brief auto-perception survey was applied at 6 months follow-up. Results: Twelve patients completed the study. An increase in the mean auditory threshold was observed up to 11.25 dB, mainly between 125 and 3000 Hz at three weeks, and a reduction of these up to 7.5 dB at ten weeks with respect to the initial ones, mainly between 125 and 2000 Hz (not statistically significant). All patients presented vestibular dysfunction on caloric testing. A significant impro-vement in the UCLA-DQ survey score was observed, remaining throughout the follow-up. No statistically significant differences were found in the overall score or subcomponents of the DHI. Seven out of eight patients reported that they would undergo the injections again. Conclusion: Transtympanic corticosteroids can help to reduce disability and impact on the quality of life of patients with Ménière's disease that is difficult to manage in the medium and long term.
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Promover la diversidad y la inclusión social de personas en situación de discapacidad (PeSD) implica garantizar oportunidades que aseguren una participación social plena junto a la eliminación de barreras. En este artículo especial, buscamos describir los principales desafíos en la formación e investigación de la educación inclusiva en kinesiología desde la perspectiva de diversidad funcional, reconociendo elementos relevantes para compartir aprendizajes sobre la implementación de la Educación Inclusiva en educación superior. Se establecen desafíos desde nuestro rol en la educación superior, en el diseño de políticas inclusivas y en la formación ética, crítica y con responsabilidad de nuestro rol en la sociedad. Junto a ello, se describen aprendizajes de la mesa local de discapacidad de la Universidad de Chile, centrados en la existencia de personal de apoyo de PeSD capacitado y participación vinculante, el desarrollo de una mirada diversa y cambiante de la discapacidad, incluir proceso basado en la investigación y diálogo social desde la perspectiva de la diversidad funcional junto con articular con un plan de empleabilidad. Contribuir a la formación de profesionales comprometidos con la diversidad e inclusión permitirá que la comunidad se beneficie de nuevos modelos educativos, mejorando la calidad de vida de todas y todos en diversas condiciones de salud o funcionalidades.
Promoting diversity and social inclusion of people with disabilities (PeSD) implies guaranteeing opportunities that ensure thorough social participation besides with the elimination of barriers. In this special article, we aim to describe the main challenges in training and research in inclusive education in kinesiology from the perspective of functional diversity, recognizing relevant elements to share learning about the implementation of Inclusive Education in higher education. Challenges are established from our role in higher education, in the design of inclusive policies and in the ethical, critical and responsible training of our role in society. Along with this, learnings from Mesa Local de Discapacidad of the Universidad de Chile are focused on the existence of trained PeSD support staff and binding participation, the development of a diverse and changing view of disability, including research-based process and communitarian dialogue from the perspective of functional diversity together with articulating with an employability plan. Contributing to the training of professionals committed to diversity and inclusion will allow the community to benefit from new educational models, improving the quality of life for everyone in various health conditions or functionalities.
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Estudio de corte psicométrico. Objetivo: analizar la estructura factorial y la consistencia interna del Inventario de sistema\r\nde creencias (SBI-15R) en universitarios y enfermos crónicos colombianos. Método: se aplicó el cuestionario SBI-15R a 265\r\nestudiantes universitarios adultos y 52 enfermos crónicos. Resultados: el análisis factorial muestra dos factores: Convicción religiosa y Soporte social religioso, sin hallar diferencias en la estructura para cada muestra, y un alfa de Cronbach total de 0,926.\r\nDespués de la eliminación de un ítem, se halló una alta confiabilidad y concordancia en la estructura factorial del inventario con\r\nla versión original mexicana. Conclusión: el Inventario de sistema de creencias (SBI-15R) presenta adecuada validez y confiabilidad\r\nen población colombiana.
Psychometric study. Objective: To analyze the factorial\r\nstructure and internal consistency of the System of Belief\r\nInventory (SBI-15R) in university students and chronic Colombian\r\npatients. Method: The SBI-15R questionnaire was given to\r\n265 adult university students and 52 chronic patients. Results:\r\nThe factorial analysis shows two factors: Religious Conviction\r\nand Religious social support, without finding differences in\r\nthe structure for each sample, and a total Cronbach's alpha\r\nof 0.926. After the elimination of an item, it was found that a\r\nhigh reliability and concordance in the factorial structure of\r\nthe inventory with the original Mexican version. Conclusion:\r\nThe System of Belief Inventory (SBI-15R) presents an adequate\r\nvalidity and reliability in the Colombian population.
Estudo de corte psicométrico. Objetivo: analisar a estrutura\r\ndos fatores e a consistência interna do Inventário do Sistema\r\nde Crenças (SBI-15R) em estudantes universitários e pacientes\r\ncolombianos crônicos. Método: o questionário SBI-15R foi\r\naplicado a 265 estudantes universitários adultos e 52 pacientes\r\ncrônicos. Resultados: a análise fatorial mostra dois fatores:\r\nConvicção religiosa e Suporte social religioso, sem encontrar\r\ndiferenças na estrutura para cada amostra e um alfa\r\ntotal de Cronbach de 0,926. Os resultados encontrados após\r\na eliminação de um item mostram uma alta confiabilidade e\r\nconcordância na estrutura fatorial do inventário com a versão\r\nmexicana original. Conclusão: os resultados encontrados\r\nimplicam validade e confiabilidade adequadas do teste na\r\npopulação colombiana.
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Religião , EstudantesRESUMO
PURPOSE: To compare discrimination and calibration of the modified Brussels score with the Simplified Acute Physiology Score version 3 (SAPS-3) in predicting mortality. DESIGN: A prospective cohort study was carried out. SETTING: The Respiratory Intensive Care Unit (RICU) of Mexico General Hospital. PATIENTS: A total of 251 patients out of 285 admissions to the RICU in 2012 were included. The mean age was 48.4±17.1 years, and 132 of the patients were men (52.8%). INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic data, SAPS-3 score upon admission and the modified Brussels score on the day 1 of stay in the RICU. RESULTS: On day 1, the modified Brussels and SAPS-3 scores were 4.7 ± 3.8 and 54.7 ± 17.8, respectively. Areas under the ROC curve for the modified Brussels score on day 1 and the SAPS-3 were 0.837 ± 0.025 (95% CI 0.787-0.887) and 0.813 ± 0.027 (95% CI 0.761-0.865), respectively. Hosmer-Lemeshow goodness-of-fit values were 5,885 (P=.660) and 4,026 (P=.855), respectively. CONCLUSIONS: The modified Brussels score on day 1 offers excellent discrimination and calibration in predicting mortality in the RICU, comparable to that of the SAPS-3.
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Mortalidade Hospitalar , Unidades de Terapia Intensiva , Índice de Gravidade de Doença , Adulto , Área Sob a Curva , Calibragem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , EspanhaRESUMO
Objetivo. Comparar la discriminación y calibración de la escala modificada de Bruselas con el sistema Simplified Acute Physiology Score version 3 (SAPS-3) como predictor de mortalidad. Diseño Cohorte prospectiva. Ámbito Unidad de Cuidados Intensivos Respiratorios (UCIR) del Hospital General de México. Pacientes De 285 ingresos en la UCIR en 2012, se incluyeron 251 pacientes, con una edad media de 48,4±17,1 años; de ellos, 132 fueron hombres (52,8%).I ntervenciones Ninguna.Variables de interésDemográficas, SAPS-3 y escala modificada de Bruselas del primer día de estancia en UCIR. Resultados. El valor de la escala de Bruselas modificada del día 1 fue 4,7±3,8, y de SAPS-3, 54,7±17,8. El área ROC para la escala de Bruselas modificada del día 1 fue 0,837±0,025 (IC 95% 0,787 a 0,887), y para SAPS-3, de 0,813±0,027 (IC 95% 0,761 a 0,865), con prueba de bondad de ajuste de Hosmer-Lemeshow de 5.885 (p=0,660) y 4.026 (p=0,855), respectivamente. Conclusiones. La escala modificada de Bruselas en el día 1 tiene una discriminación y calibración excelentes para predecir la mortalidad de los pacientes en la UCIR, comparables a las del modelo SAPS-3.
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Cuidados CríticosRESUMO
An increase in body temperature accelerates biochemical reactions and behavioral and physiological responses. A mechanism to actively increase body temperature would be beneficial during motivated behaviors. The prefrontal cortex is implicated in organizing motivated behavior; the infralimbic cortex, a subregion of the medial prefrontal cortex, has the necessary connectivity to serve the role of initiating such thermogenic mechanism at the beginning of the appetitive phase of motivated behavior; further, this cortex is active during motivated behavior and its disinhibition produces a marked behavioral and vegetative arousal increase, together with increases in histamine levels. We wanted to explore if this arousal was related to histaminergic activation after pharmacological infralimbic disinhibition and during the appetitive phase of motivated behavior. We measured core temperature and motor activity in response to picrotoxin injection in the infralimbic cortex, as well as during food-related appetitive behavior, evoked by enticing hungry rats with food. Pretreatment with the H1 receptor antagonist pyrilamine decreased thermal response to picrotoxin and enticement and completely blunted motor response to enticement. Motor and temperature responses to enticement were also completely abolished by infralimbic cortex inhibition with muscimol. To assess if this histamine dependent temperature increase was produced by an active sympathetic mediated thermogenic mechanism or was just a consequence of increased locomotor activity, we injected propranolol (i.p.), a ß adrenergic receptor blocker, before picrotoxin injection into the infralimbic cortex. Propranolol reduced the temperature increase without affecting locomotor activity. Altogether, these results suggest that infralimbic activation is necessary for appetitive behavior by inducing a motor and a vegetative arousal increase mediated by central histamine.
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Regulação da Temperatura Corporal/fisiologia , Lobo Frontal/fisiologia , Histamina/fisiologia , Antagonistas Adrenérgicos beta/farmacologia , Animais , Nível de Alerta/efeitos dos fármacos , Nível de Alerta/fisiologia , Temperatura Corporal/efeitos dos fármacos , Temperatura Corporal/fisiologia , Regulação da Temperatura Corporal/efeitos dos fármacos , Lobo Frontal/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos H1/farmacologia , Masculino , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Picrotoxina/antagonistas & inibidores , Picrotoxina/farmacologia , Propranolol/farmacologia , Pirilamina/farmacologia , Ratos , Ratos Sprague-DawleyRESUMO
El nódulo de la Hermana María José se refiere a una metástasis de una neoplasia visceral a ombligo más común de origen gastrointestinal. La importancia de esta lesión es que es de fácil aproximación por el examen físico y su alta asociación con neoplasias malignas intra abdominales y la sencillez para hacer el diagnóstico con métodos como la biopsia aspiración con aguja fina.
Sister Mary Joseph's nodule refers to the metastasis of visceral malignancy to the umbilicus, most commonly of gastrointestinal origin. The noteworthy characteristics of this lesion are its more approachable diagnosis on physical examination, its high association with intra-abdominal malignancy, and its faculty to provide a diagnosis with easily performed methods such as fine needle aspiration biopsy.
O nódulo da irmã Maria José se refere como uma metástase de uma neoplasia visceral a umbigo mais comum de origem gastrointestinal. A importância desta lesão é que é de fácil aproximação pelo exame físico, e sua alta associação com neoplasias malignas intra abdominais e a facilidade para realizar o diagnostico com métodos fáceis de realizar como a biopsia aspiração com agulha fina.
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Humanos , Nódulo da Irmã Maria José , Biópsia por Agulha Fina , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Gastrointestinais , Metástase Neoplásica , NeoplasiasRESUMO
OBJECTIVE: The main aim of the present study was to determine the sensitivity, specificity and accuracy of ultrasonography (US) in detecting monosodium urate and calcium pyrophosphate dihydrate crystals deposits at knee cartilage level using clinical definite diagnosis as standard reference. DESIGN: A total of 32 patients with a diagnosis of gout and 48 patients with pyrophosphate arthropathy were included in the study. Fifty-two patients with rheumatoid arthritis (RA), psoriatic arthritis or osteoarthritis (OA) were recruited as disease controls. All diagnoses were made using an international clinical criterion. US examinations were performed by an experienced sonographer, blind to clinical and laboratory data. Hyaline cartilage was assessed to detect two US findings recently indicated as indicative of crystal deposits: hyperechoic enhancement of the superficial margin of the hyaline cartilage and hyperechoic spots within the cartilage layer not generating a posterior acoustic shadow. RESULTS: Hyperechoic enhancement of the chondrosynovial margin was found in at least one knee of 14 out of 32 (43.7%) patients with gout and in a single knee of only one patient affected by pyrophosphate arthropathy (specificity=99%). Intra-cartilaginous hyperechoic spots were detected in at least one knee of 33 out of 48 (68.7%) patients with pyrophosphate arthropathy and in two disease controls one with OA and the second with RA (specificity=97.6%). CONCLUSIONS: The results of the present study indicate that US may play a relevant role in distinguishing cartilage involvement in patients with crystal-related arthropathy. The selected US findings were found to be highly specific.
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Condrocalcinose/diagnóstico por imagem , Gota/diagnóstico por imagem , Cartilagem Hialina/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sensibilidade e Especificidade , UltrassonografiaRESUMO
BACKGROUND: Adequate clinical nutrition care is an integral part of the complete treatment of hospitalised patients, requiring specific knowledge from the health care team. The aim of this study is to assess, in Paraguay, the health care team ability in clinical care nutrition. MATERIALS AND METHODS: A survey was made including 174 people of Paraguay university hospitals (29% physicians, 29% medicine graduating students, 11% pharmaceutics, 24% nurses, 7% dieticians), by answering voluntarily a multiple choice questionnaire of 20 items. RESULTS: The median score of the 20 questions was 6 (0-15). Physicians obtained a median of 6 (2-15), graduating students 7 (2-14), pharmaceutics 7 (0-15), nurses 3 (0-11), and dieticians 9 (4-13). The dieticians obtained a significantly higher score than the other groups (p < 0.005). CONCLUSIONS: The knowledge about clinical nutrition in the health care members from university hospitals is not adequate. The level of education in clinical nutrition is better in the dietician.
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Competência Clínica , Pessoal de Saúde , Ciências da Nutrição , Hospitais de Ensino , Paraguai , Inquéritos e QuestionáriosRESUMO
El tratamiento de la enfermedad de Ménière continúa siendo controversial. Existen muchos tratamientos disponibles con diferentes efectividades. La terapia transtimpánica es una novedosa arma terapéutica que se está introduciendo gradualmente en el campo de la otología. Este estudio pretende: 1) Evaluar la utilidad de la terapia transtimpánica en el tratamiento de la enfermedad de Ménière. 2) Dar a conocer la experiencia de nuestro centro al respecto. Para ello se evaluó retrospectivamente, por medio de una encuesta telefónica, la respuesta clínica de los pacientes con enfermedad de Ménière que recibieron terapia transtimpánica (corticoides y/o gentamicina) entre los años 2002 y 2004. Se estudió a 34 pacientes, con un promedio de edad de 53 años. El 79,4 por ciento (n=27) presentó una respuesta favorable en relación a su sintomatología vestibular (p=0,02) y un 55,9 por ciento (n=19) refirió mejoría total de ella. Cuatro pacientes que no respondieron a corticoides transtimpánicos recibieron gentamicina intratimpánica, llegando a la parálisis vestibular total y mejoría de su sintomatología vestibular. Se concluye que los corticoides transtimpánicos son efectivos en el tratamiento de la sintomatología vestibular en la enfermedad de Ménière. La gentamicina intratimpanica es una alternativa eficaz para los pacientes que no responden a corticoides transtimpánicos.
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Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Corticosteroides/uso terapêutico , Doença de Meniere/tratamento farmacológico , Gentamicinas/uso terapêutico , Vertigem/tratamento farmacológico , Corticosteroides/administração & dosagem , Estudos Retrospectivos , Avaliação de Resultado de Intervenções Terapêuticas , Gentamicinas/administração & dosagem , Injeções Intralesionais , Membrana Timpânica , Coleta de Dados , Relação Dose-Resposta a Droga , Satisfação do Paciente/estatística & dados numéricos , Vertigem/etiologiaRESUMO
La prueba calórica mínima (PCM) es un examen diseñado para estudiar el canal semicircular lateral (CSCL) y, especialmente, el canal semicircular posterior (CSCP), el cual no es examinado por la prueba calórica clásica (PCC). Nuestro objetivo es evaluar el aparato vestibular a través de la PCM, cuando la PCC no explica los síntomas de algunos pacientes. Se incluyeron aquellos pacientes que consultaron entre enero y julio de 2003 por un síndrome vertiginoso cuya sintomatología no era explicada por la PCC. Fueron evaluados mediante PCM. Se identificaron 12 pacientes con estas características. En todos los casos la PCM permitió establecer un diagnóstico más preciso. Como conclusión, la PCM en casos seleccionados complementa la PCC, otorgando información adicional relevante para el manejo de los pacientes con patología vestibular.
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Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Canais Semicirculares , Otopatias/diagnóstico , Testes Calóricos/métodos , Testes de Função Vestibular/métodos , Vertigem/fisiopatologia , Doença de Meniere/diagnóstico , Doenças Vestibulares/diagnóstico , Epidemiologia Descritiva , Estudos Prospectivos , Neuronite Vestibular/diagnóstico , SíndromeRESUMO
El vértigo postural paroxístico benigno (VPPB) es una patología de alta incidencia en el campo de la otorrinolaringología. Para su tratamiento se han descrito una variedad de terapias, destacando entre éstas la maniobra liberadora de Semont y la maniobra de reposición de partículas de Epley, debido a su simplicidad y no ser invasivas. El objetivo de este trabajo es evaluar el efecto de una nueva maniobra de reposición, la cual consiste en cuatro posiciones más que aquella descrita por Epley, en pacientes que presentan vértigo postural paroxístico benigno unilateral, con compromiso del canal semicircular posterior. Para ello se realizó un estudio prospectivo, a 142 pacientes portadores de VPPB unilateral del canal semicircular posterior, a quienes se le efectuó maniobras de reposición de partículas para el canal semicircular afectado. Se practicó un control a las 48 horas con maniobras de provocación de Dix-Hallpike, obteniéndose un 95 por ciento (135 pacientes) de remisión completa de los síntomas. En sólo siete pacientes no hubo un resultado inmediato. Estos fueron tratados con la nueva maniobra de reposición, obteniéndose una mejoría total en cuatro de ellos; en los otros tres pacientes fue necesaria una maniobra de liberación de partículas de Sermont, complementada con una tercera maniobra de reposición, lográndose un 100 por ciento de remisión de los signos y síntomas.
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Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Doenças do Labirinto/terapia , Terapia por Exercício , Vertigem/terapia , Canais Semicirculares/fisiopatologia , Distribuição por Idade , Distribuição por Sexo , Movimento , PosturaAssuntos
Humanos , Audição , Dexametasona/uso terapêutico , Gentamicinas/uso terapêutico , Membrana Timpânica , Correção de Deficiência Auditiva/normas , Vertigem/tratamento farmacológico , Antibacterianos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Dexametasona/administração & dosagem , Doença de Meniere/tratamento farmacológico , Gentamicinas/administração & dosagem , Vias de Administração de MedicamentosRESUMO
El presente trabajo revisa los hallazgos clínicos, audiométricos, funcionales de VIII par e imagenológicos de una serie consecutiva de 10 pacientes con neurinoma del acústico.En el 50 por ciento de los pacientes se presentó con síntomas atípicos como la sordera súbita o la hipoacusia fluctuante. En el 100 por ciento de los casos existía algún compromiso de la audición; sin embargo, no hubo correlación entre el tamaño del tumor y la cuantía de la pérdida auditiva. El tipo de curva en la audiometría o la alteración de las pruebas supraliminares (discriminación de la palabra, Fowler, umbral de molestia auditiva y deterioro tonal) no permitieron predecir la presencia de un neurinoma. La alteración del reflejo acústico fue la prueba no imagenológica que obtuvo la mayor sensibilidad (80 por ciento). Se observó una asimetría en la prueba calórica sólo en un 40 por ciento de los casos. Se puede concluir que la presentación clínica considerada como típica del neurinoma del acústico, los exámenes no imagenológicos tienen un rol muy limitado. La baja sensibilidad de las pruebas funcionales del VIII par reportada en la literatura y confirmada en esta serie de pacientes debe inducirnos a solicitar estudio con neuroimágenes en todos aquellos casos en los que exista una sospecha clínica. La resonancia nuclear magnética (RNM) con gadolinio fue el examen más idóneo para ello, ya que permitió hacer el diagnóstico en 2 casos en que la tomografía computada (TC) sólo fue de presunción, y en un tercer paciente reveló un tamaño tumoral significativamente mayor al observado en la TC.
Assuntos
Humanos , Adolescente , Adulto , Recém-Nascido , Lactente , Pré-Escolar , Criança , Pessoa de Meia-Idade , Neoplasias da Orelha , Neuroma Acústico/diagnóstico , Perda Auditiva/etiologia , Audiometria , Estudos Retrospectivos , Gadolínio , Imageamento por Ressonância Magnética , Neuroma Acústico , Tomografia Computadorizada por Raios XRESUMO
The manner in which terrestrial ecosystems are regulated is controversial. The "top-down" school holds that predators limit herbivores and thereby prevent them from overexploiting vegetation. "Bottom-up" proponents stress the role of plant chemical defenses in limiting plant depredation by herbivores. A set of predator-free islands created by a hydroelectric impoundment in Venezuela allows a test of these competing world views. Limited area restricts the fauna of small (0.25 to 0.9 hectare) islands to predators of invertebrates (birds, lizards, anurans, and spiders), seed predators (rodents), and herbivores (howler monkeys, iguanas, and leaf-cutter ants). Predators of vertebrates are absent, and densities of rodents, howler monkeys, iguanas, and leaf-cutter ants are 10 to 100 times greater than on the nearby mainland, suggesting that predators normally limit their populations. The densities of seedlings and saplings of canopy trees are severely reduced on herbivore-affected islands, providing evidence of a trophic cascade unleashed in the absence of top-down regulation.
Assuntos
Ecossistema , Cadeia Alimentar , Geografia , Modelos Biológicos , Árvores/fisiologia , Animais , Formigas/fisiologia , Anuros/fisiologia , Aves/fisiologia , Feminino , Água Doce , Haplorrinos/fisiologia , Iguanas/fisiologia , Lagartos/fisiologia , Densidade Demográfica , Centrais Elétricas , Reprodução , Roedores/fisiologia , Aranhas/fisiologia , Suínos/fisiologia , VenezuelaRESUMO
A new stereoisomer generation system named CAMGEC2 for generation of stereoisomers containing isolated and spiro cycles with one or more descriptors among R, S, Z, E, M, and P is developed using Graph Theory. It includes new approaches for symmetry analysis, cycle detection processes in molecular graphs in a modular way, and also an extension of the N_tuple format for linear representation of molecular graphs that keeps graph topographical information.