Low-dose Radiation Therapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19). Final results of a prospective phase I-II trial.

BACKGROUND AND PURPOSE: To evaluate the results of low-dose radiation therapy (LD-RT) to lungs in the management of patients with COVID-19 pneumonia. MATERIAL AND METHODS: We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement (oxygen saturation ≤93% on room air). Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was a radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. RESULTS: Forty-one patients were included. Median age was 71 (IQR 60-84). Eighteen patients (44%) previously received an anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. The extension score improved significantly (p = 0.02) on day +7. Mean baseline extension score was 13.7 (SD ± 4.9) with a score of 12.2 (±5.2) at day 3, and 12.4 ± 4.7 at day 7. No differences were found in the severity score. SAFI improved significantly on day +3 and +7 (p < 0.01). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p = 0.02) and in lymphocytes counts on day +3 and +7 (p = 0.02). The median number of days in hospital after RT was 11 (range 4-78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes. CONCLUSIONS: LD-RT is a feasible and well-tolerated treatment that could lead to rapid clinical improvement. Large randomized trials would be required to establish the efficacy of LD-RT to treat COVID-19 pneumonia.

Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso / Lymphocutaneous sporotrichosis in a pediatric patient, a case report

Resumen La esporotricosis es una infección fúngica de evolución subagudacrónica causada por hongos dimórficos del Complejo Sporothrix schenckii. Es más frecuente en zonas tropicales. La prevalencia en Argentina se estima entre 0,01 y 0,02%. En la mitad de los pacientes se manifiesta como una esporotricosis linfocutánea, la cual se produce tras la inoculación del hongo en la piel luego de un trauma menor. La lesión inicial es una pápula o nódulo que se sucede con la aparición de una cadena ascendente de nódulos subcutáneos móviles, indoloros y eritematosos. El diagnóstico se realiza a partir del cultivo micológico. El antifúngico de elección es itraconazol y el pronóstico es usualmente favorable. Se presenta el caso de una niña de 4 años, previamente sana, que consultó por adenopatías axilares de evolución subaguda sin respuesta a múltiples esquemas antimicrobianos, confirmándose el diagnóstico de una esporotricosis linfocutánea por el cultivo de una biopsia ganglionar.

Abstract Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Complete Spontaneous Regression of Lung Metastases after Resection of CIC-Rearranged Sarcoma: A Case Report.

The vast majority of patients with soft tissue sarcomas (STS) of the trunk and bilateral lung metastases at diagnosis are considered incurable. These tumors have poor prognosis as only a palliative therapeutic approach can be offered to patients. We report on an extremely rare case in which bilateral lung metastases disappeared spontaneously following surgical resection of the primary CIC-rearranged sarcoma with no addition of chemotherapy or any other systemic therapy. A 53-year-old female presented with a rapidly swelling mass on her back. A magnetic resonance imaging scan of the chest revealed a large soft tissue mass on the posterior chest wall and bilateral lung metastases. Soon after stereotactic core-needle biopsy confirmation of round-cell sarcoma, the patient underwent surgery of the primary tumor as it started to be increasingly symptomatic. The resected specimen was pathologically diagnosed a poorly differentiated grade 3 sarcoma. Approximately 1 month later, a new CT scan revealed that the lung metastases were smaller and some of them had completely disappeared. Shortly afterward, the patient started adjuvant external beam radiotherapy of the tumor bed for 14 months. During the last follow-up visit, the patient confirmed no evidence of disease for 35 months postoperatively. In parallel, a histological study of pulmonary nodules, molecular analyses of the tumor, and a comprehensive study of the patient's immunophenotype were performed to gain some additional insights in the potential causes of this rare phenomenon.

[Lymphocutaneous sporotrichosis in a pediatric patient, a case report]. / Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso.

Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Low-Dose Radiation Therapy in the Management of Coronavirus Disease 2019 (COVID-19) Pneumonia (LOWRAD-Cov19): Preliminary Report.

PURPOSE: Low-dose radiation therapy (LD-RT) has been shown to have an anti-inflammatory effect, and preliminary results suggest it is feasible to treat patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We conducted a prospective, single-arm, phase 1/2 clinical trial enrolling patients aged ≥50 years, who were coronavirus disease 2019 (COVID-19) positive, at phase 2 or 3 with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Primary outcome was radiologic response using severity and extension score on baseline computed tomography (CT), at days 3 and 7 after LD-RT. Secondary outcomes were toxicity using Common Terminology Criteria for Adverse Events v.5.0, duration of hospitalization, blood work evolution, and oxygen requirements using SatO2/FiO2 index (SAFI), at days 3 and 7 after LD-RT. RESULTS: Nine patients were included. Median age was 66 (interquartile range, 57-77). Severity score was stable or decreased in the third CT but was not statistically significant (P = .28); however, there were statistically significant changes in the extension score (P = .03). SAFI index significantly improved 72 hours and 1 week after LD-RT (P = .01). Inflammatory blood parameters decreased 1 week after RT compared with baseline; only lactate dehydrogenase decreased significantly (P = .04). Two patients presented grade 2 lymphopenia after RT and another (with baseline grade 3) worsened to grade 4. Overall, the median number of days of hospitalization was 59 (range, 26-151). After RT the median number of days in the hospital was 13 (range, 4-77). With a median follow-up after RT of 112 days (range, 105-150), 7 patients were discharged and 2 patients died, 1 due to sepsis and the other with severe baseline chronic obstructive pulmonary disease from COVID-19 pneumonia. CONCLUSIONS: Our preliminary results show that LD-RT was a feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.

Diagnosing Aortic Intramural Hematoma: Current Perspectives.

Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.

Tuberculosis y síndrome inflamatorio de reconstitución inmunológica. Caso pediátrico / Tuberculosis and immune reconstitution inflammatory syndrome. Pediatric case

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad.Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome in-flamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimien-to de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.

Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an im-portant public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality.We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune re-constitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical con-sequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.

Evaluation of tumor response after stereotactic body radiation therapy for lung cancer: Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

BACKGROUND: Early identification of patients who fail to lung stereotactic body radiation therapy (SBRT) is vital as they can benefit from salvage therapy. Main guidelines recommend computed tomography (CT) to assess response and use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT only when a local recurrence is suspected in CT. The pattern of radiation-induced lung injury caused by SBRT is different from changes seen after conventional radiation therapy in terms of extent, time of manifestation, and morphologic characteristics, and knowing this is crucial for proper monitoring of the tumor response. In certain cases, it may be difficult to differentiate response from progression or recurrence on CT and, in addition, some changes in CT take a long time to evolve before they are considered suspicious, making early diagnosis difficult. Metabolic changes often precede morphological changes, so 18F-FDG PET/CT quantitative and qualitative metabolic criteria can be useful in assessing early response and detecting relapses. However, the optimal practice for follow-up remains unclear and there is an active search for imaging markers for recurrent disease, including CT texture analysis, biomarker assays, new PET/CT isotopes, and magnetic resonance imaging. AIM: The aim of the study was to review the radiological changes that are objectified after pulmonary SBRT and the metabolic changes in 1F-FDG PET/CT, to assess the usefulness of following up patients with 18F-FDG PET/CT. RELEVANCE FOR PATIENTS: At present, the evaluation of response and diagnosis of relapse after SBRT are difficult and the incorporation of routine 18F-FDG PET/CT may have value in early diagnosis of relapse when the patient may still benefit from rescue treatment.

Efecto antifúngico y antimicotoxigénico de Lactobacillus plantarum CRL 778 a diferentes valores de actividad de agua / Antifungal and antimycotoxigenic effect of Lactobacillus plantarum CRL 778 at different water activity values

Ochratoxin A (OTA) is a mycotoxin produced by filamentous fungi with high impact Lactic acid bacteria; in food safety due to its toxicity. In the last decade, the presence of OTA was widely reported in different foods. In this study, the ability of Lactobacillus (L.) plantarum CRL 778 to control growth and OTA production by Aspergillus (A.) niger 13D strain, at different water activity (a w) values (0.955, 0.964, 0.971, 0.982, and 0.995) was determined in vitro. Both parame ters were significantly (p<0.05) reduced by the lactobacilli and the effect depended on a w. Greatest growth rate inhibition (46.9%) was obtained at a w = 0.995, which is the most suitable value for growth and production of antifungal metabolites (lactic acid, acetic acid, phenyllac-tic and hydroxyl-phenyllactic acids) by L. plantarum CRL 778. Besides, morphological changes and inhibition of melanin synthesis were observed in colonies of A. niger 13D in presence of L. plantarum CRL 778 at a w ranged between 0.971 and 0.995. In addition, maximum reduction (90%) of OTA production took place at a w = 0.971, while inhibition of fungi growth was more evident at a w =0.995. These findings suggest that L. plantarum CRL 778 could be used for control of ochratoxigenic fungal growth and OTA contamination in different fermented foods with a w values between 0.971 and 0.995.

Ocratoxina A (OTA) es una micotoxina producida por hongos filamentosos con un alto impacto en la seguridad alimentaria debido a su toxicidad. En la última década se ha reportado ampliamente a nivel mundial, la presencia de OTA en diversos alimentos. En este estudio se evaluó in vitro, la capacidad de Lactobacillus (L.) plantarum CRL 778 de controlar el crecimiento y la producción de OTA por Aspergillus (A.) niger 13D, a diferentes valores de actividad de agua (a w): 0.955, 0.964, 0.971,0.982 y 0.995). La cepa láctica redujo significativamente (p <0.05) ambos parámetros, siendo el efecto dependiente del valor de a w. La mayor inhibición del crecimiento (46.9%) se obtuvo a a w =0.995, valor más adecuado para el crecimiento y producción de metabolitos antifúngicos (ácido láctico, ácido acético, ácidos fenil-láctico e hidroxi-fenil láctico) por la cepa láctica. Además, se observaron cambios morfológicos en las colonias de A. niger 13D, crecidas en presencia de L. plantarum CRL 778 a valores de a w de 0.971 y 0.995. El porcentaje máximo de reducción en la producción de OTA (90%) por la cepa láctica se observó a un valor de a w = 0.971, mientras la inhibición del crecimiento fúngico fue mayor cuando a w = 0.995. Estos hallazgos sugieren que L. plantarum CRL 778 podría emplearse para el control de la contaminación por hongos ocratoxigénicos en alimentos con valores de aw comprendidos entre 0.971-0.995.

IgG4-aortitis among thoracic aortic aneurysms.

OBJECTIVE: The incidence of aortitis in patients with thoracic aortic diseases is not well established. The aim of this study was to analyse the frequency and clinical course of patients with aortitis in a surgical series. METHODS: 320 consecutive patients with ascending aorta/aortic arch aneurysm or acute aortic syndrome who underwent surgery from 2012 to 2017 in a single tertiary referral hospital were retrospectively reviewed. Epidemiological data, clinical course and variables related to diagnosis, treatment and follow-up were collected from patients with histologically proven aortitis. RESULTS: From 320 examined aortic samples, 279 (87.2%) thoracic aneurysms and 41 acute aortic syndromes (12.8%), 9 (2.8%) were aortitis: 3 cases of Takayasu's arteritis, 3 of IgG4-related aortitis, 2 of giant cell, and 1 classified as idiopathic. Median age at surgery was 53.4 (51-69.2) years and six cases were female. Seven patients presented with non-specific symptoms and the diagnosis was made at pathology. Surgery was elective in eight patients and emergent in one case of IgG4-related aortitis. 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) was performed for disease extension study and as a monitoring technique during the follow-up of five patients, with just one case performed presurgically. All the patients with IgG4-related disease showed extrathoracic aortic involvement. There were no deaths, neither in-hospital nor during the 1.7 years of median follow-up. CONCLUSIONS: In surgically treated thoracic aorta pathology, the frequency of aortitis is low; IgG4-related disease is among the most common aetiologies with a frequency similar to other types of aortitis, such as Takayasu's and giant cell arteritis, and clinical manifestations are non-specific making presurgical diagnosis difficult. 18F-FDG PET/CT allows a better assessment of disease extension and therapeutic response. Surgery can be successfully performed and corticosteroid therapy ensures a good mid-term follow-up.

Metástasis mandibular: informe de un caso clínico / Mandibular metastasis: report of a clinical case

El presente trabajo tiene como objetivo describir un caso clínico de metástasis mandibular, que según la literatura actual es de baja prevalencia. Una paciente de 60 años de edad acudió a la consulta por tumefacción y dolor del lado derecho de la mandíbula. Se realizó una tomografía axial computada de maxilar inferior y se detectó una lesión osteolítica. El examen histopatológico del tejido óseo incisional informó metástasis. A partir de este resultado, la paciente fue derivada al Departamento de Oncología, donde inició el tratamiento correspondiente y falleció a los pocos meses del diagnóstico. A pesar de la baja prevalencia de metástasis maxilar, esta debe considerarse especialmente en pacientes con presencia de tumefacción, dolor y parestesia de aparición repentina y etiología desconocida (AU)

The aim of this work is to describe a clinical case of mandibular metastasis that, according to the current literature, occurs with low frequency. A 60 year old female patient showed swelling and pain on the right side of the jaw. Axial computed tomography of the lower maxilla was performed, detecting an osteolytic lesion. Histopathological diagnosis of metastatic tissue was reported after biopsy of incisional bone tissue and the patient was referred to the oncology department for treatment and died a few months after the diagnosis. Despite the infrequent appearance of maxillary metastases, they should be considered especially in patients with presence of swelling, pain and sudden onset paraesthesia of unknown etiology (AU)

Resolución integral de una fractura coronorradicular complicada por traumatismo dentoalveolar: informe de un caso / Integral resolution of a complicated crown-root fracture by dentoalveolar traumatism: report of a case

Objetivo: Mostrar una alternativa de tratamiento para las fracturas coronorradiculares complicadas, que restablece la función y la estética de las piezas traumatizadas. Caso clínico: Una paciente de 16 años se presentó en la guardia del Centro Odontológico OSEP tras haber sufrido un accidente vial que le produjo un traumatismo dentoalveolar. El diagnóstico fue fractura coronaria sin exposición pulpar de la pieza dentaria 12 y fractura coronorradicular complicada de la pieza 11. El tratamiento incluyó restauración con resina compuesta de la pieza 12 y endodoncia, extrusión ortodóntica, alargamiento coronario y rehabilitación con perno de fibra de cuarzo y corona de resina compuesta de la pieza 11. Conclusiones: El tratamiento de las fracturas coronorradiculares representa un desafío para el odontólogo. Los resultados del tratamiento, en este paciente, fueron excelentes, ya que lograron devolver estética y función (AU)

Aim: To show an alternative treatment for complicated crown-root fractures, which restores function and aesthetics of the traumatized teeth. Case report: This paper reports the case of a 16-yearold girl who attends the OSEP Dental Center, stating that she had suffered a traffic accident resulting in a dentoalveolar trauma. The diagnosis was a coronary fracture without pulp exposure of tooth 12, and complicated crown-root fracture of tooth 11. Treatment included composite resin restoration of tooth 12 and endodontic, orthodontic extrusion, crown lengthening and rehabilitation with quartz fiber post and composite resin crown of tooth 11. Conclusions: The treatment of crown-root fractures poses a challenge for the dentist. The results of the treatment in this patient were excellent, and aesthetics and function were restored (AU)

Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography.

INTRODUCTION AND OBJECTIVES: Multidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. METHODS: We enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. RESULTS: The mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. CONCLUSIONS: Non-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement.

Lactic Acid Fermentation Improved Textural Behaviour, Phenolic Compounds and Antioxidant Activity of Chia (Salvia hispanica L.) Dough.

In this work, autochthonous lactic acid bacteria (LAB) were isolated from chia (Salvia hispanica L.) dough and selected on the basis of the kinetics of acidification and proteolytic activity. Strain no. C8, identified as Lactobacillus plantarum C8, was selected and used as starter to obtain chia sourdough. Lactic acid fermentation increased the organic acid mass fractions (lactic, acetic and phenyl lactic acids to 12.3 g, 1.0 g and 23.8 µg per kg of dough respectively), and antioxidant activities, which increased by approx. 33-40% compared to unfermented chia flour dough. In addition, total phenolic content increased 25% and its composition was strongly modified after 24 h of fermentation by L. plantarum C8. Chlorogenic acid was only found in the fermented dough (2.5 mg/g), while ferulic acid was detected from the beginning of fermentation, being 32% higher in chia sourdough (5.6 mg/g). The use of fermented chia sourdough improved the overall characteristics of white bread, including physical (e.g. reduced hardness and chewiness of the crumb) and antioxidant properties (25% on average), compared to the white bread. These results indicate that the use of chia sourdough could be a promising alternative to improve the technological and antioxidant properties of wheat bread. In addition, this work has shown, for the first time, that lactic acid bacterium is able to ferment chia dough, improving its overall characteristics.

Comportamiento y percepción del dolor en niños colombianos sometidos a electromiografía de superficie

Introducción: La Electromiografía-EMG de superficie evalúa la función muscular. Es poco utilizada como examen de rutina para valorar los músculos periorales y masticatorios, debido a que algunos consideran que puede ser molesto para el paciente pediátrico. Objetivo: Describir la percepción de dolor y el comportamiento en niños colombianos con y sin labio y paladar fisurado durante el examen de electromiografía de superficie en músculos periorales y masticatorios. Métodos: Previa aprobación del comité de ética (acta-009 2013p) y firma de consentimiento y asentimiento informado. Se realizó el examen en 69 niños entre 5-15 años: 45 con labio y paladar hendido (23-fisura unilateral, 22-fisura bilateral) y 24 sin hendidura. Se aplicaron las escalas de Wong Baker (Dolor) y Frankl (comportamiento). Resultados: 66 niños (95,65%) presentaron comportamiento Tipo 4 y 3 niños (4,35%) mostraron comportamiento Tipo 3 al inicio del examen. Al final del procedimiento, el 100% presentó comportamiento tipo 4. La percepción del dolor con la escala Wong Baker mostro ningún dolor en 62 niños (89,86%) y solo un poco de dolor en 7 (10,14%). Conclusiones: Los menores no manifiestan cambios importantes en su comportamiento por dolor o molestias durante el procedimiento de electromiografía de superficie.

The Surface electromyography-EMG evaluates muscular function. It is seldom used as a routine examination to assess perioral and masticatory muscles as it is considered to cause the pediatric patient discomfort. Objective: Describe the perception of pain and behavior displayed by Colombian children with and without cleft lip and palate during the surface electromyography test performed on perioral and masticatory muscles. Methods: Prior approval by the ethics committee (act-009-2013p) and an informed consent and assent signature were obtained. The exam were performed on 69 children between 5 and 15 years; 45 with cleft lip and palate (23 with unilateral cleft, 22 with bilateral cleft) and 24 children without cleft. The Wong Baker (pain) and Frankl (behavior) scales were used. Results: At the beginning of the exam, 66 children (95.66 %) displayed type 4 behavior and 3 children (4.35 %) displayed type 3 behavior. At the end of the procedure, 100 % of the children displayed type 4 behavior. When using the Wong Baker scale, the perception of the pain showed that 62 patients (89.86 %) felt no pain and 7 patients (10.14 %) felt just a little pain. Conclusions: Children do not show significant changes in their behavior - or pain and discomfort during the procedure of surface electromyography.

Bacteriemia nosocomial en servicios de Cuidados Críticos y en Sala General / Nosocomial bloodstream infection in critical care units and in general wards

Introducción: las bacteriemias nosocomiales (BN) están ampliamente estudiadas en servicios de cuidados críticos, principalmente la relacionada a catéteres venosos centrales (CVC). La importancia de las BN y su impacto clínico no ha sido estudiada en salas generales de internación, en donde es cada vez mayor el uso de CVC y existe un uso extendido de catéteres venosos periféricos (CVP). Objetivo: nos propusimos comparar la BN ocurridas en salas de cuidados generales y en éreas de cuidados críticos. Métodos: estudio prospectivo descriptivo de BN desde 01/12/2008 hasta 30/06/2012, en un hospital de adultos de tercer nivel con 400 camas. Resultados: se registraron 361 bacteriemias: 50,9% nosocomiales, 16,1% relacionadas al sistema de salud y 32,9% comunitarias. De 184 BN se presentaron 52 episodios (28,3%) en servicios de cuidados críticos y 132 (71,3% en Sala General, principalmente en Clínica Médica (82,5%). El foco más frecuente de las BN fue asociado a catéteres venosos (60%) y foco desconocido (28%). Los porcentajes de multirresistencia fueron similares en ambos ámbitos. No hubo diferencias estadísticamente significativas en los Servicios de Cuidados Críticos comparado con la mortalidad por BN en Sala General (46,1% vs 46,9%; p=0,99). Conclusiones: el mayor porcentaje de BN se presentó en servicios de cuidados no críticos, su impacto es relevante si consideramos que la mortalidad intrahospitalaria resultó similar a la de servicios de cuidados críticos. Siendo la principal causa de BN en sala general, la relacionada al uso de catéter venoso central y periférico, urge la necesidad de diseñar protocolos para su colocación y manejo.

Introduction: Nosocomial Bloodstream Infections (NBI) are completely studied in critical care units, mainly those associated with central venous catheter (CVC). The significance and impact of NBI has not been analyzed in general wards, where there is an incresing use of CVC as well asan extended use of peripheral lines. Objective: we compared NBI in general wards with those occurred in critical care units. Methods: prospective, descriptive study performed from 01/12/2008 since 30/06/2012, in an adult third level 400-bed hospital. Results: we obtained 361 bloodstream infections: 50.9% nosocomial, 16.1% healthcare related and 32.9% community acquired. Out of 184 NBI episodes 52 (28.3%) were from critical care units and 132 (71,3%) from general wards, mainly internal medicine service (82.5%). The most frequent source of NBI was related to venous catheters (60%) and unknown focus (28%). Frequency of multirresistant microorganisms was similar in both areas. No statistically significant differences were found in the in-hospital mortality of NBI in critical care units and general wards (46.1% vs 46.9%; p=0.99). Conclusion: General wards presented the highest percentage of NBI. Its impact is relevant considering that the in-hospital mortality was similar tothat in critical care units. The main cause of NBI in general wards is that associated to the use of venous catheter, central and peripheral ones, therefore recommendations for catheterization and maintenance of venous catheters should be implemented.

Efflux of bile acids in Lactobacillus reuteri is mediated by ATP.

PURPOSE OF WORK: To study whether an active bile acid (BA) efflux occurs in Lactobacillus reuteri CRL 1098 as well as the nature (ATP or proton motive force [PMF] mediated primary transport) of the BA extrusion mechanism. BAs are powerful detergents which disorganize the lipid bilayer structure of cellular membranes. Specific bile resistance mechanisms (bile efflux, bile salt hydrolysis, and intrinsic architecture and composition of cell membrane the most prevalent) have been described in intestinal bacteria. L. reuteri, showed a significant degree of resistance to the toxic action of BA and the presence of an active efflux ATP-dependent of conjugated (taurocholic [TCA]) and free (cholic [CA]) BA in the CRL 1098 strain is now reported. However, due the high pKa (5.5) of cholic acid (CA) compared with the conjugated species, a significant fraction (between 35 and 50% at pH 6.5 and 5.2, respectively) of free BA also diffused passively, even in the absence of ATP. To our knowledge, our results represent the first evidence of ATP as the energy source involved in the BA extrusion in L. reuteri.

[Modification to surgical technique of cesarean hysterectomy]. / Modificación a la técnica quirúrgica de cesárea-histerectomía.

BACKGROUND: Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality. OBJECTIVES: To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique. PATIENTS AND METHOD: Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care. RESULTS: Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group. CONCLUSIONS: The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.

Infección por Mycobacterium avium subsp. paratuberculosis en un rebaño criollo limonero / Mycobacterium avium subsp. paratuberculosis infection in a criollo limonero herd

El objetivo de este estudio consistió en definir, analizar y evaluar la situación de un rebaño Criollo Limonero elite en relación a la paratuberculosis bovina. La investigación se llevó a cabo utilizando las variables epidemiológicas y el análisis de muestras (leche y suero) mediante inmunoensayo enzimático (ELISA) comercial. Posteriormente, se tomaron como base estos resultados y utilizando otras herramientas diagnósticas como la exploración clínica, tinción directa, cultivos, identificación mediante ensayo de reacción en cadena de la polimerasa (PCR) y estudio histomorfológico, todas ellas dirigidas a confirmar el estado de la infección. Los resultados permiten aseverar la existencia de infección por Mycobacterium avium subsp. paratuberculosis (MAsP) en tasas de positividad variable. La técnica de ELISA mostró alta capacidad en la identificación de animales subclinicamente afectados, lo que demuestra su potencial como prueba primaria de diagnóstico en el establecimiento de futuros programas de control. La técnica de amplificación por PCR reveló la presencia de genoma de subespecies de Mycobacterium avium, lo cual apoya fuertemente la presunción de infección en estos animales por MAsP, pese a la imposibilidad de lograr claras evidencias clínicas, clinicopatológicas, microbiológicas e histopatológicas que permitieran corroborar este dictamen. La estrecha correlación entre los resultados de ELISA y PCR, ratifica no sólo la confirmación diagnóstica, sino también validan los datos obtenidos a través de la prueba serológica.

The purpose of this research was to define, analyze and evaluate the situation of an elite Criollo Limonero herd related to bovine paratuberculosis. The investigation was carried out using the epidemiological variables and samples analysis (milk and serum) through a commercial enzyme immunoassay (ELISA). The results of the above test were taken as a foundation to use other diagnostic tools, such as clinical examination, direct staining, bacterial culture, identification through polymerase chain reaction (PCR) and histopathologic studies, to find out the status of the disease. The results allowed asserting the infection by the presence of Mycobacterium avium subsp. paratuberculosis (MAsP) in positive variable rates. The ELISA technique showed high capacity in identification of the sub clinical affected animal, which proved its potential as a diagnostic primary test in the establishment of future control programs. The PCR amplification revealed Mycobacterium avium subspecie genome presence, which lead to predict these animals infection by MAsP, in spice of the impossibility to accomplish clear clinical, clinic pathologic, microbiologic and histopathologic evidences that allowed corroborating the diagnosis. The narrow relation between ELISA and PCR results ratified not only the diagnostic confirmation, but also they validated the data collected through the serological test.

Monitoreo epidemiológico para Brucella abortus en fincas doble propósito del Municipio Machiques de Perijá, Venezuela: parte II validez y seguridad de las pruebas anillo de la leche y rosa de bengala / Epidemiologic surveillance system for Brucella abortus in dual purpose farms from Machiques de Perijá county, Venezuela: part II validity and accuracy of ring test and rose bengal test

Se evalúa la capacidad operativa de las pruebas diagnósticas: anillo de la leche (PAL), inmunoensayo enzimático indirecto (ELISA-i), rosa de bengala (RB) y ELISA competitivo (ELISA-c), utilizadas tras 5 años (2003-2007) de vigilancia epidemiológica para brucelosis bovina (Brucella abortus) en el municipio Machiques de Perijá, partiendo de la revalorización de un conjunto de muestras de leche y suero probados positivos y negativos. La garantía de diagnóstico previamente positivo fue alcanzada a través de evidencias epidemiológicas y positividad comprobada en suero sanguíneo al ensayo con antígeno buferado en placa y confirmación mediante fluorescencia polarizada (FP); sólo se consideraron negativos probados, los sueros y leches globales provenientes de animales negativos a FP que a lo largo del estudio no presentaron antecedentes serológicos alguno. Los resultados en leche muestran superioridad de ELISA-i versus PAL, en sensibilidad, 98,55 contra 56,52 por ciento; especificidad 99,41 y 98,82 por ciento; predicción positiva 98,58 y 95,12 por ciento; predicción negativa 99,49 y 84,84 por ciento; y cocientes de probabilidad. El nivel de concordancia entre los resultados y el verdadero estatus de las muestras fue también preferente para ELISA-i, 97,8 contra 55,3 por ciento. Las evidencias sobre sueros probados dejan en duda la contribución de RB en el diagnóstico, control y erradicación de la enfermedad en el área de estudio, al demostrarse valores medios de validez (169,92 versus 197,21) y seguridad (171,74 versus 197,02), además de bajos coeficientes de verosimilitud entre sus resultados. ELISA-c, en cambio, mantuvo excelente capacidad diagnóstica.

The performance of the following diagnostic tests: Milk Ring Test (MRT), Indirect Enzyme-linked Immunosorbent Assay (iELISA), Rose Bengal Test (RBT) and Competitive ELISA (cELISA) used for 5 years (2003-2007) in the epidemiological surveillance system for bovine brucellosis (Brucella abortus) in Machiques de Perijá County was evaluated. For this purpose, milk and sera samples previously assessed through the abovementioned tests were reassessed to define their true condition (true positive or true negative). Samples were considered as true positive through epidemiological findings and a positive result in Buffered Plate Antigen Test, which was confirmed through Fluorescence Polarization Assay (FPA); samples were considered as true negative only when they were taken from FPA-negative animals that did not seroconvert during the study. Results from tests in milk showed a higher performance of iELISA versus MRT, in sensibility: 98.55 and 56.52 percent; in specificity: 99.41 and 98.82 percent; in positive predictive value: 98.58 and 95.12 percent; in negative predictive value: 99.49 and 84.84 percent; and in coefficients of probability, respectively. The level of agreement between test and true status of samples was higher in iELISA: 97.8 versus 55.3 percent. Results from true positive and true negative samples warrant a reappreciation of the contribution of RBT in diagnostics, control and eradication of brucellosis in the studied area, taking into account its medium values of validity (169.92 versus 197.21) and accuracy (171.74 versus 197.02), as well as its low coefficients of probability. By contrast, cELISA showed an excellent diagnostic performance.