Effects of Selective and Nonselective Beta Blockers on Bone Mineral Density in Mexican Patients with Breast Cancer.

Breast cancer (BCa) is related to chronic stress and can reduce the bone mineral density (BMD) through neurochemicals related to beta-adrenergic receptor (ADRB) 1 and 2. Selective beta blockers (sBBs) and nonselective beta blockers (nsBBs) are used to treat systemic arterial hypertension (SAH) and may have osteoprotective effects, as they inhibit ADRBs. To evaluate the effects of sBBs and nsBBs on the BMD of Mexican patients with BCa. A retrospective study was conducted. We included 191 Mexican women with BCa without SAH and with SAH treated with nsBBs, sBBs, and diuretics. BMD was evaluated using a bone density scan (DEX scan). A greater average BMD (p < 0.05) was observed in patients with prior treatment with both nsBBs and sBBs (0.54 ± 0.94 and -0.44 ± 1.22, respectively) compared to patients treated with diuretics or without SAH (-1.73 ± 0.83 and -1.22 ± 0.98, respectively). Regarding the diagnosis of osteoporosis/osteopenia, no cases were observed in patients treated with nsBBs, whereas 5.6% of the patients treated with sBBs presented osteopenia. A total of 23.1% and 10.6% patients managed with diuretics or without treatment presented with osteoporosis and 61.5% and 48% patients managed with loop diuretics and without treatment presented with osteopenia, respectively (p < 0.05). Treatment with nsBBs is a promising option for the prevention and management of osteoporosis/osteopenia in Mexican patients with BCa; however, further prospective studies are needed.

Hipertensión arterial sistémica posterior a COVID-19 / Systemic arterial hypertension after COVID-19

Introducción: un nuevo tipo de coronavirus que se nombró SARSCoV-2, responsable de la enfermedad por COVID-19, tuvo esparcimiento rápido en el mundo, por alta transmisión que resultó en pandemia. Se registraron 2'397,216 casos confirmados, con 162,956 defunciones en el mundo, de acuerdo con la Organización Mundial de la Salud (OMS), en abril de 2020. Sin embargo, la hipertensión afecta a 40% de adultos, lo que significa que alrededor de 250 millones de personas padecen de presión alta. La OMS, de acuerdo con sus reportes, refiere que la hipertensión es el factor de riesgo número uno de muerte. Uno de cada cuatro mexicanos padece hipertensión arterial. Objetivos: establecer la incidencia de la hipertensión arterial sistémica posterior a padecer COVID-19 en pacientes de la Unidad de Medicina Familiar (UMF) No. 48. Material y métodos: es un estudio transversal, observacional y descriptivo, conformado por 3,238 pacientes con diagnóstico de COVID-19 positivo, de ambos sexos, con edades entre 18 y 70 años. Por medio de la fórmula para poblaciones infinitas se obtiene una muestra de 348 pacientes. Se realizó revisión de expedientes en el Sistema de Información de Medicina Familiar, versión 6.2, para obtención de la información correspondiente. Resultados: 27 pacientes diagnosticados con hipertensión arterial posterior al diagnóstico de COVID-19, 52% del sexo masculino y 48% del femenino, con media de edad de 39 años, 74% correspondió a enfermedad leve por COVID-19 y 26% a enfermedad moderada. Se documenta mediana de ocho días por periodo de infección por COVID-19. En el círculo femenino el promedio de la aparición de hipertensión arterial fue de 13 meses y en el masculino la media de desarrollo de hipertensión arterial posterior a COVID-19 fue de seis meses (AU)

Introduction: a new type of coronavirus that was named SARSCoV-2, responsible for the COVID-19 disease, with rapid spread in the world, due to high transmission that resulted in pandemic. There were 2'397,216 confirmed cases, with 162,956 deaths in the world, according to the WHO in April 2020. However, hypertension affects 40% of adults and means that around 250 million people suffer from high blood pressure. The WHO, according to its reports, refers that hypertension is the number one risk factor for death. One in four Mexicans suffers from high blood pressure. Objectives: to establish the incidence of systemic arterial hypertension after suffering from COVID-19 in patients of the UMF No. 48. Material and methods: it is a cross-sectional, observational and descriptive study, consisting of 3,238 patients with a positive COVID-19 diagnosis of both sexes, aged 18-70 years. Through the formula for infinite populations a sample of 348 patients is obtained. Will proceed with review of files in the Family Medicine Information System, version 6.2, to obtain the corresponding information. Results: 27 patients diagnosed with hypertension after the diagnosis of COVID-19, 52% of the male sex and 48% of the female sex, with a mean age of 39 years; 74% corresponds to a mild illness by COVID-19 and 26% to moderate disease. A median of 8 days per period of infection by COVID-19 is documented. In the female circle, the average onset of hypertension was 13 months and as for the male sex, the mean development of hypertension after COVID-19 was six months (AU)

Análisis comparativo de la actividad antimicrobiana de secreciones y excreciones larvarias de Calliphora vicina y Sarconesiopsis magellanica (Diptera: Calliphoridae) / A comparative analysis of Calliphora vicina and Sarconesiopsis magellanica (Diptera: Calliphoridae) larval secretions and excretions antimicrobial activity

Introducción. La creciente resistencia bacteriana a los antibióticos representa una amenaza mundial de salud pública. Las excreciones y secreciones larvarias derivadas de moscas necrófagas de la familia Calliphoridae podrían configurar una fuente promisoria para contrarrestar sus efectos. Objetivo. Comparar la actividad antimicrobiana de las excreciones y secreciones larvarias nativas, y de las mayores y menores de 10 kDa de Calliphora vicina y Sarconesiopsis magellanica (Diptera: Calliphoridae). Materiales y métodos. El bioensayo se hizo a partir de la técnica de turbidimetría y en el caso de las excreciones y secreciones menores de 10 kDa se determinó la concentración inhibitoria mínima (CIM). Resultados. Las excreciones y secreciones nativas y las menores de 10 kDa de C. vicina y S. magellanica, evidenciaron una potente actividad antibacteriana contra tres cepas de Staphylococcus aureus y cuatro bacterias Gram negativas, siendo las menores de 10 kDa más efectivas que las nativas en las dos especies de moscas evaluadas. Además, las menores de 10 kDa presentaron la misma efectividad, aunque en las pruebas de CIM se observó que las de S. magellanica fueron más potentes en todas las bacterias evaluadas, excepto contra la cepa de S. aureus ATCC 25923. Las mayores de 10 kDa no inhibieron el crecimiento bacteriano. Conclusión. Los resultados validaron, en general, que estas sustancias son fuente importante para el aislamiento y la caracterización de agentes antimicrobianos.

Introduction: The growing resistance to antibiotics worldwide represents a global threat to public health. The larval excretions and secretions derived from necrophagous flies from the Calliphoridae family could represent a promising source for counteracting their effects. Objective: To compare the antimicrobial activity of Calliphora vicina and Sarconesiopsis magellanica (Diptera: Calliphoridae) native excretions and secretions and those weighing more than 10 kDa and less. Materials and methods: We used the turbidimetry technique for the bioassay; we determined the minimum inhibitory concentration (MIC) for excretions and secretions weighing less than 10 kDa. Results: Calliphora vicina and S. magellanica native excretions and secretions and those weighing less than 10 kDa exhibited potent antibacterial activity against three Staphylococcus aureus strains and four Gram-negative bacteria; those weighing less than 10 kDa were more effective than the native ones in the two species of flies evaluated here. Furthermore, excretions and secretions weighing less than 10 kDa had the same effectiveness, except in the MIC trials where S. magellanica excretions and secretions weighing less than 10 kDa were more potent against all the bacteria evaluated, except for S. aureus ATCC 25923. Excretions and secretions weighing more than 10 kDa did not inhibit bacterial growth. Conclusions: These results potentially validate these substances as an important source for isolating and characterizing antimicrobial agents.

Apoptosis-related gene expression induced by Colombian propolis samples in canine osteosarcoma cell line.

BACKGROUND AND AIM: Osteosarcoma (OSA) is the most common bone tumor in canines and humans. This study aimed to assess the cytotoxic and apoptotic effects of Colombian propolis samples on a canine OSA cell line (OSCA-8) by evaluating the expression of BCL-2, BAX, CASPASE 9, CASPASE 8, and TNFR1 genes involved in the apoptosis pathway. MATERIALS AND METHODS: After treating the cells with five Colombian propolis samples (Usm, Met, Fus, Sil, and Caj), we evaluated cell viability and lactate dehydrogenase (LDH) release. Early and late apoptosis was determined by flow cytometry using annexin V/propidium iodide. Furthermore, the effects of three selected samples on gene expression were analyzed by real-time polymerase chain reaction. RESULTS: The Colombian propolis samples reduced OSCA-8 cell viability and increased LDH release. All samples induced apoptosis significantly and upregulated BCL-2 and CASPASE 8 expression. Usm and Sil increased BAX expression, Met and Sil induced CASPASE 9 expression, and Usm increased TNFR1. CONCLUSION: Colombian propolis samples exhibited cytotoxic and apoptotic effects on canine OSA cells, and CASPASE 8 upregulation indicated apoptosis induction by the extrinsic pathway.

Ways to perform an endoscopic tattoo. Prospective and randomized study in patients with colorectal neoplasm.

BACKGROUND AND AIMS: intraoperative identification of colonic lesions previously detected via colonoscopy may be difficult. Endoscopic tattooing facilitates identification, but there is no evidence regarding which is the best tattoo technique. The goal of the study was to describe the efficacy and safety of endoscopic tattooing and to detect technical and clinical factors associated with its efficacy. PATIENTS AND METHODS: a prospective and randomized study was performed. All tattoo candidate patients were included prior to surgery and randomized into four groups; tattoo at two or three injection points and with a volume of 1 or 1.5 ml of labeling. Multiple variables were registered. RESULTS: one hundred and ninety-five patients were included with an endoscopic tattoo and who subsequently underwent a surgical intervention, the mean age was 70.1 years and 67.2 % were male. The laparoscopic approach was applied in 57.9 % of cases. The intraoperative visibility of the endoscopic tattoo was 89.7 % and 30 % of rectal lesions were not visible. Excluding the rectum, the marking was visible intraoperatively in 92 % of patients, without significant differences according to the surgical approach, the type of marking or any of the variables collected. The tattoo was safe in 92.3 % of the cases. The adverse effect rate was 7.7 % and none of the complications were clinically significant. There were no significant differences between any variables collected in relation to adverse effects. CONCLUSIONS: endoscopic colon tattoo is safe and effective regardless of the technique used. We recommend the technique of two injection points and 1 ml of marking volume for its simplicity, efficiency and safety.

Bloqueo plano erector de la espina en toracotomía pediátrica / Pediatric thoracotomy in erector spinae plane block

Erector spinae plane block (ESP) is a regional anesthesia technique consisting of blocking the interfascial plane, where local anesthetic (LA) is injected at the site where the dorsal branch of the spinal nerve emerges. There are various publications on the application of the block (EPS) in the adult population, however there are few reports of the use of this block in pediatric surgery. We present the first case report of an infant under 9 months of age with the presence of a tumor in the anterior mediastinum, who underwent a resection through the 6th intercostal space, previous blockage of the erector spinae under ultrasound vision. The patient did not present adverse effects and was discharged on the fourth postoperative day.

El bloqueo del plano erector de la espina (ESP) es una técnica de anestesia regional consistente en bloquear el plano interfascial, donde se inyecta anestésico local (LA) en el sitio donde emerge la rama dorsal del nervio espinal. Existen diversas publicaciones sobre la aplicación del bloqueo (EPS) en población adulta, sin embargo, hay pocos reportes del uso de este bloqueo en cirugía pediátrica. Presentamos el primer reporte de caso de una lactante menor de 9 meses de edad con presencia de tumor en mediastino anterior, al cual se le hizo una resección a través del 6° espacio intercostal, previo bloqueo del erector de la espina bajo visión ecográfica. La paciente no presentó efectos adversos y fue dada de alta al cuarto día posoperatorio.

Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions.

BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).

The chemical composition and events related to the cytotoxic effects of propolis on osteosarcoma cells: A comparative assessment of Colombian samples.

Osteosarcoma (OSA) is a type of bone cancer showing an aggressive biological behavior with metastatic progression. Because propolis potential for the development of new antitumoral drugs has been indicated, we evaluated the chemical composition of Colombian propolis samples and the mechanisms involved in their cytotoxic effects on OSA cells. The chemical composition was analyzed by GC-MS and the DPPH free radical scavenging activity was measured. Cluster and principal components analysis were used to establish an association with their inhibitory concentration 50% (IC50 ). Cell viability was analyzed by MTT assay; apoptosis was determined by flow cytometry; mitochondrial membrane permeability and reactive oxygen species were evaluated by rhodamine 123 and DCFH-DA. Transwell assay was used to evaluate the invasiveness of propolis-treated cells. Samples were grouped: Cluster 1 contained diterpenes and benzophenones and showed the highest antiradical activity; Cluster 2 was characterized by triterpenes, fatty acid, and diterpenes. Usm contained diterpenes and triterpenes different of the other samples and Sil contained triterpenes and flavonoids. Apoptosis, mitochondrial membrane alteration, and suppression of cell invasion were the main mechanisms involved in the inhibition of OSA cells in vitro, suggesting the potential of Colombian propolis to discover new antitumor drugs.

Evaluación y seguimiento antropométrico de los niños hijos de madre con diabetes gestacional / Evaluation and Anthropometric Tracking of Children of Mother's Sons with Gestational Diabetes

Resumen Objetivo: Evaluar y realizar seguimiento antropométrico a los niños hijos de madre con diabetes gestacional. Barranquilla, periodo enero de 2015 a diciembre de 2016. Materiales y métodos: Estudio descriptivo prospectivo longitudinal, en productos hijos de madre con diabetes gestacional, con seguimiento en programa Vida Saludable, niños hasta los 5 años de edad; se tomó muestra por conveniencia; se realiza evaluación en tres cortes diferentes, a los 12 meses, a los 3 y 5 años de edad; se presentan los resultados obtenidos en la primera evaluación. Para la tabulación de la información se utilizó el programa Epi-Info 7.0. Resultados: La distribución del sexo mostró mayor prevalencia de pacientes masculinos con un 66%; se observó mayor frecuencia en menores entre los 25 los 48 meses de edad, con el 62%, con una media de 27.7 ± 7.1 meses; el 94% de los pacientes presentó pero al nacer entre 2500 a 4000 gr, el 4% peso inferior a 2500 gr y el 2% peso superior a los 4000 gr, con media de 3153.2 ± 482.2 gr. Conclusiones: De acuerdo con el peso/edad, el 62% de la población estaba entre -1 y 1 (peso adecuado), el 20 % por debajo de -1, mientras que el 18 % por encima de 1; la talla/edad mostró que el 60 % estaba entre -1 y 1 (talla adecuada), el 26 % por debajo de -1 y 12 % por encima de 1; el índice de masa corporal (IMC) evidenció que el 54 % estaba entre -1 y 1 (adecuado), el 22 % entre 1 y 2 (sobrepeso), el 14 % entre -1 y -2 (riesgo), el 6 % > 2 (obesidad) y el 4 % (bajo peso).

Abstract Objective: To evaluate and carry out anthropometric follow-up of children of mothers with gestational diabetes. Barranquilla, from January 2015 to December 2016. Materials and methods: Descriptive longitudinal prospective study, in products from mothers with gestational diabetes, with follow-up in the Vida Saludable program, children up to 5 years of age; Sample was taken for convenience; evaluation is performed in three different sections, at 12 months, at 3 and 5 years of age; the results obtained in the first evaluation are presented. Epi Info 7.0 software was used for tabulation of information. Results: The sex distribution showed a higher prevalence of male patients with 66%; with an average of 27.7 ± 7.1 months; 94% of the patients presented but at birth between 2500 and 4000 gr, 4% weight less than 2500 gr and 2% weight superior to 4000 gr, with a mean of 3153.2 ± 482.2 gr. Conclusions: According to weight/age 62% of the population was between -1 and 1 (adequate weight), 20% below -1, while 18% above 1; size / age showed that 60% were between -1 and 1 (adequate size), 26% below -1 and 12% above 1; the body mass index (BMI) showed that 54% were between -1 and 1 (adequate), 22% between 1 and 2 (overweight), 14% between -1 and -2 (risk), 6% 2 (obesity) and 4% (underweight).

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. / Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas.

This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions.

This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.

Brain Metastases in Havana Cancer Patients.

INTRODUCTION: Cancer is a major public health problem worldwide and in Cuba. Approximately one third of cancer patients develop a brain metastasis. Despite this, epidemiological studies are scarce, internationally and in Cuba; published research is mainly limited to autopsy studies and hospital case series. OBJECTIVE: Characterize patients with brain metastases residing in Habana del Este Municipality, Havana, Cuba, with respect to demographics, metastasis location and primary tumor site. METHODS: A retrospective descriptive study was carried out with data for all patients with histologically confirmed cancer diagnosed in 2014 and registered in primary health care in Habana del Este Municipality. Diagnostic reports from computed tomography and/or magnetic resonance imaging were used to identify patients with brain metastases. Study variables were age, sex, skin color, number and location of brain metastases, control of primary tumor, and presence of extracranial metastases. Percentages were calculated and presented in tables. RESULTS: We identified 832 cancer patients in the Habana del Este population of 181,473 (prevalence 458.5 per 100,000 population). Among patients with cancer, 27.6% (230/832) had brain tumors, among which 83% (191/230) were brain metastases and 17% (39/230) primary tumors, a ratio of 4.9:1. Brain metastases appeared in 23% (191/832) of cancer patients (prevalence 105.2 per 100,000 population). Among patients with brain metastases, 48.2% (92/191) were aged 41-60 years and 61.3% (117/191) were female sex. The majority, 59.7% (114/191) had multiple metastases. The most frequent primary tumor location was the breast (40.8%, 78/191), followed by the lung (31.9%; 61/191); 46.8% (211/451) of brain metastases were in the parietal lobe. CONCLUSIONS: Brain metastases are more prevalent in this Cuban municipality than reported in other countries, but they constitute a higher proportion of cancer cases than seen in other population-based studies. The study's results underline the importance of detecting brain metastasis early, to permit timely interventions to improve quality of life and survival. CONTRIBUTION OF THIS RESEARCH: This is the first epidemiological study of brain metastases in Cuba and one of the few carried out internationally.

Orbitectomía en monobloque en un paciente con sarcoma neurogénico de la órbita / Single block orbitectomy in a patient with neurogenic orbital sarcoma

El sarcoma neurogénico es un tumor maligno que se origina en las células de Schwann de la vaina del revestimiento de los nervios periféricos y son poco frecuentes en la órbita. Se presenta un paciente de 23 años de edad, masculino, blanco, con antecedentes de neurofibromatosis tipo I, con desplazamiento anteroinferior del globo ocular izquierdo, dolor intenso y pérdida de la visión de 4 meses de evolución. Al examen oftalmológico se constató proptosis severa con descenso del globo ocular izquierdo, oftalmoplejia total, quemosis severa, hiperemia, opacidad corneal y aumento de volumen del párpado superior. En los estudios imagenológicos se evidenció lesión tumoral que ocupaba la totalidad del compartimiento orbitario sin infiltración de sus paredes óseas y con desplazamiento del globo ocular por fuera del reborde orbitario. Se realizó un abordaje quirúrgico combinado, y se logró una orbitectomía en monobloque con resección total del tumor y reconstrucción con colgajo rotado de músculo temporal ipsilateral. El estudio histopatológico informó la presencia de un sarcoma neurogénico de la órbita y se complementó con tratamiento adyuvante con radioterapia. El paciente se mantuvo controlado durante un año y a partir de esta fecha comenzó la aparición secuencial de varias lesiones a distancia(AU)

Neurogenic sarcoma is a malignant tumor that starts in Schwann cells of the peripheral nerves sheath and is rarely found in the orbit. Here is a 23 year old, male, Caucasian patient, with a history of Type-I Neurofibromatosis, and a left eye fore and lower side displacement of the left eyeball, intense pain and loss of vision for 4 months. A severe proptosis and the lowering of the left eyeball was detected during the ophthalmologic examination, as well as total ophthalmoplegia, severe chemosis, hyperemia, corneal opacity and increased upper eyelid volume. Imaging studies revealed a tumor lesion occupying the whole orbital compartment, with no bone wall infiltration, but causing the displacement of the eyeball out of the orbit border. A combined surgical approach was performed consisting in a single block orbitectomy with total tumor resection, as well as the reconstruction with the ipsilateral temporal muscle rotated flap. The histopathology study showed the presence of an neurogenic orbital sarcoma, so an adjuvant radiotherapy treatment was indicated. The patient was followed up for a year, after which the sequential occurrence of several lesions began(AU)

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions.

BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the ß parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

Pseudomonas aeruginosa: an emerging nosocomial trouble in veterinary / Pseudomonas aeruginosa: un problema nosocomial emergente en veterinaria

Objective. The goal of this study was to evaluate the susceptibility pattern of isolates P. aeruginosa from veterinary clinical centers in Bogotá, D.C., to some commonly used antibiotics in clinical. Materials and methods. Bacteriological standard protocols were used for the isolation and identification of bacterial strains. To evaluate the antimicrobial susceptibility of the isolates, to commonly used antibiotics, was performed the Kirby-Bauer agar-disk diffusion method on Mueller-Hinton agar. Results. A total of 160 samples was taken from clinical specimens and the environment in different veterinary clinics. Out of these samples, 89 (55.6%) were gram-negative strains, of which ten strains of P. aeruginosa were isolated (11.2%). All strains were resistant to Cefazolin, Lincomycin, Cephalothin, Ampicillin, Clindamycin, Sulfamethoxazole-Trimethoprim and Chloramphenicol while some isolates exhibited either resistance or an intermediate response to Amikacin (30%), Gentamicin (30%), Tobramycin (10%), Ciprofloxacin (20%), Ceftazidime (30%), Erythromycin (100%), Tetracycline (100%), Imipenem (10%), Meropenem (90%) and Bacitracin (90%). Conclusions. The results demonstrate that the acquired antimicrobial resistances of P. aeruginosa strains depend on antibiotic protocols applied. As observed in human hospitals, Pseudomonas aeruginosa is acting as one of the multidrug-resistant microorganisms of veterinary clinical relevance.

Objetivo. Evaluar el comportamiento a algunos antibióticos de uso común en clínica de cepas de Pseudomonas aeruginosa aisladas de centros clínicos veterinarios en Bogotá, D.C. Materiales y métodos. Un protocolo bacteriológico estándar se utilizó para el aislamiento e identificación de cepas bacterianas. Para evaluar la sensibilidad de los aislamientos bacterianos a diferentes antimicrobianos de uso clínico común, se empleó el método de difusión sobre agar Mueller-Hinton de Kirby-Bauer. Resultados. Un total de 160 muestras fueron tomadas a partir de muestras clínicas y del ambiente de diferentes clínicas veterinarias de la ciudad de Bogotá. De estas muestras, 89 (55.6%) fueron cepas bacterianas gram-negativas, de las que se aislaron 10 cepas de P. aeruginosa (11.2%). Todas las cepas de P. aeruginosa mostraron resistencia a la Cefazolina, Lincomicina, Cefalotina, Ampicilina, Clindamicina, Trimetoprim- Sulfametoxazol y Cloranfenicol; mientras que algunas de éstas, mostraron resistencia o una respuesta intermedia a Amikacina (30%), Gentamicina (30%), Tobramicina (10%), Ciprofloxacina (20%), Ceftazidima (30%), Eritromicina (100%), Tetraciclina (100%), Imipinem (10%), Meropenem (90%) y Bacitracina (90%). Conclusiones. Los resultados demuestran que la resistencia adquirida a los antimicrobianos en las cepas de P. aeruginosa aisladas de estos centros clínicos depende de los protocolos antibióticos aplicados. Al igual que sucede en los nosocomios Humanos, Pseudomonas aeruginasa se está comportando como uno de los microorganismos multirresistetes de relevancia clínica causante de infecciones nosocomiales veterinarias.

Manejo multidisciplinario en la recidiva de carcinoma epidermoide de conducto auditivo externo: presentación de un caso / Multidisciplinary handling of epidermoid carcinoma in the external auditory canal: presentation of a case

Se presenta un paciente de 42 años con el diagnóstico de un carcinoma epidermoide bien diferenciado de conducto auditivo externo (CAE), diagnosticado en junio de 2008. El mismo recibió radioterapia como tratamiento con intención curativa a dosis radical 66 Gy. En enero de 2010, comenzó con aumento de volumen exagerado del conducto auditivo externo, discutiéndose en los servicios de Neurocirugía, Radioterapia y Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología. Al paciente se le realiza la exéresis total del tumor, una radioterapia intraoperatoria fraccionada con electrones (EIORT) y reconstrucción local con colgajo músculo cutáneo del pectoral mayor. El tratamiento resultó ser tolerado por el paciente aumentándole su expectativa y calidad de vida

A 42 year-old patient is presented with the diagnostic of an Epidermoid Carcinoma of the external auditory canal on June 2008. He had got a radical radiotherapy as treatment with a completely response but in January 2010 he return with the tumour in the same place. It was the reason to discuss this patient in different department as Neurosurgery, Radiotherapy and Reconstructive Surgery. This patient received a total remove of the tumour, Intraoperative Radiotherapy with electron (EIORT) and a local reconstruction with mayor Pectoral Muscle. As Result the treatments were bear by the patient increasing his expectative and quality life

Resección microquirúrgica guiada de las malformaciones arteriovenosas cerebrales. Experiencia cubana y revisión / Guided resection microsurgery of cerebral arteriovenous malformations. Cuban experience and review

Objetivos: Se presenta un nuevo método para la resección de las malformaciones arteriovenosas (MAVs) usando una guía imagenológica transoperatoria con imágenes de angiografía por sustracción digital (ASD) combinada con imágenes de tomografía axial computada (TAC) y se describen nuestros primeros resultados quirúrgicos. Método: Se utilizan dos sistemas estereotácticos (Leksell y Estereoflex), softwre de planificación quirúrgicas (STASSIS y ANGIOWIN) y una unidad fluoroscópica portátil (SIREMOBIL 2000). Los pacientes se seleccionaron para el proceder quirúrgico después de realizar la gradación de la MAVs según Spetzler y Martín. La selección de la ADS como guía imagenológica transoperatoria se baso en la visualización bien definida de uno o más aferencias a la MAVs (pedículos). Los procederes microquirúrgicos se realizaron acorde a los métodos técnicos estándar en la resección de una MAVs, a los que se sumo la localización más ajustada de la craneotomía, la identificación rápida y precoz de las aferencias arteriales, así como la identificación precisa de los límites del nido malformativo. Resultados: En los 22 pacientes incluídos las formas clínicas más frecuentes de presentación de una MAVs fueron las hemorragias y/o convulsiones. La localización fue variable con predominio de las supratentoriales en regiones corticales. Según la clasificación de Spetzler y Martín, se incluyeron desde el grado I hasta el IV, con predominio en los grados I y III. La exérensis total se realizó en más del 90 por ciento de nuestros pacientes, utilizándose en el 100 por ciento la guía por imágenes y en el 45,5 por ciento de las intervenciones de la ADS transopeatoria postresección. La morbilidad neurológica permanente fue de solo el 4,5 por ciento y la mortalidad del 9,1 por ciento. Al año de evolución el 83,4 por ciento se consideraron pacientes con buenos resultados quirúrgicos. Conclusiones: La microcirugía se reafirma como modalidad de tratamiento efectiva. Esta combinación de métodos facilita la identificación, presillado y exéresis de los componentes de las MAVs, con un índice mínimo de complicaciones permanentes y aceptable mortalidad, considerando su clasificación.

Muerte encefálica: criterios diagnósticos / Encephalic death: diagnosis criteria

Se describen los 8 criterios empleados en el Instituto de Neurología y Neurocirugía para el diagnóstico de muerte encefálica: coma sin respuestas, apnea (comprobada por su prueba), ausencia de reflejos cefálicos, silencio eléctrico cerebral, lesión irreparable e irreversible del encéfalo, periodos de observación y la aplicación de una batería de pruebas conformada por los potenciales evocados multimodales y la electrorretinografía. Lo novedoso de este trabajo radica en la aplicación del último criterio, pués con esa batería de pruebas se puede lograr un diagnóstico precoz de muerte encefálica

Utilidad de los potenciales evocados auditivos de tallo encefálico y somatosensoriales de corta latencia en el neuromonitoreo / Usefulness of brainstem auditory evoked potentials and short latency somatosensory evoked potencial in the neuromonitoring cerebrovascular coma

Se estudian 26 enfermos en coma de causa cerebrovascular. En cada caso se registraron diariamente los potenciales evocados auditivos del tallo encefálico (PEATC) y los potenciales evocados somatosensoriales (PES) durante la etapa aguda de su enfermedad. Inmediatamente antes de comenzar el estudio electrofisiológico el paciente fue sometido a una rigurosa evaluación clínica con la aplicación de varias escalas. Esto permitió correlacionar estadísticamente las variables clinicas y de potenciales evocados (PE) entre si. En general se encontró una fuerte correlación entre la evaluación clínica y los PE, aunque fue mejor con los PES. Se pudo comprobar que ambas modalidades de PE se correlacionaban de forma diferente con las escalas para la evaluación de los reflejos corneales y tamaño.pupilar, por lo que se concluyó que ambas técnicas se complementan en la evaluación funcional del tallo encefálico. Los resultados de este trabajo permiten inferir que mediante la aplicación en forma conjunta, de los PEATC y los PES en el estudio del coma, se pueden encontrar cambios electrofisiológicos capaces de detectar precozmente una mejoría o un empeoramiento en el curso evolutivo de los enfermos