Solitary Cystic Psoas Muscle Metastasis From Rectosigmoid Adenocarcinoma.

The most common subtype of colon cancer is colorectal adenocarcinoma. Compared with other subtypes, such as signet-ring and mucinous, colorectal adenocarcinoma has been found to have lower rates of metastasis. Approximately 20% of colorectal cancer cases present with metastatic disease on initial evaluation. The most common locations for metastasis are the liver, lung, peritoneum, bone, and extra-regional lymph nodes. Metastatic disease to the skeletal muscle, however, is considerably rare. We present a clinical case of a 52-year-old female found to have a cystic iliopsoas muscle metastasis from rectosigmoid adenocarcinoma, initially classified as an infected fluid collection.

Las ciencias y la pandemia del Covid-19 / The sciences and the Covid-19 Pandemic

Durante la etapa de confinamiento social decretado para evitar el contagio de la pandemia del COVID-19, se ha redactado el presente ensayo partiendo de ejercitar la crítica a posiciones que desde algunas instituciones científicas -las academias de ciencias nacionales, en particular- se han tomado con relación a la situación actual que se vive en el país y a las decisiones tomadas por las autoridades gubernamentales para evitar la propagación de la epidemia en el territorio nacional. El cuerpo del ensayo busca mostrar, con la presentación de algunos de los campos científicos asociados a la atención científica de la pandemia ­ la virología, la epidemiología y la medicina-, la complejidad, las inconmensurabilidades y las posibles colisiones que existen entre ellas, situación que dificulta la obtención de soluciones apoyadas solo en las ciencias. Se concluye llamando la atención sobre algunas enseñanzas que se pueden desprender de la situación que ha tocado vivir en casi todos los países del mundo y en particular, el papel que Estado le ha tocado manejar en Venezuela(AU)

During stage social confine-ment decreed to avoid CO-VID-19 pandemic spread, this essay has been written basis on exercising criticism positions that from some scientific insti-tutions -the national science academies in particular- they have taken about country sit-uation current and decisions made by government authorities to prevent epidemic spread in the national territory. Essay body seeks to show, with the presentation of some scientific fields associated with the scientific care of the pandemic -virology, epidemiology, and medicine-, the complexity, the incommensurabilities and the possible collisions that exist between them, situation that makes it difficult to obtain solutions supported only in the sciences. It concludes by calling attention to some lessons that can be derived from situation that has had to be lived in almost all world countries and, in particular, the role that the State has had to deal with in Venezuela(AU)

Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study.

BACKGROUND: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. METHODS: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at -70°C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. RESULTS: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1-4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. CONCLUSIONS: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

Neurochemical and behavioral characterization of neuronal glutamate transporter EAAT3 heterozygous mice

BACKGROUND: Obsessive-compulsive disorder (OCD) is a severe neuropsychiatric condition affecting 1-3% of the worldwide population. OCD has a strong genetic component, and the SLC1A1 gene that encodes neuronal glutamate transporter EAAT3 is a strong candidate for this disorder. To evaluate the impact of reduced EAAT3 expression in vivo, we studied male EAAT3 heterozygous and wild-type littermate mice using a battery of behavioral paradigms relevant to anxiety (open field test, elevated plus maze) and compulsivity (marble burying), as well as locomotor activity induced by amphetamine. Using high-performance liquid chromatography, we also determined tissue neurotransmitter levels in cortex, striatum and thalamus-brain areas that are relevant to OCD. RESULTS: Compared to wild-type littermates, EAAT3 heterozygous male mice have unaltered baseline anxiety-like, compulsive-like behavior and locomotor activity. Administration of acute amphetamine (5 mg/kg intraperitoneally) increased locomotion with no differences across genotypes. Tissue levels of glutamate, GABA, dopamine and serotonin did not vary between EAAT3 heterozygous and wild-type mice. CONCLUSIONS: Our results indicate that reduced EAAT3 expression does not impact neurotransmitter content in the corticostriatal circuit nor alter anxiety or compulsive-like behaviors.

Programming of Dopaminergic Neurons by Neonatal Sex Hormone Exposure: Effects on Dopamine Content and Tyrosine Hydroxylase Expression in Adult Male Rats.

We sought to determine the long-term changes produced by neonatal sex hormone administration on the functioning of midbrain dopaminergic neurons in adult male rats. Sprague-Dawley rats were injected subcutaneously at postnatal day 1 and were assigned to the following experimental groups: TP (testosterone propionate of 1.0 mg/50 µL); DHT (dihydrotestosterone of 1.0 mg/50 µL); EV (estradiol valerate of 0.1 mg/50 µL); and control (sesame oil of 50 µL). At postnatal day 60, neurochemical studies were performed to determine dopamine content in substantia nigra-ventral tegmental area and dopamine release in nucleus accumbens. Molecular (mRNA expression of tyrosine hydroxylase) and cellular (tyrosine hydroxylase immunoreactivity) studies were also performed. We found increased dopamine content in substantia nigra-ventral tegmental area of TP and EV rats, in addition to increased dopamine release in nucleus accumbens. However, neonatal exposure to DHT, a nonaromatizable androgen, did not affect midbrain dopaminergic neurons. Correspondingly, compared to control rats, levels of tyrosine hydroxylase mRNA and protein were significantly increased in TP and EV rats but not in DHT rats, as determined by qPCR and immunohistochemistry, respectively. Our results suggest an estrogenic mechanism involving increased tyrosine hydroxylase expression, either by direct estrogenic action or by aromatization of testosterone to estradiol in substantia nigra-ventral tegmental area.

Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania.

BACKGROUND: In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation. METHODS: In September 2006, a molecular biology laboratory at Bugando Medical Center was established in order to perform HIV DNA PCR testing using Dried Blood Spots (DBS). Ninety-six health workers from 4 health facilities were trained in the identification and care of HIV-exposed infants, HIV testing algorithms and collection of DBS samples. Paper-based tracking systems for monitoring the program that fed into a simple electronic database were introduced at the sites and in the laboratory. Time from birth to first HIV DNA PCR testing and to receipt of test results were assessed using Kaplan-Meier curves. RESULTS: From October 2006 to March 2007, 510 HIV-exposed infants were identified from the 4 health facilities. Of these, 441(87%) infants had an HIV DNA PCR test at a median age of 4 months (IQR 1 to 8 months) and 75(17%) were PCR positive. Parents/guardians for a total of 242(55%) HIV-exposed infants returned to receive PCR test results, including 51/75 (68%) of those PCR positive, 187/361 (52%) of the PCR negative, and 4/5 (80%) of those with indeterminate PCR results. The median time between blood draw for PCR testing and receipt of test results by the parent or guardian was 5 weeks (range <1 week to 14 weeks) among children who tested PCR positive and 10 weeks (range <1 week to 21 weeks) for those that tested PCR negative. CONCLUSIONS: The EID pilot program successfully introduced systems for identification of HIV-exposed infants. There was a high response as hundreds of HIV-exposed infants were registered and tested in a 6 month period. Challenges included the large proportion of parents not returning for PCR test results. Experience from the pilot phase has informed the national roll-out of the EID program currently underway in Tanzania.

Injerto óseo pediculado de pronador cuadrado en el tratamiento de la seudoartrosis de escafoides / Pronator quadratus pedicled bone graft in the treatment of scaphoid pseudoarthrosis

La pseudoartrosis del escafoides es un reto para el cirujano de mano. Dentro de los diferentes métodos de tratamiento quirúrgico de la no unión del escafoides se resalta la fijación interna acompañada de injertos óseos autólogos de corticoesponjosa y otras técnicas de injertos óseos vascularizados. El propósito de esta investigación es mostrar nuestra experiencia con el injerto óseo pediculado al pronador cuadrado. Se reportan 17 pacientes con pseudoartrosis del escafoides carpiano sin cambios osteoartríticos a nivel de la articulación radiocarpiana, los cuales fueron tratados mediante injerto óseo pediculado al pronador cuadrado y fijación interna. En todos los pacientes operados se obtuvo consolidación de la no unión. La técnica propuesta en nuestro trabajo también permitió realizar una corrección de la deformidad angular del escafoides.

Scaphoid pseudoarthrosis is a challenge for the surgeon specialized in hands. Among the different surgical methods to treat non-union of the scaphoid, one may underline the internal fixation accompanied by autologue bone grafts of corticospongious and other vascularized bone graft techniques. The objective of this research study was to show our own experience in pronator quadratus pedicled bone graft. Seventeen cases with carpal scaphoid pseudoarthrosis, but without osteoarthritic changes at radiocarpal joint, were reported; they were all treated with pronator quadratus pedicled bone graft and internal fixator. The non-union consolidation was seen in all the patients. The suggested technique also allowed making the angle deformity corrections of the scaphoid.

La pseudarthrose du scaphoïde est un défi pour le chirurgien orthopédique. Parmi les différentes méthodes de traitement chirurgical d'une fausse articulation du scaphoïde, on met l'accent sur la fixation interne accompagnée de greffes osseuses autologues de tissu corticospongieux et d'autres techniques de greffes osseuses vascularisées. Le but de cette étude est de montrer notre expérience avec la greffe osseuse pédiculée au niveau du muscle carré pronateur. Dix-sept patients atteints de pseudarthrose du scaphoïde carpien sans changements ostéo-arthritiques au niveau de l'articulation radio-carpienne ont été traités par greffe osseuse pédiculée du carré pronateur et par fixation interne. La consolidation de la fausse articulation est obtenue chez tous les patients opérés. La technique proposée dans notre travail a aussi permis de réaliser une correction de la difformité angulaire du scaphoïde.

Criterios de amputación de una extremidad lesionada / Amputation criteria of an injured extremity

Se revisaron y discutieron la fuerza, las debilidades y la validación clínica de los sistemas de evaluación, ya publicados, de una extremidad severamente lesionada. Se expusieron los sistemas de evaluación relacionados con la toma de decisión para la amputación o preservación de la extremidad lesionada. El sistema de puntuación de severidad de la extremidad lesionada (PSEL) se planteó es el que más se emplea por su fácil cálculo y seguridad.

The strength, weaknesses and clinical validation of the already published evaluation systems of a severely injured extremity were reviewed and discussed. The evaluation systems related to the decision making for the amputation or preservation of an injured extremity were exposed. The Mangled Extremity Severity Score (MESS) is the most used for its easy calculation and security.

Transferencia del trapecio en la parálisis del plexo braquial / Translocation du trapèze dans la paralysie du plexus brachial / Transfer of the trapezius in brachial plexus palsy

Después las lesiones severas del plexo braquial que provocan parálisis del hombro, algunas veces se requieren operaciones reconstructivas para restaurar la función; por lo que es preciso utilizar varios músculos para realizar la transferencia. Se trataron 15 pacientes con lesiones del hombro que se les aplicó la técnica de Mayer, para realizar la transferencia del trapecio hacia el húmero. En los resultados obtenidos se constató 10 casos con pronóstico bueno, 4 casos regular y 1 caso de malo. En 14 pacientes se logró un hombro estable. La transferencia del trapecio brindó una mejor función con respecto a la artrodesis en la parálisis del hombro.

After severe injures in the brachial plexus causing shoulder paralysis, reconstructive surgery is sometimes required to restore the previous function, so it is necessary to use several muscles to make the transfer. Fifteen patients with shoulder injures were treated with Mayer´s technique to transfer the trapezius to the humerus. The results showed 10 cases with good prognosis, 4 cases with regular prognosis and 1 with bad outcome. Stabilized shoulder was possible in 14 patients. The transfer of the trapezius provided a better function than arthrodesis in the shoulder paralysis.

Après les lésions sévères du plexus brachial provoquant la paralysie de l'épaule, il faut parfois des chirurgies réparatrices afin de restaurer la fonction, il est donc nécessaire d'utiliser plusieurs muscles pour faire une translocation. Quinze patients atteints de lésions scapulaires ont été traités par la technique de Mayer pour faire la transposition du trapèze vers l'humérus. On a pu constater que 10 cas ont eu un bon pronostic, 4 un pronostic passable, et 1 un pronostic mauvais. On a réussi la consolidation de l'épaule chez 14 patients. La transposition du trapèze a permis d'obtenir une meilleure récupération qu'avec une arthrodèse dans les cas de paralysie de l'épaule.

Capsulitis adhesiva del hombro: tratamiento con distensión hidráulica y anestesia local / Adhesive capsulitis of the shoulder: treatment with hydraulic distention and local anesthesia

El hombro congelado es un término general que incluye todas las causas de pérdida de los movimientos del hombro, debido a una contractura de las partes blandas por el resultado de un bloqueo mecánico. Se realizó un estudio en 14 pacientes con diagnóstico de capsulitis adhesiva del hombro, que fueron tratados mediante la técnica de distensión capsular con anestesia local, en el Hospital Clínico Quirúrgico Manuel Fajardo. En relación con el estado funcional del hombro antes de recibir tratamiento, en 8 pacientes la función era mala y en 6 pacientes regular; de acuerdo al criterio evaluativo utilizado. Después del tratamiento 10 pacientes lograron una función excelente y 4 pacientes una función buena. Se demostró que la distensión hidráulica de la cápsula de la articulación glenohumeral con anestesia local es una alternativa satisfactoria para el tratamiento del hombro congelado, con probada efectividad, segura y de bajo costo

Sondeo de evaluación del Programa de Recertificación Virtual en Ciencias Básicas de la Anestesia / Hepático transplant in metabolic diseases: with regard to a case of tirosinemia

El beneficio actual del trasplante hepático (TH) en los pacientes pediátricos, se ha incrementado con el desarrollo de nuevas técnicas quirúrgicas, que permiten adaptar el tamaño del injerto a pacientes en edades extremas, realización del procedimiento de manera electiva, optimización preoperatoria del receptor, manejo anestésico depurado y mejores recursos en inmunosupresión y cuidado crítico1. La alternativa de donante vivo2,3 y la adopción de escalas de estratificación de severidad específicas para el paciente pediátrico con falla hepática, como el PELD (Pediatric End Liver Disease Score)4, han permitido conocer y ampliar la lista de patologías susceptibles a ser corregidas con el TH, minimizando los tiempos en listas de espera y reduciendo así las repercusiones sistémicas de la enfermedad...

Expression of CD64 as a potential marker of neonatal sepsis.

The aim of this study was to identify a novel immunological indicator useful for the early diagnosis (through a rapid and single determination) of neonatal sepsis (NS). Peripheral blood samples were taken from 63 neonates, who were classified into four groups: proven NS (n = 17); clinical NS (n = 14); disease without infection (n = 17); and healthy newborns (n = 15). Neutrophil expression of CD64, CD43, CD44, CD50, CD62L and Mac-1, and plasma levels of interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha (TNF-alpha) and soluble L-selectin (sCD62L), were determined. Expression of CD64 was significantly enhanced in the group with proven sepsis and clinical NS compared to newborns without infection (p < 0.05). Eight newborns with proven or clinical sepsis, but only one with disease without infection, showed an increased percentage of CD64+ cells (diagnostic specificity = 96.8%). No significant differences were found in the expression of the other leucocyte differentiation antigens studied. As previously described, TNF-alpha and IL-6 levels were significantly elevated in newborns with proven or clinical sepsis compared to neonates without infection (p < 0.05). Our results suggest that, through a single determination, the enhanced expression of CD64 is a highly specific indicator of NS, although its diagnostic sensitivity is low (25.8%). In contrast, we found that plasma levels of IL-1beta and sCD62L, as well as the expression of Mac-1, CD43, CD44, CD50, and CD62L, do not appear to be useful for the diagnosis of NS.

The anatomic characteristics of the third head of biceps brachii muscle in a colombiana population

We report the appearance of variations of the biceps brachii muscle and describe their anatomic characteristics in our population. A prospective evaluation was conducted on cadavers at the morgue of the "Nueva Granada" Military University (UMNG) - School of Medicine in Santafe de Bogota, Colombia. Thirty-two arms of 16 cadavers were included. Anatomic description was achieved by measurements of length, width, thickness, insertions, relations, innervating branches and blood supply. A third head for the biceps brachii muscle was found in 6 arms (37.5 percent, n=16). It appeared most frequently in the right arm (31.25 percent, n=16) and found bilaterally in 2(12.5 percent, n=16) cases; arising from the lower third the humeral shaft at 12.82 ± 0.59 cms. from the external humeral condyle and with a total length of 12.9 ± 0.29 cms. These results provide an anatomic description of the characteristics of this variation in the population studied and also is the first report of this accessory head among Colombians.

Costo efectividad del uso profilactico de antibioticos en Neurocirugia / Cost and effectiveness of antibiotic prophylaxis in neurosurgery

Con el objeto de comparar la efectividad y los costos del uso profiláctico de antibióticos en neurocirugía, o la ausencia de los mismos en la prevención de infecciones posoperatorias luego de cirugía electiva (craneotomías y derivaciones). Revisamos los artículos referenciados en Medline entre 1980 y 1995. Los términos que se utilizaron para la búsqueda fueron: profilaxis antibiótico en neurocirugía cruzada con cirugía de craneotomías y cirugía de derivaciones. Los datos acerca de los costos se extrajeron del Manual de tarifas del Instituto Neurológico de Colombia, los costos de los medicamentos fueron registrados en el Catálogo nacional de costos de medicamentos autorizados para el plan obligatorio en salud (POS). No se realizó descuento ni tampoco ajustes por inflación debido a lo corto del tiempo en el que se realizó el estudio. De los diferentes trabajos extrajimos los datos acerca de probabilidad de infección, probabilidad de presentar efectos secundarios cuando se utiliza la profilaxis, así como también el antibiótico utilizado y la dosis usada y el costo que se deriva de su uso en nuestro país. Construimos un árbol de decisión clínica sobre el cual se coloraron las diferentes probabilidades y los diferentes costos. Se encontraron dos artículos de metanálisis sobre el tema. El primero, sobre profilaxis antibiótica en craneotomías y el segundo, sobre profilaxis en cirugía de derivaciones. Se buscaron los artículos utilizados en los dos metanálisis. Revisamos 15 artículos con un total de más de 4.000 pacientes en los dos grupos. Dentro de los árboles de decisión que construimos se colocaron los diferentes datos obtenidos y se conmutaron las probabilidades encontradas con los costos que correspondían a cada una de las "ramas" del árbol, de esta forma pudimos establecer el costo final de cada una de ellas. En los estudios de las craneotomías las diferencias entre el uso de antibióticos o la "terapia convencional" de no utilizarlos resultan estrechas ($139.758 para la profilaxis, mientras que la no profilaxis tiene un costo de $184.486). Concluimos que en la cirugía de las derivaciones no resulta ser costo-efectivo utilizar antibióticos profilácticos. Para la cirugía de las craneotomías la diferencia es bastante estrecha pero es significativa, más si se aplica a un gran número de pacientes, donde se puede ahorrar grandes sumas de dinero

Confiabilidad del ecocardiograma bidimensional en el diagnóstico de niños con cardiopatías congénitas / Confidence of bidimensional echocardiography in the diagnosis of congenital cardiopathy in children

Se trata de un estudio transversal realizado en el Hospital Dr. Robert Reid Cabral en el período 1982-87, en cual se intentó conocer la confiabilidad del Ecocardiograma Bidimensional en niños con cardiopatias congenitas, comparando los resultados del ecocardiograma con los de la cirugia cardiaca. Se hizo la comparación en un total de 78 casos. Se encontró acertado el diagnostico con el Eco 2D en 97.5 por ciento de ellos