Core needle biopsy of breast tumours: comparison of diagnostic performance between surgery and radiology services at a national cancer centre in Latin America.

Introduction: Breast pathology is a very common reason for medical attention. Tissue diagnosis is usually obtained with core needle biopsy which could be performed by breast surgeons or interventional radiologists. Our aim was to assess the comparison of diagnostic performance between the two services. Methods: A retrospective, descriptive and cross-sectional study was carried out on patients who had breast pathology at Instituto Nacional de Enfermedades Neoplasicas in 2019. Descriptive analyses, sensitivity and specificity were calculated using the R program version 4.2.3. Results: From 1,082 patients with breast tumours who underwent core needle biopsy (CNB) during 2019, 782 cases were included. Breast surgeons performed 462 CNBs and radiologists performed 320 CNBs. The 87.5% were palpable tumours and 525 breast carcinomas were identified in the final pathology. The diagnostic performance showed that the sensitivity and specificity were greater than 95% and 98%, respectively. The waiting time in both showed that >95% underwent a CNB before 2 months. The breast surgery service performed the majority of the biopsies in less than 1 week since the indication of the execution of the CNB compared to the radiology service (90% versus 36%). Conclusion: Both hospital services, breast surgery and radiology, are efficient in determining an accurate diagnosis using CNB. However, the breast surgery service performs CNB in a shorter time interval. Breast surgical oncologists are encouraged to perform CNB if there are understaffed radiology services to expedite the diagnosis and treatment of breast cancer patients.

Safety and Outcomes in Multiplane Facial Rejuvenation with Tranexamic Acid: A Cohort Study.

Background: Tranexamic acid (TXA) has demonstrated promising outcomes in plastic surgery. Our aim was to assess the effect of TXA in intraoperative bleeding, operative time, and complications among patients undergoing facial surgical procedures. Methods: A retrospective cohort study of patients who underwent multiplane facial rhytidectomy from January 2018 to September 2022 at the Clinica Ziegler, Lima, Peru. Patients were divided into two groups according to the use of intravenous plus local infiltration of TXA. We performed the chi square test to assess associations among categorical variables, the Student t test and Mann-Whitney U test for categorical with continuous variables, and Pearson correlation for quantitative variables. Results: A total of 100 patients were included with 50 patients in each group. The median age was 59.5 years and the majority were women (88%). The median operative time was 288.5 minutes. The TXA group presented less intraoperative bleeding (40 versus 90 mL, P < 0.05) and shorter operative time (237 versus 353 minutes, P < 0.05); no differences in the development of hematoma (2% versus 12%, P = 0.11), less ecchymosis (2% versus 36%, P < 0.05), edema (2% versus 100%, P < 0.05), and time to drain removal (3 versus 6 days, P < 0.05). Conclusions: TXA improves the short- and long-term outcomes of patients who undergo multiplane facial rhytidectomy. It also decreases intraoperative bleeding by more than half and reduces the operative time by one third. Moreover, patients receiving TXA presented significantly less ecchymosis, edema, and time to drain removal.

Análisis factorial de la Escala Situacional de Empatia Emocional en una muestra universitaria chilena

La preocupación empática y angustia personal son los componentes emocionales de la empatía según los modelos más utilizados. Estos componentes pueden conceptualizarse en forma disposicional o situacional. Los análisis previos tienden a considerar escalas disposicionales con escasa evidencia para las situacionales. El presente estudio analizó la estructura factorial de la Escala Situacional de la Empatía Emocional, compuesta por la preocupación empática y angustia personal. En una muestra a conveniencia de estudiantes universitarias/os chilenos/as (N = 539), se analizó el ajuste de primer y segundo orden de la escala mediante análisis factorial. Los resultados indicaron un buen (X2/gl = 4.189, CFI = .964, ТЫ = .932, sRMR = .042, RMSEA = .086, AIC = 12041.418, BIC = 12097.185) y mejor ajuste del modelo de segundo orden Cfdiferenda(1) = 16.689,p .01, -ΔAIC- = 211.633 > 10, y -ΔBIC- = 207.342 > 10), mientras que el de un orden no mostró un buen ajuste (X2/gl = 20.878, CFI = .727, ты = .544, SRMR = .118, RMSEA = .224, AIC = 12253.051, BIC = 12304.527). Los resultados fueron consistentes con la literatura. Se discute la necesidad de nuevas evidencias de validez y el uso de muestras más representativas.

Empathic concern and personal distress are the emotional components of empathy according to most utilized models. These components can be conceptualized in a dispositional or situational form. Previous analyzes tend to consider dispositional scales, with little evidence for situational ones. The present study analyzed the factor structure of a situational scale of emotional empathy, composed of empathic concern and personal distress. In a convenience sample of Chilean university students (N = 539), the one-order and second-order fit of the scale was analyzed using factor analysis. The results indicated a good (X2/gl = 4.189, CFI = .964, ТЫ = .932, SRMR = .042, RMSEA = .086, AIC = 12041.418, BIC = 12097.185) and better Ct2 difference(1) = 16.689, p .01, -ΔAIC- = 211.633 > 10, y -ΔBIC- = 207.342 > 10) second-order fit while one-order did not show a good fit (X2/gl = 20.878, CFI = .727, ты = .544, SRMR = .118, RMSEA = .224, AIC = 12253.051, BIC = 12304.527). The results were consistent with the literature. The need for new types of validity and the use of more representative samples was discussed.

Expression of TILs and Patterns of Gene Expression from Paired Samples of Malignant Pleural Mesothelioma (MPM) Patients.

MPM is an aggressive disease with an immunosuppressive tumor microenvironment, and interest in exploring immunotherapy in this disease has been increasing. In the first line of treatment, the combination of nivolumab and ipilimumab demonstrated an improvement in survival over chemotherapy. The presence of TILs has been recognized as a marker of antitumor immune response to chemotherapy in solid tumors. The aim of our study is to identify the effect of treatment on immune cells and the immune gene profile in MPM. We investigated the changes in expression of TILs in 10 human MPM paired tumor tissues using immunohistochemistry and gene expression analysis from paired untreated and treated samples. In this small series, we demonstrated that during the evolution of disease without any treatment there was an increase in the inflammatory component in tumor samples. After systemic treatment there was a decrease in the number of TILs. We observed that after systemic treatment or disease progression immune gene signatures were suppressed. Our integrated analysis of paired samples with immune profile and genomic changes on MPM suggested that during the evolution of the disease the immune system tends to switch, turning off with treatment.

Análisis factorial confirmatorio de la Escala verbal de fusión de identidad en una muestra chilena / Confirmatory factor analysis of the Verbal Identity Fusion Scale in a Chilean sample

Resumen La fusión de identidad consiste en un sentimiento de unión con un grupo, en el que el individuo experimenta una mezcla entre su identidad personal y la social; y es un buen predictor de la conducta extrema progrupo. El presente estudio analizó la estructura factorial de la Escala verbal de fusión de identidad elaborada por Gómez et al. (2011), en una muestra chilena. Se utilizó una muestra universitaria seleccionada por conveniencia de 411 participantes (66% mujeres) con una edad media de 24.45 años (DT = 5.89). Se analizó el ajuste unifactorial y bifactorial de la Escala a través del análisis factorial, y las respectivas confiabilidades. Los resultados indicaron un buen y mejor ajuste del modelo bifactorial (χ 2/gl = 3.34, p < .001, CFI = .975, TLI = .957, SRMR = .030, y RMSEA = .085), por sobre el unifactorial, que no mostró un buen ajuste (χ 2/gl = 5.26, p < .001, CFI = .946, TLI = .919, SRMR = .042, y RMSEA = .116). Ambos modelos contaron con altas confiabilidades (> .800). Se discutió sobre el mejor ajuste de la estructura bifactorial en relación con estudios realizados en Estados Unidos, España y población inmigrante en Chile. Se proyecta la necesidad de futuros estudios que incorporen otros análisis de validez y superen la limitación del presente estudio asociada al uso de una muestra no representativa.

Abstract Identity fusion consists in a form alignment with a group and is a significant predictor of extreme pro-group behavior. The present study analyzed the factor structure of the verbal scale of identity fusion developed by Gómez et al. (2011), in a Chilean sample. A Chilean university sample by convenience of 411 participants (66% women) with a mean age of 24.45 years (SD = 5.89) was used. One-factor and two-factor fit of the scale was analyzed through factor analysis, and the respective reliabilities. The results indicated a good and better fit of the two-factor (χ2/gl = 3.34, p < .001, CFI = .975, TLI = .957, SRMR = .030, and RMSEA = .085), than the one-factor model, which did not show a good fit (χ2/gl = 5.26, p < .001, CFI = .946, TLI = .919, SRMR = .042, and RMSEA = .116). Both models had high reliabilities (> .800). The better fit of the two-factor structure was discussed in relation to studies conducted in the United States, Spain, and an immigrant population in Chile. The need for future studies incorporating other validity analyses and overcoming the limitation of the present study associated with the use of a non-representative sample is projected.

Índice de respiración rápida superficial diafragmática como predictor weaning de la ventilación mecánica / Rate of rapid superficial diaphragmatic breathing as a weaning predictor of mechanical ventilation

El destete de la ventilación mecánica (VM) es un paso clave para los pacientes sometidos a VM invasiva en la unidad de cuidados intensivos (UCI). Entre las diversas herramientas destinadas a ayudar a predecir el fracaso sucesor del destete, encontramos el índice rápido de respiración superficial (RSBI por sus siglas en inglés), es decir, la relación entre la frecuencia respiratoria y el volumen corriente (Fr/Vt) medido durante una prueba de respiración espontánea (SBT por sus siglas en inglés). Objetivo: Describir el índice de respiración superficial diagramática como predictor Weaning de la ventilación mecánica. Materiales y métodos: Estudio de revisión, de tipo monográfico. Apoyado en artículos científicos, publicados en diferentes revistas indexzada en índices reconocidos. Resultado: Durante un SBT, el valor de RSBI parece ser paralelo a la evolución de la fatiga de los músculos respiratorios. Por lo tanto, se considera que el RSBI refleja la carga inspiratoria, siendo la disminución del volumen tidal junto con el aumento de frecuencia respiratoria indicativo de posible debilidad o fatiga de los músculos inspiratorios, u otros efectos fisiológicos. Conclusión: Entre los pacientes ventilados en la UCI, una alteración multifactorial del diafragma es común y puede resultar en falla del destete y prolongación de la VM invasiva; por lo tanto, evaluar la función del diafragma es un medio útil para evaluar la capacidad del paciente para tolerar la respiración espontánea(AU)

Weaning from mechanical ventilation (MV) is a key step for patients undergoing invasive MV in the intensive care unit (ICU). Among the various tools intended to help predict successor failure weaning, we found the rapid shallow breathing index (RSBI for its acronym in English), that is, the relationship between the respiratory rate and the volume current (Fr/Vt) measured during a spontaneous breathing test (SBT by its acronym in English). Objective: To describe the rate of shallow breathing Diagrammatic as a Weaning predictor of mechanical ventilation. Materials and methods: Review study, monographic type. supported by articles scientific, published in different magazines indexed in recognized indices. Result: During an SBT, the RSBI value appears to be parallel to the evolution of respiratory muscle fatigue. Therefore, it is considered that the RSBI reflects the inspiratory load, being the decrease in tidal volume together with the increased respiratory rate indicative of possible weakness or fatigue of the inspiratory muscles, or other physiological effects. Conclusion: Among the patients ventilated in the ICU, a multifactorial alteration of the diaphragm is common and can result in weaning failure and prolongation of invasive MV; by Therefore, assessing diaphragm function is a useful means of assessing the patient's ability to tolerate spontaneous breathing(AU)

Utilización de cotilos 3D en defectos acetabulares graves / Use of 3D cups in severe acetabular defects

Introducción: Ante el aumento de las artroplastias de cadera en el último siglo, los defectos acetabulares graves son eventos cada vez más frecuentes. Su tratamiento representa un verdadero desafío, debido al déficit y la pobre calidad ósea, habitual en estos pacientes. materiales y métodos: Se presentan 6 pacientes tratados entre 2016 y 2021. Cinco casos de disrupción pélvica por revisiones fallidas, clasificadas como tipo IIIB de Paprosky y una fractura transversal de acetábulo, posible opción de tratamiento en casos de pacientes osteoporóticos. Resultados: Los pacientes tratados con esta técnica multidisciplinaria fueron controlados durante un promedio de 20 meses, ninguno presentó complicaciones posoperatorias. Los resultados valorados con escalas analógicas son prometedores e invitan a establecer este procedimiento como el patrón de referencia. Conclusiones: La evaluación estricta es necesaria en los defectos acetabulares. La inclusión de ingeniería informática médica permite estudiar la necesidad de usar injerto de banco, fabricar implantes a medida de titanio/tantalio trabecular multiporos, lo que es ideal para lograr la osteointegración, sumado a la posibilidad de planificar la dirección y la longitud de los tornillos al hueso remanente, según su calidad. La cementación de un cotilo de doble movilidad dentro del implante a medida disminuye el riesgo de luxación y de sobrecarga de este último, al eliminar la fricción metal-metal. Nivel de Evidencia: IIIB

Introduction: Given the increase in hip arthroplasties in the last century, serious acetabular defects are increasingly frequent events. Their treatment represents a real challenge, due to the bone deficit and poor bone quality that these patients usually present. Materials and Methods: Six patients treated between 2016 and 2021 are presented. Five cases of pelvic discontinuity due to failed revisions, classified as Paprosky type IIIB, and one transverse fracture of the acetabulum, a possible treatment option in cases of osteoporotic patients. Results: The patients treated with this multidisciplinary technique were followed up for an average of 20 months, and none of them presented postoperative complications. The results evaluated by analogous scales are promising and invite us to establish this procedure as the gold standard. Conclusions: Strict evaluation is necessary for acetabular defects. The inclusion of medical IT makes it possible to study the need to use bank grafting and to manufacture custom-made multiporous trabecular titanium/tantalum implants, which is ideal for achieving osseointegration, added to the possibility of planning the direction and length of the screws to the remaining bone, according to its quality. The cementation of a dual mobility cup inside the customized implant reduces the risk of dislocation and overload of the latter, by eliminating metal-metal friction. Level of Evidence: IIIB

Neuromielitis óptica: reporte de un caso clínico / Optic neuromyelitis: a clinical case report

La neuromielitis óptica (NMO) y los trastornos del espectro de neuromielitis óptica (NMOSD) son trastornos poco frecuentes, mediados por anticuerpos del sistema nervioso central (SNC) con predilección por la médula espinal y los nervios ópticos. Existe una fuerte predilección femenina. En el caso de la forma recurrente más común de la enfermedad, que representa del 80% al 90% de los casos, las mujeres están sobrerrepresentadas con una proporción de 5 a 10: 1.6. La edad media de inicio es de 39,7 años. Objetivo: Determinar la causa de neuromielitis óptica en paciente femenina de 24 años de edad. Materiales y métodos: Es una investigación enmarcada en el paradigma positivista, con enfoque cuantitativo. Con un estudio de campo-descriptivo, no experimental, en la modalidad de caso clínico único. El método utilizado fue la historia clínica y consentimiento informado. Resultado: Se presenta el caso de una paciente de sexo femenino de 24 años de edad, sin antecedentes patológicos personales. Presentó pérdida progresiva de la visión de 2 meses de evolución, que se acompañaba de dolor en región cervical de moderada intensidad y en 24 horas presentó parestesia en brazo derecho, afasia, cuadro neurológico que evolucionó hasta presentar cuadriparesia, insuficiencia respiratoria aguda. Conclusión: En IRM de columna cervical se evidencia cambio anormal de la señal medular cervical evidente en secuencias T2 flair lesión hiperintensa longitudinalmente extensa que abarca más de 3 cuerpos vertebrales. Fue tratada con corticoides y plasmaféresis(AU)

Neuromielitis optic (NMO) and neuromielitis optic spectrum disorders (NMOSD) are rare disorders mediated by antibodies of the central nervous system (CNS) with a predilection for the spinal cord and optic nerves. There is a strong female predilection. In the case of the most common recurrent form of the disease, which accounts for 80% to 90% most of the cases are women with a ratio of five to 10: 1.6. The mean age of onset is 39.7 years. Objective: To determine the cause of neuromielitis optica in a 24-year-old female patient. Materials and methods: It is an investigation framed in the positivist paradigm, with a quantitative approach. With a descriptive field study, not experimental, in the single clinical case modality. The method used was the medical history and informed consent. Result: The case of a 24-year-old female patient with no presented personal pathological history. She presented progressive loss of vision of 2 months of evolution, accompanied by pain in the cervical region of moderate intensity and within 24 hours, she presented paresthesia in the right arm, aphasia, a neurological picture that evolved until presenting cuadriparesia, acute respiratory failure. Conclusion: An MRI of the cervical spine shows an abnormal change in the cervical spinal signal evident in T2 sequences flair a longitudinally extensive hiperintensa lesion that encompasses more than 3 vertebral bodies. Her treatment was corticosteroids and plasmapheresis(AU)

Prevalence of intestinal parasite infections in stray and farm dogs from Spain.

Dogs play a potential role as reservoirs for zoonotic parasites, being especially problematic uncontrolled dog populations such as stray and farm dogs with access to populated areas. In order to investigate the prevalence of canine intestinal parasites in at-risk dog populations, we tested a total of 233 faecal samples shed by stray and dairy farm dogs from northern Spain. Telemann method was used to detect the presence of eggs and (oo)cysts of common dog intestinal parasites and Cryptosporidium was detected by PCR. One hundred and forty eight out of 233 samples (63.5%) were positive for at least one intestinal parasite, being Ancylostomidae (35.6%; 83/233) and Trichuris (35.2%; 82/233) the parasites most frequently identified. Cryptosporidium DNA was not detected in any of the faecal samples analysed. The overall prevalence was significantly higher in stray dogs than in farm dogs (72.5% vs 58.8%). Specifically, stray dogs had a significantly higher prevalence of Ancylostomatidae, Toxocara, Toxascaris and Taenidae. These dog populations are an important source of environmental contamination with intestinal parasite forms, which could be of significance to animal and human health.

Prevalence of intestinal parasite infections in stray and farm dogs from Spain / Prevalência de infecções por parasitos intestinais em cães errantes e de fazenda na Espanha

Abstract Dogs play a potential role as reservoirs for zoonotic parasites, being especially problematic uncontrolled dog populations such as stray and farm dogs with access to populated areas. In order to investigate the prevalence of canine intestinal parasites in at-risk dog populations, we tested a total of 233 faecal samples shed by stray and dairy farm dogs from northern Spain. Telemann method was used to detect the presence of eggs and (oo)cysts of common dog intestinal parasites and Cryptosporidium was detected by PCR. One hundred and forty eight out of 233 samples (63.5%) were positive for at least one intestinal parasite, being Ancylostomidae (35.6%; 83/233) and Trichuris (35.2%; 82/233) the parasites most frequently identified. Cryptosporidium DNA was not detected in any of the faecal samples analysed. The overall prevalence was significantly higher in stray dogs than in farm dogs (72.5% vs 58.8%). Specifically, stray dogs had a significantly higher prevalence of Ancylostomatidae, Toxocara, Toxascaris and Taenidae. These dog populations are an important source of environmental contamination with intestinal parasite forms, which could be of significance to animal and human health.

Resumo Os cães desempenham um importante papel como reservatório de parasitos zoonóticos, sendo especialmente problemáticas as populações descontroladas, como a de cães errantes e de fazenda, com acesso às áreas povoadas. Para investigar a prevalência de parasitos intestinais em populações caninas de risco, foram analisadas 233 amostras fecais provenientes de cães de fazendas leiteiras e errantes do norte da Espanha. O método Telemann foi utilizado para detectar ovos, cistos e oocistos dos parasitos caninos mais comuns e para a detecção de Cryptosporidium foi utilizada a técnica da PCR. Cento e quarenta e oito de 233 amostras analisadas (63,5%) foram positivas para pelo menos um parasito intestinal, sendo Ancyostomatidae (35,6%; 83/233) e Trichuris sp. (35,2%; 82/233) os parasitos identificados com maior frequência. O DNA de Cryptosporidium sp. não foi detectado em nenhuma das amostras fecais analisadas. A prevalência geral foi significativamente maior em cães errantes do que em cães de fazenda (72,5% vs 58,8%). Especificamente, os cães errantes tiveram prevalência maior para Ancylostomatidae, Toxocara, Toxascaris e Taenidae. Essas populações de cães são importantes fontes de contaminação ambiental, pois eliminam formas de vida desses parasitos, que podem ter impacto na saúde animal e humana.

Oncoplastic surgery for the conservative treatment of breast cancer in Perú's National Cancer Institute.

BACKGROUND: Oncoplastic surgery for breast cancer (OPS) has been a surgical trend for the past 25 years. In 2012, OPS has been introduced as the standard treatment for a selected group of patients at the National Cancer Institute of Peru (INEN). The aim of this study is to describe our findings. METHODS: This is a retrospective and descriptive study that identified demographics, tumour-pathologic features and includes patients solely treated since diagnosis until late follow-up at INEN. These OPS patients were identified from the conservative treatment patients group by review of medical charts and creation of a database for periods December 2005 through December 2015. RESULTS: A total of 146 patients were ruled in by the inclusion criteria. All patients were Peruvian females, 56.2% being 51 or older. 93.8% had core biopsy diagnosis of breast cancer and 52.1% located at the upper outer quadrant. 79.5% patients had upfront OPS and the round block (43.2%) and reduction/mastopexy (23.3%) were the most used techniques. pT2 was the most frequent size (54.7%). We achieved negative margins in 134 patients (93.2%) in a single procedure. Of 29 patients, who had neoadjuvant treatment, 11 achieved pCR. Only 5.5% had pN2 or higher. 95.2% received complimentary external beam radiotherapy. CONCLUSIONS: OPS has proven to be a reliable surgical option, both for aesthetic and oncologic outcomes. Important points for achieving these results are breast surgeons having properly trained under the OPS philosophy and knowing the patients' characteristics for correct technique selection.

Virulence in Mice of a Toxoplasma gondii Type II Isolate Does Not Correlate With the Outcome of Experimental Infection in Pregnant Sheep.

Toxoplasma gondii is an apicomplexan parasite that infects almost all warm-blooded animals. Little is known about how the parasite virulence in mice extrapolates to other relevant hosts. In the current study, in vitro phenotype and in vivo behavior in mice and sheep of a type II T. gondii isolate (TgShSp1) were compared with the reference type II T. gondii isolate (TgME49). The results of in vitro assays and the intraperitoneal inoculation of tachyzoites in mice indicated an enhanced virulence for the laboratory isolate, TgME49, compared to the recently obtained TgShSp1 isolate. TgShSp1 proliferated at a slower rate and had delayed lysis plaque formation compared to TgME49, but it formed more cyst-like structures in vitro. No mortality was observed in adult mice after infection with 1-105 tachyzoites intraperitoneally or with 25-2,000 oocysts orally of TgShSp1. In sheep orally challenged with oocysts, TgME49 infection resulted in sporadically higher rectal temperatures and higher parasite load in cotyledons from ewes that gave birth and brain tissues of the respective lambs, but no differences between these two isolates were found on fetal/lamb mortality or lesions and number of T. gondii-positive lambs. The congenital infection after challenge at mid-pregnancy with TgShSp1, measured as offspring mortality and vertical transmission, was different depending on the challenged host. In mice, mortality in 50% of the pups was observed when a dam was challenged with a high oocyst dose (500 TgShSp1 oocysts), whereas in sheep infected with the same dose of oocysts, mortality occurred in all fetuses. Likewise, mortality of 9 and 27% of the pups was observed in mice after infection with 100 and 25 TgShSp1 oocysts, respectively, while in sheep, infection with 50 and 10 TgShSp1 oocysts triggered mortality in 68 and 66% of the fetuses/lambs. Differences in vertical transmission in the surviving offspring were only found with the lower oocyst doses (100% after infection with 10 TgShSp1 oocysts in sheep and only 37% in mice after infection with 25 TgShSp1 oocysts). In conclusion, virulence in mice of T. gondii type II isolates may not be a good indicator to predict the outcome of infection in pregnant sheep.

La palabra y la ironía en la esquizofrenia / The word and the irony in schizophrenia

La desconexión del lazo con el otro es característica de la propia estructura esquizofrénica, lo observamos en pacientes que están verdaderamente aislados, sumidos en una apatía generalizada. Estos pacientes son la expresión clínica más pura de la esquizofrenia como estructura clínica que se caracteriza por el rechazo al lazo social y la resignación de la investidura de objeto. Pero en algunos esquizofrénicos observamos cierta aptitud para intentar reestablecer el lazo social. Intento del que habla Freud cuando conceptualiza el fenómeno de la palabra en la esquizofrenia y del que habla también Lacan cuando plantea una elección irónica signada por la insistencia. Ese intento restitutivo genera un efecto irónico cuando, como interlocutores, escuchamos esos dichos que tratan cosas concretas como si fueran abstractas. Cuando el otro es convocado, a partir de esos enunciados del esquizofrénico que desde su referencia apuntan a lo concreto, se dispone al lazo social, pero, cuando constata que esa referencia no responde a la exigencia discursiva de transparencia y es, por lo tanto, opaca, abstracta, aparece el efecto irónico en el que el intento de restitución es al mismo tiempo ataque al lazo social. El lazo social roto por estructura, el intento de restitución del lazo social y el efecto irónico que el intento de restitución genera constituyen los tres tiempos del fenómeno esquizofrénico de la palabra y su relación con la ironía que trabajaremos aquí.

The disconnection of the tie with the other is a characteristic of the proper schizophrenic structure, we observe this in patients that are truly isolated, submerged in a generalized apathy. These patients are the most pure clinic expression of schizophrenia as a clinic structure that is characterized by the reject of the social tie and the resignation of the investiture of the object. But in some schizophrenic we observe a certain attitude to try to re-establish the social tie. An attempt which is mentioned by Freud when he contextualizes the phenomenon of the word in schizophrenia and which is also referred to by Lacan when he establishes an ironic election signed by insistence. That restored attempt generate an ironic effect when, as interlocutors, we listen to these sayings that treat concrete things as if they were abstract. When the other is summoned, starting from those announcements of the schizophrenic that from his reference points to the concrete, he is disposed to the social tie, but when it is sure that that reference does not answer the discursive demand of transparency and is so dull, abstract, the ironic effect appears in the sense that the attempt to restore is at the same time an attack to the social tie. The social tie broken by structure, the attempt to restore the social tie and the ironic effect that the restitution generates constitute the three times of the schizophrenic phenomenon of the word and its relation with the irony that we are going to work with here.

Development of a murine vertical transmission model for Toxoplasma gondii oocyst infection and studies on the efficacy of bumped kinase inhibitor (BKI)-1294 and the naphthoquinone buparvaquone against congenital toxoplasmosis.

Objectives: Establishment of a mouse model for congenital toxoplasmosis based on oral infection with oocysts from Toxoplasma gondii ME49 and its application for investigating chemotherapeutic options against congenital toxoplasmosis. Methods: CD1 mice were mated, orally infected with 5, 25, 100, 500 or 2000 oocysts and monitored for clinical signs and survival of dams and pups until 4 weeks post partum . The parasite burden in infected mice was quantified by real-time PCR in lungs, brains and, in the case of surviving pups, also in eyes. Seroconversion was assessed by ELISA. T. gondii cysts in brain were identified by immunofluorescence. In a second experiment, pregnant CD1 mice challenged with 20 oocysts/mouse were treated with buparvaquone or the calcium-dependent protein kinase 1 inhibitor bumped kinase inhibitor (BKI)-1294 and the outcome of infection was analysed. Results: T. gondii DNA was detected in the brain of all infected animals, irrespective of the infection dose. Seroconversion occurred at 3 weeks post-infection. Most pups born to infected dams died within 1 week post partum , but a small fraction survived until the end of the experiment. T. gondii DNA was detected in the brain of all survivors and half of them exhibited ocular infection. Chemotherapy with both compounds led to dramatically increased numbers of surviving pups and reduced cerebral infection. Most efficient were treatments with BKI-1294, with 100% survivors and only 7% brain-positive pups. Conclusions: BKI-1294 and buparvaquone exert excellent activities against transplacental transmission in pregnant mice.

Comparación entre Fentanil y Clonidina como Potenciadores del Efecto de la Lidocaína al 2 en la Anestesia Epidural

Comparación entre fetanil y clonidina como potenciadores del efecto de la lidocaina al 2 por ciento en la anestesia epidural. El siguiente trabajo se realizó en los ambientes del Centro Quirúrgico del Hospital Goyeneche. Fueron estudiados 30 pacientes, 13 de sexo masculino y 17 de sexo femenino con riesgo quirúrgico de I-II, ASA I-II, cuyas edades oscilaron entre 20 y 55 años, con una talla promedio de 1,60 m y un peso promedio de 60 Kg. Estos pacientes fueron estudiados durante el periodo intra y postoperatorio, lasa cirugías realizadas fueron de abdomen y miembros inferiores. La premedicación se realizó algunas veces en piso y otras en sala de operaciones dependiendo si la cirugía fue electiva o de urgencia. Todos los pacientes fueron sometidos a anestesia epidural, usando uan aguja de Tuohy N§17 ó 18 (aparte de todo el equipo necesario para la anestesia epidural), en posición de cubito lateral derecho, siendo el nivel de punción D12-L1, L1-L2, L2-L3, dependiendo del tipo de cirugía a realizarse, a una velocidad de inyección de 1 ml/seg, siendo colocados inmediatamente después en posición decúbito dorsal. Para obeto de este estudio se dividio a los pacientes en dos grupos iguales en forma aleatoria, (15 para cada grupo). El primer grupo recibió Lidocaína 30 ml (500mg) + Fentanil (100mcgr), y el segundo grupo recibió Lidocaína 30 ml (500 mg) + Clonidina 2 ml (300 mcgr). Los pacientes estaban despiertos al aplicarse la anestesia epidural. Se explicó a cada pacientes que catalogase su dolor usando una escala análoga visual (VAS), graduada de 0 a 10, siendo 0= ausencia de dolor y 10= máximo dolor. Se observó a los pacientes desde el momento de la punción lumbar, para ir anotando los cambios hemodinámicos, que se iban produciendo, además para detectar los efectos colaterales importantes como sedación exceciva, hipotensión y bradicardia. La evaluación terminó transcurridos los 240 minutos. Se evaluó también el bloqueo motor con la escala Bromage: 1= Incapaz de mover los pies o ridillas. 2= Capaz de mover sólo los pies. 3= Capaz de mover las rodillas. 4= Capaz de flexionar completamente las rodillas pies...