[Palliative care for people with advanced Parkinson's disease. A systematic review]. / Cuidados paliativos para personas con enfermedad de Parkinson avanzada. Revisión sistemática.

INTRODUCTION: Palliative care refers to treatment aimed at the early and comprehensive identification of pain and other physical, psychosocial and spiritual problems that limit the quality of life of the person, their family and their caregivers. The aim of this article is to identify palliative interventions used for the assessment and control of symptoms in people with advanced Parkinson's disease (PD). MATERIALS AND METHODS: A systematic review of the literature was conducted following the steps proposed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was guided by a structured review question and included original studies of patients with advanced PD published in databases such as Medline and Google Scholar between 2010 and 2021. RESULTS: Thirty-one full-text studies were reviewed and 12 were excluded due to not meeting quality criteria. A total of 19 papers were included in this systematic review, which identified 10 clinical tools to assess palliative needs in advanced PD, four pharmacological interventions, and three non-pharmacological interventions focused on reducing motor symptoms, improving quality of life and avoiding the on/off state. One study reported the referral of patients to complementary and device-assisted therapies. CONCLUSION: As part of the palliative approach, a set of tools for identifying symptoms and assessing palliative care needs have been described. Interventions in advanced PD focus on the control of motor and non-motor symptoms so as to reduce the impact of the disease on quality of life.

TITLE: Cuidados paliativos para personas con enfermedad de Parkinson avanzada. Revisión sistemática.Introducción. Los cuidados paliativos hacen referencia al tratamiento dirigido a la identificación precoz e impecable del dolor y otros problemas físicos, psicosociales y espirituales que limitan la calidad de vida de la persona, la familia y sus cuidadores. El objetivo de este artículo es identificar las intervenciones paliativas utilizadas para la valoración y el control de síntomas en personas con enfermedad de Parkinson (EP) avanzada. Materiales y métodos. Se desarrolló una revisión sistémica de la bibliografía aplicando los pasos propuestos por Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se orientó a partir de una pregunta de revisión estructurada y se incluyeron estudios originales de pacientes con EP avanzada publicados en bases de datos como Medline y Google Scholar entre 2010 a 2021. Resultados. Se revisaron 31 estudios en texto completo y se excluyeron 12 estudios por no alcanzar los criterios de calidad. En total, se incluyeron 19 trabajos en esta revisión sistemática, identificando 10 herramientas clínicas para valorar las necesidades paliativas en EP avanzada, cuatro intervenciones farmacológicas, y tres intervenciones no farmacológicas centradas en disminuir síntomas motores, mejorar la calidad de vida y evitar el estado on/off. Un estudio notificó la derivación del paciente a terapias complementarias y asistidas por dispositivos. Conclusión. Como parte del abordaje paliativo se han descrito un conjunto de herramientas para identificar síntomas y valorar necesidades de atención paliativa. Las intervenciones en la EP avanzada se enfocan en el control de los síntomas motores y no motores para disminuir el impacto de la enfermedad sobre la calidad de vida.

Uso de bebidas energizantes y síntomas de insomnio en estudiantes de medicina de una universidad peruana / Use of energy drinks and insomnia symptoms in medical students from a Peruvian university

OBJETIVO: Determinar la asociación entre el consumo de bebidas energizantes y síntomas de insomnio en estudiantes de medicina de una universidad en Lima, Perú. MATERIALES Y MÉTODO: El tipo de estudio realizado es transversal analítico. La población objetivo fueron los estudiantes de medicina de una universidad peruana ubicada en Lima sur de segundo y quinto año. Hubo 289 participantes en el estudio. Se utilizó una encuesta compuesta por un cuestionario sobre el consumo de bebidas energizantes y el Insomnia Severity Index, del cual se determinó un punto de corte de 15 para considerar la presencia de síntomas de insomnio. El análisis multivariado crudo y ajustado se realizó usando la regresión de Poisson con varianza robusta ajustado para sexo, edad, consumo de café, y antecedente de ansiedad y depresión, para obtener el PR (Razón de Prevalencias) con un intervalo de confianza de 95%. RESULTADOS Y DISCUSIÓN: La prevalencia de síntomas de insomnio en la muestra estudiada fue de 21,80%, mientras que la de consumo de bebidas energizantes fue de 39,45%. Se encontró asociación significativa (p=0,008) entre el consumo de este tipo de bebidas y la presencia de síntomas de insomnio. Además, se encontró que los estudiantes que consumen bebidas energizantes tuvieron 1,78 veces más probabilidad de presentar síntomas de insomnio (IC95%: 1,13-2,82), en comparación con los que no consumieron bebidas energizantes (p=0,013). CONCLUSIONES: Existe asociación entre el consumo de bebidas energizantes y síntomas de insomnio.

OBJECTIVE: To determine the association between the consumption of energy drinks and symptoms of insomnia in medical students of a university in Lima, Peru. Materials and METHODS: This study is cross-sectional analytical. The target population was the second-and fifth-year medical students of a private Peruvian university in southern Lima. There were 289 participants in this study. For this study, a survey composed of a questionnaire about the consumption of energy drinks and the Insomnia Severity Index were used, from which a cut-off point of 15 was determined to consider the presence of insomnia symptoms. The multivariate crude and adjusted analysis were done with Poisson regression with robust variance adjusted for sex, age, coffee consumption, previous diagnosis of depression and previous diagnosis of anxiety; to calculate the PR (Prevalence Ratio) with a 95% CI. RESULTS AND DISCUSSION: The prevalence of insomnia symptoms in the sample studied was 21,80%, while the consumption of energy drinks was 39,45%. A significant association was found (p = 0.008) between the consumption of this type of drinks and the presence of insomnia symptoms. In addition, it was found that students who consumed energy drinks were 1,78 times more likely to have symptoms of insomnia (95% CI: 1,13-2,82), compared to those who did not consume energy drinks (p=<0,013). CONCLUSIONS: There is an association between the consumption of energy drinks and symptoms of insomnia.

Influence of Gastrointestinal Flora in the Treatment of Cancer with Immune Checkpoint Inhibitors.

The author declares he has no potential conflicts of interest concerning drugs, pro-ducts, or services used in the study. The Editorial Board declares that the manu-script met the ICMJE recommendation for biomedical papers. Submitted: 4. 10. 2018 Accepted: 14. 10. 2018.

Staging pancreatic carcinoma by computed tomography. / Estadificación mediante tomografía computarizada del carcinoma de páncreas.

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.

Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. / Evaluación de los pacientes candidatos a implante transcatéter de válvula aórtica mediante tomografía computarizada multidetector.

In transcatheter aortic valve implantation (TAVI), a biologic valve mounted in a stent is implanted without removing the native valve. This procedure was first done in humans by Alain Cribier in 2002 and was included in clinical guidelines after the multicenter PARTNER (Placement of AoRtic TraNscathetER) randomized clinical trial, which showed that TAVI obtained better outcomes than conservative medical treatment and is an alternative to surgery in patients with high surgical risk. Candidates for TAVI must be assessed to determine whether the procedure is feasible, because TAVI is not ideal for all patients who are considered inoperable. Multidetector computed tomography plays an important role in the anatomic evaluation of candidates and in guiding the procedure in those who are finally selected.

Breast cancer in the 21st century: from early detection to new therapies. / El cáncer de mama en el siglo XXI: de la detección precoz a los nuevos tratamientos.

The analysis of the causes that have given rise to a change in tendency in the incidence and mortality rates of breast cancer in the last few decades generates important revelations regarding the role of breast screening, the regular application of adjuvant therapies and the change of risk factors. The benefits of early detection have been accompanied by certain adverse effects, even in terms of an excessive number of prophylactic mastectomies. Recently, several updates have been published on the recommendations in breast cancer screening at an international level. On the other hand, the advances in genomics have made it possible to establish a new molecular classification of breast cancer. Our aim is to present an updated overview of the epidemiological situation of breast cancer, as well as some relevant issues from the point of view of diagnosis, such as molecular classification and different strategies for both population-based and opportunistic screening.

Use of Banana (Musa acuminata Colla AAA) Peel Extract as an Antioxidant Source in Orange Juices.

Using banana peel extract as an antioxidant in freshly squeezed orange juices and juices from concentrate was evaluated. Free radical scavenging capacity increased by adding banana peel extracts to both types of orange juice. In addition, remarkable increases in antioxidant capacity using 2,2'-azino-bis-(3-ethylbenzothiazoline)-6-sulfonic acid (ABTS) radical were observed when equal or greater than 5 mg of banana peel extract per ml of freshly squeezed juice was added. No clear effects were observed in the capacity to inhibit lipid peroxidation. Adding 5 mg banana peel extract per ml of orange juice did not substantially modify the physicochemical and sensory characteristics of either type of juice. However, undesirable changes in the sensory characteristics (in-mouth sensations and colour) were detected when equal or greater than 10 mg banana peel extract per ml of orange juice was added. These results confirm that banana peel is a promising natural additive that increases the capacity to scavenge free radicals of orange juice with acceptable sensory and physicochemical characteristics for the consumer.

Diabetes gestacional, hipotiroidismo y concentración urinaria de yodo en embarazadas. Yodurias en escolares en Paraguay: Exceso de yodo en la sal y riesgo de hiper e hipotiroidismo / Gestational diabetes, hypothyroidism and iodine urinary concentration in pregnant women. Urinary iodine in schoolage children in Paraguay: Iodine excess in salt and hyper and hypothyroidism risk

The main inclicator of iodine nutritional status of salt for human con-sumption is the urinary concentration of iodine, which is useful in monitoring universal levels in salt. Paraguay has suffered deficiency in salt with highprevalence of goiter in thepopulation reaching48.6%. In 2000, results of the ThyroidMobileproject in Latin America showed a goiter prevalence of 17% but 79.6% of the consumed iodized salt was adequate in paraguayan households (more than 15 ppm of iodine). The average values of iodine urinary concentration in 4487 scholars was 437 µg/L, 30% of the average value was between the ideal of 100 to 199 µg/L and 46.1% were above 300 mg/L, with risk of excess iodine. Urinary concentration of iodine during pregnancy was measure for the first time in Paraguay in 200 women; the average was 484 µg/L but diabetes and hypothyroidism during pregnancy was observe in 50% of them. Objective: Determine iodine concentration in urine of the school population in 17 departments of the country and measure the levels of iodine in urine in 200 pregnant women from 15-37 years of age and their levels of glycaemia, and thyroid TSH. Methods: During the years, 2006 and 2007 were evaluated 4487 school randomized, in a probabilistic sample, 3198 in rural areas and 1,289 in urban areas; casual urine samples was collected to determine iodine content. The urinary concentration of iodine in two hundredpregnant women, concentration of iodine in salt, and levels of glycaemia and TSH were also included in the present study All candidates agreed with the informed consent under the ethics rules. Results: These data showed by comparing the levels of iodine in urine concentration in more than adequate and excessive level but this last was markedly elevated (93.8%). The median level greater than 300 µg/L was observed in 100% of the 4,487 urine samples, while the median urinary iodine levels of300-500 µg/L was 91.3% and above 500 was 9.7%. These levels showed the risk of developing thyroid autoimmune diseases. In 200 pregnancy women the average of urine concentration of iodine was 498 pcg/L, subclinical and clinical hypothyroidism and gestational diabetes was 50% of both. Conclu-sion: To obtain normal median urinary iodine levels is necessary to decrease the amount of iodine in salt. The main recommendation is to insist on adequate monitoring of iodized salt consumption. Also continue surveillance and monitoring in sentinel sites reporting the importance of adequate iodine intake of the population especially in pregnant women that also need to be warm about the diabetes during pregnancy but also a regimen is necessary to keep them within the normal levels of glycemia. The subclinical hypothyroidism has been also studied in the same patients.

El principal indicador del impacto de la yodación de la sal de consumo humano es la concentración urinaria de yodo la cual es útil en el monitoreo de la sal. En la encuesta del año 1988 realizada en el Paraguay, se alcanzó una prevalencia de bocio de 48,6% en la población escolar con un déficit de yodo en la sal, pero el año 2000 en el estudio del proyecto de Tiroides Móvil, se redujo por el método ecográfico a 17%. Ese mismo año la mediana de los niveles urinarios en niños escolares de 6-12 años fue 258 µg/L, considerando que 30% se encontraba entre el valor ideal de 100 a 199 µg/L y 46,1% sobre 300 µg/L, implicando un riesgo de exceso de yodo en dicha población con las posibles consecuencias de aparición tanto de hipo como de hipertiroidismo. El 93% presentó exceso de yodo en la sal y la mediana urinaria fue 437 ug/ mL. Un grupo de embarazadas han sido estudiadas en el Hospital San Pablo por primera vez en el Paraguay para la determinación de la yoduria, yodo en sal, diabetes gestacional, hipotiroidismo en el embarazo y sus valores antropométricos resultando un hipotiroidismo subclínico del 50% y diabetes gestacional del 50%. Objetivo: Determinar las yodurias en la población escolar de 6-12 años pre púber de ambos sexos en 17 departamentos del país y en una submuestra en embarazadas y también niveles de glicemia en el embarazo en un hospital de Asunción. Sujetos y Métodos: En el periodo del 2006-2007 fueron evaluados 4.487 escolares randomizados, en una muestra probabilística, 3.198 en el área rural y 1.289 en el área urbana con muestras en orina casual. El año 2015, doscientas embarazadas fueron estudiadas con muestras de glicemia en ayunas y 2 horas post prandial, dosaje de TSH, yodo en sal de 100 gramos de la sal de consumo en sus hogares y de orina para ver la concentración de yodo en sal y urinaria de yodo. Todos los candidatos fueron estudiados bajo consentimiento autorizado y de acuerdo a normas éticas. Resultados: Al comparar los niveles de yodo en orina en el nivel más que adecuado y el excesivo de la yoduria se vió que éste último nivel estaba marcadamente elevado (93.8%), que la mediana de los niveles mayores a 300 ug/L era del 100% del total de las 4.487 muestras de orina, mientras que la mediana de los niveles de yoduria entre 300-500 µg/L fue de 91,3% y por encima de 500 fue 9.7% lo cual implicó el riesgo de desarrollar enfermedades tiroideas autoinmunes. Las embarazadas presentaron una mediana urinaria de yodo 484 µg/L, diabetes gestacional e hipotiroidismo subclínico en 50%. Conclusión: Para normalizar los niveles de yoduria, es necesario disminuir la cantidad de yodo en la sal. La recomendación es insistir en el monitoreo de la adecuada yodación de las sales de consumo familiar y continuar con la vigilancia y el monitoreo constante en sitios centinelas divulgando la importancia de la adecuada ingesta de yodo a la población. Un régimen dietético a las embarazadas es necesario implementar en el primer trimestre del embarazo.

Dendritic cell vaccines against non-small cell lung cancer -  an emerging therapeutic alternative.

Many clinical trials have been carried out or are in progress to assess the therapeutic potential of dendritic cell-based vaccines on cancer patients. Herewith, we describe the clinical trials of nonsmall cell lung cancer (NSCLC) published in the literature. Although the number of clinical trials and NSCLC patients enrolled in these studies is small, it is possible to conclude that the administration of dendritic cells (DCs) by any route is safe and that a clinical benefit after their administration can be observed. These initial results encourage continued investigation in clinical trials into the benefit of DCs along with different strategies to enhance their immune response in this deadly disease.

Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico / Lower Urinary Tract Infections in Adults and Pregnant Women: A Consensus for Empirical Treatment

Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido.

Background: Uncomplicated infection of the lower urinary tract and asymptomatic bacteriuria are frequent causes of visits to outpatient clinics and emergency departments in Colombia and worldwide. The lack of guidelines and a consensus for their management, and the emergence of resistance of community-based uropathogens to the available therapeutic options, make it necessary to develop recommendations to guide clinicians on the optimal approach to these entities. Objective: Define a consensus for the empiric management of asymptomatic bacteriuria and Urinary Tract Infection (UTI) in adults and pregnant women in Colombia. Methods: We carried out a consensus methodology with experts in urology, infectious diseases, internal medicine, gynecology and clinical microbiology; based on reviewing the available literature on the related terms, and emphasizing local studies. Results: We developed a management algorithm for the empirical treatment of uncomplicated lower UTI in adults with urinary antiseptics such as nitrofurantoin and fosfomycin trometamol as first line, with specific therapeutic recommendations for the treatment of asymptomatic bacteriuria in pregnant women. Additionally, we created a decision algorithm for processing urine cultures. Frequent recurrence or relapse justifies referral to urology and infectious disease professionals. Conclusions: We generated straightforward and easy-to-implement recommendations for the diagnosis and management of UTI in adults and pregnant women, and in cases where it is necessary to treat asymptomatic bacteriuria, with effective therapeutic and narrow spectrum options.

Diseño y validación de un instrumento para el registro de reacciones adversas a la donación de sangre y sus componentes / Design and validation of a program for the registration of adverse reactions to blood donation and its components", "_i": "

Introducción: La donación de sangre y sus componentes es un procedimiento en el que intervienen elementos internos y externos, los que al interactuar pueden convertirse en factores determinantes para desencadenar una reacción adversa durante la donación; ésta se entiende como un evento inesperado que pone en riesgo la salud del donante. Objetivo: Diseñar y validar un instrumento para registrar las reacciones adversas durante la donación de sangre y sus componentes que apoye la práctica de la enfermería de manera sistemática y ordenada. Material y métodosEstudio no experimental, transversal y prospectivo, en el que se diseñó un instrumento para el registro de reacción adversa durante la donación. Se validó por opinión de expertos de diferentes bancos de sangre de instituciones públicas en el período del 01 de enero al 31 de diciembre de 2011. Para determinar la consistencia interna, se utilizó la prueba de alfa de Cronbach con datos de 60 donantes que presentaron reacción adversa durante la donación durante o después del proceso de extracción de sangre. Resultados: El instrumento diseñado se integra de acuerdo con lo revisado en la literatura y con las observaciones y sugerencias aportadas por los expertos. Para procesar los datos se utilizó el programa SPSS versión 2.0; para calcular la confiabilidad del instrumento se determinó la consistencia del alfa de Cronbach, la cual arrojó un coeficiente de confiabilidad de α = 0.915 con 134 elementos analizados. Conclusiones: Se logra la validación y se cumple el objetivo de contar con un instrumento que permite el registro de reacción adversa durante la donación, apoyando el actuar de enfermería de manera ordenada y sistemática.

Introduction: The donation of blood and blood components is a procedure that involves internal an external elements which may become by interacting, determinans to trigger an adverse reaction during the donation; this is understood to be an unexpected event that threatens donor health. Objective: To design and validate and instrument to record adverse reactions to blood and its components donation in a systematic an orderly way to support nursing practice. Material and methods: Non-experimental, cross-sectional and prospective study in which and instrument was designed to record adverse reactions to donation. The instrument was validate by experts from different public blood banks in the period from January 1 to December 31, 2011. To determine the internal consistency, we used Cronbach’s alpha test with data from 60 donors who present adverse reaction during or after blood extraction procedure. Results: The designed instrument was integrated according to the reviewed literature and the comments and suggestions made be experts. To process the data, we used SPSS software version 2.0; to calculate the reliability of the instrument, we determined the consistency of Cronbach’s alpha, which yielded reliability coefficient of α = 0.915 with 134 elements analyzed. Conclusions: The validation is achieved and meets the objective of having an instrument that enables the recording of adverse reaction to blood and its components donation, thus supporting nursing performance in a systematic and orderly way.

Características clínico-demográficas y tipificación del virus de papiloma humano en mujeres paraguayas con citologías negativas para lesión escamosa intraepitelial / Clinical-demographic characteristics and typification of the human papilloma virus in Paraguayan women with negative citology for squamous intraepithelial lesion

Paraguay posee una alta tasa de incidencia de cáncer de cuello uterino de 35/100.0000 mujeres en el año 2008 y el virus de papiloma humano (HPV) es su agente causal. La planificación de medidas de prevención puede ser beneficiada con conocimientos sobre los tipos virales, por ello, el objetivo de este estudio fue determinar características clínico-demográficas y los tipos de HPV presentes en mujeres con citología negativa para lesión escamosa intraepitelial. Estudio de corte transverso con componente analítico en 207 mujeres con citología negativa para lesión escamosa intraepitelial provenientes de centros de salud de Asunción. La tipificación fue realizada por reacción en cadena de la polimerasa utilizando cebadores MY09/11 y GP5/GP6, seguida de polimorfismo de longitud de fragmentos de restricción e hibridación lineal reversa, respectivamente. La asociación entre HPV y las características clínico-demográficas fue determinada por análisis de Chi cuadrado (EpiInfo versión 3,2). Se detectó alta frecuencia de HPV (21%), siendo el tipo predominante HPV 16 (4,3%) seguido de HPV 58/31 (2,4% cada uno). Se observó asociación entre la presencia de HPV y la edad (p=0,0002), detectándose mayor frecuencia de HPV en mujeres menores a 30 años, la cual, disminuyó al aumentar la edad, presentando un ligero aumento en mujeres de 60 años o más. En conclusión, los datos muestran una alta frecuencia de HPV y HPV 16 en mujeres menores a 30 años con citología negativa y sugieren la necesidad de realizar control posteriormente, a fin de identificar las infecciones persistentes que podrían causar lesión de cuello uterino

First Confirmed Report of Sugar Beet Cyst Nematode, Heterodera schachtii, in North Dakota.

Sugar beet (Beta vulgaris L.) and canola (Brassica napus L.) are major crops in North Dakota, with sugar beet production primarily in the eastern part of the state in the Red River Valley and canola production across the northern half of the state. Both crops are hosts of sugar beet cyst nematode (SBCN), Heterodera schachtii Schmidt. In April 2011, soil samples were collected from four sugar beet fields belonging to three growers who believed the fields were infested with SBCN. The fields were located in a 65-km2 area in the Yellowstone Valley of western North Dakota. Cysts were extracted by sieving and Heterodera-like cysts with eggs were observed in all four soil samples. Population densities in the four fields ranged from 100 to 1,750 eggs/100 cm3 soil. Sugar beet seedlings (cv. M832224) were grown in a potting mix for 6 weeks in the greenhouse and then transferred to conetainers (type D40; volume 656 ml) containing autoclaved river sand. Conetainers were placed in sand in plastic pots immersed in a water bath at 27°C. Three plants were each infested with 800 eggs from field No. 2. After 55 days of incubation, the average number of females was 115 per plant. A similar experiment was conducted with canola cvs. Hyclass 940, Caliber 30, and Westar, which were inoculated with 500 eggs each from field No. 2. After 53 days of incubation, there was an average of 39, 20, and 30 females for each respective cultivar. Flask-shaped cysts (n = 26) from canola roots were light to dark brown; the vulval cone was ambifinestrate with dark brown, molar-shaped bullae positioned underneath the vulval bridge. Body length (excluding neck) ranged from 600 to 850 µm (mean 701.2 µm); body width, 350 to 580 µm (mean 469.2 µm); and length/width ratio, 1.2 to 1.8 (mean 1.5). Second-stage juvenile (J2) (n = 21) body length ranged from 400 to 485 µm (mean 437.1 µm); stylet length was 25 µm (no variation) with forwardly directed knobs; conical tail with rounded tip ranged from 37.5 to 55.0 µm long (mean 46.6 µm) with hyaline region from 20.0 to 32.5 µm (mean 27.3 µm); and lateral field presented four incisures. These morphometrics were used to identify H. schachtii according to Subbotin et al. (4). Confirmation of identification was by amplification and sequencing of a 28S rDNA gene fragment (1) from individual females (GenBank Accession No. JQ040526), which was 100% identical to H. schachtii 28S rDNA sequence (GenBank Accession No. GU475088). To our knowledge, this is the first confirmed report of H. schachtii in North Dakota. A 1958 report of SBCN in North Dakota (2) was not subsequently confirmed (3). Because there is extensive canola production across the northern part of the state bordering western and eastern sugar beet- production areas, canola may serve as a bridge for movement of SBCN from west to east. SBCN is a potential threat to these two important crops. References: (1) A. Amiri et al. Eur. J. Plant Pathol. 108:497, 2002. (2) F. Caveness. J. Sugar Beet Res. 10:544, 1958. (3) P. Donald and R. Hosford. Plant Dis. 64:45, 1980. (4) S. A. Subbotin et al. Systematics of Cyst Nematodes (Nematoda: Heteroderinae). Nematology Monographs and Perspectives. Vol. 8B. Brill, The Netherlands. 2010.

EVALUACIÓN DEL POLICULTIVO DE BOCACHICO Prochilodus magdalenae Y TILAPIA Oreochromis niloticus UTILIZANDO SUPERFICIES FIJADORAS DE PERIFITON: EVALUATION OF THE POLYCULTURE OF BOCAChICO Prochilodus magdalenae AND TILAPIA Oreochromis niloticus USING PERIPHYTON FIXING SURFACES

La piscicultura es una actividad importante para satisfacer la demanda alimenticia de una población en crecimiento y en su práctica es necesario desarrollar tecnologías responsables con el ambiente. El policultivo de tilapia-bocachico es relevante por la importancia de estas especies a nivel nacional; tilapia por sus características zootécnicas, y bocachico por su hábito alimentario detritívoro-iliófago, recientemente visto como un pez ecológico. El cultivo basado en perifiton permitiría un sistema altamente eficiente y más limpio, pues aporta alimento natural a los peces y mejora la calidad del agua. Para evaluar el efecto del perifiton sobre el desempeño del policultivo tilapia-bocachico, se ejecutó un experimento durante ocho meses en 18 estanques de 90 m², con 2,6 tilapias/m² y 0,7 bocachicos/m², sin fertilización; como sustrato para perifiton se instalaron de forma vertical tubos plásticos (3,3 tubos/m²), que se constituyeron en una variable por evaluar. Adicionalmente, tres estrategias alimentarias fueron evaluadas: 0 (sin alimento), alimentación con ración del 20% de proteína bruta (PB) y alimentación con ración del 25% de PB. Se utilizó un diseño factorial 2x3 en bloques completos al azar con tres repeticiones por tratamiento y se analizaron datos productivos mediante ANOVA con un modelo lineal general (P < 0,05). No fueron encontrados efectos del sustrato sobre los parámetros estudiados. Hubo efectos simples de la estrategia alimentaria sobre el desempeño de los peces. Por lo pronto, puede ser concluido que la producción basada en perifiton no genera problemas en el sistema ni en los peces y que se requiere más investigación para consolidar la tecnología.

Fishculture is very important to satisfy human food demand. However, the ignorance in more efficient and environment-friendly systems is a big problem for fish farming activities. Tilapia-Bocachico polyculture is of great interest; tilapia, for the excellent productive characteristics, and bocachico for being a bottom-feeder specie, beside of the great socio-cultural value in this region. An alternative approach is the adoption of periphyton-based pond systems; periphyton can: be a food source for fish and improve water quality, thus becoming into a highly efficient and cleaner system. With the aim to evaluate the periphyton effects on performance of Tilapia-Bocachico polyculture, a trial was carried out for 8 months. Eighteen 90 m² earthen ponds were used under polyculture conditions at low stocking density (2.6 tilapia/m², 0.7 bocachico/m²). These ponds were not fertilized during the experimental period. Plastic tubes of 1.2 m and 6 cm in diameter were used vertically as periphyton substrate at 3.3 tubes/m² rate. Three alimentary strategies were used: 0 (without food), fish feed (20% protein) and fish feed (25% protein); thereby constituting a factorial experiment 2x3 in a randomized complete block with three replications per treatment. They were analyzed using ANOVA with a general linear model (GLM) (p < 0.05). There were no effects of substrates on the study variables, but simple effects of alimentary strategies on the productive parameters. Other parameters are being analyzed and it is still premature to conclude.

Phase 0 clinical trials will overcome stagnation of anticancer drug development?

Recent guidance from the US Food and Drug Administration supports the conduct of a new type of exploratory clinical trials, commonly called phase 0 clinical trials, on the development of innovative anticancer agents, particularly targeted agents. Phase 0 clinical trials are controversial mainly because of the lack of clinical benefit to the participant patients. However, it was recognized that Phase 0 clinical trials can provide a platform to assessing the biological effects on the targets in tumoral human samples, evaluate biomarkers for drug effects and to generate essential human pharmacokinetics and pharmacodynamics data earlier in the drug development. It is expected that such trials will became a routine part of early-phase oncological drug development in the future.

Diagnóstico prenatal del complejo agnatia holoprosencefalia / Prenatal diagnosis of the agnathia-holoprosencephaly complex

El complejo agnatia holoprosencefalia o complejo disgnatia constituye un grupo de malformaciones severas que compromete el desarrollo del sistema nervioso central y de los arcos branquiales; casi siempre es incompatible con la vida y su extrema complejidad puede explicar su baja frecuencia, 1:100.000 neonatos.Primer caso reportado en la literatura paraguaya, gestante de 16 años, no exposición a teratógenos, remita al servicio. La ecografía informó polihidramnios, orbita ocular única, implantación baja de orejas bilateral y ausencia de cavidades bucal y nasal. Cariotipo 46XY. Nació por cesárea producto vivo, que fallece a los 15 minutos, presenta microcefalia, fontanelas cerradas, ciclopía, implantación baja de orejas, agenesia naso-bucal con esbozo único por debajo de la cavidad orbitaria con orificio permeable. Estudio radiológico: agenesia del maxilar inferior, con hipoplasia del maxilar superior. Autopsia: Holoprosencefalia alobar; ciclopía, sinoftalmia, sinotia, arhinia, agnatia; cardiopatía, pulmones hipoplásicos; criptorquidia bilateral; hipoplasia gástrica; y cordón umbilical con dos luces vasculares. La holoprosencefalia y ciclopía deben ser sospechadas durante la ecografía obstétrica de rutina y realizar ecografía detallada para corroborar diagnóstico y buscar otros defectos asociados. Es obligatoria la indicación de cariotipo fetal. Se recomienda el seguimiento obstétrico normal en los embarazos posteriores que continúan. No existen intervenciones fetales que cambien el pronóstico de los fetos con esta patología.

The agnathia-holoprosencephaly complex or disgnatia complex constitutes a group of severe malformations that compromises the development of the central nervous system and the branchial archs its low frequency, 1:100,000 neonates. This is the first case report in the Paraguayan literature, pregnant girl of 16 years old, no exposure to teratogens, remitted to the service. The ultrasound scan revealed polyhydramnios, single eye socket, low positioned ears and absence of oral and nasal cavities. Kariotype: 46XY. By C-section a baby was born alive but died at 15 minutes, presented microcefalia, closed fontanels, cyclopia, low positioned ears, oral-nasal agenesis with a single sketch below the eye socket with a permeable orifice. X-ray examination: agenesia del maxilar inferior, con hipoplasia del maxilar superior. Autopsy: alobar holoprosencephaly; cyclopia, synophtalmia, sinotia, arhinia, agnatia; cardiopathy, hypoplastic lungs; bilateral cryptorchidism; gastric hypoplasia and umbilical cord with two vessels. The holoprosencephaly and cyclopia should be suspected during the routine obstetric ultrasound and a detailed ultrasound should be performed to corroborate diagnosis and look for another associated defects. The indication of fetal karyotype is obligatory. The normal obstetric follow-up is recommended for the following pregnancies. There are not fetal interventions that change the prognosis of fetuses with this pathology.

Distribution of human papillomavirus genotypes in Paraguayan women according to the severity of the cervical lesion.

The incidence of cervical cancer in Paraguay is among the highest in the world. This study aimed to determine the distribution of human papillomavirus (HPV) genotypes in Paraguayan women, according to the severity of the cervical lesion. This cross-sectional study included 207 women without a squamous intraepithelial lesion, 164 with low-grade squamous intraepithelial lesions, 74 with high-grade squamous intraepithelial lesions, and 41 with cervical cancer. Type-specific HPV was determined by the polymerase chain reaction with MY9/11 L1 and GP5+/GP6+ L1 primers, followed by restriction fragment length polymorphism and reverse line blotting hybridization, respectively. In total, 12 high-risk and 24 low-risk HPVs types were detected. HPV 16 was the most prevalent, followed by HPV 18 in cervical cancer (14.6%), HPV 31 in high-grade squamous intraepithelial lesions (14.9%), HPVs 58/42 in low-grade squamous intraepithelial lesions (9.1% each), and HPVs 31/58 (2.4% each) in women without squamous intraepithelial lesions. Among 285 positive samples, 24.2% harbored multiple HPV types, being this more prevalent in women with squamous intraepithelial lesions (30.8% in low-grade squamous intraepithelial lesions, 22.5% in high-grade squamous intraepithelial lesions, and 22.0% in cervical cancer) than in women without lesions (9.3%). The higher prevalence of HPV 16 and other high-risk HPVs in women both with and without cervical lesions may explain the high incidence of cervical cancer in Paraguay. This information may be of importance for local decision makers to improve prevention strategies. In addition, these results may be useful as baseline pre-vaccination data for a future virological surveillance in Paraguay.