Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4 % de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alérgenos inhalados, responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore, it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4% de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alergenos inhalados responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Folliculotropic Mycosis Fungoides in a Latin American Hospital: Survival Analysis. / Análisis de supervivencia en pacientes con micosis fungoide foliculotropa de un centro latinoamericano.

INTRODUCTION: Folliculotropic mycosis fungoides is a variant that has poor prognosis and a variable clinical presentation. Concerns have been expressed that the current TNMB staging of this tumor may not be useful. A recently developed classification system based on clinical and histologic variables classifies this tumor as early or advanced, a distinction found to correlate with prognosis. The aim of this study was to compare survival in FMF in Colombia between patients with early versus advanced tumors. MATERIAL AND METHODS: Retrospective, observational study of clinical course and outcomes in patients with FMF treated at the National Cancer Institute of Colombia between 2008 and 2020. Survival was compared between early and advanced disease. RESULTS: Twenty-one patients (11 with early FMF and 10 with advanced FMF) were studied. Seven patients, all with advanced disease, died. Survival at 5 years was 62% overall and 40% for patients with advanced FMF. No differences were observed when survival was analyzed according to TNMB stage. CONCLUSIONS: TNMB staging is not useful in FMF. The new classification system based on clinicopathologic features appears to provide reliable information for assessing prognosis and guiding treatment decisions.

Cochlear morphometry in healthy ears of a mexican population: A comparison of measurement techniques.

OBJECTIVE: This study describes the cochlear morphometry of a mexican population analysed by laterality and sex. The objective is to compare Cochlear Length (CL) evaluation between Alexiades et al. formula and manual method described by Würfel et al. PATIENTS: Hispanic patients from Mexico, with an age of 18 years or older, were included. Morphometric examination was performed retrospectively on 200 subjects who underwent previously temporal bone imaging for clinical purposes. MATERIALS AND METHODS: Horos for Mac program was used to measure CL, cochlear height, distance A, and distance B. WorkStation AW Volume Share 2 was used to obtain volume. CL was measured in 400 temporal bones (228 females, 172 males). RESULTS: The mean CL was 34.02mm±2.15mm. A significant difference was found in all variables between sex (P=≤0.05) and laterality (P=≤0.05). The Alexiades equation was used for determining CL and compared with the manual formula, with no significant differences (κ=0.71). However, the time consumption was 5 times faster with the calculated method. The Alexiades formula was demonstrated to be a reliable method measurement. CONCLUSION: Preoperative Computed Tomography evaluation of the internal ear helps to plan the Cochlear Implants (CI) surgical approach and allows to choose an appropriate electrode length for each necessity. Our findings may be useful to facilitate and adapt preoperative management of CI surgery by considering the characteristics of cochlear morphology of Latin-American populations.

Effect of cholesterol on the hydration properties of ester and ether lipid membrane interphases.

Fluorescence spectroscopy and Molecular Dynamics results show that cholesterol reduces water along the chains in ether lipids by changing the water distribution pattern between tightly and loosely bound water molecules. Water distribution was followed by emission spectra and generalized polarization of 6-dodecanoyl-2-dimethyl aminonaphthalene (Laurdan) inserted in 1,2-dimiristoyl-sn-glycero-3-phosphocholine (DMPC) and 1,2-di-O-tetradecyl-sn-glycero-3-phosphocholine (14: 0 Diether PC) membranes. Molecular Dynamics simulations indicate that the action of cholesterol could be different in ether PC in comparison to ester PC. In addition, Cholesterol seems to act "per se" as an additional hydration center in ether lipids. Regardless of the phase state, cholesterol both in DMPC and 14:0 Diether PC vesicles, changed the distribution of water molecules decreasing the dipole relaxation of the lipid interphase generating an increase in the non-relaxable population. Above 10% Cholesterol/14:0 Diether PC ratio vesicles' interphase present an environment around Laurdan molecules similar to that corresponding to ester PC.

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren.

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

El acto médico en la era de la telemedicina / The medical act in the era of telemedicine

Telemedicine partially resolved inequalities in access to health care, especially in geographical areas with a low number of doctors and in places with absent or insufficient specialists. Currently, Chile has a National Telehealth Program, but there are no specific laws on digital medicine that recognize remote medical acts and it is uncertain if they really are medical acts. The goal of a medical act is the well-being of a patient, requiring a therapeutic alliance based on the doctor's knowledge of the needs, expectations and fears of such a patient. This article tries to determine if patient care by telemedicine can be considered a medical act. For this purpose, the conception of a medical act defined by P. Laín Entralgo, M. Besio and the main medical and professional associations is analyzed in depth. It is concluded that although direct physical contact between doctor and patient largely supports the therapeutic alliance, telemedicine has been successful, particularly in its synchronous modality. Taking the necessary precautions, in most cases distant medical acts can be carried out allowing a humanized and respectful care of people.

Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease. / Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert.

BACKGROUND AND OBJECTIVES: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. MATERIAL AND METHODS: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. RECOMMENDATIONS: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. CONCLUSION: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.

Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center.

BACKGROUND: Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. METHODS: A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. RESULTS: A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. CONCLUSIONS: Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with less bleeding, and no difference in the number of complications. This procedure lowers costs by decreasing the duration of the hospital stay, making is feasible to perform it at any institution with appropriately trained personnel.

Search for antibodies to Taenia solium cysticerci in paediatric patients with seizures.

Neurocysticercosis is a leading cause of seizures in adults, but in paediatric patients, the diagnosis is controversial. The aim of this study was to search for antibodies to Taenia solium cysticerci in paediatric patients with seizures. We retrospectively studied a cohort of 41 serum samples from paediatric patients and 40 serum samples from healthy children. Antibodies were analysed by ELISA (vesicular fluid) and by Western blot (glycoproteins). Clinical, image and socio-demographic data were obtained from the medical records. The frequency of positive by ELISA was of 12% (n=5) in patients with seizures, while no positive samples were found in the healthy group. Results of Western blot were negatives. The analysis of the medical records showed a cyst of unknown origin in 2/5 ELISA positive samples. According to the diagnostic criteria for neurocysticercosis, three minor criteria (positive serology, active seizures and compatible image) were associated to an epidemiological condition (Mexico is endemic for neurocysticercosis); thus, the probable frequency of neurocysticercosis in the studied sample of patients with seizures was 4.9% (2/41 patients). The three remaining positive samples were associated with problems of noninfectious origin. The positivity was associated with the identification of cysts by magnetic resonance imaging (p = 0.047; chi-square), but found no association with the socio-economic characteristics of the patients, family history or to clinical symptoms. In conclusion, scarce frequency of antibodies to T. solium cysticerci was determined in paediatric patients with seizures. The low prevalence of antibodies detected in children is an indirect indicator of the interruption of T. solium transmission. Further studies are needed to design an algorithm for the conclusive diagnosis of seizures.

Predições da espectroscopia no infravermelho próximo podem determinar a digestibilidade e o consumo alimentar de cordeiros confinados / Near-IR spectroscopy predictions can determine the digestibility and feed intake from feedlot lambs

O presente trabalho teve como objetivo validar a eficácia do método de espectroscopia de reflectância do infravermelho proximal (NIRS) em predizer o consumo e a digestibilidade da MS e nutrientes de dietas para cordeiros confinados, em comparação ao método convencional de laboratório. Amostras das dietas fornecidas, sobras e fezes de 40 cordeiros Santa Inês foram submetidas a ambos os métodos e analisadas quanto aos teores de MS, MM, FDN, FDA, PB e EE, para futuros cálculos do consumo e da digestibilidade. A maioria dos coeficientes de correlação do modelo ficou na faixa de 0,66 a 0,81, mostrando-se adequados para a predição quantitativa. Os maiores coeficientes foram observados para teores de PB das dietas (0,85) e sobras (0,87). Foram encontradas altas correlações entre os métodos na predição do consumo (média de 0,93) e digestibilidade (média de 0,90) das dietas. As correlações entre as variáveis obtidas pela predição do NIRS e pelo método convencional foram adequadas, demonstrando que, independentemente do método, os teores nutricionais das dietas, das sobras e das fezes podem ser utilizados para calcular o consumo e a digestibilidade da MS e dos nutrientes das dietas para cordeiros confinados, sendo recomendado o método NIRS pela precisão, pela rapidez e pelo baixo custo em relação ao método convencional.(AU)

This research was carried out to validate the effectiveness of the Near-IR spectroscopy method in predicting intake and digestibility of DM and nutrients of diets for feedlot lambs, in order to compare with the conventional laboratory method. Samples of diets, ort,s and feces of forty Santa Ines lambs were subjected to both methods and analyzed for DM, MM, NDF, ADF, CP, and EE for future calculations for intake and digestibility. Most of the model's correlation coefficient was in the range of 0.66 to 0.81, being suitable for quantitative prediction. Highest values for CP content of 0.85 (diets) and 0.87 (orts) were observed. There were high correlations between the methods to predicting intake (average values of 0.93) and digestibility (average values of 0.93). Correlations between the variables obtained by the prediction of NIRS and the conventional method were adequate, showing that regardless of the method, the nutritional content of diets, orts and feces can be used to calculate the intake and digestibility of DM and nutrients of lambs' diets. The Near-IR spectroscopy method is recommended for accuracy, speed and low cost compared to conventional method.(AU)

Glicerina na alimentação de cordeiros terminados em confinamento: características quantitativas da carcaça e qualitativas da carne / Glycerin in feeding of lambs finished in feedlot: quantitative characteristics of carcass and qualitative characteristics of meat

O presente trabalho foi conduzido com o objetivo de avaliar a ausência e a inclusão de glicerina na dieta de cordeiros terminados em confinamento, sobre as características da carcaça e a qualidade da carne no músculo semimembranosus. Foram utilizados 40 cordeiros machos, não castrados, da raça ½ Dorper ½ Santa Inês, desmamados com idade média de 90 dias e peso médio inicial de 21+2,3kg. Os tratamentos constituíram-se de duas dietas: G0 - ausência de glicerina e G10 - inclusão de 10% de glicerina na MS. O delineamento experimental utilizado foi o inteiramente ao acaso, com dois tratamentos e 20 repetições. Observou-se efeito para peso de abate (P=0,041) e rendimento de carcaça fria (P=0,019) entre os tratamentos. Conclui-se que os cordeiros alimentados com a inclusão de glicerina (inclusão de 10% de glicerina na MS) apresentaram melhor rendimento de carcaça fria e menor peso de abate, sem que fossem alteradas as demais características estudadas.(AU)

This study was conducted to evaluate absence and the inclusion of glycerin in the diet of feedlot finished lambs on carcass characteristics and meat quality in the semimembranosus muscle. Forty males of the breed ½ Dorper ½ Santa Inês weaned with average age of 90 days and average weight of 21+2.3kg were included. The treatments consisted of two diets: G0 - absence of glycerin and G10 - inclusion of 10% glycerol. The experimental design was completely randomized, with two treatments and 20 repetitions. There was effect to slaughter weight (P=0.041) and cold carcass yield (P=0.019) between treatments. We conclude that the lambs fed the inclusion of glycerin (10%) showed better cold carcass yield and lower slaughter weight without changing the other characteristics studied.(AU)

Análisis estadístico de los espectros de frecuencia de las regiones reguladoras del ENCODE / Statistical analysis of the Fourier Spectra of the ENCODE regulatory regions

RESUMEN En la actualidad, nuevas bases de datos genómicos (secuencias de ADN) son puestas al alcance del dominio público para su análisis. La bioinformática ha desarrollado algoritmos para extraer información y características de dichas secuencias. Sin embargo, estos algoritmos bioinformáticos tienen limitaciones. Una alternativa es utilizar herramientas propias del procesamiento digital de señales (DSP) adaptadas a secuencias genómicas (procesamiento de señales genómicas - GSP). El presente trabajo versa sobre el análisis de los cuatro primeros momentos centrales (media, desviación estándar, asimetría y curtosis) y dos momentos estadísticos (mediana y varianza) de los espectros frecuenciales de las 15 Regiones Reguladoras (RRs) de la base de datos ENCODE con el objetivo de estudiar diferencias estadísticas y frecuencias características. La base de datos seleccionada es "mapeada". Luego, la FFT es calculada a estas señales genómicas y finalmente los momentos estadísticos son implementados. Los resultados mues tran la existencia de 3 grupos de RRs utilizando la media, mediana y curtosis. La desviación estándar y la varianza, parecen no resaltar información importante. Finalmente, la asimetría revela un comportamiento homogéneo ante la presencia de valores atípicos en algunas RRs. Estas observaciones permiten inferir que la periodicidad dentro de la secuencia está relacionada o podría determinar la función biológica que desempeña la misma secuencia.

ABSTRACT Nowadays, new genomic databases (DNA sequences) are available to the whole scientist community for its analysis. The bioinformatics has developed algorithms to extract information and features of the sequences. However, the bioinformatics algorithms have restrictions. An alternative is the use of digital signal processing (DSP) tools adapted to genomic sequences (genomic signal processing - GSP). This work analyzes the first four statistics moments (mean, standard deviation, skewness and kurtosis) and other two moments (median and variance) of the frequency spectra of 15 regulatory regions (RRs) in ENCODE database with the main objective of studying the statistics di fferences and frequency features. The selected database is mapped. Then, the FFT is calculated to these genomic signals and finally the statistic moments implemented. The results show a three-group behavior in the RRs with the mean, median and kurtosis. The deviations standard and the variance do not show important behavior. Finally, the skewness shows a homogeneous behavior with the lack of atypical values in some RRs. These observations support the idea of the presence of periodicities in a sequence that may be related or may determine the biological function that a sequence may perform.

Desarrollo de una herramienta computacional para el análisis de conductancia galvánica de la piel, ECG y frecuencia respiratoria por arritmia sinusal respiratoria (SCRATER) / Development of a computational tool for the analysis of galvanic skin conductance, EKG and respiratory rate due to respiratory sinus arrhythmia (SCRATER)

Resumen: La existencia de una correlación entre la frecuencia cardíaca (FC), la frecuencia respiratoria (FR) y las respuestas electrodérmicas de la piel (Skin Conductance Response, SCR) ha sido reportada en la literatura, así como también el uso de estos parámetros como medida del nivel de activación del sistema nervioso autónomo. Objetivo: Este trabajo presenta una herramienta (SCRATER) para el análisis conjunto de SCR, FC y FR, las dos últimas, calculadas a partir del análisis del registro de electrocardiograma (ECG). Metodología: En esta investigación, se realizó una descripción detallada de cada algoritmo desarrollado, asi como una una descripción de la interfaz para utilizarlos. En la validación de los algoritmos empleados, se analizaron 192 registros de ECG y 231 registros de actividad electrodérmica (Electro-Dermal Activity, EDA) de 40 participantes masculinos sanos, de los cuales se calculó el número de complejos QRS y FC en cada registro de ECG y el número de SCRs de cada registro de EDA. Resultados: Los datos obtenidos fueron comparados con otras herramientas que analizan SCR y FC pero de manera independiente, obteniendo resultados equiparables mediante coeficientes de correlación. Limitaciones: El ruido y los artefactos presentes en los registros no permiten una correcta estimación de los parámetros y afectan los resultados de todas las herramientas empleadas en el desarrollo de este trabajo. Valor: SCRATER ofrece tres ventajas principales sobre las otras herramientas: 1) libre acceso, 2) código abierto y no utiliza formatos codificados o exclusivos. Conclusión: Este trabajo proporciona una herramienta computacional gratuita que permite analizar simultáneamente SCRs, FC y FR.

Abstract: The existence of a correlation between heart rate (HR), respiratory rate (RR) and skin conductance response (SCR) has been reported in the literature, as well as the use of these parameters as a measure of the activation level of the autonomous nervous system. Objective: This paper introduces a computational tool (SCRATER) developed with the aim to analyze simultaneous recordings of SCR, and heart and respiratory rates, which were calculated from the electrocardiogram recording (ECG) analysis. Methodology: In this research, a detailed description of each developed algorithm was made, as well as a description of the interface to be used. In the validation of the algorithms used, 192 ECG records and 231 Electro-Dermal Activity (EDA) registers of 40 healthy male participants were analyzed, from which the number of QRS complexes and HR in each ECG record and the number of SCRs of each EDA record are calculated. Results: The data obtained were compared with other tools that analyze SCR and HR separately, obtaining comparable results using correlation coefficients. Limitations: The noise and artifacts present in the records do not allow a correct estimation of the parameters and affect the results of all the tools used in the development of this work. Value: SCRATER offers three main advantages over other tools: 1) free access, 2) open source and 3) does not use coded or exclusive formats. Conclusion: This work provides a free computational tool that allows simultaneous analysis of SCRs, FC and FR.

Glicerina bruta associada à ureia na terminação de bovinos: consumo, desempenho e características da carne / Glycerin associated with urea in finishing beef cattle: performance and meat characteristics

Objetivou-se nesta pesquisa avaliar os efeitos da combinação de glicerina bruta e ureia sobre o consumo, o desempenho produtivo e as características da carne de bovinos da raça Nelore. O estudo foi conduzido no confinamento do Setor de Digestibilidade, pertencente à Faculdade de Ciências Agrárias e Veterinárias-FCAV/Unesp, Câmpus de Jaboticabal. Para tal, 28 novilhas, da raça Nelore (n=28, com aproximadamente 20 meses de idade, 278±5,6kg), foram aleatoriamente distribuídas em quatro tratamentos utilizando-se de delineamento inteiramente ao acaso. Quatro dietas com energia metabolizável e proteína bruta semelhantes foram formuladas utilizando-se a proporção volumoso:concentrado de 30:70. O volumoso empregado foi silagem de milho, e os concentrados foram compostos por milho grão moído, casca de soja, farelo de girassol, e a utilização ou não de acordo com o tratamento de glicerina e ureia. A introdução da glicerina e da ureia na dieta foi fixada, respectivamente, em 10 e 1% de inclusão na matéria seca da dieta. Os tratamentos foram: C = controle sem glicerina e ureia; U= 1% de ureia na matéria seca; G10= 10% de glicerina na matéria seca; GU10= 10% de glicerina e 1% de ureia na matéria seca. A introdução de 10% de glicerina bruta, com ou sem a presença de ureia, não modificou o consumo, tampouco nenhuma variável do desempenho produtivo (P>0,05). As características físico-químicas da carne, bem como o perfil de ácidos graxos, também não foram modificadas. O desempenho dos animais e as características da carne foram satisfatórios e dentro dos padrões esperados encontrados na literatura. Assim, a associação de glicerina com ureia pode ser uma estratégia viável em sistemas de produção de bovinos confinados.(AU)

The aim of this research was to investigate the effect of glycerol with urea, on the consumption and nutritional performance of Nelore cattle. The work was conducted within the confines of the digestibility sector, belonging to the Faculdade de Ciências Agrárias e Veterinária - FCAV/Unesp campus Jaboticabal. Heifers, Nellore, with approximately 20 months of age with an average body weight of 278kg were allotted to four treatments using a completely randomized design. Four diets with similar metabolizable energy and crude protein were formulated using the forage: concentrate ratio of 30:70. The roughage used was corn silage. The concentrates used were composed of corn, soybean hulls, sunflower meal, and the use or not of glycerin and urea in accordance with the treatment. The introduction of glycerin and urea in the diet was fixed respectively at 10 and 1% inclusion in the diet dry matter, based on recommendations found in the literature for cattle confinados. The treatments were: C = control without glycerin and urea, U = 1 % urea in dry matter; G10 = 10% glycerin dry matter; GU10 = 10% glycerin and 1 % urea in dry matter. The diets were not different ( P>0.05 ) in regards to performance of animals or meat characteristics, so the use of glycerin or glycerine association with urea did not alter the growth traits of Nelore heifers finished in confinement. Thus the association of glycerol with urea may be a viable strategy in the production of cattle feedlot systems.(AU)

Aspectos éticos en la donación de órganos, más allá de sólo generosidad / Ethical aspects in organ donation, beyond generosity

Organ donation for transplantation raises ethical dilemmas which demand a response from an anthropological vision respectful of the human person and his dignity. The ethical principles that should be respected primarily are: the defense of physical life, self-determination and non-instrumentalization of human beings. The act of donation is essentially altruistic and, as such, cannot be mandatory; consent process shall be ethically valid if it contains sufficient information and if is signed by a competent person, free of coercion. In the case of living donors, the act shall be lawful if there is an adequate relationship between the risks for the donor and the expected benefits for the recipient. Deceased organ donation occurs in two circumstances, when death is certified by neurological criteria (brain death) or by cardiovascular criterion (circulatory death); the latter usually occurs in critically ill patients in whom it has been decided to limit the therapeutic effort withdrawing life support measures. In decision-making at the end of life, physicians should always pursue the good of the patient, regardless of their status as potential donor; also, the medical team must have reasonable certainty that death has occurred when removing the organs. The person must always be treated as an end in itself and never as a mere means for obtaining other purposes, however laudable they may be.

La donación de órganos para trasplantes plantea dilemas éticos cuya respuesta demanda una visión antropológica respetuosa de la persona humana y su dignidad. Los principios éticos que deberían respetarse primariamente son: la defensa de la vida física, la autodeterminación y la no-instrumentalización del ser humano. El acto de donación es esencialmente altruista y, como tal, no puede ser obligatorio; el proceso de consentimiento será éticamente válido si es informado, suscrito por una persona competente y libre de coacción o coerción. En el caso del donante vivo, el acto será lícito en la medida que exista una relación adecuada entre los riesgos a que se somete el donante y los beneficios esperados para el receptor. La donación de órganos por alguien ya fallecido ocurre en dos circunstancias, según si la muerte se certifica mediante criterio neurológico (muerte encefálica) o por criterio cardiovascular (muerte circulatoria o en asistolía); este último caso ocurre habitualmente en pacientes críticos en quienes se ha decidido limitar el esfuerzo terapéutico suspendiendo medidas de soporte vital. Un correcto actuar médico siempre debe privilegiar el bien del paciente en la toma de decisiones al final de la vida, con independencia de su condición de potencial donante; asimismo, el equipo médico debe tener razonable certeza que la muerte ya ha ocurrido al momento de extraer los órganos. La persona debe ser tratada siempre como un fin en sí misma y nunca como mero medio para la obtención de otros fines, por muy loables que éstos sean.

Synthetic peptides for the immunodiagnosis of hepatitis A virus infection.

VP1, VP2 and VP3 molecules of hepatitis A virus are exposed capsid proteins that have shown to be antigenic and are used for diagnosis in recombinant-antigen commercial kits. In this study, we developed a sequence analysis in order to predict diagnostic peptide epitopes, followed by their spot synthesis on functionalized cellulose paper (Pepscan). This paper with synthetic peptides was tested against a sera pool of hepatitis A patients. Two peptide sequences, that have shown an antigenic recognition, were selected for greater scale synthesis on resin. A dimeric form of one of these peptides (IMT-1996), located in the C-Terminus region of protein VP1, was antigenic with a recognition frequency of 87-100% of anti-IgG antibodies and 100% of anti-IgM antibodies employing the immunological assays MABA and ELISA. We propose peptide IMT-1996, with less than twenty residues, as a cheaper alternative for prevalence studies and diagnosis of hepatitis A infection.

Green Tobacco Sickness among Thai Traditional Tobacco Farmers, Thailand.

BACKGROUND: Traditional Thai tobacco (Nicotiana abacus L.) is known as a non-Virginia type whose mature leaf contains three to four times more nicotine than that of a Virginia type. As such, the process of Thai traditional tobacco production may lead to adverse health effects such as green tobacco sickness (GTS). OBJECTIVE: To investigate the prevalence of GTS and risk factors related to GTS among Thai traditional tobacco farmers in Nan province, northern Thailand. METHODS: 473 Thai traditional tobacco farmers from rural areas in Nan province were randomly selected and interviewed in person by means of questionnaires and environmental survey. Statistical analyses were used to identify potential risk factors for GTS. RESULTS: The prevalence of GTS was 22.6% (95% CI 19.1% to 26.6%). Multivariate analysis showed various risk factors associated with GTS including gender of the farmer (ORadj 0.44, 95% CI 0.26 to 0.73), smoking (ORadj 4.36, 95% CI 1.41 to 13.47), skin rash (ORadj 0.36, 95% CI 0.19 to 0.68), wearing a wet suit (ORadj 1.91, 95% CI 1.12 to 3.23), process of curing tobacco leaves (ORadj 0.06, 95% CI 0.02 to 0.16), and watering tobacco plants (ORadj 0.42, 95% CI 0.25 to 0.72). CONCLUSION: The process of traditional Thai tobacco production can result in increased dermal exposure and can be considered a major risk factor for GTS. Body soaking during watering may further increase adverse health effects related to GTS.