Diagnóstico de parasitosis gastrointestinal en ganado vacuno de razas carniceras con diferentes técnicas coproparasitológicas / Diagnosis of gastrointestinal parasitosis in beef cattle of butcher breeds with different coproparasitological techniques

RESUMEN Las parasitosis gastrointestinales en bovinos de producción son uno de los problemas sanitarios más importantes a nivel mundial. Estos nematodos ocasionan problemas gastroentéricos que se caracterizan clínicamente por diarrea, debilidad, hemorragias y deshidratación. Entre las parasitosis gastrointestinales causadas por nematodos en ganado bovino, se destacan las familias: Trichuridae, Trichostrongylidae, Ancylostomidae, Ascaridae y Strongyloididae. El propósito de esta investigación fue determinar la eficacia de las distintas técnicas coproparasitológicas cualitativas y cuantitativas para la detección de nematodos gastrointestinales en ganado bovino. Para este estudio se utilizaron 250 muestras de vacas de raza carnicera, divididos en diferentes grupos, para la aplicación de las técnicas coproparasitológicas de tipo cualitativo y cuantitativo, los cuales fueron escogidos específicamente teniendo en cuenta criterios de inclusión y exclusión para cada animal. Los resultados entregados por este estudio indicaron que el mayor porcentaje en la identificación de estados infectantes parasitarios fue por medio de las técnicas coproparasitologicas de tipo cualitativo, principalmente aquellas de flotación de sulfato de zinc y magnesio con un 50%.

ABSTRACT Gastrointestinal parasites in production cattle are one of the most important health problems worldwide. These nematodes cause gastroenteric problems that are clinically characterized by diarrhoea, weakness, bleeding and dehydration. Within the gastrointestinal parasites caused by nematodes in cattle, the following families stand out: Trichuridae, Trichostrongylidae, Ancylostomidae, Ascaridae and Strongyloididae. The purpose of this research was to determine the efficacy of the different qualitative and quantitative coproparasitological techniques for the detection of gastrointestinal nematodes in cattle. For this study, 250 samples of beef breed cows were used, divided into different groups, for the application of qualitative and quantitative coproparasitological techniques, which were specifically chosen taking into account inclusion and exclusion criteria for each animal. The results delivered by this study indicated that the highest percentage in the identification of parasitic infective states was through qualitative coproparasitological techniques, focused mainly on zinc and magnesium sulfate flotation techniques with 50%.

Medición de los niveles de lactato sérico y frecuencia cardiaca en caninos (Canis lupus familiaris) braquicefálicos, mesocefálicos y dolicocefálicos sometidos a prueba de esfuerzo en trotadora motorizada / Measurement of serum lactate levels and heart rate in canines (Canis lupus familiaris) Brachycephalic, Mesocephalic and Dolichocephalic submitted to a stress test on a motorized treadmill

RESUMEN Se analizaron los niveles de lactato sérico y de frecuencia cardiaca (FC) en 15 perros clinicamente sanos que fueron sometidos a pruebas de esfuerzo en trotadora motorizada, buscando verificar un grado de fatiga muscular frente a una prueba de esfuerzo intenso. Se consideraron pacientes con morfologia craneana de tipo braquicefálico, mesocefálico y dolicocefálico. Las mediciones séricas de lactato fueron conseguidas por medio de un medidor portátil, mientras que las frecuencias cardiacas se obtuvieron a través de un oximetro portátil a los tiempos 0, 10, 20 y 30 minutos, en los diferentes momentos de esfuerzo fisico en la trotadora motorizada, la cual fue adaptada en su inclinación en 15% y a un máximo de velocidad de 10 km/h. Las medias de los niveles séricos entre perros mesocefálicos y dolicocefálicos fueron significativas, a diferencia de los perros braquicefálicos los cuales resultaron no significativos. Las medias de las frecuencias cardiacas no tuvieron diferencia significativa bajo un 95% de confianza.

ABSTRACT Serum lactate and heart rate (HR) levels were analyzed in 15 clinically healthy dogs that were subjected to stress tests on a motorized treadmill, seeking to verify a degree of muscle fatigue compared to an intense exercise test. Patients with brachycephalic, mesocephalic and dolichocephalic type cranial morphology were considered. Serum lactate measurements were procured by means of a portable meter, while heart rates were obtained through a portable oximeter at the times 0, 10, 20, and 30 minutes at different moments of physical effort on the motorized treadmill, which was adapted in its inclination by 15% and at a maximum speed of 10 km/h. Mean serum levels between mesocephalic and dolichocephalic dogs were significant, unlike brachycephalic dogs, which were not significant. The mean heart rates did not have a significant difference under 95% confidence.

Consenso chileno para el diagnóstico y tratamiento de gliomas del adulto / Diagnosis and treatment of glioma in adult: Chilean consensus

Resumen Los tumores cerebrales se caracterizan por su gran morbilidad y mortalidad. La gran mayoría corresponde a tumores secundarios (metástasis). Dentro de los tumores primarios del sistema nervioso central, los gliomas corresponden al 30% de éstos. En EEUU, entre el 2007-2011, se estima una incidencia aproximada de 21,4 casos por 100.000 habitantes. Los recientes avances en la comprensión molecular de la biología de estos tumores han permitido mejorar sustancialmente su clasificación, posibilitando realizar un mejor correlato con los desenlaces clínicos y el pronóstico. En esta línea, hoy en día es posible estratificar a los pacientes por riesgo y entregar tratamientos capaces de prolongar la sobrevida global entre 5-7 años, para los gliomas grado II y III. El presente consenso, elaborado por un panel multidisciplinario de expertos de diversas sociedades científicas chilenas y, por tanto, de todas las especialidades involucradas en el manejo médico-quirúrgico de las personas portadoras de gliomas cerebrales. A la luz de este nuevo conocimiento desarrollado al alero de la oncología molecular, esta propuesta ofrece un insumo de utilidad clínica real, que, articulado a una revisión actualizada en relación con el tratamiento y seguimiento de estos pacientes, permite entender la relevancia de estos biomarcadores en el manejo de precisión de la enfermedad. Cabe señalar que, este manuscrito emerge de la misma fuerza de trabajo, que elaboró el Protocolo Clínico de Gliomas del Adulto 2019, publicado por el Ministerio de Salud, y que ha diferencia de esta, que ofrece los detalles clínicos-operativos, como flujogramas y dosis, nuestra revisión intenta relevar los avances imagenológicos y moleculares y como estos impactan en el manejo actual de la enfermedad.

Brain tumors are characterized by high morbidity and mortality. The vast majority correspond to secondary tumors (metastasis). On the other hand, within the primary tumors of the central nervous system, gliomas correspond to 30% of these. In the US, between 2007-2011, an approximate incidence of 21.4 cases per 100,000 inhabitants was estimated. Recent advances in the molecular understanding of the biology of these tumors have made it possible to substantially improve their classification, allowing a better correlation with clinical outcomes and prognosis. Along these lines, today, it is possible to stratify patients by risk and deliver treatments capable of prolonging global survival between 5-7 years, for grade II and III gliomas. The present consensus, prepared by a multidisciplinary panel of experts from various Chilean scientific societies and, therefore, from all the specialties involved in the medical and surgical therapy. Enlightened from the molecular oncology, this proposal offers an input of clinical utility, which, together with an updated review in relation to the treatment and follow-up of these patients, allows us to understand the relevance of these biomarkers in precision disease management. It should be noted that this manuscript emerges from the same work force, which prepared the Clinical Protocol for Adult Gliomas 2019, published by the Ministry of Health, and that differs from it, which offers clinical-operative details, such as flowcharts and dose, our review attempts to reveal imaging and molecular advances and how they impact the current management of the disease.

Caracterización del nivel ético profesional de estudiantes y docentes de la carrera de medicina veterinaria de la Universidad Santo Tomás, sede Puerto Montt, Chile / Characterization of the professional ethical level of students and teachers of the veterinary medicine career at the Santo Tomás University, Puerto Montt headquarters, Chile

RESUMEN El objetivo principal de este estudio fue caracterizar el nivel ético en estudiantes y docentes de la carrera de medicina veterinaria de la Universidad Santo Tomás, sede de Puerto Montt, Chile. Para esto, se aplicó una encuesta dilemática a 3 grupos de estudio conformados por estudiantes de primer y quinto año, además de docentes que imparten asignaturas de formación profesional de la sede Puerto Montt. La creación de la encuesta fue por medio de la contratación de especificaciones éticas de la carrera con los diles de juicio moral en Kohlberg. De los resultados obtenidos se pudo concluir que las especificaciones de la carrera de medicina veterinaria solo contemplan el 20% de 59 artículos estudiados del Código de Ética profesional. Además, es posible decir que los estudiantes de primero y quinto año, y los docentes no conocen a cabalidad los artículos del Código de Ética según la clasificación de la teoría de Kohlberg.

ABSTRACT The main objective of this study was to characterize the ethical level in students and teachers of the veterinary medicine career of the Santo Tomás University, Puerto Montt headquarters, Chile. For this a dilemmatic survey was applied to 3 study groups, made up of students from the first and fifth years, in addition to teachers who teach professional training subjects at the Puerto Montt campus. The survey was created by contracting ethical specifications of the career with the moral judgment diles in Kohlberg. From the results obtained, it was possible to conclude that the specifications of the veterinary medicine career only contemplate 20% of the 59 articles studied of the professional code of ethics. In addition, it was possible to say that the first and fifth year students, and teachers do not fully know the articles of the code of ethics according to the classification of Kohlberg's theory.

Treatment of balanitis xerotica obliterans in pediatric patients. / Tratamiento de la balanitis xerótica obliterante en pacientes pediátricos.

OBJECTIVES: Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease with a little known incidence in pediatric population. The objective of this work was to describe our experience in the treatment of BXO. MATERIALS AND METHODS: Retrospective study carried out in 419 patients undergoing circumcision surgery between January 2014 and January 2017. Demographic, clinical, therapeutic, and anatomical and pathological variables, as well as complications during follow-up, were analyzed. RESULTS: Of the 419 patients, 41 (9.78%) were diagnosed with BXO. 6 patients were excluded owing to lack of follow-up, so 35 patients were analyzed. Mean age at diagnosis was 8.6 years. Suspicion diagnosis was clinical at physical exploration in 17 patients (48.6%), and at surgery in 18 patients (51.4%). Anatomical and pathological confirmation was performed in a total 35 patients (100%). During follow-up, 6 patients (17.14%) had lesions in the glans, 3 (8.57%) in the urethra, and 9 (25.71%) in both. 6 meatotomies (17.14%) and 5 new circumcisions (14.28%) had to be carried out. Mean recurrence time was 32.43 months. In 19 patients (54.28%), topical corticoids - ointment - were applied, and 1 patient (2.85%) received topical immunosuppressants. CONCLUSIONS: A close follow-up of patients with clinical or anatomical and pathological diagnosis of BXO is required given its high morbidity. The complications described in pediatric population include meatal and urethral stenosis, as well as recurrent phimosis, unless a sufficient amount of foreskin is resected.

OBJETIVOS: La balanitis xerótica obliterante (BXO) es una enfermedad crónica inflamatoria de incidencia poco conocida en la población pediátrica. El objetivo de este trabajo es describir nuestra experiencia en el tratamiento de las BXO. MATERIAL Y METODOS: Estudio retrospectivo de 419 pacientes intervenidos de circuncisión en el periodo comprendido entre enero de 2014 y enero de 2017. Analizamos variables demográficas, clínicas, anatomopatológicas, terapéuticas y complicaciones durante el seguimiento. RESULTADOS: De los 419 pacientes, 41 fueron diagnosticados de BXO (9,78%). Seis pacientes fueron excluidos por falta de seguimiento, por lo que se analizaron 35 pacientes. La media de edad al diagnóstico fue de 8,6 años. El diagnóstico de sospecha fue clínico durante la exploración física en 17 pacientes (48,6%) y durante la intervención en 18 (51,4%), realizando la confirmación anatomopatológica en un total de 35 pacientes (100%). Durante el seguimiento 6 pacientes (17,14%) presentaron lesiones en glande, 3 (8,57%) en uretra y 9 (25,71%) en ambas localizaciones, siendo necesaria la realización de 6 meatotomías (17,14%) y de nueva circuncisión en 5 (14,28%). El tiempo medio de recidiva fue de 32,43 meses. En 19 pacientes (54,28%) se aplicaron corticoides tópicos en pomada y en 1 paciente inmunosupresores tópicos (2,85%). CONCLUSIONES: Es necesario un seguimiento estrecho de los pacientes con diagnóstico clínico o anatomopatológico de BXO dada su elevada morbilidad. Las principales complicaciones descritas en la población pediátrica son la estenosis meatal y uretral, así como la recidiva de la fimosis si no se reseca el prepucio suficientemente.

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways.

BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

Circulating levels of adiponectin, leptin, resistin and visfatin in non-diabetics patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with insulin resistance (IR), metabolic syndrome and increased cardiovascular risk. Adipokines are biologically active, pleotropic molecules which have been involved in the development of IR and in the pathogenesis of several chronic inflammatory conditions. The aim of the present study was to analyze serum concentrations of adiponectin, leptin, resistin and visfatin in patients with HS, and investigate their possible associations with IR, HS risk and disease severity. This case-control study enrolled 137 non-diabetic individuals (76 HS-patients and 61 age and sex-matched controls). Serum concentrations of adiponectin, leptin, resistin and visfatin, and the homeostasis model assessment of IR (HOMA-IR) were measured in all the participants. Serum adiponectin concentrations were found to be significantly lower, and leptin, resistin and visfatin levels were significantly higher in HS-patients than in controls. These differences remained significant even after adjusting for age, sex and body mass index, except for leptin. In a multivariate regression analysis, HOMA-IR was inversely correlated with adiponectin and positively associated with resistin levels. Furthermore, serum levels of resistin and visfatin were independently associated with HS risk. However, we found no association between serum levels of adipokines and HS severity. Our results suggest that reduced adiponectin and increased resistin serum levels may be surrogate biomarkers for IR in patients with HS. Moreover, resistin and visfatin might be independent risk factors for the development of HS.

Carcinoma adenoneuroendocrino mixto de la ampolla de Vater: reporte de caso / Mixed adenoneuroendocrine carcinoma of the ampulla of Vater: case report

INTRODUCCIÓN: Los carcinomas adenoneuroendocrinos mixtos (MANEC) son tipos de tumores bifásicos, reconocidos morfológicamente ante la presencia de una formación neoplásica constituida de manera simultánea por epitelio glandular y células neuroendocrinas. Dentro del tracto gastrointestinal, estas neoplasias predominan en el estómago o el colon. Solo 19 casos localizados en la ampolla de Vater han sido reportados por la literatura. OBJETIVO: Reportar un caso de MANEC; revisar la epidemiología, pronóstico y tratamiento de estos tumores. MATERIALES Y MÉTODO: Presentación de caso clínico de una paciente con diagnóstico de adenocarcinoma neuroendocrino mixto de la región ampular. DISCUSIÓN: La presentación clínica, el manejo y el pronóstico son similares al del adenocarcinoma ampular. Se diagnostican con el examen histopatológico de la muestra resecada. Ambos componentes deben ser histológicamente malignos, y cada uno de ellos debe representar al menos el 30% de la lesión. CONCLUSIÓN: Los MANEC ampulares son tumores poco comunes a nivel mundial, siendo éste el primer caso reportado en nuestro instituto.

INTRODUCTION: Mixed adenoneuroendocrine carcinomas (MANEC) are types of biphasic tumors, morphologically recognized in the presence of a neoplastic formation constituted simultaneously by glandular epithelium and neuroendocrine cells. Only 19 cases located in the ampulla of Vater have been reported in the literature. Within the gastrointestinal tract, these neoplasms predominate in the stomach or colon. AIM: Report a case of MANEC; review of the epidemiology, prognosis and treatment of these tumors. MATERIALS AND METHOD: Case presentation of a patient diagnosed with mixed adeno-neuroendocrine carcinoma of the ampullary region. DISCUSSION: The clinical presentation, management and prognosis are similar to ampullary adenocarcinoma. These tumors are diagnosed with a histopathological examination of the resected specimen. Both components must be histologically malignant, and each of them must represent at least 30% of the lesion. CONCLUSION: MANEC of the ampulla are rare tumors worldwide, being this case the first reported in our institute.

Caso de desafío diagnóstico: fístula dural / Diagnostic challenge case: dural fistula

Se presenta el caso de una paciente de sexo femenino, de 69 años, que refiere tinnitus pulsátil de dos meses de evolución percibido en la región retroauricular derecha. Se presentan los hallazgos en estudios de imágenes, diagnóstico y se presenta una corta revisión del tema.

We present the case of a female patient, 69 years old, who reported pulsatile tinnitus since two months ago perceived in the right retroauricular region. We present the findings in image studies, diagnosis and a short review about the topic.

Flavonoids in Kidney Health and Disease.

This review summarizes the latest advances in knowledge on the effects of flavonoids on renal function in health and disease. Flavonoids have antihypertensive, antidiabetic, and antiinflammatory effects, among other therapeutic activities. Many of them also exert renoprotective actions that may be of interest in diseases such as glomerulonephritis, diabetic nephropathy, and chemically-induced kidney insufficiency. They affect several renal factors that promote diuresis and natriuresis, which may contribute to their well-known antihypertensive effect. Flavonoids prevent or attenuate the renal injury associated with arterial hypertension, both by decreasing blood pressure and by acting directly on the renal parenchyma. These outcomes derive from their interference with multiple signaling pathways known to produce renal injury and are independent of their blood pressure-lowering effects. Oral administration of flavonoids prevents or ameliorates adverse effects on the kidney of elevated fructose consumption, high fat diet, and types I and 2 diabetes. These compounds attenuate the hyperglycemia-disrupted renal endothelial barrier function, urinary microalbumin excretion, and glomerular hyperfiltration that results from a reduction of podocyte injury, a determinant factor for albuminuria in diabetic nephropathy. Several flavonoids have shown renal protective effects against many nephrotoxic agents that frequently cause acute kidney injury (AKI) or chronic kidney disease (CKD), such as LPS, gentamycin, alcohol, nicotine, lead or cadmium. Flavonoids also improve cisplatin- or methotrexate-induced renal damage, demonstrating important actions in chemotherapy, anticancer and renoprotective effects. A beneficial prophylactic effect of flavonoids has been also observed against AKI induced by surgical procedures such as ischemia/reperfusion (I/R) or cardiopulmonary bypass. In several murine models of CKD, impaired kidney function was significantly improved by the administration of flavonoids from different sources, alone or in combination with stem cells. In humans, cocoa flavanols were found to have vasculoprotective effects in patients on hemodialysis. Moreover, flavonoids develop antitumor activity against renal carcinoma cells with no toxic effects on normal cells, suggesting a potential therapeutic role in patients with renal carcinoma.

Aspectos anatómicos y técnicos de la cirugia de citorredución de cáncer de ovario en abdomen superior / Anatomical and technical aspects of debulking surgery for ovarian cancer in the upper abdomen

RESUMEN El Cáncer de Ovario Epitelial es la novena causa de cáncer en la mujer y la neoplasia ginecológica más letal en países desarrollados. La mayoría de las pacientes son diagnosticadas en etapa avanzada de la enfermedad debido a la ausencia de síntomas específicos. La cirugía y la quimioterapia cumplen un rol fundamental en el tratamiento de esta enfermedad. En pacientes con enfermedad avanzada (estadios III - IV) al momento del diagnóstico, la extirpación de todo tumor macroscópico (citorreducción óptima) ha demostrado ser el factor pronóstico más importante, demostrando un beneficio tanto en tiempo libre de enfermedad como en sobrevida global. Nuestro objetivo es describir, desde una perspectiva multidisciplinaria, los aspectos técnicos más relevantes de la citorreducción del abdomen superior para aquellas pacientes con neoplasias de origen ginecológico.

ABSTRACT Epithelial Ovarian cancer is the ninth most frequent cancer in women and the most lethal gynecologic malignancy in developed countries. The majority of patients are diagnosed in advanced stage of the disease due to the lack of specific symptoms. Surgery and systemic treatment play a key role in the treatment of this disease. For those patients with advanced stage at the time of diagnosis (III - IV), removal of all macroscopic disease (optimal cytoreduction) has been shown as the most important prognostic factor, demonstrating improvement not only in progression free survival but also in overall survival. Our aim is to describe, in a multidisciplinary fashion, the most relevant aspect about oncological debulking procedures in the upper abdominal cavity for women with gynecological malignancies.

First record of soybean stem fly Melanagromyza sojae (Diptera: Agromyzidae) in Paraguay confirmed by molecular evidence.

We provided the first scientific record of Melanagromyza sojae (Zehntner, 1900), through molecular characterization of partial mtDNA COI gene, that confirms the occurrence of this pest in Paraguay. Previously reported in Brazil, an outbreak of larvae of M. sojae known as the soybean stem fly (SSF) that belongs to the family Agromyzidae, was also noted in soybean fields from the Canindeyú, Alto Paraná and Itapúa Departments in Paraguay. This pest is highly polyphagous, attacking various host plant species from the family Fabaceae, such as soybean and other beans. The implications of SSF detection in Paraguay are discussed in relation to the current soybean cultivation practices from this agriculturally important South American region, including Brazil.

[Epidemiology and risk factors of patients with intra-abdominal postsurgical infection treated with tigecycline: a cohort study]. / Estudio de una cohorte de pacientes tratados con tigeciclina por infección intraabdominal tras cirugía abdominal compleja: epidemiologia y factores pronósticos.

OBJECTIVE: To study a cohort of patients with intra-abdominal postsurgical infection treated with tigecycline to analyze its effectiveness and mortality related factors. METHODS: Prospective study of patients with intra-abdominal postsurgical infection with microbiological isolation and treated with tigecycline. RESULTS: Out of 103 patients only 61 full fit inclusion criteria. Mean age was 67 year-old and 72% were male. Charlson score was ≥ 3 in 65.5%, being diabetes and colon cancer the most prevalent diseases. Cancer surgery was the most frequent procedure (n=44, 72%) and previous antibiotic administration was present in 43 cases (69%). Pitt score was ≥ 3 in 69% and most prevalent bacteria were Escherichia coli (38 %), Enterococcus spp. (34%; mainly Enterococcus faecium) and Klebsiella pneumoniae together with Enterobacter cloacae (28%). Tigecycline was prescribed alone (17; 28%) or in combination with other antibiotics (44; 72%), mainly meropenem (25; 57%) or amikacin (19, 43%). 11 patients died (18%), all of which suffered extended cancer surgery and isolation of extended-spectrum betalactamase producing Enterobacteriaceae. Factors statistically associated to death in univariate analysis were Charlson score >3, pH <7.3 and leucocyte count >20.000 cells/mm3. CONCLUSIONS: As being a cohort of patients treated with tigecycline, E. faecium isolation was very frequent. Non-fatal evolution was achieved in 82% cases, being tigecycline a potentially good option in the empiric treatment of very severe infections.

Carcinoma de glandula mamaria en una yegua criolla colombiana. reporte de caso / Mammary gland carcinoma in a colombian criollo mare. case report

Los tumores mamarios son poco frecuente en equinos; Se han reportado prevalencias entre 0,11% y 2%, en plantas de beneficio; en Colombia no hay estudios que determinen la prevalencia de este tipo de enfermedad. Se presenta un caso clínico de una yegua de raza criollo colombiano con signos de depresión, tos, dificultad respiratoria y aumento de tamaño de la glándula mamaria con dolor. Debido a la severidad de los signos respiratorios se tomó la decisión de aplicar la eutanasia. En la necropsia se encontraron múltiples masas irregulares dentro de la cavidad torácica, nódulos firmes en los pulmones y la glándula mamaria de consistencia dura al corte. Según los hallazgos histopatológicos, el diagnóstico definitivo determinó un carcinoma de glándula mamaria tipo simple, papilar, grado III con metástasis pulmonar extensa. Este artículo es el primer reporte de una yegua criolla colombiana con diagnóstico de carcinoma mamario, metástasis pulmonar, la descripción de su presentación clínica y el respectivo diagnóstico histopatológico.

Breast cancer rarely occurs in horses. A prevalence that fluctuates from 0.11% to about 0.2% have been found in slaughter houses. Nevertheless, in Colombia there are not studies that have determined this disease prevalence yet. This article describes clinical sings and progress of a Colombian Criollo mare which was depressed with cough, respiratory distress, swollen and painful udder. Due to the unfavorable clinical progress the owner decides to euthanize the mare, on postmortem examination was found several irregular masses in thoracic cavity, multiple firm nodes disseminated in the lungs, and a mammary gland swollen and hard to cut. Microscopic examination reveal a mammary gland simple papillary carcinoma grade III with extensive lung metastasis. To the authors knowledge this is the first report on a breast carcinoma with pulmonary metastasis diagnosis made on this breed, its clinical presentation and histopathological diagnosis.

Functional inhibition of mesenchymal stromal cells in acute myeloid leukemia.

Hematopoietic insufficiency is the hallmark of acute myeloid leukemia (AML) and predisposes patients to life-threatening complications such as bleeding and infections. Addressing the contribution of mesenchymal stromal cells (MSC) to AML-induced hematopoietic failure we show that MSC from AML patients (n=64) exhibit significant growth deficiency and impaired osteogenic differentiation capacity. This was molecularly reflected by a specific methylation signature affecting pathways involved in cell differentiation, proliferation and skeletal development. In addition, we found distinct alterations of hematopoiesis-regulating factors such as Kit-ligand and Jagged1 accompanied by a significantly diminished ability to support CD34+ hematopoietic stem and progenitor cells in long-term culture-initiating cells (LTC-ICs) assays. This deficient osteogenic differentiation and insufficient stromal support was reversible and correlated with disease status as indicated by Osteocalcin serum levels and LTC-IC frequencies returning to normal values at remission. In line with this, cultivation of healthy MSC in conditioned medium from four AML cell lines resulted in decreased proliferation and osteogenic differentiation. Taken together, AML-derived MSC are molecularly and functionally altered and contribute to hematopoietic insufficiency. Inverse correlation with disease status and adoption of an AML-like phenotype after exposure to leukemic conditions suggests an instructive role of leukemic cells on bone marrow microenvironment.

Reconstructive surgery of the medial zygomatic region of the cheek: presentation of 5 cases.

The cheek is the largest anatomical subunit of the face. It is a bilateral structure and symmetry must therefore be preserved. Peripherally it is related to important natural orifices whose location must also be maintained during surgical reconstructions. This is particularly important in the medial zygomatic subunit, whose delicate junction with the lower eyelid means that care must be taken to avoid ectropion. We present 5 options for the reconstruction of surgical defects secondary to the excision of tumors in this region.

Historia del ejercicio profesional de enfermeras hospitalarias del sur de Chile (1940-1980) / Hospital nursing practice history south of Chile (1940-1980)

En Chile el ejercicio profesional histórico de las enfermeras ha sido poco documentado. Objetivo: Conocer el ejercicio profesional de enfermeras hospitalarias, años 1940-1980, para develar la identidad profesional y memoria histórica. Método: Estudio histórico, historia oral a través de entrevista semiestructurada, incluyó relatos de vida. Se eligió el contexto de los años 1940-1980, por contar con referentes vivenciales de la época. Los criterios de validez considerados: subjetividad, memoria y particularidad de la fuente. Resultados: Contexto personal, presencia de influencias de los valores de la formación, obediencia a las estructuras de poder, sacrificio personal y sumisión. Contexto laboral, caracterizado por una situación de trabajo extremo y marcada carencia de enfermeras derivado de la insuficiencia de escuelas formadoras en el país. En el rol asistencial se observa déficit en el desarrollo profesional, conformidad, cooperación ciega y carencia de análisis, debido a la gran demanda de atención, por epidemias de diarreas, problemas respiratorios y accidentes. Relevancia en realización de procedimientos: arsenalería, anestesia, asistencia directa en cirugías y administración de quimioterapia. El rol administrativo estuvo caracterizado por: habilitación y organización de servicios, se devela una enfermería estructurada, centradas en la solución de problemas domésticos y en el manejo de recursos humanos, el rol educador: formación formal de auxiliares. Conclusión: La práctica y el saber en el campo de salud están ligados a la transformación histórica, recibiendo en el ejercicio profesional una fuerte influencia de los contextos sociales, políticos y económicos que le acompañan...

In Chile the historical practice of nurses has been scarcely documented. Objective: To determine the professional practice of registered nurses, years 1940-1980, to reveal the identity and historical memory. Method: Historical, oral history methodology, data collection through semi-structured interview that included stories of life. We chose the years 1940-1980 as context, because we counted on the experiential referents for that age. As validity criteria, the subjectivity, memory and particularity of the source, were considered. Results: The personal context, influences of training values, obedience to the power structures, self-sacrifice and submission. The work environment is characterized by a situation of extreme work and noticeable lack of nurses resulting from inadequate training schools in the country. In the caring role, any deficit in professional development, compliance, and lack of cooperation and blind analysis, due to the high demand for care, epidemics of diarrhea, respiratory problems and accidents. Of particular importance is carrying of some procedures as giving anesthesia, direct assistance in surgery and chemotherapy. The administrative role was characterized by empowerment and service organization, nursing shows a structured, focused on solving problems of a domestic and human resource management. The educator role consisted on formal training for Nursing Assistants offered by the Training Unit of the Hospital. Conclusion: The overall analysis leads us to conclude that the practice and knowledge in the field of health are linked to the historical transformation of the economic production process, receiving in the professional practice a strong influence of social, political and economic contexts that accompany it...