Functional domains of a ribosome arresting peptide are affected by surrounding nonconserved residues.

Expression of the Escherichia coli tnaCAB operon, responsible for L-tryptophan (L-Trp) transport and catabolism, is regulated by L-Trp-directed translation arrest and the ribosome arresting peptide TnaC. The function of TnaC relies on conserved residues distributed throughout the peptide, which are involved in forming an L-Trp binding site at the ribosome exit tunnel and inhibiting the ribosome function. We aimed to understand whether nonconserved amino acids surrounding these critical conserved residues play a functional role in TnaC-mediated ribosome arrest. We have isolated two intragenic suppressor mutations that restore arrest function of TnaC mutants; one of these mutations is located near the L-Trp binding site, while the other mutation is located near the ribosome active site. We used reporter gene fusions to show that both suppressor mutations have similar effects on TnaC mutants at the conserved residues involved in forming a free L-Trp binding site. However, they diverge in suppressing loss-of-function mutations in a conserved TnaC residue at the ribosome active site. With ribosome toeprinting assays, we determined that both suppressor mutations generate TnaC peptides, which are highly sensitive to L-Trp. Puromycin-challenge assays with isolated arrested ribosomes indicate that both TnaC suppressor mutants are resistant to peptidyl-tRNA cleavage by puromycin in the presence of L-Trp; however, they differ in their resistance to puromycin in the absence of L-Trp. We propose that the TnaC peptide two functionally distinct segments, a sensor domain and a stalling domain, and that the functional versatility of these domains is fine-tuned by the nature of their surrounding nonconserved residues.

Hipertensión arterial pulmonar en pacientes con dermatomiositis juvenil y esclerosis sistémica en un centro pediátrico de tercer nivel

INTRODUCCIÓN: La hipertensión arterial pulmonar puede estar asociada secundariamente a enfermedades del tejido conectivo. Entre estas enfermedades, predominan la esclerosis sistémica y la dermatomiositis juvenil. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo, descriptivo y transversal. Se incluyeron todos los pacientes con diagnóstico de dermatomiositis juvenil y esclerosis sistémica que acudieron a nuestro hospital. Posteriormente se verificaron los niveles de presión arterial pulmonar mediante ecocardiografía. RESULTADOS: Se incluyeron 58 pacientes, de los cuales sólo 17 pacientes tuvieron ecocardiografía diagnóstica. Entre ellos, dos pacientes presentaron hipertensión arterial pulmonar. CONCLUSIÓN: La detección oportuna de la hipertensión arterial pulmonar en las enfermedades del tejido conectivo es esencial. Generalmente es asintomático. Es necesario adherirse al protocolo internacional que sugiere realizar ecocardiografía en todos los pacientes con dermatomiositis juvenil y esclerosis sistémica.

INTRODUCTION: Pulmonary arterial hypertension may be secondary associated with connective tissue diseases. Among these diseases, systemic sclerosis and juvenile dermatomyositis predominate. MATERIALS AND METHODS: A retrospective, descriptive and cross-sectional study was carried out. All patients with a diagnosis of juvenile dermatomyositis and systemic sclerosis who attended our hospital were included. Pulmonary arterial pressure levels were subsequently verified by echocardiography. RESULTS: 58 patients were included, of which only 17 patients had a diagnostic echocardiography. Among them, two patients presented pulmonary arterial hypertension. CONCLUSION: Timely detection of pulmonary arterial hypertension in connective tissue diseases is essential. It is generally asymptomatic. It is necessary to adhere to the international protocol that suggests performing echocardiography in all patients with juvenile dermatomyositis and systemic sclerosis.

Optimizing Transitions of Care and Enhancing Surgical Education on Acute Care Surgery: A Multi-Institutional Survey Study.

OBJECTIVE: Critically ill and injured patients are routinely managed on the Trauma and Acute Care Surgery (ACS) service and receive care from numerous residents during hospital admission. The Clinical Learning Environment Review (CLER) program established by the ACGME identified variability in resident transitions of care (TC) while observing quality care and patient safety concerns. The aim of our multi-institutional study was to review surgical trainees' impressions of a specialty-specific handoff format in order to optimize patient care and enhance surgical education on the ACS service. DESIGN: A survey study was conducted with a voluntary electronic 20-item questionnaire that utilized a 5 point Likert scale regarding TC among resident peers, supervised handoffs by trauma attendings, and surgical education. It also allowed for open-ended responses regarding perceived advantages and disadvantages of handoffs. SETTING: Ten American College of Surgeons-verified Level 1 adult trauma centers. PARTICIPANTS: All general surgery residents and trauma/acute/surgical critical care fellows were surveyed. RESULTS: The study task was completed by 147 postgraduate trainees (125 residents, 14 ACS fellows, and 8 surgical critical care fellows) with a response rate of 61%. Institutional responses included: university hospital (67%), community hospital-university affiliate (16%), and private hospital-university affiliate (17%). A majority of respondents were satisfied with morning TC (62.6%) while approximately half were satisfied with evening TC (52.4%). Respondees believe supervised handoffs improved TC and prevented patient care delays (80.9% and 74.8%, respectively). A total of 35% of trainees utilized the open-ended response field to highlight specific best practices of their home institutions. CONCLUSIONS: Surgical trainees view ACS morning handoff as an effective standard to provide the highest level of clinical care and an opportunity to enhance surgical knowledge. As TC continue to be a focus of certifying bodies, identifying best practices and opportunities for improvement are critical to optimizing quality patient care and surgical education.

Nevo sebáceo de Jadassohn. A propósito de un caso neonatal

RESUMEN El nevo sebáceo de Jadassohn se presenta como una lesión hamartomatosa, de extensión variable. Puede estar presente al nacimiento y generalmente se localiza en cuero cabelludo. La zona presenta alopecia. En raras ocasiones puede malignizarse en la edad adulta. Se presenta un caso neonatal y se hace revisión de la literatura.

ABSTRACT Jadassohn's sebaceous nevus presents as a hamartomatous lesion of variable extent. It can be present at birth and is generally located on the scalp. The area shows alopecia. In rare cases, it can become malignant in adulthood. A neonatal case is presented and a literature review is made.

A protein folding robot driven by a self-taught agent.

This paper presents a computer simulation of a virtual robot that behaves as a peptide chain of the Hemagglutinin-Esterase protein (HEs) from human coronavirus. The robot can learn efficient protein folding policies by itself and then use them to solve HEs folding episodes. The proposed robotic unfolded structure inhabits a dynamic environment and is driven by a self-taught neural agent. The neural agent can read sensors and control the angles and interactions between individual amino acids. During the training phase, the agent uses reinforcement learning to explore new folding forms that conduce toward more significant rewards. The memory of the agent is implemented with neural networks. These neural networks are noise-balanced trained to satisfy the look for future conditions required by the Bellman equation. In the operating phase, the components merge into a wise up protein folding robot with look-ahead capacities, which consistently solves a section of the HEs protein.

Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013 / Extreme neonatal morbidity and its outcomes in a high complexity hospital in 2013 / Morbidade neonatal extrema e seus resultados em um hospital de alta complexidade em 2013

Introducción. La Morbilidad neonatal extrema se refiere a cualquier evento ocurrido en los primeros veintiocho días de vida con riesgo vital inminente. Es multifactorial, son relevantes los retrasos en la atención. En 2010 se describió por primera vez como indicador de salud pública en Brasil. Metodología. Estudio transversal en un hospital de alta complejidad en el año 2013. Se revisaron las características sociodemográficas y asistenciales, los eventos de morbilidad y sus desenlaces, el indicador mismo, la mortalidad neonatal y los retrasos en la atención (tipos I - IV). Resultados. Ingresaron 1,190 neonatos, se presentaron 120 casos y se analizaron los primeros 60 por saturación de datos. La tasa de morbilidad neonatal extrema fue de 59 por cada 1,000 nacidos vivos y la de mortalidad de 13.9, similares a las brasileñas y superiores a las nacionales (33 por cada 1,000). Los eventos más importantes con respecto a mortalidad fueron peso menor de 1,500 gramos, ventilación mecánica, Apgar menor de 7 a los 5 minutos y malformaciones congénitas. Los retrasos en las madres fueron predominantemente de tipo I (45.4%) por pobre control prenatal. El retraso neonatal más frecuente fue el tipo IV (40%), por mala adherencia a protocolos institucionales. Discusión. El indicador local fue mayor que el nacional por la complejidad institucional y los retrasos en la atención, los cuales causaron saturación estadística. Se puede mejorar con mayor adherencia a estrategias existentes como el control prenatal y protocolos institucionales. Conclusión. La Morbilidad neonatal extrema visibiliza las falencias en atención materno­neonatal. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Introduction. Extreme neonatal morbidity refers to any event that occurs in the first twenty-eight days of life with imminent vital risk. It is multifactorial and delays in treatment are relevant. It was described for the first time as a public health indicator in Brazil in 2010. Methodology. This was a cross-sectional study in a high complexity hospital in 2013. Sociodemographic and assistance characteristics, morbidity events and their outcomes, the indicator itself, neonatal mortality, and delays in treatment (types I - IV) were reviewed. Results. 1,190 neonates were entered, 120 cases occurred and the first 60 were analyzed due to data saturation. The extreme neonatal morbidity rate was 59 for every 1,000 children born alive and the mortality rate was 13.9. This was similar to the figures in Brazil and greater than national statistics (33 for every 1,000). The most significant events with respect to mortality were weight lower than 1,500 grams, mechanical ventilation, an Apgar score lower than 7 at 5 minutes and congenital anomalies. Delays from mothers were predominantly type I (45.4%) due to poor prenatal control. The most frequent neonatal delay was type IV (40%) due to bad adherence to institutional protocols. Discussion. The local indicator was greater than the national indicator due to the institutional complexity and delays in treatment, which cause statistical saturation. This can be improved with better adherence to existing strategies, such as prenatal control and institutional protocols. Conclusion. Extreme neonatal morbidity shows the flaws in maternal - neonatal healthcare. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Introdução. A morbidade neonatal extrema refere-se a qualquer evento que ocorra nos primeiros vinte e oito dias de vida com risco de vida iminente. É multifatorial, e os atrasos no atendimento são relevantes. Em 2010 foi descrita pela primeira vez como um indicador de saúde pública no Brasil. Metodologia. Estudo transversal em um hospital de alta complexidade em 2013. Foram revisadas as características sociodemográficas e assistenciais, os eventos de morbidade e seus resultados, o próprio indicador, a mortalidade neonatal e os atrasos no atendimento (tipos I - IV). Resultados. Foram internados 1,190 recém-nascidos, foram identificados 120 casos e os primeiros 60 foram analisados devido à saturação dos dados. A taxa de morbidade neonatal extrema foi de 59 por 1,000 nascidos vivos e a taxa de mortalidade de 13,9, semelhante às taxas brasileiras e superior às taxas nacionais (33 por 1,000). Os eventos mais importantes em relação à mortalidade foram peso inferior a 1,500 gramas, ventilação mecânica, Apgar menor que 7 em 5 minutos e malformações congênitas. Os atrasos nas mães foram predominantemente do tipo I (45.4%) devido ao cuidado pré-natal precário. O atraso neonatal mais frequente foi do tipo IV (40%), devido à falta de aderência aos protocolos institucionais. Discussão. O indicador local foi superior ao nacional devido à complexidade institucional e aos atrasos no atendimento, o que causou saturação estatística. Pode ser melhorado com uma maior adesão às estratégias existentes, como atendimento pré-natal e protocolos institucionais. Conclusão. A morbidade neonatal extrema torna visíveis as deficiências no cuidado materno-neonatal. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Uso de dispositivos móviles por parte de lactantes y preescolares: una revisión sistemática / Use of mobile devices by infants and preschoolers: a systematic review

Este estudio tiene como objetivo el examinar la frecuencia con la que los niños de 1 a 5 años hacen uso de los nuevos dispositivos móviles y su relación con la salud. Se realizó una revisión sistemática, retrospectiva, en Pubmed y Scielo; de un total de 145 artículos recolectados se incluyeron 43, cuyos criterios de inclusión y exclusión fueron: publicación de 2008 a 2021, sin predilección por alguna metodología en específico, variables de estudio (salud física, psicológica y social), no estudios en animales, trabajos repetidos y sin relevancia para el estudio, la calidad de la evidencia fue analizada con relación al valor de p y el índice de confianza 95% para cada variable en cuestión. El uso de Dispositivos móviles >2hrs/día se asocia a riesgo de desarrollo de alteraciones a la salud de los niños de 1 a 5 años, se necesita una vigilancia proactiva de los tutores(AU)

This study aims to examine the frequency with which children between the ages of 1 and 5 make use of new mobile devices and their relationship to health. A retrospective systematic review was carried out in Pubmed and Scielo; Of a total of 145 articles collected, 43 were included, whose inclusion and exclusion criteria were: publication from 2008 to 2021, without predilection for any specific methodology, study variables (physical, psychological and social health), no studies in animals, Repeated works without relevance to the study, the quality of the evidence was analyzed in relation to the value of p and the 95% confidence index for each variable in question. The use of mobile devices> 2hrs/day is associated with the risk of development of alterations to the health of children aged 1 to 5 years, a proactive vigilance of the tutors is needed(AU)

Diagnóstico y tratamiento del cáncer de mama HER2+: Guía de Práctica Clínica de la Sociedad Peruana de Cancerología / Diagnosis and treatment of HER2 + breast cancer: Clinical Practice Guide of the Peruvian Society of Cancerology

RESUMEN Introducción. En Perú, el cáncer de mama representa el tipo de cáncer más frecuente en mujeres y el sexto tipo de cáncer más letal en la población general. La sobreexpresión del receptor del factor de crecimiento epidérmico (HER2+) ocurre en 20% a 30% de los cánceres de mama, y se asocia con tumores más agresivos, con mayor recurrencia y mayor mortalidad. Objetivo. Elaborar un conjunto de recomendaciones basadas en evidencias para el diagnóstico y tratamiento del cáncer de mama HER2+, con la finalidad de contribuir a reducir la mortalidad, progresión de la enfermedad y mejorar la calidad de vida. Métodos. Se conformó un panel de especialistas clínicos y metodólogos, quienes identificaron preguntas clínicas relevantes sobre el diagnóstico y tratamiento del cáncer de mama HER2+. Se desarrolló una búsqueda sistemática de GPC en Medline (PubMed), y en organismos elaboradores y recopiladores. Para la formulación de recomendaciones, el panel de especialistas discutió la evidencia y elementos del contexto de implementación de la recomendación, siguiendo la metodología propuesta por el Ministerio de Salud del Perú. Resultados. Se priorizó nueve preguntas clínicas. Se formuló un total de 25 recomendaciones clínicas. Conclusiones. Se elaboró una GPC basada en evidencias, a través de un proceso sistemático, riguroso y transparente desarrollado por un equipo multidisciplinario.

ABSTRACT Introduction. In Peru, breast cancer represents the most common type of cancer in women and the sixth most lethal type of cancer in the general population. Overexpression of the epidermal growth factor receptor (HER2 +) occurs in 20% to 30% of breast cancers, and is associated with more aggressive tumors, with greater recurrence and greater mortality. Objective. Prepare a set of evidence-based recommendations for the diagnosis and treatment of HER2 + breast cancer, in order to help reduce mortality, disease progression and improve quality of life. Methods. A panel of clinical specialists and methodologists was formed, who identified relevant clinical questions about the diagnosis and treatment of HER2 + breast cancer. A systematic search for CPGs was carried out in Medline (PubMed), and in developing and compiling agencies. For the formulation of recommendations, the panel of specialists discussed the evidence and elements of the context of implementation of the recommendation, following the methodology proposed by the Ministry of Health of Peru. Results. Nine clinical questions were prioritized. A total of 25 clinical recommendations were made. Conclusions. An evidence-based CPG was developed through a systematic, rigorous and transparent process developed by a multidisciplinary team.

Hemangioma de colon Descripción de caso y revisión de la literatura / HEMANGIOMA OF THE COLON. Case report and literature review

El hemangioma de colon y recto es una entidad poco frecuente. El tipo cavernoso, es aún más raro por lo que existen pocos reportes de esta patología. Afecta mayormente al recto y al sigmoides, y el modo de presentación más común es la proctorragia indolora en el 90% de los casos. Más frecuente en adultos jóvenes. Esta entidad para su diagnóstico requiere alta sospecha y la realización de los estudios pertinentes ya que suele confundírsela con patologías más comunes. En esta revisión se presenta el caso de un paciente masculino de 58 años con un hemangioma cavernoso de colon transverso que se manifestó inicialmente como hematoquecia asociada a astenia. Luego de realizar estudios complementarios, se decide conducta quirúrgica. Se realizó resección de colon transverso con buena evolución postoperatoria. El resultado de anatomía patológica nos informa Hemangioma Cavernoso de colon transverso.

The hemangioma of the colon and rectum is a rare entity. The cavernous type is even more rare, so there are few reports of this pathology. It mainly affects the rectum and the sigmoid, and the most common presentation is painless proctorrhagia in 90% of cases. More frequent in young adults. This entity for its diagnosis requires high suspicion and the realization of the pertinent studies since it is usually confused with more common pathologies. In this review we present the case of a 58-year-old male patient with a cavernous hemangioma of the transverse colon that initially manifested as hematochezia associated with asthenia. After performing complementary studies, surgical behavior is decided. Transverse colon resection was performed with good postoperative evolution. The result of pathological anatomy informs us Cavernous hemangioma of transverse colon

Lesión renal aguda adquirida en el hospital: factores de riesgo y desenlaces clínicos / Non-critical care hospital-acquired acute kidney injury: analysis of 101 cases

Background: Non-critical care Hospital-Acquired Acute Kidney Injury (Non-ICU HA-AKI) is a preventable common complication. Aim: To analyze its risk factors and outcomes in a general hospital ward. Material and Methods: A retrospective paired case-control 1:2 study was carried out from April to December 2014. Non-ICU HA-AKI was defined as those patients who experienced a 1.5-fold, or 0.3 mg/dl rise in serum creatinine after 24 hours of hospitalization. Controls were randomly selected, paired by date of hospital admission and specialty causing the admission. We analyzed short-term outcomes and risk factors. Results: We included 101cases aged 65 ± 16 years (55% women). Mean length of stay at the time of diagnosis of AKI was 7.9 ± 8.9 days. Hospital length of stay was longer in patients with AKI (p < 0.01), The risk for intensive care unit (ICU) admission and mortality were also higher (odds ratio [OR], 2.43 [95% confidence intervals (CI), 1.24 to 4.75)p < 0.01 and OR, 26.2 [95% CI, 8.8 to 104, P < 0.01). In a multivariate analysis, sepsis (OR, 3.64 [95% CI, 1.30 to 10.16] p = 0.013), dehydration (OR, 14.4 [95% CI, 4.49 to 46.19), baseline glomerular filtration (OR, 0.96 [95% CI, 0.94-0.98), contrast medium exposure (OR, 4.33 [95% CI, 1.60 to 11.66), recent exposure to Nonsteroidal Anti-inflammatory Drugs (OR 3.23 [95% CI, 1.22 to 8.52 (p = 0.02)] and Charlson comorbidity index (OR, 1.23 [95% CI, 1.05 to 1.43 (p < 0.01) were independent risk factors for Non-ICU HA-AKI. Conclusions: Non-ICU HA-AKI is associated with a longer hospital stay and higher risk of ICU admission and mortality. Most risk factors are potentially preventable.

Parámetros hematológicos y recuento de células T-CD4+ en pacientes VIH con síntomas digestivos en Bucaramanga, Colombia / Haematological parameters and T-CD4+ cells count in HIV patients with digestive symptoms in Bucaramanga, Colombia

Introducción: La anemia, las citopenias y la sintomatología digestiva son hallazgos frecuentes en la población con infección por el virus de la inmunodeficiencia humana, VIH. Objetivo: Describir los parámetros hematológicos y el recuento de linfocitos T- CD4 en pacientes con VIH hospitalizados por síntomas digestivos a los que se realizaron estudios endoscópicos. Métodos: Se realizó un estudio observacional y descriptivo en 54 pacientes con VIH que se consultaron por síntomas digestivos y que requirieron procedimientos endoscópicos digestivos altos o bajos durante el año 2014 en un Hospital Universitario de tercer nivel en Bucaramanga, Colombia.Se tomaron datos sociodemográficos, se indagó sobre el uso de terapia antirretroviral altamente efectiva (TARAE), se registró la sintomatología digestiva, el tipo de procedimiento realizado, los datos del hemograma, el recuento de linfocitos T-CD4, la realización de mielograma, biopsia de médula ósea y la mortalidaddurante la estancia hospitalaria. Resultados: La prevalencia de anemia, leucopenia y trombocitopenia fue de 83.3 por ciento, 37 por ciento y 20.3 por ciento, respectivamente. Se encontró bicitopenia y pancitopenia en 25.9 por ciento y 14.8 por ciento.De los pacientes con bicitopenia y pancitopenia se les realizó estudio de médula ósea a 57.1 por ciento y 87.5 por ciento, respectivamente. Se encontró una tendencia de conteo de linfocitos T-CD4 menor en aquellos pacientes con anemia. Conclusiones: Las alteraciones hematológicas son frecuentes en pacientes con VIH y síntomas digestivos, con alta prevalencia de anemia. Los recuentos de linfocitos T-CD4 encontrados fueron notoriamente bajos(AU)

Introduction: Anemia, cytopenias and gastrointestinal symptoms are common findings in the population that are infected by the HIV. Objective: To describe hematological parameters and the T-CD4 cell counts in HIVpatients hospitalized for gastrointestinal symptoms that were taken to endoscopy. Methods: A descriptive study in 54 HIV patients who consulted for digestive symptoms and requiring high or low digestive endoscopy during 2014 in a third level University Hospital of Bucaramanga, Colombiawas carried out. Sociodemographicdata were questioned, it was the use of highly active antiretroviral therapy (HAART), it was registered digestive symptoms, type of procedure, data from blood count, T-CD4 count, myelogram, bone marrow biopsy and mortality during hospital stay were recorded. Results: The prevalence of anemia, leucopenia and thrombocytopenia were 83.3 percent, 37 percent and 20.3 percent, respectively. Bicytopenia and pancytopenia were found in 25.9 percent and 14.8 percent. Bicytopenia patients with pancytopenia and underwent bone marrow study to 57.1 percent and 87.5 percent, respectively. A trend of lower T-CD4 lymphocyte count was found in patients with anemia. Conclusions: Hematological disorders are common in patients with HIV and digestive symptoms, with high prevalence of anemia. T-CD4 counts were found notoriously low(AU)

Interactions of the TnaC nascent peptide with rRNA in the exit tunnel enable the ribosome to respond to free tryptophan.

A transcriptional attenuation mechanism regulates expression of the bacterial tnaCAB operon. This mechanism requires ribosomal arrest induced by the regulatory nascent TnaC peptide in response to free L-tryptophan (L-Trp). In this study we demonstrate, using genetic and biochemical analyses, that in Escherichia coli, TnaC residue I19 and 23S rRNA nucleotide A2058 are essential for the ribosome's ability to sense free L-Trp. We show that the mutational change A2058U in 23S rRNA reduces the concentration dependence of L-Trp-mediated tna operon induction, whereas the TnaC I19L change suppresses this phenotype, restoring the sensitivity of the translating A2058U mutant ribosome to free L-Trp. These findings suggest that interactions between TnaC residue I19 and 23S rRNA nucleotide A2058 contribute to the creation of a regulatory L-Trp binding site within the translating ribosome.

Sífilis congénita en el Hospital Universitario de Santander, Bucaramanga (Colombia), 2006 - 2007 / Congenital syphilis in the Hospital Universitario de Santander, Bucaramanga (Colombia), 2006-2007

Antecedentes. La sífilis congénita (SC) aumenta en nuestro país a pesar de existir un programa diseñado para su control. Se requiere conocer las características de los afectados y sus padres, para implementar medidas de control. Objetivo. Caracterizar los casos de SC atendidos en el Hospital Universitario de Santander, Bucaramanga (Colombia), entre Junio/2006 y Septiembre/2007. Materiales y métodos. Estudio de corte transversal prospectivo. Se analizaron variables sociodemográficas y clínicas de los recién nacidos y sus padres. Resultados. Se presentaron 36 recién nacidos (RN) con SC. Nueve sintomáticos (25%), 6 con compromiso del sistema nervioso central (16.7%); 2 murieron (5.6%). En 12 casos (33.3%) las madres no hicieron control prenatal; 16 (44.4%) no aparecen inscritas al sistema de seguridad social en salud. Tres madres (8.3%) infectadas por VIH; 6 (16.7%) con más de 9 compañeros sexuales y 10 (27.8%) con un compañero sexual; 8 (22.2%) usó drogas ilícitas. El diagnóstico de sífilis fue hecho en el tercer trimestre del embarazo en 15 casos (41.7%) y 14 (38.9%) en postparto. El 47.2% de las madres no recibió tratamiento durante el embarazo (17 casos); 25 padres (69.5%) no lo recibieron. Conclusiones. Pese a que la SC es una enfermedad prevenible, en el Hospital Universitario de Santander se encontraron 36 casos entre junio de 2006 a septiembre 2007. Sobresalen factores inherentes a la madre, a su entorno y al acceso al servicio de salud que hacen que la SC aumente en nuestro medio. Para modificar la incidencia de la SC es mandatorio mejorar la calidad del control prenatal, garantizar el acceso y captación de las gestantes de manera oportuna, lograr adherencia a los protocolos de manejo por parte de las IPS para poder mejorar la calidad de vida de la infancia en Santander.

Background: Congenital syphilis is increasing in Colombia despite of the program specifically designed for its control. Understanding the characteristics of affected individuals and their parents are of the essence for the implementation of control measures. Objective: Characterize the cases of congenital syphilis at Hospital Universitario de Santander in Bucaramanga, Colombia from June 2006 to September 2007. Materials and Methods: Prospective transversal study. Social, demographic, and clinical variables in newborn babies and their parents were analyzed. Results: 36 cases of congenital syphilis were found. Nine newborn babies showed symptoms (25%); 6 of them had a compromise of the Central Nervous System (16.7%) and 2 of them died (5.6%). 12 mothers (33.3%) were not under a prenatal control program. 16 of these mothers (44.4%) were not registered in the Social Security System. 3 mothers (8.3%) were positive for HIV; 6 mothers (16.7%) had a history of more than 9 sexual partners and 10 (27.8%) reported to have only 1 sexual partner; 8 mothers (22.2%) were drug addicts. Syphilis diagnosis was conducted on third trimester of pregnancy in 15 cases (41.7%) while 14 cases were detected after birth. 47.2% of the mothers did not receive any treatment during pregnancy (17 cases). Conversely, 25 fathers (69.5%) did not receive treatment against this condition. Conclusions: Persistence of congenital syphilis cases at Hospital Universitario de Santander is the result of the high percentage of mothers (among those who gave birth to children with congenital syphilis) that are not registered at the Social Security System or are not under any prenatal control. Furthermore, the late treatment of gestational syphilis as well as the lack of treatment of affected couples contribute also to this persistence of presentation. Correction of these variables would improve the situation.

Traumatismo encefalocraneano en niños atendidos en un hospital nacional de Lima, Perú 2004-2011 / Traumatic bran injury in children attending a national hospital in Lima, Peru 2004-2011

Con el objetivo de describir las características del traumatismo encéfalocraneano (TEC) en niños atendidos en el Hospital Nacional Cayetano Heredia entre los años 2004 y 2011 se realizó un estudio de serie de casos. Se incluyeron 316 menores de 14 años, la mediana de edad fue 4 ± 3 años. El 63,9% fueron hombres. Las principales causas del TEC fueron las caídas (80,1%), y los accidentes de tránsito (10,4%). El 42,4% (134/316) ocurrieron durante horas de la tarde. Hubo mayor frecuencia de accidentes en el hogar (59,2%). El hematoma epidural (26,9%) fue la lesión intracraneal más frecuente. Se requirió manejo en cuidados intensivos en 15,8% e intervenciones quirúrgicas en 14,2% de los casos. Se concluye que las caídas en el hogar fueron la causa principal de TEC y el hematoma epidural la lesión intracraneal más común donde son los menores de 5 años los más afectados.

In order to describe the characteristics of traumatic brain injury (TEC) in children seen at the Cayetano Heredia National Hospital from 2004 to 2011, a case study was conducted. 316, 14 year-old minors were included, the median age was 4 ± 3 years old. 63.9% were male. The main causes of TEC were falls (80.1%) and car accidents (10.4%). 42.4% (134/316) occurred in the afternoon. There was a higher incidence of falls at home (59.2%). The epidural hematoma (26.9%) was the most common intracraneal injury. Intensive care management and neurosurgical interventions were required in 15.8 and 14.2% of cases respectively. It is concluded that domestic falls were the main cause of accidents for TEC and epidural hematoma the most common intracranial injury where children under 5 were the most affected.

Tratamiento quirúrgico de la transposición de grandes arterias y factores asociados con la mortalidad / Surgical treatment of great arteries transposition and risk factors for mortality

La transposición de grandes arterias se define como una discordancia en la conexión ventrículo-arterial; su incidencia varía entre 0,02 y 0,05% de todos los nacidos vivos, correspondiendo a 5 - 8% de todas las cardiopatías congénitas. El tratamiento de elección es la cirugía de Jatene. Objetivos: Describir las características de los pacientes con transposición de grandes arterias sometidos a tratamiento quirúrgico y explorar factores asociados con mortalidad. Material y métodos: Estudio descriptivo, retrospectivo de pacientes con diagnóstico de transposición de grandes arterias tratados quirúrgicamente con la técnica de Jatene entre enero del 2001 y diciembre del 2010. Se creó una base datos en SPSS v19.0 y se analizaron las posibles variables asociadas a la mortalidad temprana. Resultados: De los 52 pacientes, 77% fueron varones, presentando un peso aproximado de 3 500 g. La edad promedio fue 54,83 días. La mayoría de los casos fueron de transposición con septum interventricular intacto con una distribución normal de las coronarias. La mortalidad hospitalaria global fue 31% y en los tres últimos años se redujo a 16%. La variable edad mayor de 23 días tuvo 6 veces más riesgo de muerte intrahospitalaria. Conclusiones: Los hallazgos observados coinciden con lo descrito internacionalmente. La edad superior a 23 días se asocia a mayor mortalidad la cual se ha logrado reducir hasta 16% en los últimos tres años del estudio. Aún queda implementar un protocolo institucional con todo el arsenal farmacológico y tecnológico que logre reducir la mortalidad a valores internacionales.

Great arteries transposition is a discordant atrioventricular connection whose incidence varies between 0.02% to 0.05% of all newborns and represents 5-8% of all congenital cardiopathies. The tratment of choice for this conditionis the Jatene ìs surgical procedure.Objectives: To describe clinical features of patients with great arteries transposition in whom Jatene ìs procedure was performed and to explore risk factors for mortality among them. Methods: A retrospective and descriptive study was conducted between January 2001 and December 2010. A database in SPSS v19.0 was created. Results: 52 patients were analyzed; 77% were male; mean body weight was 3500 g; mean age was 54.83 days. Most of the cases presented with artery transposition with intact interventricular septum and withnormal coronary arterial distribution. Overall in-hospital mortality was 31%, which was reduced to 16% in the last3-year period. Age above 23 days was associated with six times more mortality. Conclusions: Our findings are in agreement with previous international reports. Age above 23 days was a risk factor for mortality, which was reduc.

Cardiac myxoma with prenatal diagnosis.

The presentation of myxoma in the neonatal period is quite rare. We report the case of a female patient in whom two cardiac tumors were diagnosed prenatally. Surgery was performed at eight days of age, using cardiopulmonary bypass and circulatory arrest to facilitate excision of two polypoid tumors from within the right atrium. Pathology studies were consistent with myxoma. The postoperative course was satisfactory and the patient was discharged 14 days after surgery, at 22 days old.

Absceso cerebral en niños: una complicación de otomastoiditis crónica de diagnóstico tardío / Brain abscess in children: a complication of late diagnosis chronic mastoiditis

Reportamos el caso de una paciente de 7 años de edad que presentó otitis media aguda complicada con otomastoiditis crónica quien fue operada de una timpanomastoidectomía a los dos meses y medio de enfermedad, a los tres meses presentó fiebre, signos de hipertensión endocraneana y paresia del miembro superior izquierdo. La tomografía espiral multicorte mostró absceso en el lóbulo temporal ipsilateral. Recibió tratamiento antibiótico de amplia cobertura y fue sometida a resección quirúrgica del absceso. Seis semanas después de la intervención quirúrgica salió de alta con monoparesia del brazo izquierdo con desempeño independiente.

We report a case of a seven year old patient who had acute media otitis complicated with chronic otomastoiditis, who was operated of timpanomastoidectomy after two months and a half of illness, at three months she had fever, endocraneal hypertension signs and paresia of the left upper limb. The multislice spiral tomography showed the presence of an abscess on the ipsilateral temporal lobe. She received extended-spectrum antibiotic therapy and surgical excision of the abscess. Six weeks after the surgery she was discharged from the hospital with left upper limb monoparesia with independent performance.

Mixoma cardíaco con diagnóstico prenatal: presentación de un caso y revisión de literatura / Pre-natal diagnosis of cardiac myxoma: case presentation and literature review

El mixoma es la tumoración cardíaca más frecuente en el adulto, constituyendo aproximadamente el 50% de las mismas. En la edad pediátrica el tumor cardíaco más frecuente es el rabdomioma, generalmente asociado a esclerosis tuberosa. La presentación del mixoma en pacientes pediátricos es muy rara y más aun en la etapa neonatal. Presentamos el caso de una paciente de sexo femenino que fue sometida a cirugía a los 8 días de nacida por presentar dos tumoraciones intracardiacas diagnosticadas en la etapa intrauterina a las 38 semanas de gestación. La cirugía se realizó mediante esternotomía media, con circulación extracorpórea y arresto circulatorio. Las tumoraciones, que eran de aspecto polipoide se localizaban en la aurícula derecha, los estudios de patología fueron compatibles con mixoma. La evolución postoperatoria fue satisfactoria y la paciente fue dada de alta a los 14 días después de la cirugía.

Myxoma is the most frequent cardiac tumor in adults, representing approximately 50% of the cardiac tumors. In children, the most common cardiac tumor is the rhabdomyoma, usually associated with tuberous sclerosis. Myxoma of the heart is very uncommon in children including the pre-natal period. We present here the case of a female patient who underwent heart surgery at the age of 8 days to remove two intracardiac tumors diagnosed at 38 weeks of pregnancy. The surgical procedure was performed through a median sternotomy with extracorporeal circulation and cardiac arrest. The polypoid tumors were found in the right atrium and were compatible with cardiac myxomas. Post-operative evolution was satisfactory; the patient was discharged 14 days after surgery.

Addition of amifostine to the CHOP regimen in elderly patients with aggressive non-Hodgkin lymphoma: a phase II trial showing reduction in toxicity without altering long-term survival.

BACKGROUND AND OBJECTIVES: We report the 8-year follow-up of 34 patients aged ≥69 years old with NHL included in a phase IIb open-label randomized parallel groups study to evaluate the effectiveness of amifostine in preventing the toxicity of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP regime) . PATIENTS AND METHODS: Patients were randomized to receive classical CHOP (cyclophosphamide 750 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.4 mg/m(2) [maximum 2 mg] on day 1 and prednisone 100 mg/day for 5 days) or CHOP plus amifostine (6 cycles of amifostine 910 mg/m(2) on day 1). Efficacy (time to progression, TTP; disease-free survival, DFS; overall survival, OS) and toxicity endpoints were evaluated. RESULTS: Thirty-four patients were randomized to A-CHOP (n=18) or CHOP (n=16). Patients with A-CHOP vs CHOP had significantly lower toxicity; neutropenia grade 4 ocurred in 13/92 (13%) vs 23/85 (27%, P=0.007) cycles, febrile neutropenia in 3/92 A-CHOP (3%) vs 8/85 (10%, P=.056) CHOP cycles, hospitalization for toxicity in 4/92 (4%) A-CHOP vs 11/85 (13%, P=.05) CHOP cycles. Median hospitalization stay for toxicity was 5 days with A-CHOP vs 8 days with CHOP (P=.05). There were no significant differences at 8 years in TTP (A-CHOP, 48.9% vs CHOP, 36.3%; P=.65), DFS (A-CHOP, 72.9% vs CHOP 55.6%; P=.50) and OS (A-CHOP, 44.3% vs CHOP, 54.4%). There was no long-term toxicity of clinical interest. The only prognostic factor identified to 8 years was the International Prognostic Index (IPI low/low intermediate risk vs high intermediate/high risk; HR=2.98; CI 95%:1.01-8.77; P=.048). CONCLUSION: These results show that amifostine can be added to the standard CHOP treatment schedule with less acute toxicity and without influencing the outcome.