Volumetric assessment of the sella turcica: a re-evaluation.

BACKGROUND: The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method vs. the Di Chiro-Nelson method, using computed tomography (CT) images. MATERIALS AND METHODS: Morphometric examination of 173 CT scans were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: length (central, left, and right), width (central, anterior, and posterior), and height (central, left, and right). RESULTS: The mean measurements were length: central 10.11 ± 1.44, left 7.45 ± 1.67, right 7.53 ± 1.59; width: central 12.27 ± 2.11, anterior 10.99 ± 1.92, posterior 10.10 ± 1.74; height: central 7.68 ± 1.38, left 7.16 ± 1.35, right 7.40 ± 1.41. A statistically significant difference between sexes was found only in the anterior width (p = 0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm³, respectively for females and males (p = 0.02) vs. 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p = 0.05) using the Di Chiro-Nelson's method. CONCLUSIONS: Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson's. Our findings may be useful for reassessment the volume of the sella turcica as the measurements indicate a higher precision.

Development of an alternative saliva test for diagnosis of SARS-CoV-2 using TRIzol: Adapting to countries with lower incomes looking for a large-scale detection program.

The use of saliva for the diagnosis of SARS-CoV-2 has shown to be a good alternative to nasopharyngeal swabs (NPS), since it permits self-collection, avoids the exposure of healthy persons to infected patients, reduces waiting times, eliminates the need of personal protective equipment and is non-invasive. Yet current saliva testing is still expensive due to the need of specialized tubes containing buffers to stabilize the RNA of SARS-CoV-2 and inactivate the virus. These tubes are expensive and not always accessible in sufficient quantities. We now developed an alternative saliva testing method, using TRIzol for extraction, viral inactivation, and storage of SARS-CoV-2 RNA, combined with RT-qPCR, which was comparable in its performance to NPS. Paired saliva samples and NPS were taken from 15 asymptomatic healthcare workers and one patient with SARS-CoV-2. Further 13 patients with SARS-CoV-2 were only saliva-tested. All the tests were performed according to CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel. Saliva (4 mL) was taken in sterile 50 mL tubes, 1.5 mL TRIzol were added and mixed. Our results show that 5 µL of saliva RNA extracted with TRIzol allow for an adequate detection of the virus in patients positive for SARS-CoV-2 and was equally sensitive to NPS in TRIzol. We conclude that saliva testing using TRIzol is a recommendable method for diagnosis of SARS-CoV-2 since it has several advantages over currently used saliva tests: it can be done with normal sterile tubes, does not need cold-chain handling, is stable at room temperature, is non-invasive and less costly, making it more accessible for low-income countries. Cheaper saliva testing using TRIzol is especially relevant for low-income countries to optimize diagnosis and help define quarantine durations for families, healthcare workers, schools, and other public workplaces, thus decreasing infections and mortality caused by SARS-CoV-2.

[Non-invasive brain and spinal cord stimulation for motor and functional recovery after a spinal cord injury]. / Estimulación no invasiva cerebral y medular para la recuperación motora y funcional tras una lesión medular.

INTRODUCTION: Spinal cord injury is a traumatic or non-traumatic event that causes an alteration of sensory, motor or autonomic functioning and ultimately affects the physical, psychological and social well-being of the person who suffers it. A comprehensive approach to spinal cord injury requires many health resources and can place a considerable financial burden on patients, their families and the community. AIM: To review the literature published to date on the use of non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous non-invasive spinal cord stimulation (tcSCS), as therapeutic strategies to improve the functionality of patients with spinal cord injury. The studies were grouped as addressing either non-invasive brain stimulation or non-invasive spinal cord stimulation. DEVELOPMENT: Altogether 32 studies were identified: 21 involving brain stimulation (14 in rTMS and 7 in tDCS) and 11 with spinal cord stimulation (tcSCS). All the studies were conducted in adult patients who had undergone a spinal cord injury. Despite significant variability in treatment protocols, patient characteristics and clinical assessment, the changes observed were reported in almost all the studies without producing any side effects and with motor or functional improvement. CONCLUSION: Non-invasive brain stimulation, as well as spinal cord stimulation, are promising techniques for the rehabilitation of patients with spinal cord injury due to their novelty, effectiveness and minimal side effects.

TITLE: Estimulación no invasiva cerebral y medular para la recuperación motora y funcional tras una lesión medular.Introducción. La lesión medular es un evento traumático o no traumático que causa una alteración de la función sensorial, motora o autonómica y, en última instancia, afecta a las características físicas, psicológicas y el bienestar social de la persona que lo sufre. El abordaje integral de la lesión medular requiere muchos recursos de salud y puede representar una considerable carga financiera para los pacientes, sus familias y la comunidad. Objetivo. Revisar la bibliografía publicada sobre el uso de la estimulación cerebral no invasiva, incluida la estimulación magnética transcraneal repetitiva (EMTr), la estimulación de corriente continua directa transcraneal (tDCS), así como la estimulación medular no invasiva transcutánea (tcSCS), como estrategias terapéuticas para mejorar la funcionalidad de los pacientes con lesión medular. Los estudios se agruparon bien como de estimulación no invasiva cerebral, bien como de estimulación medular no invasiva. Desarrollo. Se identificaron 32 estudios: 21 de estimulación cerebral (14 en EMTr y 7 en tDCS) y 11 de estimulación medular (tcSCS). Todos los estudios se realizaron en pacientes adultos que sufrieron una lesión medular. A pesar de la variabilidad significativa en los protocolos de tratamiento, las características de los pacientes y la evaluación clínica, los cambios observados se describieron en casi todos los estudios sin producir efectos secundarios con mejoría motora o funcional. Conclusión. La estimulación cerebral no invasiva, así como la estimulación medular, son técnicas prometedoras para la rehabilitación de pacientes con lesión medular debido a su novedad, su efectividad y mínimos efectos secundarios.

GeneHunt for rapid domain-specific annotation of glycoside hydrolases.

The identification of glycoside hydrolases (GHs) for efficient polysaccharide deconstruction is essential for the development of biofuels. Here, we investigate the potential of sequential HMM-profile identification for the rapid and precise identification of the multi-domain architecture of GHs from various datasets. First, as a validation, we successfully reannotated >98% of the biochemically characterized enzymes listed on the CAZy database. Next, we analyzed the 43 million non-redundant sequences from the M5nr data and identified 322,068 unique GHs. Finally, we searched 129 assembled metagenomes retrieved from MG-RAST for environmental GHs and identified 160,790 additional enzymes. Although most identified sequences corresponded to single domain enzymes, many contained several domains, including known accessory domains and some domains never identified in association with GH. Several sequences displayed multiple catalytic domains and few of these potential multi-activity proteins combined potentially synergistic domains. Finally, we produced and confirmed the biochemical activities of a GH5-GH10 cellulase-xylanase and a GH11-CE4 xylanase-esterase. Globally, this "gene to enzyme pipeline" provides a rationale for mining large datasets in order to identify new catalysts combining unique properties for the efficient deconstruction of polysaccharides.

[Augmented-pressure colostogram in the radiological assessment of anorectal malformations]. / El colostograma distal a presión en el manejo radiológico de las malformaciones anorrectales.

OBJECTIVES: To present our experience in detecting the existence of a possible associated fistula between the pouch colon and the urogenital tract in patients with anorectal malformations by carrying out an augmented-pressure colostogram, and its subsequent correlation between radiological and surgical findings. MATERIAL AND METHODS: A 17-year retrospective revision of 43 patients with anorectal malformations was performed. 34 of them were referred to the Radiology Department in order to carry out an augmented-pressure distal colostogram prior to surgery. RESULTS: A fistula was demonstrated in 26 of the 34 patients who had an augmented-pressure distal colostogram done. In the remaining 8 patients, this technique failed to demonstrate a fistula. The radiological findings were confirmed during the surgery in each case. CONCLUSIONS: The augmented-pressure distal colostogram is a simple and accurate study to delineate the altered anatomy of anorectal malformations, to define the distance between pouch colon and perineum, and to identify the localization of any associated fistulous communication. It is the most dependable test for a surgeon in order to choose the type of surgical approach, which depends on the presence or absence of an associated fistula.

OBJETIVOS: Presentar nuestra experiencia en la detección de las fístulas asociadas a las malformaciones anorrectales (MAR), utilizando como método diagnóstico el colostograma distal a presión y su posterior correlación entre los hallazgos radiológicos y quirúrgicos. MATERIAL Y METODOS: Se han revisado retrospectivamente, en un periodo de 17 años, 43 pacientes con diagnóstico de malformación anorrectal, de los cuales 34 fueron remitidos al Servicio de Radiología para la realización de un colostograma distal a presión antes de la cirugía. RESULTADOS: De los 34 casos en los que se realizó el colostograma distal a presión, en 26 se objetivó la existencia de una fístula y en los 8 casos restantes no. En todos los casos nuestros hallazgos radiológicos fueron confirmados posteriormente en la intervención quirúrgica. CONCLUSIONES: El colostograma distal a presión es una prueba diagnóstica sencilla y precisa para definir la anatomía alterada de las MAR, conocer la distancia entre el bolsón rectal y el margen anal, y la localización anatómica de las fístulas asociadas. Es la exploración diagnóstica más fiable para la elección de la vía de abordaje quirúrgica por parte del cirujano, condicionada por la existencia o no de una fístula.

Selecting sanitation systems for sustainability in developing countries.

This paper presents a methodology for systematically incorporating multi-dimensional sustainability considerations into the selection of wastewater options for developing countries and the evaluation and comparison of these options. Appropriate technologies for developing countries were screened based on their function and their use of operational sustainability features; this list of technologies can then be used to elaborate design options. Sustainability indicators are used to enable a parallel comparison of the options from environmental, economic, and socio-cultural perspectives. For illustration, the indicator approach is applied to a case study of the sanitation options for peri-urban/rural areas of the eThekwini Municipality in South Africa.

Acute effects of three high-fat meals with different fat saturations on energy expenditure, substrate oxidation and satiety.

BACKGROUND & AIMS: To compare the acute effects of three fatty meals with different fat quality on postprandial thermogenesis, substrate oxidation and satiety. METHODS: Twenty-nine healthy men aged between 18 and 30 years participated in a randomised crossover trial comparing the thermogenic effects of three isocaloric meals: high in polyunsaturated fatty acids from walnuts, high in monounsaturated fatty acids from olive oil, and high in saturated fatty acids from fat-rich dairy products. Indirect calorimetry was used to determine resting metabolic rate, respiratory quotient, 5-h postprandial energy expenditure and substrate oxidation. Satiety was estimated by using visual analogue scales and measuring caloric intake in a subsequent ad libitum meal. RESULTS: Five-h postprandial thermogenesis was higher by 28% after the high-polyunsaturated meal (p=0.039) and by 23% higher after the high-monounsaturated meal (p=0.035) compared with the high-saturated meal. Fat oxidation rates increased nonsignificantly after the two meals rich in unsaturated fatty acids and decreased nonsignificantly after the high-saturated fatty acid meal. Postprandial respiratory quotient, protein and carbohydrate oxidation, and satiety measures were similar among meals. CONCLUSIONS: Fat quality determined the thermogenic response to a fatty meal but had no clear effects on substrate oxidation or satiety.

[Lymphatic mapping and sentinel lymph node biopsies in order to avoid axilar dissection in early breast cancer]. / Mapeo linfático y linfadenectomía del ganglio centinela para evitar la disección axilar en mujeres con cáncer temprano de mama.

OBJECTIVE: To present the characteristics of women with early breast cancer and clinically negative ganglia who were submitted to LM and SLNB in order to select the positive cases for axilar dissection and to identify the negative cases. MATERIAL AND METHODS: Cases included patients who attended the Breast Tumor Service of the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute from March 1, 2002, to April 30, 2004. Women with early breast cancer and clinically negative ganglia (N0) were included, with out previous treatment and without previous biopsies. All cases were submitted to LM and SLNB with patent blue or double-blue technique and gamma probe. The lymph nodes were evaluated histopathologically and negative or positive results were considered, in order to determine whether or not to undertake the axilar dissection. No cases were excluded. RESULTS: Sixty cases were reviewed with an average age of 51 years. The average size of the ganglia was 1.9 cm, with stages EC-0: 9%, EC-I: 33%, EC-IIA: 58%. Sentinel lymph nodes were found in 100% and 95 ganglions were dissected, for an average of 1.6 per procedure. The histopathology was definitive in 19 women with metastasis (32%) and in 41 women with negative ganglia (68%). The results of transoperative histopathology were correlated with the histopathology report (one false positive and six false negative cases), sensitivity of 68.4%, specificity of 97.5%, positive predictive value 92.8% and negative predictive value 86.9%. CONCLUSIONS: LM and SLNB avoided radical axilar dissection in 68% of the cases and reduced the cost in 10% of the cases.

[Nosocomial infection surveillance: experience at a cardiology hospital in Mexico]. / Vigilancia de infecciones nosocomiales: experiencia de un hospital de cardiología en México.

OBJECTIVE: To describe the results of the Nosocomial Infection surveillance program at the Cardiology Hospital in Centro Médico Nacional Siglo XXI of the Mexican Social Security Institute. METHODOLOGY: To inform of the epidemiologic follow-up results from January 2000 to July 2003. Global frequency, infection rates by infection site, hospital services, and frequency of most common microorganisms were estimated. RESULTS: During this period, global incidence showed that in every 100 discharges, there were 4.3 infections (4.3/100). Frequency of infection was slightly higher in the surgical intensive care unit. Average infection rate in lower respiratory tract infections was 27/1,000; in surgical-site infections: 8/1,000 (mediastinitis 0.8/1,000); it was found that in urinary tract infection, rate was 6.6/1,000. Most commonly isolated microorganisms were: coagulase-negative Staphylococcus (25%), Enterobacter sp. (17%), Candida albicans (13%), S. aureus (9%), P. aeruginosa (9%) and K. pneumoniae (6%). CONCLUSION: This study describes the epidemiology of nosocomial infections in a Cardiology Hospital. The information is obtained through epidemiologic follow-up programs. This information is very important to develop specific strategies for control of infections.

[The Ottawa ankle rules: evaluation in a pediatric emergency setting in Mexico]. / Los criterios de Ottawa para tobillo: valoración en un servicio de urgencias en México.

INTRODUCTION: Pediatric ankle injuries are a common complaint in the emergency setting. The objective of this study was to prospectively validate the Ottawa ankle rules (OAR) in children in Mexico. This could reduce costs and waiting times in the emergency room. PATIENTS AND METHODS: The authors applied the OAR to all patients aged 0 to 18 years old with an acute ankle injury. The main outcome measure was radiograph and/or clinical outcome determined through telephone contact. The presence of fracture was considered an adverse outcome. RESULTS: One hundred and eleven patients, aged 3-18 years, were enrolled. The prevalence of fractures was 15 %. The sensitivity and negative predictive value of the OAR were 100 %. Use of the OAR would have reduced the radiography rate by 5.4 %. CONCLUSIONS: The sensitivity and applicability of the OAR in children in Latin-America are confirmed, although reduction in the use of radiography is lower than in other countries.

[The impact of malnutrition on brain development, intelligence and school work performance]. / Algunas consideraciones sobre el impacto de la desnutricion en el desarrollo cerebral, inteligencia y rendimiento escolar.

The findings from several authors confirm that undernutrition at an early age affects brain growth and intellectual quotient. Most part of students with the lowest scholastic achievement scores present suboptimal head circumference (anthropometric indicator of past nutrition and brain development) and brain size. On the other hand, intellectual quotient measured through intelligence tests (Weschler-R, or the Raven Progressives Matrices Test) has been described positively and significantly correlated with brain size measured by magnetic resonance imaging (MRI); in this respect, intellectual ability has been recognized as one of the best predictors of scholastic achievement. Considering that education is the change lever for the improvement of the quality of life and that the absolute numbers of undernourished children have been increasing in the world, is of major relevance to analyse the long-term effects of undernutrition at an early age. The investigations related to the interrelationships between nutritional status, brain development, intelligence and scholastic achievement are of greatest importance, since nutritional problems affect the lowest socioeconomic stratum with negative consequences manifested in school-age, in higher levels of school dropout, learning problems and a low percentage of students enrolling into higher education. This limits the development of people by which a clear economic benefit to increase adult productivity for government policies might be successful preventing childhood malnutrition.

Value of intravascular ultrasound in the assessment of coronary pseudostenosis during coronary interventions.

Coronary pseudostenosis (PS) are increasingly visualized during coronary interventions. In many patients PS are readily recognized by a characteristic angiographic pattern, but in other cases the diagnosis remains difficult. The value of intravascular ultrasound (IVUS) in the study of PS remains unknown. In this study, IVUS was used to assess the morphologic appearance of the vessel wall in 10 consecutive patients showing images of PS during coronary interventions. Mean age of the group was 60+/-12 years and two patients were female. IVUS was performed with a motorized pullback system to assess lumen, plaque, and total vessel cross-sectional areas. Measurements were performed both at the site of PS and at the distal reference segment. PS were always located on angled coronary segments. In one patient no lumen narrowing was detected with IVUS at the site of PS. In the remaining nine patients, however, a very localized elliptic-shaped lumen narrowing was demonstrated. As compared with the distal reference segment, coronary lumen (6.3+/-2.2 vs. 12.7+/-4.8 mm2, P < 0.001) and total vessel area (11.9+/-3.3 vs. 16.1+/-6.1 mm2, P < 0.05) were smaller at the site of PS. Severe lumen asymmetry was also documented at this site. In addition, a characteristic image of a flattened, three-layered wall, overlying a hypoechogenic space, was visualized in five patients. This unique pattern was considered the correlate of a partial coronary intussusception. PS induced some resistance to the advancement of catheters in two patients and temporary flow impairment in two additional patients. However, in every case, the image of PS disappeared once the guidewire was removed. Thus, at sites with PS, IVUS allows ruling out severe atherosclerosis and coronary dissections. In addition, IVUS also provides important diagnostic clues, including the image of intussusception, for making the correct diagnosis of this benign entity.

North-South twinning in paediatric haemato-oncology: the La Mascota programme, Nicaragua.

We describe the La Mascota twinning programme between La Mascota paediatric hospital in Managua, Nicaragua, and hospitals in Monza and Milan, Italy, and Bellinzona, Switzerland. The programme was based on the belief that an attempt to reduce the gap in mortality from cancer in childhood between developed and less developed countries should become an integral part of the care and research activity of a haemato-oncological department of a developed country and not simply an exercise in solidarity. This programme for acute lymphoblastic leukaemia shows that intellectual, organisational, and financial resources can be generated by a twinning programme. What is vital for such programmes is a long-term commitment to a comprehensive and holistic strategy that incorporates supply of drugs, training and supervision of health professionals, and the care of the children and of their parents.

Thermoluminescent response and relative efficiency of TLD-100 exposed to low-energy x-rays.

The dose-response of LiF:Mg,Ti (TLD-100) exposed to 15 and 35 kVp (8.0 +/- 0.1 and 8.1 +/- 0.1 keV effective energy respectively) x-rays and 60Co gamma-rays has been measured in the dose interval from (1.2-5.4) x 10(3) Gy for x-rays, and from 0.14 to 850 Gy for gamma-rays. In both cases the total TL signal and glow curve peaks 3 to 9 show supralinearity. The supralinearity function f(D) is similar for both x-ray beams, except for peak 8, where a 30% difference is observed. The maxima of f(D) for the total TL signal and peaks 5 to 8 are 2.1, 1.7, 6.4, 3.3 and 7.5 respectively for 8.1 keV x-rays and 3.7, 3.1, 13.6, 9.9 and 11.0 for gamma-rays. The measured relative efficiencies for x-rays with respect to 60Co, for the total TL signal and peaks 5 and 7, were 1.04, 0.97 and 3.2 respectively.

[Anthropometric assessment and school achievement in school-age children from high school in Valparaiso, Chile]. / Evaluación antropométrica y rendimiento escolar en estudiantes de educación media de Valparaíso, Chile.

The purpose of this study was to determine the interrelationship between nutritional status and scholastic achievement (SA). The total population included 1,488 high school students from Valparaíso, City, V Region of Chile. A representative sample of 165 school-age children was chosen from public schools in which the Improvement Education Quality Program (MECE) from the Ministry of Education of Chile was tried. Socioeconomic status (SES) was measured by means of the Graffar's modified method. Nutritional status was assessed through anthropometric measurements of weight (W), height (T), head circumference (HC), arm circumference (AC) and triceps skindfold (TS). SA was determined by a language (SAL) and mathematics (SAM) test. Statistical analysis included analysis of variance, correlation multiple regression and chi-square. Results showed that HC is the anthropometric parameter with the greatest explanatory power in SA variance, in high school graduates (r2 = 0.7697), both SAL (r2 = 0.9258) and SAM (r2 = 0.5268), with a RR = 1.97. In this respect, 75% of school children with Z-HC values below median obtained a low percentage of achievement in the SA test. Considering that HC is a direct indicator of nutritional background and indirect indicator of brain development, these findings increase the knowledge in this area and reveal the need to carry out further research related to the interrelationship SA-brain development.

Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua.

We observed a child with acute promyelocytic leukemia (APL) who, at the onset, had extremely severe hemorrhagic and septic complications. According to our experience in Nicaragua, there was a very high risk of early death. The patient was successfully treated with a program that included all-trans retinoic acid (ATRA) followed by cytotoxic chemotherapy. ATRA has two important features: it is effective in initial treatment of APL and it is inexpensive. Because of the high cost and the need for extensive supportive care, optimal myeloablative therapy used in patients with various types of acute myeloid leukemia generally cannot be given in developing countries. ATRA treatment for APL is affordable everywhere.

[The assessment of the lumbago patient in the work environment: the diagnostic aspects and forensic medical reflections]. / La valutazione del soggetto lombalgico in ambito lavorativo: aspetti diagnostici e riflessi medico legali.

In occupational health the assessment of subjects suffering from lumbago in the case of job fitness certificates is complicated not only because of the obvious possibility of the influence of simulation, but also because of the poor specificity of diagnostic possibilities for spinal disorders. An assessment was made of the reliability of traditional clinical procedures and the most common protocols and the possibility of using them in this context.