Anaesthesia praCtice for Caesarean dElivery Snapshot Study (ACCESS): Protocol and baseline characteristics of registered centres.

BACKGROUND: Specific guidelines to manage caesarean delivery anaesthesia are lacking. A European multicentre study, ACCESS investigates caesarean delivery anaesthesia management in European centres. In order to identify ACCESS participating centres, a registration survey was created. OBJECTIVE: The aim of the current report is to describe the characteristics of ACCESS study participating centres, the rationale for the ACCESS study and the study methodology. DESIGN AND SETTING: The ACCESS study is a European multicentre cross-sectional study to describe anaesthesia management for caesarean delivery (CD) using a snapshot (2-week) design. The ACCESS registration survey gathered: contact details for National Coordinators (NC); Lead Investigators (LI) per centre; centre annual CD volume; expected no. of CD during 2-week snapshot window; centre practice information; data collection language. The ACCESS registration survey was launched July 2022 (Google Forms, Google Inc., Mountain View, CA, USA) and distributed through personal connections, national and international societies, social media networks, during Euroanaesthesia 2023, through the European Society of Anaesthesiology and Intensive Care newsletter. RESULTS: The ACCESS registration survey identified Lead Investigators for 418 centres, in 32 countries, representing an anticipated number of 15,073 CD cases over the planned 12-month study period. A median (range) of 20 (2 to 400) CD cases are anticipated per centre during the 2-week snapshot window. Most 366/418 (87.6%) centres are small, ≤2000 annual CD cases, 42 are medium 2000-5000 cases and 10 are large, ≥5000 annual CD cases. Registered centres reported in 134 (32.0%) centres that anaesthesia for caesarean delivery is performed mostly by a specialist obstetric anaesthesiologist. CONCLUSION: The ACCESS registration survey revealed variability in volume and CD practice as well as training-levels and staffing among European countries. The ACCESS study (https://www.access-study.org/) aims to generate practice data to guide CD anaesthetic management strategies.

Assessment of performance and egg quality in laying hens of Spanish indigenous breed Black Castellana as compared with a selected white egg-layer strain.

Indigenous animal genetic resources should be preserved because of their well adaptation to the environment, their tolerance to low food availability and their sociocultural importance. The characterization of the quality of the products generated by heritage breeds may bring more arguments to encourage the raising of these animals. This study aimed at evaluating the egg performance and quality of Spanish indigenous Black Castellana (BC) breed as compared with a selected strain (Lohmann LSL-Classic). Four groups of 30 hens were arranged: 1) Lohmann hens fed a control diet; 2) BC hens fed the control diet; 3) Lohmann hens fed a diet including linseed at 70 g/kg (omega-3 diet); 4) BC hens fed the omega-3 diet. Egg production was higher by 12.3% for Lohmann hens but, since BC eggs were heavier by 15.4%, no effect of genetics was found on daily egg mass. Feed intake was higher by 5.0% for BC hens. Nonetheless, no difference was detected for feed conversion ratio. Eggshell was thicker by 6.78% in Lohmann eggs. Haugh units did not differ among freshly laid and stored eggs in Lohmann hens, whereas Haugh units decreased in stored BC eggs (80.5 vs. 76.7 vs. 72.3 at 0, 14, and 30 d of storage). Yolks of BC eggs contained less fat (57.5 vs. 60.8% DM), more protein (32.8 vs. 31.9% DM) and more cholecalciferol (1.25 vs. 1.22 µg/g DM), and showed lower proportion of saturated fatty acids (29.0 vs. 37.0%) and higher proportions of monounsaturated (45.7 vs. 39.6%) and polyunsaturated (25.2 vs. 23.4%) fatty acids. Feeding the omega-3 diet reduced the yolk proportions of saturated (32.5 vs. 33.5%) and monounsaturated (42.0 vs. 43.3%) fatty acids and increased those of polyunsaturated (25.4 vs. 23.2%) and ω-3 (7.05 vs. 2.42%) fatty acids. No effect due to genetics or diet was found on yolk color score or on yolk content in cholesterol, cobalamin, retinol and γ-tocopherol. This study represents the first exhaustive characterization of eggs from Spanish indigenous Black Castellana breed.

The influence of socioeconomic status and psychological factors on surgical outcomes of the carpometacarpal osteoarthritis of the thumb. / Influencia de los factores socioeconómicos y psicológicos en los resultados del tratamiento quirúrgico de la artrosis trapecio-metacarpiana.

OBJECTIVE: This study aimed to investigate to what extent people with carpometacarpal thumb osteoarthritis that are socioeconomically disadvantaged and have psychological disorders report higher pain levels and worse patient-rated upper-extremity functionality after surgical treatment. MATERIAL AND METHOD: A single center, retrospective observational cohort study analysing 100 patients diagnosed with thumb carpometacarpal osteoarthritis between 2013 and 2019. Patients were divided into two groups (50/50), depending on whether they received surgical or conservative treatment. The socio-economic status (ESeC classification) and presence of psychological comorbidities were investigated. Functional outcomes were assessed using the Visual Analogue Scale (VAS), Q-DASH questionnaire and Kapandji score. Current mental disorders were evaluated using STAI, PHQ-9 and PCS screening scales. RESULTS: Measures of functional hand scores (Q-DASH) were higher and had considerably less pain in surgically treated participants, although thumb mobility (Kapandji) was more restricted. They were also associated with higher scores on psychological assessment scales. Sixty-four per cent of the patients came from lower socio-economic classes and suffered from poorer scores on the mental health screening questionnaires. Of the patients manage surgically, 54% were diagnosed of dysthymic disorder and showed significantly worse patient-rated upper-extremity function (Q-DASH questionnaire, median [IR]:31,8 [20,5-54,6] than patients without psychological disorders (median [IR]: 13,6 [2,3-36,5]). No differences were found for patients with and without disthymic disorder managed nonoperatively. CONCLUSIONS: Patients with higher rates of depression, anxiety and pain catastrophizing behaviour showed significantly worse outcomes after surgery for osteoarthritis of the first carpometacarpal joint. Lower socio-economic class significantly influences levels of depression and anxiety but did not affect functional outcome. Surgical treatment of carpometacarpal thumb osteoarthritis achieved better self-perceived hand function (QDASH, VAS, Kapandji) than conservative treatment.

[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. / Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina.

INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

Sistema de presión negativa como tratamiento de la venta torácica: informe de caso / Negative pressure system as a thoracic window treatment: a case report

Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.

Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.

Miastenia gravis en la infancia: una serie de tres casos / Myasthenia gravis in infancy: a series of three cases

La miastenia gravis es una enfermedad neuromuscular crónica debida a deficiencia de transmisión nerviosa en la unión neuromuscular, de origen generalmente autoinmune en el adulto, que se caracteriza por grados variables de debilidad de los músculos esqueléticos del cuerpo, que aumenta durante los períodos de actividad y disminuye después de períodos de descanso. Sin embargo en la infancia cobran especial relevancia los síndromes miasténicos congénitos, que encuentran su origen en mutaciones de genes que codifican proteínas que juegan papeles clave en el mantenimiento de la transmisión neuromuscular, teniendo edad de inicio, distribución de debilidad y respuesta a tratamiento variables. Se presentan tres casos con el objetivo de describir el comportamiento clínico de la enfermedad y la utilidad de estudios complementarios ya que es de suma importancia su precoz identificación y tratamiento. Palabras claves: Miastenia gravis, test de estimulación repetitiva, ptosis palpebral, unión neuromuscular, pares craneanos

Myasthenia gravis is a chronic neuromuscular disease due to deficiency of nerve transmission in the neuromuscular junction, usually of an autoimmune origin in the adult, which is characterized by varying degrees of weakness of the skeletal muscles of the body, which increases during periods of activity and decreases after periods of rest. In childhood, however, congenital myasthenic syndromes, which find their origin in mutations of genes that encode proteins that play key roles in maintaining neuromuscular transmission, which may have a varying age of onset, distribution of weakness and response to treatment, are particularly relevant. Three cases are presented with the aim of describing the clinical presentation and course of the disease and the usefulness of complementary studies, since its early diagnosis and treatment is of paramount importance.Keywords: Myasthenia gravis, repetitive stimulation test, palpebral ptosis, neuromuscular junction, cranial pairs.

Economic valuation of the eco-systemic benefits derived from the environmental asset lake Laguna Santa Elena, through the multi-criteria analysis / Valoração econômica dos benefícios ecossistêmicos derivados do ativo ambiental Laguna Santa Elena por meio da análise multicritério

Abstract Lake Laguna Santa Elena, a freshwater body, located in mid-south of Chile, is an environmental asset used as a water resource by the agricultural and touristic sector and is the habitat for a wide variety of endemic avifauna. The objective of this study was to assign a monetary value to this lacustrine body, using the methodology of AMUVAM (Multicriteria Analysis of Environmental Active Values). The information was collected through the application of surveys to a panel of experts involved in the use of the environmental resource. The result obtained with the AMUVAM method corresponds to the US $ 17,780,686, a figure that represents an estimated value of the TEV (Total Economic Value) of the environmental asset. This study, a pioneer in the Region, will support decision making, allowing an adequate management of this critical water resource.

Resumo A Laguna Santa Elena, um corpo de água doce localizado no centro-sul do Chile, é um ativo ambiental usado como recurso hídrico pelos setores agrícola e turístico e é o habitat de uma ampla variedade de avifauna endêmica. O objetivo deste estudo foi atribuir um valor monetário a esse corpo lacustre, utilizando a metodologia da AMUVAM (Análise Multicritério de Valores Ambientais Ativos). As informações foram coletadas por meio da aplicação de pesquisas a um painel de especialistas envolvidos no uso do recurso ambiental. O resultado obtido com o método AMUVAM corresponde a US$ 17.780.686, que representam um valor estimado do valor econômico total (VT) do ativo ambiental. Este estudo, pioneiro na região, apoiará a tomada de decisões, permitindo um gerenciamento adequado desse recurso hídrico crítico.

Identifying anti-Toxocara IgG antibodies in horses of Mexico / Identificação de anticorpos IgG anti-Toxocara em cavalos do México

Both the presence of owned dogs and stray dogs allows the spread of Toxocara, a parasite whose eggs can be found in soil, water and food. Animals, including horses, serve as definitive and paratenic hosts. In México, where consumption of horse meat is common, Toxocara is a zoonotic parasite. The aim of this study was to identify the presence of anti-Toxocara antibodies in work horses and horses intended for human consumption by ELISA. ELISA was chosen for analysis as paratenic hosts do not shed Toxocara eggs in their feces. Blood samples were collected from a total of 188 horses, 94 of which were work horses and 94 horses from the slaughter house. Samples were analyzed by ELISA, and the general equine seroprevalence was found to be 44.6% (n = 188). Adult horses for slaughter had a 61.7% greater presence of anti-Toxocara antibodies (p = 0.006). Toxocara IgG antibodies were found in horses, confirming that horses are paratenic hosts and possible sources of infection for other animals and people.(AU)

Tanto a presença de cães com dono quanto de cães vadios permitem a disseminação de Toxocara, e o parasita está presente no solo, na água e nos alimentos. Animais, incluindo cavalos, apresentam-se como hospedeiros definitivos e paratênicos. No México, o consumo de carne de cavalo é comum, e Toxocara é um parasita zoonótico. ELISA foi escolhido para análise, já que hospedeiros paratênicos não jogam ovos de Toxocara em suas fezes. O objetivo deste estudo foi identificar a presença de anticorpos anti-Toxocara por ELISA, em cavalos de trabalho e em cavalos para o consumo humano. As amostras de sangue foram retiradas de 188 cavalos: 94 cavalos de trabalho e 94 cavalos de trabalho do matadouro. Soros dos animais foram analisados por ELISA e 44,6% dos equinos apresentaram anticorpos anti-Toxocara. Cavalos adultos para abate têm 61,7% mais elevada a presença de anticorpos anti-Toxocara (P = 0,006). Anticorpos IgG Toxocara foram encontrados em cavalos, confirmando cavalos paratênicos como hospedeiros e possíveis fontes de infecção para outros animais e pessoas.(AU)

Portación de Staphylococcus Aureus en manipuladores de alimentos de servicios gastronómicos de Asunción, Paraguay (2017) / Staphylococcus Aureus in food manipulators of gastronomic services of Asunción, Paraguay (2017)

Introducción: El Staphylococcus Aureus constituye un agente etiológico frecuente de intoxicaciones alimentarias y se encuentra asociado a diversos alimentos. Objetivo: Describir la frecuencia de portación de Staphylococcus Aureus en manipuladores de alimentos de restaurantes de Asunción durante el 2017. Metodología: Se realizó un estudio observacional, prospectivo, descriptivo de corte transversal a manipuladores de alimentos de restaurantes de Asunción durante los meses de mayo a junio del 2017. Se realizaron tres hisopados nasales a cada uno de los 30 manipuladores de alimentos para determinar si la portación era intermitente, permanente u ocasional. Al mismo tiempo fueron realizadas encuestas donde se midieron variables demográficas. Resultados: La prevalencia de portación de Staphylococcus Aureus fue del 33,3 % (10), siendo el 40% (4) esporádica e intermitente y el 20% (2) permanente. En cuanto a las características demográficas de los manipuladores,el 56,66% (17) fueron del sexo masculino, eran solteros 43,33% (13) y el 50% (15) contaban con estudios secundarios completos. El promedio de edad de 29 de los manipuladores fue de 39,5 años con un rango comprendido entre 18 y 85 años. El 23,33% (7) utilizaban guantes a la hora de manipular los alimentos. Además, se pudo observar que el 26,66% (8) utilizaba gorros. Llamó la atención que el 30% (9) de los encuestados no presentaban uñas limpias durante la manipulación. Palabras clave: Staphylococcus Aureus; manipuladores; alimentos.

Introduction: Staphylococcus Aureus is a frequent etiologic agent of food poisoning and is associated with various foods. Objective : To describe the frequency of Staphylococcus Aureus in food handlers of restaurants in Asunción during 2017. Methodology: An observational, prospective, descriptive, cross-sectional study was carried out on food handlers in restaurants in Asuncion during the months of May to June 2017. Three nasal swabs were made to each of the 30 food handlers to determine if the carriage was intermittent, permanent or occasional. At thesame time, surveys were carried out where demographic variables were measured. Results: The prevalence of carrying Staphylococcus Aureus was 33.3% (10), being 40% (4) sporadic and intermittent and 20% (2) permanent. Regarding the demographic characteristics of the manipulators, 56.66% (17) were male, were single 43.33% (13) and 50% (15) had complete secondary education. The average age of 29 of the manipulators was 39.5 years with ranger between 18 and 85 years. 23.33% (7) used gloves when handling food. In addition, it was observed that 26.66% (8) used caps. It was noted that 30% (9) of theres pondents did not have clean nails during handling. Keywords: Staphylococcus Aureus; manipulators; food.

Economic valuation of the eco-systemic benefits derived from the environmental asset lake Laguna Santa Elena, through the multi-criteria analysis

Abstract Lake Laguna Santa Elena, a freshwater body, located in mid-south of Chile, is an environmental asset used as a water resource by the agricultural and touristic sector and is the habitat for a wide variety of endemic avifauna. The objective of this study was to assign a monetary value to this lacustrine body, using the methodology of AMUVAM (Multicriteria Analysis of Environmental Active Values). The information was collected through the application of surveys to a panel of experts involved in the use of the environmental resource. The result obtained with the AMUVAM method corresponds to the US $ 17,780,686, a figure that represents an estimated value of the TEV (Total Economic Value) of the environmental asset. This study, a pioneer in the Region, will support decision making, allowing an adequate management of this critical water resource.

Resumo A Laguna Santa Elena, um corpo de água doce localizado no centro-sul do Chile, é um ativo ambiental usado como recurso hídrico pelos setores agrícola e turístico e é o habitat de uma ampla variedade de avifauna endêmica. O objetivo deste estudo foi atribuir um valor monetário a esse corpo lacustre, utilizando a metodologia da AMUVAM (Análise Multicritério de Valores Ambientais Ativos). As informações foram coletadas por meio da aplicação de pesquisas a um painel de especialistas envolvidos no uso do recurso ambiental. O resultado obtido com o método AMUVAM corresponde a US$ 17.780.686, que representam um valor estimado do valor econômico total (VT) do ativo ambiental. Este estudo, pioneiro na região, apoiará a tomada de decisões, permitindo um gerenciamento adequado desse recurso hídrico crítico.

Síndrome de Vogt-Koyanagi-Harada en niños / Vogt-Koyanagi-Harada syndrome in children

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic inflammatory disease that causes chronic and bilateral granulomatous panuveitis, usually described in adults. Objectives: To describe manifestations and complications of VKH in pediatric patients. Methods: Retrospectivedescriptive study upon patients <14 years-old with VKH, attended from January 1985 to July 2010 in three different centers. Results: A total of 17 patients (34 eyes) were studied; 9 (53%) female. The mean age was 10.8 years-old. Among extraocular manifestations; neurological (71%), dermatological (29%) and auditive (24%) signs were observed. Ocular findings included optic-disc involvement (94%), anterior uveitis (79%), choroiditis (77%), serous retinal detachment (71%) and vitritis (71%). Initial visual acuity (VA) was ≤0.05 in 47% of cases and ≥0.6 in 12% of patients. 71% presented complications: glaucoma (20 eyes), sinechiae (10 eyes), maculopathy (6 eyes) cataract (5 eyes) and ptisis bulbi (1 eyes). 35% received only corticosteroids and 65% inmunosupressive drugs. After treatment, 6% had VA ≤0.05 and 59% ≥0.6. Ten patients (59%) recurred: 30% compromising posterior pole, and 50% recurred >3 times. Conclusions: VKH in children is infrequent. It presents with optic-disc involvement and complications of posterior pole. It requires a high degree of suspicion, quick evaluation and early treatment, which include inmunosupressive and extended corticosteroid therapy. Nevertheless, a high rate of recurrence is seen among this group of patients. (AU)

Caracterización morfológica y composición química de chayotas (Sechium edule) cultivadas en las Islas canarias (España) / Morphological and chemical composition characterization of chayotas (Sechium edule) grown in the Canary Islands (Spain)

Se analizaron características morfológicas relacionadas con el fruto, espinas, endocarpio y semilla, así como parámetros fisicoquímicos y nutricionales (humedad, proteínas, ºBrix, fibra alimentaria, cenizas, pH, acidez, ácido ascórbico, compuestos fenólicos totales, minerales: Na, K, Ca y Mg y elementos traza: Fe, Cu, Zn y Mn), en muestras de chayota (Sechium edule) pertenecientes a 7 entradas cultivadas en las islas de Tenerife y La Palma (España) y cosechadas durante el período comprendido entre junio y noviembre de 2005. Se observaron diferencias importantes en la composición química y características morfológicas entre las diferentes entradas de chayota estudiadas. La entrada 4 destacó por su alto contenido en minerales y sólidos solubles totales (ºBrix) y bajo contenido en agua, mientras que la entrada 1 presentó altos contenidos en Na, cenizas y ácido ascórbico. El contenido de humedad y de ácido ascórbico varió en función de la parte del fruto analizada, sin embargo, los contenidos de compuestos fenólicos y de cenizas no fueron dependientes de las partes. La fecha de muestreo mostró una gran influencia sobre la composición química, observándose las mayores diferencias en las muestras cosechadas en el mes otoñal de noviembre respecto a las restantes cosechadas en meses estivales. El análisis discriminante permitió diferenciar las muestras de chayota en función de la entrada y fecha de muestreo, por lo que es una herramienta muy útil para la caracterización de muestras(AU)

Morphological and chemical composition characterization of chayotas (Sechium edule) grown in the Canary Islands (Spain). Morphological characteristics related to the fruit, thorns, endocarp and seed, as well as physicochemical and nutritional parameters (moisture, protein, ºBrix, fiber, ash, pH, acidity, ascorbic acid, total phenolics, minerals: Na, K, Ca and Mg, and trace elements: Fe, Cu, Zn and Mn) were analyzed in samples of chayote (Sechium edule) belonging to 7 accessions grown on the islands of Tenerife and La Palma (Spain) and harvested during the period between June and November 2005. Significant differences in chemical composition and morphology between the chayote accessions studied were observed. The accession 4 features a high mineral content and soluble solids (Brix degree) and low water content, while the accession 1 had high contents of Na, ash and ascorbic acid. The moisture content and ascorbic acid varied depending on the portion of the fruit analyzed, however, the contents of phenolic compounds and ash were not affected. The sampling date showed a great influence on the chemical composition, the greatest differences observed in the samples harvested in the month of November autumn, with respect to the remaining summer months. Discriminant analysis allowed differentiate samples chayota according to the accession and sampling date, so it is a very useful tool for the characterization of these samples(AU)

Prevalencia de las enfermedades alérgicas y su asociación con la lactancia materna y el inicio de la alimentación complementaria en niños de edad escolar de Ciudad Guzmán, México / Prevalence of allergic diseases and their association with breastfeeding and initiation of complementary feeding in school-age children of Ciudad Guzmán, Mexico

Introducción. El efecto que tiene la lactancia materna y la alimentación complementaria sobre la prevalencia de las enfermedades alérgicas ha mostrado resultados inconsistentes. Objetivo. Evaluar el efecto de la lactancia materna y el momento de inicio de la alimentación complementaria en la prevalencia de las enfermedades alérgicas. Población y métodos. Estudio transversal analítico con base poblacional realizado en niños de 6 a 12 años de edad inscriptos en escuelas primarias, seleccionados mediante muestreo polietápico. Se aplicó a sus padres o tutores un cuestionario estructurado para identificar enfermedades alérgicas (asma, rinitis alérgica o dermatitis atópica), antecedente de lactancia materna prolongada y edad de inicio de la alimentación complementaria. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Resultados. Se incluyeron 740 niños. La frecuencia de lactancia e" 6 meses fue 73,4% y de alimentación complementaria con d" 4 meses fue 31,9%. La lactancia materna prolongada no tuvo efecto sobre la prevalencia de las enfermedades alérgicas. Se observó un efecto protector en la frecuencia de la dermatitis atópica cuando el inicio de la alimentación complementaria era tardío, OR ajustado= 0,36; IC95%: 0,1-0,8 (p 0,019). Conclusiones. El efecto protector de la lactancia materna sobre la prevalencia de las enfermedades alérgicas no pudo ser comprobado. La prevalencia de dermatitis atópica es menor con un comienzo tardío de la alimentación complementaria.

Introduction. The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. Objective. To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. Population and Methods. Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. Results. A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). Conclusions. The protective effect ofbreastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.

Micosis superficiales en la población Yanomami de la región de Mawaca, estado Amazonas / Superficial mycoses in the Yanomami population of the Mawaca Region, Amazon State

Este trabajo tuvo como objetivo determinar la presencia de micosis superficiales (MS) en la etnia Yanomami de Mawaca, estado Amazonas. De 176 personas examinadas, 64 mostraron lesiones sospechosas de MS, obteniendo 65 muestras: 10 de pitiriasis versicolor (PV) y 55 de dermatofitosis. El estudio micológico consistió en realizar exámenes directos, cultivos en agares micológicos, perforación del pelo in vitro, pruebas de ureasa y agar púrpura de bromocresol-glucosa-sólidos lácteos (Agar BCP-MS-G). De las 10 muestras sospechosas de PV, 3 fueron positivas, dos de niños menores de 10 años y una de un adulto, todos con lesiones en cara. En 36 raspados obtenidos se observaron hifas hialinas septadas. Se aislaron 52 colonias sospechosas de dermatofitos y de éstos, uno fue compatible con el Complejo Microsporum gypseum, de una lesión en la rodilla de un adulto. Las 51 restantes pertenecieron al Complejo Trichophyton rubrum, de los cuales, nueve perforaron el pelo in vitro, 24 hidrolizaron la urea y ninguno alcalinizó el medio Agar BCP-MS-G; la forma clínica fue tinea corporis y las lesiones se localizaron principalmente en espalda y oreja en adultos y niños, respectivamente. Estos resultados revelan la existencia de MS en la población Yanomami, sirviendo de base para futuros estudios epidemiológicos.

The purpose of this study was to determine the presence of superficial mycoses (SM) in the Yanomami ethnicity at Mawaca, Amazon State. Of 176 persons examined, 64 showed suspicious SM lesions, from which we obtained 65 samples: 10 pytiriasis versicolor (PV) and 55 dermatophytosis. The mycological study consisted in carrying out direct examination, culture in mycological agar, in vitro hair perforation, and urease and bromocresol purple-milk solids glucose agar (BCP-MS-G Agar) tests. Of the 10 PV suspicious lesions, 3 were positive, two in children under 10 years old and one in an adult, all with face lesions. In 36 scrapings we saw septate hyaline hyphae. Fifty-two dermatophyte suspicious colonies were isolated and of these, one was compatible with the Microsporum gypseum Complex, from a lesion on the knee of an adult. The other 51 belonged to the Trichophyton rubrum Complex, of which nine were in vitro hair perforations, 24 hydrolized urea, and none alkalinized the BCP-MS-G agar medium; the clinical form was tinea corporis and the lesions were mainly localized at the back and ears in children and adults respectively. These results reveal the existence of SM in the Yanomami population, serving as basis for future epidemiological studies.

Galactosemia como causa de ictericia neonatal / Neonatal jaundice caused by galactosemia

La ictericia es un problema muy frecuente en las unidades de recién nacidos. En este documento se presenta el caso de un neonato que cursó con hiperbilirrubinemia, inicialmente con predominio de la bilirrubina indirecta y posteriormente con anemia, hepatomegalia, aumento de la bilirrubina directa, alteración de la función hepática, disfunción tubular renal, cataratas y lesiones en la sustancia blanca del SNC. Se descartaron diversas causas de hiperbilirrubinemia directa en el neonato. Se encontró positiva una prueba de azúcares reductores en orina que resultó ser galactosa en la cromatografía en capa fina. Se documentó marcada reducción de la actividad enzimática de galactosa uridil transferasa, con lo cual se confirmó el diagnóstico de galactosemia. Se suspendió la alimentación con leche materna, se inició leche de soya con resolución del cuadro clínico.

Jaundice is a commonly occurring problem in hospitals' neonatal units. This report describes a newborn with hypefbilirrubinaemia; the clinical picture was initially dominated by the unconjugated bilirubin fraction and later by anaemia, hepatomegaly, increased conjugated bilirubin fraction, impaired liver function, renal tubular dysfunction, cataracts and injury to CNS white matter. Various causes of direct hyperbilirrubinaemia in the newborn were ruled out. Thin-layer chromatography revealed urine-reducing substances (i.e. galactose). A marked reduction in galactose uridyl transferaseactivity was documented, thereby confirming a diagnosis of galactosaemia. Breastfeedingwas discontinued and soy milk started which led to the symptoms becoming resolved.

Hematoma hepático subcapsular en el puerperio / Subcapsular hepatic hematoma during postpartum period

El hematoma hepático subcapsular es una complicación infrecuente y grave durante la gestación o el período puerperal. Esta patología generalmente se relaciona con preeclampsia o síndrome de HELLP. Su diagnóstico debe confirmarse por tomografía axial computarizada. La precocidad del diagnóstico y tratamiento es importante para evitar la ruptura del hematoma.

Subcapsular hepatic hematoma is a rare and severe complication during pregnancy or postpartum period. This condition is usually related to preeclampsia or HELLP syndrome. Its diagnosis must be confirmed by abdominal computed tomography. An early diagnosis and treatment are important to avoid hematoma rupture.

Grosor corneal en una muestra de adultos de la población chilena / Corneal thickness in a sample of adults of the chilean population

The central corneal thickness (CCT) is crucial to the estimation of the intraocular pressure (IOP). There are variations among different populations. The objective of the present job was to determine de CCT in a sample of Chilean population. The sample was taken at random from patients attending the office of an ophthalmologist of the Clinical Hospital of the University of Chile. The patients age ranged between 15 and 65 years. We discarded patients with IOP over 21 mm Hg, Spherical Equivalent greater than 6 diopters or with ophthalmological local treatment. The CCT was measured using ulotrasonographyc pachymeter. We enrolled 127 patients and analized 253 eyes. The CCT average was 537,70 μm 39.34 um with an standard deviation of 32.09 um. The CCT of the studied population was less than the reported in Spanish populations in USA, greater Japanese and Afro-Americans and less than Europeans and Chinese. It is important to consider the ethnic variation of the CCT in our population regarding its effect in the correction of the IO.

Recuperabilidad de la parálisis facial periférica con prednisolona vs. aciclovir/prednisolona / Recoverability of peripheral facial paralysis with prednisolone vs. acyclovir/prednisolone

En la literatura no existe suficiente evidencia que soporte la asociación de un antiviral al corticoide sistémico; sin embargo, su uso es frecuente en la práctica clínica justificada por la posible etiología viral. Objetivo: Describir la frecuencia de recuperación completa de la parálisis facial periférica idiopáticaen los pacientes que reciben prednisolona o prednisolona/aciclovir.Métodos: Se realizó un estudio de cohorte histórica identificando los casos de parálisis facial periférica. Resultados: Se reportan 106 casos, 59 mujeres (55,7%) y 47 hombres (44,3%), con edad promedio 36.9 años (DE16.7). Al ingreso el 47,2% de los pacientes presentaron parálisis grado III. Recibieron prednisolona 32 pacientes (30,2%) y prednisolona-aciclovir 74 (69,8%). La recuperación completa (House Brackman I) con prednisolona se documentó en 23 (71,9%) y 52 (70,2%) pacientes tratados con prednisolona-aciclovir. El seguimiento mediano fue 39 días. En ambos grupos lafrecuencia de mejoría fue mayor en quienes ingresaron con grados II y III de parálisis. Conclusión: La tasa de mejoría reportada es superior a la descrita con el uso de placebo pero está por debajo de lo esperado para el uso de prednisolona a 3 meses. La frecuencia de recuperación completa fue similar con prednisolona y prednisolona-aciclovir.

There is not enough evidence in the literature available that supports the addition of an anti viral to the systemic corticoid. However, it is frequently used in clinical practice where it is justified by the probable viral etiology. Objective: To describe the full recovery frequency of idiopathic peripheral facial paralysis in patients to whom prednisolone or prednisolone / acyclovir is given. Methods: A historical cohort study was conducted and the cases of peripheral facial paralysis were identified. Results: 106 cases were reported, 59 women (55,7%) and 47 men (44,3%), with an average age of 36.9 years of age (DE 16.7). 47,2% of the patients showed paralysis of the III degree upon admission. 32 of the patients (30,2%) were administered prednisolone and 74 (69,8%) were given prednisolone / acyclovir. Full recovery (House Brackman I) with prednisolone was documented in 23 (71,9%) and 52(70,2%) of the patients that had been treated with prednisolone-acyclovir. The average follow – up was 39 days. Recovery frequency was higher in both groups among the patients that were admitted to the hospital with degree II and III paralysis. Conclusion: The reported recovery rate is above the one described when using placebo but it is stillbelow the expected rate when using prednisolone for 3 months. Full recovery frequency was similar with prednisolone and with prednisolone-acyclovir.

La sexuación en hijos de hombres homoeróticos: análisis de un caso / Sexuation in children of a homoerotic men couple: case of study

El presente artículo es producto de una investigación de doctorado de corte cualitativo y con enfoque psicoanalítico. Se proponen cuatro momentos de la sexuación en la hija de una pareja de hombres homoeróticos y se abordan a profundidad los primeros dos momentos. La sexuación es entendida como la posibilidad de que alguien llegue a declarar un sexo y una elección de partenaire sexual. Los primeros vínculos, las asignaciones provenientes del otro y la separación-interdicción que pone límite al goce incestuoso entre padres e hijos son aspectos que juegan un papel decisivo en la sexuación. Dentro de los cuatro momentos de la sexuación se encuentran articulados tres planos de la diferencia localizables en el caso, estos son: la diferencia niño-adulto, la diferencia de género y la diferencia de los sexos. La articulación de estos tres planos de la diferencia, abre la posibilidad de pensar en posicionamientos sexuados diversos y singulares que cuestionan los esencialismos y las dicotomías tradicionales.

The present article is a qualitative research result. It proposes, from the psychoanalytic perspective, four sexuation moments for the daughter of a homoerotic men couple. Sexuation is defined as the process a person goes through to identify themselves with a sex and choosing a sexual partner. In this matter, the first relationships, the assignations of the other and the separation-interdiction that puts a limit to the incestuous pleasure between parents and children are factors that play a key role in sexuation. In the four moments of sexuation, there are articulated three difference levels: the child-adult difference, the gender difference and the difference between sexes. The configuration of these three difference levels, allows the possibility to think about diverse and unique sexual identity placements that challenge the traditional dichotomy.