[Obstructed hemivagina and ipsilateral renal anomaly: unusual cause of piocolpos. Report a case and review of literature ]. / Síndrome de hemivagina obstruida, con agenesia renal ipsilateral: causa inusual de piocolpos. Reporte de caso y revisión bibliográfica.

OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) by acronym and abbreviations in English or Herlyn Werner Wunderlich syndrome is a rare congenital malformation caused by an alteration in the Mullerian ducts and Wolffian Ducts. Which is characterized by a triad: uterus didelphys, obstructed and ipsilateral renal agenesis hemivagina still uncertain etiology. Patients are usually asymptomatic until menarche where the most common clinical presentation is pelvic pain, followed by a vaginal or abdominal mass, normal menstrual periods, infertility, and vaginal discharge rarely appears. The case of a female patient of 15 years, nubile with chronic fetid vaginal discharge, initially diagnosed and treated as pelvic inflammatory disease occurs, however because it is an exceptional condition with the background of the patient, by complementary studies were conducted where pelvic ultrasound revealed pyocolpos and absence of left kidney, uterus didelphys, blind hemivagina by other imaging studies, where we could integrate Herlyn-Werner-Wunderlich syndrome. In conclusion, abnormalities in the development of the Miillerian ducts are difficult to diagnose early, so you must have the embryological knowledge, conduct thorough clinical assessment and detailed picture in whom the coridition is suspected to identify malformations coexisting urinary tract and vaginal defects with the importance of preserving reproductive success through appropriate planning of surgical approach, given that the fertility rate in these patients is comparable to the average.

A Deep Q-Network based hand gesture recognition system for control of robotic platforms.

Hand gesture recognition (HGR) based on electromyography signals (EMGs) and inertial measurement unit signals (IMUs) has been investigated for human-machine applications in the last few years. The information obtained from the HGR systems has the potential to be helpful to control machines such as video games, vehicles, and even robots. Therefore, the key idea of the HGR system is to identify the moment in which a hand gesture was performed and it's class. Several human-machine state-of-the-art approaches use supervised machine learning (ML) techniques for the HGR system. However, the use of reinforcement learning (RL) approaches to build HGR systems for human-machine interfaces is still an open problem. This work presents a reinforcement learning (RL) approach to classify EMG-IMU signals obtained using a Myo Armband sensor. For this, we create an agent based on the Deep Q-learning algorithm (DQN) to learn a policy from online experiences to classify EMG-IMU signals. The HGR proposed system accuracy reaches up to [Formula: see text] and [Formula: see text] for classification and recognition respectively, with an average inference time per window observation of 20 ms. and we also demonstrate that our method outperforms other approaches in the literature. Then, we test the HGR system to control two different robotic platforms. The first is a three-degrees-of-freedom (DOF) tandem helicopter test bench, and the second is a virtual six-degree-of-freedom (DOF) UR5 robot. We employ the designed hand gesture recognition (HGR) system and the inertial measurement unit (IMU) integrated into the Myo sensor to command and control the motion of both platforms. The movement of the helicopter test bench and the UR5 robot is controlled under a PID controller scheme. Experimental results show the effectiveness of using the proposed HGR system based on DQN for controlling both platforms with a fast and accurate response.

Wetland monitoring technification for the Ecuadorian Andean region based on a multi-agent framework.

Remote sensing using satellites and unmanned aerial vehicles (UAVs) has become an important tool for wetland delimitation and saturation assessment since they enable patterns identification and wetland saturation data collection in an agile and optimum way. However, their deployment and operative costs limit their implementation in harsh environments, such as the ones presented in the high Andean wetlands. In this context, this work presents a framework to monitor cost-effectively high Andean wetlands using a multi-agent approach based on: field testing, UAV orthomosaics, and satellite imagery. The method developed comprises two stages: i) definition of the monitoring agent (field testing, satellite, UAV) and ii) image processing. For these stages, semi-empirical and statistical models, which were developed in previous works are incorporated in an open-source framework to tailor each monitoring approach accordingly to the seasonality of a representative Andean wetland. The application of the method and its results highlight the suitability of using visual spectrum low-cost remote sensing approach to compute wetlands saturation percentage. In addition, the methodology proposed allowed the development of a temporal monitoring scheme, where the viability of each monitoring agent is examined. In order to validate the method, field data and multispectral imagery were employed using as case of study the Pugllohuma wetland located in the Antisana Reserve. Thus, the main contribution of this work lies in establishing a technified monitoring framework for the Ecuadorian high Andean wetlands, which can be scaled up and extrapolated to other wetlands with similar harsh environmental conditions, helping to their management and protection policies decision-making.

Endothelial dysfunction in recently diagnosed type 2 diabetic patients evaluated by PET.

PURPOSE: To demonstrate the presence of endothelial dysfunction (ED) in asymptomatic patients with type 2 diabetes mellitus (DM) by using (13)N-ammonia-positron emission tomography (PET). PET can identify ED by quantifying myocardial blood flow (MBF) during rest, cold pressor test (CPT), and pharmacologic stress. The endothelial-dependent vasodilation index (EDVI), myocardial flow reserve (MFR), and the percentage of the change between rest and CPT (%DeltaMBF) are markers of endothelial function. PROCEDURES: Thirty-nine subjects were studied (19 women and 20 men); 22 recently diagnosed type 2 diabetic patients and 17 healthy controls (HC). A three-phase (13)N-ammonia-PET was performed. RESULTS: Mean EDVI was 1.208 +/- 0.34 vs. 1.55 +/- 0.37 (diabetic vs. HC group, respectively) (p = 0.002), MFR was 2.803 +/- 1.39 vs. 3.27 +/- 0.72 (p = NS), and the %DeltaMBF was 20 +/- 34% vs. 55 +/- 37% (p = 0.002). Rest MBF and CPT MBF were normalized to the rate pressure product (RPP). EDVI' and %DeltaMBF' were calculated using the corrected values for the RPP. Mean EDVI' was (0.864 +/- 0.250 vs. 1.110 +/- 0.238, p = 0.004) and mean %DeltaMBF' was (-8.2 +/- 14.7% vs. 4.5 +/- 12.1%, p = 0.005). CONCLUSIONS: Asymptomatic, recently diagnosed type 2 diabetes patients present ED that can be quantified by (13)N-ammonia-PET.

Endothelial dysfunction in patients with antiphospholipid syndrome assessed with positron emission tomography.

BACKGROUND: There is limited knowledge about endothelial dysfunction in patients with primary antiphospholipid syndrome (PAPS). The purpose of this study was to evaluate endothelial function in patients with PAPS assessed by positron emission tomography. METHODS AND RESULTS: A 3-phase protocol--rest, cold pressor test (CPT), and adenosine positron emission tomography with nitrogen 13 ammonia--was used in 18 patients with PAPS and 18 healthy volunteers (HVs). Myocardial blood flow (MBF) was measured in each phase, with calculation of the endothelial-dependent vasodilation index, the increase in the MBF in response to CPT, and the myocardial flow reserve. An important trend was found in the myocardial flow reserve (2.76 +/- 1.04 in PAPS group vs 3.27 +/- 0.72 in HV group, P > .05), in the endothelial-dependent vasodilation index (1.19 +/- 0.31 in PAPS group vs 1.55 +/- 0.37 in HV group, P < .05), and in the percent change in the MBF in response to CPT (from rest) (19% +/- 31% in PAPS group vs 55% +/- 37% in HV group, P < .05). CONCLUSION: The CPT results obtained in this study showed that the PAPS patients studied have endothelial dysfunction.

Pre-pulseless Takayasu's arteritis evaluated with 18F-FDG positron emission tomography and gadolinium-enhanced magnetic resonance angiography.

Takayasu's arteritis is a primary vasculitis that affects large vessels and is characterized by chronic granulomatous inflammation. Diagnosis has been primarily clinical, with verification by angiography as the gold standard. More recently, however, it has become apparent that positron emission tomography enables better evaluation of vascular inflammation. This study presents 2 cases of Takayasu's arteritis. Magnetic resonance angiography was used to evaluate aortic anatomy by analyzing vascular wall thickness and also to quantify disease activity by measuring gadolinium enhancement. Positron emission tomography was used to evaluate active vascular inflammation by quantifying fluorodeoxyglucose F18 uptake. We conclude that both techniques support clinical diagnosis and aid in the evaluation of disease activity during and after treatment.

[Detection of inflammation in an atherosclerose plaque: the role of the positron emission tomography and C reactive protein]. / Detección de inflamación en placa aterosclerosa: rol de la tomografía por emisión de positrones y de la proteína C reactiva.

OBJECTIVES: To demonstrate that inflammatory atheromatose carotid plaques can be visualized with positron emission tomography with 18F-fluorodeoxyglucose (18FDG PET) in symptomatic patients, in order to correlate them with systemic inflammatory markers, such as CRP. METHOD: Fifteen patients with cerebral ischemia due to atherosclerotic carotid disease were studied. 18FDG uptake with PET was considered and blood samples were taken for determining high sensibility C reactive protein (HsCRP). RESULTS: The mean age of the patients was 66 years; 11 of them were males (73%) and 4 were females (27%). 18FDG PET was positive in 12 patients (80%), while 100% of the studied population had low risk HsCRP with normal white cell count. CONCLUSIONS: 18FDG PET proves active inflammation in carotid atheromatose plaques. There was no significant correlation between the presence of ahteromatose carotid plaques, HsCRP serum levels, and 18FDG PET study.

[Ischemic heart disease: anatomic and functional evaluation in a single exploration with multi-slice PET-CT]. / Cardiopatía isquémica: evaluación anatomofuncional en una sola exploración con PET-CT multicorte.

A complete evaluation of the patient with ischemic heart disease requires an anatomical and functional assessment of the myocardium and coronary arteries. Recent technological advances have allowed a quantitative and physiological evaluation of the cardiovascular system with Positron Emission Tomography (PET). This method is a valuable tool for the assessment of heart metabolism, myocardial perfusion, ventricular function, coronary blood flow, myocardial viability and endothelial function. One of the major limitations of a PET study is its low spatial resolution. Cardiac Computed Tomography (CCT) is an anatomic study used for coronary calcium quantification, evaluation of wall and lumen of coronary arteries, study of vascular permeability and assessment of composition, extension and severity of atherosclerotic plaques. The main limitation of CCT is the lack of functional information that is obtained with this technique. Both methods are complementary in many ways. That is the reason of the wide spread of PET-CT hybrid equipments that can provide very useful functional and anatomic information of patients with ischemic heart disease in a single exploration.

[Identification of acute myocardial infarction with PET and CT multislice]. / Identificación del infarto agudo del miocardio mediante PET y CT multicorte.

Today non invasive cardiovascular imaging techniques exist, such as positron emission tomography (PET) and 16 multislice computed tomography (16-MSCT). With these studies, it is possible to evaluate the function and anatomy of the heart respectively. There is not enough information in the literature about the usefulness for 16-MSCT in the evaluation of infarcts. In this article, we show images of a patient who arrived to our institution and in whom it was possible to obtain important information with both imaging techniques. With the results, we obtained a good correlation of an infarct zone with PET and 16-MSCT. 16-MSCT is a good technique for observing infarcted zones of the heart. PET/CT is a non invasive cardiovascular imaging technique capable of giving enough anatomic and functional information.

Estudio Descriptivo: Perfil Microbiológico y Sensibilidad Antibiótica en Microorganismos Aislados en Urocultivos. Hospital Universitario del Río, Cuenca - Ecuador / Descriptive Research: Microbiological Profile and Antibiotic Sensitivity in Microorganisms Isolated in Urine Culture. Hospital Universitario del Río, Cuenca ­ Ecuador

INTRODUCCIÓN: Las infecciones del tracto urinario, constituyen un problema frecuente dentro de la atención primaria de salud y a nivel intrahospitalario, debido a la creciente resistencia antibiótica por parte de los microorganismos uropatógenos. El objetivo de este estudio es determinar el agente etiológico preponderante del área geográfica y su susceptibilidad a los fármacos utilizados con mayor frecuencia. MÉTODOS: Se realizó un estudio descriptivo, en donde se analizaron 1 202 urocultivos realizados en el período de Enero a Diciembre del 2016, en el Hospital Universitario del Río en la ciudad de Cuenca ­ Ecuador, en donde 308 urocultivos fueron positivos a crecimiento bacteriano. Se utilizó un formulario de recolección de datos estandarizado, los cuales fueron ingresados al programa SPSS V 15 para su posterior análisis de agente etiológico y susceptibilidad antibiótica. RESULTADOS: El principal microorganismo aislado fue Escherichia Coli (77.59 %), presentando porcentajes de resistencia en fármacos como: Ampicilina (100 %), Cefazolina (55.3 %), Trimetropin - Sulfametoxazol (52.7 %), Ciprofloxacino (48.6 %), Cefuroxima (28.2 %), Ceftriaxona (26.6 %), Nitrofurantoína (14.7 %), Fosfomicina (12.4 %), Gentamicina (9.8 %), Amikacina (6 %), Piperacilina-Tazobactam (1.8 %). CONCLUSIONES: El uropatógeno responsable con mayor frecuencia fue Escherichia Coli, presentó una amplia resistencia a fármacos recomendados para el tratamiento empírico, además considerar el uso racional o evitar antimicrobianos de primera línea, debido a los niveles de resistencia encontrados en este estudio.

BACKGROUND: Urinary tract infections are a frequent problem in healthcare, it is important to know the local patterns of antibiotic resistance. The aim of this study is to determine the predominant etiologic agent of the geographical area and its susceptibility to the most frequently used drugs. METHODS: A descriptive study was carried out, where 1 202 urocultures performed in the period from January to December 2016 were analyzed in the University Hospital of Río in the city of Cuenca - Ecuador, where 308 urocultures were positive for bacterial growth. A standardized data collection form was used, which were entered into the SPSS V 15 program for further analysis of the etiological agent and antibiotic susceptibility. RESULTS: The main microorganism was Escherichia Coli (77.59 %), presenting percentages of resistance in drugs such as: Ampicillin (100 %), Cefazolin (55.3%), Trimetropine - Sulfamethoxazole (52.7%), Ciprofloxacin (48.6%), Cefuroxime (28.2%) , Ceftriaxone (26.6%), Nitrofurantoin (14.7%), Fosfomycin (12.4%), Gentamicin (9.8%), Amikacin (6%), Piperacillin-Tazobactam (1.8%). CONCLUSIONS: The uropathogen responsible for urinary tract infections most frequently isolated was Escherichia Coli, which presented a wide resistance to drugs recommended for empirical treatment, so it was considered of great importance, also consider the rational use or avoid antimicrobials first line drugs, due to the resistance levels found in this study.

[PET evaluation of inflammatory process in Takayasu's arteritis]. / Determinación de actividad inflamatoria en pacientes con arteritis de Takayasu mediante tomografía por emisión de positrones (PET).

OBJECTIVE: To determine the application of PET in monitoring patients with Takayasu's arteritis (TA) with Inflammatory activiti (IA) and this correlation with established clnical criteria. METHODS: 35 patients diagnosed with TA were enrolled. Determination of erythrocyte sedimentation rate, C -reactive protein, fibrinogen and a complete blood count was performed and clinical criteria of activity were applied. A baseline PET was performed in all patients. Those who were positive for IA received drug treatment. Among the group of active patients, ten were randomized to undergo another PET scan and clinical criteria determination to evaluate inflammatory activity after 6 months of treatment. We compared clinical criteria with PET capacity to determine IA. The results between the initial and final PET were finally compared. RESULTS: Clinical criteria had a sensitvity of 63% and a specificity of 90% to show IA. Sensivity decreased after 6 months of treatment to 27%. DISCUSSION: This is the first prospective study that compares the findings of PET before and after treatment for IA in patients with TA. Clinical criteria lack sensitivity for the detection of IA in the follow-up after treatment. CONCLUSIONS: PET is a diagnostic technique with high sensitivity and specificity for the diagnosis and monitoring of patients with TA and inflammatory activity.

Determinación de actividad inflamatoria en pacientes con arteritis de Takayasu mediante tomografía por emisión de positrones (PET) / PET evaluation of inflammatory process in Takayasu's arteritis

Objetivos: Determinar la aplicación que tiene la tomografía por emisión de positrones en el seguimiento de pacientes con arteritis de Takayasu con actividad inflamatoria y su correlación con los criterios clínicos establecidos. Métodos: Se incluyeron 35 pacientes con diagnóstico de arteritis de Takayasu. Se determinó velocidad de sedimentación globular, proteína C reactiva, biometría hemática, así como, fibrinógeno y se aplicaron los criterios clínicos de actividad. Se realizó tomografía por emisión de positrones basal de los pacientes positivos para actividad inflamatoria, todos recibieron tratamiento farmacológico. De forma aleatoria se incluyó a 10 pacientes que posterior al tratamiento durante seis meses se les realizó un nuevo estudio clínico y una tomografía por emisión de positrones para determinar actividad inflamatoria. Se compararon los criterios clínicos con tomografía por emisión de positrones tanto del estudio basal como el de seguimiento. Resultados: Los criterios clínicos tuvieron una sensibilidad de 63% y especificidad de 90% para demostrar actividad inflamatoria en forma basal. La sensibilidad de los criterios clínicos disminuyó posterior al tratamiento hasta 27%, en donde se observó que pacientes aparentemente inactivos por clínica, continuaban activos por tomografía por emisión de positrones. Discusión: Éste es el primer estudio que compara de manera prospectiva los hallazgos de tomografía por emisión de positrones antes y después del tratamiento para actividad inflamatoria en pacientes con arteritis de Takayasu. Los criterios clínicos carecen de sensibilidad para la detección de actividad inflamatoria en el seguimiento posterior al tratamiento. Conclusiones: El tomografía por emisión de positrones es una técnica de diagnóstico con una alta sensibilidad y especificidad para el diagnóstico y seguimiento de pacientes con arteritis de Takayasu y actividad inflamatoria.

Objective: To determine the application of PET in monitoring patients with Takayasu's arteritis (TA) with inflammatory activity (IA) and its correlation with established clinical criteria. Methods: 35 patients diagnosed with TA were enrolled. Determination of erythrocyte sedimentation rate, C-reactive protein, fibrinogen and a complete blood count was performed and clinical criteria of activity were applied. A baseline PET was performed in all patients. Those who were positive for IA received drug treatment. Among the group of active patients, ten were randomized to undergo another PET scan and clinical criteria determination to evaluate inflammatory activity after 6 months of treatment. We compared clinical criteria with PET capacity to determine IA. The results between the initial and final PET were finally compared. Results: Clinical criteria had a sensitivity of 63% and a specificity of 90% to show IA. Sensitivity decreased after 6 months of treatment to 27%. Discussion: This is the first prospective study that compares the findings of PET before and after treatment for IA in patients with TA. Clinical criteria lack sensitivity for the detection of IA in the follow-up after treatment. Conclusions: PET is a diagnostic technique with high sensitivity and specificity for the diagnosis and monitoring of patients with TA and inflammatory activity.

Detección de inflamación en placa aterosclerosa: rol de la tomografía por emisión de positrones y de la proteína C reactiva / Detection of inflammation in an atherosclerose plaque: the role of the positron emission tomography and C reactive protein

OBJECTIVES: To demonstrate that inflammatory atheromatose carotid plaques can be visualized with positron emission tomography with 18F-fluorodeoxyglucose (18FDG PET) in symptomatic patients, in order to correlate them with systemic inflammatory markers, such as CRP. METHOD: Fifteen patients with cerebral ischemia due to atherosclerotic carotid disease were studied. 18FDG uptake with PET was considered and blood samples were taken for determining high sensibility C reactive protein (HsCRP). RESULTS: The mean age of the patients was 66 years; 11 of them were males (73%) and 4 were females (27%). 18FDG PET was positive in 12 patients (80%), while 100% of the studied population had low risk HsCRP with normal white cell count. CONCLUSIONS: 18FDG PET proves active inflammation in carotid atheromatose plaques. There was no significant correlation between the presence of ahteromatose carotid plaques, HsCRP serum levels, and 18FDG PET study.

Identificación del infarto agudo del miocardio mediante PET y CT multicorte / Identification of acute myocardial infarction with PET and CT multislice

Today non invasive cardiovascular imaging techniques exist, such as positron emission tomography (PET) and 16 multislice computed tomography (16-MSCT). With these studies, it is possible to evaluate the function and anatomy of the heart respectively. There is not enough information in the literature about the usefulness for 16-MSCT in the evaluation of infarcts. In this article, we show images of a patient who arrived to our institution and in whom it was possible to obtain important information with both imaging techniques. With the results, we obtained a good correlation of an infarct zone with PET and 16-MSCT. 16-MSCT is a good technique for observing infarcted zones of the heart. PET/CT is a non invasive cardiovascular imaging technique capable of giving enough anatomic and functional information.

Características clínicas y sociodemográficas de una población de pacientes epilépticos consultantes en la unidad de neurología: Hospital San Juan de Dios, 1984-1986 / Clinical and sociodemographic characteristics of a group of epileptic patients consultants at the unit of neurology: San Juan de Dios Hospital, 1984-1986

Se realizó un análisis de las características clínicas y sociodemográficas de 331 pacientes epilépticos cuya primera consulta se realizó entre los años 1984-1986 en el Departamento de Neurología del Hospital San Juan de Dios. La población evaluada resultó ser predominantemente femenina, siendo la edad promedio de 29 ñ 14 años. La forma clínica predominante fue la tónicaclónica generalizada. La mayoría de los pacientes recibió monoterapia, siendo la droga más usada la fenitoína sódica y la asociación más frecuente prescrita la fenitoína sódica más fenobarbital. Se analizaron además antecedentes personales, familiares y factores desencadenantes

Evaluación del apoyo afectivo en estudiantes de medicina con la prueba de Apgar de Smilksteina / Assesment of effect support in students of medicine through Smilkstein's Apgar tests

La evaluación rápida del apoyo afectivo individual es necesaria y útil en la práctica médica. Esta se ha hecho, en adolescentes, aplicando el Apgar Familiar y el de las amistades de Smilkstein. El presente trabajo mide, con estos instrumentos, el apoyo familiar y de las amistades en estudiantes de medicina, quienes por su sistema de estudio se ven sometidos a una fuerte presión curricular. Ambos Apgar se aplicaron a 499 alumnos correspondientes al 90,7% del total de 550 de la División de Ciências Médicas Occidente de la Universidad de Chile. El 39,1% de ellos eran menores de 21 años (n = 195) y el 40% (n = 200) eran mujeres. Las encuestas se realizaron entre Octubre de 1986 y Mayo de 1987. El Apgar satisfactorio (8 puntos o más) se encontró en el 59,9% de los casos encuestados en AF y AA. El intermedio (4-7 puntos) fue 32,3% en el Apgar familiar y 35,5% en el Apgar de las amistades. El bajo (-4 puntos) fue 7,8% en Apgar familiar y 4,6% en Apgar de las amistades (Diferencia significativa). El Apgar familiar bajo fue 9,4% en hombres y 5,5% en mujeres. El Apgar familiar bajo fue más frecuente que el Apgar de amistades bajo en cinco de los siete cursos y dos cursos destacaron por tener más de 10% de Apgar familiar bajo. Las mujeres tuvieron frecuencia significativamente más alta de Apgar de amistades satisfactorio. En total de 499 estudiantes un 19,2% tuvo Apgar familiar inferior a 6 puntos; cifra significativamente menor que la encontrada en adolescentes del área Oriente de Santiago. Se post