Screening for Obstructive Sleep Apnea in truck drivers / Rastreio de Síndrome de Apneia Obstrutiva do Sono em motoristas

Abstract Professional drivers show a higher prevalence of obstructive sleep apnea (OSA) compared with the general population. OSA has been widely associated with an increased risk of traffic accidents. This article aims to investigate the presence of risk factors for OSA, its prevalence and the value of screening tools in a truck drivers' cohort. Descriptive and analytical prospective study. Demographic, anthropometric, Epworth Sleepiness Scale, STOP-Bang and Berlin Questionnaire were used to select subjects with suspicion of OSA. Polysomnography (PSG) was performed in individuals with positive screening. Mean age was 44.6±7 years, mean body mass index was 28.7±4 kg/m². Of the 281 truck drivers screened, 88 were positive for potential OSA. Of these, 63 completed PSG study and the diagnosis was confirmed in 85.7% (prevalence of 19.2%). The following variables showed a positive correlation with the apnea-hypopnea index: neck circumference and STOP-Bang. The combination of a predominantly male population, obesity, age distribution and lifestyle could account for the high prevalence of OSA in this specific population. Questionnaires proved to be a valuable screening tool. Screening, treatment, and management of OSA should be a priority as a public safety policy.

Resumo A prevalência de Síndrome de Apneia Obstrutiva do Sono (SAOS) em motoristas profissionais é superior à da população geral e esta tem sido amplamente associada ao risco aumentado de acidentes rodoviários. Este artigo tem por objetivos investigar fatores de risco de SAOS, estimar a sua prevalência e o valor de instrumentos de rastreio numa amostra de motoristas de pesados. Estudo prospetivo descritivo e analítico. Rastreio realizado com recurso a dados demográficos, antropométricos, Escala de Sonolência de Epworth, STOP-Bang e Questionário de Berlim. Nos indivíduos com rastreio positivo foi realizada polissonografia (PSG). A idade média era de 44,6±7 anos, índice de massa corporal 28,7±4 kg/m². Dos 281 motoristas incluídos, 88 apresentavam risco elevado de SAOS. Destes, 63 realizaram PSG, com confirmação diagnóstica em 85,7% (prevalência de 19,2%). O perímetro cervical e STOP-Bang apresentaram correlação positiva com o índice de apneia-hipopneia. A combinação de género predominantemente masculino, obesidade, distribuição de idade e estilo de vida pode justificar a elevada prevalência de SAOS nesta população. O uso de questionários é uma medida eficaz de rastreio. Nos motoristas, o rastreio e tratamento de SAOS deveria ser uma medida de saúde pública prioritária.

Arthroscopic Treatment of Freiberg Disease - Case Report / Tratamento artroscópico da doença de Freiberg - Relato de caso

Abstract Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.

Resumo A doença de Freiberg é rara, e seu diagnóstico requer alto grau de suspeita clínica. A necrose avascular da cabeça do metatarso progride com colapso articular, e causa dor no antepé e limitação da atividade. Há diversas técnicas cirúrgicas para o tratamento da doença; como o diagnóstico geralmente é feito em estágios posteriores, a maioria dessas técnicas inclui procedimentos de destruição articular. A artroscopia tem sido utilizada nas pequenas articulações do pé nos últimos anos, mas sua aplicação na doença de Freiberg ainda é escassa. Procedimentos de preservação articular têm sido preconizados na doença em estágio inicial, com o objetivo de aliviar os sintomas e impedir a progressão. Neste relato, descrevemos o tratamento bem-sucedido de uma paciente de 12 anos de idade com doença de Freiberg em estágio inicial por meio de descompressão central e enxerto de medula óssea, por meio de abordagem minimamente invasiva assistida por artroscopia.

Manga gástrica laparoscópica en situs inversus total. Reporte de un caso y revisión de la literatura / Laparoscopy sleeve gastrectomy in situs inversus totalis. A case report and literature review

El objetivo de este estudio es revisar una de las opciones quirúrgicas para el tratamiento de la obesidad en pacientes con situs inversus total. Se presenta el caso de una paciente de 39 años de edad con situs inversus total (diagnóstico transquirúrgico) que fue sometida a gastrectomía en manga laparoscópica, con resultados postquirúrgicos óptimos; además, en la revisión de la literatura encontramos 14 casos publicados a nivel mundial de procedimientos quirúrgicos metabólicos.

The objective of this study is to perform a review of one of the surgicaloptions for the treatment of obesity in patients with total situs inversus. We present the case of a female patient of 39 years of age with total situs inversus (trans-surgical diagnosis) and who underwent a laparoscopic sleeve gastrectomy, with optimal postoperative results, in addition a review of the literature is made, finding 14 cases published to global level of metabolic surgical procedures.

Agrobacterium tumefaciens-mediated transformation of common bean (Phaseolus vulgaris) var. Brunca

Common bean is a crop recalcitrant to in vitro regeneration and therefore it lacks an efficient transformation protocol that can be reproduced using A. tumefaciens. The main goal of this study was to establish a protocol for A. tumefaciens mediated transformation of Phaseolus vulgaris var. Brunca by marker genes (gusA and nptII) together with the gene for trehalose-6-phosphate synthase from Saccharomyces cerevisiae (TPS1) used in other species to increase tolerance to abiotic stress. The β-glucuronidase activity was detected in 45 % of the LBA4404 ElectroMAX® pCAMBIA1301 infected explants. Transformed explants regenerated new shoots after four to five months period in a kanamycin rich media. Surviving plants were evaluated by PCR and presented an 0.5 % efficiency of transformation. The established protocol for genetic transformation of common bean has two additional advantages with respect to previous reports: (1) it allows for obtaining transformed regenerants and (2) the genetic transformation was stable for the selective gene.

El frijol común en un cultivo recalcitrante a la regeneración in vitro y se carece de un protocolo eficiente y reproducible de transformación genética usando A. tumefaciens. Desarrollamos un protocolo de transformación genética mediada por A. tumefaciens de frijol común variedad Brunca utilizando genes marcadores (gusA y nptII) junto con el gen de la trehalosa-6-fosfato sintasa de levadura (TPS1) utilizado para incrementar tolerancia a estrés abiótico. La actividad de la β-glucoronidasa fue detectada en 45 % de los explantes infectados con la cepa LBA4404 de A. tumefaciens transformada con pCAMBIA1301. Después de 4 o 5 meses se regeneraron tallos en un medio adicionado con kanamicina. Los explantes supervivientes se evaluaron mediante PCR y presentaron una eficiencia de transformación de 0.5 %. El protocolo de transformación genética de frijol común establecido tiene dos ventajas adicionales con respecto a los reportes previos: (1) permite la obtención de regenerares transformados y (2) la transformación genética fue estable para el gen selectivo.

Arthroscopic treatment of synovial chondromatosis of the ankle / Tratamento artroscópico de condromatose sinovial do tornozelo

ABSTRACT Synovial chondromatosis is a rare proliferative disease, characterized by the occurrence of metaplasia in the synovium of the joints. These lesions become pedunculated; with the evolution of the disease they become detached, leading to intra-articular loose-bodies. It occurs more frequently in males between the third and fifth decades of life, usually affecting large joints such as the knee and hip. Smaller joints, such as the ankle, are less frequently affected. Patients report articular pain, blockage, and limited range of motion caused by the loose fragments. As the disease progresses, the joint undergoes degenerative changes. This report describes a case of synovial chondromatosis of the ankle, treated by arthroscopy. The patient, a 59 year-old male, complained of pain and swelling of the left ankle. Physical evaluation showed limited tibiotarsal mobility (plantar flexion of 20° and dorsiflexion of 5°). After physical and imaging evaluation, the patient underwent ankle arthroscopy due to impingement of the joint, with limitation of mobility. Arthroscopic treatment allowed easy access to the joint, removal of loose bodies, and partial synovectomy, with low morbidity and early rehabilitation. The final prognosis was excellent.

RESUMO A condromatose sinovial é uma doença proliferativa, rara e caracterizada pela ocorrência de metaplasia na sinovial das articulações. Essas lesões tornam-se pediculadas e à medida que a doença evolui, as lesões se soltam, dão origem a corpos livres intra-articulares. A prevalência é maior em homens entre a terceira e quinta décadas de vida, atingindo normalmente grandes articulações como o joelho e o quadril. Articulações menores, como o tornozelo, são afetadas com menos frequência.Os pacientes referem dor articular, bloqueio e limitação da mobilidade causados pelos fragmentos livres. Com o evoluir da doença, a articulação sofre alterações degenerativas. Os autores apresentam um caso clínico de condromatose sinovial do tornozelo, tratado por artroscopia. O doente, do sexo masculino e de 59 anos, referia queixas de dor e edema do tornozelo esquerdo. Ao exame físico, apresentava limitação da mobilidade da tibiotársica (flexão plantar e dorsiflexão de 20° e 5°, respectivamente). Após avaliação clínica e estudo imagiológico, foi proposta artroscopia do tornozelo para tratamento de pinçamento articular com limitação da mobilidade. O tratamento artroscópico permitiu um fácil acesso à articulação, remoção dos corpos livres e sinovectomia parcial, com baixa morbilidade e reabilitação precoce. O prognóstico final foi excelente.

Micorriza arbuscular, Mucoromycotina y hongos septados oscuros en helechos y licófitas con distribución en México: una revisión global / Arbuscular mycorrhizal, Mucoromycotina and dark septate fungi in ferns and lycophytes with distribution in Mexico: a global review

ResumenLos helechos y licófitas son un grupo de plantas vasculares de interés para entender la evolución de las interacciones micorrízicas y su preservación es de relevancia por sus múltiples interacciones ecológicas. El registro de los diferentes grupos taxonómicos de hongos asociados a helechos y licófitas se encuentra fragmentado y el criterio para su diagnóstico inconsistente, lo que dificulta el entendimiento y la determinación del estatus micorrízico. El objetivo del presente trabajo fue conocer el porcentaje de especies de helechos y licófitas que tiene distribución en México de las que se tiene información sobre hongos endomicorrízicos. Se integró un listado de la presencia de hongos micorrízicos arbusculares (HMA), Mucoromycotina y hongos septados oscuros (HSO) asociados a helechos y licófitas, a través de una búsqueda exhaustiva de información. En este trabajo se consideró una especie micorrízica arbuscular, por los arbúsculos, para diferenciarla de la colonización por hifas, vesículas u ovillos. El estudio generó un listado de ocurrencia de interacciones endomicorrízicas en 27 familias, 61 géneros y 137 especies de helechos y licófitas, que representa el 13.37 % de las especies, 91 % de los géneros y 77 % de las familias registradas para México. El 78.1 % de las especies presentó colonización por hongos, el 56.2 % fueron por HMA, el 8.9 % solo presentó colonización por hifas, vesículas o coils, el 21.8 % fue por HSO y el 1. 4 % por hongos Mucoromycotina. Del total de especies, la mayor presencia de colonización se presentó en especies terrestres 76.59 %, saxícolas 33.33 %, acuáticas 20 % y epífitas con 6.25 %. Las familias de helechos y licófitas con mayor número de especies colonizadas fueron: Pteridaceae, Polypodiaceae, Aspleniaceae y Dryopteridaceae. El presente trabajo muestra que la asociación de HMA y HSO es la más ampliamente distribuida en las familias y especies de helechos y licófitas. Surge la necesidad de incluir a los helechos y licófitas en los estudios de interacciones endomicorrízicas ya que únicamente 28 especies (20 %) fueron estudiadas en ecosistemas de México. La mayoría de los estudios se enfocan en la fase esporofítica (80 %). Sin embargo, para entender el papel que juegan las micorrizas en el establecimiento de helechos y licófitas se requiere incluir a la fase gametofítica, así como estudios de ecología, biología molecular, así como trabajos experimentales de fisiología. La información presentada es de relevancia para implementar estrategias alternativas de conservación, debido a que muchas especies de helechos y licófitas requieren de la asociación micorrízica para su crecimiento y supervivencia.

AbstractFerns and lycophytes are a group of vascular plants of interest to understand the evolution of mycorrhizal interactions; their preservation is of relevance for their multiple ecological relations. The record of different taxonomic groups of fungi associated with ferns and lycophytes is fragmentary, and the criteria for it identification is inconsistent, which hinders the understanding and determination of mycorrhizal status. The aim of this study was to determine the percentage of the species of ferns and lycophytes with distribution in Mexico, and with information of fungal interactions. A checklist of the presence of arbuscular mycorrhizal fungi (AMF), Mucoromycotina and dark septate fungi (DSF) associated with ferns and lycophytes was integrated through an exhaustive global literature search. In this study, mycorrhizal species was considered by the presence of arbuscules to differentiate with hyphal, vesicular and coils colonization. The study gathered a checklist of mycorrhizal occurrences of 27 families, 61 genus and 137 species of ferns and lycophytes, which covers 13.4 % of the species, 91 % of the genus and 77 % of the families distributed in Mexico. The 78.1 % of the species showed colonization, 56.2 % by AMF, 29.9 % by DSF and 0.72 % by Mucoromycotina fungi. From the total of the species, the higher presences of colonization were in terrestrial, epiphytic, saxicolous, and aquatic plants with 76.6 %, 33.3 %, 20 %, and 6.3 %, respectively. The families of ferns and lycophytes with the higher number of species colonized were Pteridaceae, Polypodiaceae, Aspleniaceae and Dryopteridaceae. The present study showed the widespread associations of AMF and DSF in ferns and lycophytes of Mexico. It is urgently needed to include ferns and lycophytes in studies focused on endomycorhizal interactions, since only 28 species (28 %) were studied in Mexican ecosystems. The majority of studies were focused on sporophytic face (80 %). Nonetheless, to understand the role that plays the mycorrhiza in the establishment of ferns and lycophytes, it is necessary to include the gametophytic face in ecological, molecular and physiological experimental studies. This information is important to implement conservation strategies, because a considerable number of ferns and lycophytes species, depend on these mycorrhizal associations for their growth and survival. Rev. Biol. Trop. 65 (3): 1062-1081. Epub 2017 September 01.

Report of cysticercosis in sheep of Ballesta, Bolivar, Colombia / Reporte de cisticercosis en ovinos faenados en el corregimiento de Ballesta, Bolívar, Colombia / Relatório cisticercose em ovinos abatidos na aldeia de Ballesta, Bolívar, Colombia

Sheep are the intermediate hosts of Cysticercus tenuicollis, the metacestode of Taenia hydatigena. Cysticercosis produces economic losses associated with loss of condition and offal condemnation at slaughter. The aim of this study was to determine the prevalence of C. tenuicollis cysts in sheep, the most common sites and the histology of livers affected by this parasite in Bolivar, Colombia. This study included 23 sheep (4 females and 19 males) and it was carried out between August and November 2015. The prevalence of C. tenuicollis cysts was 39.13% (9/23). Fifty six percent (5/9) of the animals had body condition (BC: scale of 1 to 5) of 2; 22% (2/9) 3, and 22% (2/9) 4. A single cyst was found in 78% (7/9) of the animals, and 22% (2/9) had two cysts. Cysts were located in the rumen serosa: 44% (4/9); abomasal serosa: 22% (2/9); liver: 22% (2/9); bladder serosa 22% (2/9); and diaphragm: 11% (1/9). The C. tenuicollis metacestodes belonged to the species Taenia hydatigena. Lesions in the liver of all affected animals consisted of severe infiltration of eosinophils, lymphocytes and plasma cells. Also present were areas of periportal fibrosis. In conclusion, cysticercosis damages the liver of sheep and potentially have a deleterious effect on the productivity of the flock. This is the first report describing post-mortem diagnosis of Cysticercus tenuicollis infection in sheep in Colombia.

Los ovinos son los hospederos intermediaros de Taenia hydatigena y su forma de presentación es el Cysticercus tenuicollis. Produce pérdidas económicas asociadas a la disminución de peso y al decomiso de los órganos afectados. El objetivo de este estudio fue determinar la prevalencia de quistes por cisticercos en canales de ovejas, hacer la clasificación taxonómica, describir las localizaciones más frecuentes, estudiar la histología de la hepatitis por cisticerco en ovinos destinados al beneficio provenientes del corregimiento de Ballesta, Bolívar y poblaciones aledañas, Colombia. Se estudiaron 23 ovinos (4 hembras y 19 machos) entre agosto y noviembre de 2015. La prevalencia puntual fue del 39.13% (9/23). El 56% de los animales (5/9) tenían condición corporal (C.C) 2; el 22% (2/9) C.C 3, y el 22% (2/9) C.C 4. El 78% de los animales (7/9) presentaron un solo quiste, y el 22% (2/9), dos quistes. Los quistes se localizaron en la serosa del rumen: 44% (4/9); serosa del abomaso: 22% (2/9); hígado: 22% (2/9); vejiga: 22% (2/9); y diafragma: 11% (1/9). El metacéstodo identificado fue Cysticercus tenuicollis perteneciente al estado larval de la tenia Taenia hidatigena. Las lesiones diagnosticadas en hígado fueron infiltrado severo de eosinófilos, linfocitos y células plasmáticas; fibrosis hepática y colangiohepatitis mixta multifocal. En conclusión, la cisticercosis afecta el hígado de los ovinos y tiene un efecto potencialmente perjudicial sobre la productividad del rebaño. Este es el primer informe que describe en ovejas el diagnóstico post mortem de la infección por C. tenuicollis en Colombia.

Os carneiros sã o os anfitriões de intermediários Taenia hydatigena e sua apresentaçã o é a Cysticercus tenuicollis. Ela produz prejuízos económicos associados com reduçã o de peso e a apreensã o dos órgã os afetados. O objetivo deste estudo foi determinar a prevalência de cistos cisticercos em canais de ovelhas, tornar a classificaçã o taxonô mica, descrever os locais mais comuns, estudar a histologia dos cisticercos hepatite em ovinos destinados a beneficiar da populações circundante de Ballesta, Bolívar, Colômbia. Forum estudados 23 ovelhas (4 mulheres e 19 homens) entre agosto e novembro de 2015. A prevalência pontual foi 39,13% (9/23). 56% dos animais (5/9) tinha condiçã o corporal (C.C.) 2; 22% (09/02) 3 CC, e 22% (2/9) CC 4. 78% dos animais (7/9) tinha um único cisto, e 22% (09/02), dois cistos. Cistos foram localizados na serosa do rúmen: 44% (4/9); abomaso serosa: 22% (09/02); hepática: 22% (2/9); bexiga: 22% (09/02); e diafragma: 11% (09/01). O metacestóide foi identificado Cysticercus tenuicollis pertencentes ao estágio larval da tênia Taenia hydatigena. As lesões hepáticas graves foram diagnosticados infiltrados de eosinófilos, linfócitos e células de plasma; fibrose hepática e colangiohepatitis misturado multifocal. Em conclusã o, cisticercose afecta o fígado de carneiro e tem um efeito potencialmente nocivo sobre a produtividade do rebanho. Este é o primeiro relatório que descreve no diagnóstico postmortem ovelhas de infecçã o por C. tenuicollis na Colô mbia..

Nuevo algoritmo para análisis de riesgo en radioterapia / New algorithm for risk analysis in radiotherapy

Los análisis de riesgo aplicados a los tratamientos de radioterapia se han convertido en una necesidad innegable, partiendo de los peligros generados por la combinación del empleo de potentes campos de radiación sobre los pacientes y la ocurrencia de errores humanos y fallos de equipos durante esos tratamientos. La técnica por excelencia para llevar a cabo estos análisis ha sido la matriz de riesgo. El trabajo presenta el desarrollo de un nuevo algoritmo para ejecutar esta tarea con amplias potencialidades gráficas y analíticas, lo que lo convierte en una opción muy útil para el monitoreo del riesgo y la optimización de los programas de garantía de calidad. El sistema SECURE-MR, soporte informático de este algoritmo, se empleó con éxito en el análisis de riesgo de diversas prácticas de radioterapia. Lo distinguen nuevas posibilidades de análisis partiendo de la consideración de factores controladores del riesgo como las robusteces de frecuencia de iniciadores y de consecuencias. Sus capacidades analíticas y gráficas permiten novedosos desarrollos de ordenamiento de contribuyentes al riesgo y de representación de la información de procesos y secuencias accidentales. El trabajo muestra la aplicación del sistema propuesto a un proceso genérico de tratamiento de radioterapia con acelerador lineal.

Risk analyses applied to radiotherapy treatments have become an undeniable necessity, considering the dangers generated by the combination of using powerful radiation fields on patients and the occurrence of human errors and equipment failures during these treatments. The technique par excellence to execute these analyses has been the risk matrix. This paper presents the development of a new algorithm to execute the task with wide graphic and analytic potentialities, thus transforming it into a very useful option for risk monitoring and the optimization of quality assurance. The system SECURE-MR, which is the basic software of this algorithm, has been successfully used in risk analysis regarding different kinds of radiotherapies. Compared to previous methods, It offers new possibilities of analysis considering risk controlling factors as the robustness of reducers of initiators frequency and its consequences. Their analytic capacities and graphs allow novel developments to classify risk contributing factors, to represent information processes as well as accidental sequences. The paper shows the application of the proposed system to a generic process of radiotherapy treatment using a lineal accelerator.

Ileocolitis granulomatosa por Histoplasma capsulatum

La histoplasmosis es una enfermedad granulomatosa causada por un hongo dimór co intracelular denominado Histoplasma capsulatum. El compromiso gastrointestinal se presenta entre las diferentes formas de histoplasmosis diseminada progresiva sub aguda. Se presenta el caso de una Ileocolitis granulomatosa por Histoplasma capsulatum en una paciente inmunocompetente que debuta y se mani esta exclusivamente por síntomas gastrointestinales.

Histoplasmosis is a granulomatous disease caused by an intracellular dimorphic fungus called Histoplasma capsulatum. Gastrointestinal involvement occurs between di erent forms of progressive sub-acute disseminated histoplasmosis. We present a granulomatous Ileocolitis by Histoplasma capsulatum in an immunocompetent patient who debuts and is manifested only by gastrointestinal symptoms.

Colonización y estructura de la comunidad de hongos micorrízicos arbusculares en Alsophila firma (Cyatheaceae) en bosque mesófilo de montaña en Veracruz, México / Colonization and structure of arbuscular mycorrhizal fungi community in Alsophila firma (Cyatheales: Cyatheaceae) from a tropical montane cloud forest in Veracruz, México

Alsophila firma is a tree fern that is distributed mainly in tropical montane cloud forest (TMCF) and is considered as a threatened species. Arbuscular mycorrrhizal fungi (AMF) have been proposed as an alternative in rescue programs of endangered species. However, our knowledge about diversity of AMF and mycorrhizal status of the species of TMCF is limited. In Mexico TMCF shows different degrees of conservation because of fragmentation and land use change. In this study, we evaluated the level of colonization, richness and abundances of spores of AMF in three fragments with different conservation status: conserved (100 years), secondary vegetation (17 years) and disturbed. For this, soil samples and roots were collected from five individuals of A. firma per site, with at least 100m away from each other; a total of 100cm of roots were analysed per site. Root samples showed AMF and occasionally dark septate fungi (DSF) colonizations. For the overall study, 19 species of AMF were recorded: Gigaspora (7), Acaulospora (4), Glomus (4), Funneliformis (2), Sclerocystis (1) and Scutellospora (1). The dominant species in the three sites were Funneliformis geosporum and Acaulospora scrobiculata. The highest diversity (H’) and evenness (J’) (p<0.05) were found in the conserved site (H’=1.7, J’=0.66), when compared to the secondary vegetation (H’=1.5, J’=0.61), and the disturbed site (H’=0.74, J’=0.41). Statistical analysis showed that the AMF degree of colonization was significantly higher (p<0.05) in the conserved site; although, the disturbed site showed low richness and abundances of AMF, the degree of root colonization did not differ statistically (p<0.05) with the secondary vegetation site. Chao2 (Richness estimation model) showed that the number of analysed samples were sufficient to represent the structure of the AMF communities with values >90%. The present study confirmed that A. firma is a mycorrhizal species that exhibits high levels of colonization even in disturbed sites. We suggest that F. geosporum and A. scrobiculata may have the potential to inoculate the gametophyte and young sporophyte of A. firma, to support restoration programs, because of their abundances and high tolerance to disturbed sites.

Alsophila firma es un helecho arborescente que crece principalmente en bosque mesófilo de montaña (BMM) y se encuentra en la categoría de riesgo. Los hongos mico- rrízicos arbusculares (HMA) se han propuesto como una alternativa para programas de recuperación de especies nativas en peligro. Sin embargo, sabemos poco sobre la diversidad de HMA y del estatus micorrízico de las espe- cies vegetales del BMM. En México el BMM presenta diferentes grados de conservación debido a la fragmentación y el cambio de uso de suelo. Se evaluó el grado de colonización, riqueza y abundancia de esporas de los HMA presentes en fragmentos de BMM con diferente historia de manejo: conservado (100 años), en recuperación (17 años) y alterado. Se estudiaron muestras de suelo y raíces toma- das de 5 individuos de A. firma por cada sitio, con al menos 100m de distancia entre individuos. Se analizaron en total 100cm de raíz por cada sitio. Las muestras de raíz presentaron colonización principalmente de HMA y ocasionalmente por hongos septados oscuros (HSO). Se encontraron 19 especies: Gigaspora (7), Acaulospora (4), Glomus (4), Funneliformis (2), Sclerocystis (1) y Scutellospora (1). Las especies dominantes en los tres sitios fueron Funneliformis geosporum y Acaulospora scrobiculata. La mayor diversidad (H’) y equitatividad (J’) (p<0.05) se presentaron en el sitio conservado (H’=1.7; J’ 0.66) con respecto al sitio en recuperación (H’=1.5, J’ 0.61) y alterado (H’=0.74, J’=0.41). Los niveles de colonización micorrízica total de raíz fueron estadísticamente mayores (p<0.05) en el sitio conservado. Aunque el sitio alterado presenta una baja riqueza y abundancia de HMA la colonización micorrízica total de raíz no fue estadísticamente diferente (p<0.05) respecto al sitio en recuperación. El estimador Chao2 indica que las muestras analizadas reflejan la estructura general de la comunidad de HMA con valores superiores al 93%. El presente estudio confirma que A. firma es una especie micorrízica con altos niveles de colonización incluso en sitios alterados. Se sugiere que las especies F. geosporum y A. scrobiculata por su alta tolerancia a sitios alterados pueden tener potencial para inocular gametofitos y esporofitos de A. firma para incrementar la supervivencia en programas de restauración.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation / Malformação de Chiari e síndrome de apneia central do sono: eficácia do tratamento com servoventilação adaptativa

The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

A malformação de Chiari tipo I (MC-I) tem sido associada a distúrbios respiratórios do sono, sobretudo à síndrome de apneia central do sono. Apresentamos o caso de uma paciente do sexo feminino de 44 anos de idade com MC-I que foi encaminhada à nossa unidade de sono por suspeita de apneia do sono. A paciente havia sido submetida a cirurgia descompressiva 3 anos antes. A gasometria arterial mostrou hipercapnia. A polissonografia revelou um índice de distúrbio respiratório de 108 eventos/h, sendo todos os eventos apneias centrais. Foi iniciado tratamento com servoventilação adaptativa e houve resolução da apneia central. Este relato demonstra a eficácia da servoventilação no tratamento da síndrome de apneia central do sono associada à hipoventilação alveolar em uma paciente com MC-I previamente submetida a cirurgia descompressiva.

Forty years of a psychiatric day hospital / Quarenta anos de um hospital de dia de psiquiatria

INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. Objective: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia. .

INTRODUÇÃO: Os hospitais de dia em psiquiatria representam atualmente uma das principais alternativas ao internamento, atuando como componentes chave na psiquiatria comunitária e social. OBJETIVO: Avaliar tendências na utilização de um hospital de dia no período compreendido entre as últimas décadas do século 20 e a primeira década do século 21, com foco em idade, sexo e grupo diagnóstico, usando dados do Centro Hospitalar São João, Porto, Portugal. MÉTODOS: Dados correspondentes aos anos 1970 a 2009 foram coletados dos prontuários clínicos. Os pacientes foram classificados em sete grupos diagnósticos, tendo em conta o diagnóstico principal. Resultados: A idade média na admissão aumentou de 32.7±12.1 anos na segunda metade da década de 1970 para 43.5±12.2 anos em 2005-2009 (p < 0.001). A maioria dos pacientes era do sexo feminino (63.2%), no entanto sua proporção diminuiu de cerca de 70% na década de 1970 para 60% na primeira década do século 21. Nos homens, até o final dos anos 1980, o grupo das perturbações neuróticas (E) era o diagnóstico mais comum, representando mais de um terço das admissões. Durante os anos seguintes, essa proporção diminuiu, e o número de admissões por esquizofrenia (C) alcançou mais de 50% no período de 2004-2009. Nas mulheres, até o final dos anos 1980, as perturbações afetivas (D) e as perturbações neuróticas (E), distribuídas similarmente, respondiam pela maioria das admissões. A partir dos anos 1990, a proporção das perturbações neuróticas (E) diminuiu substancialmente, e as perturbações afetivas (D) passaram a corresponder a mais de 50% do total das admissões. Conclusões: A idade média na admissão ...

Plan de accion para elevar conocimientos sobre embarazo y sus riesgos en adolescentes atendidas en el Hogar Materno Carlos J. Finlay / Plan of accion to elevate knowledge about pregnancy and their risks in pregnant adolescents assisted in the Maternal House Carlos J. Finlay

Introducción: el embarazo en la adolescencia es un problema de salud mundial. Objetivo: determinar los conocimientos sobre embarazo en la adolescencia y sus riesgos en adolescentes embarazadas atendidas en el Hogar Materno Carlos J. Finlay. Material y Métodos: se realizó un estudio descriptivo, de corte transversal con 86 adolescentes embarazadas entre 10 y 19 años, atendidas en el Hogar Materno Carlos J. Finlay en el período comprendido de diciembre del 2007 al 2010. Se revisaron las historias clínicas de las pacientes, se aplicó un cuestionario y se analizaron las variables. Resultados: la incidencia del embarazo en la adolescencia fue alta, prevaleció la adolescencia tardía; entre los factores de riesgos biológicos y psicosociales que agravan el embarazo fueron el estado nutricional deficiente seguido del peso menor de 45Kg o talla menor de 1.45 cm, en su gran mayoría se encontraban solteras y aún estudiando. Respecto a la edad de las primeras relaciones sexuales refirieron haberlas tenido entre los 14 y 16 años y tenían antecedentes obstétricos. Se observó que no tenían orientación sexual y el personal de la salud, junto a sus padres, no tenía un papel fundamental. El conocimiento sobre los riesgos biológicos, psicológicos y socioeconómicos era pobre. Conclusiones: el poco conocimiento sobre el embarazo en la adolescencia y sus riesgos es resultado de las características socioeconómicas y el origen de la orientación sexual que poseen. Recomendaciones: crear instrumentos y estrategias que den su aporte a la disminución de la incidencia mundial del embarazo en la adolescencia.

Introduction: pregnancy in the adolescence is a health problem all over the world. Objective: to determine the knowledge on pregnancy in the adolescence and their risks in the pregnant adolescents assisted in the maternal house Carlos J Finlay. Material and Methods: it was carried out a cross section descriptive study, with 86 pregnant adolescents among 10 and 19 years old assisted in the maternal house Carlos J Finlay between December 2007 and 2010. The clinical histories of the patients were revised, a questionnaire was applied and the variables were analyzed. Results: the incidence of the pregnancy in the adolescence was high, prevailing the late adolescence, the biological and psychosocial risks factors that increase pregnancy were the poor nutritional state, weight below 45Kg or size below 1.45 cm, the majority of them were single and still studying. About the age the first sexual relationships they referred to have them before 14 to 16 years old and they had obstetrics antecedents. It was observed that they didn't have sexual orientation and that the health care personnel and their parents didn't play a fundamental role. The knowledge about the biological, psychological and socioeconomic risks was poor. Conclusions: the poor knowledge on the pregnancy in the adolescence and its risks is a result of the socioeconomic characteristics and their poor sexual orientation. Recommendations: to create instruments and strategies that gives their contribution to the decrease the world incidence of pregnancy in the adolescence.

Os heróis, vítimas e vilões: discursos sobre a anorexia nervosa / Heroes, victims and villains: discourses on anorexia nervosa

Este artigo apresenta uma revisão da literatura sobre os discursos dominantes sobre a anorexia nervosa da Idade Média à actualidade. Coloca em destaque os heróis, vilões e vítimas, culminando num olhar sistémico-familiar. Se durante séculos predominaram narrativas individuais de heroínas santas, posteriormente, na era do pensamento médico, estas heroínas passaram a vítimas de uma doença mental. Mais tarde, com os movimentos da anti-psiquiatria e da terapia familiar, emergem novas narrativas com mais protagonistas: os familiares. Se, primeiramente, as famílias são retratadas como vilãs, dadas as suas influências nocivas, nas últimas décadas as famílias são ilustradas como sistemas vítimas do impacto da doença. Na actualidade, surgem narrativas de famílias competentes, capazes de superar o problema. Este artigo termina refletindo sobre esta multiplicidade de leituras e suas implicações.

This article presents a literature review of the dominant discourses on anorexia nervosa from Middle Ages to the present. It puts on evidence heroes, villains and victims, culminating in a family systemic look. At the beginning, individuals narratives of saints heroines were prevailing, in the age of the medical thought, these heroines became victims of mental illness. Later, with the anti-psychiatry and family therapy movements, new narratives come into view with more protagonists: the relatives. If, firstly, families are shown as villains, having harmful influences, in the last decades the families became systems that suffer with the impact of the disease. And nowadays narratives have descriptions of competent families that are able to deal with the problem. This article ends with a reflexion about these multiple visions and its implications.

Conocimientos de los factores de riesgo sobre cáncer de mama en Puerto La Cruz, estado Anzoátegui, Venezuela / Knowledge of the risk factors more about breast cancer in puerto la cruz, state of Anzoátegui Venezuela

Introducción: el cáncer de mama es un problema de salud en el mundo; en Venezuela, ocupa la segunda causa de muerte en la población femenina. Objetivo: determinar el conocimiento sobre cáncer de mama. Pacientes y Métodos: se realizó un estudio descriptivo, transversal con 1 525 mujeres entre 25 y 64 años que acudieron a la consulta de Barrio Adentro I, del Municipio Puerto La Cruz, Estado Anzoátegui, en el período comprendido entre julio del 2005-julio 2006. Resultados: las variables fueron analizadas predominando el nivel educacional primario y como ocupación ama de casa. El conocimiento acerca de los factores de riesgo para el cáncer de mama fue muy pobre. No conocen el procedimiento para efectuarse el autoexamen de mama; sin embargo, refieren que su examen sirve para prevenir el cáncer mamario. Acuden a consulta solo cuando tienen algún síntoma, a pesar de que nunca realizan un control médico. Refieren que el control frecuente de las mamas es importante. Las fuentes de información para el conocimiento del cáncer de mama fueron los vecinos y/o familiares y no así el personal de salud. Conclusiones: la falta de conocimiento acerca del cáncer de mama pudiera estar en relación con la dificultad para la identificación de los factores de riesgo y la pobre asistencia a la consulta de control médico. Recomendaciones: diseñar e implementar un plan de acción, evaluando este para que brinde su aporte al aumento del conocimiento de la enfermedad en estudio.

Introduction: breast cancer is a main health problem in the world, as in Venezuela, holding the second death cause in female population. Objective: to determine actual knowledge about breast cancer. Patients and Methods : a descriptive work was carried out with 1525 women in the age range from 25 to 64, who attended our Barrio Adentro doctor´s office in Puerto La Cruz, state of Anzoátegui, from July 2005 to July 2006. Results: variables were analyzed: elementary school educational level and housewives prevailed. Knowledge about risk factors for breast cancer was poor. They didn't know the self-examination procedure. Nevertheless they knew that test is for breast cancer prevention. Turned to practice only when symptoms appear, even though didn't make a medical control. They said that breast frequent control is important. Information sources for breast cancer knowledge were relatives and/or neighbors and not healthcare personal. Conclusions: lack of knowledge about breast cancer could be related to difficult identification of risk factors and low attendance to medical control practice. Recommendations: to design and set up an action plan, evaluate it, in order to contribute the studied disease knowledge increase.

Prevalência da alexitimia na anorexia nervosa e sua associação com variáveis clínicas e sociodemográficas / Prevalence of alexithymia in anorexia nervosa and its association with clinical and sociodemographic variables

OBJETIVO: Analisar a prevalência da alexitimia numa amostra de pacientes com anorexia nervosa e sua relação com variáveis do foro clínico e sociodemográfico, em concreto, índice de massa corporal, duração da doença, idade, escolaridade e nível socioeconômico. MÉTODOS: Foram avaliados 2 grupos de participantes do sexo feminino, com idades compreendidas entre os 13 e os 34 anos. Um grupo foi composto por 80 participantes com anorexia nervosa (Grupo AN) e o outro por 80 participantes saudáveis (Grupo Controle). A versão portuguesa da Toronto Alexithymia Scale - 20 items - foi aplicada a ambos os grupos. RESULTADOS: A prevalência da alexitimia no Grupo AN foi 62,5 por cento e no Grupo Controle, 12,5 por cento. Os valores médios de alexitimia não diferiram significativamente entre os dois subtipos de AN, e ambos apresentaram valores estatisticamente superiores aos do Grupo Controle. A alexitimia não se correlacionou às variáveis clínicas e sociodemográficas consideradas, à exceção da escolaridade, cuja associação com a alexitimia foi positiva e baixa. CONCLUSÃO: Os pacientes com anorexia nervosa apresentaram, com elevada frequência, dificuldades na regulação dos afetos, independentemente de seu peso, tempo de evolução da doença, idade e nível socioeconômico. O tratamento deve privilegiar uma intervenção sistematizada no domínio das emoções.

OBJECTIVE: To analyze the prevalence of alexithymia in anorexia nervosa and its relationship with clinical and sociodemographic variables, such as, body mass index, anorexia nervosa duration, age, years of education and socioeconomic status. METHODS: Two groups of female participants, between the ages of 13 and 34 years, were recruited. One group was composed of 80 participants with anorexia nervosa (AN Group) and the other consisted of 80 healthy participants (Control Group). The Portuguese version of the Toronto Alexithymia Scale - 20 items - was applied to both groups. RESULTS: The prevalence of alexithymia in the AN Group was 62.5 percent and 12.5 percent in the Control Group. The mean values of alexithymia (total score and factors) did not significantly differ between the two AN subtypes, and both subtypes presented higher statistical values when compared to the Control Group. Alexithymia did not correlate with clinical and sociodemographic variables, with the exception of years of education, which had a positive and low association with alexithymia. CONCLUSION: Patients with anorexia nervosa revealed a high prevalence of affect regulation deficits regardless of their weight, duration of the disease, age and socioeconomic status. Therapy should focus on a systematic intervention in the domain of emotional regulation.