Heridas por proyectil de arma de fuego. Atipicidad en orificios de entrada y el fenómeno de ''cola de cometa": Reporte de caso / Gunshot wounds. Atypicality in entry holes and the "comet tail" phenomenon: Case report

El análisis de los orificios de entrada por proyectil de arma de fuego en una autopsia médico legal representa un importante papel en la determinación de la forma y causa de muerte en casos relacionados con armas de fuego. Su valoración puede proporcionar información valiosa sobre las características del arma utilizada, la distancia entre el arma de fuego y la víctima, entre otros factores que contribuyen a la investigación. El fenómeno de ''cola de cometa" observado en ciertos orificios de entrada es poco frecuente y conocido. Por lo anterior, el objetivo de este artículo es investigar las características y mecanismos de producción de los orificios de entrada con este fenómeno, proporcionando información sobre su formación, las posibles implicaciones y consideraciones médico legales a tomar en cuenta para su diagnóstico de esta causa de muerte. Se presenta un reporte de caso que destaca la descripción del fenómeno de ''cola de cometa" en una investigación forense de la vida real, proporcionando información valiosa sobre su utilidad y potencial para mejorar la precisión del análisis de heridas de bala. Se realizó revisión de artículos científicos, sobre orificios de entrada en heridas por proyectil de arma de fuego con el fenómeno de ''cola de cometa".

The analysis of firearm projectile entry holes in a medicolegal autopsy plays an important role in determining the manner and cause of death in cases involving firearms. The assessment can provide valuable information about the characteristics of the weapon used, the distance between the firearm and the victim, among other factors that contribute to the investigation. The ''comet tail" phenomenon observed in certain entry holes is rare and well known. Therefore, the objective of this article is to investigate the characteristics and mechanisms of production of the entrance orifices with this phenomenon, providing information about their formation, the possible implications, and medical-legal considerations to be taken into account for the diagnosis of this cause of death. A case report is presented highlighting the description of the ''comet tail" phenomenon in a real-life forensic investigation, providing valuable insight into its utility and potential to improve the accuracy of gunshot wound analysis. A review of scientific articles was carried out on entry holes in gunshot wounds with the "comet tail" phenomenon.

A novel interlamellar oral mucosa graft surgery technique using fibrin glue for the treatment of trichiasis / Nova técnica cirúrgica de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase

ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>

RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.

Role of Condensed Tannins in the Antioxidant Activity of Seeds of Cola nitida (Vent.) Schott & Endl. (Malvaceae)

Background: Native to West Africa, Cola nitida is a tropical tree of about 8-12 in height that grows in lowland rainforest. This plant is best known in Africa for its seeds, used in phytotherapy but for their socio-cultural importance. Aims/Objective: This study investigated the antioxidant activity of condensed tannins of Cola nitida seeds by carrying out two antioxidant tests (DPPH and FRAP). Methods: From a hydro-ethanolic extract of Cola nitida seeds, two samples were made. One treated with casein (EC) and another one without treatment (EWC). The researsh of condensed tannins were carried out by precipitation with Stiasny reagent. The total polyphenol and tannin contents were evaluated by the Folin-Denis method and the antioxidant power by DPPH and FRAP tests. Results: Extract without treatment (EWC) showed more antioxidant activity than the extract treated with casein (EC). Thus, the IC50 of EWC which contains condensed tannins was 5.54±0.005 µg/ml, while that of EC (without condensed tannins) reached 61.92±0.165 µg/ml. Conclusion: Cola nitida seeds are rich in condensed tannins that play an important role in the antioxidant activity.

Hipopotasemia asociado al consumo de bebidas cola

Resumen: La hipopotasemia se define como la concentración de potasio sérico menor a 3,5 mEq/l. La hipopotasemia menor a 3 mEq/l puede cursar con sintomatología de la esfera cardiovascular y neurológica. Se presenta un caso de miopatía secundaria a hipopotasemia por consumo excesivo de bebidas cola azucaradas. Si bien esta etiología es poco frecuente, está descrita en la literatura, y dado el alto consumo de estas bebidas, es importante tenerlo presente frente a pacientes con esta sintomatología.

Abstract: Hypokalemia is defined as serum potassium concentration less than 3.5 mEq/l. Hypokalaemia less than 3 mEq/l can present with cardiovascular and neurological symptoms. A case of myopathy secondary to hypokalaemia due to excessive consumption of sugary cola is presented. Although this etiology is rare, it is described in the literature, and given the high consumption of these beverages, it is important to keep it in mind in patients with these symptoms.

Resumo: A hipocalemia é definida como concentração sérica de potássio inferior a 3,5 mEq/l. Hipocalemia inferior a 3 mEq/l pode apresentar sintomas cardiovasculares e neurológicos. Apresenta-se um caso de miopatia secundária à hipocalemia devido ao consumo excessivo de cola açucaradas. Embora essa etiologia seja rara, é descrita na literatura e, devido ao alto consumo dessas bebidas, é importante tê-la em mente em pacientes com esses sintomas.

The use of surgical adhesive and suture fixing meshes to the abdominal wall: an experimental study in rats / O uso de cola cirúrgica e sutura na fixação de tela em parede abdominal: estudo experimental em ratos

ABSTRACT - BACKGROUND: Proper fixation of the surgical mesh determines the success of a herniorrhaphy. Understanding the inflammatory response and the mechanical properties of the mesh helps to define whether a fixation method is superior. AIM: This study aimed to evaluate the healing of defects in the abdominal wall of rats, comparing the repair of macroporous polypropylene meshes fixed with surgical glue and polypropylene thread. METHODS: In 20 Wistar rats, a defect was produced in the abdominal wall, with the integrity of the parietal peritoneum. For correction, the meshes were fixed with surgical glue (2-octyl cyanoacrylate) (subgroup C1), or polypropylene suture (subgroup C2). The two subgroups of 10 animals were euthanized on the 90th postoperative day, and the fragments of the abdominal wall were submitted to macroscopic, histological, and tensiometric analysis. RESULTS: Macroscopic analysis did not show any abnormalities. Tensiometry on the 90th postoperative day in subgroup C1 showed mean rupture tension of 28.47N and in subgroup C2 32.06N (p=0.773). The inflammatory process score revealed that both groups are in the subacute phase (p=0.380). CONCLUSION: The fixation of a polypropylene macroporous mesh to repair an abdominal wall defect can be performed with surgical glue (2-octyl cyanoacrylate) or polypropylene suture, both methods being equally effective.

RESUMO - RACIONAL: A adequada fixação da tela cirúrgica determina o sucesso de uma herniorrafia. Entender a resposta inflamatória e as propriedades mecânicas da tela contribui para definir se há superioridade de um método de fixação. OBJETIVO: Avaliar a cicatrização de defeitos em parede abdominal de ratos, comparando-se o reparo das telas de polipropileno macroporosas fixadas com cola cirúrgica e fio de polipropileno. MÉTODOS: Foi produzido defeito na parede abdominal de 20 ratos Wistar com integridade do peritônio parietal. Na correção, as telas foram fixadas com cola cirúrgica 2-octil cianoacrilato (C1) ou sutura (C2). Os dois subgrupos de 10 animais foram eutanasiados no 90º dia de pós-operatório e os fragmentos da parede abdominal foram submetidos a análise macroscópica, histológica e tensiométrica. RESULTADOS: A análise macroscópica não mostrou qualquer anormalidade. A tensiometria no 90º dia de pós-operatório no subgrupo C1 demonstrou tensão média de ruptura de 28,47N e no subgrupo C2 de 32,06N (p=0,773). O escore de processo inflamatório revelou que ambos os grupos se encontram na fase subaguda (p=0,380). CONCLUSÃO: A fixação de tela macroporosa de polipropileno para reparo de defeito em parede abdominal pode ser realizada com cola cirúrgica (2-octil cianoacrilato) ou sutura de polipropileno, sendo ambos os métodos igualmente eficazes.

Wnt1 and Wnt2b immunodetection of the regenerating tail and comparative ultrastructure of tail spinal cord in the Scincella tsinlingensis / Inmunodetección Wnt1 y Wnt2b de la cola en regeneración y ultraestructura comparativa de la médula espinal de la cola en Scincella tsinlingensis

SUMMARY: The Wnt pathway is essential for the initiation of lizard tail regeneration. The regenerated lizard tails exhibit obvious morphological differences compared to the original ones. The expression of Wnt1 and Wnt2b proteins in the regenerating tail of Scincella tsinlingensis was detected by immunohistochemistry and then comparatively analyzed for ultrastructural changes in the original and regenerated spinal cord. The ependymal layer of the original spinal cord was pseudostratified with multiciliated cells and primary monociliated cells, while the cells of the ependymal layer of the regenerated spinal cord were organized in a monolayer with a few biciliated cells. Immunolocalization indicated that Wnt1 and Wnt2b were mainly distributed in the dermis near the original tail stump, spinal cord, and clot-positive migratory cells during Stage I, 0-1 days post-amputation (dpa). Wnt1 and Wnt2b were predominantly detected in the epaxial and hypaxial musculature near the original tail stump, wound epithelium, and spinal cord in the original tail during Stage II, 1-7 dpa. Mesenchymal cells and wound epithelium showed immunostaining during Stage III and IV, 7-15 dpa. The ependymal tubes contained these signaling proteins during Stage V and VI, 20- 30 dpa. Labeling was mainly observed in nearby regenerative blood vessels, ependymal cells, epaxial and hypaxial musculature in the apical epithelial layer (AEC) after 45-160 dpa. These findings indicated that Wnt1 and Wnt2b proteins presented primarily in regenerating epidermis and nerve tissues were a critical signal for tail regeneration in S. tsinlingensis.

RESUMEN: La vía Wnt es esencial para el inicio de la regeneración de la cola del lagarto. Las colas de lagarto regeneradas exhiben diferencias morfológicas obvias en comparación con las originales. La expresión de las proteínas Wnt1 y Wnt2b en la cola en regeneración de Scincella tsinlingensis se detectó mediante inmunohistoquímica y luego se analizaron comparativamente los cambios ultraestructurales en la médula espinal original y regenerada. La capa ependimaria de la médula espinal original se pseudoestratificó con células multiciliadas y células monociliadas primarias, mientras que las células de la capa ependimaria de la médula espinal regenerada se organizaron en monocapa con algunas células bicilicadas. La inmunolocalización indicó que Wnt1 y Wnt2b se distribuyeron principalmente en la dermis cerca del muñón de la cola original, la médula espinal y las células migratorias positivas en el coágulo durante la Etapa I, 0-1 días después de la amputación (dpa). Wnt1 y Wnt2b se detectaron predominantemente en la musculatura epaxial e hipaxial cerca del muñón de la cola original, el epitelio de la herida y la médula espinal en la cola original durante la Etapa II, 1-7 dpa. Las células mesenquimales y el epitelio de la herida mostraron inmunomarcaje durante la Etapa III y IV, 7- 15 dpa. Los tubos ependimarios contenían estas proteínas de señalización durante la Etapa V y VI, 20-30 dpa. El marcaje se observó principalmente en vasos sanguíneos regenerativos cercanos, células ependimarias, musculatura epaxial e hipaxial en la capa epitelial apical (AEC) después de 45-160 dpa. Estos hallazgos indicaron que las proteínas Wnt1 y Wnt2b están presentes principalmente en la epidermis en regeneración y en los tejidos nerviosos y eran una señal crítica para la regeneración de la cola en S. tsinlingensis.

C-terminal Motifs of HIV-1 gp41 as Possible Determinants of Viral Pathogenesis / Motivos C-terminales de gp41 del VIH-1 como posibles determinantes de la patogénesis viral / Motivos C-terminais do HIV-1 gp41 como Possíveis Determinantes da Patogénese Viral

Abstract: human immunodeficiency virus type 1 (HIV-1) is the etiological agent of acquired immunodeficiency syndrome (AIDS), a pandemic with high economic and social costs. The envelope glycoprotein (ENV) of the virus mediates the infectious process by binding to and entering the host cell, one of the main target components of studies since its discovery. Its endodomain or C-terminal tail (CTT) participates in late replicative cycle processes, such as intracellular trafficking, activation, and cell death, which occurs because it interacts with multiple cellular factors through motifs or signal sequences present throughout its structure. Although these interactions have not been fully understood at specific levels, studies over more than three decades leave no doubtthatthis domain plays a fundamental role in the biology of the virus and probably the development of the disease. This review describes the studies carried out to date that demonstrate the importance of the CTT, focusing on the motifs responsible for its interactions and its possible roles in the pathogenicity of the infection.

Resumen: el virus de la inmunodeficiencia humana tipo 1 (VIH-1) es el agente etiológico del síndrome de inmunodeficiencia adguirida (SIDA), una pandemia con altos costos económicos y sociales. La glicoproteína de la envoltura (ENV) del virus media el proceso infeccioso al unirse a la célula huésped y entrar en ella, uno de los principales componentes objetivo de los estudios desde su descubrimiento. Su endodominio o cola C-terminal (CTT) participa en procesos tardíos del ciclo replicativo, como tráfico intracelular, activación y muerte celular, lo que ocurre porque interactúa con múltiples factores celulares a través de motivos o secuencias señal presentes en toda su estructura. Aunque estas interacciones no se han entendido completamente a niveles específicos, los estudios durante más de tres décadas no dejan dudas de que este campo juega un papel fundamental en la biología del virus y probablemente en el desarrollo de la enfermedad. Esta revisión describe los estudios realizados hasta la fecha que demuestran la importancia de la CTT, centrándose en los motivos responsables de sus interacciones y sus posibles roles en la patogenicidad de la infección.

Resumo: o vírus da imunodeficiência humana tipo 1 (HIV-1) é o agente etiológico da síndrome da imunodeficiência adquirida (AUXILIA), urna pandemia com elevados custos económicos e sociais. A glicoproteína do envelope (ENV) do vírus media o processo infeccioso ligando-se e entrando na célula hospedeira, um dos principais componentes alvo dos estudos desde sua descoberta. Seu endo domínio ou cauda C-terminal (CTT) participa de processos do ciclo replicativo tardio, como tráfego intracelular, ativação e morte celular, que ocorre porque interage com múltiplos fatores celulares por meio de motivos ou sequências-sinal presentes em toda a sua estrutura. Embora essas interações não tenham sido totalmente compreendidas em níveis específicos, estudos ao longo de mais de três décadas não deixam dúvidas de que esse domínio desempenha um papel fundamental na biologia do vírus e provavelmente no desenvolvimento da doença. Esta revisão descreve os estudos realizados até o momento que demonstram a importância da CTT, com foco nos motivos responsáveis por suas interações e seus possíveis papéis na patogenicidade da infecção.

Morphometric study of rat sciatic nerve recovery after three nerve repair techniques: epineural suture, polyethylene glycol hydrogel and fibrin sealant / Estudio morfométrico de la recuperación del nervio ciático de rata después de tres técnicas de reparación nerviosa: sutura epineural, hidrogel de polietilenglicol y sellante de fibrina

SUMMARY: The effectiveness of microsurgical technique has a direct impact on the recovery of the injured peripheral nerve. The aim of our study was to investigate the result of sciatic nerve regeneration in rats after complete neurotomy and after nerve repair techniques including: 1) epineural suture; 2) polyethylene glycol hydrogel (PEG) (DuraSeal); 3) fibrin sealant (Tisseel). The cross-section of distal sciatic nerve was studied at 14th, 30th and 60th days after nerve repair. Morphometry of myelinated nerve fibers in the distal stump of the sciatic nerve was performed. A significant increase in the number of myelinated nerve fibers was found, especially between 14 and 30 days. The density of myelinated nerve fibers in the distal stump at day 60 was significantly higher after using nerve repair technique including PEG and fibrin versus epineural suture (29.2 % and 32.1 % versus 21.5 %, P <0.05), and a higher level of remyelination of nerve fibers observed in the group with PEG. On day 60, complete elimination of PEG and fibrin sealant was not observed, encapsulation was found around the clusters of hydrogel. Thereby, three peripheral nerve repair techniques were equally effective, only with the use of PEG remyelination of nerve fibers was increasing.

RESUMEN: La efectividad de la técnica microquirúrgica tiene un impacto directo en la recuperación del nervio periférico lesionado. El objetivo de nuestro estudio fue investigar el resultado de la regeneración del nervio ciático en ratas después de una neurotomía completa y después de técnicas de reparación nerviosa que incluyeron: 1) sutura epineural; 2) hidrogel de polietilenglicol (PEG) (DuraSeal); 3) sellante de fibrina (Tisseel). La sección transversal del nervio ciático distal se estudió a los 14, 30 y 60 días después de la reparación del nervio. Se realizó la morfometría de fibras nerviosas mielinizadas en el muñón distal del nervio ciático. Se observó un aumento significativo en el número de fibras nerviosas mielinizadas, especialmente entre los 14 y 30 días. La densidad de las fibras nerviosas mielinizadas en el muñón distal en el día 60 fue significativamente mayor después de usar una técnica de reparación nerviosa que incluye PEG y fibrina en comparación con la sutura epineural (29,2 % y 32,1 % versus 21,5 %, P <0,05), y un mayor nivel de remielinización del nervio en fibras observadas en el grupo con PEG. El día 60, no se observó la eliminación completa de PEG y sellador de fibrina, se encontró encapsulación alrededor de los grupos de hidrogel. Por lo tanto, tres técnicas de reparación de nervios periféricos fueron igualmente efectivas, solo que aumentaba la remielinización de fibras nerviosas con PEG.

Tratamento de crescimento epitelial persistente pós-Lasik com debridamento mecânico, uso de álcool a 20% e cola de fibrina / Treatment of persistent epithelial ingrowth after Lasik with mechanical debridement, use of 20% alcohol and fibrin glue

RESUMO O Lasik é a técnica de cirurgia refrativa mais utilizada no mundo. Apesar de segura e efetiva, ela pode levar a algumas complicações. O crescimento epitelial pós-Lasik é uma complicação pós-operatória incomum, com prevalência maior em casos de retratamento. Geralmente, é um achado não progressivo e assintomático, que não requer tratamento, mas, em uma minoria de pacientes, os sintomas podem ser clinicamente significantes e variados. O tratamento é feito com debridamento mecânico do crescimento epitelial, mas alguns recursos adjuvantes também podem ser utilizados. O presente estudo consiste em um relato de caso de paciente com crescimento epitelial pós-Lasik que apresentou quatro recidivas após intervenções de debridamento epitelial, sutura de lamela corneana e ablação a laser. No quinto procedimento, o paciente foi finalmente tratado com combinação de debridamento epitelial, uso de álcool a 20% e cola de fibrina. Entretanto, a regressão do crescimento epitelial e a melhora da acuidade visual só ocorreram ao longo dos meses após a intervenção, o que mostra a importância de esperar um tempo para que ocorra a melhora da visão no pós-operatório, evitando-se reintervenções.

ABSTRACT Lasik is the most often performed laser refractive surgery worldwide. Despite its efficacy and safety, some complications may occur. Epithelial ingrowth is a rare postoperative complication of Lasik, with an increased prevalence in cases of retreatment. Epithelial ingrowth is usually a nonprogressive and asymptomatic finding, which requires no treatment; however, in a minority of cases, symptoms may be clinically significant and diverse. Treatment is done with mechanical debridement of the affected interface, and additional interventions may be required. This study reported a case of recalcitrant epithelial ingrowth after Lasik, whichrelapsed four times after mechanical debridement, flap lift and laser ablation. In the fifth intervention, the patient was finally treated with a combined scraping/use of 20% alcohol and fibrin glue. However, regression of epithelial ingrowth and better visual acuity were only observed some months after the intervention, which shows the importance of waiting for better vision in the postoperative period, thus avoiding new reinterventions.

Síndrome de cola de caballo secundario a hernia discal / Cauda equina syndrome secondary to herniated disc / Síndrome de cauda eqüina secundária a hérnia discal

Resumen: Introducción: el síndrome de cola de caballo (SCC) es una entidad poco frecuente, provocado por la compresión de las raíces nerviosas en el canal a nivel de la cola de caballo. Puede dejar graves secuelas si no es diagnosticado y tratado de forma precoz. Únicamente 2% a 6% de las hernias discales lumbares van a provocar un SCC. El diagnóstico de esta patología se basa en criterios clínicos, siendo éstos objeto de controversia dada la variabilidad de presentación del cuadro clínico. El objetivo de este trabajo es analizar la presentación clínica y evolución posoperatoria de los pacientes intervenidos por SCC secundaria a hernia de disco por equipo del Centro de Deformidades de Columna (CE.DEF.CO), entre enero de 2009 y diciembre de 2018. Material y método: realizamos un análisis retrospectivo. La población objetivo son los pacientes intervenidos por SCC secundario a hernia discal entre enero de 2009 y diciembre de 2018 por equipo del CE.DEF.CO. Analizamos 20 pacientes intervenidos quirúrgicamente, de ellos 17 (85%) casos presentaron síntomas urinarios, 18 (90%) casos dolor o elementos deficitarios en miembros inferiores, 13 casos anestesia/hipoestesia en silla de montar, 6 casos síntomas intestinales y 3 casos presentaron disfunciones sexuales. En 19 casos se realizó procedimiento quirúrgico antes de las 48 de iniciados los síntomas. Resultados: la remisión de síntomas esfinterianos al mes es de 83% y al año posoperatorio de casi 87%. Se constató un caso de disfunción sexual al año posoperatorio. Conclusión: el diagnóstico precoz por el médico emergencista es fundamental, por lo que el conocimiento de esta patología es imprescindible. Nuestros resultados en pacientes intervenidos de forma precoz, antes de las 48 horas, fueron similares a los publicados en la bibliografía internacional con bajo porcentaje de secuelas.

Summary: Introduction: cauda equina syndrome (CES) is a rare entity, caused by compression of the nerve roots in the spinal canal at the cauda equina level. It can leave serious sequelae if it is not diagnosed and treated early. Only 2-6% of lumbar disc herniation will cause CES. The diagnosis of this pathology is based on clinical criteria, these being the subject of controversy given the variability of presentation of the clinical picture. Materials and methods: we conducted a retrospective study. The target population are the patients operated on for CES secondary to herniated disc between January 2009 and December 2018 by a team from CE.DEF.CO. (center for spinal deformities). The objective is to carry out a set-up regarding the clinical presentation of this entity and to evaluate the correlation between surgical time and neurological improvement. Out of 20 patients who were operated, 17 (85%) presented urinary symptoms, 18 (90%) were patients in pain or presenting deficit elements in the lower limbs, 13 were cases of anesthesia / hypoesthesia in the saddle, 6 cases evidenced intestinal symptoms and 3 cases presented sexual dysfunction. In 19 cases, a surgical procedure was performed before 48 hours after symptoms started. Results: the remission of sphincter symptoms after one month is 83% and it rises to almost 87% one year after the surgery. One case of sexual dysfunction persisted one year after surgery. Conclusion: early diagnosis by the emergency physician is essential, so knowledge of this pathology is essential. Our experience and good results allow us to conclude that early surgical treatment is associated with symptomatic improvement and fewer neurological sequelae in the short and long term.

Resumo: Introdução: a síndrome da cauda eqüina (SCE) é uma entidade rara causada pela compressão das raízes nervosas no canal no nível da cauda eqüina. Pode deixar seqüelas graves se não for diagnosticada e tratada precocemente. Apenas 2-6% das hérnias do disco lombar causarão a síndrome da cauda eqüina. O diagnóstico desta patologia é baseado em critérios clínicos, sendo este motivo de controvérsia, dada a variabilidade da apresentação do quadro clínico. Materiais e métodos: realizamos um estudo retrospectivo. A população-alvo estava composta por pacientes operados por SCE secundária a hérnia discal entre janeiro de 2009 e dezembro de 2018 pela equipe do CE. DEF.CO (Centro de Defeitos da Coluna Vertebral). Foram analisados 20 pacientes operados, dos quais 17 (85%) apresentaram sintomas urinários, 18 (90%) dor ou elementos de deficiência em membros inferiores, 13 anestesia / hipoestesia em sela, 6 sintomas intestinais e 3 disfunções sexuais. Em 19 casos, um procedimento cirúrgico foi realizado antes de 48 horas após o início dos sintomas. Resultado: a remissão dos sintomas esfincterianos em um mês é de 83% e em um ano pós-operatório é de quase 87%. Um caso de disfunções sexuais foi encontrado um ano após a cirurgia. Conclusão: o diagnóstico precoce pelo médico de emergência é essencial, portanto o conhecimento desta patologia é fundamental. Nossos resultados em pacientes operados precocemente, antes de 48 horas, foram semelhantes aos publicados na literatura internacional com baixo percentual de seqüelas.

Safety of drainless excision of the submandibular gland / Segurança na excisão da glândula submandibular sem o uso de drenos

Abstract Introduction: Percutaneous drains can be associated with several complications, including infection, fistula formation, discomfort and prolonged hospitalization. Objective: The aim of this study was to evaluate the safety of submandibular gland excision without the use of surgical drains. Methods: We analyzed the surgery time, postoperative complications such as bleeding, facial palsy, seroma, and repeat exploration of wounds and duration of the hospital stay. Excision of the submandibular gland via a transcervical approach was undertaken by two surgeons. Prior to wound closure, the skin flap and wound bed were approximated using hemostatic fibrin glue (Greenplast-Q PFS KIT®, GC Greencross, Youngin, Korea). Neither saline irrigation nor insertion of a percutaneous drain were included. Results: A total of 23 patients underwent submandibular gland excision. The study group consisted of 14 men (60.8%) and 9 women (39.2%) (mean age, 47.6 years; range, 24-70 years). There were two patients who had minor complications. One patient showed minor bleeding on the skin incision line immediately postoperatively, and one developed a seroma at 7 days postoperatively. There were no major surgical complications. Total duration of the surgery from skin incision to closure averaged 44.86 minutes. Mean duration of the hospital stay was 3.17 days. Patients were discharged on average at 1.17 days after surgery. Conclusion: The submandibular gland can be safely excised without the use of a surgical drain, therefore allowing early patient discharge.

Resumo Introdução: Os drenos percutâneos apresentam várias complicações associadas, inclusive infecção, formação de fístulas, desconforto e permanência hospitalar prolongada. Objetivo: Avaliar a segurança da excisão da glândula submandibular sem o uso de drenos cirúrgicos. Método: Analisamos o tempo de cirurgia, as complicações pós-operatórias tais como sangramento, paralisia facial, seroma e necessidade de reexploração de ferida operatória, e a duração da internação hospitalar. A excisão da glândula submandibular por via transcervical foi realizada por dois cirurgiões. Antes do fechamento da incisão, o retalho cutâneo e o leito da ferida operatória foram aproximados utilizando cola hemostática de fibrina (Greenplast-Q PFS KIT®, GC Greencross, Youngin, República da Coréia). Não houve irrigação salina nem uso de dreno percutâneo. Resultados: Foram submetidos 23 pacientes à excisão da glândula submandibular. O grupo de estudo consistiu em 14 homens (60,8%) e 9 mulheres (39,2%) (média de 47,6 anos; variação de 24 a 70). Dois pacientes apresentaram complicações menores. Um paciente apresentou pequeno sangramento na incisão da pele no pós-operatório imediato e um deles teve seroma aos 7 dias de pós-operatório. Não houve complicações cirúrgicas importantes. A duração total da cirurgia, desde a incisão na pele até o fechamento, foi de 44,86 minutos. A duração média da internação hospitalar foi de 3,17 dias. Os pacientes receberam alta em média 1,17 dia após a cirurgia. Conclusão: A glândula submandibular pode ser excisada com segurança sem o uso de dreno cirúrgico, permitindo que o paciente tenha alta hospitalar mais precocemente.

Effectiveness of two treatments to promote tree regeneration: implications for forest restoration in the Isla del Coco National Park, Costa Rica / Efectividad de dos tratamientos para promover la regeneración de árboles: implicaciones para la restauración de bosques en el Parque Nacional Isla del Coco

Introduction: Isla del Coco is the only island in the Eastern Tropical Pacific with humid tropical forests; 296 plant species are reported, of them, 22% are endemic. Their ecology is poorly understood. Deforestation and the introduction of rats, feral pigs and white-tailed deer are the primary agents of forest degradation. After more than 120 years, the deforested areas have never recovered the native forest. Objective: To analyse if the deforested area keeps its resilience, we evaluated the natural regeneration and ecological processes associated. Methods: From August 2016 to June 2018, we conducted a restoration experiment consisting of a randomized complete blocks design including vegetation cutting, vegetation uprooting and controls as treatments. Plots were protected with an exclusion fence to avoid herbivores. Results: There were no differences between plant cutting and uprooting in stimulating natural regeneration. We only recorded the seedlings of two tree species, 35 individuals of Cecropia pittieri and three of Sacoglottis holdridgei, both endemic. Their regeneration established during the first 15 months mainly. At the end of the experiment, the structure and composition of the vegetation changed from bushes dominated by Entada gigas (28%) and Clidemia strigillosa (12%) to grasses dominated by Paspalum conjugatum (39%). Entada gigas has a high recolonizing potential with a growing rate of 1.6±0.2m/month. Conclusions: As filters for restoration we determined herbivores, which pose a strong negative impact in the development of the forest; the exhausted seed bank of tree species and scarce or null seed dispersion.

Introducción: Isla del Coco es la única isla en el Pacífico oriental con bosques tropicales húmedos, albergando 296 especies de plantas, de las cuales un 22% son endémicas. De su ecología se conoce muy poco. El bosque fue degradado con la introducción de cerdos y venados cola blanca y por deforestación. Las áreas deforestadas hace más de 120 años nunca recuperaron el bosque nativo. Objetivo: Para analizar si el área deforestada mantiene su capacidad de recuperación, se evaluó la regeneración natural y los procesos ecológicos asociados. Metodología: Desde agosto de 2016 hasta junio de 2018, se monitoreó un ensayo de restauración, establecido como un diseño de bloques completos al azar. Los tratamientos incluyeron corte de vegetación, arranque de vegetación y controles. Se utilizó una cerca de exclusión para evitar los herbívoros. Resultados: No hubo diferencias en los tratamientos de corte y arranque de la vegetación para estimular la regeneración natural. Se registró la regeneración de dos especies de árboles: 35 individuos de Cecropia pittieri y tres de Sacoglottis holdridgei, ambas endémicas. La regeneración se estableció principalmente en los primeros 15 meses. Luego de aplicados los tratamientos, la estructura y composición de la vegetación cambió de arbustos dominados por Entada gigas (28%) y Clidemia strigillosa (12%), a pastos dominados por Paspalum conjugatum (39%). Entada gigas tiene el mayor potencial de recolonización por su tasa de crecimiento de 1.6±0.2m/mes. Conclusiones: Los filtros determinados asociados con la regeneración del bosque son los herbívoros; el banco de semillas de las especies arbóreas agotado y la dispersión de semillas escasa o nula, según la especie.

Transferibilidad de marcadores microsatélites de Anas platyrhynchos al pato criollo peruano Cairina moschata domestica / Cross species transferability of microsatellite markers from Anas platyrhynchos to Peruvian Muscovy Duck Cairina moschata domestica

Resumen El pato criollo peruano (Cairina moschata domestica) es una de las especies de mayor importancia económica en la alimentación humana. Las especies de patos forman grupos genéticos complejos y difíciles de reconocer, por lo que el uso marcadores microsatélites (SSR) identificados en una especie relacionada como Anas platyrhynchos, representa una opción atractiva, de menor costo y útil para resolver temas relacionados con la conservación de la diversidad genómica, flujo génico e hibridación entre poblaciones. El objetivo de la investigación fue evaluar la transferibilidad de 24 SSR identificados para A. platyrhynchos a las poblaciones peruanas de C. moschata doméstica y determinar el grado de polimorfismo (PIC) de los marcadores transferibles. Para ello, se obtuvo ADN a partir de plumas alares usando el método cloroformo-alcohol isoamílico. Los SSR se construyeron con una secuencia adicional de 19 pb (cola M13) y se utilizaron fluoróforos 6-FAM, VIC, NED y PET para su etiquetado. Los fragmentos amplificados fueron visualizados en geles de agarosa 2% y separados por electroforesis capilar en un secuenciador automático ABI 3130XL. Los resultados mostraron 7 SSRs con un valor PIC alto (PIC>0.5) y que el marcador CMO211 se expresaba con un tamaño molecular menor del de la referencia. En conclusión, el presente trabajo demostró que el 75% de los SSR diseñados para A. platyrhynchos son transferibles a C. moschata domestica; y que sólo 7 fueron altamente informativos. Demostrando así que los SSRs son útiles en la detección de polimorfismos en especies relacionadas y pueden ser usados para mejorar las poblaciones peruanas de patos criollos.

Abstract Peruvian Muskovy duck (Cairina moschata domestica) is one of the most economically important species in human nutrition. Duck species form complex genetic groups which are difficult to recognize, thus the use microsatellite markers (SSRs) identified already in Anas platyrhynchos (related species), represents a very attractive option for its cheapness and usefulness for solving issues related to conservation of genomic diversity, gene flow and hybridization between population. The main goal of this work was to evaluate the degree of polymorphism (PIC) and the transferability of 24 SSRs identified for A. platyrhynchos to C. moschata domestica. In this study, DNA collected from wing feathers was extracted using the chloroform-isoamyl alcohol method. SSRs were constructed with an additional 19 bp sequence (M13 tail) and 6-FAM, VIC, NED and PET fluorophores were used for their labeling. The amplified fragments were visualized on 2% agarose gels and separated by capillary electrophoresis in an automatic ABI 3130XL sequencer. Results showed 7 SSR with high PIC value (PIC> 0.5) and the CMO211 marker expressed in a smaller molecular size that the one used as reference. In conclusion, we showed that 75% of the SSR designed for A. platyrhynchos were transferable to C. moschata domestica as well as we found only 7 SSR highly informative, thus we proved that SSR are highly useful for detecting polymorphisms in related species and improved the Peruvian populations of Muskovy ducks.

Morphological differences in a population of Rufous-collared Sparrow (Zonotrichia capensis, Statius Müller, 1776) (Passerine, Emberizidae) at different elevations in the Tropical Andes / Diferencias morfologicas en una poblacion de Copetón (Zonotrichia capensis, Emberizidae) a diferente altitud en los Andes tropicales

Abstract Populations that breed along steep elevation gradients show diverse physiological and morphological changes in response to the different environmental conditions. The latter has been discussed by Bergmann's and Allen's ecogeographic rules about body and appendage sizes and environmental temperature. We compared morphometric measures (mass, bill width, tarsus, wing, and tail length) of a Zonotrichia capensis population in two localities at different elevations with similar latitudes and photoperiods on the western slope of the Colombian Central Andes. We compared a Low Elevation locality (LE) at 1800 m a.s.l. and a High Elevation locality (HE) at 3853 m a.s.l. that have approximate wind speeds of 1.3 m/s and 8.4 m/s, respectively. During 12 months of sampling, we captured 46 adults using mist-nets; 26 in the LE and 20 in the HE. Each individual was sexed using molecular techniques at the Laboratory of Genetics of the Department of Biological Sciences of Universidad de Caldas. Individuals (males + females) from the HE had longer wings and tails than those from the LE (F1,44 = 5.93; P = 0.019). Also, wings of males in the HE were longer than those of females in both localities and tails of males in the HE were longer than those of LE males. Our results did not agree with what was expected according to Allen's and Bergmann's ecogeographic rules. Longer wings and tails increase sustainment, maneuverability, and balance in low atmospheric pressures and strong air currents and these conditions are found at high elevation habitats. Most likely, the longer wings found for HE males allow greater movement during territorial behavior. Further, these differences in morphological traits along elevational gradients could result from micro-evolutionary changes between localities or phenotypic plasticity of individuals exposed to different environmental conditions.

Resumen Las poblaciones que se reproducen en gradientes altitudinales, adoptan diversos cambios morfológicos para afrontar las condiciones ambientales. En el presente estudio se compararon las medidas morfológicas (peso corporal, longitud del tarso, ala, cola y culmen) de una población de Zonotrichia capensis, a diferente altitud en los Andes colombianos. Las localidades de tierra baja (TB) y alta (TA) se encuentran a 1800 m.s.n.m. y 3853 m.s.n.m., con velocidad aproximada del viento de 1.3 m/s y 8.4 m/s, respectivamente. Durante 12 meses se realizó la captura de 46 individuos (TB n=26, TA n=20) para la medición de los rasgos morfológicos. La longitud del ala de los individuos de TA fue mayor que en TB. Así mismo, en machos de TA la longitud del ala fue mayor que en hembras en general. Es posible que a las más grandes incrementen la eficiencia del vuelo en zonas ventosas y con baja presión atmosférica, como ocurre en TA. Probablemente la diferencia del tamaño del ala entre los machos de TA y las hembras, se deba a un mayor desplazamiento dentro de la conducta territorial. Estas diferencias podrían ser el resultado de cambios microevolutivos entre localidades o la plasticidad fenotípica de individuos expuestos a diferentes condiciones ambientales.

Pain, healing and satisfaction of women after perineal repair with surgical glue and suture / Dolor, cicatrización y satisfacción de la mujer después de la reparación perineal con pegamento quirúrgico e hilo de sutura / Dor, cicatrização e satisfação da mulher após reparo perineal com cola cirúrgica e fio de sutura

Abstract OBJECTIVE To compare the intensity of pain, the healing process and women's satisfaction with the repair of perineal trauma during vaginal delivery using surgical glue or suture. METHOD Cross-sectional study aligned with a clinical trial conducted at a maternity in Itapecerica da Serra, São Paulo. The sample consisted of women who were evaluated between 10 and 20 days after delivery. The outcomes were analyzed according to the distribution of women in the experimental group (EG: perineal repair with Glubran-2® surgical glue; n=55) and in the control group (CG: perineal repair with Vicryl® suture thread; n=55). RESULTS 110 puerperal women were evaluated. There was no difference between EG and CG regarding sociodemographic and clinical-obstetric characteristics. The intensity of perineal pain, assessed by the visual numeric scale was lower among women in the EG compared to the CG (p<0.001). According to the REEDA scale, there was no significant difference in perineal healing (p=0.267) between EG and CG. The satisfaction of women with perineal repair, assessed using a five-point scale, was higher with the use of surgical glue (p=0.035). CONCLUSION Surgical glue showed advantages in relation to perineal pain and greater satisfaction for women compared to the use of suture. The healing process was similar for both types of repair.

Resumen OBJETIVO Comparar la intensidad del dolor, el proceso de cicatrización y la satisfacción de la mujer con la reparación del trauma perineal durante el parto normal utilizando pegamento quirúrgico o hilo de sutura. MÉTODO Estudio transversal anidado a un ensayo clínico realizado en el hospital-maternidad de Itapecerica da Serra, São Paulo. La muestra consistió en mujeres que fueron evaluadas entre 10 y 20 días después del parto. Los resultados se analizaron según la distribución de las mujeres en el grupo experimental (GE: reparación perineal con pegamento quirúrgico Glubran-2®; n=55) y en el grupo control (GC: reparación perineal con hilo Vicryl®; n=55). RESULTADOS Se evaluaron 110 mujeres en el postparto. No hubo diferencia entre GE y CG en cuanto a las características sociodemográficas y clínico-obstétricas. La intensidad del dolor perineal, evaluada mediante la escala numérica visual, fue menor entre las mujeres del GE en comparación con aquellas del GC (p<0,001). Según la escala REEDA, no hubo diferencias significativas en la cicatrización perineal (p=0,267) entre el GE y GC. La satisfacción de las mujeres con la reparación perineal, evaluada mediante una escala de cinco puntos, fue mayor con el uso de pegamento quirúrgico (p=0,035). CONCLUSIÓN El pegamento quirúrgico mostró ventajas con relación al dolor perineal y mayor satisfacción de las mujeres, en comparación con el hilo de sutura. El proceso de cicatrización fue similar para ambos tipos de reparación.

Resumo OBJETIVO Comparar a intensidade da dor, o processo de cicatrização e a satisfação da mulher com o reparo do trauma perineal no parto normal por meio de cola cirúrgica ou fio de sutura. MÉTODO Estudo transversal alinhado a um ensaio clínico realizado na maternidade de Itapecerica da Serra, São Paulo. A amostra foi constituída por mulheres que foram avaliadas entre 10 a 20 dias após o parto. Os desfechos foram analisados segundo a distribuição das mulheres no grupo experimental (GE: reparo perineal com cola cirúrgica Glubran-2®; n=55) e no grupo controle (GC: reparo perineal com fio Vicryl®; n=55). RESULTADOS Foram avaliadas 110 puérperas. Não houve diferença entre GE e GC quanto às características sociodemográficas e clínico-obstétricas. A intensidade da dor perineal, avaliada pela escala visual numérica, foi menor entre as mulheres do GE em comparação ao GC (p<0,001). Segundo a escala REEDA, não houve diferença significativa na cicatrização perineal (p=0,267) entre GE e GC. A satisfação das mulheres com o reparo perineal, avaliada por escala de cinco pontos, foi maior com o uso da cola cirúrgica (p=0,035). CONCLUSÃO A cola cirúrgica mostrou vantagens em relação à dor perineal e maior satisfação das mulheres comparada com o uso do fio de sutura. O processo de cicatrização foi similar nos dois tipos de reparo.

Infección natural por Fasciola hepatica en cérvidos del Perú / Natural infection of Fasciola hepatica in cervids from Peru

En el presente trabajo se registra la infección natural por Fasciola hepatica en un venado de cola blanca (Odocoileus virginianus) y en una taruca (Hippocamelus antisensis), ambos procedentes del departamento de Cusco. Los animales fueron remitidos al Instituto Veterinario (IVITA-Maranganí, FMV, UNMSM) por las autoridades del Servicio Nacional de Flora y Fauna (SERFOR, Sede Cusco). Durante la necropsia de los animales se colectaron seis trematodos de los conductos biliares, los cuales fueron preservados en etanol al 70%. Las observaciones morfológicas indicaron que se trataban de F. hepatica. Esto fue confirmado analizando el ADN mitocondrial de los parásitos amplificando parcialmente los genes citocromo c oxidasa subunidad 1 (cox1) y el NADH deshidrogenasa subunidad 1 (nad1). El análisis de estos genes tuvo una identidad mayor al 99% comparado con registros del banco de genes (GenBank). El presente estudio demuestra la presencia de F. hepatica en estos cérvidos, agregando así dos nuevos hospederos definitivos para el parásito.

Natural infection by Fasciola hepatica is recorded in a white-tailed deer (Odocoileus virginianus) and a taruca (Hippocamelus antisensis), both from the department of Cusco. Animals were remitted to the Veterinary Institute (IVITA-Maranganí, FMV, UNMSM) by the authorities of the National Service of Flora and Fauna (SERFOR, Cusco Headquarters). Six trematodes were collected from the bile ducts during the necropsy of the animals, and they were preserved in 70% ethanol. Morphological analysis indicated that they correspond to F. hepatica. This was confirmed by analyzing of the mitochondrial DNA of the parasites by partially amplifying the cytochrome c oxidase subunit 1 (cox1) and the NADH dehydrogenase subunit 1 (nad1) genes. Analysis of these genes had an identity greater than 99% compared to genes from GenBank. The present study demonstrates the occurrence of F. hepatica in these cervids, thus adding two new definitive hosts for the parasite.

Síndrome de Cola de Caballo asociado a tratamiento quiropráctico: Reporte de 3 casos y revisión de la literatura / Horsetail syndrome associated with chiropractic treatment: Report of 3 cases and review of the literature

El síndrome de cola de caballo (SCC) es una urgencia quirúrgica poco frecuente con una incidencia estimada de hasta 1,8 casos por millón de habitantes, producida por la compresión de las raíces nerviosas en el extremo inferior del canal espinal. La manipulación espinal puede desempeñar un papel etiogénico, provocando la movilización y extrusión del disco. El diagnóstico temprano y el tratamiento oportuno son cruciales, ya que el pronóstico suele ser desfavorable si el tratamiento quirúrgico se retrasa produciendo un daño neurológico permanente. El objetivo de este trabajo es identificar los potenciales factores de riesgo para la manipulación espinal y optimizar esta práctica, evitando así posibles complicaciones derivadas del tratamiento quiropráctico. Presentamos 3 casos de SCC, observados y tratados en nuestro centro, en los que se sugiere una estrecha relación entre la manipulación espinal quiropráctica y la aparición de dicho síndrome. Tras realizarles una RM en la que se observó una hernia discal L5-S1 causante del SCC, los 3 pacientes fueron tratados quirúrgicamente de forma urgente. Los casos presentados demostraron la existencia de una asociación patogénica entre la manipulación espinal y el desarrollo del SCC, al producirse dicho síndrome en las horas siguientes a la manipulación debida a la protusión abrupta de un disco demostrado por RM.

Introduction: Cauda equine syndrome (CES) is a rare surgical emergency with an estimated incidence of up to 1.8 cases per million. It is caused by compression of the nerve roots at the lowest point of the spinal canal. Spinal manipulation can play a pathogenic role, resulting in mobilization and extrusion of the disc. Early diagnosis and timely treatment are crucial, since the prognosis is usually unfavorable and permanent neurological damage likely if surgical treatment is delayed. Objective: The aim of this study was to identify potential risk factors associated with spinal manipulation and, thereby, optimize this practice to reduce the risk of complications from chiropractic treatment. Methods: We present three cases of CES, observed and treated at our center, in which a close relationship between chiropractic spinal manipulation and the appearance of CES was apparent. Results: After magnetic resonance imaging (MRI) revealed an L5-S1 herniated disc causing the SCC, all three patients underwent urgent surgical treatment. Conclusion: The three presented cases demonstrate a strong pathogenic relationship between spinal manipulation and the development of CES, when this syndrome occurs within hours of spinal manipulation, secondary to MRI-documented acute disc protrusion.

Efecto protector del aceite de plukenetia volubilis (sacha inchi) en la depresión inducida de ratones albinos / Protective effect of plukenetia volubilis (sacha inchi) oil on induced depression of albino mice

Objetivo: Evaluar el efecto protector del aceite de Plukenetia volubilis (Sacha Inchi) en la depresión inducida a ratones albinos. Materiales y métodos: Los ratones fueron divididos en 4 grupos y recibieron durante 10 días las siguientes sustancias: Grupo N°01(n=6) Vehículo 5 ml/Kg/12h, Grupo Nº 02 (n=6): Fluoxetina 10 mg/Kg/24horas, Grupo Nº 03 (n=6): Aceite de sacha inchi 1g/kg/12 horas, Grupo Nº 04 (n=6): Aceite de sacha inchi 3g/kg/12 horas. Luego, fueron sometidos a la prueba de Nado Forzado, sumergiéndolos en una piscina cilíndrica durante 6 minutos y registrando el tiempo de inmovilidad. Los ratones sometidos a la prueba de Sujeción de cola fueron distribuidos de la misma manera y administrados con las mismas sustancias para después de 10 días ser suspendidos por el tercio distal de la cola registrándose el tiempo de inmovilidad. Resultados: Los ratones que recibieron el aceite de Plukenetia volubilis a dosis de 1g/kg y 3 g/kg presentaron menor tiempo de inmovilidad respecto al control para ambas pruebas, sólo teniendo el grupo con dosis 3 g/kg significancia estadística. En el nado forzado el tiempo de inmovilidad con dosis de aceite de 1g/kg y 3 g/kg fue 184,7 s y 108,0 s, respectivamente. Para la prueba de Sujeción de cola el tiempo de inmovilidad fue 118,33 s y 63,33 s para dosis de 1g/kg y 3g/kg respectivamente. Conclusiones: El aceite de Sacha Inchi administrado por vía oral a dosis de 3g/kg demostró efecto protector similar a fluoxetina, frente a la depresión inducida en los modelos animales empleados. (AU)

Objective: Evaluate protective effect of Plukenetia volubilis oil (Sacha Inchi) on induced depression in albino mice. Materials and methods: Mice were divided into 4 groups and received the following substances during 10 days: Group N°1 (n = 6) Vehicle 5 ml/Kg/12h, Group N°2 (n = 6): Fluoxetine 10 mg/Kg/24h, Group N°3 (n = 6): Sacha inchi oil 1 g/kg /12h, Group N°4 (n = 6): Sacha inchi oil 3 g/ kg/12 h. Then, they were subject to Forced Swimming test, submerging them in a cylindrical pool for 6 minutes and the immobility time was recorded. The mice subjected to the tail suspension test were distributed in the same way and administered with the same substances, after 10 days being suspended by the distal third of the tail, recording the immobility time. Results: The mice that received the Plukenetia volubilis oil at a dose of 1 g/kg and 3 g/kg had a shorter immobility time regarding control for both tests, and only the group with a dose of 3 g/kg had statistical significance. In forced swimming the immobility time with oil doses of 1 g/kg and 3 g/kg was 184.7 s and 108.0 s, respectively. For Tail suspension test, the immobility time was 118.33 s and 63.33 s for doses of 1g/kg and 3g/kg, respectively. Conclusions: Sacha Inchi oil administered orally at a dose of 3g/kg showed a protective effect similar to fluoxetine, against induced depression in the animal model used. (AU)

Observation of the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar / 中国综合临床

Objective To investigate the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar. Methods From 2010 to 2016,a retrospective study was conducted on fifty?two patients admitted to Beijing Shijitan Hospital, Capital Medical University. Results The main accompanying diseases were hypertension,coronary heart disease,diabetes mellitus and so on. Food that are easy to induce bezoar : banana, persimmon, hawthorn, chestnut, etc. The treatment included endoscopic treatment, intravenous proton pump suppression, and oral Coca?Cola and bicarbonate solution. The bezoar in two patients after 3 weeks of medical treatment were still not dissolved,finally surgery were performed. One patient's pathology showed early cardiac adenocarcinoma. Five patients had incomplete intestinal obstruction, after fasting and gastrointestinal decompression, and the bezoars were excreted through feces. All patients were cured without death. Conclusion Gastroscopy is a timely treatment that can help diagnose and treat gastric bezoar. The main predisposing factors include hypertension, coronary heart disease, diabetes mellitus and so on. Endoscopic treatment,intravenous proton pump inhibitor,sodium bicarbonate and Coca?Cola could dissolve most bezoar. We should be alert to the possibility of early cancer.

Estado de conservación de Lagothrix flavicauda y otros primates en bosques montanos de San Martín y Huánuco, Perú

Lagothrix flavicauda es endémica y vive en simpatría con otros primates en bosques montanos de Amazonas, San Martín, La Libertad y Huánuco. Información detallada sobre su abundancia y estado de conservación, así como de los sitios con poblaciones saludables son desconocidas, excepto para Amazonas donde fueron ejecutados la mayoría de los estudios. Para obtener la información sobre los aspectos mencionados fueron conducidos censos por transecto entre noviembre y diciembre del 2015, febrero a mayo del 2016 y entre junio y julio del 2016 en seis sitios de muestreo localizados entre las regiones de San Martín y Huánuco. Como resultado de los censos fueron avistados 49 grupos pertenecientes a 7 especies, siendo L. flavicauda la más observada con 14 grupos. Grupos más grandes se observaron en L. flavicauda (promedio 13.5±2.2 individuos) y Cebus yuracus (promedio 12.5±3.6 individuos) y más pequeños en Alouatta seniculus (promedio 3.0±2.4 individuos), ambos en Huánuco. La abundancia relativa fue más alta para L. flavicauda en San Martín (2.4 individuos/10 km) y más baja para A. seniculus en Huánuco (0.2 individuos/10 km). Con el registro de L. flavicauda en el lado oriental del río Huallaga su distribución en Huánuco se amplía hasta el río Pozuzo, pero en el lado occidental podemos considerarlo localmente extinta en gran parte de su distribución. En los sitios de muestreo, la deforestación y la caza son las principales amenazas para los primates y otros componentes de la fauna silvestre

Lagothrix flavicauda is endemic and lives sympatrically with other primates in the montane forests of Amazonas, San Martín, La Libertad and Huánuco. Detailed information on its density and conservation status, as well as sites with healthy populations is lacking, except for Amazonas where most of the studies were carried out. In order to obtain information on the mentioned aspects, transect censuses were conducted between November and December of 2015, February to May of 2016, and between June and July of 2016 in six survey sites located in the regions of San Martín and Huánuco. As a result of the census, 49 groups belonging to 7 species were sighted, being L. flavicauda the most observed with 14 groups. The largest groups were observed in L. flavicauda (average 13.5±2.2 individuals) and Cebus yuracus (average 12.5±3.6 individuals) and the smallest in Alouatta seniculus (average 3.0± 2.4 individuals), both in Huánuco. The relative abundance was the highest for L. flavicauda in San Martín (2.4 individuals /10 km) and the lowest for A. seniculus in Huánuco (0.2 individuals/ 10 km). Our observation of L. flavicauda on the eastern side of the Huallaga River extends its distribution in Huánuco to the Pozuzo River, but on the western side we can consider it locally extinct in much of its distributional range. At our survey sites, deforestation and hunting are the main threats to primates and other components of wildlife