Colecistectomía videolaparoscópica en el Hospital Militar Docente Dr. Mario Muñoz Monroy, Matanzas, 2014-2017 / Video laparoscopic cholecistectomy in the Military Hospital of Matanzas. 2014-2017

RESUMEN Introducción: en enero de 2000, comenzó la cirugía videolaparoscópica en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de la ciudad de Matanzas. El equipo quirúrgico, en esa época, lo constituían cirujanos con varios años de experiencia y con una sólida formación en cirugía convencional. También poseían habilidades demostradas en la realización de colecistectomía a cielo abierto. A partir de 2011, una nueva generación de cirujanos desarrolló la cirugía mínimamente invasiva, con poca experiencia en cirugía a cielo abierto. Por lo tanto, se presentó la contradicción de que cada vez menos cirujanos tenían la experiencia técnica que requieren los casos más difíciles. Objetivo: determinar la seguridad en la realización de la colecistectomía laparoscópica. Materiales y métodos: Investigación observacional, descriptiva y retrospectiva de los pacientes intervenidos de afecciones biliares benignas, por la técnica de colecistectomía laparoscópica, entre enero de 2014 y diciembre de 2017. Resultados: fueron colecistectomizados 2 016 pacientes. De ellos, 1 759 (87 %) correspondieron al sexo femenino, y 257 (13 %) al masculino. Comorbilidades presentes en el 46,3 %. Cirugías: electivas, 1 801; urgentes, 215. Eventos adversos, 38 (1,88 %). Conversiones, 28 (1,3 %). Mortalidad operatoria, 5 (0,24 %). Conclusiones: resultan seguras las colecistectomías laparoscópicas por el bajo índice de eventos adversos, conversiones y mortalidad operatoria (AU).

ABSTRACT Introduction: video laparoscopic surgery began in January 2000, at the Dr. Mario Muñoz Monroy Military Hospital. The surgical team, at that time, were surgeons with years of experience and a solid training in conventional surgery. They also had demonstrated skills in performing open cholecystectomy. Starting in 2011, a new generation of surgeons developed minimally invasive surgery, with little experience in open surgery. Therefore, it arose the paradox that fewer and fewer surgeons had the technical experience required in the most difficult cases. Objective: to determine the safety in performing laparoscopic cholecystectomy. Materials and methods: retrospective, descriptive and observational research of the patients who underwent surgeries of benign biliary conditions, by the technique of laparoscopic cholecystectomy in the period January 2014- December 2017. Results: 1759 patients were cholecystectomized. 87.25% were female ones and 257 (13%) were male: Comorbidities were present in 46.3%. 1 801 were elective surgeries; emergency surgeries were 215. There were 38 (1.88%) adverse events and 28 (1.3%) conversions. The operatory mortality was 5 (0.24%). Conclusions: laparoscopic cholecystectomy are safe because of the low index of adverse events, conversion and operatory mortality (AU).

Avaliação do potencial antioxidante frente à oxidação lipídica e da toxicidade preliminar do extrato e frações obtidas das frondes de Dicksonia sellowiana (Presl. ) Hook / Evaluation of antioxidant potential against lipid oxidation and preliminary toxicity of extract and fractions obtained from the fronds of Dicksonia sellowiana (Presl. ) Hook

RESUMOA espécie Dicksonia sellowiana, conhecida popularmente como xaxim, é uma samambaia natural do continente americano e encontrada no Brasil na Mata Atlântica. Em 2001 foi inserida na lista do IBAMA como espécie ameaçada de extinção em decorrência da exploração para a confecção de vasos para a jardinagem. O presente trabalho descreve o potencial antioxidante lipídico (TBARS e Sistema β-caroteno/ácido linoleico) do extrato bruto e frações obtidos através de aparato de Soxhlet de frondes de Dicksonia sellowiana, além da atividade citotóxica e hemolítica in vitro. Pelo método TBARS, todas as amostras testadas apresentaram atividade, destacando a fração acetato de etila e extrato bruto cuja atividade foi comparável ao padrão ácido ascórbico. No sistema β-caroteno/ácido linoleico, a fração acetato de etila e extrato bruto apresentaram inibição da oxidação do ácido linoleico, destaque para a fração acetato de etila que não se diferenciou estatisticamente do padrão BHT. Na avaliação da toxicidade preliminar, não fora observado atividade citotóxica e hemolítica do extrato bruto e frações nos modelos testados. Os resultados demonstram o potencial antioxidante da espécie vegetal nos modelos de inibição da oxidação lipídica sem apresentar toxicidade.

ABSTRACTThe species Dicksonia sellowiana, popularly known as tree fern, are a natural fern from American continent found in the Atlantic Forest in Brazil. In 2001 it was added to the list of IBAMA as endangered species due to its exploitation for pots craft for gardening species. This paper describes the antioxidant lipid potential (TBARS and System β-carotene / linoleic acid) of the crude extract and fractions obtained by Soxhlet apparatus of Dicksonia sellowianafronds, besides the cytotoxic and hemolytic activity in vitro. By the TBARS method, all samples tested showed activity, particularly the fraction ethyl acetate and the crude extract whose activity was comparable to standard ascorbic acid. In the system β-carotene / linoleic acid, the fraction of ethyl acetate and crude extract inhibited the oxidation of linoleic acid, especially the ethyl acetate fraction which did not differ statistically from the standard BHT. In a preliminary assessment of toxicity,cytotoxic and hemolytic activity of crude extracts and fractions in the tested models were not observed. The results of this study indicate the antioxidant potential of this plant species in models of inhibiting lipid oxidation without producing toxicity.

Characterization of a Mutant Bacillus thuringiensis d-endotoxin with enhanced stability and toxicity / Caracterización de una delta endotoxina mutante de Bacillus thuringiensis con estabilidad y toxicidad aumentadas

The centrally located a-helix 5 of Bacillus thuringiensis d-endotoxins is critical for insect toxicity through ion-channel formation. We analyzed the role of the highly conserved residue Histidine 168 (H168) using molecular biology, electrophysiology and biophysical techniques. Toxin H168R was ~3-fold more toxic than the wild type (wt) protein whereas H168Q was 3 times less toxic against Manduca sexta. Spectroscopic analysis revealed that the H168Q and H168R mutations did not produce gross structural alterations, and that H168R (Tm= 59 °C) was more stable than H168Q (Tm= 57.5 °C) or than the wt (Tm= 56 °C) toxins. These three toxins had similar binding affinities for larval midgut vesicles (Kcom) suggesting that the differences in toxicity did not result from changes in initial receptor binding. Dissociation binding assays and voltage clamping analysis suggest that the reduced toxicity of the H168Q toxin may result from reduced insertion and/or ion channel formation. In contrast, the H168R toxin had a greater inhibition of the short circuit current than the wt toxin and an increased rate of irreversible binding (kobs), consistent with its lower LC50 value. Molecular modeling analysis suggested that both the H168Q and H168R toxins could form additional hydrogen bonds that could account for their greater thermal stability. In addition to this, it is likely that H168R has an extra positive charge exposed to the surface which could increase its rate of insertion into susceptible membranes.

La a-Hélice 5 del domino I de las d-endotoxinas de Bacillus thuringiensis, es crítica para la toxicidad de las toxinas contra insectos al participar en la formación de canales iónicos. La participación en la función tóxica del residuo Histidina 168 (H168) –el cual es altamente conservado– fue estudiada mediante técnicas de biología molecular, electrofisiología y biofísica. La toxina mutante H168R fue ~ 3 veces más tóxica que la toxina silvestre (ts) en Manduca sexta, mientras que H168Q fue 3 veces menos tóxica. Los análisis espectroscópicos indicaron que las mutaciones no producen alteraciones estructurales significativas y que la toxina H168R (Tm= 59 °C) es más estable que las toxinas H168Q (Tm= 57.5 °C) y wt (Tm= 56 °C). Las tres toxinas exhibieron uniones de afinidad similares (Kcom) en vesículas de intestino de larvas de insecto, indicando que las diferencias en la toxicidad no se deben a cambios en la unión inicial al receptor. Los ensayos de unión/disociación y fijación de voltaje mostraron que la reducción de la toxicidad de la toxina H168Q se puede atribuir a una disminución en la inserción y/o en la formación de canales iónicos. De otro lado, H168R mostró una inhibición a la corriente de corto circuito mayor que la ts y un aumento en unión irreversible (kobs), lo cual es consistente con un menor valor de CL50. La modelación molecular sugiere que H168Q y H168R forman puentes de hidrógeno adicionales, lo que les confiere mayor estabilidad térmica. Adicionalmente, es probable que H168R tenga una carga positiva extra expuesta en la superficie, lo cual aumentaría su tasa de inserción en membranas susceptibles.

Toxicidad por insecticidas organofosforados en fumigadores de Campaña contra el Dengue, estado Aragua, Venezuela, año 2008 / Toxicity by organophosphate insecticides of fumigators working on the dengue control campaign in Aragua state, Venezuela, 2008

Un estudio descriptivo sobre las condiciones de salud y su relación con la exposición a plaguicidas, de los “fumigadores” de la campaña contra el dengue en el estado Aragua, fue realizado en una muestra no probabilística de 50 trabajadores, a los cuales se les aplicó una encuesta para investigar: características personales y de trabajo, conocimientos sobre insecticidas y enfermedades asociadas, además de inspeccionar locales, equipos y condiciones de trabajo. De la muestra general, 28% resultaron fumadores. Los grados de instrucción predominantes fueron primaria y secundaria (44%). El promedio de años como fumigador fue de 14,3. Sólo 40% tiene conocimiento de enfermedades producidas por organofosforados, 62% presentó antecedentes de intoxicación. 30% refirieron presentar enfermedades cardiovasculares, gastrointestinales y neurológicas. A mayor cantidad de años de labor, mayor la intensidad de signos y síntomas llegando a producir enfermedades. 38% de los niveles de Acetilcolinesterasa medidos, resultaron alterados. Las variables: grupo de edad, grado de instrucción, fumar, años de labor, falta de conocimiento de enfermedades y antecedentes de intoxicación, se asociaron a valores anormales de colinesterasa, sin presentar significancia estadística (P>0,05). La selección de los trabajadores, su capacitación, dotación de equipos y materiales adecuados, su vigilancia clínica epidemiológica, su evaluación permanente y su respectivo tratamiento deben ser revisados y tenidos en cuenta por la Corporación de Salud del estado Aragua (CORPOSALUD), haciéndolas, normas de obligatorio cumplimiento

A descriptive study on the conditions of health and their relation to the exhibition to pesticides, and of the “fumigators” of the campaign against dengue in the Aragua state, sampled 50 workers, to whom a survey was applied to investigate: personal characteristics of work, knowledge on insecticides and diseases, besides an inspection the premises, equipment and work environment. From this general sample 28% were smokers. The predominant educational level was elementary school and high school (44%). The fumigator average of working years was of 14.3. Only 40% had knowledge of diseases produced by organophosphate, 62% presented poisoning antecedents. 30% claimed to display cardiovascular, gastrointestinal and neurological diseases. The greater the number of work years, the greater the intensity of signs and symptoms of associated diseases. 38% of the measured levels of acetylcholinesterase were altered. The variables: smoking, years of work, educational level, age group and the lack of knowledge of diseases and intoxication antecedents were associated with abnormal values of acetylcholinesterase, without showing statistical significance. The selection of the workers, their qualification and suitable equipment and materials, their clinical epidemiologic monitoring, their permanent evaluation and respective treatment must be reviewed and taken into account by CORPOSALUD (Corporación de Salud del estado Aragua), making them norms of obligatory fulfillment

Avaliação da citotoxicidade de mini-implantes ortodônticos / Evaluation of cytotoxicity of orthodontic mini-implants

O objetivo do presente trabalho é avaliar a citotoxicidade de mini-implantes ortodônticos em células de fibroblastos L929. Foram avaliados 6 mini-implantes ortodônticos divididos em 2 grupos, assim denominados Grupo 1 (SIN - Sistema de Implante, São Paulo, SP, Brasil) cor dourada, Grupo 2 (SIN - Sistema de Implante, São Paulo, SP, Brasil) cor prateada. Previamente, os mini-implantes foram esterilizados em luz ultravioleta. Após isso os mesmos foram imersos em meio mínimo essencial de Eagle (MEM) pós 24h, onde então se procedeu a remoção do sobrenadante e colocação em contato com fibroblastos L929. Avaliou-se a citotoxicidade em 4 períodos, 24, 48, 72 e 168h. Após contato com o meio as células foram incubadas por mais 24h onde então foram adicionados 100 µl do corante vermelho neutro a 0,01%. Novamente as células foram incubadas por 3h para que as mesmas incorporassem o corante. Passado esse período as células foram fixadas e realizou-se a contagem de células viáveis em espectrofotômetro. Os resultados demonstraram que em todos os tempos avaliados não foram encontradas diferenças estatísticas entre os mini-implantes dos Grupos 1 e 2. Esses grupos também foram estatisticamente similar ao Grupo C-, em todos os tempos, e ao Grupo CC nos tempos 24 e 48h e 7 dias (p > 0.05). No tempo 72h foram encontradas diferenças estatísticas entre o Grupo 1 e o CC (p < 0.05). Os mini-implantes ortodônticos avaliados não possuem caráter citotóxico no período de até 7 dias de avaliação.

Objective the present study aims to assess the cytotoxic effect of orthodontic mini-implants on L929 fibroblast cells. Six orthodontic mini-implants were divided into 2 groups for evaluation: Group 1 (golden colour, SIN - Sistema de Implante, São Paulo, SP, Brazil) and Group 2 (silver colour, SIN - Sistema de Implante, São Paulo, SP, Brazil). All the mini-implants were previously sterilised using ultraviolet light. Next, the mini-implants were immersed into Eagle’s minimum essential medium (MEM) for 24 hours, where supernatant removal and contact with L929 fibroblasts were performed. Cytotoxicity was evaluated in four different periods of time: 24, 48, 72, and 168 hours. After being in contact with the mini-implants immersed, the cells were incubated for further 24 hours and then 100 µl of 0.01% neutral-red staining solution were added. The cells were incubated again for 3 hours so that they could absorb the stain. After this period of time, they were fixed and a spectrophotometer. The results showed that at all times evaluated were not found statistical differences between the mini-implants of Group 1 and 2. These groups were also statistically similar to Group C, in all times and the CC Group at times 24, 48 and 7 days (p > 0.05). At time 72 hours was found statistical differences between Group 1 with the CC (p < 0.05). The orthodontic mini-implants have not evaluated the cytotoxic character period of up to 7 days of evaluation.

Emponzoñamiento escorpiónico: manejo de las manifestaciones cardiovasculares: Hospital Universitario de Pediatría Doctor Agustin Zubillaga de Barquisimeto-estado Lara-Venezuela / Scorpion envenomation: management of cardiovascular manifestations: Dr. Agustin Zubillaga Pediatric Hospital of Barquisimeto-Lara state-Venezuela

Se presentan características clínicas, epidemiológicas y taxonómicas del emponzoñamiento escorpiónico en Venezuela. Se revisan aspectos de la fisiopatología de la venina en el área cardiovascular y las bases racionales del tratamiento. Finalmente, se presentan las pautas del protocolo del Centro Toxicológico Regional "Dra. EL Bermúdez" para la terapia del emponzoñamiento escorpiónico en el Hospital pediátrico "Dr. Agustin Zubillaga".

Clinical, epidemiological and taxonomic features about scorpion envenoming in Venezuela are presented. Aspects about physiopatology of the venom in the cardiovascular area and the rationale of the treatment are reviewed. Finally, the guidelines of "Dra. EL bermúdez" Regional Poison Center for therapy of the scorpion envenoming in "Dr. Agustin Zubillaga" Pediatric Hospital are presented.