[Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. / Abordaje integral del vértigo: algoritmo diagnóstico, causas, tratamientos y criterios de derivación desde la perspectiva de atención primaria. Documento de consenso SEMERGEN.

Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Cytotoxicity in Vero cells and cytokines analyses in Balb/c mice as safety assessments of the probiotic mixture Saccharomyces cerevisiae RC016 and Lactobacillus rhamnosus RC007 for use as a feed additive.

The objective was to carry out cytotoxicity assays in Vero cells and cytokines analyses in Balb/c mice as safety assessments to evaluate the probiotic mixture (M) Saccharomyces cerevisiae RC016 (Sc) and Lactobacillus rhamnosus RC007 (Lr) for use as feed additive. Vero cells (104 cells per well) were exposed to Sc (2·08 × 107 , 2·08 × 106 ; 2·08 × 105 cells per ml), Lr (8·33 × 107 ; 8·33 × 106 ; 8·33 × 105 cells per ml) and their M (1 : 1). Sc concentrations did not affect the Vero cells viability; in contrast, they were lower when exposed to Lr (P Ë‚ 0·0001). Vero cells showed increasing viability with M decreasing concentrations (91% viability with M2). Control BALB/c mice received only phosphate buffer saline and the others received the M. The IL-10, IL-6 and TNFα concentrations from intestinal fluid were analysed and no significant differences were observed among treatments. The same occurred with the ratio between IL-10/TNF-α. Beneficial effects of probiotics are associated with the regulation of the excessive inflammatory response; it is desirable they can modulate the cytokines production only under pathological conditions. Here, M administration to healthy mice did not induce negative side effects and expands the knowledge about beneficial effects of using probiotic microorganisms in mixture for feed additives development.

Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies.

INTRODUCTION: Ectopic thymic tissue can arise as an asymptomatic neck mass, which may be detected on imaging studies. The aim of this study was to determine the incidence of ectopic thymic tissue in paediatric FNAs and to the correlate clinical, radiological and cytomorphological findings. METHODS: FNAs in children with neck and mediastinal lesions performed between January 2012 and July 2016 were reviewed for cases of ectopic thymus. These were then evaluated and correlated with the cytology findings. RESULTS: Of 739 FNAs, 13 (1.8%) cases from 11 patients showed ectopic thymic tissue. The targeted lesions were in the thyroid (n = 7), submandibular region (n = 1), superior mediastinum (n = 1) and paratracheal region (n = 1). The most common indication was for microcalcifications concerning for papillary thyroid carcinoma on ultrasound (n = 6). Imaging findings included fusiform lesions with linear and punctuate bright echoes. The cytology evaluation showed small lymphocytes with discohesive epithelioid cells in most cases, and proteinaceous fluid in the cystic case. There were rare macrophages and Hassall's corpuscles. Flow cytometry and/or immunostains were performed in all cases, supporting thymic origin. CONCLUSION: Ectopic thymic tissue is rarely present as a neck mass or thyroid nodule on FNA biopsy. The ultrasound imaging findings reveal a well-defined fusiform lesion with punctate bright echoes that could be misinterpreted as papillary thyroid carcinoma. The aspirates show a small lymphoid population, immunophenotypically compatible with thymic T-cells, in addition to scattered epithelial cells. Therefore, knowledge of the typical ultrasonographic and cytopathological features can help make a definitive diagnosis and avoid more invasive procedures in paediatric patients.

Prevalence of traffic rule infractions in Cali, Colombia, at sites where injury crashes occurred.

This study aim to determine the proportion of traffic rule infractions in Cali, Colombia, in places where a road traffic injury (RTI) occurred. Description of videotaping of sites where a person was injured in an RTI in 2009. Counts of road users and infractions were established for each road user group and were compared using a Z-test. They were found 13,491 users, distributed as follow: 8.9% were pedestrians, 4.6% cyclists, 24.6% motorcyclists, and 61.8% were automobile drivers. The most frequent traffic violation among motorcyclists was transiting on lines designated for other vehicles (55.2%). Among cyclists, the most frequent violations were transiting without a helmet (99.2%) and not wearing the designated vest (100%). Among pedestrians, crossing streets at prohibited places (77.3%), even at sites where a pedestrian bridge was present (72.7%), represented two common violations. Vulnerable road users committed more traffic infractions than automobile drivers (p < 0.001). High rates of traffic rule infractions among vulnerable road users were observed. Studies to better understand the occurrence of these behaviours and the promotion of effective interventions are warranted.

Microbial interactions with chromium: basic biological processes and applications in environmental biotechnology.

Chromium (Cr) is a highly toxic metal for microorganisms as well as plants and animal cells. Due to its widespread industrial use, Cr has become a serious pollutant in diverse environmental settings. The hexavalent form of the metal, Cr(VI), is considered a more toxic species than the relatively innocuous and less mobile Cr(III) form. The study of the interactions between microorganisms and Cr has been helpful to unravel the mechanisms allowing organisms to survive in the presence of high concentrations of Cr(VI) and to detoxify and remove the oxyanion. Various mechanisms of interactions with Cr have been identified in diverse species of bacteria and fungi, including biosorption, bioaccumulation, reduction of Cr(VI) to Cr(III), and chromate efflux. Some of these systems have been proposed as potential biotechnological tools for the bioremediation of Cr pollution using bioreactors or by in situ treatments. In this review, the interactions of microorganisms with Cr are summarised, emphasising the importance of new research avenues using advanced methodologies, including proteomic, transcriptomic, and metabolomic analyses, as well as the use of techniques based on X-ray absorption spectroscopy and electron paramagnetic resonance spectroscopy.

Modelos de rehabilitación para la intervención del desorden músculo-esquelético en trabajadores

Introducción: Los modelos en salud promueven el desarrollo de intervenciones para solucionar diferentes problemáticas poblacionales. Objetivo: El objetivo de este artículo es establecer un diagnóstico de los modelos existentes para la rehabilitación del desorden músculo esquelético (DME) en la población trabajadora, a través de una revisión documental y de la literatura científica disponible. Metodología: Se realizó una revisión sistemática de la literatura en las bases de datos Ovid SP, EBSCO HOST, PROQUEST, MEDLINE, Science Direct, PubMed, y otros motores de búsqueda, siguiendo las etapas de identificación, tamización, elegibilidad e inclusión consignadas en la guía PRISMA. Resultados: Se seleccionaron 72 artículos, de los cuales 60 documentos fueron tenidos en cuenta para el análisis bibliométrico; se identificaron y abordaron doce modelos teóricos del proceso salud enfermedad, los cuales mostraron un enfoque en rehabilitación clínica. Discusión y conclusiones: Se concluyó que los modelos de rehabilitación encontrados contienen diversos elementos que los hacen complementarios y que no generan conflicto entre ellos, por el contrario de acuerdo a las disciplinas que lo definen y la interdisciplinariedad que puedan tener, los hacen aún más sólidos en sus premisas para la rehabilitación de los (DME) en trabajadores. Adicionalmente se observa como los enfoques de los modelos de rehabilitación más recientes están dirigidos a fomentar las condiciones protectoras del trabajador con el fin de prevenir alteraciones en su condición de salud.

Introduction: Health models promote the development of interventions to address various population issues. Objective: The aim of this article is to establish a diagnosis of existing rehabilitation of musculoskeletal disorder in the working population models, through a literature review and the available scientific literature. Methodology: A systematic literature review was made in databases Ovid SP, EBSCO HOST, PROQUEST, MEDLINE, Science Direct, PubMed, among other research engines following the stages of identification, screening, eligibility and inclusion contained in the PRISMA guideline. Results: 72 articles were selected, of which 60 papers were considered for the bibliometric analysis; it they identified and addressed twelve theoretical models of health-disease process, which showed a focus in Clinical Rehabilitation. Discussion and conclusions: It was concluded that models rehabilitation found contain various elements that make them complementary and not create conflict between them, on the contrary according to the disciplines that define and interdisciplinary they may have, make them even stronger in their premises for rehabilitation of DME workers. Additionally it is seen as approaches most recent models are aimed at promoting rehabilitation protective worker conditions in order to prevent changes in their health condition.

Got Dung? Resource Selection by Dung Beetles in Neotropical Forest Fragments and Cattle Pastures.

Both the impact of habitat modification on the food preferences of species and its impact on ecosystem functioning are poorly understood. In this study, we analyzed food selection by dung beetles in 80 tropical forest fragments and their adjacent cattle pastures in the Los Tuxtlas Biosphere Reserve, Mexico. Ten pitfall traps were placed at each site, half baited with human dung and the other half with fish carrion. We assessed dung beetle food selection and classified any specialization in resource use quantitatively using a multinomial classification model. We collected 15,445 beetles belonging to 42 species, 8747 beetles (38 species) in forest fragments and 6698 beetles (29 species) in cattle pastures. Twenty-five species were present in both habitats. Of all the beetles captured, 76% were caught in dung traps (11,727 individuals) and 24% in carrion traps (3718 individuals). We found 21 species of dung specialists, 7 carrion specialists, 8 generalists, and 6 species too rare to classify. The bait most frequently selected by beetles in this study was dung in both forests and pastures. Specialists tended to remain specialists in both habitats, while generalists tended to change their selection of bait type depending on the habitat. In summary, our results show that replacing forests with cattle pastures modifies the patterns of resource selection by dung beetles and this could affect ecosystem functioning.

Phenolic acid protects of renal damage induced by ochratoxin A in a 28-days-oral treatment in rats.

The present study aimed to characterize the chlorogenic acid (ChlA) capacity to reverse the toxic effects induced by ochratoxin A (OTA) in a subacute toxicity test in rats. Male Wistar rats were fed orally by gavage for 28 days with OTA (0.4mg/kg bw/day), ChlA (5mg/kg bw/day) or the combination OTA (0.4mg/kg bw/day)+ChlA (5mg/kg bw/day). No deaths, no decrease in feed intake or body weight in any experimental group were recorded. The negative control group and the animals treated with ChlA alone showed no changes in any parameters evaluated. In OTA-treated group significant changes such as decrease in urine volume, proteinuria, occult blood, increase in serum creatinine values; decrease in absolute and relative kidney weight and characteristics histopathological lesions that indicated kidney damage were observed. However, limited effect on oxidative stress parameters were detected in kidneys of OTA-treated group. Animals treated with the combination OTA+ChlA were showed as negative control group in the evaluation of several parameters of toxicity. In conclusion, ChlA, at given concentration, improved biochemical parameters altered in urine and serum and pathological damages in kidneys induced by OTA exposure, showing a good protective activity, but not by an apparent antioxidant mechanism.

Assessing the Ecological Response of Dung Beetles in an Agricultural Landscape Using Number of Individuals and Biomass in Diversity Measures.

The global increase in demand for productive land requires us to increase our knowledge of the value of agricultural landscapes for the management and conservation of biodiversity, particularly in tropical regions. Thus, comparative studies of how different community attributes respond to changes in land use under different levels of deforestation intensity would be useful. We analyzed patterns of dung beetle diversity in an Andean region dominated by sun-grown coffee. Diversity was estimated using two measures of species abundance (the number of individuals and biomass) and was compared among four types of vegetation cover (forest, riparian forest, sun-grown coffee, and pastures) in three landscape plots with different degrees of deforestation intensity (low, intermediate, and high). We found that dung beetle diversity patterns differed between types of vegetation cover and degree of deforestation, depending on whether the number of individuals or biomass was used. Based on biomass, inequality in the dung beetle community was lowest in the forest, and increased in the sun-grown coffee and pastures across all levels of deforestation, particularly for the increasing dominance of large species. The number of beetles and biomass indicate that the spatial dominance of sun-grown coffee does not necessarily imply the drastic impoverishment of dung beetle diversity. In fact, for these beetles, it would seem that the landscape studied has not yet crossed "a point of no return." This system offers a starting point for exploring biodiversity management and conservation options in the sun-grown coffee landscapes of the Colombian Andes.

In Vitro and In Vivo Cytogenotoxic Effects of Hot Aqueous Extract of Achyrocline satureioides (Lam.) DC.

In this work we extend the toxicological studies of hot aqueous extract of A. satureioides (As-HAE) evaluating cytotoxic and apoptotic effects on human peripheral blood mononuclear cells (PBMCs). We also determine genotoxic action of this extract in vivo. In addition, the extract was chemically characterized. Finally, we established a comparison with previous data of cold aqueous extract. The As-HAE induced cytotoxicity on PBMCs determined by trypan blue dye exclusion (CC50 = 653 µg/mL) and MTT (CC50 = 588 µg/mL) assays being more toxic than cold extract. However, As-HAE as well as cold extract did not induce apoptosis measured by Hoechst 33258 staining, TUNEL assay, and DNA fragmentation analysis. The in vivo micronucleus test showed that As-HAE exerted cytogenotoxic effects on bone marrow of mice, contrary to what was observed with cold extract. The chemical study of As-HAE allowed identifying the flavonoids found in cold extract: luteolin, quercetin, and 3-O-methylquercetin, but at higher concentrations. We suggest that toxic effects induced by As-HAE could be due to high concentrations of these flavonoids. Given that As-HAE is the most used in folkloric medicine, its administration should be controlled in order to prevent potential cell damage.

Polyphenols as possible bioprotectors against cytotoxicity and DNA damage induced by ochratoxin A.

The present study aimed to investigate the protective effects of luteolin (L), chlorogenic acid (ChlA) and caffeic acid (CafA) against cyto-genotoxic effects caused by OTA. Vero cells and rat lymphocytes were used and viability was measured by neutral red uptake, MTT and trypan blue dye exclusion method. L (50 and 100µg/mL), ChlA (100 and 200µg/mL) and CafA (10-50µg/mL) reduced the damage induced by OTA (10µg/mL) on both cells type shown a good protective effect. The comet and micronucleus tests in Balb/c mice were performed. ChlA (10mg/kg bw) reduced OTA (0.85mg/kg bw)-induced DNA damage on blood and bone marrow cells, CafA (10mg/kg bw) showed protective effect only in blood cells and luteolin (2.5mg/kg bw) failed to protect DNA integrity on cells. In conclusion, polyphenols tested reduced the toxicity caused by OTA on different target cells with good protective effect, being ChlA the compound that showed the best effects.

Evaluation of cytotoxicity and genotoxicity of Acacia aroma leaf extracts.

Acacia aroma, native plant from San Luis, Argentina, is commonly used as antiseptic and for healing of wounds. The present study was conducted to investigate the in vitro cytotoxicity and genotoxicity of hot aqueous extract (HAE) and ethanolic extract (EE) of A. aroma. The cytotoxic activity was assayed by neutral red uptake assay on Vero cell. Cell treatment with a range from 100 to 5000 µg/mL of HAE and EE showed that 500 µg/mL and 100 µg/mL were the maximum noncytotoxic concentrations, respectively. The CC50 was 658 µg/mL for EE and 1020 µg/mL for HAE. The genotoxicity was tested by the single-cell gel electrophoresis comet assay. The results obtained in the evaluation of DNA cellular damage exposed to varied concentrations of the HAE showed no significant genotoxic effect at range of 1-20 mg/mL. The EE at 20 mg/mL showed moderate genotoxic effect related to the increase of the DNA percentage contained in tail of the comet; DNA was classified in category 2. At concentrations below 5 mg/mL, the results of cytotoxicity and genotoxicity of aqueous and ethanolic extracts of Acacia aroma guarantee the safety at cell and genomic level. However further studies are needed for longer periods including animal models to confirm the findings.

Genotoxicity and cytotoxicity evaluation of probiotic Saccharomyces cerevisiae RC016: a 60-day subchronic oral toxicity study in rats.

AIMS: To acquire data on the safety-in-use of the probiotic Saccharomyces cerevisiae RC016 and test its ability to reduce genotoxicity caused by dietary aflatoxins (AFs). METHODS AND RESULTS: The probiotic was orally administered to Wistar rats. Six groups (n = 6) were arranged: feed and probiotic controls, two levels of AFs-contaminated feed and two treatments including both the probiotic and the toxin. Genotoxiciy and cytotoxicity were evaluated with the bone marrow micronuclei assay and the comet assay and internal organs were macroscopically and microscopically examined. The tested S. cerevisiae strain did not cause genotoxicity or cytotoxicity in vivo, and it was able to attenuate AFs-caused genotoxicity. Saccharomyces cerevisiae RC016 did not cause any impairment on the rats' health and it showed no negative impact on the weight gain. Moreover, RC016 improved zootechnical parameters in AFs-treated animals. The beneficial effects were likely to be caused by adsorption of AFs to the yeast cell wall in the intestine and the consequent reduction in the toxin's bioavailability. CONCLUSIONS: The dietary administration of RC016 does not induce genotoxicity or cytotoxicity to rats. SIGNIFICANCE AND IMPACT OF THE STUDY: Incorporation of RC016 in the formulation of feed additives increases animal productivity. Similar effects may even occur in human food applications.

Evaluation of the cytotoxicity, genotoxicity and apoptotic induction of an aqueous extract of Achyrocline satureioides (Lam.) DC.

Achyrocline satureioides is widely consumed as infusion or aperitif and shows important therapeutic properties. Previously, we reported absence of genotoxicity of cold aqueous extract (CAE) of A. satureioides by Allium test. However, one test cannot predict the genotoxic effects of a substance. Thus, the aim of this work was to investigate cytotoxicity, genotoxicity and apoptotic ability of CAE of A. satureioides. In addition, CAE was chemically characterized. The cytotoxicity was evaluated by Trypan blue and MTT assays. The apoptotic capacity was evaluated by Hoechst staining and DNA fragmentation-analysis. The genotoxicity was studied by comet assay (CA) and micronucleus test. The identification and quantification of flavonoids were performed by HPLC-ESI-MS/MS. The cytotoxicity studies indicated low toxicity of CAE. In addition, CAE did not induce apoptotic effects on human PBMCs. CAE did not show genotoxicity in vitro against Vero cells, at 10-50 µg/mL. CAE did not induce in vivo genotoxic effects, but it showed at high concentrations cytotoxicity by micronucleus assay. CAE presented flavonoids such as quercetin, 3-O-methylquercetin and luteolin. In conclusion, A. satureioides at popularly concentrations used, in aperitif or infusion, can be consumed safely because did not show any cytotoxic or genotoxic effects.

Histerectomía laparoscópica total: manejo ambulatorio: experiencia Clínica del Prado, Medellín, Colombia / Outpatient total laparoscopic hysterectomy

Objetivo: Describir los resultados de la histerectomía laparoscópica total ambulatoria. Método: Se analizan 297 pacientes sometidas a histerectomía laparoscópica total y que fueron dadas de alta luego de la recuperación anestésica, entre mayo de 2007 y marzo de 2008. Se requería una puntuación de menos de 5 en la escala visual análoga del dolor para el alta. Resultados: El promedio de edad fue de 42 años, el tiempo quirúrgico de 79,1 minutos, el sangrado estimado fue de 37,1 ml, el tiempo promedio de estancia total fue de 9,4 horas con un tiempo promedio de estancia postoperatoria de 5,4 horas. La tasa de complicaciones postoperatorias fue de 11,8 por ciento y la de readmisiones del 3,3 por ciento. El promedio de Escala Visual Análoga del dolor para la primera noche fue de 4,2 puntos. El 6 por ciento de las pacientes presentaron vómitos en su domicilio. El 99 por ciento de las pacientes recomendarían este tipo de manejo. Conclusiones: El manejo ambulatorio después de histerectomía laparoscópica total es posible, seguro y bien evaluado por las pacientes. Este manejo no conlleva un mayor riesgo de complicaciones y la tasa de readmisiones es baja.

Objective: To describe the results of a group of patients in which total laparoscopic hysterectomy was done as an outpatient procedure. Methods: We included 297 patients who were undergone to laparoscopic total hysterectomy, and were discharge to their home after recovery of anesthesia from may 2007 to march 2008. It was necessary to have a punctuation less than 5 in the analogue visual scale to be sent at home. Results: Mean age was 42 years, surgical time 79.1 minutes, estimated blood loss 37.1 ml, overall length of stay 9.4 hours, postoperative length of stay 5.4 hours. Postoperative complication rate was 11.8 percent, readmission rate was 3.3 percent. Mean VAS Score for pain during the first night was 4.2 points; 6 percent of patients vomited at home. Mean VAS Score for satisfaction with ambulatory management was 9.5, and 99 percent of the patients would recommend this type of management. Conclusions: Ambulatory management after total laparoscopic hysterectomy is possible, safe and well evaluated by patients. It does not impose a higher risk of complications and readmission rate is low.

Altitudinal variation in fish assemblage diversity in streams of the central Andes of Colombia.

This study documents differences in fish assemblages for 32 freshwater streams located between 258 and 2242 m a.s.l. on the eastern slopes of the central range of the Colombian Andes. A total of 2049 fishes belonging to 62 species, 34 genera and 16 families were collected. Species richness declined rapidly with altitude; nearly 90% of the species were recorded between 250 and 1250 m a.s.l. Three of the four physico-chemical variables, of the water, temperature, dissolved oxygen and pH, explained 53.5% of the variation in species richness along the altitudinal gradient, with temperature the most important (37.6%). An analysis of species composition showed that the distinctiveness of the fish fauna increased with elevation, with the greatest turnover observed between 1000 and 1750 m a.s.l. On this altitudinal gradient, turnover was dominated by the loss of species rather than gain, and dominance by just a few species was greater at higher elevations. Turnover was also observed along the altitudinal gradient in the structure of the three functional groups (torrential, pool and pelagic species). The study focused on understanding the pattern of diversity of fish communities inhabiting the Andes in Colombia. Anthropogenic effects on the altitudinal distribution of fish species in the region, however, are largely unknown and would require further investigations.