The Global Experience of Laryngeal Transplantation: Series of Eleven Patients in Three Continents.

BACKGROUND: The loss of laryngeal function affects breathing, swallowing, and voice, thus severely compromises quality of life. Laryngeal transplantation has long been suggested as a solution for selected highly affected patients with complete laryngeal function loss. OBJECTIVE: To obtain insights regarding the advantages, weaknesses, and limitations of this procedure and facilitate future advances, we collected uniform data from all known laryngeal transplants reported internationally. METHODOLOGY: A case series. Patients were enrolled retrospectively by each institutional hospital or clinic. Eleven patients with complete loss of laryngeal function undergoing total laryngeal transplantation between 1998 and 2018 were recruited. RESULTS: After a minimum of 24 months follow-up, three patients had died (27%), and there were two graft explants in survivors, one total and one partial, due to chronic rejection. In the remaining cases, voice was functional in 62.5% and 50% achieved decannulation. Swallowing was initially restricted, but only one patient was gastrostomy-dependent by 6 months and all had normal or near-normal swallowing by the end of year two after transplantation. Median follow-up was 73 months. Functional (voice, swallowing, airway) recovery peaked between 12 and 24 months. CONCLUSIONS: Laryngeal transplantation is a complex procedure with significant morbidity. Significant improvements in quality of life are possible for highly selected individuals with end-stage laryngeal disorders, including laryngeal neoplasia, but further technical and pharmacological developments are required if the technique is to be more widely applicable. An international registry should be created to provide better quality pooled data for analysis of outcomes of any future laryngeal transplants. LEVEL OF EVIDENCE: IV Laryngoscope, 2024.

Evidence of validity and reliability of the controlling motivational style questionnaire in the work context.

According to the self-determination theory (SDT), leaders may adopt a controlling motivational controlling style (CMS) that forces employees to think, feel, or behave in a certain way to promote employee motivation. However, a scale has yet to be developed to measure CMS in the work environment. Usually, researchers use questionnaires adapted to different contexts or designed for another motivational style. However, whether these questionnaires capture the behaviors that represent CMS in the work context is little known. This research aimed to elaborate on and analyze the validity and reliability of the questionnaire on Controlling Motivational Style at Work (CMS-W). The study was based on a literature review of the types of controlling behaviors and a review of questionnaires used by SDT researchers who assessed the controlling motivational style in different contexts. A Peruvian sample of 1100 public sector employees participated. The results show that the short and encompassing CMS-W-11 has a one-dimensional structure with good fit indices: Robust RMSEA = 0.071 with 90 % CI from 0.064 to 0.078; Robust CFI = 0.975; Robust TLI = 0.969; SRMR = 0.025 and good reliability coefficients: Ω = 0.930 and AVE 0.630. Furthermore, it shows convergent validity with controlled motivation (r = 0.260, p < .001) and discriminant validity with autonomous motivation (r = -0.270, p < .001). Moreover, the invariance of the gender category was tested. The fit indices were adequate, and the comparative results between the models were also satisfactory. In addition, the behaviors of the CMS in a work context are conditional negative regard, judging and devaluing, control through objectives, intimidation, and intrusive authority. Therefore, labor organizations will have the CMS-W validated and tested in a work context to evaluate the CMS of leaders and study how it related to the motivation of human capital and organizational objectives.

Tomographic evaluation of mandibular buccal shelf in patients with different vertical growth pattern / Evaluación de la placa ósea mandibular en pacientes con diferente patrón de crecimiento vertical

The purpose of this research was the tomographic evaluation of the Mandibular Buccal Shelf (MBS) in orthodontic patients with different vertical growth pattern. An observational, descriptive, cross-sectional and retrospective study was conducted. Tomographic images of patients aged 14 to 40 years were observed and a database was formed with those that met the inclusion criteria. The sample size was 10 for each group according to vertical growth pattern (hypodivergent, normodivergent and hyperdivergent). Then four zones of frequent insertion of extralveolar mini-screws were selected in the MBS, taking as a reference the mesial and distal roots of the first and second mandibular molar. When comparing the characteristics of MBS between vertical growth patterns, between sexes and hemiarchs, no statistically significant differences were found. However, when the characteristics of MBS were compared according to the reference root, it was found that there were statistically significant differences. The vestibular area to the distal root of the second mandibular molar presented the highest values in terms of angulation, height and thickness. There are no significant differences in the bone characteristics of MBS according to vertical growth patterns, sexes or hemiarchs. Angulation, height and thickness progressively increase from the vestibular bone of the mesial root of the first mandibular molar to the distal root of the second molar.

El propósito de esta investigación fue la evaluación tomográfica de la placa ósea mandibular (POM) en pacientes de ortodoncia con diferente patrón de crecimiento vertical. Se realizó un estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se observó imágenes tomográficas de pacientes de 14 a 40 años de edad y se formó una base de datos con las que cumplían los criterios de selección. El tamaño de muestra fue de 10 para cada grupo según patrón de crecimiento vertical (hipodivergentes, normodivergentes e hiperdivergentes). Luego se seleccionaron cuatro zonas de inserción frecuente de minitornillos extralveolares en la POM, tomando como referencia las raíces mesial y distal del primer y segundo molar mandibular. Al realizar la comparación de las características de la POM entre patrones de crecimiento vertical, entre sexos y hemiarcadas no se encontraron diferencias estadísticamente significativas. Sin embargo, cuando se comparó las características de la POM según la raíz de referencia se encontró que había diferencias estadísticamente significativas. La zona vestibular a la raíz distal de la segunda molar mandibular presento los mayores valores en cuanto angulación, altura y grosor. No existen diferencias significativas en las características óseas de la POM según patrones de crecimiento vertical, sexos o hemiarcadas. La angulación, la altura y el grosor aumenta progresivamente desde el hueso vestibular de la raíz mesial del primer molar mandibular hacia la raíz distal del segundo molar.

A SARS-CoV-2 Negative Antigen Rapid Diagnostic in RT-qPCR Positive Samples Correlates With a Low Likelihood of Infectious Viruses in the Nasopharynx.

Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) transmission occurs even among fully vaccinated individuals; thus, prompt identification of infected patients is central to control viral circulation. Antigen rapid diagnostic tests (Ag-RDTs) are highly specific, but sensitivity is variable. Discordant RT-qPCR vs. Ag-RDT results are reported, raising the question of whether negative Ag-RDT in positive RT-qPCR samples could imply the absence of infectious viruses. To study the relationship between negative Ag-RDT results with virological, molecular, and serological parameters, we selected a cross-sectional and a follow-up dataset and analyzed virus culture, subgenomic RNA quantification, and sequencing to determine infectious viruses and mutations. We demonstrated that RT-qPCR positive while SARS-CoV-2 Ag-RDT negative discordant results correlate with the absence of infectious virus in nasopharyngeal samples. A decrease in sgRNA detection together with an expected increase in detectable anti-S and anti-N IgGs was also verified in these samples. The data clearly demonstrate that a negative Ag-RDT sample is less likely to harbor infectious SARS-CoV-2 and, consequently, has a lower transmissible potential.

Efectos de un taller de Normas APA sobre los conocimientos y actitudes hacia su estilo en universitarios

El objetivo del estudio fue determinar los efectos de un taller de Normas APA sobre los conocimientos y actitudes hacia su estilo, en alumnos de la facultad de psicología de una universidad pública limeña. Participaron 102 estudiantes con edades entre los 17 y 24 años divididos en 2 grupos: experimental (n = 54) y control (n = 58). El estudio siguió un enfoque cuantitativo con un diseño cuasi-experimental, implementando un taller de 4 sesiones para estudiantes del grupo experimental, realizando medidas antes y después del taller en ambos grupos. Los instrumentos empleados fueron la Escala de Actitudes hacia el Estilo APA y la Prueba de Conocimientos hacia el Estilo, construidas para fines de la investigación, pasando previamente por el análisis de sus propiedades psicométricas en un grupo paralelo de 200 estudiantes característicamente similares. Los resultados paralelos evidenciaron adecuadas propiedades psicométricas sobre los instrumentos de medida, a partir de las evidencias de validez de contenido (V = .83-1.00), el análisis factorial confirmatorio e indicadores de consistencia interna mediante el coeficiente Omega. En cuanto al taller, se obtuvieron evidencias favorables en el conocimiento de las normas APA (p = .03, eta =.401) y las actitudes hacia su estilo (p = .004, eta = .436) de manera general y por componentes en el grupo experimental, con efectos moderados. Se concluye que el taller de 4 sesiones fue efectivo y se recomienda el aplicarlo en poblaciones similares, siempre y cuando el docente cumpla con las competencias pedagógicas y conocimientos sobre dicho estilo.

The aim of the study was to determine the effects of an APA Standards workshop on the knowledge and attitudes towards its style, in students of the psychology faculty of a public university in Lima. A total of 102 students between 17 and 24 years of age participated, divided into 2 groups: experimental (n = 54) and control (n = 58). The study followed a quantitative approach with a quasi-experimental design, implementing a 4-session workshop for students in the experimental group, taking measurements before and after the workshop in both groups. The instruments used were the APA Style Attitude Scale and the Style Knowledge Test, constructed for the purposes of the research, previously going through the analysis of their psychometric properties in a parallel group of 200 characteristically similar students. The parallel results evidenced adequate psychometric properties on the measurement instruments, based on the evidence of content validity (V = .83-1.00), confirmatory factor analysis and internal consistency indicators by means of the Omega coefficient. Regarding the workshop, favorable evidence was obtained in the knowledge of APA norms (p = .03, eta = .401) and attitudes towards their style (p = .004, eta = .436) in general and by components in the experimental group, with moderate effects. It is concluded that the 4-session workshop was effective and it is recommended to apply it in similar populations, as long as the teacher has the pedagogical skills and knowledge about APA StyleKey words: APA Style, attitudes towards APA Style, knowledge of APA Style, university students, APA norms workshop

O objectivo do estudo era determinar os efeitos de um workshop de Normas da APA sobre os conhecimentos e atitudes em relação ao seu estilo, em estudantes da faculdade de psicologia de uma universidade pública em Lima. Um total de 102 estudantes entre os 17 e 24 anos de idade participaram, divididos em 2 grupos: experimental (n = 54) e controlo (n = 58). O estudo seguiu uma abordagem quantitativa com um desenho quase experimental, implementando um workshop de 4 sessões para estudantes do grupo experimental, fazendo medições antes e depois do workshop em ambos os grupos. Os instrumentos utilizados foram a Escala de Atitude de Estilo APA e o Teste de Conhecimento de Estilo APA, construídos para efeitos de investigação, passando anteriormente pela análise das suas propriedades psicométricas num grupo paralelo de 200 estudantes caracteristicamente semelhantes. Os resultados paralelos evidenciaram propriedades psicométricas adequadas dos instrumentos de medição, com base na evidência da validade do conteúdo (V = .83-1.00), análise de factores de confirmação e indicadores de consistência interna por meio do coeficiente Omega. Quanto ao workshop, foram obtidas provas favoráveis no conhecimento das normas da APA (p = .03, eta = .401) e das atitudes em relação ao seu estilo (p = .004, eta = .436) de uma forma geral e por componentes do grupo experimental, com efeitos moderados. Conclui-se que o workshop de 4 sessões foi eficaz e recomenda-se a sua aplicação em populações semelhantes, desde que o professor tenha as competências pedagógicas e os conhecimentos sobre as palavras APA StyleKey: APA Style, atitudes em relação ao APA Style, conhecimento do APA Style, estudantes universitários, workshop de normas APA.

Efectos de un taller de Normas APA sobre los conocimientos y actitudes hacia su estilo en universitarios / Effects of an APA Standards workshop on knowledge and attitudes towards APA style in university students / Efeitos de um workshop de Estilo APA no conhecimento e nas atitudes em relação ao Estilo APA em estudantes universitários

El objetivo del estudio fue determinar los efectos de un taller de Normas APA sobre los conocimientos y actitudes hacia su estilo, en alumnos de la facultad de psicología de una universidad pública limeña. Participaron 102 estudiantes con edades entre los 17 y 24 años divididos en 2 grupos: experimental (n = 54) y control (n = 58). El estudio siguió un enfoque cuantitativo con un diseño cuasi-experimental, implementando un taller de 4 sesiones para estudiantes del grupo experimental, realizando medidas antes y después del taller en ambos grupos. Los instrumentos empleados fueron la Escala de Actitudes hacia el Estilo APA y la Prueba de Conocimientos hacia el Estilo, construidas para fines de la investigación, pasando previamente por el análisis de sus propiedades psicométricas en un grupo paralelo de 200 estudiantes característicamente similares. Los resultados paralelos evidenciaron adecuadas propiedades psicométricas sobre los instrumentos de medida, a partir de las evidencias de validez de contenido (V = .83-1.00), el análisis factorial confirmatorio e indicadores de consistencia interna mediante el coeficiente Omega. En cuanto al taller, se obtuvieron evidencias favorables en el conocimiento de las normas APA (p = .03, eta =.401) y las actitudes hacia su estilo (p = .004, eta = .436) de manera general y por componentes en el grupo experimental, con efectos moderados. Se concluye que el taller de 4 sesiones fue efectivo y se recomienda el aplicarlo en poblaciones similares, siempre y cuando el docente cumpla con las competencias pedagógicas y conocimientos sobre dicho estilo.

The aim of the study was to determine the effects of an APA Standards workshop on the knowledge and attitudes towards its style, in students of the psychology faculty of a public university in Lima. A total of 102 students between 17 and 24 years of age participated, divided into 2 groups: experimental (n = 54) and control (n = 58). The study followed a quantitative approach with a quasi-experimental design, implementing a 4-session workshop for students in the experimental group, taking measurements before and after the workshop in both groups. The instruments used were the APA Style Attitude Scale and the Style Knowledge Test, constructed for the purposes of the research, previously going through the analysis of their psychometric properties in a parallel group of 200 characteristically similar students. The parallel results evidenced adequate psychometric properties on the measurement instruments, based on the evidence of content validity (V = .83-1.00), confirmatory factor analysis and internal consistency indicators by means of the Omega coefficient. Regarding the workshop, favorable evidence was obtained in the knowledge of APA norms (p = .03, eta = .401) and attitudes towards their style (p = .004, eta = .436) in general and by components in the experimental group, with moderate effects. It is concluded that the 4-session workshop was effective and it is recommended to apply it in similar populations, as long as the teacher has the pedagogical skills and knowledge about APA StyleKey words: APA Style, attitudes towards APA Style, knowledge of APA Style, university students, APA norms workshop

O objectivo do estudo era determinar os efeitos de um workshop de Normas da APA sobre os conhecimentos e atitudes em relação ao seu estilo, em estudantes da faculdade de psicologia de uma universidade pública em Lima. Um total de 102 estudantes entre os 17 e 24 anos de idade participaram, divididos em 2 grupos: experimental (n = 54) e controlo (n = 58). O estudo seguiu uma abordagem quantitativa com um desenho quase experimental, implementando um workshop de 4 sessões para estudantes do grupo experimental, fazendo medições antes e depois do workshop em ambos os grupos. Os instrumentos utilizados foram a Escala de Atitude de Estilo APA e o Teste de Conhecimento de Estilo APA, construídos para efeitos de investigação, passando anteriormente pela análise das suas propriedades psicométricas num grupo paralelo de 200 estudantes caracteristicamente semelhantes. Os resultados paralelos evidenciaram propriedades psicométricas adequadas dos instrumentos de medição, com base na evidência da validade do conteúdo (V = .83-1.00), análise de factores de confirmação e indicadores de consistência interna por meio do coeficiente Omega. Quanto ao workshop, foram obtidas provas favoráveis no conhecimento das normas da APA (p = .03, eta = .401) e das atitudes em relação ao seu estilo (p = .004, eta = .436) de uma forma geral e por componentes do grupo experimental, com efeitos moderados. Conclui-se que o workshop de 4 sessões foi eficaz e recomenda-se a sua aplicação em populações semelhantes, desde que o professor tenha as competências pedagógicas e os conhecimentos sobre as palavras APA StyleKey: APA Style, atitudes em relação ao APA Style, conhecimento do APA Style, estudantes universitários, workshop de normas APA.

Progression patterns of range of motion progression after open release for post-traumatic elbow stiffness.

Background & Hypothesis: Post-traumatic stiffness of the elbow may be treated surgically with open osteocapsular release. This study investigated postoperative range of motion (ROM) improvements after this procedure. We hypothesized that there would be predictable recovery patterns and significant progress up to 6 months after surgery. Methods: A retrospective chart review of patients who underwent open elbow release for post-traumatic stiffness (PTS) was performed. Demographic information and surgical approach were recorded. Patients with ipsilateral primary elbow osteoarthritis were excluded. Range of motion (ROM) data were collected at preoperative, intraoperative, and postoperative intervals of 2 weeks, 6 weeks, 3 months, and 6 months. Growth mixture modeling (GMM) and latent class growth analysis (LCGA) were performed to identify motion recovery trajectory groups, and Student's t-tests were performed to compare ROM data between intervals. Results: One hundred and eighty-seven patients who underwent open elbow release for PTS were included (112 with a medial approach, 50 lateral, and 25 both). The mean preoperative arc was 84° ± 31, and the arc of motion at final follow-up was 119° ± 19 (P < .05). The mean time to the final follow-up arc of motion was 16 weeks, with 56% of patients achieving their final arc by their 3-month follow-up visit. The largest improvement was seen with extension between 6 weeks and 3 months, where 26% of the extension at final follow-up was gained. Most of the recovery occurred within the first 3 months postoperatively, with small improvements thereafter. GMM and LCGA did not identify statistically significant groups for postoperative ROM progression trajectories. Arc of motion preoperatively, intraoperatively, and at 2 weeks postoperatively did not correlate with the final arc of motion. There were no demographic or historical characteristics, or thresholds of motion, which conferred a higher likelihood of achieving a better result postoperatively. Conclusions: ROM recovery after surgical release for post-traumatic elbow stiffness did not depend on the preoperative, intraoperative, or 2-week postoperative arcs of motion. Most ROM recovery occurs early after surgery, and maximal arc of motion can be expected by approximately 16 weeks postoperatively. This knowledge may inform patients about their expected rehabilitation and splinting time and reduce the total costs of therapy.

Laryngotracheal Stenoses Post-Acute Respiratory Distress Syndrome due to COVID-19: Clinical Presentation, Histopathological Findings and Management. A Series of 12 Cases.

Coronavirus disease 2019 (COVID-19) has increased the risk of developing severe acute respiratory distress syndrome and subsequent moderate to severe laryngotracheal stenoses (LSTs) with an early presentation that occurs between two and three months after SARS-CoV-2 infection. We present a series of 12 cases of LST following SARS-CoV-2 infection. Dense lymphocyte infiltration with multinuclear giant cell granulomas was found on biopsy with intranuclear inclusions, suggestive of viral cytopathic effects in one case and intravascular fibrin thrombi with perivascular mononuclear infiltrate of CD3 + T lymphocytes. We present the largest and only series that describes clinical and histopathological characteristics of LTS and the management and outcomes after early laryngotracheal reconstruction in the context of the SARS-CoV-2 outbreak.

Percepción estética de la sonrisa según variación de la posición vertical y de la angulación del incisivo central superior en tres regiones del Perú / Esthetic Perception of the Smile According to Variation of the Vertical Position and the Angulation of the Upper Central Incisor in Three Regions of Peru

Resumen: Objetivo: Evaluar la percepción estética de la sonrisa según variación de la posición vertical y de la angulación del incisivo central superior (ICS) en estudiantes de odontología (EO) y personas comunes (PC) de las tres regiones del Perú. Materiales y Métodos: Diseño descriptivo, transversal. La muestra fueron 462 adultos, divididos en 77 para cada subgrupo de EO y PC de las regiones Lima (Costa), Junín (Sierra) y Loreto (Selva). Mediante el programa Photoshop se modificó una fotografía de sonrisa de mujer variando la posición vertical y angulación del ICS, obteniéndose imágenes que fueron evaluadas mediante la escala visual análoga. Resultados: Las PC calificaron mejor que los EO en la mayoría de las categorías (p<0,001). La sonrisa mejor valorada por EO en posición vertical fue a 1mm y 2mm; y para angulación 0°, mientras que para PC la de 1mm y de 0° respectivamente (p<0,05). Comparando por regiones los EO de Lima dieron la menor calificación para 0° con 52,63 y los de Junín la mayor para 4° con 45,90. Las PC de Loreto registraron el menor puntaje para las categorías de posición vertical (p<0,001), mientras que para angulación en Junín se calificó con un menor puntaje que en Loreto para -6° y 0°; y para 4° Lima brindó la menor calificación (p<0,001). Conclusiones: La percepción estética de la sonrisa es afectada por la variación de posición vertical y angulación del ICS en personas comunes y estudiantes de odontología en las tres regiones del Perú.

Abstract: Objective: To evaluate the esthetic perception of the smile according to the variation of the vertical position and the angulation of the upper central incisor (UPI) by dental students (DS) and common people (CP) of three regions of Peru. Materials and Methods: Descriptive cross-sectional design. The sample was 462 adults, divided into 77 for each subgroup of DS and CP of the Lima (Coast), Junín (Highlands) and Loreto (Rainforest) regions. Using the Photoshop® software, a photograph of a woman's smile was modified by varying the vertical position and angulation of the UPI, obtaining images that were evaluated using the analog visual scale. Results: The CP rated better than DS in most categories (p <0.001). The smile best valued by DS in a vertical position was 1mm and 2mm; and for angulation 0°, while for CP 1mm and 0° respectively (p <0.05). Comparing by regions, the DS of Lima gave the lowest rating for 0 ° with 52.63 and those of Junín the highest for 4° with 45.90. The PC of Loreto registered the lowest score for the vertical position categories (p <0.001), while for angulation in Junín it was rated with a lower score than in Loreto for -6 ° and 0°; and for 4° Lima provided the lowest rating (p <0.001). Conclusions: The esthetic perception of the smile is affected by the variation of vertical position and angulation of the ICS in common people and dental students in the three regions of Peru.

Bicipital aponeurosis. Anatomical study and clinical implications / Aponeurose bicipital. Estudo anatômico e implicações clínicas

ABSTRACT Objective: The aim of this study was to analyze the anatomic variations of the bicipital aponeurosis (BA) (lacertus fibrosus) and its implications for the compression of the median nerve, which is positioned medially to the brachial artery, passing under the bicipital aponeurosis. Methods: Sixty upper limbs of 30 cadavers were dissected, 26 of which were male and four, female; of the total, 15 had been previously preserved in formalin and glycerine and 15 were dissected fresh in the Laboratory of Anatomy. Results: In 55 limbs, short and long heads of the biceps muscle contributed to the formation of the BA, and the most significant contribution was always from the short head. In three limbs, only the short head contributed to the formation of the BA. In two limbs, the BA was absent. The length of the bicipital aponeurosis from its origin to its insertion ranged from 4.5 to 6.2 cm and its width, from 0.5 to 2.6 cm. In 42 limbs, the BA was thickened; of these, in 27 it was resting directly on the median nerve, and in 17 a high insertion of the humeral head of the pronator teres muscle was found, and the muscle was interposed between the BA and the median nerve. Conclusion: These results suggest that a thickened BA may be a potential factor for nerve compression, by narrowing the space through which the median nerve passes.

RESUMO Objetivo: Analisar as variações anatômicas da aponeurose bicipital (lacertus fibrosus) e suas implicações na compressão do nervo mediano, que passa sob a aponeurose bicipital (AB) e se posiciona medialmente à artéria braquial. Método: Foram dissecados 60 membros superiores de 30 cadáveres adultos, 26 do sexo masculino e quatro do feminino; 15 haviam sido previamente preservados em formol e glicerina e 15 foram dissecados a fresco no Laboratório de Anatomia. Resultados: Em 55 membros, a AB recebia contribuição das cabeças curta e longa do musculo bíceps braquial, a contribuição mais significativa foi sempre da cabeça curta. Em três membros recebia contribuição exclusiva da cabeça curta. Em dois membros, a AB estava ausente. O comprimento da AB desde sua origem até sua inserção variou entre 4,5 e 6,2 cm e sua largura entre 0,5 e 2,6 cm. Em 42 membros, a AB apresentava-se espessada, em 27 apoiava-se diretamente sobre o nervo mediano e em 17 havia inserção alta da cabeça umeral do músculo pronador redondo, de forma que o músculo ficava interposto entre a AB e o nervo mediano. Conclusão: Esses resultados sugerem que a AB espessada pode ser um dos fatores potenciais da compressão nervosa, por estreitar o espaço no qual passa o nervo mediano.

Bicipital aponeurosis. Anatomical study and clinical implications.

OBJECTIVE: The aim of this study was to analyze the anatomic variations of the bicipital aponeurosis (BA) (lacertus fibrosus) and its implications for the compression of the median nerve, which is positioned medially to the brachial artery, passing under the bicipital aponeurosis. METHODS: Sixty upper limbs of 30 cadavers were dissected, 26 of which were male and four, female; of the total, 15 had been previously preserved in formalin and glycerine and 15 were dissected fresh in the Laboratory of Anatomy. RESULTS: In 55 limbs, short and long heads of the biceps muscle contributed to the formation of the BA, and the most significant contribution was always from the short head. In three limbs, only the short head contributed to the formation of the BA. In two limbs, the BA was absent. The length of the bicipital aponeurosis from its origin to its insertion ranged from 4.5 to 6.2 cm and its width, from 0.5 to 2.6 cm. In 42 limbs, the BA was thickened; of these, in 27 it was resting directly on the median nerve, and in 17 a high insertion of the humeral head of the pronator teres muscle was found, and the muscle was interposed between the BA and the median nerve. CONCLUSION: These results suggest that a thickened BA may be a potential factor for nerve compression, by narrowing the space through which the median nerve passes.

OBJETIVO: Analisar as variações anatômicas da aponeurose bicipital (lacertus fibrosus) e suas implicações na compressão do nervo mediano, que passa sob a aponeurose bicipital (AB) e se posiciona medialmente à artéria braquial. MÉTODO: Foram dissecados 60 membros superiores de 30 cadáveres adultos, 26 do sexo masculino e quatro do feminino; 15 haviam sido previamente preservados em formol e glicerina e 15 foram dissecados a fresco no Laboratório de Anatomia. RESULTADOS: Em 55 membros, a AB recebia contribuição das cabeças curta e longa do musculo bíceps braquial, a contribuição mais significativa foi sempre da cabeça curta. Em três membros recebia contribuição exclusiva da cabeça curta. Em dois membros, a AB estava ausente. O comprimento da AB desde sua origem até sua inserção variou entre 4,5 e 6,2 cm e sua largura entre 0,5 e 2,6 cm. Em 42 membros, a AB apresentava-se espessada, em 27 apoiava-se diretamente sobre o nervo mediano e em 17 havia inserção alta da cabeça umeral do músculo pronador redondo, de forma que o músculo ficava interposto entre a AB e o nervo mediano. CONCLUSÃO: Esses resultados sugerem que a AB espessada pode ser um dos fatores potenciais da compressão nervosa, por estreitar o espaço no qual passa o nervo mediano.

The Outcome of Severe Traumatic Brain Injury in Latin America.

BACKGROUND: Traumatic brain injury (TBI) disproportionately affects lower- and middle-income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries. METHODS: This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥13 years and admitted to study hospitals with Glasgow Coma Scale score ≤8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) score at 6 months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. RESULTS: A total of 550 patients were identified. Six-month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E score of 5-8. In multivariable proportional odds modeling, higher Glasgow Coma Scale motor score (odds ratio [OR], 1.41 per point; 95% confidence interval [CI], 1.23-1.61) and epidural hematoma (OR, 1.83; 95% CI, 1.17-2.86) were significant predictors of higher GOS-E score, whereas advanced age (OR, 0.65 per 10 years; 95% CI, 0.57-0.73) and cisternal effacement (P < 0.001) were associated with lower GOS-E score. Study site (P < 0.001) and race (P = 0.004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary examination. CONCLUSIONS: Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to that of high-income countries. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations.

Nivel de depresión y ansiedad en el cuidador principal de pacientes esquizofrénicos en el Centro de Salud San Martín de Porres jurisdicción del INSM-HD-HN: 2011 / Level of depression and anxiety in the primary carer of schizophrenic patients at the Health Center of San Martin de Porres jurisdiction of the HN-HD-INSM: 2011

La esquizofrenia es una enfermedad mental, crónica, grave e incapacitante. El 1 por ciento de la población es afectada por esta enfermedad en algún momento de su vida. La esquizofrenia afecta al hombre y a la mujer con la misma frecuencia. Las personas con esquizofrenia a menudo sufren síntomas aterradores tales como escuchar voces, estar convencido que otras personas pueden leer su mente, controlar sus pensamientos o están conspirando en contra de ellos. Estos síntomas causan temor y retraimiento, con un curso habitualmente crónico y que produce diversas incapacidades psíquicas, familiares, sociales y laborales y esto se traduce en un alto costo para el paciente, la familia y la sociedad. La aparición del "cuidador principal" es frecuente en la mayoría de las unidades familiares, por consecuente está expuesto de sufrir alguna descompensación física y psicológica. El objetivo fue determinar el nivel de ansiedad y depresión en el cuidador principal de pacientes esquizofrénicos. Material y Método, el estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población en estudio fue conformado por 100 cuidadores, el tamaño de la muestra la conformaron 50 cuidadores, seleccionados según criterios de inclusión y exclusión, el instrumento que se utilizó fue la encuesta y la escala de ansiedad y depresión, aplicado previo consentimiento informado. Resultados del 100 por ciento (50), 40 por ciento (20) fue el nivel moderado la ansiedad, seguido de la ansiedad leve 26 por ciento (13), y siendo menor la ansiedad grave 8 por ciento (4), en cuanto a depresión 50 por ciento (25) fue depresión moderada, 32 por ciento (16) leve y 8 por ciento (8) grave. Conclusiones, por lo que se puede evidenciar que la mayoría de los cuidadores principales de pacientes Esquizofrénicos presentan un nivel de depresión moderada a grave. En cuanto a la ansiedad podemos afirmar que los cuidadores principales de pacientes Esquizofrénicos presentan...

A new species of Amphoropsyche (Trichoptera, Leptoceridae) from Ecuador, with a key to the species in the genus.

A new species of Amphoropsyche Holzenthal is described from Ecuador. It is similar to a group of species with dorsomesal processes on the preanal appendages (i.e., Amphoropsyche woodruffi Flint & Sykora, Amphoropsyche refugia Holzenthal, and Amphoropsyche aragua Holzenthal), but can be distinguished from these and other members of the genus by the short, digitate dorsomesal processes on the preanal appendages and the broad lateral processes of tergum X of the male genitalia. A key to males of the 14 species now known in the genus is presented based on characters of the genitalia.

Tratamiento del linfoma cutáneo de células T con bexaroteno a dosis bajas en combinación con fototerapia o interferon alfa: comunicación de ocho casos tratados en el Hospital Edgardo Rebagliati Martins, 2003-2007, Lima, Perú / Therapy for cutaneous T-cell lymphoma using low-dose bexarotene combined with phototherapy or alpha-interferon: Report of eight cases treated in Hospital Nacional Edgardo Rebagliati-Martins, Lima, Peru between 2003 and 2007

Introducción: bexaroteno es un rexinoide aprobado en el tratamiento de estadios tempranos y avanzados del linfoma cutáneo de células T (LCCT). Caso Clínico: el presente reporte de casos mostramos los resultados del empleo de bexaroteno en dosis bajas más fototerapia o Interferon alfa 9 millones en el tratamiento del LCCT. Ocho pacientes fueron tratados , cinco fueron Micosis fungoides, dos Linfoma Epidermotrópico CD8 agresivo y uno fue un Síndrome Sézary. La respuesta global fue del 62.5 por ciento (5/8) y la duración media de respuesta fue de 20 meses. El bexaroteno en dosis bajas en combinación a fototerapia o interferon alfa 2a puede ser efectivo en el tratamiento del LCCT.

Introduction: Bexarotene is a rexinoid compound that is approved for use in the therapy for early and advanced stage cutaneous T-cell lymphoma (CTCL).Clinical Cases: We present in this report the results of the use of low-dose bexarotene plus phototherapy or alpha-interferon, nine million units, in the treatment of CTCL. Eight patients were treated, five had mycosis fungoides, two had CD-8 epidermothropic aggressive lymphoma. The overall response rate was 62.5 per cent (5/8), and the mean duration of response was 20 months. Low-dose bexarotene combined with phototherapy or alpha-interferon may be effective in the treatment of CTCL.

[Primary colorectal lymphoma of diffuse large B-cells: an experience at a general hospital]. / Linfoma de células grandes B difuso primario colorectal: experiencia en un hospital general.

Primary colorectal lymphoma is a very rare disease. Primary colorectal lymphoma of diffuse large B-cells is a more frequent subtype representing 1% of all colon diseases. In a retrospective study, the clinical characteristics and treatment course of primary colorectal lymphoma of diffuse large B-cells between 1997 and 2003 were reviewed. According to Dawson's criteria, fourteen cases were identified. The average age was 65 and the ratio of men to women was 1:3. The most frequent signs and symptoms were abdominal pain (78%), diarrhea (49%) and abdominal tumor (35%). The most frequently involved regions were the cecum (42%), ascending colon (21%) and rectum (21%). Six were in Stage I, four in Stage II and four in Stage III. The 5-year survival per stage was 26, 11 and 5 months, respectively. Primary colorectal lymphoma of diffuse large B-cells usually affects the right part of the colon in an aggressive manner.

Linfoma de células grandes B difuso primario colorectal: experiencia en un hospital general / Primary colorectal lymphoma of diffuse large B-cells: an experience at a general hospital

El Linfoma primario colorectal es una enfermedad muy infrecuente. El Linfoma difuso de células B grandes primario colorectal es el subtipo más frecuente y se constituye en el 1% de todas las malignidades del colon. En un estudio retrospectivo, se revisó las características clínicas y curso de tratamiento de los linfomas de células grandes B difuso primario colorectal entre 1997-2003. De acuerdo a los criterios de Dawson fueron identificados catorce casos. La edad media fue 65 años y la relación varón /mujer1.1.3. Los signos y síntomas más frecuentes fueron: dolor abdominal (78%), diarrea (49%) y tumor abdominal (35%). Los sitios más frecuentemente involucrados fueron:ciego (42%), colon ascendente (21%) y recto (21%). Seis tuvieron un estadío I , cuatro en estadío II y cuatro en estadio III. La sobrevida a 5 años por estadios fue: 26,11 y 5 meses respectivamente.El Linfoma primario colorectal de Células grandes B difuso usualmente afecta el colon derecho con un comportamiento agresivo.

Primary colorectal lymphoma is a very rare disease. Primary colorectal lymphoma of diffuse large B-cells is a more frequent subtype representing 1% of all colon diseases. In a retrospective study, the clinical characteristics and treatment course of primary colorectal lymphoma of diffuse large B-cells between 1997 and 2003 were reviewed.According to Dawson’s criteria, fourteen cases were identified. The average age was 65 and the ratio of men to women was 1:3. The most frequent signs and symptoms were abdominal pain (78%), diarrhea (49%) and abdominal tumor (35%). The most frequently involved regions were the cecum (42%), ascending colon (21%) and rectum (21%). Six were in Stage I, four in Stage II and four in Stage III. The 5-year survival per stage was 26, 11 and 5 months, respectively. Primary colorectal lymphoma of diffuse large B-cells usually affects the right part of the colon in an aggressive manner.

Linfomas cutáneos primarios: estudio retrospectivo clinicopatológico durante el periodo 1997 - 2004 en el Hospital Edgardo Rebagliati Martins, Essalud, Lima, Perú / Cutaneous lymphoma: A retrospective clinico-pathological study during the 1997-2004 Period in Edgardo Rebagliati-Martins Hospital, Essalud, Lima, Peru

Introducción: las características clínicopatológicas de los linfomas malignos varían de acuerdo a la geografía. La piel es el segundo lugar de compromiso extranodal de linfoma no Hodgkin .El linfoma primario cutáneo tienen un comportamiento clínico y pronóstico diferente de los linfomas sistémicos Objetivo: el objetivo de este estudio fue determinar la frecuencia relativa de los linfomas cutáneos y examinar la relevancia clínica de la nueva clasificación WHO/EORTC y la sobrevida de los casos peruanos de linfoma primario cutáneo. Material y método: se realizó un estudio retrospectivo clínicopatológico de 78 casos de linfomas cutáneos, diagnosticados desde 1997 al 2004 en el Hospital Edgardo Rebagliati Martins, Essalud, Lima,Perú. Las historias clínicas, biopsias y pruebas de inmunohistoquímica de los 78 pacientes enrolados fueron revisadas. Resultados: 67/78 (85,9%) fueron linfomas primarios cutáneos y 11/78 (14,1%) fueron linfomas cutáneos secundarios. El linfoma secundario cutáneo más frecuente fue el linfoma /leucemia T del adulto (ATLL) con 72% de los casos. El linfoma primario cutáneo más frecuente fue la micosis fungoide (MF) 30/67 (44,7%) , seguido del ATLL 13/67 (19,4%) y el linfoma T periférico no especificado 4/67 (6%). La sobrevida a 5 años para la MF, ATLL cutáneo y ATLL sistémico fue de 77%. 18% y 0% respectivamente. Conclusión: MF y ATLL cutáneo fueron los linfomas primarios cutáneos más frecuentes en nuestro hospital. La MF posee un buen pronóstico mientras el ATLL cutáneo posee pobre sobrevida.

Introduction: Clinico-pathological features of malignant lymphomas vary according to geography. The skin is the second site for extranodal Non-Hodgkin Lymphoma. Primary cutaneous lymphoma has a different clinical behavior and prognosis compared with systemic lymphomas. Objective: The aim of this study was to determine the relative rate of cutaneous lymphomas and to examine the clinical relevance of the new WHO/EORTC classification and survival in Peruvian persons with primary cutaneous lymphoma. Methods: We conducted a clinico-pathological retrospective study in 78 cases of cutaneous lymphoma diagnosed between 1997 and 2004 in a National General Hospital. Clinical records, hematoxylin & eosin-stained slides and immunohistochemical studies from 78 patients with malignant lymphoma of the skin were reviewed. Results: 67/78 cases (85,9%) were primary cutaneous lymphomas and 11/78 (14,1%) were secondary cutaneous lymphomas. Most frequent secondary cutaneous lymphoma was systemic adult T-cell lymphoma/Leukemia (ATLL), accounting for 72% of cases. Most frequently found primary cutaneous lymphoma were mycosis fungoides (MF), in 30/67 (44,7%) patients, cutaneous ATLL in 13/67 (19,4%), and non-specific peripheral T-cell lymphoma in 4/67 (6%). 5-year survival rates for MF, cutaneous ATLL and systemic ATLL were 77%, 18%, and 0%, respectively.Conclusions: MF and ATLL are the more frequently found primary cutaneous lymphomas in our hospital. MF has a good prognosis, while cutaneous ATLL has a poor survival rate.

Desorden linfoproliferativo de células B asociado al virus Epstein Barr y relacionado a la edad: reporte de 9 casos y revisión de la literatura / Age-related and Epstein Barr virus-associated B-cell lymphoproliferative disorder: a 9-case report and literature review

Introducción: el desorden linfoproliferativo de células B asociado al virus Epstein Barr (VEB) y relacionado a la edad es una nueva entidad en nuestro medio. La infección por el VEB puede producir un crecimiento incontrolado de los linfocitos B que son normalmente inactivos, reportándose la aparición de desórdenes linfoproliferativos de curso agresivo y una pobre sobrevida.Casos clínicos: nueve pacientes de nacionalidad peruana diagnosticados como desorden linfoproliferativo de células B asociado al VEB y relacionado a la edad fueron incluidos en este reporte. Todos los pacientes fueron positivos para la prueba del EBER por hibridización in situ cromogénica (CISH). La morfología en todos los casos fue de linfoma de células grandes. La expresión inmunohistoquìmica de CD20, BCL6, CD10 y MUM-1/IRF4 fueron evaluados usando la técnica de tissue microarray. Los nueve pacientes tuvieron un fenotipo no centro germinal like. La mayoría de nuestros pacientes fueron pacientes con edad avanzada con pobre status performance, síntomas B, alto IPI y enfermedad avanzada. La sobrevida fue muy corta. Conclusión: reportamos en nuestro medio una nueva entidad denominada desorden linfoproliferativo de células B asociada al VEB, el cual presenta un curso agresivo y pobre pronóstico.

Introduction: Age-related B-cell lymphoproliferative disorder associatedwith Epstein-Barr virus (EBV) is a newly described condition in our country. EBV infection may lead to a non-controlled growth of normally inactive B-lymphocytes, so lymphoproliferative disorders with an aggressive course and poor survival occur. Clinical cases: Nine Peruvian patients diagnosed with age-related B-cell lymphoproliferative disorder associated EBV were included in this report. All patients were positive for EBER test using chromogenic in situ hybridization (CISH). Morphology in every case corresponded to large-cell lymphoma. CD20, BCL6, CD10, and MUM-1/IRF4 histochemical expression was assessed using a tissue microarray. All nive patients had a phenotype not germinal center-like. Most of our patients were elderly subjects with a poor performance status, type B symptoms, high values in the International Prognostic Index (IPI) and advanced disease. Their survival was quite short. Conclusion: We report for the first time a new condition called age-related B-cell lymphoproliferative disorder associated EBV, which has an aggressive course and a poor prognosis.