Lagrangian Irreversibility and Energy Exchanges in Rotating-Stratified Turbulent Flows.

Turbulence in stratified and rotating turbulent flows is characterized by an interplay between waves and eddies, resulting in continuous exchanges between potential and kinetic energy. Here, we study how these processes affect the turbulent energy cascade from large to small scales, which manifests itself by an irreversible evolution of the relative kinetic energy between two tracer particles. We find that when r_{0}, the separation between particles, is below a characteristic length ℓ_{t}, potential energy is on average transferred to kinetic energy, reducing time irreversibility, and conversely when r_{0}>ℓ_{t}. Our Letter reveals that the scale ℓ_{t} coincides with the buoyancy length scale L_{B} over a broad range of configurations until a transition to a wave-dominated regime is reached.

Milk quality of Italian Mediterranean buffalo as affected by temperature-humidity index during late spring and summer.

A total of 18 Italian Mediterranean buffalo cows were subjected to fortnightly milk sampling from May to July 2022. Air temperature and relative humidity were monitored throughout the trial. Temperature-humidity index (THI) was calculated and ranged from 69 to 79, so that 3 classes were set to study the effect of different THI on milk quality: THI less than 72 (THI<72), THI ranging from 72 to 76 (THI72-76), and THI over 76 (THI>76). Individual milk samples from buffalo cows were analyzed for milk composition and coagulation traits, fatty acid and amino acid composition, and enzymatic and mineral profiles. The THI>76 class registered higher lactose content and poorer milk clot characteristics in comparison with THI<72. Exposure to a THI over 76 resulted in increased SFA and short-chain fatty acid contents in milk, as well as in the highest atherogenic and thrombogenic index values and the lowest essential amino acid content. Moreover, the lowest values of calcium, copper, and selenium contents were found in the milk of buffalo cows exposed to a THI over 72. Results confirm that Italian Mediterranean buffalo express a good level of thermo-tolerance, even though exposure to a daily THI over 76 has a deleterious effect on some nutritional and technological properties of milk.

Nonlocal contributions to the turbulent cascade in magnetohydrodynamic plasmas.

We present evidence for nonlocal contributions to the turbulent energy cascade in magnetohydrodynamic (MHD) plasmas. Therefore, we revisit a well-known result derived directly from the MHD equations, i.e., the Politano and Pouquet law for the transfer of kinetic and magnetic energy in scale. We propose adding a term that accounts for nonlocal transfer and represents the influence of fluctuations from large scales due to the Alfvén effect. Supported by direct numerical simulations of homogeneous and isotropic MHD turbulence, we verify that in some plasma configurations, neglecting the additional nonlocal term might consistently overestimate energy dissipation rates and, thus, the contributions of turbulent energy dissipation potentially affecting solar wind heating, i.e., a central puzzle in space plasma physics that motivates the present work.

Determinación de valores de corte de 17 hidroxiprogesterona ajustados por edad gestacional para la pesquisa neonatal de la hiperplasia suprarrenal congénita / Assessment of gestational age-adjusted 17-hydroxyprogesterone cut-off values for neonatal screening of congenital adrenal hyperplasia

La pesquisa neonatal de hiperplasia suprarrenal congénita se realiza mediante la determinación de 17 hidroxiprogesterona (17OHP) en gotas de sangre seca en papel de filtro. Los bebés prematuros presentan valores más elevados que los bebés de término, siendo de utilidad contar con límites de corte apropiados. Nuestro objetivo fue actualizar los valores de corte de 17OHP ajustados por edad gestacional para la metodología en uso a nivel nacional por las jurisdicciones asistidas por el "Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas". La 17OHP se determinó utilizando el kit comercial de enzimo-inmunoanálisis (ELISA competitivo), Elizen Neonatal 17OHP Screening (Zentech, Bélgica). Se obtuvieron límites de corte utilizando percentiles de la distribución de los valores de 17OHP para cada edad gestacional. La sensibilidad obtenida fue 100%, especificidad 98,76 %, tasa de falsos positivos 1,24 % y el valor predictivo positivo 1,12 %. Destacamos la importancia de disponer de límites de corte adecuados a la población. La armonización de los mismos permitirá resultados comparables entre los programas regionales de pesquisa neonatal (AU)

Newborn screening for congenital adrenal hyperplasia is performed by the measurement of 17-hydroxyprogesterone (17OHP) in dried blood spots on filter paper. Premature infants have higher values than full-term infants, and appropriate cutoff values are useful. Our aim was to update the cut-off values of 17OHP adjusted for gestational age for the methodology used at a national level in regions assisted by the "National Program for Strengthening the Early Detection of Congenital Diseases". 17OHP was determined using the commercial enzyme-linked immunosorbent assay (competitive ELISA) kit, Elizen Newborn 17OHP Screening (Zentech, Belgium). Cut-off values were obtained using percentiles of the distribution of 17OHP values for each gestational age. Sensitivity was 100%, specificity 98.76%, false positive rate 1.24%, and positive predictive value 1.12%. It is important to have cut-off values that are adjusted to the population. Harmonization will allow for the comparison of results among regional newborn screening programs (AU)

Mujer con distensión abdominal de 2 meses de evolución / Woman with abdominal distention of 2 months duration

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Rol de los pacientes y su diversidad cultural en las guías de práctica clínica / Patients cultural diversity role in clinical practice guidelines

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Evaluación de sensibilidad-especificidad de valores de 170H progesterona sérica, basales y post estímulo con ACTH, en función del análisis molecular del gen CYP21A2 en la deficiencia de 21-hidroxilasa no clásica / Evaluation of sensitivity and specificity of serum 170H progesterone values at baseline and post ACTH stimulation in the function of molecular analysis of the CYP21A2 gene in non-classic 21-hydroxilase deficiency

La forma no clásica, post natal, de la hiperplasia suprarrenal congénita tiene una incidencia de 1 en 1000 en la población general y afecta al 6% de las mujeres hirsutas. En este estudio se estableció la sensibilidad y la especificidad de la respuesta de los niveles séricos de 17-hidroxiprogesterona (17OHP4) al estímulo agudo con ACTH en 203 pacientes de ambos sexos, pre y post puberales, con hiperandrogenismo, en los cuales se analizó si tenían una alteración molecular del gen CYP21A2. Posteriormente al estudio molecular, los pacientes fueron clasificados en tres grupos de acuerdo al genotipo: Gr0, n=61: ningún alelo mutado (no portadores de mutación); Gr1, n=55: un alelo mutado (portadores) y Gr2, n=87: dos alelos mutados (afectados). Por análisis de regresión logística (curvas ROC) se compararon los valores basales del Gr2 vs Gr0 y se obtuvo un valor de 17OHP4 de 7,2 ng/ml con una sensibilidad del 83% y una especificidad del 85%. Se sugiere entonces que en los pacientes con este nivel basal no se debería realizar el test de ACTH, y habría que confirmar el diagnóstico con el estudio molecular. Los niveles 17OHP4 a los 60 minutos post estímulo con ACTH mayores a 20 ng/ml son confirmatorios del diagnóstico con 84% de sensibilidad y 88% de especificidad. No sería necesario entonces realizar estudios moleculares. Un valor de 15,6 ng/ml diferencia Gr2 de Gr0 con una sensibilidad del 89% y una especificidad del 95%. Este es un buen valor predictivo, pero el análisis molecular no debería obviarse en aquellos casos en los que exista una fuerte sospecha clínica. (AU)

The incidence of non classic congenital adrenal hyperplasia is 1:1000 in the general population and it is present in 6% of hirsute women. In this study, the sensitivity and specificity of serum 17-hydroxyprogesterone (17OHP4) response to acute ACTH stimulation was evaluated in 203 prepubertal and pubertal patients of the two sexes with hyperandrogenism, in whom the CYP21A2 gene was analyzed. After molecular analysis patients were divided in 3 groups according to genotype: Gr0, n=61, no mutated allele (no mutation carrier); Gr1, n=55, one mutated allele (carrier); and Gr2, n=81, two mutated alleles (affected patient). Using logistic regression analysis (ROC curves), basal values in Gr2 vs. Gr0 were compared and a cutoff value of 7.2 ng/ml was defined to separate groups, with 83% sensitivity and 85% specificity. It is suggested then that in patients with levels higher than 7,2 no ACTH test is necessary and molecular analysis is required to confirm diagnosis. Serum 17OHP4 values above 20 ng/ml 60 minutes after ACTH are confirmatory of diagnosis, with 84% sensitivity and 88% specificity. No molecular studies should be necessary. A 15.6 ng/ml cutoff value is able to differentiate Gr2 from Gr0, with 89% sensitivity and 95% specificity. It is a good predictive value, but carrying out molecular analysis is only advisable if clinical evidence is strong (AU)

Hernia de hiato paraesofágica: cirugía laparoscópica vs. cirugía abierta / Paraesophageal hiatal hernia. Open vs. laparoscopic surgery

Introducción: la hernia hiatal paraesofágica representa el 5-10% de las hernias hiatales. Su importancia radica en las gravescomplicaciones que pueden presentar, como el vólvulo gástrico, yse recomienda el tratamiento quirúrgico una vez establecido eldiagnóstico.Material y métodos: estudio retrospectivo de los pacientesintervenidos en nuestro centro de hernia hiatal paraesofágica entre1985 y 2007.Resultados: estudiamos 90 casos, 68 mujeres y 22 varones,con edad media de 67,6 años (37-96). Cuarenta y cinco pacientespresentaban pirosis, 34 dolor epigástrico postprandial y 15 disfagia;ocho pacientes fueron diagnosticados como vólvulo gástrico.Se realizaron 81 intervenciones programadas y 9 urgentes. En 47casos el abordaje fue abierto y en 43 laparoscópico, de los cuales5 se convirtieron a cirugía abierta. Se realizó funduplicatura D´Oren 35 casos, Nissen en 35, Toupet en 14, cierre simple de pilaresen 2, Narbona en 1 y Lortat-Jakob en 1; en 10 pacientes se colocaronmallas. La tasa de complicaciones en cirugía abierta fue10,6% y en laparoscópica 9,5% (p > 0,05). La estancia media fue9,1 días en cirugía abierta y 3,4 en laparoscópica (p < 0,05). Enel seguimiento, analizamos 84 pacientes, con una mediana de 12años (1-19): 15 continuaban sintomáticos, objetivándose recidivaen 8 (5 fueron reintervenidos). El 95,5% de los pacientes estabansatisfechos con los resultados.Conclusión: se obtuvieron resultados equivalentes tras cirugíalaparoscópica y abierta, con estancia hospitalaria significativamentemenor en los primeros. Por ello creemos que se debe considerarla cirugía laparoscópica como abordaje de elección paratratar la hernia hiatal paraesofágica(AU)

Background: paraesophageal hiatal hernia represents 5-10%of hiatal hernias. Its importance is based on the severe complicationsit may have, including gastric volvulus, and surgical treatmentis recommended when a diagnosis is established.Material and methods: a retrospective study of all patientswho underwent surgery for paresophageal hernia between 1985and 2007.Results: we studied 90 cases, 68 females and 22 males with amedian age of 67.6 years (37-96). Forty-five patients reported pyrosis,34 epigastric postprandial pain, and 15 dysphagia; eightpatients were diagnosed with gastric volvulus. Eighty-one patientsunderwent elective surgery and 9 emergency surgery. Forty-sevencases underwent an open procedure and 43 a laparoscopicone; 5 (11.6%) of them required conversion. The techniques performedwere D´Or fundoplication in 35 cases, Nissen in 35,Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complicationrate for open procedure was 10.6 and 9.5% for the laparoscopicone (p > 0.05). Median hospital stay was 9.1 days for theopen procedure and 3.4 for the laparoscopic one (p < 0.05). Asfollow-up, we analyzed 84 patients. After a median follow-up of12 years (1-19), 15 patients were still symptomatic (17.8%), withrecurrence in 8 cases (5 required reoperation). The satisfactionrate was 95.5%Conclusion: equivalent results were observed after laparoscopicand open surgery and a significant shorter hospital stay inthe laparoscopic one. Therefore, we think that laparoscopicsurgery should be considered as the election procedure for paraesophagealhiatal hernia(AU)

Dexmedetomidine for awake craniotomy without laryngeal mask

OBJECTIVE: This paper reports the use of dexmedetomidine in three epileptic patients with cavernous angiomas that underwent awake surgery in order to map their speech areas. METHOD: Loading dose of dexmedetomidine varied from 1 microg/Kg/h to 3 microg/Kg/h over 20 minutes and maintenance dose from 0.4 microg/Kg/h to 0.8 microg/Kg/h. RESULTS: There was no occurrence of hemodynamic instability, convulsions or respiratory depression. Patients tolerated well the procedure. CONCLUSION: Dexmedetomidine was useful for awake craniotomy as it decreased patients level of consciousness but did not produce agitation. Laryngeal mask was not necessary to keep air ventilation.

OBJETIVO: Este trabalho relata o uso de desmedetomidina em três pacientes com angiomas cavernosos próximos a área de linguagem e epilepsia que foram operados acordados para mapeamento cortical. MÉTODO: A dose de ataque de dexmedetomidina variou de 1 mg/Kg/h a 3 mg/Kg/h durante 20 minutos e dose de manutenção de 0,4 mg/Kg/h a 0,8 mg/Kg/h. RESULTADOS: Os pacientes toleraram bem o procedimento e não houve instabilidade hemodinâmica, convulsões ou depressão respiratória. CONCLUSÃO: Dexmedetomidina foi útil nas craniotomias com o paciente acordado para mapeamento cortical pois gerou sedação sem agitação. A máscara laríngea não foi necessária para manter a ventilação nesses pacientes.

Oral health of the elderly: reality, myth, and perspective

As life expectancy increases, and with in both the relative and absolute mumbers of individuals age 60 and older, oro-dental health services face new challenges. This article explores the status of geriatric dental care in Latin America through a bibliographic review of epidemiologic studies included in the MEDLINE and LILACS systems, as well as PAHO studies on this subject. The areas addressed are the elderly's oro-dental health status, perceptions of their own oro-dental health, and frequency of dental service use. The review gives special attention to the critical state of oro-dental health among Latin America's elderly population, which exhibits high prevalences of caries-related tooth loss and total of dentition. The review revealed a scarcity of date relating to periodontal health and the health status of buccal soft tissues in the elderly population. It also found that elderly survey subjects tended to perceive their own oro-dental health in a manner inconsistent with clinical observations. According to several survey-based studies, most of those surveyed felt their oro-dental health was good or very good with few or no chewing problems. Regarding service utilization, many of those interviewed indicate they had not seen a dentist during the 6 months preceding the study. In view of the health, social, and psychologic consequences of the current situation for the elderly and the oral health services' potential for improving this population's quality of life, it is strongly recommended that appropiate and effective oro-dental health care programs oriented to this age group be developed

Published in Spanish in the BOSP. Vol. 116(5), May 1994

La salud bucodental de los ancianos: realidad, mitos y posibilidades / Oral health among the elderly: reality, myths, and possibilities

A medida que aumenta la esperanza de vida y con ella el número absoluto y relativo de personas de 60 años y más, los servicios de salud bucodental enfrentan nuevos desafíos. En este artículo se explora la situación de la odontología geriátrica en América Latina mediante una revisión bibliográfica de los estudios epidemiológicos publicados en los últimos 10 años e incluidos en los sistemas MEDLINE y LILACS y de obras de la OPS sobre el tema. Los aspectos enfocados son el estado de salud bucodental de los ancianos, la percepción que estos tienen de su propia salud bucodental y la frecuencia con que usan los servisios odontológicos. Nuestra revisión pone de manifiesto el estado crítico de la salud bucodental en pacientes latinoamericanos de edad avanzada, en quienes se observa una alta prevalencia de pérdida completa de la dentadura y de pérdida de dientes por caries. También revela la escasez de datos sobre el estado de salud periodontal y de los tejidos blandos de la cavidad bucal en este grupo. En general la percepción de los ancianos sobre su propia salud bucodental es poco congruente con la situación clínica observada. Según varios estudios basados en encuestas, la mayoría cree tener una salud bucodental buena o muy buena y pocos problemas de masticación o ninguno. En cuanto a la utilización de los servicios, gran parte indicó no haber ido al dentista en los 6 meses previos. En vista de las consecuencias sanitarias, sociales y psicológicas de esta situación para la población de edad avanzada y de la capacidad potencial de los servicios odontológicos de mejorar la calidad de vida de este grupo, al final se recomienda el establecimiento de programas de atención bucodental con metas a corto, mediano y largo plazo

Publicado en inglés en: Bull. PAHO. Vol. 28(3), 1994

La salud bucodental de los ancianos: realidad, mitos y posibilidades / Oral health among the elderly: reality, myths, and possibilities

A medida que aumenta la esperanza de vida y con ella el número absoluto y relativo de personas de 60 años y más, los servicios de salud bucodental enfrentan nuevos desafíos. En este artículo se explora la situación de la odontología geriátrica en América Latina mediante una revisión bibliográfica de los estudios epidemiológicos publicados en los últimos 10 años e incluidos en los sistemas MEDLINE y LILACS y de obras de la OPS sobre el tema. Los aspectos enfocados son el estado de salud bucodental de los ancianos, la percepción que estos tienen de su propia salud bucodental y la frecuencia con que usan los servisios odontológicos. Nuestra revisión pone de manifiesto el estado crítico de la salud bucodental en pacientes latinoamericanos de edad avanzada, en quienes se observa una alta prevalencia de pérdida completa de la dentadura y de pérdida de dientes por caries. También revela la escasez de datos sobre el estado de salud periodontal y de los tejidos blandos de la cavidad bucal en este grupo. En general la percepción de los ancianos sobre su propia salud bucodental es poco congruente con la situación clínica observada. Según varios estudios basados en encuestas, la mayoría cree tener una salud bucodental buena o muy buena y pocos problemas de masticación o ninguno. En cuanto a la utilización de los servicios, gran parte indicó no haber ido al dentista en los 6 meses previos. En vista de las consecuencias sanitarias, sociales y psicológicas de esta situación para la población de edad avanzada y de la capacidad potencial de los servicios odontológicos de mejorar la calidad de vida de este grupo, al final se recomienda el establecimiento de programas de atención bucodental con metas a corto, mediano y largo plazo

Oral health of the elderly: reality, myth, and perspective

As life expectancy increases, and with in both the relative and absolute mumbers of individuals age 60 and older, oro-dental health services face new challenges. This article explores the status of geriatric dental care in Latin America through a bibliographic review of epidemiologic studies included in the MEDLINE and LILACS systems, as well as PAHO studies on this subject. The areas addressed are the elderly's oro-dental health status, perceptions of their own oro-dental health, and frequency of dental service use. The review gives special attention to the critical state of oro-dental health among Latin America's elderly population, which exhibits high prevalences of caries-related tooth loss and total of dentition. The review revealed a scarcity of date relating to periodontal health and the health status of buccal soft tissues in the elderly population. It also found that elderly survey subjects tended to perceive their own oro-dental health in a manner inconsistent with clinical observations. According to several survey-based studies, most of those surveyed felt their oro-dental health was good or very good with few or no chewing problems. Regarding service utilization, many of those interviewed indicate they had not seen a dentist during the 6 months preceding the study. In view of the health, social, and psychologic consequences of the current situation for the elderly and the oral health services' potential for improving this population's quality of life, it is strongly recommended that appropiate and effective oro-dental health care programs oriented to this age group be developed

Chyle fistula in right cervical area after thyroid surgery

Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment (AU)

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