[Diagnosis and management in pediatric patients with ovarian masses]. / Diagnóstico y manejo de masas ováricas en pacientes pediátricas.

OBJECTIVE: Review of the diagnosis and management of ovarian masses in children, through the identification of preoperative risk factors of malignancy, the evaluation of surgical management and its results. METHODS: Retrospective study in pediatric patients under 18 years old, managed surgically by ovarian masses. Analyzed data were symptoms, imagining, tumor markers, treatment, outcomes and pathology. The primary endpoint was ovarian malignancy. RESULTS: We identified 54 patients with ovarian masses between 2014 and 2017, of which 49 were benign and 5 malignant; The malignant ovarian masses were significantly larger than the benign, with an average of 19.4 cm vs 6.49 cm (p = 0.0001); had greater solid component in the imaging and positive tumor markers (p = 0.001) and were treated with oophorectomy plus tumor staging surgery. Forty-three patients with benign tumors underwent ovarian preservation surgery. The postoperative follow-up of all the patients was on average 3.4 months (1-25 months) and 20.3% presented pelvic pain associated with alterations of the menstrual cycle in their postoperative control. There are no reports of recurrence or contralateral ovarian tumor. CONCLUSIONS: Large masses with solid components and positive tumor markers were significant predictors of malignancy. Minimally invasive ovarian preserving surgery should be considered as the first treatment option in masses with low risk of malignancy. On the other hand, oophorectomy plus tumor staging surgery should be considered for ovarian tumors with a high risk of malignancy.

OBJETIVO: Revisión del diagnóstico y manejo de las masas ováricas en población infantil, mediante la identificación de factores de riesgo preoperatorios de malignidad, la evaluación del manejo quirúrgico y sus resultados. METODOS: Estudio retrospectivo en pacientes pediátricas menores de 18 años, intervenidas quirúrgicamente por masas ováricas. Se analizaron datos como síntomas, imágenes diagnósticas, marcadores tumorales, tratamiento, resultados y patología. La variable principal fue malignidad ovárica. RESULTADOS: Se identificaron 54 pacientes con masas ováricas entre el año 2014 a 2017, de las cuales 49 fueron benignas y 5 malignas. Las masas ováricas malignas fueron significativamente más grandes que las benignas, con media de 19,4 cm vs 6,49 cm (p = 0,0001); tuvieron mayor componente sólido en los hallazgos imagenológicos y marcadores tumorales positivos (p = 0,001) y fueron tratadas con ooforectomía más cirugía de estadificación tumoral. A 43 pacientes con tumores benignos se les realizó cirugía preservadora de ovario. El seguimiento postoperatorio de todas las pacientes fue en promedio de 3,4 meses (1-25 meses) y el 20,3% presentaron dolor pélvico asociado a alteraciones del ciclo menstrual en su control postoperatorio. No hay reportes de recidiva ni tumor de ovario contralateral. CONCLUSIONES: Masas grandes, con componentes sólidos y marcadores tumorales positivos fueron predictores significativos de malignidad. La cirugía preservadora de ovario por vía mínimamente invasiva debe ser considerada como primera opción de tratamiento en masas con bajo riesgo de malignidad; Por otra parte, la ooforectomía más cirugía de estadificación tumoral, debe ser considerada para los tumores ováricos con alto riesgo de malignidad.

In vivo bactericidal efficacy of the Ti6Al4V surface after ultraviolet C treatment.

BACKGROUND: Biomaterial-associated infections are one of the most important complications in orthopedic surgery. The main goal of this study was to demonstrate the in vivo bactericidal effect of ultraviolet (UV) irradiation on Ti6Al4V surfaces. MATERIALS AND METHODS: An experimental model of device-related infections was developed by direct inoculation of Staphylococcus aureus into the canal of both femurs of 34 rats. A UV-irradiated Ti6Al4V pin was press-fit into the canal by retrograde insertion in one femur and the control pin was inserted into the contralateral femur. To assess the efficacy of UV radiation, the mean colony counts after inoculation in the experimental subjects and the control group were compared at different times of sacrifice and at different inoculum doses. RESULTS: At 72 h, the mean colony counts after inoculation in experimental femurs were significantly lower than those of the control group, with a reduction percentage of 76 % (p = 0.041). A similar difference between control and experimental pins was observed at 24 h using an inoculum dose <104 colony-forming units (CFU), for which the reduction percentage was 70.48 % (p = 0.017). CONCLUSION: The irradiated surface of Ti6Al4V is able to reduce early bacterial colonization of Ti6AlV pins located in the medullar channel and in the surrounding femur. The reductions depend on the initial inoculums used to cause infection in the animals and the greatest effects are detected for inoculums <104 CFU. LEVEL OF EVIDENCE: Not applicable.

Outcomes after septal myectomy in a cohort of patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) with left ventricular outflow tract obstruction that doesn't improve with pharmacological management often requires septal myectomy. However, there are few centers with experience in the practice of this procedure in our country. We describe the clinical and echocardiographic characteristics and postoperative outcomes of patients with HCM indicated for septal myectomy at a reference center in Colombia. MATERIALS AND METHODS: Retrospective cohort study. Patients undergoing septal myectomy between 2010 and 2023 were included. Data were collected before and two years after surgery. RESULTS: 18 patients were included. The mean age was 50 years. The predominant functional class was NYHA II/III (94 %). Asymmetric septal variant (83.3 %) was the most frequent as well as obstructive phenotype (88.8 %). After myectomy, 70.5 % improved to NYHA I and 62.4 % had no significant gradient (<30 mmHg), and the most of patient improved SAM. One patient died post-procedure, anymore complications were presented. DISCUSSION/CONCLUSIONS: Septal myectomy is a safe procedure, with clinical and echocardiographic improvement, with low complication rates.

Determination of biofilm production by Candida tropicalis isolated from hospitalized patients and its relation to cellular surface hydrophobicity, plastic adherence and filamentation ability.

Candida tropicalis is an emerging virulent species. The aim of this study is to determine the biofilm-forming ability of 29 strains of C. tropicalis isolated from inpatients, and to examine its relation with other virulence factors such as cellular surface hydrophobicity (CSH), immediate (15 min, IA) and late (24 h, LA) plastic adherence and filamentation ability. The study was performed in parallel using two incubation temperatures - 37 and 22 °C - to determine the effect of growth temperature variations on these pathogenic attributes of C. tropicalis. Biofilm formation (BF) was measured by optical density (OD) and by XTT reduction (XTT); Slime index (SI), which includes growth as a correction factor in BF, was calculated in both methods. All strains were hydrophobic and adherent - at 15 min and 24 h - at both temperatures, with higher values for 22 °C; the adhered basal yeast layer appears to be necessary to achieve subsequent development of biofilm. Filamentation ability varied from 76.2% of strains at 37 °C to 26.6% at 22 °C. All C. tropicalis strains were biofilm producers, with similar results obtained using OD determination and XTT measurement to evaluation methods; SI is useful when good growth is not presented. BF at 37 °C was similar at 24 h and 96 h incubation; conversely, at 22 °C, the highest number of biofilm-producing strains was detected at 96 h. CSH is an important pathogenic factor which is involved in adherence, is influenced by the filamentation of yeast, and plays a critical role in BF.

[Alkaptonuria: evolution and course of the disease towards ochronotic arthropathy. Series of cases managed with joint replacement]. / Alcaptonuria: evolución y curso de la enfermedad hacia artropatía ocronótica. Serie de casos manejados con reemplazo articular.

INTRODUCTION: alkaptonuria is a very rare metabolic disease with autosomal recessive inheritance due to HGA oxidase deficiency. Classically described and diagnosed in the third to fourth decade of life, affecting both men and women; Its diagnostic impression is clinical based on the blue/black coloration of the conjunctivae, however it is confirmed by the specific analysis of the enzyme in the urine, to date there is no cure and its treatment is palliative and symptomatic. MATERIAL AND METHODS: descriptive, observational, case series study, the primary objective of which is to describe the progression of the disease and its involvement in the musculoskeletal system. RESULTS: two clinical cases are presented in women and men in which the broad clinic is illustrated, its progressive advance and the different alterations that it can generate in the musculoskeletal system. CONCLUSIONS: alkaptonuria is a rare disease which leads to a severe secondary arthropathy, currently without a specific management which is based on treating the symptoms, in its final stages joint replacements are a management option with satisfactory results for the relief of pain.

INTRODUCCIÓN: la alcaptonuria es una enfermedad metabólica inusual, de herencia autosómica recesiva dada por la deficiencia de la oxidasa de HGA. Clásicamente descrita y diagnosticada sobre la tercera a cuarta década de la vida, la cual tiene afectación en ambos sexos, su impresión diagnóstica es clínica, basándose en la coloración azul/negro de las conjuntivas; sin embargo, se confirma mediante el análisis específico de la enzima en la orina, actualmente no existe un tratamiento definitivo, sólo alternativas en cuanto a lo paliativo y sintomático. MATERIAL Y MÉTODOS: estudio descriptivo, observacional, de tipo serie de casos, como objetivo primario se describe la progresión de la enfermedad y su compromiso en el sistema musculoesquelético. RESULTADOS: se presentan dos casos clínicos en mujer y hombre, los cuales ilustran: variedad clínica, avance progresivo y las alteraciones que puede generar en el sistema musculoesquelético. CONCLUSIONES: la alcaptonuria es una enfermedad rara, la cual conlleva una artropatía secundaria severa, sin un tratamiento definitivo dirigido a tratar los síntomas, incluso en sus estadios finales los reemplazos articulares son una opción para proporcionar manejo del dolor obteniendo resultados satisfactorios.

When to use a prophylactic mesh after stoma closure: a case-control study.

PURPOSE: The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%-40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. METHODS: An unpaired case-control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. RESULTS: 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97-17.68). CONCLUSIONS: The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

Aspartyl proteinase, phospholipase, hemolytic activities and biofilm production of Candida albicans isolated from bronchial aspirates of ICU patients.

A correlation between mucosal colonization by Candida albicans and the subsequent development of invasive respiratory infection has been previously described. The aim of this study was to evaluate different enzymatic activities in vitro and to determine the capacity to form biofilms by 17 C. albicans isolates from bronchial aspirates of mechanically ventilated patients hospitalized in intensive care units. All the C. albicans clinical isolates tested were biofilm producers and displayed detectable levels of proteinase and hemolytic activities, although phospholipase activity was not detected in one strain. The correlation noted among the virulence factors studied suggests that the presence of more than one concurrent factor could facilitate the spread of infection.

Effect of allicin on the production of polysaccharide intercellular adhesin in Staphylococcus epidermidis.

AIMS: Polysaccharide intercellular adhesin (PIA) is the main agglutination agent in the biofilm forming strain Staphylococcus epidermidis. To find an explanation for the observed inhibition of biofilm formation by allicin, we studied the effect of allicin on PIA production in samples treated with sub MIC doses of allicin and compared this with a control culture without allicin. METHODS AND RESULTS: Bacteria (Staph. epidermidis ATCC 35984) were grown in glass tubes, and PIA was extracted by vortex vibration using microbeads and NN dimethyl acetamide/LiCl as solvent. The extracts were filtered and passed through size exclusion columns. Chromatographic fractions were analysed with an excess of sodium metaperiodate and the excess was determined spectrophotometrically using 2,4,6-tripyridyl-s-triazine. CONCLUSION: The amount of exopolysaccharides in samples previously treated with allicin is significantly lower than in the control. This finding suggests a specific enzymatic inhibition in PIA synthesis. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides an insight into the mechanism of biofilm formation, and is a biochemical model for PIA inhibition by allicin. The analysis proposed may be useful in studies of production of exopolysaccharides responsible for adherence and agglutination of Staph. epidermidis. Prevention of biofilm formation by allicin opens up a new field of in vitro studies and permits us to envisage future clinical applications.

Enzymatic activities of Candida tropicalis isolated from hospitalized patients.

Secretion of hydrolytic enzymes is considered a virulence factor in Candida spp. Extracellular enzymatic activities in 29 clinical isolates of Candida tropicalis were analyzed by plate assays. C. tropicalis, similar to Candida albicans, showed elevated hemolytic and esterase activities. However, unlike C. albicans, low aspartyl protease and very low phospholipase activities were detected in C. tropicalis isolates.

Monitoring bacterial contamination in equine platelet concentrates obtained by the tube method in a clean laboratory environment under three different technical conditions.

REASONS FOR PERFORMING STUDY: There is a growing interest in the use of autologous platelet concentrates (PCs) as treatment for chronic musculoskeletal diseases in horses. However, there is no information on the risk of bacterial contamination during their preparation. OBJECTIVES: To: 1) assess the risk of bacterial contamination in equine PCs obtained by the tube method under 3 technical conditions: a) in a laminar flow cabinet, in a clean laboratory environment both with (b) and without (c) Bunsen burner; 2) identify the critical points of the process of PCs preparation with risk of bacterial contamination; and 3) identify the potential bacterial contaminants in the process and their antibiotic susceptibility. METHODS: Bacteriological samples were taken from: the skin (shaved or unshaved) of the venipuncture site in 15 horses, both before and after being disinfected; hands and throat of the operator; caps of the tubes where the blood was processed; environment where the equine blood samples were collected; laboratory environment; laminar flow cabinet; bacteriological stove; and PCs obtained under 3 technical conditions. RESULTS: Bacteria were isolated from nonaseptically prepared equine skin, hands and throat of the operator, and the place where the blood samples were taken. Bacteria were not isolated from tube caps, laboratory environment, laminar flow cabinet or PCs. The isolated bacteria were normal biota from equine skin, human skin and throat, and environmental contaminants. Of the isolated bacteria, 23% were resistant to penicillin, 19% to ampicillin, 2.12% to ceftiofur, 3.2% to sulphamethoxazole/trimethoprim and 1.1% to enrofloxacin. Resistance to amikacin and gentamicin was not seen. CONCLUSIONS AND POTENTIAL RELEVANCE: Uncontaminated PCs can be obtained by the tube method in a clean laboratory environment without the need for either a laminar flow cabinet or a Bunsen burner. It is mandatory to perform the procedure following strict aseptic technique.

[Incidence of cough after desflurane and sevoflurane administration through a laryngeal mask: a controlled clinical trial]. / Comparación de la incidencia de tos entre desflurano y sevoflurano cuando se utiliza la máscara laríngea. Ensayo clínico controlado.

OBJECTIVE: To determine the incidence of cough with the administration of desflurane and sevoflurane through a laryngeal mask. METHODS: A double-blind controlled clinical trial in 90 patients who received general anesthesia for ear, nose and throat surgery outpatient. The experimental group (n = 45) inhaled desflurane and the control group (n = 45) inhaled sevoflurane. Rugloop simulation software was used to assure that each patient was under the effect of the induction agent (propofol). The Gasman program was used to ascertain that a minimum alveolar concentration of 1 had been achieved before the hypnotic effect of propofol was lost. Cough was evaluated on the Shahbaz scale during the 10 minutes following induction and at the end of the procedure. RESULTS: Cough in the first 10 minutes was recorded in 53.6% of patients in the desflurane group and in 2.4% in the sevoflurane group (P < .05). Between-group differences were also evident at the end of surgery (desflurane group, 24%; sevoflurane group, 9.7%; P< .05). CONCLUSION: The patients who inhaled desflurane through a laryngeal mask had a higher incidence of cough than those who inhaled sevoflurane. The mechanism by which cough is being triggered by desflurane should be studied to determine whether the effect is chemical or mechanical and whether it is acting in the larynx or in the distal portion of the lung.

Cholelithiasis and associated complications in pediatric patients. / Colelitiasis y complicaciones asociadas en pacientes pediátricos.

OBJECTIVE: To review the clinical characteristics and complications associated with cholelithiasis in pediatric patients by identifying risk factors and assessing surgical management and results. METHODS: Retrospective study in patients under 18 years of age undergoing cholelithiasis surgery. The following data were analyzed: age, sex, body mass index (BMI), associated comorbidities, clinical presentation, symptom duration, surgical treatment, pathological report, postoperative complications, and hospital stay. RESULTS: 135 cholelithiasis patients underwent surgery from 2013 to 2018, with an increasing trend in the annual number of cholecystectomies. Most patients were adolescents (86.7%) and female (72.6%), and they had cholesterol gallstones (86.6%) and >85 BMI (33%). Mean symptom duration was 85 days (SD: 148). Symptomatic cholelithiasis was present in 131 cases (97%). CL associated complications were recorded in 64.4% of patients, with cholecystitis, pancreatitis, and choledocholithiasis being the most frequent ones. All patients underwent laparoscopic cholecystectomy; 4 (2.9%) required conversion to open surgery, and 6 (4.4%) had postoperative complications. Mean hospital stay and postoperative follow-up were 5.7 days (SD: 4) and 2.3 months (SD: 1.9), respectively. CONCLUSIONS: Non-hemolytic cholelithiasis in the pediatric population is more frequent in female overweight and obese adolescents. Symptomatic cholelithiasis is associated with higher risk of complications such as cholecystitis, pancreatitis, or choledocholithiasis, which supports early surgical management.

OBJETIVO: Revisión de las características clínicas y complicaciones asociadas de los pacientes pediátricos con colelitiasis, mediante la identificación de factores de riesgo, la evaluación del manejo quirúrgico y sus resultados. METODOS: Estudio retrospectivo en pacientes menores de 18 años, intervenidos quirúrgicamente por colelitiasis. Se analizaron datos como edad, género, índice de masa corporal (IMC), comorbilidades asociadas, presentación clínica, tiempo de los síntomas, tratamiento quirúrgico, reporte de patología, complicaciones posoperatorias y estancia hospitalaria. RESULTADOS: Se intervinieron quirúrgicamente 135 pacientes con colelitiasis entre los años 2013 a 2018, con una tendencia ascendente en el número de colecistectomías realizadas anualmente. La mayoría fueron pacientes adolescentes (86,7%), con cálculos de colesterol (86,6%), de género femenino (72,6%) y con IMC > 85 (33%). El tiempo de los síntomas en promedio fue de 85 días (DE 148). Colelitiasis sintomática se presentó en 131 casos (97%). Complicaciones asociadas a CL se registraron en 64,4% pacientes, siendo las más frecuentes colecistitis, pancreatitis y coledocolitiasis. En todos los pacientes se realizó colecistectomía laparoscópica, 4 (2,9%) requirieron conversión a cirugía abierta y 6 (4,4%) presentaron complicaciones postoperatorias. La estancia hospitalaria y el seguimiento posoperatorio fueron en promedio 5,7 días (DE 4) y 2,3 meses (DE 1,9), respectivamentea. CONCLUSIONES: La colelitiasis no hemolítica en la población pediátrica, es más frecuente en pacientes adolescentes de género femenino con sobrepeso u obesidad. La colelitiasis sintomática está asociada con mayor riesgo de complicaciones como colecistitis, pancreatitis o coledocolitiasis, en consecuencia, se justifica una intervención quirúrgica temprana.

First Report of Phaeoacremonium parasiticum Causing Petri Disease of Grapevine in Peru.

Since 2005, symptoms of grapevine decline have been observed on 4- to 8-month-old grapevines (cvs. Red globe and Crimson) grafted onto 1103 P rootstock in Ica and Pisco valleys in southern Peru. Affected plants exhibited weak growth, interveinal chlorosis, necrosis and wilting of leaves, and death. Dark brown-to-black streaking of the xylem was seen when transverse or longitudinal cuts were made in the trunk and shoots. Symptomatic plants were collected and sections (5 cm long) were cut from the zone between the rootstock and the scion, surface sterilized for 1 min in a 1.5% sodium hypochlorite solution, and washed twice with sterile distilled water. The sections were split longitudinally, and small pieces of discolored tissues were placed onto potato dextrose agar (PDA) supplemented with oxytetracycline (500 mg liter-1). Plates were incubated at 25°C in the dark for 15 days. A Phaeoacremonium sp. was consistently isolated from necrotic tissues. Single conidial isolates were obtained and grown on PDA and malt extract agar (MEA) in the dark at 25°C for 3 weeks until colonies produced spores (3). Colonies were brown on PDA and olive brown on MEA. Conidiophores were branched, 27.5 to 67.5 (42.5) µm long, and often consisting of a single phialide. Conidia were hyaline, oblong ellipsoidal, 2.5 to 4.5 (3.6) µm long, and 1.2 to 1.9 (1.6) µm wide. On the basis of these characteristics, the isolates were identified as Phaeoacremonium parasiticum (Ajello, Georg & C.J.K Wang) W. Gams, Crous & M.J. Wingf. (teleomorph Togninia parasitica L. Mostert, W. Gams & Crous) (2,3). Identity of isolate Ppa-1 was confirmed by PCR-restriction fragment length polymorphism of the internal transcribed spacer region (Phaeoacremonium-specific primers Pm1-Pm2) with the restriction enzymes BssKI, EcoO109I, and HhaI (1). Additionally, the beta-tubulin gene fragment (primers T1 and Bt2b) of this isolate was sequenced (GenBank Accession No. FJ151015). The sequence was identical to the sequence of P. parasiticum (GenBank Accession No. AY328379). Pathogenicity tests were conducted using the isolate Ppa-1. Approximately 20 µl of a suspension containing 103 conidia ml-1 was injected into the pith of four nodes on each of 10 dormant, unrooted, 15 cm long cuttings of cv. Red Globe. Four nodes on each of 10 cuttings were used as controls and injected with an equal volume of sterile distilled water. Inoculation points were covered with Parafilm. The cuttings were planted in plastic pots and maintained at 24 ± 3°C in diffuse light, watering as needed. Within 2 months of inoculation, all P. parasicitum-inoculated cuttings exhibited shoots with very poor growth with small leaves and short internodes. In the xylem vessels, black streaks identical to symptoms observed in declining vines in the vineyard were observed. Control plants did not show any of these symptoms. The fungus was reisolated from internal tissues of symptomatic shoots of all inoculated cuttings but not from the control shoots. To our knowledge, this is the first report of P. parasiticum causing young grapevine decline in Peru. References: (1) A. Aroca and R. Raposo. Appl. Environ. Microbiol. 73:2911, 2007. (2) P. W. Crous et al. Mycology 88:786, 2006. (3) L. Mostert et al. Stud. Mycol. 54:1, 2006.

First Report of Aspergillus flavus Colonizing Naturally Dispersed Seeds of Oxandra acuminata, Pseudomalmea diclina, and Unonopsis matthewsii in Peru.

Tree species Oxandra acuminata, Pseudomalmea diclina, and Unonopsis matthewsii (Annonaceae) are sources of wood for people of the Amazonian Region where the trees are harvested from natural populations. With increased human population and agriculture in the Amazonian Region, forest diversity is affected. To manage the forest communities, it is necessary to understand the dynamics of regeneration of forest plants. Diseases that affect seed and seedling survival are critical in determining the ultimate species composition. During the dry season in June of 2006, rotten seeds of U. matthewsii (approximately 90% of 380 seeds) were observed in seven natural locations over an area of 150 ha in lowland tropical forest in Manu National Park, Peru. Colonized seeds were open and covered with yellow, dry, powdery, easily liberated conidia. One month later, seeds of O. acuminata in the same locations showed the same symptoms. In August of 2007, P. diclina seeds were naturally dispersed (by animals) in these plots and showed similar symptoms. The disease affecting O. acuminata was found in two other sampling sites along the river at the Los Amigos Research Station located 80 km southeast of Manu National Park. In all cases, the pathogen was identified as Aspergillus flavus based on morphological characteristics (1,2). Isolation of the pathogen was made on potato dextrose agar (PDA) amended with chloramphenicol (100 mg/l) and incubated at 28°C for 5 to 7 days. Single-spore isolations were made from each plant species and maintained as stock cultures. Colonies grown on PDA were granular, flat, and yellow at first, but quickly became bright to dark yellow-green. The radiate conidial heads measured approximately 400 µm in diameter. Older globose vesicles measured from 28 to 45 µm in diameter. Conidia were globose or subglobose with roughened walls and measured 3 to 5.5 µm in diameter. For pathogenicity tests, healthy seeds from the three species obtained from several trees, were previously surface sterilized by dipping in a 0.1% chlorine solution and allowed to dry. To inoculate seeds, a small scalpel was used to make a superficial cut on the seeds, after which a conidial suspension (3 × 105 conidia/ml of distilled water) was pipetted over each wound. For each plant species, 20 seeds were inoculated and 20 were used as control. This procedure was repeated twice. Each seed was maintained in a petri plate at ambient temperature in a field station lab and evaluated daily for 10 days. Inoculated seeds of all three species showed symptoms identical to those seen in field populations. Colonized seeds died after 2 to 7 days, and dry, yellow conidia were produced inside the open seed after approximately 1 to 2 days of decay. A. flavus was reisolated from colonized seeds. Control seeds remained healthy. A. flavus is ubiquitous and has been reported on numerous host plants worldwide (1,2). However, to our knowledge, this is the first report of A. flavus causing high seed mortality of species of Annonaceae in Peru. Our observations suggest that A. flavus is an important fungus affecting survival of seeds of O. acuminata, P. diclina, and U. matthewsii in the natural plant communities where we conducted this study. References: (1) B. W. Horn. Mycologia 97:202, 2005. (2) K. B. Raper and D. I. Fennell. The Genus Aspergillus. Williams and Wilkins, Baltimore, MD, 1965.

Alcaptonuria: evolución y curso de la enfermedad hacia artropatía ocronótica. Serie de casos manejados con reemplazo articular / Alkaptonuria: evolution and course of the disease towards ochronotic arthropathy. Series of cases managed with joint replacement

Resumen: Introducción: la alcaptonuria es una enfermedad metabólica inusual, de herencia autosómica recesiva dada por la deficiencia de la oxidasa de HGA. Clásicamente descrita y diagnosticada sobre la tercera a cuarta década de la vida, la cual tiene afectación en ambos sexos, su impresión diagnóstica es clínica, basándose en la coloración azul/negro de las conjuntivas; sin embargo, se confirma mediante el análisis específico de la enzima en la orina, actualmente no existe un tratamiento definitivo, sólo alternativas en cuanto a lo paliativo y sintomático. Material y métodos: estudio descriptivo, observacional, de tipo serie de casos, como objetivo primario se describe la progresión de la enfermedad y su compromiso en el sistema musculoesquelético. Resultados: se presentan dos casos clínicos en mujer y hombre, los cuales ilustran: variedad clínica, avance progresivo y las alteraciones que puede generar en el sistema musculoesquelético. Conclusiones: la alcaptonuria es una enfermedad rara, la cual conlleva una artropatía secundaria severa, sin un tratamiento definitivo dirigido a tratar los síntomas, incluso en sus estadios finales los reemplazos articulares son una opción para proporcionar manejo del dolor obteniendo resultados satisfactorios.

Abstract: Introduction: alkaptonuria is a very rare metabolic disease with autosomal recessive inheritance due to HGA oxidase deficiency. Classically described and diagnosed in the third to fourth decade of life, affecting both men and women; Its diagnostic impression is clinical based on the blue/black coloration of the conjunctivae, however it is confirmed by the specific analysis of the enzyme in the urine, to date there is no cure and its treatment is palliative and symptomatic. Material and methods: descriptive, observational, case series study, the primary objective of which is to describe the progression of the disease and its involvement in the musculoskeletal system. Results: two clinical cases are presented in women and men in which the broad clinic is illustrated, its progressive advance and the different alterations that it can generate in the musculoskeletal system. Conclusions: alkaptonuria is a rare disease which leads to a severe secondary arthropathy, currently without a specific management which is based on treating the symptoms, in its final stages joint replacements are a management option with satisfactory results for the relief of pain.

Antibacterial effect of novel biodegradable and bioresorbable PLDA/Mg composites.

Polylactic acid/Mg composites have been recently proposed for biodegradable osteosynthesis devices because, with regards to the neat polymer, they combine an enhanced biocompatibility and bioactivity with better mechanical properties, particularly creep strength. A question still arises about their bacterial behavior. For this purpose, composites of poly-L-D-lactic acid (PLDA) loaded with 1 and 10 wt.% of Mg microparticles were evaluated using Staphylococcus epidermidis, with special emphasis on the study of bacterial adhesion and biofilm formation. During biofilm formation the bacteria viability of the composites decreased up to 65.3% with respect to PLDA. These antibacterial properties do not compromise the cytocompatibility of the material as the composites enhanced the viability of mesenchymal stem cells and their osteogenic commitment. These findings provide an important added value to the biodegradable and biocompatible PLDA/Mg composites for the manufacture of osteosynthesis devices.

[Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers]. / Resultados de una intervención para disminuir prescripciones potencialmente inapropiadas de bloqueadores beta y calcioantagonistas.

OBJECTIVE: To determine the frequency of simultaneous prescription of ß-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them. METHODS: Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a ß-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months. RESULTS: A total of 535 patients, with a mean age 75.8±6.7 years received concomitant ß-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription. CONCLUSIONS: An improved adherence to recommendations for appropriate use of ß-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently.

In vivo bactericidal efficacy of farnesol on Ti6Al4V implants. / Eficacia bactericida in vivo del farnesol sobre implantes de Ti6Al4V.

OBJECTIVE: To evaluate the in vivo anti-staphylococcal bactericidal activity of farnesol on Ti6Al4V surfaces. MATERIAL AND METHODS: An experimental model of infection in biomaterials was developed by inoculation of Staphylococcus aureus ATCC 29213 into the canal of both femurs of 15 Wistar rats. A Ti6Al4V pin impregnated with 30mM of farnesol was inserted into study femur, and a Ti6Al4V control was inserted into the control femur. To evaluate the bactericidal efficacy, a comparison was made between the median of the colony forming units recovered after inoculation in the study group and the control group for different times of euthanasia and inoculum size. RESULTS: The median expressed as Log10 CFU counts obtained with farnesol titanium pin was 4.26, and in control group, it was 4.86, which was statistically significant (P=.001) on applying the Student t test for related samples. The median reduction obtained in farnesol pins relative to the control was 74%. CONCLUSIONS: Treatment with farnesol 30mM on Ti6Al4V pins appears to decrease the rate of colonisation by Staphylococcus aureus.

[Quality of conventional release verapamil prescription in patients with arterial hypertension]. / Calidad de la prescripción de verapamilo de liberación convencional en pacientes con hipertensión arterial.

OBJECTIVE: To identify patients who were being treated for hypertension with conventional release verapamil (CRV), and to notify the professional responsible for their health care on cardiovascular risk to which they are exposed and achieve a reduction in the number of patients who are treated with this drug. METHODS: A quasi-experimental prospective before and after study without a control group was conducted on 7289 patients diagnosed with hypertension who were on treatment with CRV, between October 1, 2012 and December 31, 2012 in 8 Colombian cities, collected from a database for dispensing medicines. Socio-demographic and pharmacological variables were evaluated. A total of 108 educational interventions were performed on those responsible for their health care, and evaluated within three months with the proportion of suspension of the prescriptions of CRV being evaluated. Multivariate analysis was performed using SPSS 22.0. RESULTS: The mean age of patients was 67.9±11.8 years (range: 26-96 years), of which 70.6% were men. Withdrawal of treatment with CRV was achieved in a total of 1922 patients (26.3% of users), distributed as follows: 1160 (60.4%) were the presentation of 120mg, while 762 (39.6%) the 80mg. The variable being treated in the city of Medellin (OR: 17.6; 95% CI: 11.949 to 25.924; P<.01) was statistically significantly associated with the replacement of CRV for another antihypertensive. CONCLUSIONS: A relatively moderate adherence to recommendations about the proper use of CRV in hypertensive patients, was found. Intervention programs that reduce inappropriate prescribing of potential risks to patients of insurance companies and cities where the change was not achieved, must be enforced.