Protocolo BAMP: Reporte de Caso Clínico

El presente reporte tiene como objetivo presentar de manera secuencial y visual la protracción maxilar de un paciente clase III esqueletal, utilizando el protocolo BAMP. Una vez realizado el análisis clínico del caso se decidió realiza un tratamiento ortopédico a través del uso de miniplacas de titanio con elásticos intermaxilares de clase III siguiendo el protocolo BAMP, junto a un tratamiento ortodóncico dento alveolar con aparatología fija bimaxilar prescripción Roth 0.22" Mini sprint forestadent. Se observa el éxito del enfoque interceptivo utilizando el protocolo BAMP. Este enfoque logró reducir tanto el tiempo como la complejidad del tratamiento ortodóncico, y también disminuyó la necesidad de someterse a una cirugía ortognática en la edad adulta. El tratamiento BAMP, diseñado para ciertas edades y crecimiento, se demostró exitoso en un paciente de 12 años sin potencial de crecimiento. Las miniplacas como anclaje son efectivas para protracción maxilar en varios casos, aunque se necesita seguimiento y educación postquirúrgica. Se recomienda retirar las miniplacas cuando no sean necesarias, adaptando el protocolo a cada paciente. En resumen, el tratamiento con miniplacas es eficaz para corregir anomalías Clase III esqueléticas.

The present report aims to sequentially and visually present the maxillary protraction of a Class III skeletal patient using the BAMP protocol. After conducting a clinical analysis of the case, it was decided to perform orthopedic treatment using titanium miniplates with Class III intermaxillary elastics following the BAMP protocol, in conjunction with dentoalveolar orthodontic treatment using fixed bimaxillary appliances with Roth prescription 0.022" Mini Sprint Forestadent. The success of the interceptive approach using the BAMP protocol is observed. This approach managed to reduce both the time and complexity of orthodontic treatment and also decreased the need for orthognathic surgery in adulthood. The BAMP treatment, designed for specific ages and growth stages, proved successful in a 12-year-old patient without growth potential. Miniplates as anchorage are effective for maxillary protraction in various cases, although post-surgical follow-up and education are required. It is recommended to remove the miniplates when they are no longer necessary, adapting the protocol to each patient. In summary, miniplate treatment is effective in correcting Class III skeletal anomalies.

Characterization of inflammatory bowel disease in Colombia: Results of a national register. / Caracterización de la enfermedad inflamatoria intestinal en Colombia: resultados de un registro nacional.

AIM: To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register. METHODS: A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted. RESULTS: A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000). CONCLUSION: In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.

El espacio muerto (VD/VT) como predictor de éxito en la extubación de pacientes postquirúrgicos de cirugía cardiovascular pediátrica / Dead space (VD/VT) as a predictor of successful extubation of patients after pediatric cardiovascular surgery

Introducción: La ventilación mecánica (VM) forma parte de la recuperación postoperatoria (PO) de niños con cirugía de cardiopatía congénita, pero su uso no está exento de riesgos. El fracaso de extubación (FE) se ha asociado con internaciones prolongadas, aumento de complicaciones y mortalidad. El objetivo es determinar un valor de Vd/Vt predictor de extubación exitosa (EE). Material y métodos: estudio de cohorte prospectivo y observacional realizado del 1 de Enero al 31 de Diciembre de 2016 en niños menores de 6 meses cursando PO de cirugía cardiovascular con circulación extracorpórea (CEC) con requerimientos de VM por más de 48 horas. En los mismo se analizó el éxito o fracaso de extubación. Previo a la extubación se registraron valores de mecánica respiratoria; Vd/Vt, CO2 espiratoria final, Vt/kg, etc. Otras variables registradas: edad, sexo, peso, requerimiento de VM antes de la cirugía, fisiología de ventrículo único, duración de VM, complicaciones, duración de la internación y mortalidad. Las variables continuas se describieron como mediana y rango intercuartilo (25-75) y se compararon con prueba de Wilcoxon, las categóricas como proporciones o porcentajes y se analizaron con chi2 . Se efectuó un análisis bivariado con diferentes puntos de corte de Vd/Vt pre extubación para realizar un análisis de sensibilidad del valor predictivo de EE. Resultados: Se evaluó Vd/Vt en 67 pacientes, tres se eliminaron por parálisis cordal (1) y parálisis del diafragma (2). Mediana de edad 23 días (10-55), peso 3.2 Kg (2.89- 3.88), días de VM 5 (3-7), días de internación 15 (2- 128), mortalidad 7,8%. Se extubaron con éxito 76% de los pacientes (50/64). Las características demográficas de los pacientes, la mecánica respiratoria, gases de sangre arterial y EtCO2 no tuvieron asociación significativa con EE. Un Vd/Vt pre extubación < 0,53 se asoció con EE. Conclusión: En la población estudiada un valor de Vd/Vt <0,53 se asoció con EE. Los pacientes con ventrículo único presentaron mayor FE.(AU)

Introduction: Mechanical ventilation (MV) is part of postoperative (PO) recovery of children with congenital heart disease surgery, but is not without risks. Extubation failure (EF) has been associated with prolonged hospital stays and increased complication and mortality rates. The goal is to determine the value of Vd/Vt as a predictor of successful extubation (SE). Material and methods: A prospective and observational cohort study was conducted from January 1 to December 31, 2016, in children under 6 months of age undergoing cardiovascular surgery with extracorporeal circulation (ECC) and requiring MV for more than 48 hours. Intubation success or failure was evaluated. Prior to extubation, respiratory mechanics values, such as Vd/Vt, final expiratory CO2, and Vt/kg, were recorded. Other variables, including age, sex, weight, VM requirement before surgery, single ventricle physiology, VM duration, complications, length of hospital stay, and mortality were also recorded. Continuous variables were described as median and interquartile range (25-75) and compared with the Wilcoxon test. Categorical variables were described as proportions or percentages and analyzed with chi2. Bivariate analysis was performed with different pre-extubation Vd/Vt cut-off points to analyze the sensitivity of the predictive value for SE. Results: Vd/Vt was evaluated in 67 patients; three were excluded because of vocal fold (1) and diaphragm paralysis (2). Median age was 23 days (10-55), weight 3.2 Kg (2.89- 3.88), days on MV 5 (3-7), length of hospital stay 15 (2- 128), and mortality rate 7.8%. Overall, 76% of patients (50/64) were successfully extubated. Patient demographics, respiratory mechanics, arterial blood gases, and EtCO2 were not significantly associated with SE. A pre-extubation Vd/ Vt < 0.53 was associated with SE. Conclusion: In this series of patients, a Vd/Vt value of <0.53 was associated with SE. EF was increased in patients with a single ventricle (AU)

Lesión renal aguda en niños poscirugía cardíaca: factores de riesgo e impacto evolutivo. Estudio de cohorte retrospectiva / Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica.Población y métodos:Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos.Resultados.Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas.Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA

Introduction. Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the post-operative course.Population and methods. This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output.Results. A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications.Conclusion. In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.

Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study. / Lesión renal aguda en niños poscirugía cardíaca: factores de riesgo e impacto evolutivo. Estudio de cohorte retrospectiva.

INTRODUCTION: Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the postoperative course. POPULATION AND METHODS: This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output. RESULTS: A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications. CONCLUSION: In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica. Población y métodos: Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos. Resultados. Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas. Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA.

Interactions of valproic acid with lipid membranes of 1,2-dimyristoyl-sn-glycero-3-phosphocholine.

Lipid bilayers of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) were prepared in two forms, as a suspension of multilamellar spherical vesicles and as planar membranes deposited on a conductive solid support. We used Fourier Transformed Infrared (FTIR) and Raman spectroscopic techniques to study the lipid vesicles while the solid supported bilayers were characterized by using electrochemical experiments (cyclic voltammetry and impedance). Valproic acid (Valp) was either present in the solution or incorporated into the lipid structure. As the Valp:DMPC ratio increases the phase transition temperature decreases while the phase transition becomes less marked. Moreover, for the Valp:DMPC complex species a slight decrease in the number of gauche isomers was observed relative to the number of trans isomers what corresponds to an increase in the packing density of the acylic chains. Based on derived electrical properties of the supported membranes it can be concluded that Valp induces the formation of pores and other defects in the lipid films. Valp incorporated into the membrane is seriously detrimental to the bilayer stability.

Characterization of interactions of eggPC lipid structures with different biomolecules.

In this paper we study the interactions of two biomolecules (ascorbic acid and Annonacin) with a bilayer lipid membrane. Egg yolk phosphatidylcholine (eggPC) liposomes (in crystalline liquid state) were prepared in solutions of ascorbic acid (AA) at different concentration levels. On the other hand, liposomes were doped with Annonacin (Ann), a mono-tetrahydrofuran acetogenin (ACG), which is an effective citotoxic substance. While AA pharmacologic effect and action mechanisms are widely known, those of Ann's are only very recently being studied. Both Fourier Transformed Infrared (FTIR) and Raman spectroscopic techniques were used to study the participation of the main functional groups of the lipid bilayer involved in the membrane-solution interaction. The obtained spectra were comparatively analyzed, studying the spectral bands corresponding to both the hydrophobic and the hydrophilic regions in the lipid bilayer. Electrochemical experiments namely; impedance spectroscopy (EIS) and cyclic voltamperometry (CV) were used as the main characterization techniques to analyse stability and structural changes of a model system of supported EggPC bilayer in connection with its interactions with AA and Ann. At high molar ratios of AA, there is dehydration in both populations of the carbonyl group of the polar head of the lipid. On the other hand, Ann promotes the formation of hydrogen bonds with the carbonyl groups. No interaction between AA and phosphate groups is observed at low and intermediate molar ratios. Ann is expected to be able to induce the dehydration of the phosphate groups without the subsequent formation of H bonds with them. According to the electrochemical analysis, the interaction of AA with the supported lipid membrane does not alter its dielectric properties. This fact can be related to the conservation of structured water of the phosphate groups in the polar heads of the lipid. On the other hand, the incorporation of Ann into the lipid membrane generates an increase in the number of defects while changes the dielectric constant. This, in turn, can be associated with the induced dehydration of the phosphate groups.

Using synoptic tracer surveys to assess runoff sources in an Andean headwater catchment in central Chile.

Headwater catchments in the Andes provide critical sources of water for downstream areas with large agricultural communities dependent upon irrigation. Data from such remote headwater catchments are sparse, and there is limited understanding of their hydrological function to guide sustainable water management. Here, we present the findings of repeat synoptic tracer surveys as rapid appraisal tools to understand dominant hydrological flow paths in the semi-arid Rio Grande basin, a 572-km2 headwater tributary of the 11,696-km2 Limarí basin in central Chile. Stable isotopes in stream water show a typical altitudinal effect, with downstream enrichment in δ2H and δ18O ratios. Seasonal signals are displayed in the isotopic composition of the springtime melting season water line with a steeper gradient, whilst evaporative effects are represented by lower seasonal gradients for autumn and summer. Concentrations of solutes indexed by electrical conductivity indicate that there are limited contributions of deeper mineralised groundwater to streamflow and that weathering rates vary in the different sub-catchments. Although simplistic, the insights gained from the study could be used to inform the structure and parameterisation of rainfall runoff models to provide seasonal discharge predictions as an evidence base for decision making in local water management.

Transfusion-Related Acute Lung Injured (TRALI): Current Concepts.

Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.

Cumplimiento del tratamiento farmacológico en mujeres adultas con hipotiroidismo primario / Drug Treatment Adherence in Adult Women with Primary Hypothyroidism

Introducción: La falta de cumplimiento al tratamiento puede ser causa del fracaso terapéutico en pacientes hipotiroideos. Objetivos: Conocer en mujeres adultas hipotiroideas el cumplimiento al tratamiento farmacológico según el nivel de conocimiento de la enfermedad, los síntomas y signos que la caracterizan y la forma de controlarla. Material y Métodos: Diseño observacional transversal en muestra no probabilística de mujeres mayores de 40 años con hipotiroidismo primario tratadas con levotiroxina, que asistieron a realizarse prueba de laboratorio a un Instituto de Análisis de la Ciudad Autónoma de Buenos Aires (CABA) entre los meses de agosto y octubre de 2012. Variables: Por interrogatorio directo se estudió el conocimiento de la enfermedad medido por el Test de Batalla y cumplimiento al tratamiento farmacológico medida con el test de Morisky-Green. Estadística con el paquete estadístico SPSS 15.0 estableciendo medidas de tendencia central, Odds Rattio, X² o Prueba de Fisher según el tamaño muestral. Resultados: Se evaluaron 171 mujeres con edad promedio de 54,8 ± 7,2 años. El 57,3 % refiere un correcto conocimiento sobre la enfermedad. El 74,3 % cumple el tratamiento farmacológico. El 97,1 % de la muestra refiere tomar la levotiroxina en ayunas, el 19,9 % olvida alguna vez tomarla y solo el 5,8 % afirma abandonar el fármaco en caso de malestar. Al asociar el conocimiento de la enfermedad con el cumplimiento de la ad­ministración del fármaco, se observó que a pesar que un 42,7 % del total de mujeres no tienen conocimiento sobre la enfermedad, un 29,3 % de ellas igualmente cumple el tratamiento, no encontrándose asociación significativa entre ambas variables (OR = 1,68; IC95 % = 0,84-3,36; p = 0,15). Conclusiones: Poco más de la mitad de la muestra conoce acerca de la enfermedad. La mayoría cumple el tratamiento farmacológico. No se encontró asociación significativa entre el conocimiento de la enfermedad y el cumplimiento de su tratamiento.

Introduction: Non-adherence to treatment may be a cause of therapeutic failure in hypothyroid patients. Aims: To assess adherence to drug treatment in hypothyroid adult women by level of knowledge of the disease, signs and symptoms that characterize it and how to control it. Material and methods: Cross-sectional design; non-random sample of women aged 40 and older, with primary hypothyroidism treated with levothyroxine, who attended the Instituto de Análisis de la Ciudad Autónoma de Buenos Aires (CABA) for laboratory testing between August and October 2012. Variables studied: knowledge of the disease measured by Batalla´s Test and adherence to drug treatment measured by Morinsky Green's Test. Data collection was performed by direct questioning. Statistical analysis performed by SPSS 15.0 establishing measures of central tendency, Odds Ratio X² and Fisher test according to sample size. Results: We evaluated 171 women with an average age of 54.8 ± 7.2 years; 57.3 % reported a correct level of knowledge about the disease, 74.3 % adhered to drug treatment, 97.1 % of the sample reveals taking levothyroxine while fasting, 19.9 % admits sometimes forgetting to take it and only 5.8 % admitted to discontinuing the drug in case of discomfort. When associating knowledge of the disease with adherence to drug administration, we observed that although 42.7 % of women had no knowledge about the disease, 29.3 % of them also adhered to treatment, finding no significant association between the two variables (OR = 1.68; IC95 % = 0.84-3.36; p = 0.15). Conclusions: Just over half of the sample has knowledge about the disease. Most adhere to drug treat­ment. No significant association between knowledge of the disease and adherence to treatment was found.

Cellular mechanisms against ischemia reperfusion injury induced by the use of anesthetic pharmacological agents.

Ischemia-reperfusion (IR) cycle in the myocardium is associated with activation of an injurious cascade, thus leading to new myocardial challenges, which account for up to 50% of infarct size. Some evidence implicates reactive oxygen species (ROS) as a probable cause of myocardial injury in prooxidant clinical settings. Damage occurs during both ischemia and post-ischemic reperfusion in animal and human models. The mechanisms that contribute to this damage include the increase in cellular calcium (Ca(2+)) concentration and induction of ROS sources during reperfusion. Pharmacological preconditioning, which includes pharmacological strategies that counteract the ROS burst and Ca(2+) overload followed to IR cycle in the myocardium, could be effective in limiting injury. Currently widespread evidence supports the use of anesthetics agents as an important cardioprotective strategy that act at various levels such as metabotropic receptors, ion channels or mitochondrial level. Their administration before a prolonged ischemic episode is known as anesthetic preconditioning, whereas when given at the very onset of reperfusion, is termed anesthetic postconditioning. Both types of anesthetic conditioning reduce, albeit not to the same degree, the extent of myocardial injury. This review focuses on cellular and pathophysiological concepts on the myocardial damage induced by IR and how anesthetic pharmacological agents commonly used could attenuate the functional and structural effects induced by oxidative stress in cardiac tissue.

Síndrome de Wooblers en un caballo / Wooblers syndrome in a horse

Se describe un caso de síndrome de Wooblers en un caballo, macho entero, de 14 años de edad, procedente del municipio de Cereté (Córdoba, Colombia). Esta patología es también conocida en equinos como mielopatía estenótica vertebral cervical (MEVC), la cual es una enfermedad del desarrollo caracterizada por estenosis del canal vertebral cervical resultando en compresión intermitente o continua de la médula espinal. A este paciente se le detectaron signos de incoordinación con tropiezos, ataxia simétrica, paresia o debilidad, espasticidad y pérdida de la propiocepción, principalmente en los miembros posteriores, por lo que se le realizó radiología cervical detectando estenosis de canal medular a nivel de la vértebra cervical C4. Estos hallazgos obedecen principalmente al síndrome de Wooblers.

A case of Wooblers syndrome is described in a complete male 14-year-old horse from the town of Cereté (Cordoba, Colombia). This condition is also known as equine cervical vertebral stenotic myelopathy (CVSM), which is a disease characterized by developmental cervical spinal canal stenosis resulting in intermittent or continuous compression of the spinal cord. This patient showed to have signs of incoordination which included stumbling, symmetrical ataxia, paresis or weakness, spasticity and loss of propioception, particularly in the hindquarters, so that radiology was performed to detect cervical spinal canal stenosis at the level of the cervical vertebrae C4. These findings are related as Wooblers syndrome.

Especies promisorias para el ecoturismo en Campo Aventura Roca Madre, Toluviejo-Sucre, Colombia / Promising species for the development of ecotourism in Campo Aventura Roca Madre, Toluviejo-Sucre, Colombia

Objetivo. Determinar las especies de flora y fauna más importantes para el desarrollo del ecoturismo, en una localidad del departamento de Sucre, Colombia. Materiales y métodos. Se hizo un listado de las especies de flora y fauna observadas en el sendero ecológico de un centro de ecoturismo en Toluviejo, Sucre y se calculó su abundancia, importancia económica, estado de conservación y adaptaciones, que fueron evaluadas mediante un índice de importancia potencial para el ecoturismo, que suma los valores que se asignan a las variables consideradas de interés. Resultados. Se detectaron 18 especies promisorias de fauna, de 91 especies observadas y 16 especies vegetales de 53 observadas. Los animales de mayor potencial ecoturístico resultantes, fueron: Dendrobates truncatus y Saguinus oedipus, especies endémicas de Colombia, seguidas por Basiliscus basiliscus, Atta sp., Morpho peleides, Lycorea halia y Ara ararauna; todas estas con una alta abundancia y fácil detección. Dentro de las plantas, Anacardium excelsum obtuvo el mayor índice de importancia, como resultado de su endemismo y sus adaptaciones. Las especies Piper auritum, Matayba escrobiculata, Tabernaemontana cymosa y la comúnmente conocida como jazmín de monte, fueron fácilmente detectables y abundantes, además Brownea ariza y Tabebuia rosea resultaron las más representativas por la belleza de sus flores. Conclusiones. Se determinaron las especies que pueden ser de interés para los ecoturistas y esto hace posible mejorar el producto que se oferta a partir de profundizar en su conocimiento.

Objectives. To determine the species of flora and fauna relevant for development of ecotourism in a location of Sucre, Colombia. Materials and methods. A list of various species at the ecotourism center in the municipality of Toluviejo, Sucre, was studied which included abundance, economic and conservation relevance and adaptation data. The census was estimated and evaluated according to our index of potential importance for ecotourism, by adding the values assigned to each of the variables of interest. Results. 18 promising species of fauna and 16 promising species of plants were found. Animals with higher ecotourism potential were Dendrobates truncatus and Saguinus oedipus, endemic to Colombia, followed by Basiliscus basiliscus, Atta sp. Morpho peleides, Lycorea halia, Ara ararauna, all these of high abundance and easy detection. Regarding plants, Anacardium excelsum obtained the highest value as a result of endemism and their adaptations. Piper auritum, Matayba escrobiculata, Tabernaemontana cymosa and the specie commonly known as "jazmín de monte", were easily detectable and abundant. Brownea ariza and Tabebuia rosea were the best candidates because of the beauty of their flowers. Conclusions. The species that may be of interest to eco-tourists were determined and this makes it possible to improve the product offering from deepening their knowledge.

Air Quality Standards for Particulate Matter (PM) at high altitude cities.

The Air Quality Standards for Particulate Matter (PM) at high altitude urban areas in different countries, must consider the pressure and temperature due to the effect that these parameters have on the breath volume. This paper shows the importance to correct Air Quality Standards for PM considering pressure and temperature at different altitudes. Specific factors were suggested to convert the information concerning PM, from local to standard conditions, and adjust the Air Quality Standards for different high altitudes cities. The correction factors ranged from: 1.03 for Santiago de Chile to 1.47 for El Alto Bolivia. Other cities in this study include: Mexico City, México; La Paz, Bolivia; Bogota, Cali and Medellin, Colombia; Quito, Ecuador and Cuzco, Peru. If these corrections are not considered, the atmospheric concentrations will be underestimated.

Frequency of clinical parasitic otitis due to Rhabditiform nematodes (Rhabditis sp) in six Gyr breed cattle farms in Cordoba, Colombia / Frecuencia de otitis parasitaria clínica por nematodos Rhabditiformes (Rhabditis spp) en seis fincas de la raza Gyr en Córdoba, Colombia / Freqüência de otite parasitária clínica por nematóides Rhabditiformes (Rhabditis sp) em seis fazendas na raça Gir em Córdoba, Colômbia

Objective: to determine the frequency of presentation of clinical parasitic otitis due to rhabditiform nematode (Rhabditis sp) in six Gyr breed cattle farms in Córdoba, Colombia. Methods: a descriptive prospective study in animals of convenience, between June and October 2010 was performed. Cerumen samples were collected using sterile swabs from the external ear canals of 155 animals. Results: the frequency of occurrence of Rhabditis sp presenting clinical otitis in six Gyr breed farms in Córdoba was 63.2%. Conclusion: clinical manifestations and characteristics of the cerumen as well as microscopic observation of the parasites, reported a high number of Rhabditis sp causing clinical parasitic otitis in 6 Gyr cattle farms in the province of Córdoba, Colombia.

Objetivo: determinar la frecuencia de presentación de otitis parasitaria clínica por nematodos Rhabditiformes (Rhabditis spp) en seis explotaciones de la raza Gyr en Córdoba, Colombia. Métodos: se realizó un estudio descriptivo prospectivo en animales de conveniencia, entre los meses de junio y octubre de 2010. Se recolectaron muestras de cerumen con hisopos de los conductos auditivos externos de 155 bovinos. Resultados: la frecuencia de presentación de otitis parasitaria clínica causada por Rhabditis spp en seis fincas de la raza Gyr en Córdoba fue del 63.2%. Conclusión: las manifestaciones clínicas y características del cerumen, así como la observación microscópica del parásito, informan una elevada presencia de Rhabditis spp causante de otitis parasitaria clínica en bovinos de la raza Gyr en 6 explotaciones del departamento de Córdoba, Colombia.

Objetivo: determinar a freqüência de apresentação de otite parasitária clínica por nematóides Rhabditiformes (Rhabditis sp) em seis fazendas da raça Gir em Córdoba, Colômbia. Métodos: foi realizado um estudo descritivo, prospectivo em animais de conveniência, entre junho e outubro de 2010. As amostras de cerume foram obtidas com swab nos canais auditivos de 155 bovinos. Resultados: a freqüência de ocorrência de otite parasitária clínica causada por Rhabditis sp em seis fazendas da raça Gir em Córdoba foi de 63.2%. Conclusão: As manifestações clínicas e as características do cerume, assim como a observação microscópica do parasita, relatam uma alta freqüência do Rhabditis sp causando otite parasitária clínica em 6 fazendas de gado da raça Gir do departamento de Córdoba, Colômbia.

Reciprocal sympatho-sensory control: functional role of nucleotides and calcitonin gene-related peptide in a peripheral neuroeffector junction.

The rat vas deferens has scattered sensory afferens plus a dense network of sympathetic motor efferens; these fibers are not known to interact functionally. We ascertained whether sensory fibers modulate the release of sympathetic transmitters through the release of calcitonin gene-related peptide (CGRP) and reciprocally assessed whether sympathetic transmitters modulate the overflow of ir-CGRP from sensory fibers. The tissue overflow of electrically evoked sympathetic co-transmitters (ATP/metabolites, noradrenaline (NA), and immunoreactive neuropeptide tyrosine (ir-NPY)) and the motor responses elicited were quantified following either exogenous CGRP or capsaicin application to elicit peptide release. Conversely, the outflow of ir-CGRP was examined in the presence of sympathetic transmitters. Exogenous CGRP reduced in a concentration-dependent manner the electrically evoked outflow of ATP/metabolites, NA, and ir-NPY with EC(50) values of 1.3, 0.18, and 1.9 nM, respectively. CGRP also reduced the basal NA overflow. The CGRP-evoked modulation was blocked by CGRP8-37 or H-89. Release of endogenous CGRP by capsaicin significantly reduced the basal overflow of NA, ir-NPY, and the electrically evoked sympathetic transmitter release. ADP, 2-methylthioadenosine-5'-O-diphosphate (2-MeSADP), or UTP decreased the electrically evoked ir-CGRP overflow, whereas clonidine, α,ß-methyleneadenosine 5'-triphosphate (α,ß-mATP), or adenosine (ADO) were inactive. CGRP acting postjunctionally also reduced the motor responses elicited by exogenous NA, ATP, or electrically evoked contractions. We conclude that CGRP exerts a presynaptic modulator role on sympathetic nerve endings and reciprocally ATP or related nucleotides influence the release of ir-CGRP from sensory fibers, highlighting a dynamic sympatho-sensory control between sensory fibers and sympathetic nerve ending. Postjunctional CGRP receptors further contribute to reduce the tissue sympathetic motor tone implying a pre and postjunctional role of CGRP as a sympathetic tone modulator.

Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified.

Accidente cerebrovascular: revisión de la literatura: etiología, diagnóstico, tratamiento general y análisis pediátrico / Review of the literature: stroke: etiology, diagnostic general therapy and pediatric evaluation

El accidente cerebro vascular y la trombosis venosa cerebral son patologías de causa significativa de morbilidad y mortalidad en la población adulta y pediátrica en todo el mundo. La incidencia y prevalencia en los Estados Unidos de América es alta dada la deficiencia en hábitos de vida saludable y alta incidencia de patologías de origen genético (1). La presentación clínica en los pacientes pediátricos es diversa y con representación semiológica distinta a los pacientes adultos. En la práctica médica se debe realizar un enfoque multidisciplinario para el tratamiento de la enfermedad cerebro vascular aguda especialmente en pacientes pediátricos, lo cual permitirá el diagnóstico temprano y la disminución de secuelas (2). Por medio de este artículo explicamos cómo los equipos médicos en medicina de urgencias y los planteamientos en salud pública deben ser evaluados, desarrollados y plasmados en el personal de salud para desarrollar un tratamiento rápido y eficaz en el servicio de urgencias en el diagnóstico temprano, por medio de la aplicación multidisciplinaria del plantel con la identificación y análisis oportunos de signos y síntomas del paciente en cualquier edad (1, 2). Los equipos de emergencia de accidente vascular deben estar representados por neurólogos, hematólogos con experiencia en trastornos de la coagulación, neuro radiólogos y personal con experiencia en la rehabilitación y servicio de terapia intensivista. Es necesario realizar una gestión integral y oportuna en la capacitación y ejercicio del programa de intervención en accidente cerebro vascular por el comité científico, clínico y quirúrgico para así permitir una acción médica oportuna, audaz y estratégica temprana por el grupo de profesionales de medicina de emergencias y reducir las secuelas en la población adulta y pediátrica. Por medio de esta revisión se comprenderá la patología a fondo, teniendo en cuenta el paciente en un enfoque global biopsicosocial partiendo desde el síntoma general hasta el especifico sin descartar la patología.