Position paper on perioperative management and surgical risk in the patient with cirrhosis.

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Current vision on diagnosis and comprehensive care in hepatic encephalopathy.

The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.

El dolor en pacientes hospitalizados en una institución de alta complejidad / Pain in hospitalized patients in a high complexity institution / Dor em pacientes internados em uma instituição de alta complexidade

Objetivo: el dolor se define como "una experiencia sensorial y emocional desagradable asociada o similar a la asociada con daño tisular real o potencial". El objetivo de este estudio es describir la prevalencia, evaluación y manejo del dolor, en pacientes hospitalizados en una institución de alta complejidad. Metodología: estudio observacional descriptivo longitudinal. Se incluyeron adultos hospitalizados en una institución de alta complejidad durante tres meses; excluyendo pacientes con <48h de hospitalización, alteración del estado de conciencia, diálisis extrainstitucional o historias clínicas incompletas para cumplir los objetivos. El análisis de la información se realizó aplicando métodos descriptivos. Los análisis fueron llevados a cabo en el paquete estadístico SPSSv.26(Inc, Chicago, IL). Resultados: se incluyeron 655 pacientes hospitalizados que cumplieron criterios de elegibilidad, con una edad promedio de 53.9 años. La mediana de días de estancia hospitalaria fue de 5 (RIQ 2­8). El número de tomas del dolor en relación con el número de tomas de signos vitales es de 1:4. Los pacientes recibieron entre 2 y 6 medicamentos diferentes para el control del dolor, siendo la dipirona, con el 68.5%, la más utilizada. Al egreso casi la totalidad de los pacientes presentó un adecuado control del dolor. Conclusiones: persiste una deficiencia en las tomas de la eva cada vez que se toman los signos vitales del paciente hospitalizado. La implementación de la política institucional "clínica que alivia el dolor" busca que se logre un adecuado control del dolor durante la hospitalización.

Objective: pain is defined as "an unpleasant sensory and emotional experience associated or similar to that associated with actual or potential tissue damage." The aim was to describe the prevalence, evaluation, and management of pain in patients hospitalized in a high complexity institution. Methodology: longitudinal descriptive observational study. Adults hospitalized from an overly complex institution for three months were included; excluding patients with <48h of hospitalization, altered state of consciousness, extra-institutional dialysis or incomplete medical records to meet the objectives. The information analysis was conducted by applying descriptive methods. The analyzes were carried out in the statistical package SPSSv.26 (Inc, Chicago, IL). Results: 655 hospitalized patients who met eligibility criteria were included, with a mean age of 53.9 years. The median days of hospital stay was 5 (IQR, 2­8). The number of shots of pain in relation to the number of vital signs shots is 1: 4. The patients received between 2 and 6 different medications for pain control, with dipyrone being the most widely used (68.5%). At discharge, almost all of the patients had adequate pain control. Conclusions: a deficiency persists in the VAS measurements each time the vital signs of the hospitalized patient are taken. The implementation of the institutional policy "clinic that relieves pain" seeks to achieve adequate pain control during hospitalization.

Objetivo: A dor é definida como "uma experiência sensorial e emocional desagradável associada ou semelhante àquela associada a dano tecidual real ou potencial". O objetivo deste estudo é descrever a prevalência, avaliação e manejo da dor em pacientes internados em uma instituição de alta complexidade. Metodologia:estudo observacional descritivo longitudinal. Foram incluídos adultos internados em instituição de alta complexidade por três meses; excluindo pacientes com menos de 48h de internação, estado alterado de consciência, diálise extrainstitucional ou prontuários incompletos para atender aos objetivos. A análise das informações foi realizada por meio de métodos descritivos. As análises foram realizadas no pacote estatístico SPSSv.26( Inc , Chicago, IL).Resultados: Foram incluídos 655 pacientes internados que preencheram os critérios de elegibilidade, com média de idade de 53,9 anos. O número médio de dias de internação foi de 5 (IQR 2-8). O número de injeções de dor em relação ao número de injeções de sinais vitais é 1:4. Os pacientes receberam entre 2 e 6 medicamentos diferentes para controle da dor, sendo a dipirona , com 68,5%, a mais utilizada. Na alta, quase todos os pacientes apresentavam controle adequado da dor. Conclusões: persiste uma deficiência nas medidasvas toda vez que se mede os sinais vitais do paciente hospitalizado. A implantação da política institucional "clínica que alivia a dor" busca alcançar o controle adequado da dor durante a internação.

[Treatment with plantar supports in Müller-Weiss disease. Preliminary report]. / Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar.

The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Muscle fatigue analysis during dynamic contractions based on biomechanical features and Permutation Entropy.

Muscle fatigue is an important field of study in sports medicine and occupational health. Several studies in the literature have proposed methods for predicting muscle fatigue in isometric con-tractions using three states of muscular fatigue: Non-Fatigue, Transition-to-Fatigue, and Fatigue. For this, several features in time, spectral and time-frequency domains have been used, with good performance results; however, when they are applied to dynamic contractions the performance decreases. In this paper, we propose an approach for analyzing muscle fatigue during dynamic contractions based on time and spectral domain features, Permutation Entropy (PE) and biomechanical features. We established a protocol for fatiguing the deltoid muscle and acquiring surface electromiography (sEMG) and biomechanical signals. Subsequently, we segmented the sEMG and biomechanical signals of every contraction. In order to label the contraction, we computed some features from biomechanical signals and evaluated their correlation with fatigue progression, and the most correlated variables were used to label the contraction using hierarchical clustering with Ward's linkage. Finally, we analyzed the discriminant capacity of sEMG features using ANOVA and ROC analysis. Our results show that the biomechanical features obtained from angle and angular velocity are related to fatigue progression, the analysis of sEMG signals shows that PE could distinguish Non-Fatigue, Transition-to-Fatigue and Fatigue more effectively than classical sEMG features of muscle fatigue such as Median Frequency.

Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar / Treatment with plantar supports in Müller-Weiss disease. Preliminary report

Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

Interactions of B12N12 fullerenes on graphene and boron nitride nanosheets: A DFT study.

In the search of nanomaterials to be used in drug delivery applications, Density Functional Theory calculations were implemented to study the interaction between graphene (G) and hexagonal boron nitride nanosheet (hBNN) with octahedral B12N12 fullerenes. These B12N12 fullerenes were considered in two cases: pristine and the modified one with boron-boron, nitrogen-nitrogen (tetragon) and boron-boron-boron (hexagon) homo-nuclear bonds. The whole systems were analyzed in the gas and aqueous phases. The results reveal for all these systems that the interaction is in the range of physisorption (Eads = from -0.03 to -0.37 eV) for both phases, limiting its functions as a vehicle. However, for the nano-composite: B12N12 fullerene modified and hBNNs, the values of average chemical reactivity and HOMO-LUMO gap decreased whereas the polarity was improved, thereby this combination of quantum descriptors lead them to be considered as potential vehicle for drug delivery.

Neutrophil CD64 expression, procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS.

Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.

Profile of BAFF and its receptors' expression in lupus nephritis is associated with pathological classes.

Background/Objective B-cell activating factor (BAFF) plays an important role in the pathogenesis of systemic lupus erythematosus. However, the role of BAFF in lupus nephritis (LN) is not understood. Our aim was to evaluate the expression of BAFF and its three receptors in renal biopsy samples from patients with LN and investigate a relationship with pathological class. Methods We conducted a prospective descriptive study (2011-2014) on 52 kidney biopsy samples from patients with LN. Immunohistochemistry for BAFF, its receptors (transmembrane activator and calcium modulator and cyclophilin ligand interaction (TACI), protein maturation of B cells (BCMA), and BAFF-receptor (BAFF-R)), and CD20 expression was performed. Samples were scored according to the percentage of cells with positive expression. Results In class II LN, BAFF-R and TACI were not expressed, whereas BCMA and BAFF were lowly expressed in the interstitial inflammatory infiltrates. Proliferative class III/IV had elevated BAFF expression in the glomeruli, and TACI was expressed in interstitial inflammatory infiltrates and the glomeruli. Interestingly, the class IV cases with vasculopathy ( n = 4) had endothelial BAFF expression, which was not visible in thrombotic microangiopathy ( n = 4). Class V was characterized by low BAFF expression in interstitial inflammatory infiltrates and by BAFF, TACI, and BCMA expression in the glomeruli. BAFF expression was associated with inflammatory scores and CD20 positive infiltrates, mainly in class IV. Conclusions Expression patterns of BAFF and its receptors differ according to LN class. Our study provides evidence that BAFF could be used as a routine marker in LN biopsies and to determine which patients will benefit from anti-BAFF therapy.

Body size phenotypes comprehensively assess cardiometabolic risk and refine the association between obesity and gut microbiota.

OBJECTIVE: The gut microbiota associates with obesity and related disorders, but recent meta-analyses have found that this association is, at best, of small effect. We argue that such analyses are flawed by the use of body mass index (BMI) as sole proxy for disease, and explore a classification method that distinguishes the cardiometabolic health status of individuals to look for more comprehensive associations between gut microbes and health. DESIGN: We analyzed a 441 community-dwelling cohort on which we obtained demographic and health information, anthropometry and blood biochemistry data that served to categorize participants according to BMI, cardiometabolic health status and body size phenotypes. In addition, the participants donated fecal samples from which we performed 16S rRNA gene sequencing to analyze the gut microbiota. RESULTS: We observed that health-related variables deteriorate with increased BMI, and that there are further discrepancies within a given BMI category when distinguishing cardiometabolically healthy and unhealthy individuals. Regarding the gut microbiota, both obesity and cardiovascular disease associate with reductions in α-diversity; having lean, healthy individuals the most diverse microbiotas. Moreover, the association between the gut microbiota and health stems from particular consortia of microbes; the prevalence of consortia involving pathobionts and Lachnospiraceae are increased in obese and cardiometabolically abnormal subjects, whereas consortia including Akkermansia muciniphila and Methanobrevibacter, Oscillospira and Dialister have higher prevalence in cardiometabolically healthy and normoweight participants. CONCLUSIONS: The incorporation of cardiometabolic data allows a refined identification of dissimilarities in the gut microbiota; within a given BMI category, marker taxa associated with obesity and cardiometabolic disease are exacerbated in individuals with abnormal health status. Our results highlight the importance of the detailed assessment and classification of individuals that should be carried out prior to the evaluation of obesity treatments targeting the gut microbiota.

Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience.

Background Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant. Objective The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia. Methods Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014. Results Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection. Conclusions Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.

Self-fertilization, long-distance flash invasion and biogeography shape the population structure of Pseudosuccinea columella at the worldwide scale.

Population genetic studies are efficient for inferring the invasion history based on a comparison of native and invasive populations, especially when conducted at species scale. An expected outcome in invasive populations is variability loss, and this is especially true in self-fertilizing species. We here focus on the self-fertilizing Pseudosuccinea columella, an invasive hermaphroditic freshwater snail that has greatly expanded its geographic distribution and that acts as intermediate host of Fasciola hepatica, the causative agent of human and veterinary fasciolosis. We evaluated the distribution of genetic diversity at the largest geographic scale analysed to date in this species by surveying 80 populations collected during 16 years from 14 countries, using eight nuclear microsatellites and two mitochondrial genes. As expected, populations from North America, the putative origin area, were strongly structured by selfing and history and harboured much more genetic variability than invasive populations. We found high selfing rates (when it was possible to infer it), none-to-low genetic variability and strong population structure in most invasive populations. Strikingly, we found a unique genotype/haplotype in populations from eight invaded regions sampled all over the world. Moreover, snail populations resistant to infection by the parasite are genetically distinct from susceptible populations. Our results are compatible with repeated introductions in South America and flash worldwide invasion by this unique genotype/haplotype. Our study illustrates the population genetic consequences of biological invasion in a highly selfing species at very large geographic scale. We discuss how such a large-scale flash invasion may affect the spread of fasciolosis.

Cytotoxic and antioxidant activities of selected Lamiales species from Mexico.

CONTEXT: Methanol extracts obtained from eight species belonging to four families of the Lamiales order native to Mexico were investigated for biological action. OBJECTIVE: Cytotoxicity and antioxidant activity of methanol extracts have been investigated. MATERIALS AND METHODS: Cytotoxic activity was evaluated by the sulphorhodamine B protein staining assay against KB (nasopharyngeal), HEp-2 (larynx), HF-6 (colon), MCF7 (breast), PC-3 (prostate), and Ca Ski (cervix) carcinoma cell lines. To analyze the antioxidant activity, common stable radicals chromogens, 2,2-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid (ABTS+) and DPPH (1,1-diphenyl-2-picrylhydrazyl) were used. The ferric reducing antioxidant power (FRAP) and the total phenolic content of the samples were also determined. RESULTS: Some of the extracts, such as Limosella aquatica L. (Scrophulariaceae), Mimulus glabratus Kunth. (Phrymaceae), Pedicularis mexicana Zucc. ex Benth. (Orobanchaceae), and Penstemon campanulatus (Cav.) Willd. (Plantaginaceae) displayed remarkably selective cytotoxic activity. However, the extract from Veronica americana (Raf.) Schwein (Plantaginaceae) showed the highest activity with IC50 values of 1.46 and 0.169 g/ µL on PC-3 and HF-6 cells, respectively. With the exception of M. glabratus, all the extracts showed different degrees of antioxidant activity with IC50 values from 0.89 up to 1.8 in the ABTS assay; from 0.49 up to 1.25 mg/mL in the DPPH assay and with the FRAP evaluation, 36 to 68 equivalents in mM of FeSO4. V. americana also showed the highest antoxidant activity with IC50 values from 0.491 and 0.892 mg/mL, on DPPH and ABTS assays, respectively. DISCUSSION AND CONCLUSION: These findings demonstrated that the species studied have great potential cytotoxic and antioxidant activity.

Conductas sexuales en la adolescencia y su relación con la historia familiar / Sexual behaviours in adolescence and its relationship with the family history

Las diferencias entre normalidad y patología en las conductas adolescentes deben ser pensadas dentro de una problemática individual, familiar y social. Se presenta un caso clínico complejo que nos plantea múltiples diagnósticos y diferentes estrategias terapéuticas. Los significados al aparente hecho traumático irán apareciendo y cobrando sentido a lo largo de la evolución. Los objetivos de este trabajo son: diferenciar experiencias propias del desarrollo emocional adolescente de situaciones patológicas con riesgo devenir traumáticas. Analizar el rol de la familia, su historia, sus mitos, como generadores de hechos traumáticos. Se presenta a M.de 13 años de edad, quien concurre acompañado de sus padres. Los padres refieren que consultan porque "el primo abusó de él". El adolescente dice: "hice algo malo". Los antecedentes de abuso e intentos de suicidio enla familia, ubican a este joven en un lugar del que resulta difícil encontrar una salida. Las conductas de riesgo y los hechos traumáticos que presenta el adolescente no pueden ser comprendidos en forma aislada de su familia y entorno social. ¿Qué significado tienen las relaciones sexuales en este adolescente?¿Cuál sería la capacidad de esta familia, seeramente perturbada de generrar patología?

Ginecomastia en adolescentes, condiciones clínicas asociadas a impacto emocional / Ginecomasty in adolescents, clinicals conditions associated to emotional impact

Introducción: Ginecomastia es la proliferación benigna del tejido mamario masculino. Se presenta en el 50% de los hombres; un estudio en población adolescente informa una prevalencia del 3,9%. Pese a ser un evento puberal puede producir baja autoestima y menor participación en actividades grupales. Objetivos: 1)Conocer la prevalencia de ginecomastia en los adolescentes que consultan al Servicio de Adolescencia del Hospital de Niños Ricardo Gutiérrez, de CAB; 2)describir la relación entre ginecomastia, índice de masa corporal y estadío de maduración sexual de Tanner; 3)evaluar la presencia de enfermedades subyacentes, consumo de medicamentos y/o sustancias de abuso; y 4)evaluar el impacto emocional de la misma en el adolescente. Metodología: Estudio descriptivo, prospectivo y transversal. Se evaluaron 789 varones de 13 a 17 años entre diciembre de 2009 y abril de 2010. Solo se incluyerion pacientes con ginecomastia (diámetro >0,5cm). Los datos clínicos y antropométricos se recogieron en la historia clínica del adolescente. El impacto emocinal se valoró a través de un cuestionario con preguntas semiabiertas, diseñadas para tal motivo. Resultados: Se diagnosticaron 21 casos; se incluyeron 19 de ellos. La prevalencia fue de 2,66%. Ni las enfermedades padecidas ni las medicaciones recibidas estuvieron asociadas con ginecomastia. No se detectó consumo significativo de drogas de abuso. En base al impacto emocional, se identificaron dos grupos: uno indiferente ante la ginecomastia y otro con afectación emocional descripto como indiferencia/enojo. Conclusiones: La ginecomastia es un hecho esperable en el desarrollo puberal de los adolescentes varones, sin embargo, en muchas oasiones, genera un impacto emocional que puede condicionar la relación con pares y la integración social de los chicos que la presentan. Aunque el grupo estudiado es pequeño, en la mitad de los pacientes con afectación emocional, la ginecomastia no había sido motivo de consulta. El diagnóstico efectuado por el médico, habilitó a los adolescentes a poder expresar su malestar y a manifestar dudas e inquietudes. Destacamos la importancia dela consulta con visión integral, en un ámbito de privacidad y confidencialidad en la atención de adolescentes. Es una oportunidad única para realizar exámen físico completo y una semiología ampliada que incluya los aspectos emocionales, familiares y sociales que contribuyen a la calidad de vida de los jóvenes que atendemos

Adolescentes de hoy... ¿Mitos de ayer? / Today´s teens, yesterday´s myths?

Introducción: El conocimiento sobre la sexualidad juvenil es un tema ineludible en la atención de adolescentes. Las distintas culturas y costumbres poseen mitos que muchas veces tienen un peso mayor a la información brindada por el médico y pueden dificultar un efectivo abordaje. Si estas creencias son erróneas, se pueden transformar en un factor de riesgo para contraer infecciones de transmisión sexual (ITS/HIV) y embarazos no buscados. Objetivos: 1)conocer los mitos sobre aspectos de la sexualidad en adolescentes que consultaron en servicios especializados. 2)inferir si existe relación entre los mitos y la edad, edad de inicio de relaciones sexuales (IRS), procedencia y grado de instrucción. 3)indentificar los conocimientos que representan mayor riesgo en relación a la salud sexual y reproductiva. 4)comparar resultados entre las poblaciones estudiadas. Metodología: Estudio descriptivo, transversal, en base a una encuesta autoadministrada, voluntaria de 28 preguntas. Se seleccionaron mitos y conocimientos erróneos sobre métodos anticonceptivos (MAC), ITS/HIV, menstruación y sexualidad que se detectan en las consultas. Se realizó a 111 adolescentes mujeres, con inicio de relaciones sexuales (IRS), que concurrieron al Servicio de Ginecología Infantojuvenil del Hospital Pirovano (HP) y al de Adolescencia del Hospital de Niños Ricardo Gutiérrez (HNRG), entre marzo y abril de 2010. Resultados: La edad media de inicio de relaciones sexuales fue de 15,5 años. El 19% eran extranjeras. Todas estaban alfabetizadas. Según nacionalidad hubo diferencias estadísticamente significativas en el porcentaje de preguntas correctas. Las pacientes con secundario incompleto o en curso respondieron correctamente 60% de las preguntas y las que completaron el secundario 73%. Conclusiones: Ciertos mitos continúan vigentes entre los jóvenes, aún teniendo acceso a sistemas de salud y educación . Por eso ratificamos la necesidad de conocer estos aspectos para tenerlos en cuenta en nuestra práctica diaria , no juzgar ni prejuzgar, sino generar un espacio amigable, de confidencialidad, privacidad y confianza para poder abordar mejor estos temas, evacuar dudas, e intentar así desmitificar la sexualidad

Oral ulcers produced by mycophenolate mofetil in two liver transplant patients.

Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.

Allantoplacental ultrastructure of an Andean population of Mabuya (Squamata, Scincidae).

Mabuya species are highly matrotrophic viviparous lizards with Type IV epitheliochorial allantoplacenta. The allantoplacenta of an Andean population of this genus, currently assigned to Mabuya sp., possesses specializations related to histotrophic nutrition at the embryonic hemisphere (placentome, paraplacentome, and chorionic areolas), while at the abembryonic hemisphere it has a mixed function: histotrophic transfer (absorptive plaques) and hemotrophic nutrition (gas exchange in respiratory segments). These placental specializations were studied using high-resolution light microscopy and transmission electron microscopy, and were compared with those found in other squamate reptiles and eutherian mammals. Cytological features of the placentome suggest that this is an important region for nutritional provision; the paraplacentome also shows characteristics for nutrient transfer, especially lipids. Chorionic areolas allow the absorption of glandular products, as well as uterine and chorionic cellular debris produced by lysis of some cells of both epithelia during areola formation. In the absorptive plaques both uterine and chorionic epithelia are firmly attached and their cellular apices exhibit electron-dense granules that could be related to autocrine and paracrine functions. The short interhemal distance found in the respiratory segments confirms their role in gas exchange. A common feature of all regional specializations in the Mabuya sp. allantoplacenta is the presence of lipids in the interacting chorionic and uterine epithelia, suggesting that lipids are transferred throughout the entire embryonic chamber; placental transfer of lipids may be the principal fetal energy and lipid source in this species. In spite of this feature, each one of the specialized areas of the allantoplacenta has different features suggesting particular functions in the transfer of nutrients (as ions, lipids, proteins, amino acids, sugar, water, and gases), and in the possible synthesis of hormones and proteins. The placental complexity observed in this species of Mabuya is greater than in any other reptile, and resembles that of eutherian mammals: Each one of these specializations of the placental membranes in Mabuya sp. is similar to those found among different eutherian mammals, indicating a very impressive evolutionary convergence at the histological and cytological levels between both clades. However, no eutherian mammal species simultaneously displays all of these specializations in the embryonic chamber as does Mabuya sp.