Owl-like plaques of the Copper Age and the involvement of children.

In the Copper Age, slate engraved plaques were produced massively in the southwestern corner of the Iberian Peninsula. Researchers have speculated about the function of these palm-sized stone objects for more than a century, although most have favored the idea that they represented goddesses, and served ritual purposes. The plaques are engraved with different designs of varying complexity. In some of them, the ones sporting two large frontal eyes, we clearly see owls modelled after two species present in the area: the little owl (Athene noctua), and the long-eared owl (Asio otus). These two species, living in semi-open habitats, were possibly the most abundant owls around the human settlements and surrounding cultivated fields of the Chalcolithic period. People must have been aware of the owl presence and possibly interacted with them. Why owls but no other animals have been the models may relate to the fact they are the most anthropomorphic of all animals, with large frontally-placed eyes in their enormous heads. In the iconography, owls are systematically represented, even today, with their two eyes staring at the observer, as opposed to the lateral view used for any other animal. Additionally, slate is one of the commonest surface rocks in southwestern Iberia, and it provides a blank canvas for engraving lines using pointed tools made of flint, quartz or copper. The way slates exfoliate makes easy to craft owl-looking plaques. To silhouette animals other than owls in a recognizable way would request extra carving abilities and specific tools. Plaque manufacture and design were simple and did not demand high skills nor intensive labor as demonstrated in replication experiments. Owl engravings could have been executed by youngsters, as they resemble owls painted today by elementary school students. This also suggests that schematic drawings are universal and timeless. We propose that the owl-like slate plaques are the remains of a set of objects used in both playful activities and in ritual ceremonies. The actual engraving of the plaques may have been part of the game. Owlish slate plaques were often perforated twice at the top. We interpret this as insertion points for actual bird feathers added to the plaques, right at the place where tufts emerge in live owls. The frontier among play and ritual is diffuse in liminal societies and there is no contradiction in playing with animal-like toys and, at some point, using them as offerings as part of community rituals related, for instance, to the colossal megalithic tombs so characteristic of the Copper Age.

A Different View for an Old Disease: NEDDylation and Other Ubiquitin-Like Post-Translational Modifications in Chronic Lymphocytic Leukemia.

Despite the enormous amount of molecular data obtained over the years, the molecular etiology of chronic lymphocytic leukemia (CLL) is still largely unknown. All that information has enabled the development of new therapeutic approaches that have improved life expectancy of the patients but are still not curative. We must increase our knowledge of the molecular alterations responsible for the characteristics common to all CLL patients. One of such characteristics is the poor correlation between mRNA and protein expression, that suggests a role of post-translational mechanisms in CLL physiopathology. Drugs targeting these processes have indeed demonstrated an effect either alone or in combination with other aimed at specific pathways. A recent article unveiled an increment in ubiquitin-like modifications in CLL, with many protein members of relevant pathways affected. Interestingly, the inhibition of the NEDD8-activating protein NAE reverted a substantial number of those modifications. The present review gets the scarce data published about the role of NEDDylation in CLL together and establishes connections to what is known from other neoplasias, thus providing a new perspective to the underlying mechanisms in CLL.

Retos de la implementación del aprendizaje basado en equipos en los programas de medicina / The challenges of implementing team-based learning to the medical major programs

Introducción: El aprendizaje basado en equipos es una estrategia de enseñanza y de aprendizaje centrada en el alumno, en la cual el profesor tiene un rol facilitador. Este constituye un método pedagógico de aprendizaje activo que mejora la motivación hacia el aprendizaje y lleva a los alumnos a aplicar sus conocimientos para resolver problemas y combinar la teoría con la práctica. Los avances en educación médica a nivel mundial han llevado a las escuelas de medicina a optar por este tipo de estrategias. Objetivo: Identificar los retos de la implementación del aprendizaje basado en equipos en los programas de medicina. Resultados: Mediante la aplicación del aprendizaje basado en equipos en los programas de medicina, se identificaron los factores de sobrecarga laboral y de estudio con incidencia en los participantes en la estrategia, la necesidad de garantizar entrenamiento previo a los actores del proceso, la importancia de la realización de una adecuada distribución de los grupos de trabajo, y los recursos adicionales que deben garantizarse. Conclusiones: Para obtener beneficios pedagógicos de forma plena, la implementación del aprendizaje basado en equipos debe ser sistemática, lo que requiere procesos de formación y preparación, tanto de los estudiantes como de los profesores. Como cualquier cambio, demandará convicción, tiempo y ajustes a lo largo del proceso(AU)

Introduction: Team-based learning is a student-centered teaching and learning strategy, in which the teacher has the role of a facilitator. It constitutes an active learning pedagogical method that improves motivation towards learning and leads students to apply their knowledge to solve problems and combine theory with practice. Advances in medical education worldwide have led medical schools to opt for such strategies. Objective: To identify the challenges of implementing team-based learning in the medical major programs. Results: Through the application of team-based learning to the medical major programs, such factors as work and study overloads were identified as having an impact on the strategy participants, together with the need to guarantee prior training to the process stakeholders, the importance of adequate distribution of the working groups, and the additional resources that must be guaranteed. Conclusions: In order to obtain full pedagogical benefits, the implementation of team-based learning must be systematic, a process requiring training and preparation processes for both students and teachers. Like any change, it will demand conviction, time and adjustments throughout the process(AU)

Síndrome de Jeune en un paciente pediátrico: Reporte de caso clínico / Jeune syndrome in a pediatric patient: A clinical case report

El síndrome de Jeune es una displasia esquelética de baja frecuencia, de transmisión autosómica recesiva y potencialmente mortal. Clínicamente tiene una amplia variedad de manifestaciones; En forma clásica se presenta con un tórax estrecho, hipoplasia pulmonar secundaria, braquimelia, anormalidades pélvicas, cardiacas y renales. El compromiso pulmonar es variable y puede ser letal. El diagnóstico puede sospecharse prenatalmente con el estudio ultrasonográfico al medir la circunferencia torácica y de la jaula costal, estudiar su relación entre sí y con la circunferencia abdominal. En este artículo se describe el caso clínico de una paciente de 3 meses de edad, con forma de presentación leve y diagnóstico posnatal.

Jeune syndrome is a low frequency, autosomal recessive and potentially life-threatening skeletal dysplasia. From a clinical perspective, it has a wide variety of manifestations; however, it is commonly characterized by a narrow thorax; secondary pulmonary hypoplasia; brachymelia; and pelvic, cardiac and renal abnormalities. Lung involvement is variable and may be lethal. The diagnosis may be suspected prenatally through an ultrasonography, by measuring the thoracic and rib cage circumference, and studying the relation between them and with the abdominal circumference. This article describes the clinical case of a 3-month-old female patient with a mild disease presentation and postnatal diagnosis.

Primer reporte de enfermedad sistémica por arañazo de gato (Bartonella henselae) en el Perú / First case report of systemic cat-scratch disease (Bartonella henselae) in Peru

Introducción: la enfermedad por arañazo de gato(EAG) en la mayoría de las veces es descrita en su forma típica, las formas sistémicas son raras y de escaso reporte. La EAG puede tener una gran variedad de presentaciones, siendo algunas de ellas poco frecuentes. Es la primera vez que se reporta esta forma de presentación en el Perú. Caso clínico: presentamos aquí dos niñas de cinco y seis años de edad, hospitalizadas en el Servicio de Pediatría del HNCASE EsSalud Arequipa. Con formas sistémicas de enfermedad por arañazo de gato. Las niñas fueron arañadas por gatos cachorros sin reacción local, las cuales presentaron fiebre prolongada, malestar general, anorexia, cefalea, dolor abdominal, compromiso de ganglios, hepatomegalia y esplenomegalia, velocidad de eritrosedimentación globular (VSG) acelerada, proteína C reactiva (PCR) elevada, leucocitosis, desviación izquierda, transaminasas hepáticas discretamente elevadas o normales, en ambas se confirma el diagnóstico con la reacción serológica positiva (IgG e IgM) para Bartonella henselae y microabscesos hepatoesplénicos en la TAC abdominal. En ambas el tratamiento antibiótico combinado con macrólido más rifampicina por un mes tuvo eficacia terapéutica.

Introduction: Cat-scratch disease most of the times is described reporting its typical form; systemic forms are rare and they are seldom reported. Cat-scratch disease may have a great variety of presentations, and some of them are quite unusual. This is the very first time that the systemic form is reported in Peru. Clinical case: We present two girls, 5 and 6 years old, hospitalized in the pediatric ward of Hospital Nacional Carlos Alberto Seguin, EsSalud, Arequipa, Peru, who presented with the systemic form of cat scratch disease. Both girls were scratched by kittens without developing a characteristic local reaction, and they presented with prolonged fever, malaise, anorexia, headache, abdominal pain, lymph node enlargement, liver and spleen involvement, accelerated erythrocyte sedimentation rate, high levels of C-reactive protein, leukocytosis, left shift, slightly elevated or normal liver enzymes; and in both girls the diagnosis was confirmed with a positive result in serological testing (IgG and IgM) for Bartonella henselae. Also, some splenic microabscesses were found in the CT scan. Both girls responded to antimicrobial therapy using a macrolide combined with rifampin for one month.

Stability studies of binary mixtures of haloperidol and/or midazolam with other drugs for parenteral administration.

BACKGROUND: Haloperidol and or midazolam are frequently combined with other drugs in the same solution and infused parenterally over several days to treat symptoms. The solutions may be delivered to the home well in advance of the time of administration. Consequently, physiochemical stability of these combinations needs to be studied. OBJECTIVE: Determine the stability and physical compatibility of binary mixtures of haloperidol with morphine, scopolamine and midazolam and binary mixtures of midazolam with scopolamine and morphine. METHODS: Mixtures of drugs were prepared under aseptic conditions in 0.9% sodium chloride or 5% glucose at concentrations used clinically for continuous infusion and stored in synthetic polyisoprenoid containers at room temperature in the presence of light for 15 days. Chemical stability was evaluated by high pressure liquid chromatography. Physical compatibility was tested by visual inspection for evidence of precipitation and color change. RESULTS: No changes in color, precipitation of the components, or measurable losses of volume were noted. The majority of the combinations tested were stable for 15 days (T(90) >/= 15 day). However, the mixture of haloperidol and morphine reached T(90) at 10 and 9 days. The mixture containing haloperidol and scopolamine was stable for only 1 day (T(90)

Individualización de Carboplatino en el anciano con cáncer de pulmón no microcítico avanzado / Individual dosing of carboplatin in elderly patients with advanced non small cell lung cancer

El cáncer de pulmón no microcítico (CPNM) se diagnostica mayoritariamenteen pacientes mayores de 65 años. Los pacientes ancianos presentan una elevadacomorbilidad asociada al tratamiento antineoplásico que demanda la individualizaciónde las pautas posológicas. Las opciones de tratamiento son abundantes y elcarboplatino (CbPt) se encuentra entre los fármacos de primera línea. La dosis de CbPt se establece con la fórmula de Calvert (estándar) que requiere la medidaexacta de la función renal.El objetivo de este trabajo es aportar un modelo farmacocinético que permitaindividualizar las dosis de CbPt en ancianos con CPNM avanzado y evaluar suexactitud y precisión respecto al estándar.Los modelos farmacocinéticos para el CbPt no unido a las proteínas plasmáticas,obtenidos con las concentraciones plasmáticas de una población de 24 pacientesvarones con CPNM, indican que la edad es la covariable biométrica más estrechamenterelacionada con el aclaramiento plasmático de CbPt, sin dejar por ellode ser un factor de confusión. El error relativo medio (ERM) de la dosis ha sidopara los pacientes adultos (edad < 65 años) del 5% (1-9%) y para los pacientesancianos del 25% (19-30%). Por consiguiente, la dosificación de CbPt con la fórmulade Calvert conduce a una sobredosificación en los pacientes ancianos, produciendomayor exposición al fármaco de la deseada. El alcance clínico de estoshallazgos requiere su validación en una nueva población de pacientes

Non small cell lung cancer (NSCLC) is frequently diagnosed in patients olderthan age 65 years. Elderly patients often have comorbidities associated with theantineoplasic treatment that request individualization of the chemotherapy. Treatmentoptions are numerous and carboplatin (CbPt) is in the first line of treatment.Conventional doses of CbPt are individually adjusted applying the Calvert formulae(standar) that demands the accurate measure of renal function.The aim of this study is to develop a pharmacokinetic model in order to individualisethe dose of CbPt in elderly patients in advanced NSCLC, and to characterizeits bias and precision respect to the standard.The pharmacokinetic models for the unbound fraction of CpPt were obtainedfrom concentration-time data of ultrafiltrate plasma samples of twenty-four advancedNSCLC men patients enrolled in the study. Age was significantly related to thecarboplatin clearance, although is a confusion factor. The mean dose error, inpercentage, was 5% (1-9%) in adult patients (Age< 65 years) and 25% (19-30%) inelderly patients. Consequently, CbPt the dose regimen in enderly patients, establishedby means of Calvert’s formula is overestimated and the exposure to the antineoplasticis higher than desired. The clinical relevance of these results requiresthe validation of the model with a new population group

Aspectos clínicos, radiográficos e histopatológicos del quiste óseo solitario / Clinical, radiographics and histopatologics aspects of the solitary bony cyst

Se analizan las características clínicas radiológicas e histológicas de cinco casos de quiste óseo solitario (QOS). El rango de edad de los pacientes fue entre 12 a 20 años. Todas las lesiones fueron hallazgos radiográficos asintomáticos ubicados en la región molar-premolar mandibular. Cuatro lesiones presentaron forma de cono con la punta dirigida hacia la parte distal de la mandíbula. Además de la imagen radiográfica típica en cuatro casos se obervó erosión del hueso cortical basal. El control radiográfico en tres casos mostró reparación ósea completa después de seis meses, inflamación crónica y trabéculas óseas maduras e inmaduras. En un caso se observó un foco de lesión fibroósea benigna y médula ósea roja. Este estudio demuestra que el QOS puede corresponder a: a) lesión inflamatoria hemorrágica, b) lesión intraósea benigna y c) médula ósea roja.

Hematocrito a las 2 horas de vida en recién nacidos normales en la altura - Puno

Se realizó un estudio descriptivo transversal y analítico para determinar el hematocrito de vena periférica a las 2 horas de vida en 100 recién nacidos a término de 37 a 41 semanas de gestación, con peso adecuado para la edad gestacional, nacidos de parto eutócico y sin factores de riesgo para desarrollar Policitemia, en la ciudad de Puno a 3825 metros s.n.m. El hematocrito promedio para ambos sexos, 50 varones y 50 mujeres, fué de 57.18 por ciento, ñ 6.076 por ciento, siendo los valores extremos normales de 45.4 por ciento, a 69.32 por ciento. No encontramos relación entre el peso, talla ni la edad gestacional sobre el hematocrito. En cambio si encontramos relación con la paridad; es decir, que a mayor número de hijos, mayor nivel del hematocrito en el recién nacido. Podemos considerar que la altura si influye sobre el nivel del hematocrito del recién nacido, a mayor altura sobre el nivel del mar menor nivel de hematocrito.