First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador.

Background: COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported. Methodology: A genotyping analysis and two different types of whole genome sequencing were performed (Illumina MiniSeq and ONT MinION). When examining the phylogenetic analysis in NextClade and Pangolin webservers, and considering the genotyping findings, conflicting results were obtained. Results: The raw data of the sequencing was analyzed, and nucleotide variants were identified between different reads of the virus genome. B.1 and P.1 lineages were identified within the same sample. Conclusions: We concluded that this is a co-infection case with two SARS-CoV-2 lineages, the first one reported in Ecuador.

Estudio morfológico de pontículus pósticus en telerradiografías laterales / Morphological study of pontículus pósticus in lateral teleradiographies

OBJETIVO establecer la prevalencia de Pontículus Pósticus (PP) en pacientes atendidos en el Servicio de Imagenología de la Universidad Finis Terrae en el periodo 2015-2020. METODOLOGÍA estudio de tipo transversal descriptivo, donde se analizaron 334 telerradiografías laterales (TL) obtenidas del Servicio de Imagenología de la Universidad Finis Terrae entre los años 2015 y 2019 adquiridas mediante el equipo marca SIRONA modelo Orthophos XG, seleccionándolas según criterios de inclusión y exclusión. Se analizó la primera vértebra cervical buscando la presencia de PP consignando: sexo, edad y tipo de osificación según clasificación de Cederberg y Stubbs, asignándoles valores numéricos para posteriormente realizar el análisis estadístico de tipo descriptivo uni y bivariado. RESULTADOS se seleccionaron 320 TL. La prevalencia de PP fue del 31,9% de las TL incluidas, de los cuales el 68,1% correspondió al tipo 1 de la clasificación de Cederberg y Stubbs, el 14,1% al tipo 2, 10,3% al tipo 4 y el 7,5% al tipo 3. La edad media en pacientes con PP presente correspondió a 30,63 años +/­ 15,888 D.E con un mínimo de 12 años y un máximo de 78. En cuanto a la presencia de PP y la variable sexo, el 53,9% correspondió al sexo femenino y el 46,1% al sexo masculino, en donde no se encontró una predilección estadísticamente significativa (p = 0,08). CONCLUSIONES el PP es una variante anatómica de prevalencia variada, siendo levemente mayor en esta población chilena en comparación con otros países. Además, su evidencia es escasa y no existe un consenso sobre su prevalencia y diversas variables como el género y la edad, difiriendo en varios estudios. Es importante conocer e investigar más sobre la epidemiología de esta anomalía y su relación con distintos desórdenes neurológicos

OBJETIVE to establish the prevalence of Ponticulus Posticus (PP) in patients attended in Radiology Service of Finis Terrae University between the years 2015 and 2020. METHODOLOGY descriptive cross-sectional study, 334 lateral cephalograms were analyzed obtained from the Radiology Service of Finis Terrae University between the years 2015 and 2020 acquired from SIRONA system model Orthophos XG, selecting them following the inclusion and exclusion criteria. The first cervical vertebrae were analyzed searching for the presence of PP, consigning: Type of ossification by Cederberg and Stubbs classification, Age and Sex, assigning them numerical values to subsequently perform the descriptive statistical analysis uni and bivariate. RESULTS the prevalence of PP found was 31,9% of the 320 included TL, of which 68,1% corresponded to Type 0 of Cederberg and Stubbs classification, 14,1% to Type 1, 10,3% to Type 3 and the 7,5% al Type 2. The average age of present PP patient's was 30,63 years +­ 15,888 S.D with a minimum of 12 years and a maximum de 78. As for the presence of PP and sex variable, 53,9% corresponded to female sex and 46,1% to males, where no statistically significant predilection was found (p = 0,08). CONCLUSIONS PP is an anatomical variant with varied prevalence worldwide, being slightly higher in Chile, compared to other countries. In addition, their evidence is scarce and there is no consensus on its prevalence and various variables such as gender and age, differing in several studies. It is important to know and research more about the epidemiology of this anomaly and its relationship with different neurological disorder

Espasmo hemifacial: experiencia en un centro terciario / Hemifacial spasm: our experience in a tertiary referral hospital

Resumen El espasmo hemifacial consiste en un infrecuente trastorno del movimiento que afecta a la musculatura inervada por el nervio facial, en especial la de la hemicara superior. Existen dos formas clínicas, una primaria en la que la causa subyacente está representada por un conflicto neurovascular, y una secundaria, en la que la alteración del nervio facial es producida por algún tipo de lesión ocupante de espacio. Resulta de especial interés para el otorrinolaringólogo conocer esta entidad y ser capaz de diferenciar ambas formas clínicas dado el diferente enfoque terapéutico que pueden requerir. Aportamos una visión general de esta patología repasando su epidemiología y fisiopatología, además, de nuestra experiencia en forma de una serie de cuatro casos que ilustran las variadas formas de presentación de esta entidad, así como los signos y síntomas de alarma que pueden ayudar a realizar un correcto diagnóstico y manejo.

Abstract Hemifacial spasm consists of an unfrecuent movement disorder involving facial muscles, especially those from the upper half of the face. Two different clinical presentations are described. Primary hemifacial spasm is defined by a neurovascular conflict, and secondary occurs when facial nerve is damaged by a space occupying lesion. It is of special interest for the otorhinolaryngologist to get to know about this condition and to be able to acknowledge its clinical presentations due to the different therapeutical approach that may be needed for each of them. We contribute with a general vision of this entity reviewing its epidemiology and patophysiology. Furthermore, we show our experience by sharing a four-case series which we believe to illustrate the different ways of presentation as well as the alarm signs and symptoms that may be helpful in order to accomplish an accurate diagnose and treatment.

Interspecific evolutionary relationships of alpha-glucuronidase in the genus Aspergillus.

The increased availability and production of lignocellulosic agroindustrial wastes has originated proposals for their use as raw material to obtain biofuels (ethanol and biodiesel) or derived products. However, for biomass generated from lignocellulosic residues to be successfully degraded, in most cases it requires a physical (thermal), chemical, or enzymatic pretreatment before the application of microbial or enzymatic fermentation technologies (biocatalysis). In the context of enzymatic technologies, fungi have demonstrated to produce enzymes capable of degrading polysaccharides like cellulose, hemicelluloses and pectin. Because of this ability for degrading lignocellulosic material, researchers are making efforts to isolate and identify fungal enzymes that could have a better activity for the degradation of plant cell walls and agroindustrial biomass. We performed an in silico analysis of alpha-glucoronidase in 82 accessions of the genus Aspergillus. The constructed dendrograms of amino acid sequences defined the formation of 6 groups (I, II, III, IV, V, and VI), which demonstrates the high diversity of the enzyme. Despite this ample divergence between enzyme groups, our 3D structure modeling showed both conservation and differences in amino acid residues participating in enzyme-substrate binding, which indicates the possibility that some enzymes are functionally specialized for the specific degradation of a substrate depending on the genetics of each species in the genus and the condition of the habitat where they evolved. The identification of alpha-glucuronidase isoenzymes would allow future use of genetic engineering and biocatalysis technologies aimed at specific production of the enzyme for its use in biotransformation.

Fish as bioindicators: coal and mercury pollution in Colombia's ecosystems.

Mining in Colombia affects 488,672 ha (298,391 in coal mining and 190,281 in gold mining). However, Colombia has insufficient studies on mining and its repercussions, which limits estimates of mining impacts on ecosystems and the human population. Due to the rise of mining activities in Colombia, the negative impacts generated by coal and Hg will also continue to increase. This review analyzes national information levels on coal and Hg in island/coastal/marine as well as freshwater ecosystems and human groups using fishery resources as a framework. This is because fish are the main source of animal protein in marine coastal-island and mainland communities. Here, 15 of 32 Colombian departments have records on total mercury (THg) in water, sediments, fish, and human communities. Around 205 ton/year of mercury is discharged into the ecosystem. In human hair for example (15.3 to 50.15 µg/g), mercury exceeds the international maximum levels allowed (ILA) and the national standard (5.0 µg/g). Mercury levels in freshwater fish show 3.3 µg/g of THg and levels in marine and coastal-island fish are 1.2 µg/g THg exceeding the ILA (0.5 µg/g) standard for fish that will be consumed. Carnivorous species have a THg between 0.04 and 2.55 µg/g suggesting bioaccumulation and magnification of heavy metals. These findings were then compared with available international information.

5-Fluorouracil Induces Enteric Neuron Death and Glial Activation During Intestinal Mucositis via a S100B-RAGE-NFκB-Dependent Pathway.

5-Fluorouracil (5-FU) is an anticancer agent whose main side effects include intestinal mucositis associated with intestinal motility alterations maybe due to an effect on the enteric nervous system (ENS), but the underlying mechanism remains unclear. In this report, we used an animal model to investigate the participation of the S100B/RAGE/NFκB pathway in intestinal mucositis and enteric neurotoxicity caused by 5-FU (450 mg/kg, IP, single dose). 5-FU induced intestinal damage observed by shortened villi, loss of crypt architecture and intense inflammatory cell infiltrate as well as increased GFAP and S100B co-expression and decreased HuC/D protein expression in the small intestine. Furthermore, 5-FU increased RAGE and NFκB NLS immunostaining in enteric neurons, associated with a significant increase in the nitrite/nitrate, IL-6 and TNF-α levels, iNOS expression and MDA accumulation in the small intestine. We provide evidence that 5-FU induces reactive gliosis and reduction of enteric neurons in a S100B/RAGE/NFκB-dependent manner, since pentamidine, a S100B inhibitor, prevented 5-FU-induced neuronal loss, enteric glia activation, intestinal inflammation, oxidative stress and histological injury.

Myths and realities about knowledge, attitudes and practices of household contacts of tuberculosis patients.

SETTING: Five Colombian cities: Villavicencio, Pereira, Cucuta, Bucaramanga and Bosa. OBJECTIVE: To describe the knowledge, attitudes and practices related to tuberculosis (TB) in household contacts (HHCs) of TB patients. METHODS: A cross-sectional study was conducted. The estimated sample size required was 855. The World Health Organization guide 'Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys' was translated into Spanish and adapted to the dialect of each city. HHCs were invited to participate in the study and included if they agreed. RESULTS: We interviewed 878 HHCs. Most of them knew that TB was transmitted by airborne droplets; however, 52.2% also said that TB could be transferred from one person to another by sharing plates or clothes or shaking hands. Fifty-five per cent of HHCs acquired TB-related information from health care workers, and 44% from family members and friends. Fear was the main reaction reported by HHCs when they were informed of a TB diagnosis (60%). Eighty-five per cent of HHCs answered that the community rejects or avoids TB cases. CONCLUSION: There are significant gaps in the knowledge about TB and the stigmatisation associated with it. Educational strategies should be designed together with the community to demystify many misconceptions about TB.

Review and in silico analysis of fermentation, bioenergy, fiber, and biopolymer genes of biotechnological interest in Agave L. for genetic improvement and biocatalysis.

Several of the over 200 known species of Agave L. are currently used for production of distilled beverages and biopolymers. The plants live in a wide range of stressful environments as a result of their resistance to abiotic stress (drought, salinity, and extreme temperature) and pathogens, which gives the genus potential for germplasm conservation and biotechnological applications that may minimize economic losses as a result of the global climate change. However, the limited knowledge in the genus of genome structure and organization hampers development of potential improved biotechnological applications by means of genetic manipulation and biocatalysis. We reviewed Agave and plant sequences in the GenBank NCBI database for identifying genes with biotechnological potential for fermentation, bioenergy, fiber improvement, and in vivo plant biopolymer production. Three-dimensional modeling of enzyme structures in plant accessions revealed structural differences in sucrose 1-fructosyltransferase, fructan 1-fructosyltransferase, fructan exohydrolase (1-FEH), cellulose synthase (CES), and glucanases (EGases) with possible effects in fructan, sugar, and biopolymer production. Although the coding genes of FEH and enzymes involved in biopolymer production (CES, sucrose synthase, and EGases) remain unidentified in Agave L., our results could aid isolation of such genes in Agave. By comparing nucleotide and amino acid sequences in accessions of Agave and other plants, knowledge may be gained about transcriptional regulation and enzymatic activity factors. Future study is needed of biotechnological application of Agave genes for crop breeding aided by genetic engineering and biocatalysis. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 34:1314-1334, 2018.

Morphological features of different polyploids for adaptation and molecular characterization of CC-NBS-LRR and LEA gene families in Agave L.

Polyploidy has been widely described in many Agave L. species, but its influence on environmental response to stress is still unknown. With the objective of knowing the morphological adaptations and regulation responses of genes related to biotic (LEA) and abiotic (NBS-LRR) stress in species of Agave with different levels of ploidy, and how these factors contribute to major response of Agave against environmental stresses, we analyzed 16 morphological trials on five accessions of three species (Agave tequilana Weber, Agave angustifolia Haw. and Agave fourcroydes Lem.) with different ploidy levels (2n=2x=60 2n=3x=90, 2n=5x=150, 2n=6x=180) and evaluated the expression of NBS-LRR and LEA genes regulated by biotic and abiotic stress. It was possible to associate some morphological traits (spines, nuclei, and stomata) to ploidy level. The genetic characterization of stress-related genes NBS-LRR induced by pathogenic infection and LEA by heat or saline stresses indicated that amino acid sequence analysis in these genes showed more substitutions in higher ploidy level accessions of A. fourcroydes Lem. 'Sac Ki' (2n=5x=150) and A. angustifolia Haw. 'Chelem Ki' (2n=6x=180), and a higher LEA and NBS-LRR representativeness when compared to their diploid and triploid counterparts. In all studied Agave accessions expression of LEA and NBS-LRR genes was induced by saline or heat stresses or by infection with Erwinia carotovora, respectively. The transcriptional activation was also higher in A. angustifolia Haw. 'Chelem Ki' (2n=6x=180) and A. fourcroydes 'Sac Ki' (2n=5x=150) than in their diploid and triploid counterparts, which suggests higher adaptation to stress. Finally, the diploid accession A. tequilana Weber 'Azul' showed a differentiated genetic profile relative to other Agave accessions. The differences include similar or higher genetic representativeness and transcript accumulation of LEA and NBS-LRR genes than in polyploid (2n=5x=150 and 2n=6x=180) Agave accessions, thus suggesting a differentiated selection pressure for overcoming the lower ploidy level of the diploid A. tequilana Weber 'Azul'.

Cellulolytic and Butyrivibrio fibrisolvens bacteria population density, after supplementing fodder diets (Pennisetum clandestinum) / Densidad poblacional de bacterias celulolíticas y de Butyrivibrio fibrisolvens al suplementar dietas forrajeras (Pennisetum clandestinum)

Objective. Determine the population density of cellulolytic bacteria, Butyrivibrio fibrisolvens and the concentration of vaccenic acid, by supplementing diets consisting of kikuyu grass (Pennisetum clandestinum Hoechst. Ex Chiov. ) as base ingredient, together with cassava flour and biomass (effluent from ethanol production) in rumen simulator-Rusitec. Materials and methods. Four treatments (T) were evaluated, these were composed as: T1/Control 1: 100% kikuyu grass with a total protein intake of 23.9%, T2: a mixture of 70% kikuyu grass, 20% biomass and 10% cassava flour with a total protein intake of 19.4%; T3/Control 2: 100% kikuyu grass, with a 17.8% protein intake and T4: 70% kikuyu grass, 20% biomass and 10% cassava flour with a 15.3% protein intake. One and two-way variance analysis was made and the Pearson correlation coefficient was determined. Results. An increase was observed in the population density of viable cellulolytic bacteria (CFU/ml) and B. fibrisolvens statistically significant (p<0.005) with treatment T2, in contrast to T1, T3 and T4 treatments. In addition, there was a significant increase in the concentration of vaccenic acid (mg/L) in the ruminal content in Rusitec with the same treatment (T2). Conclusions. Results obtained in this ruminal simulation study are evidence to the benefits of kikuyu grass together with cassava flour and biomass diet implementation on the growth of ruminal cellulolytic and B. fibrisolvens bacteria, as well as on the production of vaccenic acid. The study also suggests the nutritional potential that such supplements could provide to grazing bovine feeding.

Objetivo. Determinar la densidad poblacional de bacterias celulolíticas, Butyrivibrio fibrisolvens y la concentración de ácido vaccénico, al suplementar dietas forrajeras de pasto kikuyo con harina de yuca y biomasa (resultante de la producción de etanol), en el simulador de rumen- Rusitec. Materiales y métodos. Se evaluaron cuatro tratamientos (T): T1/Control 1: 100% pasto kikuyo con un aporte total de 23.9% de proteína, T2: 70% pasto kikuyo, 20% biomasa y 10% harina de yuca con un aporte total de 19.4% proteína, T3/Control 2: 100% pasto kikuyo con un aporte total de 17.8% de proteína y T4: 70% pasto kikuyo, 20% biomasa y 10% harina de yuca con un aporte total de 15,3% de proteína. Se realizó un análisis de varianza (ANOVA) de una y dos vías y se determinó el coeficiente de correlación de Pearson. Resultados. Se observó un incremento en la densidad poblacional de bacterias celulolíticas viables (UFC/ml) y de B. fibrisolvens estadísticamente significativas (p<0.005) con el tratamiento T2, en comparación con los tratamientos T1, T3 y T4. Adicionalmente, se detectó un aumento significativo en la concentración de ácido vaccénico (mg/L) en el contenido ruminal del Rusitec con el mismo tratamiento (T2). Conclusiones. Los resultados obtenidos en este estudio de simulación ruminal indican que la suplementación del pasto kikuyo con harina de yuca y biomasa favorecen el crecimiento de las bacterias celulolíticas ruminales y de B. fibrisolvens, así como la producción de ácido vaccénico, y sugieren el potencial nutricional que podría tener este tipo de suplementación en la alimentación de bovinos en pastoreo.

Serological evidence of Hepatitis E Virus infection in Antioquia, Colombia slaughtered pigs / Evidencia serológica de infección por el Virus de Hepatitis E en cerdos faenados en Antioquia, Colombia

Objective. To detect the presence of specific antibodies against Hepatitis E virus (HEV) in pigs slaughtered in Antioquia, the department where the greatest amount of pork is produced and consumed in Colombia. Materials and methods. Between September 2011 and May 2012, blood samples from pigs were obtained in five slaughterhouses of Antioquia, four of them located in the Aburrá Valley subregion and other located in northern subregión. Serum were evaluated with a commercial ELISA kit for diagnosing HEV in humans but adapted to detect IgG and IgM antibodies in pigs. Results. A 100.0% seropositivity for IgG antibodies was found in 1000 samples evaluated, and 82.06% for IgM antibodies were found in 740 samples. Conclusions. These results indicate that pigs in slaughter age in Antioquia, and possibly in Colombia, have been exposed to HEV at some point in their production process and a high percentage of them can arrive to slaughterhouses with recent infection.

Objetivo. Detectar la presencia de anticuerpos específicos contra el virus de la Hepatitis E (HEV) en cerdos faenados en Antioquia, departamento donde se produce y consume la mayor cantidad de carne de cerdo en Colombia. Materiales y métodos. Entre septiembre de 2011 y mayo de 2012, se obtuvieron muestras de sangre de cerdos en cinco plantas de faenado, cuatro de ellas ubicadas en el Valle de Aburrá y una en la subregión Norte del departamento de Antioquia, las cuales fueron evaluadas mediante un kit de ELISA comercial para diagnóstico de HEV en humanos pero adaptado para la detección de anticuerpos tipo IgG e IgM en cerdos. Resultados. Se encontró una seropositividad de 100.0% para anticuerpos tipo IgG en 1000 muestras evaluadas y de 82.06% para anticuerpos tipo IgM en 740 muestras. Una muestra de heces positiva para la detección del genoma HEV es similar al genotipo 3 encontrada en Estados Unidos. Conclusiones. Estos resultados indican que los cerdos en edad de faenado en Antioquia y posiblemente en Colombia, han tenido exposición a HEV del, un virus zoonótico emergente a nivel mundial, en algún momento de su proceso productivo.

Asimetría en la función relativa en CR DMSA en riñones con doble sistema excretor no complicado: variante normal / Asymmetry in the relative function in CR DMSA in kidneys weith double non complicated excretor system: normal Variant

Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1–204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.

Aim: Duplex system in DMSA with asymmetry in relative function it’s a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1–204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.

[Cat-scratch disease with bone compromise: atypical manifestation]. / Enfermedad por arañazo de gato con compromiso óseo: Una forma atípica de presentación clínica.

Fever, headache, myalgias and lymphadenopathy are characteristic manifestations of cat-scratch disease but other less common findings are described in 2 to 10% of cases. We report two children that presented with hepatosplenic abscesses and bone involvement. One child, had multiple areas of increased uptake in the bone scintigram with a positive serology (IgG > 1/256, IgM slightly positive). The second child had destruction of the L2 vertebral body that compromised the channel and right foramen as visualized by MRI. In both cases, bacilli were observed in the bone biopsy by Warthing-Starry stain.

Enfermedad por arañazo de gato con compromiso óseo: una forma atípica de presentación clínica / Cat-scratch disease with bone compromise: atypical manifestation

Fever, headache, myalgias and lymphadenopathy are characteristic manifestations of cat-scratch disease but other less common findings are described in 2 to 10 percent of cases. We report two children that presented with hepatosplenic abscesses and bone involvement. One child, had múltiple áreas of increased uptake in the bone scintigram with a positive serology (IgG > 1/256, IgM slightly positive). The second child had destruction of the L2 vertebral body that compromised the channel and right foramen as visualized by MRI. In both cases, bacilli were observed in the bone biopsy by Warthing-Starry stain.

Las manifestaciones clínicas clásicas de la enfermedad por arañazo de gato (EAG) incluyen fiebre, cefaleas, mial-gias y adenopatía regional satélite al sitio de inoculación. En 5 a s 25 por ciento de los casos se describen formas atípicas con compromiso sistémico. Se comunican dos casos de niños que ingresan por fiebre prolongada con abscesos hepato-esplénicos Ambos agregan compromiso óseo. En el primero, el cintigrama óseo mostró múltiples zonas de hipercaptación y la serología específica para Bartonella henselae fue positiva (IgG > 1/256, IgM positiva débil). En el segundo, la resonancia magnética mostró proceso sustitutivo del cuerpo de L2 con compromiso de canal y foramen derecho, con indemnidad de los discos interverte-brales. En ambos casos, en la biopsia ósea se identificaron bacilos con tinción de Warthin-Starry. Se jerarquiza la búsqueda de esta etiología en niños inmunocompetentes que se presentan con fiebre prolongada y manifestaciones atípicas.

Uso de concentrado autologo rico en factores de crecimiento en la reconstruccion del ligamento cruzado anterior / Using AutoLogo concentrate rich in growth factors in the reconstruction of the anterior cruciate ligament

Hipotesis: La aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al injerto al efectuar la reeconstrucción de ligamento. cruzado anterior en deportistas, afecta positivamente el proceso de remodelación del injerto utilizado. Objetivo: Determinar el efecto que tiene en el proceso de remodelación del injerto, la aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al efectuar la reconstrucción de ligamento cruzado anterior en deportistas. Diseño del estudio: Prospectivo, clínico randomizado, con grupo control y ciego simple. Método: Se realiza en forma prospectiva el análisis de 50 reconstrucciones de LCA en 50 pacientes, todas ellas realizadas por el mismo equipo quirúrgico. Al grupo A , además de efectuar la reconstrucción de LCA, se adiciona Concentrado Plaquetario Autólogo, desarrollando una técnica de aplicación que permite estandarizar la dosis de concentrado empleada y evitar la pérdida de este en el paso del injerto a través de los túneles óseos. Los pacientes del grupo A se sometieron a estudio de resonancia magnética en forma seriada a los 3,4, 5, 6, 7, 8 Y 9 meses postoperatorio. El grupo control el estudio se realizó a los 3, 4, 6, 7,9,10 ,11 ,12 meses. La evaluación de las placas obtenidas fue realizada por un solo radiólogo en forma ciega, ya que desconocía: tiempo de evolución, técnica quirúrgica empleada o si se aplicó AGE analisis estadístico: Comparación de Grupos: T-Student (p-value <5%) Y Prueba F (p-value <5%). Modelo cuadrático predictivo de tiempo de maduración (homogeneidad) para determinar el tiempo de remodelación y maduración en cada grupo. Resultados: El puntaje promedio de maduración al momento de la resonancia magnética, entregado por el radiólogo en el grupo A fue de 1,14 y en el grupo B (control) fue de 3,25. Ambos grupos son comparables según sexo y edad (p-value <5%). El tiempo de maduración del segmento intraarticular, en el grupo A (co...

[Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake]. / Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica.

BACKGROUND: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. AIM: To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. MATERIAL AND METHODS: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. RESULTS: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor). CONCLUSIONS: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica / Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake

Background: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. Aim To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. Material and methods: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. Results: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100 percent of foci. Nine percent had a normal and 26 percent an abnormal anatomy. Before fusion 82 percent of foci were classified as potentially malignant. This figure changed to 59 percent after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72 percent of foci and fusion results would have reached a 27 percent of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasalEwingsarcoma and one with a brain tumor). Conclusions: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Consumo dietario de hierro y niveles de ferratina sérica en mujeres universitarias, no entrenadas, residentes a nivel del mar y en altitud intermedia / Dietary iron intake and serum ferritin levels in untrined college women living at sea level and intermediate altitude

El objetivo de este trabajo fue establecer el efecto de la hipoxia hipobárica en el consumo y reservas de hierro entre dos grupos de mujeres sanas, sedentarias, en edad reproductiva, siendo un grupo residente a nivel del mar y el otro en altitud intermedia (2600 msnm). Los sujetos de estudio fueron mujeres voluntarias entre 18 y 24 años de edad, universitarias no entrenadas, sin factores de riesgo asociados al estado nutricional del hierro, residentes en Bogotá (Bog -2600 msnm)(n=28) y en Barranquilla (Bq - nivel del mar)(n=26). La selección se realizó por convocatoria abierta en tres etapas: 1. Formulario de tamizaje, 2. Valoración médica y nutricional que incluyó antropometría, frecuencia de ingesta y valoración del gasto energético y de nutrientes, 3. Toma de muestra de sangre. Por medio de las etapas 1 y 2 se buscaba excluir aquellas voluntarias que tuvieran pérdidas excesivas o condiciones que pudiesen modificar el metabolismo del hierro. No se encontraron diferencias entre los grupos en cuanto a edad, ciclo y sangrado menstrual, actividad física, parámetros antropométricos, ingesta de nutrientes (relacionados y no relacionados con el hierro) y parámetros hematológicos (albúmina, proteínas totales y ferritina sérica). Hubo una diferencia significativa para los valores de hematocrito (Bog 42.54 +/- 0.57 g, Bq 36.47+/-0.86 p = 0.01). Tampoco se encontró correlación significativa entre el hierro total ingerido y los valores de ferritina sérica, ni diferencias entre la proporción de voluntarias con ferropenia entre las dos alturas, aunque fue significativamente mayor la proporción de voluntarias anémicas a nivel del mar. Estos resultados nos llevan a concluir que la respuesta eritropoyética a la hipoxia hipobárica no cursa con agotamiento de las reservas de hierro en mujeres jóvenes, sanas, residentes en altura intermedia efecto que probablemente se relacione con cambios en la biodisponibilidad mediados por respuesta a la hipoxia.

Hematuria: estudio desde el punto de vista urológico / Haematuria: study from a urological viewpoint

La hematuria verdadera se caracteriza por la presencia de más de 5 glóbulos rojos por campo microscópico corriente o por más de 3 por campos microscópicos de alto poder. Frente a la sospecha clínica de hematuria, lo primero es descartar la existencia de una pseudo-hematuria (hemoglobinuria, mioglobinuria, así como algunos alimentos y medicamentos). Las hematurias verdaderas se dividen en micro y macroscópicas así como en fisiológicas y patológicas, las que pueden ser continuas o intermitentes. En relación con su origen se reconocen hematurias renales sean glomerulares o post-glomerulares o extrarrenales (existencia o no de proteinuria y de dismorfia). Toda hematuria exige un completo estudio diagnóstico urológico y nefrológico (examen de sedimento urinario, tests de función renal; imágenes pielo, eco y topográficas y exploración endoscópica). Así y todo, no se logra precisar la etiología del 5 a 10 por ciento de las hematurias microscópicas.

Alargamiento de metacarpiano: caso clínico / Lengthening of metacarpian: clinical case

Braquimetacarpiano o braquidactilia tipo E es el acortamiento anómalo de un metacarpiano o de un dedo. Esta anomalía corresponden al 5.2 por ciento de todas las malformaciones de la mano, siendo los metacarpianos 3º, 4º y 5º los más frecuentemente afectados (1-3). El problema se diagnóstica durante el crecimiento cuando se hace evidente un dedo más corto y/o el hundimiento del nudillo al cerrar el puño. Los procedimientos de elongación de metacarpianos actualmente más utilizados son: la distracción aguda y la colocación de injerto óseo. En esta revisión se muestra el caso clínico de una paciente tratada mediante la utilización de un tutor monoplanar externo, técnica relativamente nueva. En este caso se logró un alargamiento de 18 milímetros en un período de 4 meses, con excelentes resultados estéticos y funcionales.