Characterization of mating type on aroma production and metabolic properties wild Kluyveromyces marxianus yeasts.

Kluyveromyces marxianus yeasts represent a valuable industry alternative due to their biotechnological potential to produce aromatic compounds. 2-phenylethanol and 2-phenylethylacetate are significant aromatic compounds widely used in food and cosmetics due to their pleasant odor. Natural obtention of these compounds increases their value, and because of this, bioprocesses such as de novo synthesis has become of great significance. However, the relationship between aromatic compound production and yeast's genetic diversity has yet to be studied. In the present study, the analysis of the genetic diversity in K. marxianus isolated from the natural fermentation of Agave duranguensis for Mezcal elaboration is presented. The results of strains in a haploid and diploid state added to the direct relationship between the mating type locus MAT with metabolic characteristics are studied. Growth rate, assimilate carbohydrates (glucose, lactose, and chicory inulin), and the production of aromatic compounds such as ethyl acetate, isoamyl acetate, isoamyl alcohol, 2-phenylethyl butyrate and phenylethyl propionate and the diversity in terms of the output of 2-phenylethanol and 2-phenylethylacetate by de novo synthesis were determinate, obtaining maximum concentrations of 51.30 and 60.39 mg/L by ITD0049 and ITD 0136 yeasts respectively.

Impact of cognitive impairment, depression, disease activity, and disease damage on quality of life in women with systemic lupus erythematosus.

OBJECTIVES: To define the relative role of cognitive impairment, depression, disease activity, and disease damage in the decreased health-related quality of life (HRQoL) frequently observed in systemic lupus erythematosus (SLE) patients. METHOD: We studied 101 Chilean female SLE patients and applied the 12-item Medical Outcomes Study (MOS) Short Form Health Survey version 2 (SF-12v2) to assess HRQoL and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive function. Analysis of covariance (ANCOVA) models included demographic and disease-related factors and cognitive function tests of sustained attention, memory, and executive function. RESULTS: All measures of HRQoL were lower in the 101 female SLE patients compared to the women from the Chilean general population. HRQoL was associated with the following factors: (i) depression symptoms, which were detrimental to all components of the physical and mental HRQoL scores; (ii) executive dysfunction (spatial planning), which was associated with lower scores on role limitations due to physical health problems and emotional problems, and general health perceptions; (iii) higher activity and organ damage were deleterious to role physical, bodily pain, and physical summary scores; and (iv) higher damage also impacted physical function. Impairments in sustained attention and memory did not decrease the HRQoL. CONCLUSIONS: Our results highlight the relevance of executive dysfunction to poor physical and mental health components of HRQoL in SLE together with depression, while disease activity and disease damage are associated with lower HRQoL physical components. The need for cognitive function evaluation and rehabilitation in SLE is indicated.

El uso de pantallas en pediatría y su influencia en el trastorno de déficit atencional / Pediatric screen use and its infuence in attention deficit disorder

Existe evidencia concluyente de la influencia del uso excesivo de pantallas con trastornos en el desarrollo biopsicosocial de niños y adolescentes. Objetivo: Analizar descriptivamente la influencia que ejerce el uso de medios de multimedia en el desarrollo de problemas de atención y del Trastorno de Déficit Atencional Hiperactivo (TDAH) en la población pediátrica. Método: Se efectuó una revisión de la literatura disponible en PudMed, Cochrane y EBSCO. Resultados: La exposición en la infancia y adolescencia a la televisión (TV) se relaciona con un riesgo elevado de desarrollar problemas de atención, dificultades escolares, comprensión lectora deficiente y otros trastornos cognitivos, existiendo una relación directa entre el número de horas de exposición con el fracaso académico; además, el TDAH sería un factor de riesgo de adicción a internet y juegos, existiendo evidencia sobre la asociación entre adicción a videojuegos y TDAH. Sólo un número de artículos desacreditan la asociación entre las pantallas y los problemas de atención o TDAH. Conclusiones: Existe una particular relación entre el uso excesivo de pantallas y los problemas de atención y TDAH, considerándose un factor de riesgo para su desarrollo. Palabras claves: atención, TDAH, problemas de aprendizaje, multimedia.

There is conclusive evidence of the relation between the excessive use of screens with developmental disorders in children and adolescents. Objective:Description of the relation between the use of multimedia and the development of attention difficulties and attention deficit and hyperactivity disorder (ADHD) in the pediatric population. Method: We reviewed the available literature on PudMed , Cochrane and EBSCO. Results:The exposure during childhood and adolescence to television (TV) is related with a high risk of developing attentional ad school difficulties, poor reading comprehension and other cognitive disorders. There is a direct relationship between the number of hours of exposure with academic failure; also, ADHD would be a risk factor of addiction to internet and videogames, there is evidence on the association between ADHD and addiction to video games. There is only a scant number of articles discrediting the association between screens and attention / ADHD issues. Findings: There is a relationship between excessive use of screens and ADHD, so that excessive screen use is considered a risk factor for devolping ADHD.Keywords: Attention, ADHD, Learning problems, multimedia, screen time.

Melanoma subungueal de la mano: reporte de un caso / Hand’s subungueal melanoma: A case report

El melanoma es considerado una neoplasia melanocítica maligna; la localización subungueal corresponde al 0.7-3.5% de todos los melanomas. Clínicamente se presenta como una melanoniquia en general asintomática. Comunicamos un paciente masculino de 67 años, que consulta por presentar melanoniquia estriada en el cuarto dedo de la mano izquierda. El estudio histopatológico de biopsia informa un melanoma acral, por lo que se procede a realizar resección completa de la lesión con amputación de la falange distal; el paciente evolucionó satisfactoriamente. Este melanoma se origina de la matriz ungular, aunque se ha propuesto la asociación con traumas, su etiología no está clara. Histológicamente, se caracteriza por una proliferación de melanocitos atípicos o fusiformes, con grados variables de invasión; algunas lesiones son pigmentadas y otras amelanóticas. Se debe establecer el diagnóstico diferencial con: hematomas, osteomielitis, onicomicosis, granuloma piógeno, paroniquia, enfermedad de Kaposi, carcinoma espinocelular, entre otras. Algunos factores pronósticos incluyen profundidad de invasión, índice mitótico, ulceración, índice de proliferación con Ki 67 para nombrar solo algunos factores del denominado “histopronóstico”. El retraso en el diagnóstico del melanoma subungueal condiciona un mal pronóstico. El tratamiento apunta hacia la intervención quirúrgica en estadios tempranos, con evaluación del ganglio centinela (esto varía según la escuela académica). Sin embargo, actualmente se hace referencia a nuevos fármacos, que modifican la respuesta inmune o que intervienen en el metabolismo celular, con lo que se dan los primeros pasos para modificar la historia natural de esta enfermedad.

Introduction: melanoma is considered a biologically aggressive neoplasm. It’s more common in the 6th decade. Subungual melanoma corresponding to 0.7-3.5% of all melanomas. The most common locations are hallux, thumb, index and ring. Clinically, it presents as an asymptomatic melanonychia. Case Report: male aged 67 who consulted for striated melanonychia fourth finger left hand. Biopsy histopathological study reports malignant melanoma. Complete resection of the lesion was performed with amputation of distal phalanx. Patient evolves satisfactorily. Discussion: this melanoma originates from the nail matrix. Although it has been proposed partnership with traumas, its etiology is unclear. Hasn’t been able to establish an association with race, skin type and sun exposure, as in other melanoma’s types. Histologically it is characterized by a proliferation of atypical melanocytes or fusiform with varying degrees of invasion. Some injuries are pigmented and others may be amelanotic. Should be established the differential diagnosis with hematomas, osteomyelitis, onychomycosis, pyogenic granuloma, paronychia, among other injuries. Some prognostic factors include depth of invasion, mitotic rat, ulceration, proliferation index among others. The delay in diagnosis of subungual melanoma determines a poor prognosis. The treatment aims to surgery in early stages, with evaluation of sentinel node. But now referred to new drugs that modify the immune response or that involve its cellular metabolism thus taking the first steps to modify the natural history of this disease.

Sarcoma pleomórfico gigante de la mama / Giant pleomorphic breast sarcoma

Abstract It is reported the case of a female patient 50 years old who, after failed attempts at diagnosis, arrives at breast surgery service of the E.S.E. Hospital Universitario del Caribe with history of five months consistent inthe excessive growth of a mass in right breast; patient received radical mastectomy plus reconstruction withlatissimus dorsi muscle flap. Following excision of tumor mass of 6,500 g is performed immunohistochemicaldiagnosis of a giant pleomorphic sarcoma.

Resumen introducción: Los tumores derivados del tejido conectivo interlobulillar de la mama son en mayor proporción malignos y, en virtud a su ubicación, en la actualidad reciben el nombre de "sarcomas" de la mama. Caso clínico: Se reporta el caso de una paciente femenina de 50 años de edad quien, posterior a fallidosintentos de diagnóstico, acude al servicio de cirugía de mama de la E.S.E. Hospital Universitario del Caribecon un cuadro de cinco meses de evolución consistente en el crecimiento desmedido de una masa en mamaderecha; la paciente recibió mastectomía radical más reconstrucción con colgajo de músculo dorsal ancho.Posterior a exéresis de masa tumoral de 6.500 g de peso se lleva a cabo diagnóstico inmunohistoquímico deun sarcoma pleomórfico gigante de la mama.

The effect of changing the pre-slaughter handling on bovine cattle DFD meat / Efecto del cambio en el manejo antemortem sobre la presencia de carne DFD en ganado bovino

Objective. To evaluate the effect that a series of changes in the handling techniques used throughout the pre and post slaughter periods and during the handling of cooled carcass have on the presence of DFD (Dark, firm and dry) meat. Materials and methods. Odds ratios (OR) and confidence intervals were estimated applying logistic regression models. Data from 18 visits to the slaughterhouse regarding: animal handling on arrival, slaughter period, and carcass storage was obtained through the use of a questionnaire. A total of 572 carcasses were analyzed to determine DFD meat using pH and color (L*, a*, b* and C*) measurements done on the Longissimus dorsi muscle. Results. Even after of the changes were made, the lairage period to slaughter continued to be a factor (p<0.05) associated to the presence of DFD meat (OR=1.13). Of the complementary variables, the amount of time that cattle spent on the resting pens was associated (p<0.05) to the presence of DFD meat (OR=1.003). Conclusions. Regardless of the changes made in the ante mortem handling, a high frequency of DFD was found (39%), suggesting a permanent audit program to detect other critical points in the supply chain.

Objetivo. Para evaluar el efecto de una serie de modificaciones en las técnicas de manejo usadas en el periodo pre y post-sacrificio y manejo de las canales en refrigeración en relación con la presencia de carne DFD (dura, firme y seca). Materiales y métodos. Se obtuvieron razones de desigualdad e intervalos de confianza empleando modelos de regresión logística. En 18 visitas a la planta de sacrificio, se aplicó un cuestionario obteniendo información sobre manejo de los animales desde su llegada a la planta, etapa de sacrificio y almacenamiento de las canales. Se estimó la frecuencia de carne DFD de analizar un total de 572 canales, registrando en el Longissimus dorsi pH y color (L*, a* b*, C*). Results. De las modificaciones realizadas, el tiempo de permanencia al sacrificio sigue siendo fue un factor asociado (p<0.05) a la presencia de carne DFD (OR=1.13). De las variables complementarias, el tiempo de espera en los corrales de descanso resultó correlacionado (p<0.05) a la presencia de carne DFD (OR=1.003). Conclusiones. Independientemente de los cambios realizados en el manejo ante mortem, se encontró una alta frecuencia de carne DFD (39%), sugiriendo un programa de auditoría permanente para detectar otros puntos críticos de la cadena logística.

BackCLIP: a tool to identify common background presence in PAR-CLIP datasets.

MOTIVATION: PAR-CLIP, a CLIP-seq protocol, derives a transcriptome wide set of binding sites for RNA-binding proteins. Even though the protocol uses stringent washing to remove experimental noise, some of it remains. A recent study measured three sets of non-specific RNA backgrounds which are present in several PAR-CLIP datasets. However, a tool to identify the presence of common background in PAR-CLIP datasets is not yet available. RESULTS: We used the measured sets of non-specific RNA backgrounds to build a common background set. Each element from the common background set has a score that reflects its presence in several PAR-CLIP datasets. We present a tool that uses this score to identify the amount of common backgrounds present in a PAR-CLIP dataset, and we provide the user the option to use or remove it. We used the proposed strategy in 30 PAR-CLIP datasets from nine proteins. It is possible to identify the presence of common backgrounds in a dataset and identify differences in datasets for the same protein. This method is the first step in the process of completely removing such backgrounds. AVAILABILITY: The tool was implemented in python. The common background set and the supplementary data are available at https://github.com/phrh/BackCLIP. CONTACT: phreyes@gmail.com SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Surface Study of Lithium-Air Battery Oxygen Cathodes in Different Solvent-Electrolyte pairs.

The O2/Li2O2 electrode reaction has been studied on low surface area Au electrodes in three solvent-electrolyte pairs (0.1 M LiPF6/DMSO, LiPF6/ACN, and LiBF4/ACN) using an electrochemical cell coupled to UHV XPS spectrometer, EQCM, AFM, and DEMS. The XPS spectra of the surfaces after treatment at selected electrode potentials for the O2 reduction and reoxidation of the surface show the presence of C and S from solvent decomposition and of F and P from electrolyte decomposition. Furthermore, Li 1s and O 1s peaks due to Li2O2 and decomposition products such as carbonate, organics, LiF, high oxidation sulfur, and phosphorus compounds were also observed. Using ACN instead of DMSO results in less solvent decomposition, whereas using LiBF4 results in less electrolyte decomposition. XPS, AFM, and EQCM show that O2 reduction products removal only takes place at very high overpotentials. In agreement with XPS which shows removal of carbonate surface species, DEMS confirms evolution of CO2 and consumption of O2 at 4.5 V, but LiF cannot be removed completely in a round trip of the Li-O2 battery cathode.

Diagnosis of cervical cells based on fractal and Euclidian geometrical measurements: Intrinsic Geometric Cellular Organization.

BACKGROUND: Fractal geometry has been the basis for the development of a diagnosis of preneoplastic and neoplastic cells that clears up the undetermination of the atypical squamous cells of undetermined significance (ASCUS). METHODS: Pictures of 40 cervix cytology samples diagnosed with conventional parameters were taken. A blind study was developed in which the clinic diagnosis of 10 normal cells, 10 ASCUS, 10 L-SIL and 10 H-SIL was masked. Cellular nucleus and cytoplasm were evaluated in the generalized Box-Counting space, calculating the fractal dimension and number of spaces occupied by the frontier of each object. Further, number of pixels occupied by surface of each object was calculated. Later, the mathematical features of the measures were studied to establish differences or equalities useful for diagnostic application. Finally, the sensibility, specificity, negative likelihood ratio and diagnostic concordance with Kappa coefficient were calculated. RESULTS: Simultaneous measures of the nuclear surface and the subtraction between the boundaries of cytoplasm and nucleus, lead to differentiate normality, L-SIL and H-SIL. Normality shows values less than or equal to 735 in nucleus surface and values greater or equal to 161 in cytoplasm-nucleus subtraction. L-SIL cells exhibit a nucleus surface with values greater than or equal to 972 and a subtraction between nucleus-cytoplasm higher to 130. L-SIL cells show cytoplasm-nucleus values less than 120. The rank between 120-130 in cytoplasm-nucleus subtraction corresponds to evolution between L-SIL and H-SIL. Sensibility and specificity values were 100%, the negative likelihood ratio was zero and Kappa coefficient was equal to 1. CONCLUSIONS: A new diagnostic methodology of clinic applicability was developed based on fractal and euclidean geometry, which is useful for evaluation of cervix cytology.

A novel begomovirus isolated from sida contains putative cis- and trans-acting replication specificity determinants that have evolved independently in several geographical lineages.

A novel begomovirus isolated from a Sida rhombifolia plant collected in Sinaloa, Mexico, was characterized. The genomic components of sida mosaic Sinaloa virus (SiMSinV) shared highest sequence identity with DNA-A and DNA-B components of chino del tomate virus (CdTV), suggesting a vertical evolutionary relationship between these viruses. However, recombination analysis indicated that a short segment of SiMSinV DNA-A encompassing the plus-strand replication origin and the 5´-proximal 43 codons of the Rep gene was derived from tomato mottle Taino virus (ToMoTV). Accordingly, the putative cis- and trans-acting replication specificity determinants of SiMSinV were identical to those of ToMoTV but differed from those of CdTV. Modeling of the SiMSinV and CdTV Rep proteins revealed significant differences in the region comprising the small ß1/ß5 sheet element, where five putative DNA-binding specificity determinants (SPDs) of Rep (i.e., amino acid residues 5, 8, 10, 69 and 71) were previously identified. Computer-assisted searches of public databases led to identification of 33 begomoviruses from three continents encoding proteins with SPDs identical to those of the Rep encoded by SiMSinV. Sequence analysis of the replication origins demonstrated that all 33 begomoviruses harbor potential Rep-binding sites identical to those of SiMSinV. These data support the hypothesis that the Rep ß1/ß5 sheet region determines specificity of this protein for DNA replication origin sequences.

Análisis de la Varianza de un Grupo de Experimentos en Parcelas Subdivididas / Analysis of the Variance of a Series of Experiments in Split-split Plots

Este trabajo tuvo como propósito el análisis conjunto de un grupo de experimentos en parcelas subdivididas. En el campo de las Ciencias del Agro es de uso frecuente en ensayos con pastos, en los cuales generalmente, las sub-subparcelas son las diferentes fechas o épocas de corte de los mismos. Se considera el caso en que cada experimento es diseñado en parcelas subdivididas y es repetido, bajo la misma estructura, en m lugares (localidades) o durante m años. Inicialmente; se debe realizar el análisis de la varianza individualmente para cada lugar o para cada año de la manera usual y realizar pruebas de hipótesis y obtener valores estimados de los diferentes efectos, así como de los distintos errores involucrados. Se presentó la metodología para realizar, conjuntamente, pruebas de hipótesis y obtener valores estimados para los efectos de tratamientos, considerando que se ha tomado una muestra aleatoria de la población de localidades o de la población de años. En el modelo estadístico adoptado, se admite que es balanceado y que los tratamientos son considerados como de efectos fijos. Bajo estas condiciones, se presentó la metodología para la obtención de la solución de las ecuaciones normales, las sumas de cuadrados, las esperanzas de los cuadrados medios de las diferentes causas de variación y, posteriormente, fueron deducidos los numeradores y denominadores apropiados para la realización de la prueba de F, con sus grados de libertad asociados, lo cual permitió construir la tabla para realizar el análisis de la varianza respectivo.

The purpose of this work was the joint analysis of a series of experiments in split-split plots. In the field of Agrosciences, this procedure is frequently used in experiments with grass, where sub-plots are generally the different dates of cut. The investigation considered the case in which each split-split plot experiments were repeated over m places or m years, under the same structure. Initially, the analysis of variance should be individually performed in the usual way, for each place or year and obtain tests of significance and estimate values of the different effects, as well as the various errors involved. A methodology was presented for joint analysis, test of significance, and estimated effect of treatments, considering random samples were taken from a place or year. It is agreed that the statistical model used is balanced and treatments are taken as fixed factors. Under the given conditions, the solutions of normal equations, the sum of squares, the expectations of the mean squares, the appropriate denominators for the F test, the degrees of freedom associated, and finally, the analysis of variance, were obtained.

Biochemical comparison of venoms from young Colombian Crotalus durissus cumanensis and their parents

Crotalus durissus cumanensis, a rattlesnake endemic to Colombia and Venezuela, is considered one of the most lethal snake species in Latin America. The aim of the present study was to compare the protein content and biological activity of the venom obtained from eight specimens of C. durissus cumanensis, namely two adults from different localities of Colombia and six offspring born in captivity. Protein profiles of crude venoms were analyzed by SDS-PAGE and RP-HPLC, and biological activities were evaluated for lethality, edema, defibrination, hemolytic and coagulant activities to assess individual venoms of adults and a pool of young snake venoms. Transient edema appeared rapidly after venom inoculation, whereas hemorrhagic effect was not observed. Differences in protein profiles, lethality, hemolytic, coagulant and defibrinating activities between both adult snake venoms were observed; those from the mother snake exhibited higher activities. Venoms from young snakes were similar to the one obtained from the mother, but the coagulant effect was stronger in offspring venoms. Notably, biological effects of the father snake venom were not comparable to those previously described for C. durissus cumanensis from Venezuela and C. durissus terrificus from Brazil, confirming the high variability of the venom from Crotalus species.(AU)

Biochemical comparison of venoms from young Colombian Crotalus durissus cumanensis and their parents

Crotalus durissus cumanensis, a rattlesnake endemic to Colombia and Venezuela, is considered one of the most lethal snake species in Latin America. The aim of the present study was to compare the protein content and biological activity of the venom obtained from eight specimens of C. durissus cumanensis, namely two adults from different localities of Colombia and six offspring born in captivity. Protein profiles of crude venoms were analyzed by SDS-PAGE and RP-HPLC, and biological activities were evaluated for lethality, edema, defibrination, hemolytic and coagulant activities to assess individual venoms of adults and a pool of young snake venoms. Transient edema appeared rapidly after venom inoculation, whereas hemorrhagic effect was not observed. Differences in protein profiles, lethality, hemolytic, coagulant and defibrinating activities between both adult snake venoms were observed; those from the mother snake exhibited higher activities. Venoms from young snakes were similar to the one obtained from the mother, but the coagulant effect was stronger in offspring venoms. Notably, biological effects of the father snake venom were not comparable to those previously described for C. durissus cumanensis from Venezuela and C. durissus terrificus from Brazil, confirming the high variability of the venom from Crotalus species.

Siete años de experiencia en cirugía "Tension Free Vaginal Tape" (TVT) / Seven years of experience in tension free vaginal tape (TVT) procedure

Desde la introducción del “tension free vaginal tape” (TVT) para el tratamiento de la IOE se ha popularizado como técnica quirúrgica relativamente estándar y comparable. El TVT a 7 años ha mostrado buenos resultados y pocas complicaciones en la serie histórica. El TVT además ha modificado los conceptos en que se basan la mayoría de las técnicas quirúrgicas para la IOE. Nuestro objetivo es mostrar los resultados quirúrgicos a corto y largo plazo de la técnica TVT, para lo cual realizamos una revisión retrospectiva de los registros de las pacientes operadas con la técnica TVT consignando resultados terapéuticos y complicaciones. En el período agosto 2000 a agosto del 2007 hemos operado 129 pacientes con esta técnica. El seguimiento promedio fue de 45,7 meses. El promedio de edad fue de 56 años. En 71 (55 por ciento) pacientes existía el antecedente de cirugía ginecológica o de incontinencia previa. Complicaciones intraoperatorias y post-operatorias inmediatas fueron sangramiento severo en 1 (0,8 por ciento)paciente, perforación vesical en 5 (3,9 por ciento), retención de orina en 11 (8,5 por ciento) y urgencia de Novo en 13 (10 por ciento) pacientes. Cinco pacientes debieron ser sometidas a uretrolisis por síntomas obstructivos bajos u obstrucción. Tuvimos 3 pacientes con erosión, una con cierre espontáneo y dos en que debió ser retirada la malla. De las 113 pacientes con más de 12 meses de seguimiento 13 (11,5 ciento) persisten con IOE y 100 (88,1 por ciento) se encuentran continentes. En nuestra experiencia la cirugía TVT ha reproducido con éxito los resultados originales, siendo una técnica poco invasiva recomendable para resolver.

The minimally invasive TVT procedure and similar techniques of sling placement with reported cure rate for stress incontinence from 84 percent to 95 percent, have replaced most of stress urinary incontinence procedures. The aim of the present study is to evaluate TVT outcome in our hospital. We performed a retrospective review of the hospital database between August 2000 and August 2007. 129 patients were identified with TVT surgery as treatment for stress urinary incontinence. The mean age was 56years old. 71 patients (55 percent) had a previous SUI or prolapsed surgery. Mean follow up was 45.7 months. 113 patients had a follow up longer than 12 months with a success rate of 88.5 percent (100 patients). Immediate complications were defined as bleeding, bladder perforation and postoperative urinary retention and occurred in 1 patients (0.77 percent), 5 patients (3.9 percent), 6 patients (4,65 percent) respectively. We had de novo urgency in 13 patients (10 percent). Three patients (2.3 percent) had vaginal erosion, in 2 cases we removed the mesh. Five patients (3.9 percent) had postoperative voiding disfunction that requiered urethrolysis. Subjetive complete cure rate was 88,1percent for the 113 women available for follow-up. According to our data, TVT shows good outcome in the treatment of SUI. TVT is a safe, effective, and minimally invasive option.

Resultados del Tension Free Vaginal tape (TVT) en el manejo quirúrgico de las recidivas post cirugía de Burch / The results of tension free vaginal tape after Burch's technique failure

La técnica de Burch es una de las que muestra mejores resultados a largo plazo en el tratamiento de la Incontinencia Urinaria de Esfuerzo (IOE), sin embargo también presenta recidivas. El principio básico de la uretropexia de Burch es subir el cuello vesical a una posición intrabdominal retropúbica. Si este principio no funciona deben considerarse soluciones quirúrgicas basadas en otros principios fisiopatológicos para una segunda cirugía, como es el TVT. Nuestro objetivo es evaluar los resultados del TVT en pacientes recidivadas después de cirugía de Burch, para ello realizamos una revisión retrospectiva de estas pacientes que fueron operadas por segunda vez con técnica de TVT. De 129 pacientes sometidas a TVT en nuestro Servicio, 17 presentaban el antecedente de recidiva de IOE después de cirugía de Burch. El promedio de edad fue de 56,3 años. El TVT se realizó en promedio 7,75 (3 - 13) años después del Burch. El 100 por ciento de las pacientes se mantiene sin IOE después de 49,7 (2 - 84) meses de seguimiento. No tenemos pacientes con perforación vesical ni retención de orina. En 4 (23,5 por ciento) se desarrolló urgencia de Novo. Una paciente presentó erosión que cerró espontáneamente. El TVT ha demostrado en nuestras pacientes ser una excelente alternativa para tratar las recidivas del Burch, pudiendo explicarse ya que la uretra media donde debe colocarse la malla es un área quirúrgicamente virgen y porque los mecanismos para evitar la pérdida de orina son distintos en las dos técnicas.

In most published series Burch colpocystourethropexy suggest an objective success rate for primarysurgery of between 80 percent and 90 percent. The aim of our study is to evaluate TVT as treatment after Burch failure. We evaluated retrospectively 129 TVT procedures at our institution between August 2000 and August 2007. We identified 17 patients who underwent a TVT procedure for recurrent stress urinary incontinence after Burch surgery. The mean age of the patient was 56.3 years. Mean follow-up was49.7 months (range 2 to 84). TVT was performed in average 7.75 years (range 3 to13) after Burch surgery. All the patients were considered cured. Our series didn’t have immediate complications defined as bladder or bowel perforation or postoperative urinary retention. We had one patient (5.9 percent) with vaginal erosion treated successfully with supportive measures. De novo urgency occurred in 23,4 percent(4 patients). According to our data, TVT shows good outcome in the treatment of Burch failure. TVT is a safe, effective, and minimally invasive option. We believe that clinical success is achieved because the mesh is in a different area from Burch colpocystourethropexy and different continence mechanismsare involved.

Human papillomavirus (HPV) viral load and HPV type in the clinical outcome of HIV-positive patients treated with imiquimod for anogenital warts and anal intraepithelial neoplasia.

OBJECTIVE: To evaluate the efficacy of 5% imiquimod in HIV-positive male patients with anogenital warts or anal intraepithelial neoplasia (AIN), and to elucidate whether human papillomavirus (HPV) type and viral load were important for clinical outcome and recurrences. METHODS: Thirty-seven patients with histologically proven anogenital warts or AIN were enrolled. Topical 5% imiquimod was applied three times per week for more than 8 h overnight for 16 weeks, although patients were allowed to continue therapy for 4 more weeks if they did not have complete clearance of lesions. RESULTS: Mean age was 34 years. The perianal area was the main lesion location. Thirty-three patients had CD4 counts of < 500 cells/mm(3). Eighteen patients had a histopathological diagnosis of AIN-1. Main HPV types detected corresponded to low-risk HPV types. At 20 weeks of therapy, 46% patients achieved total clearance whereas 14 patients had > 50% clearance. Recurrence was observed in 5 of 17 patients who cleared. Clearance was not influenced by patients' CD4 counts, wart location, HIV viral load or HPV viral load. CONCLUSIONS: The assumption that visible perianal warts are benign lesions in HIV-positive patients has to be reevaluated since an important number of such lesions could correspond to low-grade anal disease, which in turn could progress to high-grade anal disease or cancer. In addition, our results in this preliminary study indicate that imiquimod appears to be effective in treating AIN in HIV-positive patients. Further studies are needed to document its utility to prevent high-grade dysplasia and/or anal cancer.

Neurocognición en hiperamonemia inducida por ácido valproico: efecto del tratamiento con L-carnitina / Neurocognition in valproic acid-induced hyperammonemia: L-carnitine treatment effect

Purpose: The higher levels of ammonia associated to valproic acid (VA) is a recognizedsituation in the treatment of childhood epilepsy and it has a very well documented management, but in adult psychiatric patients in ambulatory condition, oral L-carnitine treatment with standardized doses are limited. Methods: Twelve patients receiving VA and ammonia levels up to 60 ug/dl were exposed to treatment with L-carnitine for 30 days, checking the ammonia values before and after carnitine administration. To isolate neurocognitive disturbances secondary to hyperammonemia and their further improvement with L-carnitina, Mini mental Test was applied pre and post treatment. Psychopathological factors associated to hyperammonemia production and suggested prescriptions and doses were both reviewed. Results: All patients that received Lcarnitine decreased ammonia levels from the raised baselines values. Conclusions: L-carnitine is effective in reducing hyperammonemia associated to VA and in lesser doses than the ones usually suggested by literature dealing with these issues. No important secondary effect was found. We postulate that both a simple and easy neuropsychological application test, like the MMSE, can discriminate against cognitive alterations for intraindividual ammonemia, faced with or without determinations of hiperammonemia, with p of 0.02 and an observed power of 0,696.

Objetivos: La elevación del amonio inducida por ácido valproico (AV) es una situaciónreconocida en el tratamiento de la epilepsia infantil y bien documentado su manejo, pero enpacientes adultos psiquiátricos y en tratamiento ambulatorio, los reportes de tratamiento con Lcarnitina por vía oral y con estandarización de dosis son escasos. Método: 12 pacientes en tratamiento con AV y con amonemia sobre 60 ug/dl fueron sometidos a tratamiento con Lcarnitina durante 30 días, examinándose los valores de amonio previo y posterior a su uso. Para objetivar alteraciones neurocognitivas secundarias a hiperamonemia y su corrección con Lcarnitina, se aplicó Minimental Test pre y post tratamiento. Se revisaron los factores fisiopatológicos asociados a la producción de hiperamonemia y recomendaciones sobre las indicaciones y dosis de L-carnitina para esta complicación. Resultados:Todos los pacientes que recibieron L-carnitina disminuyeron los niveles de amonemia, encontrándose que en 9 de ellos (75%) la disminución intefue en promedio de 65% desde los valores inicialmente elevados. Conclusiones: La adición de L-carnitina por vía oral es efectiva en la disminución de la hiperamonemia secundaria a AVy en dosis menores a las habitualmente recomendadas por la literatura en otras patologías ygrupos etarios, sin efectos secundarios de importancia. Postulamos que una prueba neuropsicológica simple y de fácil aplicación, como el MMSE, puede discriminar alteraciones cognitivas por amonemia intraindividuos, frente a determinaciones con y sin hiperamonemia, con un p de 0.02 y una potencia observada de 0,696.

Impact of pregnancy on the function of transplanted kidneys.

INTRODUCTION: This study reviewed the course of pregnancies in terms of impact on renal function and delivery-related data among women who received kidney transplants in our unit. METHODS: We reviewed the medical records of women transplanted between 1982 and 2002 who became pregnant. We recorded the data of medical, obstetrical, and transplant-related complications, plasma creatinine levels, and blood pressures at baseline, delivery, and 12 months after delivery. RESULTS: Thirty women had 37 pregnancies. Immunosuppressive protocols included cyclosporine, ketoconazole, azathioprine, and prednisone in 22 patients or azathioprine and prednisone in 15. Renal function decreased significantly: mean creatinine levels at baseline, delivery, and after 1 year were: 1.19 +/- 0.38 mg/dL; 1.44 +/- 0.70 mg/dL; and 1.38 +/- 0.53 mg/dL, respectively (P = .023 and P = .004 vs baseline respectively). Systolic and diastolic blood pressures at delivery were higher than at baseline (134 +/- 19 and 86 +/- 14 mm Hg vs 126 +/- 21 and 79 +/- 13 mm Hg (P = .029 and P = .053, respectively). These values normalized 1 year later (128 +/- 21 and 80 +/- 16). Decreased use of antihypertensive drugs were the cause of poor blood pressure control (1.8 +/- 1.3 vs 0.9 +/- 0.7, P < .01). Blood pressure control improved following delivery. The most frequent complications were preeclampsia (18.9%), intrahepatic cholestasis (13.5%), and urinary tract infections (13.5%). There were five rejection episodes. Seven miscarriages took place and one mole. Eleven pregnancies were uncomplicated. CONCLUSION: Renal transplantation is the best treatment for fertile women with end-stage renal disease who want to become pregnant. However, pregnancy is risky for the mother, fetus, newborn, and allograft.