Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database.

The effectiveness of emergency surgery vs. non-emergency surgery strategies for emergency admissions with acute appendicitis, gallstone disease, diverticular disease, abdominal wall hernia or intestinal obstruction is unknown. Data on emergency admissions for adult patients from 2010 to 2019 at 175 acute National Health Service hospitals in England were extracted from the Hospital Episode Statistics database. Cohort sizes were: 268,144 (appendicitis); 240,977 (gallstone disease); 138,869 (diverticular disease); 106,432 (hernia); and 133,073 (intestinal obstruction). The primary outcome was number of days alive and out of hospital at 90 days. The effectiveness of emergency surgery vs. non-emergency surgery strategies was estimated using an instrumental variable design and is reported for the cohort and pre-specified sub-groups (age, sex, number of comorbidities and frailty level). Average days alive and out of hospital at 90 days for all five cohorts were similar, with the following mean differences (95%CI) for emergency surgery minus non-emergency surgery after adjusting for confounding: -0.73 days (-2.10-0.64) for appendicitis; 0.60 (-0.10-1.30) for gallstone disease; -2.66 (-15.7-10.4) for diverticular disease; -0.07 (-2.40-2.25) for hernia; and 3.32 (-3.13-9.76) for intestinal obstruction. For patients with 'severe frailty', mean differences (95%CI) in days alive and out of hospital for emergency surgery were lower than for non-emergency surgery strategies: -21.0 (-27.4 to -14.6) for appendicitis; -5.72 (-11.3 to -0.2) for gallstone disease, -38.9 (-63.3 to -14.6) for diverticular disease; -19.5 (-26.6 to -12.3) for hernia; and - 34.5 (-46.7 to -22.4) for intestinal obstruction. For patients without frailty, the mean differences (95%CI) in days alive and out of hospital were: -0.18 (-1.56-1.20) for appendicitis; 0.93 (0.48-1.39) for gallstone disease; 5.35 (-2.56-13.28) for diverticular disease; 2.26 (0.37-4.15) for hernia; and 18.2 (14.8-22.47) for intestinal obstruction. Emergency surgery and non-emergency surgery strategies led to similar average days alive and out of hospital at 90 days for five acute conditions. The comparative effectiveness of emergency surgery and non-emergency surgery strategies for these conditions may be modified by patient factors.

Concordance of the ACR TI-RADS.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study.

BACKGROUND: Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up. METHODS: A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment. RESULTS: A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P < 0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was €1034 lower per patient managed without surgery. CONCLUSION: This study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.

High frequency of gram-negative bacilli harboring blaKPC-2 in the different stages of wastewater treatment plant: A successful mechanism of resistance to carbapenems outside the hospital settings.

Wastewater treatment plants (WWTPs) are considered to be a reservoir and a source of bacterial resistance. Worryingly, the presence of carbapenem-resistant Gram-negative bacilli (CRGNB) in WWTPs has recently been reported, but there are still many research gaps regarding its emergence and impact. The distribution of CRGNB in the different stages of a WWTP in Colombia and the relationship between the physicochemical factors involved with their presence are described in this paper. Additionally, given the impact on public health, the CRGNB detected were compared with isolates previously found in hospital patients. Residual water samples were taken from five different stages of a WWTP between January and July 2017. A total of 390 GNB were isolated, and a significant frequency of CRGNB harboring blaKPC-2 (38.2%, n = 149/390) was detected, of which 57% were Enterobacteriaceae, 41.6% Aeromonadaceae, and 1.3% Pseudomonadaceae. The Enterobacteriaceae were more frequent in the raw effluent compared to the Aeromonadaceae, which in turn were more prevalent in the recycled activated sludge and final effluent. Environmental variables such as pH, oxygen, chemical oxygen demand, and temperature were significantly correlated with the quantification of carbapenem-resistant Enterobacteriaceae (CRE) at specific points in the WWTP. Interestingly, isolated K. pneumoniae harboring blaKPC-2 from the WWTPs were diverse and did not relate genetically to the hospital strains with which they were compared. In conclusion, these results confirm the worrying scenario of the dissemination and persistence of emerging contaminants such as CRGNB harboring blaKPC-2, and reinforce the need to establish strategies aimed at containing this problem using multifocal interventions.

Concordance of the ACR TI-RADS. / Concordancia del TIRADS-ACR.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Descripción demográfica, clínica y anatomopatológica de las microcirugías de laringe: estudio retrospectivo en el Hospital Británico de Buenos Aires / Demographic, clinical, and anatomopathological description of larynx microsurgeries: Retrospective study at Hospital Británico de Buenos Aires / Descrição demográfica, clínica e anatomopatológica das microcirurgias de laringe: estudo retrospectivo no Hospital Britânico de Buenos Aires

Objetivo: la microcirugía laríngea es un procedimiento terapéutico en lesiones benignas de laringe, diagnóstico en pacientes con disfonías de evolución variable y en casos de sospecha de malignidad. El objetivo de este estudio es describir las características de los pacientes intervenidos por microcirugía laríngea y las lesiones observadas en un servicio de otorrinolaringología en Argentina. Metodología: estudio retrospectivo. Se realizó la revisión de protocolos quirúrgicos, historias clínicas, videoestroboscopias computarizadas y documentos de anatomía patológica. Análisis univariado descriptivo con utilización de la t de Student o la Chi- cuadrado, según las características de las variables (p <0.005 para significancia estadística). Resultados: el sexo masculino fue el más intervenido, con una edad media de 51.2 ± 6.6 años. El antecedente de tabaquismo fue el más frecuente. Las principales lesiones macroscópicas fueron premalignas y malignas, pólipos y quistes. En la anatomía patológica se encontraron pólipos, carcinomas y quistes. En ambos sexos la lesión más frecuente fue el pólipo (33% vs. 45%, p =0.03). En pacientes con antecedente de tabaquismo la lesión más común fue pólipo, en ambos géneros, en menores de 60 años (46% vs. 30%, p =0.02), mientras en mayores de 60 años fue el carcinoma (33% vs. 15%, p <0.001). Conclusiones: en población masculina en sexta década de la vida se encontró principalmente presencia de pólipos, quistes y carcinomas. En pacientes de este género, con antecedente de tabaquismo, se describe mayor presencia de carcinomas.

Objective: Laryngeal microsurgery is a procedure indicated in benign laryngeal lesions; it is also a diagnostic tool in patients with dysphonia or in cases where malignancy is suspected. Methodology: Retrospective study in which clinical records, surgical protocols, videoestroboscopies, and pathology documents of patients under laryngeal microsurgery between 2011 and 2016 were reviewed. Univariate analysis was performed using Chi squared test (p <0.05). Results: Mean age was 51.2 ± 6.6 years, males were the most frequently intervened. Smoking was the most common comorbidity. The main macroscopic lesions observed were premalignant and malignant, polyps and cysts; in the pathology, polyps, carcinomas, and cysts were found. Polyps were the most frequent lesions found in both genders (33% vs 45%, p = 0.03). In patients with a smoking comorbidity, polyps were the most common lesion in both women and men (46% vs. 30%, p = 0.02). A greater presence of carcinomas was described in males over 60 with a history of smoking (33% vs 15%, p = 0.0001). Conclusions: Polyps, cysts, and carcinomas were mainly found in males over 60. A greater presence of carcinomas was described in male patients with a history of smoking.

Objetivo: a microcirurgia laríngea é um procedimento terapêutico em lesões benignas de laringe, diagnóstico em pacientes com disfonias de evolução variável e em casos de suspeita de malignidade. O objetivo deste estudo é descrever as características dos pacientes intervindos por microcirurgia laríngea e as lesões observadas num serviço de otorrinolaringologia na Argentina. Metodologia: estudo retrospectivo. Se realizou a revisão de protocolos cirúrgicos, histórias clínicas, videoestroboscopias computorizadas e documentos de anatomia patológica. Análise univariado descritivo com utilização da t de Student ou a Chi- quadrado, segundo as características das variáveis (p <0.005 para significância estatística). Resultados: o sexo masculino foi o mais intervindo, com uma idade média de 51.2 ± 6.6 anos. O antecedente de tabaquismo foi o mais frequente. As principais lesões macroscópicas foram pré-malignas e malignas, pólipos e quistos. Na anatomia patológica se encontraram pólipos, carcinomas e quistos. Em ambos sexos a lesão mais frequente foi o pólipo (33% vs. 45%, p =0.03). Em pacientes com antecedente de tabaquismo a lesão mais comum foi pólipo, em ambos gêneros, em menores de 60 anos (46% vs. 30%, p =0.02), enquanto em maiores de 60 anos foi o carcinoma (33% vs. 15%, p <0.001). Conclusões: na população masculina na sexta década da vida se encontrou principalmente presença de pólipos, quistos e carcinomas. Em pacientes deste gênero, com antecedente de tabaquismo, se descreve maior presença de carcinomas.

Spatial perseveration error by alpacas (Vicugna pacos) in an A-not-B detour task.

Spatial perseveration has been documented for domestic animals such as mules, donkeys, horses and dogs. However, evidence for this spatial cognition behavior among other domestic species is scarce. Alpacas have been domesticated for at least 7000 years yet their cognitive ability has not been officially reported. The present article used an A-not-B detour task to study the spatial problem-solving abilities of alpacas (Vicugna pacos) and to identify the perseveration errors, which refers to a tendency to maintain a learned route, despite having another available path. The study tested 51 alpacas, which had to pass through a gap at one end of a barrier in order to reach a reward. After one, two, three or four repeats (A trials), the gap was moved to the opposite end of the barrier (B trials). In contrast to what has been found in other domestic animals tested with the same task, the present study did not find clear evidence of spatial perseveration. Individuals' performance in the subsequent B trials, following the change of gap location, suggests no error persistence in alpacas. Results suggest that alpacas are more flexible than other domestic animals tested with this same task, which has important implications in planning proper training for experimental designs or productive purposes. These results could contribute toward enhancing alpacas' welfare and our understanding of their cognitive abilities.

Novel serotype of bluetongue virus in South America and first report of epizootic haemorrhagic disease virus in Ecuador.

Bluetongue virus (BTV) and Epizootic haemorrhagic disease virus (EHDV) are closely related Orbiviruses that affect domestic and wild ruminants. In Ecuador previous serological studies reported the presence of BTV; however, no data are available about the presence of EHDV. In this study, 295 cattle without symptoms of infection were sampled from two farms located in Andean and Amazonian regions and from a slaughterhouse in the coastal region. ELISA analyses showed high prevalence of BTV (98.9%) and EHDV (81.3%) antibodies, and RT-qPCRs revealed the presence of EHDV (24.1%) and BTV (10.2%) genomes in cattle blood samples. Viral isolation allowed to identify EHDV serotype 1 (EHDV1) and BTV serotypes 9 (BTV9), 13 and 18. These findings suggest that BTV and EHDV are enzootic diseases in Ecuador.

Tools assessment and diagnosis to infant colic: a systematic review.

BACKGROUND: Infant colic occurs between 10% and 40% of healthy born children in their first year of life. Its assessment is complex, and there are only a few instruments of appraisement and diagnosis. METHODS: Scientific articles located through a systematic review using the Pubmed, Scopus, Cochrane, PEDro, Dialnet, IME and Dialnet databases. Two researchers obtained data independently from relevant studies previously identified. Risk of bias was assessed according to the methods recommended by the Cochrane Collaboration, with reporting following the preferred reported items for systematic reviews and meta-analyses guidelines and evaluating their methodological quality based on the EMPRO scale. RESULTS: Four tools were obtained for valuation of infant colic. Parental diary of infant cry and fuss behaviour, Crying Pattern Questionnaire, Infant Colic Scale and, lastly, a validity of the Turkish version of the Infant Colic Scale. CONCLUSIONS: Analysis of the existing tools involves the need to design and validate new assessment scales for this clinical frame.

Optimal Cotton Insecticide Application Termination Timing: A Meta-Analysis.

The concept of insecticide termination timing is generally accepted among cotton (Gossypium hirsutum) researchers; however, exact timings are often disputed. Specifically, there is uncertainty regarding the last economic insecticide application to control fruit-feeding pests including tarnished plant bug (Lygus lineolaris (Palisot de Beauvois)), boll weevil (Anthonomus grandis), bollworm (Helicoverpa zea), tobacco budworm (Heliothis virescens), and cotton fleahopper (Pseudatomoscelis seriatus). A systematic review of prior studies was conducted within a meta-analytic framework. Nine publicly available articles were amalgamated to develop an optimal timing principle. These prior studies reported 53 independent multiple means comparison field experiments for a total of 247 trial observations. Stochastic plateau theory integrated with econometric meta-analysis methodology was applied to the meta-database to determine the shape of the functional form of both the agronomic optimal insecticide termination timing and corresponding yield potential. Results indicated that current university insecticide termination timing recommendations are later than overall estimated timing suggested. The estimated 159 heat units (HU) after the fifth position above white flower (NAWF5) was found to be statistically different than the 194 HU termination used as the status quo recommended termination timing. Insecticides applied after 159 HU may have been applied in excess, resulting in unnecessary economic and environmental costs. Empirical results also suggested that extending the insecticide termination time by one unit resulted in a cotton lint yield increase of 0.27 kilograms per hectare up to the timing where the plateau began. Based on economic analyses, profit-maximizing producers may cease application as soon as 124 HU after NAWF5. These results provided insights useful to improve production systems by applying inputs only when benefits were expected to be in excess of the respective costs.

Evaluación de la contaminación microbiológica de la lechuga (lactuca sativa) en la cadena alimentaria, provincia de Quillacollo, Cochabamba, Bolivia 2015 / Evaluation of microbiological contamination of lettuce (Lactuca sativa) in the food chain, province of Quillacollo, Cochabamba, Bolivia 2015

Las enfermedades transmitidas por alimentos constituyen un problema de salud, diversos estudios demuestran la alta contaminación microbiológica de la lechuga en la cadena alimentaria. El objetivo de la presente investigación fue evaluar la contaminación microbio-lógica de la lechuga (Lactuca sativa) en la cadena alimentaria, en la provincia Quillacollo-Cochabamba-Bolivia. Muestras de lechugas fueron tomadas en los meses de abril y mayo, con el mismo de número de muestras, en tres puntos de la cadena alimentaria: parcelas de producción (localidad Combuyo), puestos de venta de lechuga y de comida de los Mercados 9 de diciembre y Central de Quillacollo. El procesamiento de las muestras fue realizado en los laboratorios de Microbiología de LABIMED, y Post Grado de Medicina Tropical de la Facultad de Medicina, UMSS. Los resultados demuestran la contaminación de las lechugas con bacterias Aerobias Mesófilas, colifor-mes totales y fecales en concentraciones superiores a los estándares permitidos en los tres puntos de la cadenas alimentaria evaluadas; identificándose Salmonella sp en una de las muestras de lechugas procesada de los puestos de venta de comida de los mercados. La contaminación parasitaria fue evidenciada en los puestos de venta solo en el mes de mayo en 83% (n=10) de las 12 muestras analizadas, detectándose quistes de Entamoeba coli y larvas de Strongyloides sp, contaminación relacionada con la utilización de abono de aves en el cultivo y la manipulación inadecuada de la lechuga en la cadena alimentaria. En conclusión podemos indicar que las lechugas presentan una importante contaminación microbiana en los tres puntos evaluados de la cadena alimentaria, por lo que constituye un riego para la salud pública.

Infectious diseases transmitted by food, are considered a public health issue, several studies shown the high microbiological contamination of the letucce in particular (Lactuca sativa). The aim of this study was to evaluate the contamination of letucce at Quillacollo Province of Cochabamba- Bolivia. The samples were taken between april and may, with the same number of samples at production plots (Combuyo location), and at selling places of vegetables and food (markets) such as "9 de diciembre” market and "Central Quillacollo” market. The samples were processed at LABIMED laboratories (microbiology, and Tropical Medicine Post grade of medicine Faculty of San Simón University). Results shows contamination of lettuce with Aerobic Mesophilic Bacterias, and total coliforms and fecal coliforms, in higher concentration than standard allowed, at any point of chain food that has been evaluate; Sallmonella sp was identify at selling points with 83% of the samples and only at the month of may (n=10 of 12 samples examined) also Entamoeba coli cysts and Strongyloides sp worms; the contamination was associate with bird fertilizer at crops and at inapropiate food management of the lettuce. Therefore we can conclude that lettuce's contamination is present at the three evaluated points of its chain, production selling points until consume, wich must be considered as a public health risk.

Reporte de caso y revisión de la literatura de caso de paciente con meningoencefalitis por amebas de vida libre / Case report and literature review of a patient with meningoencephalitis from free-living amoebae

Paciente de 14 años, proveniente de Apartadó (Antioquia), remitido al Hospital Pablo Tobón Uribe de Medellín por un cuadro febril agudo asociado a deterioro rápido del estado de conciencia, decantándose posteriormente como causa de su deterioro una ameba de vida libre (Naegleria fowleri) . Las amebas de vida libre son una causa etiológica poco común de meningitis, tienen un curso fulminante y requieren de un alto índice de sospecha para hacer un tratamiento oportuno.

A 14-year-old patient from Apartado (Antioquia, Colombia) was referred to Hospital Pablo Tobon Uribe in Medellin for acute febrile illness associated with headache and rapid loss of consciousness. The etiologic agent causing this deterioration was found to be a free-living amoeba ( Naegleria fowleri ). Free-living amoebae are a rare etiology for meningoencephalitis, have a fulminant course and require a high index of suspicion for early diagnosis.

Frecuencia de la infección por nemátodos gastrointestinales en ovinos y caprinos de cinco municipios de Antioquia / Infection frequency of gastrointestinal nematode in goats and sheep of five municipalities in Antioquia

Objetivo. Determinar la frecuencia de infección por nemátodos gastrointestinales en ovinos y caprinos de apriscos de algunos municipios de Antioquia. Materiales y métodos. Estudio descriptivo de corte realizado entre febrero y junio del 2011 en muestras de materia fecal de 84 caprinos y 11 ovinos distribuidos entre 2 y 132 meses de edad en 6 apriscos de Antioquia. Se determinó el recuento de huevos por gramo de heces (hpg) usando la técnica de Mcmaster, y para obtención del estadio larvario 3, la técnica de Corticelli y Lai. Para la identificación del género de las larvas se emplearon claves taxonómicas de nemátodos gastrointestinales de ovinos y caprinos. Se calcularon la frecuencia y asociación entre los datos epidemiológicos y la infección por tricostrongilidos mediante la prueba de independencia de Chi cuadrado, y prueba de contraste U de Mann-Whitney. Resultados. La frecuencia de infección fue 86.6% y los nemátodos con mayor prevalencia fueron Haemonchus contortus (66.3%), Oesophagostomum spp., (38.9%), Trichostrongylus spp., (34.7%) y Ostertagia spp., (24.2%). Se encontró una diferencia estadísticamente significativa entre la proporción de infectados y no infectados según la raza. Conclusiones. Existen diferencias entre la frecuencia de infección de las razas Camuro, La mancha y Toggenburg, en comparación con otras razas de los mismos apriscos. Esta variación puede relacionarse con procesos de resistencia, reponiéndose a la infección, sobre los cuales se hace necesaria la realización de investigaciones enfocadas al estudio de mecanismos de acción en ovinos y caprinos de Antioquia.

Objective. To determine the frequency of gastrointestinal nematode infection in goat and sheep folds of some municipalities of Antioquia. Materials and methods. A cross-sectional descriptive study was carried out between February and June 2011 in fecal samples of 84 goats and 11 sheep between 2 and 132 months of age in six folds in Antioquia. The number of eggs per gram of feces (epg) was determined using the McMaster technique, and the 3rd larval stage was obtained by means of Corticelli and Lai technique. For larval gender identification, gastrointestinal nematode taxonomical keys for goats and sheep were used. Tricostrongilides infection frequency and its association with epidemiological data was measured by means of chi-square test and comparison of proportions by column with Z test and U of Mann-Whitney contrast test. Results. Nematode infection frequency was 86.6% and Haemonchus contortus (66.3%), Oesophagostomum spp (38.9%), Trichostrongylus spp (34.7%) and Ostertagia spp. (24.2%) were the most prevalent nematodes. A statistically significant difference was found between infected and non-infected proportion per animal breed. Conclusions. There are differences between infection frequencies in Camuro, La mancha and Toggenburg breeds compared with other breeds in the same folds. These differences can be related with resistance and/or recovering from infection, but more research focused in mechanisms of action in goats and sheep of Antioquia is necessary.

A study of a population of Nyssomyia trapidoi (Diptera: Psychodidae) caught on the Pacific coast of Ecuador.

BACKGROUND: Cutaneous leishmaniasis is endemic to the Pacific coast of Ecuador, and Nyssomyia trapidoi is considered to be its main vector. Dujardin et al. [1] recorded some differences in body pigmentation and isoenzymatic profiles in sympatric populations of Ny. trapidoi from the Pacific coast of Ecuador and suggested the existence of two cryptic species. METHODS: Entomological collections were performed in November 2008 and March 2011 in the locality of Paraíso Escondido using CDC miniature light traps and human bait. Morphological, isoenzymatical and molecular (sequencing of cytochome b and cytochrome c oxidase 1 of the mitochondrial DNA) analyses, such as detection of Leishmania DNA and phlebovirus RNA in some females, were performed. RESULTS: Neighbor-joining trees from mitochondrial sequences grouped all of Ecuadorian Ny. trapidoi (including the two color variants) in one cluster, except for two specimens which clustered separately in both genes. Isoenzymatic characterization confirmed that the color variants belong to the same population. Additionally, 11.5% of females were found by PCR to contain Endotrypanum monterogeii kinetoplastid DNA. All pools of Ny. trapidoi were negative for phlebovirus RNA. CONCLUSION: Analysis of mitochondrial gene sequences and isoenzymes was unable to support the existence of two sibling species within Ny. trapidoi, which is a probable vector of Endotrypanum monterogeii.

Morphometric and molecular characterization of the series Guyanensis (Diptera, Psychodidae, Psychodopygus) from the Ecuadorian Amazon Basin with description of a new species.

Several populations of the series Guyanensis (Diptera, Psychodidae, Psychodopygus) were collected from the Yasuní National Park in the Ecuadorian Amazon region. The specimens comprised the species Psychodopygus geniculatus, Psychodopygus luisleoni and Psychodopygus corossoniensis. Within Ps. geniculatus, we observed two populations, one with a narrow paramere and relatively short genital filaments and the other characterized by a wider coxite and longer genital filaments. A multiple approach combining morphology, morphometry and DNA sequencing of the ribosomal internal transcribed spacer 2 (ITS2) and the mitochondrial cytochrome b gene was carried out. Morphological, morphometric and molecular data strongly suggested the presence of two populations within Ps. geniculatus. The lack of intermediate forms within these populations supported the proposal of two sympatric species. This report describes Psychodopygus francoisleponti n. sp.

Estudio de protocolo incentivo del paciente con cáncer pulmonar: en el hospital Dr. Gustavo Fricke, 1995-2001 / Study of protocol of incentive of the partient with lung cancer at: hospital Dr. Gustavo Fricke, 1995-2001

El objetivo del trabajo fue evaluar el protocolo de estudio incentivo del paciente con cáncer pulmonar, en uso desde 1992 en el Servicio de Medicina Interna del Hospital Dr. G. Fricke, estableciendo sus falencias y modificar el protocolo preexistente de acuerdo a las nuevas clasificaciones. Se revisaron retrospectivamente las fichas de los pacientes dados de alta con diagnóstico de cáncer pulmonar desde 1995 a 2001. En total se encontraron 183 casos. Sólo el 14,7 por ciento de los casos tenía protocolo de estudio y en el 100 por ciento de estos casos estaba incompleto. El 71,6 por ciento de los casos eran de sexo masculino y el 28,4 por ciento femenino. La relación hombres: mujeres fue de 2,5:1. La mayoría de los casos se concentraron en el grupo mayor de 66 años. El 79,7 por ciento de los casos tenía antecedente de tabaquismo. En relación con los exámentes diagnósticos, la radiografía de tórax aparece registrada en ficha en un 97,8 por ciento la fibrobroncoscopía en un 70,4 por ciento y el TAC de tórax en un 71,5 por ciento de los casos. El lóbulo más afectado fue el lóbulo superior derecho con un 31,6 por ciento de los casos. Sólo en un 36,6 por ciento se obtuvo histología del tumor. Con respecto a la etapificación, el 39,3 por ciento se clasificó como etapa IV, el 23,4 por ciento en etapa IIIb. Sólo un 13,6 por ciento de los pacientes recibió tratamiento con fines curativos. Del total de casos, 33 fallecen intrahospitalariamente. El tiempo transcurrido entre el diagnóstico y el tratamiento curativo fue, en promedio, de 21 días.

[The validity of the proteins concentrations in the ascitic liquid and serum for the differential diagnosis of the ascitis]. / La validez de la concentración de proteínas en el líquido ascítico y suero para el diagnóstico diferencial de las asctitis.

Prospective evaluation was performed in 60 in-patients, carriers of ascites of different etiologies, analyzing the validity of the parameters depending on protein and albumin dosage, both in the ascitic serum and fluid, for the discrimination of possible etiological causes of ascites, including in these parameters Protein Concentration in the Ascitic Fluid, the Serum-Ascites Albumin Gradient, the Protein Ascites/Serum Ratio, and the Albumin Concentration in the ascitic fluid. Average age was 46.9 +/- 19.6, all female; 21 cases were associated with Chronic Hepatic Disease, 14 to Tuberculosis, 11 to Malignant Neoplasia, 7 to Nephrotic syndrome, 4 to Congestive Heart Failure, 2 to Collagen Disease, and 1 to a severe Malnutrition case. The evaluation parameters correlate with the oncotic and hydrostatic pressures of the Starling Law, on the basis of what they could be compared with, demonstrating that their sensitivity levels and their specificity may be used as positive or negative predictive values in the discriminative evaluations of ascites in relation to its probable etiological causes. Even though the Serum-Ascites Albumin Gradient may be useful in the separation of ascites cases with portal hypertension, it is also useful for classifying exudates and transudates. However, the other parameters must not be excluded for the evaluation of those cases, aiming at establishing whether the peritoneum has been affected and hence the terms transudates and exudates should still be used on the basis of the high sensitivity value and specificity of theses tests, which do not differentiate them statistically from the Serum-Ascites Albumin Gradient. Using the cut-off points for each parameter, the most adequate for our population would be 1.5 gr/dl for Albumin and 2.5 gr/dl for protein, with the additional lower cost benefit.

The functional form of angular forces around transition metal ions in biomolecules.

A method for generating angular forces around sigma-bonded transition metal ions is generalized to treat pi-bonded configurations. The theoretical approach is based on an analysis of ligand-field and small-cluster Hamiltonians based on the moments of the electron state distribution. The functional forms that are obtained involve a modification of the usual expression of the binding energy as a sum of ligand-ligand interactions, which, however, requires very little increase in CPU time. The angular interactions have simple forms involving sin and cos functions, whose relative weights depend on whether the ligands are sigma- or pi-bonded. They describe the ligand-field stabilization energy to an accuracy of about 10%, and the interaction energy of covalently bonded systems to an accuracy of better than 4%. The resulting functional forms for the force field are used to model the structure of small clusters, including fragments of the copper blue protein structure. Large deviations from the typical square copper coordination are found when pi-bonded ligands are present.

Detection of Fasciola hepatica infection in a community located in the Ecuadorian Andes.

The presence of fascioliasis was assessed in four Andean communities using an enzyme-linked immunosorbent assay (ELISA) test to measure antibodies against Fasciola hepatica excretion-secretion antigens. Six percent (9 out of 150) of the individuals in one community were ELISA-positive for these antibodies. Fecal samples from two of the ELISA-positive individuals contained F. hepatica ova. All of the ELISA-positive cases, except for one, were children within the ages of 9 to 12 years.