Latencia diagnóstica y percepción de síntomas prodrómicos en pacientes con enfermedad de Parkinson en Yucatán / Diagnostic latency and perception of prodromal symptoms in patients with Parkinson's disease in Yucatán

Resumen Objetivo: Determinar la latencia diagnóstica en la enfermedad de Parkinson (EP), así como su relación con variables clínicas y demográficas. Determinar la percepción de síntomas no motores: disfunción olfatoria, trastorno conductual del sueño MOR, depresión y estreñimiento, previos al diagnóstico de EP. Materiales y métodos: Estudio transversal realizado en Yucatán, México en sujetos con EP. Se analizó la asociación entre la latencia diagnóstica con variables clínicas y demográficas usando las pruebas estadísticas no paramétricas: U de Mann Whitney y Kruskal-Wallis. Resultados: Se incluyeron un total de 60 sujetos con una edad promedio de 66.7 años. El tiempo promedio transcurrido desde el inicio del primer síntoma motor hasta el diagnóstico fue de 20.8 meses. El tener antecedentes familiares de EP se asoció significativamente (p=0.031) con una latencia diagnóstica más prolongada en comparación con aquellos pacientes que no refirieron familiares con EP. En cualquier momento antes del diagnóstico de EP: el 36.6% de los pacientes percibieron estreñimiento, 15% depresión, 13.3% trastorno conductual del sueño MOR y 11.6% disfunción olfatoria, 51.7% no refirió ninguno. Conclusiones: La latencia diagnóstica promedio de un grupo de 60 pacientes con EP diagnosticados en Yucatán fue de 20.8 meses. La latencia diagnóstica no se asoció significativamente con el tipo de servicio médico de neurología que realizó en diagnóstico de EP (público o privado), ni con otras variables clínicas ni demográficas además del antecedente familiar de EP.

Abstract Objective: To determine the diagnostic latency in Parkinson's disease (PD), and its relationship with clinical and demographic variables. To determine the perception of non-motor symptoms: olfactory dysfunction, REM sleep behavior disorder, depression, and constipation, prior to the diagnosis of PD. Materials and methods: Cross-sectional study conducted in Yucatan, Mexico in subjects with PD. The association between diagnostic latency with clinical and demographic variables was analyzed using the non-parametric statistical tests: Mann Whitney U and Kruskal-Wallis. Results: A total of 60 subjects with a mean age of 66.7 years were included. The average time elapsed from the onset of the first sympoton to diagnosis was 20.8 months. A family history of PD was significantly associated (p=0.031) with a longer diagnostic latency compared to those patients who did not have relatives with PD. Before the diagnosis of PD: 36.6% of the patients perceived constipation, 15% depression, 13.3% REM sleep behavior disorder and 11.6% olfactory dysfunction, 51.7% did not report any. Conclusions: The mean diagnostic latency of a group of 60 patients with PD diagnosed in Yucatan was 20.8 months. Diagnostic latency was not significantly associated with the type of neurological medical service that performed the diagnosis (public or private), or with other clinical or demographic variables in addition to a family history of PD.

Doxorubicin Interaction with Lipid Monolayers Leads to Decreased Membrane Stiffness when Experiencing Compression-Expansion Dynamics.

Physical membrane models permit to study and quantify the interactions of many external molecules with monitored and simplified systems. In this work, we have constructed artificial Langmuir single-lipid monolayers with dipalmitoylphosphatidylcholine (DPPC), dipalmitoylphosphatidylethanolamine (DPPE), dipalmitoylphosphatidylserine (DPPS), or sphingomyelin to resemble the main lipid components of the mammalian cell membranes. We determined the collapse pressure, minimum area per molecule, and maximum compression modulus (Cs-1) from surface pressure measurements in a Langmuir trough. Also, from compression/expansion isotherms, we estimated the viscoelastic properties of the monolayers. With this model, we explored the membrane molecular mechanism of toxicity of the well-known anticancer drug doxorubicin, with particular emphasis in cardiotoxicity. The results showed that doxorubicin intercalates mainly between DPPS and sphingomyelin, and less between DPPE, inducing a change in the Cs-1 of up to 34% for DPPS. The isotherm experiments suggested that doxorubicin had little effect on DPPC, partially solubilized DPPS lipids toward the bulk of the subphase, and caused a slight or large expansion in the DPPE and sphingomyelin monolayers, respectively. Furthermore, the dynamic viscoelasticity of the DPPE and DPPS membranes was greatly reduced (by 43 and 23%, respectively), while the reduction amounted only to 12% for sphingomyelin and DPPC models. In conclusion, doxorubicin intercalates into the DPPS, DPPE, and sphingomyelin, but not into the DPPC, membrane lipids, inducing a structural distortion that leads to decreased membrane stiffness and reduced compressibility modulus. These alterations may constitute a novel, early step in explaining the doxorubicin mechanism of action in mammalian cancer cells or its toxicity in non-cancer cells, with relevance to explain its cardiotoxicity.

Fístula arteriovenosa post-TIPS, un reto diagnóstico: reporte de caso / Post-TIPS arteriovenous fistula, a diagnostic challenge: case report

La hipertensión portal es una de las principales complicaciones de la cirrosis. El papel de la derivación portosistémica transyugular intrahepática (TIPS, por sus siglas en inglés), ha ganado aceptación como tratamiento efectivo en la hipertensión portal. En los últimos años su técnica se ha ido perfeccionando, disminuyendo la morbimortalidad relacionada con este procedimiento. Describimos un caso de un paciente masculino con cirrosis Child-Pugh 8 y MELD 16, con antecedente de descompensación por sangrado variceal recurrente y trombosis parcial de la vena porta, con un gradiente de presión venosa hepática (GPVH) de 20 mmHg, por lo que es llevado a TIPS como profilaxis secundaria, con un gradiente final post-TIPS de 6 mmHg. Posterior al procedimiento, presentó evolución tórpida con deterioro de las pruebas de bioquímica hepática. Se realizó una angiografía demostrando permeabilidad del TIPS sin progresión de la trombosis portal, y hallazgos anormales inespecíficos de la arteria hepática. Se decidió realizar una arteriografía selectiva, demostrando un pseudoaneurisma de la rama derecha de la arteria hepática y una fístula arteriovenosa de la arteria hepática a las colaterales portales. Se realizó embolización selectiva de la fístula con evolución satisfactoria del paciente.

Portal hypertension is a life-threatening complication of cirrhosis. The role of transyugular intrahepatic portosystemic shunt (TIPS) has gained acceptance as an effective treatment for portal hypertension. In the past few years, its technique has been improved, decreasing the mortality related with the procedure. We describe a case of a male with Child-Pugh 8 and MELD 16 cirrhosis, with previous decompensation of recurrent variceal bleeding and partial thrombosis of the portal vein. TIPS was performed due to a hepatic venous pressure gradient (HVPG) of 20 mmHg. The final measure showed HVPG of 6 mmHg. After the procedure, he presented a torpid evolution with deterioration of liver function tests. An angiography was performed demonstrating patency of the TIPS without progression of portal thrombosis and nonspecific abnormal findings of the hepatic artery. Selective arteriography was performed and revealed a pseudoaneurysm of the right branch of the hepatic artery and an arteriovenous fistula (AVF) from the hepatic artery to portal collaterals. Embolization was performed to treat the fistula with satisfactory evolution of the patient.

Cryoconite - From minerals and organic matter to bioengineered sediments on glacier's surfaces.

Cryoconite is a mixture of mineral and organic material covering glacial ice, playing important roles in biogeochemical cycles and lowering the albedo of a glacier surface. Understanding the differences in structure of cryoconite across the globe can be important in recognizing past and future changes in supraglacial environments and ice-organisms-minerals interactions. Despite the worldwide distribution and over a century of studies, the basic characteristics of cryoconite, including its forms and geochemistry, remain poorly studied. The major purpose of our study is the presentation and description of morphological diversity, chemical and photoautotrophs composition, and organic matter content of cryoconite sampled from 33 polar and mountain glaciers around the globe. Observations revealed that cryoconite is represented by various morphologies including loose and granular forms. Granular cryoconite includes smooth, rounded, or irregularly shaped forms; with some having their surfaces covered by cyanobacteria filaments. The occurrence of granules increased with the organic matter content in cryoconite. Moreover, a major driver of cryoconite colouring was the concentration of organic matter and its interplay with minerals. The structure of cyanobacteria and algae communities in cryoconite differs between glaciers, but representatives of cyanobacteria families Pseudanabaenaceae and Phormidiaceae, and algae families Mesotaeniaceae and Ulotrichaceae were the most common. The most of detected cyanobacterial taxa are known to produce polymeric substances (EPS) that may cement granules. Organic matter content in cryoconite varied between glaciers, ranging from 1% to 38%. The geochemistry of all the investigated samples reflected local sediment sources, except of highly concentrated Pb and Hg in cryoconite collected from European glaciers near industrialized regions, corroborating cryoconite as element-specific collector and potential environmental indicator of anthropogenic activity. Our work supports a notion that cryoconite may be more than just simple sediment and instead exhibits complex structure with relevance for biodiversity and the functioning of glacial ecosystems.

Corrigendum to: Does the C4 plant Trianthema portulacastrum (Aizoaceae) exhibit weakly expressed crassulacean acid metabolism (CAM)?

We examined whether crassulacean acid metabolism (CAM) is present in Trianthema portulacastrum L. (Aizoaceae), a pantropical, salt-tolerant C4 annual herb with atriplicoid-type Kranz anatomy in leaves but not in stems. The leaves of T. portulacastrum are slightly succulent and the stems are fleshy, similar to some species of Portulaca, the only genus known in which C4 and CAM co-occur. Low- level nocturnal acidification typical of weakly expressed, predominantly constitutive CAM was measured in plants grown for their entire life-cycle in an outdoor raised garden box. Acidification was greater in stems than in leaves. Plants showed net CO2 uptake only during the light irrespective of soil water availability. However, nocturnal traces of CO2 exchange exhibited curved kinetics of reduced CO2 loss during the middle of the night consistent with low-level CAM. Trianthema becomes the second genus of vascular land plants in which C4 and features of CAM have been demonstrated to co-occur in the same plant and the first C4 plant with CAM-type acidification described for the Aizoaceae. Traditionally the stems of herbs are not sampled in screening studies. Small herbs with mildly succulent leaves and fleshy stems might be a numerically significant component of CAM biodiversity.

New Ideas for Understanding the Structure and Magnetism in AgF2 : Prediction of Ferroelasticity.

In the search for new high-temperature superconductors, it has been proposed that there are strong similarities between the fluoroargentate AgF2 and the cuprate La2 CuO4 . We explored the origin of the possible layered structure of AgF2 by studying its parent high-symmetry phase and comparing these results with those of a seemingly analogous cuprate, CuF2 . Our findings first stress the large differences between CuF2 and AgF2 . Indeed, the parent structure of AgF2 is found to be cubic, naturally devoid of any layering, even though Ag2+ ions occupy trigonal sites that, nevertheless, allow the existence of a Jahn-Teller effect. The observed Pbca orthorhombic phase is found when the system is cooperatively distorted by a local E⊗e trigonal Jahn-Teller effect around the silver sites that creates both geometrical and magnetic layering. While the distortion implies that two Ag2+ -F- bonds increase their distance by 15 % and become softer, our simulations indicate that covalent bonding and interlayer electron hopping is strong, unlike the situation in cuprate superconductors, and that, in fact, exfoliation of individual planes might be a harder task than previously suggested. As a salient feature, these results prove that the actual magnetic structure in AgF2 is a direct consequence of vibronic contributions involved in the Jahn-Teller effect. Finally, our findings show that, due to the multiple minima intrinsic to the Jahn-Teller energy surface, the system is ferroelastic, a property that is strongly coupled to magnetism in this argentate.

Disruption of the odorant coreceptor Orco impairs foraging and host finding behaviors in the New World screwworm fly.

The evolution of obligate ectoparasitism in blowflies (Diptera: Calliphoridae) has intrigued scientists for over a century, and surprisingly, the genetics underlying this lifestyle remain largely unknown. Blowflies use odors to locate food and oviposition sites; therefore, olfaction might have played a central role in niche specialization within the group. In insects, the coreceptor Orco is a required partner for all odorant receptors (ORs), a major gene family involved in olfactory-evoked behaviors. Hence, we characterized the Orco gene in the New World screwworm, Cochliomyia hominivorax, a blowfly that is an obligate ectoparasite of warm-blooded animals. In contrast, most of the closely related blowflies are scavengers that lay their eggs on dead animals. We show that the screwworm Orco orthologue (ChomOrco) is highly conserved within Diptera, showing signals of strong purifying selection. Expression of ChomOrco is broadly detectable in chemosensory appendages, and is related to morphological, developmental, and behavioral aspects of the screwworm biology. We used CRISPR/Cas9 to disrupt ChomOrco and evaluate the consequences of losing the OR function on screwworm behavior. In two-choice assays, Orco mutants displayed an impaired response to floral-like and animal host-associated odors, suggesting that OR-mediated olfaction is involved in foraging and host-seeking behaviors in C. hominivorax. These results broaden our understanding of the chemoreception basis of niche occupancy by blowflies.

Does the C4 plant Trianthema portulacastrum (Aizoaceae) exhibit weakly expressed crassulacean acid metabolism (CAM)?

We examined whether crassulacean acid metabolism (CAM) is present in Trianthema portulacastrum L. (Aizoaceae), a pantropical, salt-tolerant C4 annual herb with atriplicoid-type Kranz anatomy in leaves but not in stems. The leaves of T. portulacastrum are slightly succulent and the stems are fleshy, similar to some species of Portulaca, the only genus known in which C4 and CAM co-occur. Low- level nocturnal acidification typical of weakly expressed, predominantly constitutive CAM was measured in plants grown for their entire life-cycle in an outdoor raised garden box. Acidification was greater in stems than in leaves. Plants showed net CO2 uptake only during the light irrespective of soil water availability. However, nocturnal traces of CO2 exchange exhibited curved kinetics of reduced CO2 loss during the middle of the night consistent with low-level CAM. Trianthema becomes the second genus of vascular land plants in which C4 and features of CAM have been demonstrated to co-occur in the same plant and the first C4 plant with CAM-type acidification described for the Aizoaceae. Traditionally the stems of herbs are not sampled in screening studies. Small herbs with mildly succulent leaves and fleshy stems might be a numerically significant component of CAM biodiversity.

[Endoscopic-radiologic rendezvous for biliary obstruction management. Case report and literature review]. / Rendezvous radiológico-endoscópico para manejo de obstrucción biliar. Reporte de casos y revisión de la literatura.

Biliary obstruction of different origin is a common clinical problem, with significant impact on the patients quality of life and poses a permanent risk of cholangitis. The management of these patients has evolved over time, makes collection of various technological developments and involve clinicians, surgeons, gastroenterologists, and interventional radiologists. Were port four cases of biliary obstruction that despite the significant demographic and clinical differences between them could be successfully managed approach in the biliary tract with the technique of radiological endoscopic Rendezvous.

[Colonic metastases from carcinoma of the lung, an unusual presentation. Case report and literature review]. / Metástasis a colon de un carcinoma de pulmón, una presentación inusual. Reporte de un caso y revisión de la literatura.

The symptomatic metastasis of the colon from a pulmonary cancer is rare; however, the global incidence of pulmonary cancer is 12.9%. It is an infrequent site of metastasis, with a prevalence of less than 0.5% in patients with pulmonary cancer. One of the most common manifestation is intestinal obstruction. We present a case report of a patient with an acute lower intestinal bleeding from multiple metastasis lesion of the colon as the initial manifestation of a non-small cell lung carcinoma.

From the Guiana Highlands to the Brazilian Atlantic Rain Forest: four new species of Selaginella (Selaginellaceae - Lycopodiophyta: S. agioneuma, S. magnafornensis, S. ventricosa, and S. zartmanii).

We describe four new species in the genus Selaginella (i.e., S. agioneuma, S. magnafornensis, S. ventricosa, and S. zartmanii) from Brazil, all presently classified in subg. Stachygynandrum. For each of the new taxa we discuss taxonomic affinities and provide information on habitat, distribution, and conservation status. In addition, line drawings and scanning electron microscope (SEM) images of stems sections, leaves, and spores (when present) are included. Selaginella agioneuma and S. magnafornensis are from the State of Espíritu Santo where they inhabit premontane to montane Atlantic rain forests in the Reserva Biológica Augusto Ruschi and Parque Estadual Forno Grande, respectively. Selaginella ventricosa was collected in upper montane forests at Parque Nacional Serra da Mocidade, State of Roraima and S. zartmanii in premontane Amazon rain forests on upper Rio Negro at Mpio. São Gabriel da Cachoeira, Amazonas State in both Serra Curicuriari and the Morro dos Seis Lagos Biological Reserve.

Metástasis a colon de un carcinoma de pulmón, una presentación inusual: Reporte de un caso y revisión de la literatura / Colonic metastases from carcinoma of the lung, an unusual presentation: Case report and literature review

Las metástasis sintomáticas al colon de un carcinoma de pulmón son raras, a pesar de ser una neoplasia que representa el 12,9% de la incidencia mundial de cáncer. El colon es un sitio infrecuente de metástasis, con una prevalencia reportada menor al 0,5% en pacientes con carcinomas de pulmón, existiendo en la literatura mundial pocos casos. Es inusual que sea la forma de presentación de este tipo de neoplasia. Con respecto a las manifestaciones clínicas que se reportan pueden cursar con obstrucción intestinal como síntoma cardinal. Se presenta el caso de un paciente que curso con hemorragia de vías digestivas bajas como manifestación inicial de múltiples lesiones metastásicas a colon de un carcinoma de pulmón de célula no pequeña.

The symptomatic metastasis of the colon from a pulmonary cancer is rare; however, the global incidence of pulmonary cancer is 12.9%. It is an infrequent site of metastasis, with a prevalence of less than 0.5% in patients with pulmonary cancer. One of the most common manifestation is intestinal obstruction. We present a case report of a patient with an acute lower intestinal bleeding from multiple metastasis lesion of the colon as the initial manifestation of a non-small cell lung carcinoma.

Rendezvous radiológico-endoscópico para manejo de obstrucción biliar: Reporte de casos y revisión de la literatura / Endoscopic-radiologic rendezvous for biliary obstruction management: Case report and literature review

La obstrucción biliar de diverso origen constituye un problema clínico frecuente, con importante impacto sobre la calidad de vida de los pacientes y que plantea el riesgo permanente de colangitis. El manejo de estos pacientes ha evolucionado en el tiempo, haciendo acopio de diversos desarrollos tecnológicos e involucrando a clínicos, cirujanos, gastroenterólogos y radiólogos intervencionistas. Reportamos aquí cuatro casos de pacientes con obstrucción biliar que, a pesar de las importantes diferencias demográficas y etiológicas, pudieron ser exitosamente manejados, abordando la vía biliar con la técnica de Rendezvous radiológico endoscópico.

Biliary obstruction of different origin is a common clinical problem, with significant impact on the patients´ quality of life and poses a permanent risk of cholangitis. The management of these patients has evolved over time, makes collection of various technological developments and involve clinicians, surgeons, gastroenterologists, and interventional radiologists. Were port four cases of biliary obstruction that despite the significant demographic and clinical differences between them could be successfully managed approach in the biliary tract with the technique of radiological endoscopic Rendezvous.

Fibrolamellar Hepatocellular Carcinoma and Noncirrhotic Hyperammonemic Encephalopathy.

Fibrolamellar hepatocarcinoma is an infrequent liver tumor, currently considered to be a variant different from hepatocarcinoma. The differences lie in genomic alterations, a greater prevalence of fibrolamellar hepatocarcinoma in young patients, and its lack of association with underlying liver disease. The clinical presentation is unspecific, with symptoms ranging from abdominal pain, malaise, and weight loss to atypical manifestation which include hyperammonemic encephalopathy. We present the case of a 33-year-old woman with no prior medical history who presented with a coma and a diagnosis of inoperable fibrolamellar hepatocarcinoma requiring a cadaver donor transplant. While she was on the waiting list, she received hemofiltration and ammonium benzoate treatment, with progressive improvement in her state of consciousness.

Equidad y desarrollo humano sobre la base del acceso al agua / Equity and human development on the basis of water access

Al abordar el tema del agua es fundamental hablar de la carencia o deficiencia de los recursos hídricos en el mundo, ya sea porque para consumo humano sólo se tiene el 3% de agua del planeta, o bien por la cantidad de gente que carece de agua a nivel mundial. Estos dos supuestos polariza la situación del agua, por una parte quienes la consideran como un derecho humano, el cual es un servicio a cargo del estado, porque al insertarse en el texto constitucional de México se vinculó al Estado; por el otro lado, ante la insuficiencia de agua, se le concede el carácter de mercancía, y como tal se pretende que pueda tener el justo valor que requiere, al tratarse de un bien que poco a poco se vuelve más preciado, requiriendo de inversiones para su obtención y prestación del servicio. En cuanto a equidad, la primera de las posturas buscaría beneficiar a toda la población; pero la segunda determina que solo aquellos con el suficiente recurso económico podrán disponer de agua. El último razonamiento provocaría limitación de la existencia y vida digna de muchas personas que carecen de los recursos económicos suficientes para pagar por ella (AU).

To approach the concept of water in the present, it is essential to speak of the lack or deficiency of the water resources in the world, either because for human consumption is only 3% of water on the planet, or by the number of people whom deficiency of water worldwide. These two assumptions polarizes the water situation, on the one hand those who considered it as a human right, which is a service in charge of the state, because when isintroduced into the text of the Constitution of Mexico already link up to the State; on the other hand, given the insufficiency of water, is granted the nature of goods, and as such it is intended that may have the fair value that requires to be a well that little by little becomes more precious, requiring investment for their collection and provision of the service. With regard to equity, the first of the positions would seek to benefit the entire population; but the second determines that only those with sufficient economic resource may have water. The last reasoning would lead to limitation of the existence and dignified life of many people who lack the economic resources to pay for it (AU).

Equidad y desarrollo humano sobre la base del acceso al agua / Equity and human development on the basis of water access

Al abordar el tema del agua es fundamental hablar de la carencia o deficiencia de los recursos hídricos en el mundo, ya sea porque para consumo humano sólo se tiene el 3% de agua del planeta, o bien por la cantidad de gente que carece de agua a nivel mundial. Estos dos supuestos polariza la situación del agua, por una parte quienes la consideran como un derecho humano, el cual es un servicio a cargo del estado, porque al insertarse en el texto constitucional de México se vinculó al Estado; por el otro lado, ante la insuficiencia de agua, se le concede el carácter de mercancía, y como tal se pretende que pueda tener el justo valor que requiere, al tratarse de un bien que poco a poco se vuelve más preciado, requiriendo de inversiones para su obtención y prestación del servicio. En cuanto a equidad, la primera de las posturas buscaría beneficiar a toda la población; pero la segunda determina que solo aquellos con el suficiente recurso económico podrán disponer de agua. El último razonamiento provocaría limitación de la existencia y vida digna de muchas personas que carecen de los recursos económicos suficientes para pagar por ella (AU).

To approach the concept of water in the present, it is essential to speak of the lack or deficiency of the water resources in the world, either because for human consumption is only 3% of water on the planet, or by the number of people whom deficiency of water worldwide. These two assumptions polarizes the water situation, on the one hand those who considered it as a human right, which is a service in charge of the state, because when isintroduced into the text of the Constitution of Mexico already link up to the State; on the other hand, given the insufficiency of water, is granted the nature of goods, and as such it is intended that may have the fair value that requires to be a well that little by little becomes more precious, requiring investment for their collection and provision of the service. With regard to equity, the first of the positions would seek to benefit the entire population; but the second determines that only those with sufficient economic resource may have water. The last reasoning would lead to limitation of the existence and dignified life of many people who lack the economic resources to pay for it (AU).

Factores pronósticos asociados con mortalidad en pacientes cirróticos con sangrado varicoso en dos hospitales de Bogotá, Colombia / Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices at Two Hospitals in Bogotá D.C. Colombia

Antecedentes: el 90% de los pacientes cirróticos desarrollará várices esofágicas, y en algún momento de su vida, el 30% de ellos sangrará. Objetivo: identificar los factores pronósticos asociados con mortalidad en cirróticos con sangrado digestivo varicoso. Método: se presenta una cohorte retrospectiva de pacientes con sangrado digestivo varicoso en un período de 30 meses. Resultados: se presentan 63 pacientes (33 hombres y 30 mujeres), de 56 años (desviación estándar DE 16 años) de edad media. El 52,4% tenía una clase funcional Child-Pugh B. El promedio de hospitalización fue de 10 días. De estas, 12 (19%) fallecieron; el choque hipovolémico (p = 0,033) y la transfusión de glóbulo rojos (p = 0,05) estuvieron relacionados con la mortalidad. En el análisis bivariado, la variable más relacionada con la mortalidad fue el compromiso funcional hepático Child-Pugh C (p = 0,00). Las comparaciones de las variables numéricas encontraron que el valor de creatinina; media 1,74 mg/dL (p = 0,043); y la duración de la hospitalización; media de 10 días (p = 0,057); fueron superiores en los pacientes fallecidos. En los análisis bivariados, las variables Child-Pugh C (Exp(B) = 0,068; p = 0,002) y creatinina (Exp(B) = 0,094; p = 0,034) se mantuvieron estadísticamente relacionadas con el desenlace de interés. Conclusiones: la mortalidad del paciente con sangrado varicoso en este estudio es comparable con los estándares internacionales actuales. La enfermedad hepática avanzada y una función renal deteriorada están relacionadas con mayor mortalidad, razón por la cual los pacientes con predictores de mortalidad presentes durante la descompensación por sangrado varicoso ameritan una vigilancia estrecha e intervenciones tempranas para evitar desenlaces negativos

Background: Ninety percent of cirrhotic patients will develop esophageal varices, and bleeding will occur in 30% of these patients at some point in their lives. Objective: The objective of this study was to identify prognostic factors associated with mortality in cirrhotic patients with bleeding varices. Method: We present a retrospective cohort study of patients with bleeding digestive varices over a period of 30 months. Results: This study included 63 patients (33 men and 30 women) whose average age was 56 years (SD: 16 years). 52.4% of these patients’ Child-Pugh classification was B. The average stay in the hospital was 10 days. Twelve (19%) died. Hypovolemic shock (p = 0.033) and red blood cell transfusion (p = 0.05) were related to mortality. Bivariate analysis showed that the variable most closely related to mortality was hepatic impairment with Child-Pugh C classification (p = 0.00). Comparisons of numerical variables found that the creatinine value (Mean: 1.74 mg/dl, p = 0.043) and length of hospital stay (mean time:10 days, p = 0.057) were higher in patients who died. In the bivariate analysis, Child-Pugh C (Exp (B) = 0.068, p = 0.002) and creatinine (Exp (B) = 0.094, p = 0.034) remained statistically related to the outcome of interest. Conclusions: Mortality from bleeding varices in the patients in this study is comparable to current international standards. Because advanced liver disease and impaired renal function are associated with increased mortality, patients with bleeding varices who have predictors for mortality during decompensation due to bleeding warrant close monitoring and early interventions to avoid negative outcomes

Colitis ulcerativa grave en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / A Case Report of Severe Ulcerative Colitis in an HIV Patient

Se presenta el caso de un paciente con colitis ulcerativa (CU) grave de nueva aparición y diagnóstico simultáneo de infección por virus de inmunodeficiencia humana (VIH). Dos enfermedades inmunológica y fisiopatológicamente opuestas, que raramente se asocian. Incluso se plantea que en la infección por VIH, la enfermedad inflamatoria intestinal (EII) puede ser menos agresiva. El diagnóstico se convierte en un reto, dado el espectro de enfermedades que pueden afectar el colón en el contexto de infección por VIH. Asimismo, el tratamiento es controversial teniendo en cuenta que el uso de inmunomoduladores o biológicos bloquean otro componente del sistema inmune que podría potenciar el estado de inmunosupresión en este grupo de pacientes. La historia natural, el tratamiento y el pronóstico, continúan siendo un desafío para la evidencia actual.

We present the case of a patient with severe de novo ulcerative colitis (CU) and a simultaneous diagnosis of Human Immunodeficiency Virus (HIV) infection. These two immunologically and pathophysiologically opposing diseases are rarely found in association, and it has even been suggested that inflammatory bowel disease (IAS) may be less aggressive in HIV infections. The diagnosis is challenging, given the spectrum of diseases that can affect the colon in the context of an HIV infection. Treatment is similarly controversial considering that the use of immunomodulators or biological block another component of the immune system that could enhance the state of immunosuppression in this group of patients. Natural history, treatment and prognosis remain a challenge for currently available evidence

Duodenal hemangiolymphangioma presenting as chronic anemia: a case report.

BACKGROUND: Lymphangiomas are a heterogeneous group of congenital vascular malformations characterized by cystic dilation of lymphatic vessels. They can occur at any age, but they are more common during childhood and in cutaneous localizations. Hemangiomas and vascular malformations of the gastrointestinal tract are very uncommon. Most are asymptomatic and diagnosis is often made as an incidental finding during endoscopy. On rare occasions the initial manifestation can be chronic anemia due to low grade gastrointestinal bleeding. They constitute an unusual manifestation and there is a low incidence of this type of tumor. CASE PRESENTATION: We report the case of a 43 year-old latin female, with a 2-year history of chronic anemia requiring blood transfusion. Hemoglobin and Hematocrit count were low, therefore further studies were required to rule out bleeding sources or other causes of anemia. Enteroscopy findings showed a 35 mm lesion taking up 50 % of the circumference in the distal duodenum, with raised whitish edges secondary to confluent lymphangiectasia, a center with a vascular appearance and active bleeding spots. Biopsy samples dyed with India ink confirmed the diagnosis of hemangiolymphangioma. CONCLUSION: Diagnostic difficulties in this case, highlight the need to include hemangiolymphangioma in the differential diagnosis of chronic anemia as well as the need for multiple diagnostic methods to confirm the presence of the condition.

Seven new species of Selaginellasubg.Stachygynandrum (Selaginellaceae) from Brazil and new synonyms for the genus.

We describe seven new species of Selaginellasubg.Stachygynandrum (Selaginellaalstonii, Selaginellablepharodella, Selaginellacrinita, Selaginellamucronata, Selaginellamucugensis, Selaginellasaltuicola, and Selaginellasematophylla) from Brazil and discuss their possible affinities and conservation status. Scanning electron micrographs of stem sections, leaves, and spores are provided to illustrate the new taxa. In Selaginellaalstonii and Selaginellasaltuicola vegetative growth from strobilus tips is reported and discussed. Four of the new species are from the Espinhaço Mountain Range associated with Campos Rupestres (montane savannah/rocky fields) vegetation. Three of these (i.e., Selaginellablepharodella, Selaginellacrinita, and Selaginellamucugensis) were collected in the northern part of the range in Chapada Diamantina, state of Bahia, while Selaginellaalstonii is from the southern part of the range in the state of Minas Gerais. Selaginellamucronata is found in Atlantic Rainforest vegetation in the state of Espírito Santo, whereas Selaginellasaltuicola inhabits Cerrado (tropical savannah) vegetation in the state of Mato Grosso. Selaginellasematophylla is the most widely distributed of the new species and was collected in Espírito Santo, Minas Gerais, and Rio de Janeiro states in Campos Rupestres and Atlantic Rainforest vegetation. Selaginellaalstonii occurs in rocky caves, Selaginellablepharodella, Selaginellacrinita, Selaginellamucugensis, and Selaginellasematophylla seem adapted to seasonally dry places, living on sandy or humid soils, Selaginellamucronata occupies humid, forest understory, and Selaginellasaltuicola is adapted to wet places associated with rocks or logs in waterfalls. Of the seven new species, six are considered local endemics (except for Selaginellasematophylla) because of their restricted currently known distributions to one or two localities within a single state in Brazil. Additionally, we propose new synonymy for Selaginellapalmiformis (syn. = Selaginellabahiensissubsp.manausensis, ≡ Selaginellamanausensis) and Selaginellavestiens (syn. = Selaginellafragillima); the last species is endemic to Brazil, recorded in the states of Goiás and Minas Gerais. Finally, based on literature discussed and this study, we conclude that the number of well-documented Brazilian Selaginella species is 61, of which 58 are native and three introduced and naturalized. These statistics are likely to change with further work on Selaginella from Brazil.

ResumenDescribimos siete nuevas especies de Selaginellasubg.Stachygynandrum (Selaginellaalstonii, Selaginellablepharodella, Selaginellacrinita, Selaginellamucronata, Selaginellamucugensis, Selaginellasaltuicola y Selaginellasematophylla) de Brasil y discutimos sus posibles afinidades y estado de conservación. Micrografias electrónicas de barrido de secciones de los tallos, hojas y esporas se proveen para ilustrar los nuevos taxa. Igualmente, se describe y discute el crecimiento vegetativo a partir del ápice de los estróbilos en Selaginellaalstonii y Selaginellasaltuicola. Cuatro de las especies nuevas proceden de la Cadena del Espinhaço asociadas a vegetación de Campos Rupestres (sabana montana). Tres de éstas (i.e., Selaginellablepharodella, Selaginellacrinita y Selaginellamucugensis) fueron recolectadas en la parte norteña de la Cadena del Espinhaço en la Chapada Diamantina, estado de Bahia, mientras que Selaginellaalstonii se registra para la parte sureña en el estado de Minas Gerais. Selaginellamucronata se encuentra en vegetación de Bosques Lluviosos del Atlántico en el estado de Espírito Santo, mientras que Selaginellasaltuicola habita vegetación de Cerrado (sabana tropical) en el estado de Mato Grosso. De las nuevas especies, Selaginellasematophylla es la más ampliamente distribuida y se ha recolectada en los estados de Espírito Santo, Minas Gerais y Río de Janeiro en vegetación de Campos Rupestres y Bosques Lluviosos del Atlántico. Selaginellaalstonii crece sobre rocas en cuevas, mientras que Selaginellablepharodella, Selaginellacrinita, Selaginellamucugensis y Selaginellasematophylla parecen estar adaptadas a lugares estacionalmente secos, creciendo sobre suelos arenosos o húmedos; a su vez, Selaginellamucronata crece en el sotobosque de bosques húmedos y Selaginellasaltuicola está adaptada a vivir en lugares húmedos asociada a rocas o troncos en cascadas. De las siete nuevas especies, seis son consideradas tentativamente endémicas locales (con la excepción de Selaginellasematophylla) debido a su distribución restringida a una o dos localidades dentro de un sólo estado de Brasil. Adicionalmente, proponemos nuevos sinónimos para Selaginellapalmiformis (syn. = Selaginellabahiensissubsp.manausensis, ≡ Selaginellamanausensis) y Selaginellavestiens (syn. = Selaginellafragillima), la cual se confirma como endémica de Brasil donde se registra para los estados de Goiás y Minas Gerais. Finalmente, de acuerdo con este estudio y la literatura discutida, estimamos que el número de especies brasileñas de Selaginella debidamente documentadas es de 61, de las cuales 58 son nativas y tres introducidas y naturalizadas. Esta estadística muy probablemente cambiará conforme se realicen estudios adicionales sobre Selaginella en Brasil.