Sin elevación, también puede haber oclusión / Without elevation, there may also be occlusion

Resumen Ante un dolor torácico agudo y evidencia de elevación del segmento ST, se debe instaurar un tratamiento de reperfusión urgente, con el objetivo de abrir la arteria ocluida y minimizar el daño miocárdico y, así, mejorar el pronóstico del paciente. Por ello, es necesario conocer aquellos patrones eléctricos de alto riesgo equivalentes a una elevación del segmento ST e indicativos de una oclusión coronaria aguda, para evitar que se produzca una demora inadmisible en los tiempos de actuación, tal y como ocurrió en el caso que se presenta.

Abstract In light of an acute chest pain and evidence of ST-segment elevation, an emergent reperfusion treatment should be started with the objective of opening the occluded artery and reducing myocardial damage, thus, improving the patients´s prognosis. Therefore, it is mandatory to keep in mind those high-risk electrical patterns equivalent to a ST-segment elevation and indicative of an acute coronary occlusion to avoid an unacceptable delay in the times of action, such was the case that is reported.

Kinetics and Mechanisms of Saccharomyces boulardii Release from Optimized Whey Protein-Agavin-Alginate Beads under Simulated Gastrointestinal Conditions.

Encapsulation is a process in which a base material is encapsulated in a wall material that can protect it against external factors and/or improve its bioavailability. Among the different encapsulation techniques, ionic gelation stands out as being useful for thermolabile compounds. The aim of this work was to encapsulate Saccharomyces boulardii by ionic gelation using agavins (A) and whey protein (WP) as wall materials and to evaluate the morphostructural changes that occur during in vitro gastrointestinal digestion. Encapsulations at different levels of A and WP were analyzed using microscopic, spectroscopic and thermal techniques. Encapsulation efficiency and cell viability were evaluated. S. boulardii encapsulated at 5% A: 3.75% WP (AWB6) showed 88.5% cell survival after the simulated gastrointestinal digestion; the bead showed a significantly different microstructure from the controls. The mixture of A and WP increased in the survival of S. boulardii respect to those encapsulated with alginate, A or WP alone. The binary material mixture simultaneously allowed a controlled release of S. boulardii by mostly diffusive Fickian mechanisms and swelling. The cell-release time was found to control the increment of the Damköhler number when A and WP were substrates for S. boulardii, in this way allowing greater protection against gastrointestinal conditions.

Neutropenic fever of unknown origin and disseminated granulomatous disease in a patient with acute lymphoblastic leukemia.

An 18-year-old male was admitted for his second induction chemotherapy treatment for an acute lymphoblastic leukaemia with cyclophosphamide, cytarabine, and mercaptopurine. He presented with high fever, abdominal pain, non-bloody diarrhoea, portal hypertension and leukopenia. Stool sample analysis, blood cultures and extensive work-up were negative. The only microbiologic evidence was the presence of cytomegalovirus DNA detected by PCR. A profound hypogammaglobulinemia was documented. Pathology material reported non-caseating granulomas in liver, bone marrow, duodenum and colon with negative cytomegalovirus immunostaining. What is your diagnosis?

Un varón de 18 años se internó para recibir el segundo ciclo de inducción por una leucemia linfoblástica aguda con ciclofosfamida, citarabina y mercaptopurina. Desarrolló fiebre alta, dolor abdominal, diarrea no sanguinolenta, hipertensión portal y leucopenia. El análisis de materia fecal, cultivos de sangre y una evaluación exhaustiva fueron negativas. La única evidencia microbiológica fue la detección de ADN de citomegalovirus en sangre por PCR. También se documentó una hipogamaglobulinemia profunda. El material de patología reportó granulomas no caseificantes en hígado, médula ósea, duodeno y colon con inmunohistoquímica negativa para citomegalovirus. ¿Cuál es su diagnóstico?

SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru.

BACKGROUND: Worldwide, Peru has one of the highest infection fatality rates of COVID-19, and its capital city, Lima, accumulates roughly 50% of diagnosed cases. Despite surveillance efforts to assess the extent of the pandemic, reported cases and deaths only capture a fraction of its impact due to COVID-19's broad clinical spectrum. This study aimed to estimate the seroprevalence of SARS-CoV-2 in Lima, stratified by age, sex, region, socioeconomic status (SES), overcrowding, and symptoms. METHODS: We conducted a multi-stage, population-based serosurvey in Lima, between June 28th and July 9th, 2020, after 115 days of the index case and after the first peak cases. We collected whole blood samples by finger-prick and applied a structured questionnaire. A point-of-care rapid serological test assessed IgM and IgG antibodies against SARS-CoV-2. Seroprevalence estimates were adjusted by sampling weights and test performance. Additionally, we performed RT-PCR molecular assays to seronegatives and estimated the infection prevalence. FINDINGS: We enrolled 3212 participants from 797 households and 241 sample clusters from Lima in the analysis. The SARS-CoV-2 seroprevalence was 20·8% (95%CI 17·2-23·5), and the prevalence was 25·2% (95%CI 22·5-28·2). Seroprevalence was equally distributed by sex (aPR=0·96 [95%CI 0·85-1·09, p = 0·547]) and across all age groups, including ≥60 versus ≤11 years old (aPR=0·96 [95%CI 0·73-1·27, p = 0·783]). A gradual decrease in SES was associated with higher seroprevalence (aPR=3·41 [95%CI 1·90-6·12, p<0·001] in low SES). Also, a gradual increase in the overcrowding index was associated with higher seroprevalence (aPR=1·99 [95%CI 1·41-2·81, p<0·001] in the fourth quartile). Seroprevalence was also associated with contact with a suspected or confirmed COVID-19 case, whether a household member (48·9%, aPR=2·67 [95%CI 2·06-3·47, p<0·001]), other family members (27·3%, aPR=1·66 [95%CI 1·15-2·40, p = 0·008]) or a workmate (34·1%, aPR=2·26 [95%CI 1·53-3·35, p<0·001]). More than half of seropositive participants reported never having had symptoms (56·1%, 95% CI 49·7-62·3). INTERPRETATION: This first estimate of SARS-CoV-2 seroprevalence in Lima shows an intense transmission scenario, despite the government's numerous interventions early established. Susceptibles across age groups show that physical distancing interventions must not be relaxed. SES and overcrowding households are associated with seroprevalence. This study highlights the importance of considering the existing social inequalities for implementing the response to control transmission in low- and middle-income countries.

[Immunohistochemistry of p16 and p53 in vulvar cancer]. / Inmunohistoquímica de p16 y p53 en cáncer de vulva.

Squamous cell carcinoma of the vulva may develop in association or independently of HPV infection. The relationship between pathogenesis, classification, immunohistochemical profile and prognosis has been studied in the literature with some discrepancies. The aim of this study was to observe the classical association of keratinizing carcinomas with the absence of HPV infection and warty and basaloid carcinomas with the presence of this virus. Therefore, we reviewed the clinic, morphology, and immunophenotype of 39 cases. The tumors were histologically classified into classic keratinizing squamous carcinoma (30), warty (5) and basaloid (4). In the statistical analysis, diffuse expression with p16 was significantly associated with younger age (p = 0.0025), presence of high-grade intraepithelial lesion (p < 0.0001), koilocytosis (p = 0.02), and morphological subtype (p = 0.02), and was inversely associated with the expression of p53 (p < 0.0001) and the presence of lichen sclerosus (p = 0.0051). It is curious that 4 keratinizing carcinomas of the cases studied presented coexpression of p16 and p53. Only one warty tumor was negative for p16 and positive for p53, and 9 keratinizing tumors were positive for p16 and negative for p53. Although these findings show that the use of hematoxylin and eosin could correctly define tumors associated with HPV, we strongly suggest the performance of immunohistochemistry, especially in squamous keratinizing classic carcinomas in young patients with a history of HPV.

El carcinoma escamoso vulvar puede desarrollarse de manera asociada o independiente a la infección por HPV. La relación entre la patogénesis, la clasificación, el perfil inmunohistoquímico, y el pronóstico ha sido estudiada con algunas discrepancias. El objetivo del trabajo fue observar la concordancia clásicamente descripta que asocia a los carcinomas queratinizantes con la ausencia de infección por HPV y a los carcinomas warty y basaloides con la presencia de dicho virus. Para ello, revisamos la clínica, la morfología y el inmunofenotipo de 39 casos de nuestro hospital. Los tumores fueron clasificados histológicamente en carcinomas escamosos queratinizantes clásicos (30), warty (5) y basaloides (4). En el análisis estadístico la expresión de p16 fue asociada de manera significativa con una edad menor al momento del diagnóstico (p = 0.0025), presencia de lesión intraepitelial escamosa de alto grado (p < 0.0001), coilocitosis (p = 0.02), y subtipo morfológico (p = 0.02); y fue inversamente asociado con la expresión de p53 (p < 0.0001) y con el liquen escleroso (p = 0.0051). Resulta peculiar que, de los casos estudiados, 4 carcinomas queratinizantes coexpresaron p16 y p53. Un solo tumor de tipo warty resultó negativo para p16 y positivo para p53, y 9 queratinizantes resultaron positivos para p16 y negativos para p53. Si bien estos hallazgos indican que con la sola utilización de la hematoxilina y eosina podrían definirse de manera correcta los tumores asociados al HPV, sugerimos fuertemente la realización de inmunohistoquímica, especialmente en carcinomas escamosos queratinizantes en pacientes jóvenes o con historia de HPV.

Inmunohistoquímica de p16 y p53 en cáncer de vulva / Immunohistochemistry of p16 and p53 in vulvar cancer

El carcinoma escamoso vulvar puede desarrollarse de manera asociada o independiente a la infección por HPV. La relación entre la patogénesis, la clasificación, el perfil inmunohistoquímico, y el pronóstico ha sido estudiada con algunas discrepancias. El objetivo del trabajo fue observar la concordancia clásicamente descripta que asocia a los carcinomas queratinizantes con la ausencia de infección por HPV y a los carcinomas warty y basaloides con la presencia de dicho virus. Para ello, revisamos la clínica, la morfología y el inmunofenotipo de 39 casos de nuestro hospital. Los tumores fueron clasificados histológicamente en carcinomas escamosos queratinizantes clásicos (30), warty (5) y basaloides (4). En el análisis estadístico la expresión de p16 fue asociada de manera significativa con una edad menor al momento del diagnóstico (p = 0.0025), presencia de lesión intraepitelial escamosa de alto grado (p < 0.0001), coilocitosis (p = 0.02), y subtipo morfológico (p = 0.02); y fue inversamente asociado con la expresión de p53 (p < 0.0001) y con el liquen escleroso (p = 0.0051). Resulta peculiar que, de los casos estudiados, 4 carcinomas queratinizantes coexpresaron p16 y p53. Un solo tumor de tipo warty resultó negativo para p16 y positivo para p53, y 9 queratinizantes resultaron positivos para p16 y negativos para p53. Si bien estos hallazgos indican que con la sola utilización de la hematoxilina y eosina podrían definirse de manera correcta los tumores asociados al HPV, sugerimos fuertemente la realización de inmunohistoquímica, especialmente en carcinomas escamosos queratinizantes en pacientes jóvenes o con historia de HPV.

Squamous cell carcinoma of the vulva may develop in association or independently of HPV infection. The relationship between pathogenesis, classification, immunohistochemical profile and prognosis has been studied in the literature with some discrepancies. The aim of this study was to observe the classical association of keratinizing carcinomas with the absence of HPV infection and warty and basaloid carcinomas with the presence of this virus. Therefore, we reviewed the clinic, morphology, and immunophenotype of 39 cases. The tumors were histologically classified into classic keratinizing squamous carcinoma (30), warty (5) and basaloid (4). In the statistical analysis, diffuse expression with p16 was significantly associated with younger age (p = 0.0025), presence of high-grade intraepithelial lesion (p < 0.0001), koilocytosis (p = 0.02), and morphological subtype (p = 0.02), and was inversely associated with the expression of p53 (p < 0.0001) and the presence of lichen sclerosus (p = 0.0051). It is curious that 4 keratinizing carcinomas of the cases studied presented coexpression of p16 and p53. Only one warty tumor was negative for p16 and positive for p53, and 9 keratinizing tumors were positive for p16 and negative for p53. Although these findings show that the use of hematoxylin and eosin could correctly define tumors associated with HPV, we strongly suggest the performance of immunohistochemistry, especially in squamous keratinizing classic carcinomas in young patients with a history of HPV.

Conductas de riesgo y dinámica familiar del adolescente y la de sus padres / Risk behaviors and family dynamics of adolescents and their parents / Condutas de risco e dinâmica familiar do adolescente e a de seus pais

Resumen Objetivo: determinar la relación de los elementos de la dinámica familiar como comunicación y cohesión con las conductas de riesgo del adolescente y la de sus padres. Materiales y métodos: estudio transversal descriptivo correlacional en una muestra no probabilística por conveniencia de 50 adolescentes con sus respectivos padres, pertenecientes a una telesecundaria de la ciudad de Cosoleacaque, Veracruz durante los meses de octubre y noviembre de 2014. Previo consentimiento informado se aplicó una cédula de datos sociodemográficos y el test de la Organización Panamericana de la Salud "Cómo es Tu familia" y "Cómo es Su Familia", que midió la comunicación padre-hijo y las conductas de riesgo, y la Faces III de Olson que valoró la cohesión padre-hijo. El análisis de la prueba Chi-Cuadrada y coeficiente de Spearman se realizó en el Paquete Estadístico para las Ciencias Sociales. Resultados: la media de edad de los adolescentes fue de 13.3 ± 1.23 años. La cohesión y comunicación de los padres no se asocia con la conducta de riesgo del adolescente (p=0.218>0.05 y p=.981>0.05, respectivamente). La conducta de riesgo del padre sí se asocia con la conducta de riesgo de los adolescentes (p=0.002 <0.05). Conclusión: la dinámica familiar no se asocia con las conductas de riesgo del adolescente, pero sí se asocia con la conducta de riesgo del padre, lo que es importante para el profesional de enfermería en el campo de la promoción de la salud al brindar estrategias familiares que impacten en la conducta de los padres y en su bienestar integral.

Abstract Objective: to determine the relationship of the elements of family dynamics, such as communication and cohesion, with risk behaviors of adolescents and their parents. Materials and Methods: Descriptive, correlative, cross-sectional study in a non-probabilistic sample for the convenience of 50 adolescents with their respective parents belonging to a tele-secondary school in the city of Cosoleacaque, Veracruz, during the months of October and November 2014. Prior informed consent, a sociodemographic data card and the Pan American Health Organization Parentadolescent communication scale "How is your family?" were applied, that measured parent-child communication and risk behaviors. Also, Olson's Faces III scale was applied which assessed parent-child cohesion. The analysis of the Chi-square test and the Spearman coefficient was performed in the Statistical Package for the Social Sciences. Results: the mean age of the adolescents was 13.3 ± 1.23 years. Parental cohesion and communication was not associated with adolescent risk behavior (p = 0.218> 0.05 and p = .981> 0.05, respectively). The risk behavior of the parent was associated with the risk behavior of adolescents (p = 0.002 <0.05). Conclusion: family dynamics was not associated with risk behaviors of adolescents, but it was associated with risk behavior of the parent which is important for the nursing professional in the field of health promotion to provide family strategies that impact on the behavior of parents and on their well-being.

Resumo Objetivo: determinar a relação dos elementos da dinâmica familiar como comunicação e coesão com as condutas de risco do adolescente e a de seus pais. Materiais e métodos: estudo transversal descritivo correlacional em uma amostra não probabilística por conveniência de 50 adolescentes com seus respectivos pais, pertencentes a ensino médio da cidade de Cosoleacaque, Veracruz durante os meses de outubro e novembro de 2014. Prévio consentimento informado se aplicou uma tabela de dados sócio demográficos e o teste da Organização Pan-americana da Saúde "Como é Tua família" e "Como é Sua Família", que mediu a comunicação pai-filho e as condutas de risco, e a Faces III de Olson que valorou a coesão pai-filho. O análise da prova Chi-Quadrada e coeficiente de Spearman se realizou no Pacote Estatístico para as Ciências Sociais. Resultados: a média de idade dos adolescentes foi de 13.3 ± 1.23 anos. A coesão e comunicação dos pais não se associa com a conduta de risco do adolescente (p=0.218>0.05 e p=.981>0.05, respectivamente). A conduta de risco do pai si se associa com a conduta de risco dos adolescentes (p=0.002 <0.05). Conclusão: a dinâmica familiar não se associa com as condutas de risco do adolescente, mas si se associa com a conduta de risco do pai, o que é importante para o profissional de enfermagem no campo da promoção da saúde ao brindar estratégias familiares que impactem na conduta dos pais e em seu bem estar integral.

A disputa entre modelos para o campo: apontamentos sobre a questão agrária no Brasil em busca de um novo paradigma / The dispute between models for the countryside: notes on the agrarian issue in Brazil in search of a new paradigm

RESUMO O texto procura apresentar a discussão da questão agrária brasileira na perspectiva do conflito entre dois modelos para o campo: um voltado para o agronegócio e outro voltado para a agricultura familiar, reforma agrária e comunidades tradicionais. O presente artigo pretende visitar essa disputa, atualizá-la no contexto do golpe de Estado de 2016 e apresentar possíveis alternativas para o campo no Brasil em busca de novos paradigmas.

ABSTRACT The text seeks to present the discussion of the Brazilian agrarian issue from the perspective of the conflict between two models for the countryside, one focused on the agribusiness, and one another focusing on family farming, agrarian reform, and traditional communities. The present article intends to visit such dispute, to update it in the context of the coup d'etat of 2016, and to present possible alternatives to the countryside in Brazil in search of new paradigms.

Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad / Diencephalic syndrome in a child with chronic malnutrition and hyperactivity

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

[Diencephalic syndrome in a child with chronic malnutrition and hyperactivity]. / Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

Hybrid treatment of penetrating aortic ulcer.

Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease.

A úlcera aórtica penetrante é uma entidade rara e de prognóstico desfavorável dentro da síndrome aórtica aguda. Mais raros ainda, na literatura, são os casos como o aqui relatado, localizado no arco aórtico, que começa com dor torácica e evolui com disfonia. O presente caso enfatiza o papel da tomografia computadorizada no diagnóstico da úlcera aórtica penetrante e na sua diferenciação de outras entidades dentro da síndrome aórtica aguda. Apresenta também um avanço terapêutico nessa doença, constituído por tratamento híbrido endovascular e cirúrgico.

Hybrid treatment of penetrating aortic ulcer / Tratamento híbrido de úlcera aórtica penetrante

Abstract Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease.

A úlcera aórtica penetrante é uma entidade rara e de prognóstico desfavorável dentro da síndrome aórtica aguda. Mais raros ainda, na literatura, são os casos como o aqui relatado, localizado no arco aórtico, que começa com dor torácica e evolui com disfonia. O presente caso enfatiza o papel da tomografia computadorizada no diagnóstico da úlcera aórtica penetrante e na sua diferenciação de outras entidades dentro da síndrome aórtica aguda. Apresenta também um avanço terapêutico nessa doença, constituído por tratamento híbrido endovascular e cirúrgico.

Excessive refined carbohydrates and scarce micronutrients intakes increase inflammatory mediators and insulin resistance in prepubertal and pubertal obese children independently of obesity.

BACKGROUND: Low-grade inflammation is the link between obesity and insulin resistance. Because physiologic insulin resistance occurs at puberty, obese pubertal children are at higher risk for insulin resistance. Excessive diets in refined carbohydrates and saturated fats are risk factors for insulin resistance, but calcium, magnesium, vitamin-D, and the omega-3 fatty acids likely protect against inflammation and insulin resistance. OBJECTIVE: To analyze interactions among dietary saturated fat, refined carbohydrates, calcium, magnesium, vitamin D, and omega-3 fatty acids on the risk of inflammation and insulin resistance in a sample of prepubertal and pubertal children. METHODS: A sample of 229 children from Mexico City was analyzed in a cross-sectional design. Anthropometric measurements, 24 h recall questionnaires, and blood samples were obtained. Serum insulin, glucose, calcium, magnesium, 25-OHD3, C-reactive protein, leptin, adiponectin, and erythrocytes fatty acids were measured. Parametric and nonparametric statistics were used for analysis. RESULTS: While mean macronutrients intake was excessive, micronutrients intake was deficient (P < 0.01). Inflammation determinants were central obesity and magnesium-deficient diets. Determinants of insulin resistance were carbohydrates intake and circulating magnesium and adiponectin. CONCLUSIONS: Magnesium-deficient diets are determinants of inflammation, while high intake of refined carbohydrates is a risk factor for insulin resistance, independently of central adiposity.

Enfermedad de letterer siwe abt / s. t

Se presenta un caso de reticuloendoteliosis aguda en un lactante de 7 meses de edad, de evolución fulminante mortal en 20 días desde el comienzo de la sintomatología....(AU)