Ant Community Is Not Influenced by the Addition of Olive Mill Pomace Compost in Two Different Olive Crop Managements.

Industrial production of olive oil generates large amounts of solid waste called 'alperujo'. Its compost can fertilize many crops, especially olives. Furthermore, superintensive orchards are increasing their surface globally due to higher production and savings in different costs. Ants are considered an important part of the arthropod community in olive orchards and could even play a significant role in pest control. The tree canopy and ground were sampled to compare the ant assemblage in plots fertilized with compost and mineral products in two groves with different types of crop management (superintensive and traditional) over two years. The numbers of ants in both types of fertilization in each grove were not statistically different (p > 0.05), indicating that the type of fertilization did not have a significant impact on its populations in the ground or in the canopy, but the number of individuals was significantly higher in the superintensive grove than in the traditional grove (both in the ground and in the canopy, p < 0.01). The most frequent species in the ground were Pheidole pallidula, Plagiolepis smitzii and Aphaenogaster senilis (superintensive grove) and Pheidole pallidula, Tetramorium gr semilaeve, Plagiolepis pygmaea, and Tapinoma nigerrimum (traditional grove). In the canopy, the most frequent species were Plagiolepis spp. in both groves. Differences in ant densities and species between the groves could be due to the different management, especially of the soil, but it must be confirmed using more replicas and longer periods of study.

Magic-Religious practices in chronic diseases at in a third level hospital (Mexico) / Prácticas mágico-religiosas en enfermedades crónicas en un hospital de tercer nivel en 2019 (México)

The religious system intersects within the health system. Religious practices seek the intervention of divine actors through practices, prayers, rites and rituals. In turn, magical practices are described as everyday symbolic precepts to which power is attributed to achieve technical and utilitarian ends without the intervention of a sacred rank or being. We sought to characterize the ideal type of magical-religious practices carried out by mothers of patients with chronic diseases, cared for in a tertiary care hospital. In-depth interviews were conducted with 12 mothers of children with various chronic illnesses. In all of them, they used the magico-religious practices as emotional self-care when facing loneliness and crises in their environment, in order to feel tranquility and peace in search of well-being of them and their children. Because of the widespread use of magico-religious practices, it is necessary to understand how they go through the health-disease process to balance the tension between the biomedical and the religious-spiritual in the search for social and spiritual wellbeing of chronically ill children.

Dentro de la atención para la salud, se interseca el sistema religioso. Las prácticas religiosas buscan una intervención de actores divinos por medio de prácticas, rezos, ritos y rituales. A su vez, las prácticas mágicas se describen como preceptos simbólicos cotidianos a los que se les atribuye poder para conseguir multas técnicas y utilitarios sin intervención de un rango o ser sagrado. Se buscó caracterizar el tipo ideal de las prácticas mágico-religiosas realizadas por madres de pacientes con enfermedades crónicas, atendidos en un hospital de tercer nivel de atención. Se realizaron entrevistas a profundidad en 12 madres con hijos con diversas enfermedades crónicas.En todas ellas, se destaca el uso de las prácticas mágico-religiosas como auto-cuidado emocional al afrontar la soledad y las crisis de su entorno, con el fin de sentir tranquilidad y paz en busca de este bienestar de ellas y de sus hijos. Por el uso extendido de las prácticas mágico-religiosas es necesario comprender cómo intersecan el proceso de salud-enfermedad, en donde el personal para la salud busque equilibrar la tensión entre el componente biológico de la enfermedad y el aspecto religioso-espiritual, en la búsqueda de bienestar social y espiritual del vínculo madre-hijo.

Pest mites and their interaction with Phytoseiidae and other arthropod predators in an almond orchard in South-West Spain.

The almond crop in Spain has increased in importance in recent years and consequently there is a need to improve knowledge about pests, diseases, and weeds. The present study was conducted from 2017 to 2020, with the objective of determining the fauna of spider mites and their natural enemies, with a special emphasis on phytoseiids. The main spider mite species was Tetranychus urticae Koch, and secondary species were Bryobia rubrioculus (Scheuten) and Eutetranychus banksii (McGregor). Phytoseiidae were the most abundant group of natural enemies, with 59% of the individuals observed; Euseius stipulatus (Athias-Henriot) was the predominant species, accounting for 96% of adult females identified, Typhlodromus (Anthoseius) athenas Swirski & Ragusa accounted for the remaining 4%. Other (potential) natural enemies were Chrysopidae, Scolothrips longicornis Priesner, and Stethorus sp. with 36, 2, and 3%, respectively, of the natural enemy individuals. The seasonal pattern of T. urticae indicated population peaks from July to September, and its control was based on miticides in most seasons. Euseius stipulatus and T. athenas appeared mainly in May-June and did not show interaction with the spider mite population. Chrysopidae were present throughout the season, from May to October in the 4 years, but no direct relationship with the spider mite population was observed. In contrast, the seasonal pattern of both S. longicornis and Stethorus sp. coincided with the most important peaks of spider mites and these predators were seen in the spider mite colonies, although in very low numbers. The importance of these latter specialized spider mite predators and ways to strengthen them are discussed.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños.

BACKGROUND: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. METHODS: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. RESULTS: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. CONCLUSIONS: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

INTRODUCCIÓN: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. MÉTODOS: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. RESULTADOS: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. CONCLUSIONES: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

Frequency of malnutrition in children and adolescents with child maltreatment.

Introduction: Introduction: child maltreatment (CM) can have a negative impact on physical and mental health in childhood and throughout life. Objective: to determine the frequency of malnutrition in cases of CM from the Clínica de Atención Integral al Niño Maltratado (CAINM) of the Instituto Nacional de Pediatría (INP), Mexico. Material and methods: this was a cross-sectional, retrospective, descriptive study of children with CM. Height/age, weight/height, and body mass index/age were used to determine malnutrition status (undernutrition and overweight or obesity). The frequency of malnutrition by age group and sex were compared using X2 tests. The prevalence of malnutrition at CAINM was compared to that expected in Mexico (ENSANUT-2012), serving as a reference for children without CM, using one-sample Poisson tests. Results: of the 117 cases, 41 % presented wasting or overweight/obesity, and 25 % were growth-stunted. Neither wasting nor stunting displayed any difference between age groups (p > 0.05). Overweight/obesity was observed more frequently in adolescents than in schoolchildren (p < 0.05). Being overweight or obese was most frequently associated with sexual abuse, and wasting and stunting were most often associated with neglect. Compared to the population without CM, the group under 5 years of age had a higher prevalence of wasting (p < 0.01), and those aged 5 to 11 years had a higher prevalence of both wasting and stunting (p < 0.001). Conclusions: CM cases were characterized by acute undernutrition and stunting as well as by adolescents who were overweight or obese. Malnutrition in the pediatric population should be analyzed from a wider perspective, including possible CM.

Introducción: Introducción: el maltrato infantil (MI) puede afectar la salud física y mental en la niñez y a largo plazo. Objetivo: determinar las frecuencias de mala nutrición en casos de MI de la Clínica de Atención Integral al Niño Maltratado (CAINM), perteneciente al Instituto Nacional de Pediatría de México. Métodos: estudio transversal, retrospectivo y descriptivo. Se utilizaron los cocientes de peso/talla, talla/edad e IMC/edad. Las frecuencias de mala nutrición (desnutrición y sobrepeso/obesidad) se compararon entre los grupos de edad y sexo a través de la prueba del X2. Utilizando pruebas de Poisson para una sola muestra se compararon las prevalencias de la mala nutrición con las esperadas en México (ENSANUT-2012). Resultados: de los 117 casos de MI, el 41 % presentaban emaciación o sobrepeso/obesidad, y el 25 % talla baja. Ni por emaciación ni por talla baja hubo diferencias entre los grupos de edad (p > 0,05). La frecuencia del sobrepeso/obesidad fue mayor en los adolescentes que en los escolares (p < 0,05). En el grupo de abuso sexual destacó el sobrepeso/obesidad; en el de negligencia, la emaciación y la talla baja. En comparación con las prevalencias de los niños sin MI, los niños < 5 años tuvieron prevalencias más altas de emaciación (p < 0,01); los de 5 a 11 años, de emaciación y talla baja (para ambas, p < 0,001). Conclusiones: los niños con MI se caracterizaron por desnutrición y talla baja, así como también por sobrepeso/obesidad en los adolescentes. La mala nutrición en las poblaciones pediátricas debe analizarse desde una perspectiva amplia, incluido el posible maltrato infantil.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños / Clinical practice guidelines for diagnosis and management of acute otitis media in children

Resumen Introducción: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. Métodos: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Resultados: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. Conclusiones: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

Abstract Background: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. Methods: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. Results: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. Conclusions: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

Effectiveness of an educational strategy to increase plain water consumption in children / Efectividad de una estrategia educativa para incrementar el consumo de agua simple en niños

Abstract: Objective: We tested the effectiveness of the I prefer plain water educational strategy used to increase water consumption in elementary school children. Materials and methods: A community intervention trial was performed in eight public elementary schools in Mexico City. The schools were randomized into an intervention (IG) and a control (CG) group. Each school was provided water dispensers inside the classrooms. The IG received the educational strategy. The strategy was considered effective if the students increased their water consumption by ≥220 ml. Results: Water consumption in the IG increased 167 ml vs. 37 ml in CG (p < 0.001). The goal of the educational strategy for water consumption was achieved in 166/413 children in the IG and 95/364 children in the CG (p < 0.001). Conclusions: I prefer plain water, associated with free access to water inside the classrooms, proved to be effective to increase water consumption.

Resumen: Objetivo: Evaluar la efectividad de la estrategia Prefiero agua simple para incrementar el consumo de agua en niños de escuelas primarias públicas. Material y métodos: Ensayo de intervención comunitaria en ocho escuelas en la Ciudad de México. Las escuelas se aleatorizaron en grupo de intervención (GI) y de control (GC). Se instalaron dispensadores de agua dentro de las aulas. Implementamos la estrategia al GI. Consideramos efectiva la estrategia si los estudiantes incrementaron su consumo de agua en ≥220 ml. Resultados: El incremento global en el consumo de agua del GI fue de 167 ml vs. 37 ml en GC (p <0.001). La efectividad de la estrategia para el consumo de agua se logró en 166/413 niños del GI y en 95/364 niños del GC (p <0.001). Conclusiones: Prefiero agua simple, asociada con libre acceso al agua dentro de las aulas, demostró ser efectiva para incrementar el consumo de agua.

Effectiveness of an educational strategy to increase plain water consumption in children.

OBJECTIVE: We tested the effectiveness of the I prefer plain water educational strategy used to increase water consumption in elementary school children. MATERIALS AND METHODS: A community intervention trial was performed in eight public elementary schools in Mexico City. The schools were randomized into an intervention (IG) and a control (CG) group. Each school was provided water dispensers inside the classrooms. The IG received the educational strategy. The strategy was considered effective if the students increased their water consumption by ≥220 ml. RESULTS: Water consumption in the IG increased 167 ml vs. 37 ml in CG (p < 0.001). The goal of the educational strategy for water consumption was achieved in 166/413 children in the IG and 95/364 children in the CG (p < 0.001). CONCLUSIONS: I prefer plain water, associated with free access to water inside the classrooms, proved to be effective to increase water consumption.

OBJECTIVE: Evaluar la efectividad de la estrategia Prefiero agua simple para incrementar el consumo de agua en niños de escuelas primarias públicas. MATERIALS AND METHODS: Ensayo de intervención comunitaria en ocho escuelas en la Ciudad de México. Las escuelas se aleatorizaron en grupo de intervención (GI) y de control (GC). Se instalaron dispensadores de agua dentro de las aulas. Implementamos la estrategia al GI. Consideramos efectiva la estrategia si los estudiantes incrementaron su consumo de agua en ≥220 ml. RESULTS: El incremento global en el consumo de agua del GI fue de 167 ml vs. 37 ml en GC (p < 0.001). La efectividad de la estrategia para el consumo de agua se logró en 166/413 niños del GI y en 95/364 niños del GC (p < 0.001). CONCLUSIONS: Prefiero agua simple, asociada con libre acceso al agua dentro de las aulas, demostró ser efectiva para incrementar el consumo de agua.

Tracheal growth assessment in mongrel puppies (dogs) through multidetector CT.

The aim of this study was to describe the tracheal growth pattern and its zoometric relationship in related medium-sized mongrel puppies through adulthood. Fourteen puppies were studied. CT monitoring was performed monthly, starting in the 1st month of life through the 7th month and subsequently at the 9th and 12th months. Additionally, six zoometric measurements were performed. Dorsoventral (DV) and transverse (TV) diameters and the luminal area from C1 to T2 were obtained. The global tracheal growth pattern revealed an increase up to 13 times its initial size, reaching a plateau phase during the last trimester. The relationship between the DV and the TV internal diameters of the tracheal lumen did not change during growth. As previously reported, the cranial tracheal area was wider, while the caudal part gradually decreased towards T1-T2; this consideration is important since the more distal an endotracheal tube is inserted, the greater the risk that injury may occur. The linear correlation between the zoometric measurements and the tracheal ring areas was positive. This study provides evidence for the evaluation of the morphometry of the canine trachea during physiological growth using helicoidal CT as a non-invasive, accurate tool.

Improving time to optimal Staphylococcus aureus treatment using a penicillin-binding protein 2a assay.

The penicillin-binding protein 2a (PBP2a) assay is a quick, accurate and inexpensive test for determining methicillin susceptibility in Staphylococcus aureus. A pre-post-study design was conducted using a PBP2a assay with and without the impact of an antimicrobial stewardship intervention to improve time to optimal therapy for methicillin-susceptible and methicillin-resistant S. aureus isolates. Our results demonstrate significantly improved time to optimal therapy and support the use of a PBP2a assay as part of an programme for all healthcare facilities, especially those with limited resources.

Safety and immunogenicity of an intramuscular quadrivalent influenza vaccine in children 3 to 8 y of age: A phase III randomized controlled study.

A quadrivalent, inactivated, split-virion influenza vaccine containing a strain from both B lineages (IIV4) has been developed, but its safety and immunogenicity in young children has not been described. This was a phase III, randomized, double-blind, active-controlled, multi-center study to examine the immunogenicity and safety of IIV4 in children 3-8 y of age (EudraCT no. 2011-005374-33). Participants were randomized 5:1:1 to receive the 2013/2014 Northern Hemisphere formulation of IIV4, an investigational trivalent comparator (IIV3) containing the B/Victoria lineage strain, or the licensed Northern Hemisphere IIV3 containing the B/Yamagata lineage strain. Participants who had not previously received a full influenza vaccination schedule received 2 doses of vaccine 28 d apart; all others received a single dose. 1242 children were included. For all 4 strains, IIV4 induced geometric mean haemagglutination inhibition titres non-inferior to those induced by the IIV3 comparators. For both B strains, geometric mean antibody titres induced by IIV4 were superior to those induced by the IIV3 with the alternative lineage strain. Similar proportions of participants vaccinated with IIV4 and IIV3 reported solicited injection-site reactions, solicited systemic reactions, and vaccine-related adverse events. A single vaccine-related serious adverse event, thrombocytopenia, was reported 9 d after vaccination with IIV4 and resolved without sequelae. In conclusion, in children aged 3-8 y who received one dose or 2 doses 28 d apart, IIV4 had an acceptable safety profile, was as immunogenic as IIV3 for the shared strains, and had superior immunogenicity for the additional B strain.

[GASTROSTOMY POSITIVELY AFFECTS NUTRITIONAL STATUS AND DIMINISHES HOSPITAL DAYS IN PATIENTS WITH INBORN ERRORS OF METABOLISM]. / LA GASTROSTOMÍA AFECTA POSITIVAMENTE AL ESTADO NUTRICIONAL Y DISMINUYE LOS DÍAS DE HOSPITALIZACIÓN EN PACIENTES CON ERRORES INNATOS DEL METABOLISMO.

INTRODUCTION: the nutrition management of patients with inborn errors of metabolism (IEM) requires the permanent use of elemental medical formulas whose organoleptic characteristics sometimes impede oral acceptance. In addition, these patients may have gastrointestinal disorders and require constant use of drugs, that often complicate treatment adherence, thereby committing their nutritional status and disease control. Gastrostomy is an alternative to facilitate feeding and treatment, but its use is controversial. OBJECTIVE: to compare nutrition status and length of hospitalizations before and after gastrostomy surgery in a group of IEM patients. METHODS: retrospective analysis of anthropometric data, number of hospitalizations due to metabolic decompensation and length in pediatric patients with IEM before and after gastrostomy. RESULTS: 16 children were analyzed, 40% with propionate disorders, 25% with abnormal urea cycle and 35% other IEM. After gastrostomy, the number of eutrophic patients increased from 6-56%, and malnutrition decreased from 94 to 44%. After gastrostomy inpatient hospital days significantly decrease from 425 to 131 (p = 0.011), admission numbers pre-gastrostomy decreased from 33 to 17, however this difference was not statistically significant. CONCLUSION: in this sample, gastrostomy improved nutritional status in 56% of EIM patients and significantly reduced hospital days caused by metabolic decompensation.

Introducción: el tratamiento nutricional de los pacientes con errores innatos del metabolismo (EIM) implica el uso permanente de fórmulas modificadas en aminoácidos cuyas características organolépticas pueden dificultar su aceptación por vía oral. Estos pacientes pueden tener alteraciones gastrointestinales y requieren el uso constante de medicamentos, lo cual complica la adherencia al tratamiento, comprometiéndose con ello su estado nutricional y el control de la enfermedad. La gastrostomía es una alternativa para facilitar la alimentación y el tratamiento, pero existen controversias sobre su uso. Objetivo: comparar el estado nutricional y la duración de las hospitalizaciones antes y después de la realización de la gastrostomía en un grupo de pacientes con EIM. Métodos: análisis retrospectivo de datos antropométricos, número de internamientos por descompensación metabólica y su duración en pacientes pediátricos con EIM antes y después de la gastrostomía. Resultados: se analizaron 16 niños; 40% con defectos del propionato, 25% con alteraciones del ciclo de la urea y 35% con otros EIM. Después de la gastrostomía, la proporción de pacientes eutróficos aumentó del 6 al 56% y la desnutrición disminuyó del 94 al 44%. Después de la gastrostomía, la duración de los periodos hospitalarios disminuyó significativamente de 425 a 131 días (p = 0.011); el número de internamientos disminuyó de 33 antes de la intervención a 17, sin embargo, esta diferencia no tuvo significación estadística. Conclusión: en esta muestra, la gastrostomía mejoró el estado nutricional en 56% de los pacientes con EIM, y redujo significativamente los días de hospitalización por descompensación metabólica.

La gastrostomía afecta positivamente al estado nutricional y disminuye los días de hospitalización en pacientes con errores innatos del metabolismo / Gastrostomy positively affects nutritional status and diminishes hospital days in patients with inborn errors of metabolism

Introducción: el tratamiento nutricional de los pacientes con errores innatos del metabolismo (EIM) implica el uso permanente de fórmulas modificadas en aminoácidos cuyas características organolépticas pueden dificultar su aceptación por vía oral. Estos pacientes pueden tener alteraciones gastrointestinales y requieren el uso constante de medicamentos, lo cual complica la adherencia al tratamiento, comprometiéndose con ello su estado nutricional y el control de la enfermedad. La gastrostomía es una alternativa para facilitar la alimentación y el tratamiento, pero existen controversias sobre su uso. Objetivo: comparar el estado nutricional y la duración de las hospitalizaciones antes y después de la realización de la gastrostomía en un grupo de pacientes con EIM. Métodos: análisis retrospectivo de datos antropométricos, número de internamientos por descompensación metabólica y su duración en pacientes pediátricos con EIM antes y después de la gastrostomía. Resultados: se analizaron 16 niños; 40% con defectos del propionato, 25% con alteraciones del ciclo de la urea y 35% con otros EIM. Después de la gastrostomía, la proporción de pacientes eutróficos aumentó del 6 al 56% y la desnutrición disminuyó del 94 al 44%. Después de la gastrostomía, la duración de los periodos hospitalarios disminuyó significativamente de 425 a 131 días (p=0.011); el número de internamientos disminuyó de 33 antes de la intervención a 17, sin embargo, esta diferencia no tuvo significación estadística. Conclusión: en esta muestra, la gastrostomía mejoró el estado nutricional en 56% de los pacientes con EIM, y redujo significativamente los días de hospitalización por descompensación metabólica (AU)

Introduction: the nutrition management of patients with inborn errors of metabolism (IEM) requires the permanent use of elemental medical formulas whose organoleptic characteristics sometimes impede oral acceptance. In addition, these patients may have gastrointestinal disorders and require constant use of drugs, that often complicate treatment adherence, thereby committing their nutritional status and disease control. Gastrostomy is an alternative to facilitate feeding and treatment, but its use is controversial. Objective: to compare nutrition status and length of hospitalizations before and after gastrostomy surgery in a group of IEM patients. Methods: retrospective analysis of anthropometric data, number of hospitalizations due to metabolic decompensation and length in pediatric patients with IEM before and after gastrostomy. Results: 16 children were analyzed, 40% with propionate disorders, 25% with abnormal urea cycle and 35% other IEM. After gastrostomy, the number of eutrophic patients increased from 6-56%, and malnutrition decreased from 94 to 44%. After gastrostomy inpatient hospital days significantly decrease from 425 to 131 (p=0.011), admission numbers pre-gastrostomy decreased from 33 to 17, however this difference was not statistically significant. Conclusion: in this sample, gastrostomy improved nutritional status in 56% of EIM patients and significantly reduced hospital days caused by metabolic decompensation (AU)

Differential expression of cytochrome P450 enzymes in normal and tumor tissues from childhood rhabdomyosarcoma.

Intratumoral expression of genes encoding Cytochrome P450 enzymes (CYP) might play a critical role not only in cancer development but also in the metabolism of anticancer drugs. The purpose of this study was to compare the mRNA expression patterns of seven representative CYPs in paired tumor and normal tissue of child patients with rabdomyosarcoma (RMS). Using real time quantitative RT-PCR, the gene expression pattern of CYP1A1, CYP1A2, CYP1B1, CYP2E1, CYP2W1, CYP3A4, and CYP3A5 were analyzed in tumor and adjacent non-tumor tissues from 13 child RMS patients. Protein concentration of CYPs was determined using Western blot. The expression levels were tested for correlation with the clinical and pathological data of the patients. Our data showed that the expression levels of CYP1A1 and CYP1A2 were negligible. Elevated expression of CYP1B1 mRNA and protein was detected in most RMS tumors and adjacent normal tissues. Most cancerous samples exhibit higher levels of both CYP3A4 and CYP3A5 compared with normal tissue samples. Expression of CYP2E1 mRNA was found to be significantly higher in tumor tissue, however no relation was found with protein levels. CYP2W1 mRNA and/or protein are mainly expressed in tumors. In conclusion, we defined the CYP gene expression profile in tumor and paired normal tissue of child patients with RMS. The overexpression of CYP2W1, CYP3A4 and CYP3A5 in tumor tissues suggests that they may be involved in RMS chemoresistance; furthermore, they may be exploited for the localized activation of anticancer prodrugs.

Bioabsorbable implant as a tracheal wall substitute in young developing canines.

This study evaluated a polylactic and polyglycolic acid (PLA/PGA) implant as a partial tracheal substitute in young developing canines. This experimental and longitudinal study included local stray pups that received substitution of a short cervical tracheal segment with a PLA 85%/PGA 15% plaque. We measured clinical, endoscopic, and tomographic variables for 1 year, at which time we performed histomorphological evaluations of the implant using light and electron microscopy. There were no adverse events throughout the clinical progression. On endoscopic evaluation, the implant was covered with mucosal tissue beginning in the first month, without granulation or stenosis, and the circular shape of the trachea was altered. Tomographic images of the tracheal area at the implant site were similar to adjacent healthy areas (p = 0.423). At the end of the follow-up period, the plaque had biodegraded, and the space was covered by pseudostratified epithelium and ciliated cells similar to the neighboring tissue. Implantation of a PLA/PGA plaque constituted an effective (functional) replacement of a short semicircular cervical tracheal segment without limiting the growth of the recipient. Additional studies are required to prove the efficacy of these implants for larger tracheal segment replacements and in subjects at different stages of development.

[Experimental bacterial contamination of bile and liver in mongrel dogs: an alternative treatment with cephalone, a hybrid of cephalosporine fluoroquinolone]. / Contaminación bacteriana experimental de bilis e hígado en perros criollos. Tratamiento alternativo con (cefalona), un híbrido de cefalosporina y fluoroquinolona.

OBJECTIVES: A longitudinal, randomized, single blind study was done to evaluate the efficacy of an antibacterial hybrid molecule (beta-lactamic-fluoroquinolone) named cephalone after biliary-enteric-bypass (BEB). MATERIAL AND METHODS: Four groups of mongrel dogs were operated on three consecutive periods. Cultures of bile and liver were obtained and assessed, followed by obliteration of common bile duct and BEB to groups A, B and C. Group D served as a control. Ten days later the group A received conventional treatment based on ampicillin/gentamicin and groups B and C, cephalone in two different concentration schemes during 10 consecutive days. Further samples were processed for bacteria and additional liver biopsies were obtained for histopathological analysis. RESULTS: All three treatments reverted bacterial contamination in the liver and most of the bile samples were negative or showed a significant decrease in the number of colony forming units (p = 0.002). Histopathological analysis proved no lesions. CONCLUSIONS: Comparison of efficacy among antibacterial treatments revealed undistinguishable efficacy in this short-term assessment of bacterial contamination after BEB in dogs. The use of cephalone could be considered as a viable treatment or prophylaxis in bacterial infections occurring after BEB. Further studies are needed to assess long-term impact of the cephalone in this setting.

Fibrocollagen-covered prosthesis for a noncircumferential segmental tracheal replacement.

OBJECTIVE: Fibrocollagen-covered polyester meshes can be used as possible substitutions for tracheal segments if they become integrated into the tissue without complications. The aim of this study was to assess a fibrocollagen-covered polyester prosthesis to be used as a substitution for a tracheal segment. METHODS: We performed a blind, randomized experimental assay. Adult Wistar rats were assigned to one of 2 groups. Prostheses were made by implanting polyester tubing in a group of animals to cover them with homologous collagen. They were implanted as substitutions of tracheal segments in the experimental group after creating a defect in the anterior wall of the trachea. Clinical, histomorphologic, and immunohistochemical assessments were made at 4 different time points. RESULTS: The experimental group presented some respiratory distress signs during the first 7 to 10 days, such as stertors, hissing, and low motor activity. After this initial period, the symptoms subsided progressively and disappeared at the end of the first month. These respiratory symptoms caused no mortality. Initially undifferentiated monolayer cells predominated on the implant's surface, but during the last 2 months, the proportion of epithelial and ciliated cells was similar to that seen in control animals. Types I, III, and V collagen fibers were identified around the mesh. The intraluminal area of the tracheas with prostheses and prosthesis thickness were larger during the 4 months of the experiment. The increase in thickness was due to angiogenesis without evidence of fibrosis or chronic inflammation. CONCLUSIONS: Polyester-collagen prostheses used as substitutions of tracheal segments in rats enabled the proliferation of normal respiratory epithelium and maintained tracheal function without collapse, inflammatory reaction, or secondary stenosis.

[Surgical/medical competences, self-perception among a group of students recently graduated]. / Competencias médico-quirúrgicas. Autopercepción en médicos recién egresados de la licenciatura.

BACKGROUND: Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. We undertook this study to identify the surgical/medical competencies (SMC) acquired by a group of students after graduating from the Faculty of Medicine, National Autonomous University of Mexico. METHODS: This was a cross-sectional, comparative, observational, and prospective study. Students from the class (1999-2003) who accepted to participate were included in the study. Thirty SMC were evaluated as well as demographic and academic background data from the graduates. Data were analyzed using Mann-Whitney, Kruskal-Wallis andX2tests. RESULTS: Of 341 interviewees, 310 subjects participated in the study; 61% of all participants were females. Mean age at graduation was 25 years; 66% of all participants concluded their medical training in 6 years; 30% of the interviewees had a < or = 8.0-point grade average score; 62% concluded their 6th school year in a Mexican Institute of Social Security (IMSS) and/or in a Ministry of Health (SSa) facility. Subjects reported having little or no command over 21/30 listed SMCs. Female participants rated themselves as less proficient than their male counterparts (p < or = 0.05). The presence of three other concomitant factors among several participants negatively influenced their self-perception of whether or not they possessed certain skills. CONCLUSIONS: A group of recently graduated physicians subjectively perceived themselves as possessing partial or no command over the SMCs included in the Surgery Department syllabus. These results must be completed through an objective assessment.

Difusión de cotrimoxazol a través de un expansor tisular: Estudio in vitro / Cotrimoxazole diffusion through a tissue expanders: In vitro study

Introducción: La principal complicación del uso de los expansores titulares (ET) son las infecciones. Una alternativa para evitarla, es agregar antibióticos que se difundan a través de la pared de un ET y eviten la colonización bacteriana. El objetivo de este trabajo fue evaluar la eficacia de una presentación nacional de cotrimoxazol, para difundirse a través de un ET en diferentes volúmenes de expansión. Material y método: Se realizó un experimento longitudinal con 12 ET, llenados a 50,100, 150 o 200% de su capacidad nominal, con solución fisiológica y cotrimoxazol a una concentración de 800/4000 ug/mL de trimetoprin/sulfametoxazol (TMX/SMX), sumergidos posteriormente en un sistema cerrado. Se midió la presión en el interior del ET, al inicio y al final del experimento. En los cuatro grupos se cuantificó la concentración de cotrimoxazol en la solución del contenedor, durante nueve días consecutivos. Los resultados se compararon mediante ANOVA de dos vías. Resultados: El SMX se precipitó dentro del ET. Las concentraciones de TMX en la solución del contenedor fueron diferentes en función del tiempo y el porcentaje de expansión. No hubo correlación entre el porcentaje de expansión y la presión dentro del ET. Conclusiones: La sinergia de cotrimoxazol de uso endovenoso disponible en nuestro país, no es una buena opción a emplearse en un ET a las dosis utilizadas, ya que el coeficiente de solubilidad de SMX se saturó y se formaron cristales. El incremento de difusión de TMX estuvo asociado con un mayor porcentaje de expansión, lo que es una ventaja, considerando que las infecciones son más frecuentes al final del proceso de expansión.

Introduction: Infection associated with tissue expansion is one of the main complications and force to take away the tissue expander. An alternative to avoid this action is to dilute antibiotics inside it. The aim of this experiment was to quantify the concentration of cotrimoxazole diffused through a tissue expander at different expansion and pressure volumes. Material and methods: A test was performed with 12 tissue expanders immersed in a closed system. These were divided in 4 sets according to the introduced expansion rate. Three independent variables were considered: percentage of lumen volume introduced into the expander, pressure inside the expander, and experiment duration. The concentration of the drug diffused through the expander was taken as dependent variable. The solution in which the expander was immersed was continuously sampled and drug concentration was determined by High Performance Liquid Chromatography (HPLC). ANOVA was used to determine differences between concentrations measured of every variable applied. Results: Only trimethoprim (TMX) diffused. No lineal correlation was observed between expansion rate and pressure inside the expander. The difference with respect to time and concentration of the drug outside the expander was statistically significant among the 4 sets of expanders (p = 0.0000). Conclusion: Sulfametoxazole (SMX) did not diffuse and crystallized inside the expander because of the different pk of the two drugs (SMX-TMX) respect to pH of dilution which was similar to pK of trimethoprim. The expansion rate had a proportional effect on TMX concentration outside the expander: an over-expansion of the system greater than 200% increases diffusion highly.

Comunicación de un caso de malformación arteriovenosa pulmonar en la adolescencia / Arteriovenous malformation of the lung in a fourteen year old girl

Las malformaciones arteriovenosas pulmonares (MA VP) son comunicaciones anormales entre las arterias y las venas pulmonares. Las MAVP, están caracterizadas por cortocircuitos de derecha a izquierda de grado variable y el efecto de estas comunicaciones depende del tamaño de los vasos involucrados. Puede presentarse hipoxemia, hipocratismo digital y poliglobulia secundario al cortocircuito intrapulmonar. Presentamos el caso de un paciente femenino de 14 años de edad con MA VP pulmonar, cuyos hallazgos a la exploración física fueron hipocratismo digital y cianosis.

Pulmonary arteriovenous malformations (PVAM) are abnormal communications between pulmonary arteries and pulmonary veins, which are more commonly congenital in nature. Pulmonary arteriovenous fistulae are characterized by right-to-left shunts of variable magnitude; the effect of these communications depends on the size of the vessels involved. Arterial oxygen desaturation, cyanosis, clubbing of the fingers, and polycythemia may occur, secondary to the intrapulmonary shunt. We report the case of a 14-year-old female patient with PA VM; the findings on physical examination were clubbing of her fingers and cyanosis.