Bayesian inverse problem for a fractional diffusion model of cell migration.

In the present work, both direct and inverse problems are considered for a Fisher-type fractional diffusion equation, which is proposed to describe the phenomenon of cell migration. For the direct problem, a solution is given via the Fourier method and the Laplace transform. On the other hand, we solved the inverse problem from a Bayesian statistical framework using a set of data that are the result of a cell migration experiment on a wound closure assay. We estimated the parameters of the mathematical model via Markov Chain Monte Carlo methods.

Biodegradable Biocomposite of Starch Films Cross-Linked with Polyethylene Glycol Diglycidyl Ether and Reinforced by Microfibrillated Cellulose.

Biopolymers are biodegradable and renewable and can significantly reduce environmental impacts. For this reason, biocomposites based on a plasticized starch and cross-linker matrix and with a microfibrillated OCC cardboard cellulose reinforcement were developed. Biocomposites were prepared by suspension casting with varied amounts of microfibrillated cellulose: 0, 4, 8, and 12 wt%. Polyethylene glycol diglycidyl ether (PEGDE) was used as a cross-linking, water-soluble, and non-toxic agent. Microfibrillated cellulose (MFC) from OCC cardboard showed appropriate properties and potential for good performance as a reinforcement. In general, microfiber incorporation and matrix cross-linking increased crystallization, reduced water adsorption, and improved the physical and tensile properties of the plasticized starch. Biocomposites cross-linked with PEGDE and reinforced with 12 wt% MFC showed the best properties. The chemical and structural changes induced by the cross-linking of starch chains and MFC reinforcement were confirmed by FTIR, NMR, and XRD. Biodegradation higher than 80% was achieved for most biocomposites in 15 days of laboratory compost.

Factors of poor prognosis in newborns with a prenatal diagnosis of gastroschisis in Bogota, Colombia.

OBJECTIVES: To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. METHODS: A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. RESULTS: The study included 101 patients. Preterm newborns under 32 weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). CONCLUSIONS: Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Equivalence in Color-coded Duplex Sonography Parameters before Complex Microsurgery.

Background: Color-coded duplex sonography (CCDS) is a widely proposed noninvasive diagnostic tool in microsurgery. CCDS has been applied to lower extremity salvage cases to define appropriate blood flow velocity criteria for achieving arterial success in diabetic foot and complex microsurgery cases. This study aimed to compare the success ratio of free flaps when using CCDS versus cases where CCDS was not used. Methods: We included complex microsurgery cases from 2019 to 2021. These cases were subsequently categorized into two groups: group A consisted of cases where CCDS parameters were applied, whereas group B comprised cases where CCDS was not performed at all. Results: The study encompassed 14 cases (11 men and three women). The age range varied from 23 to 62 years, with an average age of 42. Using CCDS analysis and planning demonstrated improved outcomes in comparison with cases where CCDS was not performed, albeit without statistical significance (P = 0.064). Conclusions: The application of CCDS proves to be beneficial in the realm of microsurgery. Although not achieving statistical significance, our data imply that CCDS utilization holds promise for enhancing microsurgical procedures.

Creating Value in Non-Profit Sports Organizations: An Analysis of the DART Model and Its Performance Implications.

This study aims to analyze the impact of value creation and cocreation, as measured by the dialogue, access, risk assessment, and transparency (DART) model, on the performance of non-profit sports organizations (NPSOs). To assess this impact, the authors analyzed data collected from sports and administration managers of NPSOs, specifically Colombian amateur soccer clubs. The study used partial-least-squares structural-equation modeling (PLS-SEM) with constructs of the reflexive-formative type. The results indicate that value creation has a positive impact on the performance of NPSOs through the mediating effect of value cocreation. Despite the limitations of this study, including the limited research on the relationship between value creation and cocreation and NPSO performance in Colombia, the findings contribute to the understanding of the mediating effect of cocreation. The authors found that cocreation mainly affects the sport, customers/members, communication and image, finance, and organization dimensions of NPSOs in developing countries. This study draws attention to the potential benefits of cocreation for NPSOs and emphasizes the importance of creating value in this context. The study concludes that further studies on the constructs proposed in this research would help to understand the phenomenon of innovation and its impact on NPSOs. Overall, this study provides valuable insights for managers and policymakers in NPSOs-especially in developing countries-on the importance of value cocreation in improving their performance.

B cells as modulators of HPV+ oropharyngeal cancer in a preclinical model.

Among the different immune cells present within tumors, B cells also infiltrate human papillomavirus-positive (HPV+) oropharyngeal tumors. However, the role of B cells during programmed death-1 (PD-1) blockade in HPV+ oropharyngeal cancer needs to be better defined. By using the preclinical mouse model for HPV+ oropharyngeal cancer (named mEER), we characterized B cells within tumors and determined their functional role in vivo during PD-1 blockade. We determined that treatment naïve tongue-implanted tumors, which we have previously demonstrated to be sensitive to PD-1 blockade, contained high infiltration of CD8+ T cells and low infiltration of B cells whereas flank-implanted tumors, which are resistant to PD-1 blockade, contain a higher frequency of B cells compared to T cells. Moreover, B cell-deficient mice (µMt) and B cell-depleted mice showed a slower tumor growth rate compared to wild-type (WT) mice, and B cell deficiency increased CD8+ T cell infiltration in tumors. When we compared tongue tumor-bearing mice treated with anti-PD-1, we observed that tumors that responded to the therapy contained more T cells and B cells than the ones that did not respond. However, µMt mice treated with PD-1 blockade showed similar tumor growth rates to WT mice. Our data suggest that in untreated mice, B cells have a more pro-tumorigenic phenotype potentially affecting T cell infiltration in the tumors. In contrast, B cells are dispensable for PD-1 blockade efficacy. Mechanistic studies are needed to identify novel targets to promote the anti-tumorigenic function and/or suppress the immunosuppressive function of B cells in HPV+ oropharyngeal cancer.

Effect of probiotics on glucose levels and weight gain in mice exposed to low doses of malathion.

INTRODUCTION: Owing to its ability to reduce the toxicity of environmental pollutants that are risk factors for diabetes and obesity, the use of probiotic bacteria might aid the treatment of these diseases. OBJECTIVE: To determine the effects of chronic exposure to low-dose malathion on weight and glucose levels in mice, as well as to evaluate the protective role of a probiotic supplement. METHODS: Weight and serum glucose levels of four groups of mice (control, malathion-exposed [10 ppm], probiotics and malathion + probiotics) were determined every 10 days for 180 days. RESULTS: Malathion administration induced an increase in weight and glucose levels in the malathion group mice in comparison with the other groups. CONCLUSIONS: Consumption of food contaminated with malathion residues increases glucose levels and favors weight gain, while consumption of probiotics reduces the effects generated by residues in food.

INTRODUCCIÓN: Debido a su capacidad para reducir la toxicidad de contaminantes ambientales que constituyen factores de riesgo de diabetes y obesidad, el uso de bacterias probióticas podría ayudar al tratamiento de esas enfermedades. OBJETIVO: Determinar los efectos de la exposición crónica a malatión a dosis bajas sobre el peso y los niveles de glucosa de ratones, así como evaluar el papel protector de un suplemento probiótico. MÉTODOS: Cada 10 días se determinó el peso y la glucosa sérica de cuatro grupos de ratones (de control, expuestos a malatión (10 ppm), probióticos y malatión + probióticos) durante 180 días. RESULTADOS: La administración de malatión provocó un incremento del peso y los niveles de glucosa en los ratones del grupo con malatión comparados con los demás grupos. CONCLUSIONES: El consumo de alimentos contaminados con residuos de malatión aumenta los niveles de glucosa y favorece el incremento del peso; el consumo de probióticos disminuye los efectos generados por los residuos en los alimentos.

Efecto de los probióticos en los niveles de glucosa y el incremento de peso en ratones expuestos a dosis bajas de malatión / Effect of probiotics on glucose levels and weight gain in mice exposed to low doses of malathion

Resumen Introducción: Debido a su capacidad para reducir la toxicidad de contaminantes ambientales que constituyen factores de riesgo de diabetes y obesidad, el uso de bacterias probióticas podría ayudar al tratamiento de esas enfermedades. Objetivo: Determinar los efectos de la exposición crónica a malatión a dosis bajas sobre el peso y los niveles de glucosa de ratones, así como evaluar el papel protector de un suplemento probiótico. Métodos: Cada 10 días se determinó el peso y la glucosa sérica de cuatro grupos de ratones (de control, expuestos a malatión (10 ppm), probióticos y malatión + probióticos) durante 180 días. Resultados: La administración de malatión provocó un incremento del peso y los niveles de glucosa en los ratones del grupo con malatión comparados con los demás grupos. Conclusiones: El consumo de alimentos contaminados con residuos de malatión aumenta los niveles de glucosa y favorece el incremento del peso; el consumo de probióticos disminuye los efectos generados por los residuos en los alimentos.

Abstract Introduction: Owing to its ability to reduce the toxicity of environmental pollutants that are risk factors for diabetes and obesity, the use of probiotic bacteria might aid the treatment of these diseases. Objective: To determine the effects of chronic exposure to low-dose malathion on weight and glucose levels in mice, as well as to evaluate the protective role of a probiotic supplement. Methods: Weight and serum glucose levels of four groups of mice (control, malathion-exposed [10 ppm], probiotics and malathion + probiotics) were determined every 10 days for 180 days. Results: Malathion administration induced an increase in weight and glucose levels in the malathion group mice in comparison with the other groups. Conclusions: Consumption of food contaminated with malathion residues increases glucose levels and favors weight gain, while consumption of probiotics reduces the effects generated by residues in food.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Intususcepción intestinal en adultos. Un desafío para el cirujano general. Reporte de caso / Intestinal Intussusception in Adults. A Challenge for the General Surgeon: Case Report

Resumen La intususcepción intestinal es la invaginación de un segmento de intestino en el interior de otro segmento inmediato, asociado a una alteración en la pared intestinal, siendo en intestino delgado más común por patologías benignas y en intestino grueso por patologías malignas. Presentamos caso de paciente femenino de 30 años, con dolor abdominal de 1 semana de evolución y datos de oclusión intestinal, se somete a laparotomía de urgencia, donde se encuentra intususcepción intestinal en íleon terminal. La intususcepción intestinal generalmente se va a presentar como un cuadro de obstrucción intestinal. El tratamiento es la resección del segmento afectado.

Abstract The intestinal intussusception is the invagination of one segment of the bowel into an immediately adjacent segment, associated to an alteration into the wall, the small intestinal is the most associated a benign pathology and large intestinal by malignant pathologies. We present the case of a 30-year-old female patient, who came to the emergency room due to intense abdominal pain of 1 week of evolution and evidence of intestinal occlusion, who underwent emergency laparotomy, where intestinal intussusception was found in the terminal ileum. Generally, the clinical presentation like an intestinal obstruction. Treatment is resection of the affected segment.

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data.

Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299-7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

Intestinal obstruction secundary to gallstone ileus: case report.

Gallstone ileus is an intestinal obstruction that is secondary to the presence of gallstones in the small intestine. It is a rare complication of cholelithiasis, which represents 1-3% of the causes of intestinal obstruction. The diagnosis is difficult given that the symptoms are nonspecific with intermittent intestinal obstruction, Rigler's triad (pneumobilia, stone and abdominal distention) is pathognomonic. Among the diagnostic aids are abdominal radiography, ultrasound and abdominal tomography. Treatment should be individualized depending on the patient's conditions, with laparotomy with enterotomy being the treatment of choice.

El íleo biliar es una obstrucción intestinal secundaria a la presencia de cálculos biliares en el intestino delgado. Es una complicación rara de la colelitiasis y representa el 1-3% de las causas de obstrucción intestinal. El diagnóstico es difícil dado que la clínica es inespecífica, con un cuadro de oclusión intestinal intermitente; la tríada de Rigler (neumobilia, lito y distensión abdominal) es patognomónica. Dentro de los auxiliares diagnósticos se encuentran la radiografía de abdomen, el ultrasonido y la tomografía computarizada abdominal. El tratamiento debe individualizarse dependiendo de las condiciones del paciente, siendo de elección la laparotomía con enterotomía.

Valorization of Sugarcane Straw for the Development of Sustainable Biopolymer-Based Composites.

Sugarcane straw (SCS) is a common agro-industrial waste that is usually incinerated or discarded in fields after harvesting, increasing the importance of developing added-value applications for this residue. In this study, sustainable biocomposites were produced, and the effect of sugarcane straw as a filler/reinforcement of commercial biopolymers was evaluated. Biocomposites were prepared using polylactic acid (PLA), polyhydroxybutyrate (PHB), polyhydroxybutyrate-co-hydroxyvalerate (PHBV), or green polyethylene (Green-PE) with different fiber contents (20, 30, and 40 wt.%). Dry-blending followed by compression molding was used for the biocomposites preparation. The results showed that PLA, PHB, and PHBV biocomposites retained the same impact strength as the neat matrices, even with 40 wt.% of sugarcane straw. The flexural and tensile modulus of PLA, PHB, and PHBV biocomposites increased with 20% of SCS, whereas, in Green-PE biocomposites, these properties increased at all fiber contents. Since any compatibilizer was used, both the flexural and tensile strength decreased with the addition of SCS. However, even with the highest content of SCS, the tensile and flexural strength values were around 20 MPa, making these materials competitive for specific industrial applications.

Mechanical and Physicochemical Properties of 3D-Printed Agave Fibers/Poly(lactic) Acid Biocomposites.

In order to provide a second economic life to agave fibers, an important waste material from the production of tequila, filaments based on polylactic acid (PLA) were filled with agave fibers (0, 3, 5, 10 wt%), and further utilized to produce biocomposites by fused deposition modeling (FDM)-based 3D printing at two raster angles (-45°/45° and 0°/90°). Differential scanning calorimetry, water uptake, density variation, morphology, and composting of the biocomposites were studied. The mechanical properties of the biocomposites (tensile, flexural, and Charpy impact properties) were determined following ASTM international norms. The addition of agave fibers to the filaments increased the crystallinity value from 23.7 to 44.1%. However, the fibers generated porous structures with a higher content of open cells and lower apparent densities than neat PLA pieces. The printing angle had a low significant effect on flexural and tensile properties, but directly affected the morphology of the printed biocomposites, positively influenced the impact strength, and slightly improved the absorption values for biocomposites printed at -45°/45°. Overall, increasing the concentrations of agave fibers had a detrimental effect on the mechanical properties of the biocomposites. The disintegration of the biocomposites under simulated composting conditions was slowed 1.6-fold with the addition of agave fibers, compared to neat PLA.

Estado del arte de los estudios sobre conducta suicida en población privada de la libertad / State of the art of studies on suicidal behavior in the population deprived of freedom

Resumen El suicidio en población privada de la libertad (PPL) en centros de reclusión de la ciudad de Bogotá, por la comisión de diferentes delitos, trae consigo una serie de preguntas y cuestionamientos que generan inquietud, duda y en ocasiones temor. El objetivo del estudio fue establecer el estado del arte de los estudios realizados y las tendencias halladas sobre conducta suicida en esta población. En esta investigación se encontrarán los principales estudios, investigaciones y documentos tecnicos realizados por funcionarios y académicos, recopilados en trece documentos. Se pudo establecer que son pocos los documentos encontrados (13), pocas las investigaciones y en su mayoría de tipo descriptivo.

Abstract The suicide in the population deprived of freedom (PPL, for its initials in Spanish) in prisons in the city of Bogotá, for the commission of different crimes, brings with it a series of questions and issues that generate concern, doubt and sometimes fear. The purpose of the study was to establish the state of the art of studies carried out and trends found on suicidal behavior in this population. In this research we will find the main studies, research and technical documents made by officials and academics, compiled in thirteen documents. It could be established that there are few documents found (13), few investigations and most of them are descriptive.

Embarazo heterotópico espontáneo con resultado perinatal favorable, reporte de un caso y revisión de la literatura / Spontaneous Heterotopic Pregnancy with a Favorable Perinatal Outcome, Case Report, and Literature Review / Gestação heterotópica espontânea com resultado perinatal favorável: relato de caso e revisão da literatura

Resumen: el embarazo heterotópico (EH) es una gestación múltiple en la que un embrión se implanta dentro de la cavidad uterina, y otro en cualquier otra parte como un embarazo ectópico (EE). Espontáneo, tiene una incidencia de uno en 30.000 embarazos, y con técnicas de reproducción asistida (TRA) hasta uno en cien. Su diagnóstico temprano permite reducir la morbimortalidad y mejorar el pronóstico para el embarazo intrauterino. El objetivo del artículo es realizar una revisión de la literatura sobre EH y presentar un caso clínico. Se realizó una búsqueda en bases de datos Pubmed y Medline, utilizando combinaciones con operadores booleanos de los términos MESH: heterotopic pregnancy, ectopic pregnancy therapy risk factors y prognosis. Los límites de la búsqueda fueron: artículos en texto completo, idiomas español e inglés, publicados en los últimos diez años. Se obtuvieron 275 títulos; luego de eliminar los duplicados y la evaluación del resumen, se utilizaron veintisiete referencias. Se presenta un caso de una paciente gesta 2, antecedente de EE roto, con EH espontáneo y ruptura de gestación tubárica; se describe su manejo y resultado perinatal. El EH puede tener implantación tubárica (más frecuente) o en cualquier otra localización. El diagnóstico debe estar centrado en los factores de riesgo y los criterios de ultrasonido. El manejo puede ser expectante, médico o quirúrgico, teniendo con el primero el peor pronóstico materno, con el segundo, menores tasas de pérdida gestacional y mejores resultados maternos, y con el último mayores tasas de aborto. El diagnóstico del EH se realiza por ultrasonido transvaginal; de acuerdo con cada caso se orienta el tratamiento. El abordaje quirúrgico es la primera línea en la presentación aguda. El manejo expectante o la aspiración guiada por ultrasonido son opciones razonables en la paciente estable. Son necesarias más cohortes de pacientes para evaluar los resultados del manejo en nuestro medio.

Summary: heterotopic pregnancy (HP) involves multiple gestations in which one embryo is implanted within the uterine cavity and another elsewhere, such as an ectopic pregnancy (EP). A spontaneous pregnancy has an incidence of one in 30.000 pregnancies, and with assisted reproduction techniques (ART) up to one in a hundred. Its early diagnosis allowsto reduce morbidity and mortality and improve the prognosis for intrauterine pregnancy. The article aims to perform a review of the literature on HP and present a clinical case. A search was conducted on Pubmed and Medline databases, using combinations with Boolean operators of the terms MESH: heterotopic pregnancy, ectopic pregnancy, therapy risk factors and prognosis. The search limits were: full-text articles, Spanish and English languages, published in the last ten years. 275 titles were obtained; after eliminating duplicates and abstract evaluation, 27 references were used. We present a case of a pregnant patient 2, records of broken EP, with spontaneous HP and rupture of tubal gestation; their management and the perinatal results are described. The HP may have tubal implantation (more frequent) or in any other location. The diagnosis should focus on risk factors and ultrasound criteria; the management can be expectant, medical, or surgical, having with the first the worst maternal prognosis, with the second lower rates of gestational loss and better maternal outcomes, and with the latter higher abortion rates. The diagnosis of HP is performed by transvaginal ultrasound; according to each case, the treatment is oriented. The surgical approach is the first line in the acute presentation. Expectant management or ultrasound-guided aspiration are reasonable options in the stable patient. More cohorts of patients are needed to evaluate management outcomes in our environment.

Resumo: a gestação heterotópica (GH) é urna gravidez múltipla na qual um embrião é implantado dentro da cavidade uterina, e outro, em qualquer outro lugar como uma gestação ectópica (GE). Espontânea ocorre em urna de 30.000 gestações, e com técnicas de reprodução assistida, até urna em cem. Seu diagnóstico precoce permite reduzir a morbimortalidade e melhorar o prognóstico para a gestação intrauterina. O objetivo deste artigo é realizar uma revisão da literatura sobre GH e apresentar um caso clínico. Foi realizada urna busca em bases de dados PubMed e Medline, a partir de combinações com operadores booleanos dos termos MESH: heterotopic pregnancy ectopic pregnancy therapy risk factors e prognosis. Os limites da busca foram: artigos em texto completo, em espanhol e inglês, publicados nos últimos dez anos. Foram obtidos 275 títulos; após eliminar os duplicados e a avaliação do resumo, foram utilizadas 27 referencias. É apresentado um caso de urna paciente gesta 2, antecedente de GE rota, com GH espontánea e ruptura da gravidez tubária ectópica; são descritos seu tratamento e resultado perinatal. O GH pode ter implantação tubária (mais frequente) ou em qualquer outra localização. O diagnóstico deve estar centralizado nos fatores de risco e nos critérios de ultrassom. A gravidez pode ser expectante, médica ou cirúrgica, tendo com o primeiro o pior prognóstico materno, com o segundo, menores taxas de perda gestacional e melhores resultados maternos, e com o último maiores taxas de aborto. O diagnóstico do GH é realizado por ultrassom transvaginal; de acordo com cada caso, é orientado o tratamento. A abordagem cirúrgica é a primeira linha na apresentação aguda. O tratamento expectante ou a aspiração guiada por ultrassom são opções razoáveis na paciente estável. São necessárias mais coortes de pacientes para avaliar os resultados do tratamento em nosso contexto.

Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps.

BACKGROUND: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. METHODS: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. RESULTS: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. CONCLUSIONS: A better understanding of the fat layers' thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.

Traumatismo craneoencefálico leve en el departamento de urgencias de pediatría del Hospital de Clínicas de San Lorenzo: características clínico epidemiológicas y frecuencia

RESUMEN Introducción: El traumatismo craneoencefálico ocurre comúnmente en la infancia. La mayoría de los traumatismos craneales en niños son leves y no están asociados con lesiones cerebrales o secuelas a largo plazo. Sin embargo, un pequeño número de niños que parecen estar en bajo riesgo puede tener una lesión cerebral traumática clínicamente importante. Objetivo: determinar la frecuencia, características clínicas y epidemiológicas del traumatismo cráneo encefálico leve en el departamento de emergencias pediátricas del hospital de clínicas de San Lorenzo. Materiales y Métodos: estudio observacional, descriptivo, retrospectivo de corte transversal, se incluyeron pacientes menores a 18 años con diagnóstico de Traumatismo craneoencefálico leve que ingresan a sala de observación del Departamento de Urgencias del Hospital de Clínicas desde noviembre del 2017 hasta noviembre del 2019. Resultados: fueron ingresados 55 pacientes con diagnóstico de TCE leve, el 53% del sexo masculino, el 36% pertenecían a lactantes mayores, la mayoría procedían del área metropolitana. En cuanto al mecanismo de traumatismo el 62% fue por caída de propia altura con un promedio de 0,9 ± 0,91 m, el 20% presento pérdida del conocimiento. Todos los pacientes ingresaron al departamento de urgencias vigiles y con un Glasgow 15/15, en cuanto a los hallazgos radiológicos se constató fractura de cráneo en 5% Se realizo estudios de imagen en el 55% de los pacientes en donde más del 60% fueron normales. Conclusión: en pacientes con traumatismo craneoencefálico leve los médicos deben decidir si el paciente se realizará una tomografía en base al juicio clínico y a guías internacionalmente estandarizadas para tal efecto ya que las mismas exponen a radiaciones ionizantes que aumentan los riesgos a largo plazo de neoplasias letales. Esto permite que los niños con riesgo bajo a intermedio no sean expuestos innecesariamente a radiaciones.

ABSTRACT Introduction: Traumatic brain injury occurs commonly in childhood. Most head injuries in children are mild and are not associated with long-term brain injuries or sequelae. However, a small number of children who appear to be at low risk may have a clinically important TBI. Objective: to determine the frequency, clinical and epidemiological characteristics of mild head trauma in the pediatric emergency department of the San Lorenzo Clinical Hospital. Materials and Methods: this was an observational, descriptive, retrospective and cross-sectional study that included patients under 18 years of age with a diagnosis of mild head injury who were admitted to the observation room of the Emergency Department of the Clinical Hospital from November 2017 to November 2019. Results: 55 patients with a diagnosis of mild TBI were admitted, 53% male, 36% were older infants, the majority came from the metropolitan area. Regarding the trauma mechanism, 62% was due to a fall from their own height with an average of 0.9 ± 0.91 m, 20% presented loss of consciousness. All patients were admitted to the emergency department awake and with a Glasgow 15/15, regarding the radiological findings, a skull fracture was confirmed in 5%. Imaging studies were performed in 55% of the patients, more than 60% of these were normal. Conclusion: in patients with mild head injury, doctors must decide whether the patient will undergo a tomography based on clinical judgment and internationally standardized guidelines for this purpose, since they expose them to ionizing radiation that increases the long-term risks of lethal neoplasms. This allows low to intermediate risk children to not be unnecessarily exposed to radiation.