Possible effects of different types of agricultural wastes on food security and mushroom (Pleurotus ostreatus) production.

One of the new waters, and environmentally friendly agriculture initiatives in Peru is to encourage the utilization of agricultural waste, because low agricultural output is a threat to food security there. The purpose of this research was to evaluate the effect of harvest residues on the basidiocarp production of the fungus Pleurotus Ostreatus, in Acobamba-Huancavelica. The trial had a completely randomized design, and the treatments included T1, barley stubbles; T2, wheat stubbles; T3, pea stubbles; T4, broad bean stubbles; and T5, quinoa stubbles. The research was quantitative in nature, taking the form of an experiment with an applied, explanatory level of design. The recorded data was tabulated and analyzed with analysis of variance, as well as Tukey's test (α:0.05), for which the statistical software Infostat was used. The results are presented in tables and graphs for a better interpretation. As main results, it was obtained that the time (colonization), diameter (stem, pileus), length (stem) and weight (basidiocarps), present statistical differences between treatments showing significant enhancement in all parameters. Despite a numerical difference, a Tukey average comparison test revealed that there was no statistically significant difference between the averages for the variable time for fungus colonisation, suggesting that the treatment T5 in which quinoa substrate showed the greatest average. Treatment T4 in which broad bean stubbles were used gave the most low-average. In conclusion, increment in all parámeters were noted in all treatment of Pleurotus basidiocarps ostreatus under Acobamba conditions.

Dog bites as a zoonotic risk in Ecuador: Need for the implementation of a One Health approach.

Rabies is a viral zoonotic disease that can infect all mammals and the main route of transmission to human is attributed to dog bites. Due to the limited information available about the rabies vaccination coverage, although Ecuador is supposed to be free of rabies, we conducted a retrospective study of the epidemiological surveillance records on the notification of dog attacks to humans in Guayaquil, the most populated city in Ecuador. The results showed an annual incidence rate of 105.6 dog bites per 100,000 inhabitants, where the most affected anatomical parts are the lower extremities; individuals from 1 to 14 years of age were the most affected age group (IC95% 1.42-1.92; p < 0.001). As for the severity of the wounds, most of them (65%) were mild. Moreover, 25% of the dogs were free roaming ones, and only 43% of the dogs with owner had a complete vaccination scheme against rabies virus. We found a important dog attack rate in Guayaquil city and more than half of the dogs involved were not vaccinated against rabies. Under a potential scenario of rabies circulation in canine population, there would be a serious risk for rabies transmission to humans. Hence, it is important to reinforce rabies surveillance and vaccination programs aligned to the One Health concept to manage this public health issue.

Characterization and comparison of commercial oils used for human embryo culture.

STUDY QUESTION: Are there significant differences between the available commercial oil brands used for human IVF? SUMMARY ANSWER: Important differences have been detected among the tested oil brands in their potential to stabilize culture conditions and, more importantly, in their direct effect on embryo development and viability. WHAT IS KNOWN ALREADY: Mineral oil is a critical component of the human culture system due to its protective and stabilizing roles during in vitro embryo development. Many different oils are available on the market, with differences in their viscosity, density and overall quality. STUDY DESIGN, SIZE, DURATION: Thirteen different commercial oil brands were compared. PARTICIPANTS/MATERIALS, SETTING, METHODS: Each oil was firstly analyzed to assess its viscosity, density, peroxide value and potential oxidation. Secondly, the capacity of each oil to reduce pH, osmolality and temperature fluctuations during embryo culture and manipulation was compared. Lastly, a sensitive mouse embryo assay (MEA) protocol, previously optimized to detect toxicity in oils samples, was used to compare the overall quality of the different brands in terms of embryo developmental rates up to the blastocyst stage. At the end of the MEAs, a triple labeling protocol was applied to analyze Oct4+ cells, apoptotic cells and total cell counts in the blastocysts obtained by fluorescence microscopy. MAIN RESULTS AND THE ROLE OF CHANCE: Significant divergences were detected in the rise of osmolality and the equilibration and stability of pH between different oils, which could be correlated to their physico-chemical characteristics. In particular, oil samples with a higher viscosity tended to offer an additional protection against fluctuations in the culture conditions, however, the differences in temperature stability between oils were minor. Two out of the 13 oil samples, which were commercially available, were identified as embryo-toxic by applying the MEA protocol with increased sensitivity for toxicity detection. Additionally, substantial differences in the total number of cells and the number of cells in the inner cell mass of the obtained blastocysts were also detected between oil groups. LIMITATIONS, REASONS FOR CAUTION: A single lot of oil was used for each brand and, thus, lot-to-lot variations in oil quality could not be determined. However, several bottles from the same oil were included to account for potential intra-lot variability. WIDER IMPLICATIONS OF THE FINDINGS: Commercial oils differ in both their physical characteristics and their performance in maintaining the stability of the culture conditions during in vitro embryo culture. Oil selection is important for embryo culture success. Additionally, the detection of embryo-toxic oils which had already been released to the human IVF market showcases the importance of applying sensitive MEA protocols for a better detection of toxicity in this type of samples. STUDY FUNDING/COMPETING INTEREST(S): This study was privately funded. TRIAL REGISTRATION NUMBER: N/A.

The addition of flexible endoscopic suturing to stenting for the management of transmural esophageal wall defects: a single tertiary center experience.

BACKGROUND AND AIMS: Endoscopic stenting is the standard of care for full thickness esophageal wall defects. The aim of this study is to evaluate outcomes of endoscopic closure of esophageal defects using stenting, with or without endoscopic suturing. METHODS: This is a single-center retrospective study of patients with esophageal wall defects who underwent endoscopic interventions. Outcomes of stenting with or without endoscopic suturing of the defect were assessed. Univariate and multivariate logistic regression models were used to examine factors associated with successful defect closure. RESULTS: One hundred and fourteen patients with esophageal wall defects underwent 254 endoscopies with an overall complete closure rate of 75.8%. Twenty-three (20.2%) patients underwent primary closure using endoscopic suturing and subsequent esophageal stenting, while 91 (79.8%) underwent esophageal stenting only. The dual modality group (versus the stent-only group) had similar defect closure rates (84.2 vs. 73.8%, p = 0.55) and time to stent migration (37 vs. 12.5 days, p = 0.07), but was associated with longer procedure times (60 vs. 36 min, p < 0.01) and fewer additional endoscopic procedures (13.6 vs. 43.2%, p = 0.01). Stent suturing significantly decreased migration (35.5 vs. 58.5%, p = 0.04), was associated with fewer additional endoscopies (15.4 vs. 50%, p < 0.01) and reduced need for additional stents (7.7 vs. 34.3%, p < 0.01). On multivariate analysis, chronic defects (> four weeks old) were 81% less likely to close compared to acute (≤ 4 weeks) defects (OR 0.19, CI 0.04-0.77, p = 0.02), and large diameter stents (23 mm) were associated with higher odds of defect closure (OR 3.36, CI 1.02-11.4, p = 0.04). CONCLUSION: Endoscopic treatment of esophageal wall defects is safe, effective, and more likely to be successful in acute defects using larger caliber stents. Stent suturing reduces migration, need for additional endoscopic procedures, and stent exchanges. Further comparative studies with larger cohorts are needed to validate our results.

Factors of the human embryo culture system that may affect media evaporation and osmolality.

STUDY QUESTION: Which lab-related factors impact the culture system's capacity to maintain a stable osmolality during human embryo culture? SUMMARY ANSWER: Incubator humidity, the volume of mineral oil, the type of culture media and the design of time-lapse dishes have been identified as important parameters that can cause an impact on media evaporation and consequently osmolality during culture. WHAT IS KNOWN ALREADY: Culture medium is a critical component in human embryo culture. Minimizing its evaporation during culture is an adequate strategy to stabilize osmolality and, as a result, improving culture conditions and clinical outcomes. STUDY DESIGN, SIZE, DURATION: The studied variables included media composition and supplementation; volume of mineral oil; incubator humidification; and the type of dish and incubator used. Additionally, six time-lapse dish models were compared in their ability to prevent evaporation. PARTICIPANTS/MATERIALS, SETTING, METHODS: Dishes were incubated in parallel to analyze osmolality during culture between groups: synthetic oviductal medium enriched with potassium versus human tubal fluid medium; protein versus no protein supplementation; dry versus humid atmosphere; high versus low volume of mineral oil. Additionally, media evaporation was compared between six models of time-lapse dishes with distinct designs, cultured in a joint incubator. Two of them were retested in their corresponding incubator to analyze the dish-incubator fit. Daily osmolality measurements were compared between groups. Linear regression was performed to analyze evaporation rates. MAIN RESULTS AND THE ROLE OF CHANCE: Protein supplementation did not significantly affect evaporation. Contrarily, humidity levels inside the incubators, the volume of mineral oil and the type of culture media, played an important role in osmolality stabilization. The design of time-lapse dishes and their recommended preparation protocol heavily influenced their evaporation rates, which were further altered by each incubator's characteristics. Media with initially high osmolalities had a bigger risk of reaching hypertonic levels during culture. LIMITATIONS, REASONS FOR CAUTION: While numerous, the studied variables are limited and therefore other factors could play a role in osmolality dynamics, as well. Incontrollable atmospheric factors could also result in some variation in the observed results between different centers and laboratories. WIDER IMPLICATIONS OF THE FINDINGS: Published literature has extensively described how hypertonic media may impair embryo development and negatively affect clinical outcomes; therefore, maintaining a stable osmolality during culture should be considered essential. This work is of interest both for embryologists when analyzing their culture system and methodologies, as well as manufacturers in charge of designing IVF consumables. STUDY FUNDING/COMPETING INTEREST(S): This study was privately funded. TRIAL REGISTRATION NUMBER: N/A.

Numerical Analysis of a Dental Zirconium Restoration and the Stresses That Occur in Dental Tissues.

When it is about restorative dental materials, aesthetics is traditionally preferred. This has led to the selection of materials very visually similar to the enamel, but unfortunately, their mechanical properties are not similar. This often translates into disadvantages than advantages. In the present work, a comparison is made of the stresses that occur during dental occlusion (dental bit) in a healthy dental organ and those that are generated in a dental organ with a dental zirconium restoration. Numerical simulation was carried out by means of the Finite Element Method, in computational biomodels, from Cone-Beam Tomography, to obtain the stresses generated during dental occlusion. It was found that the normal and von Mises stresses generated are substantially greater in the molar with restoration compared to those produced in the healthy molar. In addition, the normal function of the enamel and dentin to disperse these stresses to prevent them from reaching the pulp is altered. Therefore, it is necessary to analyze the indiscriminate use of this restoration material and consider other aspects, in addition to aesthetics and biocompatibility for the choice of restorative materials such as biomechanical compatibility.

Acute seizure epidemiology in a neurological emergency department. / Epidemiologia del descontrol de la epilepsia en un servicio de urgencias neurologicas.

INTRODUCTION: Acute seizures in patients with epilepsy are a potential of source of neurological damage; their causes must be researched. AIM: To explore the epidemiology of acute seizure exacerbations in patients with epilepsy in a neurological emergency department in Mexico City. PATIENTS AND METHODS: Descriptive prospective study of patients with a previous diagnosis of epilepsy that receive medical care in an emergency department due to acute seizures. RESULTS: 100 patients were analyzed between august 2016 and January 2017. 86 patients presented with focal seizures, of which 76 were focal to bilateral tonic-clonic, 2 with impaired awareness and motor onset, 3 with impaired awareness and non-motor onset, 1 without impaired awareness and motor onset, and 4 without impaired awareness and non-motor onset. 14 patients had generalized seizures with motor onset. The causes of exacerbation were as follows: 26 patients due to antiepileptic dose omission, 21 due to a unknown cause, 19 due to infection, 13 due to sleep deprivation, 3 due to stress, 3 were catamenial, 2 due to alcohol abuse and 3 due to other reasons. Of the 26 patients with dose omission, 10 were due to forgetfulness, 7 refused to comply with their prescription, 6 could not afford to buy their prescription and 3 had their prescription changed by another doctor. CONCLUSIONS: In Mexico, antiepileptic drug dose omission represents up to 25% of patients with acute seizure exacerbations; increased patient education on epilepsy hygiene measures may be an area of opportunity for reducing its frequency.

TITLE: Epidemiologia del descontrol de la epilepsia en un servicio de urgencias neurologicas.Introduccion. El descontrol de la epilepsia representa un potencial daño neurologico, por lo que deben investigarse sus causas. Objetivo. Explorar la epidemiologia de pacientes mexicanos con descontrol agudo de epilepsia en un servicio de urgencias neurologicas. Pacientes y metodos. Analisis prospectivo descriptivo de pacientes con diagnostico previo de epilepsia que acuden a un servicio de urgencias por descontrol de las crisis. Resultados. Se analizo a 100 pacientes entre agosto de 2016 y enero de 2017. Ochenta y seis fueron crisis focales, de las cuales 76 fueron focales a bilaterales tonicoclonicas, dos fueron con alteracion de la consciencia de inicio motor y tres de inicio no motor, una sin alteracion de la consciencia de inicio motor y cuatro de inicio no motor. Catorce fueron generalizadas de inicio generalizado motor. Las causas de descontrol fueron: 26 pacientes por falta de adhesion al tratamiento antiepileptico, 21 de causa desconocida, 19 por infeccion, 13 por privacion de sueño, 10 por ajuste de tratamiento, tres por estres, tres por menstruacion, dos por uso de alcohol y tres por otras razones. En los 26 pacientes con falta de adhesion, 10 fueron por olvido de dosis, siete por negarse a tomar el medicamento, seis por causas economicas y tres por indicacion de medico ajeno a la institucion. Conclusiones. En Mexico, la falta de adhesion al tratamiento representa un 25% de los casos de descontrol de la epilepsia, lo que es un area de oportunidad para incrementar la educacion de higiene de crisis y disminuir la frecuencia de estas.

Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America

Purpose. Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. Methods. All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. Results. 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). Conclusions. ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM (AU)

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Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America.

PURPOSE: Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. METHODS: All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. RESULTS: 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). CONCLUSIONS: ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM.

Tubulogenesis of co-cultured human iPS-derived endothelial cells and human mesenchymal stem cells in fibrin and gelatin methacrylate gels.

Here, we investigate the tubulogenic potential of commercially-sourced iPS-ECs with and without supporting commercially-sourced hMSCs within 3D natural fibrin or semi-synthetic gelatin methacrylate (GelMA) hydrogels. We developed a selectable dual color third generation lentiviral reporter (hEF1α-H2B-mOrange2-IRES-EGFP PGK-Puro) to differentially label the nucleus and cytoplasm of iPS-ECs which allowed real-time tracking of key steps of vascular morphogenesis such as vacuole formation and coalescence to form shared multicellular lumens. We implement 3D quantification of the network character and validate that transduced and untransduced iPS-ECs can form tubules in fibrin with or without supporting hMSCs. In addition to natural fibrin gels, we also investigated tubulogenesis in GelMA, a semi-synthetic material that has received increased interest due to its ability to be photopatterned and 3D printed, and which may thus boost development of complex 3D models for regenerative medicine studies. We find that iPS-ECs alone have a muted tubulogenic response within GelMA, but that their tubulogenic response is enhanced when they are co-cultured with a small fraction of hMSCs (2% of total cells). Our work bolsters previous findings by validating established tubulogenic mechanisms with commercially available iPS-ECs, and we expect our findings will benefit biologic studies of vasculogenesis and will have applications in tissue engineering to pre-vascularize tissue constructs which are fabricated with advanced photopatterning and three-dimensional printing.

Oxidative stress and diabetic retinopathy: development and treatment.

Diabetic retinopathy (DR) is the most common microvascular complication in diabetic patients and one of the main causes of acquired blindness in the world. From the 90s until date, the incidence of this complication has increased. Reactive oxygen species (ROS) is a free radical with impaired electron that usually participates in the redox mechanisms of some body molecules such as enzymes, proteins, and so on. In normal biological conditions, ROS is maintained in equilibrium, however its overproduction can lead to biological process called oxidative stress and this is considered the main pathogenesis of DR. The retina is susceptible to ROS because of high-energy demands and exposure to light. When the balance is broken, ROS produces retinal cell injury by interacting with the cellular components. This article describes the possible role of oxidative stress in the development of DR and proposes some treatment options based on its stages. The review of the topic shows that blindness caused by DR can be avoided by early detection and timely treatment.

Changes in the membrane carbohydrates from sperm cryopreserved with dimethylsulfoxide or polyvinylpyrrolidone of red-tailed hawk (Buteo jamaicencis).

BACKGROUND: That cryopreservation can induce alterations in sperm. OBJECTIVE: The goal of this study was to evaluate sperm quality and distribution of N-acetylglucosamine, sialic acid and mannose residues in sperm cryopreserved of red-tailed hawk (Buteo jamaicensis). MATERIALS AND METHODS: We studied twenty samples of ejaculated semen for each cryoprotectant dimethylsulfoxide or polyvinylpyrrolidone. Carbohydrate identification was carried out with lectins Triticum vulgaris agglutinin to N-acetylglucosamine and sialic acid and Concanavalia ensiformis for mannose residues. Sperm viability was not altered but motility decreased significantly with both crioprotectants compared with fresh sperm. RESULTS: Neither the number of WGA positive sperm nor the distribution of N-acetylglucosamine and/or sialic acid residues were affected by the cryopreservation procedure. The sperm proportion with fluorescence associated with the presence of mannose residues was higher in thawed sperm. CONCLUSION: Values obtained with the cryopreservation technique proposed in this study by freezing drops in liquid nitrogen, were within normal parameters established for good quality fresh semen. We can say that it can be used for assisted reproduction of Buteo jamaicensis.

Angiomixoma agresivo: reporte de un caso y experiencia global con 168 casos / Aggressive angiomyxoma: Case report and global experience of 168 cases

Resumen ANTECEDENTES: el angiomixoma vulvar agresivo es una neoplasia poco frecuente, de origen mesenquimatoso, que suele afectar la región pélvica y perineal, con alto grado de infiltración y recurrencia local. El tratamiento de elección es la extirpación quirúrgica. CASO CLÍNICO: mujer de 39 años de edad, que inició con una tumoración vulvar derecha de 6 cm, de consistencia blanda, móvil, no dolorosa, sin ulceraciones, clasificada como quiste de la glándula de Bartholin; se efectuó resección quirúrgica de la lesión sin inconvenientes ni complicaciones. En el servicio de Cirugía Oncológica del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, se solicitó una tomografía axial computada que evidenció una tumoración heterogénea, hipodensa, vascularizada, con componente quístico que desplazaba el conducto vaginal, útero y vejiga, con infiltración de tejidos blandos y piel, de 15 x 10 x 28 cm en el labio mayor derecho. Con la biopsia incisional se estableció el diagnóstico de angiomixoma agresivo profundo. En diciembre de 2016 se extirpó el tumor vulvoperineal. El reporte patológico fue de tumoración de 30 x 25 x 7 cm, con receptores positivos para estrógenos y progesterona, e intensidad +++ en más de 80%. La paciente recibió tratamiento coadyuvante con tamoxifeno; actualmente se encuentra asintomática y en vigilancia. CONCLUSIONES: la prescripción de agentes antiestrogénicos disminuye el tamaño tumoral. Este tratamiento supone abordajes quirúrgicos menos agresivos. Por la recurrencia del angiomixoma agresivo se sugiere la vigilancia a largo plazo e implementar un esquema de mantenimiento con fármacos antiestrogénicos.

Abstract BACKGROUND: Aggressive angiomyxoma of the vulva is a very rare mesenchymal neoplasm, which has a preference for the pelvic and perineal regions. It is defined to be aggressive because of its tendency to infiltrate and local recurrence. The treatment of choice is surgical excision. CLINICAL CASE: A 39-year-old female, who started with a 6 cm right vulvar tumor, soft, mobile, non-painful, without ulcerations, classified as a cyst of the Bartholin's gland; surgical resection of the lesion was performed without incidents or complications. In the Oncology Surgery service (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán), a computerized axial tomography was requested, wich evidenced a heterogeneous, hypodense, vascularized tumor with cystic component that displaced the vaginal canal, uterus and bladder, with infiltration in soft tissue and skin, of 15 x 10 x 28 cm on the right upper lip. The incisional biopsy established of deep aggressive angiomyxoma diagnosis. In December 2016 the vulvoperineal tumor was extirpated. The Department of Pathological Anatomy reported a tumor of 30 x 25 x 7 cm, with estrogen and progesterone positive receptors, and intensity +++ in more than 80%. The patient received adjuvant treatment with tamoxifen. Currently the patient is asymptomatic and under follow-up. CONCLUSIONS: The use of antiestrogenic agents has been shown to decrease tumor size. This protocol requires less aggressive surgical approaches. Given the tendency of these tumors to recur, it is necessary to provide long-term follow-up considering the treatment with antiestrogens as a maintenance therapy.

Riesgo nutricional e inseguridad alimentaria en una población infantil del municipio de Soacha / Nutritional risk and food insecurity in a young group in Soacha municipality / Risco nutricional e insegurança alimentar em uma população infantil do município de Soacha

Este es un estudio descriptivo transversal para analizar las características nutricionales de una población de niños menores de \r\ncinco años de un hogar comunitario del Municipio de Soacha. Se aplicaron encuestas descriptivas a una muestra de 74 niños y sus \r\nrespectivos cuidadores para conocer el imaginario colectivo acerca de los hábitos alimenticios y el acceso a la canasta básica de \r\nalimentos, y se analizaron los datos antropométricos de los niños.\r\nEn la evaluación antropométrica, se encontró desnutrición crónica en 30,2% de la muestra y riesgo de desnutrición aguda dada \r\npor una media a -1 desviación estándar (DE) en el indicador de perímetro braquial para la edad. También se evidenció una dife\r\n-\r\nrencia en el concepto de alimentación sana entre los niños y sus cuidadores, además de un bajo presupuesto destinado para la \r\ncanasta básica de alimentos saludables.

A descriptive transversal study of 74 children and their \r\ncaregivers was conducted to analyze nutritional characteristics. \r\nDescriptive surveys were given to the caregivers to determine \r\nthe collective eating habits and access to basic healthy meals, \r\nand anthropometric data from children was analyzed.\r\nAn appropriate weight/age ratio was found; however, chronic \r\nmalnutrition of 30.2% was seen in the data. It was also found \r\nthat the population is at risk of acute malnutrition by an average \r\nof -1 standard deviation. An alternative concept was identified \r\nfor healthy eating of children and their caregivers, as well as a \r\nlow budget for healthy basic food meals.

Este é um estudo descritivo transversal para analisar as carac\r\n-\r\nterísticas nutricionais de uma população de crianças menores \r\nde cinco anos de um lar comunitário do Município de Soacha. \r\nForam aplicadas perguntas descritivas a uma amostra de \r\n74 crianças e seus respectivos cuidadores para conhecer o \r\nimaginário coletivo sobre os hábitos alimentares e o acesso a \r\ncesta básica de alimentos, e foram analisados os dados antro\r\n-\r\npométricos das crianças.\r\nNa avaliação antropométrica, foi descoberta desnutrição \r\ncrônica em 30,2% da amostra e risco de desnutrição aguda \r\ndada por uma média de -1 desvio padrão (DP) no indicador \r\nde perímetro braquial para a idade. Também foi evidenciada \r\numa diferença no conceito de alimentação saudável entre as \r\ncrianças e seus cuidadores, além de um baixo orçamento desti\r\n-\r\nnado à cesta básica de alimentos saudáveis.

Body-QoL: un nuevo instrumento de evaluación de resultados desde la perspectiva del paciente en cirugía del contorno corporal estética y post bariátrica / Development and testing of an instrument to assess body shape related quality of life

Background: The assessment of patient satisfaction and quality of life after body remodeling surgery is important. Aim: To develop and assess a self-report instrument to evaluate the results of bariatric and body remodeling surgery. Material and Methods: A three phase methodology was used. In phase 1, literature was reviewed and in depth interviews to patients were carried out, creating a preliminary instrument that was applied to 1,340 patients in phase 2. In phase 3, the final assessment of the instrument was performed, applying it to 34 patients. The psychometric properties of the in instrument were evaluated. Results: The instrument has four domains (satisfaction with abdomen, sexual life, self-esteem and social life and psychological symptoms) and 20 items. Its score ranges from 20 (worst) to 100 (better). Response rate was 100 percent, internal reliability was 93 percent and test-re test concordance was 98 percent. Body shape related quality of life was significantly higher in men than in women. It decreases with age and with increasing body mass index. Patients subjected to bariatric surgery had lower scores than patients subjected to esthetic surgery. In the postoperative period, the score improved by 21.9 +/- 16.9 points...

Objetivo: La evaluación de resultados cualitativos demanda la utilización de instrumentos sistemáticos y reproducibles. No existe actualmente un instrumento para evaluación de resultados en cirugía de contorno corporal. nuestro objetivo fue desarrollar un nuevo instrumento de autoreporte de resultados desde la perspectiva del paciente (PROM) para medir calidad de vida (CdV) asociada a satisfacción corporal. Materiales y Métodos: Se siguió un diseño fase 3 estándar para la creación de un instrumento de autoreporte de resultados por el paciente; en la fase 1 se utilizó un diseño cualitativo en 45 pacientes para desarrollar un marco conceptual y crear los dominios e ítems de la escala preliminar. En la fase 2, se condujo una evaluación de la población a gran escala en 1.340 pacientes a fin de reducir los ítems y dominios. En la fase 3, se realizó una evaluación final del instrumento desarrollado en 34 pacientes. La evaluación estadística incluyó análisis de factores, RASCH y regresión multivariada. Las propiedades psicométricas medidas fueron la confiabilidad interna de la escala, correlaciones item-test, item-retest y correlación test-retest. Resultados: El instrumento desarrollado consta de 4 dominios (Satisfacción con el abdomen, vida sexual, autoestima-vida social y síntomas psicológicos) y 20 ítems en total. El puntaje puede variar entre 20 (peor) y 100 (mejor). La tasa de respuesta fue 100%, confiabilidad interna 93,3%, concordancia test-retest 97,7%. La calidad de vida (CdV) asociada a imagen corporal fue superior en hombres que en mujeres (p < 0,001) y disminuye con la edad (p = 0,004) e incremento del IMC (p < 0,001). Los pacientes de cirugía de contorno corporal post bariátrica, puntuaron menos que los pacientes de estética en todos los dominios del instrumento Body-QoL (p < 0,001). En el postoperatorio el puntaje mejoró un promedio de 21,9 ± 16,9 (tamaño efecto 1,8, p < 0,001)...

Prevalence of BRCA1 and BRCA2 mutations in unselected breast cancer patients from Peru.

The prevalence of BRCA1 and BRCA2 mutations among breast cancer patients in Peru has not yet been explored. We enrolled 266 women with breast cancer from a National cancer hospital in Lima, Peru, unselected for age or family history. DNA was screened with a panel of 114 recurrent Hispanic BRCA mutations (HISPANEL). Among the 266 cases, 13 deleterious mutations were identified (11 in BRCA1 and 2 in BRCA2), representing 5% of the total. The average age of breast cancer in the mutation-positive cases was 44 years. BRCA1 185delAG represented 7 of 11 mutations in BRCA1. Other mutations detected in BRCA1 included: two 2080delA, one 943ins10, and one 3878delTA. The BRCA2 3036del4 mutation was seen in two patients. Given the relatively low cost of the HISPANEL test, one should consider offering this test to all Peruvian women with breast or ovarian cancer.

Diferencias en calidad de vida asociado a la apariencia nasal en pacientes operados de rinoplastia comparado con grupo control: validez del instrumento rhinoplasty outcome evaluation / Evaluation of the rhinoplasty outcome evaluation among chilean participants

Background: The Rhinoplasty Outcome Evaluation (ROE) is an instrument to assess the cosmetic and functional aspects of the nose from the patient's perspective. Its construct validity in Chilean subjects has been published previously. Aim: To compare the ROE scores in different groups of participants. Material and Methods: The questionnaire was applied to patients waiting for a rhinoplasty, patients hospitalized for other causes and medical students. Results: The overall reliability of the scale was 84.8 percent. Significant differences between groups in the total scores of four out of six items were observed. Conclusions: The Spanish version of the ROE is adequate to evaluate the satisfaction with nasal appearance and function among Chilean individuals.

Objetivo: El Rhinoplasty Outcome Evaluation (ROE) es un instrumento específico para la evaluación cosmética y funcional de la nariz desde la perspectiva del paciente, desarrollado originalmente en inglés. El objetivo del presente estudio es comparar las distribuciones en distintas poblaciones. Material y Método: El instrumento validado en español chileno ROE fue sometido a prueba para evaluar su validez de criterio comparando los resultados de la escala en pacientes programados que deseaban someterse a rinoplastía versus 2 grupos control: 1) Pacientes hospitalizados por otras causas y 2) Estudiantes de medicina. La validez de constructo ya ha sido publicada por los creadores de la escala. Para la comparación de variables se utilizaron las pruebas t de Student, ANOVA, Wilcoxon, Kruskall Wallis, prueba exacta de Fisher o χ² según correspondiera. Para todas las pruebas se utilizó un nivel alfa de 5 por ciento. Resultados: Se aplicó la encuesta a 45 pacientes. La edad promedio de la muestra fue de 35,4 años. La confiabilidad de la escala fue de 84,78 por ciento. Se observaron diferencias estadísticamente significativas en el puntaje total (p = 0,0047) en 4 de los 6 ítems. Conclusión: Los resultados preliminares de nuestro estudio sugieren que la versión en Español del Rhinoplasty Outcomes Evaluation es útil para evaluar la satisfacción con la apariencia nasal en chilenos.

Angio TC en la identificación preoperatoria de vasos perforantes / CT angiography in preoperative identification of perforator vessels

Introducción: Los colgajos de perforantes se han convertido en una opción de cobertura válida cada vez más utilizada en cirugía reconstructiva. Se caracterizan porque requieren de la identificación preoperatoria y disección intraoperatoria del vaso perforante. El objetivo del presente trabajo fue evaluar el Angio TC en el estudio preoperatorio de los vasos perforantes y su correlación con los hallazgos intraoperatorios. Material y Métodos: Análisis retrospectivo de todos los colgajos de perforantes realizados en la Unidad de Cirugía Plástica del Hospital Clínico de la Universidad de Chile entre junio de 2009 y junio de 2012. A todos los pacientes se les solicitó un Angio TC según el protocolo de la Universidad de Gent (Bélgica). Se utilizaron puntos de referencias específicos y un sistema de coordenadas para localizar el punto en el cual la perforante cruza la fascia superficial. La información entregada por el Angio TC se comparó con los hallazgos quirúrgicos. Resultados: A un total de 41 pacientes se les realizó Angio TC para la planificación de un colgajo de perforante durante el período en estudio, 40 fueron operados: 18 mujeres y 22 hombres, edad promedio de 46,6 +/- 5,7 años. Se realizaron los siguientes colgajos: Anterolateral de Muslo (ALT) = 14, Epigástrica Inferior (DIEP) = 18, Glútea Superior (SGAP) = 5, Tibial Posterior (PTAP) = 4 y Toracodorsal (TDAP) = 2. En todos ellos el Angio TC ubicó una o varias perforantes en forma precisa y 100 por ciento concordante con los hallazgos intraoperatorios. Conclusiones: El Angio TC es un examen con alto rendimiento en la identificación preoperatoria del vaso perforante y su trayecto. Es una herramienta de gran ayuda al momento de planificar la realización de este tipo de colgajos.

Introduction: Perforator flaps have become a coverage option validated and increasingly used in reconstructive surgery. These flaps require preoperative identification and intraoperative dissection of the perforator vessels. The aim of this study was to evaluate the use of Angio CT in the preoperative assessment of perforating vessels and its correlation with intraoperative findings. Material and Methods: We retrospectively reviewed all perforator flaps performed at the Division of Plastic Surgery, University of Chile Clinical Hospital between June 2009 and June 2012. All patients were asked for an Angio CT according to the protocol of the University of Gent (Belgium). Data points were used and a specific coordinate system to locate the point at which the perforator vessel fenestrate the deep fascia. The information provided in the Angio CT was compared with surgical findings. Results: A total of 41 patients underwent perforator flap planning during the study period. 40 underwent surgery: 18 women and 22 men, with a mean age of 46.6 ± 5.7 years. Flaps were performed as follows: anterolateral thigh (ALT) = 14, inferior epigastric (DIEP) = 18, superior gluteal (SGAP) = 5, posterior tibial (PTAP) = 4 and thoracodorsal (TDAP) = 2. In all cases the Angio CT identified one or more perforator vessel with a 100% concordance with intraoperative findings. Conclusions: CT Angio is a test with high performance in preoperative characterization of perforator vessels. It is a helpful tool that must be considered whenever planning this type of flaps.

Influencia de la apariencia de las mamas en la calidad de vida: diferencias entre población preoperatoria de mamoplastía de reducción y población control / Criterion validity of a questionnaire to assess quality of life associated to the appearance of breasts in women

Objetivo: El Breast Q Reduction and Mastopexy Module es un instrumento específico para la evaluación de calidad de vida asociado a mamas desde la perspectiva del paciente, recientemente validado para uso en español en Chile. Cuenta con evaluación pre y postoperatoria. El objetivo del presente estudio es conocer la validez de criterio al comparar las distribuciones en distintas poblaciones de individuos así como la diferencia del puntaje entre el pre y postoperatorio. Materiales y Métodos: El instrumento validado en español Breast Q Reduction-Mastopexy Module fue sometido a prueba para evaluar su validez de criterio comparando los resultados de la escala en pacientes que deseaban someterse a cirugía versus 2 grupos control, uno de pacientes hospitalizados por otra causa y otro de estudiantes de medicina. Resultados: Se aplicó la encuesta a 46 mujeres, 6 pacientes preoperatorios de mamoplastía de reducción, 20 alumnas de medicina y 20 pacientes hospitalizadas por otra causa. Hubo diferencias estadísticamente significativas entre las pacientes y los grupos control en los dominios autoimagen corporal (p = 0,0001), desempeño social (p = 0,0035) y síntomas físicos (p = 0,0058), no se observaron diferencias en el dominio de sexualidad (p = 0,1432), sin embargo, sólo 4/6 pacientes contestaron la encuesta ya que las otras 2 declararon no tener vida sexual. Conclusiones: Estos resultados preliminares sugieren que la versión en español del Breast Q Reduction-Mastopexy Module es un instrumento útil para evaluar calidad de vida asociada a las mamas en mujeres chilenas.

Background: The Breast QoL Reduction and Mastopexy Module assesses quality of life associated to breast appearance from the point of view of the patient. Its Spanish version was recently validated in Chile. Aim: To assess the criterion validity of the instrument applying it in different populations of women and in the pre and post-operative periods. Material and Methods: The questionnaire was applied to six women subjected to reduction mammoplasty in the pre and post-operative period. It was also applied to 20 women hospitalized for other causes and 20 female medical students. Results: There were significant differences between operated women and their non-operated counterparts in the domains body self-image, social performance and physical symptoms. No differences in sexuality were found. However this last question was answered only by four operated patients, since two declared not to have sex life. Conclusions: The questionnaire is useful to assess quality of life associated to the appearance of breasts.

Medición de los resultados estéticos y funcionales desde la perspectiva del paciente en rinoplastía: creación del instrumento nose-qol / Development of a new patient-reported outcome measure for rhinoplasty suergery: the Nose-QoL

Background: Instruments that assess the results of plastic surgery from patient's perspective allow a multidimensional evaluation of surgical results. Aim: To develop a new instrument to assess the functional and esthetic results of rhinoplasty from the point of view of the patient. Material and Methods: A conceptual framework about important results for nasal image was developed using information from in depth interviews to patients, focal groups with experts and interviews to esthetic surgeons and patients subjected to rhinoplasty. Results: Four patients and four plastic surgeons were interviewed. The three sub scales identified for the conceptual framework were quality of life, postoperative disability and pain and surgeon's objective evaluation scale. Five domains for quality of life were identified including nose size and form, self-image and esteem, third party perceptions and social relationships, nasal function and segmental nasal analysis. Conclusions: After completion of the psychometric assessment, the Nose-QoL instrument will become a valuable instrument to measure the impact and effectiveness of rhinoplasty from the patient's perspective.

Objetivo: Desarrollar un nuevo instrumento de resultados estéticos y funcionales desde la perspectiva del paciente, diseñado para medir la satisfacción de éstos en relación a rinoplastía. Métodos: Revisión de la literatura, entrevistas en profundidad a pacientes, grupos focales de discusión de expertos, a cirujanos plásticos y pacientes sometidos a rinoplastías, con lo que se desarrolló un marco conceptual en relación a los resultados considerados importantes para la imagen nasal. Resultados: Se entrevistó a cuatro pacientes y cuatro cirujanos plásticos. Las tres Subescalas identificadas para el marco conceptual incluyen: la Calidad de Vida (CdV), la Escala de Discapacidad y Dolor Post-operatorio (EDDP) y Escala de Evaluación Objetiva del Cirujano (EEOC). Se identificaron 5 dominios para la subescala CdV, que incluyen: tamaño y forma de la nariz, autoimagen y autoestima, percepción de terceros y relaciones sociales, función nasal y análisis nasal segmentario. Conclusiones: Una vez completada la evaluación psicométrica, el instrumento Nose-QoL y subescalas, proporcionará una herramienta confiable para cirujanos plásticos, investigadores y pacientes para medir el impacto y la eficacia de las rinoplastías, desde la perspectiva del paciente. Nivel de Evidencia: 1 -Estudio cualitativo, generación de instrumentos de medición de resultado desde la perspectiva del paciente.