Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV.

Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.

Clinical and neurodevelopmental outcomes in premature infants exposed to intravenous fish- and soybean oil-based lipid emulsions.

BACKGROUND: The optimal composition of lipid emulsions in parenteral nutrition (PN) for premature infants remains controversial. This study examined the effects of a combination of soybean oil-based (SoyLE) and fish oil-based (FishLE) lipid emulsions compared to FishLE as monotherapy on the lipid and fatty acid profiles and clinical outcomes of premature infants requiring prolonged PN. METHODS: 42 premature infants received FishLE+SoyLE or FishLE. Serum concentrations of lipoproteins and 29 fatty acids (FA) were measured at baseline, 4, and 8 weeks of PN and growth and neurodevelopmental outcomes were measured at 3, 6, 12, 18, and 24 months of life. RESULTS: Lipid profiles were similar between groups. Plasma concentrations of ω-6 fatty acids tended to decrease over time in both groups. Concentrations of most ω-3 fatty acids, in particular docosapentaenoic acid, eicosapentaenoic acid, and docosahexaenoic acid, were significantly increased over time in the FishLE+SoyLE group whereas they did not change in the FishLE alone group. However, serum concentrations of almost all fatty acids were similar between groups at the end of the study period. No differences in growth parameters including weight, height, fronto-occipital circumference (FOC), and body mass index (BMI) were observed up to two years of age. Similarly, there were no differences in neurodevelopmental test scores at 6, 12, 18, and 24 months of age. CONCLUSIONS: No substantial differences in lipid profiles and short clinical outcomes were found in infants exposed to FishLE+SoyLE when compared to FishLE.

Anatomical variations in the relationship between the spinal accessory nerve and internal jugular vein: a systematic review and meta-analysis.

The relationship between the spinal accessory nerve and internal jugular vein is important for modified neck dissection surgery. Therefore, the aim of this review was to investigate variations in this relationship. Through a search of the PubMed, Scopus, Web of Science, LILACS, and SciELO databases, the review authors collected anatomical data for inclusion in a meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four relationship patterns were identified and classified: type 1, the nerve lies superficial to the vein; type 2, the nerve lies deep to the vein; type 3, the nerve crosses the branches of the vein; type 4, the nerve splits and its branches pass around the vein. The last pattern was not included in the meta-analysis. Eighteen studies were included (useful sample of 1491 hemi-necks). Type 1 variation had a prevalence of 79.7% (95% CI 77.6-81.7%), type 2 had a prevalence of 19.6% (95% CI 17.7-21.7%), and the type 3 had a prevalence of 0.7% (95% CI 0.0-1.4%). Significant differences were found among geographical subgroups. Normally, the spinal accessory nerve passes superficial to the internal jugular vein, but anatomical variations are common and there is a geographical influence. These findings are important for the safety of modified radical neck dissections.

Lymphadenectomy improves outcome in dogs with resected Kiupel high-grade cutaneous mast cell tumours and overtly metastatic regional lymph nodes.

INTRODUCTION: Historically, the prognosis for dogs with stage II Kiupel high-grade cutaneous mast cell tumours has been considered poor. OBJECTIVES: The aim of this study was to explore the impact of lymphadenectomy on outcome in dogs with Kiupel high-grade cutaneous mast cell tumours and overt regional lymph node metastasis. MATERIAL AND METHODS: Data from dogs with completely staged Kiupel high-grade cutaneous mast cell tumours with overt and/or certain regional lymph node metastasis undergoing excision of the primary tumours and adjuvant medical treatment were extracted. Dogs with a cytological diagnosis of regional lymph node metastasis that did not undergo lymphadenectomy were compared with dogs that underwent lymphadenectomy and had a histological diagnosis of overt lymph node metastasis. RESULTS: Forty-nine dogs were included, 18 did not undergo lymphadenectomy while 31 underwent lymphadenectomy. Median time to progression was significantly shorter in dogs that did not undergo lymphadenectomy (150 days, 95% confidence interval: 129 to 170) compared to the other dogs (229 days, 95% confidence interval: 191 to 266). Median survival time was also shorter in dogs that did not undergo lymphadenectomy (250 days, 95% confidence interval: 191 to 308) compared to dogs that underwent lymphadenectomy (371 days, 95% confidence interval: 311 to 430). On multivariable analysis, lack of lymphadenectomy was associated with higher risk of overall tumour progression (hazard ratio: 2.05, 95% confidence interval: 1.02 to 4.13), nodal progression (hazard ratio: 3.4, 95% confidence interval: 1.65 to 7.02) and tumour-related death (hazard ratio 3.63, 95% confidence interval: 1.72 to 7.66), whereas tumour size was associated with higher risk of local recurrence (hazard ratio: 3.61, 95% confidence interval: 1.06 to 13). CLINICAL SIGNIFICANCE: Regional lymphadenectomy may improve outcome in dogs with biologically aggressive cutaneous mast cell tumours.

MicroRNAs and their role in the malignant transformation of oral leukoplakia: a scoping review.

BACKGROUND: MiRNAs are small non-coding RNAs that regulate gene expression at the post-transcriptional level and have been associated with malignant transformation of oral epithelial precursor lesions such as oral leukoplakia. The aim was to perform a scoping review of the contemporary literature about the different roles of miRNAs during the malignant transformation of oral leukoplakia. MATERIAL AND METHODS: We conducted a systematic search with the following MeSH terms: 'oral leukoplakia', 'carcinoma in situ', 'microRNAs', 'mouth neoplasms' and 'epithelial-mesenchymal transition' in PubMed/MEDLINE, EMBASE and SpringerLink. RESULTS: Fifteen articles were included for analysis, among which in vivo and in vitro articles were included. A total of 21 different miRNAs were found to be involved in the malignant transformation process of oral leukoplakia. Regarding their possible effects, 6 miRNAs were classified as oncogenic, 5 as tumour suppressors and 10 were related to epithelial-mesenchymal transition, invasion and migration. CONCLUSIONS: Based on the current review, we concluded that miRNAs-21, 345, 181-b and 31* seem to be potential markers of malignant transformation of oral leukoplakia. However, further clinical prospective studies are needed in order to validate their utility as prognostic biomarkers.

Origin and main ramifications of coeliac artery in Cerdocyon thous.

BACKGROUND: Cerdocyon thous is the canid with the greatest geographical coverage in South America. The aim of this study was to describe the origin, skeletopy, length and main branches of the coeliac artery in C. thous. MATERIALS AND METHODS: The dissections were performed on 14 cadavers of adult specimens, 6 males and 8 females, with a rostrosacral length average of 67.00 ± 4.7 cm and 62.09 ± 5.7 cm, respectively. The specimens were collected dead on highways on the banks of the Atlantic Forest (Rio de Janeiro) and the Pampa biome (Rio Grande do Sul) in Brazil. The cadavers were fixed and preserved in a formaldehyde solution until dissection. The coeliac artery was dissected, the length was measured "in situ" and its main branches were recorded. The coeliac artery emerged as a single artery in all dissected animals. RESULTS: The average length of the coeliac artery was 1.43 ± 0.17 cm in males and 1.39 mm ± 0.24 cm in females, with no significant difference in this measurement between sexes. The predominant skeletopy was at the level of the second lumbar vertebra (57.1%), positioned on average 1.43 cm cranially to the cranial mesenteric artery. In most individuals (92.9%), the classic trifurcation was formed: the coeliac artery branched into the hepatic, left gastric, and lienal arteries. Only 1 male animal presented a bifurcation formed between the hepatic artery and a gastrolienal trunk. CONCLUSIONS: These anatomical characteristics are similar to those of other species of the Canidae family, possibly due to their phylogenetic proximity.

Índice de masa corporal y resultados hospitalarios en pacientes de 80 años con infarto de miocardio con elevación del segmento ST. Resultados de un país de bajos ingresos sin intervención coronaria

BackgroundIn most scenarios from low/middle income countries, pharmacological approach for ST elevation Myocardial Infarction is still use. In these setting and increase proportion of elderly patients is awaited. So it is also expected to have older patients with suboptimal treatment and risk stratification.ObjectiveTo investigate the impact of the body mass index (BMI) on in-hospital outcomes in a cohort of elderly (≥80 years) patients, from a center without coronary intervention.MethodsPatient's ≥80 years of age admitted to our institution between June 2014 and May 2019 with STEMI, were divided according BMI tertiles (BMI tertile 1: ≪22.36 kg/m2, BMI tertile2: 22.36–25.71 kg/m2, and BMI tertile 3: ≫25.71 kg/m2). The primary endpoint was all-cause in-hospital mortalityResultsOut of 118 patients, 41 (34.74 Percent) were women. Median age was 84.4 ± 3.5 years and median BMI 24.1 ± 3.7 kg/m2. Women had a higher BMI than men (24.4 ± 4.0 vs 24.0 ± 3.6; p: 0.535). All-cause mortality was 33.3 Percent, 2.5 Percent, and 15 Percent for lower, middle, and higher BMI tertiles (p=0.002). To belong to BMI tertile 1 was associated with an increased all-cause mortality (OR: 5.15, 95 Percent CI 1.84–14.28, p = 0.001); and in patients without administration of streptokinase (OR: 9.52, 95 Percent CI 2.34–38.45, p = 0.001).ConclusionThis study reports association between lower BMI values and increased mortality in elderly patients with and without pharmacological reperfusion with streptokinase.[AU]

índice de masa corporal y mortalidad intrahospitalaria en pacientes del Registro de Síndromes Coronarios Agudos (RESCuE)

En el Infarto Agudo de Miocardio (IAM), algunos estudios muestran mejor pronóstico del paciente obeso (paradoja de Obesidad). Objetivo: determinar la asociación existente entre Índice de Masa Corporal (IMC) y Mortalidad intrahospitalaria en serie de casos no consecutivos ingre-sados con IMA.Método: Se establecieron 4 grupos: Bajopeso (IMC <20 kg/m2), Normopeso (IMC: +20-25 kg/m2sc), Sobrepeso (IMC: +25-30 kg/m2sc), y Obeso (IMC: +30 kg/m2sc). Se dividieron en dos grupos diagnósticos: pacientes con Infarto Con Elevación de ST (IAMCEST) e IAM. Se estudiaron variables clínicas, complicaciones, estado hemodinámico al ingreso y egreso.Resultados: Con respecto a pacientes con IMC < 20 kg/m2sc, la asociación con mortalidad en pacientes con IAMCEST fue: en Normopesos 0.22 (IC: 0.05-0.86, p:0.001), Sobrepeso: 0.03 (IC: 0.02-0.23, p:0.001), Obesos 0.52 (IC: 0.11-2.4, p:0.41); en IAM: Normopesos 0.3 (0.1-1.18, p:0.007), Sobrepesos 0.05 (0.01-0.32, p:0.001), en Obesos 0.62 (0.14-2.6, p:0.52).[AU]

Enfermedad neumocócica invasiva por serotipo 38, reporte de caso clínico / Invasive pneumococcal disease by serotype 38, a clinical case report

La enfermedad neumocócica invasiva (ENI) es causa de morbimortalidad prevenible en pediatría. Con la introducción de vacunas antineumocócicas conjugadas disminuyó la prevalencia de ENI en 61,9% en los menores de 2 años, y se produjo un cambio en la distribución de serotipos y un aumento de ENI por serotipos no vaccinales. En este contexto, es relevante la vigilancia epidemiológica de los serotipos emergentes causantes de ENI en la población. Se presentará el caso de una lactante de 11 meses con diagnóstico de meningitis causada por neumococo serotipo 38, su evolución y consecuencias clínicas, y se realiza un análisis de la situación epidemiológica actual.

In pediatrics,invasive pneumococcal disease is a preventable cause ofmorbidity andmortality.The introduction of conjugated pneumococcal vaccines has reduced the prevalence of invasive pneumococcal disease by 61.9% in the under two's and has brought about a change in the distribution of serotypes and a rise in invasive pneumococcal disease caused by non-vaccine serotypes.This being the case,itis very importanttomonitorthe epidemiology ofthe emerging serotypes causing the disease in the population.We presentthe case of an 11 month old infant diagnosed with meningitis caused by serotype 38, describing his clinical course andclinical consequences; andweperforman analysis ofthepresent epidemiologica lsituation

Early replication dynamics of sex-linked mitochondrial DNAs in the doubly uniparental inheritance species Ruditapes philippinarum (Bivalvia Veneridae).

Mitochondrial homoplasmy, which is maintained by strictly maternal inheritance and a series of bottlenecks, is thought to be an adaptive condition for metazoans. Doubly uniparental inheritance (DUI) is a unique mode of mitochondrial transmission found in bivalve species, in which two distinct mitochondrial genome (mtDNA) lines are present, one inherited through eggs (F) and one through sperm (M). During development, the two lines segregate in a sex- and tissue-specific manner: females lose M during embryogenesis, whereas males actively segregate it in the germ line. These two pivotal events are still poorly characterized. Here we investigated mtDNA replication dynamics during embryogenesis and pre-adulthood of the venerid Ruditapes philippinarum using real-time quantitative PCR. We found that both mtDNAs do not detectably replicate during early embryogenesis, and that the M line might be lost from females around 24 h of age. A rise in mtDNA copy number was observed before the first reproductive season in both sexes, with the M mitochondrial genome replicating more than the F in males, and we associate these boosts to the early phase of gonad production. As evidence indicates that DUI relies on the same molecular machine of mitochondrial maternal inheritance that is common in most animals, our data are relevant not only to DUI but also to shed light on how differential segregations of mtDNA variants, in the same nuclear background, may be controlled during development.

Tratamiento quirúrgico de las hemorroides según técnica Milligan-Morgan comparando disección mediante diatermia versus sellado vascular / Surgical treatment of hemorrhoids according to Milligan-Morgan technique comparing diathermy dissection versus vascular sealing

Antecedentes: La prevalencia de patología hemorroidal está entre el 5-36 %, aunque solo en un 5-10 % se va a requerir cirugía. Objetivo: Comparar la hemorroidectomía según la técnica Milligan-Morgan mediante diatermia versus sellado vascular en pacientes con hemorroides grado III-IV, en cuanto a dolor y otras complicaciones postoperatorias. Material y métodos: Se realizan dos grupos, uno en que se lleva a cabo la disección del paquete hemorroidal con diatermia, y el otro con sellado vascular. En ambos, la cirugía es realizada con sedación profunda e infiltración plexo pudendo con ropivacaína, en régimen de Cirugía Mayor Ambulatoria. Al alta, se les entrega un protocolo con pauta analgésica y a las 24 horas se realiza una revisión telefónica. Al mes se revisan en consulta y rellenan un cuestionario con diferentes variables. Resultados: Entre el año 2007 y 2011 se han intervenido por patología hemorroidal un total de 1.010 pacientes en nuestra unidad, realizándose 362 hemorroidectomías mediante la técnica de Milligan-Morgan. El 52,8 % eran varones, edad media 48 años (17-82), 71,5 % disección mediante diatermia vs. 28,5 % sellado vascular. No hubo diferencias en cuanto a características de las hemorroides y patología anal acompañante, ni de dolor ni otras complicaciones. Sí se encontró significación estadística en una más rápida recuperación por parte del grupo de sellado vascular. Conclusiones: Ambas técnicas obtienen resultados similares, notándose recuperación más pronta en pacientes a los que se les realiza sellado vascula (AU)

Background: The prevalence of hemorrhoidal disease is between 5-36 %, although only 5-10 % will require surgery. Aims: To compare the hemorrhoidectomy according to Milligan-Morgan technique by diathermy vs. sealed in patients undergoing vascular grade III-IV hemorrhoids, in terms of pain and other postoperative complications. Methods: For this, there are two groups, one that is held hemorrhoidal Package dissection with diathermy and the other vessel sealing. In both, the surgery is performed with sedation and infiltration with ropivacaine pudendal plexus, under Ambulatory Surgery. At discharge, they are given a protocol with analgesic regimen, and 24 hours is a review phone. At month are reviewed in consultation and fill out a questionnaire with different variables. Results: Between 2007 and 2011, have been seized by hemorrhoidal disease a total of 1010 patients in our unit, performing 362 hemorrhoidectomies by Milligan-Morgan technique. 52.8 % were male, average age 48 years (17-82). Diathermy dissection 71.5 % vs. 28.5 % vascular sealing. There were no differences in characteristics of hemorrhoids and anal pathology companion. There were no differences in pain or other complications. Yes statistical significance was found in faster recovery by vascular sealing group. Conclusions: Both techniques give similar results, noting more rapid recovery in patients who underwent vascular sealing (AU)

Mixed type I and type II collagen scaffold for cartilage repair: ultrastructural study of synovial membrane response and healing potential versus microfractures (a pilot study).

The association between microfracture of the subchondral plate and a coverage scaffold has emerged as a promising strategy to treat cartilage lesions in a one-step procedure. Between different types of scaffolds (e.g. collagen, hyaluronic acid, polyglycolic acid) currently studied, type I collagen scaffold is the most used for this purpose, and is currently adopted for humans. The aim of this study was to test a novel scaffold made of mixed type I and II collagen (I-IICS) in order to define the immunological reaction of the synovial tissue and the repair capabilities induced by the collagen membrane when associated with microfracture. Eight New Zealand White rabbits, aged 180 days, were operated on bilaterally on the medial femoral condyle. A circular cartilage lesion was performed up to the calcified layer of the medial femoral condyle, and the centre of the lesion was microfractured. Randomly, one of the two lesions was covered with the I-IICS (treated), and the other was left uncovered (control). The synovial membrane reaction and the quality of the cartilage tissue repair were investigated at 2, 90, 180 and 270 days macroscopically, histomorphologically and ultrastructurally. Expression of tumor necrosis factor-alpha (TNF-alpha) in synovial tissue by immunocytochemistry analyses was also investigated. In the control group, at 2 days gold particles were localized mainly on synoviocyte type A, less on synoviocytes type B and on collagen bundles; in the treated group the reaction is more intense in cells in the matrix, but at 180 days controls and treated joints were very similar. The synovial membranes of the joints receiving the I-IICS did not reveal significant changes compared to the age-matched controls. Signs of inflammation were present at the 90-day time-point, and became less evident at afterwards. The degradation of the scaffolds was already evident at the 90-day time-point. The quality of the cartilage repair of the rabbits treated with the I-IICS was slightly better in 5 cases out of 6 in comparison to the controls. However, a statistically significant difference was not detected (p=0.06). Scaffolds made of mixed type I and II collagen exhibited good biocompatibility properties in vivo and favoured cartilage restoration when associated with microfracture, as shown in this pilot study.

Monosomic and molecular mapping of adult plant leaf rust resistance genes in the Brazilian wheat cultivar Toropi.

Leaf rust is one of the most destructive diseases affecting wheat worldwide. The most effective way to control it is to use resistant cultivars. Resistance based on slow-rusting adult plant resistance (APR) genes has proven to be the best method for developing cultivars with durable resistance. A source of slow-rusting APR for leaf rust is the Brazilian wheat cultivar Toropi. The Toropi/IAC 13 F2 and F7 recombinant inbred lines (RILs) were developed in previous studies. Phenotypic analysis of the F2 and F7 RILs showed that 2 recessive genes that were temporarily named trp-1 and trp-2 conferred APR in Toropi. In the present study, we used monosomic families and amplified fragment length polymorphism (AFLP), sequence-tagged site, and simple sequence repeat (SSR) markers to map trp-1 and trp-2 on wheat chromosomes. Analysis of the F2 monosomic RIL showed that trp- 1 and trp-2 were located on chromosomes 1A and 4D, respectively. AFLP analysis of the F7 RIL identified 2 independent AFLP markers, XPacgMcac3 and XPacgMcac6, which were associated with Toropi APR. These markers explained 71.5% of the variation in the phenotypic data in a multiple linear regression model. The AFLP markers XPacg/ Mcac3 and XPacg/Mcac6 were anchored by SSR markers previously mapped on the short arms of chromosomes 1A (1AS) and 4D (4DS), respectively. The trp-2 gene is the first leaf rust resistance gene mapped on wheat chromosome 4DS. The mapping of trp-1 and trp-2 provides novel and valuable information that could be used in future studies involving the fine mapping of these genes, as well as in the identification of molecular markers that are closely related to these genes for marker-assisted selection of this important trait in wheat.

Cirugía de control de daños / Damage control surgery

La cirugía de control de daños o damage control surgery (DCS) intenta mejorar los resultados de los traumatismos abdominales en pacientes críticos con escasa reserva fisiológica. Se define como una "cirugía por etapas", con un primer tiempo quirúrgico corto para controlar el sangrado y la contaminación, seguido de un periodo de reanimación y, finalmente, de reparación definitiva de las lesiones. Debe basarse en la toma rápida de decisiones, identificando aquellos pacientes, politraumatizados o no,que pueden ser candidatos a esta cirugía. Se revisan las indicaciones, las etapas, los procedimientos quirúrgicos y los factores pronósticos de estos pacientes (AU)

Damage control surgery (DCS) seeks to improve outcome in critical trauma patients with abdominal injuries and diminished physiological reserve. DCS is a staged approach to surgery that starts with a rapid intervention to control bleeding and contamination; this step is followed by a period of reanimation and eventually the definitive repair of lesions. Fast decision-making and selection of candidates, whether they have multiple injuries or not, are fundamental in DCS. We review the indications, stages, and surgical procedures to follow in DCS. We also discuss prognostic factors (AU)

HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus (HIV) pose two of the greatest threats to global tuberculosis (TB) control. Given expanding global access to antiretroviral therapy (ART) and second-line TB drugs, more data are needed on experiences treating MDR-TB and HIV co-infection in resource-poor settings. OBJECTIVE: To describe the clinical characteristics, management, outcomes, and factors associated with survival among HIV-positive individuals receiving treatment for MDR-TB. DESIGN: This was a retrospective case series of 52 HIV-positive individuals receiving treatment for MDR-TB in Lima, Peru. We used Cox proportional hazards regression models to identify risk factors for mortality. RESULTS: A total of 31 (57%) of the cohort died on treatment, with the majority of deaths due to MDR-TB. Low baseline weight predicted a three-fold increased rate of death (aHR 3.1, 95%CI 1.5-6.7), while individuals receiving highly active ART experienced a significantly lower rate of death compared to those who were not (aHR 0.4, 95%CI 0.2-0.9). CONCLUSION: Early ART is likely a key component of effective MDR-TB management in co-infected individuals.

Electron microscope study on a transmissible cytotoxic factor isolated from cerebrospinal fluid of neurological patients: analysis of its structure and of its effects on various types of cell cultures.

AIMS: In previous studies, the present group showed that a factor, present in the cerebrospinal fluid of seven neuro-patients, was capable of inducing cell damages on cell cultures of epithelial cells (Vero), glial cells (DG54-MG) and human primary lymphocytes. The cytotoxicity, once induced, could be transmitted to fresh cell cultures using crude preparations obtained from the cytotoxic cell cultures. METHODS AND RESULTS: The present electron microscope study describes in detail the pathological changes occurring in the previously assayed cultured cell types, and for the first time in human fibroblasts, as a consequence of the treatment with crude cytotoxic preparation. It also demonstrates with reasonable certainty the absence of virus-like particles in both the treated cells and the partially purified cytotoxic fraction. Indeed high-resolution electron microscopy analysis shows that this fraction consists almost entirely of protein spheroids with a diameter of 8-12 nm. CONCLUSIONS: The possible significance of nanotubular aggregates, observed in particular in the glial and in the epithelial cells undergoing cytotoxic damage, is also discussed.

¿Todas las hernias inguinales son subsidiarias de cirugía ambulatoria? / No disponible

La hernia de Amyand es una patología infrecuente que se presenta cuando el apéndice forma parte del saco herniario, manifestándose como una hernia inguino-crural en ocasiones incarcerada. El diagnóstico suele realizarse de forma intraoperatoria, pero en los casos en los que el apéndice se encuentre inflamado en el interior del saco, el diagnóstico diferencial deberá incluir la varicoflebitis, la hernia inguino-crural estrangulada y el escroto agudo. Requiere un manejo individualizado para decidir el tratamiento del apéndice y de la hernia. En los casos de hernias de Amy and con peritonitis purulenta localizada y gran componente infeccioso asociado, la herniorrafia asociada a drenaje de ambiente debería ser considerada como técnica de elección para tratar el defecto. Presentamos el caso de una paciente con hernia de Amy and y se realiza una revisión de laliteratura (AU)

Amyand´s hernia is a rare form that occurs when the appendixis included in the hernial sac, and becomes an incarcerated inguinal cruralhernia. Diagnosis is usually intraoperative, but when the appendixis inflamated in the sac, differential diagnosis must includeangiophlebitis, strangulated inguinal-crural hernias and acute scrotum. It requires an individualized treatment of the appendix and hernia. Amyand´s hernias with focal purulent peritonitis and infectious component associated, herniorrhaphy and ambient drainage associated must be considered the technical of choice for the treatment of the defect. We report a case of a patient with Amyand´s hernia, and a review of the literatura is done (AU)