Fiabilidad de un examen clínico objetivo estructurado para predecir la futura competencia profesional de estudiantes de medicina / Reliability of an objective structured clinical examination to assess the future professional competence of medical students

Introducción: Cuando con los resultados de un examen clínico objetivo estructurado (ECOE) se decide sobre la futura competencia profesional de estudiantes de medicina, la fiabilidad de dicha prueba debe adecuarse a esta finalidad. Objetivo: Calcular la fiabilidad (alfa de Cronbach) de una serie de ECOE y su relación con la duración, número de participantes, estaciones, ítems y evaluadores. Sujetos y métodos: Se analizan 14 ECOE realizados a 2.995 estudiantes de cuarto y quinto curso de la Facultad de Medicina de Granada desde 2004 a 2013. Resultados: La fiabilidad fue ≥ 0,70 en el 92,84% de los ECOE. También fue significativamente ≥ 0,70 cuando la duración total fue ≥ 60 minutos (p = 0,042), el número de estaciones ≥ 10 (p = 0019), el número de ítems ≥ 50 (p = 0,018) y el número de evaluadores ≥ 6 (p = 0,018). No se observaron diferencias con el número de estudiantes ni con las opciones al ítem utilizadas. Conclusiones: Los ECOE cuyos resultados se utilicen para aprobar asignaturas de la carrera de medicina deben tener una fiabilidad ≥ 0,70. Para alcanzar dicha fiabilidad o mayor, el formato debe constar de al menos 10 estaciones, durar ≥ 60 minutos, tener ≥ 50 ítems y ≥ 6 evaluadores

Introduction: When the future professional competence of medical students is decided based on results of an objective structured clinical examination (OSCE), the reliability of this test should be adequate to this purpose. Aim: To calculate the reliability (Cronbach's alpha) of each one of OSCEs we performed and its relationship with the duration, number of participants, stations, items and evaluators. Subjects and methods: Fourteen OSCE tests performed to 2995 medical students of 4th and 5th year of the Faculty of Medicine of Granada between 2004 to 2013 were analyzed. Results: The reliability was ≥ 0.70 in 92.84% of the OSCEs. It was also significant ≥ 0.70 with a total duration ≥ 60 minutes (p = 0.042), and a number of stations ≥ 10 (p = 0.019), a number of items ≥ 50 (p = 0.018) and a number of evaluators ≥ 6 (p = 0.018). No differences with the number of students, neither with the options to the item were observed. Conclusions: The OSCEs carried out in centers which results are used to approve subjects of the medical career, must have a reliability ≥ 0.70. To achieve this reliability or greater, the format should consist of at least: 10 stations, a duration ≥ 60 minutes, and having ≥ 50 items and ≥ 6 evaluators

Intercambio de gases respiratorios, respuestas cardiacas y metabólicas en altitud: estudio en pentatletas ecuatorianos / Breathing gas exchange and cardiac and metabolic responses by Ecuadorian pentathletes during altitude training

Introducción: El análisis de indicadores biomédicos como parte de la teoría y metodología del entrenamiento deportivo es sustancial en su proceso de dirección. Describe y analiza los efectos fisiológicos del entrenamiento específico en hipoxia en pentatletas es la base prospectiva para modelar entrenamientos efectivos que incidan significativamente en el rendimiento deportivo, permitiendo la dosificación correcta del estímulo físico. Objetivo: Determinar algunos indicadores relacionados con el intercambio de gases respiratorios, respuestas cardiacas y metabólicas en la altitud de pentatletas masculinos Sub 23 del Ecuador. Métodos: Se estudió la población del equipo masculino de Pentatlón Militar de las Fuerzas Armadas Ecuatorianas categoría Sub23 (6 sujetos) durante el macrociclo de entrenamiento del año 2014. Se investigaron indicadores de peso, frecuencia cardiaca, vo2 máximo, ritmo, velocidad, lactato, coeficiente de correlación y velocidad de recuperación de la frecuencia cardiaca y del lactato en sangre. Resultados: Se describieron los datos individuales y promedios de la población estudiada, entre los datos más relevantes se estimó una frecuencia cardiaca en reposo con un promedio de 46,33 por ciento, por debajo de las normativas internacionales. Otros indicadores también se comportaron muy por debajo de lo esperado, aunque el análisis individual de los sujetos mostró características útiles para futuros entrenamientos. Conclusiones: Potenciar aún más los parámetros funcionales investigados a través de un mejor estímulo físico, aprovechando las ventajas inherentes del entrenamiento en la altura y conformando posteriormente baremos nacionales de interés para el entrenador y la comisión técnica del deporte estudiado (AU)

Introduction: Analysis of biomedical indicators as a component of sport training theory and methodology is a crucial part of its management process. Describing and analyzing the physiological effects of specific hypoxic training on pentathletes is the prospective basis to model effective training programs significantly impacting on sport performance, allowing appropriate dosing of physical stimuli. Objective: Determine some indicators related to breathing gas exchange and cardiac and metabolic responses by male under-23 Ecuadorian pentathletes during altitude training. Methods: A study was conducted of the male under-23 military pentathlon team of the Ecuadorian Armed Forces (six subjects) during the 2014 training macrocycle. The indicators analyzed were weight, heart rate, VO2 max, rhythm, speed, lactate, correlation coefficient, and blood lactate and heart rate recovery speed. Results: Four tables show the data obtained, both individual and average for the study population. The most relevant data include an estimate of heart rate at rest with an average 46.33 ppm, below international standards. Other indicators were also considerably lower than the values expected, but individual analysis of subjects revealed characteristics useful for future training. Conclusions: It is recommended to further strengthen the functional parameters studied via a better use of physical stimuli, making use of the advantages inherent to altitude training to eventually develop national standard values of interest to both trainers and the technical committee for the sport being analyzed (AU)

Mutacytin-1, a New C-Type Lectin-Like Protein from the Venezuelan Cuaima (Lachesis muta muta Linnaeus, 1766) (Serpentes: Viperidae) Snake Venom Inducing Cardiotoxicity in Developing Zebrafish (Danio rerio) Embryos.

Envenomation by the Venezuelan bushmaster snake (Lachesis muta muta) (Serpentes: Viperidae) is characterized by local and cardiac alterations. This study investigates the in vivo cardiac dysfunction, tissue destruction, and cellular processes triggered by Lachesis muta muta snake crude venom and a C-type lectin (CTL)-like toxin named Mutacytin-1 (MC-1). The 28 kDa MC-1 was obtained by molecular exclusion, ion exchange, and C-18 (checking pureness) reverse-phase chromatographies. N-terminal sequencing of the first eight amino acids (NNCPQ LLM) revealed 100% identity with Mutina (CTL-like) isolated from Lachesis stenophrys, which is a Ca2+-dependent-type galactoside-binding lectin from Bothrops jararaca and CTL BpLec from Bothrops pauloensis. The cardiotoxicity in zebrafish of MC-1 was evaluated by means of specific phenotypic expressions and larvae behavior at 5, 15, 30, 40 and 60 min post-treatment. The L. muta muta venom and MC-1 also produced heart rate/rhythm alterations, circulation modifications, and the presence of thrombus and apoptotic phenomenon with pericardial damages. Acridine orange (100 µg/mL) was used to visualize apoptosis cellular process in control and treated whole embryos. The cardiotoxic alterations happened in more than 90% of all larvae under the action of L. muta muta venom and MC-1. The findings have demonstrated the potential cardiotoxicity by L. muta muta venom, suggesting the possibility of cardiovascular damages to patients after bushmaster envenoming.

Intraspecies geographical variability in the South American tigra mariposa (Bothrops venezuelensis Sandner 1952) snake venom activities.

Bothrops venezuelensis snake venoms, from five localities in the North-Central Venezuelan regions, showed biochemical and haemostatic differences. In this study, bioactivities of B. venezuelensis venoms from different regions (Aragua state; Waraira Repano (Capital District); Baruta, La Boyera and Lagunetica (Miranda state)) were compared using both natural and synthetic substrates. The protein contents of these venoms were Lagunetica 89%, La Boyera 79%, Baruta 71%, Waraira Repano 68% and Aragua 64%. Toxic activities effects were: Intraperitoneal LD50s: Aragua-14 mg/kg; Waraira Repano-6.4 mg/kg; Baruta: 8.3 mg/kg; La Boyera-4.4 mg/kg; Lagunetica-16.2 mg/kg. The MHD results: Aragua-21.4 µg/mouse; Waraira Repano-2.5 µg/mouse; Baruta-1.2 µg/mouse; La Boyera-1.4 µg/mouse and Lagunetica-12 µg/mouse. The hide powder azure results: Aragua-1.24 U/mg; La Boyera-2.26 U/mg; Baruta-2.83 U/mg; Lagunetica-3.28 U/mg and Waraira Repano-5.77 U/mg. Esterase specific activity on BAEE results: Waraira Repano-666.66 U/mg; La Boyera-805.5 U/mg; Baruta-900.00 U/mg; Lagunetica-922.19 U/mg and Aragua-1960.67 U/mg. Casein zymography showed digestion bands in the molecular weight above 100 and at 66.2 and 21.5 kDa. Analysis of casein degradation by SDS-PAGE showed two different degradation patterns. Fibrinolytic activity (mm2/µg) on fibrin plates results: Aragua-6.07; Lagunetica-27.6; Waraira Repano-35.7; La Boyera-44.27 and Baruta-45.63. In the fibrinogenolytic assay, the five venoms completely degraded the α chain after 1 min of incubation. None of the venoms completely degraded the ß and γ chains after 24 h incubation. The research indicated that venoms of B. venezuelensis of different geographic areas in Venezuela exhibit variances in composition and component concentrations; except the Aragua venom, all of them had high proteolytic activities.

Viruses in pulp and periapical inflammation: a review.

The presence of viruses in endodontic disease has been studied in the last decade. Their presence is associated with periapical radiolucency and with clinical findings, such as pain. The aim of this review is to analyze the scientific evidence currently published about viruses in pulp and periapical inflammation, and its possible clinical implications. A literature review was carried out using the Medline/Pubmed database. The search was performed, in English and Spanish, using the following keyword combinations: virus AND endodontic; virus AND periapical; virus AND pulpitis; herpesvirus AND periapical; papillomavirus AND periapical. We subsequently selected the most relevant studies, which complied with the search criterion. A total of 21 articles were included, of which 18 detected the present of viruses in the samples. In 3 of the studies, viral presence was not found in the samples studied. The Epstein-Barr virus was found in about 41 % of cases compared to controls, in which it was present in about 2 %. The main association between viruses and endodontic pathosis is between Cytomegalovirus and Epstein-Barr virus; these are found in 114 of the 406 samples of different endodontic pathosis. Some evidence supports that the Epstein-Barr virus is present in a significant number of endodontic diseases, without exact knowledge of their action in these diseases.

Virus en Endodoncia / Viruses in Endodontics

La infección endodóntica es la infección que afecta al sistema de conductos radiculares y, sin duda, es el principal agente etiológico de las periodontitis apicales. Además, de las bacterias patógenas endodónticas, se ha buscado en los últimos años asociar la presencia de virus en distintos tipos de patología endodóntica. Los virus que más se han buscado y asociado son los pertenecientes a la familia herpesvirus, los cuales se han encontrado presentes en patologías periapicales principalmente. Se ha buscado además, relacionar su presencia a patologías que cursan con mayor sintomatología, o que presentan a la imagen radiográfica destrucciones óseas periapicales mayores. El rol de los virus en las lesiones apicales de origen endodóntico está aún poco claro, se habla de efectos acumulativos a los de las bacterias, además de posibles inmunosupresiones locales que favorecerían el crecimiento y el efecto de estas últimas.

Endodontic infection is an infection of the root canal system and undoubtedly is the main etiological agent of apical periodontitis. In recent years, research has aimed to associate the presence of virus and endodontic bacterial pathogens in the different types of endodontic disease. The most common viruses that have been researched and associated are members of the herpesvirus family, which are mainly present in periapical pathologies. Furthermore, research has been carried out relating their presence to pathologies with important symptoms, or those where radiographic imaging shows extensive apical bone reabsorption. The role of viruses in apical lesions of endodontic origin are still unclear, it hypothesizes the cumulative effect with bacteria, in addition to possible local immunosuppression that favors the growth and the effect of bacteria.

The timing of cord clamping and oxidative stress in term newborns.

BACKGROUND: Clamping and cutting of the umbilical cord is the most prevalent of all operations, but the optimal timing of cord clamping is controversial, with different timings offering advantages and disadvantages. This study, for the first time, compares the influence of early and late cord clamping in correlation with oxidative stress and inflammation signaling, Because cord clamping timing may have a significant influence on placenta-to-infant blood transfer, thereby modifying oxygenation of maternal and fetal tissues, and on the transfer of inflammatory mediators throughout the placenta. METHODS: Sixty-four pregnant subjects were selected at the Gynecology and Obstetrics Services Department of the Clinico San Cecilio Hospital, Granada, Spain, based on disease-free women who experienced a normal course of pregnancy and a spontaneous, vaginal, single delivery. Half of the subjects had deliveries with early-clamped newborn infants (at 10 s), and the other half had late-clamped deliveries (at 2 min). RESULTS: Erythrocyte catalase activity was significantly greater in the late-clamped group than in the early-clamped group (P < .01 for the umbilical vein and P < .001 for the artery). The values for superoxide dismutase, total antioxidant status, and soluble tumor necrosis factor receptor II were all significantly higher in the late-clamped group compared with the early-clamped group (P < .01, P < .001, and P < .001, respectively). CONCLUSIONS: The results suggest a beneficial effect of late cord clamping, produced by an increase in antioxidant capacity and moderation of the inflammatory-mediated effects induced during delivery of term neonates.

Analysis of measurement process of placental volume in early pregnancy: an interobserver reliability study.

OBJECTIVE: To examine concordance among results obtained in measurement process of first-trimester placental volume using 3D ultrasound and eXtended Imaging Virtual Organ Computed-aided AnaLysis (XI-VOCAL®, 3DXITM, Medison, Seoul, Korea) image analysis by three different operators. METHODS: Twenty first-trimester normal pregnancy cases were selected for placental volume measuring using a Medison SA 8000 Live Prime® (Medison, Seoul, Korea) with a convex volumetric multifrequency abdominal probe. Images were processed and studied independently by three operators with different grade of training. Each operator obtained 50 slices per case. Thus, this study is based on 1000 measurements that have generated four different sets of placental volume determinations based on 5, 10, 15, and 20 slices, respectively. Results of measurement process were analyzed using reliability coefficients. RESULTS: There was a good degree of concordance in the placental length values obtained by all operators and not depend from the number of cuts measured [intraclass correlation coefficient (ICC)=0.734]. However, the number of cuts is important to obtain a placental volume with more accuracy. Reliability coefficients were low when determining placental volume adjusted to placental length (ICC=0.293), but combined results of the two operators that were trained in the same way showed higher coefficients of reliability (ICC=0.682), and therefore, greater concordance when comparing with the operator that was not trained in the same way. CONCLUSION: Higher coefficients of reliability guarantee high grades of concordance in the results among operators when measuring placental volumes independently, however, contouring process introduces high variability. Training in how to best use the image analysis software effectively assists in getting higher coefficients of reliability.

Climate effects and feedback structure determining weed population dynamics in a long-term experiment.

Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years) on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors). Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements.

An image segmentation based on a genetic algorithm for determining soil coverage by crop residues.

Determination of the soil coverage by crop residues after ploughing is a fundamental element of Conservation Agriculture. This paper presents the application of genetic algorithms employed during the fine tuning of the segmentation process of a digital image with the aim of automatically quantifying the residue coverage. In other words, the objective is to achieve a segmentation that would permit the discrimination of the texture of the residue so that the output of the segmentation process is a binary image in which residue zones are isolated from the rest. The RGB images used come from a sample of images in which sections of terrain were photographed with a conventional camera positioned in zenith orientation atop a tripod. The images were taken outdoors under uncontrolled lighting conditions. Up to 92% similarity was achieved between the images obtained by the segmentation process proposed in this paper and the templates made by an elaborate manual tracing process. In addition to the proposed segmentation procedure and the fine tuning procedure that was developed, a global quantification of the soil coverage by residues for the sampled area was achieved that differed by only 0.85% from the quantification obtained using template images. Moreover, the proposed method does not depend on the type of residue present in the image. The study was conducted at the experimental farm "El Encín" in Alcalá de Henares (Madrid, Spain).

Hemostatic and toxinological diversities in venom of Micrurus tener tener, Micrurus fulvius fulvius and Micrurus isozonus coral snakes.

The coral snake Micrurus tener tener (Mtt) from the Elapidae family inhabits the southwestern United States and produces severe cases of envenomations. Although the majority of Mtt venom components are neurotoxins and phospholipase A2s, this study demonstrated, by SDS-PAGE and molecular exclusion chromatography (MEC), that these venoms also contain high-molecular-weight proteins between 50 and 150 kDa that target the hemostatic system. The biological aspects of other Micrurus venoms were also studied, such as the LD50s of Micrurus isozonus (from 0.52 to 0.61 mg/kg). A pool from these venoms presented a LD50 of 0.57 mg/kg, Micrurus f. fulvius (Mff) and Mtt had LD50s of 0.32 and 0.78 mg/kg, respectively. These venoms contained fibrino(geno)lytic activity, they inhibited platelet aggregation, as well as factor Xa and/or plasmin-like activities. M. isozonus venoms from different Venezuelan geographical regions inhibited ADP-induced platelet aggregation (from 50 to 68%). Micrurus tener tener venom from the United States was the most active with a 95.2% inhibitory effect. This venom showed thrombin-like activity on fibrinogen and human plasma. Fractions of Mtt showed fibrino(geno)lytic activity and inhibition on plasmin amidolytic activity. Several fractions degraded the fibrinogen Aα chains, and fractions F2 and F7 completely degraded both fibrinogen Aα and Bß chains. To our knowledge, this is the first report on thrombin-like and fibrino(geno)lytic activity and plasmin or factor Xa inhibitors described in Micrurus venoms. Further purification and characterization of these Micrurus venom components could be of therapeutic use in the treatment of hemostatic disorders.

Characterization of toxins from the broad-banded water snake Helicops angulatus (Linnaeus, 1758): isolation of a cysteine-rich secretory protein, Helicopsin.

Helicops angulatus (broad-banded water snake) according to recent proposals is presently cited in the family Dipsadidae, subfamily Xenodontinae, forming the tribe Hydropsini along with the genera Hydrops and Pseudoeryx. The current work characterizes the proteolytic and neurotoxic activities of H. angulatus crude toxins from salivary excretion (SE) and describes the isolation and identification of a cysteine-rich secretory protein (CRISP) called helicopsin. The SE lethal dose (LD50) was 5.3 mg/kg; however, the SE did not contain hemorrhagic activity. Helicopsin was purified using activity-guided, Superose 12 10/300 GL molecular exclusion, Mono Q10 ion exchange, and Protein Pak 60 molecular exclusion. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed a highly purified band of approximately 20 kDa. The minimal lethal dose for helicopsin was 0.4 mg/kg. Liquid chromatography mass spectrometry (LC-MS/MS) analysis identified 2 unique peptides MEWYPEAAANAER and YTQIVWYK, representing a protein sequence (deleted homology) belonging to cysteine-rich secretory proteins, which are conserved in snake venoms (CRISPs). CRISPs are a large family of cysteine-rich secretory proteins found in various organisms and participate in diverse biological processes. Helicopsin exhibited robust neurotoxic activity as evidenced by immediate death (~8 min) due to respiratory paralysis in NIH mice. These observations for helicopsin purified from H. angulatus provide further evidence of the extensive distribution of highly potent neurotoxins in the Colubroidea superfamily of snakes than previously described.

Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term.

OBJECTIVE: To compare umbilical cord acid-base status and blood gas analysis between umbilical cords clamped within 10 s and at 2 min of delivery. METHODS: A total of 158 healthy full-term mothers were randomly assigned to an early clamping (<10 s post-delivery, n = 79) or delayed clamping (2 min post-delivery, n = 79) group. After application of inclusion criteria, umbilical vein blood acid-base status and gases were analyzed in 65 early clamped and 51 delayed clamped cords. Fewer cases could be examined in the umbilical artery: 55 cords in the early clamping group and 44 in the delayed one. RESULTS: Acid-base and gas analysis results did not significantly differ between the groups in the umbilical vein or umbilical artery, with the exception of a higher (p < 0.001) mean umbilical artery pO(2) value in the delayed versus early clamping group. No significant differences in umbilical vein or artery pCO(2) or HCO(3) (-) values were observed between the early and delayed clamp groups. CONCLUSIONS: A delay of 2 min before umbilical cord clamping does not significantly change acid-base and gas analysis results, with the exception of a higher mean umbilical artery pO(2) value in the delayed clamping group.

Intensa reacción alérgica en paciente mordido por la hormiga negra (Odontomachus bauri) / Intense allergic reaction in a patient stung by the black ant (Odontomachus bauri)

INTRODUCCIÓN: en países del área tropical y subtropical las picaduras de hormiga eran generalmente benignas, autolimitadas; sin embargo, en la actualidad se describe un mayor número de casos, que se desarrollan con cuadros alérgicos graves que pueden evolucionar hasta el choque anafiláctico o urticarias severas. MÉTODOS: un adulto joven con una reacción alérgica moderada para una picadura de hormiga es revisado y comentado en cuanto a su importancia biomédica. Se trata del segundo accidente descrito en la literatura causado por la hormiga Odontomachus bauri, lo cual acentúa su importancia epidemiológica futura. Se hace una descripción de los signos y síntomas clínicos de una reacción alérgica, así como de algunos aspectos biológicos de la hormiga. El paciente fue tratado con succinato sódico de hidrocortisona (100 mg/stat) y el antihistamínico sistémico loratadina. CONCLUSIONES: las reacciones alérgicas a consecuencia de reacciones de picadura de himenóptera se están haciendo un problema creciente en muchos países, es importante que las autoridades médicas se hagan conscientes de sus manifestaciones dermatológicas y sistémicas, que aquejan a algunos de los pacientes picados o mordidos por hormigas.

INTRODUCTION: ant stings in nations located in the tropical and subtropical regions were generally benign and not frequent; however, at present a higher number of cases develop serious allergic reactions that may evolve into anaphylactic shock or severe urticaria. METHODS: review of the case of a young man suffering moderate allergic reaction to ant stings and comments on the biomedical importance of this event. This is the second accident described in literature and associated with Odontomachus bauri ant, which stresses its epidemiological weight in the future. The clinical signs and symptoms of an allergic reaction together with some biological aspects of the ant were described. The patient was treated with hydrocortisone sodium succynate (100mg/stat) and systemic antihistaminic drug Loratadina. CONCLUSIONS: allergic reactions as a result of hymenoptera stings is becoming a growing problem in many countries; therefore it is essential that the medical authorities be aware of the dermatological and systemic manifestations affecting some patients stung by ants.

[Intense allergic reaction in a patient stung by the black ant (Odontomachus bauri)]. / Intensa reacción alérgica en paciente mordido por la hormiga negra (Odontomachus bauri).

INTRODUCTION: ant stings in nations located in the tropical and subtropical regions were generally benign and not frequent; however, at present a higher number of cases develop serious allergic reactions that may evolve into anaphylactic shock or severe urticaria. METHODS: review of the case of a young man suffering moderate allergic reaction to ant stings and comments on the biomedical importance of this event. This is the second accident described in literature and associated with Odontomachus bauri ant, which stresses its epidemiological weight in the future. The clinical signs and symptoms of an allergic reaction together with some biological aspects of the ant were described. The patient was treated with hydrocortisone sodium succynate (100 mg/stat) and systemic antihistaminic drug Loratadina. CONCLUSIONS: allergic reactions as a result of hymenoptera stings is becoming a growing problem in many countries; therefore it is essential that the medical authorities be aware of the dermatological and systemic manifestations affecting some patients stung by ants.

Use of hen egg derived immunoglobulin against scolopendra (Scolopendra gigantea) venom

Las picaduras de escolopendra (Scolopendra gigantea) en seres humanos y animales domésticos representan un accidente agudo y muy doloroso. La necrosis y otros daños ocasionados por este veneno pueden ser prevenidos, si se inyecta un antiveneno. Este estudio propone producir anticuerpos policlonales en gallinas hiper-inmunizadas contra el veneno de escolopendra (Scolopendra gigantea Linneaus 1758). Un grupo de gallinas fue inyectado subcutánea e intramuscularmente con diluciones de venenos, de acuerdo con tres rutinas diferentes. Los huevos fueron recogidos diariamente y los anticuerpos en la yema fueron purificados con un método modificado de polietilen-glicol y cloroformo. Los niveles de anticuerpos en yema fueron calculados con prueba de precipitación de gel de agar y pruebas de protección (ED50). Los huevos cosechados 15 días post-inyección tenían los títulos más altos de anticuerpos. Después de seis meses, los anticuerpos liofilizados y guardados a 5°C mantenían su actividad. Ratones envenenados, inyectados posteriormente con anticuerpos purificados, tuvieron un 100% de supervivencia al compararse con los controles. La limpieza, la eficacia, y la sencillez de producir los antivenenos en gallina, y la incapacidad de estos anticuerpos (IgY) para fijarse al complemento humano, formulan una alternativa interesante a otros antivenenos producidos en mamíferos. Este estudio puntualiza que los anticuerpos de huevo de gallina pueden ser provechosos como un instrumento terapéutico para tratar escolopendrismo en seres humanos y animales domésticos. Además, abre un campo terapéutico para la fabricación de otros antivenenos contra el espectro amplio de las toxinas y como probable herramienta de diagnóstico.

A scolopendra sting in humans and domestic animals is an acute and highly painful accident. The present study was an attempt to raise specific hyper-immune polyclonal antibodies against scolopendra centipede (Scolopendra gigantea Linneaus 1758) venom. A group of hens were injected with venoms subcutaneously and intramuscularly according to three different routines. This protocol was found to be effective for hyperimmunization. Eggs were gathered daily and antibodies were purified from yolk with a polyethylene-glycol and chloroform modified method. Titers of antibodies in yolk were estimated with an agar gel precipitation test, and a serum protection (ED50) test. Eggs harvested at 15 days post-injection had maximum antibody titers. After six months, antibodies lyophilized and stored at 5°C still maintained their activity. Envenomed mice were injected with purified antibodies, which induced 100% recovery as compared to those not treated with the antibodies. The cleanliness, effectiveness, and simplicity of producing antibodies against scolopendra venom in avian egg yolk, and their incapability to attach human complement, formulates an interesting option to equine and other mammalian antivenoms. This study infers that avian egg yolk antibodies may be useful as a therapeutic tool in treating scolopendrism in humans and domestic animals. It also opens a field for the production of other antivenoms against the wide spectrum of toxins as well as the use of these antibodies as a diagnostic tool.

Sexual behavior and findings on laparoscopy or laparotomy in women with severe chronic pelvic pain.

OBJECTIVE: To identify features of sexual behavior in women with and without chronic pelvic pain. STUDY DESIGN: A group of 41 women with chronic pelvic pain of more than 6 months' duration and scheduled to undergo laparoscopy or laparotomy were surveyed to obtain information on their sexual activity. The results were compared with a control group of 86 women of similar age and socioeconomic status who underwent planned tubal ligation for permanent contraception. RESULTS: Women with pelvic pain initiated sexual relations at a later age and had a higher rate of dyspareunia than women in the control group. There were no significant differences between groups in any other characteristics of sexual behavior. CONCLUSION: Dyspareunia, the only feature of sexual relations that differed significantly between women with and without chronic pelvic pain, should be accorded greater attention as a painful symptom and not be dismissed as simply a type of sexual dysfunction.

[Institutional experience with Prolene Hernia System in hernia surgery]. / Hernioplastia con técnica de prolene hernia system. Experiencia institucional.

BACKGROUND: The use of tension-free techniques has demonstrated the effectiveness in inguinal hernias. The most common are mesh plug and Lichtenstein patch. Recently, the Prolene Hernia System (PHS) has been introduced, with the advantage of a low rate of recurrence, prompt recovery to daily activities, and a short learning curve in the technique, making this procedure easy to perform in any hospital. We undertook this study to analyze the effectiveness of the PHS in patients with inguinal hernia in our Institution. METHODS: A prospective, observational and transverse study including 158 patients was carried out in our Institution in patients with inguinal hernia, using the PHS, between March 1998 and June 2003. Variables were sex, age, type of hernia, additional pathologies, time of evolution, anesthetic procedure, size of hernia sac, and complications, with a 4-year follow-up for final evaluation. RESULTS: Mean age of patients was 41 years, with a predominance of males. Primary hernia represented 93.7% of cases. According to the Gilbert classification, type II was the most frequent (46.8%), regional anesthesia was used, 75.3% of surgeries were ambulatory and complications were seroma (1.1%), hematoma (3.2%), wound infection (1.1%) and 6.3% of the cases had additional pathologies. There were no recurrences. CONCLUSIONS: This is an easy and useful technique in our institution. It is an ambulatory procedure with low morbidity and without recurrences.