A Spatial Interpolation Approach to Assign Magnetic Resonance Imaging-Derived Material Properties for Finite Element Models of Adeno-Associated Virus Infusion Into a Recurrent Brain Tumor.

Adeno-associated virus (AAV) is a clinically useful gene delivery vehicle for treating neurological diseases. To deliver AAV to focal targets, direct infusion into brain tissue by convection-enhanced delivery (CED) is often needed due to AAV's limited penetration across the blood-brain-barrier and its low diffusivity in tissue. In this study, computational models that predict the spatial distribution of AAV in brain tissue during CED were developed to guide future placement of infusion catheters in recurrent brain tumors following primary tumor resection. The brain was modeled as a porous medium, and material property fields that account for magnetic resonance imaging (MRI)-derived anatomical regions were interpolated and directly assigned to an unstructured finite element mesh. By eliminating the need to mesh complex surfaces between fluid regions and tissue, mesh preparation was expedited, increasing the model's clinical feasibility. The infusion model predicted preferential fluid diversion into open fluid regions such as the ventricles and subarachnoid space (SAS). Additionally, a sensitivity analysis of AAV delivery demonstrated that improved AAV distribution in the tumor was achieved at higher tumor hydraulic conductivity or lower tumor porosity. Depending on the tumor infusion site, the AAV distribution covered 3.67-70.25% of the tumor volume (using a 10% AAV concentration threshold), demonstrating the model's potential to inform the selection of infusion sites for maximal tumor coverage.

Perivascular network segmentations derived from high-field MRI and their implications for perivascular and parenchymal mass transport in the rat brain.

A custom segmentation workflow was applied to ex vivo high-field MR images of rat brains acquired following in vivo intraventricular contrast agent infusion to generate maps of the perivascular spaces (PVS). The resulting perivascular network segmentations enabled analysis of perivascular connections to the ventricles, parenchymal solute clearance, and dispersive solute transport within PVS. Numerous perivascular connections between the brain surface and the ventricles suggest the ventricles integrate into a PVS-mediated clearance system and raise the possibility of cerebrospinal fluid (CSF) return from the subarachnoid space to the ventricles via PVS. Assuming rapid solute exchange between the PVS and CSF spaces primarily by advection, the extensive perivascular network decreased the mean clearance distance from parenchyma to the nearest CSF compartment resulting in an over 21-fold reduction in the estimated diffusive clearance time scale, irrespective of solute diffusivity. This corresponds to an estimated diffusive clearance time scale under 10 min for amyloid-beta which suggests that the widespread distribution of PVS may render diffusion an effective parenchymal clearance mechanism. Additional analysis of oscillatory solute dispersion within PVS indicates that advection rather than dispersion is likely the primary transport mechanism for dissolved compounds greater than 66 kDa in the long (> 2 mm) perivascular segments identified here, although dispersion may be significant for smaller compounds in shorter perivascular segments.

Peloideterapia en adultos mayores con osteoartrosis de rodilla. Yaguaramas, 2021

Fundamento el incremento de la esperanza de vida viene aparejado con la necesidad del adulto mayor de desenvolverse en su medio y garantizar una longevidad plena. Objetivo determinar la efectividad de la peloideterapia en adultos mayores con osteoartrosis de rodilla. Métodos se realizó un estudio de intervención, cuasi experimental, en 30 pacientes con osteoartrosis de rodilla, seleccionados mediante aleatorización simple, quienes fueron atendidos en el área de salud de Yaguaramas (Abreus, Cienfuegos), en el período comprendido entre marzo y junio de 2021. Se realizó una encuesta general. La evolución del dolor se determinó mediante la escala de Likert, y la limitación articular se analizó mediante la medición del arco articular de la rodilla con el goniómetro. Resultados predominaron los pacientes del grupo de edades de 66-70 años y del sexo femenino; con tiempo de evolución entre 5-10 años (60 %); y con ambas rodillas afectadas (56,7%). Los principales signos y síntomas fueron el dolor (100 %) y la limitación del movimiento articular (93,3 %), los cuales disminuyeron tras el tratamiento. El 53,3 % refirió dolor ligero antes del tratamiento; después del tratamiento el 83,3 % describió ausencia de dolor. El 76,7 % de los pacientes manifestó limitación en la flexión de la rodilla, que después del tratamiento disminuyó a 13,3 %. Conclusiones la peloideterapia influye positivamente en los adultos mayores con osteoartrosis de rodilla, al mejorar su estado funcional e independencia personal, además de reducir las demandas de servicios médicos.

Background the increase in life expectancy is coupled with the elderly's need to function in its media and guarantee full longevity. Objective to determine the effectiveness of peloidtherapy in older adults with osteoarthritis of the knee. Method a quasi-experimental intervention study was carried out in 30 patients with osteoarthritis of the knee, selected by simple randomization, who were treated in the health area of Yaguaramas (Abreus, Cienfuegos), between March and June of 2021. A general survey was carried out. The evolution of pain was determined using the Likert scale, and joint limitation was analyzed by measuring the knee joint arc with the goniometer. Results there was a predominance of patients in the age group of 66-70 years old and of the female sex; with evolution time between 5-10 years (60%); and with both knees affected (56.7%). The main signs and symptoms were pain (100%) and limitation of joint movement (93.3%), which decreased after treatment. 53.3% reported light pain before treatment; after treatment, 83.3% described absence of pain. 76.7% of the patients manifested limitation in knee flexion, which after treatment decreased to 13.3%. Conclusions peloidtherapy has a positive influence on older adults with osteoarthritis of the knee, by improving their functional status and personal independence, as well as reducing the demands for medical services.

Caracterización de los focos de mosquitos Aedes aegypti en el municipio de Abreus. 2016-2022

Fundamento el conocimiento acerca de la focalidad por mosquitos motiva a pobladores y decisores a trabajar sobre las cuestiones que inciden en la proliferación de estos vectores; así como a una participación comunitaria eficaz, y el éxito en la prevención y control de las arbovirosis. Objetivo caracterizar los focos de mosquitos Aedes aegypti. Métodos se realizó un estudio observacional, retrospectivo, y de corte transversal, acerca de los focos de Aedes aegypti detectados en el municipio de Abreus, provincia de Cienfuegos, en el período 2016-2022. El universo fue de 390 focos, para los cuales se describieron las variables: semana estadística, mes y año de diagnóstico, consejo popular, tipo de depósito, lugar de la vivienda donde se encontró y fase del mosquito al diagnóstico. Se utilizaron datos de las encuestas entomológicas y los registros del laboratorio de Entomología Médica de la Unidad Municipal de Higiene y Epidemiología. Resultados la mediana del número de focos de Aedes aegypti correspondió a la semana estadística 32 de cada año. La mayor cantidad de focos se detectó en los consejos populares de Abreus (165) y Juraguá (102); hallados sobre todo en patios (85,5 %) y tanques bajos (55,5 %). Predominó la fase larvaria en IV estadio (82,3 %). Conclusiones en el municipio de Abreus la focalidad por mosquitos Aedes aegypti se caracterizó por su mayor incidencia en los meses de junio a septiembre, con predominio en el consejo popular de Abreus, sobre todo en tanques bajos y patios. El mayor número fue diagnosticado en la IV fase.

Background knowledge about the mosquito's breeding grounds motivates residents and decision makers to work on the issues that affect the mosquito proliferation; as well as effective community participation, and success in the prevention and control of arboviral diseases. Objective to characterize the Aedes aegypti mosquito's breeding grounds. Methods an observational, retrospective, and cross-sectional study was carried out on Aedes aegypti's breeding grounds detected in the Abreus municipality, Cienfuegos province, from 2016 to 2022. 390 breeding grounds were the universe, for which the described variables were: statistical week, month and year of diagnosis, neighborhood, type of deposit, place of residence where it was found, and phase of the mosquito at diagnosis. Data from entomological surveys and records from the Municipal Hygiene and Epidemiology Unit's Medical Entomology laboratory were used. Results the median number of Aedes aegypti breeding grounds corresponded to statistical week 32 of each year. The largest number of outbreaks was detected in the Abreus' neighborhood (165) and Juraguá (102); found mainly in yards (85.5 %) and low tanks (55.5 %). The larval phase in IV stage predominated (82.3 %). Conclusions in the municipality of Abreus, the focality of Aedes aegypti mosquitoes was characterized by its highest incidence in the months of June to September, with predominance in the popular council of Abreus, especially in low tanks and yards. The largest number was diagnosed in the IV phase.

Conocimientos de los residentes de Medicina General Integral sobre prevención y control de las arbovirosis / Comprehensive General Medicine residents: their knowledge about prevention and control of arboviruses

Fundamento: las arbovirosis son enfermedades víricas transmitidas por mosquitos, las que han propagado rápidamente en todas las regiones del mundo en los últimos años, con alta incidencia en la salud de las personas y en la economía de los países. Objetivo: identificar el nivel de conocimientos de los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, en la Dirección Municipal de Salud Abreus, en octubre de 2021. Se utilizaron métodos teóricos y empíricos para fundamentar la investigación, y estadísticos para el análisis de los datos encontrados. Resultados: la mayoría de los residentes manifestaron que han tenido preparación sobre la prevención y control de las arbovirosis, fundamentalmente, durante la educación en el trabajo, todos han adquirido experiencia previa en la pesquisa activa, y algunos señalaron haber atendido a enfermos; sin embargo, la mayoría presentaron dificultades para identificar las formas clínicas y el cuadro clínico de las arbovirosis. Conclusiones: se identificó el nivel de conocimientos alcanzados por los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis, el diagnóstico realizado mostró la necesidad de asumir nuevas metodologías en la educación en el trabajo a fin de lograr correctos modos de actuación y actualización sobre su prevención y control.

Background: arboviruses are viral diseases transmitted by mosquitoes, which have spread rapidly in all regions of the world in recent years, with a high impact on people's health and the economies of countries. Objective: to identify the level of knowledge of Comprehensive General Medicine residents from the Abreus municipality, about the prevention and control of arboviruses. Methods: an observational, descriptive, cross-sectional study was carried out at the Abreus Municipal Health Directorate, in October 2021. Theoretical and empirical methods were used to support the research, and statistical methods were used to analyze the data found. Results: most residents stated that they have had training on the prevention and control of arboviruses, mainly, during on-the-job education, all have acquired previous experience in active search, and some of them indicated had taken care for sick people; however, most of them had difficulties in identifying the clinical forms and clinical profile of arboviruses. Conclusions: the level of knowledge achieved by Comprehensive General Medicine residents from Abreus municipality was identified, regarding the prevention and control of arboviruses, the diagnosis made by them showed the need to conceive new methodologies in education at work in order to achieve adequate modes of action and updating their knowledge about the prevention and control of it.

El uso de la aplicación WhatsApp como herramienta educativa en tiempos de COVID-19 / The use of WhatsApp as an educational tool in times of COVID-19

Fundamento: WhatsApp es una aplicación que permite la continuidad del proceso docente educativo en tiempos de pandemia. Objetivo: valorar el uso de la aplicación WhatsApp como herramienta educativa en tiempos de COVID-19, en el municipio Abreus, provincia Cienfuegos, Cuba. Métodos: se realizó una investigación con predominio de una metodología cualitativa, en el municipio Abreus, entre septiembre-diciembre 2021. Se utilizaron métodos teóricos (analítico sintético, histórico-lógico y sistémico) y empíricos (análisis de documentos, y la valoración mediante una encuesta a través de la aplicación WhatsApp de docentes y residentes). Resultados: el uso de WhatsApp como herramienta educativa fue la forma principal de comunicación virtual entre los residentes y docentes. La posibilidad de integrar contactos y armar grupos lo hizo muy popular, simulando una pequeña red social, interactiva y mucho más rápida. Además, se constató que es necesaria, con ventajas y desventajas en el proceso docente educativo. Conclusiones: la valoración de docentes y residentes fue positiva; WhatsApp puede incidir en la mejora del dinamismo de los procesos enseñanza aprendizaje a distancia, por sus posibilidades de conectarse en cualquier momento y desde cualquier lugar, dentro o fuera de los contextos de aprendizaje formal, y con estrategias bien diseñadas puede generar un cambio radical y favorable en el proceso educativo.

Background: WhatsApp is an application that allows us the continuity of the educational teaching process in times of pandemic. Objective: to assess the use of WhatsApp as an educational tool in times of COVID-19, in Abreus municipality, Cienfuegos province, Cuba. Methods: a research with a predominance of a qualitative methodology was carried out in Abreus municipality from September to December 2021. Analytical-synthetic, historical-logical and systemic approaches were applied as theoretical methods; document analysis and assessment through a survey by means of the WhatsApp application of teachers and residents were used as empirical ones. Results: the use of WhatsApp as an educational tool was the main way of virtual communication between residents and teachers. The possibility of integrating contacts and creating groups made it very popular, simulating a small, interactive and much faster social network. In addition, we found that it is necessary, with its advantages and disadvantages in the educational process. Conclusions: the evaluation of teachers and residents was positive; WhatsApp can influence the improvement of the dynamism of the distance learning teaching processes, due to its possibilities of connecting at any time and from any place, inside or outside the formal learning contexts, and it can generate a radical and favourable change in the educational process with well-designed strategies.

Transmisión de la COVID-19 en el Municipio Abreus, entre las semanas 29 y 41 del año 2021 / Transmission of COVID-19 in the Abreus Municipality, between weeks 29 and 41 of the year 2021

RESUMEN Fundamento: el siglo XXI se ha caracterizado desde sus inicios por una problemática de salud que ha afectado al mundo y a Cuba, que va desde un incremento de la resistencia microbiana hasta la aparición de nuevas enfermedades infecciosas, como la COVID-19. Objetivo: describir la transmisión de la COVID-19 en el municipio Abreus, provincia Cienfuegos, entre las semanas 29 y 41 del año 2021. Métodos: estudio observacional, descriptivo, retrospectivo de corte transversal que incluye desde la semana 29 hasta la 41. El universo estuvo constituido por 3421 pacientes diagnosticados con COVID-19, confirmados por prueba diagnóstica de reacción en cadena de polimerasa en tiempo real (PCR-RT). Resultados: se observó una alta magnitud de transmisión con 3421 casos, 122 como promedio en la semana 33. Tendencia al incremento del reporte de casos y de la velocidad de transmisión desde la semana estadística 29 a la 35 (385 a 3421 casos). El pico máximo se observó en la semana estadística 33, con disminución a partir de dicha semana; además, hubo una dispersión en todos los consejos populares, con mayor concentración en los consejos populares Abreus (1035) y Horquita (725). La circulación viral estuvo por encima del 20 % en todas las semanas y la mayor ocurrió en la semana estadística 37. Conclusiones: la COVID-19 en el municipio Abreus tuvo una gran transmisión en el período estudiado. Se aportó información útil para la toma de decisiones durante el desarrollo de la enfermedad y base para la comprensión evolutiva ante futuros eventos análogos.

ABSTRACT Background: The 21st century has been characterized from the beginning by a health problem that has affected the world and Cuba, ranging from an increase in microbial resistance to the appearance of new infectious diseases, such as COVID-19. Objective: To describe the transmission of COVID-19 in the Abreus municipality, Cienfuegos province, between weeks 29 and 41 of the year 2021. Methods: An observational, descriptive, retrospective cross-sectional study was carried out from week 29-41. The universe consisted of 3,421 patients diagnosed with COVID-19, confirmed by a real-time polymerase chain reaction (RT-PCR) diagnostic test. Results: A high magnitude of transmission was observed with 3,421 cases, 122 on average in week 33. Trend of increased case reporting and transmission speed from statistical week 29 to 35 (385 to 3,421 cases). The maximum peak was observed at statistical week 33, with a decrease from that week; In addition, there was a dispersion in all the popular councils, with a greater concentration in the Abreus (1035) and Horquita (725) popular councils. Viral circulation was above 20% in all weeks and the highest occurred in statistical week 37. Conclusions: COVID-19 in the Abreus municipality had a great impact in the period studied. Useful information was provided for decision-making during the development of the disease and a basis for the evolutionary understanding of future analogous events.

Estimation of shear stress values along endothelial tip cells past the lumen of capillary sprouts.

Shear stress is recognized as a regulator of angiogenesis. However, the shear stress experienced by the endothelial cells of capillary sprouts remains unknown. The objective of this study was to estimate shear stress due to local interstitial flow along endothelial tip cells at the end of the capillary sprout lumen. Computational fluid dynamics were used to model flow within a blind-ended vessel, transendothelial flow across the vessel wall, and flow within the surrounding perivascular/interstitial space. Shear stress along the wall of the tip cells was calculated while varying sprout length, perivascular space channel width, and vessel wall hydraulic conductivity. Increasing sprout length, increasing wall hydraulic conductivity, and decreasing perivascular space width increased shear stress magnitude. Wall shear stress magnitude within the lumen ranged from 0.015 to 0.55 dyne/cm2 at the sprout entrance and linearly decreased to near zero at the base of the tip cells. Tip cell wall shear stress magnitude due to interstitial flow ranged from 0.009 to 4.65 dyne/cm2. In 3 out of 8 cases, shear stress magnitude was above 1 dyne/cm2 and considered physiologically relevant. The results provide a framework for discussing the role of local mechanical cues in regulating endothelial cell dynamics involved in angiogenesis. Mainly, interstitial flows may generate physiologically relevant shear stresses on tip cells in certain scenarios. This source of tip cell shear stress has not been previously considered or modeled.

A computational model of glioma reveals opposing, stiffness-sensitive effects of leaky vasculature and tumor growth on tissue mechanical stress and porosity.

A biphasic computational model of a growing, vascularized glioma within brain tissue was developed to account for unique features of gliomas, including soft surrounding brain tissue, their low stiffness relative to brain tissue, and a lack of draining lymphatics. This model is the first to couple nonlinear tissue deformation with porosity and tissue hydraulic conductivity to study the mechanical interaction of leaky vasculature and solid growth in an embedded glioma. The present model showed that leaky vasculature and elevated interstitial fluid pressure produce tensile stress within the tumor in opposition to the compressive stress produced by tumor growth. This tensile effect was more pronounced in softer tissue and resulted in a compressive stress concentration at the tumor rim that increased when tumor was softer than host. Aside from generating solid stress, fluid pressure-driven tissue deformation decreased the effective stiffness of the tumor while growth increased it, potentially leading to elevated stiffness in the tumor rim. A novel prediction of reduced porosity at the tumor rim was corroborated by direct comparison with estimates from our in vivo imaging studies. Antiangiogenic and radiation therapy were simulated by varying vascular leakiness and tissue hydraulic conductivity. These led to greater solid compression and interstitial pressure in the tumor, respectively, the former of which may promote tumor infiltration of the host. Our findings suggest that vascular leakiness has an important influence on in vivo solid stress, stiffness, and porosity fields in gliomas given their unique mechanical microenvironment.

Imaging acute effects of bevacizumab on tumor vascular kinetics in a preclinical orthotopic model of U251 glioma.

The effect of a human vascular endothelial growth factor antibody on the vasculature of human tumor grown in rat brain was studied. Using dynamic contrast-enhanced magnetic resonance imaging, the effects of intravenous bevacizumab (Avastin; 10 mg/kg) were examined before and at postadministration times of 1, 2, 4, 8, 12 and 24 h (N = 26; 4-5 per time point) in a rat model of orthotopic, U251 glioblastoma (GBM). The commonly estimated vascular parameters for an MR contrast agent were: (i) plasma distribution volume (vp ), (ii) forward volumetric transfer constant (Ktrans ) and (iii) reverse transfer constant (kep ). In addition, extracellular distribution volume (VD ) was estimated in the tumor (VD-tumor ), tumor edge (VD-edge ) and the mostly normal tumor periphery (VD-peri ), along with tumor blood flow (TBF), peri-tumoral hydraulic conductivity (K) and interstitial flow (Flux) and tumor interstitial fluid pressure (TIFP). Studied as % changes from baseline, the 2-h post-treatment time point began showing significant decreases in vp , VD-tumor, VD-edge and VD-peri , as well as K, with these changes persisting at 4 and 8 h in vp , K, VD-tumor, -edge and -peri (t-tests; p < 0.05-0.01). Decreases in Ktrans were observed at the 2- and 4-h time points (p < 0.05), while interstitial volume fraction (ve ; = Ktrans /kep ) showed a significant decrease only at the 2-h time point (p < 0.05). Sustained decreases in Flux were observed from 2 to 24 h (p < 0.01) while TBF and TIFP showed delayed responses, increases in the former at 12 and 24 h and a decrease in the latter only at 12 h. These imaging biomarkers of tumor vascular kinetics describe the short-term temporal changes in physical spaces and fluid flows in a model of GBM after Avastin administration.

MRI of Whole Rat Brain Perivascular Network Reveals Role for Ventricles in Brain Waste Clearance.

Investigating the mechanisms by which metabolic wastes are cleared from nervous tissue is important for understanding natural function and the pathophysiology of several neurological disorders including Alzheimer's disease. Recent evidence suggests clearance may be the function of annular spaces around cerebral blood vessels, called perivascular spaces (PVS), through which cerebrospinal fluid (CSF) is transported from the subarachnoid space into brain parenchyma to exchange with interstitial fluid (also known as the glymphatic system). In this work, an MRI-based methodology was developed to reconstruct the PVS network in whole rat brain to better elucidate both PVS uptake and clearance pathways. MR visible tracer (Gd-albumin) was infused in vivo into the CSF-filled lateral ventricle followed by ex vivo high-resolution MR imaging at 17.6 T with an image voxel volume two orders of magnitude smaller than previously reported. Imaged tracer distribution patterns were reconstructed to obtain a more complete brain PVS network. Several PVS connections were repeatedly highlighted across different animals, and new PVS connections between ventricles and different parts of the brain parenchyma were revealed suggesting a possible role for the ventricles as a source or sink for solutes in the brain. In the future, this methodology may be applied to understand changes in the PVS network with disease.

Pulsatile flow drivers in brain parenchyma and perivascular spaces: a resistance network model study.

BACKGROUND: In animal models, dissolved compounds in the subarachnoid space and parenchyma have been found to preferentially transport through the cortex perivascular spaces (PVS) but the transport phenomena involved are unclear. METHODS: In this study two hydraulic network models were used to predict fluid motion produced by blood vessel pulsations and estimate the contribution made to solute transport in PVS and parenchyma. The effect of varying pulse amplitude and timing, PVS dimensions, and tissue hydraulic conductivity on fluid motion was investigated. RESULTS: Periodic vessel pulses resulted in oscillatory fluid motion in PVS and parenchyma but no net flow over time. For baseline parameters, PVS and parenchyma peak fluid velocity was on the order of 10 µm/s and 1 nm/s, with corresponding Peclet numbers below 103 and 10-1 respectively. Peak fluid velocity in the PVS and parenchyma tended to increase with increasing pulse amplitude and vessel size, and exhibited asymptotic relationships with hydraulic conductivity. CONCLUSIONS: Solute transport in parenchyma was predicted to be diffusion dominated, with a negligible contribution from convection. In the PVS, dispersion due to oscillating flow likely plays a significant role in PVS rapid transport observed in previous in vivo experiments. This dispersive effect could be more significant than convective solute transport from net flow that may exist in PVS and should be studied further.

Hipertensión arterial en el adulto mayor / Hypertension in the elder

El presente trabajo se efectuó con el objeto de realizar un estudio prospectivo, comparativo y descriptivo, sobre la frecuencia de la hipertensión arterial en nuestro medio. Se conformaron dos grupos de sujetos: menores de 60 años (grupo I) y mayores de 60 (grupo II). Se detectaron 150 pacientes (30 por ciento) con hipertensión arterial entre 500 sujetos mayores de 60 años; y 90 (13 por ciento) en 700 individuos menores de 60 años. No se encontraron diferencias estadísticamente significativas durante el estudio. El 81 por ciento del grupo I y el 80 por ciento del grupo II tuvieron una respuesta favorable desde el inicio de su tratamiento hasta los cuatro meses que duró su evaluación

Infarto cerebral secundario a vasoespasmo por angiografía / Cerebral infraction following a vasospasm by angiography

En este estudio presentamos un caso de infarto cerebral secundario a la realización de una angiografía. Revisamos la fisiopatología, clasificación de la enfermedad vascular y se realiza una revisión del tratamiento del vasoespasmo cerebral

Mucormicosis rinocerebral: informe de dos casos resueltos favorablemente / Rhinocerebrall mucormicosis. Report of two caes with favorable results

Se presentan dos casos de dos pacientes masculinos jóvenes con cetoacidosis diabética que desarrollaron como complicación un mucormicosis rinocerebral en el Servicio de Medicina Interna del Hospital General de México. Se hace una breve descripción de la enfermedad. Se realizaron examen directo y cultivo aislándose, en ambos casos, hongos mucorales variedad Rhizopus. Los pacientes fueron tratados con imidazoles sistémicos y anfotericina B; con esta terapia se obtuvo una buena respuesta. Se hace hincapié en el diagnóstico precoz y en el control metabólico como aspectos primordiales en el tratamiento de estos pacientes, así como en las medidas quirúrgicas que se requieren en algunos casos

Biopsia hepática percutánea en el paciente adulto / Liver biopsy diagnostic in adult

La biopsia hepática percutánea continúa siendo un método diagnóstico y de evaluación terapéutica ampliamente utilizado en la práctica médica contemporánea. Bien indicada y con un conocimiento adecuado de la técnica, ofrece un margen de seguridad importante, por lo que puede llevarse a cabo en casi todos los pacientes con enfermedad hepática. A lo largo de los años en nuestro hospital se ha acumulado una gran experiencia en este procedimiento por lo que en este trabajo se hace una revisión de las indicaciones y contraindicaciones, además de describirse los tipos de agujas que existen y la técnica que debe emplearse