Scale to measure medical, nursing and midwifery students' engagement in an e-learning histology course / Escala para medir la participación de estudiantes de medicina, enfermería y obstetricia en un curso de histología e-learning

SUMMARY: E-learning courses become increasingly important and relevant in medicine and health sciences over the last decade. However, there are few teaching experiences of e-learning histology courses published in the literature worldwide. Moreover, most of these studies focus on the didactic aspects of the course without exploring student participation. The study presented below aimed to validate a scale to measure student participation in an e-learning histology course. We provide evidence of validity of the instrument based on its internal structure for use with medical, nursing, and midwifery students. The participants in this study were a group of 426 Chilean medical, nursing and midwifery students from a public university who completed the questionnaire in two consecutive semesters (2020-2021). Data from the first group of students were used to perform an exploratory factor analysis (EFA), while data from the second group of participants were used to perform a confirmatory factor analysis (CFA). The three factors identified according to the CFA were: "Habits of online," "Motivation for online learning," and "Interaction of online". After eliminating one of the initial items of the instrument, the scale showed acceptable psychometric properties suggesting that it is a useful instrument to measure students' perception of their participation in e-learning histology courses. The factors identified through the validation of the instrument provide relevant information for teachers and curriculum developers to create and implement different ways of encouraging student participation in e- learning histology courses to support online learning.

Los cursos e-learning han tomado mayor importancia y relevancia durante la ultima década en carreras de medicina y ciencias de la salud. No obstante, existen escasas experiencias docentes de cursos de histologia e-learning publicadas en la literatura mundial. Además, la mayoría de estos estudios se centran en los aspectos didácticos del curso sin explorar la participación de los estudiantes. El estudio que presentamos a continuación tuvo por objetivo validar una escala para medir la participación de los estudiantes en un curso de histología e-learning. Aportamos evidencia de validez del instrumento basada en su estructura interna para su uso con estudiantes de medicina, enfermería y obstetricia. Los participantes de este estudio fueron un grupo de 426 estudiantes chilenos de medicina, enfermería y obstetricia de una universidad pública quienes completaron el cuestionario en dos semestres consecutivos (año 2020-2021). Los datos del primer grupo de estudiantes se utilizaron para realizar un análisis factorial exploratorio (AFE), mientras que los datos del segundo grupo de participantes se utilizaron para realizar un análisis factorial confirmatorio (AFC). Los tres factores identificados según el AFC fueron: "Hábitos de los estudiantes en línea", "Motivación por el aprendizaje en línea", "Interacción de los estudiantes en línea". Luego de la eliminación de uno de los ítems iniciales del instrumento, la escala mostró propiedades psicométricas aceptables sugiriendo que es un instrumento útil para medir la percepción de los estudiantes sobre su participación en cursos de histología en formato e-learning. Los factores identificados mediante la validación del instrumento entregan información relevante para que los profesores y curriculistas desarrollen e implementen diferentes formas de estimular la participación de los estudiantes en cursos de histología e- learning y así apoyar el aprendizaje en formato online.

Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes.

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).

Adaptación e implementación del modelo de prevención de consumo de sustancias Planet Youth en Chile / Adaptation and implementation of the Planet Youth substance use prevention model in Chile

Resumen El consumo de sustancias en adolescentes es altamente prevalente en varias regiones del mundo, y especialmente en Chile, siendo su prevención un importante desafío para la salud pública. Este artículo describe el modelo islandés de prevención del consumo de sustancias en adolescentes "Planet Youth", su adaptación y factibilidad de implementación en Chile, como primera experiencia en Latinoamérica. Este modelo comunitario está enfocado en la prevención ambiental y en la promoción de la salud de niños, niñas y adolescentes, basado en un diagnóstico local y oportuno de factores protectores y de riesgo, con colaboración de la autoridad local y la academia. Seis comunas de la región metropolitana en colaboración con la Universidad de Chile y el Icelandic Centre for Social Research and Analysis inician su implementación en 2018. Se tradujo y adaptó la encuesta islandesa que fue aplicada a 7354 estudiantes de 2° medio, cuyos resultados se retroalimentaron a colegios y municipalidades para trabajar en la modificación de los principales factores de riesgo y protección. En 2020, el proceso ha requerido algunas adaptaciones debido a la pandemia por COVID-19. Se discute acerca de factores socioculturales relevantes en la adaptación de estrategias basadas en evidencia internacional que se transfieren a un país diferente. La implementación del modelo Planet Youth es factible en Chile y ofrece una importante oportunidad para prevenir el consumo de sustancias en jóvenes de manera efectiva en Latinoamérica.

The prevalence of substance use is high among adolescents in several region around the world, specifically in Chile, and its prevention is an important public health challenge. We describe the adaptation and the feasibility to implement the Icelandic model of substance use prevention in adolescents "Planet Youth" in Chile as first experience in Latin America. This community prevention model focuses on the environment, culture and the promotion of health in adolescents, informed by local risk and protective factors. Implementation requires collaboration between academia and municipal authorities. Six municipalities of the Metropolitan Region, the University of Chile and the Icelandic Centre for Social Research and Analysis collaborated in the implementation of the Planet Youth model since 2018 in Chile. A substance use survey was translated, adapted, and applied to 7354 tenth grade students. The results were informed to schools and municipalities in order to work on modifications of the main risk and protective factors in their own community. In 2020, the prevention process has required some adaptation due to COVID-19 pandemic. We discuss sociocultural factors in the adaptation of this international prevention model transferred to Latin America. The implementation of the Planet Youth model is feasible in Chile and offers an opportunity to effectively prevent the substance use behaviors of adolescents in Latin America.

Divergent molecular and growth responses of young "Cabernet Sauvignon" (Vitis vinifera) plants to simple and mixed infections with Grapevine rupestris stem pitting-associated virus.

Grapevine rupestris stem pitting associated virus (GRSPaV) is one of the most widely distributed viruses; even so, little is known about its effect on Vitis vinifera. To provide new insights, the effects of single and mixed GRSPaV infections on the V. vinifera cultivar "Cabernet Sauvignon" were studied by evaluating growth parameters, such as measurements of the total plant length, the number and distance of internodes and the number of leaves per shoot. In addition, parameters relating to gas exchange, i.e., the stomatal conductance, net photosynthetic rate, internal CO2 concentration and leaf transpiration, were also assessed. All the measurements were performed in one- and two-year-old plants with a single GRSPaV infection or mixed infections of GRSPaV and Grapevine fanleaf virus (GFLV). The results show that the plant phytosanitary status did not significantly alter the growth and gas exchange parameters in one-year-old plants. However, in two-year-old plants, single GRSPaV infections increased shoot elongation, which was accompanied by the overexpression of genes associated with the gibberellic acid response pathway. The gas exchange parameters of these plants were negatively affected, despite exhibiting higher LHCII gene expression. Plants with mixed infections did not have modified growth parameters, although they presented a greater reduction in the primary photosynthetic parameters evaluated with no change in LHCII expression. The results presented here confirm the co-evolution hypothesis for V. vinifera and GRSPaV during the early stages of plant development, and they provide new evidence about the effects of GRSPaV and GFLV co-infections on the "Cabernet Sauvignon" cultivar.

Hamartoma pulmonar como presentación de un nódulo pulmonar solitario / Pulmonary hamartoma as an example of solitary pulmonary nodule

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Metformin prevents vascular prostanoid release alterations induced by a high-fat diet in rats.

Perivascular adipose tissue dysfunction induced by high-fat feeding leads to alterations in the modulation of inflammation, contractile activity of the vascular smooth muscle and endothelial function, all risk factors in the development of hypertension. Metformin, an activator of AMP-activated protein kinase (AMPK), is currently the first-line drug treatment for type 2 diabetes (T2DM) and metabolic syndrome. Besides its glucose-lowering effect, there is an interest in actions of this drug with potential relevance in cardiovascular diseases. The high-fat (HF) diet is an experimental model that resembles human metabolic syndrome. We have previously reported an altered pattern of prostanoid release in mesenteric vessels in this model. The aim of this study was to analyse the effects of metformin on mesenteric vascular bed prostanoid release, adiposity index and its relation to blood pressure in Sprague-Dawley rats fed a HF diet for 8 and 12 weeks. Eight groups were used: control (C8, C1), HF diet (HF8, HF12, 50% w/w bovine fat), metformin-treated (CMf8, CMf12, 500 mg/kg/day) and metformin-treated HF diet (HFMf8, HFMf12, both treatments). HF diet increased mesenteric vascular bed adiposity index (%, HF8: 1.7±0.1 vs C8: 0.9±0.04 and HF12: 1.8±0.1 vs C12: 0.8±0.1, P<.001); systolic blood pressure (SBP, mm Hg, HF8: 145±6 vs C8: 118±4, P<.01 and HF12: 151±1 vs C12: 121±3, P<.001). We found a positive correlation between these two parameters. Moreover HF diet increased the release of vasoconstrictor prostanoids such as thromboxane (TX) B2 (ng PR/mg of tissue, HF8: 117±6 vs C8: 66±2 and HF12: 123±6 vs C12: 62±5, P<.001) and prostaglandin (PG) F2α (ng/mg, HF8: 153±9 vs C8: 88±3 and HF12: 160±11 vs C12: 83±5, P<.001). We also found that this increase in the release of vasoconstrictor prostanoids positively correlates with the elevation of SBP. In addition, HF diet increases the release of PGE2 and decreases the prostacyclin (PGI2 )/TXA2 release ratio at 8 and 12 weeks of treatment compared to control groups. In the HFMf group, metformin treatment prevented all these increases in mesenteric vascular bed adiposity index (%, HFMf8: 1.3±0.2 vs HF8 and HFMf12: 1.3±0.1 vs HF12, P<.05); SBP (mm Hg, HFMf8: 127±2 vs HF8 and HFMf12: 132±1 vs HF12, P<.001); TXB2 release (ng PR/mg of tissue, HFMf8: 65±12 vs HF8, P<.05 and HFMf12: 53±3 vs HF12, P<.001) and PGF2 α (ng PR/mg of tissue, HFMf8: 99±13 vs HF8, P<.01 and HFMf12: 77±8 vs HF12, P<.001). Meanwhile metformin prevented the increment in PGE2 release only at 12 weeks. On the other hand, metformin improved the PGI2 /TXA2 ratio in both periods studied. In conclusion, metformin could exert beneficial effects on adipose tissue and the vascular system by improving endothelial dysfunction induced by an imbalance of vasoactive substances in mesenteric perivascular adipose tissue in this model.

Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension.

BACKGROUND: Pulse pressure variation (PPV) and stroke volume variation (SVV) are frequently used to assess fluid responsiveness in critically ill patients on mechanical ventilation (MV). There are many factors, in addition to preload that influence the magnitude of these cyclic variations. We sought to investigate the effect of tidal volume (V(T)) on PPV and SVV, and prediction of fluid responsiveness in a model of intra-abdominal hypertension (IAH). METHODS: Twelve anesthetized and mechanically ventilated piglets on continuous pulse contour cardiac output monitoring. Hypovolemia was ruled out with 2 consecutive fluid boluses after instrumentation. IAH was induced by intraperitoneal instillation of colloid solution with a goal of reducing respiratory system compliance by 50 %. Subjects were classified as fluid responders if stroke volume increased >15 % after each fluid challenge. SVV and PPV were recorded with tidal volumes (VT) of 6, 12 and 18 ml/kg before IAH after IAH induction and after a fluid challenge during IAH. RESULTS: V(T) influenced PPV and SVV at baseline and during IAH, being significantly larger with higher V(T). These differences were attenuated after fluid administration in both conditions. After IAH induction, there was a significant increase in SVV with the three-tested V(T), but the magnitude of that change was larger with high V(T): with 6 ml/kg from 3 % (3, 4) to 5 % (4, 6.25) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 11 % (8.75, 17) (p = 0.02) and 18 ml/kg from 5 % (4,7.5) to 15 % (8.75, 19.5) (p = 0.02). Similarly, PPV increased with all the tested VT after IAH induction, being this increase larger with high VT: with 6 ml/kg from 3 % (2, 4.25) to 6 % (4.75, 7) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 13.5 % (10.25, 15.5) (p = 0.02) and 18 ml/kg from 7 % (5.5, 8.5) to 24 % (13.5, 30.25) (p = 0.02). One third of subjects responded to fluid administration after IAH, but neither SVV nor PPV were able to identify the fluid responders with the tested V(T). CONCLUSION: IAH induction in non-hypovolemic subjects significantly increased SVV and PPV with the three tested V(T), but the magnitude of that change was higher with larger V(T). This observation reveals the dependence of functional hemodynamic markers on intrathoracic as well intra-abdominal pressures, in addition to volemic status. Also, PPV and SVV were unable to predict fluid responsiveness after IAH induction. Future studies should take into consideration these findings when exploring relationships between dynamic preload indicators and fluid responsiveness during IAH.

A high-fat plus fructose diet produces a vascular prostanoid alterations in the rat.

In the rat, a high-fat (HF) plus fructose (F) diet produces cardiovascular and metabolic alterations that resemble human metabolic syndrome. Prostanoids (PR), cyclo-oxygenase-derived arachidonic acid metabolites, have vasoactive properties and mediate inflammation. The aim of this study was to analyse the effect of a HF+F diet on blood pressure (BP), metabolic parameters and mesenteric vascular bed PR production in male Sprague-Dawley rats. Four groups were studied over 9 weeks (n = 6 each): control (C), standard diet (SD) and tap water to drink; F+SD and 10% w/v F solution to drink; HF 50% (w/w) bovine fat added to SD and tap water; and HFF, both treatments. PR were determined by HPLC. Blood pressure was elevated in all experimental groups. Triglyceridaemia, insulinaemia and HOMA-IR were increased in the F and HF groups. HF+F animals showed elevated glycaemia, insulinaemia, HOMA-IR and triglyceridaemia. F decreased the vasodilator prostanoids PGI2 and PGE2 in the mesenteric vascular bed. Body weight was not significantly altered. In HFF, production of PGE2 , PGF2 alpha and TXB2 was elevated. The increased BP in HF and HFF could be partly attributed to the imbalance in vascular PR production towards vasoconstrictors. On the other hand, this dietary modification could induce inflammation, which would explain the elevation of PGE2 . In the F group, hypertension could be related to decreased vasodilator PRs. The simultaneous administration of HF and F in the rat produces deleterious effects greater than observed when treatments are applied separately.

Efecto metabólico de la metformina en adolescentes obesas con riesgo de diabetes mellitus tipo 2 / Metabolic effect of metformin in obese adolescents at risk of diabetes mellitus type 2

En adultos, se ha demostrado que la metformina favorece la reducción de peso y previene el desarrollo de Diabetes Mellitus tipo 2 (DM2). Sin embargo, aún no se han determinado estos efectos en población adolescente con riesgo de DM2. Objetivo: Analizar el impacto antropométrico y metabólico de la metformina en adolescentes obesas con riesgo de DM2. Pacientes y Método: Estudio randomizado, doble ciego, en que participaron 19 adolescentes obesas con riesgo de DM2 distribuidas aleatoriamente en dos grupos. Ambos fueron sometidos a un período de tratamiento (3 meses) con cambios en estilo de vida y farmacoterapia (dosis diaria de metformina 500 mg de liberación prolongada o placebo, respectivamente), continuado por un período de seguimiento (3 meses). Se compararon las variaciones en antropometría (peso, IMC, circunferencia cintura, presión arterial) y perfil metabólico (glicemia, HOMA, perfil lipídico, GOT y GPT) entre ellos al finalizar ambos períodos. Resultados: El grupo tratado con metformina mostró reducción significativa del peso e IMC. La disminución de IMC fue significativamente mayor que la del grupo que recibió placebo. Ningún grupo demostró mejora en el perfil de riesgo metabólico. Conclusión: La terapia con metformina, combinada con intervención en el estilo de vida, reduce el peso e IMC en adolescentes obesas con riesgo de DM2 en comparación con pacientes que reciben intervención en estilo de vida y placebo.

In adults, metformin promotes weight loss and prevents the development of type 2 diabetes mellitus (DM2). However, these effects have not been demonstrated in adolescents at risk for DM2. Objective: To analyze the anthropometric and metabolic impact of metformin in obese adolescents at risk for DM2. Patients and Methods: A double-blind, placebo-controlled study was conducted in 19 obese female adolescents at risk for DM2. A structured lifestyle intervention with nutritional and exercise education and motivational support was assessed over 3 month with an additional follow up period of 3 months. Subjects were randomized to 500 mg/ daily of extended release metformin or placebo. Anthropometric (weight, BMI, waist circumference, blood pressure) and metabolic profiles (glycemia, HOMA, lipid profile, AST, ALT) were compared between both groups at the end of both periods. Results: Metformin treated group showed a significant reduction in weight and body mass index (BMI) compared with placebo group. No improvement in the metabolic risk profile was showed in any group. Conclusion: In this study, metformin therapy in combination with a lifestyle intervention helps to reduce weight and BMI in obese adolescent females at risk for DM2, compared to lifestyle and placebo intervention.

Sodium molybdate prevents hypertension and vascular prostanoid imbalance in fructose-overloaded rats.

(1) Fructose (F) overload produces elevated blood pressure (BP), hyperglycaemia, hypertriglyceridemia and insulin resistance, resembling human metabolic syndrome. Previously, we found altered vascular prostanoid (PR) production in this model. (2) Sodium molybdate (Mo), as well as sodium tungstate, causes insulin-like effects and normalizes plasma glucose levels in streptozotocin-treated diabetic rats. We studied the effects of Mo on BP, metabolic parameters and release of PR from the mesenteric vascular bed (MVB) in F-overloaded rats. (3) Four groups of male Sprague-Dawley rats were analysed: Control, tap water to drink; F, F solution 10% W/V to drink; CMo, Mo 100 mg kg day(-1) and FMo, both treatments. After 9 weeks, the animals were killed and MVBs removed and the released PRs measured. (4) F increased BP, glycemia, triglyceridemia and insulinemia. Mo treatment prevented the increases in BP and glycemia, but did not modify triglyceridemia or insulinemia. In addition, Mo decreased BP in controls. (5) Prostaglandins (PG) F2 alpha and E2, PG 6-ketoF1 alpha and thromboxane (TX) B2 , as well as inactive metabolites of prostacyclin (PGI2 ) and TXA2 were detected. F decreased the production of vasodilator PRs PGI2 and PGE2 in MVB. Mo prevented these alterations and increased PGE2 in controls. Vasoconstrict or PRs PGF2 alpha and TXA2 release was not modified. (6) Mo treatment, beyond its known lowering effect on glycemia, prevents the reduction in the vascular release of vasodilator PR observed in this model. This could be one of the mechanisms by which Mo avoids the increase in BP caused by F overload in the rat.

Metformin reduces vascular production of vasoconstrictor prostanoids in fructose overloaded rats.

Metformin is a hypoglycaemic drug currently used to increase insulin sensitivity in the treatment of type 2 diabetes and metabolic syndrome. Its main mechanism of action is through activation of AMP-activated protein kinase, an enzyme that regulates cellular and whole organ metabolism. The fructose-overloaded rat is an experimental model with features that resemble human metabolic syndrome. We have previously reported alterations in vascular prostanoids (PR) in this model. The aim of this study was to analyse the effects of metformin treatment on blood pressure, metabolic parameters and PR production in aorta and mesenteric vascular bed (MVB) from fructose-overloaded animals. Four groups of male Sprague-Dawley rats were used: control, fructose overloaded (10% w/v fructose), metformin treated (50 mg kg(-1) day(-1) ) and fructose-overloaded treated with metformin. Rats with fructose overload had significantly elevated systolic blood pressure, glycaemia, triglyceridaemia, cholesterolaemia and insulinaemia compared with controls. Except for insulinaemia, metformin limited all these increases in fructose-overloaded animals. Fructose overload reduced prostacyclin levels in aorta and MVB, but prostaglandin E(2) levels were only reduced in MVB. Metformin treatment reduced the levels of the vasoconstrictor prostaglandins, PGF(2) α and thromboxane, in both vascular preparations from fructose-overloaded rats. PGF(2) α levels were significantly reduced by metformin in controls. In conclusion, one of the mechanisms by which metformin reduced blood pressure in this model is by decreasing vasoconstrictor prostaglandin production.

Efecto metabólico de la metformina en adolescentes obesas con riesgo de diabetes mellitus tipo 2 / Metabolic effect of metformin in obese adolescents at risk of diabetes mellitus type 2

In adults, metformin promotes weight loss and prevents the development of type 2 diabetes mellitus (DM2). However, these effects have not been demonstrated in adolescents at risk for DM2. Objective: To analyze the anthropometric and metabolic impact of metformin in obese adolescents at risk for DM2. Patients and Methods: A double-blind, placebo-controlled study was conducted in 19 obese female adolescents at risk for DM2. A structured lifestyle intervention with nutritional and exercise education and motivational support was assessed over 3 month with an additional follow up period of 3 months. Subjects were randomized to 500 mg/ daily of extended release metformin or placebo. Anthropometric (weight, BMI, waist circumference, blood pressure) and metabolic profiles (glycemia, HOMA, lipid profile, AST, ALT) were compared between both groups at the end of both periods. Results: Metformin treated group showed a significant reduction in weight and body mass index (BMI) compared with placebo group. No improvement in the metabolic risk profile was showed in any group. Conclusion: In this study, metformin therapy in combination with a lifestyle intervention helps to reduce weight and BMI in obese adolescent females at risk for DM2, compared to lifestyle and placebo intervention.

En adultos, se ha demostrado que la metformina favorece la reducción de peso y previene el desarrollo de Diabetes Mellitus tipo 2 (DM2). Sin embargo, aún no se han determinado estos efectos en población adolescente con riesgo de DM2. Objetivo: Analizar el impacto antropométrico y metabólico de la metformina en adolescentes obesas con riesgo de DM2. Pacientes y Método: Estudio randomizado, doble ciego, en que participaron 19 adolescentes obesas con riesgo de DM2 distribuidas aleatoriamente en dos grupos. Ambos fueron sometidos a un período de tratamiento (3 meses) con cambios en estilo de vida y farmacoterapia (dosis diaria de metformina 500 mg de liberación prolongada o placebo, respectivamente), continuado por un período de seguimiento (3 meses). Se compararon las variaciones en antropometría (peso, IMC, circunferencia cintura, presión arterial) y perfil metabólico (glicemia, HOMA, perfil lipídico, GOT y GPT) entre ellos al finalizar ambos períodos. Resultados: El grupo tratado con metformina mostró reducción significativa del peso e IMC. La disminución de IMC fue significativamente mayor que la del grupo que recibió placebo. Ningún grupo demostró mejora en el perfil de riesgo metabólico. Conclusión: La terapia con metformina, combinada con intervención en el estilo de vida, reduce el peso e IMC en adolescentes obesas con riesgo de DM2 en comparación con pacientes que reciben intervención en estilo de vida y placebo.

Tuberculosis laríngea diagnosticada en una escolar / Laryngeal tuberculosis diagnosed in a school girl

Tuberculosis is at the present time a worldwide endemic disease. Extrapulmonary tuberculosis is less frequent than the pulmonary form and its diagnosis represents a challenge. Laryngeal tuberculosis accounts for less than 1 percent of extrapulmonary tuberculosis. In this report, we present a case of laryngeal tuberculosis diagnosed in a 12 years old girl at the pediatric department of a general hospital. The patient had a six months history of hoarseness and persistent cough. At the time she was admitted at the hospital she complainted about stridor, odynophagia, weakness and respiratory distress. A cervical mass was the main finding at her physical exam. A laryngeal nodule was shown after practicing a direct laryngoscopy. The biopsy of this lesion revealed presence of a granulomatous inflammatory process compatible with tuberculosis. Besides the samples of sputum taken at her admission for acid -fast bacilli direct examination and culture were positive. We would like to emphasize the delay in diagnosing this case, because of the outpatient clinical study failed in proposing to carry out a direct laryngoscopy in this patient, despite she complainted of hoarseness and persistent cough.

La tuberculosis (TBC) es en la actualidad una endemia a nivel mundial. La tuberculosis extrapulmonar, menos frecuente que la forma pulmonar constituye un desafío diagnóstico. La forma laríngea representa menos del 1 por ciento de las tuberculosis extrapulmonares. En esta publicación, presentamos un caso de tuberculosis laríngea diagnosticada en una escolar de nuestro servicio de pediatría hospital Dr. Gustavo Fricke, cuyos síntomas cardinales fueron disfonía y tos presentes durante 6 meses previo al diagnóstico. Al momento de ingreso al servicio se había agregado compromiso del estado general, odinofagia estridor y dificultad respiratoria. Al examen físico destacaba la presencia de masa cervical. El diagnóstico se realizó mediante laringoscopia directa que evidenció nódulo en cuerda vocal derecha cuya biopsia reveló presencia de proceso inflamatorio crónico granulomatoso compatible con TBC. Las baciloscopías y cultivo de Koch de expectoración, realizados al momento del ingreso, resultaron positivos. Cabe destacar el retraso diagnóstico del caso, debido a que nunca se planteó realizar laringoscopia durante el estudio ambulatorio, pese a la presencia de disfonía y tos persistente.

[Intraoperative high frequency oscillatory ventilation in 2 children undergoing lung surgery]. / Uso intraoperatorio de ventilación de alta frecuencia oscilatoria en dos casos pediátricos de cirugía pulmonar.

Over the past 10 years, the application of high frequency oscillatory ventilation (HFOV) has been extended beyond the neonatal period. The technique is now used in various respiratory disease settings when conventional mechanical ventilation fails. Even though HFOV has become increasingly routine in some pediatric intensive care units, familiarity with it is still limited among anesthesiologists and surgeons and it is not often applied during surgery. We report our experience using HFOV during thoracic surgery on 2 pediatric patients, one aged 5 years and the other aged 1 month. The respective surgical procedures were to close a bronchopleural fistula and to obtain a lung biopsy in order to provide guidance for limiting therapeutic intervention. In both cases the procedure was performed without adverse effects and allowed medical interventions to be carried out. We conclude that it is possible to perform thoracic surgery in pediatric patients undergoing HFOV. This ventilation mode can be useful during surgery and teams that care for critically ill children should be familiar with the equipment.

Uso intraoperatorio de ventilación de alta frecuencia oscilatoria en dos casos pediátricos de cirugía pulmonar / Intraoperative high frequency oscillatory ventilation in 2 children undergoing lung surgery

En la última década se ha extendido el uso de la ventilaciónde alta frecuencia oscilatoria (VAFO) más alládel período neonatal, para diversas patologías respiratorias,ante el fracaso de la ventilación mecánica convencional.Pero a pesar de esta situación, cada vez más rutinariaen las diversas Unidades de Cuidados IntensivosPediátricas, está aún poco extendido su conocimiento yuso durante el intraoperatorio por el anestesiólogo y elcirujano.Presentamos nuestra experiencia con dos pacientespediátricos de cinco años y de un mes de edad, en quienesse efectuó cirugía de tórax mientras se mantenían enVAFO con diversos objetivos: cierre de fístula broncopleuraly biopsia pulmonar para limitar esfuerzos terapéuticosrespectivamente. En ambos casos el procedimientofue realizado sin inconvenientes y permitiómodificar la conducta médica. Concluimos que es posibleefectuar cirugía torácica en pacientes pediátricosmientras estén en VAFO.Este modo de ventilación puede ser útil intraoperatoriamentey debe de ser familiar al equipo que atiende aestos niños críticamente enfermos

Over the past 10 years, the application of high frequencyoscillatory ventilation (HFOV) has been extendedbeyond the neonatal period. The technique isnow used in various respiratory disease settings whenconventional mechanical ventilation fails. Even thoughHFOV has become increasingly routine in some pediatricintensive care units, familiarity with it is stilllimited among anesthesiologists and surgeons and it isnot often applied during surgery.We report our experience using HFOV during thoracicsurgery on 2 pediatric patients, one aged 5 yearsand the other aged 1 month. The respective surgical procedureswere to close a bronchopleural fistula and toobtain a lung biopsy in order to provide guidance forlimiting therapeutic intervention. In both cases the procedurewas performed without adverse effects andallowed medical interventions to be carried out. We concludethat it is possible to perform thoracic surgery inpediatric patients undergoing HFOV.This ventilation mode can be useful during surgeryand teams that care for critically ill children should befamiliar with the equipment

Fructose overload modifies vascular morphology and prostaglandin production in rats.

1. A fructose (Fru)-enriched diet induces a mild increase in blood pressure associated with hyperglycaemia, hypertriglyceridaemia, and insulin resistance, resembling the human 'syndrome X', being an useful model to study hypertension and type 2 diabetes. 2. A sustained elevation of blood pressure is associated with cardiovascular structural modifications such as left ventricular hypertrophy and increased wall thickness:lumen diameter ratio in blood vessels. 3. Prostanoids (PR), metabolites of arachidonic acid through the cyclooxygenase pathway, include vasoactive substances synthesized and released by the vessel walls. 4. The aim of the present study was to analyse, in Fru-treated rats: (i) the morphology of mesenteric vessels and; (ii) the PR production in aorta and mesenteric vessels, in order to assess whether these parameters are related with the haemodynamic alterations observed in this experimental model. 5. Blood pressure, glycaemia and triglyceridaemia, were significantly elevated in both (4 and 22 weeks) Fru-treated groups. Meanwhile body and heart weight as well as insulinaemia were similar between experimental animals and controls. 6. The mesenteric vessels of Fru-treated rats (22 weeks) showed an increased thickness and area of the media when compared with the controls; meanwhile, the lumen diameter was similar in both groups. 7. The Fru treatment for 4 weeks did not modify PR production in aorta, whereas in the mesenteric bed it diminished prostaglandin (PG) E(2) release significantly compared with the controls. However, in the group treated for 22 weeks, Fru reduced PGI(2) production in the aorta, as assessed by 6-keto-PGF(1)alpha measurements. Meanwhile, in the mesenteric bed, the chronic Fru treatment decreased PGE(2) release but, rather surprisingly, increased the output of PGI(2) when compared with its corresponding controls. 8. In conclusion, the present study shows the existence of an alteration in the morphology of mesenteric vessels in Fru-treated rats, which could be related to an increase in peripheral resistance and the consequent mild hypertension observed in this model. However, a diminished release of vasodilator PRs, such as PGE(2) in mesenteric vessels at 4 and 22 weeks and PGI(2) in aorta at 22 weeks could further impair the vessel response. The increase in PGI(2) observed in the chronic group in mesenteric vessels could be attributed to a compensatory mechanism.