Teatro-pedagogía, una experiencia de construcción de paz en Antioquia, Colombia. Sus aportes a la salud mental / Teatro pedagogia, uma experiência de construção de paz na Antioquia, Colômbia. Seus aportes à saúde mental / Theater-pedagogy, a peacebuilding experience in Antioquia, Colombia. Its contributions to mental health

Resumen El estudio de la salud mental, en Colombia y en el mundo, ha sido enfocado desde una perspectiva morbicéntrica y conductual. Este trabajo presenta un estudio de caso que tuvo como objetivo comprender de qué manera el proceso de formación en teatro-pedagogía, como iniciativa de construcción de paz, puede aportar a la salud mental. A partir de la confluencia del teatro social, la pedagogía crítica y las experiencias de vida de los y las participantes, se realizó análisis documental, y categorización al diario de campo, entrevistas y grupos de discusión. Participaron personas involucradas en la formación y público asistente en los foros de las presentaciones teatrales. Se encontraron elementos sobre sanación, cuerpo, juego, movimiento y simbolización en relación con salud mental. Se espera que este sea un aporte a la democratización en salud mental en contextos de sufrimiento social. (AU)

Resumo O estudo da saúde mental na Colômbia e no mundo tem focado numa perspectiva morbicentrica e comportamental. Este trabalho apresenta um estudo de caso que teve como objetivo compreender de que maneira o processo de formação em teatro pedagogia, como iniciativa de construção de paz, pode contribuir à saúde mental. A partir da confluência do teatro social, a pedagogia crítica e as experiências de vida dos e das participantes, e mediante categorização, realizou-se análise documental, de diário de campo, entrevistas e grupos de discussão. Participaram pessoas envolvidas na formação e público assistente nos foros das apresentações teatrais. Foram encontrados elementos sobre cura, corpo, jogo, movimento e simbolização na relação com a saúde mental. Espera-se que este seja uma contribuição à democratização na saúde mental em contextos de sofrimento social. (AU)

Abstract Research on mental health in Colombia and worldwide has emphasized a morbicentric and behavioral perspective. This article reports a case study that aimed to understand how theater-pedagogy education, as an initiative to build peace, can contribute to mental health. Due to the confluence of social theater, critical pedagogy, and the life experiences of participants, documentary analysis was carried out. Data obtained from a field diary, interviews, and discussion groups was categorized. The participants got involved in the theater-pedagogy and attended forums of theatrical performances. Elements of healing, body, playing, movement, and symbolization concerning mental health were found. This work is expected to contribute to the democratization of mental health in contexts of social suffering. (AU)

Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City.

INTRODUCTION: Several reports have emerged describing the long-term consequences of COVID-19 and its effects on multiple systems. METHODS: As further research is needed, we conducted a longitudinal observational study to report the prevalence and associated risk factors of the long-term health consequences of COVID-19 by symptom clusters in patients discharged from the Temporary COVID-19 Hospital (TCH) in Mexico City. Self-reported clinical symptom data were collected via telephone calls over 90 days post-discharge. Among 4670 patients, we identified 45 symptoms across eight symptom clusters (neurological; mood disorders; systemic; respiratory; musculoskeletal; ear, nose, and throat; dermatological; and gastrointestinal). RESULTS: We observed that the neurological, dermatological, and mood disorder symptom clusters persisted in >30% of patients at 90 days post-discharge. Although most symptoms decreased in frequency between day 30 and 90, alopecia and the dermatological symptom cluster significantly increased (p < 0.00001). Women were more prone than men to develop long-term symptoms, and invasive mechanical ventilation also increased the frequency of symptoms at 30 days post-discharge. CONCLUSION: Overall, we observed that symptoms often persisted regardless of disease severity. We hope these findings will help promote public health strategies that ensure equity in the access to solutions focused on the long-term consequences of COVID-19.

Modelo de atención comunitario en salud mental desde el primer nivel de atención: caso: Unidad Docente Asistencial Canelones al Este, Barros Blancos, Uruguay / Community care model in mental health from the first level of care: case: Canelones al Este Teaching Assistance Unit, Barros Blancos, Uruguay

El presente proyecto de tesis se enmarca en la Maestría en Psicología de la Salud (Psicología Clínica y de la Salud, Especializaciones Psicología Clínica y Psicología de la Salud) de la Universidad Europea del Atlántico/Universidad Internacional Iberoamericana para la obtención del título de Magíster en Psicología de la Salud (Psicología Clínica y de la Salud). Se titula "Modelo de atención comunitario en Salud Mental desde el Primer Nivel de Atención. Caso: Unidad Docente Asistencial Canelones al Este. Barros Blancos, Uruguay". El objetivo general del proyecto es diseñar un modelo de atención comunitario en salud mental en la Unidad Docente Asistencial Canelones al Este del Primer Nivel de Atención, Barros Blancos, Uruguay entre 2018-2020. Para concretar dicho objetivo hemos adoptado una concepción de investigación cualitativa con una estrategia de estudio de caso, utilizando técnicas de recolección de datos tales como la entrevista y búsqueda documental. Los resultados de la investigación permiten conocer competencias formativas teórico/técnicas, criterios de intervención, dificultades, posicionamiento epistémico que transversaliza las prácticas, así como significaciones y sentidos de las experiencias para los/as profesionales intervinientes, estudiantes de residencia, entre otras posibles subcategorías. El modelo de atención comunitario en Salud Mental desde el Primer Nivel de Atención. Caso: Unidad Docente Asistencial Canelones al Este en su sede de la policlínica Salvador Allende se sustenta sobre la base formativa de la medicina familiar y comunitaria y, la psicología de la salud en un macro teórico conceptual de promoción de la salud mental, los derechos humanos y la comunidad. Esta experiencia además de integrar prácticas y saberes, genera instancias formativas necesarias para el cambio de paradigma de atención en salud mental. El modelo de atención comunitaria en salud mental tiene aplicación práctica como insumo para otras Unidades Docentes Asistenciales del Primer Nivel de Atención dependientes del Dpto. de Medicina Familiar y Comunitaria, así como para la implementación del Plan Nacional de Salud Mental de Uruguay en el marco de la Ley de Salud Mental. El modelo es una posibilidad concreta y real de trabajar las situaciones en salud psicológica/mental en el lugar donde las personas viven, atendiendo como determinantes sus marcos relacionales y su historia. El modelo de atención comunitario en salud mental estudiado aporta una alternativa moderna ajustada al siglo XXI, humanizada y, que integra los saberes de la psicología de la salud y, la medicina familiar y la comunidad.

Identification and Functional Testing of Novel Interacting Protein Partners for the Stress Sensors Wsc1p and Mid2p of Saccharomyces cerevisiae.

Wsc1p and Mid2p are transmembrane signaling proteins of cell wall stress in the budding yeast Saccharomyces cerevisiae When an environmental stress compromises cell wall integrity, they activate a cell response through the Cell Wall Integrity (CWI) pathway. Studies have shown that the cytoplasmic domain of Wsc1p initiates the CWI signaling cascade by interacting with Rom2p, a Rho1-GDP-GTP exchange factor. Binding of Rom2p to the cytoplasmic tail of Wsc1p requires dephosphorylation of specific serine residues but the mechanism by which the sensor is dephosphorylated and how it subsequently interacts with Rom2p remains unclear. We hypothesize that Wsc1p and Mid2p must be physically associated with interacting proteins other than Rom2p that facilitate its interaction and regulate the activation of CWI pathway. To address this, a cDNA plasmid library of yeast proteins was expressed in bait strains bearing membrane yeast two-hybrid (MYTH) reporter modules of Wsc1p and Mid2p, and their interacting preys were recovered and sequenced. 14 previously unreported interactors were confirmed for Wsc1p and 29 for Mid2p The interactors' functionality were assessed by cell growth assays and CWI pathway activation by western blot analysis of Slt2p/Mpk1p phosphorylation in null mutants of each interactor under defined stress conditions. The susceptibility of these strains to different stresses were tested against antifungal agents and chemicals. This study reports important novel protein interactions of Wsc1p and Mid2p that are associated with the cellular response to oxidative stress induced by Hydrogen Peroxide and cell wall stress induced by Caspofungin.

Traumatic Vascular Injury and its Management with Temporary Intravascular Shunts: A Puerto Rico Trauma Hospital's Experience.

OBJECTIVE: Temporary intravascular shunts (TIVSs) are commonly used as a damagecontrol procedure in trauma settings. Currently, there is scarce literature in the civilian field, and what there is is limited to large trauma centers with multiple resources. Therefore, we aimed to describe TIVS usage, and the outcomes of that usage, at Puerto Rico Trauma Hospital. MATERIALS AND METHODS: This is a case series conducted from 2009 to 2013 with 32 patients who suffered vascular trauma, of which 13 needed TIVSs. Data related to age, trauma mechanism, injured vessel, type of shunt, Glasgow Coma Scale, vital signs, and mortality were collected. The analysis was carried out using descriptive statistics. This protocol was approved by the IRB of the Medical Sciences Campus. RESULTS: The most frequent mechanism of injury was a gunshot (11/13; 84.6%). The most commonly injured vessel was the superficial femoral artery. Indwelling time ranged from 6 to 96 hours. Only 2 of the 13 (15.4%) patients with shunts reported thrombosis. Furthermore, we performed 4 (30.7% of the patients) prophylactic fasciotomies and 4 (30.7% of the patients) amputations; 4 of the 13 (30.7%) patients died from unrelated causes. CONCLUSION: Our results are consistent with those in the literature, which supports our contention that a TIVS can be an effective component of damage-control vascular surgery and can, in both military and civilian settings, aid in extremity amputation prevention. Furthermore, it has been established that a TIVS can be fashioned from any available hollow tube. However, further research is needed to evaluate the safety of an improvised catheter of this nature.

Tratamiento quirúrgico de una perforación radicular como complicación endodóntica Presentación de un caso / Surgical treatment of a radicular perforation as endodontic complication. Presentation of a case

Introducción: durante el tratamiento endodóntico existe la posibilidad de que ocurran accidentes y complicaciones por lo que el profesional debe tener el máximo cuidado y concentración, además de una sólida base de conocimientos y un buen manejo clínico durante el procedimiento endodóntico. Objetivo: determinar la efectividad del tratamiento quirúrgico de un falso conducto radicular en un diente con pronóstico desfavorable. Caso clínico: se presenta el caso de una paciente de 31 años de edad con antecedentes de necrosis pulpar en el 21, al cual se le realizó un tratamiento pulporradicular hace 3 años aproximadamente. Acude a consulta con un proceso fistuloso a nivel de tercio medio radicular de dicho diente y discromía de la corona. A los rayos X se observó presencia de falso conducto a nivel de tercio cervical radicular. Se realizó una técnica quirúrgica, obturación retrógrada del falso conducto con amalgama de plata y retratamiento del conducto principal. Luego se aplicó la técnica de peróxido de hidrógeno activado con calor combinado con perborato de sodio para la recromia, se obtuvieron resultados favorables. Conclusiones: la técnica aplicada ofrece ampliar el arsenal terapéutico del estomatólogo para la conservación de unidades dentarias destinadas a perderse por los criterios de tratamiento convencional(AU)

Introduction: during the endodontic treatment there is the possibility that accidents and complications occur so the professional must have the utmost care and concentration, as well as a solid base of knowledge and good clinical management during the endodontic procedure. Objective: to determine the effectiveness of the surgical treatment of a false root canal in a tooth with an unfavourable prognosis. Clinical case: we present the case of a 31-year-old patient with a history of pulpal necrosis in year 21, who underwent pulporradicular treatment approximately 3 years ago. The patient comes to consultation with a fistulous process at the level of the middle third of the tooth and crown dyschromia. X-rays showed the presence of a false duct at the level of the third cervical root. A surgical technique was performed, retrograde obturation of the false canal with silver amalgam and retreatment of the main canal. Then applied the technique of activated hydrogen peroxide with heat combined with sodium perborate for rejection, favourable results were obtained. Conclusions: the applied technique offers to extend the therapeutic arsenal of the stomatologist for the conservation of dental units destined to be lost by the criteria of conventional treatment(EU)

Uso de la amalgama dental en la población cubana / Use of dental amalgam in the Cuban population

Se realizó un estudio descriptivo transversal en 180 pacientes que acudieron a la consulta estomatológica del policlínico 13 de Marzo de Bayamo durante Diciembre 2016, con el objetivo de determinar la frecuencia del uso dela amalgama en la población cubana. La información primaria se obtuvo mediante: encuestas y exploración clínica. Se estudiaron las variables: grupos de edades, sexo, dientes presentes, restauraciones de amalgama y resina, tiempo de exposición a la restauración, durabilidad promedio, preferencia en cuanto al material restaurador, conocimiento del riesgo del uso de la amalgama e información por parte del personal de salud del tema. Se obtuvo como principales resultados que existe un promedio de más 22 dientes en la boca en la población estudiada, sin diferencia significativa entre ambos sexos; con una relación de 5:1 restaurado con amalgama y de 18:1 con resina. Además de un promedio de 14.56 años expuestos a la amalgama y 11.61 años de durabilidad. No existen grandes diferencias en cuanto a la preferencia y sólo el 10.56 por ciento conoce los riesgos de la exposición al mercurio. Se obtuvo como conclusiones que existe un alto promedio de dientes en la boca en la población en estudio, predominio de las restauraciones con amalgama de plata, con más de una década de durabilidad y de exposición a este material sin muestras de algún síntoma de intoxicación por mercurio. No existen grandes diferencias en cuanto a la preferencia y muy pocas personas conocen los riesgos de la exposición al mercurio(AU)

TERT promoter mutational screening as a tool to predict malignant behaviour in follicular thyroid tumours-three examples from the clinical routine.

Follicular thyroid adenomas (FTAs) and carcinomas (FTCs), collectively the most common thyroid neoplasms, constitute a significant clinical challenge since histological evidence of invasive behaviour is required for a malignant diagnosis. Small subsets of FTAs relapse as manifest malignant FTCs, indicating that histology is not always adequate to predict malignant potential. Lately, recurrent mutations in the promoter of the Telomerase reverse transcriptase (TERT) gene have been coupled to FTCs, whereas FTAs usually lack this aberrancy. We describe three patients with follicular thyroid tumours in which TERT promoter mutational screening was employed as part of the clinical work-up to pinpoint malignant potential. In two retrospective analyses of seemingly benign lesions, the detected mutations predicted future skeletal metastases, and in one prospective case, the mutational screening led to a different clinical management of the afflicted patient. We therefore consider TERT promoter mutational screening an adjunct tool of value in equivocal cases.

Evolutionary history of metastatic breast cancer reveals minimal seeding from axillary lymph nodes.

Metastatic breast cancers are still incurable. Characterizing the evolutionary landscape of these cancers, including the role of metastatic axillary lymph nodes (ALNs) in seeding distant organ metastasis, can provide a rational basis for effective treatments. Here, we have described the genomic analyses of the primary tumors and metastatic lesions from 99 samples obtained from 20 patients with breast cancer. Our evolutionary analyses revealed diverse spreading and seeding patterns that govern tumor progression. Although linear evolution to successive metastatic sites was common, parallel evolution from the primary tumor to multiple distant sites was also evident. Metastatic spreading was frequently coupled with polyclonal seeding, in which multiple metastatic subclones originated from the primary tumor and/or other distant metastases. Synchronous ALN metastasis, a well-established prognosticator of breast cancer, was not involved in seeding the distant metastasis, suggesting a hematogenous route for cancer dissemination. Clonal evolution coincided frequently with emerging driver alterations and evolving mutational processes, notably an increase in apolipoprotein B mRNA-editing enzyme, catalytic polypeptide-like-associated (APOBEC-associated) mutagenesis. Our data provide genomic evidence for a role of ALN metastasis in seeding distant organ metastasis and elucidate the evolving mutational landscape during cancer progression.

A Review of the Use of Fine-Needle Aspiration Biopsy of Mammary Tumors for Diagnosis and Research.

The article "Aspiration Biopsy of Mammary Tumors in Diagnosis and Research - A Critical Review of 2,200 Cases" by Zajicek et al. [Acta Cytol 1967;11:169-175] is composed of two separate parts as can be seen from the title. Both are, however, of great historical interest. The first describes the early days of fine-needle aspiration cytology diagnosis of breast lesions in particular carcinomas. The results are still impressive with a diagnostic accuracy close to 90%. The second deals with the effect of negative pressure on cell viability during the aspiration procedure. These studies were aimed at evaluating the usefulness of aspirated tumor cells to analyze the effects of therapy and the origin of tumor cells.

Amputación radicular como complemento del tratamiento endodóntico. Presentación de un caso / Radicular amputation as a complement of endodontic treatment. Presentation of a case

Introducción: los recientes avances tecnológicos en el tratamiento endodóntico han permitido conservar dientes que antes se consideraban como intratables. Sin embargo, tanto la tecnología como los instrumentos y los materiales no deben considerarse como reemplazo de la habilidad clínica y la experiencia del profesional. Objetivo: determinar la efectividad de la amputación radicular como complemento del tratamiento endodóntico. Presentación de caso: se describe el caso clínico de una paciente de 13 años de edad con antecedentes de absceso periapical agudo en 46, para el cual había recibido tratamiento con amoxicilina 500 mg, acceso cameral y extirpación de la pulpa necrótica en cuerpo de guardia. Acudió a nuestros servicios para realizarse un tratamiento pulporradicular en dicho molar. A los rayos X se observó cavidad extensa, zona periapical radiolúcida en el periápice de la raíz mesial que fue diagnosticado como un absceso dentoalveolar crónico, además de una reabsorción radicular externa. Discusión: debido a la evolución poco favorable de los conductos mesiales y a la presencia de una perforación, se decidió realizar la amputación de la raíz mesial con el fin de preservar el diente, además de la obturación con conos de gutapercha del conducto distal. Conclusiones: la paciente evolucionó satisfactoriamente, se le realizaron chequeos clínicos y radiográficos al mes, 3 meses y 6 meses donde se corroboró una respuesta positiva al tratamiento(AU)

Introduction: recent technological advances in endodontic treatment have allowed the preservation of teeth that were previously considered intractable. However, both technology and instruments and materials should not be considered as a replacement for clinical skill and professional experience. Objective: to determine the effectiveness of root amputation as a complement to endodontic treatment. Case report: we report a case of a 13-year-old female patient with a history of acute periapical abscess in 46, for whom she received treatment with amoxicillin 500 mg, chambered access and excision of the necrotic pulp in the duty. She went to our services to perform a pulporradicular treatment in this molar. At the X-ray, an extensive cavity was observed, a radiolucent periapical zone in the mesial periapical root that was diagnosed as a chronic dentoalveolar abscess, in addition to an external root resorption. Discussion: due to the poor evolution of the mesial ducts and the presence of a perforation, it was decided to amputate the mesial root in order to preserve the tooth, in addition to the obturation with guttapercha cones of the distal canal. Conclusions: the patient has developed satisfactorily, clinical and radiographic check-up shave been performed at the month, 3 months and 6 months where a positive response to treatment has been corroborated(EU)

Hernia de spiegel. Nuestra experiencia / Spigelian hernia. Our experience

Introducción: La Hernia de Spiegel es una afección parietal rara de la pared abdominal, unilocular, que se localiza en el borde externo de la línea semilunar. La mayoría de las veces se encuentra ubicada bajo el músculo oblicuo mayor y corresponde a una hernia intersticial; por lo que puede pasar desapercibida. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de la hernia de Spiegel. Pacientes y método: estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de Hernia de Spiegel, tratados en la II Cátedra Clínica Quirúrgica, en el período de tiempo comprendido desde marzo 1998 a diciembre 2015. Resultados :n 14, fueron del sexo femenino 8 pacientes y 6 del masculino, el promedio de edad 57,4(±50-85). El motivo de consulta: dolor abdominal de tipo difuso, acompañado de una tumoración ventro lateral, reductible. En 10 casos la tumoración se localizó en el lado derecho y en 4 en el lado izquierdo.La sospecha clínica fue confirmada por la ecografía en 8 casos y la tomografía axial computarizada en los 6 restantes, la forma de presentación de 2 casos fue como oclusión intestinal y operados de urgencia y las demás electivas - ambulatorias. En todos los casos se realizó reparación de la pared sin tensión con malla de polipropileno, en 3 pacientes se colocó plug y en 11 pacientes se realizó refuerzo de la fascia del oblicuo mayor sublay, con el mismo material. No tuvimos complicaciones ni recidivas a los 24 meses. Conclusión: El diagnóstico de la hernia de Spiegel no resulta sencillo, debe acompañarse en todos los casos de un estudio de imagen. La técnica quirúrgica sin tensión, colocación de malla sublay, es una opción por sus resultados satisfactorios.

Introducción: Spigelian Hernia is a rare abdominal wall disease, often localizated in semilunar line. Most of the time it appeas under external oblique muscle, because of that, sometimes the diagnosis can be difficult. Objective: To describe the experience in the diagnosis and treatment of Spigelian Hernia. Patient and methods: An observational, retrospective study of patients with Spigelian Hernia, at the Second Service of Surgery, between March of 1998 to December of 2015. Results: 14 patients were diagnosed of Spigelian Hernia, 8 women and 6 men, with an average age of 57 years (±50-85). The main reason from consultation was abdominal pain with a lateral abdominal tumor. Clinical suspicious was confirm by ultrasonography in 8 cases and CT scan revealed the other 6. Surgical treatment in all cases was performed without tension using a polipropilene mesh; in 3 of them they use a plug and in the other 11 a sublay mesh to reinforce the external oblique fascia. They don´t have any complications. Conclusion: The diagnosis of Spigelian Hernia is not simple, is important to attach a image study. A tension free surgical technique, a sublaymesh, are options to have success.

Digital image analysis outperforms manual biomarker assessment in breast cancer.

In the spectrum of breast cancers, categorization according to the four gene expression-based subtypes 'Luminal A,' 'Luminal B,' 'HER2-enriched,' and 'Basal-like' is the method of choice for prognostic and predictive value. As gene expression assays are not yet universally available, routine immunohistochemical stains act as surrogate markers for these subtypes. Thus, congruence of surrogate markers and gene expression tests is of utmost importance. In this study, 3 cohorts of primary breast cancer specimens (total n=436) with up to 28 years of survival data were scored for Ki67, ER, PR, and HER2 status manually and by digital image analysis (DIA). The results were then compared for sensitivity and specificity for the Luminal B subtype, concordance to PAM50 assays in subtype classification and prognostic power. The DIA system used was the Visiopharm Integrator System. DIA outperformed manual scoring in terms of sensitivity and specificity for the Luminal B subtype, widely considered the most challenging distinction in surrogate subclassification, and produced slightly better concordance and Cohen's κ agreement with PAM50 gene expression assays. Manual biomarker scores and DIA essentially matched each other for Cox regression hazard ratios for all-cause mortality. When the Nottingham combined histologic grade (Elston-Ellis) was used as a prognostic surrogate, stronger Spearman's rank-order correlations were produced by DIA. Prognostic value of Ki67 scores in terms of likelihood ratio χ(2) (LR χ(2)) was higher for DIA that also added significantly more prognostic information to the manual scores (LR-Δχ(2)). In conclusion, the system for DIA evaluated here was in most aspects a superior alternative to manual biomarker scoring. It also has the potential to reduce time consumption for pathologists, as many of the steps in the workflow are either automatic or feasible to manage without pathological expertise.

Frecuencia de diverticulo de Meckel en el diagnostico preoperatorio de la apendicitis aguda / Frequency of Meckel diverticulum in the pre-operative diagnosis of acute appendicitis

Introducción: La incidencia del Divertículo de Meckel es del 1-3% en la población general. Presentan complicaciones como hemorragia, perforación u obstrucción intestinal que en ocasiones simulan una apendicitis aguda. Objetivo: Determinar la frecuencia de esta enfermedad, en pacientes con diagnóstico pre-operatorio de apendicitis aguda, así como el tratamiento y morbimortalidad. Diseño: Estudio descriptivo, retrospectivo y observacional. Pacientes y metodo: Se revisaron 1552 fichas, de pacientes con diagnóstico pre-operatorio de apendicitis aguda, de las que se analizaron 14 casos de Divertículo de Meckel , que fueron el hallazgo quirúrgico, de marzo 2000 a febrero 2015. Resultados: n: 14 pacientes. Fueron del sexo masculino 13 pacientes y del femenino 1. La edad promedio de 27 años. El tiempo de evolución en promedio fue de 14,5 hs (5-24hs), el motivo de consulta fue el dolor abdominal, en todos los casos, los síntomas fueron el dolor en fosa ilíaca derecha y vómitos. Todos presentaron leucocitosis, en la intervención quirúrgica se constató perforación del divertículo en 8 casos, se realizó resección y anastomosis ileal termino-terminal, en 6 casos diverticulectomía. Se realizó la apendicectomía incidental en todos los pacientes. El estudio anatomopatológico informó divertículo de Meckel con áreas de mucosa gástrica heterotrópica. Tuvimos como complicación: 2 infecciones del sitio quirúrgico, una de ellas con evisceración grado I. El tiempo de internación estuvo comprendido entre 6 y 8 días. No tuvimos óbitos. Conclusiones: El Divertículo de Meckel presentó una frecuencia de 0,9%, de pacientes con diagnóstico pre - operatorio de apendicitis aguda, el tratamiento fué quirúrgico en todos los casos y la morbilidad del 14%.

Introduction: The incidence of Meckel’s diverticulum is 1-3% in the general population. There are complications such as hemorrhage, perforation or intestinal obstruction that sometimes simulate acute appendicitis. Objective: To determine the frequency of this disease, in patients with pre-operative diagnosis of acute appendicitis, as well mortality and morbidity. Design: Descriptive, retrospective and observational. Patients and method study: revised 1552 chips, of patients with a pre-operative diagnosis of acute appendicitis, of which analyzed is 14 cases of Meckel’s Diverticulum, which were the surgical finding, from March 2000 to February 2015. Results: n: 14 patients. 13 patients were male and female 1. The average age of 27 years. The time evolution in average was 14.5 hours (5-24 hs), the reason for consultation was abdominal pain, in all cases, the symptoms were pain in the right iliac fossa, and vomiting. All showed Leukocytosis, in surgery it was found in 8 cases diverticulum perforation, resection and end-terminal ileal anastomosis, in 6 cases Meckel. Incidental appendectomy was performed in all patients. The anatomopathologic study reported Meckel’s diverticulum with heterotropica gastric mucosa areas. We had as a complication: 2 infections in the surgical site, one with evisceration grade I. The time of internment was comprised between 6 and 8 days. We had no deaths. Conclusions: Meckel’s diverticulum presented a frequency of 0,9%, of patients with diagnostic pre - surgery for acute appendicitis, the treatment was surgical in all cases and morbidity of 14%.

Nódulo tiroideo como primer signo de progresión de carcinoma de cervix uterino / Thyroid nodule as a first sign of progression in uterine cervical carcinoma

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Técnica de separación de componentes con refuerzo de malla de polipropileno para el tratamiento de afecciones parietales complejas. Nuestra experiencia / Technique for separation of components with reinforcement of polypropylene mesh for the treatment of complex parietal conditions. Our experience

Introducción: la técnica de separación de componentes o técnica de Ramírez, consiste en la separación de los componentes anatómicos de la pared abdominal anterior, consiguiendo avances de 4 a 6 cm de cada lado de los bordes del defecto con un cierre de menor tensión en el tratamiento de afecciones parietales complejas. Objetivo: valorar los resultados del tratamiento de afecciones parietales complejas con la técnica de separación de componentes con refuerzo de malla de polipropileno. Material y métodos: estudio observacional, descriptivo, prospectivo, longitudinal de pacientes operados de forma electiva, portadores de afección parietal compleja, utilizando la Técnica de Separación de Componentes con refuerzo de malla de polipropileno, en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas, Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, en mayo del 2010 a febrero del 2014...

Introduction: the technique of separation of components or technique of ramirez, in the separation of the anatomical components of the anterior abdominal wall, getting advances from 4 to 6 cm on each side of the edges of the defect with a lower tension locks in the treatment of complex wall conditions. Objective: to evaluate the results of complex parietal conditions with the technique of separation of components with polypropylene mesh reinforcement. Patients and methods: observational, descriptive, prospective, longitudinal in patients Electively, carriers of parietal complex condition, using the technique of separation of Componemtes reinforced polypropylene mesh, at the II Department of surgical clinic of the Hospital de Clínicas, Faculty of medical sciences of the National University of Asunción, in May 2010 to February of 2014...

Overexpression of proCOL11A1 as a stromal marker of breast cancer.

BACKGROUND: Our previous studies demonstrated the expression of procollagen11A1 in fibroblasts of pancreatic cancer desmoplasia and the lack of expression in fibroblasts of pancreatitis by means of the polyclonal antibody (anti-proCOL11A1 pAb) we generated. In a similar way, we decided to compare the expression of procollagen11A1 in fibroblasts of infiltrating ductal carcinoma of the breast and fibroblasts of benign sclerosing lesions of the breast, in order to validate the anti-proCOL11A1 pAb in this setting and to study how proCOL11A1 expression relates to other prognostic and predictive factors, as well as to survival. METHODS: 45 core biopsies of sclerosing adenosis and 50 core biopsies of infiltrating ductal carcinoma of the breast were stained with anti-proCOL11A1 pAb, a polyclonal antibody highly specific to the less homologous fraction of proCOL11A1 (in comparison with proCOL5A1 and proCOL11A2). In addition, the expression of the proCOL11A1 gene was measured by RT-qPCR. On the other hand, the expression of proCOL11A1 was compared to the expression of estrogenic receptors, progestagen receptors, the state of the epidermal growth factor receptor 2 (HER2), the histologic grade and the stage of the disease. We also compared the immunohistochemical expression of proCol11A1 to the disease-free interval, and to overall survival. RESULTS: The immunohistochemical analysis showed that proCOL11A1 was expressed in 100% of infiltrating ductal carcinomas, but only focally expressed in 2.2% (1 case) of sclerosing adenosis, in agreement with RT-qPCR results. ProCOL11A1 expression did not prove to have a prognostic value in relation to the disease-free interval or to overall survival in infiltrating ductal carcinoma. CONCLUSION: The anti-proCOL11A1 pAb is a stromal marker for breast cancer and the expression of proCOL11A1 does not seem to have a prognostic value in infiltrating ductal carcinoma of the breast.

Manejo de las úlceras pépticas perforadas. Años 2005 a 2013 / Management of ulcers peptic perforated. Years 2005-2013

La perforación de úlceras pépticas se presenta del 1 al 6% de los pacientes ulcerosos, infrecuente, pero representa una complicación grave con morbi-mortalidad elevada. Objetivo: Determinar la frecuencia de úlcera péptica perforada (UPP) en los abdómenes agudos, factores predisponentes, tratamiento, morbilidad y mortalidad. Pacientes y método: Trabajo descriptivo, retrospectivo, observacional de pacientes que consultaron en urgencias, con diagnóstico de UPP en la IICCQ; marzo-2005 a diciembre-2013. Resultados: Ingresaron 308 pacientes con abdomen agudo quirúrgico, 30 (9,7%) con diagnóstico de UPP; 27 varones y 3 mujeres, edad promedio 54 (26-82 años). Tiempo de evolución en promedio de 14hs (4-72hs). Los síntomas predominantes fueron: dolor abdominal, náuseas y vómitos. Factores predisponentes: consumo de AINES, etilismo y tabaquismo. El diagnóstico se realizó por clínica, radiografía de tórax (neumoperitoneo) y en algunos casos de manera intraoperatoria. El tratamiento quirúrgico consistió en sutura primaria y epiploplastia en 27 casos; 2 casos, antrectomía y gastro-yeyunoanastomosis en Y de Roux y 1 caso, resección en cuña de la úlcera y sutura primaria. La localización de la úlcera fue: 13 casos en región prepilórica; 7 en antro; 4 en píloro; 3 en primera porción duodenal y 3 en cuerpo gástrico. El tamaño de la misma fue entre 0,5-4 cm de diámetro. Complicaciones registradas: 3 casos de atelectasia; 3 de neumonía intrahospitalaria; 3 de infección de herida operatoria, 1 de inestabilidad hemodinámica; 1 laceración hepática; 2 evisceraciones; 1 fístula enterocutánea y 2 de infección de vías urinarias. La mortalidad fue de 6,6%, (2 casos); uno por sepsis de origen abdominal y otro por hemorragia digestiva alta masiva.La UPP corresponde a un cuadro grave. El tratamiento quirúrgico es la terapia de elección para el episodio agudo. A pesar de la gravedad, no registramos mortalidad elevada con respecto a otras series.

Perforation of peptic ulcers occurs from 1 to 6% of the ulcer, rarely, but represents a serious complication with high morbidity and mortality. Objective: To determine the frequency of perforated peptic ulcer (PPU) in acute abdomens, predisposing factors, treatment, morbidity and mortality. Patients and Methods: Research descriptive, retrospective and observational, at the emergency room with patients diagnosed with UPP in IICCQ; Mar-2005 to December-2013. Results: 308 patients were admitted with acute abdomen, 30 (9.7%) diagnosed with UPP; 27 men and 3 women, mean age 54 (26-82 years). Time evolution of average 14hs (4-72hs). The predominant symptoms were abdominal pain, nausea and vomiting. Predisposing factors: NSAID, alcohol consumption and smoking. The diagnosis was made by clinical, chest radiography (pneumoperitoneum) and in some cases intraoperatively. Surgical treatment consisted of primary suture and epiploplasty in 27 cases; 2 cases, gastroyeyunoanastomosis antrectomy and Roux-Y and 1 case, wedge resection of the ulcer and primary suture. The location of the ulcer was: 13 cases in prepyloric region; 7 in the antrum; 4 in pylorus; 3 in the first duodenal portion and 3 in the gastric body. Same size was between 0.5-4 cm in diameter. Complications recorded 3 cases of atelectasis; 3 of nosocomial pneumonia; 3 of wound infection, 1 of hemodynamic instability; 1 liver laceration; 2 evisceration; 1 3 enterocutaneous fistula and 2 urinary tract infection. The mortality was 6.6% (2 cases); one abdominal sepsis and another massive upper gastrointestinal bleeding. The UPP is for a severe case. Surgical treatment is the therapy of choice for acute episode. Despite the seriousness, not checking high mortality compared with other series.