[Publication in indexed journals is imperative for communication in contemporary medicine]. / La publicación en revistas indexadas es imperativa para la comunicación en la medicina contemporánea.

No Abstract available.

Pancreatoduodenectomía de urgencia. Revisión de 2 casos clínicos

Introducción: La pancreatoduodenectomía de urgencia (PDDU) es una cirugía reservada para lesiones graves pancreatoduodenales secundarias a trauma, lesiones inflamatorias o posterior a procedimientos endoscópicos. Objetivo: Describir dos casos clínicos en los que se realizó PDDU. Casos Clínicos: Se reportan 2 casos clínicos en los cuales se requirió una PDD. En el primer caso secundario a úlcera duodenal perforada que comprometía más del 50% del lumen asociado a biliperitoneo y fistula duodenal sin control; y en el segundo, a consecuencia de un trauma por herida de bala con perforación duodenal, íleon distal y desgarro de 1,5 cm en cabeza de páncreas. Discusión: En la actualidad no existe un consenso sobre las indicaciones de PPDU, sin embargo esta compleja cirugía representa una opción de tratamiento en pacientes bien seleccionados, cuando la cirugía de control de daños y los intentos de controlar la necrosis y fistulas duodenales han fracasado. Conclusión: El tratamiento de una lesión pancreática y duodenal compleja puede requerir PDDU. Sin embargo, en pacientes inestables se debe considerar una cirugía en dos tiempos por un equipo de cirujanos experimentados.

Introduction: Emergency pancreaticoduodenectomy (UPDD) is a surgery reserved for severe pancreaticoduodenal injuries secondary to trauma, inflammatory injuries or after endoscopic procedures. Aim: To describe two clinical cases in which PDDU was performed. Clinical Cases: 2 clinical cases are reported in which a PDDU was required. The first case was secondary to a perforated duodenal ulcer that compromised more than 50% of the lumen associated with biliperitoneum uncontrolled duodenal fistula; in the second one, as a consequence of a gunshot wound trauma with duodenal perforation, distal ileum and a 1.5 cm tear in the head of pancreas. Discussion: Currently there is no consensus on the indications for UPDD, however this complex surgery represents a treatment option in well-selected patients, when damage control surgery and attempts to control necrosis and duodenal fistulas have failed. Conclusión: Treatment of a complex pancreatic and duodenal injury may require pancreatoduodenectomy. However, in unstable patients, a two-stage surgery should be considered by an experienced surgical team.

Lutein and zeaxanthin content in corn imported from three countries of the American continent and in corn cultivated in Colombian territory / Conteúdo de luteína e zeaxantina em milho importado de três países do continente americano e em milho cultivado em território colombiano

Lutein and zeaxanthin are the major xanthophyll pigments found in corn kernels. These pigments provide the orange-red color of the broiler chicken skin and of the egg yolk. Therefore, knowing the corn xanthophyll content is important for the poultry feed producer. The objective of this study was to determine the lutein and the zeaxanthin content in corn cultivated in Colombia and in corn imported to Colombia from the United States, Argentina, and Brazil. Large differences in total lutein plus zeaxanthin content were found among the corn samples analyzed, with the highest mean level found in Colombian corn (2,758µg/100g), followed by Argentina (1,861µg/100g), United States (1,041µg/100g) and Brazil (947µg/100g). Large differences in lutein plus zeaxanthin content were also found among different corn hybrids cultivated in Colombia. Differences among geographical regions might be due to differences in UV-B radiation or in the light hours received by the crop during its growth. The differences among different corn hybrids might probably be due to genetic differences. Corn growers might be interested in cultivating hybrids higher in lutein and zeaxanthin as these pigments are very important in poultry production and human eye health.

Luteína e zeaxantina são os principais pigmentos xantofilas encontrados nos grãos de milho. Em aves, esses pigmentos naturais conferem a cor vermelho-alaranjada típica da pele do frango de corte e da gema do ovo. Assim, é importante conhecer o teor de xantofilas do milho utilizado nas dietas de aves. O objetivo deste estudo foi determinar o teor de luteína e zeaxantina em milho cultivado na Colômbia e em milho importado para a Colômbia dos Estados Unidos, da Argentina e do Brasil. Foram encontradas diferenças significativas no teor de luteína total mais zeaxantina entre as amostras de milho analisadas, com o nível médio mais elevado no milho colombiano (2.758µg/100g), seguido pelo milho argentino (1.861µg/100g), pelo milho dos Estados Unidos (1.041µg/100g) e pelo milho brasileiro (947µg/100g). Grandes diferenças no teor de luteína e zeaxantina também foram encontradas entre variados híbridos de milho cultivados na Colômbia. As diferenças entre as regiões geográficas podem ser devido a diferenças na radiação UV-B ou nas horas de luz recebida pela cultura durante seu crescimento. As diferenças entre os diversos híbridos de milho provavelmente podem ser devido a diferenças genéticas. Os produtores de milho podem estar interessados ​​em cultivar híbridos mais ricos em luteína e zeaxantina, pois esses pigmentos são muito importantes na produção de aves e na saúde ocular humana.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

[Lung transplant with ex vivo lung perfusion, Chilean and Latin American first experience]. / Trasplante pulmonar ex vivo . Primera experiencia en Chile y Latinoamérica.

BACKGROUND: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. AIM: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. MATERIAL AND METHODS: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. RESULTS: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). CONCLUSIONS: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Experiencia en trasplante pulmonar pediátrico en Chile / Experience with pediatric lung transplantation in Chile

El trasplante de pulmón (TP) es una opción para pacientes pediátricos con enfermedades pulmonares terminales. OBJETIVO: Evaluar resultados y sobrevida de pacientes pediátricos trasplantados de pulmón. MÉTODOS: Análisis retrospectivo de registros clínicos de pacientes TP ≤ 15 años de Clínica Las Condes. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post trasplante, complicaciones precoces y tardías y sobrevida. RESULTADOS: Nueve pacientes < 15 años de edad se han trasplantado. La edad promedio fue 12,7 años. La principal indicación fue fibrosis quística (7 pacientes). El IMC promedio fue de 17,6 y todos estaban con oxígeno domiciliario. El 77% utilizó soporte extracorpóreo intraoperatorio. Las principales complicaciones precoces fueron hemorragia y la disfunción primaria de injerto mientras que las tardías fueron principalmente las infecciones y la disfunción crónica de injerto. Cuatro pacientes han fallecido y la sobrevida a dos años fue de 85%. El trasplante les permitió una reinserción escolar y 3 lograron completar estudios universitarios. CONCLUSIÓN: El trasplante pulmonar es una alternativa para niños con enfermedades pulmonares avanzadas mejorando su sobrevida y calidad de vida.

Lung transplantation (TP) is a treatment option in children with terminal lung diseases. OBJECTIVE: To evaluate the results and survival of pediatrics lung transplant patients. METHODS: Retrospective analysis of clinical records of lung transplantation of patients ≤ 15 years from Clínica Las Condes, Santiago, Chile. Demographic data, type of transplant, baseline and post transplant lung function, early and late complications and survival rate were analyzed. RESULTS: Nine patients ≤ 15 years-old were transplanted. The average age at transplant was 12.7 years. The main indication was cystic fibrosis (7 patients). The average BMI was 17.6 and all the patients were with home oxygen therapy. 77% used extracorporeal intraoperative support. Average baseline FEV1 was 25.2% with progressive improvement in FEV1 of 77% in the first year. The main early complications were hemorrhage and primary graft dysfunction, while late complications were infections and chronic graft dysfunction. Four patients have died and the estimated 2 years survival was 85%. They achieved school reinsertion and three managed to complete university studies. CONCLUSION: Lung transplantation is an alternative for children with advanced lung diseases improving their survival and quality of life.

Trasplante pulmonar ex vivo: primera experiencia en Chile y Latinoamérica / Lung transplant with ex vivo lung perfusion, Chilean and Latin American first experience

Background: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. Aim: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. Material and Methods: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. Results: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). Conclusions: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.

[P300 cognitive event-related potentials in the diagnosis and classification of possible Alzheimer-type neurocognitive disorders]. / Potencial relacionado con eventos cognitivos P300 en el diagnóstico y clasificación del trastorno neurocognitivo debido a enfermedad de Alzheimer posible.

INTRODUCTION: The value of the P300 cognitive event-related potential in the diagnosis of Alzheimer subtype neurocognitive disorders is still incipient. Recent studies suggest that combining it with neuropsychological tests by cognitive domains would allow an objective and early characterisation of the cognitive impairment in its initial stages. AIMS: To characterise the electrophysiological patterns in the P300 potential that obtain a discriminatory value for the diagnosis and classification of the neurocognitive disorders with a possible Alzheimer-type aetiology. SUBJECTS AND METHODS: This study examines 39 patients classified, according to the DSM-5, with possible Alzheimer-type minor and major neurocognitive disorders, aged between 50 and 85 years, and 53 control subjects with normal cognitive functions. The P300 potential is registered in the auditory mode, oddball paradigm and centroparietal recording. RESULTS: P300 latency is significantly prolonged in subjects with neurocognitive disorder; there are significant differences in the mean values and confidence intervals between healthy controls and patients. No significant differences are obtained in P300 latency between groups with minor and major neurocognitive disorder. The mean amplitude value decreases in neurocognitive disorder, and the P300 amplitude logarithm of the control groups and those with minor and major neurocognitive disorder reaches significantly different mean values and confidence intervals. CONCLUSIONS: The parameters quantified in the P300 potential can be used as complementary biomarkers to classify the presence and level of cognitive dysfunction with a possible Alzheimer-type aetiology.

TITLE: Potencial relacionado con eventos cognitivos P300 en el diagnóstico y clasificación del trastorno neurocognitivo debido a enfermedad de Alzheimer posible.Introducción. El valor del potencial relacionado con eventos cognitivos P300 en el diagnóstico de los trastornos neurocognitivos subtipo Alzheimer es aún incipiente. Estudios recientes sugieren que su combinación con tests neuropsicológicos por dominios cognitivos permitiría caracterizar de forma objetiva y precoz el déficit cognitivo en sus etapas iniciales. Objetivo. Caracterizar los patrones electrofisiológicos en el potencial P300 que obtengan un valor discriminativo para el diagnóstico y clasificación de los trastornos neurocognitivos de etiología enfermedad de Alzheimer posible. Sujetos y métodos. Se estudia a 39 pacientes clasificados, según el DSM-5, con trastorno neurocognitivo menor y mayor debido a enfermedad de Alzheimer posible, en un rango de edad de 50-85 años, y a 53 sujetos control con funciones cognitivas normales. Se registra el potencial P300 en la modalidad auditiva, paradigma de oddball y registro centroparietal. Resultados. La latencia P300 se prolonga significativamente en los sujetos con trastorno neurocognitivo; sus valores medios e intervalos de confianza son significativamente diferentes entre los controles sanos y los pacientes. No se obtienen diferencias significativas de latencia P300 entre los grupos con trastorno neurocognitivo menor y mayor. El valor medio de amplitud disminuye en el trastorno neurocognitivo, y el logaritmo de amplitud P300 obtiene valores medios e intervalos de confianza significativamente diferentes entre los grupos control y con trastorno neurocognitivo menor y mayor. Conclusiones. Los parámetros cuantificados en el potencial P300 pueden utilizarse como biomarcadores complementarios clasificadores de la presencia y del nivel de la disfunción cognitiva de etiología enfermedad de Alzheimer posible.

Enfermedad de Creutzfeldt-Jakob de origen genético: serie de casos en la Patagonia Argentina / Creutzfeldt-Jakob syndrome of genetic origin: series of cases in the Argentinian Patagonia

La enfermedad de Creutzfeldt-Jakob (CJD) es un desorden neurodegenerativo poco frecuente con una incidencia estimada en 1 por cada 1.000.000 por año, típicamente caracterizado por demencia rápidamente progresiva, ataxia, mioclonus y cambios de comportamiento. Las enfermedades genéticas priónicas se desarrollan debido a mutaciones en el gen de proteína priónica PRNP. Entre el 10 y el 15% corresponden a formas familiares que se transmiten con patrón autosómico dominante con alta penetrancia. La mutación más frecuente a nivel mundial es la E200K (glutamato por lisina). Se reportan cuatro familias con CJD que fueron atendidas en el Hospital Provincial Neuquén en el año 2018. Tres de los cuatro casos índice tenían historia familiar de trastornos neurológicos y psiquiátricos pero estos datos no fueron jerarquizados en la evaluación inicial del caso. Se consideró la consulta genética por la edad temprana de presentación de la enfermedad. En todos los casos la consulta fue solicitada por el neurólogo. Los síntomas iniciales que presentaron los pacientes fueron insomnio pertinaz y depresión con pobre respuesta a la medicación psiquiátrica habitual. En todos los casos la progresión de la enfermedad fue rápida con desórdenes visuales, mioclonías, ataxia, demencia y pérdida del lenguaje. El análisis de los pedigrees permitió identificar ciento cuarenta personas que potencialmente podrían portar el gen y desarrollar la enfermedad en algún momento de la vida adulta. En todos los casos se identificó la mutación E200K. En la región existe una frecuencia aumentada de CJD. Debe ser investigada en los pacientes con síntomas neuropsiquiátricos e historia familiar sospechosa. Los estudios genéticos confirman el diagnóstico en los pacientes y permite identificarlos en individuos en etapa presintomática. Esto plantea un desafío para el asesoramiento genético familiar y para evitar la transmisión iatrogénica del trastorno.

Creutzfeldt-Jakob disease (CJD) is an uncommon neurodegenerative disorder with an incidence of 1 per 1,000,000 in humans per year, typically characterized by rapidly progressive dementia, ataxia, myoclonus and behavioral changes. Genetic prion diseases, which develop due to a mutation in the prion protein gene (PRNP), account for an estimated 10 to 15% of all CJD cases. Familial CJD is transmitted with an autosomal dominant inheritance pattern with high penetrance. Worldwide, the most common mutation is E200K (glutamate to lysine). We report four families with CJD assisted in Neuquén Hospital in 2018. Three of the four index cases had family history of neurological and psychiatric illness, though data was not taken into consideration at the moment of evaluation of the new cases. The most significant data recorded for a genetic consultation was when the problem had started, and it was required by a neurologist. The initial symptoms were persistent insomnia and depression with poor response to habitual psychiatric medication. Impoverishment is fast with visual disorder, myoclonias, ataxia, dementia and loss of language. Pedigree analysis allowed the identification of 144persons with the gene potential, who can develop the disease at any time in their adulthood. In all cases, mutation E200K was identified. There is a region of increased frequency of CJD. There must be suspicion on patients with neuropsychiatric symptoms and suspected family history(familiar background). Finding of the mutation confirms the diagnosis in patients and allows the identification on pre-symptomatic individuals. Challenge is posed on gene advice and to avoid iatrogenic disorder transmission.

Recombinant Mycobacterium bovis BCG is a promising platform to develop vaccines against Trypansoma cruzi infection.

Chagas disease, caused by the hemoflagelate parasite Trypanosoma cruzi, is one of the most prevalent endemic parasitoses, affecting 7-8 million people. Due to the complexity of the infection, no vaccines are available at present. The extraordinary adjuvant capacity of bacille Calmette-Guérin (BCG) was explored in this work to develop a vaccine candidate to protect against T. cruzi infection using the recombinant BCG (rBCG) vaccine platform. Three antigens of the parasite corresponding to the N and C terminal fragments of the enzyme trans-sialidase (NT-TS and CT-TS, respectively) and a fragment of the cruzipain enzyme (CZf) were cloned into the vectors pUS997 and pUS2000 and transformed into the BCG Pasteur strain. In vaccinated mice, rBCG expressing NT-TS in pUS2000 plasmid provided the highest protection and the lowest parasitemia after challenging BALB/c mice with a 50% lethal dose of parasites. When mice vaccinated with pUS2000-NT-TS were challenged with a 100% lethal dose of parasite, high levels of protection were also obtained, together with a low degree of cardiac lesions 120 days after infection. In immunized mice with pUS2000-NT-TS/rBCG clone, the proliferation of CD4+ cells from splenocytes stimulated with the TS antigen was significant; this stimulation increased interferon (IFN)-γ and interleukin (IL)-17 within CD4⁺ T lymphocytes (LTCD4+ ) cells and IFN-γ and CD107 expression within LTCD8+ cells. Therefore, pUS2000-NT-TS/rBCG conferred high levels of protection, which correlated with an immune response orientated towards a T helper type 1 (Th1)/Th17 profile, together with an LTC-specific response, indicating that rBCG is a promising platform to develop vaccines against T. cruzi.

Photoluminescence spectrum using DFT for double-walled carbon nanotubes with metallic constituents.

A theoretical study of the photoluminescence (PL) of double-walled carbon nanotubes (DWCNTs) using density functional theory (DFT) theory is reported in this work. The DWCNTs are of the armchair/armchair type and the structures studied have the arrangements (3,3)/(2,2), (8,8)/(4,4), (12,12)/(6,6), (16,16)/(8,8), (6,6)/(3,3), (10,10)/(5,5), (14,14)/(7,7), and (18,18)/(9,9). The PL spectra were obtained taking into account different DWCNT axial lengths ranging from 0.49 nm ≤ L ≤ 2.33 nm and their inner nanotube diameters in the range of 0.31 ≤ Dinn ≤ 1.22 nm; variations in their inter-wall separations were also considered, 0.18 ≤ Dinw ≤ 0.61 nm. Although the DWCNTs have metallic SWCNT constituents, such structures give rise to photoluminescence due mainly to both curvature effects and inter-wall interaction of the inner and outer nanotubes; these two factors modify significantly their electronic structure; besides, they also lead to these structures to exhibit the quenching effect. We realized calculations at a DFT level in which we used the generalized gradient approximation (GGA) to establish the molecular geometries and the fundamental state energies. To obtain the results of the PL spectra, the constituent SWCNTs were optimized in their ground state, with the hybrid function CAM-B3LYP, which is a mixed functional exchange and correlation, and the base set that was used is the 6-31G.

Liver Transplant From a Donor With Situs Inversus Totalis Using Orthotopic and Retroversus Technique: A Case Report.

Situs inversus totalis is an infrequent genetic malformation affecting 0.01% of the population and consists of the total rotation of the organs 180 degrees, generating the so-called mirror-image reversal. For many years donors with this pathology were discouraged from organ donation. We present a case of hepatic and renal transplantation using the 2 techniques described, orthotopic and retroversus. The recipient was a 69-year-old man with end-stage liver and kidney disease due to alcoholism and diabetes, respectively, and a Model for End-Stage Liver Disease score of 32. There was no mismatch between recipient and donor. The implant started with the piggy-back technique using the retroversus technique, generating a tense portal vein anastomosis due to the superior situation of the elements of the hepatic hilum, so it was decided to undo suprahepatic anastomosis with the orthotopic technique, rotating the liver on its axis, without complications. Roux-en-Y hepaticojejunoanastomosis was carried out. The patient was discharged 15 days after surgery with normalization of renal function. Although both techniques must be taken into account, the one that fits best for a particular recipient should be used, given the particularities of size and shape of the liver graft. This can take some art and creativity from the surgical team.

Frequency and levels of aflatoxin M1 in urine of children in Bogota, Colombia.

A study was conducted to investigate the frequency and levels of AFM1 and AFM2 in urine from children who attended the emergency service of a pediatric referral hospital in Bogota, Colombia. A survey on the consumption of foods likely to be a source of aflatoxins and on sociodemographic variables was conducted as well. The frequency of AFM1 in urine was found to be 41.7% with an average concentration in positive samples of 16 pg mL-1 ± 10.7 pg mL-1 (range > LOD-48.5 pg mL-1). The presence of AFM1 in the urine was related to the consumption of cereals likely to be contaminated with AFB1, especially corn and rice. No detectable levels of AFM2 were found in any sample. The results show that children's exposure to aflatoxins in Colombia is indeed a problem and should be one of the priorities of the health authorities. Continuous monitoring of aflatoxins in foods should be carried out, in compliance with Colombian regulations, using analytical methods that allow determination and quantification of aflatoxins in different biological and non-biological matrices at trace levels.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Identificación de estructuras de infección de Phytophthora palmivora en hojas de clones de palma de aceite Elaeis guinennsis Jacq / Identification of infection structures of Phytophthora palmivora in leaves of oil palm clones Elaeis guineensis Jacq

Este trabajo investigó el modelo de interacción planta-patógeno mediante discos de hojas de clones de palma de aceite inoculados en condiciones ex situ con un aislamiento de Phytophthora palmivora. Las inoculaciones se realizaron en condiciones controladas en cámara de crecimiento. En total, seis diferentes ortets fueron evaluados en seis tiempos de infección (2, 4, 6, 12, 24 y 48 horas postinfección, o hpi). Se determinó la presencia de estructuras de patogenicidad de P. palmivora como quiste, apresorio y tubos germinativos. Los quistes fueron identificados principalmente a las 2, 4 y 6 hpi. A partir de las 48 hpi no hubo presencia de zoosporas enquistadas para ningún ortet evaluado. En cuanto a los apresorios, estos se empezaron a desarrollar a las 4 horas de realizada la inoculación (siendo las 12 y 24 hpi los tiempos de mayor registro de estas estructuras). 121 Identificación de estructuras de infección de Phytophthora palmivora en hojas de clones de palma de aceite (Elaeis guineensis Jacq.) Méndez, K. et al. Introducción La Pudrición del cogollo (pc) es una de las principales enfermedades que afecta al cultivo de palma de aceite, destruyendo plantaciones desde 1964. En Colombia la enfermedad se presenta en las cuatro zonas palmeras y ha alcanzado proporciones epidémicas (Sarria et al., 2013a, 2016). A finales de 2004 en la Zona Suroccidental se registró un incremento en el número de casos, con un crecimiento exponencial de esta enfermedad, y a partir de 2007 se vieron afectadas más de 30.000 ha de cultivos de palma de aceite. En la Zona Central un comportamiento similar de la enfermedad fue registrado para la región de Puerto Wilches (Norte de Santander) entre 2009 y 2013, periodo en el cual se perdieron más de 40.000 ha como consecuencia de una epidemia de pc (Sanz, 2016). Por su parte, los productores de la Zona Norte actualmente hacen frente a la amenaza de una expansión epidémica de la pc con síntoma de hoja clorótica, la cual da cuenta de un estado avanzado de la enfermedad. Una amplia revisión del impacto de esta enfermedad desde sus inicios se encuentra en Benítez & García (2015), Sundram & Intan-Nur (2017) y Torres et al. (2016). La enfermedad de la Pudrición del cogollo es causada por el oomiceto hemibiótrofo P. palmivora (Sarria et al., 2008, 2013). Desde su identificación como agente causal de la pc en 2008, el Centro de Investigación en Palma de Aceite (Cenipalma) ha liderado diferentes investigaciones que han dado como resultado el desarrollo de estrategias de manejo integrado del cultivo de palma, así como la descripción del patógeno por medio de inoculación en condiciones in vitro en foliolos inmaduros de palma (Martínez et al., 2013, 2014a), entre otras. En cuanto a la presencia de esta enfermedad en otros cultivos, Mohamed-Azni et al. (2017) emplearon la técnica de foliolo inmaduro, logrando infectar foliolos de palma de aceite con P. palmivora aislada proveniente de cultivos de cacao y durián. Teniendo en cuenta que actualmente no se conocen fuentes probadas de resistencia de cultivares de Elaeis guineensis a la pc, y que un ciclo de mejoramiento genético de palma puede durar más de 25 años Por su parte, los tubos germinativos se encontraron a partir de las 48 hpi únicamente. Finalmente, se pudo establecer que el patógeno logra colonizar tejidos de foliolo no lignificados de clones de palma. Además, se encontró una relación entre el número de estructuras del patógeno con el comportamiento del cultivar de la palma donor (ramet)

Plant-pathogen model interaction was studied using leaf disks of oil palm clones inoculated ex situ with a Phytophthora palmivora isolate. The inoculation process was performed under growth chamber conditions. Six ortets were evaluated at six post-inoculation times (2, 4, 6, 12, 24 y 48 hours post infection, or hpi). Pathogen's infection structures as cyst, apressorium and germinative tubes were found. Cysts were identified mainly at 2, 4 and 6 hpi. After 48 hpi there were not any cysts for the evaluated ortets. The apresoria started to develop at 4 hpi, with the highest presence of these structures at 12 and 24 hpi. Germinative tubes were found only after 48 hpi. Therefore, it was established that the pathogen can colonize no-lignified tissue of oil palm clones. Finally, we found a relation between the pathogen's structures number and the response of the ortet related to its susceptibility and resistance response. Thus, it was found that the susceptible cultivar showed the highest number of germinative tubes

Vegetative propagation of Plukenetia polyadenia by cuttings: effects of leaf area and indole-3-butyric acid concentration / Propagação vegetativa de Plukenetia polyadenia por estacas: efeitos de área foliar e concentração de ácido indol-3-butírico

Abstract The seeds of Plukenetia polyadenia have high levels of unsaturated fatty acids and are used as medicine and food for native people in the Peruvian and Brazilian Amazon. The objective of this study was to develop a method for vegetative propagation of Plukenetia polyadenia by rooting of cuttings. The experiment was laid out in a randomized complete block design with 12 treatments and 3 replications of 8 cuttings, in a 3 × 4 factorial arrangement. The factors were: 3 levels of leaf area (25, 50 and 75%) and 3 indole-3-butyric acid - IBA concentrations (9.84, 19.68 and 29.52mM) and a control without IBA. Data were submitted to analysis of variance and means were compared by Tukey test at 5% probability. Our results show that the use of cuttings with 50% of leaf area and treatment with 29.52mM of IBA induced high percentages of rooting (93%) and the best root formation. Vegetative propagation of Plukenetia polyadenia by cuttings will be used as a tool to conserve and propagate germplasm in breeding programs.

Resumo As sementes de Plukenetia polyadenia têm altos níveis de ácidos graxos insaturados e são utilizadas como medicamentos e alimentos para as pessoas nativas da Amazônia Peruana e Brasileira. O objetivo do trabalho foi desenvolver um método de propagação vegetativa de Plukenetia polyadenia por meio do enraizamento de estacas em câmeras de sub-irrigação. Foi utilizado um delineamento de blocos ao acaso com 12 tratamentos e 3 repetições de 8 estacas, e esquema fatorial 3 × 4. Os fatores foram: 3 níveis de área foliar (25, 50 e 75%) e 3 doses de ácido indol-3-butírico - AIB (9,84; 19,68 e 29,52mM) e um controle sem AIB. Os dados foram submetidos à análise de variância e as médias foram comparadas pelo teste de Tukey a 5% de probabilidade. A maior taxa de enraizamento de estacas (93%) foi obtida com 29,52mM de AIB como indutor hormonal e estacas com área foliar de 50%. A propagação vegetativa de Plukenetia polyadenia por estacas será usada como ferramenta para conservar e propagar germoplasma em programas de melhoramento.

Vegetative propagation of Plukenetia polyadenia by cuttings: effects of leaf area and indole-3-butyric acid concentration.

The seeds of Plukenetia polyadenia have high levels of unsaturated fatty acids and are used as medicine and food for native people in the Peruvian and Brazilian Amazon. The objective of this study was to develop a method for vegetative propagation of Plukenetia polyadenia by rooting of cuttings. The experiment was laid out in a randomized complete block design with 12 treatments and 3 replications of 8 cuttings, in a 3 × 4 factorial arrangement. The factors were: 3 levels of leaf area (25, 50 and 75%) and 3 indole-3-butyric acid - IBA concentrations (9.84, 19.68 and 29.52mM) and a control without IBA. Data were submitted to analysis of variance and means were compared by Tukey test at 5% probability. Our results show that the use of cuttings with 50% of leaf area and treatment with 29.52mM of IBA induced high percentages of rooting (93%) and the best root formation. Vegetative propagation of Plukenetia polyadenia by cuttings will be used as a tool to conserve and propagate germplasm in breeding programs.