[Diagnosis and management in pediatric patients with ovarian masses]. / Diagnóstico y manejo de masas ováricas en pacientes pediátricas.

OBJECTIVE: Review of the diagnosis and management of ovarian masses in children, through the identification of preoperative risk factors of malignancy, the evaluation of surgical management and its results. METHODS: Retrospective study in pediatric patients under 18 years old, managed surgically by ovarian masses. Analyzed data were symptoms, imagining, tumor markers, treatment, outcomes and pathology. The primary endpoint was ovarian malignancy. RESULTS: We identified 54 patients with ovarian masses between 2014 and 2017, of which 49 were benign and 5 malignant; The malignant ovarian masses were significantly larger than the benign, with an average of 19.4 cm vs 6.49 cm (p = 0.0001); had greater solid component in the imaging and positive tumor markers (p = 0.001) and were treated with oophorectomy plus tumor staging surgery. Forty-three patients with benign tumors underwent ovarian preservation surgery. The postoperative follow-up of all the patients was on average 3.4 months (1-25 months) and 20.3% presented pelvic pain associated with alterations of the menstrual cycle in their postoperative control. There are no reports of recurrence or contralateral ovarian tumor. CONCLUSIONS: Large masses with solid components and positive tumor markers were significant predictors of malignancy. Minimally invasive ovarian preserving surgery should be considered as the first treatment option in masses with low risk of malignancy. On the other hand, oophorectomy plus tumor staging surgery should be considered for ovarian tumors with a high risk of malignancy.

OBJETIVO: Revisión del diagnóstico y manejo de las masas ováricas en población infantil, mediante la identificación de factores de riesgo preoperatorios de malignidad, la evaluación del manejo quirúrgico y sus resultados. METODOS: Estudio retrospectivo en pacientes pediátricas menores de 18 años, intervenidas quirúrgicamente por masas ováricas. Se analizaron datos como síntomas, imágenes diagnósticas, marcadores tumorales, tratamiento, resultados y patología. La variable principal fue malignidad ovárica. RESULTADOS: Se identificaron 54 pacientes con masas ováricas entre el año 2014 a 2017, de las cuales 49 fueron benignas y 5 malignas. Las masas ováricas malignas fueron significativamente más grandes que las benignas, con media de 19,4 cm vs 6,49 cm (p = 0,0001); tuvieron mayor componente sólido en los hallazgos imagenológicos y marcadores tumorales positivos (p = 0,001) y fueron tratadas con ooforectomía más cirugía de estadificación tumoral. A 43 pacientes con tumores benignos se les realizó cirugía preservadora de ovario. El seguimiento postoperatorio de todas las pacientes fue en promedio de 3,4 meses (1-25 meses) y el 20,3% presentaron dolor pélvico asociado a alteraciones del ciclo menstrual en su control postoperatorio. No hay reportes de recidiva ni tumor de ovario contralateral. CONCLUSIONES: Masas grandes, con componentes sólidos y marcadores tumorales positivos fueron predictores significativos de malignidad. La cirugía preservadora de ovario por vía mínimamente invasiva debe ser considerada como primera opción de tratamiento en masas con bajo riesgo de malignidad; Por otra parte, la ooforectomía más cirugía de estadificación tumoral, debe ser considerada para los tumores ováricos con alto riesgo de malignidad.

Estridor persistente / Persistent stridor

Stridor is a musical, often high-pitched sound produced by a rapid, turbulent flow of air through a narrowed segment of the large airways. The cause of stridor can be located anywhere in the extrathoracic airway (nose, pharynx, larynx, and trachea) or the intrathoracic airway (tracheobronchial tree). Stridor may be acute (caused by inflammation/infection or foreign body inhalation) or chronic. It may be congenital or acquired. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and need to be distinguished. Medical history and age of the child, together with physical examination, often allow a presumptive diagnosis. Further tests may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances

Estridor es un sonido musical, de alta frecuencia, generado por el paso de un flujo de aire turbulento en zonas con calibre disminuido de la vía aérea de mayor tamaño.La causa del estridor puede estar localizado en cualquier lugar de la vía aérea extratorácica (nariz, faringe, laringe y tráquea) o la vía aérea intratorácica (árbol traqueobronquial). El estridor puede ser agudo (causado por inflamación/infección o aspiración de cuerpos extraños) o crónica. Puede ser congénita o adquirida. Varios trastornos congénitos y adquiridos prevalecen en neonatos, lactantes, niños y adolescentes, y tienen que ser distinguidos. La historia clínica, edad del niño y examen físico a menudo permiten un diagnóstico presuntivo. Puede requerirse mayor estudio para establecer un diagnóstico definitivo, y la endoscopia flexible de la vía aérea es el procedimiento diagnóstico de elección en la mayoría de las circunstancias

Propagation of natural toad calls in a Mediterranean terrestrial environment.

Propagation patterns of animal acoustic signals provide insights into the evolution of signal design to convey signaler's information to potential recipients. However, propagation properties of vertebrate calls have been rarely studied using natural calls from individuals; instead playback calls broadcast through loudspeakers have been used extensively, a procedure that may involve acoustical and physical features differing from natural sounds. Measurements of the transmission characteristics of natural advertisement calls, which are simple tonal sounds, of the Iberian midwife toad, Alytes cisternasii, were carried out, and the results were compared with previously published results broadcasting recorded calls of the same species. Measurements of sound pressure level (SPL) of calls from individual male A. cisternasii revealed that the call amplitude decreases at distances of 1-8 m from the source at rates averaging 1-5 dB above spherical transmission loss in an omni-directional pattern. A comparison between SPLs of natural calls in the current study and of playback calls from a previous study showed that patterns of propagation did not differ in average values, but variance was significantly higher for natural calls. Results suggest that using broadcast signals for transmission experiments may result in a simplification of the conditions in which actual animals communicate in nature.

Inhibitory effect of mannan on the toxicity produced in mice fed aflatoxin B1 contaminated corn.

Aflatoxin B(1) (AFB(1)) is a potent mutagenic and carcinogenic agent found in numerous agricultural and dairy products consumed by humans. Therefore, we evaluated the capacity of mannan to cope with its genotoxic potential. We prepared a diet constituted of corn (90%) plus the recommended amount of other nutrients, as well as with the tested compounds (mannan and/or AFB(1)). Mice were fed this diet during 4 weeks as follows: one group with AFB(1)-contaminated corn (0.25 mg/kg of corn), three groups with mannan (50, 250, and 500 mg/kg of corn) plus AFB(1) (0.25 mg/kg), another group with only mannan (500 mg/kg), and the last group with an uncontaminated diet and no mannan added. We determined the weight, the micronucleated normochromatic erythrocyte rate (MNNE), the polychromatic/normochromatic index, and the sister chromatid exchange rate (SCE). We also examined the recovery response of mice during 4 additional weeks, when they were fed only the normal diet without AFB(1) or mannan. The results in the first period revealed the following: a) mice fed with mannan alone presented values in the range determined for the control group; b) mice fed AFB(1) had a significant weight decrease, as well as a significant increase in the rate of MNNE and SCE; and c) animals fed the combined regimen (AFB(1) plus mannan) presented a 25% weight increase with respect to the animals treated with AFB(1) alone, as well as a significant reduction in the level of MNNE and SCE with the two high doses tested. In the second (recovery) period, the control and the mannan fed groups maintained values similar to those exhibited in the previous phase, and the AFB(1) group as well as the groups fed the regimen combined with mannan showed an improvement in all evaluated parameters; the best response was that found in mice fed AFB(1) plus 500 mg/kg of mannan. Our study established an antigenotoxic effect of mannan that could be due to its adsorbent capacity.

Antigenotoxic effect of Saccharomyces cerevisiae on the damage produced in mice fed with aflatoxin B(1) contaminated corn.

The potential of Saccharomyces cerevisiae (Sc) was evaluated for reducing the micronucleated normochromatic erythrocytes (MNNE) rate in mice fed AFB(1) contaminated corn. The study included two groups fed AFB(1) contaminated corn (0.4 and 0.8 mg/kg), a control fed uncontaminated corn, another group fed uncontaminated corn and 0.3% of Sc (1 x 10(8) live cells/g), and two groups fed AFB(1) contaminated corn (0.4 and 0.8 mg/kg) plus 0.3% Sc. Weight and MNNE were determined weekly for six weeks. Subsequently, the same determinations were made for another three-week period, but in mice receiving only a normal diet, without AFB(1) and Sc. Results in the first period revealed the following: control and Sc fed mice had similar constant weight increase, and low MNNE rate; mice fed only AFB(1) showed weight decrease and significant MNNE increase; finally, Sc improved weight gain and reduced MNNE produced by AFB(1). In the second period, results exhibited a tendency similar to that of the previous phase in the control and Sc fed mice; the weight and MNNE values improved in the other groups. We also determined the capacity of Sc for adsorbing and modifying the mycotoxin structure. The mixture was filtered to obtain two phases, and AFB(1) content was measured. Sc revealed a potent adsorbent capacity; however, chromatographic determination suggested no structural modification.

[Validation of the cedars-sinai score in the prediction of rebleeding and mortality in non variceal upper gastrointestinal hemorrhage]. / Validación del puntaje de cedars-sinai en la predicción de resangrado y mortalidad en hemorragia digestiva alta no variceal.

INTRODUCTION: Upper gastrointestinal hemorrhage is a serious health problem with mortality rates that have remained unchanged for the last years in spite of improvements in management. OBJECTIVES: Validating the Cedars Sinai score for predicting rebleeding and mortality at the Arzobispo Loayza National Hospital. MATERIAL AND METHODS: Prospective longitudinal study in patients with upper gastrointestinal hemorrhage, collecting demographic, clinical and endoscopic data. The Cedars-Sinai score was applied in order to classify patients: low risk, medium risk and high risk. The final results were rebleeding and mortality. Calibration was done by X2, and the discrimination of the score was assessed by analysis of ROC curves. An area below the curve greater than 0.5 was considered good discrimination. RESULTS: We evaluated 143 patients, predominantly male (54.5%), the median age was 57.8. Melena (48.95%) and hematemesis (16.08) were the most frequent symptoms. Out of the total number of patients, 36.3% was taking some type of medication; NSAID's were taken by 55.7% and ACEI's by 25%. Associated comorbidity was found in 56.6%. The following diagnoses were made: gastric ulcer (32.15%), duodenal ulcer (30.75%), erosive hemorrhagic gastritis (20.3%), advanced gastric neoplasia (6.3%) and vascular lesions (4.9%). Rebleeding and mortality were 8.4% and 4.2%, respectively. The low risk group did not show any adverse events; the medium risk group, 7.25% and the high risk group, 13.2%. The areas under the curve were for rebleeding (0.79+/-0.13; p=0.01) and mortality (0.73+/-0.12; p=0.01) and considering both (0.66+/-0.12; p=0,034). CONCLUSIONS: This score is applicable in our environment and it is suitable for predicting rebleeding and mortality in patients with upper gastrointestinal hemorrhage, especially for mortality.

Validación del puntaje de Cedars-Sinai en la predicción de resangrado y mortalidad en la hemorragia digestiva alta no variceal / Validation of the score of Cedars-Sinai in the prediction of re-hemorrhage and mortality in the gigestive hemorrhage high nonvariceal

Introducción: La hemorragia digestiva alta es un serio problema de salud, con índices de mortalidad no modificados durante los últimos años, a pesar de mejoría en el manejo. Objetivo: Validar el puntaje de Cedars-Sinai, para predicción de resangrado y mortalidad en el Hospital Nacional Arzobispo Loayza. Material y Métodos: Estudio prospectivo longitudinal, en pacientes con hemorragia digestiva alta; recolectando datos demográficos, clínicos y endoscópicos. Se aplicó el puntaje de Cedars-Sinai para clasificar a los pacientes: de bajo riesgo, riesgo medio y riesgo alto. Los resultados finales considerados fueron resangrado y mortalidad. La calibración se efectuó mediante Chi cuadrado, y la discriminación de puntaje se evaluó por análisis de curvas operativas del receptor (ROC). Se consideró buena discriminación un área bajo la curva mayor de 0.5. Resultados: Se evaluaron 143 pacientes, predominando el sexo masculino (54.5 por ciento), la edad media fue 57.8 años. La melena (48.95 por ciento) y la hematemesis (16.08), fueron los síntomas más frecuentes. Del total, 36,3 por ciento tomaban algún medicamento; correspondiendo AINEs a 55.7 por ciento e Inhibidores de la enzima covertidora de la angiotensina (IECA), el 25 por ciento. El 56.6 por ciento presentó comorbilidad asociada. Se diagnosticó úlcera gástrica (32.15 por ciento), úlcera duodenal (30.75 por ciento), gastritis erosiva-hemorrágica (20.3 por ciento), neoplasia gástrica avanzada (6.3 por ciento) y lesiones vasculares (4.9 por ciento). El resangrado y la mortalidad fueron 8.4 por ciento y 4.2 por ciento, respectivamente. El grupo de bajo riesgo no presentó eventos adversos; el de riesgo medio 7.25 por ciento y el de riesgo elevado, 13.2 por ciento. Las áreas bajo la curva fueron para resangrado (0.79 más menos 0.13; p=0.01) y mortalidad (0.73 más menos 0.12; p=0.01) y considerando ambos (0.66 más menos 0.12; p=0,034). Conclusiones: Este puntaje es aplicable en nuestro medio; adecuado para...

Introduction: Upper gastrointestinal hemorrhage is a serious health problemwith mortality rates that have remained unchanged for the last years in spite ofimprovements in management. OBJECTIVES. Validating the Cedars Sinai score for predicting rebleeding and mortality at the Arzobispo Loayza National Hospital. MATERIAL AND METHODS. Prospective longitudinal study in patients with upper gastrointestinal hemorrhage, collecting demographic, clinical and endoscopie data. The Cedars-Sinai score was applied in order to classify patients: low risk, medium risk and high risk. The final results were rebleeding and mortality. Calibration was done by X2, and the discrimination of the score was assessed by analysis of ROC curves.An area below the curve greater than 0.5 was considered good discrimination.RESULTS: We evaluated 143 patients, predominantly male (54.5 percent), the median age was 57.8. Melena (48.95 percent) and hematemesis (16.08) were the most frequent symptoms.Out of the total number of patients, 36.3 percent was taking some type of medication; NSAID's were taken by 55.7 percent and ACEI's by 25 percent. Associated comorbidity was found in 56.6 percent. The following diagnoses were made: gastric ulcer (32.15 percent), duodenal ulcer (30.75 percent), erosive hemorrhagie gastritis (20.3 percent), advanced gastric neoplasia (6.3 percent) and vascular lesions (4.9 percent). Rebleeding and mortality were 8.4 percent and 4.2 percent, respectively. The low risk group did not show any adverse events; the medium risk group, 7.25 percent and the high risk group, 13.2 percent. The areas under the curve were for rebleeding (0.79:1:0.13;p=0.01) and mortality (0.73:1:0.12;p=0.01) and considering both (0.66:1:0.12; p=0,034). CONCLUSIONS. This score is applicable in our environment and it is suitable for predicting rebleeding and mortality in patients with upper gastrointestinal hemorrhage, especially for mortality.

[A novel immunization schedule for obtaining anti-LPS Haemophilus influenzae type b antibodies]. / Novedoso esquema de inmunización para la obtención de anticuerpos anti-LPS de Haemophilus influenzae tipo b.

A novel immunization schedule was tested to increase antibodies to Haemophilus influenzae type B in which a 0.5% formaldehyde-inactivated cellular antigen and a partially purified lipopolysacharid antigen obtained from a selective precipitation with organic solvents were combined as immunogens. High specificity and biological activity antibodies with titers up to 1:256 were obtained by counterinmunoelectrophoresis; they were purified through a selective precipitation with ammonium sulphate and an ion-exchange chromatography using a DEAE-Sapharose column. The method proposed in this paper facilitates the production of purified antibodies useful for the improvement of serological diagnosis and H. influenzae b strain serotyping techniques.

Latin american experience with two low-dose oral contraceptives containing 30 microg ethinylestradiol/75 microg gestodene and 20 microg ethinylestradiol/150 microg desogestrel.

The objective of this study was to compare cycle control, efficacy and tolerance of an oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel with a preparation containing 30 microg ethinylestradiol combined with 75 microg gestodene. This study involved 342 women and 4104 cycles use in Argentina, Brazil, Chile, and Mexico. Contraceptive efficacy was good with both formulations. Two pregnancies occurred in the desogestrel group but were not due to method failure. With respect to cycle control, the incidence of intermenstrual bleeding was higher during the first 3 cycles in the desogestrel group; it was significant (p <0.01) during the first 3 days of the cycle for a normal or heavy bleeding only in the Mexican group. Amenorrhea was not reported for any group, but the incidence of dysmenorrhea was significantly higher (p <0.01) in the Brazilian desogestrel group (13.8%) and was significantly lower (p <0.01) in the Mexican gestodene group (8.5%). Adverse events were similar in all the countries with headache, breast tension, and nausea, the most frequently reported symptoms. The range of mean increase in body weight varied from 0.2 kg in the Argentine group to 2.6 kg in the Chilean group (95% confidence limit, +/- 2.51) in the gestodene group, and 0.2 kg in the Argentine group to 2.5 kg in Brazilian group (95% confidence limit, +/- 2.36) in the desogestrel group. Fifteen women discontinued because of headache, but there were no significant differences between the groups regarding discontinuation for this and other medical or non-medical reasons. Both oral contraceptive preparations are reliable and well tolerated, and both have favorable effects on control cycle.

[Methods of pedicle hemostasis in laparoscopically-assisted vaginal hysterectomy (VAVH). Evaluation of results]. / Métodos para la hemostasia de pedículos en histerectomía vaginal asistida laparoscópicamente (LAVH). Evaluación de resultados.

The objective was to evaluate whether use of different techniques of hemostasia have effect on laparoscopically assisted vaginal hysterectomy (LAVH) morbidity. Was performed a review of 53 LAVH cases, parameters analyzed were type of hemostasia method and surgical complications. There were five patients with transoperative bleeding and two with incidental bladder lesion, that were managed successfully without complications. There were no significant differences between types of hemostasia with respect to transoperative bleeding. There were no mayor surgical complications in the studied patients. As conclusion LAVH allows patients a expedite recovery with low postoperative complications. All the methods used in this work to perform hemostasia in LAVH are safe and effective for patients with habitual hysterectomy indications.

Mesigyna once-a-month combined injectable contraceptive: experience in Latin America.

A phase III clinical study was carried out among 534 fertile Latin American women to evaluate cycle control, side effects, and contraceptive efficacy of a once-a-month combined injectable, Mesigyna, consisting of 50 mg norethisterone enanthate and 5 mg estradiol valerate. The pregnancy rate at 1 year was 0 per 100 woman-years for a total experience of 4688 woman-months. The overall discontinuation rate at one year was 17.9%. Discontinuation rate for bleeding problems was 5.1%. The Colombian women had a significant increase (p <0.001) in bleeding problems compared to other countries. The discontinuation rate for amenorrhea was 1.1%. There were no significant differences between the groups regarding discontinuation for other medical or non-medical reasons. Mean weight gain after one year of use was 1.02 kg. Mesigyna is an appropiate once-a-month injectable contraceptive for Latin American women since it is highly effective and its perception of normal menstrual bleeding is of importance in the Latin American population.

Cytokine expression is downregulated by collagen-polyvinylpyrrolidone in hypertrophic scars.

We evaluated the in situ expression of adhesion molecules (E-selectin and vascular cell-adhesion molecule) and proinflammatory/fibrogenic cytokines (IL-1beta, TNF-alpha, TGF-beta1, and PDGF) in sections of normal skin, hypertrophic scar, and hypertrophic scar previously treated with an irradiated mixture of collagen-polyvinylpyrrolidone and completely resolved. Expression of these proteins was detected by indirect immunoperoxidase staining. The hypertrophic scar group displayed an increased amount of IL-1beta, TNF-alpha, TGF-beta1, and PDGF compared with the normal skin and treated scar groups. Values were statistically significant when cytokines in hypertrophic scar and hypertrophic treated sections were compared. Surprisingly, no differences were detected between normal skin and treated scars. On the other hand, differences in levels of E-selectin and vascular cell-adhesion molecule were not statistically significant between the groups, except for vascular cell-adhesion molecule, which decreased in treated scars. Also, supernatants from fibroblast cultures derived from treated hypertrophic scar, showed a reduction in TGF-beta1 and PDGF expression, although apparently collagen synthesis was not affected. Based on previous data from clinical studies in human dermal fibrosis remodeling, and the results presented here, we suggest that collagen-polyvinylpyrrolidone modulates extracellular matrix turnover, mainly of collagen, because expression levels of IL-1beta, TNF-alpha, TGF-beta1, and PDGF were diminished. We infer that collagen-polyvinylpyrrolidone participation could also modify the inflammatory process observed in hypertrophic scarring, by diminishing the expression of adhesion molecules, as a consequence of lower levels of proinflammatory cytokines, mainly IL-1beta and TNF-alpha.

A clinical trial with halofantrine on patients with falciparum malaria in Colombia.

A total of 120 semi-immune adult male malaria patients from an area of multidrug-resistant Plasmodium falciparum malaria were hospitalized for 42 days in Medellin, Colombia (an area of no malaria transmission), and treated with halofantrine in a double-blind, randomized, prospective clinical trial according to five different treatment schedules. Each patient was assigned to one of the following halofantrine schedules: I, one dose of 1000 mg; II, three doses of 500 mg; III, two doses of 500 mg; IV, three doses of 250 mg; and V, one dose of 750 mg. Best results (75% cure rate) were obtained with schedule II, although there was no statistically significant difference compared with the other schedules. A total of 46 patients experienced recrudescent malaria. Drug levels in plasma 72 hours after beginning treatment showed no statistically significant difference between relapsing and cured patients. Side-effects (mainly gastrointestinal) were uncommon and mild. Cardiotoxicity was studied by electrocardiogram. A mean prolongation of 28.5 ms (6.6 +/- 6.3% increase from baseline) was observed in the Q-Tc interval on day 1 of the trial.

Genotoxicity of aflatoxin B1 and its ammonium derivatives.

Aflatoxin (AF) B1 is a main contaminant in diverse agricultural products. In an attempt to reduce this problem and the hazards to human health, an AFB1 inactivating system with ammonia has been developed. In this work we evaluated the efficiency of the system in mice using micronucleus (MN) and sister chromatid exchange (SCE) analysis. Four groups of animals were fed for 8 weeks with a special diet mainly composed of maize: (1) uncontaminated; (2) uncontaminated/inactivated; (3) contaminated/inactivated; and (4) contaminated. We evaluated MN at weekly intervals in peripheral blood, and in weeks 4 and 8 SCE frequencies were quantified in bone marrow cells. The results shows that animals fed with AFB1 contaminated/inactivated maize had a 45% lower level of induced cytogenetic damage than those animals fed with AFB1 contaminated but not inactivated maize. A residual amount of AFB1 after the inactivating treatment and reconversion back to AFB1 in the organism may account for the remaining increased levels of SCE and MN.