Retorno laboral en pacientes con lesión medular traumática en un centro hospitalario de México / Return to work in patients with traumatic spinal cord injury in a medical center in Mexico

Antecedentes y objetivo El regreso a un empleo remunerado es uno de los resultados más importantes en cuanto a reintegración social después de una lesión medular traumática y un indicador de éxito de los programas de rehabilitación; a pesar del impacto que tiene, muy pocos estudios en México se han enfocado en medir la reintegración comunitaria de estos pacientes. El objetivo es analizar la situación laboral de los pacientes con medular traumática atendidos en un centro hospitalario en México. Materiales y métodos Estudio descriptivo-transversal. Pacientes trabajadores de 19-55 años con diagnóstico de lesión medular traumática atendidos en un centro hospitalario en México a los cuales se les realizó una encuesta telefónica. Resultados Se incluyeron 18 pacientes (15 hombres, 3 mujeres), con una edad promedio de 38 años (± 10,3). Los niveles de lesión más comunes fueron cervical y torácico; los grados de escala de Asia Impairment Scale más comunes fueron A y E; 17 pacientes recibieron rehabilitación al egreso; la escala Spinal Cord Independence Measure promedio fue de 65,22 (± 35,11). Cinco pacientes fueron recontratados después de la lesión (27,7%), en un periodo medio de tiempo de 7 meses (± 2,9). Principales factores relacionados a la reintegración laboral: edad joven, niveles más bajos de la lesión, ingreso a un programa de rehabilitación, alta puntuación en la escala Spinal Cord Independence Measure y estado civil casado o en unión libre. Conclusiones Este trabajo demuestra la poca reinserción laboral después de una lesión medular traumática, así como los factores que influyen para la misma, destacando la importancia de un programa adecuado de rehabilitación con un enfoque multidisciplinario (AU)

Background and objective One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. Material and methods Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. Results Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. Conclusion This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach (AU)

Clinical characteristics of vulnerable populations hospitalized and diagnosed with COVID-19 in Buenos Aires, Argentina.

There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.

[Return to work in patients with traumatic spinal cord injury in a medical center in Mexico]. / Retorno laboral en pacientes con lesión medular traumática en un centro hospitalario de México.

BACKGROUND AND OBJECTIVE: One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. MATERIAL AND METHODS: Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. RESULTS: Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. CONCLUSION: This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach.

Reducción de masa libre de grasa en nadadores después de un periodo de entrenamiento / Reduction of Fat-Free Mass in Swimmers after Training Period

En los deportistas la masa libre de grasa (MLG) es una característica física que se busca incrementar para aumentar el rendimiento deportivo. El objetivo de este estudio fue determinar si la reducción de la MLG, expresada como índice AKS, se asocia a alteraciones fisiológicas después de un periodo de entrenamiento en nadadores de 8 a 15 años de edad. Se estudiaron 42 nadadores, después de 15 semanas de entrenamiento se formaron 2 grupos, los que disminuyeron (A) y aumentaron (B) MLG. Se encontró que el grupo A redujo el peso y la masa muscular mientras que en el grupo B aumentó. En el grupo A se observó una disminución en los linfocitos, un aumento en la urea sérica, una disminución en el VO2 y en la recuperación a un minuto. La reducción de la MLG se asoció con alteraciones fisiológicas que reducen el rendimiento deportivo

An increase in fat-free mass (FFM) improves athletic performance. The aim of this study was to determine if a decrease in the FFM, expressed as the AKS index, is associated with physiological alterations after a training period in swimmers between 8-15 years old. Forty-two swimmers participated in this study, after 15 weeks of training the swimmers were divided into two groups, those who decreased (A) and those who increased FFM (B). In group A there was a decrease in both, body weight and muscle mass, while in group B there was an increase in body weight. We found that group A showed a reduction in lymphocytes count, in addition to an increase in serum urea, a decrease in VO2, and a decrease in their 1 min recovery. We showed here that a reduction in FFM is positively associated with physiological alterations that reduce athletic performance

Use of autologous dermal flap as mesh coverage in the treatment of large abdominal-wall defect in patients following massive weight loss: presentation of a novel surgical technique.

PURPOSE: Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh. METHOD: All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD). RESULTS: Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months. CONCLUSION: Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible.

Actualidad para el diagnóstico del carcinoma ductal in situ: correlación radiopatológica / Current issues in the diagnosis of ductal carcinoma in situ: a radiopathological correlation

El carcinoma ductal in situ (CDIS) se encuentra en un grupo heterogéneo de tumores, cuyo diagnóstico se ha visto incrementado con el uso de la mamografía como método de cribado. El sistema de clasificación de Van Nuys, que se basa principalmente en el grado nuclear histológico y la presencia de necrosis, es el sistema más reproducible para la clasificación histopatológica. La anomalía más común que se observa en la mamografía son las microcalcificaciones, coexistiendo con otras lesiones como masas y distorsión arquitectural, que representan lesiones de bajo grado. El diagnóstico inicial debe realizarse mediante anamnesis y examen físico detallado que permita realizar una aproximación a las características morfoestructurales de la lesión, para posteriormente llegar a un acercamiento imagenológico y dinámico mediante resonancia magnética (RM), complementada con técnicas de inmunohistoquímica que caractericen el tumor. La presencia de distribución segmentaria morfológica es típico de malignidad (CDIS). La cinética de las lesiones en el estudio dinámico de la RM varía, siendo patognomónico de CDIS el patrón de washout en la fase de reforzamiento tardío. Sin embargo, el patrón dinámico parece estar correlacionado con los hallazgos mamográficos. Los hallazgos de RM y TC multidetector pueden ser útiles en combinación con la RM de mama para el mapeo preoperatorio. Sin embargo, existen técnicas complementarias como la espectroscopía y la difusión ponderada que mejoran la especificidad de la RM y tienen utilidad en la predicción de respuesta a la quimioterapia adyuvante. Estas aplicaciones futuras podrán mejorar la capacidad de diagnóstico oportuno y opciones de tratamiento.

Ductal carcinoma in situ (DCIS) falls into a heterogeneous group of tumors, whose diagnosis has increased with the use of mammography as screening method. The Van Nuys Prognostic Index, mainly based on histological nuclear grade and presence of necrosis, is the most reproducible histopathological classification system. The most common abnormality observed during a mammography are microcalcifications, which coexist with other lesions such as masses and architectural distortion, and represent low-grade lesions. The initial diagnosis should be performed by anamnesis and a detailed physical examination to help determine the morphostructural characteristics of the lesion. Then an imaging and dynamic approach should be achieved by magnetic resonance imaging (MRI) complemented by immunohistochemistry to characterize the tumor. The presence of morphological segmental distribution is typical of malignancy (DCIS). The kinetics of the lesions using a dynamic MRI varies, with the washout and late enhancement pattern being pathognomonic for DCIS. However, the dynamic pattern seems to be correlated with mammographic findings. Multidetector CT and MRI findings may be useful in combination with breast MRI for preoperative mapping. Nevertheless, there are complementary techniques such as spectroscopy and weighted diffusion that improve the specificity of the MRI and are useful in predicting response to adjuvant chemotherapy. These future applications will improve the ability for early diagnosis and treatment options.

Vitrificación de ovocitos bovinos parcialmente madurados de la raza frisón rojo chileno / Vitrification of partially matured bovine oocytes of the Chilean red friesian breed

Se evaluó la tasa de maduración in vitro post descongelación de ovocitos bovinos, de la raza Frisón Rojo Chileno, parcialmente madurados y vitrificados. Complejos Cúmulus-ovocito fueron obtenidos por aspiración folicular, clasificados morfológicamente y aleatoriamente cultivados in vitro en TCM199 (10 % Suero Fetal Bovino (SFB), 50 mg/mL gentamicina, 0,2 mM piruvato de sodio, 0,08 µg/mL FSH, 1 µg/mL LH y 1 µg/mL estradiol) en los grupos: a) control (n= 137), madurados por 24 h a 38,5 C, 5 % CO2 y 99 % humedad y, b) tratamiento (n= 156), madurados por 6 h, parcialmente denudados, e incubados hasta completar 20 h, para luego ser vitrificados por el método Open Pulled Straws (OPS). Los ovocitos fueron expuestos a la solución de vitrificación uno (SV1) (Buffer Fosfato Salino (PBS), 10 % Etilenglicol (EG), 10% DMSO) por 30 s, posteriormente traspasados a la SV2 (PBS, 20 % EG, 20 % DMSO) por 25 s. Inmediatamente los ovocitos fueron cargados en pajuelas francesas estiradas (OPS) y sumergidos en nitrógeno líquido. Las ovocitos fueron descongelados introduciéndolos en una secuencia de soluciones con concentraciones decrecientes de sucrosa (0,3; 0,15 y 0 M respectivamente). Finalmente, los ovocitos continuaron con la maduración por 4 h adicionales. Posterior al periodo de maduración, los ovocitos de ambos grupos fueron fijados, teñidos y evaluados. Las proporciones de ovocitos en Metafase I (MI), Metafase II (MII) y degenerados fueron comparadas mediante el test de Chi cuadrado. La vitrificación aumentó (p 0,05) el porcentaje de pérdida y de ovocitos dañados en comparación al control. Además, aumentó (p 0,05) la tasa de ovocitos en MI y el número de ovocitos degenerados, y redujo el porcentaje de ovocitos MII, en comparación al control. Por tanto, la vitrificación por el método Open Pulled Straw de ovocitos parcialmente madurados in vitro es una alternativa viable para la conservación de material genético de hembras Frisón Rojo Chileno.

Post thawing in vitro maturation rate was evaluated for partially matured vitrified oocytes from Chilean Red Friesian cattle. Cumulus-Oocytes Complexes were obtained by follicular aspiration, classified by morphology and randomly in vitro matured in TCM199 (10 % Bovine Fetal Serum (BFS), 50 mg/mL gentamicine, 0.2 mM sodium piruvate, 0.08 µg/ml FSH, 1 µg/mL LH and 1 µg/mL estradiol) in the following groups: a) control (n= 137), matured for 24 h at 38.5 C, 5 % CO2 y 99 % humidity, and b) treatment (n= 156), matured for 6 h, partially denuded, and incubated until completion of 20 h. Then, oocytes were vitrified by the Open Pulled Straws (OPS) method. Oocytes were exposed to vitrification solution one (VS1) (Phosphate Buffered Saline (PBS), 10 % Ethylen glycol (EG), 10 % DMSO) for 30 s, then they were exposed to VS2 (PBS, 20% EG, 20% DMSO) for 25 s. Afterwards, oocytes were loaded into open pulled straws and submerged into liquid nitrogen. Oocytes were thawed by exposure to sequential solutions with decreasing concentrations of sucrose (0.3; 0.15 y 0 M respectively). Finally, oocytes continued the in vitro maturation for 4 additional hours. After completion of maturation period oocytes from both groups were fixated, stained and evaluated. The proportion of lost and damaged, MI, MII, and degenerate oocytes were compared between groups by Chi square test. Vitrification procedure increased (p 0.05) the percentage of oocytes lost and damaged when compared to control group. Additionally, vitrification increased (p 0.05) the proportion of MI and degenerated oocytes, and decreased the proportion of MII oocytes. Therefore, vitrification by the OPS method of partially matured bovine oocytes is a reliable alternative for the conservation of germinal cells from Chilean Red Friesian females.

Síndrome de encefalopatía posterior reversible y embarazo: reporte de un caso / Posterior reversible encephalopathy syndrome and pregnancy: case report

El Síndrome de Encefalopatía Posterior Reversible (PRES) es una condición clínica radiológica dada por manifestaciones neurológicas junto a características imagenológicas. En el embarazo, su presentación se ve asociada a Eclampsia. Presentamos el caso clínico de una paciente de 18 años que en el puerperio inmediato desarrolla una eclampsia, HELLP, refractaria al tratamiento, por lo que se realiza diagnóstico de PRES trasladándola a cuidados intensivos. Los estudios imagenológicos confirmaron el mismo, con resultado exitoso. El PRES, está integrado por un grupo heterogéneo de procesos patológicos, desencadenados por múltiple setiologías,presentándose en nuestro caso, secundario a encefalopatía hipertensiva dado por el Síndrome Preeclampsia Eclampsia. La asociación de PRES, Síndrome Preeclampsia-Eclampsia y HELLP como se presentó en nuestra paciente, es muy poco frecuente con reportes limitados de casos...

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical and radiological condition given by neurologic signs along with characteristic imaging findings. During pregnancy, its presentation is associated to Eclampsia. We present the case of an 18-year-old patient who develops treatment refractory eclampsia and HELLP syndrome during immediate puerperium, thus leading to the diagnosis of PRES and referral to intensive care. Imaging assessment confirmed diagnosis, with successful results. PRES consists of a heterogeneous group of pathologic processes, triggered by multiple etiologies, in our case secondary to hypertensive encephalopathy caused by PreecIampsia-EcIampsia Syndrome. Association of PRES, PreecIampsia-EcIampsia Syndrome and HELLP such as the case of our patient, is extremely rare with limited amount of case reports...

Cortisol y amilasa salival en niñas: variación según la curva diurna, la ingesta de alimentos y la actividad física / Diurnal variation of salivary cortisol and alpha amylase levels in normal girls: effects of meals and physical exercise

Salivary cortisol levels and saliva alpha-amylase enzymatic activity are non-invasive markers of hypothalamic-pituitary-adrenal axis and autonomic nervous system related to stress, which could be associated with excessive energy intake in response to stressors. Aim: To describe the diurnal variation of salivary cortisol levels and á-amylase activity in prepubertal girls and to assess their change after meals and physical activity episodes. Subjects and Methods: Nine normal-weight girls aged 8 to 10 years were monitored for 14 hours, from 6:00 AM to 20:00 h. Three standardized meals were administered across the day with a controlled sport competition performed at the end of the day. Saliva samples were drawn upon awakening, 30 min after awakening, before and after lunch, before and after dinner, and before-after the controlled episode of physical activity. Results: A decreasing salivary cortisol diurnal pattern was confirmed, with an initial increase occurring 30 minutes after waking up. An ascending diurnal pattern was observed for salivary amylase activity. Meals significantly increased cortisol levels, with a non-significant trend to increase amylase activity. The magnitude of physical activity during acute exercise was associated with increased salivary amylase activity (rho = 0.84; P <0.01). Cortisol levels were positively correlated with body mass index z scores (rho = 0.87; P <0.01). Conclusions: We confirmed the existence of a diurnal pattern of salivary cortisol levels and á-amylase activity in saliva that is modulated by diet and exercise. Our preliminary results also show that salivary cortisol might be related with body weight...

Type 1 diabetes-associated TLR responsiveness of oral epithelial cells.

In type 1 diabetes (T1D), a Toll-like receptor (TLR)-hyper-inflammatory monocytic phenotype has been implicated as a mechanism of exacerbated tissue destruction. Other cells of the periodontium, including oral epithelial cells (OECs), express innate immune receptors, including TLRs. To delineate the TLR responses of OECs derived from T1D participants and to determine effects of the anti-inflammatory agent triclosan on the TLR-hyper-inflammatory phenotype, primary human OECs from individuals with T1D and diabetes-free individuals were stimulated with TLR ligands in the presence and/or absence of triclosan. The expression of pro-inflammatory cytokines and micro-RNAs (miRNAs) was evaluated. While the repertoire of TLRs expressed by OECs is similar to that expressed by macrophages (M), the relative amounts and ratios are significantly different. OECs demonstrate a TLR-response profile similar to that of M, yet attenuated. OECs have a unique response to P. gingivalis LPS, where miR146a and miR155 play a regulatory role in responsiveness. OECs from T1D participants are TLR-hyper-responsive, due to dysregulated induction of miR146a and miR155, which is abrogated by pre-treatment with triclosan. The aberrant TLR-activation of OECs in T1D has the potential to contribute to excessive soft- and hard-tissue destruction. Importantly, triclosan's anti-inflammatory property is effective in abrogating TLR-induced OEC hyperactivity.

Triclosan alters antimicrobial and inflammatory responses of epithelial cells.

UNLABELLED: Periodontal diseases are a class of pathologies wherein oral microbes induce harmful immune responses in a susceptible host. Therefore, an agent that can both reduce microbial burden and lessen pathogenesis of localized inflammation would have beneficial effects in periodontal disease; 2,4,4-trichloro-2-hydroxydiphenyl-ether [triclosan] is currently used in oral care products owing to broad spectrum antimicrobial and anti-inflammatory properties. OBJECTIVE: To determine effects of triclosan on the response of oral epithelial cells to stimulation with the inflammatory microbial product lipopolysaccharide (LPS), a ligand for toll-like receptor 4 [TLR4]. MATERIALS/METHODS: Primary human oral epithelial cells were stimulated with LPS in the presence and/or absence of triclosan after which expression of pro-inflammatory cytokines, ß-defensins, micro-RNAs [miRNAs], or TLR-signaling pathway proteins were evaluated. RESULTS: Here, we demonstrate that triclosan is a potent inhibitor of oral epithelial cell LPS-induced pro-inflammatory responses by inducing miRNA regulation of the TLR-signaling pathway. Triclosan was not a pan-suppresser of oral epithelial cell responses as ß-defensin 2 [ßD2] and ßD3 were upregulated by triclosan following LPS-stimulation. CONCLUSIONS: These data demonstrate both a novel antimicrobial mechanism by which triclosan improves plaque control and an additional anti-inflammatory property, which could have beneficial effects in periodontal disease resolution.

Hyperglycemia induced and intrinsic alterations in type 2 diabetes-derived osteoclast function.

UNLABELLED: Periodontal disease-associated alveolar bone loss is a comorbidity of type-2-diabetes, where the roles of osteoclasts are poorly understood. OBJECTIVE: To evaluate osteoclast differentiation and function in the context of type-2-diabetes. MATERIALS AND METHODS: Bone marrow-derived osteoclasts from db/db mice, a model of type-2-diabetes, as well as human osteoclasts derived from peripheral blood of individuals with type-2-diabetes were evaluated for differentiation, resorption, and soluble mediator expression. RESULTS: While db/db mice were hyperglycemic at time of cell harvest, human participants were glycemically controlled. Although db/db cultures resulted in a higher number of larger osteoclasts, individual cell receptor activator of nuclear factor kappaB ligand (RANKL)-mediated bone resorption was similar to that observed in diabetes-free osteoclasts. Osteoclasts derived from individuals with type-2-diabetes differentiated similarly to controls with again no difference in bone resorbing capacity. Murine and human type-2-diabetes cultures both displayed inhibition of lipopolysaccharide (LPS)-induced deactivation and increased pro-osteoclastogenic mediator expression. CONCLUSIONS: Hyperglycemia plays a role in aberrant osteoclast differentiation leading to an increased capacity for bone resorption. Osteoclasts derived from murine models of and individuals with type-2-diabetes are unable to be inhibited by LPS, again leading to increased capacity for bone resorption. Here, environmental and intrinsic mechanisms associated with the increased alveolar bone loss observed in periodontal patients with type-2-diabetes are described.

Várices gástricas: un reto para el manejo endoscópico / Gastric varices: a challenge for endoscopic management

La hemorragia de vías digestivas altas por várices gástricas, aunque menos frecuente que la secundaria a lasesofágicas, es una causa de alta mortalidad en los pacientes cirróticos. La ligadura es el tratamiento óptimoen las várices esofágicas, pero este tratamiento para las gástricas es todavía muy discutido.Presentamos el caso de una anciana, con antecedente de cirrosis hepática secundaria a esteatosis hepáticano alcohólica (NASH), que ingresa, con hemorragia de vías digestivas altas, evidenciándose en laesofagogastroduodenoscopia una várice fúndica subcardial con sangrado activo, para la cual se decide manejocon ligadura con banda de caucho con resultado exitoso y desaparición de la várice en control posterior

Upper digestive tract bleeding due to gastric varices, although less common than bleeding secondary toesophageal varices, is one of the causes of high mortality in cirrhotic patients. Although band ligation is theoptimal treatment for esophageal varices, its use for gastric varices is still hotly debated.We report the case of an elderly woman with a history of hepatic cirrhosis secondary to nonalcoholicsteatohepatitis (NASH) and obesity who was admitted to the hospital with upper digestive tract bleeding.An esophagogastroduodenoscopy showed an actively bleeding subcardial varice in the gastric fundus. Thedecision was made to manage the bleeding with rubber band ligation. The outcome was successful outcome,and the varice had disappeared in subsequent check-ups

Neurofibroma gigante lumbar / No disponible

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Local inflammatory markers and systemic endotoxin in aggressive periodontitis.

While much research has focused on local and systemic factors contributing to periodontal disease, little is known regarding mechanisms linking these factors. We have previously reported a systemic hyper-inflammatory response to bacterial endotoxin in localized aggressive periodontitis (LAP). The objectives of this study were to delineate cyto/chemokines in gingival crevicular fluid (GCF) and evaluate systemic levels of endotoxin associated with LAP. Clinical parameters, GCF, and peripheral blood were collected from: 34 LAP, 10 healthy siblings, and nine healthy unrelated control individuals. Cyto/chemokines were quantified in GCF, systemic endotoxin levels were quantified in plasma, and correlation analysis was performed among all parameters. Nine mediators were elevated in LAP diseased sites as compared with healthy sites (TNFα, INFγ, IL1ß, IL2, IL6, IL10, Il12p40, GMCSF, and MIP1α, p < 0.001), while MCP1, IL4, and IL8 were elevated in healthy sites (p < 0.01). Four- to five-fold-higher endotoxin levels were detected in LAP plasma compared with that from healthy participants (p < 0.0001), which correlated with all clinical parameters and most cyto/chemokines analyzed. In conclusion, higher systemic levels of endotoxin were found in LAP, which correlates with an exacerbated local inflammatory response and clinical signs of disease. (Clinicaltrials.gov number, NCT01330719).

Essential directions for teaching animal welfare in South America.

Both the public and the international institutions that regulate the veterinary profession have high expectations that veterinarians will understand and take the lead in issues of animal welfare. These expectations provide a powerful argument for the need to teach animal welfare. The objective of this paper is to share the experiences of animal welfare teaching in South America, examining which topics seem relevant and why. It builds upon the core international literature on teaching animal welfare to veterinary students, highlights priorities learned through direct experience of teaching this topic in South America, and has benefited from the experiences of other South American animal welfare professors. In addition, the authors discuss major challenges in the animal welfare field and propose the perceived best strategies. The overall conclusion of the authors is that it is not possible to work as a veterinarian and make a valuable contribution to society unless the main concepts and issues of animal welfare are thoroughly understood and incorporated into practice.

Biological and phylogenetic characterization of virulent Newcastle disease virus circulating in Mexico.

In 2002-2003, velogenic Newcastle Disease Virus outbreaks, closely related to the Mexican isolates, were confirmed in the United States (U.S.) in southern California, Arizona, Nevada, and Texas. In this report, virulent NDVs isolated in Mexico between 1998 and 2006 were subjected to biologic characterization, using standard pathogenicity tests, and to phylogenetic analysis. Chicken embryo mean death time (MDT) test results ranged from 39.7 to 61.5 hours, and intracerebral pathogenicity index (ICPI) values were between 1.59 and 1.94, compared to a possible maximum value of 2.0. These isolates showed a dibasic amino acid motif at the fusion protein cleavage site sequence required for host systemic replication. Phylogenetic analysis indicated that the Mexican virulent NDVs belong to the class II, genotype V viruses and can be clearly divided in two groups as follows: isolates from 1998 to 2001 with close epidemiologic relationship with the latest U.S. NDV outbreaks, and phylogenetically distinct viruses, isolated from 2004 to 2006, which showed higher virulence. The assessment of the evolution of viruses from Mexico and other neighboring countries will aid in the U.S surveillance efforts for early detection of highly virulent NDV.