Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance?

PURPOSE: Peripherally inserted central venous catheters (PICC) in the onco-hematological patients may be associated with thrombosis or infections that may have short- to medium-term repercussions. MATERIAL AND METHODS: Single-centre retrospective analysis of a prospectively collected cohort. Primary objective was to establish the PICC-thrombosis and infections incidence. Secondary objectives were to analyze profile of patients suffering from these complications and variables associated with an increased likelihood of developing these events. RESULTS: 549 patients were recruited. 58.5% (n = 321) were oncology patients and 41.5% (n = 228) hematology patients. The incidence of PICC-associated thrombosis was 3.5% (n = 19). Thrombosis was associated with progression of the underlying malignant pathology in 10.6% (n = 2) of cases. No association was found between clinical variables analysed and development of thrombosis. Incidence of PICC-associated infections was 7.65% (n = 42). In the 30 days prior to PICC infection, 57.1% (n = 24) had a febrile syndrome of another focus, 73.8% (n = 11) had been hospitalized, 49.5% (n = 25) had a neutrophil count of 0-500 cells/mm3 and 47.6% (n = 20) had an episode of neutropenic fever. Variables significantly associated with the development of infection were hematological patients, high-flow PICC, 3-lm PICC or PICC insertion because of administration of vesicant therapy. CONCLUSIONS: Incidence of PICC-associated thrombosis is low and apparently less prognostically aggressive than other forms of thrombosis associated with cancer, without identify predictive factors. Infection was more prevalent and the identification of risk factors in our series could facilitate its prevention.

Debaryomyces hansenii, Stenotrophomonas rhizophila, and Ulvan as Biocontrol Agents of Fruit Rot Disease in Muskmelon (Cucumis melo L.).

The indiscriminate use of synthetic fungicides has led to negative impact to human health and to the environment. Thus, we investigated the effects of postharvest biocontrol treatment with Debaryomyces hansenii, Stenotrophomonas rhizophila, and a polysaccharide ulvan on fruit rot disease, storability, and antioxidant enzyme activity in muskmelon (Cucumis melo L. var. reticulatus). Each fruit was treated with (1) 1 × 106 cells mL-1 of D. hansenii, (2) 1 × 108 CFU mL-1 of S. rhizophila, (3) 5 g L-1 of ulvan, (4) 1 × 106 cells mL-1 of D. hansenii + 1 × 108 CFU mL-1 of S. rhizophila, (5) 1 × 108 CFU mL-1 of S. rhizophila + 5 g L-1 of ulvan, (6) 1 × 106 cells mL-1 of D. hansenii + 1 × 108 CFU mL-1 of S. rhizophila + 5 g L-1 of ulvan, (7) 1000 ppm of benomyl or sterile water (control). The fruits were air-dried for 2 h, and stored at 27 °C ± 1 °C and 85-90% relative humidity. The fruit rot disease was determined by estimating the disease incidence (%) and lesion diameter (mm), and the adhesion capacity of the biocontrol agents was observed via electron microscopy. Phytopathogen inoculation time before and after adding biocontrol agents were also recorded. Furthermore, the storability quality, weight loss (%), firmness (N), total soluble solids (%), and pH were quantified. The antioxidant enzymes including catalase, peroxidase, superoxide dismutase, and phenylalanine ammonium lyase were determined. In conclusion, the mixed treatment containing D. hansenii, S. rhizophila, and ulvan delayed fruit rot disease, preserved fruit quality, and increased antioxidant activity. The combined treatment is a promising and effective biological control method to promote the shelf life of harvested muskmelon.

Desarrollo de una app móvil para la evaluación preoperatoria de la tomografía de senos paranasales: un paso hacia la inteligencia artificial / Development of a Movil App for the Preoperative Evaluation of Sinus CT Scan: One Step Towards Artificial Intelligence

Introducción: la revolución tecnológica que hemos vivido en los últimos años ha generado un extendido uso de la inteligencia artificial (IA) como tecnología de base para el desarrollo de diversos sistemas y soluciones en medicina. En el campo de la otorrinolaringología, estamos viendo hasta ahora los primeros esfuerzos para aprovechar este surgimiento. Objetivo: el presente proyecto busca describir el proceso de desarrollo de una app móvil creada gracias al trabajo colaborativo entre otorrinolaringólogos e ingenieros biomédicos, que tiene la intención de optimizar la evaluación preoperatoria de la tomografía de senos paranasales (TC de SPN). Métodos: el desarrollo de la app siguió el método de priorización para especificaciones de MoSCoW. Utilizamos la información recolectada de encuestas realizadas a 29 expertos en rinología de diferentes partes del mundo, quienes evaluaron variantes anatómicas en la tomografía y se utilizaron dos modelos de regresión para la predicción de dificultad y riesgo a partir de herramientas de aprendizaje estadístico. Conclusión: hemos desarrollado una herramienta y un modelo estadístico que es fácil de utilizar y que idealmente ayudará al cirujano en el proceso de evaluación preoperatoria de TC de SPN. Este es un ejercicio que permite demostrar la eficacia de un desarrollo colaborativo para lograr soluciones en nuestra especialidad y un acercamiento hacia la IA.

Introduction: The recent technology revolution that we have experienced has generated extensive interest in the use of artificial intelligence (AI) in the development of various systems and solutions in medicine. In the field of Otorhinolaryngology, we are seeing the first efforts to take advantage of this flourishing area. Objective: We sought to describe the development process of a mobile app created through a collaborative effort between ENT surgeons and biomedical engineers. This app has the intention to optimize the preoperative evaluation of paranasal sinus tomography (CT) to improve safety and outcomes in Endoscopic Sinus Surgery (ESS). Methods: The development of the app followed the prioritization method for MoSCoW specifications. We used the information collected from surveys of 29 Rhinology experts from different parts of the world, who evaluated anatomical variants on sinus CT scans. Two regression models were used to predict difficulty and risk using statistical learning. Conclusion: Via statistical modelling, we have developed a user-friendly tool that will ideally help surgeons assess the risk and difficulty of ESS based on the pre-operative CT scan of the sinuses. This is an exercise that demonstrates the efficacy of the collaborative efforts between surgeons and engineers to leverage AI tools and promote better solutions for our patients.

A Sustainable Alternative for Postharvest Disease Management and Phytopathogens Biocontrol in Fruit: Antagonistic Yeasts.

Postharvest diseases of fruits caused by phytopathogens cause losses up to 50% of global production. Phytopathogens control is performed with synthetic fungicides, but the application causes environmental contamination problems and human and animal health in addition to generating resistance. Yeasts are antagonist microorganisms that have been used in the last years as biocontrol agents and in sustainable postharvest disease management in fruits. Yeast application for biocontrol of phytopathogens has been an effective action worldwide. This review explores the sustainable use of yeasts in each continent, the main antagonistic mechanisms towards phytopathogens, their relationship with OMIC sciences, and patents at the world level that involve yeast-based-products for their biocontrol.

Development of a Third Generation Snack of Rice Starch Enriched with Nopal Flour (Opuntia ficus indica).

This study aimed to obtain a third-generation snack from native rice starch (NS), rice starch modified by extrusion (MS), nopal flour (NF) and xanthan gum (XG). These raw materials were characterized by proximal analysis, pH, particle size distribution, water absorption index (WAI) and water solubility index (WSI), degree of substitution (DS), differential scanning calorimetry (DSC), rheology, Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The analysis of the response variables in the nine formulations of the snack: expansion index (EI), apparent density (AD), hardness (H), luminosity (L*) and tendency to green-red (a*), was performed through a composite central design (CCD), the selected formulations were characterized by SEM. Results showed an increase in WAI, 4.69 ± 0.04, and WSI, 12.61 ± 0.10, for MS, higher than NS values due to chemical modification. According to the color analysis the NF obtained a value of 60.73 ± 0.008 in L* and -6.51 ± 0.004 in a* with green tendency. The DS value obtained was 0.09 ± 0.005, being within the FDA's permissible range for food use. By FTIR analysis, the acetyl group was corroborated. Finally, employing microwave cooking, snacks made from NS with concentrations of NF (5%) and XG (0%) obtained the highest EI value, 4.47, as well the low Dap and D value (0.37 g/cm3, 2.25 N, respectively), corroborated by SEM analysis.

Physical fitness and nutritional status in female adolescents with anorexia nervosa / Aptidão física e estado nutricional em adolescentes do sexo feminino com anorexia nervosa

ABSTRACT Objective This study aimed to determine whether physical fitness is related to nutritional status in a sample of female adolescents with anorexia nervosa, to contrast the nourished and undernourished patients, and to compare the physical fitness in these patients with normative data of healthy subjects stratified by age and gender. Methods Nutritional status was determined using the body mass index Z-score, fat mass, fat-free mass (bioelectrical impedance analysis), and the Controlling Nutritional Status score in 15 anorexic adolescents with 14.3±1.6 years. Physical fitness was assessed using the ALPHA-Fitness Battery (handgrip strength, standing broad jump, 4x10m shuttle run, and 20m shuttle run tests). Results Handgrip strength was significantly associated with all variables of nutritional status, except with the three blood components of the Controlling Nutritional Status score. The undernourished anorexic patients showed significantly worse physical fitness than the nourished anorexic patients in all tests, except in the standing broad jump and the 4x10m shuttle run tests. The physical fitness tests of the female anorexic adolescents showed scores significantly worse than those of the normative European female adolescent population. Conclusion The observation of female adolescents with anorexia nervosa showed associations between higher physical fitness levels and better nutritional statuses. Handgrip strength and 20m shuttle run tests may be options of additional indicators of undernutrition in anorexic female adolescents. The undernourished anorexic patients showed worse physical fitness than the nourished ones. According to normative data for healthy sex- and agematched adolescents, physical fitness is severely impaired in anorexic female adolescents.

RESUMO Objetivo Este estudo teve como objetivo determinar se a aptidão física está relacionada ao estado nutricional em uma amostra de adolescentes do sexo feminino com anorexia nervosa, contrastar pacientes nutridas versus desnutridas e comparar a aptidão física nesses pacientes com dados normativos de indivíduos saudáveis estratificados por idade e gênero. Métodos O estado nutricional foi determinado pelo escore Z do índice de massa corporal, massa gorda e massa livre de gordura (análise de impedância bioelétrica) e pelo escore do Estado Nutricional Controlador em 15 adolescentes anoréxicas com 14,3±1,6 anos. A aptidão física foi avaliada usando a Bateria ALPHA-Fitness (força de preensão manual, salto em distância em pé, corrida com vaivém 4x10m e corrida com vaivém de 20m). Resultados A força de preensão manual foi significativamente associada a todas as variáveis do estado nutricional, exceto aos três componentes sanguíneos do escore do Estado de Controle Nutricional. As pacientes anoréxicas desnutridas mostraram uma aptidão física substancialmente pior do que as pacientes anoréxicas nutridas em todos os testes, exceto nos saltos em pé em posição ampla e nos testes de corrida em 4x10m. Os testes de aptidão física dos adolescentes anoréxicos do sexo feminino apresentaram escores consideravelmente piores do que os da população adolescente europeia normativa. Conclusão Adolescentes do sexo feminino com anorexia nervosa apresentaram associação entre maiores níveis de aptidão física e melhor estado nutricional. Os testes de força de preensão manual e corrida de lançadeira de 20m podem ser alternativas como indicadores adicionais do estado de desnutrição em adolescentes anoréxicas. As pacientes anoréxicas desnutridas demonstraram pior condicionamento físico do que as pacientes anoréxicas nutridas. Segundo dados normativos para adolescentes saudáveis de acordo com o sexo e a idade, a aptidão física é gravemente prejudicada em adolescentes anoréxicas do sexo feminino.

Resultados de la terapia con ondas de choque extracorpórea de baja intensidad en pacientes con angina refractaria / Results of low intensity extracorporeal shock wave therapy in patients with refractory angina

RESUMEN Introducción: La terapia con ondas de choque extracorpórea de baja intensidad ha demostrado ser útil en el tratamiento de los pacientes con angina de pecho refractaria. Objetivo: Valorar los resultados de este tipo de terapia en pacientes con angina refractaria al tratamiento farmacológico. Método: Se realizó un estudio cuasiexperimental en 30 pacientes con angina de pecho refractaria a tratamiento, seleccionados de forma no probabilística a partir de los criterios de inclusión. A todos los pacientes se les aplicó terapia con ondas de choque extracorpórea de baja intensidad en el Cardiocentro Ernesto Guevara de Santa Clara, en el período comprendido de enero a diciembre de 2017. Se analizaron variables epidemiológicas, clínicas y ecocardiográficas al inicio del tratamiento y 6 meses después de concluido este. Resultados: Los resultados obtenidos demostraron una mejoría de la clase funcional (CF) de la Canadian Cardiovascular Society (CCS). Previo al tratamiento el 76,7% de los pacientes tenían una CF III y un 23,3% una CF IV, y a los 6 meses de concluida la terapia el 73,3% mejoró a la CF II y solo un 26,7% quedó en CF III. También se evidenció mejoría con respecto a parámetros ecocardiográficos como la motilidad regional y la fracción de eyección del ventrículo izquierdo, la cual, en los hombres, de una media al inicio de la terapia de un 37,81% alcanzó 44,14% a los 6 meses de concluida; y en las mujeres, de una media de 37,11% inicial llegó a 47,22% a los 6 meses después. Conclusiones: El tratamiento con ondas de choque constituye una alterativa terapéutica para los pacientes con angina refractaria.

ABSTRACT Introduction: Low intensity extracorporeal shock wave therapy has proven useful in the treatment of patients with refractory angina pectoris. Objective: To assess the results of this type of therapy in patients with refractory angina to drug treatment. Method: A quasi-experimental study was carried out in 30 patients with refractory angina pectoris to treatment, selected in a non-probabilistic way, taking into account the following inclusion criteria. All patients were applied low intensity extracorporeal shock wave therapy in the Cardiocentro Ernesto Guevara of Santa Clara, in the period from January to December 2017. Epidemiological, clinical and echocardiographic variables were analyzed at the beginning of the treatment and six months after it was completed. Results: The results obtained demonstrated an improvement of the functional class (FC) of the Canadian Cardiovascular Society (CCS). Previous to treatment, 76.7% of patients had a FC III and 23.3% a FC IV, and after six months of completed therapy, 73.3% improved to FC II and only 26.7 % remained in FC III. There was also an improvement with respect to echocardiographic parameters such as regional motility and left ventricular ejection fraction, which, in men, of an average at the start of therapy of 37.81% it reached 44.14% at six months of completed; and in women, of an average of 37.11% initially, it reached 47.22 % six months later. Conclusions: The treatment with shock waves represents a therapeutic alternative for patients with refractory angina.

On the debate about teleology in biology: the notion of "teleological obstacle" / O debate sobre teleologia na biologia: a noção de "obstáculo teleológico"

Among the epistemological obstacles described by Gaston Bachelard, we contend that unitary and pragmatic knowledge is correlated to the teleological categories of Ernst Mayr and is the basis for prevailing debate on the notion of "function" in biology. Given the proximity of the aspects highlighted by these authors, we propose to associate the role of teleological thinking in biology and the notion of unitary and pragmatic knowledge as an obstacle to scientific knowledge. Thus, teleological thinking persists acting as an epistemological obstacle in biology, according to Bachelardian terminology. Our investigation led us to formulate the "teleological obstacle," which we consider important for the future of biology and possibly other sciences.

Dentre os obstáculos epistemológicos descritos por Gaston Bachelard, propomos que o conhecimento unitário e pragmático se relaciona com as categorias de teleologia propostas por Ernst Mayr e fundamenta as discussões atuais sobre a noção de "função" em biologia. Dada a proximidade dos aspectos salientados por ambos, propomos relacionar o papel do pensamento teleológico na biologia e a noção do conhecimento unitário e pragmático como obstáculo ao conhecimento científico. O pensamento teleológico, portanto, ainda atua como obstáculo epistemológico na biologia, segundo a terminologia bachelardiana. Nossas investigações nos levaram à formulação do "obstáculo teleológico", que entendemos ser importante para o desenvolvimento da biologia e possivelmente para outras ciências.

On the debate about teleology in biology: the notion of "teleological obstacle".

Among the epistemological obstacles described by Gaston Bachelard, we contend that unitary and pragmatic knowledge is correlated to the teleological categories of Ernst Mayr and is the basis for prevailing debate on the notion of "function" in biology. Given the proximity of the aspects highlighted by these authors, we propose to associate the role of teleological thinking in biology and the notion of unitary and pragmatic knowledge as an obstacle to scientific knowledge. Thus, teleological thinking persists acting as an epistemological obstacle in biology, according to Bachelardian terminology. Our investigation led us to formulate the "teleological obstacle," which we consider important for the future of biology and possibly other sciences.

Patología de cuello uterino en adolescentes con vida sexual activa / Uterine cervical pathology in sexually active adolescents

Conocer la frecuencia de patología de cuello en las adolescentes que acudieron a la consulta de Ginecología Infantil Juvenil del Hospital "Dr. Domingo Luciani", durante el período septiembre 2001 a septiembre de 2002. Se realizó un estudio descriptivo, y prospectivo. La muestra estuvo constituida por 125 pacientes, con edades entre 14-19 años, la edad promedio fue 17,28 años. Las citologías reportaron inflamación inespecíficas (58.4%), inflamación específicas (32%) y de éstas el 57% presentó Garnerella, 25% Cándida, 12,5 Tricomona y 5% Leptotrix. 95 colposcopias fueron normales (76%), 12 (10%) insatisfactorias y 18 (14%) reportaron epitelio blanco. De 18 biopsias 14 no presentaron lesiones (78%) y 4 (22%) reportaron VPH, a éstas se les realizó PCR, siendo negativas. Las adolescentes representan un grupo de riesgo por lo que se deben establecer programa sanitario para despistaje de patología de cuello, programas escolares para evitar ETS y orientar a las pacientes de riesgo elevado para tener un adecuado control ginecológico.

An ecosystem report on the Panama Canal: monitoring the status of the forest communities and the watershed.

In 1996, the Smithsonian Tropical Research Institute and the Republic of Panama's Environmental Authority, with support from the United States Agency for International Development, undertook a comprehensive program to monitor the ecosystem of the Panama Canal watershed. The goals were to establish baseline indicators for the integrity of forest communities and rivers. Based on satellite image classification and ground surveys, the 2790 km2 watershed had 1570 km2 of forest in 1997, 1080 km2 of which was in national parks and nature monuments. Most of the 490 km2 of forest not currently in protected areas lies along the west bank of the Canal, and its management status after the year 2000 turnover of the Canal from the U.S. to Panama remains uncertain. In forest plots designed to monitor forest diversity and change, a total of 963 woody plant species were identified and mapped. We estimate there are a total of 850-1000 woody species in forests of the Canal corridor. Forests of the wetter upper reaches of the watershed are distinct in species composition from the Canal corridor, and have considerably higher diversity and many unknown species. These remote areas are extensively forested, poorly explored, and harbor an estimated 1400-2200 woody species. Vertebrate monitoring programs were also initiated, focusing on species threatened by hunting and forest fragmentation. Large mammals are heavily hunted in most forests of Canal corridor, and there was clear evidence that mammal density is greatly reduced in hunted areas and that this affects seed predation and dispersal. The human population of the watershed was 113 000 in 1990, and grew by nearly 4% per year from 1980 to 1990. Much of this growth was in a small region of the watershed on the outskirts of Panama City, but even rural areas, including villages near and within national parks, grew by 2% per year. There is no sewage treatment in the watershed, and many towns have no trash collection, thus streams near large towns are heavily polluted. Analyses of sediment loads in rivers throughout the watershed did not indicate that erosion has been increasing as a result of deforestation, rather, erosion seems to be driven largely by total rainfall and heavy rainfall events that cause landslides. Still, models suggest that large-scale deforestation would increase landslide frequency, and failure to detect increases in erosion could be due to the gradual deforestation rate and the short time period over which data are available. A study of runoff showed deforestation increased the amount of water from rainfall that passed directly into streams. As a result, dry season flow was reduced in a deforested catchment relative to a forested one. Currently, the Panama Canal watershed has extensive forest areas and streams relatively unaffected by humans. But impacts of hunting and pollution near towns are clear, and the burgeoning population will exacerbate these impacts in the next few decades. Changes in policies regarding forest protection and pollution control are necessary.

Protocolo de seguimiento de pacientes con microsomía hemifacial / A comparison of two classification systems for hemifacial microsomia

La microsomía hemifacial se manifiesta como un conjunto de anomalías congénitas que involucran el esqueleto, los tejidos blandos y las estructuras neuromusculares derivadas exclusivamente del primer y segundo arcos branquiales junto con el núcleo del hueso temporal... En este trabajo se realiza un protocolo para evaluar esta enfermedad: anomalías extracraneales y asociadas a través de las clasificaciones O.M.E.N.S y O.M.E.N.S.-Plus, diagnóstico, tratamiento, pronóstico y como se presentó en los pacientes

Protocolo de seguimiento de pacientes con microsomía hemifacial / A comparison of two classification systems for hemifacial microsomia

La microsomía hemifacial se manifiesta como un conjunto de anomalías congénitas que involucran el esqueleto, los tejidos blandos y las estructuras neuromusculares derivadas exclusivamente del primer y segundo arcos branquiales junto con el núcleo del hueso temporal... En este trabajo se realiza un protocolo para evaluar esta enfermedad: anomalías extracraneales y asociadas a través de las clasificaciones O.M.E.N.S y O.M.E.N.S.-Plus, diagnóstico, tratamiento, pronóstico y como se presentó en los pacientes

Angiofibroma juvenil / Juvenil angiofibroma

El Angiofibroma Juvenil es un tumor benigno, que se presenta con más frecuencia en el sexo masculino, durante la adolescecia; pero vemos como pueden darse casos aislados a mayor edad. La sintomatología clásica de obstrucción nasal y epistaxis aunada a la edad del paciente, sexo y hallazgos físicos, nos permiten orientar el diagnóstico. Con frecuencia pueden recidivar las lesiones tumorales, por lo que es aconsejable los controles periódicos