Nivel de conocimiento sobre Hidatidosis Humana y medidas preventivas tras la aplicación de un Programa / Level on knowledge on human hydatidosis and its preventive measures after an educational program / Nível de conhecimento sobre Hidatidose Humana e medidas preventivas após a aplicação de um Programa

Introducción Perú probablemente sea el país de la región de las Américas con una mayor incidencia y prevalencia de hidatidosis quística; la niñez es la etapa de la vida donde generalmente se adquiere la infección, por lo que es importante el desarrollo de capacidades para su prevención. Objetivo Determinar el nivel de conocimiento sobre hidatidosis humana tras la aplicación de un programa preventivo en niñas/os del quinto de primaria de una institución educativa de la localidad de Huancavelica. Metodología Estudio cuasi experimental con pre y post prueba a grupo experimental y control, muestra 28 niñas/os en cada grupo que cumplieron criterios de selección, muestreo no probabilístico. Se aplicó un cuestionario para medir conocimientos sobre hidatidosis humana y medidas preventivas, el programa estuvo basado en el Modelo Didáctico Operativo de Bustos, empleándose la "t" de Student para muestras pareadas. Resultados El nivel de conocimiento sobre hidatidosis humana antes de la intervención educativa fue 50% entre medio y alto (17.5 ± 3.4); después de la intervención 100% mostró un nivel alto (26.8 ± 1.9) p=0.001. El conocimiento sobre medidas preventivas de la hidatidosis humana antes de la intervención fue 25% bajo, 57.1% medio y 17.9% alto (5.5 ± 2.2); tras la intervención el nivel fue 10.7% medio y 89.3% alto (9.1 ± 1.4) p=0.001; el grupo control no evidenció cambios. Conclusiones El programa preventivo fue eficaz, ya que como resultado de la intervención se apreció una mejoría en el conocimiento de la hidatidosis, así como de las medidas de prevención para evitarla.

Introduction Peru is probably the country in the region of the Americas with the highest prevalence of cystic hydatidosis, and because during childhood is when the infection generally is acquired, it is important to develop strategies in order to prevent it. Objective To determine the level of knowledge about human hydatidosis after the implementation of an educational preventing program on children of the 5th grade at a school at Huancavelica, Peru. Methodology This is a quasi-experimental study with control and experimental groups and pre-post tests on a sample of 56 children (28 per group) who met the selection criteria. Sampling was non probabilistic. A questionnaire was given in order to assess the corresponding levels of knowledge, including that on the preventing measures. The program was based on the Operative Educational Model of Bustos. Paired Student's t tests were calculated. Results The level of knowledge on human hydatidosis before the educational intervention was 50% between medium or high (17.5 ± 3.4), but after the program, 100% showed a high level of knowledge (26.8 ± 1.9) p=0.001. Specific knowledge on preventive measures before the intervention was 25% low, 57.1% medium, and 17.9% high (5.5 ± 2.2), and after the program, the levels were 10.7% medium and 89.3% high (9.1 ± 1.4) p=0.001. The control group did not show changes in the scores. Conclusions The educational program improved the knowledge on hydatidosis and its preventive measures.

Introdução Peru provavelmente seja o país da região das Américas com uma maior incidência e prevalência de hidatidose cística; a infância é a etapa da vida onde geralmente adquire-se a infeção, pelo qual é importante o desenvolvimento de capacidades para sua prevenção. Objetivo Determinar o nível de conhecimento sobre hidatidose humana após a aplicação de um programa preventivo em crianças do ensino elementar (5° ano) de uma instituição educativa da localidade de Huancavelica. Metodologia Estudo quase experimental com pre e post teste a grupo experimental e controle, mostra 28 crianças em cada grupo que cumpriram critérios de seleção, amostragem não probabilística. Aplicou-se um questionário para medir conhecimentos sobre hidatidose humana e medidas preventivas, o programa esteve baseado no Modelo Didático Operativo de Bustos, empregando-se a "t" de Student para amostras em pares. Resultados O nível de conhecimento sobre hidatidose humana antes da intervenção educativa foi 50% entre médio e alto (17.5 ± 3.4); despois da intervenção 100% mostrou um nível alto (26.8 ± 1.9) p=0.001. O conhecimento sobre medidas preventivas da hidatidose humana antes da intervenção foi 25% baixo, 57.1% médio e 17.9% alto (5.5 ± 2.2); após a intervenção o nível foi 10.7% médio e 89.3% alto (9.1 ± 1.4) p=0.001; o grupo controle não evidenciou mudanças. Conclusões O programa preventivo foi eficaz, já que como resultado da intervenção apreciou-se uma melhora no conhecimento da hidatidose, assim como das medidas de prevenção para evitá-la.

Optimización de los criterios metabólicos en la valoración pronóstica de los pacientes con linfoma. Estudio multicéntrico / Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study

Objetivo: Comparar sensibilidad, especificidad y valor pronóstico de Deauville score (DS) versus ΔSUVmax, tanto en «interim» PET (iPET) como en «end» PET (ePET), en pacientes con linfoma difuso de células grandes B (LDCGB), linfoma de Hodgkin (LH), linfoma folicular (LF). Método: Estudio multicéntrico retrospectivo longitudinal en 138 pacientes (46 LDCGB, 46 LH, 46 LF). Se realizaron 3 18F-FDG PET/TC: basal, iPET y ePET. En iPET y ePET se utilizaron 2 criterios de interpretación: visual (DS) y semicuantitativo (ΔSUVmax). Se estableció el valor pronóstico en relación con el intervalo libre de enfermedad. Resultados: Análisis estadístico. Del iPET por subtipos histológicos (LDCGB, LH y LF): 1) DS obtuvo sensibilidad 76,92/83,33/61,53%; especificidad 78,78/85/81,81%, respectivamente; 2) ΔSUVmax obtuvo una sensibilidad del 53,84/83,33/61,53%; especificidad del 87,87/87,50/78,78%. Del ePET por subtipos histológicos: 1) DS obtuvo sensibilidad del 61,53/83,33/69,23%; especificidad del 90,90/85/87,87%; 2) ΔSUVmax obtuvo sensibilidad del 69,23/83,33/69,23%; especificidad del 90,90/87,5/84,84%. Evaluación pronóstica. Estudio iPET: en LDCGB el DS obtuvo que 10,3% con iPET negativo recidivó durante el intervalo libre de enfermedad y 17,1% con ΔSUVmax; en LH ambos métodos obtuvieron que 2,8% con iPET negativo recidivó; en LF el DS obtuvo que 15,6% con iPET negativo recidivó, con ΔSUVmax 16,1%, sin significación estadística para este método. Estudio ePET: en LDCGB el DS obtuvo que 14,3% con ePET negativo recidivó durante el intervalo libre de enfermedad, respecto al 11,8% con ΔSUVmax; en LH y LF ambos métodos obtuvieron que 2,8 y 12,5%, respectivamente, con ePET negativo recidivó. Conclusión: DS y ΔSUVmax no muestran diferencias significativas en LDCGB, LH, LF. El valor pronóstico del DS y ΔSUVmax no muestra diferencias significativas en LH y LF; en LDCGB el DS es superior en iPET y el ΔSUVmax en ePET (AU)

Objective: To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). Method: Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. Results: Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. Conclusion: DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET (AU)

Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study. / Optimización de los criterios metabólicos en la valoración pronóstica de los pacientes con linfoma. Estudio multicéntrico.

OBJECTIVE: To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). METHOD: Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. RESULTS: Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. CONCLUSION: DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET.

Laryngeal and cardiac amyloidosis diagnosed by 18F-Florbetapir PET/CT / Amiloidosis laríngea y cardiaca diagnosticada mediante PET/TC con 18F-Florbetapir

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Cardiac sympathetic innervation assessed with 123I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator / La valoración de la inervación simpática cardiaca con 123I-MIBG mantiene su utilidad pronóstica en pacientes diabéticos con disfunción ventricular grave evaluados para implante de desfibrilador automático en prevención primaria

Background. Scintigraphy with iodine-123-metaiodobenzylguanidine (123I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if 123I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with 123I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Material and methods. Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent 123I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of 123I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. Results. During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p = 0.014). Late HMR ≤ 1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p = 0.012) and non-diabetic patients (hazard ratio 12.31; p = 0.023). Conclusions. Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless 123I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients (AU)

Antecedentes. La gammagrafía con yodo-123-metayodobenzilguanidina (123I-MIBG) es una herramienta de la valoración de la actividad simpática cardiaca (ASC) que ha demostrado ser un predictor independiente de supervivencia. Estudios recientes han demostrado que los pacientes diabéticos con insuficiencia cardiaca (IC) presentan mayor deterioro de la ASC. Si 123I-MIBG tiene el mismo valor predictivo en diabéticos y no diabéticos es desconocido. Analizamos si la evaluación de la ASC con 123I-MIBG mantiene su utilidad pronóstica en pacientes diabéticos con IC evaluados para implante de DAI en prevención primaria. Material y métodos. Se incluyeron prospectivamente 78 pacientes (48 diabéticos) consecutivos evaluados para implante de DAI en prevención primaria a los que se les realizó una gammagrafía con 123I-MIBG para evaluar la ASC (índice corazón mediastino - ICM-). Se usó un modelo multivariado de riesgos proporcionales de Cox para analizar la influencia de 123I-MIBG en la predicción de eventos cardiacos tanto en pacientes diabéticos como no diabéticos. La variable principal de resultado es un compuesto de evento arrítmico, muerte cardiaca y hospitalización por IC. Resultados. Durante una media de seguimiento de 19.5 [9.3-29.3] meses, la variable principal de resultado ocurrío en 24 (31%) de los pacientes. El ICM tardío fue significativamente menor en el grupo de pacientes con diabetes mellitus (1.30 vs 1.41, p = 0.014). Un ICM tardío ≤1,30 fue predictor independiente de eventos cardiacos en pacientes diabéticos (HR 4,53; p = 0,012) y no diabéticos (HR 12,31; p = 0,023). Conclusión. Los pacientes diabéticos con IC grave evaluados para implante de DAI en prevención primaria presentan mayor deterioro de la ASC que los no diabéticos. 123I-MIBG mantiene utilidad pronóstica en pacientes diabéticos y no diabéticos con IC (AU)

Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.

BACKGROUND: Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). MATERIAL AND METHODS: Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. RESULTS: During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023). CONCLUSIONS: Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients.

Early response of mechanically exposed dental pulps of swine to antibacterial-hemostatic agents or diode laser irradiation.

OBJECTIVES: The purpose of this study was to compare the effectiveness of an antibacterial and hemostatic agent to diode laser irradiation in the healing of mechanically exposed porcine pulps. MATERIALS AND METHOD: The experiment required three adult swine (Sus scrofa domestica, Yorkshire) with 36 teeth prepared with occlusal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the pulps were exposed using high speed instrumentation with rubber dam isolation and a disinfected field. Following instrumentation the coronal pulpal tissue was amputated and immediately treated with ferric sulfate and chlorhexidine semi-gel (12), diluted Buckley' formocresol solution (12) for 5 minutes or laser irradiation with a diode laser (12). After treatment, hemostasis was obtained and a ZOE base applied to the treated pulps (36). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at 4 weeks (28 days). Following fixation, the samples were de-mineralized, sectioned, stained and histologically graded with a scale of 0-4. RESULTS: The treatment groups were statistically different with the Laser Treated Group demonstrating the least inflammation. CONCLUSION: Pulpotomy treatment with the KaVo Gentle Ray Diode Laser demonstrated significantly less inflammation than the other two pulpal therapy modalities. The ferric sulfate and chlorhexidine mixture demonstrated the greatest inflammation as histologically graded. Also, the histological sections of pulpotomized swine teeth treated with the ferric sulfate and chlorhexidine mixture presented with black pigmented areas in the pulp and surrounding tissue. The formocresol group (clinical standard) and the diode laser group did not present with the black precipitate.

Ancianos frágiles ¿Un nuevo objetivo terapéutico? / No disponible

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Laboratory paradigms of impulsivity and alcohol dependence: a review.

Impulsivity can be defined as choosing a smaller, immediate reward over a larger, delayed reward. From this perspective, addictive behaviors such as substance abuse and pathological gambling reflect a series of impulsive choices. However, impulsivity is not a homogeneous construct. Laboratory measures of impulsivity reflect two types of processes. The first is related to behavioral inhibition and refers to an individual's ability to appropriately inhibit thoughts or actions. The second is the delay of reward dimension, namely the degree to which immediate (rewarding) consequences have more control over an individual's behavior than consequences that are delayed. In this review, we describe how alcohol is associated with significant impairments in these paradigms. We also suggest that they may have a role in the development of alcohol dependence. These results are in agreement with a model in which delay of gratification might be a marker for early use and/or abuse of alcohol, whereas impairment in behavioral inhibition might be a marker for maintained use in time and, therefore, for progression towards alcohol dependence.

Effects of 17beta-estradiol on the cytotoxicity of etoposide in a lung carcinoma cell line and its bioavailability in ovariectomized Sprague-Dawley rats.

BACKGROUND: The activity of steroid hormones for the efficacy of antineoplastic drugs used in lung cancer treatment has not been explored. We evaluated the influence of 17beta-estradiol on the cytotoxicity of etoposide in a lung cancer cell line (A-549) and determined systemic levels of etoposide in vivoafter pretreatment with this hormone. METHODS: The effect of 17beta-estradiol alone and combined with etoposide on cellular proliferation was evaluated. Blood levels of etoposide were studied in ovariectomized female rats previously treated with 17beta-estradiol. Etoposide levels were determined by high-performance liquid chromatography, and a pharmacokinetic analysis was performed. RESULTS: 17beta-Estradiol showed a tendency towards an increase in cellular proliferation but did not change the cytotoxic effect of etoposide. This in vivo study demonstrated that the blood levels of etoposide significantly decreased in the 17beta-estradiol-treated group. CONCLUSION: The clear reduction in the in vivo systemic levels of etoposide in the presence of 17beta-estradiol suggests a possible role of this hormone in drug resistance. However, as these data cannot be extrapolated to clinic situations, more research is necessary to understand the interaction between hormonal compounds and antineoplastic drugs.

Diagnostic yield of brush cytology for biliary stenosis during ERCP.

AIM: To evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. PATIENTS AND METHODS: Data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. RESULTS: A total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. CONCLUSIONS: Brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.

Rentabilidad diagnóstica de la citología por cepillado de las estenosis biliares durante la CPRE / Diagnostic yield of brush cytology for biliary stenosis during ERCP

Objetivo: evaluar la rentabilidad de la citología por cepillado de las estenosis biliares diagnosticadas por CPRE cuando se aplica una metodología sistemática. Pacientes y métodos: se recogieron muestras de 62 pacientes consecutivos con estenosis biliares diagnosticadas mediante CPRE. Las muestras citológicas eran procesadas en la sala de endoscopias inmediatamente a su obtención y analizadas por el mismo patólogo. Para el análisis estadístico se clasificaron los casos como positivos o negativos para malignidad, sospechosos (presencia de atipias) y no válidos. Los patrones de referencia fueron el estudio de las piezas quirúrgicas, biopsias por otros métodos, o la evolución clínica y/o radiológica compatible. Resultados: fueron incluidas un total de 71 citologías. El diagnóstico fue malignidad en 49 casos, benignidad en 22 casos, y 3 muestras fueron excluidas por material insuficiente o artefactos de procesamiento. La sensibilidad de la técnica fue del 62% (IC 95% 0,47-0,77), la especificidad del 100%, el valor predictivo positivo del 100% y el valor predictivo negativo del 58% (IC 95% 0,43-0,75). Al incluir las citologías sospechosas como malignas la sensibilidad fue del 67% (IC 95% 0,54-0,81) sin modificarse el resto de parámetros. En ocho pacientes fueron necesarias nuevas CPRE durante las cuales se repitieron las tomas citológicas, llegando a un diagnóstico de certeza en todos ellos. Conclusiones: la citología biliar presenta una sensibilidad intermedia con elevada especificidad. Una metodología sistemática con un patólogo dedicado y la inclusión de las citologías con atipias celulares como malignas mejora la sensibilidad de la técnica. Dada su sencillez creemos que debe de realizarse en todos los casos de estenosis biliar observada durante una CPRE, incluyendo la repetición de las tomas citológicas siempre que sea necesario practicar más de una CPRE en el mismo paciente(AU)

Aim: to evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. Patients and methods: data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. Results: a total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. Conclusions: brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended(AU)

Effects of antibacterial agents on dental pulps of monkeys mechanically exposed and contaminated.

OBJECTIVE: The purpose of this study was to compare the effectiveness of antibacterial agents and mineral trioxide aggregate in the healing of bacterial contaminated primate pulps. STUDY DESIGN: The experiment required four adult male primates (Cebus opella) with 48 teeth prepared with buccal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the exposed pulps were exposed to cotton pellets soaked in a bacterial mixture consisting of microorganisms normally found in human pulpal abscesses obtained from the Endodontic Clinic of UNESP. Following bacterial inoculation (30 minute exposure), the pulpal tissue was immediately treated with either sterile saline, Cipro HC Otic solution (12), diluted Buckley' formecresol solution (12) or Otosporin otic solution (12) for 5 minutes. After removal of the pellet, hemostasis was obtained and a ZOE base applied to the DFC treated pulps and the non-treated controls (12). After hemostasis, the other exposed pulps were covered with mineral trioxide aggregate (ProRoot). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at one day, two days, one week and over four weeks (34 days). RESULTS: Following perfusion fixation, the samples were demineralized, sectioned, stained and histologically graded. After histologic analysis, presence of neutrophilic infiltrate and areas of hemorrhage with hyperemia were observed. The depth of the neutrophilic infiltrate depended on the agent or material used. The pulpal tissue treated with Otic suspensions demonstrated significantly less inflammation (Kruskal Wallis non parametric analysis, H = 9.595 with 1 degree of freedom; P = 0.0223) than the formocresol and control groups. The hard tissue bridges formed over the exposure sites were more organized in the MTA treatment groups than in the control and ZOE groups (Kruskal Wallis non parametric analysis, H = 18.291 with 1 degree of freedom; P = 0.0004). CONCLUSIONS: Otic suspensions and MTA are effective in treating bacterial infected pulps and stimulate the production of a hard tissue bridge over the site of the exposure.

Donación de ovocitos / Oocyte donation

Objetivo: Conocer el marco legal y científico, indicaciones, resultados, aspectos emocionales y controversias existentes relacionadas con la técnica de donación de ovocitos en reproducción asistida. Material y métodos: Revisión de las principales guías de práctica clínica publicadas en la bibliografía internacional (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gyneacologist [RCOG]). Resultados: La tasa de embarazo obtenida mediante esta técnica varía entre el 30 y 50% en función de las fuentes consultadas. La prestación asumida por el Servicio Andaluz de Salud sólo cubre el 17% de las indicaciones que se hacen en sanidad privada. Conclusiones: La donación de ovocitos es una técnica que obtiene buenos resultados en el segmento poblacional con peor pronóstico reproductivo. Su extensión difiere sustancialmente entre el sector privado y el público. Con la generalización de la técnica han aparecido nuevas controversias no del todo resueltas. El escaso número de donantes y los aspectos morales son los dos principales factores que limitan la extensión de la técnica (AU)

Objective: To determine the legal and scientific framework, indications, results, emotional issues, and current debates related to oocyte donation in assisted reproduction. Material and methods: We reviewed the main clinical practice guidelines published in the international literature (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gynecologists). Results: The pregnancy rate obtained by this technique varied between 30% and 50%, depending on the sources consulted. The services provided by the Andalusian Health Service covered only 17% of the indications covered by private health providers. Conclusions: Oocyte donation provides good results in the segment of the population with the worst reproductive prognosis. The use of this technique differs substantially between the private and public sectors. With the widespread use of this technique, new controversies have appeared that have not been entirely resolved. The two main factors limiting wider use of oocyte donation are the low number of donors and moral issues (AU)

Manejo no operatorio del trauma abdominal cerrado en el Hospital Puente Piedra / Nonsurgical handing of closed abdominal trauma at the Hospital Puente Piedra

El manejo del traumatismo abdominal cerrado, es sin duda una noxa de peculiar accionar, ante su sospecha, como una emergencia potencial de riesgo de vida. Las diferentes escuelas de cirugía, con el transcurso de los años, empiezan a cuestionarse acerca del manejo de esta patología, sea por cirugía abierta, o manejo no quirúrgico. A la actualidad existen protocolos y mayores criterios que acercan con más sensibilidad y especificidad, para decidir entre alguna alternativa. Presentamos el reporte de un caso de una mujer adulta, que sufre impacto abdominal, por una mototaxi, vehículo de transporte usual en la comunidad de Puente Piedra (Lima-Perú). Evaluada en el Hospital Puente Piedra, refiriendo como síntoma y signo principal, dolor abdominal en hipocondrio izquierdo, además hemodinamicamente estable, y con hematocrito de ingreso de 22%. Se le catalogo como traumatismo abdominal cerrado, con sospecha de ruptura esplénica, esta fue confirmada por ecografía y tomografía computada abdominal, manejándosele de forma no quirúrgica.

Handling of closed abdominal trauma is a noxa with a peculiar way of action when suspected, because of its life threatening potential. Different Schools of Surgery, as years go by, start to question how to handle this pathology, either by open surgery or non surgical procedures. Today, there are protocols and criteria with better sensitivity and specificity that approach this issue to decide among alternatives. We present the report of an adult woman that suffered abdominal trauma by an auto rickshaw (a common way of transportation in the Puente Piedra area). She was evaluated at the Hospital de Puente Piedra, referring as symptoms and main signs abdominal pain at left upper quadrant. She was hemodinamically stable, and had a 22% hematocrit level when admitted. Diagnosis was established as closed abdominal trauma with possible splenic rupture that was confirmed by tomography and ecography. Handling of the patient was non- surgical.

Evaluación psicológica del maltrato en la infancia / Psychological assessment of child maltreatment

En este trabajo se ofrece una visión genérica de las características y los principales objetivos de la evaluación psicológica en el ámbito del maltrato en la infancia. Concretamente se examinan las técnicas utilizadas para la evaluación de los distintos tipos de maltrato, de las figuras parentales y las relaciones que se establecen entre padres e hijos, la evaluación del niño (analizando las técnicas destinadas a la evaluación de la sugestionabilidad y la veracidad del testimonio) y de los aspectos ambientales y sociales

In this paper, we offer a generic approach of the characteristics and the main goals of the psychological assessment in the field of child abuse. Specifically, we examine the techniques used for the evaluation of the different child abuse types, the parental figures and the relationship established between parents and children, child evaluation (analyzing the techniques addressed to the evaluation of suggestion capacity and the truthfulness of testimony) and the environmental and social aspects