Hesitant or Confident: A Qualitative Study Examining Latinos' Perceptions of COVID-19 Vaccines in Arizona.

This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.

Decibel Decisions: The Concept of Intracranial Aneurysm Surgery With a Decibel Meter on Two Surgical Cases.

The present cases were used to investigate the reliability of the intraoperative decibel meter as an objective method of clipping efficiency in cerebral aneurysm surgery and to assess the impact of this method on the surgical procedure itself. Different methodologies have been developed and applied to directly or indirectly evaluate the placement of a clip, for example, intraoperative digital subtraction angiography (DSA), intraoperative micro-Doppler ultrasonography, and, more recently, indocyanine green (ICG). We included two patients with a previously non-treated unruptured brain aneurysm. In both patients, intraoperative micro-Doppler was used in combination with a decibel meter app. Here, we present the cases of two patients. In patient one, the pre-clipping average sound level/equivalent continuous sound pressure level (Avg/Leq) was 96.7 dB, while the post-clipping Avg/Leq was 94.4 dB, indicating a reduction in sound level after clipping. Similarly, the pre-clipping time-weighted average noise level (TWA) was 1.2%, while the post-clipping TWA was 0.5%, indicating a decrease in exposure dose after clipping. In patient two, the average sound level for the post-clipping measurement (94.2 dB) was higher than the pre-clipping measurement (93.5 dB), but the difference was not statistically significant. These cases indicate the potential for using sound measurements as a reliable indicator of adequate aneurysm occlusion during clipping procedures. Further research is needed to confirm these findings.

Attitudes, Behaviors, and Barriers among Adolescents Living with Obesity, Caregivers, and Healthcare Professionals in Spain: ACTION Teens Survey Study.

Although the prevalence of pediatric obesity is rising, understanding of the perceptions, attitudes, behaviors, and barriers to effective obesity care among Spanish adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs) is lacking. In 2021, the cross-sectional ACTION Teens survey study was conducted in 10 countries; results from the Spanish cohort are presented herein. The survey was completed by 648 ALwO, 644 caregivers, and 251 HCPs in Spain. A total of 25% of ALwO and 43% of caregivers thought that their/their child's weight was normal, and more caregivers than ALwO perceived the ALwO's health to be at least good (95% vs. 59%, respectively). Only 53% of ALwO and 9% of caregivers reported receiving an obesity diagnosis, despite HCPs reporting they provide diagnoses to 87% of ALwO/caregivers. Although 65% of HCPs felt that ALwO may not be comfortable discussing weight, only 26% of ALwO who had discussed weight with an HCP (n = 488) reported not feeling comfortable. Inability to control hunger was a key barrier to ALwO losing weight identified by ALwO/caregivers, but not HCPs. Improved communication between the three groups, a better understanding of barriers to weight loss, and improved health education on obesity are needed in order to enhance obesity care in Spain.

Efficient removal of veterinary drugs from aqueous solutions using magnetically separable carbonaceous materials derived from cobalt and iron metal-organic frameworks.

Rapid synthesis of carbon-based magnetic materials derived from cobalt and iron metal-organic frameworks (MOFs), ZIF-67, and MIL-100(Fe), by microwave-assisted method, followed by carbonization under a N2 atmosphere is described in this study. The carbon-derived MOFs (CDMs) were evaluated for the removal of the emerging pollutants sulfadiazine (SDZ) and flumequine (FLU) used as veterinary drugs. The study aimed to link the adsorption behavior with their surface properties and elemental composition. C-ZIF-67 and C-MIL-100(Fe) showed hierarchical porous structures with specific surface areas of 295.6 and 163.4 m2 g-1, respectively. The Raman spectra of the CDMs show the characteristic D and G bands associated with defect-rich carbon and sp2 graphitic carbon, respectively. The CDMs exhibit cobalt species (Co3O4, CoO, and Co) in C-ZIF-67 and iron species (Fe2O3, Fe3O4, and Fe) in C-MIL-100 (Fe) which are related to the magnetic behavior of CDMs. C-ZIF-67 and C-MIL-100 (Fe) had saturation magnetization values of 22.9 and 53.7 emu g-1, respectively, allowing easy solid-liquid separation using a magnet. SDZ and FLU removal rates on CDMs follow pseudo-second-order kinetics, and adsorption isotherms fit the Langmuir model based on regression coefficient values. Adsorption thermodynamics calculations showed that the adsorption of SDZ and FLU by CDMs was a thermodynamically favorable process. Therefore, these properties of C-ZIF-67 and C-MIL-100 (Fe) and their regeneration ability facilitate their use as adsorbents for emerging pollutants.

Examining the Relationship Between Rurality, Risk Perception, and COVID-19 Vaccine Willingness Among Rural Latinos in Arizona and California.

This study aimed to investigate the relationship between rurality and risk perception of getting or transmitting COVID-19 and willingness to get the COVID-19 vaccine in a sample of Latinos across Arizona and California's Central Valley (n = 419). The results revealed that rural Latinos are more concerned about getting and transmitting COVID-19, but less willing to get vaccinated. Our findings suggest that perceptions of risk alone do not play a sole role in influencing risk management behavior among rural Latinos. While rural Latinos may have heightened perception of the risks associated with COVID-19, vaccine hesitancy persists due to a variety of structural and cultural factors. These factors included limited access to healthcare facilities, language barriers, concerns about vaccine safety and effectiveness, and cultural factors such as strong family and community ties. The study highlights the need for culturally-tailored education and outreach efforts that address the specific needs and concerns of this community to increase vaccination rates and reduce the disproportionate burden of COVID-19 among Latino communities living in rural areas.

Mortality and Survival Factors in Patients with Moderate and Severe Pneumonia Due to COVID-19.

During the pandemic, some mortality-related factors were age, sex, comorbidities (obesity, diabetes mellitus, and hypertension), recovery time, hospitalizations, and biochemical markers. The present work aimed to identify the mortality and survival factors in adults with moderate and severe pneumonia due to COVID-19 during the first and second waves of the pandemic in Mexico at a third-level hospital (High-Specialty Regional Hospital of Ixtapaluca (HRAEI), Ixtapaluca, Estado de Mexico, Mexico). A database was generated using information from the electronic clinical records of patients hospitalized from December 2021 to August 2022. Survival analysis was performed associating age, sex, longer recovery times, and some drugs. The risk factors found were age in the patients between 40 and 60 years (OR = 1.70), male sex (OR = 1.53), the presence of comorbidities (OR = 1.66) and hypertension (OR = 2.19), work occupation (construction workers OR = 5.22, factory workers OR = 3.13, unemployed OR = 2.93), the prehospital use of metamizole sodium (OR = 2.17), cough (OR = 1.73), and in-hospital oxygen therapy (reservoir mask OR = 6.6). The survival factors found in this study were working in the healthcare field (OR = 0.26), the prehospital use of certain medications (paracetamol OR = 0.65, dexamethasone OR = 0.55, and azithromycin OR = 0.47), presenting ageusia (OR = 0.5) and hyporexia (OR = 0.34), and the time using in-hospital oxygen therapy (device 1 OR = 0.72). Prehospital treatment needs to be reevaluated as dexamethasone and azithromycin proved to be protective factors. Likewise, providing aggressive oxygen therapy during hospital admission decreased mortality risk.

Gender identity: Current concepts and gender-affirming hormone therapy.

In the past five years, healthcare organisation for trans people in Spain has changed as laws intended to protect sexual and gender diversity have been put in place. As a result, endocrinologists are not only on the front lines (understood as prescribing and following up gender-affirming hormone therapy) but also coordinating multidisciplinary healthcare for these individuals. Advances in transgender medicine, the complexity of diverse trans identities and the impact of hormone therapy on quality of life and risk of middle- and long-term complications call for in-depth examination of a personalised biopsychosocial approach to trans people that requires specific training in this field of knowledge as well as updates on the concepts, terminology and drug treatments used.

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake.

The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

Factores asociados al síndrome de burnout en profesores de universidades públicas en el noroeste de México / Factors assocciated with Burnout Syndromei n Professors of Public Universities form Northwest of Mexico

El presente estudio fue realizado con la participación de docentes de tiempo completo que trabajan en universidades públicas, en los estados de Baja California, Chihuahua, Durango, Sinaloa y Sonora, zona noroeste de México. El 56% de los docentes que participaron en el estudio son del género masculino, 49% reportó pertenecer al rango de 46 años o más, y el 36% contar entre 11 y 20 años de experiencia como docente. El objetivo del estudio fue analizar la presencia del síndrome de burnout en los docentes, así como identificar los factores asociados a la presencia del mismo, al realizar sus actividades relativas a su rol docente. Se utilizó el instrumento de Inventario de Burnout de Maslach, midiendo sus tres dimensiones: cansancio emocional, despersonalización y realización personal. El análisis de los resultados arrojó un incremento de la presencia del síndrome por la realización de actividades relacionadas al rol docente, comparado con estudios previamente realizados en México y España, así como una mayor despersonalización y menor realización personal por parte de docentes masculinos que ejercen su profesión en esta región

In the present study, full-time professors from public universities working in Baja California, Chihuahua, Durango, Sinaloa, and Sonora, northwest of Mexico, participated. 56% of the professors of this study are male, 49% belong to the range of 46 years old or more, and 36% have between 11 and 20 years of work experience in the education work field. The aim of the study was to analyze the Burnout Syndrome in professors from public universities, as well as the identification of factors associated with this syndrome while doing their activities related to the education role. The Maslach Burnout Inventory instrument was used, which measures three dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Results showed an increase in the presence of burnout syndrome, related to education role activities, compared with other studies in Mexico and Spain, as well as greater depersonalization and lower personal accomplishment by male professors working in this region

Diversidad de macro-invertebrados en sistemas silvopastoriles del sur de Quintana Roo, México

La diversidad de macro-invertebrados está relacionada con el estado de conservación del suelo, no obstante, la remoción de la cubierta vegetal natural para el establecimiento de sistemas ganaderos extensivos afecta su integridad. Una estrategia para la conservación de estos organismos es la implementación de sistemas silvopastoriles; no obstante, en el sureste de México la información aún es limitada. El propósito del presente estudio fue evaluar y comparar la riqueza y la abundancia de macro-invertebrados en cuatro agro-ecosistemas contrastantes: dos sistemas silvopastoriles conformados por Leucaena leucocephala y pastos asociados (i.e. Panicum máximum cv mombaza y Cynodon plectostachyus), un pastizal convencional de Brachiaria brizantha con árboles dispersos en baja densidad y una selva mediana subperennifolia. En cada sistema se delimitó una superficie de una hectárea y se estableció un transecto de 50 m de longitud en los que se colocaron cinco trampas de caída tipo pit-fall cada 10 m. El muestreo se realizó en febrero y mayo 2018 y en cada mes se realizaron cinco recolectas con intervalos de cinco días. Se recolectaron un total de 1 737 organismos pertenecientes a 10 órdenes de la clase Insecta y uno a la clase Gastropoda. Los sistemas con mayor abundancia de macro-invertebrados fueron el sistema de selva media subperennifolia (923 individuos) y el sistema silvopastoril de L. leucocephala con C. plectostachyus (354 individuos). Los órdenes más abundantes fueron: Hymenoptera, Coleoptera, Araneae y Orthoptera. La mayor diversidad de macro-invertebrados se presentó en los sistemas silvopastoriles de L. leucocephala con P. maximum (H'=1.58) y L. leucocephala con C. plectostachyus (H´=1.44). Los resultados encontrados muestran que los sistemas pecuarios manejados con componentes leñosos (árboles/arbustos) albergan una riqueza y abundancia importante de órdenes de macro-invertebrados en comparación con sistemas como selva mediana subperennifolia. Esta diversidad de macro-invertebrates podría contribuir a la integridad y funcionalidad de los agro-ecosistemas.

The diversity of macro-invertebrates is related to the state of disturbance of the soil, caused mainly by the land-use change for agricultural activities. A strategy for the conservation of these organisms is the implementation of diversified production systems such as silvopastoral systems. However, in the Southeast of Mexico, information is still limited. The aim of the present study was to evaluate and compare the richness, abundance and composition of macro-invertebrates in four contrasting agro-ecosystems: two silvopastoral systems made of Leucaena leucocephala and associated pastures (i.e. Panicum maximum cv mombaza and Cynodon plectostachyus), a pasture of Brachiaria brizantha with scattered trees in low density and, a medium-statured tropical dry forest. In each system, an area of one hectare was delimited and a transect of 50 m in length was established in which five pit-fall traps were placed every 10 m. The sampling was carried out in February and May of 2018 and in each month five collections were made with five-day intervals. A total of 1 737 organisms belonging to 10 orders of the class Insecta and one of the class Gastropoda were collected. The medium-statured tropical dry forest (923 individuals) and the silvopastoral systems of L. leucocephala with C. Plectostachyus (354 individuals) show the highest abundance of macro-invertebrates. The most abundant genera were: Hymenoptera, Coleoptera, Aracninae and Orthoptera. The higher macro-invertebrate diversity was found in the silvopastoral systems of L. leucocephala with P. maximum (H '= 1.58) and L. leucocephala with C. plectostachyus (H' = 1.44). The results show that livestock systems managed with woody components (trees or shrubs) are home of an important abundance and richness of macro-invertebrates, compared to tropical forests. This diversity of macro-invertebrates may contribute to the integrity and functionality of the agro-ecosystems.

Unbiased Assessment of Abundance of Rhipicephalus sanguineus sensu lato Ticks, Canine Exposure to Spotted Fever Group Rickettsia, and Risk Factors in Mexicali, México.

An epidemic of Rocky Mountain spotted fever (RMSF) is ongoing in Mexicali, México. We visited 100 neighborhoods with diagnosed human cases and 100 control neighborhoods to evaluate knowledge of the epidemic; obtain data on the spatial distribution of dogs, canine seroprevalence and active infection, tick infestations, and presence of rickettsial DNA in ticks; and evaluate risk factors for human cases, seropositivity, and tick infestation within an unbiased study design. The majority (80%) of residents had heard of RMSF, but only 48% used acaricides in the home or on dogs. Case neighborhoods and those with high canine seroprevalence tended to be on the city periphery or in the agricultural valley. No dogs were polymerase chain reaction (PCR) positive for Rickettsia rickettsii, and the overall seroprevalence was 65% (titers from 64 to 1,024). PCR prevalence in ticks was 0.70%, confirmed by DNA sequencing as R. rickettsii; neighborhood prevalence ranged from 0.7% to 6.1%. Twelve percent of dogs had high tick burdens, and all ticks were Rhipicephalus sanguineus. Epidemiologically significant risk factors were ground covering for a neighborhood having a human case; dogs having poor body condition and weighing < 10 kg for canine seropositivity; dogs living at the home for the number of ticks in the environment; and being near canals, having trash on the patio, and a dog being thin for tick burdens on dogs. A One Health approach is crucial to understanding RMSF and brown dog ticks.

Community Residents' Beliefs About Neighborhood Corner Stores in 2 Latino Communities: Implications for Interventions to Improve the Food Environment.

We assessed community residents' perceptions of corner stores to better understand what facilitates and deters patronage at these food outlets. Data came from 978 household interviews in 2 Latino communities undergoing corner store interventions. Chi-square tests, an independent sample t test, and a multivariate logistic regression were conducted to assess the relationship between residents' perceptions about corner stores and their reported patronage at these food outlets. Residents reported that corner stores do not sell a variety of fruits and vegetables and are not places where one can get information about healthy eating. Convenience, cleanliness, positive customer service, availability of culturally appropriate items, and availability of quality fresh fruit increased the odds of store patronage. Simply providing healthy foods will not incentivize patrons to purchase them. Corner store interventions can be more effective if they address the characteristics that community residents prioritize.

Prevalencia de litiasis biliar en personas concurrentes al hospital de clínicas / Prevalence of gallstones in persons who are present at the hospital de clínicas

Introducción: La prevalencia de la litiasis biliar ha sido demostrada en varios países. En nuestro país es la causa principal de patologías quirúrgicas en varios servicios de cirugía, existen pocos estudios sobre el comportamiento de esta patología en el Paraguay. Objetivo: Determinar la prevalencia de litiasis biliar en personas asintomáticas en un hospital paraguayo de referencia. Material y Métodos:En este estudio observacional descriptivo de corte transversal, se analizan por ecografía abdominal personas concurrentes al Hospital de Clínicas, que cumplen con los criterios de inclusión para detección de litiasis vesicular.Utilizando métodos ecográficos estudiamos 58 personas: 30 Mujeres y 28 Hombres con edades de entre 20 a 70 Años. Estimada por el análisis estadístico para estudios descriptivos de una variable dicotómica con nivel de confianza del 95% y seleccionados por conveniencia. Resultados: Se encontraron 4 casos de 58 personas estudiadas (prevalencia de 7%), todos los casos fueron en mujeres de entre 32 a 56 años, 2 personas en edad fértil y 2 personas en edad no fértil. Conclusión:La prevalencia ecográfica de litiasis vesicular en personas asintomáticas fue de 7%. Es un tema novedoso a nivel nacional y latinoamericano. Este estudio podría ser de mucho valor para investigaciones futuras relacionadas al tema.

Introduction: The prevalence of gallstones has been demonstrated in several countries. In our country is the main cause of surgical pathologies in several surgical services, there are few studies on the behavior of this pathology in Paraguay. Objetive: Show the prevalence of gallstones in asymptomatic patients in a Paraguayan referral hospital. Materials and methods: In this cross-sectional, observational, descriptive study, are analyzed by abdominal ultrasonography patients attending the Hospital de Clínicas, who meet the inclusion criteria for vesicular lithiasis. Using ultrasound methods, we studied 58 people: 30 women and 28 men with ages between 20 and 70 years. Estimated by statistical analysis for descriptive studies of a dichotomous variable with 95% confidence level and selected for convenience. Results: Four cases of 58 people were studied (prevalence of 7%), all cases were in women between 32 to 56 years, 2 people of childbearing age and 2 people of nonfertile age. Conclusion: The ultrasound prevalence of vesicular lithiasis in asymptomatic individuals was 7%. It is a new topic at national and Latin American level. This study could be of great value for future research related to the subject.

Experiencia en el manejo de sx de mirizzi en la ii catedra de clínica quirúrgica del hospital de clínicas / Experience in the management of the mirizzi syndrome in the ii cátedra de clínica quirúrgica del hospital de clínicas

Introducción: Se hizo una revisión de las historias clínicas de los pacientes con síndrome de Mirizzi tratados en el Hospital de Clínicas durante el período de enero de 2006 a diciembre de 2015, y se describe su presentación y la importancia de la complejidad en su manejo. Objetivo: Determinar la prevalencia de síndrome de Mirizzi en pacientes operados por patología biliar y manejo del mismo en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas de San Lorenzo.Pacientes y método:Estudio observacional, descriptivo, retrospectivo de corte trasverso. Se describe edad, sexo, diagnóstico de colelitiasis, cuadro clínico, exámenes complementarios, manejo quirúrgico, estancia hospitalaria, morbilidad y mortalidad. Resultados:Se diagnosticaron 21 pacientes. Siendo los más prevalentes el tipo I y II. Una media de 52 años. Todos presentaron dolor abdominal, ictericia (52%). Ningún paciente fue diagnosticado antes de la cirugía. En el Tipo l, se realizaron 8 colecistectomías con distintos abordajes. Tipo II, finalizaron en su totalidad por vía convencional. Las demás clasificaciones tuvieron un tratamiento quirúrgico específico.Conclusión: El síndrome de Mirizzi es una patología compleja de difícil diagnostico pre quirúrgico. La ecografía no es específica para esta patología. Todos los casos se detectaron en el intraoperatorio.

Introduction: A review of the medical records of patients with Mirizzi syndrome treated at the Hospital de Clínicas during the period from January 2006 to December 2015 was made, describing their presentation and the importance of the complexity in their management. Objective: To determine the prevalence of Mirizzi syndrome in patients operated by biliary pathology and show their management in the II Cátedra de Clínica Quirúrgica del Hospital de Clínicas de San Lorenzo. Patients and method: Observational, descriptive, retrospective cross-sectional study. Age, sex, diagnosis of cholelithiasis, clinical picture, complementary examinations, surgical management, hospital stay, morbidity and mortality are described. Results: Twenty-one patients were diagnosed. The most prevalent being types I and II. An average of 52 years. All had abdominal pain, jaundice (52%). No patient was diagnosed prior to surgery. In Type I, eight cholecystectomies were performed with different approaches. Type II, were terminated in their entirety by conventional route. The other classifications had a specific surgical treatment. Conclusion: Mirizzi syndrome is a complex pathology that is difficult to diagnose preoperatively. Ultrasound is not specific for this pathology. All cases were detected intraoperatively.

Dysmorphic Features, Frontal Cerebral Cavernoma, and Hyperglycemia in a Girl with a De Novo Deletion of 7.23 Mb in Region 7p13-p12.1.

We describe the case of a 7-year-old girl referred to our diabetes unit for hyperglycemia associated with facial dysmorphic features, intellectual disability, and cerebral cavernomas. Based on presence of anti islet antigen-2 (IA2) antibodies and a human leukocyte antigen of DR3/DR4/DQ2, the patient was initially diagnosed to be a case of type 1 diabetes mellitus. At follow-up, the very good metabolic control on a low insulin dose and negative IA2 antibodies led to a suspicion of glucokinase (GCK)-related maturity-onset diabetes of the young (MODY 2). This suspicion was substantiated in multiplex ligation-dependent probe amplification (MLPA) which showed a heterozygous GCK deletion (exons 1 to 12). However, the patient's parents did not have such a deletion and were clinically euglycemic. Given the clinical picture and the MLPA findings, array based comparative genomic hybridization was performed showing a monoallelic deletion of 7.23 Mb in the short arm of chromosome 7 (7p13-p12.1). The deleted intervals contain 39 genes listed in the Online Mendelian Inheritance in Man list, including GCK associated with MODY 2, CCM2 associated with type 2 cerebral cavernous malformations, IGFBP-3 associated with decrease in postnatal growth, and OGD associated with alpha-ketoglutarate dehydrogenase deficiency, with cognitive impairment and movement abnormalities. This previously unreported deletion was considered to explain the clinical picture of the patient. Also, the findings suggest that 7p13-p12.1 contains genes involved in intellectual disability and craniofacial development.

Evaluation of two in-house immunoenzymatic tests to serodiagnose subclinical paratuberculisis in a sheep flock in Mexicali valley, Mexico.

Paratuberculosis (PTB) or Johne's disease is a common ruminant infectious disease caused by Mycobacterium avium subsp. paratuberculosis (MAP). In this study, two MAP antigens were compared for their diagnostic utility to detect subclinical PTB in a sheep flock in Mexicali, Mexico. Sheep (n = 31) without clinical signs but positive on a direct fecal-polymerase chain reaction were tested with two preabsorbed in-house enzyme linked immunosorbent assays (ELISAs) using: (1) an ethanol-extracted surface lipid antigen (EVELISA) and (2) a protoplasmic antigen (ELISA-PPA). Sensitivities of the EVELISA and ELISA-PPA were 84% (95% CI; 66-95%) and 29% (95% CI; 14-48%), respectively. The EVELISA test could be a fast and effective way to identify subclinical ovine PTB for severely affected flocks.

Tratamiento laparoscópico de hernia incisional con malla biocompatible de ptfe intraperitoneal / Laparoscopic treatment of incisional hernia with ptfe biological mesh

Una hernia Incisional (HI) puede definirse como cualquier defecto de la pared abdominal, con o sin aumento de volumen, en el área de una cicatriz postoperatoria, perceptible o palpable por el examen clínico o imagenológico(1). La hernioplastía intraperitoneal laparoscópica constituye una opción segura para el tratamiento de hernias incisionales de la pared abdominal, asociada a una baja tasa de recurrencia que alcanza a 6,25% a largo plazo(1). Se presenta un caso de Hernioplastia laparoscópica con colocación de malla de PTFE intraperitoneal, como una alternativa válida para la reparación de hernias incisionales.

An incisional hernia can be defined a s a ny d efect o f t he abdominal wall, with or without an increase in volume, in the area of a postoperative scar, perceptible or palpable by clinical or imaging examination. The l aparoscopic i ntraperitoneal h ernioplasty is a safe option for the treatment of incisional hernias of the abdominal wall, associated with a low recurrence rate that reaches 6.25% in the long term. In this time, a case of laparoscopic hernioplasty with placement of a intraperitoneal PTFE mesh is presented as a valid alternative for the repair of incisional hernias.

Manejo quirúrgico del quiste pilonidal. Técnica cerrada con colgajo de avance / Management of pilonidal cyst with closure technique

Introducción:La técnica cerrada es cada vez más utilizada en el tratamiento quirúrgico del quiste pilonidal, ya que es simple, con periodo de corto tiempo quirúrgico, hospitalización y cicatrización, aunque en nuestro medio aún no sea la más utilizada. Objetivo: Describir la experiencia del tratamiento del quiste pilonidal con la técnica cerrada con colgajo de avance en nuestro servicio.Materiales y método:El trabajo presenta un diseño observacional, descriptivo de corte transversal. Se estudió 30 pacientes de ambos sexos con diagnóstico de quiste pilonidal, intervenidos quirúrgicamente con la técnica cerrada con colgajo de avance en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas en el periodo enero 2014 a enero 2017. Resultados: 30 pacientes, edad promedio: 27,4 conrango entre 17 a 41 años, de los cuales el 70% (21) eran del sexo masculino y 30% (9) del sexo femenino, el promedio del tiempo quirúrgico fue 39 min y la estancia hospitalaria de 6 a 12 horas post quirúrgicas, el 90% (27) de los pacientes no presentó complicación alguna, presentando buena cicatrización en 15 días, la morbilidad fue del 10% (2 infecciones del sitio quirúrgico y 1 hematoma) y mortalidad nula. Discusión: En el trabajo de Karydakis, la edad promedio fue de 24,5 años en el nuestro de 27,4; el 53% fue hombre, en el nuestro 70%; la hospitalización promedio fue de 2,5 días, el nuestro de 6 a 12 horas. La recuperación completa de la mayoría fue de 15 días en ambos trabajos.

Introduction: The closed techinique is one of the most used in the surgical treatment of the pilonidal cyst, because it is simple and reproductible, it presents a period of short surgical time, of hospital stay and cicatrizacion. Objective: to describe experience of treatment of the pilonidal cyst with the closed flap technique in our servise. Materials and methods: the study has an observational, descriptive, and transverse cut desing, 30 patients where included, they submited to this technique during the period January 2014 to january 2017 in the II service of clinical surgery in The Clinical Hospital (Paraguay) Result: 30 pacients, with a range between 17 to 41 years of age, with 70%(21) were male, and 30%(9) were female, the average surgical time was 39 minutes, and the avarege hospital stay was 6 to 12 hours post surgical procedure, 90%(27) of the patients did not present any complications, presenting good healing in an average of 15 days, the morbidity was 10% (2 surgical site infections and 1 hematoma), and mortality was null. Discussion: in a Word of Karydakis obtained similar results to our work, the average age was 24,5 years in our 27,4; the 53% was a man, in our 70%; the average hospitalization was 2,5 days, in our 6 to 12 hour period. The complete recovery of the major-ity of the patients was of 15 days in both works.

Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand.

In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.