Larvae trypanorhynch (Cestoda) infecting the dusky flounder, Syacium papillosum (Paralichthyidae: Pleuronectiformes) in the continental shelf of the Yucatan Peninsula, Mexico.

Trypanorhynch cestode larvae were found parasitizing specimens of dusky flounder Syacium papillosum (Linnaeus, 1758) in the Southeastern Gulf of Mexico (s-GoM). Plerocercoids were recovered from a total of 194 flatfish, embedded in the intestine and stomach wall. Trypanorhynch were identified using morphology and a molecular phylogeny using newly sequenced partial 28S (region D1-D3) ribosomal DNA in combination with data derived from other species of trypanorhynchs available from GenBank. Larvae representing three genera of trypanorhynch cestodes, Nybelinia Poche, 1926; Kotorella Euzet & Radujkovic, 1989 and Oncomegas Dollfus, 1929 were found in dusky flounder specimens in the s-GoM. These plerocercoids represent six species: Nybelinia sp. 1, Nybelinia sp. 2, Nybelinia sp. 3, Nybelinia sp. 4, Kotorella pronosoma (Stossich, 1901) and Oncomegas wageneri (Linton, 1890) Dollfus, 1929. All cestode specimens in this study represent new locality records for their respective species.

Integrative taxonomy of Serrasentis gibsoni n. sp. (Acanthocephala: Isthmosacanthidae) from flatfishes in the Gulf of Mexico.

The Isthmosacanthidae acanthocephalan species of the genus Serrasentis are parasites of marine teleosts and an elasmobranch. In this study, Serrasentis gibsoni n. sp. is described from the intestines of four flatfish species (Paralichthyidae), namely Ancyclopsetta quadrocellata, Cyclopsetta chittendeni, Syacium gunteri, and S. papillosum from 10 oceanic sites in the Gulf of Mexico (GoM). Twenty sequences of the 'barcoding' region of cytochrome C oxidase subunit I gene were obtained from 20 adults of Serrasentis gibsoni n. sp. Additionally, five sequences of the barcoding region were obtained from five adults of rhadinorhynchid Gorgorhynchus lepidus from C. chittendeni, S. papillosum and one species of Haemulidae, Haemulom aurolineatum, from five oceanic sites from the GoM. Two phylogenetic approaches were followed: Bayesian inference and maximum likelihood. In both phylogenetic reconstructions, the sequences of Serrasentis gibsoni n. sp. were recovered as a monophyletic group within the genus Serrasentis and placed as a sister group to G. lepidus. However, due to the lack of molecular data for species of the Isthmosacanthidae and Rhadinorhynchidea, these phylogenetic inferences must be taken with caution. Serrasentis gibsoni n. sp. is the first species of Serrasentis described from Paralichthyidae flatfish species from marine waters of the Americas and from the GoM. Based on the barcoding data set analyzed, Serrasentis gibsoni n. sp. appears to have high intraspecific genetic variation; thus, it is necessary to continue exploring the genetic diversity of this species to infer its intraspecific evolutionary patterns.

Stephanostomum minankisi n. sp. (Digenea: Acanthocolpidae) from dusky flounder Syacium papillosum (Paralichthydae) from southern Gulf of Mexico: A new species without spines?

A new species of the genus Stephanostomum is described for the southeastern Gulf of Mexico based on morphological and nucleotide evidence. Stephanostomum minankisi n. sp. infects the intestine of the dusky flounder Syacium papillosum in the Yucatan Continental Shelf, Mexico (Yucatan Peninsula). Sequences of the 28S ribosomal gene were obtained and compared with available sequences of the other species and genera of the families Acanthocolpidae and Brachycladiidae from GenBank. A phylogenetic analysis was conducted, including 39 sequences, 26 of which represented 21 species and six genera of the family Acanthocolpidae. The new species is characterized by the absence of circumoral spines and spines on the tegument. Nonetheless, scanning electron microscopy consistently revealed the pits of 52 circumoral spines distributed in a double row with 26 spines each, and forebody spined. Other distinctive features of this species are testes in contact (sometimes overlapping), the vitellaria running along the body lateral fields to the mid-level of the cirrus-sac, pars prostatica and ejaculatory duct similar in length, and uroproct present. The phylogenetic tree showed that the three species found as parasites of dusky flounder (the new adult species and two in metacercaria stages) were grouped into two different clades. S. minankisi n. sp. was the sister species of Stephanostomum sp. 1 (Bt = 56) and formed a clade with S. tantabiddii, supported by high bootstrap values (100).

Life events and the onset of motor symptoms in Parkinson's disease.

BACKGROUND: Whether there may be any relationship between stressful or traumatic life events (LE) and the subsequent motor symptoms onset in Parkinson's disease (PD) is still controversial. OBJECTIVES: To explore whether a subjectively perceived as stressful or traumatic LE were more frequently present in a group of recent motor onset parkinsonian patients (Recent Onset Parkinsonism - ROP) compared with healthy controls (HC) and a group of patients already diagnosed as PD. METHODS: A consecutive series of 139 ROP patients, 138 matched PD patients and 138 HC were pooled through a validated LE exposure questionnaire evaluating the number of patients affected by LE and the amount of LE per group occurred in the last year, segregating by subjective severity in total and severe LE. RESULTS: There was no significant difference in the percentage of patients affected by total (p = 0.134) nor by severe (p = 0.133) LE within the 3 groups. No significant difference was observed in the number of total LE between ROP and HC (p = 0.063), ROP and PD (p = 0.688), nor in severe LE (ROP vs. HC, p = 0.637. ROP vs. PD, p = 0.500). CONCLUSIONS: During the year of parkinsonian motor symptoms onset, the number of ROP patients exposed to total or severe LE or the amount of total or severe LE suffered by ROP were not significantly different to the group of PD patients or HC. A casual relationship between LE and the onset of motor symptoms in parkinsonian patients may be suggested.

[Restoring horizontal stability in III-V acromioclavicular dislocations by anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments; surgical technique]. / Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica.

INTRODUCTION: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint. MATERIAL AND METHODS: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification. RESULTS: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability. CONCLUSION: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

INTRODUCCIÓN: la luxación de la articulación acromioclavicular (AC) es una lesión frecuente que se observa en adultos jóvenes. El objetivo es describir una técnica quirúrgica que pueda restablecer la estabilidad horizontal y vertical de la articulación AC. MATERIAL Y MÉTODOS: se describe una técnica quirúrgica utilizando un aloinjerto para la reconstrucción anatómica de los ligamentos coracoclaviculares (CC) y AC para luxaciones AC grado III-V de acuerdo con la clasificación de Rockwood. RESULTADOS: es una técnica quirúrgica con reconstrucción anatómica y biológica de los ligamentos CC y AC con injerto. Se realizan dos túneles óseos en la clavícula pasando el cabo lateral del injerto por debajo del acromion; posteriormente se fijan los dos cabos con dos tornillos bioabsorbibles, restaurando de esta manera la estabilidad vertical y horizontal. CONCLUSIÓN: este procedimiento permite restablecer la estabilidad vertical y horizontal de la articulación AC. Se requieren estudios de seguimiento para reportar resultados funcionales y radiológicos con el fin de poder asegurar ventajas en comparación con las técnicas existentes.

Occurrence of Ancylostoma Caninum from a Gray Fox Urocyon Cinereoargenteus in Southeastern Mexico.

The hookworm Ancylostoma caninum is a common nematode of wild and domestic canids worldwide. In Mexico, there are few records of helminths in wild canids, especially in the southeastern region. The aim of the present study was to examine the helminths from a gray fox Urocyon cinereoargenteus in southeastern Mexico. A road-killed female gray fox found in Merida, Yucatan, Mexico, was examined for helminths. Only nematodes were found in the intestine of the gray fox and identified using morphological studies and molecular analysis of 28S rRNA gene fragments. The characteristics exhibited by the nematode specimens were in accordance with descriptions of A. caninum: e. g. oral opening with a pair of prominent chitinous plates bearing three pairs of ventral teeth, lateral rays with a common trunk, dorsal ray divided into two branches with each branch terminating in three digitations. BLAST analysis of the 28S sequence showed similarity and coverage values of 99.8 % and 100 %, respectively, with a sequence of A. caninum from the domestic dog Canis familiaris in Australia. The genetic distance between the Australian specimen and the Yucatan specimen of A. caninum was 0.1 %, that is, they were only different in a single nucleotide. The gray fox examined in this study was found close to a rural community where A. caninum has been recorded from domestic dogs, which could be the source of infection. Our study increases the distribution of this nematode parasitizing the gray fox in Mexico and provides the first nucleotide sequence of A. caninum from the gray fox.

Triggered electromyography (tEMG) in the lumbar spine It́s reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation. / Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar.

INTRODUCTION: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. METHOD: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. RESULT: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). CONCLUSION: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.

Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica / Restoring horizontal stability in III-V acromioclavicular dislocations by anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments; surgical technique

Resumen: Introducción: la luxación de la articulación acromioclavicular (AC) es una lesión frecuente que se observa en adultos jóvenes. El objetivo es describir una técnica quirúrgica que pueda restablecer la estabilidad horizontal y vertical de la articulación AC. Material y métodos: se describe una técnica quirúrgica utilizando un aloinjerto para la reconstrucción anatómica de los ligamentos coracoclaviculares (CC) y AC para luxaciones AC grado III-V de acuerdo con la clasificación de Rockwood. Resultados: es una técnica quirúrgica con reconstrucción anatómica y biológica de los ligamentos CC y AC con injerto. Se realizan dos túneles óseos en la clavícula pasando el cabo lateral del injerto por debajo del acromion; posteriormente se fijan los dos cabos con dos tornillos bioabsorbibles, restaurando de esta manera la estabilidad vertical y horizontal. Conclusión: este procedimiento permite restablecer la estabilidad vertical y horizontal de la articulación AC. Se requieren estudios de seguimiento para reportar resultados funcionales y radiológicos con el fin de poder asegurar ventajas en comparación con las técnicas existentes.

Abstract: Introduction: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint. Material and methods: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification. Results: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability. Conclusion: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

Discovery of a New Genus and Species of Allocreadiidae (Trematoda) in Mexico: Mesoamericatrema Magnisacculus n. Gen. n. Sp.

The trematodes of Allocreadiidae are mainly parasites of freshwater fish and the family contains 18 valid genera. Since 2004, 4 genera have been described in the Americas: Paracreptotrema, Paracreptotrematoides, Pseudoparacreptotrema and Auriculostoma, of which the latter was recently synonymized with Creptotrema by Franceschini et al., (2021). During a study in 2018 on fish parasites of Lacantún River, Chiapas, Mexico, allocreadiids were collected from the intestine of Atherinella alvarezi and morphological differences with other genera of the family were immediately noted. These differences were corroborated with molecular data and phylogenetic analyses, which indicated that it was a new genus and species. The objective of this study is to describe the new taxon, which we name Mesoamericatrema magnisacculus n. gen., n. sp. as well as to clarify its phylogenetic relationships, host specificity, and geographical distribution. For this, we carried out a meticulous study of the morphology and compared the new taxon with its congeners. We also obtained sequences of the 28S and ITS from the ribosomal RNA region that were used in generating molecular phylogenies and in calculating genetic distances with sequences of other species of Allocreadiidae available in the Genbank. The new genus is mainly characterized by having a very large cirrus sac in relation to the length of its body and nests in a clade that groups Creptotrema, Creptotrematina, Paracreptotrema, Paracreptotrematoides, Pseudoparacreptotrema and Wallinia, all of which have a Neotropical affinity in terms of their geographic and host distribution. Mesoamericatrema n. gen. is the fifth genus of Allocreadiidae to be described in the Americas since 2004, the third discovered in Mexico since 2016, and the first to be described as parasitizing Atheriniformes, which indicates that Middle America is a region where important speciation events have occurred in freshwater fish parasites.

Diversidade genética em Brucella canis: aplicação no desenvolvimento de vacinas / Diversidad genética en Brucella canis: aplicación en el desarrollo de vacunas / Genetic diversity in Brucella canis: application in vaccine development

La prevalencia de la brucelosis canina por B. canis, está aumentando a nivel mundial, al igual que los reportes en personas. La ausencia de vacunas y de programas de control, permiten predecir una rápida expansión de la enfermedad, con el consecuente impacto en la reproducción canina y en la Salud Pública. Por lo anterior, es urgente analizar candidatos vacunales que consideren las características genómicas de las cepas circulantes a nivel mundial, toda vez que se ha comprobado variabilidad genética, particularmente en genes asociados a factores de virulencia tales como proteínas de membrana externa y sistema de secreción tipo IV. La presencia de un conglomerado genético de cepas Latinoamericanas de B. canis debe ser considerado en estudios futuros de tal manera de generar productos vacunales sin limitaciones geográficas.(AU)

A prevalência da brucelose canina por B. canis está aumentando em todo o mundo, assim como os relatos em humanos. A falta de vacinas e programas de controle prevêem uma rápida disseminação da doença, com conseqüente impacto sobre a reprodução canina e a saúde pública. Portanto, é urgente analisar os candidatos a vacina que consideram as características genômicas das cepas que circulam pelo mundo, uma vez que a variabilidade genética foi comprovada, particularmente nos genes associados a fatores de virulência, como as proteínas da membrana externa e o sistema de secreção tipo IV. A presença de um grupo genético de linhagens latino-americanas de B. canis deve ser considerada em estudos futuros a fim de gerar produtos vacinais sem limitações geográficas.(AU)

Morphological and Molecular Identification of Nematodes in The Tayra Eira Barbara from Campeche, Mexico.

The tayra Eira barbara is a Neotropical mustelid considered as an endangered species by Mexican environmental authorities. Despite the considerable information available on the biology and ecology of E. barbara, little is known about its helminth fauna. Here, we provided new records of nematodes from a road-killed tayra in Calakmul, Campeche, Mexico. The species identification of nematodes was based on morphological studies and molecular analysis of fragments of the 28S gene. The tayra specimen was infected by three nematodes: Molineus sp., Physalopterinae gen. sp. and Angiostrongylus vasosum. To our knowledge, this study is the first to report the natural infection of E. barbara with Molineus sp. and Physalopterinae gen. sp. Our study provides the first nucleotide sequences of nematodes parasitizing E. barbara providing a starting point against which future studies may be compared.

[Mortality rate after a hip fracture in a low-income population in an orthopedic training hospital]. / Tasa de mortalidad después de una fractura de cadera en población con bajos ingresos económicos, en un hospital de entrenamiento ortopédico.

INTRODUCTION: Hip fracture are an important cause of morbidity and mortality in old patients. The one-year mortality after a hip fracture increase between 14 to 47%. The main objective was to analyze the risk factors associated with mortality after a hip fracture in a low-income population. MATERIAL AND METHODS: Retrospective study of patients with traumatic hip fracture in a four-year period in an orthopedic training hospital. The data collected was age, gender, Charlson comorbidity index (CCI), delay time in days for surgery, duration in hours for surgical procedure, transfusion. Two groups were analyzed, alive patients and deceased patients. RESULTS: A total of 96 patients with traumatic hip fracture was analyzed. Mortality rate in the first year was pf 16.6%, and at the end of the follow-up was 32.2%. The alive patients showed better values of CCI with a value of 4.2 ± 1.1 versus 5.2 ± 1.0 in the deceased patients. When compared delay time for surgery and duration of surgical procedure did not observe significant difference between patients alive and deceased. CONCLUSION: The delay time of surgery did not affect the mortality after a traumatic hip fracture in old patients with economic low-income.

INTRODUCCIÓN: Las fracturas de cadera representan una causa importante de morbimortalidad en los adultos mayores. La mortalidad a un año posterior a una fractura de cadera incrementa entre 14 y 47%. El objetivo de este estudio fue analizar los factores de riesgo que impactan la tasa de mortalidad posterior a una fractura de cadera en una población de bajos recursos. MATERIAL Y MÉTODOS: Se analizaron de manera retrospectiva pacientes con fractura de cadera traumática en un período de cuatro años en un hospital universitario con entrenamiento ortopédico. Los datos recolectados incluyeron edad, género, índice de comorbilidad de Charlson (CCI), tiempo en días para la cirugía y duración del procedimiento quirúrgico, así como necesidad de transfusión. Se analizaron dos grupos, pacientes vivos y pacientes fallecidos. RESULTADOS: Se evaluó un total de 96 adultos mayores con fractura de cadera. La tasa de mortalidad durante el primer año fue de 16.6%, mientras que al final del seguimiento fue de 32.2%. El grupo de sobrevivientes presentó una mejor evaluación de acuerdo con el CCI con valor de 4.2 ± 1.1 versus 5.2 ± 1.0 en los pacientes fallecidos. No se encontró diferencia estadísticamente significativa en la mortalidad entre ambos grupos al comparar los días de espera de tiempo quirúrgico y la duración de la cirugía. CONCLUSIÓN: El retraso de la cirugía no afecta la tasa de mortalidad después de una fractura de cadera en pacientes de edad avanzada con bajo ingreso económico.

First Evidence of Akodon-Borne Orthohantavirus in Northeastern Argentina.

Orthohantaviruses (genus Orthohantavirus, family Hantaviridae) are the etiologic agents of Hantavirus Pulmonary Syndrome in the Americas. In South America, orthohantaviruses are highly diverse and are hosted by sigmodontine rodents (subfamiliy Sigmodontinae, family Cricetidae), an also diverse group of rodents. The aims of this work were to (1) identify orthohantavirus hosts and (2) to study the spatial and temporal variations in the prevalence of infection and their associations with community, environmental and individual characteristics, in different environments of Misiones province, northeastern Argentina. Live-capture sessions were carried out during two years in different land uses, with a trapping effort of 31,653 trap nights. We captured 719 individuals from the species Akodon montensis, Rattus rattus, Mus musculus, Calomys tener, Thaptomys nigrita, Oligoryzomys nigripes, Euryoryzomys russatus, Oligoryzomys flavescens, Brucepattersonius sp., and Juliomys pictipes. Antibodies against orthohantavirus were detected in Akodon montensis in one natural protected and one periurban areas, and it was the most abundant species in almost every study sites. We observed the presence of spatial focality of orthohantavirus infection and a positive association with host abundance suggesting the existence of a threshold density. At the individual level, large, reproductively active, and male individuals were more likely to have antibodies against orthohantavirus. This is the first record of orthohantavirus infection in A. montensis in Argentina, which shows the importance of investigations about emerging diseases.

[Tropical pyomyositis of the iliacus, obturator internus, piriformis and psoas major muscles in an immunocompetent patient with claudication]. / Piomiositis tropical del músculo ilíaco, obturador interno, piriforme y psoas mayor en un paciente inmunocompetente con claudicación.

INTRODUCTION: Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected. CLINICAL CASE: Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives. CONCLUSIONS: It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.

INTRODUCCIÓN: La piomiositis es un término que denota infección piógena por lo general primaria de músculo esquelético. Clásicamente descrita de manera frecuente en zonas tropicales y en pacientes inmunocomprometidos; sin embargo, en las últimas décadas se observa cada vez más en zonas de climas templados y con relativa mayor frecuencia en pacientes inmunocompetentes, siendo el grupo etario más afectado el de menores de 30 años. CASO CLÍNICO: Masculino de 15 años sin antecedentes médicos de relevancia. Acude por presentar cuadro clínico de siete días de evolución caracterizado por dolor referido en ingle y zona de la cresta ilíaca izquierda asociado a claudicación e hipertermia no cuantificada, que cedían parcialmente a AINES y paracetamol, pero sin lograr mejoría, por lo que es llevado a urgencias por familiares. CONCLUSIONES: Es necesario tener en mente esta patología al momento de realizar el abordaje diagnóstico diferencial de un paciente que se presenta con dolor y limitación funcional de alguna articulación asociada a datos sugestivos de un proceso infeccioso o inflamatorio.

Pronación: Tecnología de enfermería que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González en la Ciudad de México / Pronation: A nursing technology that promotes wellbeing among COVID-19 patients at General Hospital Dr. Manuel Gea Gonzalez in México City

Introduction: pronation is a procedure used at the Intensive Care Unit with patients presenting Acute Respiratory Distress Syndrome (ARDS) with severe hypoxemia. Bibliographical references clearly support the application of this procedure due to the improvement it produces in oxygenation and the increased survival rate in patients. The main foundation behind this technology is that Ventral Decubitus (VD) promotes an improved redistribution of ventilation toward the dorsal regions of the lung, which are mainly collapsed during Dorsal Decubitus. Nursing staff have used this procedure because VD has proven to be a strategy with a useful and accessible impact over respiratory physiology. Objective: to analyze Pronation as a nursing technology and its promotion of COVID-19 patients' wellbeing at the General Hospital Dr. Manuel Gea González, in Mexico City. Material and methods: a nonexperimental, quantitative, cross-sectional, prolective, descriptive study to analyze pronation, as a nursing technology that promotes wellbeing in the care of COVID-19 patients at General Hospital Dr. Manuel Gea González, in Mexico City. Pronation as a nursing technology was the variable being measured. The universe was 530 nursing professionals working at the Hospital. The population and sample were 52 nursing specialists working with COVID-19 patients, representing 9.81% of the Universe. Results: as for training and experience with Pronation, 50% of the staff consider they have received sufficient training in regards to the SARS-CoV-2 virus, but they are still under training. Additionally, 84.62 % consider that Pronation promotes a remarkable recovery in the patients, with oxygen saturations between 80 to 100 %; 71.16 % believe that patients do show hemodynamic instability due to the position shift, but not in every case; and 80.77 % consider they make sure their patients do not develop pressure ulcers, given that 65.39 % practice patient hygiene and movement to prevent such ulcers. Discussion: from the interviewed staff, 50.01 % consider they have received sufficient training regarding COVID and the pronation of patients. This is consistent with Hernandez et al., who describe the need of a team trained specifically on the procedure, preferably comprised of Nurses specialized in Intensive Care. Likewise, 84.62% of staff members believe Pronation improves oxygen saturation in patients from 80% to 100%, this is contrasted with Barrantes and Vargas, who indicate that if Pronation does not result in 5% improvement in oxygen saturation, the patient must be returned to dorsal decubitus. Conclusion: ventilation in prone position is a pulmonary protective action used for over 30 years that produces an evident and continuous improvement in blood oxygenation and the respiratory physiology. Therefore, nursing specialists caring for COVID-19 patients recommend its use.

Introducción: la pronación es una maniobra utilizada en las unidades de cuidados intensivos, en pacientes que presentan síndrome de distrés respiratorio agudo (SDRA), cuando la hipoxemia es severa. Apoyada por una sólida evidencia científica, tiene impacto en la forma en que se ventila a los pacientes como parámetro de seguridad, esto aumenta la supervivencia. Objetivo: analizar la pronación, como tecnología de enfermería, que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González, en la Ciudad de México. Material y métodos: estudio de carácter cuantitativo, no experimental, transversal, prospectivo, descriptivo. Variable medida: la pronación, como tecnología de enfermería. El universo 530 profesionales de enfermería que trabajan en el hospital, muestra: 52 especialistas de enfermería que trabajan con pacientes COVID-19. Resultados: en relación a la capacitación y experiencia en pronación, el 50% del personal manifiestan que sí recibieron suficiente capacitación sobre el virus SARS-CoV-2, aunque siguen capacitándose en ésta área; el 84.62 % consideran que en la pronación, los pacientes mejoran bastante, saturando entre el 80 y 100 % de oxígeno y el 80.77 % siempre cuidan que los pacientes no tengan úlceras por presión.Discusión: el 50.01 % del personal entrevistado manifiesta que sí recibió suficiente capacitación sobre la COVID-19 para pronar a los pacientes, lo que es semejante a la investigación de Hernández GD., et al.¹ Conclusión: la ventilación en posición prono es una medida de protección pulmonar utilizada hace más de 30 años que produce una mejoría evidente y sostenida de la oxigenación de la sangre y en la fisiología respiratoria, por lo que los especialistas de enfermería que atiende pacientes COVID-19 recomiendan su aplicación, pues está asociada al aumento de probabilidad de supervivencia.

Tasa de mortalidad después de una fractura de cadera en población con bajos ingresos económicos, en un hospital de entrenamiento ortopédico / Mortality rate after a hip fracture in a low-income population in an orthopedic training hospital

Resumen: Introducción: Las fracturas de cadera representan una causa importante de morbimortalidad en los adultos mayores. La mortalidad a un año posterior a una fractura de cadera incrementa entre 14 y 47%. El objetivo de este estudio fue analizar los factores de riesgo que impactan la tasa de mortalidad posterior a una fractura de cadera en una población de bajos recursos. Material y métodos: Se analizaron de manera retrospectiva pacientes con fractura de cadera traumática en un período de cuatro años en un hospital universitario con entrenamiento ortopédico. Los datos recolectados incluyeron edad, género, índice de comorbilidad de Charlson (CCI), tiempo en días para la cirugía y duración del procedimiento quirúrgico, así como necesidad de transfusión. Se analizaron dos grupos, pacientes vivos y pacientes fallecidos. Resultados: Se evaluó un total de 96 adultos mayores con fractura de cadera. La tasa de mortalidad durante el primer año fue de 16.6%, mientras que al final del seguimiento fue de 32.2%. El grupo de sobrevivientes presentó una mejor evaluación de acuerdo con el CCI con valor de 4.2 ± 1.1 versus 5.2 ± 1.0 en los pacientes fallecidos. No se encontró diferencia estadísticamente significativa en la mortalidad entre ambos grupos al comparar los días de espera de tiempo quirúrgico y la duración de la cirugía. Conclusión: El retraso de la cirugía no afecta la tasa de mortalidad después de una fractura de cadera en pacientes de edad avanzada con bajo ingreso económico.

Abstract: Introduction: Hip fracture are an important cause of morbidity and mortality in old patients. The one-year mortality after a hip fracture increase between 14 to 47%. The main objective was to analyze the risk factors associated with mortality after a hip fracture in a low-income population. Material and methods: Retrospective study of patients with traumatic hip fracture in a four-year period in an orthopedic training hospital. The data collected was age, gender, Charlson comorbidity index (CCI), delay time in days for surgery, duration in hours for surgical procedure, transfusion. Two groups were analyzed, alive patients and deceased patients. Results: A total of 96 patients with traumatic hip fracture was analyzed. Mortality rate in the first year was pf 16.6%, and at the end of the follow-up was 32.2%. The alive patients showed better values of CCI with a value of 4.2 ± 1.1 versus 5.2 ± 1.0 in the deceased patients. When compared delay time for surgery and duration of surgical procedure did not observe significant difference between patients alive and deceased. Conclusion: The delay time of surgery did not affect the mortality after a traumatic hip fracture in old patients with economic low-income.

Enfermedad de Behcet: un reto diagnóstico en reumatología. Descripción de una serie de casos y revisión de la literatura / Behcet's disease: a diagnostic challenge in rheumatology. Description of a case series and a review of the literature

RESUMEN La enfermedad de Behcet es una entidad clínica autoinflamatoria, de etiología desconocida, generalmente con compromiso sistémico, con un patrón de exacerbación y remisión frecuente que se asocia a retraso en el diagnóstico. El diagnóstico de esta enfermedad es complejo, por esta razón presentamos 4 casos de pacientes con enfermedad de Behcet, que durante el abordaje clínico fueron consideradas otras enfermedades de naturaleza autoinmune. La revisión integrada de la historia clínica, la aparición de úlceras orales y genitales, así como el estudio de tipificación del complejo mayor de histocompatibilidad (HLA) permitieron diagnosticar la enfermedad de Behcet.

ABSTRACT Behcet disease is a rare autoinflammatory disorder of unknown aetiology and is characterised by systemic manifestations with an exacerbation-remission pattern, often associated with diagnostic delay. The diagnostic approach to this disease is complex. A report is given on four cases of patients fulfilling the diagnostic criteria for Behcet disease. Other autoimmune rheumatic diseases were considered in the clinical approach. A meticulous clinical evaluation, taking into consideration relapsing aphthous ulcers in oral mucosa and genitalia, and HLA typing allowed a proper diagnosis of Behcet disease to be made.

Following the infection dynamics of the tropical trematode Oligogonotylus mayae in its intermediate and definitive hosts for 13 years.

We present a time series of 13 years (2003-2016) of continuous monthly data on the prevalence and mean abundance of the trematode Oligogonotylus mayae for all the hosts involved in its life cycle. We aimed to determine whether annual (or longer than annual) environmental fluctuations affect these infection parameters of O. mayae in its intermediate snail host Pyrgophorus coronatus, and its second and definitive fish host Mayaheros urophthalmus from the Celestun tropical coastal lagoon, Yucatan, Mexico. Fourier time series analysis was used to identify infection peaks over time, and cross-correlation among environmental forcings and infection parameters. Our results suggest that the transmission of O. mayae in all its hosts was influenced by the annual patterns of temperature, salinity and rainfall. However, there was a biannual accumulation of metacercarial stages of O. mayae in M. urophthalmus, apparently associated with the temporal range of the El Niño-Southern Oscillation (five years) and the recovery of the trematode population after a devasting hurricane. Taking O. mayae as an example of what could be happening to other trematodes, it is becoming clear that environmental forcings acting at long-term temporal scales affect the population dynamics of these parasites.

[Hemicerebellitis due to chikungunya associated with refractory status epilepticus in the paediatric age]. / Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.

TITLE: Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.

[External fixation with reconstruction rail system as a treatment for pseudoarthrosis of the distal femur]. / Fijación externa con sistema de riel de reconstrucción como tratamiento para seudoartrosis del fémur distal.

Distal femur pseudoarthrosis also called «distal femur non-union¼ (DFNU) represents a rare complication associated with a fracture caused by high-energy trauma; its treatment is controversial, as there is a wide variety of surgical techniques that can be implemented, from open reduction plus internal fixation with plates, to the use of fixed angle plates combined with bone autograft. We expose the case of a 24-year-old man who shows up for consultation with the history of having presented a left femoral supracondylar fracture with a year of evolution, treated by osteosynthesis of the distal femur with dynamic condylar screws (DCS plate); developed a torpid evolution with severe pain in the distal third of the left thigh and functional limitation, developed a progressive varus deformity of the left thigh that caused a shortening of 3.8 cm of the limb. A focus of pseudoarthrosis was identified, which was surgically removed, the intramedullary canal was recanalized, and a lateral closed wedge osteotomy was performed to correct the angulation and allow reduction. 5.5 mm (three proximal and three distal) hydroxyapatite screws and an external fixator were placed. In addition, a review of the literature focused on the use of external fixation was carried out as a treatment for the pseudoarthrosis of the distal femur.

La seudoartrosis del fémur distal, también llamada «no unión del fémur distal¼ (NUFD), representa una complicación poco frecuente asociada a una fractura causada por un traumatismo de alta energía; su tratamiento es controversial, ya que existe una gran variedad técnicas quirúrgicas que pueden ser implementadas desde la reducción abierta más la fijación interna con placas hasta el uso de placas de ángulo fijo combinadas con autoinjerto óseo. Exponemos el caso de un hombre de 24 años de edad, el cual se presenta a la consulta con el antecedente de haber sufrido una fractura supracondílea femoral izquierda con un año de evolución, tratada mediante una osteosíntesis del fémur distal con tornillos condilares dinámicos (placa DCS); mostró una evolución tórpida con dolor severo en el tercio distal del muslo izquierdo y limitación funcional, desarrolló una deformidad en varo progresiva del muslo izquierdo que causó un acortamiento de 3.8 cm de la extremidad. Se identificó un foco de seudoartrosis, el cual se retiró quirúrgicamente, se recanalizó el canal intramedular y se realizó una osteotomía de cuña cerrada lateral para corregir la angulación y permitir la reducción. Se colocaron tornillos de hidroxiapatita de 5.5 mm (tres proximales y tres distales) y un fijador externo. Además se hizo una revisión de la literatura enfocada en el uso de la fijación externa como tratamiento de la seudoartrosis del fémur distal.