Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

[Primary hypospadias]. / Hipospadias primario.

Hypospadias is one of the most frequent male congenital anomalies. Its surgical correction is under permanent review and it is always controversial. The best surgical technique can only be chosen intraoperatively, since it is the level of corpus spongiosum division what marks the severity of the case, although it is essential to evaluate position of the meatus, penile curvature, quality of the preputial skin and penile size. It is recommended treatment age between 6-12 months. Nowadays, The most frequently used technique for hypospadias repair is the Snodgrass tubularized incised urethral plate (TIP). Moreover, distal and medial hypospadias may be treated with urethral advance or flap techniques and proximal hypospadias with modifications of these in one-step or two-step procedures. Nevertheless, there are other controversies about hypospadias, such as to preserve or not the prepuce, the use of central or peripheral anesthesia blockade, or the use of wound dressings.

Hipospadias primario / Primary hypospadias surgery

El hipospadias es una de las anomalías congénitas más frecuentes en el hombre. Su corrección quirúrgica se encuentra en permanente revisión y es siempre controvertida. La mejor técnica quirúrgica solo puede elegirse intraoperatoriamente, ya que es el nivel de división del cuerpo esponjoso el que marca la gravedad del cuadro aunque es fundamental la valoración de la posición del meato, la curvatura peneana, la calidad de la piel prepucial y el tamaño del pene. Se recomienda que la edad del tratamiento se sitúe entre 6 y los 12 meses como máximo. La técnica de reparación del hipospadias más utilizada en la actualidad es la uretroplastia con tubulo-incisión de la placa uretral de Snodgrass (TIP). Además los hipospadias distales y medios pueden tratarse con técnicas de avance uretral o técnicas de colgajos y los proximales en un tiempo con modificaciones de estas mismas técnicas o en dos tiempos. Pero en torno al hipospadias existen también otros temas controvertidos, como la conservación o no del prepucio, el uso de bloqueos centrales o periféricos en la anestesia o el uso de apósitos

Hypospadias is one of the most frequent male congenital anomalies. Its surgical correction is under permanent review and it is always controversial. The best surgical technique can only be chosen intraoperatively, since it is the level of corpus spongiosum division what marks the severity of the case, although it is essential to evaluate position of the meatus, penile curvature, quality of the preputial skin and penile size. It is recommended treatment age between 6-12 months. Nowadays, The most frequently used technique for hypospadias repair is the Snodgrass tubularized incised urethral plate (TIP). Moreover, distal and medial hypospadias may be treated with urethral advance or flap techniques and proximal hypospadias with modifications of these in one-step or two-step procedures. Nevertheless, there are other controversies about hypospadias, such as to preserve or not the prepuce, the use of central or peripheral anesthesia blockade, or the use of wound dressings

Early identification of infectious complications in lung transplant recipients using procalcitonin.

OBJECTIVES: The purpose of this study was to determine how sequential measurements of procalcitonin (PCT) could improve the diagnosis of early infectious complications after lung transplantation, and to compare this molecule with other commonly used markers (serum C-reactive protein [CRP] and leukocyte count). METHODS: Prospective observational study in a 34-bed university hospital intensive care unit (ICU). All lung transplant (LT) recipients between January and November 2010 were included. Biomarkers were measured just before surgery, on ICU admission, and daily on postoperative days 2, 3, 4, and 7. RESULTS: A total of 25 patients were included. Those patients with infectious complications presented with significantly higher levels of PCT as early as the first day after transplantation and during subsequent days. The area under receiver operating characteristic curve for PCT as a predictor of infection ranged between 0.83 and 0.97. PCT cutoff of 8.18 ng/mL on day 2 had a sensitivity of 80% and specificity of 100% for prediction of infection development. Neither CRP levels nor leukocyte count could discriminate between the patients with and without infections at any time. CONCLUSIONS: In contrast with CRP levels and leukocyte counts, measurement of PCT appears to be a useful diagnostic tool in detecting early infectious complications in LT patients.

Reconstrucción de pierna con colgajo venofasciocutáneo de safena menor. Hospital San Juan de Dios de Costa Rica, 2004-2009 / Lesser saphenous venofasciocutaneous flap for leg reconstruction. San Juan de Dios Hospital in Costa Rica, 2004-2009

El colgajo venofascicutáneo de safena se emplea con éxito para la reconstrucción de la pierna en diferentes latitudes con diferentes resultados. El objetivo del presente trabajo es describir la población de pacientes en los que se llevó a cabo cirugía reconstructiva en pierna con este tipo de colgajo, así como la aparición de algunos efectos adversos propios de su utilización (necrosis e infección intrahospitalaria), en el periodo de estudio comprendido entre marzo del 2004 y marzo del 2009 en el Servicio de Cirugía Plástica del Hospital San Juan de Dios en San José, Costa Rica. En ese período realizamos este colgajo en un total de 14 pacientes, cuya edad promedio fue de 46,6 años, y entre los que el sexo predominante fue el masculino (71,4 %). Observamos que la necrosis del colgajo se presentó en el 50 % de los casos y de ellos, en el 28,6 % fue total; asimismo la infección nosocomial en este tipo de procedimiento fue del 33,3 %. Concluimos que el colgajo venofasciocutáneo de safena menor es una herramienta útil para la reconstrucción de pierna, sin embargo debemos de tener especial cuidado para evitar posibles complicaciones que pueden afectar el resultado final de dicho procedimiento (AU)

Lesser saphenous venofasciocutaneous flap is used for leg reconstruction with success in diverse latitudes with different results. The aim of this article is to describe the patient population who have underwent leg reconstruction with this flap in the Plastic Surgery Unit, San Juan de Dios Hospital in San José, Costa Rica, from March 2004 to March 2009 and the adverse effects suffered (necrosis and nosocomial infection). We applied the technique to a total of 14 patients, whose average age was 46.6 years and predominant sex was male (71.4 %). Flap necrosis occurred in 50 % of cases and 28.6 % of them were total. Nosocomial infection also in this type of procedure was 33.3 %. We conclude that lesser saphenous venofasciocutaneous flap is a useful tool for reconstruction of leg, but we should be especially careful to avoid possible complications that could affect the outcome of the procedure (AU)

The 14q22.2 colorectal cancer variant rs4444235 shows cis-acting regulation of BMP4.

Common genetic variation at human 14q22.2 tagged by rs4444235 is significantly associated with colorectal cancer (CRC) risk. Re-sequencing was used to comprehensively annotate the 17kb region of strong linkage disequilibrium encompassing rs4444235. Through bioinformatic analyses using H3K4Me1, H3K4Me3, and DNase-I hypersensitivity chromatin signatures and evolutionary conservation we identified seven candidate disease-causing single-nucleotide polymorphisms mapping to six regions within the 17-kb region predicted to have regulatory potential. Reporter gene studies of these regions demonstrated that the element to which rs4444235 maps acts as an allele-specific transcriptional enhancer. Allele-specific expression studies in CRC cell lines heterozygous for rs4444235 showed significantly increased expression of bone morphogenetic protein-4 (BMP4) associated with the risk allele (P<0.001). These data provide evidence for a functional basis for the non-coding risk variant rs4444235 at 14q22.2 and emphasizes the importance of genetic variation in the BMP pathway genes as determinants of CRC risk.

Trasplante pulmonar con donantes de edad marginal (≥ 55 años) / No disponible

Objetivo: Analizar la supervivencia a corto (un mes), medio (un año) y largo plazo (cinco años)en todos los pacientes sometidos a un trasplante pulmonar (TP) cuyo donante tuviera al menos 55 años.Pacientes y métodos: Se incluyó a todos los pacientes sometidos a un TP cuyo donante tuviera55 años o más. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se utilizó la regresión logística en el estudio de factores de riesgo para mortalidad precoz y se utilizó la regresión de riesgos proporcionales de Cox en el estudio de factores de riesgo para la mortalidad al año y al quinto año, introduciendo las variables con un valor de p < 0,2 en el análisis bivariante. Se efectuó un análisis de supervivencia mediante el método de Kaplan-Meier.Resultados: Se analizó un total de 33 pacientes sometidos a un TP con donantes de 55 años omás. La probabilidad de supervivencia fue del 90,9, el 78,5 y el 44,8% al mes, año y cinco años respectivamente. La edad elevada del receptor (p = 0,16) y la realización de un trasplante unipulmonar(p = 0,09) fueron las variables que se asociaron o mostraron tendencia a la asociación con la mortalidad.Conclusiones: La decisión final en la aceptación de un injerto pulmonar se debe basar en la evaluación individual de cada donante y receptor. Sin embargo, dada la escasez de injertos pulmonares, parece adecuado considerar de inicio para la donación pulmonar a los pacientes de 55 o más años (AU)

[Lung transplantation using donors 55 years and older]. / Trasplante pulmonar con donantes de edad marginal (≥ 55 años).

OBJECTIVE: We analyzed short, medium and long-term mortality in transplant recipients who received lungs from donors aged 55 years or more. PATIENTS AND METHODS: All patients who underwent lung transplantation from donors aged 55 years or more were included. The association between the different study variables and early death and death at 1 year and 5 years was studied. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P<.2) in the bivariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed with a Cox regression model. The Kaplan-Meier method was used to analyze survival. RESULTS: A total of 33 patients were included. The probability of survival was 90.9%, 78.5% and 44.8% at 1 month, 1 year, and 5 years after lung transplantation, respectively. The elevated age of the recipient (P=.16) and single-lung transplantation (P=.09) were the variables associated to or with a trend towards significant associations with mortality. CONCLUSIONS: The final decision to accept a lung graft should be based on individual evaluation of each donor and recipient. However, given the lack of lung donors, donors aged 55 years or more should be considered for lung transplantation.

Factores de riesgo para el desarrollo de infecciones intrahospitalarias en pacientes quemados. Hospital S. Juande Dios, Costa Rica: Enero 2003-Diciembre 2005. Parte II / Risk factors for development of intrahospitalary infections in burned patients. Hospital S. Juan de Dios, Costa Rica: January 2003-December 2005. Part II

En los pacientes quemados, existen diferentes factores como la edad, sexo y días de estancia hospitalaria entre otros, que influyen en el desarrollo de infección intrahospitalaria (IIH). Debido a la mayor frecuencia de este tipo de infecciones en los pacientes quemados, pretendemos identificar qué factores influyen en la presentación y predicción de la infección intrahospitalaria en el sitio de la quemadura (IISQ).El presente estudio es una cohorte retrospectiva, sobre 298 registros de expedientes clínicos de pacientes ingresados en la Unidad Nacional de Quemados del Hospital San Juan de Dios (UNQ-HSJD) en Costa Rica, continuando otra investigación del mismo grupo de autores publicada anteriormente en Cirugía Plástica Ibero latinoamericana. A cada factor de riesgo estudiado se le calcularon los dos ratio crudos en un análisis univariado definiendo como variables de exposición principal la superficie corporal total quemada (SCTQ) y la profundidad de la quemadura (PQ). Observamos con este cálculo que el tipo de accidente no presentaba asociación cola IISQ. Después, realizamos un modelo multivariado logístico, no condicional, en el que se introdujeron los siguientes factores de riesgo: SCTQ,PQ, edad, número de segmentos corporales quemados (NSCQ), días de estancia hospitalaria previos a la infección intrahospitalaria en el sitio de la quemadura (DEHP-IISQ) y el agente causal de la quemadura. Consideramos variables confesora y modificadora de efecto al NSCQ y DEHP-IISQ. Determinamos que las principales variables predictoras para la IISQ fueron SCTQ (OR=3.02; 1.20-7.84), PQ (OR=11.44; 4.90-26.71),NCSQ (OR=2.80; 1.13-6.95), y DEHP-IISQ (9 a 14 días: OR=2.43; 0.52-11.29, >19 días: OR=31.89; 2.17-467.68). Pese a que no mostró significancia estadística, también se introdujo la edad en el modelo, debido a la tendencia aumentar el riesgo conforme ésta aumentaba ( >64 años: OR=3.15; 0.61-16.29) (..) (AU)

In burn victims, different factors such as age, gender and days of hospitalization among others, are influential in the development of inner-hospital infections (IHI). Due to a higher incidence of IHI in burn victims, it is pretended to identify which factors influence the presence and prediction of inner-hospital infections in the burned area (IHIBA).This study is a retrospective cohort that recruited 298 registries of medical reports from patients admitted into the National Burn Victims Unit as an Juan de Dios Hospital (NBVU-HSJD), Costa Rica, and following previous report in this journal. The odds ratio (OR) were calculated for each risk factor in a univariated analysis, and defined as principal exposition variables were the total burn surface (TBS) and the depth of the burn (DB).It was deduced from this calculation that the type of accident did not show any association with IHIBA. Subsequently, a multivariate logistic not conditioned study was carried out, in which, the following risk factors were introduced: TBS, DB, age, number of burnt body segments (NBBS), days of hospital stay previous to the IHIBA (DHSP-IHIBA) and the burn’s causing agent. Confusing and modifying variables of effect were also considered, respectively, for the NBBS and the DHSP-IHIBA. It was concluded that the main predicting variables for the IHIBA were (..) (AU)

Factores de riesgo para el desarrollo de infecciones intrahospitalarias en pacientes quemados. Hospital S. Juan de Dios, Costa Rica: Enero 2003-Diciembre 2005. Parte I / Risk factors for development of intrahospitalary infections in burned patients. Hospital S. Juan de Dios, Costa Rica: January 2003-December 2005. Part I

La infección intrahospitalaria es una de las principales causas de morbilidad y mortalidad en los pacientes quemados. El presente estudio caracteriza a los ingresados por quemadura(s) y la presencia de esta clase de infección en la Unidad Nacional de Quemados del Hospital San Juan de Dios, en Costa Rica, entre los años 2003y 2005.Realizamos un análisis descriptivo de la infección intrahospitalaria en el sitio de la quemadura según las características de los pacientes y de la quemadura así como el total de días de estancia hospitalaria, utilizando para ello un diseño de estudio tipo cohorte retrospectiva. La incidencia acumulada de la infección intrahospitalaria en el sitio de la quemadura fue de 19.0%. Los meses posteriores al ingreso clases presentaron un mayor número de hospitalizaciones por quemaduras. La edad, la superficie corporal total quemada, el número de segmentos corporales quemados, la profundidad de la quemadura y los días de estancia hospitalaria presentaron diferencias significativas entre los individuos infectados y no infectados. El tipo de accidente que produjo la quemadura y el sexo no presentaron diferencias significativas entre ambos grupos de pacientes. La electricidad fue el agente causal más frecuente en los pacientes con infección, mientras que el agua caliente lo fue en los pacientes sin infección. Concluimos que las características fisiopatológicas de las quemaduras favorecen infección en los pacientes quemados; asimismo, existen factores que pueden y deben ser tomados en cuenta para controlar y prevenir la infección y sus efectos (AU)

Intrahospitalary infection in burned patients is one of the most important causes of morbidity and mortality. This study characterizes the admitted burn victims and the presence of inner-hospital infection at the National Burn Victims Unit , San Juan de Dios Hospital, Costa Rica, between 2003 and 2005.We made a descriptive analyze of intrahospital infection in the burned area according characteristics of the patients and their burn(s), as well as the total number of days of hospital stay, using prospective cohort. The accumulated incidence for intra hospital infection in the burned area was 19.0%. In the months following the beginning of the school year, the number of burn victims admitted in the hospital increased. Age, total burnt surface, the number of burnt body segments, the depth of the burn and the days of hospital stay varied significantly between infected and not infected individuals. Theca use of the burn and the victim’s gender did not reveal any relevant differences between the groups of patients. For patients that developed intrahospital infection in the burned area, electricity was the most frequent causing agent, as was hot water for patients without intra hospital infection in the burned area. As a conclusion, physiopathology characteristics of the burns favour the occurrence of the intra hospital infection in the burned area; furthermore, there are factors than can and must be taken into account to control and prevent intrahospital infection in the burned area and its effects (AU)

Use of povidone-iodine during the first trimester of pregnancy: a correct practice?

Povidone-iodine (PVP-I) has been widely used as an antiseptic agent during invasive procedures for prenatal diagnosis. Women have been reported of thyroid dysfunction after simple exposure to PVP-I. We studied the effect on thyroid function and urinary iodine excretion after a single topical application of PVP-I in 31 women who had a miscarriage during the first trimester of pregnancy. PVP-I is absorbed through the skin and the vaginal mucosa, resulting in a sudden increase in the urinary excretion of iodine and a short-term variation in concentrations of thyroid hormones in maternal serum. This metabolic effect could have consequences for the embryo and the fetus during crucial stages of development.

Early outcome after single vs bilateral lung transplantation in older recipients.

BACKGROUND: Lung transplantation (LT) has been increasingly performed in patients older than 60 years. The outcome of LT in this recipient age group has not been extensively analyzed. The purpose of this study was to evaluate the early death (30 days) in LT recipients older than 60 years according to the type of procedure, that is, single vs bilateral LT. METHODS: We retrospectively reviewed our experience with older recipients between January 1999 and August 2007. Probability of survival was compared using the two-tailed Fisher exact test. The odds ratio for death at 30 days was estimated using multiple logistic regression. RESULTS: During the study, 167 LT procedures were performed in 164 patients, of whom 51 (30.5%) were aged 60 years or older (age range, 60-70 years; mean [SD], 63.3 [2.4] years). Thirty-seven recipients aged 60 years or older underwent single LT, and 14 underwent bilateral LT. The 30-day survival was 81% (95% confidence interval [CI], 65%-92%) in patients who underwent single LT, and 92% (95% CI, 64%-100%) in patients who underwent bilateral LT. No differences were observed in the survival probability between the two groups (P = .42). Logistic regression analysis for death at 30 days showed an odds ratio of 1.10 (95% CI, 0.08-14.5; P = .94) in the unilateral LT group. CONCLUSIONS: Early survival in LT recipients aged 60 years or older who underwent bilateral LT was comparable with that in who underwent single LT. The type of procedure is not a predictor of death in this age group. Recipients older than 60 years should not be excluded from consideration for bilateral LT.

Toxicity of seven foliar insecticides to four insect parasitoids attacking citrus and cotton pests.

Laboratory studies were carried out to compare the toxicity of seven foliar insecticides to four species of adult beneficial insects representing two families of Hymenoptera: Aphelinidae (Aphytis melinus Debach, Eretmocerus eremicus Rose & Zolnerowich, and Encarsiaformosa Gahan) and Mymaridae (Gonatocerus ashmeadi Girault) that attack California red scale, Aonidiella aurantii (Maskell); sweetpotato whitefly, Bemisia tabaci (Gennadius) (both E. eremicus and E. formosa); and glassy-winged sharpshooter, Homalodisca vitripennis (Germar), respectively. Insecticides from four pesticide classes were evaluated using a petri dish bioassay technique across a range of concentrations to develop dosage-mortality regressions. Insecticides tested included acetamiprid (neonicotinoid); chlorpyrifos (organophosphate); bifenthrin, cyfluthrin, and fenpropathrin (pyrethroids); and buprofezin and pyriproxyfen (insect growth regulators [IGRs]). Chlorpyrifos was consistently the most toxic pesticide to all four species of beneficial insects tested based on LC50 values recorded 24 h posttreatment compared with 48-h LC50 values with the neonicotinoid and pyrethroids or 96 h with the IGRs. Among the three pyrethroids, fenpropathrin was usually less toxic (except similar toxicity to A. melinus) than was cyfluthrin, and it was normally less toxic (except similar toxicity with E. formosa) than was bifenthrin. Acetamiprid was generally less toxic than bifenthrin (except similar toxicity with G. ashmeadi). The IGRs buprofezin and pyriproxyfen were usually less toxic than the contact pesticides, but we did not test for possible impacts on female fecundity. For all seven pesticides tested, A. melinus was the most susceptible parasitoid of the four test species. The data presented here will provide pest managers with specific information on the compatibility of select insecticides with natural enemies attacking citrus and cotton, Gossypium hirsutum L., pests.

Reconstrucción mamaria en el Hospital S. Juan de Dios de Costa Rica: un estudio transversal / Mammary reconstruction at the S. Juan de Dios Hospital, Costa Rica: a transversal study

La cirugía reconstructiva de mama fue introducida en el Hospital San Juan de Dios a partir de los años 80 por su demostrada mejoría en la calidad de vida de la paciente mastectomizada . Actualmente se realizan dos procedimientos quirúrgicos: el colgajo del músculo recto abdominal (TRAM) y el colgajo del músculo dorsal ancho (DA). Planteamos un estudio transversal para describir la experiencia del Hospital San Juan de Dios en relación a los dos procedimientos quirúrgicos principales para la reconstrucción mamaria. Se obtuvo una muestra de110 expedientes clínicos con un error estándar del 5% y una significancia del 97%. Se tomaron en cuenta las variables edad, complicaciones, estancia hospitalaria, decisión de reconstrucción areola pezón y simetrización mamaria. La edad promedio de las pacientes fue de 49.2 años con una desviación estándar de 8.8 años. A las complicaciones y la técnica quirúrgica seles realizó la prueba de (..) (AU)

Mammary Reconstruction was introduced in the Hospital San Juan de Dios in the 80’s for the demonstrated improvement in the quality of life of the mastectomized patient; by the moment we practise two surgical procedures: the Transversal Rectums Abdominal Muscle flap (TRAM) and the Dorsal muscle flap (DA). We made a traversal study to describe the experience of the Hospital San Juan de Dios in relation to this two main surgical procedures for mammary reconstruction. A sample of 110 clinical files was obtained with a standar error of the 5 % and a significance of 97%. We study variables such as age, complications, hospital stay and decision of symmetrical reconstruction of areola nipple and contralateral breast mammary. The average age of the patients was 49.2 years with a 8.8 year-old standard deviation. Complications and the surgical technique was carried out test of 2 lines (squared Chi) which was significant (p=0.003), therefore we discarded dependence between complications and surgical procedure. Hospital stay seems to be associated to surgery . The areola-nipple reconstruction and surgery for contralateral breast symmetry present a low frequency among the patients. The average age of the patients coincides with those described in other studies and with the age in that the appearance of mammary cancer is more frequent. There is not dependence between surgery type and the evaluated complications; nevertheless it is considered there are inherent complications to each technique. The low acceptance of surgery to get symmetry and reconstruction of the complex areola - nipple may be depends on these patients have sufered multiple surgeries and adjuvant treatments, so they are a little reluctant to other additional surgical procedures. The hospital stay can be associated to the surgical technique, since TRAM technique needs bigger cares than the DA one. As conclusion, TRAM and DA are two appropriate surgical options for mammary reconstruction; the election will depends on the patient’s characteristics and on the surgeon’s dealer. However in those patients who are candidate to both surgeries, TRAM should be the like first surgical election (AU)

Phenology and demography of Homalodisca coagulata (Hemiptera: Cicadellidae) in southern California citrus and implications for management.

Populations of Homalodisca coagulata (Say) were sampled from citrus orchards in southern California, USA to characterize and quantify seasonal occurrences of nymphs and adults with the goal of identifying management opportunities through well-timed treatments and/or natural enemy releases. Higher densities of H. coagulata in 2001 contributed to a complete seasonal profile that began in early spring with the emergence of first instar nymphs and their progression through five nymphal instars lasting until mid-August. Adult emergence began in mid-June with peak adult densities attained from mid to late August followed by a gradual decline through autumn. A persistent and significant male bias was observed in the adult sex ratio from the time of first emergence through mid-October in oranges; the same trend was present in lemons, but with more variability. Adult densities gradually declined through the winter months into the following spring before rapidly increasing again in June as the 2002 spring generation of nymphs began emerging as adults. The seasonal timing of nymphs and adults in 2002 was nearly identical to that observed the previous year. Phenology data from both years were incorporated into a stochastic, temperature-dependent model that predicts the occurrences of H. coagulata stages through time. Applications of imidacloprid early in the spring generation of nymphs proved very effective at reducing nymphs and sustaining lower densities of adults through summer.

[Effectiveness and complications of bariatric surgery in the treatment of morbid obesity]. / Eficacia y complicaciones de la cirugia bariátrica en el tratamiento de la obesidad mórbida.

INTRODUCTION AND OBJECTIVES: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. MATERIAL AND METHODS: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano's procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin, complete blood count, and phosphorus and calcium) were assessed before the bariatric procedure and one and two years after surgical treatment. Quality of life was evaluated through the B.A.R.O.S. system. RESULTS: Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 +/- 11 years. Mean pre-surgical weight was 129.7 +/- 25.6 kg and BMI 48.8 +/- 8.8 kg/m2. Two years after the surgical procedure BMI was 31.0 +/- 6.6 kg/m2, the ponderal reduction 47.7 kg and the percentage of weight loss 36.5%. Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively. Other observed nutritional deficits were: mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in 12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent in patients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass. The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1% of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellent or very good. CONCLUSION: In patients with morbid obesity, bariatric surgery is a technique by which a great improvement in anthropometrical parameters, cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them.

Eficacia y complicaciones de la cirugía bariátrica en el tratamiento de la obesidad mórbida / Effectiveness and complications of bariatric surgery in the treatment of morbid obesity

Introducción y objetivos: La cirugía bariátrica constituye una alternativa terapéutica eficaz en pacientes con obesidad mórbida refractaria al tratamiento médico. Sin embargo, estas técnicas quirúrgicas aumentan el riesgo de provocar una malnutrición proteico energética o el déficit selectivo de algunos micronutrientes. El objetivo de este trabajo ha sido analizar las modificaciones antropométricas, nutricionales, digestivas, factores de riesgo cardiovascular y calidad de vida en pacientes con obesidad mórbida sometidos a cirugía bariátrica. Material y métodos: Estudio descriptivo retrospectivo donde se ha evaluado a un grupo de pacientes con obesidad mórbida que fueron intervenidos de cirugía bariátrica (45 mediante bypass biliopancreático según técnica de Scopinaro y 25 mediante bypass gástrico laparoscópico). Se les realizó una valoración antropométrica (talla, peso,índice de masa corporal), factores de riesgo cardiovascular (tensión arterial, perfil lipídico, glucémico y uricemia) y parámetros nutricionales (albuminemia, estudio hematológico y fosfocálcico) antes dela técnica bariátrica y al año y dos años después del tratamiento quirúrgico. La calidad de vida se evaluó mediante el sistema B.A.R.O.S Resultados: Se ha analizado a 70 pacientes con obesidad mórbida (56 mujeres y 14 varones) con una edad media de 36,5 ± 11 años. El peso medio prequirúrgico fue de 129,7 ± 25,6 Kg y el IMC de48,8 ± 8,8 Kg/m2. A los dos años tras la técnica quirúrgica el IMC fue de 31,0 ± 6,6 Kg/m2, la reducción ponderal de 47,7 Kg y el porcentaje de pérdida de peso del 36,5%. El 100% de los pacientes dislipémicos, el 90% de los diabéticos y el 72% de los hipertensos normalizaron sus perfiles correspondientes tras la cirugía. La complicación nutricional más común fue la anemia y la ferropenia que ocurrieron en el 54,4% y 36,6% de los casos respectivamente. Otros déficit nutricionales observados fueron: hipoalbuminemia leve en el 20,3% de los pacientes, hipoprotrombinemia en el 14,9%, descenso de ácido fólico en el 17,8%, déficit de vitamina B12 en el 12,5%, hipocalcemia en el 23,8% e hiperparatiroidismo secundario en el 45,4% de los casos. Todas las complicaciones nutricionales fueron más frecuentes en pacientes sometidos a bypass biliopancreático excepto en el caso del déficit de B12 que ocurrió con más frecuencia en pacientes con bypass gástrico. La complicación digestiva mas frecuentemente observada fue la diarrea/esteatorrea en el 39,1% de los casos. El 64,2% de los enfermos consideraron el resultado dela cirugía como excelente o muy bueno. Conclusión: En pacientes con obesidad mórbida, la cirugía bariátrica es una técnica con la que se consigue una gran mejoría en los parámetros antropométricos, en los factores de riesgo cardiovascular y en la calidad de vida de los pacientes, pero que conlleva asociadas un porcentaje importante de complicaciones nutricionales que deberemos tener en cuenta para poderlas prevenir (AU)

Introduction and objectives: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. Material and methods: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano’s procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin,complete blood count, and phosphorus and calcium)were assessed before the bariatric procedure and one and two years after surgical treatment.Quality of life was evaluated through theB.A.R.O.S. system. Results: Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 ± 11 years. Mean pre-surgical weight was 129.7 ± 25.6 kg and BMI 48.8 ± 8.8kg/m2. Two years after the surgical procedureBMI was 31.0 ± 6.6 kg/m2, the ponderal reduction47.7 kg and the percentage of weight loss 36.5%.Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively.Other observed nutritional deficits were:mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent inpatients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass.The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1%of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellentor very good.Conclusion: In patients with morbid obesity,bariatric surgery is a technique by which a great improvement in anthropometrical parameters,cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them (AU)

Insulina glargina en nutrición enteral / Glargine insulin in enteral nutrition

Se presenta el caso de un varón de 37 años con diabetes mellitus tipo 1 de 20 años de evolución que padece una grave gastroparesia diabética. Para el tratamiento de ésta, requirió la colocación de una sonda de yeyunostomía por la que recibía nutrición enteral continua en bomba de perfusión y su diabetes estaba bien controlada con una dosis diaria de insulina glargina (AU)

We report the case of a 37-year-old man with type 1 diabetes mellitus of 20 years' duration who presented with severe gastroparesis. Gastroparesis required jejunostomy with enteral nutrition administered with continuous perfusion pump and diabetes was well regulated with a daily dose of insulin glargine (AU)

Intestinal anisakiasis mimicking intestinal obstruction.

We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.

Conservation of predatory arthropods in cotton: role of action thresholds for Bemisia tabaci (Homoptera: Aleyrodidae).

Studies were conducted in 1994 and 1995 to examine the effects of a range of action thresholds for managing Bemisia tabaci (Gennadius) Biotype B (= B. argentifolii Bellows & Perring) with insecticides in cotton on populations of arthropod predators in Imperial Valley, CA, and Maricopa, AZ. Application of insecticides significantly reduced population densities of spiders, Geocoris punctipes (Say), G. pallens (Stål), Orius tristicolor (White), Nabis alternatus Parshley, Zelus renardii Kolenati, Hippodamia convergens Guerin-Méneville, Spanogonicus albofasciatus (Reuter), Drapetis sp., and Chrysoperla carnea Stephens in one or both years and sites compared with untreated controls. Use of higher B. tabaci thresholds conserved some species and groups relative to lower thresholds. Stepwise regression analyses indicated that reductions in predator populations were generally influenced more strongly by the timing of the first insecticide application than by the total number of sprays necessary to maintain suppression of the pest below any given action threshold. A predation index, which weights the importance of each predator species based on their known frequency of predation on B. tabaci and another key pest, Pectinophora gossypiella (Saunders), was developed and analyzed. Patterns were similar to results based on changes in abundance alone, but the index generally revealed less severe effects of insecticides on overall predator function. The current action threshold for conventional insecticidal control of B. tabaci in Arizona and southern California is five adults per leaf. Results here suggest that predator conservation may be enhanced by raising the initial threshold to delay the first application or initially using more selective materials such as insect growth regulators.