Lefort I Osteotomy With and Without Osteogenic Distraction in Cleft Lip and Palate Patients: Experience at Hospital Universitario Infantil De San José.

INTRODUCTION: Cleft lip and cleft palate (CLP) are congenital diseases that lead to several secondary craniofacial anomalies, such as hypoplasia of the middle third of the face, which can be treated with different surgical techniques to help improve functional and esthetic alterations associated with the maxilla. This article reports the results of patients managed with LeFort I osteotomy in the same craniofacial surgery center for 10 years. OBJECTIVE: To determine the postoperative results regarding recurrence rates, malocclusion, and speech status after surgical treatment, in patients with retrusion of the midface with CLP, who underwent LeFort I osteotomy with or without osteogenic distraction (OD). METHODS: A descriptive cohort study was performed at the Hospital Infantil Universitario de San José in Bogotá, Colombia, between 2010 and 2020, evaluating 38 patients with CLP who met the inclusion criteria, all managed by LeFort I osteotomy with and without OD. The authors reported the sociodemographic information, as well as data related to speech before and after surgery, recurrence, complications, and cephalometric characteristics. The recurrence of the patients was described at 6 and 12 months after the surgical procedure. RESULTS: A total of 43 patients met the inclusion criteria, of which 20 patients were managed with conventional LeFort I osteotomy, and 23 with LeFort I osteotomy with OD; 5 patients were excluded due to lack of data in the medical records, with a final sample of 38 patients. The distribution based on sex was: 57.8% men and 42.1% women. Regarding laterality, we have 7 patients with right CLP (18.42%), 11 patients with left CLP (28.9%), and 20 patients with bilateral CLP (52.63%), 100% of patients with a class III bite in Angle's classification. In group 1 (OD), 55% of the patients did not present changes in speech before surgery, 30% presented improvement in speech, and 15% worsened it. In group 2 (conventional advancement), 66% of the patients did not present changes in speech, 5.5% presented improvement, and 27.7% presented worsening of speech based on the preoperative condition, with a clinical recurrence at 6 months of 15% for group 1 and of 33% for group 2, and at 1 year of 20% for group 1 and 16% for group 2. CONCLUSIONS: Osteogenic distraction is a safe method that can be applied in patients with CLP depending on the clinical characteristics. According to what is described in the literature, those patients who require advancement of up to 6 mm treated without OD have obtained good results, showing esthetic improvement by increasing the projection of the middle third of the face, without worsening of velopharyngeal insufficiency and achieving an adequate occlusal class (Angle I) in the immediate postoperative period or after the postoperative orthodontic management. However, in patients who require advances ≥7 mm, it is clear that OD is the best option, given its association with a lower recurrence rate, minimal changes in the speech, achieving occlusion edge-to-edge at the end of the distraction or Angle's class I, which is corroborated by the results obtained in this study.

Cancer Stem Cells and Androgen Receptor Signaling: Partners in Disease Progression.

Cancer stem cells exhibit self-renewal, tumorigenesis, and a high differentiation potential. These cells have been detected in every type of cancer, and different signaling pathways can regulate their maintenance and proliferation. Androgen receptor signaling plays a relevant role in the pathophysiology of prostate cancer, promoting cell growth and differentiation processes. However, in the case of prostate cancer stem cells, the androgen receptor negatively regulates their maintenance and self-renewal. On the other hand, there is evidence that androgen receptor activity positively regulates the generation of cancer stem cells in other types of neoplasia, such as breast cancer or glioblastoma. Thus, the androgen receptor role in cancer stem cells depends on the cellular context. We aimed to analyze androgen receptor signaling in the maintenance and self-renewal of different types of cancer stem cells and its action on the expression of transcription factors and surface markers associated with stemness.

Cesarean scar pregnancy, the importance of immediate treatment.

INTRODUCTION: Cesarean scar pregnancy (CSP) is an uncommon entity, with high morbidity. Its diagnosis is difficult and delays in management are frequent. We report a series of cases of CSP and analysis of the differences in the outcomes depending on the moment of pregnancy in which they are treated. CASE REPORT: Twelve patients with a diagnosis of CSP. Seven of them were diagnosed and treated in the first trimester, often required more than one type of management, but were not transfused or presented complications. The five patients diagnosed lately in the pregnancy, always required cesarean section and emergency hysterectomy, with massive bleeding, transfusions, urinary or vascular complications. DISCUSSION: CSP can be complicated by abnormal placental invasion when pregnancy continuity is allowed. The ideal management is the termination of pregnancy shortly after the diagnosis is made. Our series highlights the diagnostic difficulties that lead to late treatment with frequent complications. CONCLUSION: It is essential to perform routine analysis of the site of implantation of the gestational sac in the first-trimester ultrasonography and the CSP suspected cases should be handled by interdisciplinary teams in experienced centers.

Leptospirosis and rickettsiosis, a diagnostic challenge for febrile syndrome in endemic areas / [Leptospirosis y rickettsiosis, reto diagnóstico para el síndrome febril en zonas endémicas].

This is the case of a 50-year-old male from the region of Urabá, Colombia, with a mixed infection by Rickettsia rickettsii and Leptospira interrogans serovar Copenhageni ST78 and negative test for malaria and dengue fever. The patient presented with febrile syndrome and was unresponsive to systemic antibiotic treatment, who finally died in the intensive care unit. We established the postmortem diagnosis through molecular typification of the two etiological agents. In the inspection at the patient's home, we found a Rattus rattus specimen infected with L. interrogans of the same serovar found in him. We found no ticks parasitizing the domestic animals cohabitating with the patient. This case of a mixed infection with progressive and fatal symptoms in a patient with occupational risk in a tropical disease endemic zone highlights the importance of considering the potential presentation of simultaneous etiologies in patients with multiple medical visits for unresolved febrile syndromes associated with risky exposure during agricultural activities.

Se presenta el caso de un hombre de 50 años de edad proveniente de la región de Urabá, Colombia, con una infección mixta por Rickettsia rickettsii y Leptospira interrogans serovar Copenhageni ST78, y pruebas negativas para malaria y dengue. El paciente presentó un síndrome febril que no mejoró con el tratamiento antibiótico sistémico y, finalmente, falleció en la unidad de cuidados intensivos. El diagnóstico post mortem se hizo mediante tipificación molecular de los dos agentes etiológicos. En la inspección del domicilio del paciente, se encontró un ejemplar de Rattus rattus infectado con L. interrogans del mismo serovar detectado en él. No se encontraron garrapatas en los animales domésticos que habitaban con el paciente. Se reporta una infección mixta con síntomas clínicos progresivos y fatales en un paciente con antecedentes laborales de riesgo en una zona endémica para enfermedades tropicales, lo que obliga a tener presente la posibilidad de infecciones simultáneas en personas procedentes de áreas endémicas que consulten reiteradamente por síndrome febril sin resolución y tengan riesgo laboral relacionado con actividades agrícolas.

Ixodes tropicalis (Acari: Ixodidae) infesting a human and molecular detection of Rickettsia bellii, Colombia. / Infestación de Ixodes tropicalis (Acari: Ixodidae) en un humano y detección molecular de Rickettsia bellii, Colombia

INTRODUCTION: Ixodes tropicalis is a little-known tick species reported parasitizing wild rodents only in Colombia and Perú. OBJECTIVE: To report a case of I. tropicalis infesting a human in the south of the metropolitan area of the Valle de Aburrá, Antioquia, Colombia, and to report the molecular detection of Rickettsia bellii in this species. MATERIALS AND METHODS: The tick was identified using a morphological key and sequencing of tick mitochondrial 16S rRNA. Additionally, bacterial and protozoa pathogens were evaluated using PCR for the detection of Rickettsia spp., family Anaplasmataceae, Borrelia spp., and piroplasmid. RESULTS: We identified the tick as an I. tropicalis female according to Kohls, 1956, description and to partial 16S rRNA sequences showing a minimum of 5% divergencies compared to Ixodes sequences. We also detected the gltA gene of R. bellii in the tick with 99.87% of identity. CONCLUSION: This is the first report in Colombia of a species of the Ixodes genus parasitizing a human and the first report of the detection of R. bellii in this tick species.

Introducción. Ixodes tropicalis es una especie de garrapata poco conocida que se había reportado parasitando únicamente roedores silvestres en Colombia y Perú. Objetivo. Reportar un caso de infestación por I. tropicalis en un ser humano del sur del área metropolitana del Valle de Aburrá (Antioquia) y reportar la detección molecular de Rickettsia bellii en esta especie. Materiales y métodos. La garrapata se identificó usando claves morfológicas y mediante la secuenciación de su gen 16S ARNr mitocondrial. Además, se evaluó la presencia de agentes patógenos bacterianos y protozoos usando PCR para la detección de Rickettsia spp., la familia Anaplasmataceae, Borrelia spp. y piroplásmidos. Resultados. La garrapata se identificó como una hembra de I. tropicalis, según la descripción de Kohls, 1956, y la secuencia parcial del gen 16S ARNr, la cual mostró una divergencia de mínimo 5 % en la comparación con las secuencias de Ixodes. Además, se detectó el gen gltA de R. bellii en esta garrapata con una similitud del 99,87 %. Conclusión. Este es el primer reporte en Colombia de una especie del género Ixodes parasitando a un humano y el primer reporte de la detección de R. bellii en esta especie de garrapata.

Leptospirosis y rickettsiosis, reto diagnóstico para el síndrome febril en zonas endémicas / Leptospirosis and rickettsiosis, a diagnostic challenge for febrile syndrome in endemic areas

Resumen. Se presenta el caso de un hombre de 50 años de edad proveniente de la región de Urabá, Colombia, con una infección mixta por Rickettsia rickettsii y Leptospira interrogans serovar Copenhageni ST78, y pruebas negativas para malaria y dengue. El paciente presentó un síndrome febril que no mejoró con el tratamiento antibiótico sistémico y, finalmente, falleció en la unidad de cuidados intensivos. El diagnóstico post mortem se hizo mediante tipificación molecular de los dos agentes etiológicos. En la inspección del domicilio del paciente, se encontró un ejemplar de Rattus rattus infectado con L. interrogans del mismo serovar detectado en él. No se encontraron garrapatas en los animales domésticos que habitaban con el paciente. Se reporta una infección mixta con síntomas clínicos progresivos y fatales en un paciente con antecedentes laborales de riesgo en una zona endémica para enfermedades tropicales, lo que obliga a tener presente la posibilidad de infecciones simultáneas en personas procedentes de áreas endémicas que consulten reiteradamente por síndrome febril sin resolución y tengan riesgo laboral relacionado con actividades agrícolas.

Abstract. This is the case of a 50-year-old male from the region of Urabá, Colombia, with a mixed infection by Rickettsia rickettsii and Leptospira interrogans serovar Copenhageni ST78 and negative test for malaria and dengue fever. The patient presented with febrile syndrome and was unresponsive to systemic antibiotic treatment, who finally died in the intensive care unit. We established the postmortem diagnosis through molecular typification of the two etiological agents. In the inspection at the patient's home, we found a Rattus rattus specimen infected with L. interrogans of the same serovar found in him. We found no ticks parasitizing the domestic animals cohabitating with the patient. This case of a mixed infection with progressive and fatal symptoms in a patient with occupational risk in a tropical disease endemic zone highlights the importance of considering the potential presentation of simultaneous etiologies in patients with multiple medical visits for unresolved febrile syndromes associated with risky exposure during agricultural activities.

Ixodes tropicalis (Acari: Ixodidae) infesting a human and molecular detection of Rickettsia bellii, Colombia / Infestación de Ixodes tropicalis (Acari: Ixodidae) en un humano y detección molecular de Rickettsia bellii, Colombia

Abstract | Introduction: Ixodes tropicalis is a little-known tick species reported parasitizing wild rodents only in Colombia and Perú. Objective: To report a case of I. tropicalis infesting a human in the south of the metropolitan area of the Valle de Aburrá, Antioquia, Colombia, and to report the molecular detection of Rickettsia bellii in this species. Materials and methods: The tick was identified using a morphological key and sequencing of tick mitochondrial 16S rRNA. Additionally, bacterial and protozoa pathogens were evaluated using PCR for the detection of Rickettsia spp., family Anaplasmataceae, Borrelia spp., and piroplasmid. Results: We identified the tick as an I. tropicalis female according to Kohls, 1956, description and to partial 16S rRNA sequences showing a minimum of 5% divergencies compAred to Ixodes sequences. We also detected the gltA gene of R. bellii in the tick with 99.87% of identity. Conclusion: This is the first report in Colombia of a species of the Ixodes genus parasitizing a human and the first report of the detection of R. bellii in this tick species.

Resumen | Introducción. Ixodes tropicalis es una especie de garrapata poco conocida que se había reportado parasitando únicamente roedores silvestres en Colombia y Perú. Objetivo. Reportar un caso de infestación por I. tropicalis en un ser humano del sur del área metropolitana del Valle de Aburrá (Antioquia) y reportar la detección molecular de Rickettsia bellii en esta especie. Materiales y métodos. La garrapata se identificó usando claves morfológicas y mediante la secuenciación de su gen 16S ARNr mitocondrial. Además, se evaluó la presencia de agentes patógenos bacterianos y protozoos usando PCR para la detección de Rickettsia spp., la familia Anaplasmataceae, Borrelia spp. y piroplásmidos. Resultados. La garrapata se identificó como una hembra de I. tropicalis, según la descripción de Kohls, 1956, y la secuencia parcial del gen 16S ARNr, la cual mostró una divergencia de mínimo 5 % en la compAración con las secuencias de Ixodes. Además, se detectó el gen gltA de R. bellii en esta garrapata con una similitud del 99,87 %. Conclusión. Este es el primer reporte en Colombia de una especie del género Ixodes parasitando a un humano y el primer reporte de la detección de R. bellii en esta especie de garrapata.

Inclusion of kaolin in the diet of brown egg layers at the end of the production cycle / Caulim na alimentação de poedeiras semipesadas ao final do ciclo produtivo

ABSTRACT: This study investigated the inclusion of kaolin levels in the diet of brown egg layers at the end of the production cycle. A completely randomized design involved the distribution of 288 brown egg layers into six treatments of eight replications, with six birds per replication. When the birds reached the age of 63 weeks, the feeding of the experimental diets began. Diets differed by the inclusion of increasing levels of kaolin: Control (no additive), and the inclusion of 1%, 2%, 3%, 4%, and 5% kaolin. The performance, egg quality, intestinal morphometry, and excreta moisture were evaluated. The inclusion of kaolin promoted improvement in the jejunum villus height, enabling less feed intake; however, there were no significant differences in egg quality. The excreta moisture decreased linearly as the kaolin level in the diet increased. The inclusion of 5% kaolin in the diet of brown egg layers at the end of the production cycle improved intestinal morphometry and the quality of excreta through a reduction of moisture.

RESUMO: O objetivo deste trabalho foi investigar a inclusão de níveis de caulim na dieta de poedeiras semipesadas ao final do ciclo de produção. Foram utilizadas 288 galinhas semipesadas distribuídas em delineamento inteiramente casualizado com seis tratamentos de oito repetições, contendo seis aves por repetição. Quando as aves atingiram a idade de 63 semanas, foi iniciada a alimentação com as dietas experimentais. As dietas diferiam entre si pela inclusão de níveis crescentes de caulim: controle (sem aditivo); e a inclusão de 1, 2, 3, 4 e 5% de caulim na dieta. Foram avaliados o desempenho, a qualidade dos ovos, a morfologia intestinal e a umidade das excretas. A inclusão de caulim promoveu melhora na altura das vilosidades do jejuno, possibilitando menor consumo de ração. Não houve diferenças significativas para a qualidade dos ovos. A umidade das excretas diminuiu com o aumento do nível de caulim na dieta, respondendo de forma linear. A inclusão de caulim ao nível de 5% nas rações de poedeiras semipesadas ao final do ciclo de produção melhorou a morfometria intestinal e a qualidade dos excrementos por meio da redução de sua umidade.

Fiber levels in laying quail diets.

The objective of this work was to determine the effect of inclusion levels of dietary fiber in the Japanese quail diets. 480 Japanese quail were distributed in a completely randomized design, with 5 treatments and 12 replicates composed of 8 birds each. The treatments were constituted by five increasing levels of fiber in the diet: 2.78; 3.08; 3.38; 3.68; 3.98%. The parameters of productive performance, water consumption, egg quality, total lipids in the egg, excreta humidity, weight of digestive organs and intestinal morphology were evaluated. There was no significant effect of the use of different fiber levels on feed intake, egg production, viability, live weight, relative and absolute weight of gizzard, small intestine and cecum, and in excreta moisture of Japanese quais. Higher dietary fiber levels resulted in improvements in feed conversion per mass and per dozen eggs and higher water consumption. There was no significant difference for egg quality, except fot the color of the yolk where it was observed higher pigmentation of this structure with higher levels of fiber inclusion, and the lipid concentration in the buds was influenced in a quadratic manner. The inclusion of fiber promoted improvement in the villi of the duodenum and cecum.

Designing Microflowreactors for Photocatalysis Using Sonochemistry: A Systematic Review Article.

Use of sonication for designing and fabricating reactors, especially the deposition of catalysts inside a microreactor, is a modern approach. There are many reports that prove that a microreactor is a better setup compared with batch reactors for carrying out catalytic reactions. Microreactors have better energy efficiency, reaction rate, safety, a much finer degree of process control, better molecular diffusion, and heat-transfer properties compared with the conventional batch reactor. The use of microreactors for photocatalytic reactions is also being considered to be the appropriate reactor configuration because of its improved irradiation profile, better light penetration through the entire reactor depth, and higher spatial illumination homogeneity. Ultrasound has been used efficiently for the synthesis of materials, degradation of organic compounds, and fuel production, among other applications. The recent increase in energy demands, as well as the stringent environmental stress due to pollution, have resulted in the need to develop green chemistry-based processes to generate and remove contaminants in a more environmentally friendly and cost-effective manner. It is possible to carry out the synthesis and deposition of catalysts inside the reactor using the ultrasound-promoted method in the microfluidic system. In addition, the synergistic effect generated by photocatalysis and sonochemistry in a microreactor can be used for the production of different chemicals, which have high value in the pharmaceutical and chemical industries. The current review highlights the use of both photocatalysis and sonochemistry for developing microreactors and their applications.

Modificación técnica y experiencia con injerto óseo esponjoso de olécranon para el tratamiento de la hendidura alveolar / Technical modification and experience with cancellous bone graft from olécranon for alveolar cleft

Antecedentes y Objetivo. Para muchos cirujanos plásticos, el procedimiento quirúrgico de elección para el tratamiento de la hendidura alveolar consiste en tomar como zona donante de hueso la cresta iliaca por ser una técnica fácil y reproducible y por la alta disponibilidad de tejido que proporciona. Es escasa la literatura en cuanto al uso de olecranón como zona donante para el tratamiento de esta patología. El objetivo de este trabajo es describir los resultados del uso de injerto óseo esponjoso de olécranon para pacientes con hendidura nasoalveolar, recopilando una experiencia de más de 10 años con el procedimiento y valorando la escasa morbilidad generada. Material y método. Realizamos un estudio descriptivo y transversal sobre una serie de pacientes con diagnóstico de labio y paladar hendido uni o bilateral en los que se utilizó la técnica quirúrgica de toma de injerto esponjoso de olécranon preservando una ventana ósea de cortical para cierre del defecto. Recogimos variables sociodemográficas: edad, sexo, procedencia, diagnóstico, número de injertos; variables clínicas: tiempo de cirugía, dolor postquirúrgico, tiempo de hospitalización y de regreso a actividades cotidianas y complicaciones. Evaluamos a los pacientes clínicamente en el primer control 4 días después de la intervención. Resultados. Obtuvimos datos de 111 pacientes en los que se realizaron 146 injertos óseos de olécranon. El tiempo quirúrgico de la cirugía osciló desde 1 a 1.5 horas. El regreso a las actividades cotidianas tuvo un rango de 2 a 4 días del postoperatorio. El dolor postoperatorio en la zona donante estuvo presente en 5 pacientes (grado III-IV en escala de dolor según las facies) y solo en el primer y segundo tiempo de injerto. Cuatro de ellos tenían diagnóstico según Veau grado III y 1 grado IV. De esos 5 pacientes con dolor, 4 regresaron a sus actividades cotidianas a los 4 días de postoperatorio y 1 a los 3 días. En el momento del injerto óseo, 1 tenía 4 años de edad, 2 tenían 5 años, 1 tenia 6 años, y otro 8 años. Conclusiones. Con la modificación propuesta obtenemos únicamente injerto óseo esponjoso preservando la capa cortical para la posterior cobertura de la ventana ósea practicada en el olécranon. Nuestra casuística pone en evidencia el reducido tiempo quirúrgico de la técnica, la presencia de dolor postoperatorio en un porcentaje bajo de pacientes y su regreso a actividades cotidianas en 2-4 días

Background and Objective. For many plastic surgeons, procedure of election in the management of alveolar cleft is to take iliac crest as donor area as it is an easy surgical technique, with high availability of tissue and adequate reproducibility. The available literature regarding the use of olécranon as a donor area for alveolar cleft management is scarce. Our aim is to describe the results of olécranon cancellous bone graft management for patients with nasoalveolar cleft, compiling a more than 10-year experience performing this procedure and focusing on the low morbidity generated. Methods. We conduct a descriptive, cross-sectional study on patients with a diagnosis of unilateral or bilateral cleft lip and palate to whom olécranon bone grafts were performed preserving a bone cortical window to close de defect. Sociodemographic variables were collected such as age, sex, origin, diagnosis, number of grafts; and clinical variables such as surgery time, post-surgical pain, time of hospitalization, days of return to daily activities and complications. Patients were clinically evaluated at the first control 4 days after surgery. Results. Data were obtained from 111 patients, to whom 146 cancellous bone graft from olécranon were performed. Surgical time ranged from 1 to 1.5 hours. Return to daily activities ranged from 2 to 4 days after surgery. Five patients presented post-surgical pain in the donor area (grade III-IV in the pain scale according to the facies)., and only in the first and second time of grafts. Of those patients, 4 were diagnosed as grade III and 1 as grade IV according to Veau. Four returned to daily activities 4 days after surgery and 1 after 3 days. At the time of bone grafting, 1 patient was 4 years old, 2 were 5 years old, 1 was 6 years old, and another one was 8 years old. Conclusions. With the proposed modification we obtain only cancellous bone graft preserving cortical surface for ulterior close of the bone window created on the olécranon. Our serie of patients evidence a reduced surgical time, the presence of pain only in a low percentage of patients and their return to daily activities in 2-4 days after surgery

Encefalocele frontonasal: reporte de un caso con diagnóstico prenatal / Frontonasal encephalocele: report of a case with prenatal diagnosis

El encefalocele es un defecto congénito mayor que se caracteriza por la herniación del tejido nervioso y las meninges a través de un defecto de la bóveda craneal. Esto se debe a alteraciones del cierre del tubo neural ocurridas en la cuarta semana de gestación. El diagnóstico prenatal es posible realizarlo a través de ecografía 2D y 3D. Se presenta el caso de un neonato con encefalocele anterior, entidad poco frecuente dentro de los defectos del cierre del tubo neural. Se realizó el diagnóstico presuntivo prenatal por ecografía 2D y 3D, y se confirmó al nacimiento por los hallazgos clínicos y escanografía(AU)

The encephalocele is a major birth defect characterized by herniation of neural tissue and meninges through a defect in the skull, due to alterations of neural tube closure occurring in fourth week of pregnancy. Prenatal diagnosis is possible through 2D and 3D ultrasound. We report a case of anterior encephalocele, a rare disease among the defects of neural tube closure, with diagnosis by 3D and 2D ultrasonography, which was confirmed at birth by clinical findings and scan(AU)

Flux balance analysis in the production of clavulanic acid by Streptomyces clavuligerus.

In this work, in silico flux balance analysis is used for predicting the metabolic behavior of Streptomyces clavuligerus during clavulanic acid production. To choose the best objective function for use in the analysis, three different optimization problems are evaluated inside the flux balance analysis formulation: (i) maximization of the specific growth rate, (ii) maximization of the ATP yield, and (iii) maximization of clavulanic acid production. Maximization of ATP yield showed the best predictions for the cellular behavior. Therefore, flux balance analysis using ATP as objective function was used for analyzing different scenarios of nutrient limitations toward establishing the effect of limiting the carbon, nitrogen, phosphorous, and oxygen sources on the growth and clavulanic acid production rates. Obtained results showed that ammonia and phosphate limitations are the ones most strongly affecting clavulanic acid biosynthesis. Furthermore, it was possible to identify the ornithine flux from the urea cycle and the α-ketoglutarate flux from the TCA cycle as the most determinant internal fluxes for promoting clavulanic acid production.

Síndrome cerebro-óculo-nasal con diagnóstico prenatal / Cerebro-óculo-nasal syndrome with prenatal diagnosis

El síndrome cerebro-óculo-nasal se caracteriza por anomalías del sistema nervioso central, oculares y nasales. La prevalencia de este síndrome es muy baja, y aún no se ha identificado la etiología de esta condición. Se presenta el caso de un paciente con sospecha cínica de este síndrome con diagnóstico prenatal por ecografía 2D y 3D. Se realiza una revisión de la literatura de los casos previamente reportados.

The cerebro-óculo-nasal syndrome is characterized by central nervous system abnormalities, ocular and nasal. The prevalence of this syndrome is very low, and has not yet identified the etiology of this condition. We report the case of a patient with suspected PJS cynical prenatal diagnosis by 2D and 3D ultrasound. A review of the literature of previously reported cases.

Down syndrome passed from mother to child.

Down syndrome is the leading cause of inherited intellectual disability; it is characterized by mental retardation associated to physical growth delay and certain physical traits or features. It is caused by the presence of a third copy of chromosome 21, being this trisomy the most common chromosomal aneuploidy. Women with Down syndrome are less fertile, and pregnancy in these women is rare, although the information on exact statistics of reproduction in these patients is very limited, and they often have difficulties with miscarriage, premature birth, and difficult labor. We report the case of a preterm newborn with Down syndrome passed from her mother; this pregnancy was a result of sexual assault, which is an event that can and should be prevented in this population.

Down syndrome passed from mother to child / Transmisión de síndrome de Down de madre a hijo

Down syndrome is the leading cause of inherited intellectual disability; it is characterized by mental retardation associated to physical growth delay and certain physical traits or features. It is caused by the presence of a third copy of chromosome 21, being this trisomy the most common chromosomal aneuploidy. Women with Down syndrome are less fertile, and pregnancy in these women is rare, although the information on exact statistics of reproduction in these patients is very limited, and they often have difficulties with miscarriage, premature birth, and difficult labor. We report the case of a preterm newborn with Down syndrome passed from her mother; this pregnancy was a result of sexual assault, which is an event that can and should be prevented in this population.

El síndrome de Down es la principal causa de discapacidad intelectual congénita; se caracteriza por retraso mental asociado a retardo del crecimiento y del desarrollo psicomotor, así como a algunas características físicas típicas. Se debe a la presencia de una tercera copia del cromosoma 21, siendo esta trisomía la aneuploidía cromosómica más común. Las mujeres con síndrome de Down tienden a ser menos fértiles y el embarazo en ellas es poco frecuente, aunque los datos estadísticos de este evento son limitados, y se asocia, además, a dificultades que terminan en aborto, parto prematuro y parto difícil. Se reporta el caso de un recién nacido prematuro con síndrome de Down, hijo de madre con el mismo diagnóstico, producto de un embarazo resultado de violación, evento que debe ser prevenido de forma oportuna en esta población de alto riesgo.

Ecoepidemiología de la infección por rickettsias en roedores, ectoparásitos y humanos en el noroeste de Antioquia, Colombia / Ecoepidemiology of rickettsial infection in rodents, ectoparasites and humans in northeastern Antioquia, Colombia

Introducción. Las rickettsias son bacterias patógenas usualmente transmitidas por ectoparásitos, como garrapatas, piojos o pulgas. En la última década se presentaron tres brotes de rickettsiosis con casos fatales en la región noroccidental de Antioquia y en un municipio limítrofe de Córdoba. Objetivo. Describir la ecología y la epidemiología de las infecciones por Rickettsia spp. en el Urabá antioqueño. Materiales y métodos. Se obtuvieron muestras de 354 roedores y se recolectaron 839 ectoparásitos de estos en los municipios de Apartadó, Turbo y Necoclí. Asimismo, se obtuvieron 220 sueros humanos. Estas muestras fueron estudiadas por reacción en cadena de la polimerasa (PCR) e inmunofluorescencia indirecta (IFI) para la detección de infección por rickettsias. Resultados. Por IFI se detectaron anticuerpos antirickettsias en 130 (43 %) de los roedores y en 53 (24 %) de los sueros humanos estudiados. Además, se amplificaron secuencias del gen gltA específicas del género Rickettsia en 23 (6,8 %) muestras de hígado de roedores, las cuales mostraron una similitud del 98,7 % con R. prowazekii . Una secuencia de gltA obtenida de larvas de garrapatas del género Amblyomma sp., tuvo una identidad mayor de 99 % con las secuencias de R. tamurae . Conclusión. Estos resultados demuestran la circulación de rickettsias en roedores, ectoparásitos y humanos en los municipios estudiados.

Introduction: Rickettsia spp. are tick, flea or lice-borne pathogenic bacterium, usually carried by rodents. In the last decade three outbreaks of rickettsial disease including fatalities, occurred in the provinces of Antioquia and Córdoba in northwestern Colombia. Objective: The purpose of this study was to perform an ecological and epidemiological description of the Rickettsia spp infection in the recently affected region of Colombia. Materials and methods: Samples were obtained from 354 rodents and their parasites captured in the municipalities of Apartadó, Turbo and Necoclí. Likewise, 220 human sera were also collected, for detection of infection by Rickettsia spp. Results: Indirect immunofluorescence assay (IFA) revealed that 130 (43%) of the rodents and 53 (24%) of the humans produced antibodies to Rickettsia spp. Additionally, rickettsial DNA was amplified by PCR from 23 (6.8%) rodent liver samples using primers directed to the genus specific gltA gene. While gltA sequences from rodent samples exhibited a 98.7% similitude with R . prowazekii, a sequence amplified from larvae of Amblyomma sp exhibited identities of >99% similarity with R. tamurae . Conclusion: These results demonstrate the presence of rickettsia in rodents, ectoparasites and humans throughout the municipalities studied.

Etiología y caracterización epidemiológica del síndrome febril no palúdico en tres municipios del Urabá antioqueño, Colombia / Etiology and epidemiological characterization of non-malarial febrile syndrome in three municipalities of Urabá (Antioquia), Colombia

Introducción. La región de Urabá es endémica para varias enfermedades febriles agudas de origen infeccioso. Sin embargo, solo los pacientes con malaria pueden acceder a un diagnóstico oportuno y rápido, motivo por el cual muchos síndromes febriles no palúdicos quedan sin diagnóstico etiológico claro. Objetivo. Establecer la etiología, describir las manifestaciones clínicas y explorar algunos posibles factores de riesgo relacionados con los síndromes febriles agudos no palúdicos en pacientes procedentes de los municipios de Necoclí, Turbo y Apartadó. Materiales y métodos. Se tomaron muestras de suero en fase aguda y de convalecencia de 220 pacientes febriles negativos para malaria, provenientes de zonas rurales y urbanas de Necoclí, Turbo y Apartadó en los años 2007 y 2008. Se practicaron pruebas para diagnóstico de dengue (detección de anticuerpos IgM por ELISA), leptospirosis (detección de anticuerpos IgM e IgG por IFI), rickettsiosis (detección de anticuerpos IgG por IFI), hantavirus y arenavirus (detección de anticuerpos IgG por ELISA). Resultados. Se encontraron frecuencias de dengue, leptospirosis, rickettsiosis y arenavirus de 37,3 %, 14,1 %, 2,7 % y 0,5 %, respectivamente. Se presentaron 12 casos de coinfección de leptospirosis-dengue y uno de leptospirosis-rickettsiosis-dengue. El sexo masculino y la humedad relativa media, fueron factores de riesgo para dengue. El inicio de signos clínicos en febrero de 2008, se asoció tanto con la infección por dengue como por leptospirosis. Conclusión. Se reafirma la importancia del virus del dengue, Rickettsia spp. y Leptospira spp., como agentes causantes del síndrome febril en la región del Urabá.

Introduction: Urabá, a region on the northern coast of Colombia, is endemic to several acute febrile illnesses of infectious origin; however, only patients with malaria may have access to quick and effective diagnosis. For this reason, many non-malarial febrile patients go without a clear etiologic diagnosis. Aim: To establish the etiology and clinical signs of acute febrile non-malaria syndromes and explore some of the likely risk factors in patients originating in the municipalities of Necocli, Turbo and Apartado who exhibit these symptoms. Materials and methods: We obtained acute and convalescent sera from 220 non-malarial febrile patients from the rural and urban zones of Necocli, Turbo and Apartado during 2007 and 2008. Serologic tests for dengue (IgM by ELISA), leptospirosis (IgM and IgG by IFA), rickettsiosis (IgG by IFI), hanta and arenavirus (IgG by ELISA) were performed. Results: We found that the frequency of infection for dengue, leptospirosis, rickettsiosis and arenavirus, was 37.3%; 14.1%; 2.7% and 0.5%, respectively. There were 12 co-infection cases of leptospirosis-dengue and one of leptospirosis-rickettsiosis-dengue. Male gender and relative humidity were considered risk factors for dengue, and the beginning of clinical signs in February of 2008 was associated with the infection of dengue and leptospirosis. Conclusion: This study confirms previous records that underline the importance of Rickettsia spp, dengue virus and Leptospira spp as causal agents of febrile syndrome in this region of Colombia.

[Ecoepidemiology of rickettsial infection in rodents, ectoparasites and humans in northeastern Antioquia, Colombia]. / Ecoepidemiología de la infección por rickettsias en roedores, ectoparásitos y humanos en el noroeste de Antioquia, Colombia.

INTRODUCTION: Rickettsia spp. are tick, flea or lice-borne pathogenic bacterium, usually carried by rodents. In the last decade three outbreaks of rickettsial disease including fatalities, occurred in the provinces of Antioquia and Córdoba in northwestern Colombia. OBJECTIVE: The purpose of this study was to perform an ecological and epidemiological description of the Rickettsia spp infection in the recently affected region of Colombia. MATERIALS AND METHODS: Samples were obtained from 354 rodents and their parasites captured in the municipalities of Apartadó, Turbo and Necoclí. Likewise, 220 human sera were also collected, for detection of infection by Rickettsia spp. RESULTS: Indirect immunofluorescence assay (IFA) revealed that 130 (43%) of the rodents and 53 (24%) of the humans produced antibodies to Rickettsia spp. Additionally, rickettsial DNA was amplified by PCR from 23 (6.8%) rodent liver samples using primers directed to the genus specific gltA gene. While gltA sequences from rodent samples exhibited a 98.7% similitude with R . prowazekii, a sequence amplified from larvae of Amblyomma sp exhibited identities of >99% similarity with R. tamurae . CONCLUSION: These results demonstrate the presence of rickettsia in rodents, ectoparasites and humans throughout the municipalities studied.