COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis.

BACKGROUND: Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. METHODS: We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. RESULTS: During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. CONCLUSIONS: According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.

Reduction in contraceptive use during the COVID-19 pandemic among women in an indigenous Mexican community: a retrospective crossover study.

Background: Being indigenous, being a woman, and living in poverty are social determinants that contribute to reduced access to healthcare, including reproductive health services. The COVID-19 pandemic might have exacerbated this lag. Objective: This study explored how the COVID-19 pandemic affected the contraceptive use of a group of indigenous Mexican women and adolescents in their community. Methods: Between June and December of 2021, 158 indigenous Mexican women who had experienced recurrent pregnancies were interviewed at two health centers in San Cristóbal de las Casas, Chiapas. Participants were either pregnant when they completed the questionnaire or had been pregnant during the COVID-19 pandemic. Women were asked about their contraceptive practices before and during the pandemic. The change in contraceptive practice was estimated using a logistic model. Results: The COVID-19 pandemic reduced contraceptive use by 50%. Among women who wanted contraception, 58% did not receive it. During the pandemic, 77% of previous contraceptive users reported difficulty obtaining contraception, and only 23% sought family planning assistance. Conclusion: During the COVID-19 pandemic, indigenous women in the studied community used fewer contraceptive methods and did not use intrauterine devices. Additionally, there was a decline in the percentage of women using contraceptives. These results highlight the impact on indigenous populations and the difficulties they could face in accessing reproductive health services during health emergencies.

Cholec80-CVS: An open dataset with an evaluation of Strasberg's critical view of safety for AI.

Strasberg's criteria to detect a critical view of safety is a widely known strategy to reduce bile duct injuries during laparoscopic cholecystectomy. In spite of its popularity and efficiency, recent studies have shown that human miss-identification errors have led to important bile duct injuries occurrence rates. Developing tools based on artificial intelligence that facilitate the identification of a critical view of safety in cholecystectomy surgeries can potentially minimize the risk of such injuries. With this goal in mind, we present Cholec80-CVS, the first open dataset with video annotations of Strasberg's Critical View of Safety (CVS) criteria. Our dataset contains CVS criteria annotations provided by skilled surgeons for all videos in the well-known Cholec80 open video dataset. We consider that Cholec80-CVS is the first step towards the creation of intelligent systems that can assist humans during laparoscopic cholecystectomy.

Tratamiento endoscópico del divertículo de Zenker / Endoscopic management of Zenker's diverticulum

Introducción: el divertículo de Zenker es un saco que se produce como resultado del aumento de presión a nivel de la pared posterior de la hipofaringe que lleva a la protrusión de mucosa y submucosa a través de los músculos constrictor inferior de la faringe y cricofaríngeo. Discusión: es característico de los pacientes adultos mayores en la séptima y octava década de la vida, con una discreta predilección por el sexo masculino. El síntoma principal es la disfagia y en casos severos episodios de broncoaspiración. Tiene diferentes opciones de tratamiento, entre las que se encuentran el abordaje quirúrgico y endoscópico, siendo esta última la técnica más recomendada dado sus buenos resultados y menores tasas de complicaciones descritas.

Introduction: Zenker ́s diverticulum is a saccular formation in the posterior wall of the hypopharynx due to increased pressure, leading to mucosal and sub-mucosal herniation between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle. Discussion: it is primarily seen in elderly individuals in the seventh and eighth decades of life, with a discrete higher predominance in men. Dysphagia is the main symptom and episodes of pulmonary aspiration may present in severe cases. There are several treatment options, among which is endoscopic surgical approach. The latter constitutes the most recommended technique for it has shown good results and lower complication rates.

Acute Disseminated Toxoplasmosis in Two Specimens of Macropus rufogriseus Caused by a Genotype so far Exclusive to South America.

Macropods are included among the species considered highly susceptible to Toxoplasma gondii infection. Clinically, it is difficult to distinguish between acute toxoplasmosis due to primary infection and reactivation of chronic latent infection in susceptible species until pathologic studies are performed. Here, we described the clinical cases and lesions found in two deceased Bennett's wallabies (Macropus rufogriseus) with a presumptive diagnosis of toxoplasmosis, as well as the genetic characterization of the T. gondii isolates obtained from these specimens. Both animals presented acute infection lesions in the lungs, liver, spleen and lymph nodes associated to T. gondii infection. Histopathology and immunohistochemistry also demonstrated tissue cysts of different sizes, indicating that the wallabies were previously infected with this parasite. Two isolates were obtained, one from each specimen and the molecular characterization was done; both isolates were the ToxoDB #116 genotype. This is the first study that reports the isolation of this particular genotype outside South America, and given the histopathological findings, it could be considered virulent for this species. The dynamics of infection that T. gondii is causing in definitive and intermediate hosts in a region allows us to know the risks to which the animals and humans that live in the area are exposed, and in the future to implement a preventive medicine plan against this parasite.

Cardiac Operative Risk in Latin America: A Comparison of Machine Learning Models vs EuroSCORE-II.

BACKGROUND: Machine learning is a useful tool for predicting medical outcomes. This study aimed to develop a machine learning-based preoperative score to predict cardiac surgical operative mortality. METHODS: We developed various models to predict cardiac operative mortality using machine learning techniques and compared each model to European System for Cardiac Operative Risk Evaluation-II (EuroSCORE-II) using the area under the receiver operating characteristic (ROC) and precision-recall (PR) curves (ROC AUC and PR AUC) as performance metrics. The model calibration in our population was also reported with all models and in high-risk groups for gradient boosting and EuroSCORE-II. This study is a retrospective cohort based on a prospectively collected database from July 2008 to April 2018 from a single cardiac surgical center in Bogotá, Colombia. RESULTS: Model comparison consisted of hold-out validation: 80% of the data were used for model training, and the remaining 20% of the data were used to test each model and EuroSCORE-II. Operative mortality was 6.45% in the entire database and 6.59% in the test set. The performance metrics for the best machine learning model, gradient boosting (ROC: 0.755; PR: 0.292), were higher than those of EuroSCORE-II (ROC: 0.716, PR: 0.179), with a P value of .318 for the AUC of the ROC and .137 for the AUC of the PR. CONCLUSIONS: The gradient boosting model was more precise than EuroSCORE-II in predicting mortality in our population based on ROC and PR analyses, although the difference was not statistically significant.

Sociodemographic and Clinical Factors Associated with Severe Obesity in Adults.

BACKGROUND: In the last decades, obesity in general, including severe obesity (BMI ≥40 kg/m2), has increased disproportionately around the world, especially in low-income and lower-middle income regions. AIMS: To analyze sociodemographic and clinical characteristics of people with severe obesity in Mexico, as well as their associated factors. METHODS: A secondary analysis was carried out from the 2018-19 National Health and Nutrition Survey. Descriptive statistics and bivariate analyses by sex were used. Logistic models were estimated to identify the main factors associated with severe obesity. RESULTS: Of the total number of people with obesity in the country (2.2 million people), 3.6% had severe obesity, with an average age of 48.2. There were statistically significant differences by sex in the variables of age group, education, socioeconomic status, health insurance, hypertension, myocardial infarction, and heart failure. Being a woman, having hypertension, and hypertension/diabetes increased the odds of severe obesity. These associations were maintained when comparing people with a BMI <40 kg/m2, with those with a BMI ≥30 kg/m2 and a BMI <40 kg/m2. CONCLUSIONS: Severe obesity must appear on the Mexican political agenda. Data must be produced that can direct decision-making around the promotion of healthy lifestyles, and obesity prevention, treatment, and follow-up, based in people-centered care and through intersectoral strategies, multidisciplinary management, and holistic approaches.

Caracterización de los cuidadores de pacientes terminales / Characterization of Caregivers of Terminally ill Patients

Introducción: Resultan alarmantes las cifras de pacientes terminales tanto a nivel mundial como en Cuba, por lo que es necesario estudiar la preparación de los cuidadores de estos pacientes. Objetivo: Caracterizar al cuidador del paciente con enfermedad terminal, su preparación, experiencia, conocimientos sobre los cuidados y sobrecarga emocional en el municipio de San Luis. Métodos: Se realizó un estudio descriptivo y transversal en el periodo 2017-2019, en un universo de 47 cuidadores, a los que se les aplicó un muestreo no probabilístico. La muestra quedó conformada por 20 cuidadores que cumplieron los criterios de inclusión establecidos y dieron su consentimiento informado. Los instrumentos usados fueron la entrevista individual y la escala de carga del cuidador de Zarit. Se utilizó el método empírico y el estadístico y los textos se procesaron con Word XP, las tablas y gráficos se realizaron con Excel XP. Resultados: Prevaleció el nivel de escolaridad preuniversitaria y el estado civil casado. El grado de parentesco más frecuente en la muestra fue los hijos que no poseían experiencia previa de cuidado. Las causas más frecuentes de las enfermedades terminales fueron las demencias. Conclusiones: Predominaron los mayores de 60 años, el sexo femenino con escasos conocimientos sobre los cuidados, lo que influyó en la alta sobrecarga emocional presente en ellos(AU)

Introduction: The figures corresponding to terminally ill patients, both worldwide and in Cuba, are alarming, a reason why it is necessary to study the preparation of the caregivers of these patients. Objective: To characterize the caregiver of the terminally ill patient, their preparation, experience, knowledge about care and emotional overload in San Luis Municipality. Methods: A descriptive and cross-sectional study was carried out in the period 2017-2019, with a universe of 47 caregivers, to whom a nonprobabilistic sampling was applied. The sample was made up of twenty caregivers who met the established inclusion criteria and gave their informed consent. The instruments used were the individual interview and the Zarit Caregiver Load Scale. Empirical and statistical methods were used. The texts were processed with Word XP. The tables and graphs were made with Excel XP. Results: There was a prevalence of pre-university education level and married as marital status. The most frequent degree of kinship in the sample was made up of children who had no previous caregiving experience. The most frequent causes of terminal illnesses were dementias. Conclusions: Those over sixty years of age predominated, as well as the female sex with little knowledge about care, which influenced the high emotional overload present in them(AU)

Blue rubber bleb nevus syndrome: Presentation of a case and review of the literature.

Blue Rubber Bleb Nevus Syndrome, is a rare condition characterized by skin lesions caused by vascular malformations most frequently associated with lesions of the gastrointestinal tract, although rare, it can present with lesions in the central nervous system, thyroid, liver, spleen and lungs; common symptoms are: digestive tract bleeding and iron deficiency anemia. The main manifestation are skin lesions that are characterized by being button-like, with a bluish tint, covered by skin, called blue nevus with a rubbery consistency due to its rubber-like consistency. We present a case of Blue Rubber Bleb Nevus Syndrome with involvement in the central nervous and gastrointestinal systems.

Prevención de la conducta suicida en niños y adolescentes en atención primaria / Prevention of suicidal behavior in children and adolescents from primary care

Objetivo: el suicidio es un grave problema de salud pública, con una mayor incidencia en niños y adolescentes. No obstante, es prevenible mediante intervenciones oportunas, por lo cual se considera fundamental encontrar y elegir programas de prevención de suicidio en estos grupos etarios desde la atención primaria en salud. Metodología: se revisó la literatura sobre la prevención del suicidio desde atención primaria en documentos oficiales y artículos en las bases de datos Web of Science, Clinicalkey, PubMed y Science Direct. Se seleccionaron 35 documentos y se organizaron en 4 categorías: familia, entorno, personal de salud y prevención en atención primaria. Resultados: se encontraron programas enfocados en la familia, que ayudan a mejorar la relación padre-hijo e informan a los padres sobre métodos letales y cómo restringir su acceso. Por otro lado, hay documentos en donde se capacita al personal de salud para identificar, diagnosticar y tratar oportunamente las enfermedades mentales o las situaciones que predisponen las conductas suicidas; y así mismo, se interviene a aquellos que están en riesgo o han tenido intentos de suicidio previos. Conclusión: existen múltiples estrategias e intervenciones para reconocer y responder a las señales de advertencia de suicidio. Es importante que el personal de salud de atención primaria identifique y se capacite para el manejo inicial de pacientes con riesgo de suicidio y pueda brindar educación a la red de apoyo del menor sobre las estrategias para afrontar estas conductas..Au

Objective: suicide is a serious public health problem which has a higher incidence in children and adolescents; however, it is preventable through timely interventions; therefore, it is essential to find suicide prevention programs in these age groups from Primary Health Care. Methodology: a review of the literature about suicide prevention from primary care was carried out by searching official documents and articles in the Web of Science, Clinicalkey, PubMed and Science Direct databases. 35 documents were selected and organized into 4 categories: family, environment, health personnel and prevention in primary care. Results: through the review were found family-focused programs that help improve the parent-child relationship and teach parents about lethal practices and how to restrict their access. On the other hand, there are interventions where health personnel are trained to identify, diagnose and timely treat mental illnesses or situations that predispose to suicidal behavior; and likewise, those who are already at risk or have previous suicide attempts are intervened. Conclusion: there are multiple strategies and interventions to recognize and respond to warning signs of suicide. Therefore, it is important that primary care health personnel identify and have the capacity to carry out the initial management of patients at risk of suicide and can provide education to the minor's support network regarding strategies to deal with these behaviors..Au

Toxoplasma gondii infection in European mouflons (Ovis musimon) and captive wild felines from Puebla, México.

The presence of Toxoplasma gondii in zoos is cause of alert because many susceptible species kept in captivity die of clinical toxoplasmosis. Moreover, excretion of T. gondii oocysts by infected captive wild felines into the facilities could pose a risk to workers. Herbivores in wild collections can serve as sentinels of local transmission, since they get infected by the consumption of oocysts present in ground or water. Both herbivores and felids may reveal the parasite variants which are circulating in the region. We determined the seroprevalence of T. gondii in European mouflons (n = 55) and wild felines (n = 15) from a private zoological collection located in the Eastern region of México, as well as the incidence in 41 of the mouflons using ELISA. The prevalence of T. gondii in mouflons was 14.5% (n = 55) and 17.1% (n = 41) in 2011 and 19.5% in 2012. The estimated incidence was 9.8%-12.2%. In wild felines the frequency was 80%. Four sero-positive animals (two mouflons and the two oldest African lions) were euthanized. Histopathology, conventional PCR (for B1 and SeqRep529 loci) and molecular characterization were carried out. All euthanized animals were positive to T. gondii by PCR. We identified a triple infection (I + II + III) in the brain of a mouflon. In conclusion, a high infective pressure of T. gondii in the collection was found, supported by changes in its prevalence in European mouflons. A high prevalence of infection in wild felines was determined. At least four genotypes of T. gondii are present in herbivores and carnivores, and one mouflon had a mixed infection.

Caracterización de pacientes con trauma esplénico atendidos en un hospital de tercer nivel entre enero de 2000 y diciembre de 2017 / Characteristics of splenic trauma patients treated at a level III hospital between January 2000 and December 2017

Introducción. Es frecuente (46 %) que la lesión esplénica se acompañe de otra lesión visceral concomitante, con una alta tasa de morbimortalidad. La evolución de las técnicas para el abordaje de estas lesiones incluye procedimientos quirúrgicos, intervencionistas y de manejo expectante. Métodos. Se trata de un estudio con cohorte única retrospectiva y observacional. Se incluyeron pacientes mayores de 13 años de edad con trauma esplénico, atendidos entre enero de 2000 y diciembre de 2017. Se describieron las características relacionadas con el proceso de atención.Resultados. Se identificaron 116 pacientes con trauma esplénico, el 85,2 % de ellos hombres, con una edad promedio de 26 años. El 75,9 % de los pacientes presentaba lesiones concomitantes; las más frecuentes fueron de diafragma (31,0 %), de hígado (17,2 %) y de riñón (11,2 %). Los mecanismos de lesión más frecuentes fueron por arma corto-punzante (29,3 %), por arma de fuego (22,4 %) y por accidentes de tránsito (22,4 %). La gravedad fue clasificada como de grado V en el 24,1 % de los pacientes y de grado I en el 23,3 %. Se practicó esplenectomía total en el 39,7 % de los pacientes y el 15,2 % fue manejado de forma conservadora. La mortalidad fue del 4,3 %, tres casos en el posoperatorio inmediato (menos de 24 horas) y dos en la primera semana postoperatoria. Discusión. El manejo conservador de las lesiones esplénicas de poca gravedad es una estrategia segura y efectiva, con una tasa de fracaso de menos del 5 %. El abordaje quirúrgico se reserva para lesiones de mayor gravedad y su relación con otros órganos lesionados, con una mayor morbimortalidad (63 %)

Introduction. Splenic injuries are usually accompanied by another concomitant visceral lesion (46 %), with a high rate of morbidity and mortality. The evolution of techniques for approaching these injuries includes surgical, interventional and expectant management procedures.Methods. Retrospective, observational single cohort study. Patients older than 13 years of age with splenic trauma who were treated between January 2010 and December 2017 were included. The characteristics related to the care process were described.Results. 116 patients with splenic trauma were identified, 85,2 % were men and the average age was 26 years. Concomitant lesions were identified in 75,9% of patients, the most common were diaphragm (31 %), liver (17,2 %), and kidney (11,2 %). The most common mechanisms of injury were stab wounds (29,3 %), gunshot wounds (22,4 %), and motor vehicle collisions (22,4 %). Severity was classified as grade V in 24,1 % of patients and grade I in 23,3 %. Total splenectomy was performed in 39,7 % of patients and 15,2 % was conservatively managed. Mortality was 4,3 %, three cases in the immediate postoperative period (within 24 hours) and two in the first week postoperative week. Discussion. Conservative management of low-grade splenic injuries is a safe and effective strategy, with a failure rate of less than 5 %. Surgical approach is reserved for injuries with greater severity and their relationship with other injured organs, with greater morbidity and mortality (63 %)

Beneficial mutations for carotenoid production identified from laboratory-evolved Saccharomyces cerevisiae.

Adaptive laboratory evolution (ALE) is a powerful tool used to increase strain fitness in the presence of environmental stressors. If production and strain fitness can be coupled, ALE can be used to increase product formation. In earlier work, carotenoids hyperproducing mutants were obtained using an ALE strategy. Here, de novo mutations were identified in hyperproducers, and reconstructed mutants were explored to determine the exact impact of each mutation on production and tolerance. A single mutation in YMRCTy1-3 conferred increased carotenoid production, and when combined with other beneficial mutations led to further increased ß-carotene production. Findings also suggest that the ALE strategy selected for mutations that confer increased carotenoid production as primary phenotype. Raman spectroscopy analysis and total lipid quantification revealed positive correlation between increased lipid content and increased ß-carotene production. Finally, we demonstrated that the best combinations of mutations identified for ß-carotene production were also beneficial for production of lycopene.

An in Vitro Effectiveness Evaluation of Chemical Agents for Toothbrushes Disinfection

Objective: To evaluate in the vitro effectiveness of three chemical agents for toothbrush disinfection. Material and Methods: Sixteen new toothbrushes were evaluated, previously sterilized and classified in five experimental groups (n=3) and one item as control. Three chemical agents were assessed: 0.12% Chlorhexidine gluconate (CHX), essential oil mouth rinse (Listerine) and 3.5% Sodium hypochlorite (NaOCl). The five selected strains were inoculated on toothbrushes and incubated for a 24 hours period and 37°C temperature in aerobic conditions. The incubated toothbrushes were immersed for a 15 min period into selected chemical agents and after drying in a controlled air stream, again re-cultured into enriched broth. A comparison was made between the initial and final microorganisms density recovered after chemical disinfection based on Mc Farland scale. The data obtained was compared by descriptive analysis and ANOVA methodology. Results: 3.5% NaOCl was the most effective chemical agent for toothbrush disinfection followed by CHX; Listerine was not effective to eliminate the inoculated bacteria in toothbrushes. Conclusion: 3.5% NaOCl and 0.12% CHX are the most effective chemical agents for toothbrush disinfection and Listerine was only effective against C. albicans.

Metabolites from the Dark Septate Endophyte Drechslera sp. Evaluation by LC/MS and Principal Component Analysis of Culture Extracts with Histone Deacetylase Inhibitors.

Secondary metabolites from the cultures of the dark septate fungal endophyte (DSE) Drechslera sp., isolated from the roots of rye grass (Lollium sp.) and cultured under different experimental conditions, are described here for the first time. The use of suberoylanilidehydroxamic acid (SAHA) and other histone deacetylase inhibitors as epigenetic modifiers in the culture medium was evaluated by LC/MS and LC/MS/MS. Several differences in the metabolite production were detected by means of supervised principal component analysis (PCA) of LC/MS data. The presence of the compounds in the culture medium or in the mycelium was compared. In order to confirm their structure, many of these natural products were isolated from a larger scale culture. These metabolites were characterized as prenylhydroxybenzoic acids and chromans, two compounds, one of each class were previously undescribed, prenylquinoids, diketopiperazines and macrosphelides. Some of the compounds, which were released to the medium, showed good antifungal activity, suggesting that these compounds could protect Lollium from fungal phytopatogens. The use of SAHA as an additive of the cultures also induced the release of hexosylphytosphyngosine to the culture medium. The biotransformation of the inhibitors was observed in addition to the production of antifungal metabolites, showing the ability of this endophytic strain to control xenobiotics.

Los ritmos circadianos en cáncer y la cronoterapia / The circadian rhythms in cancer and chronotherapy / Os ritmos circadianos em câncer e a cronoterapia

Los ritmos circadianos, períodos fisiológicos de 24 horas aproximadamente, coordinan la actividad temporal de la mayoría, si no, de todos los seres vivos del planeta. Uno de los procesos más importantes del cuerpo, la proliferación celular, también está regulado por el reloj biológico cuya alteración puede tener repercusiones directas en el desarrollo del cáncer. El concepto de cronoterapia ha surgido a partir de la evidencia que tanto la proliferación de las células, como los mecanismos responsables de la farmacocinética y la farmacodinamia de los antineoplásicos ocurren a horas específicas del día. En esta revisión se presentan las generalidades del ciclo circadiano y su relación con el ciclo celular y el cáncer. Además, se expone evidencia del uso de la cronoterapia en pacientes con leucemia linfocítica aguda y en estudios clínicos de cáncer de colon, endometrio y ovario con asignación aleatoria. Se concluye que la hora de administración de la quimioterapia debe tener en cuenta los ritmos circadianos de los pacientes. Se enfatiza en la necesidad de hacer estudios clínicos enfocados en la quimioterapia cronomodulada, con el fin de aumentar la tolerancia y efectividad de los medicamentos con los protocolos existentes.

Circadian rhythms, physiological periods of about 24 hours, coordinate the temporal processes of most, or maybe all, living beings on the planet. Cell proliferation, one of the most important events in the body, is also regulated by the biological clock, whose alteration may have a direct impact on cancer development. The concept of chronotherapy comes from evidence showing that both cell proliferation and the mechanisms responsible for pharmacokinetics and pharmacodynamics of antineoplastic drugs occur at specific times of the day. This review presents an overview of the circadian cycle and its relation to cell cycle and cancer. Also, it presents evidence for the use of chronotherapy in patients with acute lymphocytic leukemia and in randomized clinical trials for colon, endometrial and ovarian cancer. As a conclusion, the time of chemotherapy administration should take into account the circadian rhythms of patients. We emphasize on the need to conduct clinical trials focused on chronomodulated chemotherapy, in order to increase the tolerance and effectiveness of drugs under the existing protocols.

Os ritmos circadianos, períodos fisiológicos de 24 horas aproximadamente, coordenam a atividade temporal da maioria, se não, de todos os seres vivos do planeta. Um dos processos mais importantes do corpo, a proliferação celular, também está regulada pelo relógio biológico cuja alteração pode ter repercussões diretas no desenvolvimento do câncer O conceito de cronoterapia há surgido a partir da evidência que tanto a proliferação das células, como os mecanismos responsáveis da farmacocinética e a farmacodinâmica dos antineoplásicos ocorrem a horas específicas do dia. Nesta revisão se apresentam as generalidades do ciclo circadiano e sua relação com o ciclo celular e o câncer. Ademais, se expõe evidência do uso da cronoterapia em pacientes com leucemia linfocítica aguda e em estudos clínicos de câncer de cólon, endométrio e ovário com designação aleatória. Se conclui que na hora de administração da quimioterapia deve ter em conta os ritmos circadianos dos pacientes. Se enfatiza na necessidade de fazer estudos clínicos enfocados na quimioterapia cronomodulada, com o fim de aumentar a tolerância e efetividade dos medicamentos com os protocolos existentes.

Experiencia del Hospital Universitario San Ignacio en el manejo con microcirugía transoral con láser robótico de CO2 para carcinoma glótico temprano / Experience of San Ignacio University Hospital in the management of early glottic carcinoma with transoral CO2 robotic laser microsurgery

Objetivo: Evaluar de manera retrospectiva el rol de la microcirugía transoral con láser robótico de CO2 para el tratamiento del carcinoma glótico temprano de laringe. Diseño: Análisis retrospectivo de registros médicos. Metodología: Estudio retrospectivo de 8 casos de carcinoma glótico temprano (7 T1a y 1 Tis) llevados a cordectomía con láser robótico de CO2 en un período comprendido entre los años 2012 y 2014. Resultados: La tasa de control local global fue del 75%, con una supervivencia libre de enfermedad estimada por el método de Kaplan y Meier del 75% y una supervivencia global del 100%. Conclusiones: La cordectomía con láser robótico de CO2 frente a otras terapias tiene beneficios relacionados con costoefectividad, preservación laríngea, posibilidad de seguimiento y alternativa como terapia de salvamento.

Objetives: To evaluate retrospectively transoral CO2 robotic laser microsurgery role for treatment of early glottic carcinoma of the larynx. Study Design: Retrospective analysis of medical records. Methods: Retrospective study of eight cases of early glottic carcinoma (7 T1a y 1 Tis) treated with transoral CO2 robotic laser microsurgery in the period between 2012 and 2014. Results: Global local control rate was 75%, with a disease-free survival rate of 75% according to the Kaplan ­ Meier method, and a global survival rate of 100%. Conclusions: Transoral CO2 robotic laser microsurgery in comparison with other alternatives has benefits related to costs, laryngeal preservation, follow up and finally as salvage surgery.

Entorno alimentario en universidades de Argentina / Food environment in universities of Argentina

INTRODUCCIÓN El sobrepeso y la obesidad se encuentran actualmente entre los principales factores de riesgo de muerte y de carga de enfermedad a nivel mundial. La evidencia existente respalda la asociación entre el aumento de peso corporal y el consumo de productos ultraprocesados, la ingesta habitual de bebidas azucaradas y la actividad física insuficiente. OBJETIVO Conocer las características de la oferta y de la promoción de alimentación saludable (y no saludable) en universidades de Argentina. MÉTODOS Estudio multicéntrico de corte transversal. Se relevaron 174 edificios universitarios en las provincias de Buenos Aires, Chaco, Córdoba, Santa Fe, Entre Ríos, Mendoza, Tucumán, Río Negro, San Juan, San Luis, Neuquén y CABA. RESULTADOS En el 42.2% de los edificios de régimen público y en el 27.8% de los de régimen privado no hay oferta de agua segura gratuita. Se registraron 213 puntos de expendio de alimentos y bebidas; el 82,6% tenía mayor oferta de alimentos no recomendados que promovidos; en el 48.3% la sal no se encontraba a libre disposición para su consumo y en el 77% ninguna de las comidas ofrecidas estaba señalizada como elaborada sin sal agregada. El 96% ofrecía bebidas no recomendadas. Sólo el 12% ofrecía agua sin costo y en un 11% había un bebedero/dispenser cercano. La mitad de las máquinas expendedoras de infusiones no permite regular el contenido de azúcar. En el 35,1% de los edificios relevados se registraron mensajes relacionados a la promoción de la salud. DISCUSIÓN Existe en el ámbito universitario una elevada oferta de alimentos y bebidas de alto valor calórico y baja densidad nutricional, así como una escasa oferta de aquellos promovidos. Este ámbito podría resultar una oportunidad para la realización de intervenciones que prevengan la obesidad, como la modificación de los entornos para que sean saludables

Experiencia de 22 años de trasplante autólogo de células hematopoyéticas en pacientes con mieloma múltiple o amiloidosis sistémica. 1992-2014 / Autologous hematopoietic cell transplantation in patients with multiple myeloma. Experience in 53 patients

Background: Autologous hematopoietic cell transplantation (THA) in patients with multiple myeloma and amyloidosis is the standard of care to promote disease free survival and quality of life. Aim: To report our experience with THA in patients with multiple myeloma. Material and Methods: Retrospective review of the hematopoietic cell transplantation database of a hospital of a Medical School. Forty seven patients with multiple myeloma and six with amyloid light chain amyloidosis were identified. Clinical and demographic data were obtained from the records. Results: The overall five year survival of patients was 55%. Transplant-related or non-relapse mortality occurred in 7%. We found no differences in outcomes among patients younger or older than 50 years. Conclusions: Our data supports that THA can be done in our country with similar results to those obtained in international transplantation centers. Chronological age should not be a limitation to offer this therapy to patients with multiple myeloma and amyloidosis.