Fracture-Associated Microbiome and Persistent Nonunion: Next-Generation Sequencing Reveals New Findings.

INTRODUCTION: Fracture nonunion remains a devastating complication and may occur for several reasons, though the microbial contribution remains poorly estimated. Next-generation sequencing (NGS) techniques, including 16S rRNA gene profiling, are capable of rapid bacterial detection within clinical specimens. Nonunion cases may harbor microbes that escape detection by conventional culture methods that contribute to persistence. Our aim was to investigate the application of NGS pathogen detection to nonunion diagnosis. METHODS: In this prospective multicenter study, samples were collected from 54 patients undergoing open surgical intervention for preexisting long-bone nonunion (n = 37) and control patients undergoing fixation of an acute fracture (n = 17). Intraoperative specimens were sent for dual culture and 16S rRNA gene-based microbial profiling. Patients were followed for evidence of fracture healing, whereas patients not healed at follow-up were considered persistent nonunion. Comparative analyses aimed to determine whether microbial NGS diagnostics could discriminate between nounions that healed during follow-up versus persistent nonunion. RESULTS: Positive NGS detection was significantly correlated with persistent nonunion, positive in 77% more cases than traditional culture. Nonunion cases were observed to have significantly increased diversity and altered bacterial profiles from control cases. DISCUSSION: NGS seems to be a useful adjunct in identification of organisms that may contribute to nonunion. Our findings suggest that the fracture-associated microbiome may be a significant risk factor for persistent nonunion. Ongoing work aims to determine the clinical implications of isolated organisms detected by sequencing and to identify robust microbial predictors of nonunion outcomes. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Provision of a protein-rich supplement for grazing suckling female beef calves to improve productive performance and metabolic response.

OBJECTIVE: This study was conducted to evaluate the effects of the provision of a protein-rich supplement on productive performance, and metabolic profile on grazing suckling female beef calves in tropical conditions during 150 d of experimentation. METHODS: Fifty-six Nellore suckling female calves, and their respective dams were distributed in a completely randomised design and made to undergo two treatments as follows: UNS (without supplementation), and SUP (supplementation with 5 g/kg body weight [BW] of a protein supplement). Throughout the experiment, animal performance and metabolic profile were evaluated. Also, ureagenesis and gluconeogenesis were assessed for gene expression. RESULTS: SUP female calves showed a higher voluntary intake (p≤0.03) of the diet components evaluated, digestibility of organic matter (p≤0.02) and microbial nitrogen production (MICN; p≤0.02) compared to UNS female calves. In its turn, serum urea nitrogen (p≤0.01) and insulin-like growth factor-1 (p≤0.03) levels and ureagenesis (p≤0.04) increased in SUP female calves compared to UNS female calves. Blood glucose and triglyceride levels were not affected by supplementation. The average daily gain (ADG) from SUP female calves was higher (p≤0.02) compared with UNS female calves. However, supplementation did not affect the body measures of the animals. CONCLUSION: In summary, provision of a protein-rich supplement improves the intake and nutrients digestibility, ADG and final BW and increases metabolic indicators of the protein status in grazing suckling female beef calves in tropical conditions.

Employment status monitoring in an Argentinian population of patients with multiple sclerosis: Particularities of a developing country.

BACKGROUND: Multiple sclerosis (MS) is a neurological chronic disease that causes a number of physical, cognitive and emotional symptoms. The identification of these factors will allow mitigating unemployment and improve quality of life of patients. The Buffalo Vocational Monitoring Survey (BVMS) is a tool to characterize Work-Challenged patients. OBJECTIVE: To describe and analyze BVMS data in people with multiple sclerosis (PwMS) from Argentina. To study the association with physical, cognitive and psychiatric morbidity in employed patients, comparing the performance of MS Work-Challenged and MS Work-Stable patients, with and without accommodations. METHODS: 119 MS patients were administered the Argentina adaptation of the BVMS, and completed measures of physical disability, fatigue, depression, cognitive processing speed, memory and verbal fluency. RESULTS: 65.54% of the patients were employed and 19.32% were unemployed, the remaining having roles of housewife, students and disability retirees. Within the employed subgroup, 60.26% were working as employees and 39.74% were self-employed. Cognitive and clinical variables differentiate patients with and without negative events and accommodations (p >  0.05). CONCLUSIONS: This Spanish version BVMS is considered a new tool to monitor employment difficulties in Spanish-speaking MS patients. MS Work-Challenged had a higher depression, fatigue and worse performance in cognitive variables.

The electronic nose as a rule-out test for tuberculosis in an indigenous population.

INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.

Prevalence of active infection by herpes simplex virus type 2 in patients with high-risk human papillomavirus infection: A cross-sectional study.

The aim is to determine the prevalence of active infection by herpes simplex virus type 2 (HSV-2) among Mexican women with high-risk human papillomavirus (HR-HPV) cervical infection, recruited from public gynecology and colposcopy services. In a cross-sectional study, HSV-2 antibodies, HSV-2 DNA, and HR-HPV DNA were quantified. Significant differences in HSV-2 seroprevalence and HSV-2 active infection rates were found between negative and positive HR-HPV cases. HSV-2 seroprevalence was 28.15% and 16.1% (P = .0001), while HSV-2 active infection rates were 6.83% and 0.62% (P = .001) for positive and negative HR-HPV groups, respectively. The risk of HSV-2 seropositivity was 1.7 times greater for HR-HPV-positive cases (P = .02). Similarly, HR-HPV-positive cases were nine times more likely to have an HSV-2 active infection than HR-HPV-negative cases (P = .03). High HSV-2/h-HPV coinfection rates were observed among women recruited from public gynecology and colposcopy services. The main factors related to an HSV-2 active infection are a history of risky sexual behavior and HR-HPV infection. The prevalence of HSV-2 active infection among positive HR-HPV subjects indicate that these infections constitute an important group of STIs in Mexico.

Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings.

To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.

A prospective cohort study to evaluate immunosuppressive cytokines as predictors of viral persistence and progression to pre-malignant lesion in the cervix in women infected with HR-HPV: study protocol.

BACKGROUND: Cervical cancer (CC) is caused by a persistent infection of high-risk human papillomavirus (HR-HPV). While most HPV infections are transient, persistent HPV infections are a significant health problem in Mexico. With an estimated HPV prevalence of 10% among women in reproductive age, approximately 25% of these women present at least a positive result in triage test, which according to previous studies is expected to be confirmed as positive CIN-2/3. The immune system has a key role in the natural history of HPV infection; alterations in the cellular immune response are responsible for the failure to eliminate HPV. The objective of this project is to assess the prognostic value of detecting immune markers (IL-10, IL-4, TGFß1, IFNγ, IL-6, and TNFα), the expression of HPV-HR E6/E7 proteins, and the viral load at the cervical level with respect to the persistence or clearance of HR-HPV infection, and the regression or progression of a cervical premalignant lesion. METHODS: A dynamic cohort study is being conducted in women with colposcopic, cytological, and histopathological results negative for squamous intraepithelial lesion (SIL) in the cervix and a positive HPV test; the subjects will be followed-up for 5 years, period from which 3 years have already elapsed, with yearly studies (colposcopy, cytology, and histopathology diagnosis, along with molecular HPV test, quantification of viral load and of IL-10, IL-4, TGFß1, INFγ, IL-6, and TNFα levels, along with the expression of the HR-HPV E6/E7 proteins in the cervix as a viral marker. The outcome will be categorized as viral persistence or clearance; and as SIL persistence, progression, or regression. Binomial and/or multinomial regression models adjusted for potential confounders will be used, associating the relative risk of the outcome with the immune and viral markers evaluated. DISCUSSION: This research will generate knowledge about immune markers with predictive value for the persistence and clearance of HPV, which will improve the triage of positive HPV women and thus reduce the economic burden for the Mexican health system imposed by the management of high-grade SIL and CC cases, which are still detected in late stages.

Alternativas de uso y eficacia analgésica en el dolor de origen dental en un servicio de urgencias de atención primaria / Alternatives for the use and analgesic efficacy in dental pain in a primary care emergency department

El propósito de esta investigación fue conocer las características del dolor de origen dental (DOD) urgente en un Servicio de Urgencias de Atención Primaria, las preferencias terapéuticas de los médicos de Urgencias y su eficacia clínica. Para ello se realizó un cuestionario a 114 médicos de Urgencias, analizando la frecuencia y alternativas analgésicas más usadas en el DOD. Se seleccionaron las cuatro más prevalentes: Metamizol, Diclofenaco, Metamizol+Diclofenaco y Metilprednisolona, y fueron las que recibieron, en ensayo simple ciego, los cuatro grupos formados aleatoriamente de una muestra de 300 pacientes. Registramos mediante Escala Visual Numérica (EVN) la intensidad del dolor inicial, dolor percibido a las 12 y 24 h tras tratamiento, grado de mejoría, tiempo de mejora percibida y analgesia de rescate. Los cuatro grupos se compararon estadísticamente utilizando el test de Chi Cuadrado y el test ANOVA. Entre otros datos, hemos conocido las características del DOD urgente en la población seleccionada, hayando resultados estadísticamente significativos en las valoraciones medias en la EVN tras el tatamiento, más bajos en los tratados con Metilprednisolona y más altos con Diclofenaco. De igual forma, se observó un mayor porcentaje de mejoría clínica notable en el grupo tratado con Metilprednisolona, seguido de Metamizol+Diclofenaco, y en el extremo opuesto, un porcentaje mayor sin mejoría con Diclofenaco, que además fue el de mayor uso de analgesia de rescate.

The purpose of this research was to know the characteristics of dental origin pain (DOP) in an Emergency Department of Primary Care, the therapeutic preferences of emergency physicians and clinical efficacy. A questionnaire was submitted to 114 emergency physicians by reporting the frequency and analgesic alternatives most used in the DOP. We selected the four most prevalent: Metamizole, Diclofenac, Diclofenac and Metamizole + Methylprednisolone, received in a single-blind trial. The four groups were selected randomly from a sample of 300 patients. We recorded by Visual Numeric Scale (VNS) the initial pain intensity, perceived pain at 12 and 24 h after treatment, the degree of improvement, the time improvement was perceived, and the analgesia relief. The four groups were compared statistically using the chi-square test and ANOVA test. Among other data, the characteristics of the urgent DOP were studied in the selected population, noting statistically significant results in average ratings on VNS following treatment, lower in those treated with methylprednisolone and higher with diclofenac. Similarly, a higher percentage of significant clinical improvements was recorded in the group treated with methylprednisolone group, followed by Metamizole + Diclofenac, and at the opposite end, a higher percentage without improvement with diclofenac, in which the highest use of analgesia relief was also observed.

Content Validation of a Catalog of Exercises for Judo.

This study aimed to assess the content validity of a catalog of 76 judo exercises. Two groups of raters comprising 16 judo experts evaluated the following content validity indicators: Clarity of Language, Practical Pertinence, Theoretical Relevance, and the Dimension of each exercise. The results confirmed the content validity of the judo training catalog with indicators showing scores greater than 0.80. These findings suggest that all 76 judo exercises are pertinent, representative of judo training and understandable for judo coaches. Thus, this catalog of judo exercises may help judo coaches in the selection and recording of exercises.

Cervical cancer-associated promoter polymorphism affects akna expression levels.

Cervical cancer (CC) is responsible for >260,000 deaths worldwide each year. Efforts are being focused on identifying genetic susceptibility factors, especially in genes related to the immune response. Akna has been proposed to be one of them, but data regarding its functional role in the disease is scarce. Supporting the notion of akna as a CC susceptibility gene, we found two polymorphisms associated with squamous intraepithelial lesion (SIL) and CC; moreover, we identified an association between high akna expression levels and CC and SIL, but its direction differs in each disease stage. To show the potential existence of a cis-acting polymorphism, we assessed akna allelic expression imbalance for the alleles of the -1372C>A polymorphism. We found that, regardless of the study group, the number of transcripts derived from the A allele was significantly higher than those from the C allele. Our results support the hypothesis that akna is a CC susceptibility genetic factor and suggest that akna transcriptional regulation has a role in the disease. We anticipate our study to be a starting point for in vitro evaluation of akna transcriptional regulation and for the identification of transcription factors and cis-elements regulating AKNA function that are involved in carcinogenesis.

Trombectomía mecánica en el ICTUS: experiencia con trevo en Hospital Provincial Clínico Barcelona / Mechanical thrombectomy in stroke: experience with trevo at Hospital Provincial Clinic Barcelona

Objectives: to report our experience, the efficiency, safety and results of endovascular mechanical thrombectomy with the Trevo device in acute ischemic cerebral stroke. Materials and Methods: we performed a retrospective study of 145 acute ischemic stroke patients treated with mechanical throm-bectomy using the Trevo system, between october 2008 and march 2012. 87.3percent in anterior circulation and 12.7 percent in posterior circulation. Results: mean age at presentation was 67 years (range 21-82, 54.5 percent males). The NIHSS presentation baseline was 17 (range, 18-22). The median interval from the onset of symptoms to arterial punction was 263 minutes (173-296). Satisfactory recanalization defined TICI (2-3) in 91 percent with 45 percent showing a good functional prognosis (mRS 0-2) at 90 days. 23 percent mortality at 90 days with 11 percent intracerebral haemorrage. Conclusions: in our experience, endovascular treatment of acute ischemic stroke with the Trevo device is safe and effective.

Objetivos: reportar nuestra experiencia, eficacia, seguridad y resultados del tratamiento endovascular mediante trombectomía mecánica con el dispositivo Trevo en el ictus cerebral isquémico agudo. Materiales y Métodos: realizamos un estudio retrospectivo de 145 pacientes con infarto cerebral isquémico agudo tratados mediante trombectomía mecánica con el dispositivo Trevo entre octubre del 2008 y marzo del 2012. 87,3 por ciento circulación anterior y 12,7 por ciento circulación posterior. Resultados: la edad media de presentación fue 67 años (rango 21-82; 54,5 por ciento sexo masculino). El NIHSS basal de presentación fue de 17 (rango, 18-22). La mediana desde el inicio de los síntomas a punción arterial fue de 263 minutos (173-296). Recanalización satisfactoria (TICI 2-3) del 91 por ciento con un 45 por ciento de buen pronóstico funcional (mRS de 0-2) a los 90 días. Mortalidad de 23 por ciento a los 90 días con 11 por ciento de sangrado intracerebral. Conclusiones: en nuestra experiencia, el tratamiento endovascular del ictus isquémico agudo con el dispositivo Trevo es seguro y eficaz.

[Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia]. / Eficacia del bloqueo de nervios intercostales con ropivacaína, en la analgesia de pacientes operados de colecistectomía abierta urgente bajo anestesia general.

INTRODUCTION: Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. AIMS: To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. MATERIAL AND METHODS: A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. RESULTS: Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups. CONCLUSIONS: Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.

HPV 16 E2 protein induces apoptosis in human and murine HPV 16 transformed epithelial cells and has antitumoral effects in vivo.

OBJECTIVE: Our aims were to examine the ability of the human papillomaviruse (HPV) 16 E2 protein to induce apoptosis in a murine HPV-transformed cell line, and to evaluate its antitumor properties on HPV-associated tumors in vivo in immunocompetent mice. METHODS: HPV-transformed murine BMK-16/myc cells and human SiHa cells were transfected with the HPV 16 E2 gene to examine the effects of the E2 protein on cell growth and on the E6 and E7 oncogenes as well as DNA fragmentation and activation of the extrinsic pathway of apoptosis. Finally, to test the antitumor effect of the E2 protein on an experimental mouse tumor model, we generated a recombinant adenovirus expressing the E2 protein. RESULTS: The E2 protein inhibited the growth of SiHa and BMK-16/myc cell lines, and repressed the E6 and E7 oncogenes. Moreover, the E2 protein induced DNA fragmentation and apoptosis through activation of caspases 8 and 3 in BMK-16/myc cells. On the other hand, E2 also showed antitumor effects in vivo. CONCLUSIONS: Our findings indicate that E2 exerts pro-apoptotic activity in a murine HPV-transformed cell line as well as an antitumor effect in vivo.

Desarrollo y evlluación de un postre lácteo con fibra de naranja / Preparation andeevaluation of a milk dessert with orange fiber

El consumo de fibra dietaria se ha asociado con propiedades de alimentos funcionales porque provee condiciones que favorecen la salud intestinal, la prevención de cáncer de colon, las enfermedades cardiovasculares y ayuda en el mantenimiento del peso. En el presente estudio se busca elaborar y evaluar un postre lácteo adicionado con fibra de residuos resultantes de la separación de pulpa de naranja. Se selecciona la fibra de naranja como materia prima para la elaboración de postres, ya que se trata de una buena fuente de fibra dietaria tanto soluble como insoluble; además, en la caracterización sensorial, realizada por jueces entrenados, se encuentra que esta fibra presenta olor y aroma propios de la fruta y características texturales bucales agradables. El análisis proximal muestra que la fibra de naranja contiene un 59.1 % de fibra dietaria total FDT y la fracción soluble FDS es de 27.5 %, con buen contenido de hierro y fósforo y otros nutrientes a excepción de la grasa cruda. Desde el punto de vista tecnológico es factible incorporar hasta un 5.0 % de fibra de naranja en el postre lácteo, el cual presenta un 2.1 % de grasa láctea, 7.3 de sólidos lácteos y un 25.3 % de sólidos totales. El perfil del sabor muestra que el postre con fibra de naranja presenta una calidad sensorial media. Los descriptores de sabor que presenta este producto son: naranja, cítrico, ácido, dulce, cocido y con un sabor residual amargo. Los descriptores de textura percibidos son: húmedo, blando, masticable y fibroso. Este nuevo producto alimenticio aporta los nutrientes propios y una cantidad adicional de fibra, lo que lo convierte en alimento saludable y una alternativa agradable, sencilla y económica para que las personas incrementen el consumo diario de fibra dietaria. Además, mediante el aprovechamiento de los residuos de la transformación de naranja se contribuye a disminuir la contaminación ambiental.

The consumption of dietary fiber has been associated with functional food properties which improves people's intestinal health. It also contributes towards the prevention of colon cancer, cardiovascular diseases, and weight control. The purpose of this study is to prepare and evaluate a milk dessert added with fiber from residues resulting from orange pulp separation. Orange fiber is selected as a raw material to prepare desserts because orange is a good source of soluble and insoluble dietary fiber and besides in the sensorial characterization made by trained judges, it was found that this fiber has odor and aroma of the fruit -the orange- and pleasant textural mouth characteristics. Proximal analysis shows that orange fiber has 59.1 % of total dietary fiber, and the soluble fraction is 27.5 %, with a good content of iron, phosphorus, and other nutrients, except for raw grease. From the technological point of view, it is feasible to incorporate until 5.0 % of orange fiber in the milk dessert, which presents 2.1 % of milk fat, 7.3 of milk solids, and a 25.3 % of total solids. The taste profile shows that the dessert with orange fiber has a medium sensorial quality. Taste describers of this product are: orange, citric, sour, sweet, cooked, and with a residual bitter flavor. Texture describers perceived are: humid, soft, masticable, and fibrous. This new food contributes with its own nutrients and with an additional quantity of fibers which make it a healthy food and are a pleasant, simple, and economic alternative, so people can increase their daily intake of dietary fiber. Besides, through the use of residues in orange transformation, environmental pollution can be decreased.

Hypereosinophilia, hyper-IgE syndrome, and atopic dermatitis in a toddler with food hypersensitivity.

We describe a 20-month-old girl with hypereosinophilia, hyper-immunoglobulin (Ig) E syndrome, and atopic dermatitis. Her peripheral eosinophil count and IgE plasma levels were 2.65 x 10(9)/L and 6702 IU/mL, respectively. Specific IgE levels for a variety of foods and inhalants were high and single-blind food challenges were positive for cow's milk, hen's egg, oat, wheat, and soy. When the patient received an extensively hydrolyzed milk formula, an exclusion diet, and 2 mg/kg of prednisone daily, the atopic dermatitis partially improved. Further improvement was observed with 1 mg/kg of azathioprine daily. Long-term clinical response was satisfactory. We suggest that food hypersensitivity should be ruled out in patients with hypereosinophilia, hyper-IgE syndrome, and atopic dermatitis. Azathioprine may be a good therapeutic alternative for treatment in such cases.

Índice de cesárea e indicaciones médica de primera cesárea en el servicio de obstetricia del Hospital San Juan de Dios / Cesarean section ratio and medical indication for first c-section in obstetrics service of San Juan de Dios Hospital

International medical community has been concerned because the high rates of cesarian section in certain countries worldwide, being the chilean figures among the highest, exceeding WHO recommended rates. To decrease this so high rate in our country is an important public health goal of the Ministry of Health (MINSAL) for the current decade. Information about the last two years C-section rates in the hospitals depending on the Servicio de Salud Metropolitano Occidente was collected. Also, a review of the causes referred and indications for first C-section in San Juan de Dios Hospital during 2006 was performed. The overall ratio of C-section in the Servicio de Salud Metropolitano Occidente was 38,4 for cent. The lowest figure was that of San Juan de Dios Hospital, with 32,33 for cent. In this hospital a trend to increase in the rate of C-section was observed in 2003, followed by a decrease and further stabilization of the figures. First C -section accounted or 65,3 for cent. The main indications were: fetal distress, podalic presentation, fetal macrosomy, cephalo-pelvic incompatibility and stationary dilatation. The rate of C-section in the surveyed health service overcomes the limits recommended by WHO and the guidelines of MINSAL. The main diagnostics stated as indication or first C-section are susceptible of critical analysis according to the current guidelines bye the treating physical. This is an important group within the design of strategies or diminishing the rates of C-section. Generation of guidelines for labor care and the daily discussion of the clinical activities might be influencing the results achieved in San Juan de Dios Hospital.

Las altas tasas de cesárea alcanzadas en algunos países han sido motivo de preocupación por parte de la comunidad médica internacional, reconociéndose en Chile una de las más altas a nivel mundial, superando la recomendación establecida por la Organización Mundial de la Salud (OMS). La disminución de este índice en nuestro país constituye un importante objetivo sanitario del Ministerio de Salud (MINSAL) para la presente década. Se recabó información sobre los índices de cesárea de los hospitales pertenecientes al servicio de salud metropolitano occidente en los últimos dos años, Además, se realizó una revisión de las indicaciones referidas como causales de primera cesárea durante el año 2006 del Hospital San Juan de Dios. En el servicio de salud metropolitano occidente se registró un índice de cesárea global para el área de un 38,4 por ciento. El establecimiento que presentó la menor proporción de cesáreas fue el Hospital San Juan de Dios, con un 32,33 por ciento. Este hospital mostró un aumento del índice de cesárea hasta el año 2003, presentando luego una disminución y estabilización en los siguientes años. El porcentaje de primeras cesáreas correspondió a un 65,39 por ciento. Las principales indicaciones de primera cesárea en este período fueron: sufrimiento fetal agudo, presentación podálica, macrosomía, desproporción céfalo-pélvica y dilatación estacionaria. La tasa de cesárea consignada para el servicio de salud estudiado supera el límite recomendado por la OMS y los objetivos establecidos por el MINSAL. Los principales diagnósticos referidos como causales de indicación de primera cesárea son susceptibles a análisis crítico por el médico tratante de acuerdo a las recomendaciones actuales, siendo éste un grupo importante en el diseño de estrategias para la disminución de los índices de cesárea...

Evaluación biológica de galletas con fibra de cereales como alimento funcional / Evaluation of crackers with cereal fiber as a functional food

El consumo de fibra dietaria se ha asociado con propiedades de alimentos funcionales, es decir, que además de nutrir proveen condiciones que favorecen la salud intestinal, ayudan en la prevención de cáncer colonrectal, las enfermedades cardiovasculares y el mantenimiento del peso. En el presente estudio se evalúan las propiedades funcionales de galletas elaboradas con adición de una mezcla de fibra de cereales en un grupo control y un grupo experimental de voluntarios sanos, los cuales consumen 100 gramos diarios de galletas durante 10 días y suministran información diaria acerca de los efectos y la tolerancia digestiva del producto. Se realizan recuentos microbiológicos, cuantificación de ácidos grasos volátiles (AGV: acético, propiónico, butírico), determinación de pH en muestras de materia fecal (MF) y perfil lipídico el día 0 y el día 11. Con el consumo de las galletas se encontraron tendencias positivas en los efectos intestinales mecánicos de los voluntarios

Caracterización fisicoquímica y funcional de tres concentrados comerciales de fibra dietaria / Physicalchemical and functional characterizacion of three commercial concentrates from dietary fiber

En Colombia se han realizado pocos estudios sobre la funcionalidad de extractos comerciales de fibra dietaria micropulverizada, lo que motiva a desarrollar un estudio experimental para establecer metodologías adecuadas en su evaluación, para el desarrollo de nuevos productos alimenticios que promuevan efectos fisiológicos benéficos. El presente estudio busca caracterizar dos extractos comerciales de fibra dietaria micropulverizada de trigo (375) y avena (528) y uno de manzana (659). La composición proximal, el contenido de fibra dietaria total (FDT), soluble (FDS) e insoluble (FDI), además de la viscosidad (nu), tamaño de partícula, capacidad de retención de agua (CRA), capacidad de hichamiento (CH), capacidad de adsorción de moléculas orgánicas (CAMO), capacidad de intercambio catiónico (CIC) y capacidad fermentativa in vitro (CF), presentaron diferencias significativas. Aquellos con mayor contenido de fibra insoluble (375 y 528), muestran valores más bajos de CRA (3.8 y 3.9 g de H2O/g de materia seca MS) y mayores valores de CAMO (11.7 y 10.9 g de aceite/g de MS); la fibra de 375 muestra la mayor CH (7.1 g de H2O/g de MS). En general la CF es baja, lo que se evidencia por la baja cantidad y proporción molar de ácidos grasos acético, popiónico y butírico

Optimización de un preparado sólido de fibra dietaria a partir de diferentes residuos de frutas / Optimization of a solid prepare of dietary fiber from different remainders of fruits

Se presenta un procedimiento para optimizar las características fisicoquímicas y nutricionales de varias fuentes de fibra dietaria, procesadas como comprimidos. El término optimización se refiere a la utilización de una serie de técnicas matemáticas con las que se busca reducir a una sola variable o a la menor combinación de variables que muestren la respuesta más adecuada entre varias posibles. Para este estudio se utiliza un método de sumatoria lineal porcentual y el análisis de los componentes principales (ACP) para evaluar es necesario emplear todas las fuentes iniciales de fibra o sólo una o algunas de ellas, de tal manera que se obtengan los beneficios óptimos nutricionales esperados con la elaboración del comprimido de fibra mediante dosificación de diferentes fuentes. En el estudio se concluye que elaborando un preparado que contenga únicamente fibra dietaria proveniente de residuos de maracuyá, es posible obtener un comprimido optimizado en cuanto a sus propiedades funcionales y de utilización de recursos, comparado con el obtenido a partir de mezclas de otras 5 fibras dietarias

Tratamiento de la neoplasia intra epitelial vulvar mediante vulvectomía tegumentaria / Treatment of vulvar intraepithelial neoplasia using tegumentary vulvectomy

Entre 1999 y 2005 ingresaron 12 pacientes con el diagnóstico de neoplasia intraepitelial de la vulva. La edad promedio fue 50 años, con rango de 26 a 74 años. El diagnóstico se hizo mediante biopsia dirigida por vulvoscopia. Se efectuó vulvectomía tegumentaria a 9 pacientes según técnica que se describe. 54,5 por ciento de las pacientes presentaba lesiones vulvares múltiples y 45,5 por ciento presentó una lesión al examen. En la biopsia, 63 por ciento de las lesiones presentaban signos sugerentes de infección por virus papiloma humano. 55,5 por ciento de las pacientes tratadas no presentó nuevas lesiones y 33 por ciento tuvo una o más recurrencias, 11 por ciento no asistió a control, no hubo complicaciones quirúrgicas ni mortalidad.