Vitamina C, tiamina e hidrocortisona: ¿aliados en shock séptico? / Vitamin C, thiamine and hydrocortisone: allies against septic shock?

Objetivo: Determinar la efectividad del uso de un protocolo de vitamina C, tiamina e hidrocortisona en shock séptico a las dosis empleadas en el estudio Marik. Método: Estudio observacional retrospectivo antes-después que compara dos grupos de pacientes con shock séptico: grupo tratamiento (GT), tratado con el protocolo, desde enero 2019 a mayo 2020, frente a un grupo control (GC) en un periodo previo. Los objetivos principales fueron la supervivencia a los 14 y a los 28 días. Resultados: Se incluyeron 91 pacientes, 44 en GC y 47 en GT. No se encontraron diferencias estadísticamente significativas en la supervivencia a los 14 ni a los 28 días ni en la duración de estancia hospitalaria ni en la Unidad de Reanimación (REA) (p>0,05). La variación de los valores de creatinina entre los días 1 y 4 presentó una mediana de -0,04 (RIC -0,24;0,8) en el GC frente a -0,3 del GT (RIC -0,079;-0,03), p<0,05. Los valores de procalcitonina descendieron en el 27,3% de los pacientes del GC frente al 91,5% del GT (p<0,05). La necesidad de soporte vasoactivo con noradrenalina fue del 93% GC vs 76,6% GT en el día 2; 75% GC vs 55,3% GT en el día 3; 50% GC vs 27,7% GT en el día 4 (p<0,05). Conclusiones: Los datos de nuestro estudio muestran un beneficio limitado del uso del protocolo en pacientes con shock séptico, pero son necesarios estudios de mayor reclutamiento con un diseño prospectivo randomizado para asegurar el beneficio real y/o dosis óptimas. (AU)

Objective: To determine the effectiveness of using a protocol of vitamin C, thiamine and hydrocortisone for the treatment of septic shock at the doses used in the Marik study. Methods: Retrospective observational before-after study comparing two groups of patients with septic shock: treatment group (GT), treated with the protocol, between January 2019 and May 2020, versus a control group (GC) in a previous period. The primary outcomes were 14-Day and 28-Day Survival. Results: 91 patients were included, 44 in GC and 47 in GT. No statistically significant differences were found in 14-day and 28-day survival, in length of hospital or Resuscitation Unit (REA) stay (p>0.05). The median creatinine variation between days 1 and 4 was -0.04 (IQR -0.24;0.8) in the GC vs -0.3 in the GT (IQR -0.079; -0.03) (p<0.05). Procalcitonin values decreased in 27.3% of GC versus 91.5% of GT (p<0.05). The need for vasoactive drugs (noradrenaline) was 93% in GC vs 76.6% GT on day 2; 75% GC vs 55.3% GT on day 3; 50% GC vs 27.7% GT on day 4 (p<0.05). Conclusions: Our results show a limited benefit of the use of the protocol in patients with septic shock, but larger recruitment studies with a prospective randomized design are needed to ensure real benefit and/or optimal doses. (AU)

Neurocognitive reorganization of emotional processing following a socio-cognitive intervention in Colombian ex-combatants.

Ex-combatants often exhibit atypical Emotional Processing (EP) such as reduced emphatic levels and higher aggressive attitudes. Social Cognitive Training (SCT) addressing socio-emotional components powerfully improve social interaction among Colombian ex-combatants. However, with narrow neural evidence, this study offers a new testimony. A sample of 28 ex-combatants from Colombian illegal armed groups took part in this study, split into 15 for SCT and 13 for the conventional program offered by the Governmental Reintegration Route. All of them were assessed before and after the intervention with a protocol that included an EP task synchronized with electroencephalographic recordings. We drew behavioral scores and brain connectivity (Coherency) metrics from task performance. Behavioral scores yielded no significant effects. Increased post-intervention connectivity in the delta band was observed during negative emotional processing only SCT group. Positive emotions exposed distinctive gamma band connectivity that differentiate groups. These results suggest that SCT can trigger covert neurofunctional reorganization in ex-combatants embarked on the reintegration process even when overt behavioral improvements are not yet apparent. Such covert functional changes may be the neural signature of compensatory mechanisms necessary to reshape behaviors adaptively. This novel framework may inspire cutting-edge translational research at the crossing of neuroscience, sociology, and public policy-making.

Validation of the Extreme Experiences Scale (EX2) for Armed Conflict Contexts.

Psychological approaches to the study of armed conflict have focused on analyzing post-traumatic stress outcomes, and on evaluating the intensity of exposure to violent confrontation. Nevertheless, psychometrically valid tools required for measuring these traumatic experiences are scarce To validate the Extreme Experiences scale (EX2) for armed conflict contexts for its use in Colombia, and to provide a framework for validation in conflict contexts around the world This Cross-sectional aims to validate the scale with 187 participants, study of validate with 187 participants, comprising population with high exposure to conflict (former combatants and a set of armed conflict victims) and low conflict-exposed individuals (control group). Structures of two domains and 18 items were confirmed: Direct Extreme Experiences (dEX2) and Indirect Extreme Experiences (iEX2); these dimensions were also validated by expert judgment, producing 14-item version. Good levels of internal consistency were found, with a KR-20 of 0.80 for the 18-item version, and 0.77 for the 14-item. The scale differentiates between population with 'high exposure to conflict' from population with 'low exposure' (dnp > 0.5 and area under the ROC >0.90). The scale scores have significant correlation with some mental health constructs. The EX2 scale has good internal consistency, as well as structural validity with regard to exposed groups. This scale can be potentially validated for its use in countries with armed confrontation history. In future versions, the scale may include additional items in order to improve content validity.

Papel de la linfadenectomía paraaórtica inframesentérica durante la histerectomía radical en pacientes con cáncer cervical estadio IB1 en el Instituto Nacional de Cancerología Bogotá, Colombia / Role of inframesenteric para-aortic lymphadenectomy during radical hysterectomy in patients with IB1 cervical cancer in Instituto Nacional de Cancerología Bogota, Colombia

INTRODUCCIÓN: El cáncer cervical es una patología común en países en vías de desarrollo. La histerectomía radical es el estándar de manejo en estadios tempranos sin deseo de fertilidad. La linfadenectomía paraaórtica como parte del tratamiento quirúrgico es controversial. El objetivo de este estudio es determinar la frecuencia de compromiso ganglionar paraaórtico en una serie retrospectiva de pacientes con carcinoma cervical estadio IB1 (clasificación FIGO 2009) llevadas a histerectomía radical mas linfadenectomía pélvica y paraaórtica en el Instituto Nacional de Cancerología durante el periodo de enero 1 de 2009 a marzo 31 de 2017. MÉTODOS: Estudio descriptivo, retrospectivo. Se describieron variables clínicas, operatorias e histopatológicas. Se determinó la frecuencia de compromiso ganglionar a nivel paraaórtico o pélvico, y concurrente. Se realizó análisis univariado en el software estadístico R Project versión 3.6.0. RESULTADOS: Se incluyeron 88 casos. El promedio de edad fue 44,24 ± 9,99 años. La mediana del número de ganglios pélvicos y paraaórticos resecados fue de 23 (6-68) y 4 (1-25), respectivamente. En el 12,5% de las pacientes se observó compromiso tumoral ganglionar pélvico. No se detectó compromiso metastásico de ganglios paraórticos en ningún caso. Dos pacientes presentaron recaída ganglionar paraaórtica durante el seguimiento, recibiendo tratamiento con quimioterapia y quimiorradioterapia de campo extendido, respectivamente. CONCLUSIÓN: En este estudio no se detectó compromiso paraaórtico en pacientes con cáncer cervical IB1 sometidas a histerectomía radical. Este resultado se debe considerar al ofrecer linfadenectomía paraaórtica en pacientes con ganglios pélvicos aparentemente normales en el acto operatorio y/o en los estudios de imágenes prequirúrgicas.

INTRODUCTION: Cervical cancer is a common pathology in developing countries. Radical hysterectomy is the standard of management in early stages without desire for fertility. Paraaortic lymphadenectomy as part of surgical treatment is controversial. The objective of this study is to determine the frequency of paraaortic lymph node involvement in a retrospective series of patients with stage IB1 cervical carcinoma (FIGO 2009 classification) underwent to radical hysterectomy plus pelvic and paraaortic lymphadenectomy at the Instituto Nacional de Cancerologia during the period of January 1 2009 to March 31 2017. METHODS: Descriptive, retrospective study. Clinical, operative, and histopathological variables were described. The frequency of paraaortic, pelvic, concurrent lymph node involvement and adjuvant treatment was determined. A univariate analysis of the variables was performed in the R project statistical software version 3.6.0. RESULTS: 88 cases were included. The mean age was 44,24 ± 9,99 years. The median number of resected pelvic and para-aortic nodes was 23 (6-68) and 4 (1-25), respectively. In 12,5 % of the patients, involvement of the pelvic lymph nodes was present. No patient had paraaortic lymph node involvement. Two patients presented para-aortic lymph node relapse during follow-up, receiving treatment with chemotherapy and extended field chemoradiotherapy, respectively. CONCLUSION: In this study, the frequency of paraaortic involvement in patients with cervical cancer IB1 was 0%. This result should be considered when offering paraaortic lymphadenectomy in patients with apparently normal pelvic nodes in presurgical imaging studies and during the procedure.

Successive Intramuscular Boosting with IFN-Alpha Protects Mycobacterium bovis BCG-Vaccinated Mice against M. lepraemurium Infection.

Leprosy caused by Mycobacterium leprae primarily affects the skin and peripheral nerves. As a human infectious disease, it is still a significant health and economic burden on developing countries. Although multidrug therapy is reducing the number of active cases to approximately 0.5 million, the number of cases per year is not declining. Therefore, alternative host-directed strategies should be addressed to improve treatment efficacy and outcome. In this work, using murine leprosy as a model, a very similar granulomatous skin lesion to human leprosy, we have found that successive IFN-alpha boosting protects BCG-vaccinated mice against M. lepraemurium infection. No difference in the seric isotype and all IgG subclasses measured, neither in the TH1 nor in the TH2 type cytokine production, was seen. However, an enhanced iNOS/NO production in BCG-vaccinated/i.m. IFN-alpha boosted mice was observed. The data provided in this study suggest a promising use for IFN-alpha boosting as a new prophylactic alternative to be explored in human leprosy by targeting host innate cell response.

Silica coating of the pore walls of a microporous polycaprolactone membrane to be used in bone tissue engineering.

Polycaprolactone/silica microporous hybrid membranes were produced in two steps: A microporous polycaprolactone membrane with an interconnected porosity of 80% was obtained via a freeze extraction procedure, then silica was formed by a sol-gel reaction inside the micropores using tetraethyl orthosilicate, TEOS, as silica precursor. It is shown that silica forms a thin coating layer homogeneously distributed over the pore walls when sol-gel reaction is catalyzed by hydrochloric acid, while it forms submicron spherical particles when using basic catalyzer. Some physical properties and the viability and osteoblastic differentiation of bone marrow rat mesenchymal stem cells cultured on pure and hybrid membranes were studied.

Intrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials.

BACKGROUND: The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several clinical trials in recent years. We performed a meta-analysis of the available literature. METHODS: Randomized clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as odds ratio (OR, neutral=1) for dichotomous outcomes. RESULTS: Twelve studies totaling 817 patients were included. The "time to first analgesia request" was at least 35 minutes longer when intrathecal magnesium was included in the intervention (SDM 0.94, 95%CI 0.51 to 1.37, P<0.001). The "onset time to sensory block" (SDM 0.64, 95%CI 0.15 to 1.12, P=0.01) and the "time to maximal motor block" (SDM 0.97, 95%CI 0.28 to 1.67, P=0.006) were 2.4 minutes slower with intrathecal magnesium. There was no difference in "time to full motor recovery, incidence of pruritus, postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention". No cases of respiratory depression or neurotoxicity were recorded in these studies. CONCLUSION: The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the included clinical studies but additional evidence is advised.

Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina / Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin

La seguridad en el uso del suero salino hipertónico ha sido comprobada por estudios en el campo de la reanimación con pequeños volúmenes para el shock hipovolémico y en el tratamiento de la hipertensión intracraneal. En el ámbito del shock séptico, ha sido poco experimentado en seres humanos. Existen efectos inmunomodulatorios beneficiosos detectados en estudios preclínicos. Las interacciones con el eje hipofisario-adrenal y con la secreción de la hormona antidiurética son diversas y sugerentes, pero insuficientemente entendidas. Por otra parte, la vasopresina ejerce acciones cardiovasculares, osmorreguladoras, sobre la coagulación y también sobre el eje hipotálamo-hipofisario-adrenal. En el shock séptico hay un déficit relativo de vasopresina. Su uso en estos pacientes no parece presentar ventajas en cuanto a la mortalidad, pero puede ser beneficioso en pacientes en riesgo de insuficiencia renal aguda o en aquellos que reciben corticoides. La terlipresina es un análogo de la vasopresina que también se ha estudiado. La sinergia entre la vasopresina y el suero salino hipertónico es una hipótesis que se fundamenta, sobre todo, en estudios preclínicos. El uso del suero salino hipertónico en el shock séptico sigue siendo experimental, aunque prometedor, y debe quedar restringido al campo de los ensayos clínicos controlados(AU)

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials(AU)

[Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin]. / Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina.

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does not seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials.

Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca / Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery

Objetivo: Determinar la incidencia del síndrome coronario agudo (SCA) sintomático con y sin elevación del ST, los factores con los que se relacionó, la estancia media y la mortalidad atribuible en el periodo postoperatorio en pacientes de cirugía no cardiaca. Material y métodos: Se registraron prospectivamente los datos de una cohorte de pacientes intervenidos de cirugía no cardíaca que pasaron por la unidad de reanimación postoperatoria del Hospital General de Ciudad Real en el periodo comprendido entre abril de 2006 y diciembre de 2009. Se evaluó la incidencia de SCA sintomático. Resultados: Treinta y dos de 1.919 pacientes presentaron SCA (incidencia 1,7%). Los factores asociados fueron: sexo varón (p = 0,046), edad (p = 0,001), hipertensión arterial (68,8%; p = 0,012) y cardiopatía isquémica previa (34,4% p = 0,001). Los pacientes que sufrieron intervenciones quirúrgicas que presentaron SCA postoperatorio de forma significativa (p < 0,004) fueron cirugía general (37,5%), ortopedia-traumatología (28,1%) y cirugía vascular (15,6%). Fueron transfundidos el 20% de los pacientes en general, y el 50% de los que tuvieron SCA (p = 0,001). El tratamiento fue médico en el 87,5% de los pacientes. La estancia media de los pacientes en la unidad fue de 2,96 ± 6,3 días frente a 3,88 ± 5 días en los pacientes con SCA (p = 0,39) y la mortalidad del 5% frente al 6% respectivamente (p = 0,45). El análisis multivariante mostró como variables independientes para presentar SCA en el periodo postoperatorio: antecedentes de cardiopatía isquémica (OR = 4,59; IC 95% 1,98-10,62), y sangrado quirúrgico (OR =3,18; IC 95%, 1,51-6,71). La cirugía ginecológica (OR = 0,063; IC 95%, 0,004-1,09) mostró la menor probabilidad de presentar dicha alteración en el postoperatorio. Conclusión: La incidencia de SCA en nuestra cohorte en el postoperatorio de cirugía no cardiaca es del 1,7%. Son factores de riesgo la edad, el sexo masculino, los antecedentes de hipertensión arterial y cardiopatía isquémica, el tipo de cirugía y la hemorragia operatoria que precisó transfusión de concentrados de hematíes. Dada la gravedad de esta complicación es importante estratificar el riesgo de estos pacientes preoperatoriamente(AU)

Objetives: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. Material and methods: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. Results: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). Conclusions: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery(AU)

[Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery]. / Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca.

OBJECTIVES: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. MATERIAL AND METHODS: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. RESULTS: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). CONCLUSIONS: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery.

Evidence of restoration cost in the annual gynodioecious Phacelia dubia.

A negative pleiotropic effect on fitness of nuclear sex-determining genes (cost of restoration) could explain nuclear-cytoplasmic gynodioecy but rarely has been demonstrated empirically. In a gynodioecious Phacelia dubia population, maternal lineages produce only hermaphroditic progenies irrespective of the pollen parent (N) or can segregate females (S). Natural progenies of N maternal plants had lower seed viability than that of S. Full-sib progenies of unrelated hermaphrodites from all possible matings between N and S lineages had similar pollen filling but differed in sporophyte performance, mainly at seed germination stage. A discrete multivariate analysis reveals that the performance of N(female symbol) x S(male symbol) progeny at early stages of development was significantly lower than that of the other three types of mating in agreement with the silent-cost-of-restoration hypothesis, affecting the sporophyte. The restoration cost and male sterility appear to be dominant and consequence of nuclear-cytoplasmic incompatibilities that may maintain nuclear-cytoplasmic polymorphism by frequency-dependent selection.

Thermal resistance of Francisella tularensis in infant formula and fruit juices.

Francisella tularensis is a gram-negative bacterium that can cause gastrointestinal or oropharyngeal tularemia from ingestion of contaminated food or water. Despite the potential for accidental or intentional contamination of foods with F. tularensis, little information exists on the thermal stability of this organism in food matrices. In the present study, the thermal resistance of the live vaccine strain of F. tularensis in four food products (liquid infant formula, apple juice, mango juice, and orange juice) was investigated. D-values ranged from 12 s (57.5 degrees C) to 580 s (50 degrees C) in infant formula with a z-value of 4.37 degrees C. D-values in apple juice ranged from 8 s (57.5 degrees C) to 59 s (50 degrees C) with a z-value of 9.17 degrees C. The live vaccine strain did not survive at temperatures above 55 degrees C in mango juice and orange juice (>6-log inactivation). D-values at 55 to 47.5 degrees C were 15 to 59 s in mango juice and 16 to 105 s in orange juice with z-values of 9.28 and 12.30 degrees C, respectively. These results indicate that current pasteurization parameters used for destroying common foodborne bacterial pathogens are adequate for eliminating F. tularensis in the four foods tested. This study is the first to determine thermal inactivation of F. tularensis in specific foods and will permit comparisons with the thermal inactivation data of other more traditional foodborne pathogens.

[Sagittal sinus thrombosis as a rare cause of postpartum headache: a case report]. / Trombosis del seno sagital cerebral: causa infrecuente de cefalea del postparto: a propósito de un caso.

Postpartum cerebral vein thrombosis is a very rare entity (3-4 cases per million). Clinical manifestations vary, though persistent headache is almost always reported, meaning that differential diagnosis should be performed to rule out other causes of postpartum headache. Recognized risk factors for this disease are the prothrombotic state of pregnancy (third trimester), excess weight, and thrombophilia Accidental dural puncture, protein C and S deficiencies, factor V Leiden mutation, antiphospholipid syndrome, and the use of oral contraceptives have also been implicated. The diagnostic test of choice is magnetic resonance imaging, as it is convenient and harmless, though transcranial Doppler ultrasound can also be used. Pulmonary angiography is the gold-standard test. The treatment of choice is anticoagulant therapy with heparin (a treatment that is controversial, however, due to the high risk of rebleeding), followed by long-term treatment with antivitamin K drugs. We report a case of thrombosis of the upper longitudinal sinus associated with persistent postpartum headache and a history of a failed attempt at epidural puncture for analgesia during labor. The case posed interesting diagnostic questions.

Trombosis del seno sagital cerebral: causa infrecuentede cefalea del postparto: a propósito de un caso / Sagittal sinus thrombosis as a rare cause of postpartum headache: a case report

Las trombosis venosas cerebrales del postparto sonuna entidad muy poco frecuente (3-4 casos por millón).Sus manifestaciones clínicas son variadas, siendo la cefaleapersistente casi una constante, lo que implica hacerun diagnóstico diferencial con otras causas de cefaleadurante el puerperio. Los factores predisponentes reconocidosde ésta patología son el estado protrombótico delembarazo (tercer trimestre), el sobrepeso y la existenciade trombofilias. Además se han implicado en su producciónla punción dural accidental, la existencia de deficienciasde proteína C y S, Factor V Leiden, el síndromeantifosfolípido e ingesta de anticonceptivos orales. Laprueba diagnóstica de elección es por su comodidad einocuidad la resonancia magnética, aunque puede utilizarsetambién la ecografía Doppler transcraneal. Laarteriografía es la prueba de referencia. El tratamientode elección es la anticoagulación con heparina (controvertidopor el riesgo elevado de nuevo sangrado), seguidade fármacos antivitamina K durante largos periodos.Describimos un caso de trombosis de seno longitudinalsuperior en el contexto de una cefalea persistente duranteel puerperio con el antecedente de intento fallido depunción epidural para analgesia de trabajo de parto quesupuso un interesante dilema diagnóstico (AU)

Postpartum cerebral vein thrombosis is a very rareentity (3-4 cases per million). Clinical manifestationsvary, though persistent headache is almost alwaysreported, meaning that differential diagnosis should beperformed to rule out other causes of postpartumheadache. Recognized risk factors for this disease are theprothrombotic state of pregnancy (third trimester),excess weight, and thrombophilia Accidental duralpuncture, protein C and S deficiencies, factor V Leidenmutation, antiphospholipid syndrome, and the use of oralcontraceptives have also been implicated. The diagnostictest of choice is magnetic resonance imaging, as it isconvenient and harmless, though transcranial Dopplerultrasound can also be used. Pulmonary angiography isthe gold-standard test. The treatment of choice isanticoagulant therapy with heparin (a treatment that iscontroversial, however, due to the high risk ofrebleeding), followed by long-term treatment withantivitamin K drugs. We report a case of thrombosis ofthe upper longitudinal sinus associated with persistentpostpartum headache and a history of a failed attempt atepidural puncture for analgesia during labor. The caseposed interesting diagnostic questions (AU)

Effect of inbreeding depression on outcrossing rates among populations of a tropical pine.

Inbreeding depression is common among plants and may distort mating system estimates. Mating system studies traditionally ignore this effect, nonetheless an assessment of inbreeding depression that may have occurred before progeny evaluation could be necessary. In the neotropical Pinus chiapensis inbreeding depression was evaluated using regression analysis relating progeny F-values with seed germinability, the mating system was analysed in three populations with contrasting size, using isozymes, obtained a corrected outcrossing rate. Selfing decreased seed viability by 19%, relative to an outcrossed plant. Multilocus outcrossing rates, t(m), varied widely among populations. In the two smallest populations t(m) congruent with 1. Therefore, inbreeding depression did not affect the estimates, but overestimated t(m) by 10% in the third population, which has a true mixed mating system (selfing was the major source of inbreeding), and an unusually low t(m) for pines (t(m) = 0.54, uncorrected, t(m) = 0.49, corrected). Inbreeding depression may be an uneven source of bias for outcrossing estimates even at the infraspecific level. Accuracy [corrected] but not precision [corrected] may be gained by including inbreeding depression in outcrossing estimates. Therefore, caution should be taken when comparing t(m) among species or even populations within the same species.

Linfangioma cervical: manejo terapéutico con OK-432 (Picibanil) / Cervical lymphangioma: therapeutic management with OK-432 (Picibanil)

Introducción: El linfangioma es una malformación del sistemalinfático. El abordaje clásico ha sido la cirugía. El OK-432 (Picibanil) tieneacción esclerosante y se está utilizando cómo primer escalón terapéutico.El objetivo es aportar un nuevo caso de linfangioma tratado con OK-432y hacer una revisión de la literatura.Material y método: Aportamos un varón de 16 años con un linfangiomacervical macroquístico de 10 x 6 cm tratado con una dosis de OK-432.Resultados: A las 16 semanas del tratamiento, el tamaño del linfangiomaera de 6 x 2 cm, siendo clínicamente inapreciable.Discusión: El tratamiento con OK-432 tiene una alta tasa de curación,con una baja tasa de recidiva y una fibrosis circunscrita a la lesión. Enrelación con la cirugía, se evitan cicatrices y posibles lesiones de estructurasvitales(AU)

Introduction: Lymphangioma is a malformation of thelymphatic system. The classic approach is surgery. OK-432 (Picibanil)has sclerosing action and is being used as the first therapeutic step.The objective was to report a new case of lymphangioma treatedwith OK-432 and to review the literature.Material and method: We report the case of a 16-year-old manwith a 10x6-cm macrocystic cervical lymphangioma treated witha dose of OK-432.Results: At 16 weeks of treatment, the size of the lymphangiomawas 6x2 cm and it was clinically unappreciable.Discussion: OK-432 treatment has a high cure rate, low recurrencerate, and fibrosis circumscribed to the lesion. Compared to surgery,scars and possible harm to vital structures are avoided(AU)

Evolución temporal de las plaquetas y los anticuerpos antiplaquetarios en pacientes de área endémica con malaria no complicada / Temporal evolution of platelets and anti-platelets antibodies in patients of endemic area with non complicated malaria

Objetivo: evaluar plaquetas y anticuerpos antiplaquetarios IgG Ac-Pl (medidos por citometría de flujo) en pacientes de Turbo (Antioquia, Colombia) con paludismo no complicado. Metodología: estudio descriptivo, prospectivo y longitudinal de 45 pacientes (14-67 años). Treinta enfermos se siguieron 7 días. Resultados: A) Pretratamiento: hubo trombocitopenia malárica (TM) en 71% y Ac-Pl en 33%, con asociación significativa entre TM y Ac-Pl. La TM no se asocia con zona de residencia, haber tenido malaria en último año ni especie actual de Plasmodium, pero si con sexo (hombres) (p = 0,02078195), pero la concentración de Ac-Pl es similar en hombres y mujeres. Igualmente, la cantidad de plaquetas es estadísticamente igual entre los valores de las variables anteriores. La presencia de Ac-Pl no se relacionó con las anteriores variables. Hay baja e inversa correlación lineal entre plaquetas y Ac-Pl (r = -0,342 (p = 0,02310). B) Durante el seguimiento, la regresión lineal múltiple entre plaquetas y edad, años de residencia, número de episodios de malaria en el último año, parasitemia (expresada logarítmicamente) y concentración de Ac-Pl demostró que ningún coeficiente es significativo y la máxima explicación lograda (17%) la dan la parasitemia y los Ac-Pl. El mismo análisis entre Ac-Pl y edad, años de residencia en la zona, número de episodios de malaria en el último año, parasitemia (expresada logarítmicamente) demostró que las tres primeras explican 38% de los cambios en Ac-Pl, mientras que los episodios de malaria y el tiempo de residencia en la zona explican el 28%

Aim: To evaluate the number of platelets and the title of anti-platelet antibodies IgG Ac-PI (by flow cytometry) in patients with non-complicated malaria. Methods: Descriptive, prospective and longitudinal study from 45 patients (aged among 14-67). Thirty patients were followed during 7 days. Results: A) Pretreatment: it was found malarial thrombocytopenia (MT) in 71 % and significant association between MT and Ac-PI in 33 %. MT was not associated to residence zone, to have had malaria in the last year and Plasmodium species but sex associated (males, p= 0,02078195), although, the Ac-PI titers of male and female was similar. Correspondingly, the number of platelets was statistically similar to the values of above variables. There was a low and an inverse lineal correlation between platelets and titres of Ac-P1 (r= -0,342 (p= 0,02310)). B) During the following, multiple linear regression among platelets, age, years of residence in the zone, number of malaria episodes in the last year, parasitaemia (logarithmically expressed) and Ac-P1 titers showed no significant coefficient and the maximum explanation achieved (17%) was parasitaemia and Ac-P1 titers. Similar analysis among Ac-P1 and age, years of residence in the zone number of malaria episodes in the last year, parasitaemia (logarithmically expressed) showed that the first three explain 38 % of the changes in Ac-P1, whereas malaria episodes and years of residence in the zone explain 28%

[Temporal evolution of platelets and anti-platelet antibodies in patients of endemic area with non complicated malaria]. / Evolución temporal de las plaquetas y los anticuerpos antiplaquetarios en pacientes de área endémica con malaria no complicada.

AIM: To evaluate the number of platelets and the title of anti-platelet antibodies IgG Ac-PI (by flow cytometry) in patients with non-complicated malaria. METHODS: Descriptive, prospective and longitudinal study from 45 patients (aged among 14-67). Thirty patients were followed during 7 days. RESULTS: A) Pretreatment: it was found malarial thrombocytopenia (MT) in 71 % and significant association between MT and Ac-PI in 33 %. MT was not associated to residence zone, to have had malaria in the last year and Plasmodium species but sex associated (males, p= 0.02078195), although, the Ac-PI titers of male and female was similar. Correspondingly, the number of platelets was statistically similar to the values of above variables. There was a low and an inverse lineal correlation between platelets and titres of Ac-P1 (r= -0.342 (p= 0.02310)). B) During the following, multiple linear regression among platelets, age, years of residence in the zone, number of malaria episodes in the last year, parasitaemia (logarithmically expressed) and Ac-P1 titers showed no significant coefficient and the maximum explanation achieved (17%) was parasitaemia and Ac-P1 titers. Similar analysis among Ac-P1 and age, years of residence in the zone number of malaria episodes in the last year, parasitaemia (logarithmically expressed) showed that the first three explain 38 % of the changes in Ac-P1, whereas malaria episodes and years of residence in the zone explain 28%.

[Nutritional status and immunoglobulin and cytokine concentrations in children with malaria]. / Estado nutricional y niveles de inmunoglobulinas y citocinas en niños con malaria.

OBJECTIVES: To relate nutritional status and concentrations of immunoglobulins and cytokines in children with malaria from two areas with different risk of malaria transmission. METHODS: We performed a descriptive, cross-sectional study comparing children aged 4-11 years old from two areas with different risk of malaria transmission in Colombia. The sample consisted of 66 children from El Bagre and Zaragoza (high transmission area) and 62 children from Turbo (low transmission area). To determine the risk of undernutrition, height/weight, age/height and weight/age indexes were calculated, and serum concentrations of interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), total IgE and malaria-specific IgE were measured. RESULTS: In the high transmission area, concentrations of total and specific IgE and of TNF-alpha were significantly higher. In both areas, the values obtained for total IgE (84 %), specific-IgE (32 %), TNF-alpha (72 %) and IL-10 (84 %) were higher than standard values. Anthropometric indicators revealed acute undernutrition (wasting) in 33 %, chronic undernutrition (stunting) in 52 %, and global undernutrition in 56 % of the population. CONCLUSIONS: Malaria and protein-energy malnutrition were highly prevalent in both areas. In children from the low transmission area, stunting was significantly greater. In the high transmission area, the mean total IgE was twice that found in the low transmission area and no association with nutritional status was observed. Levels of specific IgE did not differ according to the species of Plasmodium infection.