Immunolocalization of activin and inhibin at different stages of follicular development in the lizard Sceloporus torquatus.

The activins and inhibins are glycoproteins with a role in the follicular development of vertebrates, that are found in follicular fluid and somatic follicular cells, with a different pattern among taxa. The principal function of activin (Act) is to modulate the follicle-stimulating hormone (FSH) synthesis and secretion, whereas inhibin (Inh) downregulates it. Both factors are modulators of intraovarian follicular recruitment, oocyte maturation, cell proliferation, and steroidogenic activity. Our aim was to characterize the immunolocalization of Act and Inh in the ovarian follicles during the reproductive cycle of the lizard Sceloporus torquatus. Act was detected in the granulosa cells and oocyte cortex in the different stages of follicular development. On the other hand, we identified Inh in the oocyte cortex and the cytoplasm of pyriform and small cells of previtellogenic follicles. Also, we found immunoreactivity in the oocyte cortex, theca, and small cells of vitellogenic and preovulatory follicles. Our data provide evidence that Act and Inh have changes related to the stage of follicular development. This dynamic appears to be conserved among vertebrates and is fundamental to ensure an adequate follicular development in this specie.

[Utility and prognosis value of the electroencephalogram in COVID-19 and encephalopathy: electroencephalographic patterns in a case series]. / Utilidad y valor pronóstico del electroencefalograma en la COVID-19 y la encefalopatía: patrones electroencefalográficos en una serie de casos.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a collapse situation in many hospitals around the world. The aim of this study is to analyse the utility of the electroencephalogram (EEG) in the management of the neurological patient during the COVID-19 pandemic. PATIENTS AND METHODS: The Clinical Neurophysiology Department of the Hospital Central de la Defensa Gomez Ulla was dissolved due to the hospital collapse situation. Therefore, the EEG was performed exceptionally in those cases with the greatest probability of providing a benefit in its management. We describe seven patients (four in ICU and three hospitalized) diagnosed with COVID-19, who underwent through an EEG. RESULTS: The EEG showed abnormalities in all cases, including one case of brain death. The EEG resulted in a change in clinical management in four of the patients (57%) and helped the clinician provide information to the family. In the other three cases, a toxic-metabolic origin was suspected before the EEG was performed, so it did not imply a change in the clinical management already proposed, although it facilitated a prognostic orientation. Slow polymorphic waves were evident in five cases. Five patients were unresponsive. Currently, one patient remain hospitalized and four have died. CONCLUSIONS: The EEG was useful and facilitated decision making in COVID-19 patients in whom it was requested. It guided the diagnosis in cases where CT was non-contributory and led to a change in therapeutic management in most patients. The most frequent findings were signs of encephalopathy and epileptiform discharges.

TITLE: Utilidad y valor pronóstico del electroencefalograma en la COVID-19 y la encefalopatía: patrones electroencefalográficos en una serie de casos.Introducción. La enfermedad por coronavirus 2019 (COVID-19) causó el colapso de muchos hospitales. El objetivo de este estudio es analizar la utilidad del electroencefalograma (EEG) en el tratamiento del paciente neurológico durante la pandemia de COVID-19. Pacientes y métodos. El Servicio de Neurofisiología Clínica del Hospital Central de la Defensa Gómez Ulla fue disuelto debido a la situación de saturación hospitalaria. En consecuencia, se realizó un EEG excepcionalmente a los pacientes a los que tenía mayor probabilidad de aportar un beneficio en su tratamiento. Se describen siete pacientes (cuatro en cuidados intensivos y tres hospitalizados) diagnosticados con COVID-19 a quienes se les realizó un EEG. Resultados. El EEG mostró anormalidades en todos los casos, incluyendo un caso de muerte cerebral. El EEG supuso un cambio en el tratamiento clínico en cuatro de los pacientes (57%) y ayudó al clínico a informar a la familia. En los otros tres casos, se sospechó un origen tóxico-metabólico previo al EEG, por lo que no implicó un cambio en el tratamiento ya propuesto, aunque facilitó una orientación pronóstica. Se evidenciaron ondas lentas polimorfas en cinco casos. Actualmente, un paciente permanece hospitalizado y cuatro han fallecido. Conclusiones. El EEG fue de utilidad y facilitó la toma de decisiones en los pacientes con COVID-19 en los que se solicitó. Orientó al diagnóstico en casos en los que la tomografía computarizada no contribuyó y supuso un cambio en el tratamiento terapéutico en la mayoría de los pacientes. Los hallazgos más frecuentes fueron signos de encefalopatía y descargas epileptiformes.

Caseínato de calcio y nutrición enteral en pacientes con desnutrición proteica visceral / Calcium caseinate and enteral feeding in patients with visceral proteic malnutrition

La desnutrición en pacientes es una de las causas principales de algunas complicaciones intrahospitalarias. Los pacientes con algún grado de desnutrición proteica (albuminemia menor a 3,0 g/dl) que son capaces de ingerir por boca sus requerimientos nutricionales y que mantienen parcial o totalmente la funcionalidad del tubo digestivo, son candidatos a nutrición enteral (requerimientos a través de una sonda nasoyeyunal o nasogástrica). Existen muchas complicaciones a la nutrición enteral, entre ellas la més importante y frecuente es la diarrea hiperosmolar. En este estudio se demostró , después de analizar a 29 pacientes con nutrición enteral y distinto grado de desnutrición proteica visceral, que el régimen enteral adicionado a caseinato de calcio, es un tratamiento efectivo al síndrome diarreico; ya que inhibe la motilidad intestinal y contribuye con el trofismo de la vellosidad. También se llegó a la conclusión que la tolerancia al régimen enteral depende de un adecuado manejo en la progresión del aporte y del grado de desnutrición proteica (albuminemia) del paciente.

Tratamiento de la hiperplasia prostática benigna / Treatment of benign prostatic hyperplasia

En el campo de la Urología, una de las causas més frecuentes de consulta la constituye la patología prostática y dentro de ésta, la hiperplasia benigna de la próstata. Esta consiste en un incremento de células en el área periuretral prostática, lo que puede ser debido a una proliferación celular aumentada, a una alteración de la apoptosis, o a una combinación de ambos mecanismos. Entre las principales opciones terapÚuticas actuales para la hiperplasia prostática benigna están: - Tratamiento quirúrgico, que continua siendo la principal alternativa de terapia, representado principalmente por la resección transuretral. Tratamiento farmacológico, utilizado como alternativa y/o complemento a la cirugía y representado por dos grandes grupos de fármacos: los antagonistas adrenÚrgicos y la terapia endocronológica (finasteride). El presente trabajo es una revisión bibliográfica actualizada sobre las distintas opciones de tratamiento disponibles para la hiperplasia prostática benigna y sus respectivas indicaciones.

Distribución y forma de presentación clínica del megacolon chagßsico en 96 pacientes serológicamente positivos a Trypanosoma Cruzi del Hospital San Juan de Dios: Santiago, Chile: 1990-2000 / Regional distribution and clinical finding of chagas' megacolon among 96 patients seropositive for Trypanosoma Cruzi from the San Juan de Dios Hospital in Santiago, Chile

La enfermedad de Chagas en Chile, es una infección parasitaria prevalente entre la I y la VI regiones del país, estim´´andose los infectados en alrededor de 400.000 personas. La infección por Trypanosoma cruzi puede presentarse en forma asintomática o manifestarse con cardiopatía o megaformaciones digestivas. El costo de mantención anual de un cardiópata chagásico es de alrededor de 500 dólares, pero no se ha establecido cual es el costo del megacolon chagásico, patología seguramente més costosa debido al componente quirúrgico que involucra. Con el objetivo de establecer como se distribuye la patología digestiva, específicamente el megacolon en pacientes seropositivos para T. cruzi, se estudiaron 96 fichas de pacientes con diagnóstico de enfermedad de Chagas procedentes del Hospital San Juan de Dios, Santiago de Chile, en el período 1990-2000. Los resultados mostraron que de las 96 fichas estudiadas, 66 correspondieron a casos crónicos asintomßticos, 4 a cardiopatías chagásicas, 10 a esofagopatía y 16 a megacolon chagásico, correspondientes a 6 mujeres y 10 hombres. Desde el punto de vista clínico, los síntomas més importantes del megacolon chagásico fueron la retención de heces o gases, el dolor abdominal, la distensión abdominal, la constipación y el compromiso del estado general. Con respecto a tratamiento, lo recomendable es la cirugía y dentro de ella la operación de Duhamell-Haddad que es actualmente la intervención de elección.

Puente miocardico: caso clínico y revisión bibliografica / Myocardial bridge: clinical case and review of literature

Se presenta el caso de un paciente con ausencia de factores de riesgo cardiovascular que fue ingresado a la Unidad Coronaria del Hospital San Juan de Dios por un cuadro característico de angina inestable, sin ECG categórico de isquemia ni exámenes que la ratificaran. El enfermo fue sometido a cateterismo cardíaco, el que reveló la presencia de un puente muscular en la porción media de la arteria descendiente anterior. El paciente evolucionó en forma satisfactoria con tratamiento médico y en controles posteriores no ha vuelto a presentar sintomatología. Se aprovecha el caso observado para revisar la bibliografía pertinente. Esta revela que los puentes miocárdicos no son tan excepcional como se cree y que pueden explicar casos de angor en coronarias normales.

Impacto de una red comunitaria de apoyo psicosocial en la salud perinatal / Impact of a community network of psycho-social support on perinatal health

Objetivo. Determinar el impacto de una intervención comunitaria en la salud perinatal. Diseño. Intervención comunitaria. Emplazamiento. Nivel comunitario, en Chihuahua, México. Participantes. Se diseñó una intervención comunitaria incluyendo mujeres embarazadas (n = 1.233) antes de la semana 22 de gestación, de las cuales 1.148 concluyeron el seguimiento (6,74 por ciento de pérdidas; grupo de intervención, 261, y grupo control, 887), todas ellas residentes en las colonias periféricas de las 2 localidades. Mediante un sorteo aleatorio se asignaron a los grupos de estudio. Intervención. Consistió en 5 visitas previas al parto en las semanas 22, 26, 30, 34 y 38, así como una visita en el puerperio en los primeros 8 días, en las que se les proporcionó apoyo de tipo social y educativo. Al grupo control se le visitó en 2 ocasiones, semana 22 y puerperio, indicándoles continuar con las medidas habituales. Mediciones y resultados principales. Tasa de mortalidad perinatal, parto prematuro (< 37 semanas), bajo peso al nacer (< 2.500 g) y morbilidad perinatal. La tasa de mortalidad perinatal I fue menor en el grupo de intervención (3,8 por 1.000 nacidos vivos); en el grupo control fue de 13,1. No se encontraron diferencias estadísticamente significativas en parto prematuro, bajo peso al nacer y morbilidad perinatal. Conclusión. La intervención comunitaria proporciona apoyo a mujeres embarazadas con factores de riesgo psicosocial; sin embargo, no contribuye a disminuir de forma significativa el parto prematuro, el bajo peso al nacer o las complicaciones perinatales (AU)

[Impact of a community network of psychosocial support in perinatal health]. / Impacto de una red comunitaria de apoyo psicosocial en la salud perinatal.

OBJECTIVE: Determine the impact of a community intervention in perinatal health in, cities of the State of Chihuahua, Mexico. PATIENTS, MATERIAL AND METHODOLOGY: A community intervention was designed including pregnant women (n = 1233), and finally 1148 (6.74% of loss) group intervention (n = 261) control group (n = 887). Intervention consisted of five visits prior to delivery during the 22nd, 26th, 30th, 34th and 38th weeks, as well as a visit during the first 8 days in puerperium, providing social and educational support. In regards to the control group, they were visited in two different occasions, week 22 and purperium, indicating them to continue with their regular care. The outcome variables were perinatal mortality, premature birth (< 37 weeks), low weight at birth (< 2500 grams) and perinatal morbidity. RESULTS: Perinatal mortality rate was smaller in the intervention group 3.8 per 1000 born alive; perinatal mortality in the control group was 13.1. No statistically considerable difference was found in premature birth, in low weight at birth and in perinatal morbidity. CONCLUSION: Community intervention provides a support to pregnant women under psychosocial risk factors; nevertheless, it does not contribute to considerably decrease premature birth, low weight at birth or perinatal complications.

[Congenital absence of the vagina. Mayer-Rokitansky-Kuster-Hauser syndrome. Presentation of a case and review of the literature]. / Ausencia congénita de vagina. Síndrome Mayer-Rokitansky-Kuster-Hauser. Presentación de un caso y revisión de la literatura.

The normal development of the feminine reproductive tract depends on complete interaction between genetic, hormonal and environmental factors to produce the differentiation of the Müellerian, Wolff and urogenital sinus. The alteration in this balance result in a wide spectrum of the reproductive tract anomalies including imperforated hymen, vaginal septum, vaginal atresia, incomplete fusion of the Müellerian conducts and Müellerian aplasia. In order to evaluate the feminine genital tract disorders, we studied a feminine with amenorrhea and primary sterility. Ultrasonography and diagnosis laparoscopy where performed. Incomplete fusion of Müellerian conducts was observed. Blood genetics tests plus biopsy of ovarian tissue were taken which reported 46 XX karyotype with no structural anomalies. Conservative evaluation and management.

Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project.

OBJECTIVE: To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data. DESIGN: Cross-sectional and longitudinal analysis of data from an open-enrollment cohort. SETTING: One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia. PARTICIPANTS: A total of 508 female CSW who work at brothels and attend a public STD clinic. INTERVENTION: Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization. MAIN OUTCOME MEASURES: Prevalence of gonorrhea, syphilis (reactive plasma reagin titer > or = 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence. RESULTS: From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (Cl), 0.41-0.97], syphilis (OR, 0.39; 95% Cl, 0.23-0.64), and trichomoniasis (OR, 0.44; 95% Cl, 0.32-0.71). In 1995, HIV seroprevalence among CSW was 0.1%. CONCLUSION: Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.

[Analytic study of amniocentesis in prenatal genetic diagnosis. Transversal study of cases]. / Estudio analítico de la amniocentesis en el diagnóstico genético prenatal. Estudio transversal de casos.

The experience obtained in 44 cases, in which amniocentesis was practiced for genetic diagnostic purpose in the private center in México City is presented. Indications, morbility and results are similar to those reported in the literature, is considered that this method should be offered to the couples who receive information about it and have maternal age 35 or older, antecedent of family chromosomal disease, alteration in maternal serum screening or family anguish. This is a safe method and easy to perform with a high sensibility and specificity, this is the first report in a private center in México that analyzes technique.

[Uterine sarcoma. Analytic study of 37 cases]. / Sarcoma uterino. Estudio analítico de 37 casos.

The lack of uniformity in the nomenclature of the uterine sarcomas, it have contributed to a variety and variability of classifications. Fortunately the sarcomas of uterus are rare. The incidence of this tumor is of 3-5% of all the uterine cancers or of 1.7/100,000 women of 20 years or more. The clinical presentation of these tumors is diverse could come bleed uterine abnormal, abdominal pain, pelvic mass, discharge or cervix prominent mass. Clinical discoveries associated with exist the sarcomas how they are the obesity and high blood pressure in a 30% of the patients it are also observed antecedents of pelvic radiation in a 5-10% of the cases. The genomic alterations that is reported the chromosomes in the literature is associated with 1, 7 11 playing an important paper in the initiation or progression of the sarcomas. We was carried out a retrospective analysis of 37 cases of uterine sarcoma managed in the National Institute of Cancerology at one time of 5 years. Being that the leiomiosarcomas comes in the 51.3% of the cases, followed by the stromal sarcoma, bleed uterine abnormal it was the clinical fact of high importance, detecting these patients in Ia and IIa stadiums predominantly. We observed an increment in the incidence of the uterine sarcoma in patients of 40 years or more. 17 patients were managed exclusively with surgery, 17 patients with surgery and radiotherapy and 5 patients with surgery and chemotherapy (2 patients were managed with surgery + radiotherapy + chemotherapy). The index of failure was from the 45.1% to two years in general form, coming metastasic illness in lung, liver and breast mainly. In conclusion, the adjuvant radiotherapy and chemotherapy to the hysterectomy doesn't increase the index of survivor in the several subtype of uterine sarcomas.

[HELLP syndrome. Severe consequence of hypertensive disease induced by pregnancy]. / Síndrome de HELLP. Consecuencia severa de enfermedad hipertensiva inducida por el embarazo.

A descriptive, transversal retrospective study was performed, to determine the prevalence of HELLP syndrome among patients with Pregnancy-Induced Hypertension (PIH), who were admitted into the Gynecology and Obstetrics Service the American British Cowdray Hospital in Mexico City, since July 1992 to June 1995. We detected a total or 11 patients who had the diagnostic parameters proposed by Sibaí, those were 11.8% of all the patients with PIH. The medial gestational age was 33 weeks (range from 30 to 39) The mean tensional levels were 170/ 107 mm Hg, in base of platelet count, nine patients were classified as Class I (82%) and two in Class II (18%), the medial peak levels of transaminases and bilirubins was reached 40 hours and that of lactic deshidrogenase 60 hours after the diagnosis was established, while the minimum levels of hematocrit and platelets were at 48 and 57 respectively. The mean weight of the neonates was 1,655 g, the maternal mortality rate was 9% and the perinatal 8.3%, the diagnosis of HELLP syndrome was established before delivery in 40% of the cases and after that in 60%, puerperal HELLP may occur more frequently that is believed. Point out the importance of early detection of this clinic entity in order to establish an opportune and efficient treatment which improves maternal and fetal prognosis.

[Laparoscopic treatment of dermoid cyst. First report in Mexico]. / Tratamiento laparoscópico de quiste dermoide. Primer informe en México.

The laparoscopic treatment of adnexal masses has been controversial; however, the study of the case with the judicious use of the laboratory and ultrasound permit the laparoscopic approach of the most of the adnexal masses, including the dermoid cyst or mature cystic teratomas, and offer to the patient the benefits of the laparoscopic surgery with low morbidity. However, it should be do it in medical centers with the human and technics recourse need it for the performance. It present the first report in Mexico of laparoscopic treatment in contrast with a group of patients with laparotomy. The results of this study, are in conformity with the reports on the literature and suggest the initial laparoscopic approach of the dermoid cyst.

[The perception of health, social support and family function in HIV seropositivity]. / Percepción de salud, apoyo social y función familiar en VIH positivo.

OBJECTIVE: To discover the perception of health, social support and family function for asymptomatic HIV carriers. DESIGN: This was an observation crossover study, using validated questionnaires. SETTING: Almanjayar and Cartuja Health Centres in Granada. PATIENTS AND OTHER PARTICIPANTS: 58 HIV+ patients belonging to the two basic areas were included. They were selected from the archives of the health centres and from the infectious diseases clinic of the referral hospital. There were an equal number of controls with similar socio-demographic characteristics. MEASUREMENTS AND MAIN RESULTS: The questionnaires used were as follows: GHQ, DUKE-UNC, the family APGAR, which measure health perception, social support and family function, respectively. Of seropositive patients, 58% presented a negative perception of their health, mainly expressed through symptoms of anguish and anxiety; as against 25% of the control group. As to social support, 29% of the HIV+ carriers perceived low levels of support, as against 6.9% of the control group. We found family dysfunction among 46% of seropositive patients, as against 12% of the control group. The Chi squared test was used for the analysis: all the differences were significant. CONCLUSIONS: Patients who are HIV carriers, even when they are asymptomatic, have a poor health perception, which can be attributed to the nature of the illness. The low level of social support detected, linked to the stress involved in being seropositive, may be the origin of the family dysfunction observed in 46% of our sample. We recommend action at individual, family and community levels in order to improve these patients' quality of life, strength their support structures and restore balance to family function.

Hipoplasia pulmonar unilateral en un adulto joven / Unilateral pulmonary hypoplasia in a young adult male

Caso clínico de un hombre joven, previamente asintomático, quien consultó por síntomas de un cuadro infeccioso respiratorio alto. El hallazgo de asimetría torácica y signología de condensación basal izquierda motivó el estudio broncográfico, angiográfico y de función diafragmática, lo que permitió comprobar una hipoplasia pulmonar izquierda. Se presenta una revisión bibliográfica sobre el desarrollo normal del pulmón y algunas alteraciones del desarrollo del aparato respiratorio

[Idiopathic membranous glomerulonephritis]. / Glomerulonefritis membranosa idiopática.

The only case of idiopathic membranous glomerulonephritis seen out of 106 nephropathic patients biopsied in the two last years at the C. H. 20 de Noviembre, I.S.S.S.T.E., is reported. Twenty-six showed nephrotic syndrome not associated to systemic disease, including the present case, which gave us an incidence of 3.8% of this entity. We were impressed by the low frequency of this disease, so we made a statistical epidemiological analysis localizing it geographically based on the available medical literature. On comparing the results of these studies we confirmed that this disease is significantly low in our environment.