Alginate-waterborne polyurethane 3D bioprinted scaffolds for articular cartilage tissue engineering.

Articular cartilage defects comprise a spectrum of diseases associated with degeneration or damage of the connective tissue present in particular joints, presenting progressive osteoarthritis if left untreated. In vitro tissue regeneration is an innovative treatment for articular cartilage injuries that is attracting not only clinical attention, but also great interest in the development of novel biomaterials, since this procedure involves the formation of a neotissue with the help of material support. In this work, functional alginate and waterborne polyurethane (WBPU) scaffolds have been developed for articular cartilage regeneration using 3D bioprinting technology. The particular properties of alginate-WBPU blends, like mechanical strength, elasticity and moistening, mimic the original cartilage tissue characteristics, being ideal for this application. To fabricate the scaffolds, mature chondrocytes were loaded into different alginate-WBPU inks with rheological properties suitable for 3D bioprinting. Bioinks with high alginate content showed better 3D printing performance, as well as structural integrity and cell viability, being most suitable for scaffolds fabrication. After 28 days of in vitro cartilage formation experiments, scaffolds containing 3.2 and 6.4 % alginate resulted in the maintenance of cell number in the range of 104 chondrocytes/scaffold in differentiated phenotypes, capable of synthesizing specialized extracellular matrix (ECM) up to 6 µg of glycosaminoglycans (GAG) and thus, showing a potential application of these scaffolds for in vitro regeneration of articular cartilage tissue.

Single photon emission computed tomography (SPECT) diagnostic accuracy in active unilateral condylar hyperplasia: Retrospective study.

The aim of this study was to assess the diagnostic accuracy of single photon emission tomography (SPECT) in unilateral condylar hyperplasia (UCH). To this end, 3D morphometric changes of the mandibles in one year were assessed (T0 vs. T1) and compared over SPECT results in T1, in a sample of 40 patients. A contingency table was constructed based on these results for SPECT diagnostic accuracy evaluation, classifying patients as SPECT true-positive, true-negatives, false positives and false-negatives. Additionally, the morphometric analysis was used to describe the presentation of mandibular changes using principal component analysis (PCA) and non-parametric statistics. We obtained diagnostic accuracy results of sensitivity 81%, specificity 63%, positive predictor value (PPV) 59%, negative predictor value (NPV) 83% and accuracy 70%, showing that SPECT yields poor results regarding accuracy diagnostic performance. The morphometric analysis showed that individuals without progress of asymmetry and those with more progress differ particularly in a group of landmarks representing the mental region and the right mandibular body. Based on these landmarks, difference among the four SPECT-accuracy groups was statistically significant (p < 0.001), where the landmark showing the largest change within a year had a mean increase of 1.13 + 0.66 mm. Within the limitations of the study, it seems that SPECT alone is not suitable for making surgical decisions regarding condylectomy in active UCH. Follow up with morphological assessment methods are recommended for confirming an active UCH in combination with SPECT.

Instrumento de medición del conocimiento declarativo y procedimental en el baloncesto escolar / Instrument for measurement of declarative and procedural knowledge in basketball

El propósito de este estudio fue diseñar y validar un instrumento para la evaluación del conocimiento declarativo y procedimental en un deporte de invasión como el baloncesto en el contexto escolar. En el proceso de validación participaron 15 jueces expertos. El instrumento estuvo formado por 34 ítems distribuidos en dos bloques, declarativo y procedimental. Responde al siguiente tipo de preguntas: ¿Qué es?, ¿Sirve para?, ¿Qué se consigue?, ¿Cuál es? y ¿Cómo se realiza? La validez de contenido se calculó mediante el coeficiente V de Aiken y sus intervalos de confianza. Para la consistencia interna se empleó el coeficiente α de Cronbach. Ninguna de las preguntas que componen el test de conocimiento declarativo y procedimental fue eliminada al superar el valor crítico exacto (V≥.74). La consistencia interna de las preguntas fue excelente (α=.95). Por tanto, el instrumento es válido y fiable para la evaluación del conocimiento en el baloncesto escolar. (AU)

The purpose of this study has been the design and validation of an instrument for the evaluation of declarative and procedural knowledge in an invasion sport such as basketball in the school context. 15 expert judges participated in the validation process. The instrument consisted of 34 items distributed in two blocks, declarative and procedural. Answers the following type of questions: Is it useful for?, What is it ?, What is achieved ?, Which one is it? In addition, how is it done? Content validity was calculated using Aiken's V coefficient and its confidence intervals. Cronbach's α coefficient was used for internal consistency. None of the questions that make up the declarative and procedural knowledge test were eliminated by exceeding the exact critical value (V≥.74). The internal consistency of the questions was excellent (α=.95). Therefore, the instrument is valid and reliable for the evaluation of knowledge in school basketball. (AU)

Impact of the COVID-19 pandemic: Community and hospital shared pharmaceutical care model. Satisfaction and acceptability of patients with HIV infection on antiretroviral treatment.

OBJECTIVE: The health crisis due to the COVID-19 pandemic is a challenge in the dispensing of outpatient hospital medication (OHM). Models of Antiretroviral Therapy (ART) based on community pharmacy support (ARTCP) have proven to be successful. The aim was to evaluate the degree of satisfaction, acceptability and limitations of the implementation of ARTCP, in the context of a pandemic, in our environment. METHODS: Descriptive cross-sectional study carried out in a Barcelona hospital, during the months of July-November 2020. A telephone survey was carried out via a questionnaire on the quality dimensions of the model (degree of satisfaction, acceptability) and associated inconveniences. Data collected: demographics, antiretroviral treatment (ART), concomitant medication, drug interactions (DDIs), CD4 lymphocyte count and plasma viraemia. Data analysis included descriptive statistics. RESULTS: A total of 533 (78.0%) HIV patients receiving ART were included. 71.9% (383/533) of these patients were very satisfied and 76.2% preferred attending the community pharmacy rather than the hospital. The mean satisfaction rating was 9.3 (DS: 1.4). The benefits reported were: 1) proximity to home (406: 76.1%); 2) lower risk of contagion of COVID-19 (318: 59.7%); 3) shorter waiting time (201: 37.1%); 4) time flexibility (104: 19.5%); 5) reduction of financial expenses (35: 6.57%). A total of 11 (2%) patients reported no benefit. Only 22.9% reported disadvantages associated with ARTCP: 1) lack of privacy (65: 12.2%); 2) lack of coordinationorganization (57: 10.7%). CONCLUSIONS: The COVID-19 pandemic has had an impact on the provision of pharmaceutical care for HIV patients. The ARTPC model has proved efficient, with patients reporting a high degree of satisfaction.

Histologic findings and related diagnostic methods in condylar hyperactivity.

Condylar hyperactivity (CH) is a rare condition that entails a progressive deviation and deformation of the mandible. There is no consensus regarding characteristic histopathological features or a standardized diagnostic process; thus, histopathological analysis of the condyle cannot confirm or exclude an active CH after condylectomy is performed. An electronic search was performed in Medline, Embase, Web of Science, LILACS and grey literature up to December 2019. Additionally, a manual search was performed. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale and the Institute of Health Economics Quality Appraisal. All analyses were performed independently and in duplicate. Seventeen articles from 660 were included. Six articles were cross-sectional studies and 11 were case series. Almost all the articles (14) described an augmented thickness of the cartilage layer associated with cartilage islands within the subchondral bone in patients affected by CH. Histological findings seem to be mostly related to the age of the sample rather than a characteristic description of CH. No clear association was found between SPECT/scintigram uptake and a specific histological finding. Hence, there is a necessity for the development of specific tools for evaluating and reporting studies where histology is needed for diagnosis confirmation.

Cetoacidosis normoglicémica en paciente embarazada con neumonía por COVID-19. Reporte de un caso clínico / Euglycaemic ketoacidosis in a pregnant woman with COVID-19 pneumonia. A case report

RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.

ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.

Carga externa según la situación de juego y metodología en baloncesto escolar / External Load in Basketball According To Game Situation and Methodology

El objetivo fue caracterizar y comparar la carga externa en sesiones de educación física según la situación de juego en dos metodologías de enseñanza-aprendizaje diferentes. Se emplearon dos programas de intervención diseñados y validados, Direct Instruction y Tactical Game Approach. La muestra estuvo compuesta por 40 tareas. Participaron 70 alumnos de entre 10 y 12 años de un centro de educación primaria de España. Las variables analizadas fueron la situación de juego y la carga externa. Los resultados muestran que los estudiantes de la metodología Tactical Game Approach obtienen valores más altos de carga externa que los de la metodología Direct Instruction. Además, la carga externa disminuye cuando aumenta la complejidad de la situación de juego. La intensidad de las tareas del método Tactical Game Approach permite alcanzar los objetivos de actividad física recomendados por la Organización Mundial de la Salud y que garantizan la salud de los estudiantes

The aim was to characterize and compare the external training load according to the game situation in physical education in two different teaching-learning methodologies. Two unit was design and validated with a Direct Instruction methodology, and the other with a Tactical Game Approach methodology. The study sample consisted of 40 tasks. The study involved 70 students between 10 and 12 years of age in a primary school in Spain. The analyzed variables were the game situation and the external load. The results show that students of the Tactical Game Approach methodology obtain higher values of external training load than students of the Direct Instruction methodology. In addition, the external training load decreases when the complexity of the game situation increases. The intensity of the tasks of the Tactical Game Approach method allows reaching the physical activity objectives recommended by the World Health Organization and guarantee the health of the students

Additive manufactured, highly resilient, elastic, and biodegradable poly(ester)urethane scaffolds with chondroinductive properties for cartilage tissue engineering.

Articular cartilage was thought to be one of the first tissues to be successfully engineered. Despite the avascular and non-innervated nature of the tissue, the cells within articular cartilage - chondrocytes - account for a complex phenotype that is difficult to be maintained in vitro. The use of bone marrow-derived stromal cells (BMSCs) has emerged as a potential solution to this issue. Differentiation of BMSCs toward stable and non-hypertrophic chondrogenic phenotypes has also proved to be challenging. Moreover, hyaline cartilage presents a set of mechanical properties - relatively high Young's modulus, elasticity, and resilience - that are difficult to reproduce. Here, we report on the use of additive manufactured biodegradable poly(ester)urethane (PEU) scaffolds of two different structures (500 µm pore size and 90° or 60° deposition angle) that can support the loads applied onto the knee while being highly resilient, with a permanent deformation lower than 1% after 10 compression-relaxation cycles. Moreover, these scaffolds appear to promote BMSC differentiation, as shown by the deposition of glycosaminoglycans and collagens (in particular collagen II). At gene level, BMSCs showed an upregulation of chondrogenic markers, such as collagen II and the Sox trio, to higher or similar levels than that of traditional pellet cultures, with a collagen II/collagen I relative expression of 2-3, depending on the structure of the scaffold. Moreover, scaffolds with different pore architectures influenced the differentiation process and the final BMSC phenotype. These data suggest that additive manufactured PEU scaffolds could be good candidates for cartilage tissue regeneration in combination with microfracture interventions.

Mielopatía isquémica con múltiples microinfartos renales y esplénicos tras embolización de arterias bronquiales: a propósito de un caso / Ischemic myelopathy with multiples renal and splenic microinfarctions after bronchial artery embolization: a case report

La hemoptisis puede representar una situación de riesgo vital que requiere de un inmediato diagnóstico y tratamiento con una gran variedad de causas subyacentes. Se recomienda una rápida intervención mediante fibrobroncoscopia para localizar e intentar controlar el sangrado. En los casos en los que no se puede controlar el sangrado, la embolización de las arterias bronquiales (EAB) es un tratamiento no quirúrgico seguro y efectivo para los pacientes con una hemoptisis masiva. Se han descrito complicaciones asociadas a la EAB, siendo la isquemia de la médula espinal la más grave. Informamos del caso de un paciente con hemoptisis masiva en contexto de una neumonía necrotizante, en el que se realizó una EAB tras no conseguir controlar el sangrado mediante fibrobroncoscopia

Hemoptysis may represent a life-threatening situation requiring immediate diagnosis and therapy and it can have a variety of underlying causes. It is recommended an early investigation with bronchoscopy for localization and control of bleeding. In those cases with non-controlled bleeding, bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Complications of BAE have been reported, being spinal cord ischemia the most dangerous one. We report a case of a patient with massive hemoptysis in the context of necrotizing pneumonia, in whom a BAE was performed after an unsuccessful control of bleeding by bronchoscopy

One-day point prevalence of healthcare-associated infections and antimicrobial use in four countries in Latin America.

BACKGROUND AND AIMS: Experience in the region shows that in some countries there is very good surveillance of Healthcare-associated infections (HAIs) in health services, but there is no national data consistently in all countries. Therefore, we set to estimate the total burden of HAIs and antimicrobial use in acute care hospitals in Brazil, Venezuela, Mexico, and Colombia using the one-day point prevalence methodology. METHODS: The survey was conducted between June and July 2016. In each ward or unit, HAIs and antimicrobial use data were collected on a single day by a trained team of researchers. Also, for each patient, we collected data on risk factors for infections. RESULTS: One out of ten individuals surveyed had at least one healthcare-associated infection (HAI). Pneumonia and surgical site infections were the most relevant among the surveyed countries. Most of the surveyed participants, regardless of their HAI status, received antibiotics except the individuals managed in Brazil. Carbapenems and third-generation Cephalosporins were among the most frequently used antibiotics. CONCLUSION: Our results add to WHO's recent efforts to understand HAIs prevalence and antibiotic consumption in low and middle-income countries, of which we studied three that were not included in their last report.

Placentitis bacteriana como causa de aborto en yeguas: reporte de caso / Placentitis Bacterial as a cause of abortion in mares: Case Report / Placentite causa bacteriana de aborto em éguas: relato de caso

Resumen La placentitis en yeguas ocasionada por bacterias es una de las causas más importantes de abortos, en Colombia no existe evidencia escrita de su presentación. En el presente artículo se reporta el caso de una yegua Silla Francesa de 10 años de edad, que abortó a los 9 meses de gestación y fue atendida en la Clínica Veterinaria San Jorge - Escuela de Equitación Ejército Nacional en Bogotá. La paciente presentó signos de lactancia prematura y se observó engrosamiento de la placenta, además en los hallazgos histopatológicos predominan cambios vasculares (congestión, edema y fibrina) lo que indica una placentitis aguda. En la tinción de Gram de la placenta se encontraron cocobacilos gram negativos adheridos a la superficie de las células de las vellosidades corioalantóicas y entremezclados con el material proteináceo, aparentemente algunos se ubican intracelularmente; asociando estos fenómenos a un proceso infeccioso por posibles enterobacterias (E.coli o Salmonella spp).

Abstract Placentitis in mares caused by bacteria is one of the most important causes of abortions, there aren't any documented cases in Colombia as of yet. In this article, we take a look at a particular case of a "Silla Francesa" mare 10 years of age. The Mare had an abortion at 9 months of gestation and was treated at the Veterinary Clinic San Jorge - Army Equitation School from Bogota. The mare suffered from a premature lactation and presented thickening in the placenta which indicated placentitis, showing signs of vascular changes (congestion, edema and fibrin).In gram staining of placenta, It was found a negative gram coccobacilli adhered to the surface of the chorioallantoic villus cells and mixed with the proteinaceous material, apparently some are located intracellularly, confirming the process of infection potentially due to the presence of enterobacteias. (E.coli or Salmonella sp).

Resumo O placentite em éguas causadas por bactérias é uma das mais importantes causas de abortos, na Colômbia não está escrita a apresentação de provas. Este artigo relata o caso de uma égua cadeira francesa de 10 anos de idade, que o aborto aos 9 meses de gestação e foi tratado na Clínica Veterinária São Jorge - Escola de Equitação do Exército em Bogotá. O paciente apresentou sinais de lactação prematura e espessamento foi observado indicando placentite placenta porque predominantemente alterações vasculares agudas (edema, congestão e fibrina). Na coloração de gram da placenta, cocobacilos gram-negativo foi encontrada aderida à superfície das células das vilosidades corioalantóicas e misturado com o material proteico, aparentemente algumas estão localizadas intracelularmente, o que confirma o processo de potencial infeccioso de enterobactérias (E. coli ou Salmonella sp).

Validación del Iolf5c para la eficacia del lanzamiento en fútbol para ciegos / Validation of the Iolf5c instrument for the efficacy of shooting on goal in football for the blind

El objetivo del estudio es diseñar y validar un instrumento de observación para conocer los Indicadores de Rendimiento Competitivo en Fútbol a 5 para personas ciegas a través de jueces expertos. La muestra se compuso por 12 entrenadores expertos en Fútbol a 5. Tras la realización de un estudio preliminar, el IOLF5C quedó estructurado en dos partes: acciones básicas durante el lanzamiento a portería en situaciones de juego, y durante el penalti. La validez de contenido se realizó a través de la V de Aiken y sus intervalos de confianza. Para comprobar la consistencia interna del instrumento se empleó α de Cronbach. Los resultados indicaron que el IOLF5C dispone de niveles óptimos de validez obteniendo valores superiores a 0,875 en todos los ítems durante el juego y 0,96 en penalti. La consistencia del instrumento fue de 0,894. Por tanto, el IOLF5C es un instrumento válido y fiable

The aim of this study was to design and validate an observational instrument to identify essential competitive performance indicators in Football 5-a-Side for blind and partially sighted players through the assistance of expert evaluators. The sample was comprised of twelve Football 5-a-Side expert coaches. After a preliminary study, the OLF5C instrument was structured to include two groups of actions: basic actions during shots on goal in game situations and shooting actions penalty situations. Aiken's V statistic and confidence interval values were used to assess the content validity and Cronbach' value was used to assess the internal consistency of the instrument. Results indicated that the IOLF5C has good validity indices with obtained values reaching .875 in all items during game situations and 0.96 on penalty shot actions. The overall level of instrument consistency was .894. The IOLF5C is considered to be a valid and reliable instrument

Punción transvascular guiada por ecobroncoscopia / Endobronchial ultrasound-guided transvascular needle aspiration

Presentamos el caso de un varón de 74 años con un nódulo pulmonar en lóbulo medio en el que el único abordaje posible para la toma de biopsia era la punción transvascular, atravesando la arteria interlobar para alcanzar la adenopatía localizada en 11Ri, todo esto guiado por ecobroncoscopia

We report a case of a 74-year-old man with a pulmonary nodule in the middle lobe in whom the only possible approach for biopsy was transvascular puncture, crossing the interlobar artery to reach the localized adenopathy in 11Ri, all guided by ecobronchoscopy

Terapias no quirúrgicas para el carcinoma basocelular: revisión / Nonsurgical Therapies for Basal Cell Carcinoma: A Review

El carcinoma basocelular (CBC) es el tumor maligno más frecuente en seres humanos, y tiene la capacidad de causar una significativa morbilidad asociada a su potencial de destrucción local. El tratamiento del CBC demanda altos costes de atención para los sistemas de salud, por la gran incidencia de esta enfermedad, especialmente en pacientes mayores. El tratamiento estándar para la mayoría de los CBC consiste en la resección quirúrgica con márgenes y control histológico de los bordes de sección, o mediante cirugía micrográfica de Mohs. Sin embargo, en algunos pacientes con contraindicación para cirugía, que tienen comorbilidades importantes o altas expectativas estéticas, existen en la actualidad nuevas alternativas terapéuticas no quirúrgicas, con las cuales se puede lograr muy buen control local, preservar la función y obtener un excelente resultado cosmético (AU)

Basal cell carcinoma (BCC) is the most prevalent malignant tumor in humans and the local destruction of tissue that can result from excision has a significant impact on well-being. Treating BCC is costly for health care systems given the high incidence of this tumor, especially in older patients. Standard treatment involves either resection with histologic assessment of margins or Mohs micrographic surgery. Surgery is sometimes contraindicated, however, due to the presence of significant comorbidity or high cosmetic expectations. For such patients, nonsurgical treatments have become available. These alternatives can offer good local control of disease, preserve function, and achieve excellent cosmetic results (AU)

Vertical Maxillary Measurements using a Virtual External Reference Point in Orthognathic Surgery: Technical Innovation.

It is extremely important to achieve vertical position of the upper jaw in orthognathic surgery. A common method used is measuring distances at surgery using external reference points. Unfortunately, surgeons have been making mistakes when calculating the goal distance of our external reference systems. A possible explanation is that when the author measure the baseline and goal vertical distances, the author usually do not consider the variations produced by the triangulation effect generated due the horizontal or/and transverse movements of the maxilla. A method is proposed to fix this phenomenon in an easy way through the virtual customization of the ERP in computer-assisted surgical simulation. The technique entails creating, in the planning software, the same reference system one will use at surgery. In this virtual system, one measures the difference between the baseline and target distances, and then uses them at surgery.

Tissue factor variants induce monocyte transformation and transdifferentiation into endothelial cell-like cells.

Essentials Monocytes (Mo) transdifferentiate into endothelial cell-like (ECL) cells. Mo induce tissue factor (TF) expression and secretion in microvascular endothelial cells (mECs). TF interacts with Mo in a paracrine fashion, inducing their transdifferentiation into ECL cells. TF generates a positive feedback crosstalk between Mo and mECs that promotes angiogenesis. SUMMARY: Background Monocytes (Mo) increase neovascularization by releasing proangiogenic mediators and/or transdifferentiating into endothelial cell-like (ECL) cells. Recently, we have reported that Mo-microvascular endothelial cells (mECs) crosstalk induces mEC-tissue factor (TF) expression and promotes angiogenesis. However, the effect of TF on Mo remains unknown. Objective Here, we analyzed whether TF might exert angiogenic effects by inducing transdifferentiation of Mo. Methods Full-length TF (flTF) and alternatively spliced TF (asTF) were overexpressed in mECs, and their supernatants were added to Mo cultures. CD16 positivity and expression of vascular endothelial cell (VEC) markers in Mo were analyzed by fluorescence activated cell sorting. The capacity to form tube-like structures were visualized in three-dimensional cultures. Results In mECs flTF and asTF expression and release were increased in cultures with Mo-conditioned media. TF variants induced expansion of a CD16+ Mo subset and Mo transdifferentiation into ECL-cells expressing VEC markers that can form new microvessels. CD16+ Mo exposed to TF showed an increased expression of VE-cadherin, von Willebrand factor (VWF) and eNOS. Mo cultured with supernatants obtained from TF-silenced mECs did not transdifferentiate to ECL-cells or expressed VEC markers. Blocking ß1-integrin in Mo significantly blocked the effects of the TF variants. Conclusions Mo induce mECs to express and release TF, which drives CD16- Mo to transform into CD16+ Mo and to transdifferentiate into ECL-cells that can form new microvessels. Our results reveal a TF-mediated positive feedback between mECs and Mo that stimulates Mo differentiation and induces angiogenesis.

Nonsurgical Therapies for Basal Cell Carcinoma: A Review. / Terapias no quirúrgicas para el carcinoma basocelular: revisión.

Basal cell carcinoma (BCC) is the most prevalent malignant tumor in humans and the local destruction of tissue that can result from excision has a significant impact on well-being. Treating BCC is costly for health care systems given the high incidence of this tumor, especially in older patients. Standard treatment involves either resection with histologic assessment of margins or Mohs micrographic surgery. Surgery is sometimes contraindicated, however, due to the presence of significant comorbidity or high cosmetic expectations. For such patients, nonsurgical treatments have become available. These alternatives can offer good local control of disease, preserve function, and achieve excellent cosmetic results.

Actinomicetoma en el embarazo. Reporte de un caso: ¿Qué hacer y cómo tratarlo? / Actinomycetoma in pregnancy. Case report: what to do, how to handle?

Resumen ANTECEDENTES: El micetoma es una infección causada por hongos y actinomicetos aeróbicos. Es un padecimiento frecuente en México, con mayor afectación en hombres que en mujeres (3:1). Se caracteriza por aumento de volumen, deformidad del sistio de lesión y formación de fístulas. OBJETIVO: Reportar un caso de actinomicetoma durante el embarazo y analizar el protocolo de tratamiento. CASO CLINICO: Paciente de 29 años de edad, en su cuarto embarazo, con 29 semanas de gestación. El padecimiento se inició 13 años atrás, con dermatosis localizada en la extremidad inferior izquierda, constituida por un nódulo indoloro, que permaneció sin cambios hasta el inicio de la gestación actual, cuando le aparecieron múltiples lesiones nodulares y fístulas. En el examen directo de la secreción se observaron granos y en el cultivo se identificó Nocardia brasiliensis. Después del embarazo a término y con recién nacido sano, si indicó lactancia durante 4 meses y se interrumpió para prescribir bromocriptina. La dermatosis se extendió al doble, sin afectación ósea; se indicó tratamiento con sulfametoxazol-trimetoprima y dapsona. El tiempo total de tratamiento fue de 15 meses y seguimiento sin medicación durante un año. Se obtuvo curación clínica y microbiológica. CONCLUSIONES: El micetoma en mujeres embarazadas es excepcional. La mayor parte de los portocolos de tratamiento deben contraindicarse durante el embarazo. Cuando el micetoma se localiza en una zona que no afecta otros órganos ni se extiende, se sugiere continuar el embarazo y la lactancia sin prescripción de medicamentos pero iniciarla posterior al nacimiento.

Abstract BACKGROUND: Mycetoma is an infection caused by fungi and aerobic actinomycetes. It is a frequent condition in Mexico; it presents less in women than men (1:3). It is characterized by increased volume deformity of the region and sinuses. OBJECTIVE: We present a case of actinomycetoma in a pregnant patient and to analyze the behavior in its therapeutic management CLINICAL CASE: We present female, 29 years old, attending her fourth pregnancy at 29 weeks of gestation. It began 13 years ago with a localized dermatosis of the lower left limb, constituted by a painless nodule, remained unchanged until the beginning of the current gestation, developed multiple nodules and sinuses. A direct examination of the secretion was performed, observing grains, Nocardia brasiliensis was identified. After product birth, lactation was allowed for 4 months and discontinued with bromocriptine. The dermatosis extended to double without bone affection, treatment with sulfamethoxazole/trimethoprim + dapsone was given. Total time was 15 months and follow-up without medication for one year. Clinical and microbiological cure was achieved. CONCLUSIONS: The development of mycetoma in pregnant women is rare, it is important to know the etiology, in eumycetoma all the antimycotics are teratogenic and in actinomycetoma most antibiotics cannot be used in pregnancy with some exceptions. If mycetoma is located in an area that does not compromise other organs or does not spread it is best to leave the course of pregnancy and lactation and then start treatment.

A critical review of the current knowledge regarding the biological impact of nanocellulose.

Several forms of nanocellulose, notably cellulose nanocrystals and nanofibrillated cellulose, exhibit attractive property matrices and are potentially useful for a large number of industrial applications. These include the paper and cardboard industry, use as reinforcing filler in polymer composites, basis for low-density foams, additive in adhesives and paints, as well as a wide variety of food, hygiene, cosmetic, and medical products. Although the commercial exploitation of nanocellulose has already commenced, little is known as to the potential biological impact of nanocellulose, particularly in its raw form. This review provides a comprehensive and critical review of the current state of knowledge of nanocellulose in this format. Overall, the data seems to suggest that when investigated under realistic doses and exposure scenarios, nanocellulose has a limited associated toxic potential, albeit certain forms of nanocellulose can be associated with more hazardous biological behavior due to their specific physical characteristics.

[Enterocolitis associated with Hirschsprung's Disease. Experience in a pediatric teaching hospital]. / Enterocolitis asociada a enfermedad de Hirschsprung. Experiencia en un Hospital Universitario Pediátrico.

Hirschsprung's associated enterocolitis (HAEC) is the most serious and potentially fatal complication of the disease, with a significant morbidity and mortality. The effect of HAEC varies remarkably among the publications since the lack of consensus and the absence of established diagnostic criteria. Patients diagnosed with Hirschsprung's disease (HD) were selected and treated between January 2009 and December 2012 in Fundación HOMI, finding 41 cases of HD, 6 of them with total aganglionosis. 76% of the patients had HAEC, 18 of them during the neonatal period and 6 of them after the final pull-through; 23% presented recurrent enterocolitis episodes. HAEC was the first clinical manifestation in 25 (61%) of the patients with HD. From HD patients limited to the rectum and sigmoid 67% had enterocolitis unlike TCA (total colonic agangliniosis) cases in which all presented HAEC episodes. In our setting, HAEC remains to be an unknown complication; this revision demonstrates its high incidence and mortality.

La enterocolitis asociada a la enfermedad de Hirschsprung (EAEH) es la complicación más grave y potencialmente fatal de la enfermedad, con una morbilidad y mortalidad significativas. La incidencia de EAEH varía notablemente entre las publicaciones dada la falta de consenso y la ausencia de criterios diagnósticos establecidos. Se seleccionaron los pacientes con diagnóstico de enfermedad de Hirschsprung (EH) tratados entre Enero de 2009 a Diciembre de 2012 en la Fundación Hospital de La Misericordia (HOMI) encontrando 41 casos de EH, 6 de ellos con aganglionosis total. En el 76% de los pacientes se realizó el diagnóstico de EAEH, 18 de ellos en el periodo neonatal y 6, tras el descenso definitivo; 23% presentaron episodios de enterocolitis recurrente. La EAEH fue la primera manifestación clínica en 25 (61%) de los pacientes con EH. De los pacientes con EH limitada al recto y sigmoides, un 67% tuvieron enterocolitis a diferencia de los casos de aganglionosis total del colon (ATC), donde todos presentaron episodios de EAEH.