Abordaje diagnóstico y terapéutico de la mastalgia. Un reto cotidiano en la consulta ginecológica.

La mastalgia es uno de los principales motivos de consulta diaria para el ginecólogo. Se estima que alrededor del 70% de las mujeres experimentará mastalgia en algún momento de su vida, además que es un síntoma que puede presentarse de manera reincidente. Es un cuadro que suele representar gran angustia en la paciente dada la posible asociación con algún proceso maligno, lo cual se ha demostrado que tan solo ocurre hasta en el 3% de los casos, por lo que se debe tranquilizarla durante la consulta de primer contacto. Se trata de un síntoma con múltiples etiologías, que en la mayoría de los casos se deben a patologías benignas de la glándula mamaria. La evaluación por estudios de imagen debe apegarse a las recomendaciones emitidas por las diferentes guías internacionales y no solicitar estudios innecesarios que lleven a un sobrediagnóstico y sobretratamiento. El abordaje en el tratamiento puede representar un gran reto para el ginecólogo, ya que existen diversas opciones que abarcan desde terapéuticas no farmacológicas, como son modificaciones en el estilo de vida y múltiples terapéuticas farmacológicas, sin embargo, existen pocos ensayos clínicos aleatorizados que permitan demostrar la superioridad de uno. En objetivo del presente es revisar las diversas recomendaciones en el abordaje diagnóstico y tratamiento que sustentan el manejo clínico de la mastalgia.

In-field hyperspectral imaging dataset of Manzanilla and Gordal olive varieties throughout the season.

Because spectral technology has exhibited benefits in food-related applications, an increasing amount of effort is being dedicated to develop new food-related spectral technologies. In recent years, the use of remote sensing or unmanned aerial vehicles for precision agriculture has increased. As spectral technology continues to improve, portable spectral devices become available in the market, offering the possibility of realising in-field monitoring. This study demonstrates hyperspectral imaging and spectral olive signatures of the Manzanilla and Gordal cultivars analysed throughout the table-olive season from May to September. The data were acquired using an in-field technique and sampled via a non-destructive approach. The olives were monitored periodically during the season using a hyperspectral camera. A white reference was used to normalise the illumination variability in the spectra. The acquired data were saved in files named raw, normalised, and processed data. The normalised data were calculated by the sensor by correcting the white and black levels using the acquired reflectance values. The olive spectral signature of the images is saved in the processed data files. The images were labelled and processed using an algorithm to retrieve the olive spectral signatures. The results were stored as a chart with 204 columns and 'n' rows. Each row represents the pixel of an olive in the image, and the columns contain the reflectance information at that specific band. These data provide information about two olive cultivars during the season, which can be used for various research purposes. Statistical and artificial intelligence approaches correlate spectral signatures with olive characteristics such as growth level, organoleptic properties, or even cultivar classification.

The Medical and Financial Burden of Illegal Abortion.

More than a heated debate subject, abortion is a matter that has been present in human history for a very long time. As our society evolves and advances in medicine and socioeconomic systems are made, the subject of the medical procedure known as abortion appears to be a differentiator in our behaviors as a society. This article highlights the known effects and medical complications of illegal abortion and the financial impact of the procedure's legal status. A retrospective search using EBSCO, PubMed/Medline, Cochrane, EMBASE: Excerpta Medica Database, and DARE electronic databases was conducted, focused on detailing the risks of illegal abortion, the financial cost of complications, the socioeconomic impact of unwanted progeny, and the rationale behind seeking the procedure, legally or otherwise. Each author independently reviewed and extracted data to write up each assigned section, and group collaborations occurred to create the final draft. Out of the 87 resources reviewed, 16 sources were deemed eligible for this article, and their data are herein outlined.

Effects of Aerobic Exercise Versus High-Intensity Interval Training on V̇O2max and Blood Pressure.

Today, more than 20% of the world's population suffers from hypertension, a major risk factor for heart disease. Therefore, lifestyle modifications such as dietary change, smoking cessation, and exercise are often prescribed to hypertensive patients as a first-line treatment. This study aims to examine and compare the effects of different exercise regimens on the cardiovascular system, particularly that of high-intensity interval training (HIIT) and lower-to-moderate-intensity aerobic exercise (aka aerobic exercise).  After researching various databases and extracting 4,724 studies, 196 were viable within the exclusion criteria related to exercise's effects on blood pressure and maximal oxygen uptake (V̇O2max). Of these, 36 studies were selected as viable, and their data is herein outlined. In addition, the results provided by these studies were summarized, respectively, and the raw data were analyzed using a two-tailed unpaired t-test. Through this study, we aim to clarify whether HIIT or lower-to-moderate-intensity aerobic exercise differ in their effects on improving cardiovascular health. It was observed that HIIT was non-inferior to lower-to-moderate-intensity aerobic exercise in the reduction of ambulatory blood pressure of hypertensive or normotensive individuals. However, HIIT was more effective at increasing cardiorespiratory fitness by means of V̇O2max than aerobic exercise was. Considering the significant time-to-completion difference between both exercise modalities, it is remarkable that HIIT has the same benefits as lower-to-moderate-intensity aerobic exercise on blood pressure and higher efficiency in increasing V̇O2max.

Charles Bonnet Syndrome in the Setting of a Traumatic Brain Injury.

Traumatic brain injuries are often associated with a broad range of neuropsychiatric sequelae, for which no straightforward treatment approach is established. Historically, the treatment of traumatic brain injuries has been tailored towards the symptoms presented by the patient. In this paper, we present the case of a 42-year-old male with a past medical history significant for retinitis pigmentosa who suffered a traumatic brain injury and subsequently developed visual hallucinations consistent with Charles Bonnet syndrome.

Management of Psychosis in the Setting of Binge Eating, Mania, and Extrapyramidal Side Effects.

Psychosis is a mental disorder in which an individual exhibits a loss of contact with reality; this definition, however, often fails to convey the broadness and complexity behind the diagnosis. While studies agree that it is best practice to address psychosis by treating its underlying cause, manifestations of psychosis do vary widely and may be challenging to identify in some clinical scenarios, such as the one presented here. Binge eating in the setting of psychosis has been observed in instances where alterations of the gut microbiota in response to an eating disorder trigger psychotic episodes. However, instances in which the manifestation of psychosis itself is the catalytic factor for the presentation of a binge-eating event with aggression and delusions are seldom observed in the current medical literature. Of note, many of the drugs used to treat mental illness have been associated with regulating food intake. We aim to further expand on the association between psychosis, eating disorders, and management thereof in the setting of polypharmacy and undesired side effects. Here, we present the case and management of a 71-year-old male Hispanic patient with a significant history of mental illness who was admitted to the hospital due to acute gastroenteritis precipitated by binge eating during a psychotic episode.

Managing Bipolar Disease Complicated with Psychosis in Conjunction with Polypharmacy, Parkinson's Disease, and Multiple Comorbidities.

The lifelong prevalence of bipolar disorder in adults, including subsyndromal forms, has increased over the years in the United States. By contrast, neurodegenerative diseases such as Parkinson's disease have demonstrated an age-related rise in prevalence. As the global population manages to live longer thanks to sociomedical developments, it is expected to observe a rise in the occurrence of comorbid neuropsychiatric disorders. Herein, we present the case and management regimen of a 51-year-old female patient with multiple comorbidities and in the presence of polypharmacy. She was diagnosed with Parkinson's disease and bipolar disorder type I alongside multiple comorbidities; her polypharmacy and medical history presented a significant clinical challenge in managing her condition. This case report focuses on the pharmacologic management of neuropsychiatric disorders titrated to this patient's particular needs, which were complicated by psychosis and comorbidities.

The lower energy diffraction and scattering side-bounce beamline for materials science at the Canadian Light Source.

A new diffraction beamline for materials science has been built at the Canadian Light Source synchrotron. The X-ray source is an in-vacuum wiggler with a 2.5 T peak magnetic field at 5.2 mm gap. The optical configuration includes a toroidal mirror, a single side-bounce Bragg monochromator, and a cylindrical mirror, producing a sub-150 µm vertical × 500 µm horizontal focused beam with a photon energy range of 7-22 keV and a flux of 1012 photons per second at the sample position. Three endstations are currently open to general users, and the techniques available include high-resolution powder diffraction, small molecule crystallography, X-ray reflectivity, in situ rapid thermal annealing, and SAXS/WAXS. The beamline design parameters, calculated and measured performance, and initial experimental results are presented to demonstrate the capabilities for materials science.

Wide field imaging energy dispersive X-ray absorption spectroscopy.

A new energy dispersive X-ray absorption spectroscopy (EDXAS) method is presented for simultaneous wide-field imaging and transmission X-ray absorption spectroscopy (XAS) to enable rapid imaging and speciation of elements. Based on spectral K-Edge Subtraction imaging (sKES), a bent Laue imaging system diffracting in the vertical plane was developed on a bend magnet beamline for selenium speciation. The high flux and small vertical focus, forming a wide horizontal line beam for projection imaging and computed tomography applications, is achieved by precise matching of lattice plane orientation and crystal surface (asymmetry angle). The condition generating a small vertical focus for imaging also provides good energy dispersion. Details for achieving sufficient energy and spatial resolution are demonstrated for both full field imaging and computed tomography in quantifying selenium chemical species. While this system has lower sensitivity as it uses transmission and may lack the flux and spatial resolution of a dedicated focused beamline system, it has significant potential in rapid screening of heterogeneous biomedical or environmental systems to correlate metal speciation with function.

A Wide-Area Coverage 35 Gb/s Visible Light Communications Link for Indoor Wireless Applications.

Visible Light Communications (VLC) can provide both illumination and communications and offers a means to alleviate the predicted spectrum crunch for radio-frequency wireless communications. In this paper, we report a laser diode based white-light communications link that operates over a wide area and supports high data rates. The proposed system is a four-colour multiplexed high-speed VLC system that uses a microelectromechanical system (MEMS) mirror-based beam-steering. The system operates at record data-rates of more than 35 Gb/s (Bit Error Rate(BER) < 3.8 × 10-3) with a coverage area of 39 m2 at a link distance of 4 m. To the best of our knowledge this is the fastest VLC demonstration reported thus far. The paper also addresses issues of eye-safety, showing data rates of  more than 10 Gb/s are feasible.

A spectrally efficient equalization technique for optical sources with direct modulation.

In this Letter, a novel equalization method for directly modulated optical sources is introduced. Conventional source equalization methods balance the low- and high-frequency responses of the source by cutting down the low-frequency components in any drive signal. Typically, this ensures a flat frequency and linear signal response up to some predetermined upper-frequency limit. It is conventionally done under a fixed linear dynamic range. However, in this Letter, it is found that the source's dynamic range varies by frequency. We describe a novel method that determines the limit of signal linearity at each frequency and uses this to create the enhanced equalizer response. This leads to an improved source bandwidth and, in practice, allows greater transmitted signal energy. Experimental results for a resonant-cavity LED transmitter show date-rate improvement of ∼40% and, to the best of our knowledge, a record date rate of 8.76 Gb/s with a bit-error-rate less than 3.8×10-3.

Phase-preserving beam expander for biomedical X-ray imaging.

The BioMedical Imaging and Therapy beamlines at the Canadian Light Source are used by many researchers to capture phase-based imaging data. These experiments have so far been limited by the small vertical beam size, requiring vertical scanning of biological samples in order to image their full vertical extent. Previous work has been carried out to develop a bent Laue beam-expanding monochromator for use at these beamlines. However, the first attempts exhibited significant distortion in the diffraction plane, increasing the beam divergence and eliminating the usefulness of the monochromator for phase-related imaging techniques. Recent work has been carried out to more carefully match the polychromatic and geometric focal lengths in a so-called `magic condition' that preserves the divergence of the beam and enables full-field phase-based imaging techniques. The new experimental parameters, namely asymmetry and Bragg angles, were evaluated by analysing knife-edge and in-line phase images to determine the effect on beam divergence in both vertical and horizontal directions, using the flat Bragg double-crystal monochromator at the beamline as a baseline. The results show that by using the magic condition, the difference between the two monochromator types is less than 10% in the diffraction plane. Phase fringes visible in test images of a biological sample demonstrate that this difference is small enough to enable in-line phase imaging, despite operating at a sub-optimal energy for the wafer and asymmetry angle that was used.

Pesquisaje auditivo en menores de tres años con factores de riesgo de discapacidad auditiva / Hearing screenings on children under three years at risk of hearing impairment

Se realizó un estudio descriptivo, con el objetivo de describir una serie devariables clínico, epidemiológicas y de laboratorio de 398 pacientes, menoresde tres años con factores de riesgo de discapacidad auditiva, a los que se lesrealizó pesquisaje auditivo, mediante potenciales evocados auditivos (PEATC),pertenecientes al Hospital Pediátrico Provincial de Sancti spíritus (2008-2010).Las variables del estudio fueron: edad, sexo, factores de riesgo, resultado decomplementarios y caracterización de la discapacidad auditiva. Dondepredominó la edad de 1-6 meses al momento del diagnóstico (58,3 porciento), el sexomasculino 237 (62,27 porciento), los factores de riesgo que influyeron en mayor medidafueron: la ventilación mecánica, la encefalopatía hipóxico isquémica y el uso deantibióticos aminoglucósidos. En 362 pacientes (91,2 porciento) la audición fue normal,y 36 (8,98 porciento) presentaron algún grado de discapacidad auditiva. Prevaleciendolas hipoacusias neurosensoriales en 27 casos (6,8 porciento). Conclusiones. Ladiscapacidad auditiva en los niños con factores de riesgo se comporta ennuestro medio de forma similar a lo reportado en la literatura sobre el tema,predominando en el sexo masculino y las hipoacusias severas bilaterales. Lamayoría de los pacientes fueron diagnosticados antes de los seis meses de edad(AU)

This article presents the results of newborn hearing screenings on infants underthree years at risk of hearing impairment at Paediatric Hospital of SanctiSpíritus¸on from 2008 to 2010. All children at risk of hearing impairment weretested by an auditory brainstem response (ABR) for the positive diagnosis ofhearing impairment. Results: Over the period, 398 infants were screened,among whom 36 (8,98 percent ) were diagnosed as deaf or hard of hearing. twentyseven children (6,8 percent ) had a sensorineural hearing impairment, The mostimportant risk factors for sensorineural hearing loss were: severe birth asphyxia;mechanic ventilation, and antibiotics.Conclusion: Our hearing screening oninfants at risk allowed 36 children diagnosed as hearing impairment, all of thenreceived early management(AU)

Cefalea en el paciente pediátrico, Correlación clínico-EEG / Headache in the paediatrics patients, clinical-EEG Correlation

Se realizó un estudio descriptivo, con el objetivo de describir un grupo devariables clínico- epidemiológicas y de laboratorio de 108 pacientes a los quese les realizó Electroencefalograma (EEG) y cuyo síntoma fundamental fue lacefalea; en el período de enero a diciembre de 2009. El dato se tomó delregistro de pacientes del departamento de neurofisiología del HospitalPediátrico Provincial. Las variables del estudio fueron: edad, sexo, tipo decefalea, resultados del EEG, características de la actividad patológica EEG.Los resultados fueron expresados en tablas y gráficos y analizados de formaporcentual. Predominaron los pacientes de 14 a 16 años (40,7 porciento), del sexofemenino (53,7 porciento), clínicamente la cefalea aguda recurrente observada en 60casos fue la que prevaleció, así como normalidad en el EEG (81,5 porciento), en loscasos patológicos observamos paroxismos en 15 pacientes (75 porciento) yalteraciones focales en el 80 porciento de los EEG patológicos. Conclusiones: Ennuestro medio la cefalea en el paciente pediátrico es una patología frecuenteque motiva la realización de diversos estudios entre ellos el EEG, siendo estenormal en la mayoría de los casos y las alteraciones no específicas, predominala cefalea aguda recurrente y en los adolescentes del sexo femenino(AU)

A descriptive study was made, with the objective to describe to a clinical groupof variables epidemiologists and of laboratory of 108 patients to whom it was made to them and EEG and whose fundamental symptom was the headache; inthe period January to December of 2009. The data was taken from the registryof patients of the neurophysiology department of Paediatric Hospital. Thevariables of the study were: age, sex, type of headache, results of the EEG, andcharacteristics of pathological EEG activity. The results were expressed ingraphical and analyzed tables and of percentage form. The patients of 14 to 16years predominated (40,7 percent), female patient (53,7 percent), clinically the observed recurrent acute migraine in 60 cases was the one that prevailed, as well as normality in the EEG (81,5 percent), the pathological cases we observed focalparoxysms in 15 patients (75 percent) and focal alterations in 80 percent of the pathological EEG. Conclusions: In our environment the migraine in the paediatric patient is a frequent pathology that motivates the accomplishment of diverse studies among them the EEG, being this normal one in most of the cases and the non-specific alterations, the recurrent acute migraine and female patients prevailed

Photoinduced magnetism in core/shell Prussian blue analogue heterostructures of K(j)Ni(k)[Cr(CN)6]l·nH2O with Rb(a)Co(b)[Fe(CN)6]c·mH2O.

Core/shell and core/shell/shell particles comprised of the Prussian blue analogues K(j)Ni(k)[Cr(CN)(6)](l)·nH(2)O (A) and Rb(a)Co(b)[Fe(CN)(6)](c)·mH(2)O (B) have been prepared for the purpose of studying persistent photoinduced magnetization in the heterostructures. Synthetic procedures have been refined to allow controlled growth of relatively thick (50-100 nm) consecutive layers of the Prussian blue analogues while minimizing the mixing of materials at the interfaces. Through changes in the order in which the two components are added, particles with AB, ABA, BA, and BAB sequences have been prepared. The two Prussian blue analogues were chosen because B is photoswitchable, and A is ferromagnetic with a relatively high magnetic ordering temperature, ~70 K, although it is not known to exhibit photoinduced changes in its magnetic properties. Magnetization measurements on the heterostructured particles performed prior to irradiation show behavior characteristic of the individual components. On the other hand, after irradiation with visible light, the heterostructures undergo persistent photoinduced changes in magnetization associated with both the B and A analogues. The results suggest that structural changes in the photoactive B component distort the normally photoinactive A component, leading to a change in its magnetization.

Zeolitic polyoxometalates metal organic frameworks (Z-POMOF) with imidazole ligands and epsilon-Keggin ions as building blocks; computational evaluation of hypothetical polymorphs and a synthesis approach.

We investigate here a new family of zeolitic Metal Organic Frameworks (MOFs) based on imidazole (im) as the ligand and epsilon-type Keggin PolyOxoMetalates (POMs) as building units. The POM used in this study is the epsilon-{PMo(12)O(40)} Keggin isomer capped by four Zn(ii) ions (noted epsilon-Zn) in tetrahedral coordination. We describe here our methods to first construct and then evaluate the stability of hypothetical 3-D POMOFs possessing a tetrahedral network, typified by dense silica polymorphs and zeotypes and referred here to as Z-POMOFs. We use the analogy between the connectivity of silicon ion in dense minerals or zeolites and the epsilon-Zn, using imidazolate ligands to mimic the role of oxygen atoms in zeolites. Handling the epsilon-Keggin and imidazole as the constitutive building-blocks, a selection of 40 polymorphs were constructed and their relative stabilities computed. Among these Z-POMOFs, the cristobalite-like and zni-structure were identified as the most stable candidates. In parallel, we have attempted to synthesize Z-POMOF structures with epsilon-Zn POMs, synthesized in situ under hydrothermal conditions, and imidazole ligands. We present our first experimental result, the extended material [NBu(4)][PMo(V)(8)Mo(VI)(4)O(37)(OH)(3)Zn(4)(im)(Him)], named epsilon(im)(2). The structure of the hybrid framework is built by the connection of dimerized epsilon-Zn POMs to imidazole ligands in two directions. The obtaining of the first POMOF based on imidazole ligand is an encouraging step towards the synthesis of a new family of POMOFs.

Zeolitic polyoxometalate-based metal-organic frameworks (Z-POMOFs): computational evaluation of hypothetical polymorphs and the successful targeted synthesis of the redox-active Z-POMOF1.

The targeted design and simulation of a new family of zeolitic metal-organic frameworks (MOFs) based on benzenedicarboxylate (BDC) as the ligand and epsilon-type Keggin polyoxometalates (POMs) as building units, named here Z-POMOFs, have been performed. A key feature is the use of the analogy between the connectivity of silicon in dense minerals and zeolites with that of the epsilon-type Keggin POMs capped with Zn(II) ions. Handling the epsilon-Keggin as a building block, a selection of 21 zeotype structures, together with a series of dense minerals were constructed and their relative stabilities computed. Among these Z-POMOFs, the cristobalite-like structure was predicted to be the most stable structure. This prediction has been experimentally validated by the targeted synthesis of the first experimental Z-POMOF structure, which was strikingly found to possess the cristobalite topology, with three interpenetrated networks. Crystals of [NBu(4)](3)[PMo(V)(8)Mo(VI)(4)O(36)(OH)(4)Zn(4)(BDC)(2)].2H(2)O (Z-POMOF1) have been isolated under hydrothermal conditions from the reduction of ammonium heptamolybdate in the presence of phosphorous acid and Zn(II) ions. Tetrabutylammonium cations play the role of counterions and space-filling agents in this tridimensional interpenetrated framework. Moreover, the electrochemistry of the epsilon-Keggin POM is maintained and can be exploited in the insoluble Z-POMOF1 framework, as demonstrated by the electrocatalytic reduction of bromate.

Tratamiento del quiste oseo simple de los huesos largos con enclavado endomedular. Seguimiento entre 5 y 19 años / Intramedullary nailing for the treatment of unicameral bone cysts in long bones. Follow-up 5 to 19 years

Introducción: Numerosos autores coinciden en que laobstrucción del retorno venoso sería el principal factoretiológico del quiste óseo simple (QOS). La descompresiónpermanente con clavos endomedulares favorecería lacuración de la lesión. Materiales y métodos: Se evaluaron 48 pacientes consecutivos tratados entre enero de 1988 y junio de 2000. El promedio de edad fue de 10,3 años. El seguimiento promedio fue de 9,8 años. Se utilizaron los criterios radiográficos de Capanna para la evaluación de los resultados. El objetivo fue evaluar la eficacia de la descompresión del QOS de los huesos largos con enclavado endomedular y comparar la respuesta al tratamiento según su ubicación. Resultados: Los quistes se localizaron en el húmero proximal(n = 24), la diáfisis humeral (n = 2), el fémur proximal(n = 19), la tibia distal (n = 2) y el peroné distal (n = 1). El 62,5 por ciento debutó con una fractura espontánea. El 89,5 por ciento de los pacientes tuvieron un resultado satisfactorio (26 curación total, 17 curación con radiolucidez residual) y 4 recidivas. El húmero presentó un mayor porcentaje de curación que el fémur (p = 0,1499) y una mayor tendencia a la restitución ad íntegrum. Conclusiones: El enclavado endomedular representó en este protocolo el tratamiento de elección para los quistes óseos simples de los huesos largos. Es un método mínimamente invasivo, permite una estabilización aceptable y, al descomprimir la lesión, posibilita que ésta se cure. No se encontraron diferencias significativas en los resultadosen las diversas localizaciones.