[Quality of healthcare in oncological patients from health personnel's perspective]. / Calidad de la atención en pacientes oncológicos desde la perspectiva del personal de salud.

INTRODUCTION: The quality of care in health institutions is a constant challenge, mainly in oncology. The literature shows it has partially evaluated in contrast to it proposed by Donabedian; in addition, health personnel's perspective, who has direct contact with the patient, knows and executes the care process, has not been considered. The objective of the present study was to establish a framework to evaluate the quality of healthcare provided to patients with colorectal or ovarian cancer from health personnel's perspective. MATERIAL AND METHODS: Cross-sectional study that included health personnel belonging to nine services of a cancer hospital. A questionnaire was applied to evaluate the quality of healthcare through amenities, the interpersonal and scientific-technical dimension (Donabedian's model). The variables were standardized, compliance with them among services was compared using non-parametric tests (Kruskal-Wallis test and Mann-Whitney U test), and 40 indicators were evaluated. RESULTS: Health personnel's 181 members participated, the evaluated oncology hospital presented regular compliance to the quality of healthcare (bad ≤82, regular 83-109, good ≥110). When comparing this in the nine services, differences were detected between surgery and radiotherapy (higher compliance scores, 132 and 126 respectively) versus the other services P<.05. Both services had more than 25 indicators with compliance ≥80%. CONCLUSIONS: It is shown that the established framework is useful for evaluating the quality of healthcare from health personnel's perspective (an approach not used so far for this type of evaluation), by detecting differences in its compliance, specific problems and its causes by service.

Magnesium requirement of some of the principal rumen cellulolytic bacteria.

Information available on the role of Mg for growth and cellulose degradation by rumen bacteria is both limited and inconsistent. In this study, the Mg requirements for two strains each of the cellulolytic rumen species Fibrobacter succinogenes (A3c and S85), Ruminococcus albus (7 and 8) and Ruminococcus flavefaciens (B34b and C94) were investigated. Maximum growth, rate of growth and lag time were all measured using a complete factorial design, 2(3)×6; factors were: strains (2), within species (3) and Mg concentrations (6). R. flavefaciens was the only species that did not grow when Mg was singly deleted from the media, and both strains exhibited a linear growth response to increasing Mg concentrations (P<0.001). The requirement for R. flavefaciens B34b was estimated as 0.54 mM; whereas the requirement for R. flavefaciens C94 was >0.82 as there was no plateau in growth. Although not an absolute requirement for growth, strains of the two other species of cellulolytic bacteria all responded to increasing Mg concentrations. For F. succinogenes S85, R. albus 7 and R. albus 8, their requirement estimated from maximum growth was 0.56, 0.52 and 0.51, respectively. A requirement for F. succinogenes A3c could not be calculated because there was no solution for contrasts. Whether R. flavefaciens had a Mg requirement for cellulose degradation was determined in NH3-free cellulose media, using a 2×4 factorial design, 2 strains and 4 treatments. Both strains of R. flavefaciens were found to have an absolute Mg requirement for cellulose degradation. Based on reported concentrations of Mg in the rumen, 1.0 to 10.1 mM, it seems unlikely that an in vivo deficiency of this element would occur.

Ionized calcium requirement of rumen cellulolytic bacteria.

Ionized calcium (Ca(+2)) appears to be required by the 3 predominant species of rumen cellulolytic bacteria, Fibrobacter succinogenes, Ruminococcus flavefaciens, and Ruminococcus albus. The present study evaluated the role of ionized calcium in growth and cellulose digestion. Maximum growth or rate and extent of digestion and lag time were the criteria used to evaluate Ca(+2) requirements. All cultures except F. succinogenes A3c grew when repeatedly transferred in a medium without added Ca(+2). As Ca(+2) concentration increased in cellobiose medium, the rate of growth increased and lag time decreased for F. succinogenes A3c, whereas F. succinogenes S85 exhibited increases in both maximum growth and rate of growth. No responses in any of the criteria were observed for the ruminococci in cellobiose medium. Both strains of F. succinogenes had an absolute requirement for Ca(+2) with cellulose as the only substrate. For strain A3c the requirement was 0.36 to 0.42 mM and for S85, >0.64 mM. Increases in extent of cellulose degradation occurred with all strains of ruminococci as Ca(+2) concentration increased; however, degradation in Ca(+2)-free medium was similar to that of F. succinogenes with Ca(+2). Although the ruminococci presumably have cellulosomes that require Ca(+2) in their structure, such was not evident in our studies. The function of Ca(+2) in cellulose degradation by F. succinogenes is unknown, but may be related to the secretion or activation of their cellulolytic enzymes. Based on reported concentrations of Ca(+2) in the rumen, it seems unlikely that an in vivo deficiency would occur for these bacteria.

[Ischemic stroke and cardiac myxomas. Findings in cranial magnetic resonance imaging]. / Ictus isquémicos y mixomas cardíacos. Hallazgos de resonancia magnética craneal.

INTRODUCTION: We report three patients with ischemic stroke as initial manifestation of left atrial myxomas. CASES REPORTED: Case 1: man with difficulty in speaking for 15 minutes at the age of 33 years and dysarthria, right hemiparesis and hemisensory loss at the age of 36. Case 2: woman aged 29 with facial weakness and left limbs weakness for an hour. Case 3: woman with transient vertigo and paresthesia in right hemiface and upper limb for a month at the age of 35 years and difficulty for speaking, weakness of right limbs and loss of vision in left eye at the age of 40 years. The three patients had an atrial myxoma diagnosed by transthoracic or transesophageal echocardiography. CONCLUSIONS: The three patients had ischemic stroke at a young age. The initial manifestation of the myxoma was a transient ischemic attack in two of them. Diagnosis was delayed more than 3 years in two of the patients. The second episode of the third patient affected all the left internal carotid territory including the posterior cerebral artery arising from the internal carotid and branches of the central retinal artery. Comparing the magnetic resonance with the previous one, new hyperintense images on T2 with gadolinium enhancement were found in the left hemisphere consistent with subacute infarcts that had stabilized 5 months later.

Perianal Crohn's disease.

A 13-year-old girl with a history of 4 months of perianal skin lesions is described. Physical examination revealed three 0.5 I 1-cm red, swollen, fleshy, skin tags extending from the perianal area to the perineum (Fig. 1). The patient reported intermittent fever, diarrhea, and abdominal pain, and her body weight was below the third percentile for her age. Laboratory studies showed an erythrocyte sedimentation rate of 101 mm/h; hematocrit of 26%; white blood cell count of 9800/mm3; serum iron of 15 mg/L (normal value (NV), 60-160 mg/L); ferritin of 43.4 microg/L (NV, 12-150 microg/L); transferrin of 203 mg/100 mL (NV, 200-400 mg/100 mL); transferrin saturation of 6% (NV, 20-50%); hypoalbuminemia; negative purified protein derivative (PPD), cytomegalovirus (CMV), human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL), and antinuclear antibody tests; and Toxoplasma titers of 1/16, Van de Kamer 1.67 g/day. A barium examination revealed marked irregularity of the descending colon, and a colonoscopy showed uneven areas of mucosal edema and pseudopolyps in the transverse and descending colon, associated with irregular thickening and stenosis. Histopathologically, large intestine and skin lesions consisted of noncaseating epithelioid and giant cell granulomas (Fig. 2). Cultures for acid-fast bacilli and fungi were negative, and under polarized light no foreign bodies were seen. Treatment with metronidazole (250 mg three times a day), prednisone (0.5 mg/kg/day), and acetylsalicylic acid (75 mg/kg/day) was moderately effective. Vitamin, folic acid, and iron supplements were also added.

Effects of fat source and copper on unsaturation of blood and milk triacylglycerol fatty acids in Holstein and Jersey cows.

Fatty acid composition of plasma triacylglycerides and milk fat was analyzed from Holstein and Jersey cows with control or depleted copper status and fed roasted whole soybeans or tallow. Conjugated linoleic acid in plasma was higher in Jersey cows. Dietary fat source influenced the proportions of all fatty acids in plasma and in milk, except for conjugated linoleic acid in milk. Feeding soybeans increased plasma C14:1, C18:0, C18:2, and conjugated linoleic acid, and decreased C14:0, C16:0, C16:1, and cis- and trans-C18:1 compared with feeding tallow. Low copper diets decreased C18:0 and increased cis- and trans-C18:1, and conjugated linoleic acid in plasma. A fat source x copper status interaction occurred for cis-C18:1 in plasma. Proportions of C4:0 to C14:0 were higher, and cis16:1, cis- and trans-C18:1, and conjugated linoleic acid were lower in milk fat of Jersey compared with Holstein cows. Generally, the effects of copper depletion were less apparent in milk than in plasma. Copper depletion increased C4:0, trans-C18:1, and conjugated linoleic acid, and decreased C16:1 in milk. Feeding whole soybeans increased C4:0 to C14:0, C18:0, C18:2, and C18:3, and decreased C14:1, C16:0, C16:1, and cis- and trans-C18:1 in milk. Breed x fat interactions occurred for C4:0, C14:1, C16:1, and conjugated linoleic acid in milk. Copper status x fat source interaction occurred for trans-C18:1. The breed x copper status interaction was apparent in milk fat for C16:1 and C18:0 and conjugated linoleic acid in milk. Both C18:0 and trans-C18:1 were desaturated by mammary tissue; however, whereas desaturation of C18:0 was linear, desaturation of trans-C18:1 reached a plateau that could have been caused by presence of the trans-10 isomer, which is not desaturated and was not separated from trans-11 C18:1 in our analysis. Comparison of the plasma triacylglycerol fatty acid profile with the milk fat profile was useful to interpret separate events of biohydrogenation in the rumen and desaturation by the mammary gland.

Granuloma anular subcutáneo / Subcutaneous annular granuloma

Se comunica un caso de granuloma anular subcutáneo en un niño de 10 años de edad. El cuadro clínico se manifiesta por múltiples nódulos subcutáneos en áreas acrales. Se menciona el antecedente de una B talasemia menor familiar, hecho no referido en la bibliografía. La ausencia de manifestaciones reumáticas, asociada a su cuadro histológico avalan el diagnóstico de G.A.S. Las lesiones persistieron durante años a pesar del tratamiento con corticoides

Granuloma anular subcutáneo / Subcutaneous annular granuloma

Se comunica un caso de granuloma anular subcutáneo en un niño de 10 años de edad. El cuadro clínico se manifiesta por múltiples nódulos subcutáneos en áreas acrales. Se menciona el antecedente de una B talasemia menor familiar, hecho no referido en la bibliografía. La ausencia de manifestaciones reumáticas, asociada a su cuadro histológico avalan el diagnóstico de G.A.S. Las lesiones persistieron durante años a pesar del tratamiento con corticoides (AU)

Enfermedad por arañazo de gato / Cat-scratch disease

Se presentan dos casos de enfermedad por arañazo de gato, cuya primera consulta fue dermatológica, presentando uno de los mismos solo manifestaciones cutáneas, mientras que el otro se asoció a neumonitis. Ambos evolucionaron favorablemente

Enfermedad por arañazo de gato / Cat-scratch disease

Se presentan dos casos de enfermedad por arañazo de gato, cuya primera consulta fue dermatológica, presentando uno de los mismos solo manifestaciones cutáneas, mientras que el otro se asoció a neumonitis. Ambos evolucionaron favorablemente (AU)

Carcinoma cuniculatum localizado en el lecho subungueal / Carcinoma cuniculatum in nail bed

Se comunica un caso de Carcinoma Cuniculatum localizado en lecho subungular del pulgar derecho, en un hombre de sesenta años. Sustenta el calificativo de Cuniculatum el aspecto clínico e histopatológico con cavidades y trayectos múltiples, anastomosados, revestidos por epitelio plano estratificado cornificado, con alto grado de diferenciación. El tratamiento fue quirúrgico, con desarticulación metacarpofalángica. El motivo de este trabajo fue comunicar la existencia de esta variedad de Carcinoma Espinocelular, de por sí poco frecuente, en una localización inusual

Carcinoma cuniculatum localizado en el lecho subungueal / Carcinoma cuniculatum in nail bed

Se comunica un caso de Carcinoma Cuniculatum localizado en lecho subungular del pulgar derecho, en un hombre de sesenta años. Sustenta el calificativo de Cuniculatum el aspecto clínico e histopatológico con cavidades y trayectos múltiples, anastomosados, revestidos por epitelio plano estratificado cornificado, con alto grado de diferenciación. El tratamiento fue quirúrgico, con desarticulación metacarpofalángica. El motivo de este trabajo fue comunicar la existencia de esta variedad de Carcinoma Espinocelular, de por sí poco frecuente, en una localización inusual (AU)