Frequency of BRAF V600E immunoexpression in ameloblastomas: a multi-institutional analysis of 86 cases in Latin America and comprehensive review of the literature.

BACKGROUND: The initiation of odontogenic tumorigenesis often involves the activation of the MAP-kinase pathway, with a pivotal role played by the BRAF V600E mutation. This study aimed to investigate the frequency of BRAF V600E immunoexpresion in ameloblastomas diagnosed in four Latin American centers and correlate this finding with the histological types and subtypes of the analyzed cases. MATERIAL AND METHODS: A total of 86 samples of ameloblastomas were examined for immunohistochemistry using anti-BRAF V600E antibody. The histopathological features of each case were analyzed. RESULTS:  Positivity for anti-BRAF V600E antibody was detected in 65/86 cases (75.6%). BRAF V600E was positive in 38/56 cases (67.9%) of conventional ameloblastomas and in 27/30 cases (90.0%) of unicystic ameloblastomas. A statistically significant difference in BRAF V600E positivity was observed when comparing unicystic ameloblastomas to conventional ameloblastomas (p=0.03). No statistically significant difference in BRAF V600E positivity was observed when comparing histological variants, both for conventional ameloblastomas and unicystic ameloblastomas. CONCLUSIONS: This study highlights a high frequency of BRAF V600E immunoreactivity in ameloblastomas among Latin American cases. The prevalence of the BRAF V600E immunoexpresion may suggest the feasibility of utilizing BRAF-targeted therapy for ameloblastomas with this mutation.

Programa educativo virtual para mejorar la prescripción antibiótica en médicos rurales / Virtual educational program to improve the antibiotic prescription in rural physicians

OBJETIVO Evaluar un programa educativo virtual dirigido a médicos rurales de las provincias del Azuay, Cañar, Morona Santiago y Loja para mejorar conocimientos y la prescripción de antibióticos en faringitis, infección del tracto urinario, diarrea infecciosa y piodermias. METODOLOGÍA Estudio experimental aleatorizado doble ciego que contó con la participación de 102 médicos rurales de las provincias mencionadas durante el periodo febrero - octubre de 2011. Mediante plataforma virtual MOODLE se aplicó un curso sobre prescripción de antibióticos basado en las guías OPS, Sandford y del MSP a 53 médicos del grupo intervención y en otra plataforma un curso sobre "Análisis crítico de promoción farmacéutica" a 49 médicos del grupo control. Se evaluaron mediante aplicación de cuestionario antes y después los conocimientos adquiridos y la calidad de recetas antes y después del curso. RESULTADOS El curso virtual mejoró significativamente la media del puntaje de cuestionarios de 7,5/10 a 8,07/10, (p= 0,037) en el grupo intervención, así como el puntaje de las recetas en todos los diagnósticos. El riesgo relativo de la intervención sobre la presencia de mala prescripción fue de 0,53 (p= 0,0) y sobre la mala calificación en cuestionarios de 0,78 (p= 0,0). CONCLUSIONES El programa educativo virtual mejoró significativamente los conocimientos y la calidad de recetas en consulta externa para faringitis, infección del tracto urinario, diarrea infecciosa y piodermias.

OBJECTIVE To evaluate a virtual educational program for rural doctors in the provinces of Azuay, Cañar, Loja and Morona Santiago to improve knowledge and prescription of antibiotics in pharyngitis, urinary tract infection, infectious diarrhea and pyoderma. METHODOLOGY A random experimental double-blind study was made, in which 102 rural doctors from the provinces mentioned before attended during the period February-October 2011. Through the virtual platform MOODLE a course of antibiotics based on OPS, Sandford and from MSP was applied to 53 doctors in the intervention group, and on another platform, a course about "Critical analysis of pharmaceutical promotion" was applied to 49 physicians in the control group. They were evaluated with a questionnaire applied before and after the new knowledge acquired and the quality of prescriptions before and after the course. RESULTS The virtual course improved significantly, the average score of the questionnaire was 7.5 / 10 to 8.07 / 10 (p = 0.037) in the intervention group, as well as the score of the recipes in all diagnoses. The relative risk of the intervention on the presence of a bad prescription was 0.53 (p = 0.0) and about bad questionnaire's grade was 0.78 (p = 0.0). CONCLUSIONS The virtual education program improved significantly the knowledge and the quality of outpatient prescriptions for pharyngitis, urinary tract infection, infectious diarrhea and pyoderma

[Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation]. / Fiabilidad del navegador en la colocación de tornillos pediculares toracolumbares.

INTRODUCTION: Computer image guidance is one of the most significant technologic advancements in the spine surgery, because preoperative or intraoperative images can be used for multiplanar, three-dimensional intraoperative navigation. MATERIAL AND METHODS: We performed a prospective clinical study to assess the accuracy of pedicle screw insertion using an optoelectronic navigation system (SurgiGATE Spine 2.1 Medivision). The study population included 29 patients with diverse disorders of the thoraco- lumbar spine (degenerative 54%, spondylolisthesis 21%, fractures 14%, scoliosis 7% and spondylodiscitis 4%). One patient was excluded from the study because problems with the specific instruments or the computer system. Pre and post-operative axial computed tomography images were obtained for each patient and analyzed by two independent radiologists to placement accuracy. The correct location was defined accord to Heary scale in 5 grades. RESULTS: 163 image-guided thoraco-lumbar pedicle screws were placed 29 in the thoracolumbar spine and 134 in the lumbosacral spine. We achieved a completely intraosseous placement (Grade I) in 99.4% of lumbosacral spine screws and 100% of thoracolumbar spine screws. Only one misplaced screw (Grade III) in the pedicle of L III in the concavity of a scoliosis was reported. No implant related complications were noted. CONCLUSIONS: The low rate of misplaced screws in this prospective study compares favorably with previously published results. Our initial results indicate that Image-guided spinal surgery is a safe technique which improves surgical performance during posterior transpedicle stabilization.

Fiabilidad del navegador en la colocación de tornillos pediculares toracolumbares / Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation

Introducción. La cirugía guiada por imagen es uno de los más importantes avances tecnológicos dentro de la cirugía del Raquis ya que permite al cirujano realizar una navegación multiplanar tridimensional en tiempo real en el interior de una vértebra. Material y métodos. Realizamos un estudio clínico prospectivo no randomizado sobre la fiabilidad en la colocación de tornillos pediculares mediante un sistema de navegación optoelectrónico (SurgiGATE Spine 2.1 Medivision). Se estudiaron veintinueve pacientes intervenidos por diferentes patologías en columna toracolumbar incluyendo: degenerativas (54%), espondilolistesis(21%), fracturas (14%), escoliosis (7%) y espondilodiscitis(4%). Un paciente fue eliminado del estudiodebido a un fallo técnico en el equipo de navegación.Se obtuvieron imágenes de TC pre y postoperatorias de cada paciente y éstas fueron evaluadas por dos neurorradiólogos independientes. La colocación correcta se definió de acuerdo a la escala de Heary en 5 grados.Resultados. Se colocaron 163 tornillos, 29 en la columnatoracolumbar y 134 en la columna lumbosacra.Hemos conseguido una colocación totalmente intraósea(Grado I) en el 99,4% de tornillos en la columnalumbosacra y en un 100% en la columna toracolumbar. Se comprobó el error de colocación (Grado III) en un pedículo de L3 en la concavidad de una escoliosis.No se observaron complicaciones relacionadas con los implantes.Conclusiones. El bajo porcentaje de tornillos mal colocados en este estudio se compara favorablemente con los resultados publicados en la literatura. Nuestros resultados indican que la cirugía guiada por imagen aplicada a la cirugía del raquis es una técnica segura para la fijación transpedicular (AU)

Introduction. Computer image guidance is one of the most significant technologic advancements in the spinesurgery, because preoperative or intraoperative images can be used for multiplanar, three-dimensional intraoperative navigation. Material and methods. We performed a prospective clinical study to assess the accuracy of pedicle screw insertion using an optoelectronic navigation system (SurgiGATE Spine 2.1 Medivision). The study population included 29 patients with diverse disorders of the thoracolumbar spine (degenerative 54%, spondylolisthesis 21%, fractures 14%, scoliosis 7% and spondylodiscitis 4%). One patient was excluded from the study because problems with the specific instruments or the computer system. Pre and post-operative axial computed tomography images were obtained for each patient and analyzed by two independent radiologists to place mentaccuracy. The correct location was defined accord to Heary scale in 5 grades. Results. 163 image-guided thoraco-lumbar pedicle screws were placed 29 in the thoracolumbar spine and 134 in the lumbosacral spine. We achieved a completely intraosseous placement (Grade I) in 99.4% of lumbosacral spine screws and 100% of thoracolumbar spinescrews. Only one misplaced screw (Grade III) in the pedicle of L III in the concavity of a scoliosis was reported. No implant related complications were noted. Conclusions. The low rate of misplaced screws in this prospective study compares favorably with previously published results. Our initial results indicate that Image-guided spinal surgery is a safe technique which improves surgical performance during posterior transpedicle stabilization (AU)

Percepción de usuarios del programa de recuperación del niño en riesgo nutricional nutrir más del área urbana de la ciudad de Santa Fe, Argentina / Users' perception of the recovery program of the child in nutritional risk

The present study corresponds to a quali-quantitative research, which inquired into user's perception of the Recovery Program of the Child in Nutritional Risk Nutrir Más, in Santa Fe city urban area in the last trimester of 2007. Specifically, it aimed at identifying the perceptions related to the program's components: training workshops, health controls and alimentary assistance through tickets; program's positive and negative aspects; usefulness of knowledge gained in the upbringing daily tasks; and the relationship between beneficiaries and program's leaders in the workplace and the health staff. About 50 percent of the beneficiaries who had been in the program for more than a year, participated in a survey through a semi-structured interview. In general, the users reported a high level of satisfaction towards the activities proposed by the program and highlighted its importance for educational actions, the improvement of their knowledge and alimentary practices towards their underweight children, the diversification of daily feeding and the reinforcement of the emotional bond between mother and child. This research recognizes the importance of perception studies because they allow to improve the program's management and to be aware of the user's satisfaction, as well.

El presente estudio corresponde a una investigación cuali-cuantitativa que indagó la percepción de los usuarios del Programa de Recuperación del Niño en Riesgo Nutricional "NUTRIR MAS" del área urbana de la ciudad de Santa Fe en el último trimestre del 2007. Se buscó identificar las percepciones vinculadas a los componentes del programa: actividades educativas, controles de salud y prestación alimentaria a través de tickets; con el propósito de identificar aspectos positivos y negativos del mismo, la utilidad de los conocimientos impartidos y la relación entre los usuarios y los referentes del programa en terreno y el equipo de salud. Se realizó una encuesta semiestructurada al 50 por ciento de los usuarios de la ciudad de Santa Fe que tenían una permanencia en el programa mayor a un año. El 99 por ciento de los encuestados reportó un alto nivel de satisfacción hacia las actividades propuestas por el programa y destacaron su valor por las acciones educativas, el mejoramiento de sus conocimientos y prácticas alimentarias, la diversificación de la alimentación cotidiana y el fortalecimiento del vínculo madre-hijo. Esta investigación reconoce la importancia de los estudios de percepción porque permite mejorar la gestión del programa adaptando las estrategias de intervención a la población destinataria.

Absceso piógeno hepático. Presentación de tres casos / Pyogenic hepatic abscess. A report of 3 cases

El absceso piógeno hepático es infrecuente en niños, y muestra síntomas y signos inespecíficos. El desarrollo de las técnicas de imagen ha revolucionado su diagnóstico y tratamiento. El presente trabajo describe 3 casos diagnosticados en un período de 6 meses, tratados con antibioterapia y drenaje percutáneo mediante aguja con control ultrasonográfico. Los tres pacientes tenían antecedentes de piodermitis, y S. aureus fue el agente etiológico. Uno de los pacientes falleció por diagnóstico tardío de la enfermedad y el resto evolucionó favorablemente, con resolución del absceso en un período de 3-4 semanas.Se pone énfasis en la necesidad de un diagnóstico y tratamiento precoces por la gravedad de esta enfermedad (AU)

The influence of pre-anaesthetic administration of buprenorphine on the anaesthetic effects of ketamine/medetomidine and pentobarbitone in rats and the consequences of repeated anaesthesia.

Rats received pentobarbitone (60, 48 and 36 mg/kg i.p.) or ketamine/medetomidine (75/100, 60/80 and 45/60 mg/microg/kg i.p.) alone, or one hour following buprenorphine (0.5 mg/kg s.c.). Animals were anaesthetized once per week for 6 weeks with one of three anaesthetic doses according to a randomized block design. In the pentobarbitone group, animals which received buprenorphine had longer sleep times (236 +/- 22 cf. 204 +/- 21 min) and longer durations of surgical anaesthesia (83 +/- 14 cf. 27 +/- 8 min) (P<0.01), these effects being potentiated with increasing anaesthetic doses (P<0.01). A greater degree of respiratory depression was found in animals that received buprenorphine (P<0.01) although this was judged clinically acceptable in all cases. Unexpectedly high mortality and a high incidence of anaesthetic complications (nine of 16 animals) in the ketamine/medetomidine group made statistical analysis of these data impossible. We conclude that for pentobarbitone, pre-anaesthetic administration of buprenorphine reduces the dose of anaesthetic required to produce surgical anaesthesia, in addition to the presumed benefits of pre-emptive analgesia. In view of the high mortality encountered, we advise caution when considering pre-anaesthetic use of opioids in combination with ketamine/medetomidine in rats.

Increased uptake and accumulation of vitamin C in human immunodeficiency virus 1-infected hematopoietic cell lines.

Vitamin C (ascorbic acid) is required for normal host defense and functions importantly in cellular redox systems. To define the interrelationship between human immunodeficiency virus (HIV) infection and vitamin C flux at the cellular level, we analyzed vitamin C uptake and its effects on virus production and cellular proliferation in HIV-infected and uninfected human lymphoid, myeloid, and mononuclear phagocyte cell lines. Chronic or acute infection of these cell lines by HIV-1 led to increased expression of glucose transporter 1, associated with increased transport and accumulation of vitamin C. Infected cells also showed increased transport of glucose analogs. Exposure to vitamin C had a complex effect on cell proliferation and viral production. Low concentrations of vitamin C increased or decreased cell proliferation depending on the cell line and either had no effect or caused increased viral production. Exposure to high concentrations of vitamin C preferentially decreased the proliferation and survival of the HIV-infected cells and caused decreased viral production. These findings indicate that HIV infection in lymphocytic, monocytic, and myeloid cell lines leads to increased expression of glucose transporter 1 and consequent increased cellular vitamin C uptake. High concentrations of vitamin C were preferentially toxic to HIV-infected host defense cell lines in vitro.