Attitudes scale toward cancer-related cognitive changes - an initial Colombian validation.

OBJECTIVE: The aim of this study was to develop an initial valid tool to measure attitudes toward cancer-related cognitive changes. SUBJECTS AND METHODS: After revising the literature, three main dimensions were hypothesized. Eight judges were contacted to obtain content validity evidence. A robust Exploratory Factor Analysis (EFA) was performed via a parallel analysis with an Unweighted Least Squares (ULS) estimator and polychoric correlations. The results were crossed with sociodemographic variables to find possible statistical differences and estimate the size effect. Analysis was performed in the software Factor and the statistical package R. RESULTS: A sample of 374 participants was obtained, involving oncology patients, their caregivers, and people from the general community. A statistical fit was found in two dimensions: Awareness and Judgments [root mean squared error of approximation (RMSEA) = 0.042, standardized root mean square residual (SRMR) = 0.02, comparative fit index (CFI) = 0.99, Tucker-Lewis index (TLI) = 0.98] with a moderate correlation between them (r = 0.612). Optimal reliability indices were obtained for the total scale and its dimensions. No real statistical difference was found between sociodemographic variables; the interpretation norms were established via the quartiles. CONCLUSIONS: The first attempt to measure the construct of interest was developed with two primary validity evidence based on the content and its internal structure. This instrument could help strengthen the prevention of cancer-related cognitive changes. More research is needed to adhere more valid evidence to the scale.

Implementing a Rapid Response System in a tertiary-care hospital. A cost-effectiveness study.

PURPOSE: The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital. METHODS: We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon. RESULTS: 42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year. CONCLUSIONS: The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.

Disfunción urinaria en la enfermedad de Parkinson: una revisión práctica / Urinary dysfunction in Parkinson's disease: a practical review

Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.

Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.

Anti-glycative and anti-inflammatory effects of macamides isolated from Tropaeolum tuberosum in skin cells.

Tropaeolum tuberosum, commonly known as Mashua, is an herbal remedy used on the skin in order to treat local pain and to heal wounds. This study aimed to evaluate the extracts and isolated compounds from T. tuberosum with anti-glycative and anti-inflammatory activities. Guided isolation by bioassay led to the isolation and characterisation by NMR and MS of (S)-(-)-N-(α-methylbenzyl)-oleamide (1) and (S)-(-)-N-(α-methylbenzyl)-linoleamide (2). Both compounds inhibited the production of TNF-α with IC50 values of 9.38 µM (NIH/3T3 cells) and 10.06 µM (PA317 cells) for compound 1, and 5.3 µM (NIH/3T3 cells) and 6.48 µM (PA317 cells) for compound 2. Compounds 1 and 2 showed the inhibitory effect on the BSA-MGO formation at concentrations of 9.38 µM (3.39%) and 5.30 µM (8.53%), respectively. Moreover, both compounds showed significant breaking properties on the MGO-AGE-protein crosslink with percent modification of 6.58% (9.38 µM) and 18.08% (5.30 µM), respectively.

Systemic oxytocin increases glutamate efflux in the nucleus accumbens core of cocaine-experienced male and female rats but only increases dopamine efflux in males.

Oxytocin attenuates cocaine-seeking when administered both systemically and directly into the nucleus accumbens core. This effect is blocked by intra-accumbens antagonism of mGlu2/3 and, together with our finding that intra-accumbens oxytocin increases glutamate concentrations in this brain region, indicates that pre-synaptic regulation of glutamate release by oxytocin influences cocaine relapse. However, mGlu2/3 receptors also regulate dopamine release in the nucleus accumbens. Here we aimed to determine whether systemic oxytocin increases glutamate and dopamine concentrations in the nucleus accumbens core of cocaine-experienced and cocaine-naïve male and female rats. A subset of rats self-administered cocaine (0.5 mg/kg/infusion) and then underwent extinction training for 2-3 weeks. Rats were implanted with microdialysis probes in the accumbens core and samples were collected for a baseline period, and following saline (1 mL/kg), and oxytocin (1 mg/kg, IP) injections. Locomotion was assessed during microdialysis. In cocaine-experienced rats, oxytocin increased glutamate concentrations in the accumbens core to the same extent in males and females but only increased dopamine concentrations in male rats. Oxytocin did not alter glutamate levels in cocaine-naïve rats. Oxytocin did not produce sedation. These results extend previous findings that systemic oxytocin increases nucleus accumbens dopamine in a sex-specific manner in cocaine-experienced rats. These data are the first to find that systemic oxytocin increases nucleus accumbens glutamate after cocaine experience, providing a mechanism of action by which oxytocin attenuates the reinstatement of cocaine seeking in both male and female rats.

Seroepidemiological evidence for Taenia solium taeniasis/cysticercosis in three Venezuelan rural communities.

Taenia solium is the most common parasite infection of the brain, causing neurocysticercosis and typically found in rural communities with free-ranging pigs. Identification of transmission in rural areas is essential for its control. Risk factors and transmission of the parasite were evaluated in three rural Venezuelan communities (Valle del Rio and Potrero Largo, Cojedes state; and Palmarito, Portuguesa state) by a questionnaire (112 households) and coprological (492 samples) and serological (433 human and 230 porcine sera) analysis, respectively. Typical risk factors were found in all three communities: free-foraging pig husbandry, deficient sanitary conditions, high open defecation and ignorance of the parasite life cycle. Coprological examinations revealed a high level of soil-transmitted parasites. Importantly, two T. solium adult worm carriers were identified in each of the three communities. Anti-metacestode antibodies and the HP10 secreted metacestode glycoprotein were detected at significant levels in human and porcine sera in Valle del Rio, Potrero Largo and Palmarito. In conclusion, these communities may be considered to be endemic for taeniasis/cysticercosis, and the instigation of an appropriate control programme is recommended.

Low dose intrathecal morphine for hip arthroplasty / Dosis baja de morfina intratecal para artroplastía cadera

OBJECTIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.4514.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.

OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastía de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastía de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar, pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo. p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC 95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI 95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI 95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI 95% 1,61-7.82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastía cadera, proporciona analgesia postoperatoria comparable a 100 mcg, pero con menor incidencia de efectos adversos relacionados a opioides.

Low dose intrathecal morphine for hip arthroplasty / Dosis baja de morfina intratecal para artroplastía de cadera

OBJETIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case-control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.45-14.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI 95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.

OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastia de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastia de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo, p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI95% 1,61-7,82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastia cadera, proporciona analgesia postoperatoria comparable a 100 mcg pero con menor incidencia de efectos adversos relacionados a opioides.

Tungiasis: reporte de un caso clínico con evolución inesperada. fenómeno isotópico / Tungiasis with unexpected development.isotopic phenomenoncase report

RESUMEN Latungiasisesuna ectoparasitosistransitoria en el ser humano, que se produce a causa de la penetración en la piel de la hembra grávida de la "pulga de arena", Tunga penetrans. También es conocida como "nigua", "bichodopé", "sandflea",entre otras denominaciones. Es una enfermedad endémica en áreas rurales y playas de Centro y Sudamérica, Caribe y África Subsahariana. En Argentina se la encuentra en zonas del Noreste y Mesopotamia. Debido al incremento de los destinos vacacionales a dichas regiones tropicales, comenzaron a observarse casos de tungiasis fuera de las áreas endémicas (casos importados). Comunicamos el caso de una niña argentina, que vacacionó en las playas caribeñas y adquirió la infestación por Tunga penetrans, la cual evolucionó de manera llamativa, manifestando un fenómeno isotópico.

SUMMARY Tungiasis is a transitory ectoparasitosis caused by penetration into the skin of the female flea Tungapenetrans, also known as "nigua", "bichodo pé", or "sand flea". It's an endemic disease that can be found at rural zones, Caribbean beaches and Sub-Saharan Africa. In Argentina, it's distributed in the northeastand Mesopotamia. Because of the increasement of holiday destinations, in these tropical regions, cases of tungiasis were reported outside the endemic areas. People who went to those zones, carried the disease to their birthplaces (imported Infestations). We report the case of a little Argentinian girl who went to a Caribbean beach and acquired the infestation by tungapenetrans, which made its develop in a striking way; showing an isotopic phenomenon.

Mapeo del proceso clínico de pacientes con ideación suicida activa que consultan en el centro de salud familiar "San Alberto Hurtado" en Chile / Mapping of the clinical process of patients with active suicidal ideation who consult at the primary health care facility "San Alberto Hurtado" in Chile

Introducción: el suicidio es un fenómeno complejo y prevalente. En Chile, los centros de atención primaria pesquisan pacientes consideación suicida activa y los derivan a centros terciarios, pero el proceso es complejo y poco fluido. El objetivo de este trabajo fue mapear el proceso clínico que siguen los pacientes con ideación suicida activa derivados desde el centro de salud familiar Áncora San Alberto Hurtado en Santiago, Chile. Métodos: se realizaron reuniones con los principales protagonistas y se recolectaron protocolos de manejo. Se graficaron los procesos clínicos según la edad del paciente, identificando nudos, brechas y quiebres. Resultados: los pacientes menores de 15 años son derivados al servicio de urgencia pediátrica en el Complejo Asistencial Dr. Sótero del Río, donde son evaluados por un psiquiatra infanto-juvenil, quien determina si son dados de alta para continuar seguimiento en el nivel secundario o son hospitalizados. Los pacientes mayores de 15 años son referidos al servicio de urgencia psiquiátrica del Complejo Asistencial Barros Luco Trudeau para ser evaluados por un psiquiatra, quien evalúa si requieren seguimiento a nivel secundario u hospitalización. En este último caso, son derivados nuevamente al Hospital Sótero del Río. Se identificaron nudos, brechas y quiebres que dificultan la atención y seguimiento de los pacientes. Conclusión: existen condiciones que afectan el proceso clínico de pacientes con ideación suicida activa derivados desde un centro de atención primaria, y es fundamental reparar las dificultades identificadas para ofrecer a la población una atención en salud mental eficiente.(AU)

Introduction: suicide is a complex and prevalent phenomenon. In Chile, primary health care centers detect most cases of patients with active suicidal ideation and refer them to hospitals, however, this process is complex and not very fluid. The objective was to map the clinical process of patients with active suicidal ideation referred from a primary care center in Santiago, Chile. Methods: we held multiple meetings with the principal persons in charge, and collected management protocols. We mapped the clinical process according to patient age, identifying knots, breaches, and breaks. Results: Patients 14 years or younger attend the pediatric emergency service in Dr. Sótero del Río Welfare Complex, where they receive an assessment by a child and adolescent psychiatrist who determines whether they are hospitalized or discharged to continue to follow up at the secondary level. Patients 15 years or older attend the psychiatric emergencyservice in Hospital Barros Luco Trudeau, where they undergo a psychiatric evaluation which determines whether they are hospitalized or require to follow up at the outpatient setting. If, however, the patient needs to be hospitalized, he/she must return to Hospital Sóterodel Río. Multiple knots, breaches, and breaks were identified, that make health care and follow up of these patients difficult. Conclusion:multiple determinants affect the clinical process of patients with active suicidal ideation referred from a primary health care center. The difficulties identified must be repaired in order to offer the population efficient mental health care.(AU)

Enfermedad por IgG4 multisistémica: a propósito de un caso: revisión de la literatura / Multisystemic IgG4 disease: a case report: literature review

We report a 63-year-old male patient who consulted for a 4-month history of xerophthalmia, xerostomia and cervicalgia, associated with jaundice, choluria, low weight and night sweats. Exams show an obstructive pattern and abdominal ultrasound describes a possible mass in the pancreatic head with secondary dilation of the bile duct. Colangio-MRI (magnetic resonance imaging) confirms a focal pancreatic head lesion that determines intrapancreatic bile duct stenosis, proximal dilation of the bile duct and stenosis of the main pancreatic duct. Pancreatic neoplasia versus autoimmune pancreatitis (PAI) is proposed, complementing a study with a count of IgG subclasses where IgG4 stands out at 1050 mg/dl (normal range: 3.9-86) and computed tomography (CT) of the thorax, abdomen and pelvis, that in addition to the biliary-pancreatic alterations, shows thickening of the vesicular wall, multiple bilateral lesions in the renal parenchyma and peri-aortic soft tissue. Salivary gland biopsy reports lymphoplasmacytic infiltrate characteristic of IgG4 disease. A disease related to IgG4 (ER-IgG4) is diagnosed with pancreatic, renal, biliary, vascular, lymphatic, salivary and lacrimal glands involvement. It is treated with corticoidal therapy, evolving favorably with resolution of the symptomatology and regression of imaging alterations.

Se reporta caso de paciente de sexo masculino de 63 años que consulta por cuadro de 4 meses de xeroftalmia, xerostomía y cervicalgia, asociado a ictericia, coluria, baja de peso y sudoración nocturna. En exámenes destaca pruebas hepáticas con un patrón obstructivo y ecografía abdominal que muestra una posible masa en la cabeza pancreática con dilatación secundaria de la vía biliar. Colangio-resonancia (resonancia magnética-RM) confirma una lesión focal en la cabeza pancreática que determina estenosis del colédoco intrapancreático, dilatación proximal de la vía biliar y estenosis del conducto pancreático principal. Se plantea neoplasia de páncreas versus pancreatitis autoinmune (PAI), complementando estudio con recuento de subclases de IgG donde destaca IgG4 de 1.050 mg/dl (rango normal: 3,9-86) y tomografía computada (TC) de tórax, abdomen y pelvis, que además de las alteraciones bilio-pancreáticas, demuestra engrosamiento de la pared vesicular, lesiones múltiples bilaterales en el parénquima renal y tejido de partes blandas peri-aórtico. Biopsia de las glándulas salivales informa sialoadenitis crónica e inespecífica. Se diagnostica una enfermedad relacionada a IgG4 (ER-IgG4) con compromiso pancreático, renal, biliar, vascular, linfático, de glándulas salivales y lagrimales. Se trata con terapia corticoidal, evolucionando favorablemente con resolución de la sintomatología y regresión de las alteraciones imagenológicas.

Tiroides ectópica dual hiperfuncionante: abordaje quirúrgico dual / Dual hyperfunctioning thyroid ectopia: dual surgical approach

RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.

ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.

Utilidad diagnóstica de la ecografía tiroidea en la evaluación de nódulos tiroideos en niños y adolescentes / Diagnostic utility of thyroid ultrasound ecografy in thyroid nodules evaluation in children and adolescents

AIM: To evaluate the diagnostic utility of ultrasonography and other antecedents and exams usually availables, in the study of patients with thyroid nodules aged 0-20 years. SUBJECTS AND METHODOLOGY: Cross-sectional analytical observational study. We reviewed the data of patients undergoing FNAP (thyroid puncture with a fine needle) and / or thyroidectomy between January 2007 and December 2013. The ultrasound evaluation was performed by 3 specialists. The surgical biopsy was considered an indicator of benignity or malignancy and, in its absence the FNAP (excluding the Bethesda diagnoses 3 and 4). The association between cancer and the different variables was evaluated through binary logistic regression, with measure of association of odds ratio (OR). With the initially significant variables, a multivariate analysis was carried out and a cut-off score was subsequently defined to allow the diagnosis to be discriminated. RESULTS: 104 nodules are included in the analysis (100 patients), 89♀ / 11♂; age x16 ± 2.8; TSH 2.8 uIU / ml ± 5; lymphocytic thyroiditis 30%; pathological anatomy: benign 46 (44%) cancer 58 (56%). Sonographic findings predictive of malignancy were: hypoechogenicity (OR 2.95 p = 0.008) irregular shape (100% CA) non-smooth edges (OR 8.5 p = 0.000) microcalcifications (OR 39 p = 0.000) thick calcifications (OR 18 p = 0.001) and presence of suspicious adenopathy (100% CA). In the TIRADS classification, cases classified as 4 and 5 corresponded to cancer in 50 and 92%. The presence of thyroiditis did not show an insignificant association with malignancy. From the joint analysis of the significant variables, a score with adequate sensitivity and specificity is obtained. CONCLUSIONS: The usefulness of ultrasound as a fundamental examination in the evaluation of the pediatric patient who consults by thyroid nodule is corroborated. Accurately describing their sonographic characteristics and, above all, analyzing them together, allows us to determine an approximate risk of malignancy and define with greater certainty the indication of performing FNAP

La mentira, una reivindicación moral. De cómo la mentira es útil en un paciente en etapa terminal / The lie, a moral claim. How lying is useful in a terminally ill patient

Resumen: La mentira es considerada un antivalor moral, siempre tiene una connotación negativa. Sin embargo, su uso está muy extendido desde el punto de vista biológico como mecanismo de supervivencia y en el ser humano incluso desde el punto de vista de integración social. El autoengaño, considerado una manifestación suprema del uso humano de la mentira, tiene estrecha relación con la generación de optimismo y esperanza, las personas con problemas para integrar un autoengaño tienen con más frecuencia alteraciones patológicas en el estado de ánimo, sobre todo depresión. Este artículo analiza desde algunos puntos de vista ético-filosóficos las ventajas y desventajas del uso de la mentira para promover el autoengaño en pacientes con enfermedad terminal.

Abstract: The lie is considered a moral flaw, always has a negative connotation. Nevertheless its use is very extended from the biological point of view as mechanism of survival and in the human being, even from the point of view of social integration. Self-deception, considered a supreme manifestation of the human use of lies, is closely related to the generation of optimism and hope, people with problems to integrate self-deception have more frequently pathological alterations in mood, especially depression. The advantages and disadvantages of the use of lying to promote self-deception in patients with terminal illness are analyzed from some ethical-philosophical points of view.

RedeAmericas: building research capacity in young leaders for sustainable growth in community mental health services in Latin America.

The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional 'Hubs' funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities - Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina - working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future capacity-building efforts, and also comment on future prospects for maintaining this type of effort.

Low cost digester monitoring under realistic conditions: Rural use of biogas and digestate quality.

The purpose of this work was to assess the behaviour of anaerobic digestion of cattle manure in a rural digester under realistic conditions, and estimate the quality and properties of the digestate. The data obtained during monitoring indicated that the digester operation was stable without risk of inhibition. It produced an average of 0.85Nm3biogas/d at 65.6% methane, providing an energy savings of 76%. In addition, the digestate contained high nutrient concentrations, which is an important feature of fertilizers. However, this method requires post-treatment due to the presence of pathogens.

Migración de endoprótesis biliar como causa de dolor abdominal / Biliary stent migration as a cause of abdominal pain

Las endoprotesis de vía biliar son dispositivos utilizados para aumentar el calibre de las vías biliares, y son implementadas en el alivio sintomático de neoplasias de la vía biliar; sin embargo en el último tiempo se ha diversificado su uso en el manejo de los casos de coledocolitiasis que no se resuelven con los métodos convencionales. Sus complicaciones más comunes son la colangitis y la obstrucción de la endoprótesis; las menos frecuentes son la pancreatitis, hemorragia digestiva, perforación intestinal y migración de la endoprótesis. Se presenta el caso de una paciente con dolor abdominal secundario a la migración distal de la endoprótesis biliar. Caso clínico: Mujer de 93 años, colecistectomizada, con antecedentes de colocación de endoprotesis biliar. Consulta por dolor abdominal, sin signos de irritación peritoneal. Exámenes de laboratorio con parámetros inflamatorios elevados. Tomografía computada (TC) de abdomen y pelvis muestra neumobilia y presencia de cuerpo extraño tubular enclavado en divertículo sigmoideo. Se interpretan los hallazgos como migración distal de endoprótesis biliar, con enclavamiento en divertículo sigmoideo. Se hospitaliza para extracción de endoprótesis mediante colonoscopía la cual fue realizada con éxito. Luego es dada de alta indicándose manejo con ácido ursodeoxicólico y control en policlínico para control de litiasis de la vía biliar. Conclusión: La migración de endoprótesis biliar es una complicación poco frecuente del uso de estos dispositivos, que puede debutar con dolor abdominal. Su diagnóstico se basa en los antecedentes de colocación de la endoprótesis, la forma de presentación clínica y los hallazgos radiológicos encontrados.

Bile duct stents are devices used to increase the caliber of the bile ducts and are used in the symptomatic relief of biliary tract neoplasias; However, lately their use has been extended into the management of choledocholithiasis cases not amenable to conventional treatment. The most common complications are cholangitis and stent obstruction, and the least common are pancreatitis, gastrointestinal bleeding, intestinal perforation, and stent migration. We present the case of a patient with abdominal pain secondary to the distal migration of a biliary stent. Case report: 93 year old female, cholecystectomy, with a history of biliary stent, admitted for abdominal pain with no signs of peritoneal irritation. Laboratory tests showed elevated inflammatory parameters. Abdomen and pelvis CT-scan showed pneumobilia and presence of a tubular foreign body embedded in the sigmoid diverticulum. These findings were interpreted as distal migration of a biliary stent which embedded in the sigmoid diverticulum. She was hospitalized for stent extraction by colonoscopy, which was performed successfully. She was then discharged, prescribed ursodeoxycholic acid and sent to follow-up in the outpatients´ clinic in order to monitor biliary tract lithiasis. Conclusion: Biliary endoprosthesis migration is a rare complication of the use of these devices, and may present as abdominal pain. Its diagnosis is based on the history of stent placement, clinical presentation and radiological findings.

Encapsulación de probióticos para aplicaciones alimenticias / Encapsulation of probiotics for food applications

Los alimentos funcionales contienen componentes activos que con un consumo habitual favorecen la salud de consumidor. Dentro del concepto de funcional se encuentran los alimentos con microorganismos probióticos, los cuales al ser ingeridos en dosis adecuadas confieren diversos beneficios, estos microorganismos son sensibles a factores tecnológicos y ambientales que pueden reducir su viabilidad, estabilidad y su capacidad funcional. Existen tecnologías como la encapsulación, las cuales permiten mejorar la estabilidad de los probióticos al protegerlos mediante un material de recubrimiento. En este trabajo se realizó una búsqueda sistemática en diversas bases de datos sobre los probióticos más empleados en la industria de alimentos, su capacidad catalítica en matrices alimenticias, métodos de encapsulación, tipos de matrices en la encapsulación, estabilidad bajo condiciones gastrointestinales y los mecanismos de liberación. Se encontró que la encapsulación, además de favorecer la estabilidad de los microorganismos probióticos frente a factores adversos, condiciona según sus características, su aplicación e incorporación en matrices alimenticias de diversas cualidades.

Functional foods contain active components, which under their regular use favor consumers' health. Within the functional concept food with probiotics are found, which when ingested in adequate doses confer various benefits. These microorganisms are sensitive to technological and environmental factors that can reduce their viability, stability, and functional capacity. There are some technologies such as encapsulation, which allow improving the stability of probiotics by protecting them with a coating material. This a systematic search in several databases on the most widely used probiotics in the food industry, their catalytic capacity in food matrices, encapsulation methods, types of matrices in encapsulation, stability in gastrointestinal conditions and release mechanisms. It was found that encapsulation, besides favoring the stability of probiotic microorganisms against adverse factors, conditions, according to their characteristics, their application and incorporation in food matrices of different qualities.

Síndrome de Hallermann-Streiff y embarazo: manejo de la vía aérea difícil en embarazadas / Hallermann-Streiff syndrome and pregnancy: management of difficult airway in pregnant women

El síndrome de Hallermann-Streiff es una rara entidad asociada a hipoplasia del tercio inferior de la cara, determinando así una vía aérea de difícil manejo. Se presenta el caso de una mujer de 21 años con ese síndrome, acondroplasia, escoliosis severa e infección respiratoria los días previos a la interrupción exitosa de su embarazo mediante cesárea. El manejo requirió una cuidadosa evaluación preoperatoria y disponibilidad inmediata de dispositivos alternativos para el manejo de la vía aérea en caso necesario. La gravidez, así como ciertas comorbilidades asociadas, aumentan la posibilidad de una intubación fallida con morbi-mortalidad secundaria importante, dado ello, es necesaria la preparación e implementación de algoritmos atingentes para el manejo de la vía aérea en casos como el presentado.

The Hallermann-Streiff syndrome is a rare entity associated to hypoplasia of the lower third of the face, determining a difficult airway management. We report the case of a 21 years female with this syndrome, achondroplasia, severe scoliosis and respiratory infection at the days prior to the interruption of her preg-nancy by cesarean section. Her management required a carefully preoperative evaluation and availability of alternative devices to secure her airway. Pregnancy and certain comorbidities increase the chance of a failed intubation with severe secondary morbidity and mortality, given this, the correct preparation and implementation of difficult airway algorithms in pregnancy if it’s necessary.

[Prevalence of HPV high-risk serotypes detected by PCR in patients with normal cervical cytology at the Hospital Regional Adolfo López Mateos, ISSSTE]. / Prevalencia de genotipos de alto riesgo de VPH detectados por PCR en pacientes con citología normal del Hospital Regional Adolfo López Mateos, ISSSTE.

Background: Is fundamental to determine the prevalence of human papiloma virus (HVP) high-risk serotypes in local and regional population in order for health providers to offer patients, vaccines and treatments against specific population-based serotypes. Objetive: To determine the prevalence of HPV High risk serotypes detected by PCR in patients with normal cytology from the ISSSTE Adolfo Lopez Mateos Regional Hospital. Methods: An observational, descriptive, prospective study was conducted from cervical cytologies and high risk HPV test by PCR in patients from the Regional Hospital Adolfo López Mateos, ISSSTE, during the period January 2013-December 2015. Cases of patients with negative cervical cytology were included. Information about age, the result of cervical cytology and high risk HPV test by PCR was obtained. The overall prevalence of HPV infection and the most prevalent serotypes by age groups were calculated. Results: A total of 3258 cervical smears were performed, of which 2557 were negative (78.4%), from this, the global prevalence of HPV infection was 10.2% (n=262). We found that 1.8% (n = 45) of negative reports had HPV16 infection, 0.5% (n=13) had HPV18 and 8.9% (n = 227) were infected by Viral Pool of other high-risk serotypes. The prevalence of infection by viral pool of high risk serotypes was 11.5% in women <20 years, 12.9% in women between 20-29 years and 22.2% in women between 30-39 years. This prevalence was lower in patients older than 40 years (p<0.05). Conclusion: A higher prevalence of viral pool high risk serotypes was found in patients with normal cytology, than the HPV16 and HPV-8 prevalence, which was significantly higher in women younger than 40 years.