Influencia de la incorporación de la tomosíntesis en un centro de diagnóstico mamario / The impact of integrating breast tomosynthesis in a Breast Diagnostic Center / Influência da incorporação da tomossíntese em um centro diagnóstico de mama

Resumen: Introducción: se han producido múltiples avances tecnológicos en la historia de la mamografía. En los años más recientes surge la mamografía digital directa con tomosíntesis con mayores capacidades para detectar el cáncer. Objetivo: evaluar el efecto de la nueva tecnología en el desempeño de la mamografía, en la Unidad de Diagnóstico Mamario del Hospital Británico. Material y métodos: se compara el desempeño de la mamografía durante los años 2019-2020 en relación con los años 2010-2018. En el año 2019 se sustituyó la tecnología anterior por un mamógrafo digital directo con tomosíntesis, Hologic modelo Selenia Dimensions. Resultados: en los años 2019 a 2020 se realizaron 10.725 mamografías. Se detectaron 84 cánceres y la tasa de detección de cáncer fue de 8/1.000. El VPP fue de 35%. En los años 2010 a 2018 se realizaron 45.438 mamografías. Se detectaron 229 cánceres y la tasa de detección de cáncer fue de 5/1.000. EL VPP fue de 40%. En relación a las manifestaciones imagenológicas, se destaca el aumento de las microcalcificaciones en el período 2019-2020, que pasaron de ser 7% de los casos, a ser 19% de los casos. Las distorsiones aumentaron de 11% a 13%. En relación a los tipos histológicos de cáncer, se destaca el porcentaje del carcinoma ductal in situ (CDIS) que fue 4 veces superior en el período 2019-2020 en relación al anterior (17% de todos los casos detectados). Conclusiones: con la incorporación de la tomosíntesis aumentó 60% la tasa de detección de cáncer y el porcentaje de CDIS aumentó 4 veces.

Abstract: Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening. Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital. Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018. In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model. Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%. DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases). Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.

Resumo: Introdução: a história da mamografia registra vários avanços tecnológicos. Nos anos mais recentes, a mamografia digital direta com tomossíntese surgiu com uma maior capacidade de detectar a presença de câncer. Em 2019 a Unidade de Diagnóstico de Mama (UDM) do Hospital Britânico no Uruguai, incorporou um mamógrafo digital direto com tomossíntese, Hologic modelo Selenia Dimensions. Objetivo: avaliar desempenho do mamógrafo digital direto com tomossíntese na UDM. Material e métodos: faz-se uma comparação dos resultados das mamografias durante dois períodos 2019-2020 e 2010-2018. Resultados: no período 2019 a 2020 foram realizadas 10.725 mamografias; 84 cânceres foram detectados com una taxa de detecção de 8/1000. O valor preditivo positivo (VPP) foi de 35%. No período 2010-2018, foram realizadas 45.438 mamografias, 229 cânceres foram detectados com una taxa de detecção de 5/1000. O VPP foi de 40%. Em relação às manifestações de imagem, destaca-se o aumento das microcalcificações no período 2019-2020, que passou de 7% para 19% dos casos. As distorções aumentaram de 11% para 13%. Em relação aos tipos histológicos de câncer, destaca-se a porcentagem de carcinoma ductal in situ (CDIS), que foi quatro vezes maior no período 2019-2020 do que no anterior (17% do total de casos detectados). Conclusões: com a incorporação da tomossíntese, a taxa de detecção de câncer aumentou 60% e a porcentagem de CDIS aumentou quatro vezes.

[Study of confirmed cases of human brucellosis in Puebla, Mexico]. / Estudio de casos confirmados de brucelosis humana en Puebla, México.

BACKGROUND: Human brucellosis is a global health problem. Mexico is one of the main countries affected; timely diagnosis and serological tests are the basis for detection. AIM: To know the frequency of confirmed cases of brucellosis in different of Family Medicine Units of the Mexican Social Security Institute in the state of Puebla, Mexico. METHODS: Cross-sectional study in patients of both genders, adults and pediatrics, with clinical manifestations suggestive of brucellosis; serological tests were performed for the confirmatory diagnosis. RESULTS: Out of a total of 77 patients, 39 (50.6%) were positive, 21 (27.3%) cases coming out of infection, 9 (11.7%) were negative and 8 (10.4%) were defined with immunological memory; of positive cases, 32 (82.1%) were found in the adult group and 30 (76.9%) were female. CONCLUSION: Around half of samples were confirmed as brucellosis, the clinical manifestations of the patients studied were non-specific, which highlights the importance of laboratory diagnosis.

Follow-up to the baby friendly hospital initiative in two hospitals of the Mexican Social Security Institute / Seguimiento de la iniciativa hospital amigo del niño y la niña en dos hospitales del Instituto Mexicano del Seguro Social

Abstract Background: The Baby Friendly Hospital Initiative has proven to be effective to increase exclusive and prolonged breastfeeding. Material and methods: Longitudinal study, in two hospitals of second level, in the period from 2015 to 2018. A percentage above 85% in each step was considered acceptable. The statistical analysis was descriptive using student's t test to compare the mean between the two hospitals and ANOVA to compare the mean throughout time in SPSS v.25. Results: Steps 1 and 7 were different between the hospitals with p = 0.010 and p = 0.023, respectively. In the follow-up, General Zone Hospital No. 5 kept steps 1, 2, 3, 7, 8, and 9 above 85%, while those who did not were steps 4, 5, 6, and 10, p = 0.37. Steps of General Hospital No. 15 that remained over 85% were 1, 3, 7, and 9; those that oscillated over time with a <85% rating were steps 2, 4, 5, 6, 8, and 10, p = 0.003. Conclusion: Monitoring child-friendly hospitals allow us to observe areas of opportunity to strengthen training for both clinical and non-clinical staff, pregnant women, the general population, and to improve exclusive and prolonged breastfeeding.

Resumen Introducción: La Iniciativa Hospital Amigo del Niño y la Niña ha probado ser efectiva para mejorar la lactancia materna exclusiva y prolongada. Material y métodos: Estudio longitudinal, en dos hospitales de segundo nivel, en el periodo de 2015 a 2018. Un porcentaje superior al 85% en cada paso se consideró aceptable. El análisis estadístico fue descriptivo, utilizando la prueba t de Student para comparar las medias entre los dos hospitales y el análisis de la varianza para compararlas a lo largo del tiempo empleando el programa SPSS v.25. Resultados: Los pasos 1 y 7 variaron entre los hospitales (con p = 0.010 y p = 0.023, respectivamente). En el seguimiento, el Hospital General de Zona (HGZ) 5 mantuvo los pasos 1, 2, 3, 7, 8 y 9 por encima del 85%, y < 85% los pasos 4, 5, 6 y 10 (p = 0.37). Las medidas del HGZ 15 que se mantuvieron > 85% fueron 1, 3, 7 y 9; aquellos que oscilaron a lo largo del tiempo con una calificación < 85% fueron los pasos 2, 4, 5, 6, 8 y 10 (p = 0.003). Conclusión: Estos seguimientos permiten observar áreas de oportunidad para reforzar la capacitación al personal clínico y no clínico como a las mujeres embarazadas, a la población en general y para mejorar la lactancia materna exclusiva y prolongada.

Estudio de casos confirmados de brucelosis humana en Puebla, México / Study of confirmed cases of human brucellosis in Puebla, Mexico

INTRODUCCIÓN: La brucelosis humana es un problema zoo-sanitario global. México es uno de los principales países que se ven afectados, el diagnóstico oportuno y las pruebas serológicas confirmatorias son la base para la detección. OBJETIVO: Conocer la frecuencia de casos confirmados de brucelosis en diferentes Unidades de Medicina Familiar del Instituto Mexicano del Seguro Social en el estado de Puebla, México. PACIENTES Y MÉTODOS: Estudio transversal en pacientes de ambos sexos, adultos y pediátricos, con manifestaciones clínicas sugestivas de brucelosis; se realizaron pruebas serológicas para el diagnóstico confirmatorio. RESULTADOS: De un total de 77 pacientes, se obtuvieron 39 (50,6%) casos positivos, 21 (27,3%) casos saliendo de la infección, 9 (11,7%) negativos y 8 (10,4%) con memoria inmunológica; de los casos positivos, 32 (82,1%) eran adultos y 30 (76,9%) fueron del género femenino. CONCLUSIÓN: Del total de muestras, la mitad tuvo diagnóstico de brucelosis, las manifestaciones clínicas de los pacientes estudiados fueron inespecíficas, lo cual resalta la importancia del diagnóstico de laboratorio.

BACKGROUND: Human brucellosis is a global health problem. Mexico is one of the main countries affected; timely diagnosis and serological tests are the basis for detection. AIM: To know the frequency of confirmed cases of brucellosis in different of Family Medicine Units of the Mexican Social Security Institute in the state of Puebla, Mexico. METHODS: Cross-sectional study in patients of both genders, adults and pediatrics, with clinical manifestations suggestive of brucellosis; serological tests were performed for the confirmatory diagnosis. RESULTS: Out of a total of 77 patients, 39 (50.6%) were positive, 21 (27.3%) cases coming out of infection, 9 (11.7%) were negative and 8 (10.4%) were defined with immunological memory; of positive cases, 32 (82.1%) were found in the adult group and 30 (76.9%) were female. CONCLUSION: Around half of samples were confirmed as brucellosis, the clinical manifestations of the patients studied were non-specific, which highlights the importance of laboratory diagnosis.

Immunohistological Biomarkers of Toxicity by a Pharmaceutical Antidepressant in the Freshwater Cichlid Fish Cichlasoma dimerus (Teleostei, Cichliformes).

Melano-macrophage centers (MMCs) are nodular clusters of pigmented macrophages, implicated in homeostasis and destruction and recycling of endogenous and exogenous material. They can increase in size and/or frequency under environmental stress resulting in immunohistological biomarkers of water quality. Fluoxetine (FLX), a commonly prescribed antidepressant, can cause neuroendocrine, behavioral and reproductive alterations in teleost fish. In the present study, we analyzed the effects of a 2-week 50 µg/L FLX exposure on MMCs in histological sections of spleen and head-kidney (HK) of the cichlid fish Cichlasoma dimerus. In the spleen, FLX caused an increase in the area and a decrease in the number of MMCs. An increase in the proportion of the HK occupied by MMCs was observed in FLX-exposed fish, due to an increase in their number but not their area. The deposition rate of MMCs varies according to the hemolymphopoietic organ and would be the result of a differential response to FLX on homeostatic functions (elimination of cellular debris, iron processing and immune response).

Troponin I, creatine-phosphokinase and creatine-phosphokinase-MB in newborns with suspected neonatal asphyxia. / Troponina I, creatina-fosfocinasa y creatina-fosfocinasa-MB en recién nacidos con sospecha de asfixia neonatal.

BACKGROUND: The cardiac troponin I (cTnI), creatine phospokinase (CPK), and creatine kinase- myocardial band (CK-MB) are cardiac biomarkers used in newborns with asphyxia. OBJECTIVE: To analyze the relationship between cTnI, CPK and CPK-MB levels with clinical and biochemical diagnostic criteria for neonatal asphyxia. METHODS: Analytical cross-sectional study in neonates with at least one diagnostic criterion of asphyxia. Relationship among cTnI and CPK-MB levels at birth, serum levels of CPK and CPK-MB determined 24 hours after delivery, with metabolic acidosis, Apgar test at 5 minutes with scores of 0-3, neurological alterations and/or multiple organ failure were analyzed. RESULTS: Thirty-four neonates, 73.5% born by cesarean section, 71% term neonates with a mean weight of 3,096 ± 453g, 2,275 ± 509g for preterm, and a mean of 7.77 ± 1.481 and 7.03 ± 1.705 5-minute Apgar score, respectively. 17.6% of the neonates reported a pH value < 7.20, 58% a base deficit of 12 mmol/L, 5.8% obtained a 5-minute Apgar score < 3, and 38.23% had neurological alterations and/or multiple organ dysfunction syndrome. All patients reported cTnI within the normal reference range. CPK and CPK-MB values, 24 hours after delivery, were elevated in 29% of the cases with one or two diagnostic criteria for neonatal asphyxia. The percentage of CPK-MB was associated with gestational age. CONCLUSIONS: cTnI values were normal in suspected cases of neonatal asphyxia, whereas CPK and CPK MB can elevate in these population, principally in preterm newborns. Biochemical markers were not associated with any clinical parameter.

INTRODUCCIÓN: La troponina I (cTnI), la creatina-fosfocinasa (CPK) y la creatina-fosfocinasa-MB (CPK-MB) son biomarcadores cardiacos usados en neonatos con asfixia. OBJETIVO: Analizar la relación entre las concentraciones de cTnI, CPK y CPK-MB con los criterios diagnósticos clínicos y bioquímicos de asfixia neonatal. MÉTODOS: Estudio analítico transversal en neonatos con al menos un criterio diagnóstico de asfixia. Se analizó la relación entre los niveles de cTnI y CPK-MB al nacimiento, niveles séricos de CPK y CPK-MB determinados 24 horas después del parto, con acidosis metabólica, prueba de Apgar a los 5 minutos con puntajes de 0-3, alteraciones neurológicas y/o falla orgánica múltiple. RESULTADOS: De 34 recién nacidos, el 73.5% nacieron vía cesárea, el 71% eran a término con un peso promedio de 3,096 ± 453 g, en los prematuros el peso fue de 2,275 ± 509 g, y la puntuación de Apgar a los 5 minutos fue de 7.77 ± 1.481 y 7.03 ± 1.705, respectivamente. El 17.6% de los neonatos tuvieron un pH < 7.20, el 58% un déficit de base < 12 mmol/l, el 5.8% Apgar < 3 a los 5 minutos y el 38.23% alteraciones neurológicas o falla orgánica múltiple. El 100% de los recién nacidos tuvieron unos valores de cTnI normales. La CPK y la CPK-MB a las 24 horas se encontraron alteradas en un 29% con uno o dos criterios de asfixia. El porcentaje de CPK-MB se asoció con la edad gestacional. CONCLUSIONES: La cTnI fue normal en los neonatos con sospecha de asfixia, pero no así la CPK y la CPK-MB, que pueden elevarse en estos pacientes, principalmente en los nacidos pretérmino. Los marcadores bioquímicos no se asociaron con ninguno de los parámetros clínicos.

Fluoxetine exposure disrupts food intake and energy storage in the cichlid fish Cichlasoma dimerus (Teleostei, Cichliformes).

Human pharmaceuticals are pollutants of special concern due to their widespread consumption over the last decades, their high persistence in the environment, and the reported alterations produced on non-target organism. The antidepressant fluoxetine (FLX) exerts its effect by inhibiting serotonin (5-HT) reuptake at the presynaptic membrane, thus increasing brain serotonergic activity. In vertebrates, there is a clear inverse relationship between hypothalamic 5-HT levels and food intake, therefore we hypothesized that FLX would inhibit food intake, and in consequence alter energy metabolism in freshwater fish. The aim of this study was to analyze the effect of FLX on feeding behavior and energy storage of the cichlid fish Cichlasoma dimerus. Adult fish were intraperitoneally injected daily with 2 or 20 µg.g-1 FLX or saline for a 5-day period, during which the 20 µg.g-1 FLX-injected fish exhibited a marked reduction in food intake, consistent with a decrease in total body weight and total hepatocyte area observed at the end of the experiment. Although not statistically significant, a marked 50% decrease in glycogen and lipid content and an increase in protein levels in liver was observed for the 20 µg.g-1 FLX dose. This was evidenced histochemically by a weak PAS positive reaction and an intense Coomasie Blue stain. Taken together, these results suggest that the SSRI antidepressant FLX produces an anorectic effect in adults of C. dimerus, which could alter normal physiological function and, in consequence, have a negative impact on fish growth, reproduction, and population success.

[Breastfeeding and infant feeding in the first level of attention]. / Lactancia materna y alimentación infantil en el primer nivel de atención.

Breastfeeding is one of the oldest and most useful practices for human race. It is crucial for optimal newborn development and yet the stigma built around it has proven to be devastating for its implementation over the years. For the past few decades, numerous studies have been conducted to shed light on the countless benefits of breastfeeding and to cast off the taboo around it. In 1991 the World Health Organization, together with the United Nations International Children's Emergency Fund, created the Baby-Friendly Hospital Initiative (BFHI) with the aim of protecting, promoting and strengthening breastfeeding in hospitals and health centers, through the implementation of 10 steps to successful breastfeeding. There are a number of requirements that must be fulfilled in order to implement this initiative. However, due to local and regional characteristics of each health care unit, a certain degree of adequacy of these steps is required for its implementation. Therefore, at the Instituto Mexicano del Seguro Social (Mexican Institute for Social Security), seven steps and three annexes have been adapted for their implementation in the first level health care units of this institution.

La lactancia materna es una de las prácticas más útiles y antiguas de la raza humana. Es un pilar para el desarrollo óptimo del recién nacido y, sin embargo, el estigma construido alrededor de ella ha probado ser devastador para su implementación a lo largo de los años. En las últimas décadas se han realizado numerosos estudios planeados para atraer luz sobre los incontables beneficios de la lactancia materna y para desechar el tabú que existe en torno a ella. En 1991 la Organización Mundial de la Salud, junto con el Fondo de las Naciones Unidas para la Infancia, creó la Iniciativa Hospital Amigo del Niño y la Niña (IHANN) con el objetivo de proteger, promover y fortalecer la lactancia materna en hospitales y centros de salud, a partir de implementar los 10 pasos para una lactancia materna exitosa. Existe una serie de requisitos que se deben cumplir para poner en práctica esa iniciativa. Las características locales y regionales de cada unidad de salud requieren un grado de adecuación de los 10 pasos y, por eso, en el Instituto Mexicano del Seguro Social se han adecuado a siete pasos y tres anexos para su implementación en las unidades de primer nivel de atención.

The SSRI fluoxetine exhibits mild effects on the reproductive axis in the cichlid fish Cichlasoma dimerus (Teleostei, Cichliformes).

Among the wide variety of pharmaceuticals released into the environment, Fluoxetine (FLX), a selective serotonin reuptake inhibitor, is one of the most prescribed for the treatment of major depression. It inhibits serotonin (5-HT) reuptake at the presinaptic membrane, increasing serotonergic activity. In vertebrates, including fish, the serotonergic system is closely related to the Hypothalamic Pituitary Gonadal (HPG) axis which regulates reproduction. As FLX can act as an endocrine disrupting compound (EDC) by affecting several reproductive parameters in fish, the aim of this study was to provide an integral assessment of the potential effect of FLX on the reproductive axis of the Neotropical freshwater fish Cichlasoma dimerus. Adult fish were intraperitoneally injected with 2 µg g-1 FLX or saline every third day for 15 days. No significant differences were found on serotonergic turnover (5-HIAA/5-HT ratio). Pituitary ßLH content in FLX injected females was significantly higher than control females; no significant differences were seen for ßFSH content. Sex steroids remained unaltered, both in males and females fish, after FLX treatment. No plasma vitellogenin was induced in treated males. Some alterations were seen in testes of FLX injected males, such as the presence of foam cells and an acidophilic PAS positive, Alcian-Blue negative secretion in the lobular lumen. Although there is no clear consensus about the effect of this drug on reproductive physiology, these results indicate that FLX is acting as a mild EDC in adults of C. dimerus.

Mechanism of action of endosulfan as disruptor of gonadal steroidogenesis in the cichlid fish Cichlasoma dimerus.

The organochlorine pesticide endosulfan (ES) is used in several countries as a wide spectrum insecticide on crops with high commercial value. Due to its high toxicity to non-target animals, its persistence in the environment and its ability to act as an endocrine disrupting compound in fish, ES use is currently banned or restricted in many other countries. Previous studies on the cichlid fish Cichlasoma dimerus have shown that waterborne exposure to ES can lead to both decreased pituitary FSH content and histological alterations of testes. As gonadotropin-stimulated sex steroids release from gonads was inhibited by ES in vitro, the aim of the present study was to elucidate possible mechanisms of disruption of ES on gonadal steroidogenesis in C. dimerus, as well as compare the action of the active ingredient (AI) with that of currently used commercial formulations (CF). Testis and ovary fragments were incubated with ES (AI or CF) and/or steroidogenesis activators or precursors. Testosterone and estradiol levels were measured in the incubation media. By itself, ES did not affect hormone levels. Co-incubation with LH and the adenylate cyclase activator forskolin caused a decrease of the stimulated sex steroids release. When co-incubated with precursors dehydroandrostenedione and 17αhydroxyprogesterone, ES did not affect the increase caused by their addition alone. No differences were observed between the AI and CFs, suggesting that the effect on steroidogenesis disruption is mainly caused by the AI. Results indicate that action of ES takes place downstream of LH-receptor activation and upstream of the studied steroidogenic enzymes.

Effects of waterborne exposure to 17ß-estradiol and 4-tert-octylphenol on early life stages of the South American cichlid fish Cichlasoma dimerus.

Estrogenic chemicals are often detected in the aquatic environment and can negatively affect animal development and reproduction. In teleost fishes, the hormonal regulation during a critical period of larval development has a strong influence on gonadal sex differentiation; thus this process may be affected by the exposure to environmental estrogens. In this study, we first assessed the lethal acute toxicity of the natural estrogen 17ß-estradiol (E2) and the weaker estrogen mimics 4-tert-octylphenol (OP) and 4-nonylphenol (NP) on larval stages of the South American cichlid fish Cichlasoma dimerus. In a further experiment, we analyzed the effects of chronic waterborne exposure to E2 and OP on gonad development and sex differentiation. Exposure to high concentrations of E2 had a pronounced feminizing effect directing sex differentiation towards ovarian development, while testis development was inhibited at a lower, environmentally relevant concentration. Among OP-exposed fish, 15-38.5% of the males exhibited testicular oocytes (TOs), a commonly reported biomarker of estrogenic exposure. However, since TOs were also recorded in control males and the proportion of males with TOs was not significantly higher in OP treatments, their occurrence could not be attributed to OP exposure. In addition, TOs did not seem to impair male gonad development and functionality since normal spermatogenesis was observed in testes of OP-treated fish. These results indicate that E2 occurring in the South American aquatic environment may affect male reproductive development and pose a risk for wild C. dimerus, especially under prolonged exposure, while the effects of weaker xenoestrogens such as OP would be negligible for gonad development in this species. As illustrated by this study, the natural occurrence of TOs indicates that conclusions concerning the causes of this phenomenon must be drawn with care.

Apendagitis epiploica primaria: Clínica y evolución de 73 casos

La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.

Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.

[Primary epiploic appendagitis: clinical features in 73 cases]. / Apendagitis epiploica primaria. Clínica y evolución de 73 casos.

Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.

Apendagitis epiploica primaria. Clínica y evolución de 73 casos. / [Primary epiploic appendagitis: clinical features in 73 cases].

Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74

) were men. Abdominal pain (left lower quadrant in 89

of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60

) of patients, computed tomography on 21 (29

), and both studies on 8 (11

) of cases in this series. In 49

of cases surgery consultation was requested. Fifteen patients (21

) were treated with antibiotics, 73

of them were prescribed by a clinician. Sixty seven patients (92

) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.

[Functional prognostic factors in older adults with hip fracture]. / Factores pronósticos de funcionalidad en adultos mayores con fractura de cadera.

INTRODUCTION: Hip fracture is common in elderly people who fall. We now describe clinical and social factors independently associated with incomplete functional recovery. OBJECTIVE: to identify clinical and social factors associated with postoperative function in elderly hip fracture. METHODS: A prospective, analytical study of elderly postoperative hip fracture, using non-probability sample of cases including consecutive patients older than 60 years with postoperative hip fracture, excluding those with hyperactive and hypoactive delirium or noy independent in activities of daily life before the injury. Data were collected on age, sex, number of comorbidities, type of fracture and surgery. Within the first 24 to 48 hours we evaluated the cognitive and emotional status, family status, with a final assessment of the Katz index at 3 months after the fracture. Statistical analysis was done using logistic regression. RESULTS: We obtained adjusted odds ratios (ORA) associated functionality, for age < 85 years: 7.21 (95% CI, 1.79-28.98), normal cognitive status 10.74 (95% CI, 3.13-38.83), and functional family situation 8.5 (95% CI, 1.97-32.76). CONCLUSIONS: Age, cognitive status, and family status are important predictors of functional recovery in the short term elderly postoperative hip fracture.

Assessment of the acute toxicity of the organochlorine pesticide endosulfan in Cichlasoma dimerus (Teleostei, Perciformes).

The organochlorine insecticide endosulfan (ES) is widely used despite its high toxicity to fish (96-h LC(50) median value of 2.6 µg L(-1)). This study aimed to assess the acute toxicity, histological and physiological parameters after exposure to 0; 0.25; 1; 2; 3; 4 and 16 µg L(-1) ES for 96 h under semi-static conditions in a freshwater perciform fish, Cichlasoma dimerus. Prior to death, fish exhibited behavior indicative of neurotoxicity. No difference was found in brain AChE activity. A decrease in erythrocyte mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration in exposed fish suggests a state of anemia. Histological alterations observed in exposed fish included hyperplasia of the interlamellar epithelium, blood congestion in secondary lamellae, and mucous cells hyperplasia and hypertrophy in gills; pycnotic nuclei and hydropic degeneration in liver; testicular damage. These moderate pathological responses in major organs could become crucial during reproduction and under prolonged exposure periods.