hsp70 PCR-RFLP as an alternative tool to identify Sauroleishmania species.

Sauroleishmania spp. comprises one of the four Leishmania subgenera, which has been historically considered a non-pathogenic protozoan of reptiles. However, some strains appear to be transiently infective to mammals, and recent findings have detected these parasites in dogs and humans in areas where leishmaniasis is endemic. Herein, the digestion pattern of PCR-RFLP of the 234 bp-hsp70 fragment was evaluated as a simpler and cheaper tool to distinguish the Sauroleishmania species from the other Leishmania subgenera. As a result, the digestion of the 234 bp-hsp70 fragments with HaeIII produced a banding pattern specific to the four Sauroleishmania strains assessed. This technique could contribute to the identification of Leishmania parasites isolated from sandflies, reptiles, or even mammals in fieldworks as an alternative to the use of laborious and expensive methodologies.

"Cap polyposis", refractory to drug treatment, including infliximab.

Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.

Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus in Wild Birds, Chile.

In December 2022, highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus emerged in Chile. We detected H5N1 virus in 93 samples and obtained 9 whole-genome sequences of strains from wild birds. Phylogenetic analysis suggests multiple viral introductions into South America. Continued surveillance is needed to assess risks to humans and domestic poultry.

Histone H3K27 Methylation Perturbs Transcriptional Robustness and Underpins Dispensability of Highly Conserved Genes in Fungi.

Epigenetic modifications are key regulators of gene expression and underpin genome integrity. Yet, how epigenetic changes affect the evolution and transcriptional robustness of genes remains largely unknown. Here, we show how the repressive histone mark H3K27me3 underpins the trajectory of highly conserved genes in fungi. We first performed transcriptomic profiling on closely related species of the plant pathogen Fusarium graminearum species complex. We determined transcriptional responsiveness of genes across environmental conditions to determine expression robustness. To infer evolutionary conservation, we used a framework of 23 species across the Fusarium genus including three species covered with histone methylation data. Gene expression variation is negatively correlated with gene conservation confirming that highly conserved genes show higher expression robustness. In contrast, genes marked by H3K27me3 do not show such associations. Furthermore, highly conserved genes marked by H3K27me3 encode smaller proteins, exhibit weaker codon usage bias, higher levels of hydrophobicity, show lower intrinsically disordered regions, and are enriched for functions related to regulation and membrane transport. The evolutionary age of conserved genes with H3K27me3 histone marks falls typically within the origins of the Fusarium genus. We show that highly conserved genes marked by H3K27me3 are more likely to be dispensable for survival during host infection. Lastly, we show that conserved genes exposed to repressive H3K27me3 marks across distantly related Fusarium fungi are associated with transcriptional perturbation at the microevolutionary scale. In conclusion, we show how repressive histone marks are entangled in the evolutionary fate of highly conserved genes across evolutionary timescales.

Peristomal cutaneous Crohn's disease by contiguity.

Peristomal ulcer is a frequent complication that, in most cases, is mild and responds to topical treatment. In much less frequent cases, it is associated with other pathologies, such as Crohn's disease, requiring in these cases systemic treatment, including surgery. The differential diagnosis between Cutaneous Inflammatory Bowel Disease and Pyoderma Gangrenosum is interesting, although both are managed in a similar way.

Cautionary Notes on Use of the MoT3 Diagnostic Assay for Magnaporthe oryzae Wheat and Rice Blast Isolates.

The blast fungus Magnaporthe oryzae is comprised of lineages that exhibit varying degrees of specificity on about 50 grass hosts, including rice, wheat, and barley. Reliable diagnostic tools are essential given that the pathogen has a propensity to jump to new hosts and spread to new geographic regions. Of particular concern is wheat blast, which has suddenly appeared in Bangladesh in 2016 before spreading to neighboring India. In these Asian countries, wheat blast strains are now co-occurring with the destructive rice blast pathogen raising the possibility of genetic exchange between these destructive pathogens. We assessed the recently described MoT3 diagnostic assay and found that it did not distinguish between wheat and rice blast isolates from Bangladesh. The assay is based on primers matching the WB12 sequence corresponding to a fragment of the M. oryzae MGG_02337 gene annotated as a short chain dehydrogenase. These primers could not reliably distinguish between wheat and rice blast isolates from Bangladesh based on DNA amplification experiments performed in separate laboratories in Bangladesh and in the United Kingdom. Specifically, all eight rice blast isolates tested in this study produced the WB12 amplicon. In addition, comparative genomics of the WB12 nucleotide sequence revealed a complex underlying genetic structure with related sequences across M. oryzae strains and in both rice and wheat blast isolates. We, therefore, caution against the indiscriminate use of this assay to identify wheat blast and encourage further development of the assay to ensure its value in diagnosis.

[A decade of lead monitoring in schoolchildren in the metropolitan area of Monterrey NL, Mexico]. / Una década de monitoreo de plomo en sangre en niños escolares del área metropolitana de Monterrey, NL.

OBJECTIVE: To establish the blood lead concentration and associated risk factors in schoolchildren during 1998 and 2008. MATERIALS AND METHODS: A blood lead screening was conducted in schoolchildren of 6-12 years of age, enrolled in 17 elementary schools of the metropolitan area of Monterrey, México, during 1998 and 2008. RESULTS: The mean blood lead level were 9.6 ± 3.0 (µg/dL range of 3.18 to 20.88) in 1998 and 4.5±4.8 µg/dL (range of 3.3 to 53.7) showing a 2.1-times reduction in blood lead levels (p<0.01). CONCLUSIONS: This reduction in blood lead levels demonstrate environmental and industrial control improvements and the benefits of fading out the leaded gasoline during the 1990's.

Role of gestational age and maternal biological factors in early term neonatal morbidity.

BACKGROUND: The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). METHODS: This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. RESULTS: The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95% CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95% CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks. CONCLUSIONS: The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being.

INTRODUCCIÓN: La morbilidad de los recién nacidos a término temprano (RNTT) se asocia con la inmadurez de sus órganos y factores biológicos maternos (FBM). En este estudio se determinó la relación entre FBM y el nacimiento a término temprano. Además, se evaluó el papel de la edad gestacional (EG) y los FBM en la morbilidad de los RNTT comparados con los recién nacidos a término completo (RNTC). MÉTODOS: Este estudio de cohorte retrospectivo incluyó RNTT y RNTC. La frecuencia de morbilidades se comparó entre grupos estratificados por EG con la prueba de X2 o la prueba exacta de Fisher. La asociación de FBM con EG y morbilidad se calculó mediante modelos de regresión binomial entre variables correlacionadas con morbilidad de ETNB mediante la correlación de Spearman. Se estimó un nivel de significación del 5% para todos los análisis. RESULTADOS: Los RNTT presentaron una probabilidad 1.9 veces mayor de morbilidad al nacer comparado con los RNTC (37.5% vs 19.9%), ya que requirieron mayor admisión a la unidad neonatal y más días de hospitalización; la patología más frecuente fue la ictericia. Los FBM asociados con el nacimiento a término temprano fueron los: trastornos hipertensivos gestacionales, restricción del crecimiento intrauterino e hipertensión crónica. No se encontró asociación entre factores biológicos maternos y la morbilidad a las 37 y 38 semanas. CONCLUSIONES: La morbilidad del RNTT se relaciona con la inmadurez fisiológica. Los FBM adversos favorecen un medio intrauterino hostil afectando el bienestar fetal y neonatal.

Cross-species transmission and PB2 mammalian adaptations of highly pathogenic avian influenza A/H5N1 viruses in Chile.

H5N1 highly pathogenic avian influenza viruses (HPAIV) emerged in wild birds in Chile in December 2022 and spilled over into poultry, marine mammals, and one human. Between December 9, 2022 - March 14, 2023, a coordinated government/academic response detected HPAIV by real-time RT-PCR in 8.5% (412/4735) of samples from 23 avian and 3 mammal orders. Whole-genome sequences obtained from 77 birds and 8 marine mammals revealed that all Chilean H5N1 viruses belong to lineage 2.3.4.4b and cluster monophyletically with viruses from Peru, indicating a single introduction from North America into Peru/Chile. Mammalian adaptations were identified in the PB2 segment: D701N in two sea lions, one human, and one shorebird, and Q591K in the human and one sea lion. Minor variant analysis revealed that D701N was present in 52.9 - 70.9% of sequence reads, indicating the presence of both genotypes within hosts. Further surveillance of spillover events is warranted to assess the emergence and potential onward transmission of mammalian adapted H5N1 HPAIV in South America.

Neural tube defects prevalence does not increase after modification of the folic acid fortification program in Chile.

BACKGROUND: In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago. METHODS: This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends. RESULTS: The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17). CONCLUSIONS: Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates.

First report and genetic characterization of Seneca Valley virus (SVV) in Chile.

Seneca Valley virus (SVV) is a non-enveloped RNA virus and the only member of the Senecavirus A (SVA) species, in the Senecavirus genus, Picornaviridae family. SVV infection causes vesicular lesions in the oral cavity, snout and hooves of pigs. This infection is clinically indistinguishable from trade-restrictions-related diseases such as foot-and-mouth disease. Other clinical manifestations include diarrhoea, anorexia, lethargy, neurological signs and mortality in piglets during their first week of age. Before this study, Chile was considered free of vesicular diseases of swine, including SVV. In April 2022, a suspected case of vesicular disease in a swine farm was reported in Chile. The SVV was confirmed and other vesicular diseases were ruled out. An epidemiological investigation and phylogenetic analyses were performed to identify the origin and extent of the outbreak. Three hundred ninety-five samples from 44 swine farms were collected, including faeces (208), oral fluid (28), processing fluid (14), fresh semen (61), environmental samples (80) and tissue from lesions (4) for real-time RT-PCR detection. Until June 2022, the SVV has been detected in 16 out of 44 farms, all epidemiologically related to the index farm. The closest phylogenetic relationship of the Chilean SVV strain is with viruses collected from swine in California in 2017. The direct cause of the SVV introduction has not yet been identified; however, the phylogenetic analyses suggest the USA as the most likely source. Since the virus remains active in the environment, transmission by fomites such as contaminated feed cannot be discarded. Further studies are needed to determine the risk of the introduction of novel SVV and other transboundary swine pathogens to Chile.

Randomized Controlled Trial of Nonsynchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal CPAP after Extubation of VLBW Infants.

BACKGROUND AND OBJECTIVES: Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Some evidence suggests that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Nonsynchronized NIPPV (NS-NIPPV) is being widely used in preterm infants without conclusive evidence of its benefits and side effects. Our aim was to evaluate whether NS-NIPPV decreases extubation failure compared with NCPAP in ventilated very low birth weight infants (VLBWI) with respiratory distress syndrome (RDS). METHODS: Randomized controlled trial of ventilated VLBWI being extubated for the first time. Before extubation, infants were randomized to receive NCPAP or NS-NIPPV. Primary outcome was the need for reintubation within 72 h. RESULTS: 220 infants were included. The mean ± SD birth weight was 1,027 ± 256 g and gestational age 27.8 ± 1.9 weeks. Demographic and clinical characteristics were similar in both groups. Extubation failure was 32.4% for NCPAP versus 32.1% for NS-NIPPV, p = 0.98. The frequency of deaths, bronchopulmonary dysplasia, intraventricular hemorrhage, air leaks, necrotizing enterocolitis and duration of respiratory support did not differ between groups. CONCLUSIONS: In this population of VLBWI, NS-NIPPV did not decrease extubation failure after RDS compared with NCPAP.

Role of gestational age and maternal biological factors in early term neonatal morbidity / Rol de la edad gestacional y factores biológicos maternos en la morbilidad del neonato a término temprano

Abstract Background: The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). Methods: This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. Results: The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95% CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95% CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks. Conclusions: The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being.

Resumen Introducción: La morbilidad de los recién nacidos a término temprano (RNTT) se asocia con la inmadurez de sus órganos y factores biológicos maternos (FBM). En este estudio se determinó la relación entre FBM y el nacimiento a término temprano. Además, se evaluó el papel de la edad gestacional (EG) y los FBM en la morbilidad de los RNTT comparados con los recién nacidos a término completo (RNTC). Métodos: Este estudio de cohorte retrospectivo incluyó RNTT y RNTC. La frecuencia de morbilidades se comparó entre grupos estratificados por EG con la prueba de X2 o la prueba exacta de Fisher. La asociación de FBM con EG y morbilidad se calculó mediante modelos de regresión binomial entre variables correlacionadas con morbilidad de ETNB mediante la correlación de Spearman. Se estimó un nivel de significación del 5% para todos los análisis. Resultados: Los RNTT presentaron una probabilidad 1.9 veces mayor de morbilidad al nacer comparado con los RNTC (37.5% vs 19.9%), ya que requirieron mayor admisión a la unidad neonatal y más días de hospitalización; la patología más frecuente fue la ictericia. Los FBM asociados con el nacimiento a término temprano fueron los: trastornos hipertensivos gestacionales, restricción del crecimiento intrauterino e hipertensión crónica. No se encontró asociación entre factores biológicos maternos y la morbilidad a las 37 y 38 semanas. Conclusiones: La morbilidad del RNTT se relaciona con la inmadurez fisiológica. Los FBM adversos favorecen un medio intrauterino hostil afectando el bienestar fetal y neonatal.

Chronic Exposure to Arsenic in Drinking Water Causes Alterations in Locomotor Activity and Decreases Striatal mRNA for the D2 Dopamine Receptor in CD1 Male Mice.

Arsenic exposure has been associated with sensory, motor, memory, and learning alterations in humans and alterations in locomotor activity, behavioral tasks, and neurotransmitters systems in rodents. In this study, CD1 mice were exposed to 0.5 or 5.0 mg As/L of drinking water for 6 months. Locomotor activity, aggression, interspecific behavior and physical appearance, monoamines levels, and expression of the messenger for dopamine receptors D1 and D2 were assessed. Arsenic exposure produced hypoactivity at six months and other behaviors such as rearing and on-wall rearing and barbering showed both increases and decreases. No alterations on aggressive behavior or monoamines levels in striatum or frontal cortex were observed. A significant decrease in the expression of mRNA for D2 receptors was found in striatum of mice exposed to 5.0 mg As/L. This study provides evidence for the use of dopamine receptor D2 as potential target of arsenic toxicity in the dopaminergic system.

Prevalencia de la xerostomía y su asociación con síndromes geriátricos en pacientes ancianos que asisten a un centro de atención de primer nivel / Prevalence of the xerostomia and its association with geriatric syndromes in elderly patients who assist to a primary care level center

RESUMEN Antecedentes: A nivel mundial la población envejecida está aumentando y esto es seguido por un aumento en resultados negativos llamados síndromes geriátricos (SG). Un elemento clave del envejecimiento exitoso es la salud oral (SO). La alteración en los componentes de OH, como la presencia de xerostomía, se ha asociado con una mayor probabilidad de desarrollar algunos SG. Objetivos: Determinar la prevalencia de la xerostomía y sus asociaciones entre las características sociodemográfi cas, el estado de salud y algunos GS en adultos de 60 años o más, que asisten a consulta de primer nivel en México. Material y métodos: Estudio transversal en participantes de 60 años o más, reclutados en 2016. Los participantes se sometieron a una evaluación geriátrica integral (EGI), con la que se obtuvo el diagnóstico de xerostomía y SG. Se determinaron los análisis de regresión ajustados por las variables de confusión para establecer la asociación entre la xerostomía, las características sociodemográfi cas y algunos SG. Resultados: Se incluyeron 264 sujetos; la edad media fue de 73 años (DE ± 6), las mujeres representaron el 60%. En general, el 33% informó la presencia de xerostomía. Después de ajustar por edad, sexo y lectoescritura, los análisis de regresión logística múltiple mostraron una asociación signifi cativa entre la xerostomía y algunos SG (depresión y dolor). Conclusión: Este estudio mostró que la prevalencia de xerostomía es mayor en ancianos mexicanos. Estos resultados sugieren la importancia de monitorear el deterioro de la salud oral, ya que la xerostomía parece tener una infl uencia negativa en el estado de salud de los ancianos, y que la evaluación de la xerostomía debe incluirse en la evaluación geriátrica para prevenir los SG.

ABSTRACT Background: Worldwide aged population is increasing and this is followed by an increase a in negative outcome called geriatric syndromes (GS). A key element of a successful aging is oral health (OH). Alteration of OH components, such as the presence of xerostomia, have been associated with a higher probability of develop some GS. Objectives: Determine the prevalence of xerostomia and its associations between the sociodemographic characteristics, the state of health and some GS in adults of 60 years or older, who attend fi rst level consultation in Mexico. Material and methods: Transverse study in participants of 60 years or more, recruited in 2016. The participants underwent an integral geriatric evaluation (IGE), with which the diagnosis of xerostomia and GS was obtained. The adjusted regression analysis were determined by the confounding variables to establish the association between xerostomia, sociodemographic characteristics and some GS. Results: 264 subjects were included; the average age was 73 years (SD ± 6), women accounted for 60%. In general, 33% reported the presence of xerostomia. After adjusting for age, sex and literacy, multiple logistic regression analysis showed a signifi cant association between xerostomia and some GS (depression and pain). Conclusion: This study showed that the prevalence of xerostomia is higher in mexican elderly. These results suggest the importance of monitoring the deterioration of oral health, since xerostomia seems to have a negative infl uence on the state of health of the elderly and that the evaluation of xerostomia should be included in the geriatric assessment to prevent GS.

Una década de monitoreo de plomo en sangre en niños escolares del área metropolitana de Monterrey, NL / A decade of lead monitoring in schoolchildren in the metropolitan area of Monterrey NL, Mexico

Objetivo. Establecer las concentraciones de plomo (Pb) en sangre en niños escolares de 1998 y 2008, así como su asociación con factores de riesgo. Material y métodos. Se llevó a cabo un monitoreo de Pb en sangre de niños de entre 6 y 12 años que cursan educación primaria en 17 escuelas diferentes, ubicadas en distintas zonas del área metropolitana de Monterrey, de 1998 a 2008. Resultados. Se obtuvieron niveles séricos de 9.6 ± 3.0 (µg/dL rango de 3.18 a 20.88) en 1998 y de 4.5±4.8 µg/dL (rango de 3.3 a 53.7) en 2008, lo que mostró una disminución de 2.1 veces en nivel de Pb (p<0.01). Conclusiones. La reducción de los niveles séricos de Pb demuestran los mejores controles ambientales e industriales y probablemente el éxito de retirar el Pb de la gasolina durante los años noventa.

Objective. To establish the blood lead concentration and associated risk factors in schoolchildren during 1998 and 2008. Materials and methods. A blood lead screening was conducted in schoolchildren of 6-12 years of age, enrolled in 17 elementary schools of the metropolitan area of Monterrey, México, during 1998 and 2008. Results. The mean blood lead level were 9.6 ± 3.0 (µg/dL range of 3.18 to 20.88) in 1998 and 4.5±4.8 µg/dL (range of 3.3 to 53.7) showing a 2.1-times reduction in blood lead levels (p<0.01). Conclusions. This reduction in blood lead levels demonstrate environmental and industrial control improvements and the benefits of fading out the leaded gasoline during the 1990's.

Sistemas dinámicos cardiacos en neonatos normales: Ley caótica cardiaca neonatal / Cardiac dynamic systems in normal neonates: Neonate chaotic cardiac law

Objetivo: Caracterizar matemáticamente la dinámica cardiaca neonatal normal en cuatro estados: Dormido quieto, Dormido activo, Despierto quieto y Despierto activo, para desarrollar una generalización determinando todos los posibles atractores normales. Materiales y métodos: Con base en la teoría de los sistemas dinámicos se tomaron los intervalos RR mínimos y máximos de un neonato en cuatro estados comportamentales. Se realizó una simulación de la frecuencia de la dinámica cardiaca para cada estado construyendo atractores caóticos. Posteriormente se cuantificaron los espacios de ocupación y las dimensiones fractales de los atractores en el espacio generalizado de Box Counting, buscando igualdades y diferencias entre estos estados dinámicos. Finalmente se calcularon todos los posibles atractores normales, con base en una ley exponencial desarrollada previamente para la dinámica cardiaca de adultos. Resultados: Se encontraron diferencias entre los cuatro estados comportamentales al comparar medidas de ocupación espacial, las cuales presentaron valores de 199 para S1, 131 para S2, 61 para S3 y 175 para S4 en la rejilla Kp. Asimismo, se encontraron valores de dimensión fractal diferenciadores para cada uno de los estados. El número de atractores normales totales fue de 4602. Conclusión: Se desarrolló una nueva metodología fisicomatemática causal de la dinámica cardiaca neonatal que permite la diferenciación de diferentes estados comportamentales y el establecimiento de la totalidad de dinámicas normales.

Objective: To characterize mathematically normal cardiac dynamic on neonate in four states: Quiet asleep, Active asleep, Quiet awake, and Active awake, to develop a generalization determining all possible normal attractors. Materials and methods: Based on dynamic system theory, there were taken minimal and maximal RR intervals on a neonate in four behavioral states. Were made a simulation of cardiac dynamic frequency for each state building chaotic attractors. Later were quantified occupation spaces and fractal dimensions of the attractors on Box Counting general space, searching similarities and differences between these dynamic states. Finally there were calculated all possible normal attractors, based on an exponential law previously developed for adults cardiac dynamic. Results: There were found differences in every four behavioral states, comparing space occupation measures, which had values of 199 for S1, 131 for S2, 61 for S3 and 175 for S4 on Kp grille. Also there were found fractal dimension values distinguished for every state. Normal attractor's total number was 4602. Conclusion: There were developed a new a causal physical-mathematical methodology of neonate cardiac dynamic, which allow distinguish different behavioral states and establishment of all normal dynamics.

Diplopia y epistaxis como complicación de la técnica anestésica al nervio maxilar superior / Diplopia and epistaxis, clinical complications to maxillary nerve anesthesic technique

La segunda rama del nervio Trigémino puede ser fácilmente bloqueada por vía intraoral. La técnica más usada consiste en entrar por el agujero Palatino Posterior, atravesando el conducto del mismo nombre con una aguja y depositando una solución de anestésico local en la parte más alta de la fosa Pterigopalatomaxilar, por donde emerge desde en endocráneo, vía agujero Redondo Mayor el nervio Maxilar Superior. Las indicaciones, contraindicaciones, técnica y consideraciones anatómicas se presentan, seguidas de una comparación entre agujas de 3.1 cm y 4.1 cm de longitud en relación con las complicaciones de Diplopia y Epistaxis