Lianas increase lightning-caused disturbance severity in a tropical forest.

Lightning is an important agent of plant mortality and disturbance in forests. Lightning-caused disturbance is highly variable in terms of its area of effect and disturbance severity (i.e. tree damage and death), but we do not know how this variation is influenced by forest structure and plant composition. We used a novel lightning detection system to quantify how lianas influenced the severity and spatial extent (i.e. area) of lightning disturbance using 78 lightning strikes in central Panama. The local density of lianas (measured as liana basal area) was positively associated with the number of trees killed and damaged by lightning, and patterns of plant damage indicated that this occurred because lianas facilitated more electrical connections from large to small trees. Liana presence, however, did not increase the area of the disturbance. Thus, lianas increased the severity of lightning disturbance by facilitating damage to additional trees without influencing the footprint of the disturbance. These findings indicate that lianas spread electricity to damage and kill understory trees that otherwise would survive a strike. As liana abundance increases in tropical forests, their negative effects on tree survival with respect to the severity of lightning-related tree damage and death are likely to increase.

Biased Clonal Evolution in Acute Promyelocytic Leukemia through Imbalances Affecting the der(17) but Not the der(15) Chromosome: Report of Two Cases.

Acute promyelocytic leukemia (APL) is characterized by the chromosomal translocation t(15;17)(q24;q21), raising two hybrid genes: PML::RARA and RARA::PML. There is a biased clonal evolution in APL since imbalances affecting the der(15) chromosome (the one that carries the transforming PML::RARA gene) have never been reported; instead, imbalances of the der(17), mainly in form of an ider(17)(q10), have been repeatedly documented. We here present two cases with APL who acquired an ider(17)(q10) as a secondary chromosomal change. The presence of the ider(17)(q10) implies several genomic consequences with potential to fuel tumor progression: (1) a duplication of the hybrid gene RARA::PML; (2) a cumulative haploinsufficiency for tumor suppressor genes located in the 17p arm; and (3) a cumulative triplosensitivity of genes located in 17q10→RARA::PML→15qter. Both our patients were treated following the PETHEMA LPA 2012 protocol with ATRA plus idarubicin and they have had a long event-free survival.

Dose Escalation and Safety of Capsaicin for Cerebral Perfusion Augmentation: A Pilot Study.

Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in the setting of acute ischemic stroke to enhance collateral flow. Capsaicin poses an alternative to chemically stimulate the sphenopalatine ganglion. Therefore, the objective of this study was to determine the safety and effect of increasing doses of capsaicin upon serial transcranial Doppler markers of cerebral blood flow. Methods: We performed serial transcranial Doppler testing in 30 healthy volunteers divided into 5 equal groups. Capsaicin doses ranged from 33 to 165 µMol. We recorded peak systolic and end-diastolic velocities in the middle cerebral artery, arterial pressure, and perceived pungency in 5-minute intervals up to 20 minutes. We then calculated the mean velocity, the pulsatility index, and the cerebral blood flow index. Results: The participants' median age was 21 years (range, 5 years); all reported consumption of capsaicin in their diets. After and during the study, none reported side effects. Perceived pungency peaked at 5 minutes, and by the 20-minute mark, none perceived any pungency. All the tested doses produced the same pattern, consisting of augmentation of the middle cerebral artery mean velocity with the pulsatility index's diminution. The effects peaked between the 5- and the 10-minute measurements and then returned to basal levels except for the 66-µMol doses, which produced a sustained effect. We found no correlation between perceived pungency and dose, but the middle cerebral artery mean velocity was strongly correlated with the dose administered. Conclusions: This study provides evidence supporting the safety and tolerability of oral capsaicin in a population of healthy volunteers. Capsaicin appears to produce effects similar to those of sphenopalatine ganglion electrical stimulation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04545892.

1,2:3,4-Diepoxybutane Induces Multipolar Mitosis in Cultured Human Lymphocytes.

1,3-Butadiene, a colorless gas regularly used in the production of plastics, thermoplastic resins, and styrene-butadiene rubber, poses an increased leukemia mortality risk to workers in this field. 1,3-Butadiene is also produced by incomplete combustion of motor fuels or by tobacco smoking. It is absorbed principally through the respiratory system and metabolized by several enzymes rendering 1,2:3,4-diepoxybutane (DEB), which has the highest genotoxic potency of all metabolites of 1,3-butadiene. DEB is considered a carcinogen mainly due to its high potential as clastogen, which induces structural chromosome aberrations such as sister chromatid exchanges, chromosomal breaks, and micronuclei. Due to its clastogenic effect, DEB is one of the most used agents for diagnostic studies of Fanconi anemia, a recessively inherited disease related to mutations affecting several genes involved in a common DNA repair pathway. When performing Fanconi anemia diagnostic tests in our laboratory, we have observed occasional multipolar mitosis (MM) in lymphocyte cultures exposed to 0.1 µg/ml of DEB and harvested in the absence of any mitotic spindle inhibitor. Although previous studies reported an aneugenic effect (i.e. it induces aneuploidy) of DEB, no mechanism was suggested to explain such observations. Therefore, the aim of this study was to investigate whether exposure to 0.1 µg/ml of DEB is significantly associated with the occurrence of MM. We blindly assessed the frequency of MM in lymphocyte cultures from 10 nonsmoking healthy individuals. Two series of 3 cultures were performed from each sample under different conditions: A, without DEB; B, with 0.1 µg/ml of DEB, and C, with 25 µM of mitomycin C as positive control. Cultures exposed to DEB showed higher frequencies of MM (23 of 2,000 cells) than did the unexposed ones (3 of 2,000 cells).

[A current perspective of natural orifices transluminal endoscopic surgery (NOTES)]. / Perspectiva actual de la cirugía endoscópica transluminal por orificios naturales (CETON).

Natural orifice transluminal endoscopic surgery (NOTES) represents an alternative in surgical approach, combined with the progress and experience gained from conventional and endoscopic surgery. Bibliographic research in PubMed, Medline database from 2000 to 2015 and analysis of the literature reviews found. NOTES provides vision and natural orifice approach, it has optimized operating times as well as reduced complications and better cosmetic results. Small series of patients have been reported, but there is not a valid clinical multicenter study by evidence-based medicine. NOTES can help to improve the standard operations, complemented with laparoscopic surgery rather than replace it and thus develop tools for the resolution of various diseases that require surgical treatment. This option in current surgery is safe and presents satisfactory results in the reported cases. The development of this new approach of performing surgical procedures requires further study and development of new technology in order to increase the accessibility of these procedures and represent in a practical and sustained way, a better option to approach surgical pathology.

[Child malnutrition in children under 5 years of age in Peru: trends and determinants]. / Desnutrición infantil en menores de cinco años en Perú: tendencias y factores determinantes.

OBJECTIVE: Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period. METHODS: Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days. RESULTS: AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model. CONCLUSIONS: In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall figures remaining fairly low, and affecting to a greater extent highly localized areas and groups of the country. However, the current rates of chronic malnutrition and anemia continue to be very high, which represents a true challenge for public policy, as occurs in other countries of the region. In order to overcome this challenge it will be necessary to change the approach, no longer conceiving of child malnutrition exclusively as a nutritional problem and instead placing greater emphasis on the related determinants. Finally, comprehensive and integrated initiatives should be encouraged and strengthened in the poorest communities.

Chronic Neck Pain Prevalence Before and After COVID-19 Restrictions and Its Relationship With Digital Device Screen Viewing: A Population Study.

OBJECTIVE: To estimate the prevalence of chronic neck pain (CNP) among the adult population in Peru during the post-coronavirus disease 2019 (COVID-19) restriction period compared with that during the pre-pandemic period and evaluate its association with prolonged digital devices connected to the internet (DDCI) screen viewing. METHODS: We conducted a cross-sectional study using a representative sample of adults living in Peru in November 2022. A structured survey was employed to identify CNP, and the exposure variable was set as the duration of DDCI screen viewing. The McNemar test was used to compare CNP prevalence pre- and post-COVID-19 restrictions, and ordinal logistic regression was used to evaluate its association with prolonged screen viewing. RESULTS: A total of 1,202 individuals participated, with 52.8% females and 79.9% residing in urban areas. Following the restrictions, the prevalence of CNP occurring daily or almost daily and at least once a week was 14.8% and 27.8%, respectively (95% confidence Interval [95% CI], 12.6-17.3 and 24.9-30.9), representing a significant increase (p<0.001) compared with pre-pandemic estimates. Notably, among those viewing DDCI screens for ≥8 hours, the odds ratio for CNP frequency escalation compared with those who did not or rarely view screens was 1.61 (95% CI, 1.04-2.50; p=0.033). CONCLUSION: Approximately 4 of 10 adults in Peru experienced CNP following the lifting of COVID-19 social restrictions, more than double the pre-pandemic prevalence. Furthermore, prolonged viewing of DDCI screens increased the risk of having this condition.

[The National Tuberculosis Research Agenda in Peru, 2011-2014]. / Agenda Nacional de Investigación en Tuberculosis en Perú, 2011-2014.

Selection of the priority tuberculosis (TB) research topics in Peru occurred in three stages: a literature review of TB research findings and information in Peru; proposal of the most important topics by 31 key investigators identified through 233 articles published between 1981 and 2011,16 (48.5%) of the 33 regional coordinators of the National Tuberculosis Prevention and Control Strategy, and influential 16 academics and officials in the area of TB; and a participatory workshop attended by 103 health professionals and officials grouped under 10 thematic discussion groups. Of the 49 research topics identified in the second stage of the process, the 30 most important ones for Peru were selected and prioritized during the workshop. These topics, selected through this inclusive, transparent, and participatory methodology, became the National Tuberculosis Research Agenda in Peru for 2011 - 2014. These results should help to improve TB control strategies in the country and optimize the use of financial and human resources.

Tropical tree species differ in damage and mortality from lightning.

Lightning is an important agent of mortality for large tropical trees with implications for tree demography and forest carbon budgets. We evaluated interspecific differences in susceptibility to lightning damage using a unique dataset of systematically located lightning strikes in central Panama. We measured differences in mortality among trees damaged by lightning and related those to damage frequency and tree functional traits. Eighteen of 30 focal species had lightning mortality rates that deviated from null expectations. Several species showed little damage and three species had no mortality from lightning, whereas palms were especially likely to die from strikes. Species that were most likely to be struck also showed the highest survival. Interspecific differences in tree tolerance to lightning suggest that lightning-caused mortality shapes compositional dynamics over time and space. Shifts in lightning frequency due to climatic change are likely to alter species composition and carbon cycling in tropical forests.

Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study.

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+ percentage (CD4%) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL (> 0.5 log10) and decreases in CD4% (> 20% relative decrease in CD4%) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87% were asymptomatic. The median CD4% values were: HD [34% (PR); 25% (TR)] and PP [29% (PR); 24% (TR)]. The VL increases were 60% (PR) and 19% (TR) (p < 0.0001). The CD4% decreases were 36% (PR) and 18% (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95% CI: 5.5-10.9) and a CD4% decrease (AOR 2.3; 95% CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4% decreases compared to those receiving TR. The clinical implications of these VL and CD4% changes remain to be explored.

[Comparison of the porosity characteristics of Portland cement, mineral trioxide aggregate and Biodentine by scanning electron microscopy]. / Evaluación comparativa de las características de porosidad entre el cemento Portland, mta y Biodentine con microscopio electrónico de barrido.

Objective: The purpose of this study was to compare the porosity characteristics of Portland cement, mineral trioxide aggregate (MTA) Angelus® and Biodentine Septodont® by scanning electron microscopy. Materials and Methods: Cements were prepared according to the manufacturer's instructions and packed in cylindrical polyethylene tubes with an internal diameter of 10 mm and a height of 5 mm. The porosity of the samples was analyzed using scanning electron microscopy. Statistical analyses were performed using the Kruskall Wallis test. The level of significance was established at 0.05. Results: The largest size mean diameter valus was found with Portland cement (11.07). There were significant differences between the mean pore diameters (p = 0.05). MTA Angelus® had the largest number of pores, followed by Biodentine Septodont®, and finally, Portland. There were no significant differences in the pores of the three cements (p = 0.09). Conclusion: The results of this comparative analysis of endodontic cements showed that Portland cement has a larger pore diameter than MTA Angelus® and Biodentine Septodont®, demonstrating that these latter two cements present better resistance and permeability properties, and thereby prevent microleakage.

The contributions of lightning to biomass turnover, gap formation and plant mortality in a tropical forest.

Lightning is a common source of disturbance, but its ecological effects in tropical forests are largely undescribed. Here we quantify the contributions of lightning strikes to forest turnover and plant mortality in a lowland Panamanian forest using a real-time lightning monitoring system. We examined 2,195 lightning-damaged trees distributed among 93 different strikes. None exhibited scars or fires. On average, each strike disturbed 451 m2 (95% CI: 365-545 m2 ), created a canopy gap of 304 m2 (95% CI 198-454 m2 ), and caused 7.36 Mg of woody biomass turnover (CI: 5.36-9.65 Mg). Cumulatively, we estimate that lightning strikes in this forest create canopy gaps equaling 0.39% of forest canopy area, representing 20.1% of annual gap area formation, and are responsible for 16.1% of total woody biomass turnover. Trees, lianas, herbaceous climbers and epiphytes were killed by lightning at rates 8-29 times greater than their baseline mortality rates in undamaged control sites. The likelihood of lightning-caused death was higher for trees, lianas, and herbaceous climbers than for epiphytes, and high liana mortality suggests that lightning is an important driver of liana turnover. These results indicate that lightning influences gap dynamics, plant community composition and carbon storage capacity in some tropical forests.

Concordance between self-sampling and standar endocervical sample collection to identify sexual transmission infections in an urban-rural area of Peru. / Concordancia entre autotoma y colección estándar de muestras endocervicales para identificar infecciones de trasmisión sexual en un área urbano-rural del Perú.

With the objective of evaluating the concordance between the self-sampling of vaginal samples and the standard collection of endocervical samples for the identification of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Candida spp. carried out by health personnel in women from an urban-rural area of Peru, a prospective and cross-sectional study was carried out in 206 women of childbearing age, we identified some sexually transmitted infections such as Chlamydia trachomatis or Trichomonas vaginalis in 9/206 (4.4%). We obtained a high degree of agreement in the identification of Candida spp. (k = 0.97), Chlamydia trachomatis (k=0.92) and Trichomonas vaginalis by microscopy (k=1.00), and a considerable agreement for the identification of Trichomonas vaginalis by culture (k=0.66). The self-sampling technique can be used to identify some sexually transmitted infections in urban-rural populations.

Con el objetivo de evaluar la concordancia entre la autotoma de muestras vaginales y la toma estándar de muestras endocervicales para la identificación de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis y Candida spp. realizadas por el personal de salud en mujeres de un área urbano-rural del Perú, se realizó un estudio prospectivo y transversal en 206 mujeres en edad fértil, identificamos algunas infecciones de transmisión sexual como Chlamydia trachomatis o Trichomonas vaginalis en 9 mujeres (4,4%). Obtuvimos una concordancia casi perfecta en la identificación de Candida spp. (k=0,97), Chlamydia trachomatis (k=0,92) y Trichomonas vaginalis por microscopía (k=1,00), y considerable para la identificación de Trichomonas vaginalis por cultivo (k=0,66). La técnica de la autotoma de muestras vaginales podría ser usada para la identificación de algunas infecciones de transmisión sexual en población urbano-rural.

Hybrid salivary gland tumor of the upper lip or just an adenoid cystic carcinoma? Case report.

UNLABELLED: A 65 year-old male patient with a one year-duration tumoral growth located in the upper lip was diagnosed on incisional biopsy as epithelial-myoepithelial carcinoma. After wide surgical excision the histopathological analysis revealed the lesion was composed predominantly (>90%) of adenoid cystic carcinoma. In new sections it was found a very small and isolated area of adenoid cystic carcinoma at the bottom of the incisional biopsy. As surgical margins were free of lesion, no adjuvant treatment was given. The occurrence of a transitory ischaemic attack at 36 months of follow-up led to a neurological and MRI evaluation, which disclosed a well-defined 3.5 x 3 cm lesion suggestive of metastasis, located on the right temporal area. The lesion was surgically removed and a histopathological diagnosis of neurocysticercosis was rendered. After 40 months of follow-up there is no evidence of recurrence. CONCLUSION: True hybrid tumors of salivary glands are rare and treatment in each case should be done according to the component with the higher aggressiveness. However, the occurrence of epithelial-myoepithelial carcinoma areas within an adenoid cystic carcinoma seems to be a frequent finding, and because both lesions share a common origin, some authors consider that this may not be a true hybrid neoplasm but a variant of the latter.

Unexpected Ground-Glass Opacities on Abdominopelvic CT of a Patient With a Negative SARS-CoV-2 Antigen Test Result and No Respiratory Symptoms Upon Admission.

One of the biggest challenges during the coronavirus disease 2019 (COVID-19) pandemic continues to be the detection of asymptomatic and presymptomatic persons infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Persons infected with SARS-CoV-2 who do not have symptoms of COVID-19 may transmit the virus to others and may have subclinical lung abnormalities. Some hospitals use SARS-CoV-2 antigen tests for pre-admission screening testing because they are relatively inexpensive, have a rapid turnaround time, and can be performed at the point of care; however, antigen tests are generally less sensitive than nucleic acid amplification tests with reverse transcription polymerase chain reaction (RT-PCR) assay. Moreover, as the local COVID-19 prevalence increases, the negative predictive value of antigen tests may decrease, meaning that the probability of having false-negative results may increase. We present a case of a patient who, prior to admission for a surgical procedure, had a negative antigen test result for SARS-CoV-2, had no respiratory symptoms, and had no suspected or known exposure to SARS-CoV-2; however, she tested positive for SARS-CoV-2 RNA after admission. The only factor that led the healthcare team to suspect SARS-CoV-2 infection was an unexpected finding of bilateral ground-glass opacities on an abdominopelvic computed tomography (CT), which was performed to assess the extent of a perianal abscess the patient presented. This case highlights the importance of using highly sensitive SARS-CoV-2 tests for pre-admission screening testing in the hospital setting.

Cooperation program for volunteer medical students for training in pediatric cardiopulmonary resuscitation and accident prevention in Honduras.

OBJECTIVES: To analyze a training program in accident prevention and care and Pediatric Basic Cardiopulmonary Resuscitation taught by medical students. RESULTS: Medical students were trained as instructors. Four courses of were launched in Honduras, and the results were analyzed through a theoretical and practical evaluation and an anonymous survey. The volunteer experience for the students and the benefits to the population were positively valued. 37 students received the training. The score in the initial theoretical evaluation was 5.9 of 17 and in the final 10.5, p < 0.001. 89.1% and 91.9% of the students achieved adequate practical learning in basic Cardiopulmonary Resuscitation for children and infants respectively. The course was rated excellently by the students. We conclude that a training program in accident prevention and care and Pediatric Basic Cardiopulmonary Resuscitation taught by medical students could be useful in a cooperation health program.

Ethical evaluation of medical errors and the patient's safety.

In the offer of health care services, errors may arise that are repeated, so when one has occurred, it is essential to reflect on the elements that could cause it and act on them; however, in general, there is a natural tendency to hide them, mainly due to fear of sanctions or lawsuits. The ethics of clinical safety finds it essential to reveal errors, including almost errors or those without significant consequences, betting on transparent management of them. No error should be filed, since its review in an honest and open manner is not only an ethical obligation, but it can also help to lessen its effects and improve the doctor-patient relationship. Achieving safe medical care requires continuous learning about how the different components of the system interact, this implies putting into practice the behaviors that have shown their effectiveness to reduce the probability of the appearance of faults and errors, increase their detection and reduce their consequences, as well as continuing to investigate the factors that contribute to improving patient safety and the quality of care. In this paper we analyze the incidents related to patient safety, through statistical information from the Comisión Nacional de Arbitraje Médico (CONAMED), referring to complaint files concluded by arbitral award in the 2012-2016 period.

En la prestación de servicios de atención médica pueden surgir errores que se repiten; por ello, cuando se ha producido uno es indispensable reflexionar sobre los elementos que pudieron ocasionarlo y actuar sobre ellos. Sin embargo, de manera general, existe una tendencia natural a ocultar los errores, principalmente por temor a sanciones o demandas. La ética de la seguridad clínica encuentra indispensable revelar los errores, incluso los casi errores o aquellos sin consecuencias significativas, apostando por una gestión transparente de los mismos. Ningún error debe ser archivado, pues su revisión de forma honesta y abierta no solo es una obligación ética, sino que puede contribuir a aminorar sus efectos y mejorar la relación médico-paciente. Lograr una atención médica segura requiere aprendizaje continuo sobre cómo interaccionan los diferentes componentes del sistema; ello implica poner en práctica las conductas que han mostrado su efectividad para reducir la probabilidad de aparición de fallas y errores, aumentar su detección y disminuir sus consecuencias, así como continuar investigando sobre los factores que contribuyen a mejorar la seguridad del paciente y la calidad de la atención. En este trabajo se analizan los incidentes relacionados con la seguridad del paciente, a través de información estadística de la Comisión Nacional de Arbitraje Médico (CONAMED) referente a expedientes de queja concluidos por laudo en el periodo 2012-2016.

Immunological and biochemical response of older adults with urinary tract infection to uropathogenic Esherichia coli virulence factors. / Respuesta inmunológica y bioquímica de ancianos con infección urinaria frente factores de virulencia en Escherichia coli uropatógenas.

Descriptive study in which 24 urine samples from older adults with urinary tract infection (UTI), from nursing homes, were evaluated; in order to identify differences in the immune and biochemical response from older adults with UTI by Escherichia coli (E. coli) to major virulence factors in the pathogenesis of UTI. Iron concentration, TNF-α, IL-1ß and antioxidant capacity in urine were determined. A relation was found between, an increase in iron and red blood cell concentration in urine, and the presence of the pap GII gene found in E. coli. It is concluded that older adults, with UTIs by E. coli with the gene pap GII, have increased tissue damage.

Con el objetivo de evidenciar diferencias en la respuesta inmunológica y bioquímica de ancianos con infección del tracto urinario (ITU) por Escherichia coli (E. coli) frente a factores de virulencia de importancia en la patogenia de la ITU, se realizó un estudio descriptivo en el cual se evaluaron 24 muestras de orina de adultos mayores con ITU provenientes de centros de reposo gerontológicos. Se determinó la concentración de hierro, TNF-α, IL-1ß y la capacidad antioxidante en la orina, encontrándose una relación entre una mayor concentración de hierro y de hematíes en la orina con la presencia del gen pap GII en la E. coli. Se concluye que los adultos mayores con ITU por E. coli portadoras del gen pap GII, presentan mayor daño tisular.

[A clinical and therapeutic analysis in acute megakaryoblastic leukemia]. / Análisis clínico-terapéutico de leucemia aguda megacarioblástica.

OBJECTIVE: to show clinical and therapeutic findings in patients with diagnosis of acute megakaryoblastic leukemia (AML). METHODS: twenty four patients with diagnosis AML was carried out. Clinical, laboratory survey results and treatment response were studied. Nineteen patients had primary form and five secondary, attended during a period of eight years. The diagnosis was established by a highly clinical suspicious, with immunophenotype cytometry flow or/and bone biopsy with immunohistochemistry study which proves definitely AML. RESULTS: Fourteen were women, the median age was 43 years, 18 were treated with antineoplasic agents, ten obtained response, six complete and four partial. The response may improve with schemes with high dose of cytosine arabinoside. CONCLUSIONS: our results with the treatment showed that 27 % patients are alive under maintenance treatment long 18 months. The allogeneic bone marrow transplant seems to be one more option in long term.

[Association between exclusive breastfeeding and atopic dermatitis in a third level of care hospital]. / Asociación entre lactancia materna exclusiva y dermatitis atópica en un hospital de tercer nivel de atención.

OBJETIVE.: To assess whether exclusive breastfeeding is associated with atopic dermatitis in children under seven years of age. MATERIALS AND METHODS.: Non-paired case and control type study conducted in a third level of care hospital (Lambayeque Regional Hospital) between June 2016 and May 2018 in which 260 cases and 260 controls recruited in outpatient consultation of the Dermatology and Pediatrics services were evaluated. The UK criteria were used for the diagnosis of atopic dermatitis, as well as a survey with possible risk factors. RESULTS.: In the bivariate analysis, differences were found between cases and controls in relation to exclusive breastfeeding (p=0.001), family history of atopy (p<0.001), parents' educational level (p<0.001), smoking in the presence of the child (p=0.006), and origin (p=0.002). Exclusive breastfeeding was present in 93 (35.8%) of cases compared to 132 (50.8%) of controls. The multivariate analysis using logistic regression found that exclusive breastfeeding would have a protective effect on the presence of atopic dermatitis (OR= 0.62; 95% CI= 0.41-0.94) adjusted by age, sex, background, parents' educational level, initiation of complementary feeding, family member with atopy, and smoking habit. CONCLUSIONS.: Exclusive breastfeeding would have a protective effect on the appearance of atopic dermatitis in children under the age of seven.

OBJETIVOS.: Evaluar si la lactancia materna exclusiva se asocia a la dermatitis atópica en niños menores de siete años. MATERIALES Y MÉTODOS.: Estudio tipo casos y controles no pareado, realizado en un hospital de tercer nivel de atención (Hospital Regional Lambayeque) entre junio de 2016 y mayo de 2018 en donde se evaluó 260 casos y 260 controles captados en consulta externa de los servicios de Dermatología y Pediatría. Se usaron los criterios del Reino Unido para el diagnóstico de dermatitis atópica y una encuesta con posibles factores de riesgo. RESULTADOS.: En el análisis bivariado se encontró diferencias entre los casos y controles en relación a lactancia materna exclusiva (p=0,001), antecedente familiar de atopia (p<0,001), nivel educativo de padres (p<0,001), hábito de fumar en presencia del niño (p=0,006) y procedencia (p=0,002). La lactancia materna exclusiva estuvo presente en 93 (35,8%) de los casos en comparación con 132 (50,8%) en los controles. En el análisis multivariado usando regresión logística se encontró que lactancia materna exclusiva tendría un efecto protector sobre la presencia de dermatitis atópica (OR= 0,62; IC95%= 0,41-0,94) ajustado por edad, sexo, procedencia, nivel educativo de los padres, inicio de alimentación complementaria, familiar con atopía y hábito de fumar. CONCLUSIONES.: La lactancia materna materna exclusiva tendría un efecto protector sobre la presencia de dermatitis atópica en niños menores de siete años.