Proposal and Implementation of a Procedure for Compliance Recognition of Objects with Smart Tactile Sensors.

This paper presents a procedure for classifying objects based on their compliance with information gathered using tactile sensors. Specifically, smart tactile sensors provide the raw moments of the tactile image when the object is squeezed and desqueezed. A set of simple parameters from moment-versus-time graphs are proposed as features, to build the input vector of a classifier. The extraction of these features was implemented in the field programmable gate array (FPGA) of a system on chip (SoC), while the classifier was implemented in its ARM core. Many different options were realized and analyzed, depending on their complexity and performance in terms of resource usage and accuracy of classification. A classification accuracy of over 94% was achieved for a set of 42 different classes. The proposed approach is intended for developing architectures with preprocessing on the embedded FPGA of smart tactile sensors, to obtain high performance in real-time complex robotic systems.

A Study on the Application of Convolutional Neural Networks to Fall Detection Evaluated with Multiple Public Datasets.

Due to the repercussion of falls on both the health and self-sufficiency of older people and on the financial sustainability of healthcare systems, the study of wearable fall detection systems (FDSs) has gained much attention during the last years. The core of a FDS is the algorithm that discriminates falls from conventional Activities of Daily Life (ADLs). This work presents and evaluates a convolutional deep neural network when it is applied to identify fall patterns based on the measurements collected by a transportable tri-axial accelerometer. In contrast with most works in the related literature, the evaluation is performed against a wide set of public data repositories containing the traces obtained from diverse groups of volunteers during the execution of ADLs and mimicked falls. Although the method can yield very good results when it is hyper-parameterized for a certain dataset, the global evaluation with the other repositories highlights the difficulty of extrapolating to other testbeds the network architecture that was configured and optimized for a particular dataset.

Natural clays with an inherent uranium component that nevertheless sequester uranium from contaminated water.

Clays present a cost effective and sustainable method for removing uranium and heavy metals from drinking water because of their cation exchange capabilities. However, managing muddy suspensions is problematic; therefore, clay pellets as presented in this article are a promising alternative. Three standard clays and two regional clays were evaluated for sorption, both in powder form and in pellet structure for comparison. The objective was to evaluate individual sorption processes and assess the effect on uranium sorption due to the process of altering the clay powder to produce pellets. The sorption capacity of the pellets is sufficiently large to not only sorb the intrinsic non-bonded uranium but to continue to sorb uranium from contaminated water. Furthermore, the uranyl cation was also removed preferentially in the presence of Pb2+ and Cd2+ heavy metal cations, hydronium ions, and more importantly the naturally occurring cations, Na1+, Ca2+, and Mg2+ that occur in abundant concentrations. Clay pellets as well as powders reduced uranium concentrations, and in extreme cases from 450 ppb, 15 times the Environmental Protection Agency maximum contaminant level to non-detectable limits. Clay pellets are excellent candidates for the safe and manageable removal of uranium and heavy metals to produce potable water.

Efficacy and safety of weekly vitamin D3 in patients with fibromyalgia: 12-week, double-blind, randomized, controlled placebo trial.

INTRODUCTION: FM is a chronic musculoskeletal disorder characterized by the presence of generalized pain. There are contradictory results regarding the prevalence and supplementation effect of vitamin D deficiency on FM patients. We aim to determine the safety and efficacy of a 12-week vitamin D supplementation on FM patients. METHODS: We conducted a randomized, placebo-controlled, double-blind clinical trial. We included female participants of 18 years old or older, who met 1990 or 2010 ACR criteria for fibromyalgia. The Spanish validated FIQ and the VAS of pain were applied at baseline. The participants were then randomized to receive placebo or 50,000 IU of Vitamin D3 PO, weekly for 12 weeks. RESULTS: We included 80 patients. There was no statistical difference in the initial and final FIQ between both groups. The FIQ delta also did not prove to be different at the end of the study. The increase in vitamin D levels in the intervention group was corroborated. Regarding serious adverse effects, none was reported in both groups. There was no statistical difference in minor adverse events. CONCLUSION: In this double-blind placebo-controlled randomized study conducted to measure the efficacy and safety of vitamin D exclusively in patients with FM, we found that there is no evidence of a trend in favor of vitamin D treatment, since we did not observe improvement in the VAS of pain or FIQ. TRIAL REGISTRY: Clinical Trials.gov number: NCT03369379 Key Points • There are conflicting results in vitamin D to treat fibromyalgia. • In this double-blind, randomized controlled trial, we did not find a difference in the VAS nor FIQ with vitamin D supplementation. • The increase in vitamin D levels in the intervention group was corroborated.

Concordance analysis between different methodologies used for identification of oral isolates of Candida species.

BACKGROUND: The yeasts species determination is fundamental not only for an accurate diagnosis but also for establishing a suitable patient treatment. We performed a concordance study of five methodologies for the species identification of oral isolates of Candida in Colombia. METHODS: Sixty-seven Candida isolates were tested by; API® 20C-AUX, Vitek®2 Compact, Vitek®MS, Microflex® and a molecular test (panfungal PCR and sequencing). The commercial cost and processing time of the samples was done by graphical analysis. RESULTS: Panfungal PCR differentiated 12 species of Candida, Vitek®MS and Microflex® methods identified 9 species, and API® 20C-AUX and Vitek®2 Compact methods identified 8 species each. Weighted Kappa (wK) showed a high agreement between Panfungal PCR, Vitek®MS, Microflex® and API® 20C-AUX (wK 0.62-0.93). The wK that involved the Vitek®2 Compact method presented moderate or good concordances compared with the other methods (wK 0.56-0.73). Methodologies based on MALDI TOF MS required 4 minutes to generate results and the Microflex® method had the lowest selling price. CONCLUSION: The methods evaluated showed high concordance in their results, being higher for the molecular methods and the methodologies based on MALDI TOF. The latter are faster and cheaper, presenting as promising alternatives for the routine identification of yeast species of the genus Candida.

INTRODUCCIÓN: La clasificación a nivel de especies de las levaduras del género Candida de origen clínico es fundamental para el diagnóstico y la instauración de un adecuado tratamiento para el paciente. Se realizó un estudio de concordancia de cinco metodologías usadas para la identificación de aislamientos orales de Candida spp en Colombia. MÉTODOS: Sesenta y siete aislamientos de Candida spp fueron identificados a nivel de especie utilizando; API® 20 C AUX' Vitek® 2 Compact, MALDI TOF (Vitek® MS y Microflex®) y una prueba molecular, PCR Panfungal y secuenciación. Un análisis del costo comercial y tiempo de procesamiento de las muestras por cada método fue realizado mediante el análisis gráfico de ambas variables. RESULTADOS: La PCR Panfungal y secuenciación diferenció 12 especies de Candida' los métodos Vitek® MS y Microflex® identificaron 9 especies y los métodos API® 20 C AUX y Vitek® 2 Compact identificaron 8 especies. El análisis de Kappa ponderado (wK) demostró una concordancia alta entre los métodos PCR Panfungal y secuenciación' Vitek® MS' Microflex® y API® 20 C AUX' concordancias agrupadas en las categorías buena y muy buena (wK 0.62 - 0.93); los Kp que involucraron el método Vitek® 2 Compact presentaron concordancias moderadas o buenas frente a los otros métodos (wK 0.56 - 0.73). Las metodologías basadas en MALDI TOF MS requirieron 4 minutos para generar un resultado y el método Microflex® fue el método que en nuestro medio presentó el menor precio de venta del servicio. CONCLUSIÓN: Los métodos evaluados presentaron una alta concordancia en sus resultados' siendo más alta para los métodos moleculares y las metodologías basadas en MALDI TOF MS; estas últimas son metodologías más rápidas, económicas y precisas, las cuales se presentan como alternativas prometedoras para la identificación rutinaria de especies de levaduras del género Candida.

Range Expansion and the Origin of USA300 North American Epidemic Methicillin-Resistant Staphylococcus aureus.

The USA300 North American epidemic (USA300-NAE) clone of methicillin-resistant Staphylococcus aureus has caused a wave of severe skin and soft tissue infections in the United States since it emerged in the early 2000s, but its geographic origin is obscure. Here we use the population genomic signatures expected from the serial founder effects of a geographic range expansion to infer the origin of USA300-NAE and identify polymorphisms associated with its spread. Genome sequences from 357 isolates from 22 U.S. states and territories and seven other countries are compared. We observe two significant signatures of range expansion, including decreases in genetic diversity and increases in derived allele frequency with geographic distance from the Pennsylvania region. These signatures account for approximately half of the core nucleotide variation of this clone, occur genome wide, and are robust to heterogeneity in temporal sampling of isolates, human population density, and recombination detection methods. The potential for positive selection of a gyrA fluoroquinolone resistance allele and several intergenic regions, along with a 2.4 times higher recombination rate in a resistant subclade, is noted. These results are the first to show a pattern of genetic variation that is consistent with a range expansion of an epidemic bacterial clone, and they highlight a rarely considered but potentially common mechanism by which genetic drift may profoundly influence bacterial genetic variation.IMPORTANCE The process of geographic spread of an origin population by a series of smaller populations can result in distinctive patterns of genetic variation. We detect these patterns for the first time with an epidemic bacterial clone and use them to uncover the clone's geographic origin and variants associated with its spread. We study the USA300 clone of methicillin-resistant Staphylococcus aureus, which was first noticed in the early 2000s and subsequently became the leading cause of skin and soft tissue infections in the United States. The eastern United States is the most likely origin of epidemic USA300. Relatively few variants, which include an antibiotic resistance mutation, have persisted during this clone's spread. Our study suggests that an early chapter in the genetic history of this epidemic bacterial clone was greatly influenced by random subsampling of isolates during the clone's geographic spread.

Detection of protozoa in water samples by formalin/ether concentration method.

Methods to detect protozoa in water samples are expensive and laborious. We evaluated the formalin/ether concentration method to detect Giardia sp., Cryptosporidium sp. and Toxoplasma in water. In order to test the properties of the method, we spiked water samples with different amounts of each protozoa (0, 10 and 50 cysts or oocysts) in a volume of 10 L of water. Immunofluorescence assay was used for detection of Giardia and Cryptosporidium. Toxoplasma oocysts were identified by morphology. The mean percent of recovery in 10 repetitions of the entire method, in 10 samples spiked with ten parasites and read by three different observers, were for Cryptosporidium 71.3 ± 12, for Giardia 63 ± 10 and for Toxoplasma 91.6 ± 9 and the relative standard deviation of the method was of 17.5, 17.2 and 9.8, respectively. Intraobserver variation as measured by intraclass correlation coefficient, was fair for Toxoplasma, moderate for Cryptosporidium and almost perfect for Giardia. The method was then applied in 77 samples of raw and drinkable water in three different plant of water treatment. Cryptosporidium was found in 28 of 77 samples (36%) and Giardia in 31 of 77 samples (40%). Theses results identified significant differences in treatment process to reduce the presence of Giardia and Cryptosporidium. In conclusion, the formalin ether method to concentrate protozoa in water is a new alternative for low resources countries, where is urgently need to monitor and follow the presence of theses protozoa in drinkable water.

Black flower coloration in wild Lisianthius nigrescens: its chemistry and ecological consequences.

The major pigments responsible for the flower color within the black flowered Gentianaceae, Lisianthius nigrescens, were characterized by HPLC and chemical analyses HPLC analysis showed one major and one minor anthocyanin and 3 major and 3 minor flavone glycosides. The anthocyanins [delphinidin-3-O-rhamnol(1-6)galactoside and its 5-O-glucoside] comprised an extraordinary 24% of the dry weight of wild collected L. nigrescens corallas, and were accompanied in a 1:1 ratio by a range of apigenin and luteolin 8-C-glucosides and their 7-O-methyl ethers. The high levels of anthocyanins and flavones (and their co-pigmentation) is thought to account for the almost complete absorption of both UV and visible wavebands observed by reflectance photography.

Evaluation of IgG anti-toxoplasma avidity and polymerase chain reaction in the postnatal diagnosis of congenital toxoplasmosis.

Confirmatory tests for congenital toxoplasmosis were evaluated in 23 infected and 31 uninfected newborns. Conventional polymerase chain reaction was better than real-time polymerase chain reaction, but did not identify additional cases. Avidity tests added 2 new cases that were not identified by other criteria. Overall sensitivity was 82.6%. Avidity assay, but not polymerase chain reaction, increased the sensitivity of confirmatory assays in congenital toxoplasmosis.

Concordance analysis between different methodologies used for identification of oral isolates of Candida species / Análisis de concordancia de diferentes metodologías para la identificación de aislamientos orales de especies de Candida

Abstract Background: The yeasts species determination is fundamental not only for an accurate diagnosis but also for establishing a suitable patient treatment. We performed a concordance study of five methodologies for the species identification of oral isolates of Candida in Colombia. Methods: Sixty-seven Candida isolates were tested by; API® 20C-AUX, Vitek®2 Compact, Vitek®MS, Microflex® and a molecular test (panfungal PCR and sequencing). The commercial cost and processing time of the samples was done by graphical analysis. Results: Panfungal PCR differentiated 12 species of Candida, Vitek®MS and Microflex® methods identified 9 species, and API® 20C-AUX and Vitek®2 Compact methods identified 8 species each. Weighted Kappa (wK) showed a high agreement between Panfungal PCR, Vitek®MS, Microflex® and API® 20C-AUX (wK 0.62-0.93). The wK that involved the Vitek®2 Compact method presented moderate or good concordances compared with the other methods (wK 0.56-0.73). Methodologies based on MALDI TOF MS required 4 minutes to generate results and the Microflex® method had the lowest selling price. Conclusion: The methods evaluated showed high concordance in their results, being higher for the molecular methods and the methodologies based on MALDI TOF. The latter are faster and cheaper, presenting as promising alternatives for the routine identification of yeast species of the genus Candida.

Resumen Introducción: La clasificación a nivel de especies de las levaduras del género Candida de origen clínico es fundamental para el diagnóstico y la instauración de un adecuado tratamiento para el paciente. Se realizó un estudio de concordancia de cinco metodologías usadas para la identificación de aislamientos orales de Candida spp en Colombia. Métodos: Sesenta y siete aislamientos de Candida spp fueron identificados a nivel de especie utilizando; API® 20 C AUX‚ Vitek® 2 Compact, MALDI TOF (Vitek® MS y Microflex®) y una prueba molecular, PCR Panfungal y secuenciación. Un análisis del costo comercial y tiempo de procesamiento de las muestras por cada método fue realizado mediante el análisis gráfico de ambas variables. Resultados: La PCR Panfungal y secuenciación diferenció 12 especies de Candida‚ los métodos Vitek® MS y Microflex® identificaron 9 especies y los métodos API® 20 C AUX y Vitek® 2 Compact identificaron 8 especies. El análisis de Kappa ponderado (wK) demostró una concordancia alta entre los métodos PCR Panfungal y secuenciación‚ Vitek® MS‚ Microflex® y API® 20 C AUX‚ concordancias agrupadas en las categorías buena y muy buena (wK 0.62 - 0.93); los Kp que involucraron el método Vitek® 2 Compact presentaron concordancias moderadas o buenas frente a los otros métodos (wK 0.56 - 0.73). Las metodologías basadas en MALDI TOF MS requirieron 4 minutos para generar un resultado y el método Microflex® fue el método que en nuestro medio presentó el menor precio de venta del servicio. Conclusión: Los métodos evaluados presentaron una alta concordancia en sus resultados‚ siendo más alta para los métodos moleculares y las metodologías basadas en MALDI TOF MS; estas últimas son metodologías más rápidas, económicas y precisas, las cuales se presentan como alternativas prometedoras para la identificación rutinaria de especies de levaduras del género Candida.

Preoperative medical consultation: maximizing its benefits.

BACKGROUND: The increasing complexity of medical and surgical care often demands comprehensive preoperative work-ups by medical consultants and detailed management recommendations to optimize the patient's medical ailments before surgery. This article aims to review the available evidence and discuss elements of the preoperative medical consultation that are of particular relevance to surgeons. METHODS: The authors performed a comprehensive review of the available medical literature and guidelines pertaining to preoperative medical management and present a narrative summary of their findings. RESULTS: Although many preoperative recommendations are based on expert opinion and consensus, a growing number of studies and clinical practice guidelines provides direction as to what is the best management of patients with medical problems before surgery. CONCLUSIONS: Collaborative efforts and adequate communication between the medical and surgical teams are necessary to ensure appropriate patient management before surgery. Although higher-risk patients may require thorough preoperative evaluations, extensive routine investigations may not always be necessary.

First Colombian multicentric newborn screening for congenital toxoplasmosis.

AIMS: To determine the incidence of congenital toxoplasmosis in Colombian newborns from 19 hospital or maternal child health services from seven different cities of five natural geographic regions (Caribbean, Central, Andean, Amazonia and Eastern). MATERIALS AND METHODS: We collected 15,333 samples from umbilical cord blood between the period of March 2009 to May 2010 in 19 different hospitals and maternal-child health services from seven different cities. We applied an IgM ELISA assay (Vircell, Spain) to determine the frequency of IgM anti Toxoplasma. The results in blood cord samples were confirmed either by western blot and repeated ELISA IgM assay. In a sub-sample of 1,613 children that were negative by the anti-Toxoplasma IgM assay, the frequency of specific anti-Toxoplasma IgA by the ISAGA assay was determined. All children with positive samples by IgM, IgA, clinical diagnosis or treatment during pregnancy were recalled for confirmatory tests after day 10 of life. RESULTS: 61 positive samples for specific IgM (0.39%) and 9 positives for IgA (0.5%) were found. 143 questionnaires were positive for a clinical diagnosis or treatment for toxoplasmosis during pregnancy. 109 out of the 218 children that had some of the criteria for postnatal confirmatory tests were followed. Congenital toxoplasmosis infection was confirmed in 15 children: 7 were symptomatic, and three of them died before the first month of life (20% of lethality). A significant correlation was found between a high incidence of markers for congenital toxoplasmosis and higher mean annual rainfall for the city. CONCLUSIONS: Incidence for congenital toxoplasmosis is significantly different between hospitals or maternal child health services from different cities in Colombia. Mean annual rainfall was correlated with incidence of congenital toxoplasmosis.

Validación de pruebas ELISA IgM anti-Toxoplasma para uso en programas de tamización en recién nacidos / Validation of anti-Toxoplasma IgM ELISA tests in newborn screening programs

Objetivos. Evaluar y determinar el punto de corte para la detección de IgM anti-Toxoplasma por el método ELISA, en muestras de sangre de cordónumbilical, mediante dos ensayos comerciales diferentes, y correlacionar los resultados obtenidos con el diagnóstico de toxoplasmosis congénitarealizado por seguimiento serológico y los datos clínicos. Métodos. Se evaluó la prueba IgM anti-Toxoplasma ELISA de Vircell®, frente a los resultados por Western blot e IgM ELISA de Labsystems®. Seestudiaron 105 muestras de cordón umbilical de niños colombianos, obtenidas de seis ciudades diferentes por Western blot y seguimiento clínico yserológico en aquellos positivos. Se obtuvo una curva receptor-operador (ROC) para la prueba ELISA IgM anti-Toxoplasma de Vircell® y de Labsystems®. Se analizó la concordancia entre pruebas en 105 sueros obtenidos de cordón umbilical. Resultados. El mejor desempeño para la prueba Vircell® fue con un punto de corte de índice 8 y la prueba de Labsystems® con un punto de cortede 16 inmunounidades enzimáticas. Frente al Western blot, la prueba Vircell® tuvo una sensibilidad de 100 % (IC 95%; 71,8-100) y una especificidadde 78 % (IC 95%; 69-85,7), la prueba Labsystems® tuvo una sensibilidad de 100 % (IC95%; 71,8-100) y una especificidad de 100 % (IC95%; 96-100). Laconcordancia entre ambas pruebas (Labsystems® y Vircell®) fue de 80 %, con un índice kappa de 0,45. Conclusiones. Un punto de corte de un índice 8 para la prueba ELISA IgM anti-Toxoplasma de Vircell® y un punto de corte de 16 inmunounidadesenzimáticas por Labsystems®, permiten identificar infecciones congénitas en sangre de cordón umbilical en niños colombianos.

Objectives: To evaluate and validate the detection of anti-Toxoplasma IgM ELISA in umbilical cord blood by means of two different commercialassays and to correlate the results with the diagnosis of congenital infection in children by serological follow up and clinical data. Materials and methods: We evaluated the commercial anti-Toxoplasma IgM ELISA kitÔ from Vircell (Granada, Spain) compared to the results of Toxoplasma IgM Western blotÔ (LDbio, Lyon, France) and IgM ELISA testÔ from Labsystems (Finland). We obtained the receptor-operator curve (ROC) for the IgMELISA assay form Vircell and Labsystems. We studied 105 umbilical cord blood serum samples from Colombian children from six different cities by Westernblot, and clinical and serological follow up for positive cases. The kappa agreement index was determined for the 105 sera obtained from umbilical cords. Results: The Vircell assay showed a better performance with a cut-off index of 8 against a 16 for Labsystems for enzyme immunounits (EUI). Whenthe results were evaluated against the Western blot assay, the Vircell IgM assay had a sensitivity of 100% (IC95%: 71.8-100) and a specificity of 78%(IC95%: 69-85.7), the IgM assay from Labsystems had a sensitivity of 100% (IC95%; 71.8-100) and a specificity of 100% (IC95%; 96-100). Agreement between both tests (Labsystems and Vircell) was 80% and had a kappa index of 0.45. Conclusions: A cut-off point of 8 for the anti-Toxoplasma IgM ELISA assay from Vircell and 16 EIU for the Labsystems assay allow the identificationof congenital infections in umbilical cord blood samples from Colombian children.

Multiplexed DNA sequencing-by-synthesis.

We report a new DNA sequencing-by-synthesis method in which the sequences of DNA templates, hybridized to a surface-immobilized array of DNA primers, are determined by sensing the number of nucleotides by which the primers in each array spot are extended in sequential DNA polymerase-catalyzed nucleotide incorporation reactions, each with a single fluorescein-labeled deoxyribonucleoside triphosphate (dNTP) species. The fluorescein label is destroyed after each readout by a photostimulated reaction with diphenyliodonium chloride. A DNA polymerase with enhanced ability to incorporate, and to extend beyond, modified nucleotides is used. Self-quenching of adjacent fluorescein labels, which impedes readout of homopolymeric runs, is avoided by diluting the labeled dNTP with unlabeled reagent. Misincorporation effects have been quantified and are small; however, low-level contamination of dNTPs with other nucleotides mimics misincorporation and can produce significant false-positive signals. These impurities are removed by polymerase-catalyzed incorporation into complementary "cleaning duplexes." Here, we demonstrate the accurate sequence readout for a small array of known DNA templates, the ability to quantify homopolymeric runs, and a short sequencing example of sections of the wild-type and mutant BRCA1 gene. For a 20,000-spot array, readout rates in excess of 6000 bases per minute are projected.

Arritmia ventricular derecha de alta densidad en pacientes sin cardiopatía estructural: características clínicas y electrocardiográficas / Right ventricular arrhythmia of high density in patients without structural heart disease: clinical characteristics and electrocardiographic

Las arritmias ventriculares originadas en el ventrículo derecho son un motivo frecuente de consulta en cardiología y suelen ser medicadas con antiarrítmicos. Objetivo. Describir las características clínicas y electrocardiográficas de pacientes con arritmia ventricular derecha de alta densidad. Métodos. presentamos 32 pacientes con arritmia ventricular de alta densidad (CVP ≥ 30/h), originada en el VD y con ecocardiografía normal. Resultados. la edad promedio de los pacientes fue 56 ± 18 años, la HTA y la dislipidemia fueron las comorbilidades más frecuentes, el 85% se encontraba sintomático en la primera evaluación y en su mayoría estaban medicados con fármacos antiarrítmicos. En la monitorización electrocardiográfica ambulatoria se encontró un promedio de 9350,09 ± 3455 CVP/ 24 h (casi un tercio tuvieron más de 10 000 CVP), los dos patrones ECG más frecuentes en V1 fueron el QS y el rS, con eje inferior derecho y onda R monofásica en D I. EL 45% de los pacientes se encontraron en tratamiento con betabloqueadores En el seguimiento de 6 y 12 meses los pacientes referían menos síntomas incluso sin tratamiento farmacológico, ninguno de ellos requirió del uso de amiodarona. Conclusión. Las arritmias ventriculares derechas originadas en el tracto de salida, de alta densidad y no asociadas a cardiopatía estructural, presentan una evolución y pronóstico favorable, incluso sin tratamiento farmacológico.

The ventricular arrhythmias originated in the rigth ventricle are one of the most common reasons of cardiology consulting and almost always medicated with antiarrhythmic drugs. Objective. To describe the clinical and electrocardiographic characteristicsin patients with high density right ventricular arrhythmia. Methods. we introduce 32 patients diagnosed with high density ventricular arrhythmia (VPCs ≥ 30/h), originated in the RV andnormal echocardiography. Results. The average age was 56 ± 18 years, hypertension and dyslipidemia were the most common comorbilities, the 85% ofpatients complained about symptoms in the first examination and the majority had been treated with antiarrhythmics drugs. During the ambulatory electrocardiographic monitorization wefound an average of de 9350,09 ± 3455 VPCs/ 24 hours (about a third presented more than 10000 VPCs), the two most common electrocardiographic patterns in VI were QS and rS, with right inferior axis and monophasic R wave in DI. The 45% of patients had been treated with beta-blockers. During the follow up at 6 and 12 months, the patients reported less symptoms des pite they do not receive any treatment, amiodarona was not required. Conclusion. The high-density right ventricular arrhythmias originated in the outflow tract and no associated with structural abnormalities, present a non complicated prognosis, even if they are not medicated.

Mortalidad en un servicio de medicina interna / Mortality in an internal medicine service

Antecedentes: el Hospital General Dr. Darío Fernández Fierro es un hospital de segundo nivel de atención que atiende a población de la zona sur de la Ciudad de México. Objetivo: mostrar las características epidemiológicas y los padecimientos asociados de la población fallecida. Material y métodos: se revisó la mortalidad durante 1997 en el servicio de medicina interna del Hospital General Dr. Darío Fernández Fierro. En cada caso se anotó la edad, sexo, duración de la hospitalización, enfermedades asociadas y causa de la muerte, según el certificado de defunción. Resultados: la edad promedio de los fallecidos fue de 73 años, con una estancia promedio global de cinco días. Todos los fallecidos tenían dos o más padecimientos. Conclusiones: los hallazgos coinciden con lo observado en otros hospitales de segundo nivel en México.

Scintimammography in the evaluation of axillary lymph node invasion in patients with breast cancer

Purpose. To correlate axillary Technetium-99m-sestamibi uptake with the axillary histology in patients with proven breast cancer. Secondly, to correlate the breast scintimammography results with the tumor histology. Materials and methods. Fifty-one patients with operable breast cancer T1, T2 or T3 and N0 or N1 had a scintimammography before surgery. Images were interpreted directly from the computer screen by two specialists who did not have knowledge about clinical or radiological information concerning the patients. Surgical treatment included conservative surgery or mastectomy, both followed by axillary dissection for malignant tumors (45 patients) and only excision for benign lesions (6 patients). Statistical analysis correlated scintimammography and histologic results. Results. The sensitivity and specificity of Tc99m-sestamibi to assess histologic lymph node involvement in patients with operable breast cancer was 35 percent (95 percent CI:14-61 percent) and 57 percent (95 percent CI:37-75 percent) respectively. The positive predictive value was 33 percent (95 percent CI:13-58 percent) and the negative predictive value was 59 percent ( 95 percent CI: 38-77 percent). The sensitivity and specificity of Tc99-sestamibi to assess breast tumor malignancy was 97 percent (95 percent CI:88-99 percent) and 33 percent (95 percent CI: 4-77 percent) respectively, calculated in only six patients. The positive predictive value was 91 percent (95 percent CI: 80-97 percent) and the negative predictive value was 66 percent (95 percent CI:9-99 percent). Conclusion. Our findings regarding the preoperative axillary assessment with Tc99m-sestamibi do not support the use of this imaging modality for this purpose

Diabetes mellitus secundaria: caso clínico y revisión de la literatura / Secondary diabetes mellitus: a clinical case and literature review

Se reporta el caso de un paciente masculino con más de cincuenta años de edad con pancreatitis crónica posalcohol y calcificaciones en el conducto de Wirsung. Se analizó su diabetes mellitus tipo 2 y se descubrieron los aspectos clínicos característicos del padecimiento: pancreatitis crónica, sensibilidad exagerada a la insulina, mayor hipoglucemia, esteatorea y desnutrición

Evolución de la cirugía de tiroides en el Instituto Nacional de la Nutrición Salvador Zubirán / Changing trends in thyroid surgery at the Instituto Nacional de la Nutricion Salvador Zubiran

Los procedimientos diagnósticos y el tratamiento quirúrgico de las enfermedades tiroideas han mostrado importantes cambios en las últimas décadas. El objetivo del presente estudio fue evaluar la evolución de la cirugía de tiroides en nuestra institución mediante el análisis de una muestra representativa de las décadas comprendidas entre 1960 y 1992. Fue clara tendencia a diagnosticar las enfermedades tiroideas malignas en forma más precoz a través del tiempo. El diagnóstico de carcinoma de tiroides que inicialmente se estableció durante el transoperatorio, pudo ser hecho con un alto índice de confiabilidad en la última década mediante el uso de la biopsia por aspiración con agua fina (BAAF). La resección selectiva de las neoplasias malignas fue substituída por la excisión total o casi total de la glándula, y en la muestra de la última década no se observaron las complicaciones que acompañaron en un inicio a este tipo de operaciones. Este estudio hizo evidente un fuerte impacto de la BAAF en el manejo de los problemas tiroideos, lográndose reducir con ella el número de tiroidectomías realizadas por enfermedad benigna con el consecuente aumento de la proporción de intervenciones por cáncer

Carcinoma anaplásico de tiroides en el Instituto Nacional de la Nutrición Salvador Zubirán / Anaplastic carcinoma of the Thyroid at the Instituto Nacional de la Nutricion Salvador Zubiran

Antecedentes. El carcinoma anaplástico de tiroides (CAT) es un tumor muy agresivo cuya supervivencia media después del diagnóstico es de seis meses. Su rareza ha limitado el conocimiento de muchas de sus características clínicas y de evolución. Objetivo. Analizar la forma de presentación, diagnóstico, tratamiento y superviviencia de los pacientes con CAT, así como sus características morfológicas, inmunohistoquímicas y contenido nuclear de DNA. Pacientes y métodos. Fueron 12 pacientes con CAT (11 mujeres) con edad promedio de 65 años y que recibieron atención en nuestra institución de 1970 a 1995. La información clínica se obtuvo de los expedientes y para los análisis morfológico, inmunohistoquímico y genético se emplearon laminillas provenientes de bloques de tejido archivado. Resultados. En 10 pacientes se documentó coexistencia de enfermedad tiroidea (9 bocios y un Graves). La presentación más frecuente fue una tumoración de crecimiento rápido acompañada de disfagia, dolor cervical, disfonía y disnea que en 10 correspondió gamagráficamente a un nódulo frío. En todos se corroboró el diagnóstico por biopsia o por histología. El patrón celular predominante fue fusiforme. Se encontró coexistencia con carcinoma papilar en ocho pacientes. En seis casos estudiados, se demostró positividad para S-100 y vimentina en todos, en 5 (83 por ciento) se detectó el antígeno de membrana epitelial, el antígeno carcinoembrionario en la mitad, para tiroglobulina y calcitonina en 2/6 casos, y para enolasa neuronal específica en 1/6. La citometría de flujo mostró un patrón diploide de DNA en los 6 casos evaluados. Se logró resección completa en 2/11 sometidos a cirugía. Conclusiones. El CAT es un tumor agresivo que se asocia con otras enfermedades tiroideas. El patrón morfológico predominante es el fusiforme, con frecuente reactividad para vimentina, S-100 y antígeno de membrana epitelial, y un patrón diploide de DNA