Effects of the Rho GTPase-activating toxin CNF1 on fibroblasts derived from Rett syndrome patients: A pilot study.

The bacterial product CNF1, through its action on the Rho GTPases, is emerging as a modulator of crucial signalling pathways involved in selected neurological diseases characterized by mitochondrial dysfunctions. Mitochondrial impairment has been hypothesized to have a key role in paramount mechanisms underlying Rett syndrome (RTT), a severe neurologic rare disorder. CNF1 has been already reported to have beneficial effects in mouse models of RTT. Using human RTT fibroblasts from four patients carrying different mutations, as a reliable disease-in-a-dish model, we explored the cellular and molecular mechanisms, which can underlie the CNF1-induced amelioration of RTT deficits. We found that CNF1 treatment modulates the Rho GTPases activity of RTT fibroblasts and induces a considerable re-organization of the actin cytoskeleton, mainly in stress fibres. Mitochondria of RTT fibroblasts show a hyperfused morphology and CNF1 decreases the mitochondrial mass leaving substantially unaltered the mitochondrial dynamic. From a functional perspective, CNF1 induces mitochondrial membrane potential depolarization and activation of AKT in RTT fibroblasts. Given that mitochondrial quality control is altered in RTT, our results are suggestive of a reactivation of the damaged mitochondria removal via mitophagy restoration. These effects can be at the basis of the beneficial effects of CNF1 in RTT.

Association of the genetic variants (-794 CATT5-8 and -173 G > C) of macrophage migration inhibitory factor (MIF) with higher soluble levels of MIF and TNFα in women with breast cancer.

BACKGROUND: Functional variants -173 G > C (rs755622) and -794CATT5-8 (rs5844572) MIF gene have been associated with the risk in several types of cancer, as well as with the increase of soluble levels of MIF and TNFα. However, in previous studies contradictory and uncertain results have been presented on the implication of MIF polymorphisms with the association in cancer, specifically in breast cancer (BC). We investigated whether the variants are associated with the susceptibility to develop BC and the soluble levels of MIF and TNFα in women with BC from western Mexico. MATERIALS AND METHODS: A total of 152 women with BC and 182 control subjects (CS) were enrolled in this study. The determination of genotypes -173 G > C and -794 CATT5-8 MIF polymorphisms was performed by PCR-RFLP and PCR, respectively. In addition, the soluble levels of MIF and TNFα in both studied groups were quantified by ELISA and MILLIPLEX assay, respectively. RESULTS: The most frequent allele found in BC was the G (74.3%) and 6 (54%) in the variants -173G > C and -794 CATT5-8 , respectively, without significant differences in both groups. Nevertheless, the women with BC carriers -173*C and -794CATT7 have higher levels of MIF in comparison with CS. An increase of MIF (BC: 11.1 ng/mL vs CS: 5.2 ng/mL, P < .001) and TNFα (BC: 24.9 ng/mL vs CS: 9.9 pg/mL, P < .001) was found. CONCLUSION: The functional variants of MIF are not genetic susceptibility markers for BC. Nevertheless, the alleles -173*C and -794CATT7 are associated with the increase of MIF circulating in women with BC.

The Crosstalk between Gut Microbiota and White Adipose Tissue Mitochondria in Obesity.

Adipose tissue (AT) dysregulation is a key process in the pathophysiology of obesity and its cardiometabolic complications, but even if a growing body of evidence has been collected over recent decades, the underlying molecular basis of adiposopathy remains to be fully understood. In this context, mitochondria, the intracellular organelles that orchestrate energy production and undergo highly dynamic adaptive changes in response to changing environments, have emerged as crucial regulators of both white (WAT) and brown adipose tissue (BAT) metabolism and function. Given that the gut microbiota and its metabolites are able to regulate host metabolism, adipogenesis, WAT inflammation, and thermogenesis, we hypothesize that their frequently observed dysregulation in obesity could affect AT metabolism by exerting direct and indirect effects on AT mitochondria. By collecting and revising the current evidence on the connections between gut microbiota and AT mitochondria in obesity, we gained insights into the molecular biology of their hitherto largely unexplored crosstalk, tracing how gut microbiota may regulate AT mitochondrial function.

Evaluation of human papillomavirus DNA in colorectal cancer and adjacent mucosal tissue samples.

BACKGROUND: Although the role of viral agents, such as human papillomavirus (e.g. HPV16, HPV18) in colorectal cancer (CRC) has been previously investigated, results remain inconclusive. METHODS: To further evaluate the involvement of oncogenic HPV types in CRC, 40 frozen neoplastic and 40 adjacent colonic tissues collected from Italian patients were analyzed by Luminex-based assays that detect a broad spectrum of HPV types, i.e. Alpha (n = 21), Beta (n = 46) and Gamma HPVs (n = 52). In addition, 125 frozen CRC samples and 70 surrounding mucosal tissues were collected from Czech patients and analyzed by broad spectrum PCR protocols: (i) FAP59/64, (ii) FAPM1 and (iii) CUT combined with Next Generation Sequencing (NGS). RESULTS: Using Luminex-basedassays, DNA from HPV16 was detected in 5% (2/40) CRC tissues from Italian patients. One HPV16 DNA-positive CRC case was subsequently confirmed positive for E6*I mRNA. Cutaneous beta HPV types were detected in 10% (4/40) adjacent tissues only, namely HPV111 (n = 3) and HPV120 (n = 1), while gamma HPV168 (n = 1) and HPV199 (n = 1) types were detected in adjacent and in tumor tissues, respectively. The NGS analysis of the CRC Czech samples identified HPV sequences from mucosal alpha-3 (HPV89), alpha-7 (HPV18, 39, 68 and 70) and alpha-10 species (HPV11), as well as cutaneous beta-1 (HPV20, 24, 93, 98, 105,124) beta-2 (HPV23), beta-3 (HPV49) and gamma-1 species (HPV205). CONCLUSIONS: Our findings indicate that HPV types belonging to the mucosal alpha, and the 'cutaneous' beta and gamma genera can be detected in the colonic mucosal samples with a low prevalence rate and a low number of HPV reads by Luminex and NGS, respectively. However, additional studies are required to corroborate these findings.

Roadmapping 5.0 Technologies in Agriculture: A Technological Proposal for Developing the Coffee Plant Centered on Indigenous Producers' Requirements from Mexico, via Knowledge Management.

The coffee plant, with more than 40 billion shrubs, 9 million tons of grains produced, and 80% of its production accounted for by small-scale producers, has been severely damaged since the emergence of Hemileia vastatrix and Hypothenemus hampei. Despite technological support, these pests have caused 20% to 40% production losses, a 50% to 60% deficit in performance, and a cost of between USD 70 million and USD 220 million to the world economies, which forces us to rethink actions centered on people as the key elements to develop appropriate solutions. For this, the present study presents a technological proposal centered on small indigenous coffee producer requirements for introducing Industry 5.0 technologies, considering roadmapping, knowledge management, statistical analysis, and the social, productive, and digital contexts of five localities in Mexico. The results show a correlation between monitoring and control, soil analysis, the creation of organic fertilizers, accompaniment, and coffee experimentation, as the actions to be implemented, proposing the introduction of a mobile application; sensors, virtual platforms, dome-shaped greenhouses, and spectrophotometric technology as relevant technologies centered on indigenous coffee producers' requirements. This study is important for policymakers, academics, and producers who wish to develop strategies centered on people in Mexico and the world.

Bariatric surgery-induced weight loss and associated genome-wide DNA-methylation alterations in obese individuals.

BACKGROUND: Obesity is a multifactorial and chronic condition of growing universal concern. It has recently been reported that bariatric surgery is a more successful treatment for severe obesity than other noninvasive interventions, resulting in rapid significant weight loss and associated chronic disease remission. The identification of distinct epigenetic patterns in patients who are obese or have metabolic imbalances has suggested a potential role for epigenetic alterations in causal or mediating pathways in the development of obesity-related pathologies. Specific changes in the epigenome (DNA methylome), associated with metabolic disorders, can be detected in the blood. We investigated whether such epigenetic changes are reversible after weight loss using genome-wide DNA methylome analysis of blood samples from individuals with severe obesity (mean BMI ~ 45) undergoing bariatric surgery. RESULTS: Our analysis revealed 41 significant (Bonferroni p < 0.05) and 1169 (false discovery rate p < 0.05) suggestive differentially methylated positions (DMPs) associated with weight loss due to bariatric surgery. Among the 41 significant DMPs, 5 CpGs were replicated in an independent cohort of BMI-discordant monozygotic twins (the heavier twin underwent diet-induced weight loss). The effect sizes of these 5 CpGs were consistent across discovery and replication sets (p < 0.05). We also identified 192 differentially methylated regions (DMRs) among which SMAD6 and PFKFB3 genes were the top hypermethylated and hypomethylated regions, respectively. Pathway enrichment analysis of the DMR-associated genes showed that functional pathways related to immune function and type 1 diabetes were significant. Weight loss due to bariatric surgery also significantly decelerated epigenetic age 12 months after the intervention (mean = - 4.29; p = 0.02). CONCLUSIONS: We identified weight loss-associated DNA-methylation alterations targeting immune and inflammatory gene pathways in blood samples from bariatric-surgery patients. The top hits were replicated in samples from an independent cohort of BMI-discordant monozygotic twins following a hypocaloric diet. Energy restriction and bariatric surgery thus share CpGs that may represent early indicators of response to the metabolic effects of weight loss. The analysis of bariatric surgery-associated DMRs suggests that epigenetic regulation of genes involved in endothelial and adipose tissue function is key in the pathophysiology of obesity.

Comparative survival analysis using the International Stratification Score (ISS) in newly-diagnosed multiple myeloma in the Uruguayan population.

BACKGROUND AND AIMS: Multiple myeloma is a frequent hematologic malignancy, in which the International Stratification Score (ISS) is widely used to estimate the overall survival. However, there are no studies in Latin America evaluating its performance. This study aims to describe the ISS performance in the overall survival estimation for newly diagnosed multiple myeloma patients in Uruguay. METHODS: This is a retrospective registry-based survival analysis through the Grupo Uruguayo de Mieloma Múltiple (GUMMA) database, including newly diagnosed multiple myeloma patients from January 2001 until May 2019. RESULTS: 249 patients were included, 51.81% males and an average age of 63.49 years. According to ISS and Durie-Salmon score (DSS), 47.79% and 82.3% were ISS III and DSS III, respectively. Also, 32.3% were DSS B. Auto hematopoietic stem cell transplantation was performed in 31.73% of patients, and bortezomib was used in 44.18% as frontline therapy. The overall survival was 80% for ISS1, 64.9% ISS2, and 48.6% ISS3 (Log-Rank; p <0.01). The average overall survival was 116.5 months for ISS 1, 77.6 months for ISS 2, and 57.8 months for ISS 3. The hazard ratio between ISS II and ISS I was 2.42 (95% CI 1.10-5.33; p<0.05), and 3.94 (95% CI 1.88-8.26; p<0.05) between ISS III and ISS II. CONCLUSION: The ISS staging system allows an adequate stratification of patients according to overall survival in the real-practice setting. However, considering the relevance of the new cytogenetic advances, it is necessary to increase the availability and quality of iFISH in Latin America.

A POST-TREATMENT RETROSPECTIVE EVALUATION OF SLIPPED CAPITAL FEMORAL EPIPHYSIS.

OBJECTIVE: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. METHODS: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. RESULTS: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. CONCLUSION: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients' clinical and functional outcome. Level of Evidence II, Retrospective study.

OBJETIVO: Analisar os casos de epifisiólise do fêmur proximal operados pelo serviço de Ortopedia Pediátrica do Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, entre os anos de 2016 e 2019. MÉTODOS: Foram analisados retrospectivamente os pacientes submetidos a tratamento cirúrgico de epifisiólise no Hospital Risoleta Tolentino Neves entre janeiro/2016 a janeiro/2019. Os dados coletados para análise foram: sexo, idade, lado acometido, cirurgia realizada, complicações pós-operatórias. RESULTADOS: De janeiro de 2016 a janeiro de 2019, foram tratados 21 pacientes no HRTN. Houve predomínio do sexo feminino (57%), com média de idade de 12 anos. Cerca de 80% dos pacientes apresentaram quadro de epifisiólise crônica/ crônica-agudizada no primodiagnóstico. O lado esquerdo foi ligeiramente mais acometido em relação ao direito (6:5), com bilateralidade de 47%. A necrose avascular foi a complicação mais frequente, em 33% dos casos. CONCLUSÃO: Trata-se de quadro de alta morbidade associada, devendo haver um diagnóstico precoce, investigação de distúrbios endócrinos e tratamento cirúrgico adequado, visando uma melhora do prognóstico clínico e funcional do paciente. Nível de Evidência II, Estudo retrospectivo.

Methods for assessing movement path recursion with application to African buffalo in South Africa.

Recent developments of automated methods for monitoring animal movement, e.g., global positioning systems (GPS) technology, yield high-resolution spatiotemporal data. To gain insights into the processes creating movement patterns, we present two new techniques for extracting information from these data on repeated visits to a particular site or patch ("recursions"). Identification of such patches and quantification of recursion pathways, when combined with patch-related ecological data, should contribute to our understanding of the habitat requirements of large herbivores, of factors governing their space-use patterns, and their interactions with the ecosystem. We begin by presenting output from a simple spatial model that simulates movements of large-herbivore groups based on minimal parameters: resource availability and rates of resource recovery after a local depletion. We then present the details of our new techniques of analyses (recursion analysis and circle analysis) and apply them to data generated by our model, as well as two sets of empirical data on movements of African buffalo (Syncerus caffer): the first collected in Klaserie Private Nature Reserve and the second in Kruger National Park, South Africa. Our recursion analyses of model outputs provide us with a basis for inferring aspects of the processes governing the production of buffalo recursion patterns, particularly the potential influence of resource recovery rate. Although the focus of our simulations was a comparison of movement patterns produced by different resource recovery rates, we conclude our paper with a comprehensive discussion of how recursion analyses can be used when appropriate ecological data are available to elucidate various factors influencing movement. Inter alia, these include the various limiting and preferred resources, parasites, and topographical and landscape factors.

High-resolution episcopic microscopy enables three-dimensional visualization of plant morphology and development.

The study of plant anatomy, which can be traced back to the seventeenth century, advanced hand in hand with light microscopy technology and relies on traditional histologic techniques, which are based on serial two-dimensional (2D) sections. However, these valuable techniques lack spatial arrangement of the tissue and hence provide only partial information. A new technique of whole-mount three-dimensional (3D) imaging termed high-resolution episcopic microscopy (HREM) can overcome this obstacle and generate a 3D model of the specimen at a near-histological resolution. Here, we describe the application of HREM technique in plants by analyzing two plant developmental processes in woody plants: oil secretory cavity development in citrus fruit and adventitious root formation in persimmon rootstock cuttings. HREM 3D models of citrus fruit peel showed that oil cavities were initiated schizogenously during the early stages of fruitlet development. Citrus secretory cavity formation, shape, volume, and distribution were analyzed, and new insights are presented. HREM 3D model comparison of persimmon rootstock clones, which differ in their rooting ability, revealed that difficult-to-root clones failed to develop adventitious roots due to their inability to initiate root primordia.

Cancer risk associated with living at high altitude in Ecuadorian population from 2005 to 2014.

BACKGROUND AND AIMS: Cancer is a leading cause of death in Ecuador with high social and economic impact. This study aims to determinate the influence of living at a high altitude on the risk of developing or dying from cancer among the Ecuadorian population. METHODS: This is an ecological and epidemiological analysis of cancer mortality and prevalence rates, based on national data from the Ecuadorian National Statistics and Census Institute, corresponding to the period between 2005 and 2014. This study includes the analysis of various types of cancer: gastric, colorectal, hepatic/bile duct, breast, uterine/cervix, and lymphatic/hematopoietic, using rates of mortality and prevalence. Additionally, the association between the risk of getting or dying from cancer and living at high altitude was investigated. This comparison was made between the population living in Highlands, over 2000 meters above sea level, and low-lying regions. RESULTS: Living at high altitude was associated with a higher prevalence of cancer and also with a high mortality rate due to cancer. Risk of getting cancer was related to living at a higher altitude, as well as an increased risk of death by cancer: gastric (OR:1.204; p<0.001), colorectal (OR:1.421; p<0.001), hepatic/bile duct (OR:1.184; p<0.001), breast (OR:1.067; p=0.030), or lymphatic/hematopoietic neoplasms (OR:1.135; p<0.001). CONCLUSIONS: Through an epidemiologic analysis, the association between developing or dying from cancer and living at high altitude was obtained. However, further researche is needed to clarify these findings, something that could have a substantial impact on cancer prevention.

Morphometric study of adipocytes on breast cancer by means of photonic microscopy and image analysis.

Worldwide, breast cancer (BrCa) is currently the leading cause of deaths associated to malignant lesions in adult women. Given that some studies have mentioned that peritumoral adipocytes may contribute to breast carcinogenesis, present work sought to quantitative evaluate the morphometry of these cells in a group of adult women. Three thousand six hundred sixty four breast adipocytes, that came from biopsies of a group of adult females with different types of breast carcinomas (ductal, lobular, and mixed) and one with normal tissues, were evaluated through an image analysis (IA) process regarding six morphometric descriptors: area (A), perimeter (P), Feret diameter (FD ), aspect ratio (AR), roundness factor (RF), and fractal dimension of cellular contour (FDC ). Data showed that the adipocytes of the normal tissues group were bigger (A: 3398 ± 2331 µm2 , P: 239 ± 83 µm, and FD : 79.9 ± 24.5 µm) than those from BrCa samples (A: 2860 ± 1933 µm2 , P: 214 ± 66 µm, and FD : 73.2 ± 22.5 µm), and presented a more irregular contour (FDC of 1.370 ± 0.037 for normal group and of 1.335 ± 0.049 for the oncologic one). Moreover, it could be accounted that adipocytes of mixed carcinomas were largest (FD : 75.1 ± 22.4 µm) than those of lobular lesions (FD : 61.6 ± 22.6 µm), while the adipocytes of ductal carcinomas were the most oval (AR: 1.421 ± 0.524) and roughest (FDC : 1.324 ± 0.050) cells. IA results suggest that BrCa lesions can be categorized through a quantitative morphometric evaluation of peritumoral adipocytes. These findings could let the development of an analytical tool to help the Pathologist to enhance the accuracy of the oncologic diagnose.

Confiabilidade da classificação de nash & moe em pacientes com escoliose idiopática do adolescente / Confiabilidad del método de nash & moe en pacientes con escoliose idiopática del adolescente / Reliability nash and moe s grades in patients with adolescent idiopathic scoliosis

ABSTRACT: Objective: Evaluate the inter and intra-observer reliability of Nash and Moe's grades, used to assess patients diagnosed with Adolescent Idiopathic Scoliosis (AIS). Methodology: Forty-seven representative x-rays of patients with AIS were randomly selected to evaluate the apical vertebral rotation (AVR) using Nash and Moe's grades. The evaluation of the AVR was made independently in two distinct moments by two observers. The inclusion criteria in the study were a patient diagnosed with AIS and an orthostasis radiography with a good-quality image. An agreement study between the evaluations and the inter and intraobserver's reliability was determined using Kappa's statistics with a confidence interval of 95%. Results: The interobservers' Kappa's value in the first evaluation was 0,44 (CI 95%; 0,22-0,66) and 0,37 (CI 95%; 0,17-0,56) in the second. In the intraobservers' evaluations, the Kappa's value for examiner 1 was 0,61 (CI 95%; 0,40-0,81) and 0,46 (CI 95%; 0,22-0,70) for examiner 2. Conclusion: This study's results demonstrated that Nash and Moe's grades are unreliable for evaluating vertebral rotation in patients with AIS. Level of Evidence III; A Cross-Sectional Study.

RESUMO: Objetivo: Avaliar a confiabilidade inter e intraobservador da classificação de Nash & Moe, usada em pacientes diagnosticados com escoliose idiopática do adolescente (EIA). Metodologia: Quarenta e sete radiografias representativas de pacientes com EIA foram selecionadas aleatoriamente para avaliação da rotação da vértebra apical (RVA), usando a classificação de Nash & Moe. A avaliação do RVA foi realizada de forma independente em dois momentos distintos, por dois examinadores. Os critérios de inclusão no estudo foram: paciente com diagnóstico de EIA e radiografia realizada em ortostase, com imagem de boa qualidade. Foi realizado um estudo de concordância entre as avaliações, e a confiabilidade inter e intraobservador foi calculada utilizando a estatística de Kappa com intervalo de confiança (IC) de 95%. Resultados: O valor de Kappa interobservador na primeira avaliação foi de 0,44 (IC 95% de 0,22-0,66) e na segunda de 0,37 (IC 95% de 0,17 -0,56). Nas avaliações intraobservadores, o valor de Kappa para o examinador 1 foi de 0,61 (IC 95% de 0,40-0,81) e para o examinador 2 foi de 0,46 (IC 95% de 0,22-0,70). Conclusão: Os resultados deste estudo demonstraram que a classificação de Nash & Moe apresenta baixa confiabilidade na avaliação do grau de rotação vertebral em pacientes com EIA. Nível de Evidência III; Estudo Transversal.

RESUMEN: Objetivo: Evaluar la confiabilidad inter e intraobservador para la clasificación de Nash & Moe, usada para estudiar pacientes diagnosticados con Escoliosis Idiopática del Adolescente (EIA). Metodología: Cuarenta y siete radiografías representativas de pacientes con EIA fueron seleccionadas aleatoriamente para evaluación de la rotación de la vértebra apical (RVA) usando la clasificación de Nash & Moe. La evaluación fue hecha de modo independiente en dos momentos distintos, por dos evaluadores. Los criterios de inclusión en el estudio fueron: paciente con diagnóstico de EIA y radiografía realizada en ortostasis, con buena calidad de imagen. Se realizó un estudio de concordancia entre las evaluaciones y se calculó la fiabilidad interobservador e intraobservador mediante la estadística de Kappa con un intervalo de confianza (IC) del 95%. Resultados: El valor Kappa interobservador en la primera evaluación fue de 0,44 (IC 95%: 0,22-0,66) y en la segunda de 0,37 (IC 95%: 0,17 -0,56). En las evaluaciones intraobservador, el valor Kappa para el examinador 1 fue de 0,61 (IC 95%: 0,40-0,81) y para el examinador 2 fue de 0,46 (IC 95%: 0,22-0,70). Conclusión: Los resultados de este estudio demostraron que la clasificación de Nash & Moe tiene una baja fiabilidad para evaluar el grado de rotación vertebral en pacientes con EIA. Nivel de Evidencia III; Estudio Transversal.

Métodos diagnósticos de VPH para la prevención del cáncer cérvico uterino en Ecuador

Resumen El cáncer cérvico uterino (CCUes la segunda causa de muerte en mujeres entre los 35 y 64 años en Ecuador. La intervención en salud sugiere el diagnóstico temprano de la infección con el Virus del Papiloma Humano (VPH) y el estado citológico de células epiteliales cervicales. El VPH se considera la causa etiológica principal del 99 % del CCU. Objetivo . Valorar el diagnóstico del CCU a partir del empleo de métodos citológicos y moleculares en mujeres de Ecuador. Métodos . Revisión sistemática sobre diagnóstico de VPH y prevención del CCU. La búsqueda abarcó artículos originales en inglés y español desde 2010-2020. Se emplearon bases de datos como Pudmed, Scielo, Elsevier, Redalyc y Scopus. Resultados . La citología como método de tamizaje primario ha disminuido la incidencia de CCU, aunque su baja sensibilidad pone límites a la eficacia. La implementación de métodos moleculares ha permitido detectar diferentes genotipos y obtener confiabilidad en los resultados, pero su accesibilidad se encuentra limitada en poblaciones con bajos recursos financieros. El poco conocimiento y la aplicación de métodos heterogéneos dificultan que se realice un diagnóstico temprano como prevención de la infección y su relación con el CCU. Conclusiones . El diagnóstico certero del CCU es una necesidad urgente en el ámbito ecuatoriano. La combinación de métodos como el PAP y los métodos moleculares de identificación del VPH pueden ser herramientas suficientes a tal efecto. La valoración adecuada de la técnica de genotipificación a emplear es relevante con la finalidad de asegurar un método de diagnóstico sensible, específico y accesible a la mujer ecuatoriana.

Abstract Cervical uterine cancer (CUC) is considered the second cause of death in women between the ages of 35 and 64 in Ecuador. Health intervention suggests early diagnosis of Human Papillomavirus (HPV) infection and cytological status of cervical epithelial cells. HPV is considered the main etiological cause of 99% of CCU. Objective . To assess the diagnosis of CCU from the use of cytological and molecular methods in women from Ecuador. Methods . Thematic review on HPV diagnosis and CCU prevention. The search covered original articles in English and Spanish from 2010-2020. Databases such as Pudmed, Scielo, Elsevier, Redalyc, Scopus were used. Resulted . Cytology as a primary screening method has decreased the incidence of CCU, although its low sensitivity limits efficacy. The implementation of molecular methods has made it possible to detect different genotypes and obtain reliability in the results, but their accessibility is limited in populations with low financial resources. The little knowledge and the application of heterogeneous methods makes it difficult to make an early diagnosis to prevent infection and its relationship with CCU. Conclusions . The accurate diagnosis of CCU is an urgent need in the Ecuadorian environment. The combination of methods such as PAP and molecular methods for HPV identification may be sufficient tools for this purpose. Adequate assessment of the genotyping technique to be used is relevant in order to ensure a sensitive, specific and accessible diagnostic method for Ecuadorian women.

Resumo O câncer cervical uterino (CUC) é considerado a segunda causa de morte em mulheres entre 35 e 64 anos no Equador. A intervenção em saúde sugere o diagnóstico precoce da infecção pelo papilomavírus humano (HPV) e o estado citológico das células epiteliais cervicais. O HPV é considerado a principal causa etiológica de 99% das UCC. Objetivo : Avaliar o diagnóstico de CCU a partir do uso de métodos citológicos e moleculares em mulheres equatorianas. Métodos . Revisão temática sobre diagnóstico de HPV e prevenção de CCU. A pesquisa cobriu artigos originais em inglês e espanhol de 2010-2020. Bancos de dados como Pudmed, Scielo, Elsevier, Redalyc, Scopus foram usados. Resultados . A citologia como método de rastreamento primário diminuiu a incidência de CCU, embora sua baixa sensibilidade limite a eficácia. A implementação de métodos moleculares tem permitido detectar diferentes genótipos e obter confiabilidade nos resultados, mas sua acessibilidade é limitada em populações com poucos recursos financeiros. O pouco conhecimento e a aplicação de métodos heterogêneos dificultam o diagnóstico precoce para prevenção da infecção e sua relação com o CCU. Conclusões : O diagnóstico preciso do CCU é uma necessidade urgente no meio ambiente equatoriano. A combinação de métodos como PAP e métodos moleculares para identificação do HPV podem ser ferramentas suficientes para esse fim. A avaliação adequada da técnica de genotipagem a ser utilizada é relevante para garantir um método diagnóstico sensível, específico e acessível para as mulheres equatorianas.

A post-treatment retrospective evaluation of slipped capital femoral epiphysis / Avaliação pós-tratamento de epifisiólise proximal do fêmur: estudo retrospectivo

ABSTRACT Objective: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. Methods: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. Results: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. Conclusion: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients' clinical and functional outcome. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Analisar os casos de epifisiólise do fêmur proximal operados pelo serviço de Ortopedia Pediátrica do Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, entre os anos de 2016 e 2019. Métodos: Foram analisados retrospectivamente os pacientes submetidos a tratamento cirúrgico de epifisiólise no Hospital Risoleta Tolentino Neves entre janeiro/2016 a janeiro/2019. Os dados coletados para análise foram: sexo, idade, lado acometido, cirurgia realizada, complicações pós-operatórias. Resultados: De janeiro de 2016 a janeiro de 2019, foram tratados 21 pacientes no HRTN. Houve predomínio do sexo feminino (57%), com média de idade de 12 anos. Cerca de 80% dos pacientes apresentaram quadro de epifisiólise crônica/ crônica-agudizada no primodiagnóstico. O lado esquerdo foi ligeiramente mais acometido em relação ao direito (6:5), com bilateralidade de 47%. A necrose avascular foi a complicação mais frequente, em 33% dos casos. Conclusão: Trata-se de quadro de alta morbidade associada, devendo haver um diagnóstico precoce, investigação de distúrbios endócrinos e tratamento cirúrgico adequado, visando uma melhora do prognóstico clínico e funcional do paciente. Nível de Evidência II, Estudo retrospectivo.

Score PELOD-2, predictor de Mortalidad en Pacientes ingresados en la Unidad de Cuidados Intensivos en el Hospital Baca Ortiz desde Marzo hasta Agosto de 2018 / PELOD-2Score, Predictor of Mortality of Patients admitted to the Intensive Care Unit in the Baca Ortiz Hospital from March to August 2018

Introducción: El síndrome de disfunción multiorgánica (SDMO) es la falla de dos o más órganos en pacientes críticamente enfermos, por lo que se han creado puntajes que permiten estimar su mortalidad. El objetivo del presente estudio fue determinar el valor diagnóstico de la escala Disfunción Pediátrica Logística de órganos-2 (PELOD-2) como predictor de mortalidad en los pacientes ingresados en la Unidad de Cuidados Intensivos (UCIP) en el Hospital Baca Ortiz. Métodos: Este estudio observacional analítico fue realizado en la UCI del Hospital Pediátrico Baca Ortiz , Quito-Ecuador en Marzo a Agosto 2018. Se incluyeron todos los posibles casos analizables. Las variables edad gestacional, sexo, variables clínicas del puntaje PELOD-2 y mortalidad. El Grupo 1 (G1): niños con fallecimiento, Grupo 2 (G2): niños vivos. Se calculó Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP), Valor Predictivo Negativo (VPN) de cada Puntaje. Resultados: 188 casos fueron incluidos. Fueron 97 mujeres (51.6%). Pacientes de 1 a 4 años de edad 66/188 (35.1%) Con falla respiratoria 100 casos/188 (53.7%). Mortalidad de 35 casos/188 (18.6% IC 95% 18.21-19.02%). PELOD2>16mortalidad 63%. OR 511.7 (IC95% 29.4-8909) P<0.0001. S:62.9%, E:100%, VPP:100%, VPN:92.2%. Exactitud: 93.1%. Conclusión: El puntaje PELOD-2 es un predictor de mortalidad aceptable, y altamente específico

Introduction: The multiorgan dysfunction syndrome (MOMS) is the failure of two or more organs in critically ill patients, for which scores have been created that allow estimating their mortality. The objective of this study was to determine the diagnostic value of the "Pediatric Logistic Organ Dysfunction- -2) scale as a predictor of mortality in patients admitted to the Intensive Care Unit (PICU) at Baca Ortiz Hospital. Methods: This analytical observational study was carried out in the ICU of the Pediatric Hospital "Baca Ortiz", Quito-Ecuador from March to August 2018. All possible analysable cases were included. The variables gestational age, sex, clinical variables of the PELOD-2 score and mortality. Group 1 (G1): children with death, Group 2 (G2): living children. Sensitivity (S), Specificity (E), Positive Predictive Value (PPV), Negative Predictive Value (NPV) of each Score were calculated. Results: 188 cases were included. There were 97 women (51.6%). Patients aged 1 to 4 years 66/188 (35.1%) With respiratory failure 100 cases / 188 (53.7%). Mortality of 35 cases / 188 (18.6% 95% CI 18.21- 29.4-8909) P <0.0001. S: 62.9%, E: 100%, PPV: 100%, NPV: 92.2%. Accuracy: 93.1%. Conclusion: The PELOD-2 score is an acceptable and highly specific predictor of mortality

Quiste Óseo Aneurismático en Clavícula: Reporte de un caso / Clavicle Aneurysmal Bone Cyst, Case Report

Introducción:El quiste óseo aneurismático es una neoplasia benigna poco común de aparición en edad temprana. Tiene mayor incidencia en huesos largos y en la columna vertebral. Su etiología es incierta, aunquesuele asociarse a traumatismo, probablemente debido a obstrucción venosa o a la formación de fístulas que se producen tras la contusión. Caso:En este estudio se presenta el caso de un paciente de 15 años sin antecedentes de trauma que presenta un quiste óseo aneurismático en clavícula, localización poco habitual para esta patología. Evolución: Se le brindótratamiento con terapia esclerosante con Polidocanol al 3% por 8 ocasiones con respuesta favorable.No ha requerido cirugía hasta el momento. Conclusión:El tratamientoesclerosante fue exitoso en este informe de casos

Introduction: The aneurysmal bone cyst is a rare benign neoplasm that appears at an early age. It has a higher incidence in long bones and in the spine. Its etiology is uncertain, although it is usually associated with trauma, probably due to venous obstruction or the formation of fistulas that occur after contusion. Case: This study presents the case of a 15-year-old patient with no history of trauma who presents with an aneurysmal bone cyst in the clavicle, an unusual location for this pathology. Evolution: Treatment with sclerosing therapy with 3% Polidocanol was given 8 times with a favorable response. He has not required surgery so far. Conclusion: Sclerosing treatment was successful in this case report

Contaminación de líquido de preservación en trasplante renal. Reporte y revisión de la literatura / Contamination of preservation fluid in kidney transplant. Report and literature review

Resumen La enfermedad renal crónica es un problema de salud pública con una alta morbilidad y mortalidad. El trasplante renal es una de las actuales alternativas terapéuticas. Se incluyen en este artículo 12 trabajos publicados referentes a la contaminación del líquido de preservación en trasplante renal, 4 reportes de caso, y 8 estudios de prevalencia. En este estudio la prevalencia de contaminación de líquido de preservación para cualquier microorganismo varió entre 17,43 % a 59,72 %, mientras que para los limitados al reporte de Candida sp, la frecuencia varió de 1,69 % a 8,57 %. En los reportes de caso, todos fueron asociados a la infección por Candida sp, con arteritis de la arteria renal y pérdida del injerto como las complicaciones más frecuentes. En nuestra institución, Hospital de Especialidades de las Fuerzas Armadas N°1, de un total de 59 pacientes trasplantados se aisló al menos un microorganismo en 20 casos (28,17 %). Con estos resultados sugerimos que la contaminación del líquido de preservación es un fenómeno frecuente en trasplante renal, sin embargo al no poseer publicaciones en las que se describan las complicaciones asociadas a la infección por otros microorganismos, creemos que la contaminación por Candida sp, a pesar de no tener una gran frecuencia, es clínicamente la más relevante.

Abstract Chronic kidney disease is a public health problem with high morbidity and mortality, kidney transplantation being one of the current therapeutic alternatives. In12 published works concerning the contamination of the preservation fluid in kidney transplant, four case reports, and eight prevalence studies. The prevalence of preservation liquid contamination for any microorganism ranged from 17.43% to 59.72%, while for those limited to the Candida sp report, the frequency varied from 1.69% to 8.57%. In the case reports, all were associated with Candida infection, with renal artery arteritis and graft loss as the most frequent complications. In our institution, of a total of 59 transplant patients, at least one microorganism was isolated in 20 cases (28.17%). Preservation fluid contamination is a frequent phenomenon in kidney transplantation. However, since no publications are describing the complications associated with infection by other microorganisms, we could say that contamination by Candida sp, despite not having a high prevalence, it is clinically the most relevant.

Dysentery by CTX-M Type ESBL Producing Shigella flexneri / Disentería por Shigella flexneri productora de BLEE tipo CTX-M

According to the World Health Organization, diarrheal infections cause 525 000 deaths of children under five years of age every year, and shigellosis. Shigellosis is a relevant cause of dysentery, which increases the morbidity and mortality in pediatric patients. Therefore, emergingthe emergence of antimicrobial resistant strains of Shigella is a concerningworrisome problem worldwide. We report the case of a 7-year-old patient with acute dysentery caused by CTX-M Type ESBL Producing Shigella flexneri, being. This was the first case treated in the Specialties Hospital of Specialties of the Armed Forces N°1, in Quito, Ecuador. The antibiogram demonstrated sensibilityshowed sensitivity to ampicillin-sulbactam. As a result, after five days of microbiologically directed treatment, the patient improved his condition without relapse. Proper clinical diagnoses and accurate laboratory studies like stool culture and antibiogram are crucial to givingindicate an appropriate therapy in infections caused by Shigella and other enteric bacilli(AU)

Según la Organización Mundial de la Salud, las infecciones diarreicas provocan 525 000 muertes de niños menores de cinco años de edad cada año. La shigelosis es una causa importante de disentería que aumenta la morbilidad y mortalidad de los pacientes pediátricos. Es por eso que el surgimiento de cepas de Shigella resistentes a los antibióticos es un preocupante problema a nivel mundial. Presentamos el caso de un paciente de 7 años de edad con disentería aguda provocada por Shigella flexneri productora de BLEE tipo CTX-M. Se trata del primer caso tratado en el Hospital de Especialidades de las Fuerzas Armadas Nº 1, en Quito, Ecuador. El antibiograma mostró sensibilidad a la combinación ampicilina/sulbactam. Al cabo de cinco días de tratamiento microbiológico, el paciente mejoró su estado y no se produjeron recaídas. Un diagnóstico clínico correcto, así como estudios precisos de laboratorio como los cultivos de heces y los antibiogramas, son vitales para indicar una terapia apropiada en las infecciones causadas por Shigella y otros bacilos entéricos(AU)