Biomimetic Non-Heme Iron-Catalyzed Epoxidation of Challenging Terminal Alkenes Using Aqueous H2O2 as an Environmentally Friendly Oxidant.

Catalysis mediated by iron complexes is emerging as an eco-friendly and inexpensive option in comparison to traditional metal catalysis. The epoxidation of alkenes constitutes an attractive application of iron(III) catalysis, in which terminal olefins are challenging substrates. Herein, we describe our study on the design of biomimetic non-heme ligands for the in situ generation of iron(III) complexes and their evaluation as potential catalysts in epoxidation of terminal olefins. Since it is well-known that active sites of oxidases might involve imidazole fragment of histidine, various simple imidazole derivatives (seven compounds) were initially evaluated in order to find the best reaction conditions and to develop, subsequently, more elaborated amino acid-derived peptide-like chiral ligands (10 derivatives) for enantioselective epoxidations.

X-ray crystallographic structure of a novel enantiopure chiral isothiourea with potential applications in enantioselective synthesis.

The synthesis of a chiral isothiourea, namely, (4aR,8aR)-3-phenyl-4a,5,6,7,8,8a-hexahydrobenzo[4,5]imidazo[2,1-b]thiazol-9-ium bromide, C15H17N2S+·Br-, with potential organocatalytic and anti-inflammatory activity is reported. The preparation of the heterocycle of interest was carried out in two high-yielding steps. The hydrobromide salt of the isothiourea of interest provided suitable crystals for X-ray diffraction analysis, the results of which are reported. Salient observations from this analysis are the near perpendicular arrangement of the phenyl ring and the mean plane of the heterocycle. This conformational characteristic may be relevant with regard the stereoselectivity induced by the chiral isothiourea in asymmetric reactions. Furthermore, evidence was found for the existence of an S...Br- halogen bond.

Synthesis of charged bis-heteroaryl donor-acceptor (D-A+) NLO-phores coupling (π-deficient-π-excessive) heteroaromatic rings.

Charged chromophores based on heteroaromatic cations were prepared by reaction of alkylazinium salts with N-heteroarylstannanes under Stille conditions. This approach provides easy access to potential single donor D-A(+) chromophores in which the acceptor moiety A(+) is the pyridinium cation and the donors are different π-excessive N-heterocycles. The ß hyperpolarizabilities were measured in hyper-Rayleigh scattering experiments and the experimental data are supported by a theoretical analysis that combines a variety of computational procedures, including density functional theory and correlated Hartree-Fock-based methods. In some chromophores, the absence of a bridge between donor and acceptor fragments increases the NLO properties.

Donor-(π-bridge)-azinium as D-π-A+ one-dimensional and D-π-A(+)-π-D multidimensional V-shaped chromophores.

Heteroaromatic cations reacted with N-heteroarylacetylenes under Sonogashira conditions to allow easy access to potential single donor D-π-A(+) and V-shaped D-π-A(+)-π-D chromophores, where the acceptor moiety A is the π-deficient pyridinium cation and the donor moiety is represented by different π-excessive N-heterocycles. The ß hyperpolarizabilities were measured using hyper-Rayleigh scattering experiments and the experimental data are supported by a theoretical analysis that combines a variety of computational procedures, including Density Functional Theory (DFT) and correlated Hartree-Fock-based methods (RCIS(D)).

Ayudas cognitivas en quirófano. Experiencia del Departamento de Anestesia en el Centro Médico ABC / Cognitive aids in the operating room. Experience of the Anesthesia Department at ABC Medical Center

Resumen: Los manuales de emergencia desarrollados a partir de las ayudas cognitivas son componente esencial dentro de la sala de operaciones para el manejo oportuno de crisis, con la ventaja de disminuir los errores por omisión. El propósito de esta redacción fue retomar la experiencia mundial actualizada con los mismos y compararla con la del Centro Médico ABC. El proceso de recolección de datos se hizo mediante una encuesta a través de Google Forms; los datos obtenidos de la encuesta se convirtieron en porcentajes y se usaron para resumir las variables categóricas. Los resultados mostraron que la mayoría de los médicos tenían conocimiento de esta herramienta en quirófano y más de la mitad en efecto lo utilizaron en situaciones críticas. Las situaciones más descritas fueron: broncoespasmo, choque anafiláctico y sospecha de hipertermia maligna.

Abstract: The emergency manuals based on cognitive aids are an essential component within the operating room for timely crisis management, with the advantage of reducing errors due to omission. The purpose of this writing was to resume the current world experience with them and compare it with the ABC Medical Center. The data obtained from the survey were converted into percentages and used to summarize the categorical variables. The results showed that most doctors were aware of this tool in the operating room and more than a half actually used it in critical situations. The most described situations were: bronchospasm, anaphylactic shock and suspicion of malignant hyperthermia.

Consumo de hierbas medicinales para aliviar síntomas de afecciones respiratorias y COVID-19 / Use of medicinal herbs to relieve symptoms of respiratory conditions and COVID-19 / Uso de ervas medicinais para aliviar sintomas de doenças respiratórias e COVID-19

Con el brote de COVID-19, se incrementó el consumo de plantas medicinales a raíz de su fácil, económica disponibilidad y conocimientos empíricos de sus propiedades medicinales y efectos terapéuticos para algunas enfermedades. Esta realidad de consumo de hierbas medicinales para aliviar síntomas de afecciones respiratorias y COVID-19, motivó la presente investigación. Objetivo. Determinar el grado de asociación entre el consumo de hierbas medicinales y su efecto en alivio de síntomas del virus. Materiales y método. La metodología se basa en estudio descriptivo, enfoque cuantitativo, prospectivo. Se recolectó los datos desde febrero hasta mayo del 2021 con una muestra de 400 personas que comprendió ambos sexos. Se encuestó sobre ¿Qué hierbas medicinales consumieron en forma de infusión? y ¿Con qué frecuencia consumen para aliviar los síntomas relacionados a afecciones respiratorias y COVID-19? Resultados. Los resultados determinaron que las hierbas medicinales de mayor consumo fueron Matico (Buddleja globosa), Eucalipto (Eucalyptus globulus), Escorzonera (Perezia multiflora) y Huamanripa (Senecio tephrosioides); con una frecuencia de 2 a 3 veces por día y 4 o 5 días por semana; marzo se obtuvo 3% consumo de Huamanripa y mayo 6% de hierbas combinada para afecciones respiratorias y COVID-19 respectivamente, febrero con 29% para afecciones respiratorias y mayo con 73% para dolencias del COVID-19. Sintieron alivio al ingerir infusiones de hierbas medicinales en mayo con 79% y coeficiente de determinación de 0.9984 que indica una alta asociación. Conclusiones. Al analizar los datos entre consumo de hierbas medicinales y alivio de síntomas de COVID-19, se obtuvo una alta correlación; por lo tanto, indica que alivia los síntomas.

With the outbreak of COVID-19, the consumption of medicinal plants increased due to their easy, inexpensive availability and empirical knowledge of their medicinal properties and therapeutic effects for some diseases. This reality of consumption of medicinal herbs to alleviate symptoms of respiratory conditions and COVID-19, motivated the present investigation. Objective. To determine the degree of association between the consumption of medicinal herbs and their effect in relieving symptoms of the virus. Materials and method. The methodology is based on a descriptive study, quantitative approach, prospective. Data were collected from February to May 2021 with a sample of 400 people comprising both sexes. A survey was conducted on What medicinal herbs did they consume in the form of infusion? and How often do they consume them to alleviate symptoms related to respiratory conditions and COVID-19? Results. The results determined that the most consumed medicinal herbs were Matico (Buddleja globosa), Eucalyptus (Eucalyptus globulus), Escorzonera (Perezia multiflora) and Huamanripa (Senecio tephrosioides); with a frequency of 2 to 3 times per day and 4 or 5 days per week; In March there was 3% consumption of Huamanripa and May 6% of combined herbs for respiratory conditions and COVID-19 respectively, February with 29% for respiratory conditions and May with 73% for COVID-19 ailments. They felt relief by ingesting medicinal herbal infusions in May with 79% and coefficient of determination of 0.9984 indicating a high association. Conclusions. When analyzing the data between consumption of medicinal herbs and relief of COVID-19 symptoms, a high correlation was obtained; therefore, it indicates that it relieves symptoms.

Com o surgimento da COVID-19, o consumo de plantas medicinais aumentou devido à sua disponibilidade fácil e barata e ao conhecimento empírico de suas propriedades medicinais e efeitos terapêuticos para algumas doenças. Esta realidade de consumo de ervas medicinais para aliviar os sintomas de problemas respiratórios e a COVID-19 motivou a presente pesquisa. Objetivo. Para determinar o grau de associação entre o consumo de ervas medicinais e seu efeito no alívio dos sintomas do vírus. Materiais e método. A metodologia é baseada em um estudo descritivo, quantitativo e prospectivo. Os dados foram coletados de fevereiro a maio de 2021 com uma amostra de 400 pessoas de ambos os sexos. Pesquisamos quais ervas medicinais eles consumiram na forma de chá de ervas e com que freqüência consumiram para aliviar os sintomas relacionados às condições respiratórias e à COVID-19. Resultados. Os resultados determinaram que as ervas medicinais mais consumidas foram matico (Buddleja globosa), Eucalyptus (Eucalyptus globulus), Escorzonera (Perezia multiflora) e Huamanripa (Senecio tephrosioides); com uma freqüência de 2 a 3 vezes por dia e 4 a 5 dias por semana; Março teve 3% de consumo de Huamanripa e maio 6% de ervas combinadas para doenças respiratórias e COVID-19 respectivamente, fevereiro com 29% para doenças respiratórias e maio com 73% para doenças COVID-19. Eles sentiram alívio ao ingerir chás de ervas em maio com 79 % e um coeficiente de determinação de 0,9984 indicando uma alta associação. Conclusões. Ao analisar os dados entre o consumo de ervas medicinais e o alívio dos sintomas da COVID-19, foi obtida uma alta correlação; portanto, indica que ela alivia os sintomas.

Analgesia obstétrica en la paciente con síndrome de Stickler: un reporte de caso y revisión de la literatura / Obstetric analgesia in the patient with Stickler syndrome: a case report and review of the literature

Resumen: El síndrome de Stickler tiene una incidencia de uno en 7,500-9,000 recién nacidos. Es una enfermedad del tejido conectivo con patrón de herencia autosómico dominante en la mayoría de los casos, aunque también con patrón recesivo, por afección patogénica de genes procolágeno como COL2A1, COL11A1, entre otros. Cursa con manifestaciones multisistémicas craneofaciales, oculares, auditivas, esqueléticas/articulares y se ha asociado a prolapso de la válvula mitral. Se diferencian tres tipos: tipo I (el más frecuente, 75%) o síndrome de Stickler completo, tipo II o síndrome de Stickler ocular y el tipo III u oto-espóndilo-displasia megaepifisaria. El diagnóstico se realiza al probar las manifestaciones o al demostrar una variante genética patogénica. Respecto al manejo anestésico en la paciente obstétrica, se recomienda evitar la anestesia general. Se presenta el caso de una paciente de 26 años con diagnóstico de síndrome de Stickler tipo I, con embarazo a término y su relación con la anestesia neuroaxial. A pesar de su incidencia, no existe literatura médica acerca del manejo de la anestesia neuroaxial en este tipo de pacientes.

Abstract: Stickler syndrome has an incidence of 1/7.500-9.000 in newborns. It is a connective tissue disease with an autosomal dominant inheritance pattern in most cases, but also with a recessive pattern, due to the pathogenic involvement of procollagen genes such as COL2A1, COL11A1, among others. It is characterized by craniofacial, ocular, auditory and skeletal/joint multisystemic signs and symptoms, and has been associated with prolapse of the mitral valve. Three types are differentiated: type I (the most frequent, 75%) or complete Stickler syndrome, type II or ocular Stickler syndrome and type III or oto-espondilo-megaepiphyseal dysplasia. The diagnosis is made by confirming the signs and symptoms or by verifying the presence of a pathogenic genetic variant. With respect to the anesthetic management in the obstetric patient, it is recommended to avoid general anesthesia. The article illustrates the case of a female patient of 26 years with Stickler syndrome type I and full-term pregnancy, and associated implications for neuroaxial anesthesia. Despite its incidence, there is no medical literature on the management of neuraxial anesthesia in this type of patients.

Impacto de la presión de distensión alveolar en los pacientes con síndrome de distrés respiratorio agudo (SDRA): revisión narrativa / Impact of alveolar distention pressure on days under mechanical ventilation in patients with acute respiratory distress syndrome (SDRA) / Impacto da pressão da distensão alveolar em pacientes com síndrome do desconforto respiratório agudo (SDRA): revisão narrativa

Resumen: Introducción: El síndrome de distrés respiratorio agudo (SDRA) se caracteriza por una heterogeneidad del daño en el parénquima pulmonar; la asociación entre el volumen tidal (Vt) y la distensibilidad pulmonar estática (Cst) puede ser evaluada mediante la presión de distensión (PD). Se desconoce hasta el día de hoy si el control de la PD impacta en otros objetivos, tales como la disminución de los días bajo ventilación mecánica. Material y métodos: Se realizó una revisión de artículos médicos científicos en Pubmed, EMBASE y Medigraphic con las siguientes palabras clave: «driving pressure¼ y «acute respiratory distress syndrome¼ para relacionar la PD y los días libres de ventilación mecánica en los principales estudios sobre SDRA; se analizaron las variables respiratorias reportadas por estas publicaciones y se tomaron estudios de revisión, revisiones sistematizadas y metaanálisis, lo cual fue evaluado por seis de los autores principales. Resultados: Se encontró en la revisión sistematizada la siguiente relación: los pacientes ventilados con SDRA y PD < 15 cmH2O se asociaban con menos días de ventilación mecánica con un valor de p = 0.03; los pacientes ventilados con SDRA y PD < 15 cmH2O, al comparar la mortalidad a 90 días, la disminuían, tomando un valor de p ≤ 0.0001; los pacientes sin SDRA y PD < 15 cm cmH2O, comparando la mortalidad a 28 días con una p = 0.005, las complicaciones pulmonares postoperatorias, la PD < 15 cmH2O y los valores de PD mayores a 15 cmH2O se asociaron con barotrauma, infecciones pulmonares postoperatorias, con una p ≤ 0.0001; en supervivencia y mortalidad a los 90 días, se correlacionó con una razón de momios (RM) de 0.60 a favor de PD < 15 cmH2O, y en mortalidad a 28 días con una RM de 0.29 a favor de la PD menor, al valor de corte. Conclusión: La PD se asocia con mortalidad de manera directamente proporcional y los valores más bajos de PD se asocian con menos días de ventilación mecánica.

Abstract: Introduction: ARDS is characterized by a heterogeneity of damage in the lung parenchyma and the association between tidal volume (Vt) and static lung compliance (Cst) can be evaluated by DP. Most studies on DP and ARDS focus on mortality, showing a lower percentage of survival while the level of DP is higher, however, it is unknown until today whether the control of DP impacts on other objectives such as decrease of days under mechanical ventilation. Material and methods: A systematic review of medical articles in Pubmed, EMBASE and Medigraphic was carried out with key words: driving pressure and acute respiratory distress syndrome to relate DP and days free of mechanical ventilation in the main studies on ARDS, analyzing the respiratory variables reported by these publications. Results: The relationship was found in the systematized review; that patients ventilated with ARDS and DP < 15 cmH2O was associated with fewer days of mechanical ventilation with a p = 0.03, patients with ARDS and DP < 15 cmH2O comparing mortality at 90 days, decreased their mortality with p ≤ 0.0001, patients without ARDS and PD < 15 cm cmH2O comparing mortality at 28 days with p = 0.005, patients with ARDS and DP association of postoperative pulmonary complications and DP < 15 cmH2O, DP values greater than 15 cmH2O was associated with barotrauma, postoperative pulmonary infections, with a p ≤ 0.0001 of, in survival and mortality at 90 days, correlated with a odds ratio (OR) of 0.60 in favor of DP less than 15 cmH2O and in mortality at 28 days with an OR of 0.29, in favor of DP below 15 cmH2O. Discussion: DP is associated with mortality in a directly proportional way. Conclusion: Lower values of DP are associated with fewer days of mechanical ventilation.

Resumo: Introdução: A SDRA é caracterizada pela heterogeneidade do dano do parênquima pulmonar e a associação entre volume corrente (Vt) e complacência pulmonar estática (Cst) pode ser avaliada por pressão de distensão alveolar (PD). Não se sabe até hoje se o controle da PD afeta outros objetivos, como redução de dias sob ventilação mecânica. Material e métodos: Foi realizada uma revisão de artigos médicos científicos no Pubmed, EMBASE e Medigraphic com palavras-chave: pressão de distensão e síndrome do desconforto respiratório agudo para relacionar PD e dias sem ventilação mecânica nos principais estudos de SDRA, analisando as variáveis relatados por essas publicações, realizando estudos de revisão, revisões sistemáticas e meta-análises, sendo avaliados por 6 dos principais autores. Resultados: A relação foi encontrada na revisão sistemática; que ventilaram pacientes com SDRA e PD < 15 cmH2O estiveram associados a menos dias de ventilação mecânica com p = 0.03, pacientes ventilados com SDRA e PD < 15 cmH2O comparando a mortalidade em 90 dias, sua mortalidade diminuiu com p ≤ 0.0001, pacientes sem SDRA e PD < 15 cm cmH2O comparando mortalidade em 28 dias com p = 0.005, associação de complicações pulmonares pós-operatórias e PD < 15 cmH2O, valores de PD maiores que 15 cmH2O foram associados a traumatismo barro, infecções pulmonares pós-operatórias , com p ≤ 0.0001 de, na sobrevida e mortalidade aos 90 dias, foi correlacionada com uma Odds Ratio (RM) de 0.60 a favor da PD menor que 15 cmH2O e na mortalidade aos 28 dias com uma RM de 0.29, a favor do PD menor que o valor de corte. Conclusão: a PD está associada à mortalidade de maneira diretamente proporcional. e valores mais baixos de PD estão associados a menos dias de ventilação mecânica.

[Spontaneous spinal epidural hematoma. A case report]. / Hematoma epidural espinal espontáneo. Reporte de un caso.

Spontaneous spinal epidural hematoma (SSEH) is a rare entity. We report a case of thoracolumbar SSEH in a 69 years-old woman, that occurred in 2005 without an etiologic factor to justify it. She recovered ad integrum after surgical decompressive treatment. We reviewed and discussed etiology, presentation, diagnostic approaches, and treatment.

NHE1, NHE2, and NHE4 contribute to regulation of cell pH in T84 colon cancer cells.

The isoforms of the Na+/H+ exchanger present in T84 human colon cells were identified by functional and molecular methods. Cell pH was measured by fluorescence microscopy using the probe BCECF. Based on the pH recovery after an ammonium pulse and determination of buffering capacity of these cells, the rate of H+ extrusion (JH) was 3.68 mM/min. After the use of the amiloride derivative HOE-694 at 25 microM, which inhibits the isoforms NHE1 and NHE2, there remained 43% of the above transport rate, the nature of which was investigated. Evidence of the presence of NHE1, NHE2, and NHE4 was obtained by reverse transcriptase polymerase chain reaction (RT-PCR) (mRNA) and Western blot. There was no decrease of JH by the NHE3 inhibitor S3226 (1 microM) and no evidence of this isoform by RT-PCR was found. The following functional evidence for the presence of NHE4 was obtained: 25 microM EIPA abolished JH entirely, but NHE4 was not inhibited at 10 microM; substitution of Na by K increased the remainder, a property of NHE4; hypertonicity also increased this fraction of JH. Cl--dependent NHE was not detected: in 0 Cl- solutions JH was increased and not reduced. In 0 Cl- cell volume decreased significantly, which was abolished by the Cl- channel blocker NPPB, indicating that the 0 Cl- effect was because of reduction of cell volume. In conclusion, T84 human colon cells contain three isoforms of the Na+/H+ exchanger, NHE1, NHE2, and NHE4, but not the Cl-dependent NHE.

Increased NHE1 expression is associated with serum deprivation-induced differentiation in immortalized rat proximal tubule cells.

We studied the proton secretion mechanisms involved with pHi regulation in immortalized rat proximal tubule cells (IRPTC), a SV40-immortalized cell line derived from rat proximal tubule, and characterized the effects of serum deprivation on them. Using pHi measurements with the fluorescent probe BCECF, we demonstrated that the IRPTC express both Na+/H+ exchanger and H+-ATPase, but only NHE1 is modulated by serum deprivation. In these cells, 24 h of serum starvation increased pHi from 7.08+/-0.008 (n=34) to 7.18+/-0.018 (n=33) as well as the pH recovery rate from intracellular acidification with NH4Cl from 0.29+/-0.022 pH U/min (n=14) to 0.50+/-0.024 pH U/min (n=14), without modifying their buffering capacity. These effects were followed by several modifications in morphological features, indicating an increase in differentiation status. The altered activity of NHE1 was consistent with an increase of both transcription and translation of the antiporter, as the utilization of actinomycin D and cycloheximide significantly inhibited the upregulation of NHE1 induced by serum withdrawal. Inhibition of tyrosine phosphorylation by genistein blocked the serum deprivation-dependent activation of NHE. Moreover, the pharmacological inhibition of MEK1/2, the upstream activator of ERK1/2 by UO-126, significantly inhibited the stimulatory effect of serum starvation on Na+/H+ exchanger activity, whereas the putative p38 MAPK inhibitor SB-203580 failed to cause any effect on pHi recovery rates. Our findings indicate that during IRPTC differentiation by serum deprivation, there was a net enhancement of NHE1 activity. This upregulation of NHE by serum removal was consistent with an increase of RNA and protein synthesis of the exchanger, which depends on tyrosine kinase phosphorylation and ERK pathway activation.

¿Es importante vigilar la temperatura durante el transanestésico? / Is it important to take under control the body temperature during the anesthetic procedure?

La importancia de la temperatura corporal fue inicialmente reconocido por Hipócrates, pero fue hasta el Siglo XIX cuando se utilizó como parte del monitoreo médico. Es bien conocido en la actualidad que las drogas anestésicas pueden producir alteraciones del centro termorregulador que conllevan con mayor frecuencia a disminución de la temperatura durante el acto anestésico-quirúrgico ya sea de manera intencionada (cirugía cardíaca) o no intencionada. Sin embargo cuando es en el sentido del incremento importante y súbito debemos pensar en la existencia de hipertermia maligna. La presente revisión es con el fin de llamr la atención en la importancia de utilizar las diversa técnicas y métodos ante cualquier procedimiento anestésico por sencillo o corto que parezca para detectar y corregir oportunamente cualquier alteración de la temperatura y evitar situaciones que pueden poner en peligro la vida del paciente

Reporte de un caso: Relajación nuromuscular prolongada con la administración de mivacurio en infusión continua / Case report: prolonged neuromuscular blockade with coninous infusion of mivacurium

Se presenta el caso clínico de una paciente femenina, 63 años, sometida a laparatomía exploradora, sin antecedentes quirúrgicos-patológicos importantes, la cual recibió inducción anestésica con Propofol, fentanilo y mivacurio. Mantenimiento anestésico con O2/Sevoflurano, además de infusión de fentanil y mivacurio. Después de 1hr y habiendo disminuido la concentración de la infusión del relajante, no se percibe respuesta en el neuroestimulador (TOF), suspendiendo la infusión, pero permanece de la misma forma al terminar la cirugía 4hrs después. Se traslada a la Unidad de terapia Intensiva para asistencia mecánica ventilatoria, en espera de recuperación neuromuscular. Se extuba a las 20 hrs, después de haber suspendido la infusión de mivacurio. Se tomaron exámenes de laboratorio encontrando una colinesterasa plasmática y un por ciento de inhibición de dibucaína disminuidos. La paciente egresó a los 12 días de su cirugía sin problemas, dándose las recomendaciones pertinentes para futuros procedimientos anestésicos.

Reflujo gastroesofágico en pacientes pediátricos desnutridos / Reflux gastroesofagico in patient pediatric undernourished

Con el objeto de conocer la prevalencia de reflujo gastroesofágico en niños desnutridos menores de 5 años institucionalizados en el Centro de Recuperación Nutricional Infantil "Dr. Pastor Oropeza" en el período comprendido de enero 1996-junio 2000. Se hizo un trabajo retrospectivo, prospectivo, no experimental, observacional y transversal sobre una muestra de 358 pacientes a los que se les clasifico la desnutrición de kwashiorkor, marasmo y mixta, la intensidad en zona crítica, leve moderada y grave y el reflujo gastroesofágico en grados I al V. Resultados en el reflujo gastroesofágico grado IV 45,7 por ciento con una mayor ocurrencia en los varones (54,2 por ciento) sobre las hembras incluidas (45,7 por ciento). Se concluye que el reflujo gastroesofágico y la desnutrición no puede relacionarse como efecto y/o causa en ninguno de los 2 sentidos. En este trabajo se sugiere abrir una línea de investigación en reflujo gastroesofágico en el  área de la nutrición. Pero en cuanto al tipo de desnutrición solo en el marasmo se observa esta tendencia ya que en los mixtos un 90 por ciento hay todos los grados IV 37,9 por ciento. No hay relación con el sexo pero si es mas frecuente en los menores de 2 años de edad.

Edema pulmonar no cardiogénico secundario a laringoespasmo posterior a anestesia general / Laryngospasm induced pulmonary edema following general anesthesia. A case report

Se presenta el caso clínico de un paciente joven, sano, que desarrolló edema pulmonar no cardiogénico secundario a laringoespasmo posterior a la extubación, no detectándose el problema en forma inmediata, sino hasta 24 hrs después cuando se manifestó con taquicardia y desaturación por oximetría de pulso. La radiografía de tórax, mostró infiltrados alveolares bilaterales difusos y zona de confluencia en el lóbulo superior del pulmón derecho. No requirió reintubación. La terapia consistió en oxígeno suplementario por puntas nasales, restricción de líquidos, diuréticos, esteroides, broncodilatadores y antibióticos. Después del tratamiento establecido, hubo franca mejoría 24 hrs después, confirmado clínica y radiológicamente