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Glioblastoma (GBM), an aggressive form of brain cancer, has a higher incidence in non-Hispanics when compared to the US Hispanic population. Using data from RT-PCR analysis of 21 GBM tissue from Hispanic patients in Puerto Rico, we identified significant correlations in the gene expression of focal adhesion kinase and proline-rich tyrosine kinase (PTK2 and PTK2B) with NGFR (nerve growth factor receptor), PDGFRB (platelet-derived growth factor receptor B), EGFR (epithelial growth factor receptor), and CXCR1 (C-X-C motif chemokine receptor 1). This study further explores these correlations found in gene expression while accounting for sex and ethnicity. Statistically significant (p < 0.05) correlations with an r value > ±0.7 were subsequently contrasted with mRNA expression data acquired from cBioPortal for 323 GBM specimens. Significant correlations in Puerto Rican male patients were found between PTK2 and PTK2B, NGFR, PDGFRB, EGFR, and CXCR1, which did not arise in non-Hispanic male patient data. The data for Puerto Rican female patients showed correlations in PTK2 with PTK2B, NGFR, PDGFRB, and EGFR, all of which did not appear in the data for non-Hispanic female patients. The data acquired from cBioPortal for non-Puerto Rican Hispanic patients supported the correlations found in the Puerto Rican population for both sexes. Our findings reveal distinct correlations in gene expression patterns, particularly involving PTK2, PTK2B, NGFR, PDGFRB, and EGFR among Puerto Rican Hispanic patients when compared to non-Hispanic counterparts.

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OBJECTIVE: Our neurosurgical program did not have a cadaver laboratory. The need to create one arose following a decrease in elective cranial cases at our institution after Hurricane Maria. Many neurosurgical programs are in countries where financial support for projects such as developing a cadaver research laboratory cannot be expected from their parent institutions. This article describes how, despite limited resources, a neurosurgical cadaver dissection laboratory can be created and maintained to promote resident education and stimulate future research. MATERIALS AND METHODS: The University of Puerto Rico Institutional Review Board evaluated and approved the proposal for creating a neurosurgical cadaver laboratory. The process to establish the laboratory was broken into steps. After obtaining the basic materials, the laboratory was created. RESULTS: The creation of our neurosurgical cadaver laboratory was divided into discrete steps that can be undertaken by any institution with a similar goal. First, a suitable workspace was identified. Second, the surgical instruments and equipment required to perform dissections were obtained. Third, cadaveric specimens for dissection and for practicing surgical approaches were acquired. Last, documentation regarding the laboratory's development was maintained, and an expansion plan was created. We created a dissection laboratory by gathering decommissioned or donated operating room equipment, seeking out contributions from other institutions, and, sometimes, by monetary contribution from the faculty or residents. CONCLUSION: Clear goals, interdepartmental collaboration, and a high degree of motivation were essential in creating, despite limited resources, a working neurosurgical cadaver laboratory to improve resident education.

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Desde los inicios de la medicina, la reproducción de imágenes de pacientes, ya sea con fines didácticos o de compartir experiencias, fue considerada una práctica habitual en el quehacer médico. La aparición de la fotografía facilitó y generalizó enormemente esta práctica dentro de los equipos de salud. Las imágenes de los pacientes requieren el mismo consentimiento y garantías de confidencialidad que otras partes del registro médico. Se remarca la importancia del consentimiento informado. Se considera la responsabilidad legal de estos actos.

From the beginning of medicine, the reproduction of patients' images, initially as drawings, either for didactic purposes or to share experiences, were common in medical practice. Photography greatly facilitated and generalized this practice within health teams. The images of the affected patients need the same consents and guarantees of confidentiality as any other parts of the medical record, so the importance of obtaining informed consent is highlighted. Beyond ethical aspects, professionals have to take into account the legal responsibility involved in carrying out this act.

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From the beginning of medicine, the reproduction of patients' images, initially as drawings, either for didactic purposes or to share experiences, were common in medical practice. Photography greatly facilitated and generalized this practice within health teams. The images of the affected patients need the same consents and guarantees of confidentiality as any other parts of the medical record, so the importance of obtaining informed consent is highlighted. Beyond ethical aspects, professionals have to take into account the legal responsibility involved in carrying out this act.

Desde los inicios de la medicina, la reproducción de imágenes de pacientes, ya sea con fines didácticos o de compartir experiencias, fue considerada una práctica habitual en el quehacer médico. La aparición de la fotografía facilitó y generalizó enormemente esta práctica dentro de los equipos de salud. Las imágenes de los pacientes requieren el mismo consentimiento y garantías de confidencialidad que otras partes del registro médico. Se remarca la importancia del consentimiento informado. Se considera la responsabilidad legal de estos actos.

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New information and communication technologies have had an impact on our lives in general, as well as in our health care and pediatric practice. Given this fact, it is essential to establish an initial framework for this type of interactions between physicians and patients in order to provide the necessary security tools to all the involved parties. The existing legislative gap to date has not been an impediment to the use of these technologies in medical communication, but it is necessary to establish what the responsibilities, obligations and rights of each party are, arising from their use. This document briefly describes the available electronic communication channels, with their advantages and disadvantages, and suggests recommendations for the responsible and safe use. Our aim is to frame this new modality of interaction between doctors and their patients, in order to highlight its value and evaluate its limitations.

Las nuevas tecnologías de información y comunicación, como parte de la revolución digital, han impactado en nuestras vidas en general y han atravesado la práctica pediátrica. Consideramos esencial establecer un primer encuadre para este tipo de interacciones entre médicos y pacientes a los fines de brindar la seguridad necesaria a todas las partes involucradas. El vacío legislativo, hasta la fecha, no es un impedimento para la utilización de estas tecnologías en la comunicación médica, pero es necesario establecer cuáles son las responsabilidades, obligaciones y derechos de cada parte, emergentes de su utilización. Este documento describe brevemente los distintos canales de comunicación electrónica disponibles con sus respectivas ventajas y desventajas, y se generan recomendaciones para el uso responsable y seguro de cada herramienta. Su objetivo es enmarcar esta nueva modalidad de interacción médico-paciente, resaltar su valor y, a su vez, reconocer sus limitaciones.

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Intradural extramedullary spinal cavernous malformations (CMs) remain the least common variant of these lesions and can originate from the inner surface of the dura mater, the pial surface of the spinal cord, and the blood vessels in the spinal nerves. Root-based-only extramedullary CMs are very rare in the thoracic region with only four cases reported. We present a case of 56-year-old male with 1-year progression of lower extremities weakness. Magnetic resonance imaging demonstrated a hyperintense lesion in the upper thoracic region. Surgical exploration revealed a CM with origin in the second thoracic nerve root with gross total resection. Histopathological examination confirmed a CM. The patient had complete recovery of neurological function at 3 months interval. Intradural extramedullary CM is extremely rare entity that must be considered in the differential diagnosis of intradural extramedullary lesions. Surgical resection is the treatment of choice to prevent further neurological damage.

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Ustilago maydis, a dimorphic fungus causing corn smut disease, serves as an excellent model to study different aspects of cell development. This study shows the influence of chitosan, oligochitosan and glycol chitosan on cell growth and physiology of U. maydis. These biological macromolecules affected the cell growth of U. maydis. In particular, it was found that chitosan completely inhibited U. maydis growth at 1mg/mL concentration. Microscopic studies revealed swellings on the surface of the cells treated with the polymers, and chitosan caused complete destruction of the membrane and formation of vesicles on the periphery of the cell. Oligochitosan and chitosan caused changes in oxygen consumption, K(+) efflux and H(+)-ATPase activity. Oligochitosan induced a faster consumption of oxygen in the cells, while glycol chitosan provoked slower oxygen consumption. It is noteworthy that chitosan completely inhibited the fungal respiratory activity. The strongest effects were exhibited by chitosan in all evaluated aspects. These findings showed high sensitivity of U. maydis to chitosan and provided evidence for antifungal effects of chitosan derivatives. To our knowledge, this is a first report showing that chitosan and its derivatives affect the cell morphology and physiological processes in U. maydis.

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Through history, diagnosis and management of sex development disorders has been very difficult due to the significant impact on affected children, their families and care takers, representing a great challenge to healthcare professionals. Nowadays, there is significant debate regarding these children's care and outcome. This discussion is not only a medical issue, but it also includes legal and ethical matters. The Bioethics Committee of the "Hospital de Niños Ricardo Gutiérrez" has been considering this conflict and discussing its different aspects. Here we share our beliefs and opinions taking into account that they should not be considered the only and whole truth. There is an open debate in which all involved people should participate.

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The antifungal activities of chitosan and oligochitosan have been used to control postharvest decay of the fruits. The effect of chitosan and oligochitosan on mycelium growth, spore germination, and mitochondrial function of Rhizopus stolonifer was evaluated in order to establish a connection between fungus development and the main organelle in charge to provide energy to the cell. The mycelium growth of R. stolonifer was significantly reduced on minimum media amended with chitosan or oligochitosan. The highest antifungal indexes were obtained on media containing chitosan or oligochitosan at 2.0 mg ml(-1). Microscopic observation showed that chitosan and oligochitosan affected the spore germination and hyphae morphology. Both polymers increased oxygen consumption of R. stolonifer. Respiratory activity was restored with NADH in permeabilized treated and untreated cells, and was inhibited with rotenone and flavones. Complex III and IV were inhibited by antimycin A and cyanide, respectively, in treated and untreated cells. Chitosan and oligochitosan increased NADH dehydrogenase activity in isolated mitochondria. However, there were not changes in the cytochrome c oxidase and ATPase activities by effect of these polymers. These results suggest that both chitosan and oligochitosan affect the development of R. stolonifer and might be implicated in the mitochondrial dysfunction.

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Rhizopus stolonifer (Ehrenb.:Fr.) Vuill mitochondria contain the complete system for oxidative phosphorylation, formed by the classical components of the electron transport chain (complexes I, II, III, and IV) and the F(1)F(0)-ATP synthase (complex V). Using the native gel electrophoresis, we have shown the existence of supramolecular associations of the respiratory complexes. The composition and stoichiometry of the oxidative phosphorylation complexes were similar to those found in other organisms. Additionally, two alternative routes for the oxidation of cytosolic NADH were identified: the alternative NADH dehydrogenase and the glycerol-3-phosphate shuttles. Residual respiratory activity after inhibition of complex IV by cyanide was inhibited by low concentrations of n-octyl gallate, indicating the presence of an alternative oxidase. The K(0.5) for the respiratory substrates NADH, succinate, and glycerol-3-phosphate in permeabilized cells was higher than in isolated mitochondria, suggesting that interactions of mitochondria with other cellular elements might be important for the function of this organelle.

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Rhizopus stolonifer es el agente causal de la pudrición blanda, enfermedad poscosecha que ocasiona pérdidas económicas importantes. Se han empleado fungicidas sintéticos como el dicloran para controlar a este microorganismo, sin embargo, se ha demostrado que los fungicidas representan un riesgo para el ambiente y la salud humana. Actualmente se buscan alternativas naturales para el control de las pudriciones poscosecha. Se evaluó in vitro e in situ el efecto antifúngico del quitosano y de los aceites esenciales de canela (Cinnamomum zeylanicum), clavo (Syzygium aromaticum) y tomillo (Thymus vulgaris) y dicloran sobre Rhizopus stolonifer. Los tratamientos más efectivos para inhibir in vitro a Rhizopus stolonifer fueron obtenidos con quitosano a 10 mg mL-1, con los tres aceites esenciales probados a la concentración de 0,3 mg mL-1, las mezclas de quitosano a 10 mg mL-1 con los aceites a 0,3 mg mL-1 y el dicloran a 1 mg mL-1. Los experimentos in situ mostraron que el tratamiento individual con quitosano fue el mejor para reducir el porcentaje de infección de los frutos de tomate (Lycopersicon esculentum) inoculados con Rhizopus stolonifer y que la mezcla de quitosano con aceites esenciales no mejora la actividad antifúngica. El quitosano y el dicloran fueron los mejores tratamientos para reducir la pérdida de peso de los frutos. Los tratamientos individuales con quitosano representan una alternativa natural para controlar la pudrición blanda en frutos de tomate.

Rhizopus stolonifer is the causal agent of soft rot, postharvest disease that causes important economic losses. Synthetic fungicides such as dichloran have been used to control this microorganism; however, it has been shown that fungicides represent a risk for the environment and human health. Actually, natural alternatives are looked for the control of postharvest rotting. In vitro and in situ experiments the antifungal effect of chitosan, essential oils of cinnamon (Cinnamomum zeylanicum), clove (Syzygium aromaticum), and thyme (Thymus vulgaris) and dichloran on Rhizopus stolonifer were evaluated. The most effective treatments for in vitro inhibition of Rhizopus stolonifer were obtained by quitosano to 10 mg mL-1, with the three essential oils proved to the concentration of 0.3 mg mL-1, the mixtures chitosan to 10 mg mL-1 with the oils at 0.3 mg mL-1 and dichloran at 1 mg mL-1. In situ experiments showed that the individual treatment with chitosan was the best to reduce the infection percentage of the tomato (Lycopersicon esculentum) fruits inoculated with Rhizopus stolonifer and chitosan mixture with essential oils did not improve its antifungal activity. Chitosan and dichloran were the best treatments to reduce the weight loss of the fruits. Individual treatments with chitosan represent a natural alternative for the control of soft rot on tomato fruits.

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El arroz es fuente de alimento para una gran parte de la población mundial, con alto promedio de consumo anual. En este cultivo las enfermedades de origen microbiano constituyen uno de los factores que inciden en la obtención de bajos rendimientos y calidad de los granos. La piriculariosis o añublo del arroz, causada por Pyricularia grisea, es la enfermedad más importante en este cultivo en América Latina, ya que puede provocar hasta el 100% de reducción de los rendimientos. Como parte de la estrategia de agricultura sostenible, se trata de controlar estos patógenos y lograr altos rendimientos del cultivo mediante una combinación adecuada de fertilizantes químicos y productos biológicos. En este sentido, la aplicación de inoculantes bacterianos constituidos por bacterias promotoras del crecimiento vegetal (Plant Growth- Promoting Bacteria, PGPB, por sus siglas en inglés) ha constituido una alternativa ecológica que favorece la conservación del medioambiente y el ecosistema. Este trabajo tiene como objetivo abordar el estado actual y las perspectivas de uso de bacterias rizosféricas en el control de Pyricularia grisea en el cultivo del arroz, tratando algunos temas relevantes, como son las principales enfermedades que afectan al cultivo, los géneros de PGPB más utilizados para el control de las mismas y sus principales mecanismos de acción.

Rice is an important food supply for a large part of the world population and its consumption rates are very high. Microbial diseases are one of the main causes that provoke low yields and low-quality spotted grains. Although fungi, bacteria and viruses are mostly the responsible for these losses, fungal diseases strike more frequently. Among fungi, Pyricularia grisea, the blast fungus is responsible for up to 100% of reduction in yields, being the blast the most important rice disease in Latin America. To control this pathogen, a strategy of sustainable agriculture might be developed, combining accurately chemical and biological products. PGPB based bioproducts have been considered as an eco-friendly alternative, which favours environment preservation. This work was aimed to approach the current status and outlook of the use of rhizobacteria in the biocontrol of Pyricularia grisea on rice. Main diseases attacking rice, most beneficial PGPB and its mechanisms of action will be discussed too in this review.

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En este trabajo se evaluó el efecto antifúngico del quitosano (0; 0,5; 1,0; 1,5; 2,0 mg mL-1) en el desarrollo in vitro (crecimiento micelial, formación de cuerpos fructíferos, esporulación, germinación y liberación de proteínas) de Rhizopus stolonifer en dos medios de cultivo (papa dextrosa agar y medio mínimo). Los resultados obtenidos demostraron que el quitosano inhibió el crecimiento micelial de R. stolonifer en ambos medios de cultivo. El mayor índice antifúngico se observó en el medio papa dextrosa agar. El quitosano no afectó la formación de los cuerpos fructíferos de R. stolonifer en los medios estudiados. La esporulación y la germinación de las esporas se afectaron en ambos medios de cultivo por efecto de quitosano, siendo más notable en el medio medio mínimo. Se demostró la liberación de proteínas por efecto del quitosano en medio mínimo y caldo papa dextrosa. En general, en este estudio se evidenció el efecto antifúngico del quitosano en el desarrollo in vitro de Rhizopus stolonifer con independencia del medio de cultivo empleado. Sin embargo, en medio medio mínimo podrían observarse mejor los efectos antifúngicos del quitosano.

In this work the antifungal effect of chitosan (0, 0.5, 1.0, 1.5, 2.0 mg mL-1) on the in vitro development (mycelial growth, fruit bodies formation, sporulation, germination and proteins release) of Rhizopus stolonifer on two culture medium (Potato Dextrose Agar and Minimal medium) was evaluated. The obtained results demonstrated that chitosan inhibited the mycelial growth of R. stolonifer in both culture medium. The highest antifungal effect was observed on potato dextrose agar medium. Chitosan was not affected the fruit bodies formation of R. stolonifer on the studied medium. Sporulation and spore germination were affected in both culture mediun by effect of chitosan, it was more noticeable in minimal medium. It was demonstrated proteins release by effect of chitosan in minimal medium and potato dextrose broth medium. In general, in this study it was showed the antifungal effect of chitosan on in vitro development of Rhizopus stolonifer regardless of the culture medium used. However, in minimal medium could be observed best the antifungal effects of chitosan.

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Although medical ethics is part of medicine since its beginning, it is only in the last decades that it is recognized as a necessary discipline. A survey of pediatricians of Hospital de Niños Ricardo Gutiérrez was carried out to determine a) the knowledge of basic concepts of bioethics b) the place and function of the committee. A total of 150 surveys were given out, 90 responses were obtained (60%). Basic concepts of bioethics (definition of bioethics, end of life, autonomy, justice, beneficence, and informed consent) were correctly answered by 75.2%; 97.8% knew of the existence of the committee in the hospital, it had been consulted by 61.1%. From the group that had consulted the recommendations suggested by the committee to solve the ethical dilemma was considered: useful by 23.6%, partially useful by 45.5% and not useful by 27.3%; 37.8% had never consulted the committee. Of these, 64.7% had never had a dilemma, 11.7% considered not useful any possible answer of the committee, and 11.7% did not give a reason. The majority of the responders had appropriate information of the basic bioethical concepts. Both the index of consultation to the committee and the assessment of its judgements as totally or partially useful (69.1%) guarantee its presence. It is peculiar that the principal argument for not consulting the committee was the absence of dilemmas. Both the committee in the hospital and the universities should intensify the teaching of medical ethics (mainly practical ethics), in order to facilitate the detection of ethical dilemmas by the health team.

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La ética médica (EM) forma parte de la medicina desde sus comienzos pero recién en las últimas décadas se la reconoce como disciplina independiente. Se realizó un estudio observacional y descriptivo a médicos del Hospital de Niños Ricardo Gutiérrez para determinar: a) el conocimiento de conceptos básicos de EM entre sus miembros, b) la inserción y función del comité de bioética (CB) en dicha institución. Se repartieron 150 encuestas, se recuperaron 90 (60%). Los conceptos teóricos de EM (definiciones de bioética, paciente terminal, autonomía, justicia, beneficencia, y consentimiento informado) fueron respondidos correctamente por el 75.2%. Conocía la existencia del CB el 97.8%. Lo había consultado alguna vez el 61.1%. De aquellos que consultaron, la recomendación sugerida por el CB para resolver el dilema ético presentado fue: totalmente útil, para el 23.6%, parcialmente útil para el 45.5%, y no útil para el 27.3%. Nunca había consultado al CB el 37.8%, del cual el 64.7% refería no haber tenido dilema, el 11.7% consideraba no útil ¶a priori÷ la posible respuesta del CB, el 11.7% no justificó la causa, el 2.9% no distinguió los dilemas y a otro 2.9% no se le ocurrió consultar. La mayoría de los que respondieron tenía información adecuada sobre conceptos básicos de EM. Tanto el índice de consultas al CB como la valoración de sus dictámenes como total o parcialmente útiles (69.1%) avalan la acción del mismo. Es llamativo que el principal argumento por el cual no se consultó al CB fue el no tener dilemas éticos. Tanto el CB en el HNRG como las universidades deberían intensificar la docencia en EM, fundamentalmente en los aspectos prácticos, que facilitaría a los integrantes del equipo de salud detectar dilemas éticos.(AU)

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Although medical ethics is part of medicine since its beginning, it is only in the last decades that it is recognized as a necessary discipline. A survey of pediatricians of Hospital de Niños Ricardo Gutiérrez was carried out to determine a) the knowledge of basic concepts of bioethics b) the place and function of the committee. A total of 150 surveys were given out, 90 responses were obtained (60

). Basic concepts of bioethics (definition of bioethics, end of life, autonomy, justice, beneficence, and informed consent) were correctly answered by 75.2

; 97.8

knew of the existence of the committee in the hospital, it had been consulted by 61.1

. From the group that had consulted the recommendations suggested by the committee to solve the ethical dilemma was considered: useful by 23.6

, partially useful by 45.5

and not useful by 27.3

; 37.8

had never consulted the committee. Of these, 64.7

had never had a dilemma, 11.7

considered not useful any possible answer of the committee, and 11.7

did not give a reason. The majority of the responders had appropriate information of the basic bioethical concepts. Both the index of consultation to the committee and the assessment of its judgements as totally or partially useful (69.1

) guarantee its presence. It is peculiar that the principal argument for not consulting the committee was the absence of dilemmas. Both the committee in the hospital and the universities should intensify the teaching of medical ethics (mainly practical ethics), in order to facilitate the detection of ethical dilemmas by the health team.

RESUMEN

La ética médica (EM) forma parte de la medicina desde sus comienzos pero recién en las últimas décadas se la reconoce como disciplina independiente. Se realizó un estudio observacional y descriptivo a médicos del Hospital de Niños Ricardo Gutiérrez para determinar: a) el conocimiento de conceptos básicos de EM entre sus miembros, b) la inserción y función del comité de bioética (CB) en dicha institución. Se repartieron 150 encuestas, se recuperaron 90 (60%). Los conceptos teóricos de EM (definiciones de bioética, paciente terminal, autonomía, justicia, beneficencia, y consentimiento informado) fueron respondidos correctamente por el 75.2%. Conocía la existencia del CB el 97.8%. Lo había consultado alguna vez el 61.1%. De aquellos que consultaron, la recomendación sugerida por el CB para resolver el dilema ético presentado fue: totalmente útil, para el 23.6%, parcialmente útil para el 45.5%, y no útil para el 27.3%. Nunca había consultado al CB el 37.8%, del cual el 64.7% refería no haber tenido dilema, el 11.7% consideraba no útil ôa prioriö la posible respuesta del CB, el 11.7% no justificó la causa, el 2.9% no distinguió los dilemas y a otro 2.9% no se le ocurrió consultar. La mayoría de los que respondieron tenía información adecuada sobre conceptos básicos de EM. Tanto el índice de consultas al CB como la valoración de sus dictámenes como total o parcialmente útiles (69.1%) avalan la acción del mismo. Es llamativo que el principal argumento por el cual no se consultó al CB fue el no tener dilemas éticos. Tanto el CB en el HNRG como las universidades deberían intensificar la docencia en EM, fundamentalmente en los aspectos prácticos, que facilitaría a los integrantes del equipo de salud detectar dilemas éticos.

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Paciente de 15 años y 10 meses con diagnóstico de lupus eritematoso sistémico(LES)que 5 años antes presentó un cuadro de corea interpretado como una corea de Sydenham(CS)La presencia de estos hechos en un mismo paciente con un intervalo libre de varios años nos llevaron a buscar la probable conexión entre los mismos,como se describe en la literatura.las coreas adquiridas más frecuentes en pediatría son:la corea de Sydenham y la corea lúpica.Hacemos una revisión de ellas,de sus características clínicas,sus dificulatades diagnósticas y sugerimos conductas,destacando algunos elementos de laboratorio }

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Paciente de 15 años y 10 meses con diagnóstico de lupus eritematoso sistémico(LES)que 5 años antes presentó un cuadro de corea interpretado como una corea de Sydenham(CS)La presencia de estos hechos en un mismo paciente con un intervalo libre de varios años nos llevaron a buscar la probable conexión entre los mismos,como se describe en la literatura.las coreas adquiridas más frecuentes en pediatría son:la corea de Sydenham y la corea lúpica.Hacemos una revisión de ellas,de sus características clínicas,sus dificulatades diagnósticas y sugerimos conductas,destacando algunos elementos de laboratorio }

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