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BACKGROUND: Most evidence for anticoagulation in aortic bioprosthesis is centered on embolic events, bleeding and re-intervention risk. The effect of anticoagulation on hemodynamics has not been previously assessed. Our hypothesis was that patients with anticoagulation (AC) early after aortic valve replacement (AVR) with porcine bioprosthesis have better hemodynamics at 3 years of follow-up. METHODS: This is a follow-up evaluation of the ANTIPRO trial. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The AC group received warfarin+aspirin and the non-AC(control) only aspirin. The primary outcome was mean gradient after 3 years of AVR and change in New York Heart Association (NYHA) class. Secondary outcomes were major and minor bleeding and embolic events. RESULTS: Of 140 participants in the study, 71 were assigned to the AC group and 69 to the control group. Mean age of the overall population was 72.4(SD: 7.1) years. Global euroSCORE was 7.65(SD: 5.73). At 3 years the mean gradient was similar between both groups (19.4(SD: 9.6 mmHg) and 18.6(SD: 8.2 mmHg) in the control and AC group respectively, p = 0.7). No differences in functional class at 3 years were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral anticoagulation to anti-aggregation treatment did not affect bioprosthetic hemodynamics nor functional class at years after AVR.
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Anticoagulantes , Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Humanos , Bioprótesis/efectos adversos , Femenino , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Masculino , Anciano , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Animales , Porcinos , Válvula Aórtica/cirugía , Factores de Tiempo , Aspirina/uso terapéutico , Aspirina/administración & dosificación , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Warfarina/uso terapéutico , Warfarina/administración & dosificación , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.
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Estomía , Estomas Quirúrgicos , Estudios Transversales , Humanos , Calidad de Vida , Estudios Retrospectivos , Cuidados de la Piel , Estomas Quirúrgicos/efectos adversosRESUMEN
OBJECTIVE: The objective of this study was to determine the psychometric properties of the 3-dimensional latent model of empathy on the Jefferson Scale of Physician Empathy instrument (version S), and to verify the existence of cutoff points capable of differentiating empathy measures classified as: "high," "medium," and "low" using data collected from observations of students from 11 dental faculties of 5 Central American and Caribbean countries (n = 3082) between 2015 and 2019. METHODS: This is an exploratory, "a posteriori," and non-experimental study. Factor structure and factor invariance by country and gender were analyzed. Hierarchical cluster analysis and bifactorial analysis were applied, and the data were normalized by cluster and by percentiles within them. RESULTS: Confirmatory factor analysis showed that the original model was replicable and fit the data, while multigroup analysis allowed assuming an invariant factor structure by country and by gender. There is reliability in the measurement made by the scale and its dimensions. CONCLUSIONS: The instrument has adequate psychometric properties, and cutoff values obtained allow people with lower or higher levels of empathy and its components to be classified. Therefore, these results solve the problem of comparing the scores and observed levels of empathy between dental schools within and between countries and between genders. Such comparisons were only possible since the original data of each study were made available for traditional statistical methods.
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Empatía , Estudiantes de Medicina , Femenino , Humanos , Masculino , Psicometría , Reproducibilidad de los Resultados , Estudiantes de Odontología , Encuestas y CuestionariosRESUMEN
Objectives: To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older. Methods: Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers. Results: Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant's average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study's analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128). Conclusions: There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults
No disponible
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Interacciones Farmacológicas , Contraindicaciones de los Medicamentos , Estudios Retrospectivos , Polifarmacia , Servicios Farmacéuticos/estadística & datos numéricos , México/epidemiologíaRESUMEN
OBJECTIVES: To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older. METHODS: Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers. RESULTS: Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant's average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study's analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128). CONCLUSIONS: There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults.
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PURPOSE: To study the retinal pigment epithelium (RPE) and retinal alterations in chronic central serous chorioretinopathy treated with photodynamic therapy, and its correlation with functional parameters such as best-corrected visual acuity (BCVA) and contrast sensitivity (CS). METHODS: Retrospective, noncomparative, consecutive evaluation by optical coherence tomography and its correlation with BCVA and CS in 31 eyes of 26 patients. RESULTS: In all affected patients, 88.5% were male with a mean age of 42.9 years. The right eye was involved in 64.5% of cases, bilateral in 19% and 73.9% were hyperopic (spherical refraction between 0 and +5.0 diopters). Of these cases, 51.5% had peri-RPE abnormalities, 17.3% hyperreflective substances at RPE, 19.4% RPE atrophy, 55.3% foveolar atrophy, 3.1% pigment epithelial detachment, 5.2% subretinal fluid persistence, 8.3% fibrin deposits, 68.4% photoreceptor inner and outer segment line interruption and 31.1% external limiting membrane interruption. CONCLUSIONS: Time evolution and number of outbreaks were related to the decrease in foveal and chorodial thickness and in those with worse BCVA and CS. RPE abnormalities and atrophy were related to the age of onset of symptoms. Photoreceptor elongation has been correlated with poor BCVA and inner and outer segment line destructuring and interruption with poor CS.
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Coriorretinopatía Serosa Central/tratamiento farmacológico , Fotoquimioterapia/métodos , Porfirinas/administración & dosificación , Retina/diagnóstico por imagen , Agudeza Visual , Adulto , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/fisiopatología , Enfermedad Crónica , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Fármacos Fotosensibilizantes/administración & dosificación , Retina/efectos de los fármacos , Retina/fisiopatología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
PURPOSE: Early identification and referral have been shown to improve long-term outcomes for children with disabilities. However, the number of children enrolled in early intervention services continues to be lower than the number of children confirmed to be developmentally delayed later in life. This study investigated the pattern of developmental surveillance and referral practices of pediatricians in a traditionally medically underserved border community. DESCRIPTION: An online survey was created by members of a community/academic partnership. Emails were followed up with a personal contact to doctor's offices to increase the response rate. ASSESSMENT: Response rate for the survey was 26.7 %. Most respondents reported using a combination of formal screening tools and parent interviews to complete developmental screenings in their practice with the Modified Checklist of Autism in Toddlers being the most commonly used tool. CONCLUSION: Although most respondents reported referring children for the Individuals with Disabilities Education Act Part C services, gaps were identified in available services and in the referral process that need to be addressed. Additionally, future studies need to evaluate the efficacy of a referral and feedback system to improve earlier access to intervention services for children with disabilities.
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Trastorno Autístico/diagnóstico , Área sin Atención Médica , Vigilancia de la Población/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Niño , Preescolar , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Pediatría , Médicos de Familia , Odontología Preventiva , Atención Primaria de Salud , Encuestas y CuestionariosRESUMEN
Misinterpretations or lack of compliance with national standards established to guide health professionals working with low-English-proficient (LEP) patients continue to negatively impact patient care. Most of the literature on training health professionals to work with interpreters focuses on physicians. We reviewed this current literature and propose an interprofessional educational module to extend the interpreter training to other health professions. Our module trains rehabilitation science students from different health disciplines (physical therapy, occupational therapy, and speech-language pathology) using strategies from the literature. The educational module is tailored to student's bilingual proficiency, suggests relevant outcomes measures, and highlights unanswered questions and areas for future research.
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Barreras de Comunicación , Lenguaje , Multilingüismo , Rehabilitación/educación , Estudiantes , Comunicación , Hispánicos o Latinos , HumanosRESUMEN
Researchers have reported positive associations between physical activity and academic achievement. However, a common belief is that improving academic performance comes at the cost of reducing time for and resources spent on extracurricular activities that encourage physical activity. The purpose of this study was to examine the relationship between self-reported physical activity and grade point average (GPA) for health science graduate students. Graduate students in health science programs completed the International Physical Activity Questionnaire and reported their academic progress. Most participants (76%) reported moderate to vigorous physical activity levels that met or exceeded the recommended levels for adults. However, there was no significant correlation between GPA and level of physical activity. Negative findings for this study may be associated with the limited range of GPA scores for graduate students. Future studies need to consider more sensitive measures of cognitive function, as well as the impact of physical activity on occupational balance and health for graduate students in the health fields.
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Educación de Postgrado , Escolaridad , Empleos en Salud/educación , Actividad Motora , Adulto , Evaluación Educacional , Femenino , Humanos , Masculino , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
En el siguiente artículo exponemos los resultados de una investigación que dio cuenta de los escenarios de participación política en los llanos del Yarí, una región habitada por campesinos de tradición comunista, con presencia histórica de las FARC y en donde el estado despliega desde 2003 la más grande estrategia contrainsurgente que se haya adelantado en la historia del país. Para tal efecto, nuestro foco de atención se orienta hacia la relación que existe entre las condiciones del ejercicio político (entendido como la construcción del sentido de lo político y la definición/participación en escenarios propios de la política) con la historia del proceso de apropiación territorial. Tal inspección nos ha permitido establecer que en esta región la plataforma de acción de la organización comunitaria, constituye tanto su plataforma político-social, como su escenario político-electoral, indagaremos más fondo sobre estas relaciones a partir de las narrativas de las experiencias campesinas, las condiciones sociales de la región y la aguda situación de guerra que allí viven.
This current article shows the results of an investigation that dealt with the scenarios of political participation in the Yari Plains, a region inhabited by peasants from Communist tradition, with the historic presence of the FARC and where the State deploys the largest counterinsurgency strategy which has been moved forward in the history of the country since 2003. To such effect, our focus of attention is directed to the existing relationship between the conditions of the political exercise (understood as the construction of the sense of the political and the definition or participation in political scenarios per se) with the history of the process of territorial appropriation. Such inspection has enabled us to establish that in this region, the platform of action of the community organization, is both its political and social platform, as its political-electoral scenario. We will delve deeply into these relationships from the narratives of peasant experiences, the social conditions in the region, and the acute war situation that people experience there.
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Various models of interprofessional education, including service-learning, are used to teach students how to be effective members of healthcare teams. The purpose of this study was to examine pilot data related to the impact of an elective one-credit global health course with an international service-learning experience (ISL) on the student participants. An interdisciplinary team of 3 faculty accompanied 4 students representing occupational therapy, physical therapy, and speech-language pathology programs for an 8-day ISL experience. Students responded to faculty-developed reflection questions pre-travel, during travel, and 2-weeks and 4-months post travel. Content analysis was used to analyze themes that emerged from the students' written reflections. Three major themes emerged: collaboration, satisfaction, and self-discovery. The most prominent theme was related to interprofessional collaboration.
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Intercambio Educacional Internacional , Modelos Educacionales , Grupo de Atención al Paciente/organización & administración , Rehabilitación/educación , Comunicación , Conducta Cooperativa , Emociones , Humanos , Relaciones Interprofesionales , Satisfacción en el Trabajo , Terapia Ocupacional/educación , Especialidad de Fisioterapia/educación , Proyectos Piloto , Patología del Habla y Lenguaje/educaciónRESUMEN
Vitamin B6 (pyridoxal phosphate) is an essential cofactor in enzymatic reactions involved in numerous cellular processes and also plays a role in oxidative stress responses. In plants, the pathway for de novo synthesis of pyridoxal phosphate has been well characterized, however only two enzymes, pyridoxal (pyridoxine, pyridoxamine) kinase (SOS4) and pyridoxamine (pyridoxine) 5' phosphate oxidase (PDX3), have been identified in the salvage pathway that interconverts between the six vitamin B6 vitamers. A putative pyridoxal reductase (PLR1) was identified in Arabidopsis based on sequence homology with the protein in yeast. Cloning and expression of the AtPLR1 coding region in a yeast mutant deficient for pyridoxal reductase confirmed that the enzyme catalyzes the NADPH-mediated reduction of pyridoxal to pyridoxine. Two Arabidopsis T-DNA insertion mutant lines with insertions in the promoter sequences of AtPLR1 were established and characterized. Quantitative RT-PCR analysis of the plr1 mutants showed little change in expression of the vitamin B6 de novo pathway genes, but significant increases in expression of the known salvage pathway genes, PDX3 and SOS4. In addition, AtPLR1 was also upregulated in pdx3 and sos4 mutants. Analysis of vitamer levels by HPLC showed that both plr1 mutants had lower levels of total vitamin B6, with significantly decreased levels of pyridoxal, pyridoxal 5'-phosphate, pyridoxamine, and pyridoxamine 5'-phosphate. By contrast, there was no consistent significant change in pyridoxine and pyridoxine 5'-phosphate levels. The plr1 mutants had normal root growth, but were significantly smaller than wild type plants. When assayed for abiotic stress resistance, plr1 mutants did not differ from wild type in their response to chilling and high light, but showed greater inhibition when grown on NaCl or mannitol, suggesting a role in osmotic stress resistance. This is the first report of a pyridoxal reductase in the vitamin B6 salvage pathway in plants.
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Oxidorreductasas de Alcohol/genética , Oxidorreductasas de Alcohol/metabolismo , Proteínas de Arabidopsis/metabolismo , Arabidopsis/metabolismo , Vitamina B 6/biosíntesis , Secuencia de Aminoácidos , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Biocatálisis , Vías Biosintéticas/genética , Regulación de la Expresión Génica de las Plantas , Immunoblotting , Isoenzimas/genética , Isoenzimas/metabolismo , Manitol/farmacología , Datos de Secuencia Molecular , Mutación , NADP/metabolismo , Raíces de Plantas/efectos de los fármacos , Raíces de Plantas/genética , Raíces de Plantas/crecimiento & desarrollo , Piridoxal/metabolismo , Piridoxina/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Homología de Secuencia de Aminoácido , Cloruro de Sodio/farmacología , Sacarosa/farmacologíaRESUMEN
Introducción: la percepción de la salud es un predictor significativode mortalidad, de actitudes hacia la muerte y de cumplimientode tratamientos durante la enfermedad; cómo seobservan las personas en bienestar físico actual, futuro y adaptaciónpsicológica; por tanto, tiene un papel importante en la conductapromotora de salud. Lo descrito motivó la reflexión sobreesos conceptos y la actuación de los pacientes con diabetesmellitustipo 2 (PDMT2), enfermedad que representa un problema desalud pública mundial.Propósito: determinar el efecto de los factores personales(biológicos, psicológicos y socioculturales) sobre el resultadode conducta (estilo de vida) de los pacientes con diabetes mellitustipo 2.Marco teórico: Modelo de promoción de la salud dePender (1).Metodología: diseño descriptivo-correlacional, en unamuestra de 125 pacientes.Resultados: la variable factores personales mostró efectosobre la variable estilo de vida (nutrición, ejercicio, responsabilidaden salud y manejo adecuado del estrés) (F cal = 4.780 R238,7, p = ,001).Conclusión: los resultados apoyan la relación entre losconceptos seleccionados del Modelo de promoción de la saludde Pender (2003) y muestran que la percepción de saludde los PDMT2 promueve cambios de la conducta promotora(estilo de vida), por lo que se cree que los pacientes pueden actuar,corresponsablemente con el equipo de salud, para mejorarel control del padecimiento y evitar o retrasarcomplicaciones.
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Humanos , Estilo de Vida , SaludRESUMEN
PDX3 and SALT OVERLY SENSITIVE4 (SOS4), encoding pyridoxine/pyridoxamine 5'-phosphate oxidase and pyridoxal kinase, respectively, are the only known genes involved in the salvage pathway of pyridoxal 5'-phosphate in plants. In this study, we determined the phenotype, stress responses, vitamer levels, and regulation of the vitamin B(6) pathway genes in Arabidopsis (Arabidopsis thaliana) plants mutant in PDX3 and SOS4. sos4 mutant plants showed a distinct phenotype characterized by chlorosis and reduced plant size, as well as hypersensitivity to sucrose in addition to the previously noted NaCl sensitivity. This mutant had higher levels of pyridoxine, pyridoxamine, and pyridoxal 5'-phosphate than the wild type, reflected in an increase in total vitamin B(6) observed through HPLC analysis and yeast bioassay. The sos4 mutant showed increased activity of PDX3 as well as of the B(6) de novo pathway enzyme PDX1, correlating with increased total B(6) levels. Two independent lines with T-DNA insertions in the promoter region of PDX3 (pdx3-1 and pdx3-2) had decreased PDX3 activity. Both also had decreased activity of PDX1, which correlated with lower levels of total vitamin B(6) observed using the yeast bioassay; however, no differences were noted in levels of individual vitamers by HPLC analysis. Both pdx3 mutants showed growth reduction in vitro and in vivo as well as an inability to increase growth under high light conditions. Increased expression of salvage and some of the de novo pathway genes was observed in both the pdx3 and sos4 mutants. In all mutants, increased expression was more dramatic for the salvage pathway genes.
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Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimología , Arabidopsis/genética , Piridoxal Quinasa/genética , Piridoxal Quinasa/metabolismo , Piridoxaminafosfato Oxidasa/metabolismo , Vitamina B 6/metabolismo , Arabidopsis/efectos de los fármacos , Proteínas de Arabidopsis/genética , Liasas de Carbono-Nitrógeno , Cromatografía Líquida de Alta Presión , Clonación Molecular , Frío , ADN Bacteriano/genética , ADN de Plantas/genética , Regulación de la Expresión Génica de las Plantas , Luz , Manitol/farmacología , Estructura Molecular , Mutagénesis Insercional , Mutación , Transferasas de Grupos Nitrogenados/metabolismo , Fenotipo , Piridoxaminafosfato Oxidasa/genética , Cloruro de Sodio/farmacología , Sacarosa/farmacología , Factores de Tiempo , Vitamina B 6/química , AguaRESUMEN
This report presents a case of dentigerous cyst associated with a formocresol pulpotomized deciduous molar detected during routine examination. Dentigerous cyst is an epithelial-lined developmental cavity that encloses the crown of an unerupted tooth at the cementoenamel junction. The present case describes a 9-year-old girl sent to the dental clinic by her dentist, who had accidentally discovered in the panoramic radiograph a single, unilocular, well-defined, radiolucent area enclosing the second left unerupted mandibular premolar. The second left primary molar had been pulpotomized 2 years before and buccal swelling without redness occurred near the tooth, evidencing bone expansion. Surgical treatment was carried out, the tooth was extracted, and a cystectomy was performed under local anesthesia in the dental office. The histological study confirmed the suspected diagnosis of dentigerous cyst. The relation between pulpotomy and dentigerous cysts is discussed.
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Quiste Dentígero/etiología , Formocresoles/uso terapéutico , Enfermedades Mandibulares/etiología , Diente Molar/patología , Pulpotomía/métodos , Diente Primario/patología , Diente Premolar/diagnóstico por imagen , Niño , Femenino , Estudios de Seguimiento , Humanos , Radiografía , Diente no Erupcionado/diagnóstico por imagenRESUMEN
ABSTRACT Morphological characteristics and vegetative compatibility groups (VCGs) of 486 isolates of Glomerella cingulata, Colletotrichum gloeosporioides, and C. acutatum collected from apple leaves with Glomerella leaf spot (GLS) symptoms and fruit with bitter rot symptoms in the United States and Brazil were studied. From this collection, 155 isolates of G. cingulata (93 from fruit, 61 from leaves, and 1 from buds), 42 isolates of C. gloeosporioides from fruit, and 14 isolates of C. acutatum (10 from fruit and 4 from leaves) were studied using mitochondrial (mt)DNA restriction fragment length polymorphism (RFLP) haplotypes. A subset of 24 isolates was studied by examining the sequence of a 200-bp intron of the glyceraldehyde 3-phosphate dehydrogenase (GDPH) nuclear gene. In addition, 98 isolates were tested for pathogenicity on leaves of cvs. Gala and Golden Delicious in the greenhouse, and 24 isolates were tested for pathogenicity on fruit of cv. Gala in growth chambers. In total, 238 and 225 isolates of G. cingulata were separated into four distinct morphological types and six VCGs, respectively. Five morphological types and six VCGs were identified among 74 and 36 isolates of C. gloeosporioides, respectively. Three morphological types and four VCGs were identified among 74 and 23 isolates of C. acutatum, respectively. Seven different mtDNA RFLP haplotypes were observed within isolates of G. cingulata, two within isolates of C. gloeosporioides, and two within isolates of C. acutatum. Phylogenetic trees, inferred based on maximum likelihood and maximum parsimony methods using the intron sequence, produced similar topologies. Each species was separated into distinct groups. All isolates tested were pathogenic on fruit, though only isolates with specific VCGs and haplotypes were pathogenic to leaves. Vegetative compatibility was a better tool than molecular characters for distinguishing isolates of G. cingulata pathogenic on both leaves and fruit from the ones pathogenic only on fruit. Isolates of G. cingulata capable of causing both GLS and bitter rot were included in haplotypes and groups based on the sequence analysis of the 200-bp intron that also included isolates capable of causing bitter rot only. Additionally, isolates of G. cingulata from the United States and Brazil which cause GLS were included in different haplotypes and sequence analysis groups. Therefore, one hypothesis is that isolates of G. cingulata from the United States capable of causing both GLS on foliage and bitter rot on fruit may have arisen independently of Brazilian isolates of G. cingulata capable of causing both GLS and bitter rot, and the two groups of isolates may represent distinct populations.
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The population diversity within isolates of Glomerella cingulata and Colletotrichum spp. associated with Glomerella leaf spot and bitter rot of apples was studied in an orchard of cv. Granny Smith located in Wilkes County, NC, and one orchard each of cultivars Granny Smith and Gala located in Lincoln County, NC. Morphological characters and vegetative compatibility groups (VCGs) were used to determine diversity within the species. The relative frequencies of the morphological types found within each species in each orchard were also determined. G. cingulata was the predominant species associated with bitter rot in the three orchards and Glomerella leaf spot in the Gala orchard. In the three orchards, different morphological types were observed within isolates of G. cingulata and Colletotrichum acutatum, but not within isolates of Colletotrichum gloeosporioides. Isolates of C. gloeosporioides were not found in the orchard of cv. Granny Smith in Lincoln County. In the other two orchards, C. gloeosporioides represented the lowest proportion of the population. Three VCGs were found among isolates of G. cingulata (VCG-1, 2, and 6), two among isolates of C. gloeosporioides (VCG-9 and 10), and two among isolates of C. acutatum (VCG-15 and 16). VCGs 2, 6, 9, 10, 15, and 16 were found in the Granny Smith orchard in Wilkes County, VCGs 1, 2, and 6 in the Gala orchard in Lincoln County, and VCGs 2 and 6 in the Granny Smith orchard in Lincoln County. Differences in frequencies among the different morphological types found within the three orchards remained relatively similar throughout the season and from year to year, suggesting that the relative frequencies of G. cingulata, C. gloeosporioides, and C. acutatum remain stable in an orchard once the fungi are established.
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Objetivo: conocer el abordaje diagnóstico y terapéutico del sangrado uterino anormal. Material y método: Se hizo un estudio de corte transversal, de junio a diciembre de 2002. La población de estudio fueron 102 pacientes con sangrado uterino anormal. Resultados: el 57 porciento de las pacientes eran perimenopáusicas. El 25 porciento recibió terapia hormonal previa. En el 61 porciento, el criterio de ingreso fue la duración del sangrado. Los trastornos hemodinámicos se presentaron en el 13 porciento y la anemia severa en el 20 porciento. La ecografía pélvica se hizó en el 69 porciento y el legrado uterino en el 96 porciento. La miomatosis uterina se detectó por ecografía en el 38 porciento. El 62 porciento de las perimenopáusicas tenían miomatosis uterina. El 59 porciento de los hallazgos histopalógicos fueron la alteraciones estructurales endometriales por trastorno hormonal. El 95 porciento tuvo enfermedades ginecológicas asociadas, siendo la miomatosis uterina y las alteraciones estructurales endometriales, las más comunes. El adenocarcinoma se detectó sólo en tres pacientes. El tratamiento prescrito al egreso más frecuentemente fueron analgésicos- antinflamatorios no esteroides..