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PURPOSE: To evaluate the association between concurrent use of opioids and benzodiazepines (BZDs) and emergency room (ER) visits and hospital admissions in patients with cancer. METHODS: Data were obtained from the Puerto Rico Central Cancer Registry-Health Insurance Linkage. Odds ratios (ORs) with 95% CIs and incidence rate ratio (IRR) were estimated using logistic and negative binomial regression analyses to assess the association between concurrent use of opioids and BZDs (overlap of at least 7 days) and ER visits and hospital admissions. RESULTS: A total of 9,259 patients were included in the main analysis. The logistic regression results showed a significant association between concurrent use of opioids and BZDs and at least one ER visit (OR, 1.28 [95% CI, 1.07 to 1.54]) or hospital admission (OR, 1.42 [95% CI, 1.18 to 1.71]) compared with individuals with BZDs alone, after adjusting for age, sex, comorbidity index, cancer stage, health insurance, and health region. Compared with individuals with opioid use alone, the association did not reach significance. In the negative binomial regression, a significant association was observed for ER visits (IRR, 1.52 [95% CI, 1.31 to 1.76]) and hospitalizations (IRR, 1.34 [95% CI, 1.20 to 1.50]) when compared with individuals with BZDs alone. Compared with individuals with opioids alone, it only reached significance for ER visits (IRR, 1.39 [95% CI, 1.20 to 1.61]). CONCLUSION: Careful evaluation must be done before prescribing concurrent opioids and BZDs in patients with cancer, as the results suggest that coprescribing may increase the odds of ER visits and hospitalizations.

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Introducción: La candidemia es considerada el tipo de fungemia más frecuente asociada a pacientes en unidades de cuidados intensivos. Es una afección rápidamente progresiva con elevada mortalidad, la cual presenta dificultad en un diagnóstico precoz y capacidad de resistencia al tratamiento. Objetivos: Caracterizar aspectos epidemiológicos, clínicos y microbiológicos de las especies de Candida aisladas en niños hospitalizados en unidades de cuidados intensivos. Métodos: Se realizó un estudio descriptivo y transversal en 143 aislamientos de especies de Candida obtenidas en hemocultivos de pacientes menores de 18 años, en el laboratorio de Microbiología del Hospital Universitario Ginecobstétrico «Mariana Grajales», en el período de enero de 2009 a diciembre de 2018. Se utilizaron tablas de contingencia (prueba de Ji Cuadrado y V de Cramer); se utilizaron las variables: edad, sexo, factores de riesgo, especies y servicios hospitalarios. Resultados: Los mayores aislamientos de candidemia correspondieron a pacientes del sexo femenino de edades comprendidas entre 29 días y 18 años. Todos fueron sometidos al uso de antimicrobianos y con ventilación mecánica. El mayor número de aislamientos en pacientes de 9 años correspondió a Candida tropicalis, que fue la más aislada en la Unidad de Neonatología y Cuidados Intensivos Pediátricos, no así en Cuidados Intermedios donde predominó Candida sin precisar especie. Por estas razones se puede señalar que existe una relación entre las especies y los servicios hospitalarios. Conclusiones: Predominaron pacientes del sexo femenino mayores de 29 días y hasta 18 años hospitalizados en la Unidad de Cuidados Intensivos Pediátricos; la especie más aislada fue Candida tropicalis.

Introduction: candidemia is considered the most frequent type of fungemia associated with patients hospitalized in intensive care units. It is a rapidly progressive condition with high mortality, difficult to diagnose early and resistant to treatment. Objective: to characterize the epidemiological, clinical and microbiological aspects of Candida species isolated from children hospitalized in intensive care units. Methods: a descriptive and cross-sectional study was carried out on 143 isolates of Candida species corresponding to blood cultures from patients under 18 years of age and obtained in the Microbiology laboratory at "Mariana Grajales" Gynecological and Obstetric University Hospital, from January 2009 to December 2018. Contingency tables were used (Chi- square and Cramer's V tests); age, gender, risk factors, species and hospital services were the used variables. Results: the largest candidemia isolates corresponded to female patients aged between 29 days and 18 years. All were subjected to the use of antimicrobials and mechanical ventilation. The highest number of isolates in 9-year-old patients corresponded to Candida tropicalis, which was the most isolated species in the Neonatology and Pediatric Intensive Care Unit, but not in the Intermediate Care Unit where Candida predominated without specifying the species. For these reasons, it can be pointed out that there is a relationship between species and hospital services. Conclusions: female patients older than 29 days and up to 18 years hospitalized in the Pediatric Intensive Care Unit predominated; the most isolated species was Candida tropicalis.

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Background: Anxiety and depression symptoms are known to increase cancer symptom burden, yet little is known about the longitudinal integrations of these among Hispanic/Latinx patients. The goal of this study was to explore the trajectory and longitudinal interactions among anxiety and depression, cancer symptom burden, and health-related quality of life in Hispanic/Latinx cancer patients undergoing chemotherapy. METHODS: Baseline behavioral assessments were performed before starting chemotherapy. Follow-up behavioral assessments were performed at 3, 6, and 9 months after starting chemotherapy. Descriptive statistics, chi-square tests, Fisher's exact tests, and Mann-Whitney tests explored associations among outcome variables. Adjusted multilevel mixed-effects linear regression models were also used to evaluate the association between HADS scores, follow-up visits, FACT-G scale, MDASI scale, and sociodemographic variables. RESULTS: Increased cancer symptom burden was significantly related to changes in anxiety symptoms' scores (adjusted ß^ = 0.11 [95% CI: 0.02, 0.19]. Increased quality of life was significantly associated with decreased depression and anxiety symptoms (adjusted ß^ = -0.33; 95% CI: -0.47, -0.18, and 0.38 adjusted ß^= -0.38; 95% CI: -0.55, -0.20, respectively). CONCLUSIONS: Findings highlight the need to conduct periodic mental health screenings among cancer patients initiating cancer treatment.

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RESUMEN Introducción: Las infecciones de las úlceras del pie diabético son comunes, complejas, de alto costo y constituyen la principal causa de amputación no traumática de las extremidades inferiores. Objetivo: Identificar los microorganismos aislados para estimar tanto la sensibilidad a los antibióticos como la coincidencia entre el tratamiento empírico y los resultados microbiológicos en pacientes con úlceras del pie diabético. Métodos: Se realizó una investigación descriptiva-retrospectiva. La población de estudio estuvo constituida por 210 pacientes ingresados en el Hospital Universitario Clínico Quirúrgico "Comandante Faustino Pérez Hernández" de Matanzas entre junio de 2017 y junio de 2020. Las variables de salida fueron la frecuencia y el tipo de germen, la cantidad de gérmenes por úlcera, la sensibilidad para cada tipo de antibiótico, y el porcentaje de coincidencia entre el tratamiento empírico y el resultado microbiológico. Resultados: Se identificaron 259 gérmenes y se observaron 1,23 gérmenes por úlcera. El 62,5 por ciento de los gérmenes encontrados fueron Gram negativos, pero el germen más representado fue el Staphylococcus aureus. El 58,8 por ciento de los Staphylococcus aureus se mostraron resistentes a la meticillin. La vancomicina y el linezolid resultaron efectivos en el 100 por ciento de los Gram positivos. La amikacina fue el antibiótico más efectivo para los Gram negativos. Se observó coincidencia entre el tratamiento empírico y el resultado del antibiograma en el 27,6 por ciento de los pacientes. Conclusiones: Resulta necesario un apropiado diagnóstico microbiológico de las úlceras del pie diabético para identificar los gérmenes presentes en las lesiones y diseñar algoritmos de terapia antimicrobiana adecuados(AU)

ABSTRACT Introduction: Diabetic foot ulcer infections are common, complex, high cost and are the leading cause of non-traumatic lower extremity amputation. Objective: To identify the microorganisms isolated to estimate both the sensitivity to antibiotics and the coincidence between empirical treatment and microbiological results in patients with diabetic foot ulcers. Methods: A descriptive-retrospective investigation was performed. The study population consisted of 210 patients admitted to the University Hospital "Comandante Faustino Pérez Hernández" of Matanzas between June 2017 and June 2020. The output variables were the frequency and type of germ, the number of germs per ulcer, the sensitivity for each type of antibiotic, and the percentage of coincidence between the empirical treatment and the microbiological result. Results: A total of 259 germs were identified and 1.23 germs per ulcer were observed. The 62.5 percent of the germs found were Gram negative, but the most represented germ was Staphylococcus aureus. Of the Staphylococcus aureus, 58.8 percentwere resistant to methicillin. Vancomycin and linezolid were effective in 100 percent of Gram positives. Amikacin was the most effective antibiotic for Gram-negatives. Agreement between empirical treatment and antibiogram result was observed in 27.6 percent of patients. Conclusions: An appropriate microbiological diagnosis of diabetic foot ulcers is necessary to identify the germs present in the lesions and to design adequate antimicrobial therapy algorithms(AU)

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OBJECTIVE: To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS: Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS: Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION: The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.

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OBJECTIVE: To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS: Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS: Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION: The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy. DESCRIPTORS: Autopsy. Hemorrhagic Fevers, Viral, etiology. Arbovirus Infections, mortality

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ABSTRACT OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.

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RESUMEN Introducción: la psicología social comunitaria toma a la comunidad como su objeto de estudio particular. En esta revisión teórica de la psicología social comunitaria, se mostraron las consideraciones desde una visión marxista, las cuales facilitaron investigaciones de problemáticas sociales en la atención primaria de salud. Objetivo: implementar programas para promover estilos de vida saludables y la prevención de enfermedades en las comunidades, mediante los aportes del marxismo. Métodos: se realizó una revisión bibliográfica sistemática sobre el tema. Para la recolección de los datos se elaboró una ficha instructiva y para el tratamiento de estos se aplicó un análisis de contenido de tipo directo. Conclusiones: las consideraciones sobre la psicología social comunitaria permitieron, desde lo teórico, realizar aportes en el trabajo interventivo en la comunidad, para que la atención primaria de salud pueda dar respuesta a problemas sociales y sanitarios, y contribuyeron a la promoción de conductas saludables y la prevención de enfermedades.

ABSTRACT Introduction: community social psychology takes the community as its particular object of study. The considerations were shown from a Marxist perspective in this theoretical review of community social psychology, which will facilitate investigations of social problems in primary health care. Objective: to implement programs for promoting healthy lifestyles and disease prevention in communities through the contributions of Marxism. Methods: a systematic bibliographic review on the subject was carried out. An instructive card was elaborated for data collection and a direct content analysis was applied for their processing. Conclusions: the considerations on the social community psychology allowed, from the theoretical point of view, to make contributions in the intervention work in the community; that primary health care can respond to social and health problems; and contributed to the promotion of healthy behaviors and disease prevention.

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For the preservation of tissue samples, formalin fixation followed by paraffin embedding (FFPE) has been the method of choice for decades, mainly because it maintains the morphologic characteristics of the original tissue particularly preserved, as well as its genetic material. FFPE cells can be used to perform molecular tests, such as conventional (c) or quantitative (q) reverse transcriptase polymerase chain reaction (RT-PCR), in retrospective investigations. However, extracting RNA from archived FFPE tissues is a challenging procedure, as it requires time and the use of complex extraction methods. As specific FFPE extraction methods are not always available in the laboratories, the objective of this study was to evaluate the performance of a method based on phenol-chloroform (PC) and 2 commercial methods for RNA extraction, adapting their protocols for FFPE tissues. For this study, a pool of FFPE tissues underwent RNA extraction by PC, QIAmp Viral RNA Mini, and RNeasy Mini Kit. Both the RT-cPCR and the RT-qPCR results were favorable, demonstrating the viability of the RNA. As these results expanded the alternatives for low-budget FFPE extraction, the choice of the ideal method to be used will depend on the availability of reagents and kits.

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RESUMEN Los principales problemas de la producción de pepino, residen mayormente en la escasez de fertilizantes minerales, afectaciones climatológicas y limitado uso de los biofertilizantes, por lo cual, es importante buscar alternativas eficientes que aumenten la productividad, la racionalidad y la sustentabilidad. El objetivo de esta investigación fue evaluar la utilización individualizada y asociada de los biofertilizantes microorganismos eficientes y vermicompost lixiviado en el incremento agroproductivo del pepino. El trabajo fue desarrollado en la unidad productiva "El Estadio", Sancti Spíritus, Cuba, entre enero a abril de 2015 y fue utilizado el cultivar Su Yi Sung de pepino. Los tratamientos aplicados fueron un control, inoculación al suelo y aplicaciones foliares de Microorganismos eficientes y vermicompost lixiviado, a 100 y 200mL L-1 y la inoculación al suelo, con Microorganismos eficientes, a 100mL L-1 y aplicaciones foliares con vermicompost lixiviado, a 100mL L-1. Las variables evaluadas fueron el número de hojas, de flores femeninas y de frutos por planta, longitud de frutos (cm), masa de los frutos (g) y el rendimiento (kg m-2). Los resultados mostraron que la aplicación individual y combinada de los biofertilizantes tuvieron un efecto bioestimulante en la producción de pepino y la aplicación de microorganismos eficientes a 100mL L-1 y la combinación con vermicompost lixiviado a 100mL L-1 constituyen una alternativa en la productividad del cultivo, especialmente, porque aumentaron el número de hojas, flores femeninas, frutos, masa y longitud de los frutos e incrementaron el rendimiento en 42% con relación al tratamiento control.

ABSTRACT The main problems of cucumber production reside fundamentally by the mineral fertilizer's shortage, climatic affectation and limited use of biofertilizers, which is important to looking for efficient alternatives that increase productivity, rationality and sustainability. The objective of this research was to evaluate the effect of individualized and associated use of biofertilizers efficient microorganisms and lixiviate vermicompost on the agro-productive increase of cucumber. The work was developed in the productive unit "El Estadio", Sancti Spíritus, Cuba, between January to April 2015 and Su Yi Sung cultivar of cucumber was used. The treatments used were a control (no application), soil inoculation and foliar applications with efficient microorganisms and lixiviate vermicompost at 100 and 200mL L-1, and soil inoculation with efficient microorganisms at 100mL L-1 and foliar applications with lixiviate vermicompost at 100mL L-1. The following variables were observed: number of leaves, female flowers and fruits per plant, length of fruits (cm), mass of fruits (g) and yield (kg m-2). The results showed that the individual and combined application of biofertilizers had a biostimulants effect on cucumber production. The efficient microorganism's application at 100mL L-1 and the combination with lixiviate vermicompost to 100mL L-1 constituting a sustainable alternative in the cucumber productivity, especially because they increased the number of leaves, female flowers, fruits, mass and length of fruits and increasing the yield by 42 % compared to control treatment.

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RESUMEN La maternidad en las adolescentes significa un riesgo para su salud y la de su hijo. Se realizó una investigación cuantitativa, descriptiva, correlacional, de corte transversal, cuya muestra total estuvo conformada por 115 adolescentes y el objetivo fue describir características clínicas y epidemiológicas de las adolescentes embarazadas, según variables de interés entre enero 2016 - diciembre 2017. Se pudo constatar que el 71,30 % de la muestra estaba en la etapa media de la adolescencia. El mayor porcentaje correspondió a pacientes de Secundaria Básica (58,26 %). El 59,13 % tenía pareja estable, mientras que el 63,33 % eran estudiantes. El inicio de las primeras relaciones sexuales fue entre los 12-14 años de edad, (59,13 %). Predominaron las adolescentes embarazadas entre 15-18 años de edad. Se constató la no planificación del embarazo. Prevalecieron las que usaban condón, ocasionalmente durante las relaciones sexuales y las enfermedades con mayor incidencia fueron: anemia e infección vaginal.

ABSTRACT Maternity in adolescents means a risk for their own health and their child. A quantitative, descriptive, correlational and cross-sectional investigation, whose total sample consisted of 115 adolescents, was aimed at describing clinical and epidemiological characteristics of pregnant adolescents, according to variables of interest, between January 2016 and December 2017. It was found that the 71.30% of the sample was in middle adolescence. The highest percentage corresponded to patients from Secondary School (58.26%). The 59.13% had a steady partner, while 63.33% were students. The initiation of the first sexual intercourse was between 12 and 14 years of age (59.13%). Pregnant teenagers between 15 and 18 years predominated. It was found that pregnancies were unplanned. Those who occasionally used the condom during intercourse prevailed, and the diseases with higher incidence were anemia and vaginal infection.

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OBJECTIVE: The purpose of this study was to describe the preferences, the use, satisfaction of mental health services (MHS) among a sample of Puerto Rican patients with cancer undergoing oncology treatment. METHODS: A convenience sample of 120 patients diagnosed with cancer was recruited. Self-report questionnaires assessed socio-demographic and background questions, and the Mental Health Service Preference, Utilization and Satisfaction Questionnaire (MHSPUS). The Socio-demographic and Background Questionnaire inquired about participants' demographic and socioeconomic characteristics, and included questions such as history of psychiatric diagnosis and spiritual practices. Univariate and Chi square analyses were used for descriptive purposes. Logistic regressions were used to explore associations between sociodemographic factors and MHS preferences and use. RESULTS: The majority of the sample were females (53.8%), 61 and older (53.8%), and married or living with partner (57.1%), and reported an income equal to or less than $12,000 per year (44.4%), which places them under the US federal poverty line. Most of the participants (66.7%) reported being receptive to seeking services. Findings showed a significant association between living situation and past (p < .05) and lifetime use (p < .05) of MHS and past use of MHS. Participants living alone were more like to have used MHS in the past and during their lifetime. Adjusted logistic regression analyses revealed that living with someone was a protective factor for not using MHS in their lifetime (OR = 0.28; C1 = 0.08-0.95). Participants preferred to receive MHS at the oncology clinic, preferably on the date of their oncology appointments and during morning hours. CONCLUSION: Findings support the integration of mental health services within the oncology practice setting.

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El cáncer de próstata es una neoplasia hormono-dependiente de importante heterogeneidad. El comportamiento clínico, la respuesta a tratamientos y la supervivencia varían dependiendo de cada paciente. Más del 95% de los cánceres prostáticos son adenocarcinomas, las variantes que no lo son pueden dividirse en dos grupos con base en su origen celular: epitelial y no epitelial. Las variantes epiteliales son más diferenciadas y biológicamente menos agresivas, mientras que las no epiteliales tienen un comportamiento muy invasor. Su tratamiento está orientado al alivio de la sintomatología, al control de su expansión y a elevar las probabilidades de curación.

Prostate cancer is a hormone-dependent neoplasm of significant heterogeneity. Clinical behavior, response to treatments and survival vary depending on each patient. More than 95% of prostate cancers are adenocarcinomas, variants that cannot be, are divided into two groups based on their cellular origin: epithelial and non-epithelial. Epithelial variants are more differentiated and biologically less aggressive, whereas non-epithelial variants have a very invading behavior. Its treatment is oriented to the relief of the symptomatology, the control of its expansion and to increase the probabilities of cure.

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El cáncer de próstata es una neoplasia hormono-dependiente de importante heterogeneidad. El comportamiento clínico, la respuesta a tratamientos y la supervivencia varían dependiendo de cada paciente. Más del 95 por ciento de los cánceres prostáticos son adenocarcinomas, las variantes que no lo son pueden dividirse en dos grupos con base en su origen celular: epitelial y no epitelial. Las variantes epiteliales son más diferenciadas y biológicamente menos agresivas, mientras que las no epiteliales tienen un comportamiento muy invasor. Su tratamiento está orientado al alivio de la sintomatología, al control de su expansión y a elevar las probabilidades de curación.(AU)

Prostate cancer is a hormone-dependent neoplasm of significant heterogeneity. Clinical behavior, response to treatments and survival vary depending on each patient. More than 95 percent of prostate cancers are adenocarcinomas, variants that cannot be, are divided into two groups based on their cellular origin: epithelial and non-epithelial.Epithelial variants are more differentiated and biologically less aggressive, whereas non-epithelial variants have a very invading behavior. Its treatment is oriented to the relief of the symptomatology, the control of its expansion and to increase the probabilities of cure.(AU)

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La tiña negra es una micosis cutánea superficial causada por un hongo levaduriforme denominado Hortaea werneckii, es frecuente en regiones cálidas y en zonas de playa. Se comunica su aislamiento de la palma de la mano de un niño sin antecedentes de contacto con fuente infecciosa ni de hiperhidrosis que fue tratado con pomada de Whitfield con azufre desapareciendo la lesión al mes sin recidivas. Se considera significativo presentar este caso dada la escasa frecuencia de su diagnóstico(AU)

Tinea nigra is a superficial cutaneous mycosis, caused by the yeasty-form fungus called Hortaea werneckii. It is frequent in warm regions and in beach zones. Its isolation in the hand palm of a boy without antecedents of infectious contact or hyperhidrosis is reported in this article. He was treated with an ointment of benzoic acid, salicylic acid and sulfur; lesions disappeared after a month without recurrence. The presentation of the case was considered significant due to the scarce frequency of this diagnose(AU)

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La tiña negra es una micosis cutánea superficial causada por un hongo levaduriforme denominado Hortaea werneckii, es frecuente en regiones cálidas y en zonas de playa. Se comunica su aislamiento de la palma de la mano de un niño sin antecedentes de contacto con fuente infecciosa ni de hiperhidrosis que fue tratado con pomada de Whitfield con azufre desapareciendo la lesión al mes sin recidivas. Se considera significativo presentar este caso dada la escasa frecuencia de su diagnóstico.

Tinea nigra is a superficial cutaneous mycosis, caused by the yeasty-form fungus called Hortaea werneckii. It is frequent in warm regions and in beach zones. Its isolation in the hand palm of a boy without antecedents of infectious contact or hyperhidrosis is reported in this article. He was treated with an ointment of benzoic acid, salicylic acid and sulfur; lesions disappeared after a month without recurrence. The presentation of the case was considered significant due to the scarce frequency of this diagnose.

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Objetivo: Valorar las características basales de una serie de pacientes con hemorragia subaracnoidea aneurismática y el impacto sobrelos resultados quirúrgicos de un protocolo de manejo dinámico basado fundamentalmente en el ultrasonido Doppler transcraneal.Métodos: Se realizó un estudio descriptivo longitudinal en 233 pacientes con hemorragia subaracnoidea aneurismática operados en el Hospital Hermanos Ameijeiras durante el período 2006–2010 y evaluados posoperatoriamente por un año.Resultados: La edad media fue 49,19 años. El sexo femenino representó el 66 (Por ciento). Al ingreso, 58,4 (Por ciento) de los casos fueron grado 1 de laescala modificada de la FMSN. El estado preoperatorio evolucionó a 69,5 (Por ciento)en grado 1. El grado 3 de Fisher predominó y se asoció a la presencia de vasospasmo. El 28,8 (Por ciento) de los casos presentó vasospasmo angiográfico, elevándose el diagnóstico al 49,4 (Por ciento) con el DopplerTranscraneal, en el 25,8 (Por ciento) se hizo sintomático y el 15,9 (Por ciento) desarrolló déficit isquémico. El 73,4 (Por ciento) tuvieron aneurismas únicos de la circulación anterior. El 79,4 (Por ciento) de los aneurismas midieron entre 4–10 mm. La evolución fue favorable en el 93 (Por ciento) y la mortalidad fue de 4,29 (Por ciento). Los resultados al alta se relacionaron significativamente con: el estado al ingreso y preoperatorio, la escala de Fisher, el número de aneurismas, vasospasmo y resangramiento. Las complicaciones médicas y quirúrgicas más frecuentes fueron el vasospasmo, elresangramiento, el infarto cerebral, las infecciones urinarias, la hidrocefalia y la ruptura transoperatoria.Conclusiones: Los resultados fueron propicios comparados con la literatura especializada. Se evidenció la utilidad del manejo protocolizado y el uso de Doppler Transcraneal en estos pacientes(AU)

Objective: To assess basal characteristics and surgical outcome in patients with aneurismatic subarachnoid hemorrhage managed with one dynamic protocol based mostly on transcranial Doppler ultrasound.Methods: A descriptive longitudinal study was carried out in 233 patients with aneurismatic subarachnoid hemorrhages, who received neurosurgical clipping in the years 2006–2010 and were followed during one year.Results: Mean age was 49.19 years. Female were 66 (Per cent). At the admission, 58.4 (Per cent) of cases were in grade 1 according to the modified scale of World Federation of Neurosurgical Societies (WFNS). Preoperatively 69.5 (Per cent) of patients become grade 1. Patients were mostly Fisher 3 according to CT scan results, and this was statistically associated with vasospasm. Angiographic vasospasm was present in 28.8 (Per cent) of the cases, but increased to 49.4 (Per cent) by using transcranial Doppler. In 25.8 (Per cent) of cases vasospasm was symptomatic, and 15.9 (Per cent) develop delayed ischemic deficit. Single aneurysms on the anterior Willis circle were most relevant statistically and accounted for 73.4 (per cent) of the cases. Aneurysms were mostly of relatively small size, and in 79.4 (Per cent) of the patients they ranged between 4 and 10 mm. Outcome was favorable in 93 (Per cent), and mortality was 4.29 (Per cent). Outcome was significant associated with: neurological status at the admission, Fisher scale, numbers of aneurysms, vasospasm, and re–bleeding. Most frequents surgical and medical complications were vasospasm, re–bleeding, cerebral infarct urinary infection, hydrocephalus and intraoperative rupture.Conclusions: Compared with several series from specialized literature, outcome in this series was good. These suggest the utility of one dynamic protocol based on transcranial Doppler in patients with aneurismatic subarachnoid hemorrhage(AU)

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Introducción: La cirugía de la hemorragia subaracnoidea aneurismática (HSA) realizada en las primeras 72 horas es beneficiosa. Cuando los casos arriban transcurrido este período el mejor momento quirúrgico es controversial. Objetivo. Evaluar la influencia sobre los resultados de la cirugía en la HSA de un protocolo para decidir el momento quirúrgico apoyado en el monitoreo con Doppler transcraneal (DTC). Material y Método: Se comparan los resultados quirúrgicos al alta y al año de seguimiento según la escala de Glasgow para resultados (EGR), en una serie de 233 casos con HSA rotos operados Enero de 2006 - Diciembre de 2010 y seguidos hasta Enero de 2012, en los que la cirugía en el período intermedio se decidió teniendo en cuenta las velocidades de flujo de los segmentos proximales del polígono de Willis registradas por DTC, con los de un grupo control histórico operado Diciembre de 1983 - Diciembre de 2005 sin la ayuda de dicho monitoreo. Resultados: La mortalidad al alta y al año en la serie de estudio fue de 4,3 y 4,5 por ciento y en el grupo control 7 y 7,7 por ciento respectivamente. Se observaron resultados satisfactorios (grados 4 y 5 en EGR) en el 93,1 al alta y 92,8 por ciento al año en la serie de estudio. Entre los controles históricos estos índices fueron 85,6 y 88,1 por ciento respectivamente (p = 0,004 y p = 0,036). Conclusiones: Los resultados del tratamiento microquirúrgico de la HSA se benefician con la atención protocolizada y la consideración de los resultados del DTC para seleccionar el momento quirúrgico.

Background: Aneurysmal subarachnoid hemorrhage (SAH) surgery, practiced in the first 72 hours is beneficial. The optimal surgical timing, for microsurgical clipping of ruptured intracranial aneurysms, remains controversial when patients arrive between 4 and 14 days. Some surgeons favor a prompt operation regardless the timing. Other ones prefer to wait 2 weeks. Most patients in developing countries are taken to neurosurgical attention late, which not permit an early surgery. Object. To evaluate the surgical outcome in a series of patients with subarachnoid hemorrhage (SAH) managed according to a dynamic protocol. Methods: The authors evaluated surgical outcome by means of Glasgow Outcome Scale (GOS) score in a series of 233 patients with SAH who received neurosurgical clipping in the years 2006-2010 and were followed until January 2012, whose surgical timing was decided according to transcranial Doppler (TD) monitoring. These outcomes were compared with results in a series of 445 historic controls operated 1983-2005. Results: Series mortality at the discharge and at the year were 4.3 and 4.5 percent, and 7 and 7.7 percent in the control group respectively. Series show good outcomes (grade 4 and grade 5 in GOS score) in 93.1 at the discharge and 92.8 percent at the year. Among the historic controls cases with good outcome were 85.6 and 88.1 percent respectively (p = 0.004 y p = 0.036). Conclusions: Surgical outcomes of SAH can be favored by the impact of protocolized attention and TD to decide the best surgical timing in SAH.

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Scrapie is a disease that affects sheep and goats and is characterized by the accumulation of an abnormal isoform (PrPSc) of the cellular prion protein, PrPC, in the central nervous system (CNS) and in lymphoid tissues. Detection of PrPSc in these tissues can be attempted by a variety of techniques, including immunohistochemistry (IHC) and western blotting (WB), for which a wide range of monoclonal and polyclonal antibodies are commercially available. The objective of this study was to test and compare the efficacy of monoclonal antibodiesF89/160.1.5, F99/97.6.1, and P4 and polyclonal antibodies M52 and R486 in the detection of PrPSc in lymphoid and CNS tissue samples by using IHC. Positive and negative control samples of sheep brain and tonsils were provided by the Animal Health and Veterinary Laboratories Agency (AHVLA, UK). The IHC examination of CNS samples with both monoclonal and polyclonal antibodies confirmed the granular deposition of PrPSc in the neurons of the positive control tissues. However, while the monoclonal antibodies did not produce positive reactions in the negative controls, the polyclonal antibodies showed some non-specific staining. The testing of positive control tonsil samples with polyclonal and monoclonal antibodies identified positive control-specific reactions, whereas the negative control tissues were IHC-negative with all antibodies, although P4...(AU)

Scrapie é uma doença que afeta ovinos e caprinos, sendo definida pelo acúmulo de uma isoforma anormal (PrPSc) da proteína priônica celular (PrPC) no Sistema Nervoso Central (SNC) e em tecidos linfoides. Para as técnicas de eleição do diagnóstico de scrapie, imunohistoquímica (IHQ) e western blotting (WB), podem ser utilizados uma vasta gama de anticorpos monoclonais e policlonais comercialmente disponíveis. O objetivo deste estudo foi testar e comparar a eficácia dos anticorpos monoclonais disponíveis comercialmente, F89/160.1.5, F99/97.6.1 e P4, e os anticorpos policlonais R486 e M52, para a identificação da presença da PrPSc em amostras de tecido linfoide e SNC através da técnica de IHQ. Foram utilizadas nas avaliações de IHQ amostras positivas e negativas de cérebro e tonsila palatina de ovinos, cedidas pelo Animal Health Veterinary Laboratory Agency (AHVLA), Reino Unido. Para WB, foram utilizadas amostras de encéfalo, baço, linfonodo, terceira pálpebra e mucosa retal de ovino. As análises IHQ utilizando anticorpos monoclonais e policlonais em amostras positivas de cérebro confirmaram a deposição da PrPSc em neurônios, caracterizada por marcações de aspecto granular intraneural. Na amostra negativa de cérebro, os anticorpos monoclonais não identificaram marcações positivas, o que foi possível verificar ao utilizar os anticorpos policlonais. Testando a amostra positiva de...(AU)

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Scrapie is a disease that affects sheep and goats and is characterized by the accumulation of an abnormal isoform (PrPSc) of the cellular prion protein, PrPC, in the central nervous system (CNS) and in lymphoid tissues. Detection of PrPSc in these tissues can be attempted by a variety of techniques, including immunohistochemistry (IHC) and western blotting (WB), for which a wide range of monoclonal and polyclonal antibodies are commercially available. The objective of this study was to test and compare the efficacy of monoclonal antibodiesF89/160.1.5, F99/97.6.1, and P4 and polyclonal antibodies M52 and R486 in the detection of PrPSc in lymphoid and CNS tissue samples by using IHC. Positive and negative control samples of sheep brain and tonsils were provided by the Animal Health and Veterinary Laboratories Agency (AHVLA, UK). The IHC examination of CNS samples with both monoclonal and polyclonal antibodies confirmed the granular deposition of PrPSc in the neurons of the positive control tissues. However, while the monoclonal antibodies did not produce positive reactions in the negative controls, the polyclonal antibodies showed some non-specific staining. The testing of positive control tonsil samples with polyclonal and monoclonal antibodies identified positive control-specific reactions, whereas the negative control tissues were IHC-negative with all antibodies, although P4...

Scrapie é uma doença que afeta ovinos e caprinos, sendo definida pelo acúmulo de uma isoforma anormal (PrPSc) da proteína priônica celular (PrPC) no Sistema Nervoso Central (SNC) e em tecidos linfoides. Para as técnicas de eleição do diagnóstico de scrapie, imunohistoquímica (IHQ) e western blotting (WB), podem ser utilizados uma vasta gama de anticorpos monoclonais e policlonais comercialmente disponíveis. O objetivo deste estudo foi testar e comparar a eficácia dos anticorpos monoclonais disponíveis comercialmente, F89/160.1.5, F99/97.6.1 e P4, e os anticorpos policlonais R486 e M52, para a identificação da presença da PrPSc em amostras de tecido linfoide e SNC através da técnica de IHQ. Foram utilizadas nas avaliações de IHQ amostras positivas e negativas de cérebro e tonsila palatina de ovinos, cedidas pelo Animal Health Veterinary Laboratory Agency (AHVLA), Reino Unido. Para WB, foram utilizadas amostras de encéfalo, baço, linfonodo, terceira pálpebra e mucosa retal de ovino. As análises IHQ utilizando anticorpos monoclonais e policlonais em amostras positivas de cérebro confirmaram a deposição da PrPSc em neurônios, caracterizada por marcações de aspecto granular intraneural. Na amostra negativa de cérebro, os anticorpos monoclonais não identificaram marcações positivas, o que foi possível verificar ao utilizar os anticorpos policlonais. Testando a amostra positiva de...

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