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Water pollution in developing countries continues to be a major health problem due to various anthropological activities that contribute to the spread of many parasitic diseases, including those caused by helminths. The aim of this study is to explore the ability of ozone and peroxone to disinfect drinking water contaminated samples with Toxocara canis eggs. The oxidants used were ozone and ozone-hydrogen peroxide combination. The treatment of Toxocara canis eggs was carried out in a 50 ml reactor with an operating volume of 10 ml. The pH conditions (5, 7 and 10) were varied for each treatment. The treatment effect was calculated by counting eggs and examining the condition of the larvae larval condition (whole, broken and hatched larvae) using an optical microscope. The experiment was carried out by exposing the eggs for 60 and 120 minutes to ozone and peroxone. The best results were obtained for helminths treated with the ozone/hydrogen peroxide combination at pH 10, with an inactivation of 79.2%. The synergistic effect of ozone combined with hydrogen peroxide allows higher helminth egg inactivation rates, demonstrating that advanced oxidation processes are a real alternative to apply in the inactivation of Toxocara canis eggs. The results obtained in this study show that the ozone and peroxone treatment could be a useful disinfection process to destroy or inactivate Toxocara canis eggs in processes commonly applied in water treatment.

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The capuchin monkey (Sapajus apella), a New World monkey species, exhibits prominent characteristics that make it an ideal model for neuroscience research. These characteristics include its phylogenetic traits, telencephalization coefficient, anatomical structures and pathways, genetic profile, immune responses, cognitive abilities, and complex behavioral repertoires. Traditionally, methodologies for stereotactic neurosurgery in research models have relied on the use of brain atlases. However, this approach can lead to errors due to the considerable variation in brain size and shape among individual monkeys. To address this issue, we developed a protocol for deriving individual coordinates for each monkey using a straightforward and relatively inexpensive method involving MRI imaging. Our protocol utilizes a specially designed, 3D-printed stereotactic head-holder that is safe to use with an MR magnet, non-invasive placement of fiducial markers, and post-processing with open-source software. This approach enhances MRI data visualization, improves anatomical targeting, and refines the design of neurosurgical experiments. Our technique could also prove beneficial in other areas of neuroscience research that require accurate calculation of stereotaxic coordinates. Furthermore, it could be useful for other nonhuman primate species for which brain atlases are typically unavailable.

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INTRODUCCIÓN: Panamá ocupa la quinta posición en incidencia acumulada de países latinoamericanos y la cuarta posición de muertes en Centroamérica por COVID-19. Hay pocos datos en la población pediátrica panameña. Se describen las características de esta población, admitidos al Hospital Materno Infantil José Domingo De Obaldía, durante el primer año de pandemia. OBJETIVOS: Describir factores clínicos y epidemiológicos asociados al ingreso hospitalario a salas o Unidad Terapia Intensiva Pediátrica (UCIP). MÉTODOS: Estudio descriptivo, transversal, retrospectivo con componente analítico con edad de 1 mes a 13 años 11 meses, de pacientes hospitalizados entre 01 abril 2020 y 30 abril 2021 y diagnóstico de SARS-CoV2 mediante reacción de polimerasa en cadena, detección de antígeno o serología al ingreso o durante su hospitalización. Los datos fueron analizados con IBM SPSS versión 25.0. RESULTADOS: 84 pacientes fueron evaluados, 71 (85%) cumplieron los criterios de inclusión. Los factores de riesgo asociados a ingreso a UCIP: indígena 1,86 (3,08-1,13), referido de Bocas del Toro 9,33(43,43-2), desnutrición 5,6 (30,53-1,02), enfermedad neurológica 7,46 (36,94-1,5), radiografía de tórax con infiltrado intersticial y consolidación 14,93 (123,9-1,8), shock 1,32 (1,58-1,1), alteración del estado de alerta 22,4 (172-2,91), hipoxia 6,22 (23,13-1,67) y disnea 2,61 (5,7-1,19). La mortalidad fue 4%, asociada a compromiso respiratorio y comorbilidades. CONCLUSIONES: Ser indígena, tener comorbilidades, radiografía de tórax (infiltrados intersticiales y consolidados) predominaron en los ingresos a la UCIP.

BACKGROUND: Panama occupies the fifth position in cumulative incidence of Latin American countries and the fourth position in deaths in Central America from COVID-19. There are few data in the Panamanian pediatric population. The characteristics of this population, admitted to the José Domingo De Obaldia Maternal and Child Hospital, during the first year of the pandemic, are described. AIM: To describe clinical and epidemiological factors associated with hospital admission to wards or Pediatric Intensive Care Unit (PICU). METHODS: Descriptive, cross-sectional, retrospective study with an analytical component with an age range of 1 month to 13 years 11 months, patients hospitalized between April 1,2020 to April 30, 2021 and diagnosis of SARS-CoV2 by polymerase chain reaction, antigen detection, or serology. upon admission or during hospitalization. Data were analyzed with IBM SPSS version 25.0. RESULTS: 84 patients were included, 71 (85%) met the inclusion criteria. Risk factors associated with admission to the PICU: indigenous 1.86 (3.08-1.13), referred from Bocas del Toro 9.33 (43.43-2), malnutrition 5.6 (30.53-1.02), neurological disease 7.46 (36.94-1.5), chest X-ray with interstitial infiltrate and consolidation 14.93 (123.9-1.8), shock 1.32 (1.58-1.1), altered alertness 22.4 (172-2.91), hypoxia 6.22 (23.13-1.67) and dyspnea 2.61 (5.7-1.19). Mortality was 4%, associated with respiratory compromise and comorbidities. CONCLUSIONS: Being indigenous, having comorbidities, chest X-ray (interstitial and consolidated infiltrates) predominated in admissions to the PICU.

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Resumen La literatura actual ofrece la posibilidad de aportar argumentos tanto a favor como en contra a la discusión sobre la eficacia de los medicamentos antidepresivos. Tanto la metodología, modelos de estudio y herramientas utilizadas para comparar la eficacia de los medicamentos plantean controversia. Este debate se agudiza al considerar la existencia del efecto placebo en resultados que promueven o cuestionan el uso de estos medicamentos. Entender los mecanismos de acción del placebo no solo permite una mejor comprensión de los resultados de la investigación con relación al uso de antidepresivos, sino que además respecto a la efectividad de los distintos tratamientos que hoy en día se utilizan en salud mental.

Current literature offers the possibility to contribute to the discussion about the effectiveness of antidepressants, with arguments both in favor and opposing it. Methodology, study models, and tools used to compare drug effectiveness, all raise controversy. This debate is intensified when involving the existence of placebo effect in results either promoting or questioning the use of these drugs. Understanding the mechanism of action of placebo not only allows for a better grasp of study results around antidepressant use but could also contribute to the effectiveness of distinct treatments used nowadays in mental health.

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BACKGROUND: Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF). METHODS: A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence. DISCUSSION: This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources. TRIAL REGISTRATION NUMBER: NCT04825184 , registered 30th March 2021.

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Methicillin resistance mediated by the mecA gene in Staphylococcus aureus, also known as "true MRSA", is typically associated with high oxacillin MIC values (≥8 mg/L). Because non-mecA-mediated oxacillin resistant S. aureus phenotypes can also cause hard-to-treat diseases in humans, their misidentification as methicillin-susceptible S. aureus strains (MSSA) can compromise the efficiency of the antimicrobial therapy. These strains have been refereed as Borderline Oxacillin-Resistant S. aureus (BORSA) but their characterization and role in clinical microbiology have been neglected. Considering the increasing importance of livestock-associated methicillin-resistant S. aureus ST398 (LA-MRSA) as an emerging zoonotic pathogen worldwide, this study aimed to report the genomic context of oxacillin resistance in porcine S. aureus ST398 strains. S. aureus isolates were recovered from asymptomatic pigs from three herds. Oxacillin MIC values ranged from 4 to 32 mg/L. MALDI-TOF-confirmed isolates were screened for mecA and mecC by PCR and genotyped by means of PFGE and Rep-PCR. Seven isolates were whole genome sequenced. None of the isolates harbored the mecA gene or its variants. Although all seven sequenced isolates belonged to one sequence type (ST398), two different spa types (t571 and t1471) were identified. All isolates harbored conserved blaZ gene operon and no mutations on genes encoding for penicillin-binding-proteins were detected. Genes conferring resistance against other drugs such as aminoglycosides, chloramphenicol, macrolide, lincosamide and streptogramin (MLS), tetracycline and trimethoprim were also detected. Isolates also harbored virulence genes encoding for adhesins (icaA; icaB; icaC; icaD; icaR), toxins (hlgA; hlgB; hlgC; luk-PV) and protease (aur). Pigs can serve as reservoirs of non-mecA-mediated oxacillin-resistant ST398 strains potentially pathogenic to humans. Considering that mecA has been the main target to screen methicillin-resistant staphylococci, the occurrence of BORSA phenotypes is probably underestimated in livestock.

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La traqueomalacia (TM) consiste en una excesiva colapsabilidad traqueal debida a una anomalía estructural del cartílago y/o de la pared membranosa posterior. Cuando se extiende a uno o ambos bronquios principales se denomina traqueobroncomalacia (TBM). Considerando diferentes clasificaciones, la mayoría de las TM son adquiridas, localizadas e intratorácicas. El diagnóstico clínico es difícil porque los síntomas son inespecíficos y se superponen con los de otras enfermedades respiratorias crónicas. Los síntomas más frecuentes incluyen estridor espiratorio, tos perruna e infecciones respiratorias recurrentes, en los casos más graves se presentan episodios de dificultad respiratoria severa, cianosis e incluso muerte súbita. La fibrobroncoscopía sigue siendo el método diagnóstico estándar de oro, complementándose con la tomografía computarizada que es esencial en la visualización de las estructuras adyacentes a la vía aérea. En los casos leves el tratamiento es conservador, considerando la resolución espontánea de la mayoría de los casos hacia los 2 años de edad. En los pacientes más sintomáticos la estrategia terapéutica se debe evaluar caso a caso, siendo la presión positiva contínua en vía aérea (no invasiva o invasiva por traqueostomía) el tratamiento más utilizado. En las TM-TBM más severas, entre posibles tratamientos que incluyen cirugía traqueal y prótesis en la vía aérea, lo más usado es aortoarteriopexia y traqueopexia, a la espera de resultados promisorios de mallas endoluminales biodegradables y prótesis reabsorbibles personalizadas impresas en 3D.

Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the cartilaginous rings and/or the posterior membrane. When the main bronchi is also affected this condition is termed as tracheobronchomalacia (TBM). According classifications TM is mostly acquired, localized and intrathoracic. Diagnosing TM is challenging because symptoms are nonspecific and overlap with those of other chronic respiratory disorders. The most common symptoms include expiratory stridor, barking cough and recurrent respiratory tract infections, in severe cases, severe respiratory distress episodes and acute life threatening events can occur. While flexible bronchoscopy is still considered as the gold standard diagnostic method, computed tomography is essential in assessing the surrounding structures. Conservative therapy is preferred in milder cases since the outcome is usually favorable within the first 2 years of life. Treatment of more symptomatic children should be discussed on an individual basis, continuous positive airway pressure (non invasive o invasive via tracheostomy) being the most widely used therapy. For more severe TM-TBM, amongst possible treatments including tracheal surgery and airway stenting, aortoarteriopexy and tracheopexy are mostly used, nevertheless absorbable stent and 3D printed customed prosthesis are being developed with promising results.

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Natural elicitors derived from pathogenic microorganisms represent an ecologic strategy to achieve resistance in plants against diseases. Glucosylceramides (GlcCer) are classified as neutral glycosphingolipids. GlcCer were isolated and purified from Fusarium oxysporum mycelium. F. oxysporum is a plant pathogenic fungus, abundant in soil and causing severe losses in economically important crops such as corn, tobacco, banana, cotton and passion fruit. In this study we evaluate the capacity of GlcCer in inducing resistance in N. tabacum cv Xanthi plants against Tobacco mosaic virus (TMV). Spraying tobacco plants with GlcCer before virus infection reduced the incidence of necrotic lesions caused by TMV. In addition, plants already infected with the virus showed a reduction in hypersensitive response (HR) lesions after GlcCer treatment, suggesting an antiviral effect of GlcCer. Our investigations showed that GlcCer stimulates the early accumulation of H2O2 and superoxide radicals. In addition, the expression of PR-1 (pathogenesis-related 1, with suggested antifungal action), PR-2 (ß-1,3-glucanase), PR-3 (Chitinase), PR-5 (Osmotin), PAL (Phenylalanine ammonia-lyase), LOX (Lipoxygenase) and POX (Peroxidase) genes was highly induced after treatment of tobacco plants with GlcCer and induction levels remained high throughout a period of 6 to 120 hours. Our experiments demonstrate that GlcCer induces resistance in tobacco plants against infection by TMV.

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OBJECTIVES: Even when new cases of syphilis are notifiable since 1944, the Mexican National Epidemiological Surveillance System lacks information on the changes of the rate of case reports considering the geographic and demographic variables. Therefore, it is necessary to have evidence, with particular attention to the study of the epidemiological behavior by the identification of risk factors and groups. The objective of this study was to analyze the epidemiology, geographical distribution, and forecast of syphilis in Mexico. STUDY DESIGN: The design of the study was a secondary research of epidemiological databases. METHODS: A retrospective analysis of the national surveillance data (2007-2017) of acquired and congenital syphilis (CS) issued by the General Directorate of Epidemiology was performed. RESULTS: Of all cases, 34,998 and 1030 cases were reported for acquired syphilis (AS) and CS , respectively, reflecting an increasing trend in the whole country for both diseases. Cases and incidence of AS per year showed that, male gender presented an increase in reproductive age. Distribution of the rate of case reports is mostly commanded by the states in the extreme north (Gulf of California and northern Gulf of Mexico) and south (Gulf of southern Mexico and the Caribbean Sea). Likewise, the Seasonal Autoregressive Integrated Moving Average model was selected as the best-fit model for the forecast analysis. This model was used to forecast AS cases during 2018-2019. AS may have a slight fluctuation (on the rise) during the following 24 months. CONCLUSIONS: These findings underscore the importance of intensifying, as well as expanding screening and treatment in adult population, including men, who are not routinely benefiting from maternal and reproductive service-based syphilis screening and treatment.

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INTRODUCTION: Subtrochanteric fractures are associated with a high rate of complications. Intramedullary nails have proven to be the best choice for treatment, but no implant has been shown to be superior to another. We want to study the differences between treating subtrochanteric fractures in the elderly with two different types of nails: T2 Recon vs Gamma3 long. MATERIAL AND METHODS: Comparative retrospective study between 2013 and 2015 with 54 patients with subtrochanteric fractures and more than 65 years. The average follow-up is 12 months; 26 patients were treated with T2 Recon, and 28 with Gamma3. The duration of surgery, need for transfusion, evolution and complications of fractures were compared in both groups. RESULTS: The duration of surgery was significantly longer for T2 Recon (p = 0.035), while the need for transfusion and fracture evolution were similar in both groups. Three cases required another surgery to achieve the final consolidation of the fracture. Two of them due to a failure of the T2 Recon implant, which represents 7.69% of the patients in this group, while the other case belonged to the Gamma3 group and it was sufficient to perform a nail dynamization. CONCLUSIONS: We found no statistically significant differences, except for a longer surgical time in the T2 Recon group, being a surgeon-dependent variable that is not enough to prove that one nail is better than another.

INTRODUCCIÓN: Las fracturas subtrocantéreas se asocian a una alta tasa de complicaciones. Los clavos intramedulares han demostrado ser la mejor opción para su tratamiento, pero ningún implante ha demostrado ser superior a otro. El objetivo es estudiar las diferencias entre tratar las fracturas subtrocantéreas en el anciano con dos tipos de clavos diferentes: T2 Recon vs Gamma3 largo. MATERIAL Y MÉTODOS: Estudio retrospectivo comparativo entre los años 2013 y 2015, con 54 pacientes con fracturas subtrocantéreas y más de 65 años. El seguimiento medio es de 12 meses; 26 pacientes fueron tratados mediante T2 Recon y 28 con Gamma3. La duración de la cirugía, necesidad de transfusión, evolución y complicaciones de las fracturas fueron comparadas en ambos grupos. RESULTADOS: La duración de la cirugía fue significativamente mayor para los T2 Recon (p = 0.035), mientras que la necesidad de transfusión y evolución de las fracturas fueron similares en ambos grupos. Tres casos fueron reintervenidos para conseguir la consolidación final de la fractura. Dos de ellos debido a un fallo del implante T2 Recon, lo cual representa 7.69% de los pacientes de este grupo, mientras que el otro caso pertenecía al grupo de los Gamma3 y fue suficiente con realizar una dinamización del clavo. CONCLUSIONES: No encontramos diferencias estadísticamente significativas, exceptuando un mayor tiempo quirúrgico en el grupo de los T2 Recon, siendo una variable cirujano-dependiente que no es suficiente para demostrar que un clavo sea mejor que otro.

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This study focused on the detection and quantification of eight cyanotoxins in water samples in three reservoirs located in the eastern department of Antioquia, Colombia. The reservoirs are a source of water supply and hydroelectricity, and also generate economic activities in fishing and recreation. Between May 2015 and October 2016, 8 samplings were carried out at times of high temperatures, which ranged from 20 to 29 °C. This period was selected because of a significant or strong El Niño phenomenon, according to the World Meteorological Organization. For the study, 270 integrated samples were taken from the photic zone (PZ) and the surface of the reservoirs, at each of the three sampling points. The samples were analyzed by the analytical technique of ultra-high-performance liquid chromatography coupled to triple quadrupole mass spectrometry (UHPLC MS/MS). The quantification performed for six microcystins (MCs), a nodularin (NOD) and a cylindrospermopsin (CYN), showed positive results well above 1 µg L-1. In the water of the Abreo Malpaso and Peñol reservoirs, microcystin-LR (MC-LR), microcystin-YR (MC-YR) and [D-Asp3,(E)-Dhb7]- microcystin-RR toxins were detected at levels of considerable concentration, especially between May and September 2015, when there was no rainfall in this region. In the Playas reservoir, positive results for [D-Asp3,(E)-Dhb7]-MC-RR were detected from May to November 2015, with the highest concentrations being reached in dry season. The temperatures reached and the changes in climatic conditions witnessed during the monitoring period of this study were important factors in the production of cyanotoxins. This was evidenced in this work by the high concentrations of detected cyanotoxins and their absence in periods of rain, as happened from the second quarter of 2016 until the end of the study in October. This is the first study of the detection and quantification of cyanotoxins in tropical reservoirs of northeastern Colombia using the UHPLC MS/MS analytical technique, which allowed the toxins to be unequivocally detected and confirmed. A method was developed and validated, proving to be sensitive, reproducible and accurate. For each of the toxins (microcystin-LR (MC-LR), microcystin-RR (MC-RR), microcystin-YR (MC-YR), [D-Asp3,(E)-Dhb7]- microcystin-RR, microcystin-LW (MC-LW), microcystin-LF (MC-LF), nodularin (NOD) and cylindrospermopsina (CYN)) the correlation coefficients (R2) were in a range between 0.9907 and 0.9999. Verification of the accuracy of the method was performed through a calibration curve in solvent. The recovery percentages of the accuracy and precision tests of the method for low level, medium level and high level were in a range between 64% and 115% for all the cyanotoxins. The validation of the cyanotoxin method shows that it is possible to detect them individually in natural water with a quantification limit (LOQ) of approximately 0.05 µg L-1.

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OBJECTIVES: Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immediate detection and treatment of patients with acute HIV infection. METHODS: A nationwide cohort of patients with acute HIV infection was created in 2015. In order to identify cases and treat them promptly at our centre, an interdisciplinary group coordinated through an instant-messaging tool using smart phones was established. When a probable case was detected, a discussion was initiated to confirm the diagnosis and facilitate the administrative processes to initiate ART as soon as possible. We compared time to ART initiation with that in a comparison group of patients with chronic HIV infection enrolled during the same period (May 2015 to February 2017) through routine care, using survival analysis estimators and log-rank tests. RESULTS: We recruited 29 patients with acute HIV infection. The median time to ART initiation was 2 days in these patients, in contrast to 21 days for patients with chronic infection. There were no significant differences in the percentages of patients engaged in care, on treatment or virologically suppressed at 1 year of follow-up. CONCLUSIONS: Implementing immediate ART initiation programmes is feasible in Mexico, in spite of the substantial administrative barriers that exist in the country. More extensive replication of this model in other centres and in patients with chronic infection is warranted to evaluate its effect on the continuum of care.

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Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.

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The irreducible dislocation of the hallux interphalangeal joint is an infrequent condition and only a few cases have been described. It presents as dorsal dislocation with interposition of the sesamoid bone, which has the possibility of being radiologically undetectable. We present the case of a 29 year-old patient who, after a sports trauma sustained a hallux interphalangeal dislocation that went unnoticed for eight days. Since, closed reduction was not possible, as occurred in several cases reported in the literature, open reduction was performed through a dorsal incision. Based on a bibliographic review, it is possible to state that there are several treatment options and multiple approaches, and that these lesions usually have a good prognosis.

La luxación irreductible de la articulación interfalángica del hallux es una patología poco frecuente y hay pocos casos descritos. Se presenta como una luxación dorsal con interposición del sesamoideo; éste puede ser radiológicamente indetectable. Reportamos el caso de un paciente de 29 años que tras un traumatismo deportivo presentó una luxación interfalángica del hallux que pasó desapercibida hasta el octavo día. Al igual que en varios casos descritos en la literatura, no se pudo realizar una reducción cerrada, por lo que se procedió a una reducción abierta por una incisión dorsal. Una revisión bibliográfica revela que existen varias opciones terapéuticas, al igual que múltiples tipos de abordajes, y que estas lesiones generalmente presentan un buen pronóstico.

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Resumen: La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.

Abstract: Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

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Resumen: La luxación irreductible de la articulación interfalángica del hallux es una patología poco frecuente y hay pocos casos descritos. Se presenta como una luxación dorsal con interposición del sesamoideo; éste puede ser radiológicamente indetectable. Reportamos el caso de un paciente de 29 años que tras un traumatismo deportivo presentó una luxación interfalángica del hallux que pasó desapercibida hasta el octavo día. Al igual que en varios casos descritos en la literatura, no se pudo realizar una reducción cerrada, por lo que se procedió a una reducción abierta por una incisión dorsal. Una revisión bibliográfica revela que existen varias opciones terapéuticas, al igual que múltiples tipos de abordajes, y que estas lesiones generalmente presentan un buen pronóstico.

Abstract: The irreducible dislocation of the hallux interphalangeal joint is an infrequent condition and only a few cases have been described. It presents as dorsal dislocation with interposition of the sesamoid bone, which has the possibility of being radiologically undetectable. We present the case of a 29 year-old patient who, after a sports trauma sustained a hallux interphalangeal dislocation that went unnoticed for eight days. Since, closed reduction was not possible, as occurred in several cases reported in the literature, open reduction was performed through a dorsal incision. Based on a bibliographic review, it is possible to state that there are several treatment options and multiple approaches, and that these lesions usually have a good prognosis.

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Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women.

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Se presenta el caso de un paciente con colitis ulcerativa (CU) grave de nueva aparición y diagnóstico simultáneo de infección por virus de inmunodeficiencia humana (VIH). Dos enfermedades inmunológica y fisiopatológicamente opuestas, que raramente se asocian. Incluso se plantea que en la infección por VIH, la enfermedad inflamatoria intestinal (EII) puede ser menos agresiva. El diagnóstico se convierte en un reto, dado el espectro de enfermedades que pueden afectar el colón en el contexto de infección por VIH. Asimismo, el tratamiento es controversial teniendo en cuenta que el uso de inmunomoduladores o biológicos bloquean otro componente del sistema inmune que podría potenciar el estado de inmunosupresión en este grupo de pacientes. La historia natural, el tratamiento y el pronóstico, continúan siendo un desafío para la evidencia actual.

We present the case of a patient with severe de novo ulcerative colitis (CU) and a simultaneous diagnosis of Human Immunodeficiency Virus (HIV) infection. These two immunologically and pathophysiologically opposing diseases are rarely found in association, and it has even been suggested that inflammatory bowel disease (IAS) may be less aggressive in HIV infections. The diagnosis is challenging, given the spectrum of diseases that can affect the colon in the context of an HIV infection. Treatment is similarly controversial considering that the use of immunomodulators or biological block another component of the immune system that could enhance the state of immunosuppression in this group of patients. Natural history, treatment and prognosis remain a challenge for currently available evidence

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Roxarsone is included in chicken food as anticoccidial and mainly excreted unchanged in faeces. Microorganisms biotransform roxarsone into toxic compounds that leach and contaminate underground waters used for human consumption. This study evaluated roxarsone biotransformation by underground water microorganisms and the toxicity of the resulting compounds. Underground water from an agricultural field was used to prepare microcosms, containing 0.05 mM roxarsone, and cultured under aerobic or anaerobic conditions. Bacterial communities of microcosms were characterized by PCR-DGGE. Roxarsone degradation was measured by HPLC/HG/AAS. Toxicity was evaluated using HUVEC cells and the Toxi-ChromoTest kit. Roxarsone degradation analysis, after 15 days, showed that microcosms of underground water with nutrients degraded 90 and 83.3% of roxarsone under anaerobic and aerobic conditions, respectively. Microcosms without nutrients degraded 50 and 33.1% under anaerobic and aerobic conditions, respectively. Microcosms including nutrients showed more roxarsone conversion into toxic inorganic arsenic species. DGGE analyses showed the presence of Proteobacteria, Firmicutes, Actinobacteria, Planctomycetes and Spirochaetes. Toxicity assays showed that roxarsone biotransformation by underground water microorganisms in all microcosms generated degradation products toxic for eukaryotic and prokaryotic cells. Furthermore, toxicity increased when roxarsone leached though a soil column and was further transformed by the bacterial community present in underground water. Therefore, using underground water from areas where roxarsone containing manure is used as fertilizer might be a health risk.

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PURPOSE: The present study examines religiousness and its connection to suicidal thoughts, plans, and attempts among Trinidad and Tobago adolescents and young adults. METHOD: Data are from Trend Research Empowering National Development on adolescents and young adults in Trinidad and Tobago (N = 4448). Religious affiliation, self-perceived religiousness, attendance at religious services, prayer frequency, socio-demographic variables, and suicidal thoughts, plans, and attempts were assessed. RESULTS: Compared to nonreligious, Catholics (OR 0.63, p < 0.05) and Seventh-day Adventists (OR 0.47, p < 0.01) were less likely to think about suicide, and hindus (OR 5.81, p < 0.05) and other affiliates (OR 7.28, p < 0.01) were more likely to be treated for suicide. Higher self-rated religiosity was related to lower likelihood of thinking about suicide (OR 0.86, p < 0.01) and lower likelihood of planning suicide (OR 0.78, p < 0.001). Attendance at religious services was related to lower likelihood of thinking about suicide (OR 0.94, p < 05) and fewer suicide attempts (ß = -0.11, p < 0.01). More frequent prayer was related to lower likelihood of thinking about suicide (OR 0.92, p < 0.01) and lower likelihood of planning suicide (OR 0.90, p < 0.001). CONCLUSIONS: Religiousness may offer benefits for adolescents and young adults in Trinidad and Tobago by reducing the likelihood that they engage in suicide thoughts and behaviors. Results may hold implications for counselors, clergy, teachers, and others working with adolescents and young adults in Trinidad and Tobago.

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