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INTRODUCTION: COVID-19 pandemic has disrupted educational activities since 2020. AO Trauma Latin American courses took place in a blended modality during 2021 and participant's feedback was positive. In this study, we aim to identify if there was any difference in learning, planning, and executing an osteosynthesis on a bone model with synchronous or asynchronous faculty support during an online asynchronous learning program. MATERIAL AND METHODS: we designed an online asynchronous course designed for teaching about trimalleolar ankle fractures. We randomized twenty participants into two groups: the control group had synchronous faculty support and the intervention group had asynchronous faculty support. Participants were evaluated with initial and final quizzes, preoperative planning, and execution of an osteosynthesis on a bone model. Comparisons of scores between CG and IG were performed using the Mann-Whitney U test for non-parametric variables. A two-tailed p < 0.05 was considered statistically significant. RESULTS: we did not find a significant difference between synchronous or asynchronous faculty support during our asynchronous learning program in quiz results, preoperative planning, global rating scale or the result of the osteosynthesis as compared to the preoperative plan. CONCLUSION: there appears to be no difference in participant learning with synchronous or asynchronous faculty support during an online, asynchronous course. Asynchronous activities appear to be effective teaching methods and should be considered in continuous medical education in orthopedics. Larger studies are needed to identify differences in participant learning outcomes between synchronous and asynchronous faculty support models.

INTRODUCCIÓN: la pandemia de COVID-19 ha interrumpido las actividades educativas desde 2020. Los cursos de AO Trauma Latinoamérica se realizaron en modalidad semipresencial durante 2021 y la retroalimentación de los participantes fue positiva. En este estudio, nuestro objetivo es identificar si hubo alguna diferencia en el aprendizaje, la planificación y la ejecución de una osteosíntesis en un modelo óseo con el apoyo sincrónico o asincrónico de la facultad durante un programa de aprendizaje asincrónico en línea. MATERIAL Y MÉTODOS: diseñamos un curso asíncrono en línea para la enseñanza de las fracturas trimaleolares de tobillo. Se distribuyó aleatoriamente a 20 participantes en dos grupos: el grupo de control tuvo apoyo docente sincrónico y el grupo de intervención tuvo apoyo docente asincrónico. Se evaluó a los participantes con cuestionarios iniciales y finales, planificación preoperatoria y ejecución de una osteosíntesis en un modelo óseo. Las comparaciones de las puntuaciones entre GC e GI se realizaron mediante la prueba U de Mann-Whitney para variables no paramétricas. Una p de dos colas < 0.05 se consideró estadísticamente significativa. RESULTADOS: no encontramos diferencia significativa entre el apoyo del profesorado síncrono o asíncrono durante nuestro programa de aprendizaje asíncrono en los resultados de los cuestionarios, la planificación preoperatoria, la escala de valoración global o el resultado de la osteosíntesis en comparación con el plan preoperatorio. CONCLUSIÓN: no parece haber diferencias en el aprendizaje de los participantes con el apoyo sincrónico o asincrónico del profesorado durante un curso en línea asincrónico. Las actividades asíncronas parecen ser métodos de enseñanza eficaces y deberían tenerse en cuenta en la formación médica continua en ortopedia. Se necesitan estudios más amplios para identificar las diferencias en los resultados de aprendizaje de los participantes entre los modelos de apoyo docente síncrono y asíncrono.

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Abstract: Introduction: COVID-19 pandemic has disrupted educational activities since 2020. AO Trauma Latin American courses took place in a blended modality during 2021 and participant's feedback was positive. In this study, we aim to identify if there was any difference in learning, planning, and executing an osteosynthesis on a bone model with synchronous or asynchronous faculty support during an online asynchronous learning program. Material and methods: we designed an online asynchronous course designed for teaching about trimalleolar ankle fractures. We randomized twenty participants into two groups: the control group had synchronous faculty support and the intervention group had asynchronous faculty support. Participants were evaluated with initial and final quizzes, preoperative planning, and execution of an osteosynthesis on a bone model. Comparisons of scores between CG and IG were performed using the Mann-Whitney U test for non-parametric variables. A two-tailed p < 0.05 was considered statistically significant. Results: we did not find a significant difference between synchronous or asynchronous faculty support during our asynchronous learning program in quiz results, preoperative planning, global rating scale or the result of the osteosynthesis as compared to the preoperative plan. Conclusion: there appears to be no difference in participant learning with synchronous or asynchronous faculty support during an online, asynchronous course. Asynchronous activities appear to be effective teaching methods and should be considered in continuous medical education in orthopedics. Larger studies are needed to identify differences in participant learning outcomes between synchronous and asynchronous faculty support models.

Resumen: Introducción: la pandemia de COVID-19 ha interrumpido las actividades educativas desde 2020. Los cursos de AO Trauma Latinoamérica se realizaron en modalidad semipresencial durante 2021 y la retroalimentación de los participantes fue positiva. En este estudio, nuestro objetivo es identificar si hubo alguna diferencia en el aprendizaje, la planificación y la ejecución de una osteosíntesis en un modelo óseo con el apoyo sincrónico o asincrónico de la facultad durante un programa de aprendizaje asincrónico en línea. Material y métodos: diseñamos un curso asíncrono en línea para la enseñanza de las fracturas trimaleolares de tobillo. Se distribuyó aleatoriamente a 20 participantes en dos grupos: el grupo de control tuvo apoyo docente sincrónico y el grupo de intervención tuvo apoyo docente asincrónico. Se evaluó a los participantes con cuestionarios iniciales y finales, planificación preoperatoria y ejecución de una osteosíntesis en un modelo óseo. Las comparaciones de las puntuaciones entre GC e GI se realizaron mediante la prueba U de Mann-Whitney para variables no paramétricas. Una p de dos colas < 0.05 se consideró estadísticamente significativa. Resultados: no encontramos diferencia significativa entre el apoyo del profesorado síncrono o asíncrono durante nuestro programa de aprendizaje asíncrono en los resultados de los cuestionarios, la planificación preoperatoria, la escala de valoración global o el resultado de la osteosíntesis en comparación con el plan preoperatorio. Conclusión: no parece haber diferencias en el aprendizaje de los participantes con el apoyo sincrónico o asincrónico del profesorado durante un curso en línea asincrónico. Las actividades asíncronas parecen ser métodos de enseñanza eficaces y deberían tenerse en cuenta en la formación médica continua en ortopedia. Se necesitan estudios más amplios para identificar las diferencias en los resultados de aprendizaje de los participantes entre los modelos de apoyo docente síncrono y asíncrono.

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Pertrochanteric fractures account approximately a half of the proximal femoral fractures. Incidence of these fractures is highest in women, age > 65 years and presents a mortality rate of 14 to 50%. Treatment goals include stable fixation, immediate mobilization and restore activities. Complications after treatment present in 17% and include: nonunion, cut out and varus displacement. OBJECTIVE: Correlation between complications after surgical treatment and presence of instability, inadequate reduction, Tip Apex Index (TAI) > 25 mm, Tip Apex Index to calcar (TAIcal) > 20 mm and parker index. MATERIAL AND METHODS: A case control study was conducted in patients with pertrochanteric fractures treated between January 2009 and December 2014, 91 patients were included and complications were measured up to 6 months after surgery. RESULTS: 27 patients were included in group 1, which were the ones who presented complications. Values of TAI measured in this group were 13.7 to 45 mm, and were significantly higher than group 2. Position of the blade/screw central in the lateral view and inferior in the AP view didn´t present complications. CONCLUSIONS: We found 27 patients with complications in the follow up (29%). Initial reduction and stability is determinant to success. We recommend the use of proximal femoral nail in all unstable fractures. It is confirmed that TAI > 25 mm as a predictor of failure.

Las fracturas transtrocantéricas representan la mitad de las fracturas del fémur proximal. La mayor incidencia es en > 65 años, mujeres y presentan mortalidad al año del 14 al 50%. Los objetivos de tratamiento son: fijación estable, restaurar la movilidad y recuperar la función. Las complicaciones tienen una incidencia de 17%, siendo las más comunes: desplazamiento en varo, no unión y cut out. Objetivo: Evaluar la asociación entre falla de la osteosíntesis y los siguientes factores: mala reducción, inestabilidad, índice punta ápice > (TAI) 25 mm, punta ápice modificado al calcar (TAICal) > 20 mm e índice de Parker. Material y métodos: Se realizó un estudio de casos y controles anidado en una cohorte de pacientes con fracturas transtrocantéricas. De enero del 2009 a diciembre del 2014, se incluyeron 91 pacientes que cumplieron los criterios de selección. El seguimiento se hizo a 6 meses para valorar complicaciones. Resultados: Se incluyeron en el grupo 1 a 27 pacientes que presentaron falla y en el grupo 2 a 64 pacientes. Se obtuvieron en el grupo 1 valores de TAI 13.7 a 45 mm y en el grupo 2 valores de 11 a 31.2 mm. Se encontró que la posición central en lateral e inferior en AP no presentó fallo. Conclusiones: Se encontraron 27 pacientes con complicaciones (29%). La estabilidad inicial es un factor determinante, se recomienda fijación con CCM en los casos de fracturas inestables. Se confirmó la validez de un TAI > 25 mm como un predictor de fallo.

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Pepper (Capsicum annuum L.) is an important horticultural crop in many regions of the world. The final shape and size of the fruit are known to be determined at a very early step of flower development. During flower development hormonal treatments using gibberellins seem to promote growth resulting in higher yield and fruit quality. However, the morphological changes that occur in the pepper flowers after these treatments are largely unknown. In the present study, we provide a description of floral development landmarks of jalapeño chili pepper (cultivar Huichol), divided in nine representative stages from its initiation until the opening of the bud. We established a correlation among external flower development and the time and pattern of reproductive organogenesis. Male and female gametogenesis progression was used to define specific landmarks during flower maturation. The pattern of expression of key genes involved in gibberellin metabolism and response was also evaluated in the nine flower stages. The proposed development framework was used to analyze the effect of gibberellin treatments in the development of the flower. We observed both an effect of the treatment in the histology of the ovary tissue and an increase in the level of expression of CaGA2ox1 and CaGID1b genes. The developmental stages we defined for this species are very useful to analyze the molecular and morphological changes after hormonal treatments.

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Resumen: Las fracturas transtrocantéricas representan la mitad de las fracturas del fémur proximal. La mayor incidencia es en > 65 años, mujeres y presentan mortalidad al año del 14 al 50%. Los objetivos de tratamiento son: fijación estable, restaurar la movilidad y recuperar la función. Las complicaciones tienen una incidencia de 17%, siendo las más comunes: desplazamiento en varo, no unión y cut out. Objetivo: Evaluar la asociación entre falla de la osteosíntesis y los siguientes factores: mala reducción, inestabilidad, índice punta ápice > (TAI) 25 mm, punta ápice modificado al calcar (TAICal) > 20 mm e índice de Parker. Material y métodos: Se realizó un estudio de casos y controles anidado en una cohorte de pacientes con fracturas transtrocantéricas. De enero del 2009 a diciembre del 2014, se incluyeron 91 pacientes que cumplieron los criterios de selección. El seguimiento se hizo a 6 meses para valorar complicaciones. Resultados: Se incluyeron en el grupo 1 a 27 pacientes que presentaron falla y en el grupo 2 a 64 pacientes. Se obtuvieron en el grupo 1 valores de TAI 13.7 a 45 mm y en el grupo 2 valores de 11 a 31.2 mm. Se encontró que la posición central en lateral e inferior en AP no presentó fallo. Conclusiones: Se encontraron 27 pacientes con complicaciones (29%). La estabilidad inicial es un factor determinante, se recomienda fijación con CCM en los casos de fracturas inestables. Se confirmó la validez de un TAI > 25 mm como un predictor de fallo.

Abstract: Pertrochanteric fractures account approximately a half of the proximal femoral fractures. Incidence of these fractures is highest in women, age > 65 years and presents a mortality rate of 14 to 50%. Treatment goals include stable fixation, immediate mobilization and restore activities. Complications after treatment present in 17% and include: nonunion, cut out and varus displacement. Objective: Correlation between complications after surgical treatment and presence of instability, inadequate reduction, Tip Apex Index (TAI) > 25 mm, Tip Apex Index to calcar (TAIcal) > 20 mm and parker index. Material and methods: A case control study was conducted in patients with pertrochanteric fractures treated between January 2009 and December 2014, 91 patients were included and complications were measured up to 6 months after surgery. Results: 27 patients were included in group 1, which were the ones who presented complications. Values of TAI measured in this group were 13.7 to 45 mm, and were significantly higher than group 2. Position of the blade/screw central in the lateral view and inferior in the AP view didn´t present complications. Conclusions: We found 27 patients with complications in the follow up (29%). Initial reduction and stability is determinant to success. We recommend the use of proximal femoral nail in all unstable fractures. It is confirmed that TAI > 25 mm as a predictor of failure.

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Freshwater fish helminths, the most well known Mexican vertebrate parasites, include approximately 260 species (platyhelminthes, acanthocephalans, nematodes, and hirudineans). The distribution patterns of adult helminth diversity (throughout parasite and host groups and hydrological regions) are described and the effects of host traits and environmental and geographical factors on diversity are evaluated. Adult helminths include 160 species, parasitizing 149 fish species of 23 families distributed in 21 regions. Nematoda was the most species-rich (>50 species). Cichlidae harboured rich helminth assemblages, with widespread parasites. By contrast, Atherinopsidae and Goodeidae showed relatively poor helminth assemblages, including specific parasites with narrow distribution. Helminth richness in southeastern Mexico was higher than northern or central regions. Non-parametric richness estimators were used to avoid confusion in comparisons with unequal sampling efforts. Bootstrap values, the method with the best performance, indicated that estimated richness shows the same distribution pattern that observed richness. Non-phylogenetic and phylogenetic analyses were used to determine the role of different factors in the parasite diversification. The distribution range was the most important richness predictor (widespread fishes harbour richer parasite assemblages), although interactions between this variable and others such as trophic level, latitude, habitat temperature and precipitation are also important. Likewise, biogeographical factors can also affect parasite diversity.

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Prokaryotes have developed multiple strategies to survive phage attack and invasive DNA. Recently, a novel genetic program denominated the CRISPR/Cas system was demonstrated to have a role in these biological processes providing genetic immunity. This defense mechanism is widespread in the Archaea and Bacteria, suggesting an ancient origin. In the last few years, progress has been made regarding the functionality of the CRISPR/Cas system; however, many basic aspects of the system remain unknown. For instance, there are few studies about the conditions and regulators involved in its transcriptional control. In this work, we analyzed the transcriptional organization of the CRISPR/Cas system as well as the positive and negative regulators involved in its genetic expression in Salmonella enterica serovar Typhi. The results obtained show that in S. Typhi the CRISPR/Cas system is a LeuO-dependent operon silenced by the global regulator LRP, in addition to the previously known nucleoid-associated protein H-NS; both LRP and H-NS bind upstream and downstream of the transcriptional start site of casA. In this study, relevant nucleotides of the casA regulatory region that mediate its LeuO transcriptional activation were identified. Interestingly, specific growth conditions (N-minimal medium) were found for the LeuO-independent expression of the CRISPR/Cas system in S. Typhi. Thus, our work provides evidence that there are multiple modulators involved in the genetic expression of this immune system in S. Typhi IMSS-1.

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BACKGROUND: Glomus type of tumors are benign tumors of the hand phalanges. Their most frequent location is the nail bed. The diagnosis requires a certain index of suspicion and is usually a clinical one. The recommended approach is surgery. MATERIAL AND METHODS: The clinical files of patients with glomus of the hand were reviewed from June 1978 to May 2010, analyzing the characteristics of their management. RESULTS: Twelve patients with a glomus type of tumor were found; 4 females and 8 males, ages 31-55 years. The distal phalanx and the little finger were the most frequent sites. The diagnosis was mostly clinical and treatment in all cases was surgical. Mean follow-up was 8 years. CONCLUSIONS: The glomus type of tumor is a lesion often involving the distal phalanx, with unique clinical and pathologic characteristics that the orthopedic surgeon should know to determine management.

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offhough the concept of domain merging and shuffling as a major force in protein evolution is well established, it has been difficult to demonstrate how domains coadapt. Here we show evidence of coevolution of the Sinorhizobium meliloti NifA (SmNifA) domains. We found that, because of the lack of a conserved glycine in its DNA-binding domain, this transactivator protein interacts weakly with the enhancers. This defect, however, was compensated by evolving a highly efficient activation domain that, contrasting to Bradyrhizobium japonicum NifA (BjNifA), can activate in trans. To explore paths that lead to this enhanced activity, we mutagenized BjNifA. After three cycles of mutagenesis and selection, a highly active derivative was obtained. Strikingly, all mutations changed to amino acids already present in SmNifA. Our artificial process thus recreated the natural evolution followed by this protein and suggests that NifA is trapped in a restricted sequence space with very limited solutions for higher activity by point mutation.

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The Bradyrhizobium japonicum fixRnifA operon is transcribed from two promoters: fixRp1, a -24/-12 promoter recognized by the sigma54-holoenzyme form of the RNA polymerase, and fixRp2, a -35/-10 promoter that is transcribed by a second, unidentified, form of RNA polymerase holoenzyme. The fixRp1 promoter is autoregulated during microaerobiosis by NifA, whereas fixRp2 is also activated, but by a different regulatory protein. The main transcription start sites for these promoters are just two nucleotides apart, such that the conserved -12 and -10 regions of fixRp1 and fixRp2, respectively, must overlap each other, whereas the -24 and -35 regions lie one DNA helical turn apart. Using in vivo genomic dimethyl sulfate and KMnO4 footprinting, we showed that the promoter region is differentially protected, depending upon which holoenzyme is bound. Mutagenesis analyses indicated that positions from -12 to -14 are critical for the activity of both promoters, whereas mutations at -10 and -11 affected mainly fixRp2 expression. When the sequence of the putative -35 region of fixRp2 was modified to match the putative consensus, expression from this promoter was increased 3-fold and the reactivity toward KMnO4, but not the transcriptional start site, moved two nucleotides further upstream, indicating that the altered promoter forms a different open complex. Additionally, we detected NifA-dependent methylation protection of two atypical NifA binding sites and protection of guanine -75. The latter residue is located in a region critical for fixRp2 promoter activation. The results present direct physical evidence of the complexity of the organization, regulation, and function of the fixRnifA promoter region.

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We designed PCR primers by comparison of the deduced amino acid sequences of several ornithine decarboxylase (ODC) genes. They were used to amplify fragments homologous to these genes from several dimorphic fungi. These were sequenced and the deduced amino acid sequences were compared with the corresponding regions of ODCs from different sources. Fungal ODCs fell into a compact group, well separated from the ODCs of other taxa. Sequence homology among fungal enzymes corresponded to their taxonomic position. Interesting patterns of amino acid conservation in ODCs from fungi, distinct from other organisms, were detected.

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We present results of four years in oral rehydration therapy (ORT) in the Hospital Infantil del Estado de Sonora. There was 10.2 consults by diarrhoea for day. Children lower of one year old received oral rehydration therapy in 86.8%, were included 11% of prolonged diarrhoea and 32.3% of children with malnutrition. During the procedure diarrhoea there was complicated in 3% with paralytic ileus sepsis and pneumonia. Effectivity of ORT was in 90.9%; 92.8% in light dehydration and 78.7% moderate. Failure in 8.6% was due to vomitus, no acceptation of the oral solution, abundant evacuations and other complication presented. Were observed reduction in hospitalization, rate of 19.2% in 1986 to 38.4% in 1989. The diarrheal mortality decreased in the Urgence Department in 42% and in the Infectology Department in 54%. We considered these results as satisfactory, but are susceptible to better when we diffuse more the oral rehydration therapy in own region.

PIP: A retrospective study was conducted of the daily reports of the Outpatient Emergency Service of the Children's Hospital of the State of Sonora. Records of children receiving oral rehydration therapy between January 1986 and December 1989 were reviewed to assess the efficacy of the treatment and its impact on hospital admissions and mortality. Children of any age and nutritional status with diarrhea of any etiology and duration were included. Children in shock or with contraindications to oral therapy were excluded. 975 of the 14,893 children consulting for diarrhea in the four years (6.5%) received oral rehydration therapy. 868 of the children (89.0%) had acute diarrhea and 107 (11%) had prolonged diarrhea defined as over two weeks duration. The average patient age was 7.4 months and 847 (86.9%) were under one year old. 754 of the children had mild and 221 had moderate dehydration. 315 of the children (32.3%) were malnourished. 123 of the 975 children were hospitalized. Treatment was considered to have failed in 84 cases (8.6%), including 29 with persistent vomiting, 20 who did not accept oral rehydration solution, 18 with fecal output exceeding 10 ml/kg/h, and 17 with complications of diarrhea. The 847 children successfully rehydrated by the oral route represented a reduction of 29.1% in hospitalizations for diarrhea over the four years, during which 2062 children were hospitalized for intravenous rehydration. The magnitude of the reduction in hospital admissions increased from 19.2% in 1986 to 38.4% in 1989. The case fatality rate from diarrhea declined from an average of 7.0% between 1980 and 1985 to an average of 4.0% between 1986 and 1989. Mortality from prolonged diarrhea averaged 6.0% between 1984 and 1989.

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Se revisaron los expedientes clinicos de cinco pacientes con coccidioidomicosis meningea, internados en el Hospital del Nino del Noroeste DIF. La edad de los pacientes vario de cuatro meses a 13 anos, todos eran residentes de area endemica y cursaron con sintomatologia neurologica cronica y vaga. El diagnostico etiologico no fue posible establecerlo en base a los hallazgos clinicos, radiologicos ni aun con las alteraciones descritas en el estudio citoquimico del liquido cefalorraquideo, por lo que fue necesario realizar pruebas inmunologicas especificas en este y buscar intencionadamente el hongo para llegar al diagnostico de certeza. El tratamiento en tres de los casos fue medicoquirurgico mediante la administracion de anfotericina B intravenosa e intratecal y colocacion de reservorio subcutaneo craneal y/o derivacion ventriculoperitoneal. La respuesta al tratamiento fue mala, interviniendo varios factores para ello, principalmente la tardanza para establecer la etiologia del padecimiento. De los casos tratados, un solo paciente vive (33%); no ha presentado recaidas y lleva una vida normal. Se concluye que la coccidioidomicosis meningea no es rara en areas endemicas, debiendose investigar en todos aquellos pacientes con manifestaciones neuropsiquiatricas de evolucion prolongada y que residan en dichas areas, ya que la tardanza en su diagnostico se acompana de una alta morbilidad y letalidad. Coccidioidomicosis meningea

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