RESUMEN

Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.

Asunto(s)

Insuficiencia Hepática Crónica Agudizada , Trastornos de la Coagulación Sanguínea , Humanos , Insuficiencia Hepática Crónica Agudizada/complicaciones , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/terapia , Cirrosis Hepática/complicaciones , Cirrosis Hepática/terapia , Coagulación Sanguínea , Hemostasis

RESUMEN

Polymeric blends are employed in the production of filaments for additive manufacturing to balance mechanical and processability properties. The mechanical and thermal properties of polymeric filaments made of poly (lactic acid) (PLA), polyhydroxyalkanoates (PHA), and its blend (PLA-PHA) are investigated herein and correlated to their measured structural and physicochemical properties. PLA exhibits the highest stiffness and tensile strength, but lower toughness. The mechanical properties of the PLA-PHA blend were similar to those of PLA, but with a significantly higher toughness. Despite the lower mechanical properties of neat PHA, incorporating a small amount (12 wt.%) of PHA into PLA significantly enhances toughness (approximately 50%) compared to pure PLA. The synergistic effect is attributed to the spherulitic morphology of blended PHA in PLA, promoting interactions between the amorphous regions of both polymers. Thermal stability is notably improved in the PLA-PHA blend, as determined by thermogravimetric analysis. The blend also exhibits lower cold crystallization and glass transition temperatures as compared to PLA, which is beneficial for additive manufacturing. Following additive manufacturing, X-ray photoelectron spectroscopic showed that the three filaments present an increase in C-C and C=O bonds associated with the loss of C-O bonds. The thermal process induces a slight increase in crystallinity in PHA due to chain reorganization. The study provides insights into the thermal and structural changes occurring during the melting process of additive manufacturing.

RESUMEN

BACKGROUND: Nitric oxide is produced by different nitric oxide synthases isoforms. NO activates two signaling pathways, one dependent on soluble guanylate cyclase and protein kinase G, and other where NO post-translationally modifies proteins through S-nitrosylation, which is the modification induced by NO in free-thiol cysteines in proteins to form S-nitrosothiols. High levels of NO have been detected in blood of breast cancer patients and increased NOS activity has been detected in invasive breast tumors compared to benign or normal breast tissue, suggesting a positive correlation between NO biosynthesis, degree of malignancy and metastasis. During metastasis, the endothelium plays a key role allowing the adhesion of tumor cells, which is the first step in the extravasation process leading to metastasis. This step shares similarities with leukocyte adhesion to the endothelium, and it is plausible that it may also share some regulatory elements. The vascular cell adhesion molecule-1 (VCAM-1) expressed on the endothelial cell surface promotes interactions between the endothelium and tumor cells, as well as leukocytes. Data show that breast tumor cells adhere to areas in the vasculature where NO production is increased, however, the mechanisms involved are unknown. RESULTS: We report that the stimulation of endothelial cells with interleukin-8, and conditioned medium from breast tumor cells activates the S-nitrosylation pathway in the endothelium to induce leukocyte adhesion and tumor cell extravasation by a mechanism that involves an increased VCAM-1 cell surface expression in endothelial cells. We identified VCAM-1 as an S-nitrosylation target during this process. The inhibition of NO signaling and S-nitrosylation blocked the transmigration of tumor cells through endothelial monolayers. Using an in vivo model, the number of lung metastases was inhibited in the presence of the S-nitrosylation inhibitor N-acetylcysteine (NAC), which was correlated with lower levels of S-nitrosylated VCAM-1 in the metastases. CONCLUSIONS: S-Nitrosylation in the endothelium activates pathways that enhance VCAM-1 surface localization to promote binding of leukocytes and extravasation of tumor cells leading to metastasis. NAC is positioned as an important tool that might be tested as a co-therapy against breast cancer metastasis.

Asunto(s)

Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/patología , Adhesión Celular , Células Endoteliales , Molécula 1 de Adhesión Celular Vascular/metabolismo , Óxido Nítrico/metabolismo , Melanoma Cutáneo Maligno

RESUMEN

INTRODUCCIÓN: En las últimas décadas, se ha incrementado la prevalencia de infecciones por bacilos gramnegativos resistentes a carbapenémicos. OBJETIVO: Determinar los tipos y la frecuencia de las distintas carbapenemasas en aislados de Klebsiella spp. y Pseudomonas aeruginosa, en seis hospitales de alta complejidad de Bogotá-Colombia. MÉTODOS: Estudio observacional descriptivo en seis hospitales de la ciudad de Bogotá, en el período de enero de 2017 a agosto de 2018. Se realizaron RPC para genes de KPC, GES, VIM, NDM, IMP y OXA-48 en cepas de Klebsiella spp y P aeruginosa resistentes a carbapenémicos. RESULTADOS: 52 aislados de P aeruginosa amplificaron para una carbapenemasa, de los cuales 39 (75%) fueron positivos para KPC, 11 (21%) para VIM y 2 co-producciones de KPC y VIM. En cuanto a Klebsiella spp., 165 cepas amplificaron al menos para una carbapenemasa, 98% expresaron KPC y 4 aislados tuvieron co-producciones de metalo-beta-lactamasas y KPC. DISCUSIÓN: Este estudio aporta información valiosa, como el incremento de producción de KPC en P. aeruginosa y la co-producción de KPC y metalo-beta-lactamasas, locual tiene una implicancia tanto en la selección del tratamiento, las medidas de aislamiento de contacto y el pronóstico de los pacientes.

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BACKGROUND: In the last decades, the prevalence of infections by carbapenem resistant gram-negative bacilli has been increased. OBJECTIVE: To determine types and frequency of the different carbapenemases in Klebsiella spp. and Pseudomonas aeruginosa, in six hospitals in Bogotá-Colombia. METHODS: Descriptive and observational study, in six hospitals in the city of Bogotá, in the period ftom January 2017 to August 2018. PCR were performed for KPC, GES, VIM, NDM, IMP and OXA-48 genes, in carbapenem resistant Klebsiella spp. and P aeruginosa. RESULTS: 52 P aeruginosa isolates amplified a carbapenemase gene, of which 39 (75%) were positive for KPC, 11 (21%) for VIM and two co-productions of KPC and VIM. Regarding Klebsiella spp. 165 strains amplified at least one carbapenemase gene, 98% expressed KPC and four isolates had co-productions of metallo-P-lactamases and KPC. DISCUSSION: This study provides valuable information, such as the increased production of KPC in P. aeruginosa información valiosa, como el incremento de producción de KPC en P. aeruginosa and the co-production of KPC plus metallobetalactamases, which has an implication both in treatment selection, isolation precautions and patient prognosisy.

Asunto(s)

Humanos , Pseudomonas aeruginosa/genética , Klebsiella , Proteínas Bacterianas/genética , beta-Lactamasas/genética , Pruebas de Sensibilidad Microbiana , Carbapenémicos/farmacología , Colombia/epidemiología , Hospitales , Antibacterianos/farmacología

RESUMEN

Establishing affordable, efficient, accessible, innovative, and multidisciplinary methodologies to the diagnosis of the conservation state of an artwork is key to carry out appropriate strategies of conservation and consequently to the creation of modern public policies on cultural heritage. Limited access to large-format paintings is a challenge to restoration scientists seeking to obtain information quickly, in a non-destructive and non-invasive manner, and identify regions of interest. Therefore, we put forward two unique software tools based on multispectral imaging techniques, with the long-term aim to assess the artist's intentions, creative process, and colour palette. This development paves the way for a comprehensive and multidisciplinary understanding of the mysteries encompassed in each pictorial layer, through the study of their physical and chemical characteristics. We conducted the first ever study on Musas I and Musas II, two large-format paintings by Italian artist Carlo Ferrario, located in the National Theatre of Costa Rica. In this study, we used our novel imaging techniques to choose regions of interest in order to study sample layers; while also assessing the works' state of conservation and possible biodeterioration. We explored the applications of our two versatile software tools, RegionOfInterest and CrystalDistribution, and confirmed paint stratigraphies by means of microscopy and spectroscopy analyses (OM, SEM-EDX, Fluorescent microscopy, FTIR-ATR and micro-Raman). In a pilot study, we identified the artist's main colour palette: zinc white, lead white, chrome yellow, lead read, viridian, along with artificial vermilion and ultramarine pigments. We were able to identify artificial vermilion and ultramarine and distinguish them from the natural pigments using CrystalDistribution to map the average size and diameter of the pigment crystals within the paint layers. This study demonstrated that software-based multidisciplinary imaging techniques are novel in establishing preventive and non-invasive methods for historical painting conservation studies, in addition, this study provides tools with great potential to be used in the future in applications such as virtual restoration.

RESUMEN

BACKGROUND: In the last decades, the prevalence of infections by carbapenem resistant gram-negative bacilli has been increased. OBJECTIVE: To determine types and frequency of the different carbapenemases in Klebsiella spp. and Pseudomonas aeruginosa, in six hospitals in Bogotá-Colombia. METHODS: Descriptive and observational study, in six hospitals in the city of Bogotá, in the period ftom January 2017 to August 2018. PCR were performed for KPC, GES, VIM, NDM, IMP and OXA-48 genes, in carbapenem resistant Klebsiella spp. and P aeruginosa. RESULTS: 52 P aeruginosa isolates amplified a carbapenemase gene, of which 39 (75%) were positive for KPC, 11 (21%) for VIM and two co-productions of KPC and VIM. Regarding Klebsiella spp. 165 strains amplified at least one carbapenemase gene, 98% expressed KPC and four isolates had co-productions of metallo-P-lactamases and KPC. DISCUSSION: This study provides valuable information, such as the increased production of KPC in P. aeruginosa información valiosa, como el incremento de producción de KPC en P. aeruginosa and the co-production of KPC plus metallobetalactamases, which has an implication both in treatment selection, isolation precautions and patient prognosisy.

Asunto(s)

Klebsiella , Pseudomonas aeruginosa , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Carbapenémicos/farmacología , Colombia/epidemiología , Hospitales , Humanos , Pruebas de Sensibilidad Microbiana , Pseudomonas aeruginosa/genética , beta-Lactamasas/genética

RESUMEN

Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3-) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.

Asunto(s)

Gases de Efecto Invernadero , Metano , Alimentación Animal/análisis , Animales , Bovinos , Dieta/veterinaria , Leche , Poaceae , Rumen , Rumiantes

RESUMEN

The non-neuronal cholinergic system refers to the presence of acetylcholine, choline acetyltransferase, acetylcholinesterase and cholinergic receptors, nicotinic and muscarinic (mAChRs) expressed in non-neuronal cells. The presence of mAChRs has been detected in different type of tumor cells and they are linked with tumorigenesis. We had previously documented the expression of mAChRs in murine and human mammary adenocarcinomas and the absence of these receptors in normal mammary cells of the same origins. We also demonstrated that mAChRs are involved in breast cancer progression, pointing to a main role for mAChRs as oncogenic proteins. Since the long term treatment of breast cancer cells with the muscarinic agonist carbachol promoted cell death, here we investigated the ability of low doses of this agonist combined with paclitaxel (PX), a taxane usually administered to treat breast cancer, to inhibit the progression of human MCF-7 tumor cells. We demonstrated that PX plus carbachol reduced cell viability and tumor growth in vitro probably due to a down-regulation in cancer stem cells population and in the expression of ATP "binding cassette" G2 drug extrusion pump; also a reduction in malignant-induced angiogenesis was produced by the in vivo administration of the mentioned combination in a metronomic schedule to MCF-7 tumor-bearing NUDE mice. Our results confirm that mAChRs could be considered as therapeutic targets for metronomic therapy in breast cancer as well as the usefulness of a muscarinic agonist as repositioning drug in the treatment of this type of tumors.

Asunto(s)

Antineoplásicos Fitogénicos/administración & dosificación , Carbacol/administración & dosificación , Agonistas Colinérgicos/administración & dosificación , Neoplasias Mamarias Experimentales/tratamiento farmacológico , Neovascularización Patológica/tratamiento farmacológico , Paclitaxel/administración & dosificación , Receptores Muscarínicos/metabolismo , Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/metabolismo , Administración Metronómica , Animales , Línea Celular , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Interacciones Farmacológicas , Femenino , Humanos , Glándulas Mamarias Animales/irrigación sanguínea , Glándulas Mamarias Animales/efectos de los fármacos , Glándulas Mamarias Animales/metabolismo , Glándulas Mamarias Animales/patología , Neoplasias Mamarias Experimentales/metabolismo , Neoplasias Mamarias Experimentales/patología , Ratones Desnudos , Neovascularización Patológica/metabolismo , Neovascularización Patológica/patología

RESUMEN

OBJECTIVE: To explore whether the IFNL3/4 rs12979860 genotype may influence serum levels or production of interferon-inducible protein-10 (IP-10) by peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE). METHODS: Sixty-six patients with SLE and 22 healthy blood donors (controls) were included. The IFNL3/4 rs12979860 polymorphism was genotyped by real-time polymerase chain reaction. IP-10 levels in sera supernatants of IFNα stimulated peripheral blood mononuclear cells were measured by enzime-linked immunosorbent assay. RESULTS: Allelic frequencies were CC (29%), CT (52%) and TT (20%) in SLE, and CC (32%), CT (41%) and TT (27%) in healthy controls. Median serum IP-10 levels were higher in SLE patients than in controls (190.8 versus 118.1 pg/ml; p < 0.001), particularly in those with high disease activity (278.5 versus 177.2 pg/ml; p = 0.037). However, serum IP-10 levels were not influenced by IFNL3/4 genotypes. Higher IP-10 production by peripheral blood mononuclear cells was found in both SLE patients (median 519.3 versus 207.6 pg/ml; p = 0.012) and controls (median 454.0 versus 201.7 pg/ml; p = 0.034) carrying the IFNL3/4 C allele compared with carriers of the T allele. CONCLUSIONS: Although IFNL3/4 rs12979860 allele C does not appear to influence serum IP-10 levels in SLE, it plays an important role in the production of IP-10 by peripheral blood mononuclear cells after IFNα stimulation.

Asunto(s)

Quimiocina CXCL10/sangre , Interferones/genética , Interleucinas/genética , Leucocitos Mononucleares/metabolismo , Lupus Eritematoso Sistémico/genética , Adulto , Alelos , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Lupus Eritematoso Sistémico/sangre , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple

RESUMEN

RESUMEN Tanto la diabetes mellitus como la insuficiencia cardíaca son dos enfermedades que frecuentemente van de la mano. Los resultados de recientes estudios sobre disminución de mortalidad, hospitalización por insuficiencia cardíaca y aparición de eventos cardiovasculares, que han demostrado ciertos hipoglucemiantes no insulínicos, han hecho que cambien las recomendaciones en cuanto al tratamiento de la diabetes mellitus. El objetivo clásico del tratamiento de la diabetes, centrado en la reducción de la hemoglobina glicada para reducir el daño microvascular, aunque siga siendo importante, puede que haya pasado a un segundo plano, ahora que disponemos de fármacos que podrían disminuir también el daño macrovascular.

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ABSTRACT Both diabetes mellitus and heart failure often go hand in hand. The results of recent studies on decreased mortality, heart failure hospitalization and the occurrence of cardiovascular events, which have shown certain non-insulin hypoglycemic agents, have brought about changes in the diabetes treatment recommendations. The classic goal of diabetes treatment, focused on reducing glycated hemoglobin to reduce microvascular damage, although still important, may have faded into the background, since we have drugs that could also reduce macrovascular damage.

Asunto(s)

Diabetes Mellitus , Enfermedades Cardiovasculares , Quimioterapia , Insuficiencia Cardíaca

Asunto(s)

Insuficiencia Cardíaca , Volumen Sistólico , Terapéutica , Clasificación

RESUMEN

OBJECTIVE: To report the results using Micropulse® transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. METHODS: Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse®. The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5ms (31.3%) of active cycle. RESULTS: A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180seconds. Definition of success: 5mmHg

Asunto(s)

Glaucoma/terapia , Láseres de Semiconductores/uso terapéutico , Fotocoagulación/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Fotocoagulación/instrumentación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven

RESUMEN

BACKGROUND: Infection and instability are the complications of prosthetic shoulder surgery of more difficult management. Instability builds up to half of the cases, while the fungal infection accounts for less than 1% of all and can cause severe damage to bone and soft tissue. METHODS: In this case clinical fungal infection by Candida parapsilosis is presented in a shoulder hemiarthroplasty indicated by a fracture of the proximal humerus. He received surgical treatment in two-stages and administration of fluconazole for eight weeks prior to the second surgical time. In revision surgery was placed a reverse prosthesis as definitive treatment; however, the patient suffered several episodes of dislocation in the postoperative period; a second revision prosthetic surgery was necessary to use more stable components. During this surgery, we extracted samples that were analyzed, obtaining negative results for infection. RESULTS: Now after three years of follow-up, the patient is well, no limitations in their daily work and has a Constant Score of 50.5. DISCUSSION: We report our experience in this exceptional situation. We know, this is one of the first cases where the fungal infection and dislocation prosthetics in the same patient meet. This situation is a challenge for the surgeon, which has to treat complications two practically at the same time; we do not have scientific evidence to establish a criterion unified for the treatment of complications after surgery for revision of arthroplasty of the shoulder, especially in reverse or mega-denture prosthesis.

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ANTECEDENTES: La infección e inestabilidad se encuentran entre las complicaciones de más difícil manejo en la cirugía protésica de hombro. La inestabilidad acumula hasta la mitad de los casos, mientras que la infección por hongos representa menos de 1% del total de infecciones y pueden causar daño severo a nivel óseo y de partes blandas. MÉTODOS: En este caso clínico se presenta una infección fúngica por Candida parapsilosis en una hemiartroplastía de hombro indicada por una fractura de húmero proximal. Se dio tratamiento quirúrgico en dos tiempos y administración de fluconazol durante ocho semanas previo al segundo tiempo quirúrgico. En la revisión se colocó una prótesis reversa como tratamiento definitivo; sin embargo, el paciente sufrió varios episodios de luxación en el postoperatorio. Fue necesaria una segunda cirugía de revisión protésica para sustituir por componentes de mayor estabilidad. Durante la misma, se extrajeron muestras que fueron analizadas, obteniéndose resultados negativos para infección. RESULTADOS: Actualmente tras tres años de seguimiento, el paciente se encuentra bien, sin limitaciones en su labor diaria y tiene un Constant Score de 50.5. DISCUSIÓN: Reportamos nuestra experiencia en esta situación excepcional. A nuestro conocer, éste es uno de los primeros casos en los que la infección fúngica y la luxación protésica coinciden en un mismo paciente. Esta situación es un reto para el cirujano, el cual tiene que tratar las dos complicaciones prácticamente a la vez. No se dispone de una evidencia científica para establecer un criterio unificado para el tratamiento de las complicaciones tras cirugía de revisión de artroplastía de hombro, especialmente en la prótesis reversa o megaprótesis.

Asunto(s)

Artroplastía de Reemplazo de Hombro , Candidiasis , Reoperación , Artroplastía de Reemplazo de Hombro/efectos adversos , Candida parapsilosis/aislamiento & purificación , Candidiasis/etiología , Humanos , Masculino , Rango del Movimiento Articular , Articulación del Hombro , Resultado del Tratamiento

Asunto(s)

Diagnóstico , Insuficiencia Cardíaca , Terapéutica , Algoritmos

RESUMEN

Resumen: Antecedentes: La infección e inestabilidad se encuentran entre las complicaciones de más difícil manejo en la cirugía protésica de hombro. La inestabilidad acumula hasta la mitad de los casos, mientras que la infección por hongos representa menos de 1% del total de infecciones y pueden causar daño severo a nivel óseo y de partes blandas. Métodos: En este caso clínico se presenta una infección fúngica por Candida parapsilosis en una hemiartroplastía de hombro indicada por una fractura de húmero proximal. Se dio tratamiento quirúrgico en dos tiempos y administración de fluconazol durante ocho semanas previo al segundo tiempo quirúrgico. En la revisión se colocó una prótesis reversa como tratamiento definitivo; sin embargo, el paciente sufrió varios episodios de luxación en el postoperatorio. Fue necesaria una segunda cirugía de revisión protésica para sustituir por componentes de mayor estabilidad. Durante la misma, se extrajeron muestras que fueron analizadas, obteniéndose resultados negativos para infección. Resultados: Actualmente tras tres años de seguimiento, el paciente se encuentra bien, sin limitaciones en su labor diaria y tiene un Constant Score de 50.5. Discusión: Reportamos nuestra experiencia en esta situación excepcional. A nuestro conocer, éste es uno de los primeros casos en los que la infección fúngica y la luxación protésica coinciden en un mismo paciente. Esta situación es un reto para el cirujano, el cual tiene que tratar las dos complicaciones prácticamente a la vez. No se dispone de una evidencia científica para establecer un criterio unificado para el tratamiento de las complicaciones tras cirugía de revisión de artroplastía de hombro, especialmente en la prótesis reversa o megaprótesis.

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Abstract: Background: Infection and instability are the complications of prosthetic shoulder surgery of more difficult management. Instability builds up to half of the cases, while the fungal infection accounts for less than 1% of all and can cause severe damage to bone and soft tissue. Methods: In this case clinical fungal infection by Candida parapsilosis is presented in a shoulder hemiarthroplasty indicated by a fracture of the proximal humerus. He received surgical treatment in two-stages and administration of fluconazole for eight weeks prior to the second surgical time. In revision surgery was placed a reverse prosthesis as definitive treatment; however, the patient suffered several episodes of dislocation in the postoperative period; a second revision prosthetic surgery was necessary to use more stable components. During this surgery, we extracted samples that were analyzed, obtaining negative results for infection. Results: Now after three years of follow-up, the patient is well, no limitations in their daily work and has a Constant Score of 50.5. Discussion: We report our experience in this exceptional situation. We know, this is one of the first cases where the fungal infection and dislocation prosthetics in the same patient meet. This situation is a challenge for the surgeon, which has to treat complications two practically at the same time; we do not have scientific evidence to establish a criterion unified for the treatment of complications after surgery for revision of arthroplasty of the shoulder, especially in reverse or mega-denture prosthesis.

Asunto(s)

Humanos , Masculino , Reoperación , Candidiasis/etiología , Artroplastía de Reemplazo de Hombro/efectos adversos , Articulación del Hombro , Rango del Movimiento Articular , Resultado del Tratamiento , Candida parapsilosis/aislamiento & purificación

RESUMEN

We report here the O K-edge x-ray absorption spectra of hexagonal and orthorhombic YMnO3 thin films, aiming at comparing the changes in the Mn 3d bands as well as the role of Y 4d-O 2p hybridization. The experimental results were analyzed using first principles (GGA) band structure calculations. The spectra present clear differences in the Mn 3d bands, which are attributed to changes in the Mn-O coordination and symmetry. A strong Y 4d-O 2p hybridization is observed in both the hexagonal and orthorhombic films, and its possible role on the occurrence of the observed ferroelectricity is discussed.

RESUMEN

INTRODUCTION: Riedel´s thyroiditis is a thyroid inflammation with invasive fibrosis. CASE REPORT: Female 84 years old, studied by dysphagia to liquids and dysphonia, with cervical mass poorly demarcated and immobile. Computed Tomography (CT) (CT) showed tumor that diverted the trachea and esophagus compressed. Fine Needle Aspiration (FNA) obtained cells with atypia. Thyroidectomy was performed, appreciating a stony tumor which included the right recurrent laryngeal nerve. Given the high suspicion of thyroid malignancy tracheostomy it was performed. The pathology report as fibrosing Riedel thyroiditis. DISCUSSION: This is the less common type of chronic thyroiditis. Etiology is unknown. The normal thyroid parenchyma is replaced by fibrous connective tissue. Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. Puncturing the mass could give us the diagnosis but is often difficult. Treatment to relieve symptoms or rule out malignancy is surgery. The prognosis is usually good. CONCLUSIONS: Riedel´s thyroiditis is an entity with histopathologic diagnosis essential

Asunto(s)

Humanos , Tiroiditis/patología , Neoplasias de la Tiroides/diagnóstico , Carcinoma Anaplásico de Tiroides/diagnóstico , Tiroidectomía , Tiroiditis/cirugía , Tiroiditis/patología , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial

RESUMEN

Some studies suggest an inflammatory mechanism associated with the presence of depression in multiple sclerosis (MS); however, there is little data concerning these findings. The purpose of this study was to investigate the presence of brain structural changes in patients with MS and depression and to compare them with patients suffering from MS without depression and healthy controls. METHODS: A case-control study that included patients with relapsing-remitting MS (RRMS) defined by validated criteria, over 18 years of age, with less than three years from disease onset, EDSS ≤ 3, with no history of previous depression and under immunomodulatory treatment with interferon beta, if any. A control group paired by age and gender was also included. Patients were clinically assessed to determine the presence of depression. Demographic clinical and structural aspects of parameters from the scan, such as lesion volume, total brain volume (TBV), white matter volume (WMV), neocortical gray matter volume (NGMV), and fractional anisotropy (FA) were analyzed. RESULTS: Sixty-five individuals were enrolled: 20 healthy controls, 22 patients with MS without depression, and 23 patients with MS with depression. Patients with MS and depression showed a lower TBV (P = 0.01), NGMV (0.01) together with an increase in lesion burden in T2 (P < 0.01) but not in T1 (P = 0.09) and no differences in global FA among groups (P = 0.23) and in WMV (P = 0.12). CONCLUSION: Patients with RRMS and depression had a reduced total brain volume and a significantly increased lesion burden at T2 MR than patients with RRMS without depression.

Asunto(s)

Encéfalo/diagnóstico por imagen , Trastorno Depresivo/complicaciones , Trastorno Depresivo/diagnóstico por imagen , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple Recurrente-Remitente/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Sustancia Gris/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Esclerosis Múltiple Recurrente-Remitente/psicología , Tamaño de los Órganos , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Sustancia Blanca/diagnóstico por imagen

RESUMEN

An experiment was carried out to determine the effect of supplementing ground pods of Enterolobium cyclocarpum in a basal ration of Pennisetum purpureum grass on feed intake, rumen volatile fatty acids (VFAs), and protozoa and methane (CH4) production by hair sheep. Four male sheep (Pelibuey × Katahdin) with a mean live weight of 27.0 kg (SD ± 0.5) were supplemented with 0.00, 0.15, 0.30, and 0.45 kg of dry matter (DM) of E. cyclocarpum pods daily; equivalent to 0.00, 4.35, 8.70, and 13.05 g of crude saponins, respectively. Dry matter intake (DMI), organic matter intake (OMI), and molar proportions of propionic acid increased linearly (P < 0.05) as pods of E. cyclocarpum in the ration were increased. Higher intakes of DM and OM were found when lambs were fed 0.45 kg DM per day of E. cyclocarpum, and the highest proportion of propionic acid (0.21 and 0.22, respectively) was obtained with 0.15 and 0.30 kg of DM per lamb of E. cyclocarpum, while apparent digestibility of neutral detergent fiber (NDF) and molar proportion of acetic acid were reduced (P < 0.05). Rumen CH4 production decreased (P < 0.05) when 0.30 and 0.45 kg of DM/lamb/day of E. cyclocarpum were fed (21.8 and 25.3 L CH4/lamb/day, respectively). These results suggest that to improve the feeding of sheep fed tropical grass, it is advisable to supplement the basal ration with up to 0.30 kg DM of E. cyclocarpum pods.

Asunto(s)

Digestión/efectos de los fármacos , Fabaceae , Fermentación/efectos de los fármacos , Metano/metabolismo , Saponinas/administración & dosificación , Alimentación Animal/análisis , Animales , Fibras de la Dieta , Suplementos Dietéticos , Ingestión de Alimentos , Ácidos Grasos Volátiles/metabolismo , Masculino , Pennisetum , Rumen/metabolismo , Rumen/parasitología , Saponinas/metabolismo , Ovinos , Oveja Doméstica