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Resumen En el presente estudio se cuantifican las reservas de carbono existentes en siete fragmentos del paisaje agropecuario: (1) el bosque primario altamente talado, (2) bosques secundarios de 5, (3) 10 y (4) 15 años procedentes de pasturas, (5) agroforestería de cacao, (6) pastizal de Brachiaria decumbens en producción y (7) pastizal de Brachiaria decumbens degradado; estos fragmentos son característicos de los fundos agropecuarios del departamento de Ucayali, Perú. El carbono almacenado (la suma total de la parte aérea y del suelo) en el Bosque Primario fue de 267.26 t/ha; en Bosque Secundario de 15 años 232.30 t/ha; en Bosque Secundario de 10 años, 162.1 t/ha; en Bosque Secundario de 5 años, 124.42 t/ha; en agroforestería con cacao, 108.82 t/ha; en pastizal de B. decumbens, 72.57 t/ha; y en pastizal de B. decumbens degradada, 60.47 t/ha. Se observaron diferencias significativas (p ≤ 0.0001) entre los valores de carbono almacenado de los siete fragmentos, (R2 = 0.51, y CV = 53.66%). La prueba de contrastes ortogonales mostró que el carbono almacenado en el fragmento de bosque primario superó significativamente al promedio de carbono de los demás fragmentos; mientras que, el carbono almacenado en los bosques secundarios superó significativamente al carbono almacenado en el fragmento de agroforestería de cacao. No se encontraron diferencias del carbono almacenado en ambas pasturas, tampoco entre los bosques secundarios de 10 y 15 años. El incremento del número de familias y especies en relación directa a la edad del bosque secundario seria evidencia de la recuperación de la diversidad botánica.

Abstract In the present study, carbon stocks were quantified in seven agroforestry landscape fragments: (1) heavily logged primary forest, (2) secondary forests of 5, (3) 10, and (4) 15 years originating from pastures, (5) cacao agroforestry, (6) productive Brachiaria decumbens grassland, and (7) degraded Brachiaria decumbens grassland. These fragments are characteristic of agricultural estates in the Ucayali department, Peru. The carbon stored (the total sum of aboveground and soil) in the primary forest was 267.26 t/ha; in 15-year secondary forest, 232.30 t/ha; in 10-year secondary forest, 162.1 t/ha; in 5-year secondary forest, 124.42 t/ha; in cacao agroforestry, 108.82 t/ha; in productive B. decumbens grassland, 72.57 t/ha; and in degraded B. decumbens grassland, 60.47 t/ha. Significant differences (p ≤ 0.0001) were observed between the carbon stock values of the seven fragments (R2 = 0.51, and CV = 53.66%). Orthogonal contrast tests showed that the carbon stored in the primary forest fragment significantly exceeded the average carbon of the other fragments, while the carbon stored in the secondary forests significantly exceeded that stored in the cacao agroforestry fragment. No differences were found in the carbon stored in both grasslands, nor between the 10- and 15-year secondary forests. The increase in the number of families and species directly related to the age of the secondary forest provides evidence of the recovery of botanical diversity.

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INTRODUCTION: Identify risk factors for lumbar musculoskeletal disorders (MSD) associated with manual handling (MHL) of meat products in truck loading and unloading activities. METHOD: Cross-sectional descriptive observational study with a mixed approach, based on ergonomic analysis of work activity. The 4 workers from the loader and loader-driver positions participated. Kinematic and dynamometric analyzes were performed to determine compression and shear forces and musculoskeletal risk in the lumbar area. Interviews and observations were conducted to analyze tasks and determine the times involved in each operation, type of exposure and the determinants of work activity. RESULTS: The work context is highly variable during the loading and unloading of the truck, considering the variability at each delivery point the characteristics of the parking lots, weather conditions, the presence of animals and other obstacles during manual transport of the load. The MHL produces forces over 4000 N of disc compression at levels L4-L5 and L5-S1, the initial push and pull forces were 51.2 kg*f and 27.3 kg*f respectively, which shows the risk of MSD. The work activity is determined by the type of working day, the organization of the distribution and the lack of mechanical means to support the loading and unloading of trucks. CONCLUSIONS: The manual handling tasks in this industry are physically very demanding and improving these working conditions represents a significant challenge for prevention.

Introducción: Identificar los factores de riesgo de trastornos musculoesqueléticos (TME) lumbares asociados al manejo manual (MMC) de productos cárnicos en las actividades de carga y descarga de camiones. Método: Estudio observacional descriptivo transversal con enfoque mixto, basado en el análisis ergonómico de la actividad de trabajo. Participaron los 4 trabajadores de los puestos de cargador y cargador-conductor. Se realizaron análisis cinemáticos y dinamométricos para determinar las fuerzas de compresión y cizallamiento y el riesgo biomecánico musculoesquelético en la zona lumbar. Se realizaron entrevistas y observaciones para analizar tareas y determinar los tiempos involucrados en cada operación, tipo de exposición y los determinantes de la actividad de trabajo. Resultados: El contexto de trabajo es sumamente variable durante la carga y descarga del camión, considerando la variabilidad en cada punto de entrega las características de los estacionamientos, las condiciones climáticas, la presencia de animales y otros obstáculos durante el transporte manual de la carga. El MMC produce fuerzas sobre los 4000 N de compresión discal en los niveles L4-L5 y L5-S1, las fuerzas iniciales de empuje y arrastre fueron de 51.2 kg*f y 27.3 kg*f respectivamente, lo que evidencia el riesgo de TME. La actividad de trabajo está determinada por el tipo de jornada, la organización del reparto y la falta de medios mecánicos de apoyo para la carga y descarga de los camiones. Conclusiones: Las tareas de MMC en esta industria son físicamente muy exigentes y mejorar estas condiciones de trabajo representa un desafío importante para la prevención.

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Introducción: La pandemia no se detiene, los estudios sobre la misma tampoco; esta pandemia produce dolor, tristeza, desesperación y muertes, cuyos números son incalculables. Ante esta situación difícil y dolorosa, la risa levanta su bandera de esperanza. Objetivo: El estudio tiene el objetivo de describir los niveles y los factores demográficos de la risa, en el contexto la COVID-19. Métodos: El estudio corresponde a un enfoque cuantitativo, de tipo descriptivo, de corte transversal. Los datos sobre los niveles de la risa se obtuvieron mediante una encuesta virtual, cuyos participantes fueron 101, de edades entre 20 y 60 años, quienes participaron voluntariamente, procedentes de las tres regiones del Perú: costa, sierra y selva. Los datos sobre la experiencia de la risa, con misma encuesta, con el tipo Likert: nunca, a veces y siempre. Resultados: De los 101 participantes, 87 (entre 20 y 60 años) presentan una risa en el nivel alto y 14 en el nivel medio. 14 participantes (entre solteros, casados, divorciados y convivientes) revelan una risa en el nivel medio y 87 en el nivel alto. De las tres regiones (costa, sierra y selva), 14 participantes se ubican en el nivel medio y 87 en el nivel alto. Por otro lado, 6 hombres y 8 mujeres practican una risa ubicada en el nivel medio, en el alto 28 y 59, respectivamente. En el factor: religión, 14 (entre católicos, adventistas, evangélicos y otros) revelan una sonrisa en el nivel medio, 87 en el alto. Según el factor: nivel de estudios (primario, secundario y superior), 14 y 87 ubican su risa en el nivel bajo y alto, respectivamente. En el círculo familiar y de los amigos, se experimenta siempre la risa: 58.4% y 66.3%, respectivamente; para los encuestados es más fácil reír, siempre, 54.5% y 66.3%, en el entorno familiar y de los amigos, respectivamente. Declararon que la risa previene las enfermedades, fortalece la salud, evita el covid-19, fortalece el sistema inmunológico y limita la producción de la hormona cortisol (responsable del estrés), siempre 70.3%, 31.7%, 81.2; 31.7%, 71.3% y 83.2%, respectivamente. Conclusión: En el contexto de la COVID-19, los niveles más significativos de la risa encontrados en el estudio son dos: medio y alto; los factores demográficos más ponderados son: edad, sexo, religión y estado laboral.

Introduction: The pandemic does not stop, neither does the studies on it; This pandemic produces pain, sadness, despair and deaths, the numbers of which are incalculable. Faced with this difficult and painful situation, laughter raises its flag of hope. Objective: The study aims to describe the levels and demographic factors of laughter, in the context of COVID-19. Methods: The study corresponds to a quantitative, descriptive, cross-sectional approach. The data were obtained through a virtual survey, whose participants were 101, from the three regions. Results: Of the 101 participants, 87 (between 20 and 60 years old) are located in the high level and 14 in the medium level. Similarly, 14 (among single, married, divorced and cohabitants) in the medium level and 87 in the high level. Of the three regions (coast, mountains and jungle), 14 in the medium level and 87 in the high level. On the other hand, 6 men and 8 women are in the medium level, in the high 28 and 59, respectively. In the factor: religion, 14 (among Catholics, Adventists, Evangelicals and others) in the medium level, 87 in the high. According to the factor: educational level (primary, secondary and higher), 14 and 87 are located in the low and high level, respectively. In the family and friends circle, laughter is always experienced: 58.4% and 66.3%, respectively; for respondents it is easier to laugh, always, 54.5% and 66.3%, in the family environment and with friends, respectively. They declared that laughter prevents diseases, strengthens health, prevents covid-19, strengthens the immune system and limits the production of the hormone cortisol (responsible for stress), always 70.3%, 31.7%, 81.2; 31.7%, 71.3% and 83.2%, respectively. Conclusion: In the context of COVID-19, the most significant levels of laughter found in the study are two: medium and high; the most weighted demographic factors are: age, sex, religion, and employment status.

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Introduction: The process to evaluate the effectiveness of preventive programs involves follow-up and monitoring activities, assessing if these programs really contribute to the improvement of oral health conditions of the target population. Objective: To evaluate the effectiveness of oral health programs, according to their levels of prevention, applied to schoolchildren at educational institutions in Chiclayo and Pimentel, in the district of Lambayeque, Peru. Materials and Methods: A retrospective, longitudinal and descriptive study was carried out on 237 schoolchildren between 6 and 7 years of age, from four educational institutions located in Chiclayo and Pimentel. A record of the oral hygiene index and caries' incidence was carried out in four stages, including a baseline diagnosis and three follow-up evaluations every six months between 2016 and 2017, with a previously verified calibration process for the oral hygiene index (k=0.86) and for caries registration (k=0.79). Results: A greater effectiveness was observed in programs with level 2 prevention, achieving a progressive decrease in the oral hygiene index from a baseline mean of 2.04 to 1.98 at 6 months, 1.77 at 12 months and 1.64 at 18 months, with significant differences between them. Regarding the incidence of caries in permanent first molars, no significant differences were found in the effectiveness of programs with levels 1 and 2 of prevention, according to mixed factorial ANOVA (p<0.05). Conclusion: Programs with level 2 prevention have a greater effectiveness in terms of improving oral hygiene conditions, with significant differences in comparison to programs with level 1 prevention. No significant differences were found between the effectiveness of Level 1 and 2 programs regarding the incidence of dental caries.

Introducción: La efectividad como proceso de evaluación de los programas preventivos implica acompañamiento y seguimiento, permitiendo determinar si realmente contribuyen a mejorar las condiciones de salud bucal de una población. Objetivo: Evaluar la efectividad de programas de salud bucal según sus niveles de prevención aplicados a escolares de instituciones educativas de Chiclayo y Pimentel, Lambayeque­Perú. Material y Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, con 237 escolares entre 6 y 7 años de cuatro instituciones educativas de Chiclayo y Pimentel. El registro del índice de higiene oral y de incidencia de caries fue realizado en cuatro momentos, incluyendo un diagnóstico basal y tres evaluaciones de seguimiento cada seis meses entre los años 2016 y 2017, habiendo verificado un proceso previo de calibración para el índice de higiene oral (k=0.86) y para el registro de caries (k=0.79). Resultados: Se determinó una mayor efectividad en los programas con nivel 2 de prevención, logrando disminuir progresivamente el índice de higiene oral de una media basal de 2,04 a 1,98 a los 6 meses, 1,77 a los 12 meses y 1,64 a los 18 meses, encontrando diferencias significativas. En cuanto a incidencia de caries en primeras molares permanentes, no se encontraron diferencias significativas en la efectividad de los programas con niveles 1 y 2 de prevención, ANOVA factorial mixto (p<0,05). Conclusiones: Los programas con nivel 2 de prevención alcanzan mayor efectividad en cuanto a mejorar las condiciones de higiene oral, encontrando diferencias significativas en comparación a los programas con nivel 1. En cuanto a incidencia de caries, no se encontraron diferencias significativas entre la efectividad de los programas de nivel 1 y 2.

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Resumen La sospecha de hemotórax inicia con una historia clínica adecuada, particularmente, el padecimiento actual, por ejemplo, casos con trauma torácico. El paso inicial de la evaluación es diferenciar los derrames pleurales hemorrágicos de los verdaderos hemotórax. Confirmar el diagnóstico de manera temprana es fundamental, dado que, conforme progresan las fases de organización del coágulo, se van desarrollando adherencias entre la superficie del parénquima pulmonar y la pleura parietal, aspecto que dificulta evacuarlo mediante drenaje pleural convencional. La radiografía de tórax continúa siendo el estudio complementario inicial, sin embargo, es importante realizar estudios adicionales que permitan orientar la decisión terapéutica; la elección del análisis paraclínico puede justificarse con base en la experiencia y disponibilidad de recursos en el centro de atención. La instalación del tratamiento primario es crucial e inicia con el drenaje de la cavidad torácica vía sonda pleural en la mayoría de los casos; el uso de fibrinolíticos se considera de segunda línea y particularmente en hemotórax coagulado o casos que tienen riesgos significativos de complicaciones al someterse a un procedimiento quirúrgico mayor (Por ejemplo. decorticación). Las complicaciones se pueden disminuir al sistematizar el enfoque diagnóstico-terapéutico.

Abstract Initial approach of cases with suspected hemothorax begins with a complete clinical history (eg. recent thoracic trauma). The first step is to differentiate hemorrhagic pleural effusion of true hemothorax; then, prompt diagnosis is essential. We must keep in mind, as time progresses, the clot firmly adheres to the lung and pleural surface making it difficult to treat; therefore, any delay in this process diminishes the opportunity to evacuate the hemothorax through conventional thoracostomy with chest tube insertion and pleural drainage. Chest X-ray still the initial study, however, complementary tests should be performed in order to guide therapeutic decisions. The choice must be justified on local availability and experience. Undoubtedly, primary evacuation is mandatory; fibrinolytics are reserved as second-line treatment, also can be considered in coagulated hemothorax or patients who are at a high risk of surgical complications. In order to diminish any morbidity it is advisable to perform a systematic diagnostic and therapeutic approach.

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Contexto: Aun cuando la división sexual del trabajo remunerado ha sido examinada en muchos estudios, a veces considerada como la extensión de los roles diferenciados en el ámbito doméstico, el resultado de la jerarquía vertical donde los hombres se encuentran en los puestos superiores, la asociación de los hombres a las máquinas (distintas a las de limpieza o la costura) o la división de otras condiciones de trabajo y empleo por género. El género y el sexo rara vez son considerados en la investigación en ergonomía. Metodología: A través de una revisión de los datos publicados en encuestas chilenas con representación nacional, en bases de datos gubernamentales y artículos de ergónomos chilenos publicados en Ergonomics, Ciencia y Trabajo, etc. Objetivo: Este artículo busca orientar sobre las principales diferencias de sexo y género en los hombres y las mujeres para comprender sus implicancias en actividad de trabajo en Chile y cuál ha sido la contribución de la ergonomía a este aspecto. Conclusiones: El tomar en cuenta el sexo de las trabajadoras/es enriquece el análisis del trabajo y el análisis ergonómico a su vez enriquece la comprensión sobre la división sexual del trabajo y cómo esta genera diferentes exposiciones a los riesgos profesionales para las mujeres y los hombres.

Context: Even though the sexual division of paid work has been examined in many studies, sometimes thought of as the extension of differentiated roles in the domestic sphere, the result of a vertical hierarchy where men are found in higher positions, the association of men with machines (other than those used in cleaning or sewing), or a division of other working and employment conditions by gender. Gender and sex have rarely been considered in ergonomics research. Methodology: Through a review of published data from Chilean surveys with national representation, from governmental databases and published articles in Ergonomics, Ciencia y Trabajo, etc. Objective: This article aims to guide about the principals differences of sex and gender in men and women to understand the implications of sex and gender for work activity in Chile and what has been the contribution of ergonomics to this issue. Conclusions: Taking into account the sex of women and men workers enriches the analysis of work and the ergonomic analysis in turn enriches the understanding of the sexual division of work and how this generates different exposures to occupational risks for women and men.

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Introducción: Colombia es el segundo país con mayor biodiversidad del mundo, posee 10 % del recurso vegetal mundial representado en 50 000 especies vegetales, de las cuales la costa norte colombiana posee cerca de 3 400. Esta región se caracteriza por mantener una rica tradición de uso de este recurso natural para tratar sus problemas de salud. Objetivo: realizar el estudio químico sobre 45 extractos etanólicos de 39 especies vegetales, que son utilizadas en la medicina tradicional de la costa atlántica colombiana, con el propósito de contribuir al conocimiento con base científica, de los metabolitos secundarios presentes en estas plantas. Métodos: se recolectaron cada uno de los órganos de las especies; la droga fresca fue sometida a extracciones sucesivas con etanol 98 % y en los extractos se identificaron los diferentes grupos de metabolitos secundarios presentes. Resultados: en los diferentes extractos etanólicos se detectó una alta diversidad de metabolitos secundarios, con predominio de los flavonoides, derivados antracénicos, triterpenos, compuestos cardiotónicos y alcaloides. Por primera vez se reportaron estudios químicos para las especies Sarcostemma clausum (Jacq) Schult., Diospyros inconstans Jacq., Sterculia apetala (Jacq.) H. Karst., Ceratopteris pteridoides Hooker., Cecropia peltata L., Cordia dentata Poir. y Gustavia superba (Kunth) O. Berg. Conclusiones: se evidenció presencia de flavonoides como fitoconstituyentes más abundantes en las especies seleccionadas. Los resultados constituyen un apoyo para continuar con los estudios químicos y farmacológicos de estas especies.

Introduction: Colombia is the second country with the highest biodiversity in the world, about 10 % of the world's plant resources are represented by 50,000 species of plants, and the north Colombian´s coast has about 3,400 of these species. This region is characterized by maintaining a rich tradition of use of this natural resource to treat several primary health problems. Objective: to conduct a phytochemical study of 45 ethanol extracts of 39 plants, which are used in traditional medicine in the Colombian Atlantic coast, with the aim of contributing to science-based knowledge of secondary metabolites present in these plants. Methods: different organs from each species were collected, fresh drug was subjected to successive extractions with 98 % ethanol and were identified in the extracts different groups of secondary metabolites present in each plants. Results: in the different ethanol extracts was detected high diversity of secondary metabolites; flavonoids, anthracene derivatives, triterpenes, cardiotonic compounds and alkaloids were predominantly present in each extracts. This studies were reported for first time the phytochemical study for species such as Sarcostemma clausum (Jacq) Schult., Diospyros inconstans Jacq., Sterculia apetala (Jacq.) Karst., Ceratopteris pteridoides Hooker., Cecropia peltata L., Cordia dentata Poir. and Gustavia superba (Kunth) O. Berg. Conclusions: there was evidence the presence of flavonoids as phytoconstituents most abundant in the species selected. The results provide support for further chemical and pharmacological studies of these species.

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OBJECTIVE: To determine trends in the prevalence and identify the main risk factors associated with the development of pancreatic cancer. MATERIALS AND METHODS: Study of trends in incidence and case-control population consisted of a total of 134 patients. Patients were grouped into: a) CASES: 67 patients diagnosed with pancreatic cancer treated at the Abdomen's Service of the Specialized Surgery Department of the Regional Institute of Neoplastic Diseases "Dr. Luis Pinillos Ganoza "- IREN North during the period 2008 to 2011; and b) CONTROLS: 67 patients diagnosed with gallstones and / or benign biliary disease treated at Belen Hospital in Trujillo during the period 2008 to 2011. RESULTS: The trend curve of incidence of pancreatic cancer showed a curve almost constant throughout the quadrennium 2008 to 2011, with incidence rates of 5.38%, 5.08%, 5.5% and 5.0% respectively. The overall incidence was 5.37%. The trend function was Y = (1756) ± (0.001) (x), with an R2 = 0.318 (p = 0.436). The main risk factors associated with pancreatic cancer were age bigger and equal to 60 years (p = 0.0001), male sex (p = 0.007), diabetes mellitus (p = 0.002) and family history of malignancy (p = 0.016). CONCLUSIONS: The trend in incidence in pancreatic cancer was low and constant in its appearance was significantly influenced by age, gender, and presence of diabetes mellitus and family history of cancer.

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OBJETIVO. Determinar la tendencia en la incidencia e identificar los principales factores de riesgo asociados al desarrollo de cáncer de páncreas MATERIAL Y MÉTODOS. El presente estudio de tendencias de incidencia y de casos y controles, estuvo constituida por una población total 134 pacientes. Los pacientes fueron agrupados en: a) Casos: 67 pacientes con diagnóstico de cáncer de páncreas atendidos en el Servicio de Abdomen del Departamento de Cirugía Especializada del Instituto Regional de Enfermedades Neoplásicas ôDr. Luis Pinillos Ganozaõ - IREN Norte durante el periodo 2008 al 2011; y b) Controles: 67 pacientes con diagnóstico de litiasis vesicular y/o patología biliar benigna atendidos en el Hospital Belén de Trujillo durante el periodo 2008 û 2011. RESULTADOS. La curva de tendencia de incidencia de cáncer de páncreas evidenció una curva casi constante a lo largo del tetraenio 2008 al 2011, siendo las tasas de incidencias de 5.38%, 5.08%, 5.5% y 5.0% respectivamente. La incidencia global acumulada fue de 5.3% atendidos. La función de tendencia fue Y = (-1.756) ± (0.001) (x); con un R2 = 0.318 (p = 0.436). Los principales factores de riesgo asociados a cáncer de páncreas fueron: edad mayor e igual a 60 años (p = 0.0001), sexo masculino (p = 0.007), diabetes mellitus (p = 0.002) y antecedente familiar de neoplasia maligna (p = 0.016). CONCLUSIONES. La tendencia de incidencia en cáncer pancreático fue baja y constante, y su aparición estuvo influenciada significativamente por la edad, género, y presencia de diabetes mellitus e historia familiar de cáncer.

OBJECTIVE. To determine trends in the prevalence and identify the main risk factors associated with the development of pancreatic cancer. MATERIALS AND METHODS. Study of trends in incidence and case-control population consisted of a total of 134 patients. Patients were grouped into: a) Cases: 67 patients diagnosed with pancreatic cancer treated at the Abdomen's Service of the Specialized Surgery Departament of the Regional Institute of Neoplastic Diseases "Dr. Luis Pinillos Ganoza"-IREN North during the period 2008 to 2011; and b) Controls: 67 patients diagnosed with gallstones and / or benign biliary disease treated at Belen Hospital in Trujillo during the period 2008 to 20111. RESULTS. The trend curve of incidence of pancreatic cancer showed a curve almost constant throughout the quadrennium 2008 to 2011, with incidence rates of 5.38%, 5.08%, 5.5% and 5.0% respectively. The overall incidence was 5.37%. The trend function was Y = (1756) ± (0.001) (x), with an R2 = 0.318 (p=0.436). The main risk factors associated with pancreatic cancer were age bigger and equal to 60 years (p = 0.0001), male sex (p = 0.007), diabetes mellitus (p = 0.002) and family history of malignancy (p = 0.016). CONCLUSIONS. The trend in incidence in pancreatic cancer was low and constant in its appearance was significantly influenced by age, gender, and presence of diabetes mellitus and family history of cancer.

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PURPOSE: To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). MATERIALS AND METHODS: An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology program coordinators for them to forward to their residents. 142 UR completed the survey. RESULTS: After the initial unsuccessful attempt by a nurse, 92% of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76%) size 18F (51%). For situations where multiple sizes and types of catheters (12-20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74%, 62% and 63%; blind passage of a glidewire was second with 15%, 23% and 20%; and blind use of filiforms and followers was chosen in 7%, 9% and 9% of the scenarios respectively. CONCLUSIONS: The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.

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PURPOSE: To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). MATERIALS AND METHODS: An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology program coordinators for them to forward to their residents. 142 UR completed the survey. RESULTS: After the initial unsuccessful attempt by a nurse, 92 percent of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76 percent) size 18F (51 percent). For situations where multiple sizes and types of catheters (12 - 20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74 percent, 62 percent and 63 percent; blind passage of a glidewire was second with 15 percent, 23 percent and 20 percent; and blind use of filiforms and followers was chosen in 7 percent, 9 percent and 9 percent of the scenarios respectively. CONCLUSIONS: The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.

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El presente estudio prospectivo, descriptivo reporta seis casos de absceso cerebral piógenos, atendidos en el Servicio de Medicina del Hospital II EsSalud de Cajamarca, Perú, durante el periodo de 1990 al 2006. La edad promedio fue de 42 años, la mínima 9 años y el 66 por ciento fueron mayores de 40 años; 3 casos de sexo masculino y 3 de sexo femenino. Los focos primarios fueron: bronquiectasia, otitis media crónica, absceso dentario, sinusitis crónica, de origen cardiogénico y en 1 caso no se determinó. La desnutrición, VIH positivo, diabetes mellitus y endocarditis bacteriana; en 2 no se determinó enfermedad de fondo y en 1 hubo curetaje de absceso dental. Los síntomas de inicio son: cefalea en 50 por ciento convulsiones 17 por ciento. El síntoma principal: convulsiones en 66 por ciento, la hemiparesia y alteraciones del sensorio. El cuadro clínico estuvo caracterizado por cefalea (83 por ciento) convulsiones (66 por ciento), hemiparesia (66 por ciento), fiebre (66 por ciento), afasia (50 por ciento) edema de papila y vómito (50 por ciento) de alteración de memoria, signos meningeos y signos prefrontales (33 por ciento). Los sindromes clínicos: sindrome de cefalea (33 por ciento), neurológico focal (83 por ciento) epileptico focal (67 por ciento) febril (67 por ciento) de HEC (50 por ciento), meníngeo (33por ciento) de funciones superiores (33 por ciento). La TAC y IRM cerebal reveló 6 casos de absceso cerebral, de localización hemisférica derecha en 5 casos, 3 únicos y 3 múltiples; 2 en el lóculo frontal, 1 frontapariental, 1 frontotemporal y 1 parietal. Dos casos en fase de cerebritis y 4 encapsulados, con edema circundante y efecto de masa. El tratamiento se realizó cocn cefotaxima 1gr c/6 hs. VEV/20 días. 1 caso se prolongó el tratamietnno hasta 60 días con metronidazol por vía oral. Las secuelas fueron: hemiparesia, alteraciones prefrontales, convulsiones, polineuropatía periférica por metronidazol. La evolución clínica y tomográfica fue favorable en ...

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PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1) Passage of either a Glidewire, guide wire or filiform under direct vision; 2) Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3) "The Peel-away sheath placed on a cystoscope/resectoscope technique"; 4) "The rigid ureteroscope placed inside the 22F Foley technique"; 5) Suprapubic catheterization; and 6) "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

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PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1) Passage of either a Glidewire, guide wire or filiform under direct vision; 2) Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3) "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4) "The rigid ureteroscope placed inside the 22F Foley technique"; 5) Suprapubic catheterization; and 6) "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

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Lead (Pb) in blood, bone, and semen was measured in 162 to 186 environmentally exposed men from Mexico City, aged 19- 48. Semen Pb was measured by inductively coupled plasma mass spectrometry, blood Pb by atomic absorption spectrometry and bone Pb by K X-ray fluorescence. Mean Pb levels in blood, semen, tibia (cortical) and patella (trabecular) bone were 12 microg/dl, 2.7 microg/l, 13 microg/g, and 20 microg/g, respectively. Semen Pb was determined by blood Pb and patella Pb. Determinants of higher tibia Pb were age, living near industry in which Pb is used, and a high occupational Pb exposure index. Higher patella Pb was predicted by age, higher traffic density near home, a high index of occupational exposure to Pb and a greater number of cigarettes smoked per day in the year prior to the study. Blood and bone Pb results are consistent with findings in other populations. Semen results provide new information on the semen-bone Pb relationship. Bone, especially trabecular one, proved to be a significant endogenous lead source for blood and semen burdens in reproductive aged men.

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The abdominal oblito that can be formed in an involuntary way after making an invasive procedure abdominal constitutes a serious problem that is not very analyzed in the medical literature. The purpose in the presentation of this case of intestinal obstruction by oblito is to aid the support of the concept that all has not still been said about the ways of presentation of the abdominal oblito. Also to insist in the importance of the prevention and the inform of the personnel of the surgical room. The daily chore confirms that this topic is a taboo issue and that it generates dilemmas in diverse planes which magnitude is as enough as to be discussed.

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