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BACKGROUND: Sucrose accumulation in sugarcane is affected by several environmental and genetic factors, with plant moisture being of critical importance for its role in the synthesis and transport of sugars within the cane stalks, affecting the sucrose concentration. In general, rainfall and high soil humidity during the ripening stage promote plant growth, increasing the fresh weight and decreasing the sucrose yield in the humid region of Colombia. Therefore, this study aimed to identify markers associated with sucrose accumulation or production in the humid environment of Colombia through a genome-wide association study (GWAS). RESULTS: Sucrose concentration measurements were taken in 220 genotypes from the Cenicaña's diverse panel at 10 (early maturity) and 13 (normal maturity) months after planting. For early maturity data was collected during plant cane and first ratoon, while at normal maturity it was during plant cane, first, and second ratoon. A total of 137,890 SNPs were selected after sequencing the 220 genotypes through GBS, RADSeq, and whole-genome sequencing. After GWAS analysis, a total of 77 markers were significantly associated with sucrose concentration at both ages, but only 39 were close to candidate genes previously reported for sucrose accumulation and/or production. Among the candidate genes, 18 were highlighted because they were involved in sucrose hydrolysis (SUS6, CIN3, CINV1, CINV2), sugar transport (i.e., MST1, MST2, PLT5, SUT4, ERD6 like), phosphorylation processes (TPS genes), glycolysis (PFP-ALPHA, HXK3, PHI1), and transcription factors (ERF12, ERF112). Similarly, 64 genes were associated with glycosyltransferases, glycosidases, and hormones. CONCLUSIONS: These results provide new insights into the molecular mechanisms involved in sucrose accumulation in sugarcane and contribute with important genomic resources for future research in the humid environments of Colombia. Similarly, the markers identified will be validated for their potential application within Cenicaña's breeding program to assist the development of breeding populations.
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Estudo de Associação Genômica Ampla , Umidade , Saccharum , Sacarose , Saccharum/genética , Saccharum/metabolismo , Colômbia , Sacarose/metabolismo , Polimorfismo de Nucleotídeo Único , GenótipoRESUMO
PURPOSE: Clinical practice guidelines recommend that all patients with metastatic colorectal cancer (mCRC) should be tested for mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H). We aimed to describe the dMMR/MSI-H testing practice in patients with mCRC in Spanish centers. METHODS: Multicenter, observational retrospective study that included patients newly diagnosed with mCRC or who progressed to a metastatic stage from early/localized stages. RESULTS: Three hundred patients were included in the study from May 2020 through May 2021, with a median age of 68 years, and two hundred twenty-five (75%) had stage IV disease at initial diagnosis; two hundred eighty-four patients received first-line treatment, and dMMR/MSI-H testing was performed in two hundred fifty-one (84%) patients. The results of the dMMR/MSI-H tests were available in 61 (24%) of 251 patients before the diagnosis of metastatic disease and in 191 (81%) of 236 evaluable patients for this outcome before the initiation of first-line treatment. Among the 244 patients who were tested for dMMR/MSI-H with IHC or PCR, 14 (6%) were MMR deficient. The most frequent type of first-line treatment was the combination of chemotherapy and biological agent, that was received by 71% and 50% of patients with MMR proficient and deficient tumors, respectively, followed by chemotherapy alone, received in over 20% of patients in each subgroup. Only 29% of dMMR/MSI-H tumors received first-line immunotherapy. CONCLUSION: Our study suggests that a high proportion of patients with mCRC are currently tested for dMMR/MSI-H in tertiary hospitals across Spain. However, there is still room for improvement until universal testing is achieved. TRIAL REGISTRATION: Not applicable.
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Neoplasias Encefálicas , Neoplasias do Colo , Neoplasias Colorretais , Síndromes Neoplásicas Hereditárias , Neoplasias Retais , Idoso , Humanos , Neoplasias do Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/tratamento farmacológico , Instabilidade de Microssatélites , Estudos Retrospectivos , EspanhaRESUMO
Dysbiosis plays an important role in the development of bacterial infections in the gastric mucosa, particularly Helicobacter pylori. The international guidelines for the treatment of H. pylori infections suggest standard triple therapy (STT). Nevertheless, because of the increasing resistance rates to clarithromycin, metronidazole has been widely considered in several countries. Unfortunately, the non-justified administration of antibiotics induces dysbiosis in the target organ. We characterized the gastric microbiota of patients diagnosed with follicular gastropathy and pangastropathy attributed to H. pylori infection, before and after the administration of STT with metronidazole. Dominant relative abundances of Cutibacterium were observed in pre-treatment patients, whereas H. pylori was observed at <11%, suggesting the multifactor property of the disease. The correlation of Cutibacterium acnes and H. pylori with gastric infectious diseases was also evaluated using quantitative real-time polymerase chain reaction. The dominance of C. acnes over H. pylori was observed in gastritis, gastropathies, and non-significant histological alterations. None of the microorganisms were detected in the intestinal metaplasia. Post-treatment alterations revealed an increase in the relative abundances of Staphylococcus, Pseudomonas, and Klebsiella. Non-H. pylori gastrointestinal bacteria can be associated with the initiation and development of gastric diseases, such as pathobiont C. acnes.
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Selection in the Iowa Stiff Stalk Synthetic (BSSS) maize population for high yield, grain moisture, and root and stalk lodging has indirectly modified plant architecture traits that are important for adaptation to high plant density. In this study, we developed doubled haploid (DH) lines from the BSSS maize population in the earliest cycle of recurrent selection (BSSS), cycle 17 of reciprocal recurrent selection, [BSSS(R)17] and the cross between the two cycles [BSSS/BSSS(R)C17]. We aimed to determine the phenotypic variation and changes in agronomic traits that have occurred through the recurrent selection program in this population and to identify genes or regions in the genome associated with the plant architecture changes observed in the different cycles of selection. We conducted a per se evaluation of DH lines focusing on high heritability traits important for adaptation to high planting density and grain yield. Trends for reducing flowering time, anthesis-silking interval, ear height, and the number of primary tassel branches in BSSS(R)17 DH lines compared to BSSS and BSSS/BSSS(R)C17 DH lines were observed. Additionally, the BSSS(R)C17 DH lines showed more upright flag leaf angles. Using the entire panel of DH lines increased the number of SNP markers identified within candidate genes associated with plant architecture traits. The genomic regions identified for plant architecture traits in this study may help to elucidate the genetic basis of these traits and facilitate future work about marker-assisted selection or map-based cloning in maize breeding programs.
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Background: Occipital encephalocele is a congenital defect of the neural tube at the level of the cranial midline, which results in herniation of meninges and brain tissue. The results of the management of myelomeningocele study determine the maternal and fetal risks for an open fetal surgery and have motivated the constant review of the concepts and strategies which the pediatric neurosurgeon can employ for the treatment of neural tube defects in the prenatal period. Case Description: We present a case of a female patient in utero of 26 gestational weeks with the diagnosis of an occipital encephalocele treated by open fetal surgery. During week 20 of gestation, the diagnosis of occipital encephalocele was made by ultrasound, which was corroborated by fetal magnetic resonance that showed cranial protrusion of neural and meningeal content in the occipital region, measuring 1.6 × 2.8 × 3.3 cm with an approximate volume of 7.7 cc through a bone defect of 6 mm. The closure of the defect was performed by the postnatal surgical technique adapted to the open fetal surgery. Later, the patient was born transabdominal with a 2.8 cm occipital wound, with suture points and approximated borders, normocephalic, without clinical signs of sepsis, hydrocephalus, or overt neurologic compromise. Conclusion: Open fetal surgery is a therapeutic option in the face of an isolated occipital encephalocele. This case report demonstrates the viability of the surgical procedure by the adaptation of a postnatal surgical technique to a prenatal surgery. Further studies are needed to evaluate the long-term functional results, comparing them with those seen in patients who undergo a postnatal procedure.
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Resumen: Introducción: a través de los índices de oxigenación valoramos la función del sistema respiratorio de oxigenación y ventilación. Objetivo: determinar el valor de los índices de oxigenación como factor de pronóstico para el desenlace en neumonía grave por SARS-CoV-2. Material y métodos: estudio retrospectivo, longitudinal, descriptivo, analítico. Se incluyeron pacientes > 18 años con diagnóstico de neumonía por SARS-CoV-2 entre el 01 junio y el 31 de diciembre de 2020. Se clasificó a los pacientes de acuerdo al desenlace: sobreviviente o no sobreviviente. Se empleó estadística descriptiva y pruebas paramétricas y no paramétricas de acuerdo al caso, se construyeron curvas ROC (Receiver Operating Characteristic Curve) para determinar los puntos de corte de los gases arteriales con la mejor sensibilidad y especificidad y se determinó el área bajo la curva (ABC) para el desenlace fatal. Resultados: se incluyeron 175 pacientes, 70.3% correspondió al sexo masculino, la media de edad fue de 56 años (rango intercuartil 45-64). El grupo de sobrevivientes incluyó 51 pacientes y el grupo de no sobrevivientes 124 pacientes. Al analizar los gases arteriales al momento de ingresar a la unidad de cuidados intensivos sobresale la PaO2/FiO2 de 100 mmHg y el índice respiratorio (IR) > 2.4 con un ABC de 0.694 y 0.722 respectivamente. A las 96 horas de ingreso destaca PaO2/FiO2 de 145 mmHg, el IR >3 y la PaO2/PAO2 de 0.22 con un ABC de 0.846, 0.840 y 0.842 respectivamente. Conclusión: los gases arteriales medidos a las 96 horas de ingreso a la UCI son marcadores pronósticos para el desenlace fatal en la neumonía grave por SARS-CoV-2.
Abstract: Introduction: oxygenation indices we assess the function of the respiratory system of oxygenation and ventilation. Objective: to determine the value of arterial gases as a prognostic factor for the outcome of patients with severe SARS-CoV-2 pneumonia. Material and methods: retrospective, longitudinal, descriptive, analytical study. We included patients > 18 years with a diagnosis of SARS-CoV-2 pneumonia between 1 June and 31 December 2020. Patients were classified according to outcome: survivor or non-survivor. Descriptive statistics and parametric and non-parametric tests were used according to the case, ROC (Receiver Operating Characteristic Curve) curves were constructed to determine the cut-off points of arterial gases with the best sensitivity and specificity and the area under the curve (AUC) for the fatal outcome was determined. Results: we included 175 patients, 70.3% corresponded to the male sex, the mean age was 56 years (interquartile range 45-64). The survivor group included 51 patients and the non-survivor group 124 patients. When analyzing arterial gases at the time of admission to the ICU, paO2/FiO2 of 100 mmHg and respiratory index (RI) > 2.4 with ABC 0.694 and 0.722 respectively. At 96 hours of admission, PaO2/FiO2 of 145 mmHg stands out, the RI > 3 and the DA-aO2 of 0.22 with ABC 0.846, 0.840 and 0.842 respectively. Conclusion: arterial blood gases measured at 96 hours of ICU admission are prognostic markers for fatal outcome in severe SARS-CoV-2 pneumonia.
Resumo: Introdução: através dos índices de oxigenação avaliamos a função do sistema respiratório de oxigenação e ventilação. Objetivo: determinar o valor dos índices de oxigenação como fator prognóstico para o desfecho em pneumonia grave por SARS-CoV-2. Material e métodos: estudo retrospectivo, longitudinal, descritivo, analítico. Icluíram-se pacientes com mais de 18 anos de idade diagnosticados com pneumonia por SARS-CoV-2 entre 1º de junho e 31 de dezembro de 2020. Os pacientes foram classificados de acordo com o desfecho: sobreviventes ou não sobreviventes. Foram usadas estatística descritiva e testes paramétricos e não paramétricos de acordo com o caso, foram construídas curvas ROC (Receiver Operating Characteristic Curve) para determinar os pontos de corte da gasometria arterial com melhor sensibilidade e especificidade e determinou-se a área sob a curva (ABC) para o desfecho fatal. Resultados: incluíram-se 175 pacientes, 70.3% eram do sexo masculino, a média de idade foi de 56 anos (rango interquartil 45-64). O grupo sobrevivente incluiu 51 pacientes e o grupo não sobrevivente 124 pacientes. Na análise dos gases arteriais no momento da admissão na UTI, destacam-se a PaO2/FiO2 de 100 mmHg e o índice respiratório (IR) > 2.4 com AUC 0.694 e 0.722 respectivamente. Às 96 horas de internamento destaca-se PaO2/FiO2 145 mmHg, IR > 3 e PaO2/PAO2 de 0.22 com ABC 0.846, 0.840 e 0.842 respetivamente. Conclusão: os gases sanguíneos arteriais medidos 96 horas após a admissão na UTI são marcadores prognósticos para desfecho fatal em pneumonia grave por SARS-CoV-2.
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Background: Pediatric intracranial aneurysms (PIAs) are uncommon. Flow diverters (FDs) have shown to be effective on treatment of selected aneurysms. Methods: We describe 10 cases of PIAs treated with FDs at one medical center in Mexico, from April 2015 to April 2020. Results: Out of 230 patients treated with FDs, 10 (4.3%) were pediatric. Average age was 9.4 years old (R: 6-15). Two patients (20%) had subarachnoid hemorrhage, 3 had epilepsy (30%), 3 (30%) had clinical signs of cranial nerve compression, and 4 (40%) had only headache. Two patients were in 1a grade of Hunt and Kosnik scale. Out of the nonruptured aneurysms, 7 (70%) were in 15 points of Glasgow Coma Scale and 1 patient (10%) was in 13 points. Treatment was performed without complications; nevertheless, appropriate distal deployment was not achieved in one case. At discharge, nine patients had 5 points of Glasgow Outcome Scale. All patients underwent computed tomography angiography or digital subtraction angiography at 1, 3, 6, and 12 months, 2 patients (20%) had a 2-year follow-up, and 3 patients (30%) had a 3-year follow-up. According to Kamran grading scale, 9 patients (90%) were classified as Grade 4 and 1 patient (10%) as Grade 3. Conclusion: Even though it is a small series, as this is an uncommon disease, we may suggest that FDs are useful to treat properly selected PIAs. Our study has consecutive imaging assessment at least a year of follow-up in which aneurysm stable occlusion was observed in 90% of patients.
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Resumen El abordaje sobre la mejor estrategia para diagnosticar y manejar pacientes en estado de choque (EC) de forma rápida y eficiente es dinámico, depende de las características propias del paciente, de la tecnología disponible y la evidencia científica siempre en evolución; todo esto lleva a que exista considerable variación en la práctica diaria. El objetivo de esta propuesta es dar a conocer un algoritmo basado en criterios clínicos, optimizando las herramientas disponibles y logrando un proceso diagnóstico sencillo y rápido con el principal objetivo de ser útil para el manejo del paciente.
Abstract The approach on the best strategy to diagnose and manage patients in shock disease (CD) quickly and efficiently is dynamic, it depends on the characteristics of the patient, the available technology, the scientific evidence always in evolution; All of this leads to considerable variation in daily practice. The objective of this proposal is to present an algorithm based on clinical criteria and optimizing the available tools, achieving a simple, fast diagnostic process with the main objective of being useful to the patient.
Resumo A abordagem sobre a melhor estratégia para diagnosticar e manejar pacientes em choque (PC) de forma rápida e eficiente é dinâmica, depende das características do paciente, da tecnologia disponível, das evidências científicas sempre em evolução; tudo isso leva a uma variação considerável na prática diária. O objetivo desta proposta é apresentar um algoritmo baseado em critérios clínicos e otimizando as ferramentas disponíveis, alcançando um processo diagnóstico simples e rápido com o objetivo principal de ser útil para o manejo do paciente.
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Resumen: Introducción: Detectar y corregir el metabolismo anaerobio es indispensable en el paciente críticamente enfermo; desafortunadamente, no existe un estándar de oro. Los pacientes con neumonía grave por SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) presentan hipoxemia severa, aumentando el metabolismo anaerobio. El lactato y la diferencia de presión venoarterial de dióxido de carbono/diferencia del contenido arteriovenoso de oxígeno (Δp(v-a)CO2/ΔC(a-v)O2) son útiles en este contexto. Material y métodos: Estudio de cohorte, prospectivo, descriptivo y analítico, que incluyó pacientes ingresados a la Unidad de Cuidados Intensivos (UCI) en el periodo comprendido entre el 18 de abril de 2020 al 18 de enero de 2021 con neumonía grave (definida por el inicio de ventilación mecánica invasiva) por SARS-CoV-2 confirmados. Resultados: En el periodo comprendido se incluyeron 91 pacientes que cumplieron con los criterios de inclusión. Del total, 39 pacientes se incluyeron en el grupo de supervivientes y 52 en el grupo de no supervivientes. Se puede observar que la Δp(v-a)CO2/ΔC(a-v)O2, o índice de anaerobiosis, tiene OR de 4.4, IC de 95% 1.51-13.04, p = 0.006 en el análisis multivariable. Conclusión: El incremento de la Δp(v-a)CO2/ΔC(a-v)O2, o índice de anaerobiosis, > 1.4 mmHg/mL está relacionado con 4.44 veces más riesgo de muerte en los pacientes con neumonía grave (intubados) por SARS-CoV-2.
Abstract: Introduction: Detecting and correcting anaerobic metabolism is essential in the critically ill patient, unfortunately, there is no gold standard. Patients with severe pneumonia due to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) present severe hypoxemia, increasing anaerobic metabolism. Lactate and the venoarterial carbon dioxide pressure difference/arteriovenous oxygen content difference (Δp(v-a)CO2/ΔC(a-v)O2) are useful in this context. Material and methods: Prospective, descriptive and analytical cohort study that included patients admitted to the Intensive Care Unit (ICU) in the period from April 18, 2020 to January 18, 2021 with severe pneumonia (defined by the start of invasive mechanical ventilation) by SARS-CoV-2 confirmed. Results: In the period covered, 91 patients who met the inclusion criteria were included. Of the total, 39 patients were included in the survivors group and 52 in the non-survivors group. It can be seen that the Δp(v-a)CO2/ΔC(a-v)O2 also called anaerobiosis index has OR 4.4, 95% CI 1.51-13.04, p = 0.006 in the multivariate analysis. Conclusion: The increase in the Δp(v-a)CO2/ΔC(a-v)O2 also called anaerobiosis index > 1.4 mmHg/mL is associated with a 4.44 times higher risk of death in patients with severe pneumonia (intubated) due to SARS-CoV-2.
Resumo: Introdução: Detectar e corrigir o metabolismo anaeróbio é essencial no paciente crítico, infelizmente, não existe um «padrão ouro¼. Pacientes com pneumonia grave por SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) apresentam hipoxemia grave, aumentando o metabolismo anaeróbio. O lactato e a diferença de pressão venoarterial de dióxido de carbono/diferença do conteúdo arteriovenoso de oxigênio (Δp(v-a)CO2/ΔC(a-v)O2) são úteis neste cenário. Material e métodos: Estudo de coorte, prospectivo, descritivo e analítico que incluiu pacientes internados na Unidade de Terapia Intensiva (UTI) no período de 18 de abril de 2020 a 18 de janeiro de 2021 com pneumonia grave (definida pelo início da ventilação mecânica invasiva) por SARS-CoV-2 confirmados. Resultados: No período compreendido, foram incluídos 91 pacientes que atenderam aos critérios de inclusão. Do total, 39 pacientes foram incluídos no grupo sobrevivente e 52 no grupo não sobrevivente. Pode-se observar que o Δp(v-a)CO2/ΔC(a-v)O2 ou índice de anaerobiose tem OR 4.4, IC 95% 1.51-13.04, p = 0.006 na análise multivariada. Conclusão: Um aumento em Δp(v-a)CO2/ΔC(a-v)O2 ou índice de anaerobiose > 1.4 mmHg/mL está associado a um aumento de 4.44 vezes no risco de morte em pacientes com pneumonia grave (entubados) por SARS-CoV-2.
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INTRODUCCIÓN. La fundoplicatura laparoscópica de Nissen es la técnica quirúrgica de elección en el tratamiento de la enfermedad por reflujo gastroesofágico, en la que la disfagia persistente postoperatoria como secuela, está presente con incidencia del 1 al 36% a nivel mundial. OBJETIVO. Determinar la incidencia de disfagia persistente, en pacientes postoperados de fundoplicatura laparoscópica de Nissen. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo; con una población y muestra conocida de 15 Historias Clínicas de pacientes operados de fundoplicatura laparoscópica de Nissen en el Servicio de Cirugía General del Hospital General Dr. Fernando Quiroz Gutiérrez, Ciudad de México, periodo enero 2014 a mayo 2016. Criterios de inclusión: mayores de 18 años de ambos sexos, pos fundoplicatura laparoscópica de Nissen. Los datos se obtuvieron de las Historias Clínicas, y se aplicó un cuestionario vía telefónica. Para el análisis de datos se utilizó el programa Microsoft Excel 2013. RESULTADOS. La incidencia de disfagia persistente fue de 46,6% (7; 15), siendo frecuente en los hombres con un 60% (9; 15), frente a 40% (6; 15) en mujeres, con una incidencia por sexo de 66,6% (4;6) en mujeres y 33,3% (3; 9) en hombres. DISCUSIÓN. La detección de disfagia persistente aún requiere validación y tropicalización del test que evite sesgos al momento de su aplicación por parte de personal calificado. CONCLUSIÓN. Se determinó que la incidencia de disfagia persistente, en pacientes postoperados de fundoplicatura laparoscópica de Nissen a los 3 y 6 meses fue del 46%.
INTRODUCTION. Nissen laparoscopic fundoplication is the surgical technique of choice in the treatment of gastroesophageal reflux disease, in which persistent postoperative dysphagia as a sequel is present with an incidence of 1 to 36% worldwide. OBJECTIVE. To determine the incidence of persistent dysphagia in postoperative patients with Nissen laparoscopic fundoplication. MATERIALS AND METHODS. Observational, descriptive study; with a population and known sample of 15 Clinical Histories of patients operated on for Nissen laparoscopic fundoplication in the General Surgery Service of the General Hospital Dr. Fernando Quiroz Gutiérrez, Mexico City, period january 2014 to may 2016. Inclusion criteria: older than 18 years of both sexes, after Nissen laparoscopic fundoplication. The data were obtained from the Medical Records, and a questionnaire was applied via telephone. For data analysis, the Microsoft Excel 2013 program was used. RESULTS. The incidence of persistent dysphagia was 46,6% (7; 15), being frequent in men with 60% (9; 15), compared to 40% (6; 15) in women, with an incidence by sex of 66,6% (4; 6) in women and 33,3% (3; 9) in men. DISCUSSION. The detection of persistent dysphagia still requires validation and tropicalization of the test to avoid bias at the time of its application by qualified personnel. CONCLUSION. The incidence of persistent dysphagia in postoperative patients with Nissen laparoscopic fundoplication at 3 and 6 months was determined to be 46%.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Período Pós-Operatório , Transtornos de Deglutição , Refluxo Gastroesofágico , Incidência , Laparoscopia , Fundoplicatura , Cirurgia Geral , Terapêutica , Inquéritos e Questionários , Análise de Dados , MétodosRESUMO
Remote sensing is revolutionizing the way in which forests studies are conducted, and recent technological advances, such as Structure from Motion (SfM) photogrammetry from Unmanned Aerial Vehicle (UAV), are providing more efficient methods to assist in REDD (Reducing Emissions from Deforestation and forest Degradation) monitoring and forest sustainable management. The aim of this work was to develop and test a methodology based on SfM from UAV to generate high quality Digital Terrain Models (DTMs) on teak plantations (Tectona grandis Linn. F.) situated in the Coastal Region of Ecuador (dry tropical forest). UAV overlapping images were collected using a DJI Phantom 4 Advanced© quadcopter during the dry season (leaf-off phenological stage) over 58 teak square plots of 36 m side belonging to three different plantations located in the province of Guayas (Ecuador). A workflow consisting of SfM absolute image alignment based on field surveyed ground control points, very dense point cloud generation, ground points filtering and outlier removal, and DTM interpolation from labeled ground points, was accomplished. A very accurate Terrestrial Laser Scanning (TLS) derived ground points were employed as ground reference to estimate the UAV-SfM DTM vertical error in each reference plot. The plot-level obtained DTMs presented low vertical bias and random error (-3.1 cm and 11.9 cm on average, respectively), showing statistically significant greater error in those reference plots with basal area and estimated vegetation coverage above 15 m2/ha and 60%, respectively. To the best of the authors' knowledge, this is the first study aimed at monitoring of teak plantations located in dry tropical forests from UAV images. It provides valuable information that recommends carrying out the UAV image capture during the leaf-off season to obtain UAV-SfM derived DTMs suitable to serve as ground reference in supporting teak plantations inventories.
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Monitoramento Ambiental/métodos , Florestas , Tecnologia de Sensoriamento Remoto/métodos , Conservação dos Recursos Naturais , EquadorRESUMO
Resumen: Existe alta necesidad de órganos para trasplante en Chiapas y no hay registro previo de donación multiorgánica con fines de trasplante en el estado. Caso clínico: Hombre de 19 años con probable muerte encefálica debido a traumatismo craneoencefálico atendido en el IMSS y con imposibilidad de traslado a hospitales de tercer nivel, se coordinó la red chiapaneca de apoyo interinstitucional y en «Ciudad Salud¼ se diagnosticó muerte cerebral, se activó la red nacional de trasplantes y los equipos tardarían en llegar para procuración. El donador se mantuvo en terapia intensiva donde sus condiciones generales se mantuvieron de manera óptima, la donación fue exitosa gracias al apoyo multidisciplinario. Conclusión: En Chiapas la red de coordinación interinstitucional y el apoyo multidisciplinario fueron clave para la primera donación multiorgánica con fines de trasplante. El manejo en terapia intensiva fue crucial para el éxito de la donación.
Abstract: There is a high need of organs for transplantation in Chiapas and there is no previous registration of multiorgan donation for transplant purposes in the state. Case report: A 19 year old man with probably brain death due to traumatic brain injury treated at IMSS and unable to transfer to third level hospitals, the Chiapanecan interinstitutional support network was coordinated and in «Ciudad Salud¼, brain death was diagnosed, the national network of transplants was activated and the teams would arrive late for procurement, the donor stayed in Intensive Care Unit where their general conditions were maintained in optimal conditions, the donation was successful thanks to the multidisciplinary support. Conclusion: In Chiapas, the interinstitutional coordination network and multidisciplinary support were key for the first multiorgan donation for transplant purposes, the management in intensive care was crucial for the success of the donation.
Resumo: Há uma grande necessidade de órgãos para transplante em Chiapas e não há registro prévio de doação de múltiplos órgãos para fins de transplante no estado. Caso clínico: Homem de 19 anos com provável morte encefálica por traumatismo cranioencefálico tratado no IMSS e com inviabilidade de transferência para hospitais de terceiro nível, coordenou-se a rede Chiapaneca de apoio interinstitucional, na «Ciudad Salud¼ foi diagnosticada morte encefálica. Ativou-se a rede nacional de transplantes e as equipes chegariam atrasadas para a aquisição, o doador permaneceu em Terapia Intensiva onde suas condições gerais foram mantidas em condições ótimas, a doação foi bem sucedida graças ao apoio multidisciplinar. Conclusão: Em Chiapas a rede de coordenação interinstitucional e o apoio multidisciplinar foram fundamentais para a primeira doação de múltiplos órgãos para fins de transplante, o manejo em Terapia Intensiva foi fundamental para o sucesso da doação.
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El pinzamiento femoroacetabular provoca dolor agudo en la ingle anterior y limita la movilidad de la cadera. Es un síndrome clínico propiciado por una alteración en la anatomía ósea. Los osteocondromas son los principales tipos de tumores benignos, alteran la anatomía ósea y, según su localización, pueden generar dolor y pinzamiento. Este reporte de caso tuvo como objetivo el describir el tratamiento dado y la evolución clínica de un paciente con pinzamiento secundario a un osteocondroma ilíaco solitario. Se presenta un paciente masculino de 20 años con agudización de un dolor punzante y disminución en los arcos de movilidad en la articulación de la cadera derecha, sin mejoría con tratamiento sintomático. Mediante estudios de imagen se identificó una masa tumoral en la región afectada. Se realizó resección quirúrgica total mediante un abordaje lateral directo extendido de Hardinge. Dada la naturaleza benigna del tumor y su total resección, el paciente evolucionó satisfactoriamente y se pudo incorporar a sus actividades cotidianas. Se concluye que los osteocondromas no son exclusivos de las metáfisis o epífisis de huesos largos. Deben sospecharse las presentaciones atípicas cuando el cuadro clínico es sugestivo, aun después de la adolescencia(AU)
Femoroacetabular impingement generates acute pain in the anterior groin and limitation of hip mobility. It is a clinical syndrome caused by an alteration in bone anatomy. Osteochondromas are the main types of benign tumors, they alter the bone anatomy and depending on their location, they can generate pain and impingement. This case report aims to serve as a reference for specialized care in communicating the diagnostic challenges and approach in a patient with secondary clamping to osteochondroma of atypical presentation. The present case report aims to describe the given treatment and clinical evolution of a patients presenting femoroacetabular impingement secondary to a solitary osteochondroma. We report a 20-year-old male patient with exacerbation of a shooting pain and decrease in the mobility arches in his right hip joint, with no improvement with symptomatic treatment. Through imaging studies, a tumor mass was identified in the affected region. Total surgical resection was performed through an extended direct lateral approach of Hardinge. Given the benign nature of the tumor and its total resection, the patient evolved satisfactorily. The prognosis is favorable. He was able to return to his daily activities. We concluded that osteochondromas are not exclusive to the metaphysis or epiphyses of long bones. Atypical presentations should be suspected when clinical manifestations suggest so, even after adolescence(AU)
Le pincement fémoro-acétabulaire provoque une douleur aigue au niveau du bassin antérieur et empêche la mobilité de la hanche. Il s'agit d'un syndrome clinique poussé par une altération de l'anatomie osseuse. Les ostéochondromes sont des tumeurs bénignes, altérant l'anatomie osseuse et, selon leur localisation, pouvant même déclencher la douleur et le pincement. Ce rapport de cas a le but de décrire le traitement proposé et l'évolution clinique d'un patient atteint de pincement secondaire à un ostéochondrome iliaque solitaire. Un patient âgé de 20 ans souffrant la recrudescence d'une douleur aigue et la diminution des arcs de mobilité de l'articulation de la hanche droite, sans soulagement, même sous traitement symptomatique, est présenté. Une masse tumorale a été identifiée par imagerie dans la région affectée. On a effectué une résection chirurgicale totale par la voie d'abord latérale directe et étendue de Hardinge. Étant données la nature bénigne de la tumeur et sa totale résection, le patient a eu une évolution satisfaisante, et a pu s'incorporer aux activités de la vie quotidienne. On peut conclure que les ostéochondromes ne sont pas exclusifs de la métaphyse ou de l'épiphyse des os longs. On doit suspecter des présentations atypiques lorsque le tableau clinique est suggestif, même après l'adolescence(AU)
Assuntos
Humanos , Masculino , Adulto , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Osteocondroma/cirurgia , Osteocondroma/diagnóstico por imagem , Impacto Femoroacetabular/etiologia , Ílio/cirurgiaRESUMO
Resumen: El fundamento básico de la terapia hídrica es aumentar el gasto cardiaco, mejorar la perfusión y la oxigenación tisular para garantizar el adecuado funcionamiento de órganos. La cantidad de líquidos administrada es esencial para el pronóstico; existe controversia sobre cuál solución es la mejor. La prescripción de fluidos intravenosos varía considerablemente a nivel mundial, la elección parece basarse en costumbres locales, comercialización, costos y disponibilidad de las soluciones; los registros globales de atención médica demuestran el uso indiscriminado de este recurso terapéutico de forma empírica, principalmente en la población adulta. Hoy se conocen, por múltiples estudios, los efectos adversos atribuidos a la sobrecarga hídrica, a las soluciones ricas en cloro y al impacto que tienen en los costos hospitalarios, la morbilidad y la mortalidad global. En este artículo se analizan todos estos factores y las nuevas directrices de manejo basadas en la evidencia científica.
Abstract: The basic basis of fluid therapy is to increase cardiac output, improve perfusion and tissue oxygenation to ensure proper organ function, the amount of fluids administered is critical to the prognosis and there is controversy over which fluid is better over the others. Globally, there is great variation in the prescription of intravenous fluids, the choice seems to be based on local customs, marketing, costs and availability of the solutions; The global records of health care demonstrate the indiscriminate use of this therapeutic resource in an empirical way mainly in the adult population, the adverse effects attributed to water overload, chloride rich solutions and the impact this leads to In hospital costs, morbidity and overall mortality. This article analyzes all these factors and the new management guidelines based on the scientific evidence.
Resumo: O fundamento básico da terapia hídrica é aumentar o débito cardíaco, melhorar a perfusão e a oxigenação tecidual para garantir o funcionamento adequado dos órgãos, a quantidade de fluído administrado é fundamental para o prognóstico e há controvérsia sobre qual solução é melhor do que as demais. A nível mundial, existe uma grande variação na prescrição de fluídos intravenosos, a escolha parece estar baseada nos costumes locais, comercialização, custos e disponibilidade de soluções; os registros globais de atenção médica demonstram o uso indiscriminado deste recurso terapêutico de forma empírica, principalmente na população adulta, hoje sabemos por meio de estudos múltiplos os efeitos adversos atribuídos à sobrecarga hídrica, as soluções ricas em cloro e ao impacto que isso leva nos custos hospitalares, morbidade e mortalidade global. Este artigo analisa todos esses fatores e as novas diretrizes de manejo baseadas em evidências científicas.
RESUMO
OBJECTIVES: To identify and evaluate the cerebral aneurysm remnants after clipping and the endovascular treatment in our institution. METHODS AND MATERIALS: We made a clinical ambispective collection of all aneurysms microsurgically clipped during four years and we analyzed their endovascular treatment. RESULTS: There were 290 cerebral aneurysms; in 270 a digital subtraction angiography was made. Ten aneurysm remnants were found (3.7%); of these, a second operation was performed on two, and coil placement was done in six patients. CONCLUSION: The cerebral aneurysm remnants after clipping in our institution are equivalent to international results. The endovascular treatment of this aneurysm is safe and effective.
Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Instrumentos Cirúrgicos , Falha de TratamentoRESUMO
BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in premature lightweight. While in the decade of 1970-1980 the incidence was 40-50%, now it is at least 20%. But it presents a challenge because of the multiple existing therapies and the results in terms of neurological sequelae. MATERIAL AND METHODS: We performed a retrospective review of 48 patients managed with ventriculo subgaleal shunt and a therapeutic decision based on gestational age, weight, and grade of intraventricular hemorrhage. RESULTS: Of the patients, 29 (60%) of the cases were female and 19 (40%) were male. The average gestation age for placing the subgaleal system was 30 months, with an average weight of 1,511 g, and with an infection rate of 4%. In 44 cases peritoneal system was placed (92%) because four died (8%). No mortality was observed at surgery. CONCLUSIONS: Mortality in the past appeared in 75% of patients, with the realization that derivation of subgaleal irrigation reduces infections besides allowing proper control of hydrocephalus and thus decreases the long-term neurological sequelae.
RESUMO
Objetivo: Evaluar el uso de la anestesia general en las pacientes sometidas a cesárea, las causas de su empleo y la morbimortalidad asociada a la anestesia. Material y métodos: Estudio observacional, retrospectivo y transversal. Se evaluó la base de datos de los servicios de anestesia y obstetricia por un periodo de dos años para determinar las causas que llevaron a anestesia general en las pacientes gestantes sometidas a cesárea, las causas de conversión de anestesia neuroaxial a anestesia general y las complicaciones anestésicas asociadas. Resultados: El 23.5% de los partos acabaron en cesárea, siendo la anestesia espinal la técnica neuroaxial más frecuente. La falla de la técnica neuroaxial intraoperatoria fue del 0.8% La anestesia general fue utilizada en el 2% de todos los partos por cesárea, siendo los problemas relacionados a la anestesia la primera causa que llevo al empleo de la anestesia general. conclusiones: Es factible alcanzar en un hospital universitario, los estándares de calidad propuestas en las guías de auditoría en obstetricia. Dado que la anestesia general no puede ser eliminada de esta práctica, el entrenamiento continuo en vía aérea difícil y el trabajo protocolizado en esta población son la base de una atención de alta calidad.
Objective: To evaluate the use of general anesthesia in patients undergoing cesarean section, the causes od their employment and morbi-mortality associated with anesthesia. Meterial and methods: Observational, retrospective and transversal study. We evaluated the database of anesthesia and obstetrics services for a period of two years to determie the causes that led to general anesthesia in pregnant patients undergoing cesarean section, the causes of neuroaxial anesthesia conversion to general anesthesia and anesthetic complications associated. Results: 23.5% of total births ended by caesarean section, beig spinal anesthesia was used in 2% of all cesarean deliveries, being the problems related to anesthesia the first cause that led to the use of general anesthesia. Conclusions: It is feasible to achieve in an university hospital, the quality standards proposed in obstetric audit guidelines. Since general anesthesia cannot be eliminated from this practice, the continuous training in difficult airway and work docketed in this population are the basis of high quality care.
Assuntos
Humanos , Feminino , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Anestesia Obstétrica , Cesárea , Hospitais Universitários , Estudo Observacional , Estudos Retrospectivos , Estudos TransversaisAssuntos
Ameaça de Aborto/terapia , Obstetrícia/história , Aborto Habitual/etiologia , Aborto Habitual/terapia , Ameaça de Aborto/etiologia , Adulto , Incompatibilidade de Grupos Sanguíneos/complicações , Anormalidades Congênitas/embriologia , Feminino , História do Século XX , Hormônios/uso terapêutico , Humanos , Desnutrição/complicações , Doenças Placentárias , Gravidez , Complicações na Gravidez , Doenças Uterinas/complicaçõesRESUMO
OBJECTIVE: To assess the impact of a 2-year recreational physical activity program in 1044 fourth- and fifth-grade primary schoolchildren from the Province of Cuenca, Spain. STUDY DESIGN: Cluster-randomized controlled trial with 10 intervention and 10 control schools. The program consisted of 3 90-minute sessions of physical activity per week,during 28 weeks every year.Changes in endpoints between baseline (September 2004) and the end of follow-up (June 2006) were compared between the control and intervention group by using mixed regression models, with adjustment for the baseline endpoint value, age, and the school. RESULTS: Compared with control subjects, intervention girls reduced the frequency of overweight (odds ratio, 0.55; 95% CI, 0.39-0.78; P<.001). However, intervention was associated with an increase in the percentage of body fat in boys (0.97%; 95% CI, 0.14-1.81; P=.02). Girls in the intervention group had lower total cholesterol level (-6.86 mg/dL; 95% CI, -9.70--4.01; P<.001) and apolipoprotein B level (-3.61 mg/dL; 95% CI, -6.27--0.95; P=.008) than control subjects. Results were similar in boys. CONCLUSION: In 2 years, the physical activity program lowered the frequency of overweight in girls and reduced total cholesterol and apolipoprotein B in both girls and boys.