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BACKGROUND: Fractional exhaled nitric oxide (FeNO) testing is a simple, noninvasive approach to assessing airway inflammation with minimal discomfort that provides results within a few minutes. For policy makers, the economic impact of this technology is the main concern, especially in developing countries. We evaluated the budget impact of asthma management using FeNO monitoring in patients aged between 4 and 18 years in Colombia. METHODS: A budget impact analysis was performed to evaluate the potential cost of FeNO monitoring. The analysis was based on a 5-year time horizon and performed from the perspective of the Colombian National Health System. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which FeNO is reimbursed, from the cost of conventional treatment without FeNO (management based on clinical symptoms [with or without spirometry/peak flow] or asthma guidelines [or both] for asthma-related cases). Univariate 1-way sensitivity analyses were performed. RESULTS: In the base case analysis the 5-year costs associated with FeNO and non-FeNO were estimated to be 469 904 130 and 480 485 149, respectively, indicating savings for the Colombian National Health System of 10 581 019 if FeNO is adopted for the routine management of patients with persistent asthma. This result proved to be robust in the univariate 1-way sensitivity analysis. CONCLUSION: FeNO monitoring generated cost savings in emergency settings for infants with persistent asthma. This evidence can be used by decision makers in Colombia to improve clinical practice guidelines and should be replicated to validate the results in other middle-income countries.
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Asma , Expiração , Adolescente , Asma/tratamento farmacológico , Asma/terapia , Testes Respiratórios/métodos , Criança , Pré-Escolar , Colômbia , Teste da Fração de Óxido Nítrico Exalado , Humanos , Lactente , Óxido NítricoRESUMO
The recent outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has been brought to global attention in the search of knowledge about the virus and its pathogenesis. The immune response is essential to control and eliminate the infection, however, maladjusted immune responses may result in severe disease fisiopathology. Gaining a deeper understanding of the interaction between SARS-CoV-2 and the immune systems of the hosts may help us anticipate the development of persistent pulmonary inflammation and, why not, be the first step to therapeutic success and trying to save more lives. In this review, we provide an update on CoV virology and our vision of pathogenesis understanding it from the stages of infection, without forgetting the cytokine storm resulting from the interaction of the virus with ACE2 receptors widely distributed in the body.
La reciente emergencia de síndrome de distrés respiratorio agudo producido por coronavirus 2 (SARS-CoV-2), enfermedad denominada COVID-19 ha traído la atención mundial a la búsqueda de conocimiento sobre este virus y su patogenia. La respuesta inmune es esencial para controlar y erradicar la infección, sin embargo, las respuestas inmunes descontroladas pueden resultar en la fisiopatología de la enfermedad grave. Lograr una comprensión más profunda de la interacción entre SARS-COV-2 y el sistema inmune de los huéspedes podría ayudar a anticiparnos al desarrollo de una inflamación pulmonar persistente causada por el SARS-CoV-2, y por qué no, ser la puerta de entrada al éxito terapéutico e intentar salvar mayor número de vidas. En esta revisión, proporcionamos una actualización sobre la virología y nuestra visión de la patogenia, entendiéndola desde las fases o etapas de la infección, sin olvidar el estallido de citoquinas resultantes de la interacción del virus con los receptores ACE2 ampliamente distribuidos en el organismo.
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Humanos , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Betacoronavirus/fisiologia , Citocinas/fisiologia , Peptidil Dipeptidase A/fisiologia , Betacoronavirus/patogenicidade , Imunidade Inata/fisiologiaRESUMO
INTRODUCTION AND AIMS: There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. MATERIALS AND METHODS: Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. RESULTS: In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. CONCLUSIONS: Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.
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Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Adulto , Idoso , Efeitos Psicossociais da Doença , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
We examine the hydrographic variability induced by tides, winds, and the advance of the austral summer, in Maxwell Bay and tributary fjords, based on two recent oceanographic campaigns. We provide the first description in this area of the intrusion of relatively warm subsurface waters, which have led elsewhere in Antarctica to ice-shelf disintegration and tidewater glacier retreat. During flood tide, meltwater was found to accumulate toward the head of Maxwell Bay, freshening and warming the upper 70 m. Below 70 m, the flood tide enhances the intrusion and mixing of relatively warm modified Upper Circumpolar Deep Water (m-UCDW). Tidal stirring progressively erodes the remnants of Winter Waters found at the bottom of Marian Cove. There is a buoyancy gain through warming and freshening as the summer advances. In Maxwell Bay, the upper 105 m were 0.79 °C warmer and 0.039 PSU fresher in February than in December, changes that cannot be explained by tidal or wind-driven processes. The episodic intrusion of m-UCDW into Maxwell Bay leads to interleaving and eventually to warming, salinification and deoxygenation between 80 and 200 m, with important implications for biological productivity and for the mass balance of tidewater glaciers in the area.
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Although Heat Waves (HWs) are expected to increase due to global warming, they are a regional phenomenon that demands for local analyses. In this paper, we assess four HW metrics (HW duration, HW frequency, HW amplitude, and number of HWs per season) as well as the share of extremely warm days (TX95, according to the 95th percentile) in South America (SA). Our analysis included observations as well as simulations from global and regional models. In particular, Regional Climate Models (RCMs) from the Coordinated Regional Climate Downscaling Experiment (CORDEX), and Global Climate Models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) were used to project both TX95 estimates and HW metrics according to two representative concentration pathways (RCP4.5 and RCP8.5). We found that in recent decades the share of extremely warm days has at least doubled over the period December-January-February (DJF) in northern SA; less significant increases have been observed in southern SA. We also found that by midcentury, under the RCP4.5 scenario, extremely warm DJF days (as well as the number of HWs per season) are expected to increase by 5-10 times at locations close to the Equator and in the Atacama Desert. Increases are expected to be less pronounced in southern SA. Projections under the RCP8.5 scenario are more striking, particularly in tropical areas where half or more of the days could be extremely warm by midcentury.
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Soiling by dry deposition affects the power output of photovoltaic (PV) modules, especially under dry and arid conditions that favor natural atmospheric aerosols (wind-blown dust). In this paper, we report on measurements of the soiling effect on the energy yield of grid-connected crystalline silicon PV modules deployed in five cities across a north-south transect of approximately 1300 km in the Atacama Desert ranging from latitude 18°S to latitude 30°S. Energy losses were assessed by comparing side-by-side outputs of four co-planar PV modules. Two of the PV modules of the array were kept clean as a control, while we allowed the other two to naturally accumulate soiling for 12 months (from January 2017 to January 2018). We found that the combination of high deposition rates and infrequent rainfalls led to annual energy losses that peaked at 39% in the northern coastal part of the desert. In contrast, annual energy losses of 3% or less were measured at relatively high-altitude sites and also at locations in the southern part of the desert. For comparison, soiling-induced annual energy losses of about 7% were measured in Santiago, Chile (33°S), a major city with higher rainfall frequency but where urban pollution plays a significant role.
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Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.
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Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Proteínas do Leite/efeitos adversos , Aleitamento Materno , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/imunologia , Proteínas do Leite/imunologia , Resultado do TratamentoRESUMO
La alergia a la proteína de leche de vaca (APLV) es una enfermedad frecuente, con una prevalencia entre 2-7%, cifras que van en aumento. Se caracteriza por una reacción alérgica a una o más pro teínas de la leche de vaca. No existen manifestaciones clínicas patognomónicas, y éstas dependerán del tipo de reacción inmunológica involucrada. Una buena aproximación diagnóstica evita el sub y sobre diagnóstico y por lo tanto, sub y sobre tratamiento. El tratamiento de la APLV es la eliminación de la proteína de leche de vaca de la dieta. Una dieta de restricción en un niño que no la requiere o que ha desarrollado tolerancia, puede alterar el crecimiento, la calidad de vida y producir costos innecesarios. El objetivo de esta actualización es presentar las diferentes fórmulas y brebajes usados en Chile para tratar la APLV en aquellos casos en que no sea posible la lactancia materna con dieta de exclusión. Para ello se revisó la composición nutricional, ingredientes y otras características relevan tes de todas aquellas fórmulas o brebajes que se comercializan en Chile como tratamiento de APLV. La información se obtuvo desde los distribuidores o vendedores oficiales, o en su defecto, desde las páginas web oficiales. Se puede concluir que existen y se usan múltiples fórmulas y brebajes para el tratamiento de APLV, no todas ellas del todo adecuadas desde el punto de vista nutricional y de seguridad. Conocerlas en detalle ayudará al pediatra a indicarlas de manera más informada de acuerdo a sus beneficios y sus carencias para el manejo adecuado de esta patología.
Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.
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Humanos , Recém-Nascido , Lactente , Hipersensibilidade a Leite/dietoterapia , Fórmulas Infantis/química , Proteínas do Leite/efeitos adversos , Aleitamento Materno , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/imunologia , Resultado do Tratamento , Proteínas do Leite/imunologiaRESUMO
The world's highest levels of surface ultraviolet (UV) irradiance have been measured in the Atacama Desert. This area is characterized by its high altitude, prevalent cloudless conditions, and a relatively low total ozone column. In this paper, we provide estimates of the surface UV (monthly UV index at noon and annual doses of UV-B and UV-A) for all sky conditions in the Atacama Desert. We found that the UV index at noon during the austral summer is expected to be greater than 11 in the whole desert. The annual UV-B (UV-A) doses were found to range from about 3.5 kWh/m2 (130 kWh/m2) in coastal areas to 5 kWh/m2 (160 kWh/m2) on the Andean plateau. Our results confirm significant interhemispherical differences. Typical annual UV-B doses in the Atacama Desert are about 40% greater than typical annual UV-B doses in northern Africa. Mostly due to seasonal changes in the ozone, the differences between the Atacama Desert and northern Africa are expected to be about 60% in the case of peak UV-B levels (i.e. the UV-B irradiances at noon close to the summer solstice in each hemisphere). Interhemispherical differences in the UV-A are significantly lower since the effect of the ozone in this part of the spectrum is minor.
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Clima Desértico , Raios Ultravioleta , Altitude , Chile , Monitoramento Ambiental , Ozônio/química , Doses de Radiação , Estações do Ano , Análise Espectral , Luz SolarRESUMO
Motor execution and planning are tightly regulated by dopamine D1 and D2 receptors present in basal ganglia circuits. Although stimulation of D1 receptors is known to enhance motor function, the global effect of D2 receptor (D2R) stimulation or blockade remains highly controversial, with studies showing increasing, decreasing or no changes in motor activity. Moreover, pharmacological and genetic attempts to block or eliminate D2R have led to controversial results that questioned the importance of D2R in motor function. In this study, we generated an inducible Drd2 null-allele mouse strain that circumvented developmental compensations found in constitutive Drd2-/- mice and allowed us to directly evaluate the participation of D2R in spontaneous locomotor activity and motor learning. We have found that loss of D2R during adulthood causes severe motor impairments, including hypolocomotion, deficits in motor coordination, impaired learning of new motor routines and spontaneous catatonia. Moreover, severe motor impairment, resting tremor and abnormal gait and posture, phenotypes reminiscent of Parkinson's disease, were evident when the mutation was induced in aged mice. Altogether, the conditional Drd2 knockout model studied here revealed the overall fundamental contribution of D2R in motor functions and explains some of the side effects elicited by D2R blockers when used in neurological and psychiatric conditions, including schizophrenia, bipolar disorder, Tourette's syndrome, dementia, alcohol-induced delusions and obsessive-compulsive disorder.
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Destreza Motora/fisiologia , Transtornos Parkinsonianos/metabolismo , Receptores de Dopamina D2/metabolismo , Técnicas de Ablação/métodos , Animais , Gânglios da Base/metabolismo , Corpo Estriado/metabolismo , Antagonistas de Dopamina/farmacologia , Humanos , Aprendizagem/efeitos dos fármacos , Locomoção/genética , Masculino , Camundongos , Camundongos Knockout , Atividade Motora/efeitos dos fármacos , Transtornos Parkinsonianos/fisiopatologia , Receptores de Dopamina D1/metabolismo , Receptores de Dopamina D2/fisiologiaRESUMO
The Atacama Desert has been pointed out as one of the places on earth where the highest surface irradiance may occur. This area is characterized by its high altitude, prevalent cloudless conditions and relatively low columns of ozone and water vapor. Aimed at the characterization of the solar spectrum in the Atacama Desert, we carried out in February-March 2015 ground-based measurements of the spectral irradiance (from the ultraviolet to the near infrared) at seven locations that ranged from the city of Antofagasta (on the southern pacific coastline) to the Chajnantor Plateau (5,100 m altitude). Our spectral measurements allowed us to retrieve the total ozone column, the precipitable water, and the aerosol properties at each location. We found that changes in these parameters, as well as the shorter optical path length at high-altitude locations, lead to significant increases in the surface irradiance with the altitude. Our measurements show that, in the range 0-5100 m altitude, surface irradiance increases with the altitude by about 27% in the infrared range, 6% in the visible range, and 20% in the ultraviolet range. Spectral measurements carried out at the Izaña Observatory (Tenerife, Spain), in Hannover (Germany) and in Santiago (Chile), were used for further comparisons.
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This study aimed to determine which meteorological conditions are associated with respiratory syncytial virus (RSV) isolates in a population of children hospitalized with acute lower respiratory infection (ALRI) in Bogota, Colombia. In an analytical cross-sectional study, links were examined between the number of monthly RSV infections and monthly average climatic variation (temperature, relative humidity, rainfall, wind speed, solar radiation) between 1 January 2010 and 30 April 2011 in a population of hospitalized children aged <3 years with ALRI caused by RSV. Out of a total of 1548 children included in the study (mean age 9·2 ± 8·5 months), 1194 (77·1%) presented RSV infection during the 3-month period from March to May. In the multivariate analysis, after controlling for wind speed, relative humidity, and solar radiation, monthly average temperature [incident rate ratio (IRR) 3·14, 95% confidence interval (CI) 1·56-6·30, P = 0·001] and rainfall (IRR 1·008, 95% CI 1·00-1·01, P = 0·048) were independently associated with the monthly number of RSV infections. In conclusion, in Bogota, a tropical Latin American city, average temperature and rainfall are the meteorological variables most strongly associated with RSV isolation in children hospitalized with ALRI in the city.
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Chuva , Infecções por Vírus Respiratório Sincicial/epidemiologia , Temperatura , Clima Tropical , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Humanos , Umidade , Lactente , Luz Solar , Fatores de Tempo , VentoRESUMO
We have sampled the spatial distribution of the UV radiation (i.e. the UV radiance) at a station located on the southern pacific coastline (Valparaiso, Chile, 33.03°S-71.58°W). The site is characterized by the partial horizon obstruction (due to the surrounding topography). Our spectral measurements were carried out over the period January-March 2012 and were meant to weigh up the effects of the local cloudiness, the heterogeneous albedo, and the horizon obscuration. We found that a nearly translucent overcast sky affects the radiance distribution such that from its maximum (measured close to the solar zenith angle) the radiance is monotonically decreasing towards the horizon. Under cloudless conditions, the radiance distribution becomes less isotropic with the wavelength; we detected spatial variations in the distribution of radiation up to a factor of 5 at 320 nm, and up to a factor of 9 at 400 nm. We also observed that radiances measured at points over the sea are greater than those measured at the corresponding point over the land; we partially attributed this effect to the spatial variations in the albedo. Moreover, we found that the horizon obscuration leads to significant reductions in the radiance at points on the blocked horizon; these reductions range from 60% (at 400 nm) to 80% (at 300 nm). Methodological details are provided below.
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Raios Ultravioleta , Chile , Estações do Ano , Luz SolarRESUMO
BACKGROUND: In Mexico, the prevalence of Helicobacter pylori (H. pylori) infection is high. The bacterial eradication rate with the administration of antibiotic regimens recommended by international guidelines is not yet clear. AIMS: To determine the eradication frequency of H. pylori infection in the adult Mexican population that underwent treatment with the conventional triple regimen. MATERIAL AND METHODS: A cross-sectional study was carried out that evaluated the effectiveness of the triple regimen in individuals with confirmed infection that received consensual treatment and then underwent tests to corroborate eradication. RESULTS: From a total of 249 potential case records, 26 did not meet the inclusion criteria. Two hundred and twenty-three patients were enrolled for analysis, 64,00% women and 36,00% men, with a mean age of 49,4 years (range 17-86). Comorbidities presented in 55,60% of the patients and 28,60% referred to chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs). Bacterial eradication with the triple regimen was 65,50% (146/223); of the 77 patients with no eradication, 11 received a quadruple regimen as second-line treatment resulting in bacterial eradication in 5/11 (45,45%) patients, for an overall eradication of 67,70%. CONCLUSIONS: The eradication rate in our study population was suboptimal due to the probability of multiple factors that are difficult to identify, given the retrospective design of the study. A prospective and controlled evaluation of the recommended regimens needs to be carried out in order to determine their true effectiveness.
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Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Estudos Transversais , Feminino , Infecções por Helicobacter/microbiologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
We evaluated the effect of Ascaris lumbricoides on Giardia duodenalis infection and TH1/TH2 type immune mechanisms toward this parasite in 251 rural parasitized and 70 urban non-parasitized school children. The children were classified according to light (0-5000 eggs/g faeces) or moderate (>5001-50,000 eggs/g faeces) A. lumbricoides infection. Anti G. duodenalis skin hyper-reactivity, IgE, IgG, IL-13, IFN γ, IL6 and IL-10 levels were compared among G. duodenalis infected and non-infected children according to light or moderate A. lumbricoides infection. It was found that 62% of the A. lumbricoides moderately infected children were co-infected by G. duodenalis compared to 45% of the lightly infected group. After treatment, 42% of the A. lumbricoides moderately group were infected with G. duodenalis compared to 11% of their lightly counterparts, being A. lumbricoides IL-10 levels higher (p<0.0001) in the moderately infected group. In the A. lumbricoides lightly parasitized children, G. duodenalis infection was associated to a significant increase (p<0.005) of the levels of G. duodenalis IL-13, IFN-γ, IL-6, IgE, IgG and skin test hyper reactivity. In contrast, there was no effect of G. duodenalis infection in the elevation of these parameters among the A. lumbricoides moderately parasitized group, being those levels similarly lower as those observed in the control group. Inverse correlations were found between the levels of anti G duodenalis antibodies, skin test hyper-reactivity and cytokines with the intensity of A. lumbricoides infection (p>0.0001) and A. lumbricoides IL-10 levels (p>0.0001), suggesting that co-infection with A. lumbricoides may affect both TH1 and TH2 type immunity against G. duodenalis that may play an important role in the susceptibility to the infection after chemotherapy in children from endemic areas.
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Ascaríase/imunologia , Giardíase/imunologia , Imunomodulação , Animais , Anticorpos/imunologia , Ascaríase/complicações , Ascaríase/epidemiologia , Ascaríase/parasitologia , Ascaris lumbricoides/fisiologia , Estudos de Casos e Controles , Criança , Citocinas/imunologia , Giardia lamblia/fisiologia , Giardíase/complicações , Giardíase/epidemiologia , Giardíase/parasitologia , Interações Hospedeiro-Patógeno , Humanos , Hipersensibilidade/imunologia , Imunoglobulinas/imunologia , Contagem de Ovos de Parasitas , População Rural , Índice de Gravidade de Doença , Testes Cutâneos , Equilíbrio Th1-Th2 , Venezuela/epidemiologiaRESUMO
La cobertura de heridas complejas en extremidades inferiores es un desafío de difícil manejo. Se realizó un estudio retrospectivo, analizando el resultado y las complicaciones en el uso del colgajo sural a pedículo distal para cobertura de defectos de extremidad inferior. Material y Método: Revisión de fichas clínicas de todos los pacientes sometidos a colgajo sural en los Hospitales Militar y Trabajador de Santiago entre los años 1995 y 2005, analizando características epidemiológicas, técnica quirúrgica y complicaciones del procedimiento. Resultados: Colgajos surales totales: 40 casos. Etiología de lesión: Fracturas: 33 casos (82,5%), heridas complejas (infectadas, inestables) 4 casos (10%), desforrramiento: 2 casos (5%) y quemadura: 1 caso (2,5%). En 20 casos no hubo complicación, y dentro de las complicaciones se encontraron necrosis parcial: 8 casos (20%), infección: 5 casos (12,5%), epidermolísis: 4 casos (10%) y seroma en 3 casos (7,5%). No se reportaron casos de necrosis total. Conclusión: El colgajo sural a pedículo distal es una alternativa válida de cobertura en lesiones complejas de extremo distal de extremidad inferior, con complicaciones de manejo aceptables, y con buen resultado a largo plazo.
Background: The covering of complex wounds of lower extremities is a difficult challenge. Aim: To analyze the results and complications on the use of sural flaps with distal pedicle for the covering of lower extremity defects. Material and Methods: We reviewed the clinical records of all the patients that had sural flaps between 1995 and 2005 at the Military Hospital and Workers Hospital of Santiago, Chile. We analyzed the epidemiologic characteristics, surgical techniques and complications of the procedure. Results: We found 40 cases of sural flaps. The etiology of the lesions were fractures in 33 cases (82.5%), complex wounds: four cases (10%), skin tearing and muscle laceration in 2 cases (5%) and burns 1 case (2.5%). In 20 cases there were no complications. Eight cases had partial necrosis (20%), five had infections (12.5%), four had epidermolysis and three had a seroma (7.5%). There were no reports of total necrosis. Conclusions: Sural flaps with a distal pedicle are a valid alternative for the covering of complex wounds of the distal portion of lower extremities, with a low rate of complications and good long term results.
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Humanos , Nervo Sural/transplante , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/transplante , Extremidade Inferior/cirurgia , Extremidade Inferior/lesões , Complicações Pós-Operatórias , Período Pós-Operatório , Nervo Sural/cirurgiaRESUMO
La arteria cerebral media (ACM) es el más largo y complejo de todos los vasos intracerebrales, irrigando la mayor parte de los lóbulos frontales, parietales y temporales de ambos hemisferios cerebrales. Además de suplir el riego sanguíneo de una gran parte del cerebro, la ACM y sus ramas, están frecuentemente involucradas en enfermedades intracerebrales como hemorragias cerebrales, patología ateroesclerótica o degenerativa de la pared arterial, embolias y procesos inflamatorios. La alta frecuencia de patología y el amplio volumen cerebral irrigado por esta arteria hacen que el conocimiento de su anatomía sea fundamental en la descripción de los posibles mecanismos fisiopatológicos de las enfermedades que la involucran, así como para su estudio imagenológico y abordaje quirúrgico. El objetivo de este trabajo es comparar la anatomía macroscópica y microscópica de la ACM de sujetos chilenos con la publicada en series internacionales. Se estudiaron 10 hemisférios cadavéricos provenientes de 5 pacientes adultos de nacionalidad chilena cuya muerte no fue de causa encefálica, fijados con solución de formalina sometiendo a tinción los vasos arteriales. Se realizaron mediciones de la ACM y sus segmentos M1 y M2 comparando mediante análisis estadístico los resultados obtenidos con los publicados en la literatura. El análisis de éstos sugiere que las características anatómicas de la ACM de hemisferios provenientes de sujetos de nacionalidad chilena son similares a los reportados por estudios realizados con hemisferios cerebrales de sujetos de origen anglo-sajón.
Assuntos
Adulto , Humanos , Artéria Cerebral Média/anatomia & histologia , Artéria Cerebral Média/cirurgia , Artéria Cerebral Média/fisiologia , Microcirurgia/métodos , Telencéfalo/fisiologia , Encefalopatias , Cadáver , Valores de ReferênciaRESUMO
Se explora la evaluación del hipocinetismo como factor de riesgo para la salud. A tal fin fueron analizados los hábitos de actividad física y el nivel de riesgo cardiovascular, en 314 estudiantes no atletas de la Universidad Central de Venezuela con edades entre 17 y 29 a¤os, mediante la aplicación del Cuestionario Internacional de Actividad Física-IPAQ (2004) y un cuestionario de Hoeger y Hoeger (2002) para la estimación del riesgo cardiovascular. Los resultados indicaron que globalmente 31,53 por ciento de los sujetos tenían un nivel de actividad física que se relaciona con hipocinetismo. Se evidenció que las jóvenes estudiadas mostraron mayores niveles de riesgo cardiovascular. Se identificaron asociaciones entre las variables género y la categoría de riesgo cardiovascular, asícomo entre esta última y los niveles de actividad física, apuntando a que el hipocinetismo representa un factor de riesgo adicional en el desarrollo de enfermedades crónicas no transmisibles en los ucevistas evaluados.
Assuntos
Humanos , Masculino , Feminino , Resistência Física , Esforço Físico , Estudantes , Medicina , VenezuelaRESUMO
Bioassays in a Y-tube olfactometer showed that workers of Solenopsis geminata (Hymenoptera: Formicidae) were attracted to venom gland extracts of queens. Gas chromatography coupled mass spectrometry analysis of individual glands of queens of S. geminata showed that the secretion is composed mainly of a large amount of 2-alkyl-6-methylpiperidine alkaloids and a tiny amount of a delta-lactone and a a-pyrone, which have been earlier identified as components of the queen attractant pheromone of Solenopsis invicta Buren. However, additional small amounts of a mixture of sesquiterpenes and pentadecene were found. The possible function of the sesquiterpenoid compounds is discussed.