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In this work, it is presented a first approach of a mathematical and kinetic analysis for improving the decoloration and further degradation process of an azo dye named acid red 27 (AR27), by means of a novel microbial consortium formed by the fungus Trametes versicolor and the bacterium Pseudomonas putida. A multivariate analysis was carried out by simulating scenarios with different operating conditions and developing a specific mathematical model based on kinetic equations describing all stages of the biological process, from microbial growth and substrate consuming to decoloration and degradation of intermediate compounds. Additionally, a sensitivity analysis was performed by using a factorial design and the Response Surface Method (RSM), for determining individual and interactive effects of variables like, initial glucose concentration, initial dye concentration and the moment in time for bacterial inoculation, on response variables assessed in terms of the minimum time for: full decoloration of AR27 (R1 = 2.375 days); maximum production of aromatic metabolites (R2 = 1.575 days); and full depletion of aromatic metabolites (R3 = 12.9 days). Using RSM the following conditions improved the biological process, being: an initial glucose concentration of 20 g l-1, an initial AR27 concentration of 0.2 g l-1 and an inoculation moment in time of P. putida at day 1. The mathematical model is a feasible tool for describing AR27 decoloration and its further degradation by the microbial consortium of T. versicolor and P. putida, this model will also work as a mathematical basis for designing novel bio-reaction systems than can operate with the same principle of the described consortium.

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Se presenta el caso clínico de una paciente de 63 años, con indicación de tiroidectomía total, a causa de un bocio multinodular con infiltrado neoplásico folicular. La evolución posquirúrgica fue tórpida y se caracterizó por la presencia de insuficiencia cardiaca aguda, hepatomegalia, neuropatía periférica y equimosis periorbitaria, condiciones clínicas sugerentes de amiloidosis, la que fue confirmada por medio de estudios como amiloidosis de cadenas ligeras (AL).

We present the clinical case of a 63-year-old patient, with indication of total thyroidec-tomy, due to a multinodular goiter with a follicular neoplastic infiltrate. Postoperative evolution was torpid and was characterized by the presence of acute heart failure, hepatomegaly, peripheral neuropathy and periorbital ecchymosis, clinical conditions suggestive of amyloidosis, which was confirmed by studies such as amyloidosis of light chains (AL).

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El manejo del dolor articular ofrece para la población afectada novedosos suplementos nutricionales que incluyen el colágeno, y cuya extracción es desde variadas fuentes de origen animal, no así de vegetales. Esta revisión tiene como objetivo aclarar qué es el colágeno, su constitución estructural molecular, el rol que cumple en nues-tro organismo y revisar las indicaciones propuestas por la literatura, tanto para la profilaxis como el tratamiento de cuadros reumatológicos de alta prevalencia o impacto funcional, como son Artrosis, Artritis Reumatoidea y Osteoporosis.

Novel nutritional supplements for the management of joint pain have been made available to the population, including collagen, which can not be extracted from plant products, but from a variety of animal sources. This review aims to clarify what it is collagen, the molecular structures that constitute it, the determined role they play in our body and review the indications that the literature proposes both in prophylaxis and treatment, for high prevalence rheumatologic or functional impact, such as osteoarthritis, rheumatoid arthritis and osteoporosis.

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Introducción: El prolapso genital impacta negativamente la calidad de vida y autoimagen de la mujer. Rutinariamente indicamos la colpoperineocleisis de Labhardt a pacientes de edad avanzada y sin actividad sexual. Objetivo: Evaluar los resultados con esta técnica e identificar posibles factores de riesgo que predigan la falla. Métodos: Análisis retrospectivo de pacientes tratadas con la técnica entre los años 2008-2010. Se realizó análisis univariado y multivariado para identificar factores de riesgo asociados a la falla y se construyeron curvas libre de falla anatómica a fin de evaluar la durabilidad. Resultados: 68 pacientes cumplieron los criterios de inclusión. La edad promedio fue 71,9 +/- 5,7 años; 95,6 por ciento fueron clasificadas en etapa III o IV según POP-Q. El tiempo operatorio fue de 54 +/- 20 minutos. Seguimiento promedio de 21 meses; la tasa de recidiva anatómica fue de 14,7 por ciento. La tasa de incontinencia de orina de esfuerzo (IOE) de novo fue de 5,9 por ciento. El análisis univariado identificó como factor predictor de recidiva el flujo vaginal posoperatorio; en análisis multivariado de Cox, esa condición mantuvo significancia estadística (OR 6,3). Se identificó como factor de riesgo el no acatamiento de la técnica quirúrgica (OR 7,2). Conclusión: La colpoperineocleisis de Labhardt es una técnica segura, con baja tasa de complicaciones, una tasa de recurrencia aceptable y baja tasa de IOE de novo. Pilar del éxito es evitar la infección y respetar la técnica quirúrgica. Es necesario estudios comparativos con otras técnicas oclusivas, como también evaluar el rol de la infección como causa de falla de la técnica.

Introduction: Genital prolapse affects up to 50 percent of multiparous women, impacting their quality of life and self-image. At our Institution Labhardt's colpoperineocleisis is usually proposed to older patients, without sexual activity, regardless the type or grade of prolapse. Objective: To evaluate the results with this technique and identify potential risk factors predicting the failure. Methods: Analysis of a retrospective cohort of patients treated with this technique between 2008 and 2010. Univariate and multivariate analysis were carried out to identify risk factors and failure-free curves were built to estimate durability. Results: 68 patients met the inclusion criteria. Average age was 71.9 +/- 5.7 years; 95.6 percent of patients were classified as stage III or IV based on POP-Q system. Operative time was 54 +/- 20 min. At 21 months of follow-up, recurrence rate was 14.7 percent. De novo stress urine incontinence (SUI) was diagnosed in 5.9 percent of patients. In univariate analysis, post operative vaginal discharge was identified as predicting factor for defect recurrence. In Cox analysis, this condition remained significant (OR 6.3), In addition, failure to observe the surgical technique was also identified as risk factor for defect recurrence (OR 7.2). Conclusion: Labhardt 's colpoperineocleisis is a safe technique, with low complication rate, acceptable recurrence rate, and low de novo SUI rate. Mainstay for success is to avoid infection and observe the surgical technique. Comparative studies with other occlusive techniques might be carried out, as well as exploring the role of infection as predisposing condition for failure.

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El uso sistemático de la mamografía y ultrasonido ha incrementado el diagnóstico de lesiones mamarias no palpables y con ello, la indicación de biopsia. Material y Método: Presentamos nuestra experiencia en 315 biopsias excisionales de lesiones mamarias ocultas con localización preoperatoria. Utilizamos la mamografía en el 83,8% y el ultrasonido en el 10,5% de los casos para posicionar una guía metálica; en el 5,7% se realizó marcación sobre la piel, guiada por ultrasonido. Resultados: Obtuvimos 21,2% de tumores malignos, 17,5% de hiperplasia atípica y 60,3% de patología benigna. No obtuvimos una muestra adecuada en el 1% de los casos (3 pacientes). Discusión: La incidencia de 21,2% de patología maligna es consistente con los hallazgos de la literatura general (entre 20 y 30%). Si incluimos la hiperplasia atípica, como patología premaligna, los resultados positivos alcanzan el 38,7%. Más de la mitad de las lesiones son de etiología benigna. Es necesario mejorar tanto la sensibilidad como la especificidad de los métodos diagnósticos, para evitar cirugías innecesarias.

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We report the synthesis and voltamperometric reduction of 5H-benzo[b]carbazole-6,11-dione (BCD) and its 2-R-substituted derivatives (R = -OMe, -Me, -COMe, -CF(3)). The electrochemical behavior of BCDs was compared to that of the 2-[(R-phenyl)amine]-1,4-naphthalenediones (PANs) previously studied. Like PANs, BCDs exhibit two reduction waves in acetonitrile. The first reduction step for the BCDs represents formation of the radical anion, and the half-wave potential (E(1/2)) values for this step are less negative than for that of the PANs. The second reduction wave, corresponding to the formation of dianion hydroquinone, has E(1/2) values that shift to more negative potentials. A good linear Hammett-Zuman (E(1/2) vs sigma(p)) relationship, similar to that for the PAN series, was also obtained for the BCDs. However, unlike the PANs, in the BCDs, the first reduction wave was more susceptible to the effect of the substituent groups than was the second wave, suggesting that the ordering of the two successive one-electron reductions in BCDs is opposite that in PANs. This is explained by the fact that the electron delocalizations in the two systems are different; in the case of BCDs there is an extra aromatic indole ring, which resists loss of its aromatic character. The electronic structures of BCD compounds were, therefore, investigated within the framework of the density functional theory, using the B3LYP hybrid functional with a double zeta split valence basis set. Our theoretical calculations show that the O(1).H-N hydrogen bond, analogous to that previously described for the PAN series, is not observed in the BCDs. Laplacians of the critical points (nabla(2)rho) and the natural charges for the C-O bonds indicate that the first reduction wave for the BCDs corresponds to the C(4)-O(2) carbonyl, while in the PAN series the first one-electron transfer occurred at the C(1)-O(1) carbonyl. Natural bond orbital analysis showed that, in all the BCDs, the lowest unoccupied molecular orbital (LUMO) is located at C(4), whereas for the PANs, the LUMO is found at C(1). The good correlation between the LUMO energy values and the E(1/2) potentials (wave I) established that the first one-electron addition takes place at the LUMO. Analysis of the molecular geometry confirmed that, in both series of compounds, the effect of the substituent groups is mainly on the C(4)-O(2) carbonyl. These results explain the fact that reduction of the C(4)-O(2) carbonyl (voltammetric wave II in the PANs and voltammetric wave I in the BCDs) is more susceptible to the effect of the substituent groups than is reduction of the C(1)-O(1) carbonyl (wave I in the PANs and wave II in the BCDs).

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Theoretical analysis within the frame of the Topological Theory of Atoms in Molecules confirms the repulsive steric interaction between an axial dimethylphosphinoyl group and the syn-diaxial hydrogens in cyclohexane derivative 2-ax. In seemingly good agreement with experiment, equatorial isomer 2-eq was calculated to be 1.49 kcal/mol more stable than 2-ax. (Experimental energy difference in (diphenylphosphinoyl)cyclohexane, Delta H(o) = 1.96 kcal/mol.) In contrast, axial 2-(dimethylphosphinoyl)-1,3,5-trithiane, 3-ax, was calculated to be 6.38 kcal/mol more stable than 3-eq. (Experimentally, the axial conformer of 2-(diphenylphosphinoyl)-1,3,5-trithiane, was found to be 1.43 kcal/mol more stable than the equatorial conformer, in solvent chloroform.) Theoretical analysis, in particular the electron density at the bond critical point within the C(4,6)-H...O=P bonding trajectory, implies significant bonding in this segment of interacting atoms. By the same token, substantial positive charge is acquired by the C--H bonds adjacent to the sulfonyl groups in disulfone 4. Hydrogen bonding between the phosphoryl group and H(4,6) leads to stabilization of 4-ax, which is estimated to be 5.0 kcal/mol lower in energy than 4-eq. This conclusion is supported by examination of P==O...H--C(4,6) bond trajectories, as well as from evaluation of the critical point properties along those interacting moieties. By contrast, fluorinated derivative 5 is more stable in the equatorial conformation, indicating a repulsive electrostatic interaction of the C--F...O-P entity in 5-ax.

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BACKGROUND: Among hypertensive patients, other risk factors for mortality and morbidity, besides blood pressure, must be considered when therapeutic decisions are done. AIM: To assess the incidence and relevance of cardiovascular risk factors in a cohort of patients with essential hypertension. MATERIAL AND METHODS: A cohort of 1,072 treated patients with essential hypertension was followed for a period up to 25 years. Four hundred eighty six were men and 586 were women, age ranged from 31 to 70 years. At entry, 56% of subjects did not have any organic complications associated to hypertension (stage I WHO criteria), 30% had mild alterations (Stage II) and 14% had major complications (myocardial infarction, stroke, heart failure or renal failure). Likewise, 43.8% had mild, 14.5%, moderate and 41.7%, severe hypertension. Patients were treated with monotherapy or combined therapy based on diuretics, beta blockers, calcium antagonists and angiotensin converting enzyme inhibitors. Goal of therapy was 140/90 mm Hg. Risk factors associated diseases and complications were registered carefully. Causes of death were obtained from hospital records and death certificates. Mortality was analyzed using life tables (intention to treat method included). RESULTS: Blood pressure dropped significantly during follow up from a mean of 182/110 to 154/92 mm Hg. During follow up, 143 patients died and 429 complications (lethal or non lethal) were recorded. Twenty four percent of patients smoked, 24% reported alcohol intake, 56% had hypercholesterolemia, 11% were obese, 13% had diabetes and 3% had gout. The proportional hazard model showed that the existence of previous complications, the presence of more than 3 risk factors, and age over 60 and mean systolic and diastolic pressure during therapy, were independent and significant risk factors for mortality. CONCLUSIONS: The incidence of risk factors among our hypertensive patients is very similar to that of other national or international cohorts.

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BACKGROUND: The V JNC consensus stated that although new antihypertensive agents, such as angiotensin converting enzyme inhibitors and calcium channel blockers, are considered safer drugs, there is no firm evidence from large controlled trials that these drugs are associated with a lower cardiovascular mortality. AIM: To study the association between cardiovascular risk factors, blood pressure levels, pharmacological treatment and mortality in a group of hypertensive patients followed at an hypertension outpatient clinic. PATIENTS AND METHODS: Patients with essential hypertension were treated with different antihypertensive medications, according to physicians criteria, and controlled until death or loss from follow up. Causes of death were obtained from hospital records and death certificates. Survival was analyzed using life tables, comparisons between groups of patients were done using chi square or a Cox's proportional hazards model. RESULTS: Three hundred thirty-nine hypertensive patients aged 33 to 80 years old were followed for a mean period of 9.8 +/- 4.9 years. Eighty-six were treated with beta blockers, 64 with diuretics, 133 with calcium antagonists and 56 with ACE inhibitors. Blood pressure dropped similarly with all medications. During follow up, 79 patients died. Life table analysis showed that patients with a history of angina, diabetes or myocardial infarction had higher mortality rates. Similarly, patients treated with beta blockers and diuretics had higher mortality than patients treated with calcium antagonists or angiotensin converting enzyme inhibitors. The proportional hazards model showed that the effect of treatment modality persisted after correction for the other risk factors for mortality. CONCLUSIONS: In this series of hypertensive patients, those treated with beta blockers or diuretics had higher mortality rates than those receiving calcium channel antagonists or angiotensin converting enzyme inhibitors.

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Este trabajo propone al método dinámico de estimulación kinesiológica MEDEK como una opción terapéutica distinta en el campo de la rehabiliatción infantil precoz. Características fundamentales del método son expuestas, así como los procedimientos de evaluación del desarrollo evolutivo motor-postural. Se analizan los conceptos de ejercicio dinámico y de estímulo óptimo. Se introduce el concepto de período de prueba para comprobar el eficacia del tratamiento en cada caso en partícular. Este terapia es utilizable para el tratamiento kinesiológico de niños que padezcan secuelas de diversos grados de daño cerebral así como de trastornos de origen genético

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Este trabajo propone al método dinámico de estimulación kinesiológica MEDEK como una opción terapéutica distinta en el campo de la rehabilitación infantil precoz. Características fundamentales del método son expuestas, así como los procedimientos de evaluación del desarrollo evolutivo motor postural. Se analizan los conceptos de ejercicio dinámico y de estimulación óptimo. Se introduce el concepto de período de prueba para comprobar la eficacia del tratamiento en cada caso en partícular. Esta terapia es utilizable para el tratamiento kinesiológico de niños que padezcan secuelas de diversos grados de daño cerebral así como de trastornos de origen genético

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Insulin resistance is associated to hypertension, obesity and diabetes and may be an independent cardiovascular risk factor. The exact assessment of insulin resistance requires complex metabolic studies. However, there is a good correlation between this parameter and fasting serum insulin levels. The aim of this work was to study fasting serum insulin levels by radio immuno analysis in 43 hypertensive patients aged 56 +/- 5.5 years old (27 male, 17 obese and 8 diabetics) and 20 normotensive controls aged 50 +/- 4.8 years old (13 male). Insulin levels were 3.8 UI/L in controls, 12.1 UI/L in normal weight, 15.5 UI/L in obese and 18.3 UI/L in diabetic hypertensives (ANOVA p < 0.001). These levels were above two standard deviations of control values in 50% of normal weight, 66% of obese and 62% of diabetic hypertensives. It is concluded that normal weight, obese and diabetic hypertensive subjects have high fasting insulin levels.

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The mitral valve stenosis is the most frequently valvuloplasty in pregnant patients. When it carries a significant risk of mortality for both mother and fetus, it can be performed a surgical commissurotomy, with a high risk for the fetus. We report our experience in percutaneous mitral valvuloplasty (PMV) in 3 patients during the third trimester of pregnancy with severe mitral stenosis. In this cases, we performed PMV in NYHA (New York Heart Association) CF III patients refractory to medical treatment. We used the transseptal double balloon technique protecting the abdominal wall using a lead apron. The mitral areas increased from 1 to 2 cm2, without a significant development of mitral regurgitation. In all cases, the infants delivered at term without complications and with normal weight. The PMV arise like an ideal intervention for the treatment of mitral stenosis during pregnancy.

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In order to establish morbidity and mortality in treated patients with essential hypertension, a prospective study was started in 1974. 714 patients were followed for 15 years. Admission criteria included diastolic blood pressure over 95 mmHg during one month on placebo, absence of malignant or accelerated hypertension and no recent (6 month) cardiovascular complication. According to target organ damage, 51% of patients were in WHO stage I, 35% in stage II and 14% in stage III. There were 342 males and 372 females, with mean age 58.7 +/- 9.8 years. Mean initial blood pressure was 181/110 +/- 12/8.9 mmHg. Treatment schedules included diuretics alone (23%), beta blockers alone (32%), diuretic and betablocker (38%), combined therapy with vasodilators (9%) and other forms of therapy (5%). 75 subjects failed to comply with therapy but were maintained in the analysis (intention to treat). A significant reduction in blood pressure was observed in the group as a whole (154/93 +/- 7/9 mmHg). Sustained normalization of BP (< 90 mmHg) was obtained in 40.2% of patients, reductions to between 91 and 100 mmHg in 37.2% and reductions to over 101 mmHg in 22.5% 47 patients died from cerebro vascular complications (15-year cumulative death rate of 12.3%). Total morbidity rate was 40.1% (232 events) with 61 coronary events (13.3%), 43 cerebrovascular events (8.7%), 30 cases of heart failure (12.9%) and 21 cases of renal failure (4.3%). These figures are in agreement with internationally reported ones with the exception of coronary morbidity which appears lower in this study.

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Celiprolol is a third generation beta blocking drug with intrinsic vasodilator effect. We evaluated the effect of this drug at a fixed dose of 400 mg daily in 20 patients with coronary artery disease and stable angina having 2 to 40 episodes of pain a week. All patients had positive exercise stress test with greater than 1 mm ST depression. Compared to the 1 month baseline placebo phase, patients after 3 months of treatment with celiprolol had less episodes of angina (2.4 vs 7.2 a week, p less than 0.001), higher angina threshold (667 vs 337 sec, p less than 0.025), higher ischemia threshold (614 vs 401 sec, p less than 0.001) and were able to perform more work (3937 vs 2403 kgm/min. p less than 0.01). 9 patients had no pain during exercise. A decrease in blood pressure, heart rate and double product was evident in the stress tests of the active phase. Adverse effects included headache (4 patients), sweating (1) and fatigue (1) not requiring modification of drug dose. No adverse effects were seen in 13 patients. Thus, celiprolol is effective to decrease angina during daily life and increase exercise tolerance in patients with chronic stable angina pectoris.

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El presente Manual de Organización, Educación y Saneamiento Ambiental se encuentra especialmente diseñado para lograr una secuenciación que pasa por la creación de repertorios protectivos del medio ambiente en los participantes, hasta lograr cumplir metas de educación, información y prevención. El Recurso metodológico en este caso particular corresponde al enfoque de técnicas de participación grupal, aglutinado en un paquete instruccional de seis sesiones que puden ser desarrolladas de manera contínua o discontinua, segun los interes del programa.

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El presente trabajo tiene como objetivo arrojar luz sobre los problemas de vivienda, de servicios básicos y de saneamiento ambiental que confrontan los habitantes de dos zonas periféricas de la ciudad de La Paz. Pretenden convertirse en un instrumento que permita establecer las prioridades de acción de los proyectos de mejoramiento ambiental y servir como un sistema retroalimentación y concientización que favorezca e impulse las actividades de autogestión en salud de los pobladores de las zonas involucradas

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