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BACKGROUND: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). METHODS: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure-time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. RESULTS: Twenty patients mechanically ventilated for 9 [5-14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of -2.8 [-3.8--1.9] cm H2O, -3.6 [-3.9--2.4] cm H2O and -2.1 [-2.5--1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118-209] cm H2O s/min, 197 [145-269] cm H2O s/min, and 134 [93-169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (ß = -2.771, p-value < 0.001) and inspiratory effort (ß = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (ß = 2.606, p = 0.010 for NAVA, and ß = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (ß = 2.643, p = 0.009 for PAV +). CONCLUSIONS: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.

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The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were - 8.4 [- 6.7; - 10.2] cmH2O, 15.2 [12.3-16.5] cmH2O and 8.1 [7.3-8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.

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RATIONALE: Cyclic strain may be a determinant of ventilator-induced lung injury. The standard for strain assessment is the computed tomography (CT), which does not allow continuous monitoring and exposes to radiation. Electrical impedance tomography (EIT) is able to monitor changes in regional lung ventilation. In addition, there is a correlation between mechanical deformation of materials and detectable changes in its electrical impedance, making EIT a potential surrogate for cyclic lung strain measured by CT (StrainCT ). OBJECTIVES: To compare the global StrainCT with the change in electrical impedance (ΔZ). METHODS: Acute respiratory distress syndrome patients under mechanical ventilation (VT 6 mL/kg ideal body weight with positive end-expiratory pressure 5 [PEEP 5] and best PEEP according to EIT) underwent whole-lung CT at end-inspiration and end-expiration. Biomechanical analysis was used to construct 3D maps and determine StrainCT at different levels of PEEP. CT and EIT acquisitions were performed simultaneously. Multilevel analysis was employed to determine the causal association between StrainCT and ΔZ. Linear regression models were used to predict the change in lung StrainCT between different PEEP levels based on the change in ΔZ. MAIN RESULTS: StrainCT was positively and independently associated with ΔZ at global level (P < .01). Furthermore, the change in StrainCT (between PEEP 5 and Best PEEP) was accurately predicted by the change in ΔZ (R2 0.855, P < .001 at global level) with a high agreement between predicted and measured StrainCT . CONCLUSIONS: The change in electrical impedance may provide a noninvasive assessment of global cyclic strain, without radiation at bedside.

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Ancient biomolecule analyses are proving increasingly useful in the study of evolutionary patterns, including extinct organisms. Proteomic sequencing techniques complement genomic approaches, having the potential to examine lineages further back in time than achievable using ancient DNA, given the less stringent preservation requirements. In this study, we demonstrate the ability to use collagen sequence analyses via proteomics to assist species delimitation as a foundation for informing evolutionary patterns. We uncover biogeographic information of an enigmatic and recently extinct lineage of Nesophontes across their range on the Caribbean islands. First, evolutionary relationships reconstructed from collagen sequences reaffirm the affinity of Nesophontes and Solenodon as sister taxa within Solenodonota. This relationship helps lay the foundation for testing geographical isolation hypotheses across islands within the Greater Antilles, including movement from Cuba toward Hispaniola. Second, our results are consistent with Cuba having just two species of Nesophontes (N. micrus and N. major) that exhibit intrapopulation morphological variation. Finally, analysis of the recently described species from the Cayman Islands (N. hemicingulus) indicates that it is a closer relative to N. major rather than N. micrus as previously speculated. This proteomic sequencing improves our understanding of the origin, evolution, and distribution of this extinct mammal lineage, particularly with respect to the approximate timing of speciation. Such knowledge is vital for this biodiversity hotspot, where the magnitude of recent extinctions may obscure true estimates of species richness in the past.

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The approach to the study of human anatomy is the subject of discussion by teachers and students. Nowadays, the debate revolves around the use of cadaveric material or it's relacement with virtual technologies. It questioned how necessary is the use of preparations, the efficiency of the virtual plataforms, the cost-benefit relation, their limitations and if they would replace the cadaveric material or if they would be a complement. Traditionally, dissections are exposed in tables during practical works. Observing a persistent year through year increment in the number of entrant students to Medical School and considering the inconveniences in the attainment of dissecting material and the diminished durability of the preparations due to extensive and not always careful manipulation, the proposal for the creation of interactive bottled preparations arises organically. When they are engaged, their durability increases, while, being interactive, the capacity for indirect manipulation is maintainded. In addition, the degreee of contamination is considerably reduced because the bottle, being sealed, prevents the emission of toxic gases generated by the evaporation of formaldebyde acid, preventing direct exposure. Another questioned axis in the scientific field is the ethical aspect of the use of cadaveric material as a pedagogical tool. In opposition, the preparations fulfill the role of representing the first approach of the student with his patient, understanding that it is not an object-machine but that it is a person, being his firts physical contact with death, taking it as a biological fact. Subsequently, the individual will relate to his real patient with a greater sensitivity and a more humanitic approach

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The use of kidney grafts with aneurysmal disease involving the renal arteries for transplantation is very uncommon and relatively controversial. We herein present the case of a 52-year-old woman who volunteered to become a living-nonrelated donor; during the preoperative imaging workup, a computed tomography angiography revealed a 1.5-cm saccular aneurysm in the left kidney, while the contralateral renal artery was normal. We decided to utilize the left kidney for a 25-year-old male patient with end-stage renal disease, and following the ex vivo repair using the recipient epigastric vessels and saphenous veins, we completed the transplantation in the right pelvic fossa. The postoperative period was uneventful, and at 8 months from the surgery, the graft remains functional. The surgical repair of renal artery aneurysms followed by immediate kidney transplantation is a safe technique and an effective replacement therapy for recipients. The incidental finding of isolated aneurysmal disease in renal arteries should not exclude graft potential availability for transplantation following repair.

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BACKGROUND: The preferred treatment for intracranial hemangioblastomas is surgical resection with or without preoperative embolization, however, embolization remains controversial due to risks such as distal tip entrapment, vascular injury during navigation, and embolic agent migration. CASE DESCRIPTION: A 54-year-old woman was admitted for surgical resection and preoperative embolization of a cerebellar hemangioblastoma. Although experience using Onyx with detachable and nondetachable tip microcatheters has been well reported in a variety of clinical circumstances, we describe the first case of a presurgical embolization of an intra-axial tumor using a second-generation detachable-tip microcatheter and a nonadhesive liquid embolic agent. Following the procedure, a nearly complete angiographic obliteration was achieved, as well as a successful subsequent surgical resection. CONCLUSION: Preoperative embolization with detachable-tip microcatheters and liquid embolic agents should be taken into consideration when assessing patients with hemangioblastomas of the posterior fossa due to the reduced risks of cardiac arrest, hemorrhage, and death.

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Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT.

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El propósito de este estudio descriptivo longitudinal fue evaluar el comportamiento de los tejidos blandos en pacientes sometidos a cirugía ortognática bimaxilar en el Hospital Universitario San Vicente de Paúl (HUSVP) por medio de radiografías cefálicas laterales. Se estableció una población de veintiún sujetos, seleccionados por conveniencia, con edad promedio de 22,8 años, a los sujetos se les tomaron radiografías cefálicas prequirúrgica y posquirúrgica. Todos los sujetos presentaban ortodoncia prequirúrgica, se les practicó cirugía LeFort I de impactación y avance maxilar, en la mandíbula se realizó retroceso utilizando técnica sagital de rama. En esta población se encontró un comportamiento diferente a los reportados en otras publicaciones con diferentes grupos étnicos. El movimiento en el plano horizontal mostró seguimiento ascendente desde la punta nasal hasta el punto superior anterior del labio. Para la punta nasal se observó acompañamiento del 46,9 por ciento. Para subnasal y el punto superior anterior del labio seguimiento del 63,5 y 73,0 por ciento respectivamente. Para la mandíbula el acompañamiento fue del 51,0 por ciento para el labralis superius, el punto B acompañó en 82,9 por ciento y el pogonion 75,0 por ciento. En sentido vertical el seguimiento fue del 67,6 por ciento para la punta nasal, 64,0 por ciento para subnasal y 50,0 por ciento para el labralis superius. La mandíbula mostró seguimiento del 34,7 por ciento para el labralis inferius y un promedio del 67.7 por ciento para los restantes puntos de la mandíbula. En conclusión, es importante considerar las características étnicas de nuestra población y el tipo de cirugía ya que presentan un comportamiento diferente, a los reportados en la literatura.

The purpose of this longitudinal descriptive study was to evaluate the behavior of soft tissues in patients who underwent bimaxilar ortognatic surgery at the Hospital University San Vicente de Paul (HUSVP) by means of lateral cephalic headplates. A total of twenty one patients selected by convenience, with an average age of 22,8 years, were treated , all of them received lateral cephalic headplates pre and post surgery. All of the subjects had received pre-surgical orthodontic treatment, they also received LeFort I surgery of impactation and maxilar advance, the mandible was retruded using a sagittal technique of the ramus. A different behaviour to the one found in different ethnic groups was found in this population. The movement in the horizontal plane showed an ascending path from the nasal point up to the upper superior point of the lip. For the nasal point a 46.9% movement was found. For the sub nasal and the superior anterior point of the lip a movement of 63.5% and 73% respectively. For the mandible the movement was51.0 % for labralis superius, point point B followed with 82.9 % and pogonion with 75%. In the vertical direction the movement was 67% for the nasal point, 64% for sub nasal point and 50% for the labralis superior. The mandible showed a movement of 34, 7% for labralis inferior and an average of 67,7% for the remaining points of the mandible. In conclusion, it is important to consider the ethnic characteristics of our population and the type of surgery, since they presented a different behavior than the one reported in the literature.

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Leishmania (Viannia) braziliensis and its variants were implicated in the epidemic outbreak of mucocutaneous leishmaniasis that occurred in Salta, northwestern Argentina, in 1985. A total of 24 suspected, untreated cases were evaluated clinically and parasitologically. Four of five stable isolates were consistent with the reference strain of L. (V.) braziliensis as determined by monoclonal antibodies and indirect immunofluorescence or radioimmunobinding assays. Zymodeme analysis in agarose gels showed a close relationship with L. (V.) guyanensis and L. (V.) panamensis. All zymograms obtained with polyacrylamide gels belonged to the subgenus Viannia; the patterns were different from, but very closely related to, the reference strains of L. (V.) braziliensis as determined by dendrogram analysis. Hamsters infected with two isolates showed a pattern consistent with L. (V.) braziliensis. The pattern of development in the gut of Lutzomyia longipalpis was consistent with members of Viannia.

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El análisis retrospectivo de 166 pacientes embarazadas y con diagnóstico de diabetes mellitus, atendidas en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, permite apreciar un registro inadecuado de la información, lo que le resta confiabilidad, y la carencia de protocolos apropiados de manejo. La diabetes gestacional (DMG) se presentó en 81 pacientes (48.8 por ciento), seguida por la diabetes mellitus no insulino dependiente (DMNID) (69 pacientes; 41.5 por ciento) y por último la diabetes insulina dependiente (DMID) en 16 pacientes (9.6 por ciento). Se halló una tasa de morbilidad perinatal del 52.2 por ciento (72 casos de los 138 en que se dispuso de información), inaceptable para esta población, distribuida así por entidades: macrosomía (16 casos; 22.2 por ciento), sufrimiento fetal agudo (15 casos; 20.8 por ciento), sufrimiento fetal crónico (10 casos; 13.9 por ciento), polihidramnios (9 casos; 12.5 por ciento), hipoglicemia (8 casos; 11.1 por ciento), trauma fetal (6 casos; 8.3 por ciento), síndrome de dificultad respiratoria (5 casos; 6.9 por ciento) hiperbilirrubinemia (5 casos; 6.9 por ciento) e hipocalcemia (1 caso). Cabe resaltar que las entidades potencialmente prevenibles (macrosomía, sufrimiento fetal agudo y crónico, polihidramnios, trauma fetal y síndrome de dificultad respiratoria ) fueron más frecuentes en la población de DMNID y DMG, lo que refleja un manejo clínico inadecuado. La mortalidad fetal fue del 3.6 por ciento (5 casos) y en tres de ellos se asoció a hipertensión materna. Se puso en evidencia la urgente necesidad de un protocolo interdisciplinarlo de manejo clínico, con el cual se puedan establecer un registro adecuado y pautas de manejo conforme a las necesidades de la población de riesgo que atiende esta Institución de referencia

Retrospective analysis of 166 pregnant women with gestational diabetes mellitus, at San Vicente de Paúl Hospital, Medellín, Colombia, evidenced inadequate registration of information and lack of clinical management protocols, despite the fact that this is a reference institution. Gestational diabetes mellitus (GDM) was found in 81 patients (48.8%), non-insulin-dependent diabetes mellitus (NIDDM) in 69 (41.5%) and insulin-dependent diabetes mellitus (IDDM) in 16 (9.6%). Perinatal morbidity rate was 52.2% (72 cases among the 138 in which information was available), distributed as follows: macrosomy (16 cases; 22.2%), acute fetal distress (15 cases; 20.8%), chronic fetal distress (10 cases; 13.9%), polyhydramnios (9 cases; 12.5%), hypoglycemia (8 cases; 11.1 %) and delivery fetal trauma (6 cases; 8.3%). It was remarkable that the potentially preventable entities (macrosomy, acute and chronic fetal distress, polyhydramnios, fetal trauma and respiratory failure syndrome) were more frequent in NIDDM and GDM groups, indicating an inadequate clinical management; fetal mortality was 3.6% (5 patients) mostly associated to maternal hypertension. These results point out to the urgent need of establishing in this third level hospital an interdisciplinary management protocol of gestational diabetes, with apropriate registration of information and clear clinical guides

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La angina de pecho es un sintoma comun y fisiopatologico que no nos permite identificar al enfermo, no obstante se debe buscar el similimum. En este trabajo describimos las caracteristicas clinicas que permiten el diagnostico nosologico, mencionamos varias de las rubricas repertoriales que nos ayudan en la modalizacion y resumimos diez (10) de los medicamentos pasibles de ser utilizados. Describimos las etiologias mas frecuentes, dado que su conocimiento es de vital importancia para la correcta seleccion de los pacientes

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La angina de pecho es un sintoma comun y fisiopatologico que no nos permite identificar al enfermo, no obstante se debe buscar el similimum. En este trabajo describimos las caracteristicas clinicas que permiten el diagnostico nosologico, mencionamos varias de las rubricas repertoriales que nos ayudan en la modalizacion y resumimos diez (10) de los medicamentos pasibles de ser utilizados. Describimos las etiologias mas frecuentes, dado que su conocimiento es de vital importancia para la correcta seleccion de los pacientes.

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La angina de pecho es un sintoma comun y fisiopatologico que no nos permite identificar al enfermo, no obstante se debe buscar el similimum. En este trabajo describimos las caracteristicas clinicas que permiten el diagnostico nosologico, mencionamos varias de las rubricas repertoriales que nos ayudan en la modalizacion y resumimos diez (10) de los medicamentos pasibles de ser utilizados. Describimos las etiologias mas frecuentes, dado que su conocimiento es de vital importancia para la correcta seleccion de los pacientes.

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Se aplicó una encuesta a nivel nacional a 4.522 alumnos y a 334 profesores. Los resultados son extrapolables a los jóvenes mayores de 15 años, que habitan en los grandes centros urbanos del país. La población que habita en zonas rurales tendría una tendencia más tradicional y conservadora en términos de actitudes y conductas. Lo anterior implica que los resultados son extrapolables a 330.000 jóvenes, aproximadamente. Existe un buen conocimiento teórico, que se invalida por creencias erróneas, como creer que el Sida no se contagia si se mantienen relaciones dentro del mismo grupo social, que se evita con un aseo genital postcoital o consultando por la conducta sexual previa de la pareja. El 44,2 por ciento de los alumnos encuestado se encuentra sexualmente activo. El 32,6 por ciento de los hombres y el 10,8 por ciento de las mujeres, sexualmente activos, mantiene relaciones sexuales al margen de su pareja estable. El 72,9 por ciento considera que no hay ninguna posibilidad que se contagie de Sida o ésta es muy baja. Las creencias erróneas, el alto nivel de actividad sexual, la precocidad en el inicio de las relaciones sexuales, la actividad sexual con prostitutas y promiscuidad en los encuestados, junto con la generalizada y falsa percepción que no hay posibilidades que se contagien, confirma que nuestra juventud se encuentra en muy alto riesgo de contraer el virus del Sida y se requiere de una toma de conciencia nacional y de una política gubernamental que dé solución global urgente a este problema

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En este estudio retrospectivo de los tumores de la glándula parótida se incluye a 14 pacientes vistos y tratados en el Servicio de Cirugía Oncológica del Hospital Regional "Lic. Adolfo López Mateos", en los cuales se efectuaron 15 procedimientos quirúrgicos (10 parotidectomías superficiales y tres parotidectomías totales, por procesos benignos; y dos disecciones radicales de cuello por procesos malignos, uno de ellos tratado con radioterapia coadyuvante). La mayor frecuencia de presentación, en cuento a tipo histológico se refiere, corresponde al adenoma pleomórfico (40 porciento), a la enfermedad de Mickulicz y a los tumores de Warthin (13.3 porciento cada uno, respectivamente), así como a la parotiditis crónica difusa. Las complicaciones se presentaron en bajo porcentaje y a los dos años de sobrevida de una paciente con proceso maligno no hay evidencia de actividad tumoral; ni en el resto de los casos evidencia de recurrencia. Tampoco se reportan cifras de mortalidad.

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Se analiza el papel jugado por los medios de comunicación, en especial la televisión, en la actual cultura de masas que vive en nuestra sociedad, en los cambios conductuales, en la falta de valores, y en la falta de conocimiento real y objetivo de la epidemia de SIDA. Es fundamental que los comunicadores y los directores de escuelas de periodismo comprendan a tiempo que su nuevo papel es básicamente educar, ya que los padres, tradicionales transmisores de valores, han perdido en gran parte esta función y los educadores no pueden abarcarla en su totalidad. A las generaciones futuras les costará comprender por qué no detuvimos esta epidemia con los actuales recursos que nos otorga la tecnología de las comunicaciones. Los medios de comunicación tienen un desafío histórico y tienen la palabra

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Se desconoce el comportamiento inmunológico fetal como paciente intrauterino. El diagnóstico de estas enfermedades y el criterio de curación se realizan sólo en la madre dejando al feto fuera de éste. La presencia de inmunoglobulina M en el líquido amniótico es un indicador de infección fetal y permitiría un diagnóstico preciso de enfermedad o curación fetal correlacionando dicha medición con la presencia o ausencia de gérmenes en el líquido amniótico, estudiando así el comportamiento inmunológico fetal frente a estos microorganismos. El objetivo de este trabajo fue determinar la frecuencia de estas enfermedades de transmisión sexual en el líquido amniótico de embarazadas portadoras de gérmenes de transmisión sexual y evaluar la prevalencia y evolución de estas patologías en el feto. En las 13 amniocentesis realizadas (8 pre y post-tratamiento) no encontramos agentes de transmisión sexual, ni presencia de inmunoglobulina M. No pudimos observar lo opuesto, vale decir la presencia de gérmenes y su relación con inmunoglobulina. Se necesitan más casos para llegar a alguna conclusión acerca de la inmunología fetal y a un mejor entendimiento de las propiedades antibacterianas del líquido amniótico. Concluimos que no encontramos contaminación del líquido amniótico ni contaminación o infección fetal en embarazadas portadoras de enfermedades de transmisión sexual

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Se informará la presentación clínica poco usual de un absceso retroperitoneal en un paciente diabético insulino dependiente

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