RESUMO
Introducción. La colecistectomía laparoscópica es el procedimiento laparoscópico más comúnmente realizado por el cirujano general. La lesión de la vía biliar es la complicación más temida debido a sus implicaciones clínicas y económicas. El objetivo de esta investigación fue determinar la incidencia de la lesión de la vía biliar en un centro de formación académica e identificar los posibles factores de riesgo asociados a su presentación. Materiales y métodos. Se llevó a cabo un estudio observacional retrospectivo en pacientes a quienes se les practicó una colecistectomía laparoscópica en el Hospital Universitario San Vicente Fundación de Medellín entre marzo de 2011 y septiembre 2016. Se realizó un análisis univariado y bivariado para explorar la asociación de algunas variables preoperatorias e intraoperatorias con la lesión de la vía biliar. Se utilizó el programa estadístico Stata 2014™. Resultados. Se incluyeron 1.601 pacientes. La incidencia de lesión de la vía biliar fue de 0,8 % (14 pacientes), con una mortalidad global de 0,4 %. La mayoría de estas lesiones fueron tipo A de Strasberg; solo dos pacientes requirieron una reconstrucción compleja de la vía biliar. Se encontró relación estadísticamente significativa con mayor tiempo operatorio (p<0,05) y mayor sangrado intraoperatorio (p<0,05) con la presentación de lesión de la vía biliar. Conclusión. La colecistectomía laparoscópica es un procedimiento seguro en el Hospital Universitario San Vicente Fundación, centro de formación de residentes quirúrgicos. La tasa de lesión de la vía biliar es similar a la reportada en la literatura
Introduction. Laparoscopic cholecystectomy is the most common laparoscopic procedure performed by the general surgeon. Bile duct injury (BDI) is the most feared complication due to its clinical and economic implications. The goal of this study was to determine the incidence of BDI at a teaching hospital and to identify possible related risk factors. Methods. This is an observational retrospective study that included patients who underwent laparoscopic cholecystectomy at San Vicente Foundation University Hospital (HUSVF) in Medellin, Colombia, in the period 2011 to September 2016. Univariate and bivariate analyses were performed to explore possible association of some perioperative variables with BDI. Statistic software STATA 2014 was used. Results. A total of 1,601 patients were included. BDI incidence was 0.8% (14 patients), global mortality was 0.4%. Most of BDIs were type A of the Strasberg classification and only two patients required complex reconstructions of the bile ducts. Longer operative time (p>0.05) and higher intraoperative blood loss (p<0.05) were related with BDI. Conclusion. Laparoscopic cholecystectomy is a safe procedure at HUSVF, a training center for surgical residents. Bile duct injury rate at this hospital is similar to that reported in the literature
Assuntos
Humanos , Ducto Colédoco , Colecistectomia Laparoscópica , Colecistite Aguda , Complicações IntraoperatóriasRESUMO
BACKGROUND: The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized tool used to measure cognitive function in diverse populations and is sensitive for assessing developmental changes in children. Although CANTAB has been used in several countries, its applicability in a Mexican child population is unknown. This study examined developmental trends on CANTAB in a large sample of urban Mexico City youth and tested the hypothesis that their performance would be similar to a large US normative sample. METHOD: As part of a birth cohort, Early Life Exposures in Mexico to Environmental Toxicants, 826 children, ages 5-15 years, completed CANTAB. Subtests measured planning (Stockings of Cambridge; SOC), short-term memory (Delayed Matching to Sample; DMS), sustained attention (Rapid Visual Information Processing; RVP), ability to match visual stimuli (Match to Sample Visual Search; MTS), flexibility (Intra-extra Dimensional Set Shift; IED), and response inhibition (Stop Signal Task; SST). Determinants of performance on the CANTAB, including age, maternal/child IQ, and sex, were analyzed using Spearman correlation and Welch t tests. Equivalence testing compared performance with existing norms. RESULTS: Performance improved with age on all measures. Child IQ was mildly associated with measures of memory and attention but not executive functioning, consistent with US norms. Maternal IQ was not associated with any outcomes, and males performed better on IED. Mexican norms were comparable to US norms on almost all outcomes, with the exception of a short-term visual recognition memory task (DMS). CONCLUSIONS: This study provides the largest normative data for CANTAB performance in a community sample of Mexican youth. Findings demonstrate the expected maturational effects of executive function, specifically in cognitive shifting and inhibition. Levels of executive function performance demonstrated by a Mexican sample were consistent with normative values reported in US youth. These findings, as well as expected associations with child IQ, indicate high applicability of CANTAB for Mexican youth in neurobehavioral studies.
Assuntos
Envelhecimento/psicologia , Atenção/fisiologia , Cognição/fisiologia , Função Executiva/fisiologia , Memória de Curto Prazo/fisiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , México , Testes Neuropsicológicos , Valores de ReferênciaRESUMO
Cellulase is a family of at least three groups of enzymes that participate in the sequential hydrolysis of cellulose. Recombinant expression of cellulases might allow reducing their production times and increasing the low proteins concentrations obtained with filamentous fungi. In this study, we describe the production of Trichoderma reesei cellobiohydrolase II (CBHII) in a native strain of Wickerhamomyces anomalus. Recombinant CBHII was expressed in W. anomalus 54-A reaching enzyme activity values of up to 14.5 U L-1. The enzyme extract showed optimum pH and temperature of 5.0-6.0 and 40°C, respectively. Enzyme kinetic parameters (KM of 2.73 mM and Vmax of 23.1 µM min-1) were between the ranges of values reported for other CBHII enzymes. Finally, the results showed that an enzymatic extract of W. anomalus 54-A carrying the recombinant T. reesei CBHII allows production of reducing sugars similar to that of a crude extract from cellulolytic fungi. These results show the first report on the use of W. anomalus as a host to produce recombinant proteins. In addition, recombinant T. reesei CBHII enzyme could potentially be used in the degradation of lignocellulosic residues to produce bioethanol, based on its pH and temperature activity profile.
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OBJECTIVE: To identify the relationship between stimulation at home and motor development among 36 month-old children. MATERIALS AND METHODS: The development of gross and fine motor skills of 169 infants (50.9% boys and 49.1% girls) was assessed at the age of 36 months with the Peabody Developmental Motor Scale. The quality of home stimulation was determined during a prior evaluation (at 30 months) by means of the HOME Scale. RESULTS: Total stimulation at home was significantly associated with better performance in the gross and fine motor areas. Particular aspects of this home stimulation were related to better gross and fine motor functions. CONCLUSION: Static balance and locomotion (gross motor skills) and grasping and visual-motor integration (fine motor skills) are associated with particular aspects of home stimulation, such as parent-child interaction, verbal reinforcement of the child's positive actions and providing the child with clear boundaries.
Assuntos
Desenvolvimento Infantil , Educação Infantil , Destreza Motora , Adulto , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos de Coortes , Feminino , Força da Mão/fisiologia , Humanos , Locomoção/fisiologia , Masculino , México , Destreza Motora/fisiologia , Testes Neuropsicológicos , Relações Pais-Filho , Equilíbrio Postural/fisiologia , Desempenho Psicomotor/fisiologia , Reforço Psicológico , Meio SocialRESUMO
OBJETIVO: Identificar la relación entre la estimulación en el hogar y el desarrollo motor en niños de 36 meses de edad. MATERIAL Y MÉTODOS: Se evaluó el desarrollo motor grueso y fino de 169 infantes (50.9 por ciento varones) mediante la Escala de Desarrollo Motor de Peabody y se determinó la calidad de estimulación en el hogar en una evaluación previa con la Escala HOME a los 30 meses de edad. RESULTADOS: La estimulación total en el hogar se asoció significativamente con un mejor desempeño en las áreas motora gruesa y fina. Aspectos particulares de esta estimulación se relacionaron con una mejor motricidad gruesa y fina. CONCLUSIÓN: Equilibrio y locomoción en la motricidad gruesa y agarre e integración visomotora en la motricidad fina son los componentes motores asociados a aspectos particulares de la estimulación como la interacción madre-hijo, el reforzamiento de acciones positivas en forma verbal y la presencia de límites claros.
OBJECTIVE: To identify the relationship between stimulation at home and motor development among 36 month-old children. MATERIALS AND METHODS: The development of gross and fine motor skills of 169 infants (50.9 percent boys and 49.1 percent girls) was assessed at the age of 36 months with the Peabody Developmental Motor Scale. The quality of home stimulation was determined during a prior evaluation (at 30 months) by means of the HOME Scale. RESULTS: Total stimulation at home was significantly associated with better performance in the gross and fine motor areas. Particular aspects of this home stimulation were related to better gross and fine motor functions. CONCLUSION: Static balance and locomotion (gross motor skills) and grasping and visual-motor integration (fine motor skills) are associated with particular aspects of home stimulation, such as parent-child interaction, verbal reinforcement of the child's positive actions and providing the child with clear boundaries.
Assuntos
Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Desenvolvimento Infantil , Educação Infantil , Destreza Motora , Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Força da Mão/fisiologia , Locomoção/fisiologia , México , Destreza Motora/fisiologia , Testes Neuropsicológicos , Relações Pais-Filho , Equilíbrio Postural/fisiologia , Desempenho Psicomotor/fisiologia , Reforço Psicológico , Meio SocialRESUMO
Using the Bayley test, the mental and psychomotor development in a cohort of 253 children were evaluated. Maternal dietary intake of vitamin B(12) and folate was assessed from a semiquantitative questionnaire administered during the first trimester of pregnancy. Maternal genotypes of MTHFR (677C>T and 1298A>C), were ascertained by PCR-RFLP. The 677T and 1298C variant alleles were present in 59% and 10% of participants, respectively. A dietary deficiency of vitamin B(12) was negatively associated with mental development (beta = -1.6; 95% CI = -2.8 to -0.3). In contrast, dietary intake of folate (< 400 mg/day) reduced the mental development index only among children of mothers who were carriers of the TT genotype (beta = -1.8; 95% CI = -3.6 to -0.04; P for interaction = 0.07). Vitamin B(12) and folate supplementation during pregnancy could have a favorable impact on the mental development of children during their first year of life, mainly in populations that are genetically susceptible.
Assuntos
Encéfalo/crescimento & desenvolvimento , Dieta , Ácido Fólico/administração & dosagem , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Efeitos Tardios da Exposição Pré-Natal , Vitamina B 12/administração & dosagem , Adolescente , Adulto , Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Meio Ambiente , Feminino , Deficiência de Ácido Fólico/complicações , Genótipo , Humanos , Lactente , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Gravidez , Complicações na Gravidez , Transtornos Psicomotores/epidemiologia , Transtornos Psicomotores/etiologia , Deficiência de Vitamina B 12/complicaçõesRESUMO
BACKGROUND: Evidence suggests that p,p'-dichlorodiphenyldichloroethene (DDE) affects neurodevelopment in infants, although a critical exposure window has not yet been identified. OBJECTIVES: Our goal was to assess the prenatal DDE exposure window and its effect on the psychomotor development index (PDI) and mental development index (MDI) during the first year of life. METHODS: We recruited 244 children whose pregnancies and deliveries were uncomplicated, and whose mothers were monitored throughout the pregnancy. Participating mothers were not occupationally exposed to DDT (dichlorodiphenyltrichloroethane) but were residents of a zone in Mexico with endemic malaria. We measured serum levels of DDE before pregnancy and during each trimester of the pregnancy. We evaluated PDI and MDI of the Bayley Scales for Infant Development (BSID-II), at 1, 3, 6, and 12 months of age. We adjusted for quality of the home environment and maternal intellectual coefficient (IQ). We used generalized mixed-effects models for statistical analysis. RESULTS: Third-trimester DDE level (7.8 +/- 2.8 ppb) was significantly higher than the level at baseline, first, and second trimesters, but the differences never exceeded 20%. Only DDE levels during the first trimester of pregnancy were associated with a significant reduction in PDI (every doubled increase of DDE level reduced the PDI 0.5 points). DDE was not associated with MDI. CONCLUSIONS: A critical window of exposure to DDE in utero may be the first trimester of the pregnancy, and psychomotor development is a target of this compound. Residues of DDT metabolites may present a risk of developmental delay for years after termination of DDT use.