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Background: Pompe disease (PD) is a rare autosomal recessive genetic disorder (1 in 14,000) which affects the synthesis of acid alpha-glucosidase (AGA), leading to intralysosomal glycogen accumulation in muscle tissue. The clinical presentation is heterogeneous, with variable degrees of involvement and progression, classifiable based on the age of onset into infantile (classic or non-classic) and late-onset forms (juvenile or adult). The diagnostic test of choice is the enzymatic analysis of AGA, and the only pharmacological treatment is enzyme replacement therapy (ERT). This document aims to report a clinical case of late-onset PD. Clinical case: 14-year-old male who started at the age of 5 with postural alterations, gait changes, and decreased physical performance compared to his peers. A diagnostic evaluation was initiated in 2022 due to worsening neuromuscular symptoms, accompanied by dyspnea, tachycardia, and chest pain. A suspicion of a lysosomal storage myopathy was established, and through enzymatic determination of AGA the diagnosis of PD was confirmed. The study of the GAA gene revealed the association of 2 previously unreported genomic variants. ERT was initiated, resulting in clinical improvement. Conclusions: The age of symptom onset, severity of clinical presentation, and prognosis of the disease depend on the specific mutations involved. In this case, the identified genetic alterations are associated with different phenotypes. However, based on the clinical presentation, it is categorized as juvenile PD with an indeterminate prognosis.

Introducción: la enfermedad de Pompe (EP) es un padecimiento genético autosómico recesivo poco frecuente (1:14,000) que afecta la síntesis de alfa-glucosidasa ácida (AGA) y condiciona un depósito de glucógeno intralisosomal en tejido muscular. La presentación clínica es heterogénea, con grados variables de afectación y progresión, clasificable según la edad de aparición en infantil (clásica y no clásica) y de inicio tardío (juvenil o de adultez). La prueba diagnóstica de elección es el análisis enzimático de AGA y el único tratamiento farmacológico es la terapia de reemplazo enzimático (TRE). Este documento tiene como objetivo reportar un caso clínico de EP de inicio tardío. Caso clínico: paciente de sexo masculino de 14 años que comenzó a los 5 años con alteraciones de la postura, marcha y desempeño físico. Se inició protocolo de estudio ante agravamiento de los síntomas neuromusculares, a los que se agregaron disnea, taquicardia y dolor torácico. Se sospechó de una miopatía metabólica de depósito lisosomal y mediante determinación enzimática de AGA se confirmó el diagnóstico de EP. El estudio molecular del gen GAA reportó una asociación de 2 variantes genómicas no descritas previamente. Se empleó la TRE con mejoría clínica. Conclusiones: la edad de inicio del cuadro clínico, severidad y pronóstico dependen de las mutaciones presentadas. En este caso, las alteraciones genéticas encontradas están relacionadas con diferentes fenotipos; no obstante, por clínica es categorizado como una EP juvenil con pronóstico indeterminado.

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Pathogenic lagoviruses (Rabbit hemorrhagic disease virus, RHDV) are widely spread across the world and are used in Australia and New Zealand to control populations of feral European rabbits. The spread of the non-pathogenic lagoviruses, e.g., rabbit calicivirus (RCV), is less well studied as the infection results in no clinical signs. Nonetheless, RCV has important implications for the spread of RHDV and rabbit biocontrol as it can provide varying levels of cross-protection against fatal infection with pathogenic lagoviruses. In Chile, where European rabbits are also an introduced species, myxoma virus was used for localised biocontrol of rabbits in the 1950s. To date, there have been no studies investigating the presence of lagoviruses in the Chilean feral rabbit population. In this study, liver and duodenum rabbit samples from central Chile were tested for the presence of lagoviruses and positive samples were subject to whole RNA sequencing and subsequent data analysis. Phylogenetic analysis revealed a novel RCV variant in duodenal samples that likely originated from European RCVs. Sequencing analysis also detected the presence of a rabbit astrovirus in one of the lagovirus-positive samples.

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A binocular vision-based approach for the restoration of images captured in a scattering medium is presented. The scene depth is computed by triangulation using stereo matching. Next, the atmospheric parameters of the medium are determined with an introduced estimator based on the Monte Carlo method. Finally, image restoration is performed using an atmospheric optics model. The proposed approach effectively suppresses optical scattering effects without introducing noticeable artifacts in processed images. The accuracy of the proposed approach in the estimation of atmospheric parameters and image restoration is evaluated using synthetic hazy images constructed from a well-known database. The practical viability of our approach is also confirmed through a real experiment for depth estimation, atmospheric parameter estimation, and image restoration in a scattering medium. The results highlight the applicability of our approach in computer vision applications in challenging atmospheric conditions.

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Abstract: Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min); opportunity for emergency surgeries (104.69 ± 102.55 min); starting time of anesthesia (10.11 ± 9.85 min); starting time of surgery (40.03 ± 24.68 min); time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min); turnover or replacement time (177.97 ± 174.33 min); active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work.

Resumen: Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora.

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This paper reports on the synthesis and characterization of La2O3:Eu3+ luminescent aerogels fabricated by the sol-gel method and the supercritical drying technique. The % mol concentration of the Eu3+ ion was varied to study the effects on the luminescent properties of the aerogels. XRD and TEM analysis showed that the La2O3:Eu3+ aerogels exhibited a semi-crystalline behavior regardless of whether the concentration of europium was increased. SEM micrographs revealed a porous structure in the aerogels, which were composed of quasi-spherical nanoparticles that were interconnected and formed coral-shaped agglomerates. Photoluminescence spectroscopy characterization showed that the aerogels had an infrared emission located at λ = 793 nm, and the maximum photoluminescence emission intensity was observed for the aerogel with 50% Eu3+. The results demonstrate that, without heat treatment, it is possible to manufacture luminescent aerogels of rare-earth oxides that can be used in opto-electronic devices.

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Resumen: Introducción: El diferimiento quirúrgico desde el inicio de la pandemia COVID-19 representa un riesgo para la salud de los pacientes y un reto para las instituciones sanitarias. La métrica de indicadores de productividad en quirófano, como la tasa de diferimiento quirúrgico, nos brindará información para planear estrategias basadas en evidencia científica que nos permitan mejorar la calidad de la atención. Objetivo: Determinar la tasa de diferimiento quirúrgico durante la pandemia COVID-19. Material y métodos: Se realizó un estudio, retrospectivo, descriptivo y transversal en el que se analizaron 297 pacientes cuyas cirugías fueron diferidas durante el período comprendido del 11 de marzo de 2020 al 10 de marzo de 2021. Para el análisis de variables se efectuó estadística descriptiva, utilizando medidas de tendencia central y dispersión, frecuencias simples y proporciones. Adicionalmente se realizó un diagrama de Pareto. La información fue procesada con SPSS v-25.0. Resultados: La proporción de diferimiento fue de 7.34%; 20.92% de las causas fueron atribuidas al paciente, 31.65% a causas médicas y 47.49% fueron logístico-administrativas. Conclusión: Las causas de diferimiento quirúrgico establecidas son evitables y revelan fracasos en los procesos logístico-administrativos que requieren planes de mejora continua.

Abstract: Introduction: Surgical deferral since the beginning of the COVID-19 pandemic represents a risk to the health of patients and a challenge for health institutions. The metric of productivity indicators in the operating room, such as the surgical deferral rate, will provide us with information to plan strategies based on scientific evidence that allow us to improve the quality of care. Objective: To determine the surgical deferral rate during the COVID-19 pandemic. Material and methods: A retrospective, descriptive and cross-sectional study was carried out in which 297 patients whose surgeries were deferred during the period from March 11, 2020 to March 10, 2021 were analyzed. Descriptive statistics were employed, using measures of central tendency and dispersion, simple frequencies and proportions. Additionally, a Pareto diagram was made. The information was processed with SPSS v-25.0. Results: The deferral rate was 7.34%. 20.92% of the causes were attributed to the patient, 31.65% to medical causes and 47.49% logistic-administrative. Conclusion: The established causes of surgical deferral are avoidable and reveal failures in the logistical-administrative processes that require continuous improvement plans.

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PURPOSE: The study aimed to assess the frequency of Langer's arch in patients undergoing axillary dissection for breast cancer. METHODS: From January-2015 to March-2020, in a general hospital in México City, female patients undergoing axillary dissection for breast cancer were studied. The analysis involved: demographic and anthropometric data, type of surgical treatment, histopathologic diagnosis, number of lymph nodes harvested, and frequency of Langer's arch finding. RESULTS: The sample studied was 123 axillary dissections. The mean age of the patients was 59 ± 10.5-years. Modified radical mastectomy was done in 117 cases (95.1%). Ductal carcinoma occurred in 96 cases (78%). The mean number of lymph nodes harvested was 24 ± 6.5. Langer's arch finding occurred in 33 cases (26.8%). CONCLUSION: Langer's arch is frequent in our patients undergoing axillary dissection for breast cancer.

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Resumen: Introducción: con los cambios demográficos el término «fragilidad¼ trasciende cada vez más en el ámbito quirúrgico. La relación entre fragilidad medida por dinamometría y la morbimortalidad en cirugía cardíaca no ha sido del todo estudiada. Objetivo: establecer la utilidad de la fragilidad determinada mediante dinamometría como predictor de morbimortalidad en pacientes geriátricos con bajo riesgo quirúrgico sometidos a cirugía cardíaca. Material y métodos: se realizó un estudio de cohortes prospectivo que incluyó 65 pacientes geriátricos de moderado riesgo quirúrgico sometidos a cirugía cardíaca electiva con derivación cardiopulmonar. A los pacientes se les realizó dinamometría preoperatoria para determinar fragilidad y se estimó su relación con la morbimortalidad postoperatoria. Se calculó sensibilidad, especificidad, valores predictivos y coeficientes de probabilidad positivos y negativos, coeficiente alfa de Cronbach y área bajo la curva ROC. Los datos se procesaron con SPSS v-24.0. Resultados: la evaluación del componente de calibración mostró que se ajusta a nuestra muestra (coeficiente alfa de Cronbach 0.79). La evaluación del componente de discriminación mostró que puede distinguir la población con riesgo de morbilidad (0.625) y mortalidad (0.597). Conclusión: la fragilidad determinada mediante dinamometría es útil como predictor de morbimortalidad en pacientes ancianos con bajo riesgo quirúrgico sometidos a cirugía cardíaca.

Abstract: Introduction: recent demographic changes have meant that more and more frail patients undergo surgery. The relationship between frailty, measured by dynamometry, and morbidity and mortality in cardiac surgery has not been fully studied. Objective: determine the usefulness of frailty, as measured by dynamometry, as a predictor of morbidity and mortality in geriatric patients with low surgical risk undergoing cardiac surgery. Material and methods: a prospective cohort study including 65 geriatric patients with moderate surgical risk undergoing elective cardiac surgery with cardiopulmonary bypass. The patients underwent preoperative dynamometry to determine their frailty, whose relationship with postoperative morbidity and mortality was evaluated. Sensitivity, specificity, predictive values, positive and negative probability coefficients, Cronbach's alpha coefficient and area under the ROC curve were calculated. The data were processed with SPSS v-24.0. Results: the evaluation of the calibration component showed that it fitted our sample (Cronbach's alpha coefficient 0.79). The evaluation of the discrimination component showed that it was able to distinguish between risk of morbidity (0.625) and risk of mortality (0.597). Conclusion: frailty, measured by dynamometry, is a useful predictor of morbidity and mortality in elderly patients with low surgical risk undergoing cardiac surgery.

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A stereo matching method based on adaptive morphological correlation is presented. The point correspondences of an input pair of stereo images are determined by matching locally adaptive image windows using the suggested morphological correlation that is optimal with respect to an introduced binary dissimilarity-to-matching ratio criterion. The proposed method is capable of determining the point correspondences in homogeneous image regions and at the edges of scene objects of input stereo images with high accuracy. Furthermore, unknown correspondences of occluded and not matched points in the scene can be successfully recovered using a simple proposed post-processing. The performance of the proposed method is exhaustively tested for stereo matching in terms of objective measures using known database images. In addition, the obtained results are discussed and compared with those of two similar state-of-the-art methods.

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Abstract: Introduction: Inducing hypocapnia is a common practice during pediatric general anesthesia, even though it has not shown clear benefits. Objective: To compare the impact of carbon dioxide values after aortic impingement (< 32.7 vs ≥ 32.7 mmHg) on postoperative morbimortality among pediatric patients undergoing cardiac surgery. Material and methods: A case-control study included 90 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. The study cases consisted of 45 patients who died within 30 days of the postoperative period. Cases and controls were individually matched (1:1 ratio). Descriptive and inferential statistics (Mann-Whitney's U, Student's t and χ2 tests) were used to analyze the results. A p < 0.05 was considered significant. A univariate analysis was also carried out. The strength of association between morbimortality and carbon dioxide values after aortic impingement was determined using the odds ratio. The data were processed using SPSS v-24.0. Results: The group with carbon dioxide values of < 32.7 mmHg after aortic impingement was associated with greater morbidity (OR 24.75; 95% CI 4.92-124.32) and mortality (OR 22.47; 95% CI 4.85-10.17) at 30 days. Conclusion: Pediatric patients undergoing cardiac surgery with carbon dioxide values of < 32.7 mmHg after aortic impingement showed higher postoperative morbimortality than those with carbon dioxide values of ≥ 32.7 mmHg.

Resumen: Introducción: La hipocapnia es una práctica común durante la anestesia general pediátrica; sin embargo, a lo largo del tiempo no ha mostrado beneficios bien definidos. Objetivo: Comparar el impacto del bióxido de carbono post-pinzamiento aórtico (< 32.7 vs ≥ 32.7 mmHg) sobre la morbimortalidad postoperatoria en los pacientes pediátricos sometidos a cirugía cardíaca. Material y métodos: Se realizó un estudio de casos y controles que incluyó 90 pacientes pediátricos sometidos a cirugía cardíaca con derivación cardiopulmonar. Se consideraron casos 45 pacientes que fallecieron dentro de los 30 días del postoperatorio. Los controles fueron pareados en relación 1:1. Para su análisis se realizó estadística descriptiva e inferencial con U de Mann-Whitney, t de Student y χ2 según fue el caso. Una p < 0.05 fue significativa. Se realizó un análisis univariado. La fuerza de asociación entre la morbimortalidad y los valores de bióxido de carbono post-pinzamiento aórtico se obtuvo mediante el odds ratio. Los datos fueron procesados mediante SPSS v-24.0. Resultados: El grupo con valores de bióxido de carbono post-pinzamiento aórtico < 32.7 mmHg se asoció con una mayor morbilidad a los 30 días (OR 24.75; IC del 95% 4.92-124.32) y mortalidad (OR 22.47; IC del 95% 4.85-10.17). Conclusión: Los pacientes pediátricos sometidos a cirugía cardíaca con valores de bióxido de carbono post-pinzamiento aórtico < 32.7 mmHg tienen mayor morbimortalidad postoperatoria que los que tienen valores ≥ 32.7 mmHg.

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Seneca Valley virus (SVV) is a non-enveloped RNA virus and the only member of the Senecavirus A (SVA) species, in the Senecavirus genus, Picornaviridae family. SVV infection causes vesicular lesions in the oral cavity, snout and hooves of pigs. This infection is clinically indistinguishable from trade-restrictions-related diseases such as foot-and-mouth disease. Other clinical manifestations include diarrhoea, anorexia, lethargy, neurological signs and mortality in piglets during their first week of age. Before this study, Chile was considered free of vesicular diseases of swine, including SVV. In April 2022, a suspected case of vesicular disease in a swine farm was reported in Chile. The SVV was confirmed and other vesicular diseases were ruled out. An epidemiological investigation and phylogenetic analyses were performed to identify the origin and extent of the outbreak. Three hundred ninety-five samples from 44 swine farms were collected, including faeces (208), oral fluid (28), processing fluid (14), fresh semen (61), environmental samples (80) and tissue from lesions (4) for real-time RT-PCR detection. Until June 2022, the SVV has been detected in 16 out of 44 farms, all epidemiologically related to the index farm. The closest phylogenetic relationship of the Chilean SVV strain is with viruses collected from swine in California in 2017. The direct cause of the SVV introduction has not yet been identified; however, the phylogenetic analyses suggest the USA as the most likely source. Since the virus remains active in the environment, transmission by fomites such as contaminated feed cannot be discarded. Further studies are needed to determine the risk of the introduction of novel SVV and other transboundary swine pathogens to Chile.

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Resumen: Introducción: El impacto en el sistema inmunitario de la hemodilución normovolémica como técnica de ahorro hemático perioperatoria plantea un posible aumento de la inmunoglobulina M, y un factible incremento de las infecciones, sobre todo de las asociadas a catéteres. Objetivo: Comparar el papel de la hemodilución normovolémica aguda en infecciones postoperatorias en pacientes sometidos a cirugía cardíaca. Material y métodos: Se realizó un ensayo clínico controlado, en el que se incluyeron 99 pacientes sometidos a cirugía cardíaca electiva que se distribuyeron de manera aleatoria en dos grupos: grupo I (no hemodiluidos) o grupo II (hemodiluidos) y durante el período postoperatorio mediato se determinó la presencia o no de infección. Para el análisis de variables se utilizó estadística descriptiva e inferencial mediante χ2. Una p < 0.05 fue significativa. Los datos fueron procesados en SPSS statistics 25.0. Resultados: La incidencia global de infección fue 3.03%. Los pacientes hemodiluidos se infectaron más que los no hemodiluidos (p = 0.045). Los organismos aislados fueron Escherichia coli (66.6%) y Enterobacter aerogenes (3.33%). Conclusión: Los pacientes sometidos a cirugía cardíaca a quienes se les practica hemodilución normovolémica aguda, presentan más infecciones postoperatorias en comparación con los que no se les aplica.

Abstract: Introduction: The impact on the immune system of normovolemic hemodilution as a perioperative blood-saving technique raises a possible increase in immunoglobulin M, and a possible increase in infections, especially those associated with catheters. Objective: To compare the role of acute normovolemic hemodilution in postoperative infections in groups of patients undergoing cardiac surgery. Material and methods: A controlled clinical trial in 99 patients undergoing elective cardiac surgery who were randomized into two groups: group I (non-hemodiluted) and group II (hemodiluted). The presence or absence of infection was determined during the postoperative period. Data analysis was performed using descriptive and inferential statistics χ2. A p < 0.05 was considered significant. The data were processed using SPSS v.25.0. Results: The overall incidence of infection was 3.03%. Hemodiluted patients became infected more frequently than non-hemodiluted patients. The isolated organisms were Escherichia coli and Enterobacter aerogenes. Conclusion: Patients undergoing cardiac surgery who undergo acute normovolemic hemodilution suffer more frequently from postoperative infections than those who do not undergo acute normovolemic hemodilution.

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The reaction between L-cysteine (Cys) and 6-maleimidohexanoic acid (Mhx) in an aqueous medium at different levels of pH was analyzed via RP-HPLC, finding the presence of two reaction products throughout the evaluated pH range. By means of solid-phase extraction (SPE), it was possible to separate the products and obtain isolated profiles enriched up to 80%. The products were analyzed individually through mass spectrometry, DAD-HPLC, NMR 1H, 13C, and two-dimensional evidence of isomerization between the hydrogen atoms of the α-amino and the thiol group present in the cysteine. Thus, it was concluded that the products obtained corresponded to a mixture of the isomer Cys-S-Mhx, where the adduct is formed by a thioether bond, and the isomer Cys-NH-Mhx, in which the union is driven by the amino group. We consider that the phenomenon of isomerization is an important finding, since it has not previously been reported for this reaction.

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BACKGROUND: The over prescription of antibiotics for acute respiratory infections is a major public health problem worldwide. Aim: To evaluate the frequency of prescription of antibiotics for non-pneumonia acute respiratory infections in private outpatient clinics in individuals without chronic diseases or immunosuppression. MATERIAL AND METHODS: All medical records of adult consultants in a national network of private ambulatory medical centers during May 2018 whose primary diagnosis corresponded to acute respiratory infections not pneumonia (ICD10) were identified and retrospectively analyzed, excluding those with chronic respiratory conditions or states of immunosuppression. RESULTS: Of the 38,072 consultants (aged 36 years, 63% women) who met this criterion, 54% (n = 20,499) received a prescription for at least one antibiotic. The diagnoses that most frequently received this prescription were acute bronchitis (28.7%), acute sinusitis (16.5%) and acute tonsillitis (16.2%). The most frequently prescribed antibiotic globally was azithromycin (37.4%), followed by amoxicillin (20.1%) and amoxicillin plus clavulanic acid (17.7%). Levofloxacin prescription reached 12.5% of total prescriptions. CONCLUSIONS: An antibiotic was prescribed in more than half of the non-pneumonia outpatient acute respiratory infections. Azithromycin was the most prescribed antibiotic, while levofloxacin exceeded 10% of prescriptions. These results reinforce the need to implement an antibiotic prescription surveillance system at the outpatient level.

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Resumen: Introducción: Se han propuesto varios métodos para controlar la inflamación y preservar el miocardio durante la circulación extracorpórea (CEC), entre ellos podemos mencionar la administración de electrolitos, tales como el magnesio (Mg2+). Objetivo: Comparar el efecto del uso de sulfato de magnesio (MgSO4) prepinzamiento aórtico (pre-PAo) vs placebo sobre los niveles séricos de lactato en el seno coronario en pacientes sometidos a revascularización miocárdica (RVM) multivaso con CEC. Material y métodos: Se realizó un ensayo clínico controlado en 52 pacientes sometidos a RVM multivaso con CEC, aleatorizados para recibir placebo (grupo I) o MgSO4 (grupo II) pre-PAo, y se tomaron muestras sanguíneas del seno coronario en dos tiempos diferentes: T0: pre-PAo y T1: previo al cierre de tórax, cuantificándose el lactato sérico. Para su análisis, se utilizó t de Student y χ2. Una p < 0.05 fue significativa. La información se procesó en SPSS v-22.0. Resultados: Los niveles séricos de lactato en el seno coronario postpinzamiento aórtico (pos-PAo) fueron menores en el grupo II (2.967 ± 0.86 vs 2.154 ± 1.14) mostrando diferencias significativas (p = 0.006). Conclusión: El uso de MgSO4 pre-PAo disminuye los niveles séricos de lactato en el seno coronario en pacientes sometidos a RVM multivaso con CEC.

Abstract: Introduction: Several methods have been proposed to control inflammation and to preserve the myocardium during cardiopulmonary bypass (CABG), including the administration of electrolytes such as magnesium (Mg2+). Objective: To compare the effect of using magnesium sulfate (MgSO4) or a placebo before aortic clamping (AoC) on the serum levels of lactate in the coronary sinus in patients undergoing myocardial multivessel revascularization (MRV) with CABG. Material and methods: A clinical assay was conducted with 52 patients undergoing MRV multivessel with CEC; the patients were randomized to receive a placebo (group I) or MgSO4 (group II) before AoC, and blood samples were taken from the coronary sinus to quantify serum lactate at two different times: T0: pre-AoC and T1: before closing the chest. Statistical analysis was performed on Student's t-test and χ2. A p < 0.05 was considered statistically significant. The data were processed with SPSS v-22.0. Results: Serum levels of lactate in the coronary sinus post-AoC were lower in group II (2.967 ± 0.86 vs 2.154 ± 1.14), with significant differences (p = 0.006). Conclusion: The use of MgSO4 before AoC reduces serum lactate levels in the coronary sinus in patients undergoing MRV multivessel with CABG.

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Abstract: Introduction: One of the various instruments that can be used to evaluate the impact of risk factors on the survival of patients undergoing valve surgery is the VMCP score. This work evaluates the performance of this tool. Objective: To validate the surgical risk score for heart valve surgery (VMCP score) in our hospital unit. Material and method: A prospective cohort study was conducted on 239 patients undergoing heart valve surgery, estimating the risk with the VMCP score. The sample was divided into two groups at a cut-off point of 8. The discriminating power of the score was analyzed based on the area under the ROC curve. A value of p < 0.05 was considered significant. The data were processed using SPSS v.25.0. Results: The score stratified the samples as follows: 40.6% of patients were without risk and 59.4% were at risk. The evaluation of the calibration component showed that the score was not appropriate for our sample (Cronbach's alpha coefficient: 0.59). The discrimination component of the score showed a poor capacity to distinguish between the population at risk of mortality (0.630) and/or morbidity (0.655). Conclusion: It is not valid to use the surgical risk score for heart valve surgery (VMCP score) in our hospital unit.

Resumen: Introducción: Existen diversos instrumentos para evaluar el impacto de los factores de riesgo sobre la supervivencia del paciente sometido a cirugía valvular, entre los que encontramos la escala VMCP, por lo que conminaremos a una evaluación del desempeño. Objetivo: Validar la escala de riesgo quirúrgico para cirugía valvular: Escala VMCP en nuestra unidad hospitalaria. Material y métodos: Se realizó un estudio de cohortes prospectivo en 239 pacientes sometidos a cirugía valvular y se les estimó el riesgo mediante la escala VMCP. La muestra se dividió en dos grupos de acuerdo con un punto de corte de 8. La capacidad de discriminación se analizó mediante el área bajo la curva ROC. Una p < 0.05 fue significativa. Los datos se procesaron con SPSS v-25.0. Resultados: La estratificación de la escala mostró: 40.6% de pacientes sin riesgo y 59.4% con riesgo. La evaluación del componente de calibración mostró que la escala no se ajusta a nuestra muestra (Coeficiente Alfa de Cronbach 0.59). La evaluación del componente de discriminación mostró que no puede distinguir la población con riesgo de mortalidad (0.630) y/o morbilidad (0.655). Conclusión: No es válido el uso del sistema de estratificación de riesgo quirúrgico para cirugía valvular, la escala VMCP, en nuestra unidad hospitalaria.

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BACKGROUND: The over prescription of antibiotics for acute respiratory infections is a major public health problem worldwide. AIM: To evaluate the frequency of prescription of antibiotics for non-pneumonia acute respiratory infections in private outpatient clinics in individuals without chronic diseases or immunosuppression. MATERIAL AND METHODS: All medical records of adult consultants in a national network of private ambulatory medical centers during May 2018 whose primary diagnosis corresponded to acute respiratory infections not pneumonia (ICD10) were identified and retrospectively analyzed, excluding those with chronic respiratory conditions or states of immunosuppression. RESULTS: Of the 38,072 consultants (aged 36 years, 63% women) who met this criterion, 54% (n = 20,499) received a prescription for at least one antibiotic. The diagnoses that most frequently received this prescription were acute bronchitis (28.7%), acute sinusitis (16.5%) and acute tonsillitis (16.2%). The most frequently prescribed antibiotic globally was azithromycin (37.4%), followed by amoxicillin (20.1%) and amoxicillin plus clavulanic acid (17.7%). Levofloxacin prescription reached 12.5% of total prescriptions. CONCLUSIONS: An antibiotic was prescribed in more than half of the non-pneumonia outpatient acute respiratory infections. Azithromycin was the most prescribed antibiotic, while levofloxacin exceeded 10% of prescriptions. These results reinforce the need to implement an antibiotic prescription surveillance system at the outpatient level.

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Resumen: Introducción: Existe discrepancia para la extubación temprana de los pacientes sometidos a reemplazo valvular aórtico por estenosis, debido a su tendencia a desarrollar hipertensión postoperatoria que puede condicionar un fracaso del tratamiento quirúrgico. Objetivo: Comparar la incidencia de reintubación postoperatoria por hipertensión arterial en pacientes sometidos a reemplazo valvular aórtico con la técnica de extubación estándar vs ultra fast-track. Material y métodos: Se realizó un estudio de cohortes retrospectivo, incluyó a 73 pacientes sometidos a reemplazo valvular aórtico, se asignaron a dos grupos dependiendo de la técnica de extubación: estándar (grupo I) y ultra fast-track (grupo II). Se evaluó la presencia de hipertensión arterial y de reintubación postoperatoria. El análisis de variables se realizó con χ2. Una p < 0.05 fue significativa. El procesamiento se realizó con el software SPSS v-24.0. Resultados: Cuarenta y cinco pacientes pertenecían al grupo I y 28 al grupo II. La incidencia de hipertensión arterial y de reintubación fue mayor para el grupo II (p = 0.027), no hubo diferencias en cuanto a la morbilidad (p = 0.348), mortalidad (p = 0.202) y días de estancia postoperatoria (p = 0.182). Conclusión: La incidencia de reintubación postoperatoria por hipertensión arterial en pacientes sometidos a reemplazo valvular aórtico con la técnica ultra fast-track es mayor que con la extubación estándar en nuestra unidad hospitalaria.

Abstract: Introduction: There is controversy about the use of early extubation in patients undergoing aortic valve replacement due to stenosis, given their tendency to develop postoperative hypertension, which could defeat the whole purpose of the surgical intervention. Objective: To compare the incidence of postoperative reintubation for hypertension in patients undergoing aortic valve replacement using the standard extubation technique and the ultra fast-track. Material and methods: A retrospective cohort study that included 73 cases of patients undergoing aortic valve replacement. The patients were divided into two according to the extubation technique used: standard (group I) and ultra fast-track (group II). The presence of hypertension and postoperative reintubation was evaluated. The analysis of variables was performed using the χ2 test. A p < 0.05 was considered significant. The data were processed using SPSS v. 24.0. Results: 45 patients were in group I and 28 in group II. The incidence of hypertension and reintubation was higher in group II (p = 0.027). There were no differences in morbidity (p = 0.348), mortality (p = 0.202) and length of postoperative stay (p = 0.182). Conclusion: In our hospital unit, the incidence of postoperative reintubation for hypertension in patients undergoing aortic valve replacement with the ultra fast-track technique is higher than with standard extubation.

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PREMISE: The mechanisms generating the geographical distributions of genetic diversity are a central theme in evolutionary biology. The amount of genetic diversity and its distribution are controlled by several factors, including dispersal abilities, physical barriers, and environmental and climatic changes. We investigated the patterns of genetic diversity and differentiation among populations of the widespread species Brosimum alicastrum in Mexico. METHODS: Using nuclear DNA microsatellite data, we tested whether the genetic structure of B. alicastrum was associated with the roles of the Trans-Mexican Volcanic Belt and the Isthmus of Tehuantepec as geographical barriers to gene flow and to infer the role of past events in the genetic diversity patterns. We further used a maximum-likelihood population-effects mixed model (MLPE) to identify the main factor affecting population differentiation in B. alicastrum. RESULTS: Our results suggested that Mexican B. alicastrum is well differentiated into three main lineages. Patterns of the genetic structure at a finer scale did not fully correspond to the current geographical barriers to gene flow. According to the MLPE mixed model, isolation by distance is the best model for explaining the genetic differentiation of B. alicastrum in Mexico. CONCLUSIONS: We propose that the differentiation patterns might reflect (1) an ancient differentiation that occurred in Central and South America, (2) the effects of past climatic changes, and (3) the functions of some physical barriers to gene flow. This study provides insights into the possible mechanisms underlying the geographic genetic variation of B. alicastrum along a moisture gradient in tropical lowland forests.

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Resumen: Introducción: Se ha sugerido que el recuperador celular reduce el contenido de citocinas proinflamatorias después de la cirugía cardíaca mejorando su equilibrio en la circulación sistémica, lo que puede minimizar la respuesta inflamatoria que contribuye a la disfunción pulmonar postoperatoria. Objetivo: Comparar el intercambio gaseoso postoperatorio de pacientes sometidos a cirugía cardíaca con y sin el uso de recuperador celular. Material y métodos: Se realizó un estudio de cohortes prospectivo que incluyó 253 pacientes sometidos a cirugía cardíaca bajo circulación extracorpórea. Los pacientes se asignaron a cada uno de los grupos de estudio dependiendo de si usaron o no recuperador celular: grupo I (sin recuperador) y grupo II (con recuperador), estimándose la PaO2/FiO2 y la morbilidad respiratoria postoperatoria. Para el análisis se utilizó estadística descriptiva e inferencial mediante t de Student o U de Mann-Whitney. Una p < 0.05 fue significativa. Los datos se procesaron con SPSS v. 24.0. Resultados: 59.29% usaron recuperador celular. La PaO2/FiO2 fue menor en el grupo II (p = 0.018). No hubo diferencias entre ambos grupos en la morbilidad respiratoria a los 30 días de postoperados (p = 0.943). Conclusión: El intercambio gaseoso postoperatorio de pacientes sometidos a cirugía cardíaca es menor con el uso de recuperador celular que sin él.

Abstract: Introduction: It has been suggested that the use of a cell saver reduces the content of proinflammatory cytokines after cardiac surgery, improving the balance of these cytokines in the systemic circulation, which in turn could minimize the inflammatory response that contributes to postoperative pulmonary dysfunction. Objective: To compare the postoperative gas exchange in patients undergoing cardiac surgery with the use of cell saver and without it. Material and methods: A prospective cohort study that included 253 patients undergoing cardiac surgery under cardiopulmonary bypass. The patients were assigned to two study groups depending on whether a cell saver was used: group I (without cell saver) and group II (with cell saver). The PaO2/FiO2 ratio and the postoperative respiratory morbidity were then estimated. The analysis was done using descriptive and inferential statistics by means of the Student t test and Mann-Whitney U test. A p < 0.05 was considered significant. The data were processed using SPSS v. 24.0. Results: 59.29% of patients underwent surgery with the use of a cell saver. The PaO2/FiO2 ratio was lower in group II (p = 0.018). There were no differences between groups in respiratory morbidity 30 days after surgery (p = 0.943). Conclusion: The postoperative gas exchange is lower in patients undergoing cardiac surgery with the use of a cell saver than without it.