Enfermedad de Behcet: Manifestaciones neurológicas y psiquiátricas observadas en dos pacientes en el Hospital Nacional Dos de Mayo (Lima, Perú).

The neurological and psychiatric manifestations in two patients who met clinical criteria of Behcet’s disease are observed and described throughout several decades. The presence of recurrent oral and genital canker sores is illustrated with images. One of the patients developed thrombosis of the femoral vein, and erythema nodosus was present in both. The ophthalmological evaluation showed absence of uveitis in both patients, and blindness by adult monocular dystrophic maculopathy without signs of retinal vasculitis in the female. Laboratory tests on blood and cerebrospinal fluid evidenced lymphocytic pleocytosis. The patergia skin test was negative. Likewise, laboratory tests determined an absence of findings compatible with other autoimmune diseases. Throughout the evaluation period, the clinical manifestations were correlated with the findings from tomography and brain magnetic resonance magnetic. Similarly, recurrent myelitis and its correlation with the results of medular magnetic resonance imaging are explained. The evaluation and follow-up period through outpatient consultation and hospitalization was prolonged: the 73-year-old male patient, who started the disease at age 35, was followed-up for 34 years; and the 50-year-old female patient, fell ill at the age of 28 and was followed-up for 8 years. This process allowed the understanding of the different morbid factors that influenced the serious evolution of the clinical picture.Se describen las manifestaciones neurológicas y psiquiátricas de dos pacientes con características clínicas de la enfermedad de Behcet, observados a lo largo de varias décadas. Se ilustra con imágenes la presencia de aftas orales y genitales recidivantes. Uno de ellos desarrolló trombosis de la vena femoral y en ambos hubo presencia de eritema nodoso. La evaluación oftalmológica determinó ausencia de uveitis en ambos pacientes y ceguera por maculopatía distrófica monocular sin signos de vasculitis retinal en la paciente mujer. Exámenes de laboratorio en sangre y en el líquido cerebro espinal evidenciaron pleocitosis linfocítica. El test cutáneo de patergia fue negativo. Asimismo, se determinó la ausencia de hallazgos compatibles con otras enfermedades autoinmunes. Durante el periodo de evaluación se correlacionaron las manifestaciones clínicas y los hallazgos en tomografía (TM) y resonancia magnética cerebral (RMC). Se explica igualmente la mielitis recidivante y su correlato con los resultados de la resonancia magnética medular (RMM). El tiempo de evaluación y seguimiento por consulta externa y durante la hospitalización en el paciente varón (73 años), que inició la enfermedad a los 35 años, fue de 34 años; la paciente mujer (50 años, inició su enfermedad a los 28 años y fue seguida por espacio de 8 años. Este proceso permitió comprender los diferentes factores mórbidos que influyeron en la grave evolución del cuadro clínico estudiado

Índices gonadosomático y hepatosomático en relación con la maduración y muda del camarón Cryphiops caementarius del río Pativilca (Perú)

The aim of this study was to determine the gonadosomatic (IGS) and hepatosomatic (IHS) indices in relation to the gonadal maturation and moult stages of the Cryphiops caementarius shrimp from the Pativilca River (Peru). A total of 143 male shrimp (4.07-11.70 cm of total length) and 97 females (1.75-8.02 cm of total length) were used. The shrimp were weighed, measured and the molting state was determined. The hepatopancreas and gonads were removed by dissection, weighed and the ovarian stages determined. During the maturation of the ovary, the IGS increased from 0.97 to 5.01% and the IHS decreased from 5.37 to 4.44%. In mature and non-ovulating females in post-moulting A, the highest IGS was 8.28% and the lowest IHS was 1.72%. In females with immature and non-ovulating ovaries, the IGS increased from 1.40 to 3.38% and in immature and ovigerous females from 0.38 to 1.79%, while the opposite happened in mature non-ovigerous females. In males the IGS varied from 1.74 to 0.78% and the IHS from 5.08 to 5.92% during the moulting cycle. In females the IGS increased as the ovary matured and was maximum in post-moulting A and minimum in post-moulting B2; however, the IHS varied inversely with the IGS. In male shrimp, low IGS and high IHS suggest that they do not invest energy for reproduction.El objetivo del estudio fue determinar los índices gonadosomático (IGS) y hepatosomático (IHS) en relación con la maduración gonadal y los estados de muda del camarón Cryphiops caementarius del río Pativilca (Perú). Se emplearon 143 camarones machos (4.07-11.70 cm de longitud total) y 97 hembras (1.75-8.02 cm de longitud total). Los camarones se pesaron, midieron y se determinó el estado de muda. Los hepatopáncreas y gónadas se extrajeron por disección, se pesaron y se determinaron los estados del ovario. Durante la maduración del ovario, el IGS incrementó de 0.97 a 5.01% y el IHS disminuyó de 5.37 a 4.44%. En hembras maduras y no ovígeras en postmuda A, el mayor IGS fue de 8.28% y el menor IHS de 1.72%. En hembras con ovarios inmaduros y no ovígeras, el IGS incrementó de 1.40 a 3.38% y en hembras inmaduras y ovígeras de 0.38 a 1.79%, en tanto que lo contrario sucedió en hembras maduras no ovígeras. En los machos el IGS varió de 1.74 a 0.78% y el IHS de 5.08 a 5.92% durante el ciclo de muda. En hembras el IGS incrementó conforme maduró el ovario y fue máximo en postmuda A y mínimo en postmuda B2; en cambio, el IHS varió de manera inversa con el IGS. En camarones machos los bajos IGS y los altos IHS sugieren que estos no invierten energía para reproducción. &nbsp

Xantomatosis cerebrotendinosa. Reporte de un caso en el Perú: Evaluación clínica integral y estudios de neuroimágenes.

The case of a 73 years-old woman that, since approximately the age of 30 years started to complain of pain when walking, is presented. The symptom was mainly located in the acchillean regions which, as time advanced, showed gradual volume increase and, finally, forced her to seek medical evaluation. Accompanying relatives reported a several years history of gradually increasing cognitive difficulties (i.e., forgetfulness, disorientation, poor attention and concentration), fluctuating mood (from periods of good humor switching to sudden episodes of sadness and crying spells), emotional lability and anxiety crises evolving into brief panic attacks. The Mini-cognitive Fenton Test confirmed severe dementia and the neurological evaluation showed cerebellar ataxia and partial pyramidalism. The ophthalmological examination revealed xanthelasmas, cataracts and dense arcus senilis. Xanthomas were detected in the Achillean tendons of both lower extremities. Auxiliary laboratory and densitometric tests demonstrated mixed dyslipidemia and dorsal-lumbar osteoporosis, respectively, and magnetic resonance imaging of the brain (RMC) confirmed SNC damage and suggested deposits of cholestenol, thus confirming the diagnosis of Cerebroitendinous Xanthomatosis.Se presenta el caso de una paciente de 73 años de edad que, a los 30 años aproximadamente, comenzó a quejarse de dolor al caminar, localizando la molestia a nivel de las regiones aquilianas, con subsecuente aumento de volumen; al paso del tiempo, estas molestias la obligaron a efectuar consulta médica. Los análisis de laboratorio mostraron severa dislipidemia mixta. Al lado de información de significativa declinación cognitiva, provista por familiares (vgr., (i.e., olvidos frecuentes, desorientación, atención disminuida, concentración pobre), hubo evidencia de ánimo fluctuante, labilidad emocional, crisis ansiosas evolucionando hacia ataques de pánico. El test minicognitivo de Folstein, mostró severo estado demencial y en el examen neurológico se constataron ataxia cerebelosa y signos de piramidalismo parcial. El examen oftalmológico puso en evidencia xantelasmas, cataratas y un denso arco senil. El estudio del cerebro con resonancia magnética (RM) mostró el daño encefálico y signos sugestivos de depósitos del colastenol en el SNC. La presencia de xantomas , los hallazgos oftalmológicos, la demencia definidamente progresiva y la ataxia cerebelosa fueron hallazgos clínicos que permitieron establecer el diagnóstico de xantomatosis cerebrotendinosa

Trigger efficiencies of a proposed beam monitoring detector (BeBe) for p+p collisions at NICA energies

The Multipurpose Detector (MPD) consists of a typical array of sub-detectors to study the nuclear matter originating from the collisions of beams provided by the Nuclotron-based Ion Collider fAcility (NICA). A beam monitoring detector~(BeBe) is proposed for stage 2 of MPD to increase the trigger capabilities. BeBe is constituted of two plastic scintillator disks segmented in 80 cells $\pm~2~m$ away from the interaction point of MPD. Laboratory measurements to obtain the energy resolution of an individual BeBe cell prototype are presented. It is shown that an energy resolution of $22\pm6\%$ can be obtained. Based on Monte Carlo simulations, the trigger efficiencies of the BeBe are presented for p+p collisions at 11~GeV considering a threshold in the energy loss of the charged particles reaching the detector

Dinámica de uso y cobertura del suelo en un parque nacional mexicano

To understand the dynamics of land cover at the Parque Nacional Cofre de Perote, the rates of change in land use were compared at two different scales during the period 1995-2004. At the meso scale, these patterns were studied throughout the entire Parque Nacional Cofre de Perote, which is one of the 60 priority mountains of Mexico, and an important natural protected area of the country located in the state of Veracruz. At a micro scale, the work was focused in ejido El Conejo, located within the boundaries of this national park. Federal government digital orthophotos were used to determine changes in nine categories of land use. In both, the meso- and micro-scale, it was found that the predominant land cover categories are agriculture and forest. The probabilities of land cover change at both scales are low and essentially the same for most land use categories, reflecting both small gains in forest cover park-wide as well as the effectiveness of the ejido in managing natural resources within the park. The authors consider that the findings of the study may be applicable to the broader situation of national parks in Mexico and, finally, the importance of integrating local stakeholders in the management of natural protected areas is discussedPara entender la dinámica de la cobertura del suelo en el Parque Nacional Cofre de Perote, se hizo una comparación de las tasas de cambio de uso a dos escalas durante el periodo 1995-2004. A escala meso, se estudiaron estos patrones en toda la superficie del Parque Nacional Cofre de Perote, que es una de las 60 montañas prioritarias de México y también una importante área natural protegida del país ubicada en el estado de Veracruz. A escala micro el estudio se enfocó en el ejido El Conejo que se encuentra dentro de los límites de este parque nacional. Se utilizaron ortofotos digitales del gobierno federal para determinar el cambio en nueve categorías de uso del suelo. En ambas, meso y microescalas, se encontró que las categorías predominantes de cobertura son la agricultura y el bosque. Las probabilidades de cambio de cobertura del suelo en ambas escalas son bajas y tienen valores esencialmente iguales para la mayoría de las categorías de uso, reflejando tanto pequeñas ganancias en cobertura forestal en todo el parque como la efectividad del ejido en el manejo de recursos naturales dentro del parque. Se considera que los hallazgos de este estudio pueden ser aplicables a la situación prevaleciente en los restantes parques nacionales de México; al final se discute la importancia de integrar a los actores locales en el manejo de áreas naturales protegidasS

The influence of flap design on patients’ experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review

Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane’s Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient’s perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon’s experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs

Alocação de recursos médicos em tempo de COVID-19: uma abordagem bioética

Introduction: The COVID-19 pandemic has claimed more than two million lives, leading to the collapse of health systems around the world, especially in low-income countries. As the pandemic progressed, the imbalance between the supply of and demand for medical resources created ethical dilemmas regarding how best to allocate available resources. Discussion: Peru did not have the necessary resources to deal with a pandemic like that of COVID-19, which is why its health system collapsed, showing the highest mortality rate worldwide during the first wave. Faced with the saturation of hospital services, the dilemma presented was: when, how and to whom should the few available medical resources be allocated? From a bioethical point of view, health professionals should seek to save as many lives as possible, giving priority to patients with better prognosis and those who could contribute to this aim, such as health workers. Conclusion: Identifying the ethical dilemmas that arise from the pandemic will help doctors make decisions that are close to what is considered appropriate for the group, not only of health workers, but also of patients and family members. The recommendations described here could help in making these decisions.Introducción: La pandemia de la COVID-19 ha cobrado más de dos millones de muertes, generando el colapso de los sistemas de salud en todo el mundo, especialmente en países de bajos recursos. A medida que la pandemia fue avanzando, el desequilibrio entre la oferta y la demanda de recursos médicos creó dilemas éticos relacionados con la mejor manera de asignar los recursos disponibles. Discusión: El Perú no contaba con los recursos necesarios para enfrentar una pandemia como la del COVID-19, es por ello que su sistema sanitario colapsó, mostrando la tasa de mortalidad más alta a nivel mundial durante la primera ola. Ante la saturación de los servicios hospitalarios, el dilema que se presentó fue: ¿cuándo, cómo y a quién se le debe asignar los pocos recursos médicos disponibles? Desde un punto de vista bioético, los profesionales de la salud deben buscar salvar la mayor cantidad de vidas, dando prioridad a los pacientes con mejor pronóstico y a quienes podrían contribuir a este fin, como el personal sanitario. Conclusión: La identificación de los dilemas éticos que surgen por la pandemia ayudará a los médicos a tomar decisiones cercanas a lo que se considere adecuado para el grupo, no solo de trabajadores de salud, sino también de pacientes y familiares. Las recomendaciones aquí descritas podrían ayudar a la toma de estas decisiones.Introdução: A pandemia da COVID-19 causou mais de dois milhões de mortes, causando o colapso dos sistemas de saúde em todo o mundo, especialmente em países de baixos recursos. À medida que a pandemia foi avançando, o desequilíbrio entre a oferta e a procura de recursos médicos criou dilemas éticos relacionados com a melhor maneira de alocar os recursos disponíveis. Discussão: O Peru não tinha os recursos necessários para enfrentar uma pandemia como a do COVID-19, por isso seu sistema de saúde entrou em colapso, mostrando a maior taxa de mortalidade mundial durante a primeira onda. Perante a saturação dos serviços hospitalares, o dilema que se apresentou foi: como, quando e a quem devem ser atribuídos os poucos recursos médicos disponíveis? Do ponto de vista bioético, os profissionais de saúde devem procurar salvar o maior número possível de vidas, dando prioridade aos pacientes com melhor prognóstico e aos que poderiam contribuir para este fim, como o pessoal de saúde. Conclusão: A identificação dos dilemas éticos que surgem por causa da pandemia ajudará os médicos a tomar decisões próximas ao que se considere adequado para o grupo, não só de trabalhadores da saúde, mas também de pacientes e familiares. As recomendações aqui descritas podem ajudar a tomar estas decisões

An explicit approach to conceptual density functional theory descriptors of arbitrary order

We present explicit formulas for arbitrary-order derivatives of the energy, grand potential, electron density, and higher-order response functions with respect to the number of electrons, and the chemical potential for any smooth and differentiable model of the energy versus the number of electrons. The resulting expressions for global reactivity descriptors (hyperhardnesses and hypersoftnesses), local reactivity descriptors (hyperFukui functions and local hypersoftnesses), and nonlocal response functions are easy to evaluate computationally. Specifically, the explicit formulas for global/local/nonlocal hypersoftnesses of arbitrary order are derived using Bell polynomials. Explicit expressions for global and local hypersoftness indicators up to fifth order are presented. (C) 2016 Elsevier B.V. All rights reservedVanier-CGS fellowship Ghent University CONACYT FONDECYT 114031

Age at menopause in Latin America

OBJECTIVE: To assess the age at menopause (AM) in Latin America urban areas. DESIGN: A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis. RESULTS: The mean age of the entire sample was 49.4 ± 5.5 years. Mean educational level was 9.9 ± 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P less than 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P less than 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P less than 0.001) were more prone to an earlier onset of menopause. CONCLUSIONS: The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause. © 2006 by The North American Menopause Society