Colostomía endoscópica percutánea como tratamiento de un vólvulo de sigma recidivante en paciente casi centenario

Presentamos el caso de un varón de 96 años, institucionalizado, con deterioro cognitivo avanzado y sin intervenciones quirúrgicas previas, que ingresa por vólvulo a nivel de sigma. Tras realizar descompresión endoscópica con éxito y sin incidencias, el paciente presentó dos recidivas más en las siguientes 76 horas que requirieron nueva descompresión. Tras presentar nuevo episodio y desestimar cirugía por importante comorbilidad, se decide la realización de una colostomía endoscópica percutánea mediante la técnica habitual de colocación de una gastrostomía. El manejo inicial del vólvulo de sigma consiste en la descompresión endoscópica, siendo su recurrencia muy frecuente. El tratamiento definitivo es la sigmoidectomía, que suele implicar un elevado riesgo quirúrgico en pacientes de edad avanzada y comorbilidad asociada. La colostomía endoscópica percutánea podría suponer una alternativa eficaz y segura en el manejo del vólvulo de sigma en el paciente senil, con importante comorbilidad y por lo tanto no candidato a cirugía

App de Mascotas Attila

32 páginasCon el actual movimiento de la tecnología y las tendencias mundiales, es muy importante estar al día, para así adaptarse a posibles nuevas necesidades que se creen para suplirlas y llenar un vacío a un posible consumidor. Hoy en día, el mundo tecnológico ya es parte de nuestras vidas y diario vivir, presentes en pequeñas aplicaciones que llevamos en nuestros bolsillos a donde vayamos millones de empresas logran cumplir necesidades como servicio a domicilio de lo que sea, servicios de música, de dinero virtual, entre muchas otras. De la mano con nuevas tendencias que se desarrollan con fuerza en los consumidores del siglo XXI. Siendo la humanización de las mascotas nuestro enfoque principal, en donde las familias tratan a sus mascotas como un miembro más del núcleo familiar. Nace la necesidad de buscarle pareja a las mascotas, ya sea por calmar sus impulsos instintivos o por obtener una nueva camada de cachorros que adoptar, vender o conservarlos en la familia. Tristemente, para los dueños, no hay un sitio a donde recurrir, que se enfoque en la búsqueda de la pareja, y los mismos dueños no cuentan con el tiempo para emprender el camino por ellos mismos

Bovine decellularized amniotic membrane: Extracellular matrix as scaffold for mammalian skin

Decellularized membranes (DM) were obtained from bovine amniotic membranes (BAM) using four different decellularization protocols, based on physical, chemical, and mechanical treatment. The new material was used as a biological scaffold for in vitro skin cell culture. The DM were characterized using hematoxylin-eosin assay, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR-ATR), and differential scanning calorimetry (DSC). The in vitro cytotoxicity of DM was evaluated using MTT. The efficacy of decellularization process was assessed throughDNAquantification and electrophoresis. All the used protocols showed a high effectiveness in terms of elimination of native cells, confirmed by DNA extraction and quantification, electrophoresis, and SEM, although protocol IV removes the cellular contents and preserve the native extracellular matrix (ECM) architecture which it can be considered as the most effective in terms of decellularization. FTIR-ATR and DSC on the other hand, revealed the effects of decellularization on the biochemical composition of the matrices. There was no cytotoxicity and the biological matrices obtained were a source of collagen for recellularization. The matrices of protocols I, II, and III were degraded at day 21 of cell culture, forming a gel. The biocompatibility in vitro was demonstrated; hence these matrices may be deemed as potential scaffold for epithelial tissue regeneration

Wind power generation in the urban environment

A raíz del continuo desarrollo de la generación eólica, así como tambiénde la descentralización de esta; el presente trabajo analiza el potencialeólico en terrazas de edificios a partir de ensayos experimentales entúnel de viento. Los ensayos consistieron en visualizaciones medianteinyección de humo y mediciones con anemometría de hilo calientedel campo de velocidad en la terraza de un edificio típico en laregión latinoamericana, así como la influencia de diferentes edificioscercanos. Se realizaron mediciones para configuraciones especificasde dos edificios, donde el primero se considera obstáculo ubicadoúnicamente a barlovento, pudiendo modificar su altura respecto aledificio en estudio. Con las mediciones realizadas se cuantificaronvelocidades medias y fluctuaciones en distintas ubicaciones sobrela terraza y se seleccionaron las ubicaciones más favorables parala colocación de aerogeneradores. Se encontró una gran influenciade la altura del obstáculo en las velocidades medias y turbulencias,con lo cual la elección de dichas ubicaciones dependerá del entornocircundante.In accordance with the continuous developments in wind energy, and the decentralization in its production, the present work analyzes the wind energy potential in the building roofs through experimental tests in a wind tunnel. These tests involve two different methods, visualizations with smoke injection and hot-wire measurements of the velocity field, over the roof of a building model with the characteristics of the most relevant buildings in Latin-America. Additionally, the influence of a windward obstacle of different heights was studied. Mean velocities and fluctuation were identified with the tests over different locations in the roof of the test model and the most favorable for the wind energy production were identified. An important influence of the obstacle height in the mean and fluctuations influence was found, showing a dependency of the most favorable location for the wind energy production with respect to the closest environment.Fil: Padilla Segura, Victor Manuel. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Algozino, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Marañon Di Leo, Julio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Delnero, Juan Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Mantelli, Pablo Marcelo. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; Argentin

Experimental study for the optimization of wind generation in the urban environment

A raíz del continuo desarrollo de la generación eólica, así como también de la descentralización en la generación de esta; el presente trabajo analiza el potencial eólico en terrazas de edificios a partir de ensayos experimentales en túnel de viento. Los ensayos consistieron en visualizaciones mediante inyección de humo y mediciones con anemometría de hilo caliente, del campo de velocidades en las terrazas de un edificio típico en la región latinoamericana, así como la influencia de diferentes edificios cercanos. Se realizaron mediciones para una configuración específica de dos edificios, donde el primero se considera obstáculo ubicado únicamente a barlovento pudiendo modificar su altura respecto al edificio en estudio. Con las mediciones realizadas se cuantificaron velocidades medias y fluctuaciones en distintas ubicaciones sobre la terraza y se seleccionaron las ubicaciones más favorables para la colocación de aerogeneradores. Se encontró una gran influencia de la altura del obstáculo en las velocidades medias y turbulencias, con lo cual la elección de dichas ubicaciones dependerá del entorno circundante.As a result of the continuous development of the wind generation, as well as of the decentralization in the generation of this; The present work analyzes the wind potential in terraces of buildings from experimental tests in wind tunnel. The tests consisted of visualizations by smoke injection and measurements with anemometry of hot wire, of the velocity field on the terraces of a typical building in the Latin American region, as well as the influence of different nearby buildings. Measurements were made for a specific configuration of two buildings, where the first one is considered an obstacle located only to windward, being able to modify its height with respect to the building under study. With the measurements made, average speeds and fluctuations were quantified in different locations on the terrace and the most favorable locations were selected for the placement of wind turbines. A great influence of the height of the obstacle in the average speeds and turbulences was found, with which the election of said locations will depend on the surrounding environment.Fil: Padilla Segura, Victor. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Algozino, Santiago. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Marañon Di Leo, Julio. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Delnero, Juan Sebastian. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Mantelli, Pablo Marcelo. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; ArgentinaFil: Gamarra, Ariel Nicolas. Universidad Nacional de La Plata. Facultad de Ingeniería. Departamento de Aeronáutica. Laboratorio de Capa Límite y Fluído Dinámica Ambiental; Argentin

Potential ecological and socio-economic effects of a novel megaherbivore introduction: the hippopotamus in Colombia

Introduced species can have strong ecological, social and economic effects on their non-native environment. Introductions of megafaunal species are rare and may contribute to rewilding efforts, but they may also have pronounced socio-ecological effects because of their scale of influence. A recent introduction of the hippopotamus Hippopotamus amphibius into Colombia is a novel introduction of a megaherbivore onto a new continent, and raises questions about the future dynamics of the socio-ecological system into which it has been introduced. Here we synthesize current knowledge about the Colombian hippopotamus population, review the literature on the species to predict potential ecological and socio-economic effects of this introduction, and make recommendations for future study. Hippopotamuses can have high population growth rates (7–11%) and, on the current trajectory, we predict there could be 400–800 individuals in Colombia by 2050. The hippopotamus is an ecosystem engineer that can have profound effects on terrestrial and aquatic environments and could therefore affect the native biodiversity of the Magdalena River basin. Hippopotamuses are also aggressive and may pose a threat to the many inhabitants of the region who rely upon the Magdalena River for their livelihoods, although the species could provide economic benefits through tourism. Further research is needed to quantify the current and future size and distribution of this hippopotamus population and to predict the likely ecological, social and economic effects. This knowledge must be balanced with consideration of social and cultural concerns to develop appropriate management strategies for this novel introduction

Ocular Involvement in Friedreich Ataxia Patients and its Relationship with Neurological Disability, a Follow-up Study

Background: This study compared functional and structural visual changes in Friedreich ataxia (FRDA) patients with healthy controls (HC) and correlated these changes with neurological disability. Methods: Eight FRDA Spanish patients and eight HC were selected from 2014 to 2018. Best corrected visual acuity (BCVA), visual field (VF), optic coherence tomography (OCT), and neurological disability measured by “scale for the assessment and rating of ataxia” (SARA) were taken in a basal exploration and repeated after 6 months. A linear mixed analysis and Bonferroni p-value correction were performed. Results: FRDA baseline and follow-up patients showed statistically significant decreases in BCVA, VF, and OCT parameters compared with the HC. Some of the VF measurements and most of the OCT parameters had an inverse mild-to-strong correlation with SARA. Moreover, the analysis of the ROC curve demonstrated that the peripapillary retinal nerve fiber layer (pRNFL) average thickness was the best parameter to discriminate between FRDA patients and HC. Conclusions: The follow-up study showed a progression in OCT parameters. Findings showed a sequential effect in pRNFL, ganglion cell complex (GCC), and macula. The VF and the OCT could be useful biomarkers in FRDA, both for their correlation with neurological disease as well as for their ability to evaluate disease progression

Changes in Retinal OCT and Their Correlations with Neurological Disability in Early ALS Patients, a Follow-Up Study

Background: To compare early visual changes in amyotrophic lateral sclerosis (ALS) patients with healthy controls in a baseline exploration, to follow-up the patients after 6 months, and to correlate these visual changes with neurological disability. Methods: All patients underwent a comprehensive neurological and ophthalmological examination. A linear mixed analysis and Bonferroni p-value correction were performed, testing four comparisons as follows: Control baseline vs. control follow-up, control baseline vs. ALS baseline, control follow-up vs. ALS follow-up, and ALS baseline vs. ALS follow-up. Results: The mean time from the diagnosis was 10.80 ± 5.5 months. The analysis of the optical coherence tomography (OCT) showed: (1) In ALS baseline vs. control baseline, a macular significantly increased thickness of the inner macular ring temporal and inferior areas; (2) in ALS follow-up vs. ALS baseline, a significant macular thinning in the inner and outer macular ring inferior areas; (3) in ALS follow-up vs. ALS baseline, a significant peripapillary retinal nerve fiber layer (pRNFL) thinning in the superior and inferior quadrants; and (4) ALS patients showed a moderate correlation between some OCT pRNFL parameters and Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) score. Conclusion: The OCT showed retinal changes in patients with motoneuron disease and could serve as a complementary tool for studying ALS

Neuro-Ophthalmological Findings in Friedreich’s Ataxia

Friedreich ataxia (FRDA) is a progressive neurodegenerative disease caused by a severe autosomal recessive genetic disorder of the central nervous (CNS) and peripheral nervous system (PNS), affecting children and young adults. Its onset is before 25 years of age, with mean ages of onset and death between 11 and 38 years, respectively. The incidence is 1 in 30,000–50,000 persons. It is caused, in 97% of cases, by a homozygous guanine-adenine-adenine (GAA) trinucleotide mutation in the first intron of the frataxin (FXN) gene on chromosome 9 (9q13–q1.1). The mutation of this gene causes a deficiency of frataxin, which induces an altered inflow of iron into the mitochondria, increasing the nervous system’s vulnerability to oxidative stress. The main clinical signs include spinocerebellar ataxia with sensory loss and disappearance of deep tendon reflexes, cerebellar dysarthria, cardiomyopathy, and scoliosis. Diabetes, hearing loss, and pes cavus may also occur, and although most patients with FRDA do not present with symptomatic visual impairment, 73% present with clinical neuro-ophthalmological alterations such as optic atrophy and altered eye movement, among others. This review provides a brief overview of the main aspects of FRDA and then focuses on the ocular involvement of this pathology and the possible use of retinal biomarkers

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London