Íleo Biliar, reporte de un caso y revisión de la bibliografía

El íleo biliar constituye una complicación de la colelitiasis, causada por la impactación de un cálculo a nivel del lumen intestinal, provocando obstrucción intestinal mecánica, presenta una tasa de morbilidad del 50% y mortalidad del 12%-27%, con predominio en mujeres sobre hombres en relación 3.5-3.6:1. Se trata de un paciente masculino de 52 años, con antecedente de derrame cerebral hace 1 año, con clínica de 7 días de evolución de dolor abdominal difuso de moderada intensidad 7-8 en la escala de Eva, localizado en fosa ilíaca derecha, acompañado de vómito, alza térmica e hiporexia. Al examen físico, se evidenció: abdomen blando, depresible, doloroso a la palpación superficial y profunda en flanco y fosa iliaca derecha, ruidos hidroaéreos disminuidos, mcburney +, blumberg + y puño percusión bilateral +. Se realizó exámenes de laboratorio con evidencia de leucocitosis más neutrofilia, Rx de abdomen con distención de asas intestinales y niveles hidroaéreos, ecografía abdominal con signos sugestivos de íleo paralitico y apendicitis aguda.   Por los hallazgos en el examen físico y estudios radiológicos, se decidió realizar una laparotomía exploratoria con evidencia de presencia de 2 litos (6cm) impactados a nivel de la válvula ileocecal causando obstrucción total de la luz intestinal y apéndice cecal eritematosa y se realizó enterotomía y extracción de litos + rafia primaria en 2 planos, apendicetomía convencional, con postoperatorio convencional y sin complicaciones. Conclusión: Se trata de una patología con alta morbilidad y mortalidad, que presenta diferentes manejos quirúrgicos, la evidencia muestra que la enterotomía sola presenta resultados favorables

Hernia de Amyand, presentación de un caso y revisión de la bibliografía

La hernia inguinal es una de las patologías mas frecuentes para el cirujano general; sin embargo, no siempre la presentación clínica de la enfermedad es la misma, pudiendo tener algunas variables, como se presenta en el siguiente reporte. La hernia de Amyand, es una entidad clínica infrecuente de la hernia inguinal, estimando que su prevalencia es alrededor del 1%. Se trata de un paciente de 56 años de edad, que acude a consulta externa del Hospital Teodoro Maldonado Carbo por presentar hace 2 años tumoración a nivel de región inguinal derecha, la misma que con el tiempo aumentado de tamaño, se acompaña de dolor local de moderada intensidad.   Mediante el examen físico y ecografía de región inguinal, se evidencio una hernia inguinal indirecta Nyhus tipo II cuyo contenido era epiploico y apéndice cecal. Por lo cual se programa cirugía electiva donde se realiza plastia inguinal derecha con técnica de Lichtestein sin apendicetomía. La presente publicación tiene la intensión de informar sobre un caso y revisar estrategias para el tratamiento quirúrgico

Terapia de Mindfulness y Compasión en la salud mental de mujeres víctima de violencia doméstica

Many researchers agree that domestic violence exercised culturally by men against women has psychological consequences on them; the abuse has its origin in behaviors and attitudes that are different in each case, demonstrating that physical abuse, economic abuse, sexual abuse, Verbal and psychological abuse, emotional blackmail, among others. In Ecuador the rates of violence are very high, being a population in which certain violent behaviors are culturally covered up and over time have become normalized. The objective of this work is to analyze the clinical usefulness of the intervention based on mindfulness and compassion therapy in women victims of domestic violence in Jipijapa, Ecuador. Mindfulness is a third generation therapy that seeks to enable those who practice it to consciously pay attention to the experience in the present moment, with a different attitude to the negative experience; Compassion therapy is a response to suffering that has only one direction, which is to heal the suffering, and its practice encourages an attitude of care towards oneself. The intervention program consists of 3 stages, each one has a number of sessions assigned with defined objectives; The first stage has 2 sessions, the second stage consists of 8 sessions and the third stage has 1 session. The purpose is to evaluate the changes in the levels of anxiety, depression and self-compassion that the participants have pre and post treatment, therefore questionnaires will be applied that will measure the aforementioned dimensions.Muchos investigadores coinciden que la violencia doméstica ejercida culturalmente de hombres a mujeres tiene consecuencias psicológicas en ellas, los abusos tienen su origen en conductas y actitudes que son diferentes en cada caso, demostrando que el maltrato físico, el abuso económico, el abuso sexual, el maltrato verbal y psicológico, el chantaje emocional, entre otras. En Ecuador los índices de violencia son muy elevados, siendo una población en la que culturalmente se encubre y con el paso del tiempo se ha normalizado ciertas conductas violentas. El presente trabajo tiene por objetivo analizar la utilidad clínica de la intervención basada en la terapia de mindfulness y compasión en mujeres víctima de violencia doméstica en Jipijapa, Ecuador. Mindfulness es una terapia de tercera generación que busca que quien la practique pueda prestar atención de manera consciente a la experiencia en el momento presente, con una actitud diferente a la experiencia negativa; la terapia de compasión es una respuesta al sufrimiento que tiene una sola dirección, que es sanar el sufrimiento, y su práctica fomenta una actitud de cuidado hacia uno mismo. El programa de intervención consta de 3 etapas, cada una tiene un número de sesiones asignadas con objetivos delimitados; la primera etapa tiene 2 sesiones, la segunda etapa consta de 8 sesiones y la tercera etapa 1 sesión. La finalidad es evaluar los cambios en los niveles de ansiedad, depresión y autocompasión que tengan las participantes pre y post tratamiento por ello se aplicarán cuestionarios que medirán las dimensiones antes mencionadas

Selective sweeps on novel and introgressed variation shape mimicry loci in a butterfly adaptive radiation.

Natural selection leaves distinct signatures in the genome that can reveal the targets and history of adaptive evolution. By analysing high-coverage genome sequence data from 4 major colour pattern loci sampled from nearly 600 individuals in 53 populations, we show pervasive selection on wing patterns in the Heliconius adaptive radiation. The strongest signatures correspond to loci with the greatest phenotypic effects, consistent with visual selection by predators, and are found in colour patterns with geographically restricted distributions. These recent sweeps are similar between co-mimics and indicate colour pattern turn-over events despite strong stabilising selection. Using simulations, we compare sweep signatures expected under classic hard sweeps with those resulting from adaptive introgression, an important aspect of mimicry evolution in Heliconius butterflies. Simulated recipient populations show a distinct 'volcano' pattern with peaks of increased genetic diversity around the selected target, characteristic of sweeps of introgressed variation and consistent with diversity patterns found in some populations. Our genomic data reveal a surprisingly dynamic history of colour pattern selection and co-evolution in this adaptive radiation

A coarse-grained force field for Protein–RNA docking

The awareness of important biological role played by functional, non coding (nc) RNA has grown tremendously in recent years. To perform their tasks, ncRNA molecules typically unite with protein partners, forming ribonucleoprotein complexes. Structural insight into their architectures can be greatly supplemented by computational docking techniques, as they provide means for the integration and refinement of experimental data that is often limited to fragments of larger assemblies or represents multiple levels of spatial resolution. Here, we present a coarse-grained force field for protein-RNA docking, implemented within the framework of the ATTRACT program. Complex structure prediction is based on energy minimization in rotational and translational degrees of freedom of binding partners, with possible extension to include structural flexibility. The coarse-grained representation allows for fast and efficient systematic docking search without any prior knowledge about complex geometry

Host life-history traits predict haemosporidian parasite prevalence in tanagers (Aves: Thraupidae)

Vector-borne parasites are important ecological drivers influencing life-history evolution in birds by increasing host mortality or susceptibility to new diseases. Therefore, understanding why vulnerability to infection varies within a host clade is a crucial task for conservation biology and for understanding macroecological life-history patterns. Here, we studied the relationship of avian life-history traits and climate on the prevalence of Plasmodium and Parahaemoproteus parasites. We sampled 3569 individual birds belonging to 53 species of the family Thraupidae. Individuals were captured from 2007 to 2018 at 92 locations. We created 2 phylogenetic generalized least-squares models with Plasmodium and Parahaemoproteus prevalence as our response variables, and with the following predictor variables: climate PC1, climate PC2, body size, mixed-species flock participation, incubation period, migration, nest height, foraging height, forest cover, and diet. We found that Parahaemoproteus and Plasmodium prevalence was higher in species inhabiting open habitats. Tanager species with longer incubation periods had higher Parahaemoproteus prevalence as well, and we hypothesize that these longer incubation periods overlap with maximum vector abundances, resulting in a higher probability of infection among adult hosts during their incubation period and among chicks. Lastly, we found that Plasmodium prevalence was higher in species without migratory behaviour, with mixed-species flock participation, and with an omnivorous or animal-derived diet. We discuss the consequences of higher infection prevalence in relation to life-history traits in tanagers.Fil: Aguiar de Souza Penha, Victor. Universidade Federal do Paraná; BrasilFil: Maia Chaves Bicalho Domingos, Fabricius. Universidade Federal do Paraná; BrasilFil: Fecchio, Alan. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagónica. Universidad Nacional de la Patagonia "San Juan Bosco". Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Bell, Jeffrey A.. University of South Dakota; Estados UnidosFil: Weckstein, Jason D.. No especifíca;Fil: Ricklefs, Robert E.. University of Missouri; Estados UnidosFil: Martins Braga, Erika. Universidade Federal de Minas Gerais; BrasilFil: de Abreu Moreira, Patrícia. Universidade Federal de Ouro Preto; BrasilFil: Soares, Leticia. University of Western Australia; AustraliaFil: Latta, Steven. No especifíca;Fil: Tolesano Pascoli, Graziela. Universidade do Brasília; BrasilFil: Alquezar, Renata Duarte. Universidade do Brasília; BrasilFil: Del Claro, Kleber. Universidade Federal de Uberlandia; BrasilFil: Tonelli Manica, Lilian. Universidade Federal do Paraná; Brasi

A functional definition to distinguish ponds from lakes and wetlands

Ponds are often identified by their small size and shallow depths, but the lack of a universal evidence-based definition hampers science and weakens legal protection. Here, we compile existing pond definitions, compare ecosystem metrics (e.g., metabolism, nutrient concentrations, and gas fluxes) among ponds, wetlands, and lakes, and propose an evidence-based pond definition. Compiled definitions often mentioned surface area and depth, but were largely qualitative and variable. Government legislation rarely defined ponds, despite commonly using the term. Ponds, as defined in published studies, varied in origin and hydroperiod and were often distinct from lakes and wetlands in water chemistry. We also compared how ecosystem metrics related to three variables often seen in waterbody definitions: waterbody size, maximum depth, and emergent vegetation cover. Most ecosystem metrics (e.g., water chemistry, gas fluxes, and metabolism) exhibited nonlinear relationships with these variables, with average threshold changes at 3.7 ± 1.8 ha (median: 1.5 ha) in surface area, 5.8 ± 2.5 m (median: 5.2 m) in depth, and 13.4 ± 6.3% (median: 8.2%) emergent vegetation cover. We use this evidence and prior definitions to define ponds as waterbodies that are small (< 5 ha), shallow (< 5 m), with < 30% emergent vegetation and we highlight areas for further study near these boundaries. This definition will inform the science, policy, and management of globally abundant and ecologically significant pond ecosystems.Fil: Richardson, David C.. State University of New York at New Paltz; Estados UnidosFil: Holgerson, Meredith A.. Cornell University; Estados UnidosFil: Farragher, Matthew J.. University of Maine; Estados UnidosFil: Hoffman, Kathryn K.. No especifíca;Fil: King, Katelyn B. S.. Michigan State University; Estados UnidosFil: Alfonso, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Andersen, Mikkel R.. No especifíca;Fil: Cheruveil, Kendra Spence. Michigan State University; Estados UnidosFil: Coleman, Kristen A.. University of York; Reino UnidoFil: Farruggia, Mary Jade. University of California at Davis; Estados UnidosFil: Fernandez, Rocio Luz. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Hondula, Kelly L.. No especifíca;Fil: López Moreira Mazacotte, Gregorio A.. Leibniz - Institute of Freshwater Ecology and Inland Fisheries; AlemaniaFil: Paul, Katherine. No especifíca;Fil: Peierls, Benjamin L.. No especifíca;Fil: Rabaey, Joseph S.. University of Minnesota; Estados UnidosFil: Sadro, Steven. University of California at Davis; Estados UnidosFil: Sánchez, María Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; ArgentinaFil: Smyth, Robyn L.. No especifíca;Fil: Sweetman, Jon N.. State University of Pennsylvania; Estados Unido

Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

OBJECTIVES: The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant's ability to apply PI-QUAL. METHODS: Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. RESULTS: There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50-0.66]) to post-teaching (0.96 [0.92-0.98]), an improvement of 0.37 [0.21-0.41] (p < 0.001). CONCLUSIONS: A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. KEY POINTS: • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations

Identification of Lynch syndrome among patients with colorectal cancer

CONTEXT: Lynch syndrome is the most common form of hereditary colorectal cancer (CRC) and is caused by germline mutations in DNA mismatch repair (MMR) genes. Identification of gene carriers currently relies on germline analysis in patients with MMR-deficient tumors, but criteria to select individuals in whom tumor MMR testing should be performed are unclear. OBJECTIVE: To establish a highly sensitive and efficient strategy for the identification of MMR gene mutation carriers among CRC probands. DESIGN, SETTING, AND PATIENTS: Pooled-data analysis of 4 large cohorts of newly diagnosed CRC probands recruited between 1994 and 2010 (n = 10,206) from the Colon Cancer Family Registry, the EPICOLON project, the Ohio State University, and the University of Helsinki examining personal, tumor-related, and family characteristics, as well as microsatellite instability, tumor MMR immunostaining, and germline MMR mutational status data. MAIN OUTCOME: Performance characteristics of selected strategies (Bethesda guidelines, Jerusalem recommendations, and those derived from a bivariate/multivariate analysis of variables associated with Lynch syndrome) were compared with tumor MMR testing of all CRC patients (universal screening). RESULTS: Of 10,206 informative, unrelated CRC probands, 312 (3.1%) were MMR gene mutation carriers. In the population-based cohorts (n = 3671 probands), the universal screening approach (sensitivity, 100%; 95% CI, 99.3%-100%; specificity, 93.0%; 95% CI, 92.0%-93.7%; diagnostic yield, 2.2%; 95% CI, 1.7%-2.7%) was superior to the use of Bethesda guidelines (sensitivity, 87.8%; 95% CI, 78.9%-93.2%; specificity, 97.5%; 95% CI, 96.9%-98.0%; diagnostic yield, 2.0%; 95% CI, 1.5%-2.4%; P < .001), Jerusalem recommendations (sensitivity, 85.4%; 95% CI, 77.1%-93.6%; specificity, 96.7%; 95% CI, 96.0%-97.2%; diagnostic yield, 1.9%; 95% CI, 1.4%-2.3%; P < .001), and a selective strategy based on tumor MMR testing of cases with CRC diagnosed at age 70 years or younger and in older patients fulfilling the Bethesda guidelines (sensitivity, 95.1%; 95% CI, 89.8%-99.0%; specificity, 95.5%; 95% CI, 94.7%-96.1%; diagnostic yield, 2.1%; 95% CI, 1.6%-2.6%; P < .001). This selective strategy missed 4.9% of Lynch syndrome cases but resulted in 34.8% fewer cases requiring tumor MMR testing and 28.6% fewer cases undergoing germline mutational analysis than the universal approach. CONCLUSION: Universal tumor MMR testing among CRC probands had a greater sensitivity for the identification of Lynch syndrome compared with multiple alternative strategies, although the increase in the diagnostic yield was modest

Riscos coletivos e impacto do uso de agrotóxicos sobre a saúde humana e ambiental: um estudo piloto de saúde ocupacional

Este artigo mostra os resultados obtidos em um projeto de avaliação do impacto do uso de agrotóxicos sobre uma comunidade agrícola do cstado do Rio dc Janciro ativamcntc cnvolvida com o uso dc pcsticidas. A abordagem utilizada foi de avaliaçào de riscos ocupacionais e coletivos. já que além do grupo de trabalhadores ocupacionalmente cxpostos aos agrotóxicos. também foi avaliado um grupo de crianças ejovens da comunidade. alguns dos quais também trabalhadores rurais. Os resultados obtidos demonstram claramente que ocorre superexposição aos pesticidas utilizados. evidenciando agravos nào só à saúde das populações expostas. mas também ao meio ambiente