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A discrete event simulation-optimization heuristic is presented for configuring a selective pallet rack system. To the rack system under study pallets arrive dynamically over time to be stored for a given period of time. The storage duration, arrival time and pallet height are assumed to be continuous random variables with known density functions. In such a system, if there is no available slot in the rack to store an arriving pallet, it is placed on the floor. The proposed heuristic aims at minimizing the number of racking banks needed so that the long term proportion of pallets that are placed in a rack slot reaches a minimum pre-specified value. The computational experiments conducted suggest that the proposed heuristic effectively solves the problem under study.En este artículo se presenta un heurístico de simulación-optimización para la configuración de un sistema de almacenamiento en estantería selectiva simple. Al sistema de almacenamiento objeto del estudio llegan pallets dinámicamente en el tiempo para ser almacenados por un periodo de tiempo. Se asume que la duración del almacenamiento, el instante de llegada y la altura de los pallets son variables aleatorias continuas con funciones de densidad conocidas. En este sistema, si al momento de llegada de un pallet no hay disponible una posición en la estantería en la que éste se pueda almacenar, el pallet se almacena en el suelo. El heurístico propuesto busca minimizar en el número de módulos de estantería necesarios de tal manera que en el largo plazo la proporción de pallets ubicados en la estantería alcance un valor mínimo preestablecido. Los experimentos computacionales llevados a cabo sugieren que el heurístico propuesto es efectivo para resolver el problema en estudio.

El objetivo central del presente trabajo es encontrar las expresiones analíticas para el cálculo de la probabilidad de detección correcta y de falsa alarma de un detector digital no lineal, usado como elemento central en la etapa de detección, de un receptor que procesa señales de comunicación y navegación para bajos niveles de relación señal a ruido y altos corrimientos Doppler. Para ello se encontrará el espectro energético del cuadrado de la envolvente compleja del proceso entrante y la p.d.f resultante en la salida del procesador de Fourier. Dichos resultados permiten graficar las curvas de detección de la señal, para una probabilidad de alarma falsa dada, y comparar con resultados obtenidos experimentalmente en simulación.

La Hospitalización a Domicilio (HAD) es una opción asistencial que posibilita proporcionar cuidados propios de un hospital en el domicilio del paciente. El soporte nutricional (SN) -enteral por sonda o parenteral- suele indicarse en pacientes de edad avanzada y/o severamente discapacitados por lo que la nutrición artificial cobra gran interés en la atención domiciliaria. Objetivos: Analizar las características de los pacientes, atendidos en el domicilio, por cuestiones específicas del SN que reciben. Material y métodos: Estudio descriptivo, observacional y retrospectivo de los pacientes atendidos por la Unidad de Soporte Nutricional (SN), en el ámbito de la HAD, desde el 1 de Septiembre del 2006 hasta el 31 de Agosto del 2007. Resultados: En el domicilio del paciente el procedimiento realizado fue: recambio de sonda de ostomia en 158 ocasiones; modificación de la pauta de nutrición enteral (NE) o nutrición parenteral (NP) en 53 casos; adiestramiento de la técnica de nutrición artificial en 14 casos. Se realizaron 39 visitas urgentes por complicaciones -fundamentalmente por infección o incontinencia del estoma y por obstrucción de la sonda-. Sólo en 3 pacientes (7,7%) la asistencia domiciliaria indicó el traslado del paciente al Servicio de Urgencias. Conclusión: En nuestro centro, la infraestructura de la HAD ha permitido dar respuesta a las necesidades de los pacientes que reciben SN domiciliario en nuestra área de influencia.The Hospital at Home (HAD) is a choice of care that enables own care in a hospital at home patient. Moreover, the nutritional support (NS) -enteral or parenteral nutrition- is usually indicated in patients with serious underlying disease, and/or frequently remain severely disabled. Aims: To analyze the characteristics of the patients, attended at home for specific questions of the NS that receive. Material and methods: descriptive and retrospective study of the patients attended by the Nutritional Support Unit (NSU), in the area of the HAD, from September 1, 2006 until August 31, 2007. Results: At home, the realized procedure was: refill of gastrostomia or jejunostomia feeding tube in 158 cases; modification of the guideline of enteral nutrition (EN) or parenteral nutrition (PN) in 53 cases; training of the skill of artificial nutrition in 14 cases. 39 visits were realized by complications -by infection or lead throught the estoma and by obstruction of the feeding tube-. Only in 3 patients (7.7%) the domiciliary assistance indicated the movement of the patient to the Emergency Unit. Conclusion: In our center, the infrastructure of the HAD has allowed to give answer to the needs of the patients who receive NS at home in our area of influence.

The family Calliphoridae is widely known to lead the colonization of corpses and their development rates are frequently used to estimate the postmortem interval. This study presents the larval growth of five forensically important species of Calliphoridae in Colombia. Rearing took place in semicontrolled field conditions where the egg masses were collected. We show curves of larval growth, larval length and time intervals to reach all immature stages for Lucilia eximia and Cochliomyia macellaria at two sites with different climatic conditions and for Chrysomya albiceps, Chrysomya megacephala and Calliphora nigribasis at one site. Overall, high temperatures speeded up the development of the species reared at two different sites, whereas low temperatures for C. nigribasis, lengthened the total development time. Differences between this study and others can be explained by the experimental conditions in the field without the possibility of strict laboratory rearing controls.La familia Calliphoridae es ampliamente conocida por liderar la colonización de los cadáveres y sus tasas de desarrollo son frecuentemente utilizadas para estimar el intervalo postmortem. Este estudio presenta el crecimiento larval de cinco especies de Calliphoridae de importancia forense en Colombia, considerando que la cría se dio en condiciones de campo semicontroladas en los lugares donde las masas de huevos fueron colectadas. Mostramos también, los intervalos de longitud y el tiempo empleado en alcanzar todos los estadios inmaduros para Lucilia eximia y Cochliomyia macellaria en dos lugares con diferentes condiciones climáticas y Chrysomya albiceps, Chrysomya megacephala y Calliphora nigribasis, en un solo lugar. En general, las altas temperaturas producen una aceleración en el desarrollo de las especies criadas en dos sitios diferentes, mientras que bajas temperaturas para C. nigribasis, alargaron el tiempo utilizado para completar el desarrollo. Las diferencias entre este estudio y otros, pueden estar dadas por las condiciones experimentales presentadas en campo sin los controles estrictos que son posibles durante la cría en laboratorio.

En este trabajo se presenta un procedimiento que permite establecer el comportamiento del throughput de los usuarios de datos de una estación base celular en operación, como una función de la relación señal a ruido más interferencia utilizando el método Monte Carlo. Se inicia indicando un diagrama de flujo con las tareas principales, posteriormente se describe cada tarea y se complementa con un ejemplo aplicado al caso de estudio. Finalmente, los resultados obtenidos con la aplicación del método son presentados. El método muestra cómo se pueden combinar las mediciones reales de campo con la simulación para conocer las posibilidades de servicio HSDPA de la estación base y su comportamiento bajo diferentes situaciones, economizando tiempo del ingeniero de diseño y facilitando la realización de diferentes pruebas difíciles de probar experimentalmente en campo.

Paciente de 14 años, proveniente de Apartadó (Antioquia), remitido al Hospital Pablo Tobón Uribe de Medellín por un cuadro febril agudo asociado a deterioro rápido del estado de conciencia, decantándose posteriormente como causa de su deterioro una ameba de vida libre (Naegleria fowleri) . Las amebas de vida libre son una causa etiológica poco común de meningitis, tienen un curso fulminante y requieren de un alto índice de sospecha para hacer un tratamiento oportuno.

Objective: To assess depressive symptoms in men deprived from freedom in a prison in a Colombian intermediate city. Material and Method: A cross sectional study was performed on a sample of three hundred and three patients in the Medium Security penitentiary and Prison Facility of the city of Manizales between April and May 2014. The information was collected through the Zung self-rating depression scale (SDS), subsequently there were established the positive results for depression screening according to the final score of the scale. Results: 303 men deprived from freedom were evaluated, mean age of 32.96 years +/- 10.8 years, 43.5% were living in cohabitation, 38% were single and 10.2% married; 33.7% had a primary education, 58% had secondary or incomplete secondary education, 5.6% reported higher studies; 38.6% (95% CI: 35.8; 41.4) reported symptoms of depression, predominating in ages between 18 to 44 years, no statistically significant differences p> 0.05 between the variables analyzed were found. Conclusions: The results of this study give rise to clinical evaluation, by specialized staff in the area of psychiatry and his intervention, given the characteristics of self-reported depression for this population.

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome. This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia., (Copyright © 2020 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Pediatric kidney transplant patients have an increased risk of developing arterial hypertension, dyslipidemia, carbohydrate intolerance and diabetes mellitus, risk factors associated with increased cardiovascular morbidity and mortality., Objective: This study evaluates the frequency of arterial hypertension, dyslipidemia and alteration in carbohydrate metabolism in a cohort of pediatric kidney transplant patients during 2006-2016 at the Pablo Tobon Uribe Hospital, in Colombia., Material and Methods: Retrospective descriptive study in which descriptive statistics were used. Additionally, a bivariate analysis was performed to compare patients according to the outcome of arterial hypertension, dyslipidemia and alteration in carbohydrate metabolism., Results: From a total of 48 pediatric kidney transplants in the period studied, complete information was obtained from 43 patients at one year of follow-up. There was a post-transplant frequency of hypertension of 86%, dyslipidemia 48%, carbohydrate intolerance 14% and diabetes of 2%., Conclusions: In the evaluated cohort a high frequency of arterial hypertension and dyslipidemia was found after kidney transplantation. The development of early diagnosis and treatment guidelines is suggested to reduce the impact of these diseases associated with cardiovascular risk in adult life., (Copyright: © 2020 Revista Medica del Instituto Mexicano del Seguro Social.)

Objective: To analyze the psychological, social and family dimensions of a health professional quarantined by COVID-19., Method: Case report. A matrix was used as a daily log to collect information from the three dimensions analyzed. The anonymity of the person was respected at all times., Results: A case study is presented with the main milestones in the daily life of a health professional during the 14 days of quarantine. In the psychological dimension, feelings of fear and uncertainty in the face of risk are highlighted, in the social dimension the importance of the accompaniment of family and friends who strengthened the adaptability to the process stands out, and in the family dimension the relevance of affective bonds and permanent communication., Conclusion: The aspects developed in the different dimensions should be considered by those who participate in the management and follow-up of cases in primary care, as they are the possibility of strengthening the neuronal and hormonal mechanism through family and social support. Being a health professional and having knowledge on the subject can generate a greater effect of involuntary isolation related to the risk of COVID-19. This is not only clinical, but also psychological, social and family. In this sense those who manage the cases should consider the integrality in health conditions.

Objective: To show the experience of the use of hepatobiliary scintigraphy in patients with suspected complications after liver transplantation in a high complexity centre., Material and Method: Retrospective, observational and descriptive study. All consecutive adult patients with liver transplantation between January 2013 and February 2018 were included, with one or more hepatobiliary scintigraphy during the early or late postoperative period. A total of 58 studies were analyzed in 38 patients (22 men and 16 women). Mean age: 48 years. In 34/38: cadaverous donor (89%), and in 4 (11%): a living donor. Demographic data and relevant information regarding the transplant were obtained, and the result was related to the surgical findings to determine the correlation between them. The influence of the test on the final clinical decisions was evaluated., Results: Findings: 9 scans (14%) were normal, 36 studies were negative, and 21 were positive for biliary complications. Of the total of 58 studies, 50 (86%) had impact on the clinical behaviour of observation or intervention. All the patients with findings of biliary complications (21/21; 100%) had clinical repercussion since 18/21 patients were taken to invasive studies or treatments, and 3/21 patients continued in medical management for findings of non-surgical biliary complications. In 14/18 patients taken to studies or procedures, correlation was found with the scintigraphic study. In 24/36 (66%) of patients with negative scintigraphy, an impact on clinical behaviour was found., Conclusion: Hepatobiliary scintigraphy is a simple, non-invasive, reliable, current and available form for the early study of biliary complications in patients with liver transplantation. Important hepatocellular dysfunction should be taken into account as a frequent cause of false negative studies., (Copyright © 2019 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To obtain versions adapted to the Colombian context of the Primary Care Assessment Tools Child Edition and Adult Edition questionnaires (PCAT-CE and PCAT-AE, respectively) to assess the functions of primary care with equivalence to their original versions., Methods: Transcultural adaptation process based on the adapted versions in Spanish validated in Argentina, Uruguay and Spain, in agreement with the Ibero-American Collaboration IA-PCAT., Results: Eighteen out of 99 PCAT-CE items and 31 out of 112 PCAT-AE items were suitable for Colombia according to the Latin American versions. Of them, 76 and 73, respectively, required minimal idiomatic changes, 2 and 4 required major changes, and 1 and 4 items were removed. Interviews confirmed understanding and allowed improvements., Conclusions: Versions tailored to the Colombian health system were obtained. The methodology used capitalized on the results of other countries and can contribute to achieving greater equivalence between instruments from different countries.

Introduction: Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward)., Objective: To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression., Methods: A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison., Results: Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (P>.05). There were significant differences (P<.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective., Conclusions: The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction., (Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objectives: To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia., Methods: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced., Results: The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia., Conclusion: Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations., (Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objectives: To determine the most effective pharmacological intervention and to bring recommendations for decision-making in the management of adults with schizophrenia with violent behavior or agitation., Methods: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced., Results: It is recommended the use of parenteral drugs in all agitated patient who does not respond to the measures of persuasion. The drugs with better evidence on effectiveness (control of violent behavior) are haloperidol and benzodiazepines, administered jointly or individually. Olanzapine is also an option considering that should only be used in institutions where a psychiatrist is available 24hours. Ziprasidone can be considered as a second-line drug. The information about the side effects associated with these drugs is insufficient and has low quality., Conclusion: Violent behavior in adults with schizophrenia represents a risk for themselves and for those around them, so the opportune implementation of interventions aimed to calm the patient, in order to prevent potential negative outcomes is necessary. It is recommended to initiate these interventions with measures of verbal persuasion, and if these measures are not effective, appropriate use of parenteral drugs: haloperidol and benzodiazepines as first-line and olanzapine and ziprasidone as second choices., (Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

The study was aimed at identifying Latin-American countries' public policy which has been related to the social determinants of health. A topic review was thus made of papers kept in the 22 Latin-American countries' databases and official documents issued by their multilateral organisations and ministries of health. The World Health Organization's concept of the social determinants of health has been summarised and a history given of the pertinent work developed worldwide in regions such as Europe and Latin-America. Public policy regarding the field of study in Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, México and Venezuela has been described. It was concluded that Latin-America provides a panorama of inequality regarding the application of policy concerning the social determinants of health and that there was segmented intervention, mainly regarding intermediate determinants of health, without taking an integrated approach from different entrance points into account, according to the stated conceptual framework.

A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

This article presents the case of a young woman with massive hemoptysis (1,000 mL in 6 hours) due to tuberculosis, which could not be controlled by insertion of a Fogarty catheter through a fiber-optic bronchoscope. Because of asphyxia and persistent bleeding risk we instilled fibrinogen-thrombin through a fiber-optic bronchoscope inserted catheter, achieving bleeding cessation and permitting the placing of a double-lumen oro-tracheal tube. Later on, the patient underwent lobectomy and anti-tuberculosis treatment. The fibrinogen-thrombin could be considered as a bridge, transitory measure for massive hemoptysis, while definitive treatment could be established.

Introduction: IgM nephropathy (IgMN) is a glomerulonephritis characterised by diffuse mesangial immunoglobulin M (IgM) deposits. It usually presents with nephrotic range proteinuria and, according to some previous work, it occurs most often in patients who are resistant to or dependent on steroid treatment., Objective: To perform a clinical, histological and immunopathological description and assess the response to steroid treatment of paediatric patients diagnosed with nephrotic syndrome and diffuse mesangial IgM deposits., Method: This is a descriptive, retrospective study carried out in two hospitals, where the clinical records of paediatric patients with IgMN were analysed and the histological sections were re-assessed., Results: thirteen children were included in this study. IgMN corresponded to 5.17% of all paediatric renal biopsies. The age of patients ranged from 1 year to 12 years (median: 2 years), 46.7% were women. The most common morphological finding was diffuse mesangial hypercellularity (46.1%), followed by focal segmental glomerulosclerosis (30.8%) and minimal glomerular changes (23.1%). All patients received steroids; in 4 cases (30.7%) as the only immunosuppressant medication, 3 (23.1%) also received cyclophosphamide, 5 (38.4%) mycophenolate, and 1 (7.7%) cyclosporine. Seven patients (53.8%) had frequent relapses, 5 (38.5%) were cortico-resistant and 1 (7.7%) cortico-dependent. Two patients (15.38%) had chronic impairment of renal function., Conclusion: The presence of diffuse mesangial IgM in paediatric patients with nephrotic syndrome is not a very uncommon finding; its clinical presentation has been associated with lower response to steroids. However, the long-term prognosis of these patients is still unknown.

Objective: Determining levels of inactivity in the population aged 18 to 60 years old in the city of Manizales., Methods: This was a cross-sectional study with phase correlation of 631 people aged 18 to 60 years in Manizales. People were selected by random sampling using the K systematic method. The variables analyzed were age, gender, weekly practice, BMI, hip circumference and initial heart rate., Results: 631 people were studied (305 males and 326 females) having a mean age of 37.7 ± 12.1 years. Physical inactivity (PI) prevalence was 72.7 % (69.2-76.1 95 %CI). Male sedentarism was 60.7 % (57-63 95 %CI) and 84 % in females (80.1-88 95 %CI); the variables explaining the level of sedentarism in the target population were age (p=0.03), gender (p=0.00), weekly physical activity (PA) frequency (p=0.00), hip circumference (p=0.042) and initial heart rate (p=0.00). PI level and BMI risk factors, such as alcohol and smoking, were not predicted., Conclusions: 72.7 % of the population aged 18 to 60 years had a sedentary life-style. Age, gender, weekly PA/PI, hip circumference and initial heart rate significantly explained sedentarism level patterns; the correlation between observed values and those predicted by the model was 72.5 %.

The following document was aimed at offering reflection about the attention deficit hyperactivity disorder (ADHD) as a true public health problem in Colombian children, involving very large challenges for childhood policy regarding this problem. This (in addition to all treatment protocols advanced to date) should include approaches implicitly involving motricity since one of this pathology's comorbid disorders becomes manifest in motor difficulties in the first instance, integrally involving family and school for success in managing the event.

Unlabelled: The Hospital at Home (HAD) is a choice of care that enables own care in a hospital at home patient. Moreover, the nutritional support (NS) -enteral or parenteral nutrition- is usually indicated in patients with serious underlying disease, and/or frequently remain severely disabled., Aims: To analyze the characteristics of the patients, attended at home for specific questions of the NS that receive., Material and Methods: descriptive and retrospective study of the patients attended by the Nutritional Support Unit (NSU), in the area of the HAD, from September 1, 2006 until August 31, 2007., Results: At home, the realized procedure was: refill of gastrostomia or jejunostomia feeding tube in 158 cases; modification of the guideline of enteral nutrition (EN) or parenteral nutrition (PN) in 53 cases; training of the skill of artificial nutrition in 14 cases. 39 visits were realized by complications -by infection or lead throught the estoma and by obstruction of the feeding tube-. Only in 3 patients (7.7%) the domiciliary assistance indicated the movement of the patient to the Emergency Unit., Conclusion: In our center, the infrastructure of the HAD has allowed to give answer to the needs of the patients who receive NS at home in our area of influence.

Objective: The Colombian National Institute of Health has been studying the epidemiology of several respiratory viruses since 1997 to identify their circulation patterns and the role they play as pathogenic agents of acute and/or moderate respiratory infection (RI) in children aged less than 5., Methods: The study used sentinel surveillance methods in sentinel hospitals in Bogotá and Manizales. Four to eight nasopharyngeal samples were collected every week in the sentinel hospitals from children aged less than five consulting for low or high RI. Nasopharyngeal samples were processed by indirect immunofluorescence., Results: 1,743 children were examined from January 1997 to December 2003; 35 % were found to be positive for respiratory viruses. Respiratory syncytial virus was found more frequently while adenovirus was found in 47 patients (2,6 % of the sample; 1,4-2,5 % 95 %CI). Adenovirus was detected throughout the year (excepting January) but peaks occurred in March, July, October and December. Most patients were hospitalised (50-87%) and were in need of oxygen support. Fatality:case ratio was 7%; B7, 2, C1, and B3 serotypes were identified., Conclusion: The data suggested that respiratory infection due to adenovirus was a low frequency event amongst the children seeking medical care at the sentinel hospitals. However, when respiratory disease was caused by adenovirus, it was severe.

Introduction and Objectives: Alzheimer s disease is a neurodegenerative disorder characterized neuropathologically by beta amyloid plaques, neurofibrillary tangles, gliosis and neuronal loss. Recently, we have elucidated a molecular cascade of cell death induced by A beta 25 35 involving the activation of nuclear factor kappa B (NF kB), p53, and c Jun transcription factors in vitro. At present, no comparative reports have been published to establish a similar cell death signalization pathway in in vitro and in in vivo. The aim of this investigation was to determine if AD brains might activate NF kB, p53, c Jun, Par 4 transcription factors and to establish whether there exist a relationship between neuronal DNA damage and transcription factors activation., Patients and Methods: We investigated Ab plaques, neurofibrillary tangles and NF kB, p53, and c Jun transcription factor activation in five cerebral regions from 3 normal subjects and from six demented patient with sporadic AD and one patient with AD familiar according to CERAD criteria. Using TUNEL we determine neuronal damage., Results: We demonstrated neuronal damage in 17 out of 50 regions evaluated as TUNEL positive, and their distribution was heterogeneous in all brain regions evaluated; and the activation of NF kB, p53, c Jun and Par 4 transcription factors from case # 24 and #22, corresponding to TUNEL positive., Conclusions: We found a correlation between severity of DNA damage and nuclear activation of the transcription factors. These findings suggest that the AD brain may induce cell death by a molecular signalization similar to a non neuronal model by Ab exposure. This in situ study might validate previous Ab induced cell death observations in vitro.

Objectives: In this article, the authors analyzed critically the morphological and biochemical evidences of cell death by apoptosis from postmortem studies in Alzheimer s, Parkinson s, Huntington s and Wilson s diseases., Development: During the last few years, apoptosis has been postulated as a type of neuronal death responsible for the neurodegenerative process in those heterogeneous, chronic and progressive neurological disorders, which are characterized by a selective and a symmetric loss of neurons in motor, sensory or cognitive systems. With regard to neuronal death mechanism and the contribution of the mutated or metabolic altered proteins such as betaA, P-tau, alpha-synuclein, Parkin, Huntingtin, ATP78B, proteins in the pathogenesis of those disorders are still unknown., Conclusions: We consider that the morphological (e.g. DNA fragmentation without showing classical apoptotic morphology) and biochemical evidences are still insufficient and contradictory to formally indict apoptosis as the mechanism of neuronal cell death in those neurological disorders. The establishment of the molecular mechanisms leading neurons to cell death (by apoptosis?) could provide significant information for the design of therapeutic strategies to retard or prevent the development of such neurodegenerative diseases in affected individuals.

The spontaneous perforation of the esophagus is an entity with a difficult diagnosis due to the absence of predisposing pathological antecedents and the variability of symptoms. Although the diagnosis may be clinically suspected, only the imaging techniques, mainly thoracic radiography, esophagogram and, most recently, axial computerized tomography and nuclear magnetic resonance, allow a reliable diagnosis. We present the case of a spontaneous perforation of the esophagus in which the image obtained with computerized tomography allowed its diagnosis and surgical treatment within a short period of time.

Acute dissection of the aorta is a relatively frequent clinical entity, with a poor prognosis and a global mortality of 40% during the first 48 hours. A correct diagnosis and an early surgical treatment may modify the natural course of the dissection of aorta. We present a case of a patient with high clinical suspicion in the aortography, thoraci CAT and transthoracic echocardiogram (TTE). However, it was not possible to establish the diagnosis. The transesophagic echocardiogram (TEE), on the contrary, suggested the presence of dissection of aorta, as was later verified in the necropsis methods, seems to support the TEE as the first election method in the dissection of aorta.

The cytoskeleton of the myocardiocyte is a complex network of protein filaments. The intermediate filaments, consisting fundamentally of desmin, are considered markers of cellular differentiation. We used indirect immunofluorescence with specific monoclonal antibody to characterize the expression of desmin during the different phases of heart maturation, and demonstrated a direct relationship between the expression of this protein and myocardiocyte development. Our results show that in auricular myocardiocytes, desmin is present in early stages of development, whereas in ventricular myocardiocytes, this protein, which is intimately involved in contractile function, first appears in HH stage 25.