Search

Resumen: Introducción: El infarto cerebral embólico de origen no determinado (ESUS por sus siglas en inglés) representa el 25% de todos los infartos cerebrales y solo el 30% se asocia con fibrilación auricular (FA) paroxística. Existen diferentes hallazgos bioquímicos, electro y ecocardiográficos que sugieren daño auricular izquierdo y aumento del riesgo de embolismo en ausencia de FA o flutter auricular clínicamente documentados. En la presente revisión analizamos la evidencia disponible sobre cardiopatía atrial o enfermedad auricular, su implicación en el ESUS y su identificación mediante marcadores electrocardiográficos, ecocardiográficos y séricos y sus posibles implicaciones terapéuticas. Desarrollo: Se realizó una búsqueda sistematizada a través de la fuente de información MEDLINE (PubMed), utilizando una estrategia diseñada con términos MeSH [ESUS] + [atrial cardiopathy] + [atrial fibrillation] + [interatrial block] + [treatment]. Se seleccionaron las publicaciones originales de estudios prospectivos, retrospectivos y de revisión consideradas como las más útiles. Se procedió a la lectura del texto completo y la bibliografía aportada en cada artículo.Se incluyeron los factores epidemiológicos y demográficos de los pacientes ESUS, así como la evidencia reciente relacionada con su forma de presentación, pronóstico y factores asociados con recurrencia y mortalidad. Se revisó la contribución de la presencia de cardiopatía auricular previo a la documentación de FA y las variables clínicas, electro y ecocardiográficas, así como los marcadores bioquímicos asociados con su desarrollo y su contribución como fuente potencial de embolismo cerebral. Conclusiones: La búsqueda sistemática de alteraciones bioquímicas, electro y ecocardiográficas pueden ser de utilidad para identificar pacientes ESUS con mayor riesgo de recurrencia. Abstract: Introduction: Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. Development: A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS] + [atrial cardiopathy] + [atrial fibrillation] + [interatrial block] + [treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article.We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. Conclusions: The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence.

Antecedentes: estudios previos reportan la presencia de grasas saturadas y grasas trans en productos de panadería, relacionadas con enfermedades crónicas no transmisibles. Sin embargo, se desconoce la procedencia y calidad de las materias primas grasas utilizadas por los panaderos en Medellín. Objetivo: caracterizar las materias primas grasas utilizadas para la preparación de productos de panadería. Materiales y métodos: estudio descriptivo transversal, de tipo exploratorio, con 24 muestras. Por cada muestra se realizó una encuesta a los panaderos para evaluar la calidad de las grasas y un análisis por cromatografía de gases para cuantificar 17 grasas saturadas y grasas trans. Resultados: el promedio de grasas trans en las materias primas grasas fue de 0,46 g en 100 g, mientras la normatividad permite 5 g en 100 g (Resolución 2508 de 2012, del Ministerio de Salud y Protección Social); el 42,1 % del contenido graso proviene de grasas saturadas; y algunas materias primas grasas no cumplen con la normatividad vigente para el etiquetado de alimentos envasados, pues no tienen rotulado nutricional. Conclusiones: en ninguna de las 24 materias primas grasas evaluadas cromatográficamente se cuantificó un contenido de grasas trans superior a lo permitido por la Resolución 2508, lo cual evidencia el esfuerzo de la industria de alimentos. Es necesario mantener la vigilancia del etiquetado para asegurar su cumplimiento.

Dentro de las actividades que alteran la composición del suelo está la minería, que causa el aumento de daños visibles al suelo mediante la creación de minas a cielo abierto, escombreras, estanques de residuos y otras instalaciones de minas. El objetivo principal de este trabajo fue evaluar el efecto de la lombriz roja californiana sobre el crecimiento de microorganismos en suelos contaminados con mercurio en el municipio de Segovia, Antioquia. Estos suelos representan una problemática importante debido a la acumulación de mercurio en exceso que ocasiona la pérdida de la calidad del suelo. Para este estudio se tomaron cuatro tratamientos en diferentes concentraciones de mercurio y un tratamiento más como blanco con lombrices rojas californianas (Eisenia foetida). Para esto, se evaluó el crecimiento de microorganismos a través de diferentes cultivos en el laboratorio, encontrando un crecimiento satisfactorio de los mismos luego de 25 y 90 días de tratamiento. De acuerdo al comportamiento observado, se evidencia una inmovilización del mercurio y una adaptación de los microorganismos al suelo contaminado, mostrando un aumento significativo de estos con el transcurso del tiempo.

En este trabajo se propone la representación de la dinámica del Índice de Oscilación del Sur usando una nueva clase de modelo híbrido no lineal. En este nuevo modelo, la no-linealidad en la media es representada usando un sistema adaptativo neurodifuso de inferencia (ANFIS), mientras que la varianza es representada usando una componente autoregresiva heterocedástica condicional. En adición, una estrategia de especificación es desarrollada para el modelo propuesto, la cual está basada en una batería de pruebas estadísticas. Los resultados indican que el modelo propuesto captura de mejor forma las principales características de la serie de tiempo estudiada, en comparación con otros modelos competitivos.In this paper, we propose the representation of the Southern Oscillation Index (SOI) dynamics using a new class of nonlinear hybrid model. In this new model, the non-linearity in the mean is represented by an adaptive neurofuzzy inference system (ANFIS), while the variance is represented using an autoregressive conditional heterocedastic (ARCH) component. In addition, a specification strategy for the proposed model, which is based on a battery of statistical tests is developed. The results indicate that the proposed model captures in a better way the main features of the studied time series, when compared to other competitive models.

Mosquito cell derived cultures are useful tools for arbovirus isolation, identification or characterization. For studying dengue (DENV) and yellow fever viruses (YFV) Aedes albopictus C6/36 or Aedes pseudoscutellaris AP-61 cell lines, are normally used. The Aedes aegypti AEGY-28 cell line was obtained from embryonic tissues and characterized previously by one of us. In order to evaluate its susceptibility to two Flavivirus, AEGY- 28 cells were inoculated with different multiplicity of infection (MOI) with type 2 DENV (COL-789, MOI: 1 and 5) and YFV clinical isolates (V-341, MOI 0,02) then processed at different times post infection (p.i.). Immunostai ning and fluorometric cell-ELISA were carried out to identify and quantify viral antigens. C6/36 and Vero cells were used as positive controls. Unexpectedly, immunoreactivity was not found in inoculated AEGY-28 cells, even in higher MOI or late times p.i., therefore antigen quantification using fluorometric cell-ELISA were not plausible. Reverse transcriptase PCR with specific primers did not detect viral RNA in AEGY-28 inoculated cells. We can conclude that Aedes aegypti AEGY-28 cell line is not susceptible to dengue and yellow fever Flavivirus, a finding possibly related with the lacking of specific molecules at the plasma membrane or absence of cell machinery necessary for viral replication.

Context: Cutaneous leishmaniasis is a disease of public health importance; treatment is based on the use of pentavalent antimonials with high toxicity and low efficacy; therefore, it´s necessary to search for therapeutic alternatives derived from natural products, based on the study of medicinal plants as a source of molecules with highly effective leishmanicidal potential. Aims: To carry out a systematic review between 2018 and 2022 on medicinal plants with potential leishmanicidal activity on parasite strains from the New World causing cutaneous leishmaniasis. Methods: The review study was conducted in four phases following the PRISMA methodology. First, research questions and objectives were formulated to establish the topic areas and construct the search algorithm. Second, a search was performed across different databases, including ScienceDirect, Scopus, PubMed, Web of Science, EBSCO, Taylor and Francis, and Scielo. Third, articles were chosen based on specific inclusion and exclusion criteria. Finally, the relevant information for the review was systematically organized. Results: The search yielded 163 articles, and 12 of them were selected as the basis for the construction of the review. Ethanolic and aqueous extracts stand out, as well as biocompounds such as terpenes and flavonoids. Antioxidant activity on reactive oxygen species was the most frequently cited. Conclusions: Promising terpene and flavonoid molecules with high antileishmanial activity (IC50 1) were identified in this study; these findings provide a scientific basis for the traditional use that communities have given to plants as a therapeutic source to treat cutaneous leishmaniasis in the New World.

This case study focuses on an interdisciplinary educational experience in which university Pharmacy and Humanities early and late Spanish-English bilinguals were paired to translate questions related to sociobehavioral aspects of medication use. This work describes the personal and professional benefits reported by the translators and the prevailing themes from verbal negotiations. The participants were an undergraduate in Spanish, seven pharmacy professional doctorate students, and five Hispanic studies graduate students. After completing individual translations, students were paired and met virtually to create a final, collaborative version of their translation. Participants were subsequently invited to answer open-ended questions about their experience. Translators’ transcribed interactions and questionnaire responses became the basis for this article. Results show that the main reported perceived benefit was the participants’ improved language skills. The findings also suggest that length, quality, and richness of interactions depended on whether the members of the pairings exhibited mutual respect, curiosity, and empathy.

This research aims to determine the relationship between the variables adaptation to the disease, resilience and dispositional optimism in women with breast cancer in Montería (Colombia). This study is a descriptive-correlational type, evaluating 116 participants. The instruments applied were the Font Quality of Life Questionnaire, to assess the Index of Adaptation to Disease, Wagnild and Young's Resilience Scale (RS) and the Life Orientation Test-Revised (LOT-R). The statistical program SPSS 25.0 was used for the analysis of the data. A normality test was performed which led to the application of the Spearman correlation coefficient. Findings indicated the presence of adaptation in the participants and resilient and optimistic characteristics, however, there is no significant relationship between these variables and adaptation to the disease., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications., Development: A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS]+[atrial cardiopathy]+[atrial fibrillation]+[interatrial block]+[treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism., Conclusions: The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence., (Copyright © 2019 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

This research aims to determine the relationship between the variables adaptation to the disease, resilience and dispositional optimism in women with breast cancer in Montería (Colombia). This study is a descriptive-correlational type, evaluating 116 participants. The instruments applied were the Font Quality of Life Questionnaire, to assess the Index of Adaptation to Disease, Wagnild and Young's Resilience Scale (RS) and the Life Orientation Test-Revised (LOT-R). The statistical program SPSS 25.0 was used for the analysis of the data. A normality test was performed which led to the application of the Spearman correlation coefficient. Findings indicated the presence of adaptation in the participants and resilient and optimistic characteristics, however, there is no significant relationship between these variables and adaptation to the disease., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In Chile, hemophilia was incorporated into the System of Explicit Health Guarantees (GES), which ensures access to treatment and financial protection for these patients. To support patients and their families, educational programs have been proposed that focus on managing possible complications of the pathology, first aid, and prophylaxis, however, there are no educational instances focused on the needs of the patients., Objective: To know the educational needs of parents with hemophilic chil dren and adolescents regarding contents, people, place, methodology, and stage of the illness. Sub jects and Method: Descriptive qualitative study of 15 parents with hemophilic children in outpatient care. For the data collection, we used a semi-structured interview with five open questions, aimed at the search for educational needs such as what (contents), how (methodology), when (moment), who (person), and where (place) is education needed. For data analysis, were used the Berelson's content analysis technique. To guarantee the scientific validity of the qualitative results, the methodological rigor criteria of Guba and Lincoln were used., Results: The most frequent educational needs reported by parents include content such as venipuncture training, injury prevention, pathophysiological as pects of the disease, among others; with methodology developed in group workshops and guided by a peer; in a comfortable and familiar place; in three stages of the disease's development (diagnosis, blee ding events, and development of autonomous activities), and provided by professionals and peers., Conclusion: Knowledge of educational needs is the basis for the creation of an educational program that guides the comprehensive care of hemophilic children and their parents.

Background: Ocular Surface Disease Index (OSDI) is the most commonly used questionnaire worldwide to detect dry eye disease. Although it is massively used in clinical practice in Chile, its use has not been validated yet in the country., Aim: To develop a cultural adaptation and to validate the OSDI questionnaire for the Chilean population., Material and Methods: For cultural adaptation, a translation, retro-translation and an expert panel review was carried out. The resulting questionnaire was applied to a pilot group of twelve participants and their comments were considered for the final questionnaire version. The final questionnaire was applied to a non-random sample of 200 patients aged 53 ± 17 years (75% women). Internal consistency and construct validity were evaluated by Cronbach's alpha and exploratory factor analysis respectively., Results: According to the OSDI score, 81% of respondents had dry eye (55% severe). Reliability was 0.91 and factor analysis resulted in three factors explaining 75.4% of the total variance., Conclusions: The OSDI questionnaire version obtained in this study demonstrated excellent internal consistency values and adequate construct validity making it applicable to clinical practice and dry eye research.

Introducción: existen características respecto a los ritmos circadianos (ciclo sueño-vigilia), lo que genera un rasgo denominado cronotipo (madrugador o trasnochador). Se ha asociado el cronotipo vespertino a menos horas de sueño y hábitos alimentarios poco saludables. El cronotipo vespertino se asocia con un mayor riesgo de desarrollar obesidad.Objetivo: determinar la asociación del cronotipo con variables antropométricas en jóvenes de 18 a 25 años.Métodos: jóvenes (n = 65) (18 a 25 años), se les determinó el cronotipo (cuestionario de Horne-Ostberg) y mediciones antropométricas (peso, talla, porcentaje de grasa y perímetro de cintura). Resultados: los hombres con cronotipo trasnochador presentaron significativamente mayor perímetro de cintura (p = 0,03). Las mujeres con un porcentaje de grasa < 25% se asoció con cronotipo trasnochador (p = 0,05). Conclusiones: el cronotipo trasnochador se asocia a mayor perímetro de cintura y mayor porcentaje de grasa. El cronotipo constituye un nuevo foco para la prevención y el tratamiento de la obesidad.

An alternative to solve the problem of the overall deficit of proteins has been the use ofdefatted cakes generated by the extraction of oil from vegetable sources such as rapeseed, soybean, lupin, etc. This process at the same time increases the protein content, making this feasible to be used to enrich some types of food. This is the case of the chilean hazelnut (Gevuina avellana, Mol), monotypic species characterized by their high percentage of oil (50%) and whose defatted cake isolated protein could be used to obtain an isolated protein. For this purpose optimized conditions of extraction of protein were carried out using the surface response methodology (SRM) and a central composite design with three independent variables: time of contact of the cake with the solvent, sample/solvent ratio and pH was used. All variables were controlled at five different levels. The data were subjected to an analysis of regression and ANOVA, the first to determine the polynomial equation and the second to select the control factors with significant effect on the extraction of the protein. The best combination of factors turned out to be: time between 30 and 40 minutes, pH between 9 and 9.5 and a relationship sample/solvent between 1/15 to 1/16 with a final yield of 76%. The physical characteristics were: density 0,504 g/cm3, compaction 43, 34% apparent and pale yellow. Proximal analysis showed a concentration of protein of 76%, 13%, raw fiber carbohydrate 0.68% and oil 1.29%. With regard to the functional properties emphasized water absorption (320 g/100 g), absorption of oil (410 g/100 g) and foaming capacity (221%).

Introduction and Objectives: Ménière's disease (MD) is a chronic disorder of the inner ear affecting health-related quality of life in 85% of patients. Although different studies have evaluated the impact of MD on quality of life, sexual health has not been investigated in these patients. The aim of this study was to assess sexual health in patients with MD., Material and Methods: A cross-sectional pilot study was carried out using the general health instrument SF-36, the Dizziness Handicap Inventory Short Form (DHI-S) and two specific questionnaires on sexual functioning, the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. A statistical analysis of domains of the instruments was performed to compare the score obtained to reference values, and correlation coefficients were calculated to determine the association among different instruments. The level of significance accepted was p<0.05., Results: Forty-eight individuals (26 women and 22 men) with a mean age of 55 and a low-medium culture level were studied. Men showed a high prevalence of erectile dysfunction, twice the national reference values; women had alterations in the sexual satisfaction and pain domains. In both situations, sexual function disorders were dependent upon the SF-36 emotional domains., Conclusions: Emotional problems associated with Ménière's disease may be associated with sexual function disorders, including sexual desire in women and erectile dysfunction in men., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, on the operating table, when a patient has not had enough general anesthetic or analgesic to prevent consciousness or waking up during surgery. According to international studies its global incidence ranges from 0.1 to 0.2%. Its impact on people can be as severe as other traumatic experiences such as natural disasters, violent fights or sexual abuse. The prevalence of symptoms compatible with post traumatic stress disorder can be as high as 50%, after experiencing the awareness phenomenon. This paper reviews the main issues of the awareness phenomenon.

Morphology and cytochemistry of Aedes aegypti's cell cultures (Diptera: Culicidae) and susceptibility to Leishmania panamensis (Kinetoplastida: Trypanosomatidae). The first cellular line of Aedes aegypti was developed by Grace in 1966; afterwards, other cellular lines of this species have been generated. These have been used for the study of pathogenic organisms like viruses, bacteria and parasites, which demonstrates their importance in biomedical applications. This research describes, for the first time, some cytochemical characteristics of A. aegypti cell cultures, that were infected with (MHOM/CO/87CL412) strain of Leishmania panamensis. A morphological study of the cell culture was also carried out. Maintenance of the cell culture, parasites and infection in vitro were carried out in the Laboratory of Entomology, Cell Biology and Genetics of the Universidad de La Salle. The cell cultures infected with the parasite were maintained in a mixture of mediums Grace/L15, supplemented with 10 % fetal bovine serum (FBS) at pH 6.8 and a temperature of 26 degrees C, during 3, 6 and 9 post-infection days. After this, these cell cultures were processed through High Resolution Light Microscopy (HRLM) and Transmission Electron Microscopy (TEM) based on standard protocols defined by the Group of Microscopy and Image Analyses of the Instituto Nacional de Salud. Semi-fine slices of 1 microm colored with toluidine blue were used for the morphological analysis of the culture, and ultra fine cuts of 60 to 90 nm stained with uranyl acetate and lead citrate where used for the ultrastructural study. In addition, PAS and peroxidase staining was carried out in cells fixed with methanol. The morphometric study was analyzed with software ImageJ (NIH). In the semi-fine slices, small cells were observed showing fibroblastic appearance 10.84 +/- 2.54 microm in length and 5.31 +/- 1.26 microm wide; other cells had epithelial appearance with a great peripheral nucleus, voluminous and vacuolated cytoplasm, 23.04 +/- 4.00 microm in length and 13.96 3.70 microm wide. These last ones predominated over the ones with fibroblastic appearance. Regarding the PAS coloration, 7.08% of the cells presented abundant PAS positive cytoplasmatic granules which indicated polysaccharides presence. The peroxidase test gave a negative result. The greatest percentage of infection (18.90%) of one total of 101 cells, turned up by day 6. Some cells analyzed by TEM presented a vacuolated aspect cytoplasm; some contained parasites, other fibrillar material and others were empty. The results indicate that A. aegypti cell culture can support the internalization and transformation of the parasite, which demonstrates the capacity that these cell cultures have to be infected with L. panamensis and to maintain the infection for approximately one week.

Objective: To evaluate the eye movement response to the head auto-rotation test (HART) in the vertical plane in patients with benign paroxysmal positional vertigo., Design: A transversal, descriptive study. SETTING UP: Outpatient clinic in a general Hospital., Individuals: 34 posterior canal BPPV cases with a video-oculographic diagnosis, older than 18 years old, 7 of them were not able to perform the HART., Intervention: HART was performed by a an electrooculographic system with simultaneous recording of head movement by an acelerometer in the vertical plane (Vorteq, Micromedical Instruments). The HART with eyes fixation was performed 3 times to determine its reliability., Main Outcome Measures: Gain, asymmetry and phase for the vertical VOR respectively. A statistical analysis was carried out to determine the test reliability and the number of individuals with an abnormal result., Results: Gain is the only variable that showed a reproducible result in the HART for the active head movement at 1-2 Hz (test-retest reliability 0.83-0.89). The values of gain showed a moderate correlation at the frequencies 1-3 Hz (correlation 0.60-0.87). Asymmetry and phase were not reproducible variables (correlation < 0.55). Thirteen of 27 (48%) patients presented a decrease of the vertical gain, another 13 showed normal values and one case showed raised values., Conclusion: Gain is the only useful variable in the vertical HART. Forty-eight percent of patients with posterior canal BPPV have a reduced vertical gain, suggesting an impairment of inferior vestibular nerve function.

Objective: To obtain reference values for the vestibulo-ocular reflex response to the head-shaking nystagmus and the bithermal caloric test in the spanish population., Design: A descriptive study. SET UP: General hospital., Individuals: One hundred and seven healthy sex and age stratified voluntiers were included. The final sample included 97 individuals over 18 years of age., Intervention: Spontaneous nystagmus (SN), head-shaking nystagmus (HSN) and caloric induced nystagmus were explored. The eyes movement was recorded by a video-oculographic system. The SN or HSN was considered significant when at least 6 consecutive beats with a slow phase velocity of 2 degrees/sec were detected. The caloric test was performed with water flow at 250mL/20 s at 30 degrees C and 44 degrees C with an interval of 10 minutes between irrigations. The percentage of canal paresis (CP) and directional preponderance (DP) was calculated using maximum slow phase velocity and the Jongkees index formula., Main Outcome Measurements: Presence of SN, horizontal and vertical SHN, percentage of CP and DP., Results: SN was found in 10,3% individuals (6 women and 4 men). Horizontal HSN was also observed in 9 women and 10 men (19,5%), and vertical HSN in 8 women and 10 men (18,6%). The mean and 95 percentil for CP were 13,10 and 28,60 in women and 11,02 and 27,30 in men. For DP, the mean and 95 percentil were 11,76 and 35,80 in women and 11,58 and 28,65 in men. The 5 percentils for slow phase velocity of nystagmus after each irrigation were 6,30; 5,14; 5,96; 4,02 degrees/s (left ear 44 degrees, right ear 44 degrees, left ear 30 degrees, right ear 30 degrees, respectively) in the group of women; and 5,82; 6,99; 5,67; 4,55 degrees/s in men (with the same irrigation sequence)., Conclusion: Results presented should be considered as a population-based norms and may be useful as references for water bithermal test for VOG studies. The SN or HSN could be observed in subjects without vestibular pathology.

Prospective evaluation was performed in 60 in-patients, carriers of ascites of different etiologies, analyzing the validity of the parameters depending on protein and albumin dosage, both in the ascitic serum and fluid, for the discrimination of possible etiological causes of ascites, including in these parameters Protein Concentration in the Ascitic Fluid, the Serum-Ascites Albumin Gradient, the Protein Ascites/Serum Ratio, and the Albumin Concentration in the ascitic fluid. Average age was 46.9 +/- 19.6, all female; 21 cases were associated with Chronic Hepatic Disease, 14 to Tuberculosis, 11 to Malignant Neoplasia, 7 to Nephrotic syndrome, 4 to Congestive Heart Failure, 2 to Collagen Disease, and 1 to a severe Malnutrition case. The evaluation parameters correlate with the oncotic and hydrostatic pressures of the Starling Law, on the basis of what they could be compared with, demonstrating that their sensitivity levels and their specificity may be used as positive or negative predictive values in the discriminative evaluations of ascites in relation to its probable etiological causes. Even though the Serum-Ascites Albumin Gradient may be useful in the separation of ascites cases with portal hypertension, it is also useful for classifying exudates and transudates. However, the other parameters must not be excluded for the evaluation of those cases, aiming at establishing whether the peritoneum has been affected and hence the terms transudates and exudates should still be used on the basis of the high sensitivity value and specificity of theses tests, which do not differentiate them statistically from the Serum-Ascites Albumin Gradient. Using the cut-off points for each parameter, the most adequate for our population would be 1.5 gr/dl for Albumin and 2.5 gr/dl for protein, with the additional lower cost benefit.

Background: Low molecular weight heparin can be administered by the subcutaneous route and has a stable and prolonged antithrombotic effect. These features have prompted clinical essays about its use as an alternative to unfractionated heparin in the treatment of unstable angina., Aim: To compare the clinical effects of low molecular weight heparin and unfractionated conventional heparin in patients with unstable angina or non Q infarction., Patients and Methods: Seventy patients (47 male) admitted to the hospital with the diagnosis of unstable angina or non Q acute myocardial infarction were randomly assigned to receive unfractionated intravenous heparin or subcutaneous low molecular weight heparin bid. All received aspirin p.o. and i.v. nitroglycerin. The incidence of recurrent angina, acute myocardial infarction or a need for emergency surgical revascularization during hospital stay were assessed in both groups., Results: Compared to patients with low molecular weight heparin, patients receiving unfractionated heparin had a higher incidence of recurrent resting angina (23 and 47.5% respectively, p < 0.04) and higher need for emergency surgical revascularization (3.3 and 17.5% respectively, p < 0.06). Patients treated with unfractionated conventional heparin had a 3 times higher risk of having an adverse cardiovascular event than patients receiving low molecular weight heparin (O.R. 0.33, confidence intervals 0.11-0.58)., Conclusions: Low molecular weight heparin is superior to unfractionated conventional heparin in the treatment of unstable angina and non Q acute myocardial infarction.

Laparoscopy is an invasive endoscopic procedure, that permits the vision of the abdominal cavity, through a little hole in the abdominal wall. This method permits a almost complete vision of abnormalities. It also helps to define diagnosis and classify or visualize the progress of some diseases. In this study done in 141 patients with liver diseases detected by laparoscopy and biopsy in the Arzobispo Loayza General Hospital in Lima, Perú, we verified the diagnostic efficacy of laparoscopy in hepato-biliary diseases like cirrhosis and hepatocarcinoma etc., and also to establish the etiology of peritoneal diseases. Emphasis is made in the importance of biopsies taken under visual control.

We study the clinic, surgical pathologic aspects of 81 patients with cancer of the gallbladder and extrahepatic bile ducts, dividing them in 4 groups by localization. The majority of cases were women, the average in age was 57.05 years with the greatest incidence between the 5th and 6th decade of life. We can conclude that the symptoms and signs are not useful as well as the laboratory and radiologic test. Adenocarcinoma was the most common type of cancer and the outcome of the patients was very poor because cancer has grown beyond the limits of resectability before it is clinically apparent. Its important to be aware that 80% of the cancers of the gallbladder had lithiasis.

Parotid gland lymphomas are very uncommon. Two patients with this condition were treated in the last decade. Surgery should be used only for diagnosis and becomes unnecessary when adenopathy is present, since a lymph node biopsy will establish the diagnosis.

Neoplasia may develop in patients with malignant hematologic disorders, during remission after radio and/or chemotherapy. A multifactorial origin related to therapy may be postulated. From 1978 to 1987, among 142 patients with malignant hematologic disorders (Hodgkin lymphoma 33, non-Hodgkin lymphoma 51, Multiple Myeloma 35 and Chronic Myeloid Leukemia 31) we observed 3 patients developing another neoplasia. An additional patient with acute non-lymphatic leukemia had been submitted to chemotherapy for gastric cancer. Four other patients with double neoplasia, one of them a hematologic one, had not been submitted to chemotherapy. The lack of national registries for neoplastic diseases precludes an estimation of the odd ratios involved in our findings.

A specific DNA probe containing part of the structural B-globulin gene was used to confirm the diagnosis of sickle cell anemia in a caucasian woman. The patient's genomic DNA was digested with the restriction endonuclease Dde I, fractioned by agarose electrophoresis and Southern blotting. Molecular hybridization was performed with the DNA probe prepared by chemical labelling with photobiotin. The beta 8/beta 8 genotype rendered only 1 fragment of length 376 bp. Upon digestion with Dde I, the DNA of an individual with the normal genotype containing the enzyme recognition sequence at the site of sickle cell mutation, resulted in 2 fragments of 201 and 175 bp. The pedigree of the patient's caucasian family was studied by Hb electrophoresis. Four out of 7 brothers carried the sickle cell trait.

An old test to investigate fecal fermentation was modified with the purpose of changing it from qualitative to quantitative. The modified test consists in placing in stove, at 37 degrees C for 24 hours, 5 grams of feces, suspended in water. The fermentable alimentary residues, present in the feces, suffer the action of bacteria, also there present, yielding gas that is collected and measured. Using the test, fecal fermentation was determined in 3 groups of individuals: a) 40 patients with meteorism that had persisted or improved only slightly or fairly with treatment; b) 28 apparently healthy subjects; and c) 6 patients with meteorism that had disappeared or become minimal with treatment. In the group of 28 apparently healthy subject, the obtained results varied from 0.1 to 1.1 ml gas/24 h., with a mean +/- s.d. of 0.55 +/- 0.29 ml. gas/24 h. When a distribution curve was made with the results obtained in the group of 40 patients with meteorism, these results separated into 2 subgroups: one subgroup with 28 patients, in whom results varied from 1.0 to 13.3 ml. gas/24 h., with a mean of 4.8 gas/24 h. (only) in 1 of these 28 patients a normal result of 1.0 ml. gas/24 h. was obtained, while in the remaining 27 patients results of 1.5 or more ml. gas/24 h. were obtained); and the other subgroup with 12 patients, in whom results varied from 0.0 to 0.9 ml. gas/24 h., with a mean of 0.29 ml. gas/24 h. Finally, in the group of 6 patients with successfully treated meteorism, results were from 0.1 to 0.9 ml. gas/24 h., with a mean of 0.4 ml. gas/24 h. The above mentioned results strongly suggest the existence of a relationship between meteorism and exagerated fecal fermentation. The nature of this relationship has not yet been completely clarified. However, the test used to determine fecal fermentation already promises to be very helpful for a better understanding and management of meteorism.