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BACKGROUND: As far as public health is concerned, brain tumors burden is significant despite their low incidence, because they comprise high direct costs (specific diagnostic resources, high complexity treatments, and rehabilitation) and high-unforeseen costs (labor leave, family, and social issues). Although the Argentine's Health System is supposed to provide healthcare to all the population, it would not guarantee equity of access for brain tumors treatment. In order to analyze this hypothesis we decided to carry out a survey to obtain data on access, availability and resources for tumor management in Argentina. METHODS: An online questionnaire with eight dimensions and 29 queries was conducted addressing all professionals involved in tumor management. Two variables were generated: (1) type of medical center according to their financial support, and (2) the geographic region (GeoR). Analysis of association between these variables and the accessibility to different resources was performed with Chi-square and Fisher's exact test. Multivariate analyses through multiple logistic regression models were also tested. RESULTS: One hundred and fourteen surveys were collected from 56 state-managed centers and 55 private/trade-union managed centers. Responders came from 15 provinces grouped into integrated GeoR. Results and analysis of each dimension were reported. CONCLUSION: The data obtained provides information about the accessibility to brain tumors treatment, exposing the unequal distribution of human and technologic resources in Argentina. This problem exceeds the limits of public health to become a bioethical problem. We think these results could be essentially associated to our health system fragmented structure, and the large geographical extension of our country. Finally, we believe that collaboration of professional associations working together with public and private sector authorities responsible for financial resources and logistic should bring a principle of solution.

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El linfoma no Hodgkin primario de la mama es una patología poco frecuente, constituye menos del 0,5 por ciento de todos los tumores mamarios malignos, debido a que carecen de características propias, tanto clínicas, mamográficas como ultrasonográficas. Es difícil el diagnóstico preoperatorio, la citología mediante BAAF tiene mejor rendimiento que el estudio con material congelado ya que este último tiende a confundirse con el carcinoma. En la actualidad se prefiere el tratamiento con quimioterapia tanto para el tratamiento local como para el regional. Presentamos el caso de un linfoma no Hodgkin primario de la mama en una paciente de 72 años. (AU)

Primary non-Hodgkin lymphoma of the breast is a rare entity. It represents less than 0.5 percent of all breast cancer malignancies. No features at clinical presentation distinguish patients with lymphoma from those with carcinoma of the breast. There are both mammographic and sonographic difficulties to establish the preoperative diagnosis. Contemporary frozen sections can be mistaken with breast carcinoma. In this article we present a case of a primary non-Hodgkin lymphoma of the breast in 72 years old women.(AU)

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Evaluar el patrón de caries dental en indígenas residentes en la comunidad de Corozal, Maniapure, Estado Bolívar, Este es un estudio descriptivo y transversal del status de caries dental en indígenas Panares que residen en Corozal, comunidad ubicada en la región de Maniapure, Municipio Cedeño del Estado Bolívar, Venezuela, realizado durante el año 2011. La edad de los sujetos evaluados oscilo entre 2 y 60 años de edad (n= 31), el examen clínico fue realizado por dos estudiantes de odontología previamente calibrados usando los criterios reportados por Radike (1972), modificado por Acevedo et al., (2005). El examen clínico se llevó a cabo con el explorador N°23, espejo bucal N°5 y luz natural. Los resultados se analizaron mediante el test no paramétrico de la U de Mann-Whitney y Kruskal-Wallis. El 100% de los sujetos evaluados estaban afectados por la caries dental. No obstante, de las 3.682 superficies dentarias evaluadas 3.016 se encontraban libres de la enfermedad (81,9%) y 306 estaban afectados por la caries dental (8,3%). Con respecto a la severidad de las lesiones, las no cavitadas fueron las menos frecuentes (3,8%), mientras que el 96,1% tenían al menos un signo de cavitación. De las lesiones cavitadas en la dentición permanente el 62,2% correspondían a lesiones con micro-cavitación en el esmalte, 7,3% fueron lesiones que abarcaban el 50% de la estructura dentaria sin compromiso pulpar y solo 0,5% presentaron compromiso pulpar. Por el contrario, en la dentición primaria el 69.2% de las lesiones presentó compromiso del órgano dentino-pulpar, de las cuales el 6.5% correspondían a cavidades que abarcaban el 50% de la estructura dentaria con compromiso pulpar, 36,8% con destrucción total de la estructura coronaria y 25,9% de restos radiculares.

The aim of this study was to evaluate the epidemiological status of dental caries in Indigenous residing in Corazal, Maniapure, Bolivar State, Venezuela. A cross-sectional study of dental caries condition in indigenous Panare residing in Corozal, community located in Maniapure, Cedeño Municipality, Bolivar State, Venezuela was undertaken in 2011. Subjects from 2 to 60 years of age (N=31) allow to be examined by two dental students previously calibrate using the criteria reported by Radike (1972) as modified by Acevedo et al., (2005). The clinical examination was conducted with explorer N° 23 and dental mirror N°5 using natural light. The results were analyzed using the non-parametric test of U- Mann-Whitney and Kruskal-Wallis. One hundred percent of the evaluated subjects were affected by caries (100%). However, from the total of 3.682 surfaces evaluated, 3.016 were sound (81.9%) and 306 were affected by caries (8.3%). From the total of caries lesion detected the non-cavitate lesion were the least frequent (3.8%) and 96.1% have at least one sign of cavitations. From the cavitated lesion in the permanent dentition 62.2% of lesions showed early enamel breakdown, 17.3% were to lesion that cover 50% of the tooth surface without reaching the pulp and only 0,5 % of the lesion had reach the pulp. In contrast, in the primary dentition 69.2% of the cavities advanced into the pulp. From this group 6.5% were cavities that cover 50% of tooth surface and reach the pulp, 38.6% showed complete destruction of the crown and 25.9% corresponded to remaining root. The mean DMFS and defs were 17.08±26.18 and 5.70±12.61 respectively. The DMFS in the female group (29.07±32.06) was significantly higher as compared to the male (6.75±6.51) (p=0.001), in contrast the defs was higher in the males (12.40± 14.52) as compare to the female (5.63±6.63) (p=0.012).

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Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido.

Background: Uncomplicated infection of the lower urinary tract and asymptomatic bacteriuria are frequent causes of visits to outpatient clinics and emergency departments in Colombia and worldwide. The lack of guidelines and a consensus for their management, and the emergence of resistance of community-based uropathogens to the available therapeutic options, make it necessary to develop recommendations to guide clinicians on the optimal approach to these entities. Objective: Define a consensus for the empiric management of asymptomatic bacteriuria and Urinary Tract Infection (UTI) in adults and pregnant women in Colombia. Methods: We carried out a consensus methodology with experts in urology, infectious diseases, internal medicine, gynecology and clinical microbiology; based on reviewing the available literature on the related terms, and emphasizing local studies. Results: We developed a management algorithm for the empirical treatment of uncomplicated lower UTI in adults with urinary antiseptics such as nitrofurantoin and fosfomycin trometamol as first line, with specific therapeutic recommendations for the treatment of asymptomatic bacteriuria in pregnant women. Additionally, we created a decision algorithm for processing urine cultures. Frequent recurrence or relapse justifies referral to urology and infectious disease professionals. Conclusions: We generated straightforward and easy-to-implement recommendations for the diagnosis and management of UTI in adults and pregnant women, and in cases where it is necessary to treat asymptomatic bacteriuria, with effective therapeutic and narrow spectrum options.

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INTRODUCTION: The prevalence of hyponutrition in hospitalized patients in our setting is 53%. The therapeutic approach is controversial. OBJECTIVES: To determine whether an early nutritional intervention in hospitalized patients by means of oral nutritional support can improve their prognosis regarding decreased morbimortality and hospital stay. MATERIAL AND METHODS: Randomized prospective study comprised by a treatment group and a control group of malnourished patients hospitalized at the Internal Medicine and Respiratory Medicine Departments. The nutritional diagnosis was made by using the Subjective Global Assessment. Groups B and C were assigned to receive the hospital diet according to their needs and pathology (control group) and the treatment group also received a standard nutritional supplement. We recorded the development of infections, pressure ulcers, hospitalization days, mortality, and weight. RESULTS: We performed more than 1,700 Subjective Global Assessments. Five hundred and thirty seven patients (264 treated and 273 controls) were followed-up until hospital discharge or death. We did not find statistically significant differences in mortality, hospital stay, or occurrence of complications between the treatment group and the control group. The treatment group presented statistically significant weight increase as compared with the control group. CONCLUSIONS: We could not demonstrate benefits when using the oral nutritional supplement in terms of mortality, hospital stay, infectious complications, or pressure ulcers. The significant weight increase in the treatment group allowed us concluding that the supplement effectively treated hyponutrition in this group. This new clinical status implies a better prognosis, as it has already been shown. However, this could not be observed by means of the study parameters. Long-term studies are required to determine for how long this nutritional improvement can be sustained, implying a better prognosis in the long run.

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Trophic molecules are key regulators of survival, growth and differentiation of neural cells. Neuronal cell type Neuro-2a is a good model to study development and molecules modulating this process, and retinoic acid (RA) and neurotrophins (NGF, BDNF, NT-3 and NT-4) have been shown to be active in this modulation. The purpose of the present study was the functional analysis of these trophic molecules in our short-term bioassay of Neuro-2a cells, an immortalised murine neuroblastoma cell line. Through cell counting, image process and arithmetic combination of digital parameters of treated and untreated cultures, we show that RA inhibits growth and induces morphological neuronal phenotype of treated cells. Through DNA labelling with BrdU we also show that NGF, BDNF, and NT-3 increase survival and proliferation of cells, grown in serum-deprived media. From these results we conclude that neurotrophins have manifest trophic effects on cells improving survival, growth and proliferation and we also confirm the growth arrest and differentiation properties of RA on Neuro-2a cells.

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La presente investigación se llevó a cabo con el fin de establecer la distribución sistémica y los efectos colaterales de la infiltración de PGE2 en maxilares. Se realizó una evaluación de los tejidos mediantes cortes histológicos y autorradiografía in situ y en órganos vitales como celebro, corazón,pulmón,riñon,hígado,en musculo estriado esquelético y mucosa oral adyacente al sitio de filtración. Se utilizarón 13 cabayos machos,el primer caballo se tomó con el fin de estandarizar la técnica en cuanto a tiempo y marcaje. Los doce caballos restantes se distribuyeron en cinco grupos experimentales y un caballo fue tomado como control absoluto. En el primero grupo experimental al caballo se le aplicó únicamente PGE2, al del segundo grupo solamente fluresceína sódica al 10, estos caballos fueron sacrificados a las 24 horas. Los nueve restantes, se les aplicó la mezcla de 0.1 ml Timidina 3H. Los tres grupos de caballos se sacrificaron a las 24,72 y 120 horas respectivasmente. La infiltración de la mezcla se realizó en el surco yugal distal a los incisivos superior e inferior derechos, y previa aplicación de 1 ml de Adrenalina intramuscular con el fin de evitar un shock anafiláctico.

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I. Introducción; II. Justificación; III. Objetivos (Objetivo general, Objetivos específicos); IV. Marco teórico (tipos de presentación pélvica, Posiciones en la presentación pélvica, Diagnóstico, Mecanismos del trabajo de parto, Diagnóstico diferencial, Complicaciones, Manejo obstétrico del parto pélvico; V. Metodo de Investigación; VI. Técnica; VII. Resultados; VIII. Cuadros; IX. Conclusiones; X. Recomendaciones; XI. Resumen; XII. Bibliografía

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