RESUMO: O estudo foi realizado em um ovino, fêmea, de três anos de idade, da raça santa inês, procedente de uma propriedade localizada do município de Santo Antônio de Tauá, oeste do Pará. O animal acometido tinha histórico de exoftalmia no olho esquerdo, secreção nasal e dificuldade respiratória há mais de três meses. Ao exame físico o animal apresentava baixo escore corporal, apatia, assimetria facial unilateral, moderada exoftalmia unilateral esquerda, dispneia mista e exsudação nasal serossanguinolenta profusa unilateral. À necropsia, foi observada grande massa nasal, predominantemente branco-amarelada com áreas vermelho enegrecidas, de superfície irregular, finamente granular, úmida e friável. A massa invadia desde a junção mucocutânea do nariz esquerdo até as coanas, se infiltrava pelos seios nasais frontais, placa cribiforme e alcançava as meninges e a porção frontal do cérebro. À microscopia da superfície do epitélio nasal notou-se severa destruição dos cornetos e dos epitélios, evidenciada por extensas áreas de necrose com muitos debris celulares, ulceração e infecção bacteriana secundária. No sistema nervoso central (SNC) havia meningite piogranulomatosa com acentuada congestão de vasos, focos de necrose e inflamação granulomatosa. O diagnóstico de rinite granulomatosa de origem micótica associada ao fungo Conidiobolus lamprauges foi baseado nos achados da imuno-histoquímica. RESUMO ovino fêmea idade inês Tauá Pará meses corporal apatia esquerda necropsia brancoamarelada branco amarelada enegrecidas irregular granular friável coanas frontais cérebro notouse notou epitélios celulares secundária SNC (SNC vasos imunohistoquímica. imunohistoquímica imuno histoquímica. histoquímica imuno-histoquímica

ABSTRACT: The study was conducted on a 3-year-old female Santa Inês sheep from a property located in the municipality of Santo Antônio de Tauá, west of Pará. The affected animal had a history of exophthalmos in the left eye, nasal discharge, and breathing difficulty for more than three months. On physical examination, the animal had a low body score, apathy, unilateral facial asymmetry, moderate unilateral left exophthalmos, mixed dyspnea and unilateral profuse serosanguinous nasal discharge. At necropsy, a large nasal mass was observed, predominantly yellowish-white with blackish-red areas, with an irregular, finely granular, moist, and friable surface. The mass invaded from the mucocutaneous junction of the left nostril to the choanae, infiltrated the frontal sinuses, the cribiform plate, and reached the meninges and the frontal portion of the brain. Microscopy of the surface of the nasal epithelium showed severe destruction of the turbinates and epithelia, evidenced by extensive areas of necrosis with a large amount of cellular debris, ulceration, and secondary bacterial infection. In the central nervous system there was pyogranulomatous meningitis with marked vessel congestion, as well as foci of necrosis and granulomatous inflammation. Immunohistochemistry showed intense staining of numerous intralesional hyphae for antibodies against Conidiobolus lamprauges. The diagnosis of granulomatous rhinitis of mycotic origin associated with the Conidiobolus lamprauges was based on epidemiological, clinical-pathological, and immunohistochemical data. ABSTRACT 3yearold yearold 3 year old Tauá Pará eye discharge months examination score apathy asymmetry necropsy observed yellowishwhite yellowish white blackishred blackish red irregular granular moist choanae sinuses plate brain epithelia debris ulceration infection congestion inflammation epidemiological clinicalpathological, clinicalpathological clinical pathological, pathological clinical-pathological data

Resumen Introducción: Aunque la vena subclavia ofrece ventajas significativas sobre otros abordajes para el acceso venoso central guiado por ultrasonido, no se considera la primera opción en la población pediátrica, principalmente debido a su proximidad con la pleura y la arteria subclavia. Objetivo: Evaluar las características sonoanatómicas de la vena subclavia y sus estructuras adyacentes utilizando el abordaje supraclavicular en la población pediátrica. Materiales y métodos: Estudio observacional de corte transversal durante el periodo intraoperatorio, desde junio de 2021 hasta marzo de 2022. Participaron niños ASA I, II y III sometidos a procedimientos quirúrgicos no emergentes bajo anestesia general. Se realizaron las imágenes bajo anestesia general, utilizando un transductor lineal de alta frecuencia para identificar la vena subclavia y medir características anatómicas. Resultados: Se reclutaron 67 niños, con una mediana de 6 años (RIQ 2-12 años), predominando el sexo masculino (61 %). La mediana de peso fue de 22 kg (RIQ12,2-34 kg) y la de estatura fue de 115 cm (RIQ 88-142 cm). Las mediciones del vaso mostraron una distancia media de la piel al vaso de 0,70 cm (DE: 0,18 cm) y una de la piel a la pleura de 1,31 cm (DE: 0,28 cm). El diámetro de la vena tuvo una mediana de 0,49 cm (RIQ 0,40-0,63 cm). El ángulo hipotético de aproximación al vaso presentó una media de 22,09 grados (DE: 4,37 grados), mientras que el ángulo de aproximación a la pleura fue de 39 grados (DE: 5,31 grados). No se documentó la visualización simultánea de la arteria y la vena en ninguna de las ventanas sonoanatómicas registradas. Las pruebas indicaron una diferencia promedio de 0,61 cm en la profundidad del vaso respecto a la pleura, y 16,91 grados menos en el ángulo de aproximación al vaso comparado con el ángulo pleural (p < 0,001). Conclusiones: Mediante esta técnica, el abordaje supraclavicular para punción de la vena subclavia en niños es seguro y viable, con una distancia promedio de la piel al vaso de 0,70 cm, minimizando el riesgo de punción pleural. Se requieren estudios adicionales para optimizar esta técnica en la población pediátrica.

Abstract Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

Resumen Introducción. Los problemas en la cadena de suministro aumentaron los costos de las materias primas y redujeron la disponibilidad de materiales para la producción de agentes de control biológico. Esto puede ejercer mayor presión de enfermedades y menores rendimientos en las granjas. Objetivo. Determinar el efecto de diferentes cantidades de almidón y el uso de ingredientes locales en procesos de fermentación a pequeña y gran escala para Trichoderma harzianum. Materiales y métodos. El estudio se ralizó en San José, Costa Rica, entre 2016 y 2018. Se realizaron ensayos en matraces para investigar la reducción o eliminación de almidón en medios de fermentación comerciales. Se llevaron a cabo ensayos en recipientes de fermentación para evaluar la efectividad de un medio local alternativo, que incluyó tres tratamientos: 1) medio comercial como control, 2) melaza al 10 % y 3) melaza al 10 % con 0,5 % de extracto de levadura. Se realizaron recuentos de esporas viables para determinar las unidades formadoras de colonias (UFC/mL). Resultados. La reducción de almidón al 10 % del medio original no tuvo impacto en las UFC/mL. Sin embargo, la ausencia de almidón resultó en un crecimiento desigual durante la fermentación. La melaza produjo aproximadamente la mitad de las UFC/mL en comparación con el medio comercial, pero superó el umbral de 107 UFC/mL utilizado en estudios para el control biológico de patógenos de plantas. Los resultados obtenidos en un fermentador a escala comercial fueron similares a los de la fermentación a escala piloto. Conclusión. La reducción del contenido de almidón en el medio comercial no afectó al crecimiento, pero la ausencia de almidón provocó acumulaciones sólidas de micelio. El uso de un medio de melaza de origen local a escala comercial parece factible mientras se mantenga un recuento de esporas viables requeridas para su uso en el campo.

Abstract Introduction. Supply chain issues have increased the costs of raw material and reduced the availability of materials for the production of biological control agents. This can result in greater disease pressure and lower yields on farms. Objective. To determine the effect of different amounts of starch and the use of local ingredients in small- and large-scale fermentation processes for Trichoderma harzianum. Materials and methods. The study was conducted in San José, Costa Rica, between 2016 and 2018. Flask experiments were performed to investigate the reduction or elimination of starch in commercial fermentation media. Fermentation vessel trials were conducted to evaluate the effectiveness of an alternative local medium, which included three treatments: 1) commercial medium as a control, 2) 10 % molasses medium, and 3) 10 % molasses with 0.5% yeast extract. Viable spore counts were performed to determine colony-forming units (CFU/mL). Results. Reducing starch to 10 % of the original medium had no impact on CFU/mL. However, the absence of starch resulted in uneven growth during fermentation. Molasses produced approximately half the CFU/mL compared to the commercial medium but exceeded the threshold of 107 CFU/mL used in studies for the biological control of plant pathogens. Results obtained in a commercial-scale fermenter were similar to those of pilot-scale fermentation. Conclusion. Reducing starch content in the commercial medium did not affect growth, but the absence of starch led to solid mycelium clumps. The use of a local molasses-based medium on a commercial scale feasible as long as the required viable spore count for field use is maintained.

Abstract Introduction: Vasculitis is a heterogeneous group of immune-mediated diseases defined by the inflammation of blood vessels. They can affect vessels of any caliber, resulting in various signs and symptoms, making the diagnosis difficult. This case report shows the importance of anamnesis and careful objective examination, paying attention to potential triggering factors, namely medication intake. Case description: Male, 71 years old, with a personal history of arterial hypertension, hypertriglyceridemia, and benign prostatic hypertrophy, medicated with losartan + amlodipine and dutasteride + tamsulosin. The patient sought consultation due to a condition compatible with an uncomplicated lower respiratory infection. A diagnosis of community-acquired pneumonia was made, and he was medicated with amoxicillin 500 mg 8/8 h for seven days, with improvement of the symptoms. However, on the tenth day after starting antibiotic treatment started with progressive worsening, with prostration, bilateral subconjunctival haemorrhage, and the appearance of new macular lesions, painful to the touch, dispersed in the palms of the hands and ventral face of the wrists. In the blood tests alterations suggestive of inflammation and autoimmunity were highlighted, which led to a presumed diagnosis of amoxicillin hypersensitivity vasculitis and was medicated with corticosteroid therapy with symptomatic improvement. Comment: In this case, the multisystemic presentation and the positive response to corticosteroid therapy points to a diagnosis of vasculitis. Skin lesions associated with episcleritis, and asthenia are more suggestive of small vessel vasculitis. This is potentially secondary to a hypersensitivity reaction to the medication with amoxicillin, considering the temporal evolution of the condition, suggestive of an association. To carry out this difficult diagnosis, the general practitioner, by the nature of his work, accompanying the patient longitudinally, is uniquely qualified to identify cases with temporal evolution and associations between pathologies and previous medications.

Resumo Introdução: As vasculites são um grupo heterogéneo de doenças imunomediadas definidas pela inflamação dos vasos sanguíneos. Podem afetar vasos de qualquer calibre, resultando numa ampla variedade de sinais e sintomas, o que dificulta o seu diagnóstico. O caso clínico apresentado mostra a importância de uma anamnese e exame objetivo cuidados, atentando em potenciais fatores desencadeadores, nomeadamente a toma de medicação. Descrição do caso: Homem, 71 anos, com antecedentes pessoais de hipertensão arterial, hipertrigliceridemia e hipertrofia benigna da próstata, medicado com losartan + amlodipina e dutasterida + tansulosina. Recorreu à consulta por quadro compatível com infeção respiratória baixa, não complicada. Foi feito o diagnóstico de pneumonia adquirida na comunidade e medicado com amoxicilina 500 mg 8/8 h durante sete dias, com melhoria sintomática. Contudo, ao décimo dia após iniciar antibiótico inicia um agravamento progressivo com prostração, hemorragia subconjuntival bilateral e surgimento de novo de lesões maculares dolorosas ao toque dispersas nas palmas das mãos e face ventral dos punhos. Nas análises destacavam-se alterações sugestivas de inflamação e autoimunidade, pelo que se presumiu diagnóstico de vasculite de hipersensibilidade à amoxicilina, tendo sido medicado com corticoterapia com melhoria sintomática. Comentário: Neste caso, a apresentação multissistémica e com boa resposta à corticoterapia aponta para um diagnóstico de vasculite. As lesões cutâneas associadas a episclerite e astenia são mais sugestivas de vasculite dos pequenos vasos. Esta é potencialmente secundária a uma reação de hipersensibilidade à medicação com amoxicilina, tendo em conta a evolução temporal do quadro, sugestiva de associação. Para realizar este difícil diagnóstico, o médico de família, pela natureza do seu trabalho e acompanhando longitudinalmente o doente, está capacitado para identificar casos com evolução temporal e associações entre patologias e medicações anteriores.

RESUMEN: El envejecimiento es un proceso biológico inevitable que afecta la función de todos los órganos, incluida la glándula suprarrenal, fundamental para la producción de hormonas esteroides que regulan el metabolismo, la respuesta al estrés y la activación inmunológica. Comprender cómo el envejecimiento afecta la morfología de esta glándula es crucial para desarrollar intervenciones que mitiguen sus efectos adversos. Así, el objetivo de este estudio fue describir las alteraciones morfocuantitativas de la glándula suprarrenal en ratas Sprague Dawley senescentes comparadas con ratas adultas. Se utilizaron 12 ratas macho, divididas en dos grupos: 6 ratas adultas de 6 meses de edad (grupo A) y 6 ratas senescentes de 36 meses de edad (grupo S). Se realizaron estudios histopatológicos, cuantificación de fibras de colágeno tipos I y III y análisis estereológicos para determinar la densidad de volumen (Vv), de superficie (Sv) y de número (Nv) de los núcleos de las células de la zona fasciculada. El tejido de la glándula suprarrenal del grupo S presentó displasia, metaplasia, acumulación de grasa intracelular, fibrosis, dilatación de vasos sanguíneos y mayor presencia de células apoptósicas. También se observó un engrosamiento de la cápsula y un incremento del colágeno tipo I. Hubo una disminución significativa en Vv, Sv y Nv de los núcleos de la zona fasciculada en el grupo S en comparación con el grupo A. Los resultados indican que el envejecimiento induce cambios morfocuantitativos significativos en la glándula suprarrenal, lo que podría contribuir a la disminución en la producción de glucocorticoides y alteraciones en la secreción de aldosterona y cortisol observadas en la senescencia. Comprender estas alteraciones es crucial para desarrollar intervenciones que mitiguen los efectos adversos del envejecimiento en el sistema endocrino.

SUMMARY: Aging is an inevitable biological process that affects the function of all organs, including the adrenal gland, which is essential for producing steroid hormones that regulate metabolism, stress response, and immune activation. Understanding how aging affects the morphology of this gland is crucial to developing interventions to mitigate its adverse effects. Thus, this study aimed to describe the morphoquantitative alterations of the adrenal gland in senescent Sprague Dawley rats compared to adult rats. Twelve male rats were divided into 6 adult rats aged 6 months (group A) and 6 senescent rats aged 36 months (group S). Histopathological studies, quantification of collagen fibers types I and III, and stereological analysis were performed to determine the volume density (Vv), surface area (Sv), and number (Nv) of the nuclei of the zona fasciculata cells. Adrenal gland tissue from group S presented dysplasia, metaplasia, intracellular fat accumulation, fibrosis, blood vessel dilation, and increased presence of apoptotic cells. Capsule thickening and increased collagen type I were also observed. There was a significant decrease in Vv, Sv, and Nv of zona fasciculata nuclei in group S compared to group A. The results indicate that aging induces significant morphoquantitative changes in the adrenal gland, which could contribute to the decrease in glucocorticoid production and alterations in aldosterone and cortisol secretion observed in senescence. Understanding these alterations is crucial to developing interventions that mitigate the adverse effects of aging on the endocrine system.

SUMMARY: The anatomical structure of wood from tree species found in floodplain forests can undergo alterations due to seasonal fluctuations in water levels, potentially affecting the volume of wood available for sustainable forest management in inundated areas. Thus, this study aims to characterize the anatomical features of Hura crepitans, Ocotea cymbarum and Eschweilera albiflora, assessing whether these characteristics differ from descriptions reported in previous studies of the same species conducted in other environments. Samples were collected from six adult trees of each species in two sustainable development reserves (SDR), Mamirauá and Amanã, located in the middle Solimões region, state of Amazonas, using a non-destructive method with an increment borer. Two samples were collected from three different heights (0.30, 1.30, and 2.30 m). Microscopic descriptions of the species were determined (porosity, axial parenchyma, rays, fibers, and vessel elements). Two-way factorial ANOVA followed by Tukey’s post hoc test was used to verify the differences in the anatomical elements of the wood samples collected at the three heights. The wood of H. crepitans has diffuse porosity, a predominance of solitary vessels, diffuse-in-aggregates, scarce axial parenchyma, non-storied rays, and libriform fibers. The wood of O. cymbarum has solitary vessels in radial multiples, vasicentric axial parenchyma, non-storied rays, and septate fibers. E. albiflora has a radial grouping of vessels, banded parenchyma, and non-storied rays. This study confirms previous descriptions of this species, revealing that its anatomical characteristics remain constant throughout the trunk.

RESUMEN: La estructura anatómica de la madera de las especies de árboles que se encuentran en los bosques de llanuras aluviales puede sufrir alteraciones debido a las fluctuaciones estacionales en los niveles de agua, afectando potencialmente el volumen de madera disponible para el manejo forestal sostenible de las áreas inundadas. Así, este estudio tiene como objetivo caracterizar las características anatómicas de Hura crepitans, Ocotea cymbarum y Eschweilera albiflora, evaluando si estas características difieren de las descripciones reportadas en estudios previos de las mismas especies realizados en otros ambientes. Se recolectaron muestras de seis árboles adultos de cada especie en dos reservas de desarrollo sustentable (RDS), Mamirauá y Amanã, ubicadas en la región media de Solimões, estado de Amazonas, utilizando un método no destructivo con barrenador incremental. Se tomaron dos muestras en cada una de tres alturas diferentes (0,30, 1,30 y 2,30 m). Se determinaron descripciones microscópicas de las especies (porosidad, parénquima axial, radios, fibras y elementos de los vasos). Se utilizó ANOVA factorial de dos vías seguido de la prueba post hoc de Tukey para verificar las diferencias en los elementos anatómicos de las muestras de madera recolectadas en las tres alturas. La madera de H. crepitans tiene porosidad difusa, predominio de vasos solitarios, difusos en agregados y escaso parénquima axial, radios no estratificados y fibras libriformes. La madera de O. cymbarum tiene vasos solitarios en múltiplos radiales, parénquima axial vasicéntrico, radios sin pisos y fibras septadas. La madera de E. albiflora tiene agrupaciones radiales de vasos, parénquima bandeado y radios sin pisos. Este estudio confirma descripciones previas de la especie, revelando que las características anatómicas permanecen sustancialmente constantes en todo el tronco.

ABSTRACT Background: Cephalic pancreaticoduodenectomy (CPD) with venous resection is indicated for the treatment of ductal adenocarcinoma and neuroendocrine tumors of the pancreas, either through laparoscopy or laparotomy. Objective: The aim of this study was to describe the results of a series of patients undergoing CPD with venous vascular resection and compare morbidity and mortality between the laparoscopic approach and open surgery. Material and methods: We conducted a retrospective, comparative and observational study of patients who underwent CPD with venous vascular resection between January 2022 and July 2023. Criteria for laparoscopic surgery were age < 80 years, interface between tumor and vein of 180° of the circumference of the vessel wall or less on computed tomography, good performance status, and no previous neoadjuvant treatment. Results: A total of 23 CPD procedures with venous vascular resection were performed: 11 by laparoscopy and 12 by laparotomy. The 11 laparoscopic procedures were lateral resections, and in the 12 patients approached by laparotomy, 5 were total portal vein resections and 7 were lateral resections. Portal vein clamping time and need for transfusion was similar in both groups. The pathological examination reported R0 resections in 78.2% and venous invasion in 40.9%. The complications associated with laparoscopy and laparotomy were pancreatic fistula in 4 and 3 patients, respectively, delayed gastric emptying in 1 and 4 patients, respectively, biliary fistula in 1 and 0 patients, respectively, aspiration pneumonia i 1 and 1 patients, respectively and surgical site infection in 0 and 1 patients, respectively. Mortality was 8.6% (n =2), one in each group. Conclusion: According to the criteria used, the morbidity and mortality of CPD with vascular resection were similar for laparoscopy and laparotomy.

RESUMEN Antecedentes: la duodenopancreatectomía cefálica (DPC) con resección vascular venosa está indicada para el tratamiento del adenocarcinoma ductal y de tumores neuroendocrinos de páncreas, tanto por laparoscopia como por laparotomía. Objetivo: describir los resultados de una serie de pacientes operados de DPC con resección vascular venosa y comparar la morbimortalidad entre los abordados por laparoscopia y por laparotomía. Material y métodos: se realizó un estudio observacional, comparativo, retrospectivo de pacientes con DPC con resección vascular entre enero de 2022 y agosto de 2023. El abordaje laparoscópico fue determinado en menores de 80 años, invasión venosa tumoral igual a 180° o menor en la tomografía, buen performance status, y no haber realizado tratamiento neoadyuvante. Resultados: fueron realizadas 23 DPC con resección vascular venosa: 11 por laparoscopia y 12 por laparotomía. Las 11 realizadas por laparoscopia fueron resecciones laterales, y, en los 12 abordados por laparotomía, se realizó resección total de vena porta en 5 y en el resto, resección lateral. El tiempo de “clampeo” (pinzamiento) portal y la necesidad de transfusiones fue similar en ambos grupos. El estudio patológico reveló R0 en el 78,2% de los pacientes e invasión venosa en el 40.9%. La morbilidad con laparoscopia y con laparotomía consistió, respectivamente, en: fístula pancreática en 7 (4 y 3), vaciamiento gástrico retardado en 4 (1 y 4), fístula biliar en uno (1 y 0), neumonía en dos (1 y 1) e infección de herida en uno (0 y 1). La mortalidad fue de 8,6% por el fallecimiento de dos pacientes, uno en cada grupo. Conclusión: de acuerdo con los criterios empleados, la morbimortalidad de la DPC con resección vascular fue similar por laparoscopia y por laparotomía.

ABSTRACT Carotid dolichoarteriopathies (CDA) represent a group of morphological abnormalities, with changes in the geometry and tortuosity of the carotid arteries. They were described in 1925 for the first time and were classified in three types according to the angle of torsion, in tortuosity (angle > 90°), coiling (S-shaped curve or loop) and kinking (angle < 90°). The pathophysiology of CDA is controversial and includes congenital mechanisms, genetic factors, connective tissue diseases, acquired mechanisms which can be associated with but not dependent on cardiovascular risk factors, and anomalies of the cervical spine. CDA have been associated with different cardiovascular and cerebrovascular events secondary to hemodynamic abnormalities, thromboembolism and cerebrovascular insufficiency and ischemia. However, the evidence is limited and for some authors they are more of a curiosity than a real predictor of ischemic events. Other studies support the clinical value of the diagnosis and follow-up of CDA and their understanding not only by internists, cardiologists and neurologists, but also by surgeons and otolaryngologists. Several authors proposed different therapeutic strategies to correct CDA, including surgical procedures. However, the indications and management approaches are controversial, and further randomized, multicenter, prospective studies are required to determine the most appropriate course of action. Until then, imaging techniques remain the basis for the etiologic diagnosis of cerebrovascular adverse events when all other causes have been excluded, and close clinical monitoring and follow-up of patients remain key strategies for the prevention of secondary events.

RESUMEN Las dolicoarteriopatías carotídeas (DAC) son un grupo de anomalías morfológicas, con alteración de la geometría y torsión de los vasos carotídeos. Descriptas por primera vez en 1925, las DAC fueron clasificadas en tres tipos, según el grado de torsión: tortuosidad (ángulo mayor de 90°), enrollamiento o coiling (forma de S o looping), y acodamiento o kinking (ángulo menor de 90º). La fisiopatología de las DAC es controvertida, pero se han propuesto mecanismos congénitos, genéticos, enfermedades del tejido conectivo, adquiridos, relacionados con, pero no dependientes de, factores de riesgo cardiovascular, y alteraciones de la columna cervical. Las DAC han sido asociadas a diferentes eventos cardio y cerebrovasculares, secundarios a alteraciones hemodinámicas, tromboembolismo e insuficiencia e isquemia cerebrovascular. Pero la evidencia es limitada y, para algunos autores, son más una curiosidad que una condición clínica grave. Otros trabajos sustentan el valor clínico del diagnóstico y seguimiento de las DAC, y su reconocimiento no solo por internistas, cardiólogos y neurólogos, sino también por cirujanos y otorrinolaringólogos. Varios autores propusieron diversas estrategias terapéuticas, incluyendo procedimientos quirúrgicos para corregirlas. Sin embargo, las indicaciones y métodos de tratamiento son controvertidos, y son necesarios más estudios aleatorizados, multicéntricos y prospectivos para determinar cómo proceder. Hasta entonces, técnicas de imagen son la base para el diagnóstico etiológico de eventos adversos cerebrovasculares cuando se descartan todas las otras causas, y el control clínico cercano y seguimiento de los pacientes continúan siendo estrategias clave para la prevención de eventos secundarios.

ABSTRACT Introduction: A narrative review was carried out of the studies published from 2016 to 2021 on the clinical, etiological, imaging and therapeutic aspects of the different clinical forms of vascular cerebral disease in the elderly. The databases of Medline (PubMed), SciELO, Cochrane and Google Scholar were consulted. Original articles, published in peer-reviewed journals, that included patients over 65 years of age, with a diagnosis of cerebral vascular disease, were taken into account. Objective: Update on the particularities of cerebral vascular disease in older adults. Development: In cerebrovascular disease of the elderly, particular conditions are observed: biological, psychological and social, which are less frequent or may even be absent in younger age groups. Large vessel atherosclerosis, cardioembolism, small vessel disease, and cerebral amyloid angiopathy are the predominant etiologies, although other causes may exist. Vascular cognitive impairment represents the second cause of dementia and is a clinical form of presentation of cerebral vascular disease in this age group. Conclusions: Cerebrovascular disease in the elderly presents particular characteristics that are summarized in: greater comorbidity and richness of risk factors, which require a systemic, dialectically interrelated and personalized diagnostic approach, in which neuroimaging occupies a unique place. importance; which, in interaction with the clinic, will allow a more comprehensive diagnosis and evolutionary follow-up of these patients.

RESUMEN Introducción: Se realizó una revisión narrativa de los estudios publicados desde 2016 hasta 2021 sobre los aspectos clínicos, etiológicos, imagenológicos y terapéuticos de las diferentes formas clínica de la enfermedad cerebral vascular en los ancianos. Se consultaron las bases de datos de Medline (PubMed), SciELO, Cochrane y Google Académico. Se tuvieron en cuenta los artículos originales, publicados en revistas con revisión por pares, que incluyeran pacientes mayores de 65 años, con diagnóstico de enfermedad vascular cerebral. Objetivo: Actualizar sobre las particularidades de la enfermedad vascular cerebral en el adulto mayor. Desarrollo: En la enfermedad cerebrovascular del adulto mayor se observan condiciones particulares: biológicas, psicológicas y sociales, que son menos frecuente o incluso pueden estar ausentes, en los grupos etarios más jóvenes. La arterioesclerosis de grandes vasos, el cardioembolismo, la enfermedad de pequeños vasos y la angiopatía cerebral amiloidea constituyen las etiologías predominantes, aunque pueden existir otras causas. El deterioro cognitivo vascular representa la segunda causa de demencia y es una forma clínica de presentación de la enfermedad vascular cerebral en este grupo etario. Conclusiones: La enfermedad cerebrovascular en el adulto mayor, presenta características particulares que se resumen en: mayor comorbilidad y riqueza de factores de riesgo, que obligan a un enfoque diagnóstico sistémico, dialécticamente interrelacionado y personalizado, en el cual las neuroimágenes ocupan un lugar de singular importancia; que, en interacción con la clínica, permitirán un diagnóstico y seguimiento evolutivo más integral de estos pacientes.

ABSTRACT Introduction: Cerebrovascular disease is the most prevalent neurological condition, globally it represents 11% of total annual deaths and in Cuba is the third cause of death. Objective: Characterize early mortality in patients with ischemic stroke. Methods: An observational, descriptive, longitudinal and prospective study was carried out on patients who suffered an ischemic stroke during one year. Summary and dispersion measures were used with a 95% confidence interval. Results: Mortality was 15.1%, with a slight predominance of the female sex and white skin colors prevailed. Almost two-thirds of the death occurred in the first seven days of the acute ischemic event and in more than half of the patient cerebral edema was present as the cause of death. The vascular risk factors that predominated were high blood pressure, smoking and diabetes mellitus, with the large vessel atherothrombotic stroke subtype prevailing. When comparing the mean values between living and deceased patients, the variables: age, National Institute of Health Stroke Scale, leukocytes, blood glucose, leukoglycemic index, erythrocyte sedimentation rate and C-reactive protein were statistically significant. Conclusions: Stroke mortality in the Julio Trigo hospital behaves from a clinical and epidemiological point of view almost similarly to what was reported by other authors in other geographical regions and also in Cuba.

RESUMEN Introducción: La enfermedad cerebrovascular es la afección neurológica de mayor prevalencia; globalmente representa el 11 % del total de defunciones anuales y en Cuba es la tercera causa de muerte. Objetivo: Caracterizar la mortalidad temprana en los pacientes con ictus isquémico. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo de los pacientes que sufrieron un ictus isquémico durante un año. Se emplearon medidas de resumen y dispersión, con un intervalo de confianza del 95 % para la prueba t de Student. Resultados: La mortalidad fue de un 15,1 %, con ligero predominio del sexo femenino y prevaleció el color blanco de la piel. Casi 2 tercios de los fallecidos (58,9 %) ocurrieron en los primeros 7 días del evento isquémico agudo y en más de la mitad de los pacientes se presentó edema cerebral como causa directa de muerte. Los factores de riesgo vascular que predominaron fueron la hipertensión arterial, el tabaquismo y la diabetes mellitus, y prevaleció el subtipo de ictus aterotrombótico de gran vaso. Al comparar los valores de la media entre los pacientes vivos y fallecidos, resultaron ser estadísticamente significativos las variables: edad, escala National Institute of Health Stroke Scale, leucocitos, glucemia, índice leuco-glucémico, eritrosedimentación y la proteína C reactiva. Conclusiones: La mortalidad por ictus, en el Hospital “Julio Trigo”, es similar, desde el punto de vista clínico y epidemiológico, a lo reportado por otros autores en otras regiones geográficas y también en Cuba.

Abstract Introduction: Thoraco-bifemoral bypass (TBF) is an alternative to aorto-bifemoral bypass (ABF) or axilo-bifemoral bypass for severe aortoiliac occlusive disease. TBF may be particularly useful in select patients with concurrent visceral aortic branch vessel disease, infrarenal aortic occlusions, or after failed ABF. We describe a clinical case of a symptomatic Leriche syndrome in the presence of concurrent visceral aortic branch vessel disease. Case report: A 57-year-old male patient with a history of Leriche syndrome and acute thrombosis of the right renal artery with acute kidney injury underwent parallel grafting of the celiac trunk, superior mesenteric artery, and right renal artery 12 months before the current episode. He developed intermittent claudication for very short distances (around 5 meters), with significant limitations for activities of daily living and an inability to carry out his work activity. We decided to perform a TBF bypass through a left thoracotomy, which was uneventful. The patient is asymptomatic and has palpable pedal pulses at the 24-month follow-up. Postoperative computed tomography angiography revealed visceral aorta branches and TBF bypass patency. Conclusion: TBF bypass can be performed with good outcomes for patients with severe AIOD, especially if concomitant visceral/infrainguinal reconstruction is warranted. These results support a continued role for TFB in selected patients.

Resumen Este artículo presenta un modelamiento para la caracterización de dos bombas peristálticas utilizando regresión no lineal. Se realizaron pruebas de precisión variando el nivel de altura de la bomba respecto al recipiente y se concluye que esto no influye en la rapidez del flujo. Se tomaron datos de llenado para 300ml teniendo en cuenta el voltaje aplicado a las bombas y el tiempo de llenado. Con los datos registrados se realizó ajuste de curvas por mínimos cuadrados determinando el modelo exponencial como el más acertado para las dos bombas y aplicando regla de tres simple se halló la ecuación para cualquier volumen solicitado. Finalmente se realizaron pruebas de llenado para comparar los datos del modelo con datos reales. El coeficiente de determinación del modelo de la primera bomba fue de 0,9875 y para la segunda fue de 0,9956 concluyendo que los modelos son acertados, lo cual se reitera en las pruebas de llenado comparativas donde se evidencia un asertividad superior a 99% en todas las pruebas realizadas. Se sugiere ampliar las investigaciones en el uso de este método matemático como alternativa en el control no invasivo de fluidos cuyos instrumentos requieran un tratamiento estéril.

Abstract This paper presents a modeling approach to characterize two peristaltic pumps using nonlinear regression. Accuracy tests were performed by varying the height level of the pump with respect to the vessel, and it was found to have no effect on the flow rate. Filling data was recorded for 300 ml considering the voltage applied to the pumps and the filling time. A least squares curve fitting was performed with the recorded data. The exponential model was determined to be the most accurate for the two pumps, and using a simple rule of three, the equation for each desired volume was found. Finally, filling tests were performed to compare the model data with the real data. The coefficient of determination of the model for the first pump was 0.9875 and for the second pump was 0.9956. It can be concluded that the models are accurate, which is also confirmed in the comparative filling tests, where an assertiveness of more than 99% was demonstrated in all the tests performed. It is proposed to extend the studies on the use of this mathematical method as an alternative in the non-invasive control of fluids whose instruments must be handled in a sterile manner.

Resumen La detección y el diagnóstico de diabetes e hipertensión presentan un escenario desafiante, principalmente en etapas tempranas. Estos dos son degenerativos y de graves consecuencias, provocando daños en múltiples órganos, incluidos los ojos. El oftalmólogo examina el fondo de la retina para discriminar el tipo de enfermedad. En el caso de la retinopatía, como enfermedad crónica, se evidencia en varias clases de progresión. La retinopatía diabética se clasifica en cuatro, que incluyen etapas leve, moderada, grave y proliferativa. En la etapa proliferativa, la retina produce factores vasoproliferativos que estimulan el crecimiento de nuevos vasos sanguíneos, aumentando el riesgo de pérdida de visión. En cuanto a la retinopatía hipertensiva, el método de clasificación más utilizado es la clasificación de Keith-Wagener-Barker. Similar a la retinopatía diabética, también consta de cuatro clases, que van de leves a graves. En la etapa grave, existe un mayor riesgo de desarrollar papiledema o edema retiniano. El objetivo principal de esta investigación es realizar la segmentación y clasificación de imágenes de fondo de retina con retinopatía diabética e hipertensiva. Se propuso una combinación de una red convolucional UNet y una ConvNet para la segmentación de máscara de vasos y la clasificación de retinopatía, respectivamente. El proceso de clasificación se basa en diez clases definidas, donde los valores que van del 0 al 4 representan la retinopatía diabética y los valores del 5 al 9 corresponden a la retinopatía hipertensiva. Los resultados aproximados en la segmentación fueron índices Jaccard de 74%, F1 de 85% y un Accuracy de 96%, y en la clasificación un Accuracy de 80%.

Abstract The detection and diagnosis of diabetes and hypertension present a challenging scenario, mainly in the early stages. These two are degenerative and with severe consequences, causing damage to multiple organs, including the eyes. The ophthalmologist examines the retinal fundus to discriminate between the type of disease. In the case of retinopathy, as a chronic disease, evidence in various classes of progression. Diabetic retinopathy is categorized into four, which include mild, moderate, severe, and proliferative stages. In the proliferative stage, the retina produces vasoproliferative factors that stimulate the growth of new blood vessels, increasing the risk of vision loss. As for the hypertensive retinopathy the most widely used method for classifying is the Keith-Wagener-Barker classification. Like diabetic retinopathy, it consists also of four classes, ranging from mild to severe. In the severe stage, there is an increased risk of developing papilledema or retinal edema. The main objective of this research is to perform segmentation and classification of diabetes and hypertensive retinopathy retinal fundus images. Using a combination of a convolutional network UNet and a ConvNet was proposed for vessel mask segmentation and retinopathy classification, respectively. The classification process relies on ten defined classes, where values ranging from 0 to 4 represent diabetic retinopathy, and values ranging from 5 to 9 correspond to hypertensive retinopathy. The approximate results in the segmentation were Jaccard index of 74%, F1 of 85%, and an Accuracy of 96%, and in the classification was Accuracy of 80%.

RESUMEN Antecedentes: Dentro de la familia Cranchiidae, las especies del género Leachia conocidos como calamares de “cristal” tienen una distribución cosmopolita; con tres especies que habitan en el Pacífico tropical: L. pacifica, L. danae y L. dislocata. Sin embargo, debido a los escasos registros, se conoce muy poco sobre aspectos biológicos básicos de este grupo. Objetivo: En este trabajo se reporta por primera vez la presencia de juveniles y adultos de L. dislocata, además se aportan datos de su estructura de tallas, proporción de sexos y relación peso-longitud. Métodos: Los especímenes de L. dislocata fueron recolectados en el Golfo de Tehuantepec durante abril de 2022, en un crucero pesquero y oceanográfico del Instituto Mexicano de Investigación en Pesca y Acuacultura Sustentables a bordo del buque de investigación Dr. Jorge Carranza Fraser del Instituto Nacional de Pesca y Acuacultura del Gobierno de México. Se realizaron 50 lances de pesca distribuidos, previa visualización con ecosonda científica. Resultados: Se presentaron 128 organismos de L. dislocata, 82 hembras, 34 machos, y 12 juveniles. La proporción de sexos tuvo una clara predominancia de hembras (3H:1M, p < 0.05). La relación entre la Longitud del manto y el peso, tanto para hembras y machos presentó un crecimiento alométrico negativo (p < 0.05). Conclusiones: Estos nuevos registros representan el límite más al sur de la distribución geográfica de esta especie. La presencia de juveniles y adultos aquí reportados, junto con los registros previos de paralarvas, proporcionan evidencia de que el Golfo de Tehuantepec es un área de reproducción de esta especie.

ABSTRACT Background: Within the Cranchiidae family, species of the genus Leachia known as “glass” squid, have a cosmopolitan distribution. There are three species that inhabit the tropical Pacific: L. pacifica, L. danae and L. dislocata. However, due to few records, very little is known about basic biological aspects of this group. Objective: In this work, the presence of juveniles and adults of L. dislocata is reported for the first time, and data on its size structure, sex ratio and weight-length relationship are also provided. Methods: L. dislocata specimens were collected during April 2022, in a fishing and oceanographic cruise aboard the research vessel Dr. Jorge Carranza Fraser of the Mexican Institute for Research in Sustainable Fisheries and Aquaculture of the National Institute of Fisheries and Aquaculture of the Government of Mexico. 50 distributed fishing hauls were made, after visualization with a scientific echo sounder. Results: 128 organisms of L. dislocata were presented, with a total of 82 females, 34 males, and 12 juveniles. The sex ratio had a clear predominance of females (3H:1M, p < 0.05). The relationship between mantle length and weight for females and males presented a negative allometric growth (p < 0.05). Conclusions: These new records represent the southernmost limit of the geographic distribution of this species. On the other hand, the presence of juveniles and adults reported here, along with previous records of paralarvae, provide evidence that the Gulf of Tehuantepec is a breeding area for this species.

Resumo Objetivos: A doença dos pequenos vasos cerebrais refere-se a um conjunto de processos patológicos, cró,nicos e progressivos que afetam as arteríolas, capilares e pequenas veias responsáveis pela vascularização da substância branca e estruturas profundas da substância cinzenta. Métodos: Foram avaliados 43 doentes hipertensos, com idades compreendidas entre os 38 e os 82 anos e sem antecedentes cardiovasculares, dos quais 42% eram do género feminino e 50% eram diabéticos. Foi estudada a associação entre a média da profundidade de sondagem, média da perda de inserção, hemorragia pós-sondagem e área total de superfície periodontal inflamada com as hiperintensidades da substância branca diagnosticadas por ressonância magnética. Foi considerado um nível de significância estatística (α) de 0.05, e aplicados os testes qui-quadrado de Pearson e Mann-Whitney. Resultados: A média da profundidade de sondagem, hemorragia pós-sondagem e área total de superfície periodontal inflamada correlacionaram-se inversamente com as hiperintensidades da substância branca. Pelo contrário, a análise dos dados mostrou uma correlação positiva entre a média da perda de inserção e as hiperintensidades da substância branca. Conclusões: No nosso estudo, e com a nossa amostra, menores valores de profundidade de sondagem, hemorragia pós-sondagem e área total de superfície periodontal inflamada correspondem a um maior número de hiperintensidades da substância branca. Em sentido inverso, a maiores perdas de inserção estão associadas mais lesões de substância branca identificadas por ressonância magnética.

Abstract Objectives: Cerebral small vessel disease is a chronic, progressive disorder of arterioles, capillaries, and small veins supplying the brain’s white matter and deep structures of gray matter. The latest evidence seems to suggest that chronic oral infections such as periodontitis contribute to cerebral small vessel disease progression. This study evaluated the relationship between periodontal disease and brain white matter hyperintensities. Methods: Forty-three hypertensive patients, aged between 38-82, without previous cardiovascular events, of which 42% were female and 50% diabetic, were evaluated. An association between mean probing depth, mean attachment level, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities diagnosed by magnetic resonance was studied. A significance level (α) of 0.05 was considered, and Pearson’s chi-square and Mann-Whitney tests were applied. Results: Data analysis revealed an inverse correlation between mean probing depth, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities. A positive correlation was found between mean attachment level and white matter hyperintensities. Conclusions: In our study and within our sample, lower values of mean probing depth, bleeding on probing, and total periodontal inflamed surface area were associated with more White matter hyperintensities. Contrarily, mean attachment level was positively associated with white matter hyperintensities.