Resumo A biodisponibilidade de nutrientes, a escassez de fertilizantes sintéticos e o aumento do custo dos combustíveis contribuíram para um aumento nos custos de produção, o que, por sua vez, reduziu a produtividade das culturas e levou os cientistas a procurar novos métodos para garantir resultados de alta qualidade. Neste contexto, várias dosagens de citocininas foram testadas no Peru para examinar se afetavam a qualidade do caigua, num esforço para resolver estes problemas. Para mitigar esses problemas, foi realizado um experimento em vaso para verificar os efeitos de diversas doses de citocinina na qualidade do caigua no Peru. O experimento consistiu de cinco tratamentos, incluindo 0, 50, 100, 150 e 200 mL de citocinina utilizando Anthesis Plus por 200 L de água como fonte, cada um com três repetições e dispostos seguindo um delineamento em blocos completos casualizados (RCBD). O tratamento com 100 mL de análise foliar de citocininas resultou em comprimento de caigua de 18,9 cm, aumento de diâmetro de 5,65 cm e melhora na espessura da polpa de 7,60 mm. Os parâmetros fisiológicos das plantas de caigua colhidas após 45 dias da semeadura melhoraram consideravelmente com o mesmo tratamento. Da mesma forma, a concentração de N, K e Zn nas folhas foi maior no caso da análise foliar de 100 mL de citocininas. Portanto, os decisores políticos devem aconselhar a utilização da quantidade recomendada de citocininas para provocar a transição de regime, e os primeiros podem ganhar injetando 100 mL de citocininas para impulsionar a produção e a economia. Concluiu-se que a dose adequada de citocininas está no tratamento T3, que elevou o valor da concentração de potássio nas folhas, isso influenciou no desenvolvimento ideal, no fortalecimento contra o estresse ambiental e consequentemente na qualidade. Por esse motivo, foram realizadas pesquisas sobre o estudo comparativo de doses de citocinina na qualidade do caigua no Peru; o objetivo foi determinar a dose adequada para obter frutos de maior qualidade. Da mesma forma, foi sublinhado que o objetivo era empregar uma alternativa ecológica de origem vegetal, como a utilização de fito-hormona que estimulasse o crescimento da planta e, consequentemente, a qualidade do fruto. Os resultados obtidos serviram de recomendação para os agricultores da região. nutrientes vez contexto problemas tratamentos 0 50 15 20 fonte RCBD. RCBD . (RCBD) 10 189 18 9 18, 565 5 65 5,6 760 7 60 7,6 mm 4 forma N Portanto regime economia Concluiuse Concluiu T3 T ideal motivo vegetal fitohormona fito hormona fruto região 1 2 (RCBD 56 6 5, 76 7,

Abstract Bioavailability of nutrients, the scarcity of synthetic fertilisers, and the rising cost of fuel have all contributed to an increase in production costs, which has in turn reduced crop productivity and led scientists to seek out new methods to ensure high-quality output. In this context, various cytokinins dosages were tested in Peru to see whether they affected the quality of caigua, in an effort to address these issues. To mitigate these problems, a pot experiment was carried out to check the effects of various doses of cytokinin in the quality of caigua in Peru. The experiment consisted of 5 treatments including (0, 50, 100, 150 and 200 mL of cytokinin) by using (Anthesis Plus per 200 L of water) as a source, each with three replicates and placed following a randomized complete block design (RCBD). Treatment with 100 mL of cytokinins foliar analysis resulted in a caigua length of 18.9 cm, an increase in diameter of 5.65 cm, and an improvement in pulp thickness of 7.60 millimeters. Physiological parameters of caigua plants taken after 45 days of sowing were considerably improved with the same treatment. Similarly, N, K and Zn concentration in leaf was higher in case of 100 mL of cytokinins foliar analysis. Therefore, policymakers must advise using the recommended quantity of cytokinins to bring about regime transition, and formers can gain by injecting 100 mL of cytokinins to boost production and the economy. It was concluded that the adequate dose of cytokinins is in treatment T3, which raised value of potassium concentration in leaves, this influenced optimal development, strengthening against environmental stress and therefore quality. For this reason, research was carried out on the comparative study of cytokinin doses in the quality of caigua in Peru; the objective was to determine the appropriate dose to obtain higher quality fruit. Likewise, it was underlined that the objective was to employ an ecological alternative of plant origin such as the usage of phytohormone that stimulates the growth of the plant and consequently the quality of the fruit. The obtained the results were served as a recommendation for farmers in the area. nutrients fertilisers costs highquality high output context issues problems 0, 0 (0 50 15 20 Anthesis water source RCBD. RCBD . (RCBD) 10 189 18 9 18. cm 565 65 5.6 760 7 60 7.6 millimeters 4 Similarly N Therefore transition economy T3 T leaves development reason fruit Likewise area ( 1 2 (RCBD 56 6 5. 76 7.

Resumo O consumo de produtos com alto valor nutricional e capacidade antioxidante tem aumentado notavelmente nos últimos anos. Devido a problemas de saúde, como triglicerídeos e problemas cardiovasculares, seu uso está cada vez mais reduzido. Assim, a chia (Salvia hispanica) e o sachatomato (Cyphomandra betacea) têm ganhado interesse como alternativa para o desenvolvimento de produtos nutracêuticos, em comparação aos produtos convencionais. O objetivo do estudo foi determinar o efeito da substituição parcial da manga (Mangifera indica) e da chia moída (Salvia hispanica) na capacidade antioxidante na elaboração de néctar à base de Sachatomate. As características físico-químicas foram determinadas onde a amostra 11 atende aos parâmetros estabelecidos: 13,4° Brix, pH 4,323, 0,354 de C6-H8-O7 e viscosidade 3967,3 mPas, conforme norma NTP 203.110. Quanto à capacidade antioxidante, a amostra 12 foi a mais ótima, de acordo com o método DPPH, foram determinados 104,3 micromoles equivalentes de Trolox; de acordo com o método ABTS, foi determinado um teor antioxidante de 187,4 micromoles equivalentes de Trolox. Em relação à avaliação química proximal, a amostra 12 foi considerada a mais adequada, com percentual de umidade de 87,45%, cinzas 0,32%, fibra bruta 0,09%, gordura 0,10%, proteína 0,45% e carboidratos 11,59%. Concluir que a substituição do sachatomato pela chia moída influencia significativamente a capacidade antioxidante, aumentando para 104,3 e 187,4 micromoles equivalentes de Trolox, determinados por ambos os métodos, indica que o consumo de néctar pode ser utilizado para melhorar a saúde dos consumidores. anos cardiovasculares reduzido Assim Salvia hispanica Cyphomandra betacea nutracêuticos convencionais Mangifera Sachatomate físicoquímicas físico químicas 1 estabelecidos 134 13 4 13,4 Brix 4323 323 4,323 0354 0 354 0,35 C6H8O7 CHO C6 H8 O7 C H C6-H8-O 39673 3967 3 3967, mPas 203110 203 110 203.110 ótima DPPH 1043 104 104, Trolox ABTS 1874 187 187, proximal adequada 8745 87 45 87,45% 032 32 0,32% 009 09 0,09% 010 10 0,10% 045 0,45 1159 59 11,59% métodos consumidores 13, 432 4,32 035 35 0,3 C6H8O 396 20311 20 203.11 18 874 8 87,45 03 0,32 00 0,09 01 0,10 04 0,4 115 5 11,59 43 4,3 0, 39 2031 2 203.1 87,4 0,0 0,1 11,5 4, 203. 87, 11,

Abstract The consumption of products with high nutritional value and antioxidant capacity has increased notably in recent years. Due to health problems such as triglycerides and cardiovascular problems, its use is becoming reduced. So that, chia (Salvia hispánica) and sachatomate (Cyphomandra betacea) have gained interest as an alternative to develop nutraceutical products, compared to conventional products. The objective of the study was to determine the effect of the partial substitution of mango (Mangifera indica) and ground chia (Salvia hispánica) on the antioxidant capacity in the elaboration of nectar based on Sachatomate. The physicochemical characteristics were determined where sample 11 complies with the established parameters: 13.4° Brix, pH 4.323, 0.354 of C6-H8-O7 and viscosity 3967.3 mPas, according to the NTP 203.110 standard. Regarding the antioxidant capacity, sample 12 was the most optimal, according to the DPPH method, it has been determined 104.3 micromoles Trolox equivalents; according to the ABTS method, it was determined with an antioxidant content of 187.4 micromoles Trolox equivalents. Regarding the proximal chemical evaluation, sample 12 was determined to be the most suitable with a moisture percentage of 87.45%, ash 0.32%, crude fiber 0.09%, fat 0.10%, protein 0.45% and carbohydrates 11.59%. Concluding that substituting sachatomate and ground chia significantly influences the antioxidant capacity, increasing to 104.3 and 187.4 micromoles Trolox equivalents, determined by both methods, indicates that nectar consumption can be used to improve the health of consumers. years reduced Salvia hispánica Cyphomandra betacea Mangifera indica Sachatomate 1 parameters 134 13 4 13.4 Brix 4323 323 4.323 0354 0 354 0.35 C6H8O7 CHO C6 H8 O7 C H O C6-H8-O 39673 3967 3 3967. mPas 203110 203 110 203.11 standard optimal method 1043 104 104. equivalents 1874 187 187. evaluation 8745 87 45 87.45% 032 32 0.32% 009 09 0.09% 010 10 0.10% 045 0.45 1159 59 11.59% methods consumers 13. 432 4.32 035 35 0.3 C6H8O 396 20311 20 203.1 18 874 8 87.45 03 0.32 00 0.09 01 0.10 04 0.4 115 5 11.59 43 4.3 0. 39 2031 2 203. 87.4 0.0 0.1 11.5 4. 87. 11.

Resumo O uso crescente de medicamentos antimicrobianos tem sido associado ao aumento de fungos resistentes aos medicamentos nos últimos anos. A resistência antimicrobiana está sendo estudada sob diversas perspectivas devido à importante implicação clínica da resistência. Os processos subjacentes a esta resistência, os métodos melhorados para identificar a resistência quando esta surge, as opções alternativas de tratamento para infecções causadas por organismos resistentes, etc., são revistos, juntamente com estratégias para prevenir e regular a formação e propagação da resistência. Esta visão geral focará no mecanismo de ação dos antifúngicos e nos mecanismos de resistência contra eles. A ligação entre resistência antibacteriana e antifúngica também é brevemente discutida. Com base no seu mecanismo de ação, os antifúngicos são divididos em três categorias distintas: azóis, que têm como alvo a síntese do ergosterol; 5-fluorocitosina, que tem como alvo a síntese macromolecular, e polienos, que interagem físicoquimicamente com esteróis da membrana fúngica. A resistência antifúngica pode surgir de várias maneiras. Superexpressão do alvo do medicamento antifúngico, alterações no alvo do medicamento, alterações na biossíntese de esterol, diminuição da concentração intercelular da enzima-alvo e outros processos. Existe uma correlação entre os mecanismos de resistência aos antibacterianos e aos antifúngicos, apesar de a comparação entre os dois ser inevitavelmente limitada por vários parâmetros mencionados na revisão. A extrusão de fármacos através de bombas de membrana foi exaustivamente documentada em células procarióticas e eucarióticas, e o desenvolvimento de novos compostos e estratégias antifúngicas também foi bem caracterizado. anos surge etc etc. revistos eles discutida distintas azóis ergosterol 5fluorocitosina, 5fluorocitosina fluorocitosina 5 fluorocitosina, 5-fluorocitosina macromolecular polienos fúngica maneiras antifúngico esterol enzimaalvo enzima revisão eucarióticas caracterizado

Abstract The increasing use of antimicrobial drugs has been linked to the rise of drug-resistant fungus in recent years. Antimicrobial resistance is being studied from a variety of perspectives due to the important clinical implication of resistance. The processes underlying this resistance, enhanced methods for identifying resistance when it emerges, alternate treatment options for infections caused by resistant organisms, and so on are reviewed, along with strategies to prevent and regulate the formation and spread of resistance. This overview will focus on the action mechanism of antifungals and the resistance mechanisms against them. The link between antibacterial and antifungal resistance is also briefly discussed. Based on their mechanism action, antifungals are divided into three distinct categories: azoles, which target the ergosterol synthesis; 5-fluorocytosine, which targets macromolecular synthesis and polyenes, which interact physiochemically with fungal membrane sterols. Antifungal resistance can arise through a wide variety of ways. Overexpression of the target of the antifungal drug, changes to the drug target, changes to sterol biosynthesis, decreased intercellular concentration of the target enzyme, and other processes. A correlation exists between the mechanisms of resistance to antibacterial and antifungals, despite the fact that the comparison between the two is inevitably constrained by various parameters mentioned in the review. Drug extrusion via membrane pumps has been thoroughly documented in both prokaryotic and eukaryotic cells, and development of new antifungal compounds and strategies has also been well characterized. drugresistant years emerges organisms reviewed them discussed categories azoles 5fluorocytosine, 5fluorocytosine fluorocytosine 5 fluorocytosine, 5-fluorocytosine polyenes sterols ways biosynthesis enzyme review cells characterized

Resumen: Las mandarinas presentan una gran diversidad en características sensoriales y de calidad de fruta, así como una cosecha extendida. El mejoramiento genético de cítricos se focaliza en la búsqueda de nichos de cosecha para la obtención de mayores precios, así como en aspectos nutricionales y sensoriales, entre otras características. En este contexto, la caracterización sensorial de nuevos híbridos y la identificación de las características sensoriales claves que influyen en la aceptabilidad de los consumidores proveen de una valiosa información para el mejoramiento y las estrategias de marketing. Estudios previos mostraron que las características sensoriales, especialmente el sabor, son claves en la aceptación de las mandarinas por los consumidores. Se llevaron a cabo dos estudios durante la estación de cosecha de mandarinas (media y tardía) aplicando la metodología «marque todo lo que corresponda» (CATA) y con la participación de al menos 100 consumidores. La aceptabilidad de los cultivares que fueron más aceptados se situó entre 6,5 y 7,7 en una escala hedónica de 9 puntos, evidenciando una reacción hedónica positiva. Los nuevos híbridos presentaron puntajes de aceptabilidad similares o superiores a los cultivares de referencia Tango, Gold Nugget, Murcott y Ortanique. A su vez, los resultados mostraron que el color naranja, la forma regular, la piel lisa, el dulzor, la jugosidad, el sabor intenso y el sabor típico a mandarina son características claves que determinan la aceptabilidad de las mandarinas, y que la apariencia externa no es un buen predictor del sabor. Los híbridos F3P8, F5P8 y F2P3 fueron descritos por los consumidores con términos sensoriales positivos, recibiendo valores de aceptabilidad similares o mayores que los cultivares de referencia como tango, reafirmando la importancia de la incorporación de estudios sensoriales en el contexto del mejoramiento genético.

Abstract: Mandarin cultivars show a great diversity of fruit-quality and sensory characteristics, together with an extended harvest season. Citrus breeding is focused on exploiting season niches for higher prices as well as nutritional and sensory aspects, among others. In this context, the sensory characterization of new hybrids and the identification of key characteristics of consumers´ liking provide valuable information towards breeding efforts and marketing strategies. Previous works showed that sensory characteristics, and specially flavor, play a key role in consumer acceptance of mandarins. Two studies were carried out during mandarin harvest season (mid and late) applying “check all that apply” (CATA) questions with at least 100 consumers. Overall liking scores of the most liked hybrids and cultivars ranged between 6.5 to 7.7 in the 9-point hedonic scale, evidencing a positive hedonic reaction. Local hybrids showed similar or higher values than the reference cultivars Tango, Gold Nugget, Murcott and Ortanique. Results showed that orange color, regular shape, smoothness, sweetness, juiciness, intense and typical flavor are the key drivers of consumer's liking of mandarins, and that external appearance is not a good predictor of mandarin tasting experience. Hybrids F3P8, F5P8 and F2P3 were described using terms related to positive sensory characteristics and received liking scores similar or higher to reference cultivars such as Tango, stressing the importance of sensory and consumer science as an integral part of breeding strategies.

Resumo: As cultivares de tangerina apresentam grande diversidade na qualidade dos frutos e nas características sensoriais, juntamente com uma época de colheita prolongada. O melhoramento cítrico tem como foco a exploração de nichos sazonais por preços mais elevados, além de aspectos nutricionais e sensoriais, entre outros. Nesse contexto, a caracterização sensorial de diferentes híbridos e a identificação das características-chave do gosto do consumidor fornecem informações valiosas para os esforços de melhoramento e estratégias de marketing. Trabalhos anteriores mostraram que as características sensoriais e principalmente o sabor desempenham um papel fundamental na aceitação das tangerinas pelo consumidor. Dois estudos foram realizados durante a safra de tangerina (meio e final) aplicando perguntas do tipo cheque todos que se aplicam (CATA) com pelo menos 100 consumidores. As pontuações de aceitação geral dos híbridos e cultivares mais apreciados variaram entre 6,5 a 7,7 na escala hedônica de 9 pontos, evidenciando uma reação hedônica positiva. Os híbridos locais apresentaram valores semelhantes ou superiores aos cultivares de referência Tango, Gold Nugget, Murcott e Ortanique. Os resultados mostraram que a cor laranja, formato regular, maciez, doçura, sabor intenso y sabor tangerina e suculência típicos são os principais motivadores do gosto do consumidor por tangerinas e que a aparência externa não é um bom indicador da experiência de degustação da tangerina. Os híbridos F3P8, F5P8 e F2P3 foram descritos usando termos relacionados a características sensoriais positivas e receberam pontuações de gosto semelhantes ou superiores a cultivares de referência como o Tango, enfatizando a importância da ciência sensorial e do consumidor como parte integrante das estratégias de melhoramento.

OBJETIVOS: Desenvolver um modelo de predição para o tempo de permanência hospitalar (TPH) em lactentes de muito baixo peso ao nascer (MBPN) e comparar esse resultado entre 20 centros de uma rede neonatal, visto que o TPH é utilizado como uma medida da qualidade da assistência em lactentes de MBPN. MÉTODOS: Utilizamos dados coletados prospectivamente de 7.599 lactentes com peso ao nascer entre 500 e 1.500 g no período entre os anos de 2001 a 2008. O modelo de regressão de Cox foi empregado para desenvolver dois modelos de predição: um modelo prévio com dados do nascimento e outro posterior, que acrescenta morbidades relevantes dos primeiros 30 dias de vida. RESULTADOS: A mediana do TPH estimado e ajustado a partir do nascimento foi de 59 dias; 28 dias depois do tempo de sobrevida de 30 dias. Houve uma alta correlação entre os modelos (r = 0,92). O TPH esperado e o TPH observado variaram bastante entre os centros, mesmo depois de correção para as morbidades relevantes após 30 dias. O TPH mediano (variação: 45-70 dias) e a idade concepcional na alta hospitalar (variação: 36,4-39,9 semanas) refletem uma variabilidade alta entre centros. CONCLUSÃO: Um modelo simples, com fatores apresentados no nascimento, pode predizer o TPH de um lactente de MBPN em uma rede neonatal. Observou-se uma variabilidade nos TPHs considerável entre unidades de terapia intensiva neonatal. Especulamos que os resultados sejam provenientes das diferenças entre as práticas dos centros.

OBJECTIVES: To develop a prediction model for hospital length of stay (LOS) in very low birth weight (VLBW) infants and to compare this outcome among 20 centers within a neonatal network. METHODS: Data from 7,599 infants with birth weights of 500-1,500 g born between the years 2001-2008 were prospectively collected. The Cox regression model was employed to develop two prediction models: an early model based upon variables present at birth, and a late one that adds relevant morbidities for the first 30 days of life. RESULTS: Median adjusted estimated LOS from birth was 59 days ‒ 28 days after 30-day point of survival. There was a high correlation between models (r = 0.92). Expected/observed LOS varied widely among centers, even after correction for relevant morbidity after 30 days. Median observed LOS (range: 45-70 days), and postmenstrual age at discharge (range: 36.4-39.9 weeks) reflect high inter-center variability. CONCLUSION: A simple model, with factors present at birth, can predict a VLBW infant's LOS in a neonatal network. Significant variability in LOS was observed among neonatal intensive care units. We speculate that the results originate in differences in inter-center practices.

The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150x10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48h from the onset of symptoms), with a dose of 75mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10ml / kg and plateau pressure <35mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.

El diagnóstico de gripe A/H1N1 es fundamentalmente clínico sobre todo durante los picos de la gripe estacional o en brotes epidémicos. Se recomienda realizar un test diagnóstico a todos los pacientes con fiebre y cuadro gripal que requieran hospitalización. La muestra respiratoria (exudado nasal, faríngeo o muestra profunda en pacientes intubados) se debe obtener lo antes posible e iniciar inmediatamente tratamiento antiviral empírico. Los métodos moleculares basados en técnicas de amplificación de ácidos nucleicos (rt-PCR) son el «gold standard» para el diagnóstico de la gripe A/H1N1. Los métodos inmunocromatográficos son poco sensibles, por lo cual un resultado negativo no excluye la infección activa. El cultivo clásico en células es poco sensible y lento. La inmunofluorescencia directa tiene una sensibilidad del 90%, pero requiere una muestra de calidad. Los métodos indirectos de detección de anticuerpos tienen solo interés epidemiológico. Los pacientes afectados de gripe A/H1N1 pueden presentar leucopenia relativa, con elevación de LDH, CPK y PCR, aunque estas variables del laboratorio no se asocian de forma independiente con el pronóstico. Sin embargo, niveles plasmáticos de LDH >1.500U/L y la presencia de plaquetopenia <150 x10(9)/L podrían definir una población de pacientes con riesgo de complicaciones graves. La administración del antiviral (oseltamivir) debe ser precoz (<48 h desde el inicio de los síntomas), en una dosis de 75mg cada 12 h, con una duración de al menos 7 días o hasta la mejoría clínica evidente. La administración precoz se asocia a mejor superviviencia en pacientes críticos. Nuevos antivirales, en especial aquellos formulados para administración intravenosa, podrían ser los de elección en futuras epidemias. Los pacientes con alta sospecha de gripe A/H1N1 deben continuar con tratamiento, independientemente de los resultados negativos de las pruebas iniciales, a menos que se pueda establecer un diagnóstico alternativo o los criterios clínicos sugieran una baja probabilidad de influenza En pacientes con neumonía por gripe A/H1N1 y dada la posibilidad de coinfección bacteriana, se recomienda cobertura antibiótica empírica (asociando un betalactámico con un macrólido) administrada lo antes posible. Los resultados de los cultivos y las variables clínicas o de laboratorio decidirán la retirada o no de los antibióticos. Como medida de prevención se recomienda la vacunación antineumocócica en la población de riesgo. A pesar de que se ha propuesto el uso de corticosteroides en dosis moderadas-bajas para el tratamiento de la neumonía por gripe A/H1N, con la finalidad de mejorar la lesión pulmonar aguda, hasta el presente no existe evidencia científica suficiente que permita recomendar el uso de esteroides en estos pacientes. El tratamiento del síndrome de distrés respiratorio agudo en pacientes con gripe A/H1N1 debe basarse en el empleo de estrategias ventilatorias protectoras del pulmón (volumen tidal <10ml/kg y presión plateau <35mmHg) y utilización de presión positiva al final de la espiración alta ajustada a la mecánica pulmonar del paciente, combinadas con el empleo de ventilación en decúbito prono, relajación muscular y maniobras de reclutamiento. La ventilación mecánica no invasiva no puede ser considerada una técnica de elección en los pacientes con síndrome de distrés respiratorio agudo, aunque podría ser útil en centros de gran experiencia y en casos de insuficiencia respiratoria asociados a reagudización de enfermedad pulmonar obstructiva crónica o insuficiencia cardiaca. La oxigenación por membrana extracorpórea es una técnica de rescate en la gripe A/H1N1 con síndrome de distrés respiratorio agudo refractario. La evidencia científica es débil y no es la técnica de primera elección. Se instaurará si todas las otras medidas para mejorar la oxigenación han fracasado. Es recomendable la centralización de la técnica en hospitales de referencia. Los resultados clínicos muestran una supervivencias entre el 50-60% de los pacientes. La afectación cardiovascular de la gripe A/H1N1 es frecuente y secundaria a la inestabilización de miocardiopatías preexistentes, miocarditis, cardiopatía isquémica y disfunción del ventrículo derecho. El diagnóstico precoz y la monitorización adecuada permiten iniciar un tratamiento efectivo y valorar, en los casos más graves, la necesidad de instaurar sistemas de soporte circulatorio. Se recomienda la vacunación antigripal a todos los pacientes con riesgo, aunque podría ser necesario ampliar esta indicación a todos los mayores de 6 meses, salvo contraindicaciones. Los niños deben recibir 2 dosis con 1 mes de diferencia. Los inmunodeprimidos y la población con riesgo han de recibir una dosis con revacunación anual. La frecuencia de efectos adversos de la vacuna contra la gripe A/H1N1 es similar a la de la gripe estacional. La quimioprofilaxis siempre ha de ser considerada un complemento de la vacunación y está indicada en personas con alto riesgo de complicaciones así como en el personal sanitario que ha sufrido exposición.

Mercury is an essential element for extracting gold from river beds in illegal gold mining in Madre de Dios Region in Peru. Water pollution by mercury has become a very serious public health problem for this area, because of the dissemination of this metal in the food chain and being humans the final destination of mercury. Exposure to this element in pregnant women may lead to chronic mercury poisoning, and fetuses and embryos may become irreversibly affected, with the occurrence of congenital neurological disorders.

El mercurio constituye un elemento esencial para la extracción del oro por amalgamación en las zonas amazónicas de extracción aurífera informal, como lo es la región de Madre de Dios, en Perú. La contaminación del agua de los ríos por el mercurio constituye un grave problema de salud pública para la región, debido a las consecuencias de su difusión en la cadena trófica alimentaria y su llegada final a seres humanos, pudiéndo ocasionar intoxicación crónica inclusive intraútero; motivo por el cual embriones y fetos podrían ser contaminados de manera irreversible en forma temprana generando patologías neurológicas congénitas.

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic, and in this latter case, gastrointestinal tract involvement represents 3-15% of cases, being most frequently located in the rectal-sigmoid region. Appendix involvement in endometriosis is rare, accounting 3-5% of all endometriosis cases. For this reason we present this case of appendicular endometriosis, which was incidentally diagnosed in a patient admitted in the emergency service with a condition resembling acute appendicitis.

La endometriosis es una condición en que el tejido endometrial es localizado fuera de la cavidad uterina. Esta puede ser pélvica o extra pélvica, y de esta última, la afectación del tracto gastrointestinal representa de 3-15% y de localización más frecuente en el rectosigmoides, siendo el compromiso apendicular raro con 3-5% de todas las endometriosis, motivo por el cual se presenta este caso, diagnosticado incidentalmente en una paciente admitida en emergencia por cuadro de apendicitis aguda.

This study examines the effect of crop sequence, inoculation and fertilization on the behavior of nodulation and soybean yield in extensive farming systems of the central area of Cordoba. The experience was developed during two campaigns with different hydric stress levels, in fields under no-tillage systems, both in the soybean-soybean and corn-soybean sequences. The effect of the application of no nitrogen fertilizers and inoculate were analyzed. During the R5 soybean growth stage the number and fresh weight of nodules in main and secondary roots and the percentage of functional nodules were measured; grain yield and root morphology were also evaluated. The average weight of the main root nodules was the most sensitive variable to the different cultural practices. The corn-soybean rotation was the main factor that favored the nodular system. The effect of fertilization and inoculation was not significant for most of the variables measured. The weight of main root nodules during the wetter campaign, was double that in the dry campaign. Grain yields did not show differences between the treatments considered nor were they correlated with nodulation patterns. The greatest nodulation appeared in fields with less nitrogen availability.

Se estudió el efecto de la secuencia de cultivos, la inoculación y la fertilización sobre la nodulación y el rendimiento del cultivo de soja, en sistemas agrícolas extensivos del área central de Córdoba. La experiencia se desarrolló durante dos campañas con distinto nivel de estrés hídrico, bajo siembra directa con secuencias soja-soja y maíz-soja, donde se evaluó el efecto de la aplicación de fertilizante no nitrogenado e inoculante. Durante la etapa R5 del cultivo se midieron número y peso fresco de nódulos en raíces principal y secundarias y porcentaje de nódulos funcionales; además, se evaluó el rendimiento de granos y morfología de raíces. El peso promedio de los nódulos de la raíz principal fue la variable más sensible a las diferentes prácticas culturales. La rotación maíz-soja fue el principal factor que favoreció al sistema nodular. Para la mayoría de las variables, los efectos de prácticas como fertilización e inoculación no resultaron significativos. En la campaña húmeda los nódulos de la raíz principal pesaron el doble que en la campaña seca. Los rendimientos no mostraron diferencias entre tratamientos ni correlacionaron con los patrones de nodulación. La mayor nodulación se presentó en lotes de menor disponibilidad de nitrógeno.

The human immunodeficiency virus (HIV) infection is a disease with great sociosanitary impact. Since 1981, when the first cases of AIDS were described, more than 60 million people have become infected. During these 25 years there have been a lot of advances in the infection management and we know that prevention and early diagnosis are crucial. Family Physician's role is essential since this is a privileged point of global attention, counseling and support for these patients. The main objective is to reduce the new HIV infections incidence. In addition, other objectives are: primary prevention and health promotion, early diagnosis, recruitment infected patients, monitoring and end-of-life caring. It is important to know that all of us are susceptible to contract the virus and, although the HIV testing is voluntary, there are screening recommendations from the CDC: persons with signs or symptoms that suggest infection, pregnant women, persons at high risk for infection and all patients aged 13-64 years, as a part of routine clinical care. The communication of the result is a key point in the therapeutic relation. If it is negative we must make intervention on risk attitudes. If it is positive we must inform and support the patient, to convince him about the need to be followed up by an specialized level. The AIDS terminal patient is a very immunodeficient one and needs palliative cares like other terminal disease. Another challenge is prevention and control of HIV infection among the immigrant community. In conclusion, Family Physicians must investigate risk practices, inform, prevent new cases and, in the infected people, monitor the evolution, supporting and comforting.

La infección por el virus de la inmunodeficiencia humana (VIH) es una enfermedad con gran impacto sociosanitario. Desde 1981, cuando se describieron los primeros casos de sida, se han infectado más de 60 millones de personas. En estos 25 años se han realizado muchos avances en cuanto a su manejo y sabemos que la prevención y el diagnóstico precoz son fundamentales. El papel del médico de familia es esencial ya que es un punto privilegiado de atención global, counseling y apoyo para estos pacientes. El principal objetivo es disminuir la incidencia de nuevas infecciones por VIH. Además, otros objetivos son: prevención primaria y promoción de la salud, diagnóstico precoz, captación de pacientes infectados, seguimiento y cuidados al paciente terminal. Es importante conocer que todos somos susceptibles de contraer el virus y, aunque la realización de la serología de VIH es voluntaria, existen recomendaciones de los CDC: sujetos con signos o síntomas sugestivos de infección, mujeres embarazadas, sujetos con situaciones de riesgo y entre los 13 y 64 años de manera rutinaria. La comunicación del resultado es un punto clave en la relación terapéutica. Si es negativo se debe hacer intervención sobre las conductas de riesgo. Si es positivo debemos informar y apoyar al paciente, además es importante una buena captación y valoración para su derivación a la consulta especializada. El paciente terminal de sida está muy inmunodeprimido y necesita cuidados paliativos como otra enfermedad terminal. Otro reto es la prevención y control de la infección VIH en la población inmigrante. En conclusión, el médico de familia debe investigar prácticas de riesgo, informar, prevenir nuevos casos y, en la población infectada, seguimiento de la evolución, apoyando y confortando.

Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of post-transplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion.

Objetivo: el objetivo de este estudio ha sido evaluar la supervivencia a corto y largo plazo del paciente trasplantado de hígado por hepatocarcinoma (CHC), el riesgo de recidiva tumoral postrasplante y los factores asociados a esta complicación. Diseño: estudio restrospectivo de una serie consecutiva de pacientes trasplantados de hígado por hepatocarcinoma. Pacientes y métodos: enfermos trasplantados por hepatocarcinoma desde el año 1989 hasta noviembre de 2003. Los pacientes fueron seleccionados con unos límites generales de tamaño y número de nódulos que fueron posteriormente publicados como criterios de Milán. En su diagnóstico pretrasplante se siguieron asimismo criterios consensuados en la Conferencia de Barcelona. Resultados: la supervivencia de este grupo de 81 pacientes trasplantados por hepatocarcinoma fue del 80, 61 y 52%, a los 1, 5 y 10 años respectivamente. En el 32% de los casos el CHC fue un hallazgo incidental en el explante. En el 12,3% se constató recidiva tumoral. El estudio multivariante identificó como factores de riesgo de recidiva el tamaño del nódulo (OR = 1,7944) (IC 95% = 1,1332-2,8413) y la invasión vascular (OR = 6,6346) (IC 95% = 1,4624-30,1003). Conclusiones: el trasplante de hígado en pacientes seleccionados con CHC obtiene buenos resultados a medio y largo plazo. El riesgo de recidiva tumoral postrasplante se ha reducido notablemente y está asociado con el tamaño del nódulo y con la invasión vascular microscópica.

INTRODUCTION: Chemotherapy (CT) and thoracic radiotherapy (TRT) constitute the standard care of patients with inoperable/unresectable locally advanced NSCLC. However, the optimal schedule of treatment remains to be determined. METHODS: A prospective study was conducted in patients with locally advanced stage IIIA or IIIB NSCLC, to determine the tolerability and local control obtained with 7 weekly courses of concurrent chemo-radiotherapy using Docetaxel (D: 20 mg/m²) or Paclitaxel (P: 60 mg/m²) and TRT (2 Gy daily Monday through Friday, totalizing 70 Gy in the seven weeks), after 3 cycles of cisplatinum-based induction chemotherapy (cisplatinum + gemcitabine +/- vinorelbine). RESULTS: From December 1999 to December 2004, fifty two out of 129 patients treated with induction chemotherapy and at least with stable disease were considered eligible for analysis. Twenty seven were treated with docetaxel (D) and twenty five with paclitaxel (P). The average of weeks of treatment was 5 for D (range 7-3) and 6 for P (7-1), and 40% and 58% of patients respectively in each group completed 7 weeks and received the programmed doses. Significant toxicity during concurrent therapy included (D/P %): esophagitis (grade I, 22/18; grade II, 25/29; grade III, 30/8), pneumonitis (grades I-II, 14/5), diarrhea (grades I-II, 14/0). The percentage of local progression and median time elapsed were 41% and 180 days in the D group of patients, and 46% and 240 days in the P group. CONCLUSION: No definitive conclusions can be made, considering the small size of the sample in this study, but the observed trends suggest that concurrent chemo-radiotherapy employing TRT and Docetaxel or Paclitaxel administered weekly offer similar local efficacy, Paclitaxel showing a lower toxicity.

INTRODUCCIÓN: La quimioterapia (QT) y la radioterapia torácica (RT-T) constituyen el tratamiento estándar para los pacientes con carcinoma de pulmón no microcítico localmente avanzado inoperable/irresecable (CPNM-I) aunque el mejor esquema de administración está por determinar. MATERIAL Y MÉTODOS: Se ha realizado un estudio prospectivo en pacientes con CPNM-I estadio IIIA o IIIB no quirúrgicos, para determinar la tolerabilidad y el control local utilizando el siguiente esquema: 7 ciclos de Docetaxel (D: 20 mg/m²) o Paclitaxel (P: 60 mg/m²) semanal, concurrente con RT-T (2 Gy diariamente de lunes a viernes, dosis total 70 Gy, durante 7 semanas) después de 3 ciclos de QT de inducción basada en cisplatino (CDDP+gemcitabina +/-vinorelbina). RESULTADOS: Desde Diciembre 1999 a Diciembre 2004, cincuenta y dos pacientes de 129 tratados con QT de inducción fueron considerados elegibles para el análisis: 27 recibieron Docetaxel y 25 Paclitaxel. La mediana de semanas de tratamiento administradas fue 5 para el D (rango 7-3) y 6 para el P (7-1). 40% (D) y 58% (P) de los pacientes en cada grupo completaron 7 semanas y las dosis programadas del tratamiento. La toxicidad registrada incluye (D/P;%): Esofagitis grado (G)I (22/18); GII (25/29), GIII (30/8), neumonitis G I-II (14/5), diarrea GI-II (14/0). La progresión local y mediana de tiempo hasta la progresión local fue 41% y 180 días para D y 46% y 240 días para P. CONCLUSIONES: Los resultados de este pequeño estudio prospectivo sugieren que la asociación concurrente de radioterapia torácica con docetaxel o paclitaxel semanal ofrece un control similar de la enfermedad así como una tendencia a una menor toxicidad no hematológica con paclitaxel.

Entre outubro de 2001 e março de 2002, foram examinados 103 espécimes de A. tricolor provenientes de Angra dos Reis (23°01'S, 44°19'W), litoral do Estado do Rio de Janeiro, Brasil, para o estudo de suas infracomunidades de metazoários parasitos. Foram coletadas 10 espécies de metazoários parasitos: 4 digenéticos, 1 cestóide, 1 acantocéfalo, 2 nematóides, 1 copépode e 1 hirudíneo; e 77% dos peixes estavam parasitados por 1 ou mais metazoários, com média de 3,5 ± 6,2 parasitos/peixe. Os digenéticos foram dominantes, representando 53,2% do total de parasitos coletados, e Ergasilus sp., a espécie mais abundante. A abundância e a prevalência de Parahemiurus merus (Linton, 1910) foram positivamente correlacionadas ao comprimento total dos hospedeiros. Relações entre a abundância parasitária total e a riqueza parasitária média ao comprimento total dos hospedeiros foram observadas. A diversidade parasitária média foi corrrelacionada com o comprimento total dos hospedeiros, apresentando diferenças significativas entre os peixes machos e fêmeas. Dois pares de espécies de larvas apresentaram associação e covariação positiva significativas. As infracomunidades de metazoários parasitos de A. tricolor demonstraram dominância nas larvas de endoparasitos, correlação entre abundância parasitária, diversidade e riqueza de espécies e o comprimento total dos hospedeiros e o baixo número de associações interespecíficas parasitárias. A comunidade parasitária de A. tricolor apresentou algumas semelhanças com a comunidade parasitária de outros engraulídeos do Atlântico Sul-Americano.

Between October 2001 and March 2002, 103 specimens of A. tricolor from Angra dos Reis (23°01'S, 44°19'W), in the coastal zone of the State of Rio de Janeiro, Brazil, were analyzed in order to study their metazoan parasite infracommunities. Ten species of metazoan parasites were collected: 4 digeneans, 1 cestode, 1 acantocephalan, 2 nematodes, 1 copepod, and 1 hirudinean; 77.7% of the fishes were parasitized by one or more metazoan, with a mean of 3.5 ± 6.2 parasite/fish. Digenean was the most dominant with 4 species that accounted for 53.2% of the total parasites collected; Ergasilus sp. was the most abundant species. Abundance and prevalence of Parahemiurus merus (Linton, 1910) were positively correlated with the total length of host. Relationships between total body length of fish and both total parasite abundance and mean parasite species richness were observed. Mean parasite diversity of species was correlated to host's total length, with significant differences found between male and female fishes. Two pairs of larval species showed significant positive association and covariation. The metazoan parasite infracommunities of A. tricolor presented dominance of larval endoparasites; correlation of parasite abundance, diversity, and species richness with host total length; and low number of parasite interspecific relationships. The parasite community of A. tricolor showed some similarities with the parasite community of another South American Atlantic engraulid.