ABSTRACT The study analyzes the association between self-destructive indirect behaviors and social anomie in a sample of 509 fourth grade high school students from Lima. A data sheet, the Kelley et al. (1985) Self-destructive behaviors Scale adapted to Spanish language by Ponce (2007) and the Li et al. (1999) Anomie Scale validated by Vera et al. (2013) were applied. The study found direct and significant association between both variables in the total sample (in cases with and without domestic violence), with moderate effect. In cases without domestic violence, discontent is associated with all self-destructive behaviors’ dimensions, followed by distrust associated to four of them. In teenagers who are victims of domestic violence, discontent is associated with lack of planning and anticipation and neglecting their duties and distrust is associated with neglecting their duties. Finally, in accordance with the results from multivariate logistic regression analyses, the only dimension of social anomie statistically significant (p<.05) to predict self-destructive behaviors is discontent.

RESUMEN El estudio analiza la asociación entre las conductas autodestructivas indirectas y la anomia social en una muestra de 509 escolares de cuarto de secundaria de instituciones educativas de Lima. Se empleó una ficha de datos, la escala de conductas autodestructivas de Kelley et al. (1985) adaptada al español por Ponce (2007) y la escala de anomia social de Li et al. (1999) validada por Vera et al (2013). Se halló asociación directa y significativa entre ambas variables en la muestra total (con y sin violencia familiar), con tamaño del efecto moderado. Cuando no existe violencia, el descontento se asocia con todas las dimensiones de las conductas autodestructivas, seguido de la desconfianza asociada con cuatro de ellas; en adolescentes con violencia, el descontento se asocia con falta de planeación, de anticipación y descuido de deberes y la desconfianza con descuido de deberes. Finalmente, de acuerdo con los resultados de la regresión logística, a nivel multivariado, la única dimensión de la anomia social que resulta estadísticamente significativa (p<.05) en la predicción de las conductas autodestructivas es descontento.

Abstract This study aimed to investigate the effect of growth and differentiation factor 9 (GDF-9) during the in vitro culture of isolated caprine early antral follicles. The isolated and selected early antral follicles were individually cultured for 18 days, and the following treatments were tested: α-MEM+ (control treatment) or α-MEM+ supplemented with 200 ng/mL GDF-9. The following endpoints were evaluated: follicular growth and morphology, estradiol production, oocyte nuclear maturation, and relative expression of key genes related to steroidogenesis (CYP19A1, CYP17, and insulin receptor) and basement membrane remodeling (MMP-9 and TIMP-2). In both treatments, a decrease was observed in the percentage of morphologically intact follicles with a concomitant increase in the rates of extruded and degenerated follicles (P < 0.05). The GDF-9 treatment showed higher rates of extruded follicles only on day 6 of culture (P < 0.05). Follicle diameter increased progressively throughout the culture period (P < 0.05) with similar diameters between treatments at all culture times (P > 0.05). Growth and differentiation factor 9 increased the daily growth rate from the first to the second third of culture, with higher values (P < 0.05) than control in the second third. Oocyte maturation rate as well as estradiol levels and relative mRNA expression for CYP19A1, CYP17, MMP-9, TIMP-2, and insulin receptor genes were similar between treatments (P > 0.05). This study shows for the first time that GDF-9 added to a culture medium increased the follicle growth rate of goat early antral follicles cultured in vitro.

Resumo Este estudo teve como objetivo investigar o efeito do GDF-9 durante o cultivo in vitro de folículos antrais iniciais caprinos isolados. Os folículos antrais iniciais isolados e selecionados foram cultivados individualmente por 18 dias, e os seguintes tratamentos foram testados: α MEM+ (tratamento controle) ou α-MEM+ suplementado com 200 ng/mL de GDF-9 (tratamento GDF-9). Os seguintes parâmetros foram avaliados: crescimento e morfologia folicular, produção de estradiol, maturação nuclear do oócito e expressão relativa de genes-chave relacionados a esteroidogênese (CYP19A1, CYP17 e receptor de insulina) e remodelamento da membrana basal (MMP-9 e TIMP-2). Em ambos os tratamentos, observou-se diminuição na porcentagem de folículos morfologicamente intactos com aumento concomitante nas taxas de folículos extrusos e degenerados (P < 0,05). O tratamento GDF-9 apresentou maiores taxas de folículos extrusos apenas no 6º dia de cultivo (P < 0,05). O diâmetro do folículo aumentou progressivamente ao longo do período de cultivo (P < 0,05) com diâmetros semelhantes entre os tratamentos em todos os tempos de cultivo (P > 0,05). O GDF-9 aumentou a taxa de crescimento diário do primeiro para o segundo terço de cultivo, sendo maior (P < 0,05) que o controle no segundo terço. A taxa de maturação oocitária assim como os níveis de estradiol e a expressão relativa de RNAm para os genes CYP19A1, CYP17, MMP-9, TIMP-2 e receptor de insulina foram similares entre os tratamentos (P > 0,05). Em conclusão, este estudo mostra pela primeira vez que GDF-9 adicionado a um meio de cultivo aumentou a taxa de crescimento de folículos antrais iniciais caprinos cultivados in vitro.

Resumen Introducción: La deficiencia congénita de proteína S es una enfermedad muy rara en la población. En gestantes está asociada a aborto espontáneo y muerte fetal, entre otras complicaciones. Presentación del caso: Presentamos el caso de una multigesta de 32 años con embarazo de 36 semanas, con tromboprofilaxis con enoxaparina desde la semana cuarta de gestación y con diagnóstico de trombofilia -por deficiencia de proteína S funcional-, la cual fue intervenida con cesárea electiva bajo anestesia espinal. Además, se realizó revisión de la literatura al respecto. Discusión: El riesgo de tromboembolismo venoso es aproximadamente 4 a 5 veces mayor durante la gestación, y la recomendación de tromboprofilaxis en trombofilias de bajo riesgo se basa en la presencia de factores de riesgo asociados. En pacientes que reciben Heparinas de Bajo Peso Molecular (HBPM) como tromboprofilaxis, se recomienda un intervalo de al menos 12 horas después de la última dosis de HBPM antes de la punción del neuroeje, y reiniciar la siguiente dosis después de al menos 4 horas de uso de la técnica espinal. Conclusión: Las técnicas neuroaxiales deben ser individualizadas y recibir tromboprofilaxis pre y posparto. Además, se deben tener en cuenta las medidas de tromboprofilaxis no farmacológicas en el periodo perioperatorio. La anestesia espinal fue efectiva y segura en esta paciente.

Abstract Introduction: Congenital protein S deficiency is a very rare disease in the population. In pregnant women it is associated with spontaneous abortion and fetal death, among other complications. Case presentation: We present the case of a 32-year-old multigravida with a 36-week pregnancy, with thromboprophylaxis with enoxaparin from the 4th week of gestation and with a diagnosis of thrombophilia-due to functional protein S deficiency-which was intervened with elective c-section under spinal anesthesia. In addition, a review of the relevant literature was conducted. Discussion: The risk of venous thromboembolism is approximately 4 to 5 times greater during gestation, and the recommendation of thromboprophylaxis in low-risk thrombophilia is based on the presence of associated risk factors. In patients receiving low molecular weight heparin (LMWH) as thromboprophylaxis, an interval of at least 12 hours after the last dose of LMWH before neuropsy and restarting the next dose after at least 4hours of spinal technique use is recommended. Conclusion: Neuroaxial techniques should be individualized and receive pre and postpartum thromboprophylaxis. In addition, non-pharmacological thromboprophylaxis measures in the perioperative period should be considered. Spinal anesthesia was effective and safe in this patient.

Abstract A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

A colon volvulus is the twisting of a colonic segment on its mesentery causing bowel obstruction. The transverse colon volvulus is an uncommon condition. We report the case of a 55-year-old male who initially showed bloating and abdominal pain, lack of bowel movements and flatus, nausea and hyporexia. During an exploratory laparotomy, a volvulus covering the transverse colon to the splenic flexure was found and resected with a posterior anastomosis of the transverse and descending colon. In conclusion, this clinical case report aims to show an uncommon case of colon volvulus and, at the same time, send the message that a colon volvulus is an acute (surgical) abdomen that medical personnel should know how to clinically recognize, because its immediate intervention will prevent the ischemia and subsequent necrosis of the large intestine

El vólvulo de colon es la torcedura de un segmento del mismo sobre su mesenterio y es causa de obstrucción intestinal. El vólvulo de colon transverso es de presentación rara. Reportamos el caso de un varón de 55 años que inicia con distensión y dolor abdominal, ausencia de deposiciones y flatos, náuseas e hiporexia. Durante una laparotomía exploratoria, se halla un vólvulo que abarca el colon transverso hasta el ángulo esplénico y se le realiza resección de los mismos y una posterior anastomosis transverso-descendente. En conclusión, el presente caso clínico busca mostrar un caso raro de vólvulo colónico y a la vez enviar el mensaje de que el vólvulo colónico es una presentación de abdomen agudo quirúrgico que el personal médico debe saber reconocer clínicamente, debido a que su intervención inmediata evitará la isquemia y posterior necrosis del intestino grueso