Abstract Liver rupture secondary to preeclampsia represents a complication that, if is not recognized early, can be fatal. Its presentation is rare, but very complex to treat, having options that are not clearly protocolized and usually derive from the experience of the surgeon who faces it. We present a case of liver rupture of a patient from Toluca, State of Mexico who was admitted by emergency air transfer with immediate puerperium complicated by severe preeclampsia, postpartum hemorrhage, liver rupture with hemodynamic instability, it was necessary to intervene surgically for a total of seven occasions to control the hemorrhage, as well as pharmacological, medical measures and multiple transfusions; however, she died on the eighteenth day of his hospitalization for septic shock.

RESUMEN El cacao es la principal materia prima para producir chocolate, así como para su uso en las industrias alimentaria, cosmética y farmacéutica. Sin embargo, Moniliophthora roreri es una de las enfermedades fúngicas más destructivas y la principal limitante de la producción de cacao en todo el mundo. Así, este trabajo evaluó el efecto inhibidor de extractos obtenidos de Zingiber officiale (T1) y Aloe vera (T2), y Trichoderma harzianum + Bacillus subtillis (T3) en la infección producida por Moniliophthora roreri en Theobroma cacao; además, un cultivo control (T4) también fue evaluado. Cada tratamiento se aplicó a seis plantas de cacao. La incidencia de la infección por monilia y el peso de la fruta se monitorearon cada 15 días (en total cuatro períodos) después del tratamiento por pulverización. Se encontraron diferencias significativas (P<0.05) entre los tratamientos por incidencia. Se observó que la pulverización de árboles enteros de cacao después de dos veces (aproximadamente 30 días) mostró una reducción de la infección por monilia. Después de todos los períodos, T1, T2 y T3 mostraron una reducción en la infección por monilia de 20,5, 17,7 y 14,9% respectivamente, en comparación con el control cultural de 41,1%. Esta reducción de la infección por moniliasis se tradujo en un aumento del peso promedio de los frutos en T3 (8,4 kg), T2 (7,3 kg) y T1 (6,9 kg). En cambio, el control cultural (T3), el peso promedio de la fruta disminuyó a 5,3 kg. El control biológico mostró un manejo eficiente de patógenos como M. roreri. Recomendamos el uso de este tipo de antifúngicos (en especial Aloe vera) aplicados durante al menos 120 días lo que disminuiría más la incidencia de la infección.

ABSTRACT Theobroma cacao is the main raw material to produce chocolate, as well as for use in the food, cosmetic, and pharmaceutical industries. However, Moniliophthora roreri is one of the most destructive fungal diseases and the main limiting of cacao production worldwide. Thus, this work aimed to assess the inhibitory effect of extracts of Zingiber officinale (T1) and Aloe vera (T2), and Trichoderma harzianum + Bacillus subtillis. (T3) on Moniliophthora roreri infection in Theobroma cacao; in addition, a control (T4) was also evaluated. Each treatment was applied to six plants of cacao. Incidence of monilia infection and fruit weight were monitored every 15 days (in total four periods) after the application of the treatment by spray. Significant differences (P<0.05) were found among treatments for incidence. It was observed that spraying entire cacao trees after two times (approximately 30 days) showed a reduction of monilia infection. After all periods, T1, T2, and T3 showed an incidence of monilia infection by 20.5, 17.7, and 14.9% respectively, compared to cultural control of 41.1%. This reduction of moniliasis infection translates into an increase in fruit weight average for T3 (8.4 kg), T2 (7.3 kg), and T1 (6.9 kg). In contrast, in the control (T3), the fruit weight average decreased by 5.3 kg. Biological control showed efficient management of pathogens as M. roreri. It is recommended to use such antifungal (Aloe vera) spray over at least 120 days which would decrease infection incidence even more.

Abstract The profitability of dairy farms is closely linked to reproductive performance. Identifying risk factors that compromise this performance is vital to implementing strategies to improve productivity. An analysis was done of the effects on reproductive performance of artificial insemination (AI) use, herd size and high seroprevalence of reproductive infectious diseases. Data on reproductive events were collected from 52 farms (10-100 cows; 959 lactations) over 18 mo (births 2011-2012). Neosporosis, bovine infectious rhinotracheitis (IBR) and bovine viral diarrhea (BVD) seroprevalences were documented at each farm. Multiple logistic regression analyses were applied to determine the degree of association (odds ratio, OR) between potential risk factors and reproductive variables. Herds of 33 or more cows (OR= 1.5) and high neosporosis seroprevalence (OR= 2.3) were risk factors for assisted calving. High IBR and BVD seroprevalences (OR= 1.3 and 1.9, respectively) were risk factors for days to first service over 70 d in milk (DFS>70). Artificial insemination was a common risk factor for DFS>70 (OR= 2.4) and days open over 110 days in milk (OR= 1.3). Herds of 33 or more cows was a risk factor for non- pregnant cows at first service (OR= 1.7). Artificial insemination, herds of 33 or more cows and high neosporosis, IBR and BVD seroprevalences are factors associated with reproductive performance in small-scale dairy farms in various geographical regions in Mexico.

Resumen La rentabilidad de los establos lecheros está fuertemente asociada con el desempeño reproductivo. Por lo tanto, la identificación de factores de riesgo que comprometen este desempeño es primordial para implementar estrategias que mejoren la productividad. En este estudio, se probaron los efectos del uso de inseminación artificial (IA), hatos grandes y seroprevalencia alta de enfermedades infecciosas reproductivas sobre el desempeño reproductivo. Se incluyeron al estudio 52 establos (10-100 vacas; 959 lactaciones) registrando eventos reproductivos durante 18 meses (partos 2011-2012). Las seroprevalencias de neosporosis, rinotraqueitis infecciosa bovina (IBR) y diarrea viral bovina (BVD) se registraron en cada establo. Se utilizaron análisis de regresión logística múltiples para determinar el grado de asociación (razón de momios, OR) entre factores potenciales de riesgo y variables reproductivas. Establos ≥33 vacas y seroprevalencia alta de neosporosis fueron factores de riesgo para Asistencia al Parto (OR 1.5 y 2.3, respectivamente). Seroprevalencias altas de IBR y BVD fueron factores de riesgo para Días a Primer Servicio>70 Días en Leche (DPS>70, OR 1.3 y 1.9, respectivamente). La IA fue un factor de riesgo común para DPS>70 y Días Abiertos>110 Días en Leche (OR 2.4 y 1.3, respectivamente). Establos ≥33 vacas fue un factor de riesgo para Vacas No Gestantes al Primer Servicio (OR 1.7). En conclusión, la IA, establos ≥33 vacas y seroprevalencias altas de neosporosis, IBR y BVD son factores asociados al desempeño reproductivo en establos de producción de leche a pequeña escala en varias regiones geográficas de México.

RESUMO Racional: Residência em Cirurgia Geral pode durar entre 2-6 anos, dependendo do país. Residência mais curta deve otimizar a exposição dos residentes às cirurgias. Sabe-se que o treinamento cirúrgico simulado encurta as curvas de aprendizado, mas a informação relacionada à como isso afeta a residência em relação à exposição clínica é escassa. Objetivo: Analisar o efeito da introdução de um programa de treinamento laparoscópico simulado validado em procedimentos abdominais realizados por residentes em um programa de Residência em Cirurgia Geral de três anos. Métodos: Um estudo de coorte não simultâneo foi desenhado. Quatro gerações (2012-2015) de cirurgiões graduados foram incluídos. Apenas os procedimentos abdominais em que os cirurgiões graduados foram o cirurgião principal foram descritos e analisados. O grupo controle foi de cirurgiões graduados de 2012 sem programa de treinamento laparoscópico simulado. Procedimentos cirúrgicos por ano de programa, técnica cirúrgica, intervenção de emergência ou eletiva e local do hospital (hospitais principais/comunitários) foram descritos. Resultados: Intervenções de 28 cirurgiões graduados foram analisadas (controle=5; programa de treinamento simulado=23). Os cirurgiões graduados realizaram média de 372 procedimentos abdominais, com maior número médio de procedimentos de médio a complexo no grupo de programa de treinamento simulado (48 vs. 30, p=0,02). Cirurgiões graduados treinados com programa de treinamento simulado realizaram número maior de procedimentos abdominais totais (384 vs. 319, p=0,04) e procedimentos laparoscópicos (183 vs. 148, p<0,05). Conclusões: A introdução do programa de treinamento laparoscópico simulado pode aumentar o número e a complexidade dos procedimentos totais e laparoscópicos na Residência em Cirurgia Geral de três anos.

ABSTRACT Background: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents’ surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía» la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada» como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.

OBJECTIVE: Estimate the prevalence of human immunodeficiency virus (HIV) infection and Treponema pallidum in Argentine female sex workers (FSW), and describe the sociodemographic characteristics of this population group associated with HIV transmission. METHODS: A cross-sectional study and convenience sampling were conducted in FSW over 18 years of age in nine Argentine cities from October 2006 to December 2009. A total of 1 255 women participated in this study. A group of FSW was especially trained to invite other women to participate in the workshops and undergo screening for HIV and T. pallidum. RESULTS: The most noteworthy socioepidemiological characteristics of the FSW included a high percentage of sexual abuse, limited condom use with noncommercial sex partners, and a high percentage of violence. HIV prevalence was 2% (25/1 255, 95% confidence interval [95% CI]:1.2-2.8) and T. pallidum prevalence was 22.4% (245/1 094; 95% CI: 19.9-24.9). In the city of La Plata, HIV prevalence in FSW was significantly lower compared to that of other regions of the country (0.3% vs. 2.7%, P < 0.05, respectively). CONCLUSIONS: The lower HIV prevalence and the higher rate of condom use reported by the women from La Plata surveyed suggest that the presence of a health center for FSW has a direct influence on reducing risky behavior and, consequently, HIV infection. The creation of "friendly" health centers like the one already in this city contributes to providing a comprehensive response to the problems faced by these women and encourages use of the health system. It therefore helps reverse their vulnerability and higher risk of contracting HIV and other sexually transmitted infections.

OBJETIVO: Estimar la prevalencia de infección por el virus de la inmunodeficiencia humana (VIH) y de Treponema pallidum en mujeres trabajadoras sexuales (MTS) de Argentina, y describir las características sociodemográficas de este grupo de población asociadas a la transmisión del VIH. MÉTODOS: Entre octubre de 2006 y diciembre de 2009 se realizó un estudio de corte transversal y un muestreo por conveniencia en MTS mayores de 18 años de nueve ciudades de Argentina. Un total de 1 255 mujeres participaron en este estudio. Se capacitó especialmente a un grupo de MTS para convocar a las otras mujeres a participar en talleres y a realizarse el diagnóstico del VIH y T. pallidum. RESULTADOS: Las características socio-epidemiológicas más destacadas de las MTS incluyeron un alto porcentaje de abuso sexual, escaso uso de preservativos con parejas sexuales no comerciales y un alto porcentaje de situaciones de violencia. La prevalencia del VIH fue de 2% (25/1 255, intervalo de confianza de 95% [IC95%]:1,2-2,8) y la de T. pallidum, de 22,4% (245/ 1 094, IC95%: 19,9-24,9). En las MTS de la ciudad de La Plata, la prevalencia del VIH fue significativamente más baja comparada con las participantes del resto del país (0,3% vs 2,7%, P < 0,05, respectivamente). CONCLUSIONES: La menor prevalencia del VIH y la mayor tasa de uso de preservativos informadas por las mujeres encuestadas de La Plata sugieren que la presencia de un lugar de atención sanitaria para MTS influye directamente en la disminución de sus conductas de riesgo y, por ende, en la infección por el VIH. La creación de centros de salud "amigables", como el que ya hay en dicha ciudad, contribuye a dar una respuesta integral al problema que enfrentan estas mujeres; asimismo, favorece su acercamiento al sistema de salud y contribuye así a revertir su situación de mayor vulnerabilidad y mayor riesgo frente al VIH y otras infecciones de transmisión sexual.