Abstract Schwannomas are tumors that appear in the sheath that surrounds the nerves; they are formed of Schwann cells which form the myelin sheath in peripheral nerves. In this document, we report a case of Schwannoma of the dorsal nerve of the penis in a man 40-year-old male with no history of neurofibromatosis. Despite the abundant innervation of the penis, it is rare to find them in this location with < 50 cases reported in the literature. Its diagnosis is integrated based on physical examination and supported by imaging. The definitive diagnosis is obtained with histopathology with immunohistochemistry.

Abstract It is important to have forest seeds in sufficient quality and quantity in order to alleviate and reverse the processes of deforestation and land use change that occur at local, national and global levels; therefore, the objective of the present study was to evaluate the productive potential of cones and seeds in two pine species of the El Salto region in Pueblo Nuevo, Durango, Mexico. A total of 63 specimens of Pinus cooperi and 53 of Pinus durangensis were sampled; an average of five cones were collected from each individual, and the total number of the remaining cones in the whole crown of each tree was counted; the length, diameter and biological potential of each cone was determined, and the seeds were classified as infested, aborted and viable, based on X-ray tests. The results showed that only 17 % of the P. cooperi and 21 % of P. durangensis seeds in the region are viable, 34 % and 27 %, respectively, are aborted, and 49 % and 52 % are infested with pests. No statistical differences were found for the variables of the cones and seeds in P. durangensis (α≤0.05 %); however, for P. cooperi, statistical differences were obtained in cone length, biological potential, and developed seeds.

Resumen La necesidad de disponer de semillas forestales de calidad y en cantidad suficiente es importante para mitigar y revertir los procesos de deforestación y de cambio de uso de suelo que ocurren a nivel local, nacional y mundial; por tanto, el objetivo del presente estudio fue evaluar el potencial productivo de conos y semillas de dos especies de pino en la región de El Salto, Pueblo Nuevo, Durango, México. Se muestrearon 63 ejemplares de Pinus cooperi y 53 de Pinus durangensis; de cada árbol se recolectaron, en promedio, cinco conos y se contabilizó el total existente en toda la copa; se determinó la longitud, diámetro y el potencial biológico de cada cono, y se clasificaron las semillas como plagadas, abortadas y viables, mediante pruebas de rayos X. Los resultados mostraron que solo 17 % de las pertenecientes a P. cooperi y 21 % de P. durangensis fueron viables; 34 % y 27 % correspondieron a la categoría de abortadas; mientras que, 49 % y 52 %, respectivamente presentaron plagas. No se obtuvieron diferencias estadísticas para las variables de los conos y semillas en P. durangensis (α≤0.05%); sin embargo, para P. cooperi sí se registraron en la longitud del cono, potencial biológico y semillas desarrolladas.

Abstract A generalized epileptic seizure lasting five or more minutes, or the presence of two or more seizures without recovery of consciousness in thirty minutes, or a focal seizure that persists for more than 10 min or with altered consciousness for 60 min or more duration is called status epilepticus. It can be classified into generalized and focal, motor and non-motor. Its etiology may or may not be recognized. The electroencephalographic pattern shows focal or generalized persistent epileptic activity. It is a dangerous situation, which requires algorithmic management since it is detected, in the emergency Room and if required in the intensive therapy unit. In-hospital management would include the initial ABCDE , hypertonic glucose solution and thiamin if hypoglycemia is detected. Lorazepam (midazolam or diazepam) to juggle seizures, followed by phenytoin, valproate or levetiracetam in impregnation and sustain. If the status epilepticus persists for more than an hour, the patient will be referred to an ICU with intubation and continuous administration of midazolam, propofol or thiopental with intubation and continuous monitoring. If it does not yield with two drugs, it is called refractory epileptic status, and if it continues for 24 h or more, it is recognized as super-refractory. A third of these patients die.

Resumen Una crisis epiléptica generalizada que dura cinco o más minutos, o la presencia de dos o más crisis sin recuperación de la consciencia en un periodo de 30 minutos, o una crisis focal que persiste durante más de 10 minutos o con alteración de la consciencia durante 60 minutos o más de duración, se denomina estado epiléptico. Puede dividirse en generalizado y focal, en motor y no motor. Su etiología puede o no reconocerse. El patrón electroencefalográfico muestra actividad epiléptica persistente focal o generalizada. Es una situación grave, que requiere un manejo algorítmico desde que se detecta en Urgencias y, si lo requiere, en la Unidad de Terapia Intensiva (UTI). El manejo intrahospitalario incluye el ABCDE inicial, solución glucosada hipertónica y tiamina si se detectó hipoglucemia; lorazepam (midazolam o diazepam) para yugular las crisis, seguido de fenitoína, valproato o levetiracetam en impregnación y sostén. Si el estado epiléptico persiste durante más de una hora pasará a una UTI con intubación y administración continua de midazolam, propofol o tiopental con intubación y monitorización continua. Si no cede con dos fármacos se denomina estado epiléptico refractario y si continúa durante 24 horas o más se reconoce como superrefractario. Hasta un tercio de los pacientes muere.

Resumen En este trabajo se evalúa la eficiencia en la extracción del glucósido cianogénico amigdalina de semillas de manzanas (Maluspumila Mill) empleando las técnicas tradicionales con solventes de reflujo y Soxleth, las cuales son comparadas con la técnica más contemporánea de microondas. Las eficiencias de extracción son determinadas a través de cromatografía líquida de alta eficiencia (HPLC) empleando un método estandarizado que requiere tiempos de retención de alrededor de 1 minuto. La mejor separación cromatográfica es obtenida con el método de reflujo; sin embargo, la eficiencia de separación total más alta es alcanzada empleando la técnica de microondas, la cual requiere de solo un 10% del tiempo total y solventes necesarios en las extracciones por reflujo y Soxhlet. En contraste, la mayor cantidad de extraída de amigdalina de las semillas es obtenida con la técnica de Soxhlet, la cual corresponde al triple y al doble de las cantidades que logran ser extraídas con las metodologías de reflujo y microondas respectivamente. La pureza e identificación estructural de la amigdalina extraída es verificada espectroscópicamente usando las técnicas de UV-vis, RMN (*H and 13C) y FTIR.

Abstract This work evaluates the efficiency in the extraction of the cyanogenic glycoside amygdalin [D-mandelonitrile- p-D-gentiobioside] from seeds of apples (Malus pumila Mill) by using the two most conventional solid-to-liquid methodologies (reflux and Soxhlet) in relation to the more contemporary microwave technique. The extraction efficiencies are determined by an optimized and standardized high-performance liquid chromatography (HPLC) method that requires retention times of about 1 min only. The best chromatographic separation of amygdalin is found in extracts obtained using the reflux method; however, the highest total separation efficiency, requiring only 10% of total time and the solvents inverted in reflux or Soxhlet extraction, is reached by employing microwave radiation. In contrast, the higher extraction amounts of amygdalin from the seeds are obtained using the Soxhlet solid-to-liquid technique. With the Soxhlet methodology, quantities of amygdalin from apple seeds are obtained in excess of three times and twice those obtained with reflux and microwave methodologies, respectively. The purity and structural identification of the extracted amygdalin were verified spectroscopically using UV-vis, NMR and FTIR techniques.

Resumen Los polifenoles son compuestos químicos con una diversidad de interacciones que pueden ser responsables de muchas funciones, que van desde la toxicidad hasta la protección y blindaje contra la luz/UV. Baccharis antioquensis es una fuente potencial de compuestos fotoprotectores con capacidad antioxidante. El objetivo del presente trabajo fue desarrollar un protocolo de micropropagación para B. antioquensis y evaluar la producción de polifenoles in vitro por exposición a la radiación UVB. Ramas juveniles fueron colectadas y cultivadas en medio de Murashige y Skoog (MS) y suplementadas o no con reguladores de crecimiento (TDZ, BA o GA3) en diferentes condiciones de luz/oscuridad y medios líquidos/sólidos. Después de los tratamientos UVR, se midió el espectro de absorción UV y se evaluó el coeficiente de absorción en la región UVA-UVB, la capacidad antioxidante y TPC tanto en las plantas in vitro como en las plantas silvestres. Los tratamientos que contenían reguladores BA + GA3 (2 y 0.5 mg / L respectivamente) y TDZ (0.5 mg / L) mostraron resultados positivos en el crecimiento del brote en medio líquido y en condiciones de oscuridad. Los resultados mostraron que la UVR tiene efectos promotores sobre la acumulación de metabolitos secundarios, aumentando el coeficiente de absorción en la región UVA-UVB, la capacidad antiradicalaria y TPC en las plantas in vitro.

Abstract Polyphenols are a large diversity of chemical types and interactions that can be responsible for a multiplicity of protective functions ranging from toxicity and light/UV shielding to signal transduction. Bacharis antioquensis has been described as a potential source of new photoprotective compounds with antioxidant capacity associated to polyphenols compounds. The aim of the present work was to develop a micropropagation protocol of B. antioquensis and evaluate the production of polyphenols by in vitro plants exposure to UVB radiation. Branches in juvenile stage of B. antioquensis were collected, desinfected and cultured on half strength Murashige and Skoog medium, supplemented or not with growth regulators (TDZ, BA or GA3) on light/darkness conditions and liquid/solid media. After UV treatments, the absorption coefficient in the UVA-UVB range, the antioxidant capacity and the total phenol content (TPC) from all tissue cultures and the wild tissue were evaluated. Growth regulators, light conditions and type of culture medium (solid or liquid) had a favorable effect on the response of explants. Treatments containing BA + GA3 regulators (2 and 0.5 mg/L respectively) and TDZ (0.5 mg/L) showed positive results in bud growth in liquid medium and darkness. Results showed that UVR exhibited promoting effects on the accumulation of polyphenols, enhancing the absorption coefficient in the UVA-UVB range, the antiradical capacity and the TPC of B. antioquensis in vitro plants. Rev. Biol. Trop. 66(2): 754-764. Epub 2018 June 01.

Resumen Introducción: Los eventos críticos intraoperatorios son situaciones raras, y su manejo en ocasiones podría ser inoportuno e inadecuado. Objetivo: Traducir y actualizar las listas de chequeo para manejo de eventos críticos en salas de cirugía desarrolladas por Ariadne Labs y adaptar la lista para el manejo de la toxicidad por anestésicos locales, a partir de evidencia clínica secundaria. Materiales y métodos: Para la traducción y actualización de las listas de chequeo se siguieron las recomendaciones de Ariadne Labs para la modificación de las lista de chequeo originales de acuerdo a una metodología sistemática dividida en fases: 1) traducción de las listas originales; 2) búsqueda sistemática de la literatura; 3) evaluación y selección de la evidencia; 4) adaptación de la lista para manejo de toxicidad por anestésicos locales; 5) cambios, sustracciones y adiciones a las listas traducidas, y 6) diagramación de las listas de chequeo. Resultados: Se tradujeron al español las 12 listas de chequeo originales y se adaptó una nueva lista para el manejo de toxicidad por anestésicos locales. Como resultado de la búsqueda sistemática de la literatura se tamizaron 1.407 referencias, de las cuales se seleccionaron e incluyeron 7 artículos con los que se actualizaron las nuevas listas de chequeo con base en la evidencia. Las nuevas listas se diagramaron según las recomendaciones de diseño de las listas originales. Conclusión: Se presentan 12 listas de chequeo traducidas y actualizadas y se adaptó una nueva para el manejo de toxicidad por anestésicos locales. Todo ello a partir de una revisión sistemática de la literatura.

Abstract Introduction: Critical intraoperative events are rare and may sometimes be managed poorly and too late. Objective: To translate and update the checklists developed by Ariadne Labs for management of critical events in the OR and to adapt the list for managing anesthetic toxicity, based on secondary clinical evidence. Materials and methods : In order to translate and update the checklists, the recommendations given by Ariadne Labs were followed to change the original checklists in accordance with a systematic methodology that comprises three phases: 1) translation of the original lists, 2) systematic literature search, 3) evaluation and selection of evidence, 4) adaptation of the list for managing anesthetic toxicity, 5) changes, deletions, and additions to the translated lists, and 6) layout of the checklists. Results: The 12 original checklists were translated into Spanish and a new list was adapted for managing toxicity from local anesthetic agents. As a result of the systematic literature search, 1407 references were screened, from which 7 articles were selected and included for evidence-based updating of the new checklists. The layout of the new lists was consistent with the design recommendations of the original lists. Conclusion: 12 translated and updated checklists were submitted and a new list was adapted for the management of local anesthetics toxicity, based on a systematic literature review.

INTRODUCTION: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied. OBJECTIVE: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities. METHODS: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18 - 59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed. RESULTS: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), β2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%). CONCLUSIONS: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

INTRODUCTION: In El Salvador, end-stage renal disease is the leading cause of hospital deaths in adults, the second cause of death in men and the fifth leading cause of death in adults of both sexes in the general population. OBJECTIVE: Identify risk factors for chronic kidney disease and urinary markers of renal and vascular damage, measure kidney function and characterize prevalence of chronic kidney disease in persons aged >18 years in the Bajo Lempa region of El Salvador. METHODS: A cross-sectional analytical epidemiological study was carried out using active screening for chronic kidney disease and associated risk factors in individuals aged >18 years in the Bajo Lempa Region, a rural, coastal area in El Salvador. Door-to-door visits and clinical examinations were conducted. Epidemiological and clinical data were collected including: family and personal clinical history of disease; biological, behavioral, social and environmental risk factors; physical measurements; urinalysis for markers of renal and vascular damage; and blood tests (serum creatinine, serum glucose, lipid profile). Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula. Chronic kidney disease case confirmation was done three months later. Multiple logistic regression was used for data analysis. RESULTS: A total of 375 families and 775 individuals (343 men, 432 women) were studied-88.3% of the total resident population in the region. Elevated prevalence of risk factors was observed: diabetes mellitus, 10.3%; hypertension,16.9%; family history of chronic kidney disease, 21.6%; dyslipidemias, 63.1%; overweight, 34%; obesity, 22.4%; metabolic syndrome, 28.8%; use of non-steroidal anti-inflammatory drugs, 74.8%; infectious diseases, 86.9%; agricultural occupation, 40.6% (80.6% in men); and contact with agrochemicals, 50.3% (82.5% in men). Prevalence renal damage markers was 15.8% (greater in men): microalbuminuria 6.3%; proteinuria 5.7%; hematuria 3.5%; proteinuria-hematuria 0.3%. Proteinuria of <1 g/L predominated. Prevalence of chronic kidney disease was 17.9% (25.7% in men; 11.8% in women). Distribution by stages: stage 1, 4.6%; stage 2, 3.5%; stage 3, 6.2%; stage 4, 3.0%; stage 5, 0.6%. In patients with chronic kidney disease, most common was non-diabetic chronic kidney disease (86.3%), followed by chronic kidney disease associated with neither diabetes nor hypertension (54.7%). Prevalence of chronic renal failure was 9.8% (17% in men; 4.1% in women). Multiple logistic regression showed significant association with increasing age, male sex, hypertension and family history of chronic kidney disease. CONCLUSIONS: Elevated prevalence of chronic kidney disease, chronic renal failure and risk factors was found, compared to international reports. Most common was chronic kidney disease of unknown cause, associated with neither diabetes nor hypertension. Associations were found with age, male sex, hypertension and family history of chronic kidney disease, with decline in kidney function beginning at early ages. Male farmers have a dual burden of non traditional (occupational, toxic environmental) and traditional (vascular) risk factors that could act in synergy, contributing to kidney damage.

The diet of Ameiva edracantha Bocourt 1874, a terrestrial diurnal teiid lizard distributed in northwestern Peru and southwestern Ecuador is described for the first time. Stomach contents of fifteen individuals collected from quebrada La Angostura were analyzed. Lepidopteran larvae, coleopterans, orthopterans and spiders were the dominant preys in the lizard’s diet. Snout-vent length and head length, width and height were not correlated to prey length, width and volume. Other parameters such as profitability and prey target selection could be involved in prey selection by A. edracantha.

Se describe por primera vez la dieta de Ameiva edracantha, una especie de lagartija teiida diurna terrestre que se distribuye en la costa noroeste de Perú y suroeste de Ecuador. Se analizó el contenido estomacal de 15 individuos colectados en la quebrada La Angostura. La dieta de A. edracantha estuvo compuesto principalmente por larvas de lepidópteros, coleópteros, ortópteros y arañas. La longitud hocico-cloaca y la longitud, ancho y alto de la cabeza no se relacionó con la longitud, ancho y volumen de las presas. Otros parámetros como selección específica de presas y profitabilidad, podrían estar involucrados en la selección de presas en A. edracantha.

La hemofilia se define como una condición hereditaria de carácter recesivo, cuyo gen está asociado al cromosoma sexual X. Se caracteriza por la deficiencia de algunos factores de la coagulación (hemofilia A, factor VIII, y hemofilia B, factor IX). Clínicamente una persona con hemofilia presenta sangrados espontáneos (principalmente intrar-ticulares) y el control de la hemostasia de éstos, ya sean espontáneos o traumáticos, es difícil; por lo tanto, cualquier procedimiento quirúrgico y su buen manejo intraoperatorio en una persona con hemofilia representa un verdadero reto. Este artículo presenta el caso de un paciente hemofílico tipo A de 62 años de edad, con diagnóstico de cirrosis hepática secundaria a infección con hepatitis C. El paciente presentaba un hepatocar-cinoma de 22 mm en el segmento VI del hígado y fue sometido exitosamente a un trasplante hepático ortotópico en el Hospital Universitario Fundación Santa Fe de Bogotá.

Hemophilia is defined as a recessive hereditary trait linked to the X chromosome. It is characterized by a deficiency of several coagulation factors (hemophilia A: factor VIII, and hemophilia B: factor IX) Clinically, a person with hemophilia has spontaneous bleeding (mostly intra-articular) and the hemostatic control of it is difficult for which the intraoperative management of hemophiliac patients is challenging. This case report describes a 62 year old patient with hemophilia A, who had a diagnosis of liver cirrhosis secondary to a hepatitis C infection. The patient developed a 22 mm hepatocarcinoma in segment VII of the liver and was successfully subjected to an orthotopic liver transplant at the University Hospital Fundación Santa Fe de Bogotá.

We report our experience with the percutaneous closure of patent ductus arteriosus with a Nit-Occlud device made of Nitinol (Nickel-Titanium alloy) in 13 patients; 10 women and 3 men, average age of 23.2 ±21.1 years. Average diameters were 3.8 + 0.8 mm and the morphologies, according to Krichenko's classification, were 10 type A, 2 type E, and 1 type C. The device was selected according to the aortic ampule and the narrowest part of the ductus. We implanted 8 occluders of 11 x 6 mm, 4 of 9 x 6 mm, and 1 of 7 x 6 mm. In three patients (25%) total occlusion was observed 15 minutes after implantation, in seven (54%) a trivial leak was observed, and in only two patients (16.6%) was the leak moderate to severe. In on patient, the occluder migrate to the pulmonary artery trunk and was successfully removed percutaneously; the patient was subjected then to surgical closure. Echocardiography follow-up 24 h later showed total occlusion in nine patients (69%). Six months after the procedure, two patient presented trivial leak (15%). One patient developed an endocarditic infection and died. We concluded that this occluder might be useful for this pathology, but further studies must be done.

Se presenta la experiencia de 13 pacientes con diagnóstico de persistencia de conducto arterioso permeable tratados por vía percutánea con un dispositivo de nitinol (aleación de níquel y titanio), llamado Nit-Occlud. Fueron 10 mujeres y 3 hombres con edad promedio de 23.2 ±21.1 años. La angiografía en la aorta descendente previa al cierre reportó diámetro promedio del conducto arterioso de 3.8 ± 0.8 mm y la morfología del mismo fue de 10 conductos tipo A, 2 tipo E y 1 tipo C según la clasificación de Krichenko. El tamaño del oclusor seleccionado se basó en el diámetro de la ámpula aórtica y del sitio más estrecho del conducto. Se utilizaron 8 dispositivos 11x6 mm, 4 dispositivos 9x6 mm y 1 dispositivo 7x6 mm. Tres pacientes (25%) mostraron oclusión del 100% en forma inmediata (15 min después de la liberación del dispositivo), 7 (53%) presentaron fuga leve y difusa y sólo 2 pacientes (16.6%) mostraron fuga moderada a severa. Un paciente presentó migración del dispositivo a la rama izquierda de la arteria pulmonar (RIAP), se logró su rescate por vía percutánea enviándose el paciente posteriormente a cirugía. En el seguimiento ecocardiográfico a las 24 h 9 pacientes (69%) mostraron oclusión del 100%. A los 6 meses de seguimiento 10 tienen oclusión al 100% y sólo 2 pacientes tienen fuga residual leve (15%). Un paciente desarrolló cuadro de endocarditis infecciosa que finalmente provocó su deceso. Se concluye que el dispositivo Nit-Occlud es útil para el cierre de esta patología aunque hace falta mayor experiencia.