Purpose: To determine the influence of emotional alterations in the arterial stiffness index and cardiovascular risk of pre-hypertensive patients.Methods: A cross-sectional study was carried out in 48 pre-hypertensive patients. Emotional alterations, global cardiovascular risk and arterial stiffness index were evaluated. The PPG technique was used to record the arterial pulse wave in the first finger of the lower right limb, using the ANGIODIN® digital plethysmograph.Results: Pre-hypertensive patients with emotional alterations had major Weight, Body Mass Index, systolic blood pressure, diastolic blood pressure and arterial stiffness index with respect to patients who did not find emotional alterations. In pre-hypertensive patients, 58.3% presented a positive Cornell test, 39.6% of them female, and 18.8% male. There was a significant relationship (plt;0.001) between the presence of emotional disturbances and moderate cardiovascular risk.Conclusions: Emotional alterations in pre-hypertensive patients is associated with an increase in arterial stiffness and an increased global cardiovascular risk.

ABSTRACT Objective: To analyze the relationship between spiritual wellbeing, quality of life satisfaction, functional status, and sense of the suffering in a population of religious elderly residents. Methods: Descriptive, transversal and correlational study. The sample included N=435 residents (average age=83.17, SD=7.04). FACIT Sp Ex scale, Sense of Suffering Humannizing scale, Lawton's Philadelphia scale and Barthel's Index were used. Student's T and Pearson's correlations were obtained. Results: There is a high percentage (42.3 %, N=88) of unsatisfied residents with quality of life in the oldness. The average of sense of suffering as change (M=3.62) was significantly (p<.05) greater than as a charge (M=2.36), which showed moderate and positive significant correlation (p<.01) with all dimensions of spiritual well-being (r=.276), overall well-being (r=.315) and purpose/ peace (r=.343). Independence group (according to Barthel index) earned a significantly higher average (p <.05) in dimensions peace and purpose (M=26.28), overall well-being (M=40.36), spiritual well-being (M=78.29) and attitudes towards old age (M=2.72) than dependence group (M=24.45, M=38.07, M=74.63 and M=2.25 respectively). Conclusions: Elderly care must include the spiritual dimension. The sense of suffering as a charge explicits inner transformation that religious population can give to the suffering. It is highlighted the importance of promoting social relationship satisfaction and positive attitudes towards old age in order to generate well-being, reduce levels of anxiety and prevent dissatisfaction due to fear to getting older.

RESUMEN Objetivo: Analizar la relación entre el bienestar espiritual, la satisfacción con la calidad de vida, el estado funcional y el sentido del sufrimiento de una población de religiosos ancianos residentes. Método: Estudio descriptivo, correlacional y transversal. La muestra fue de N = 435 residentes (media de 83,17 años, DT = 7,04). Se utilizaron las escalas FACIT Sp Ex, Humanizar sobre el sentido del sufrimiento, Filadelfia de Lawton e índice de Barthel. Se calcularon la t de Student y correlaciones de Pearson. Resultados: Existe un alto porcentaje (42,3%, N = 88) de residentes insatisfechos con su calidad de vida en la vejez. La media del sentido del sufrimiento como cambio (M = 3,62) fue significativamente (p < 0,05) mayor que como carga (M = 2,36), que mostró correlación significativa (p < 0,01) moderada y positiva con todas las dimensiones del bienestar espiritual (r = 0,276), bienestar general (r = 0,315) y propósito/paz (r = 0,343). El grupo de independencia (según el índice de Barthel) obtuvo una media significativamente mayor (p < 0,05) en las dimensiones paz y propósito (M = 26,28), bienestar general (M = 40,36), bienestar espiritual (M = 78,29) y actitudes hacia la vejez (M = 2,72) que el grupo de dependencia (M = 24,45, M = 38,07, M = 74,63 y M = 2,25, respectivamente). Conclusión: La atención a mayores debe incluir el plano espiritual. El sentido de sufrimiento como carga explicita la transformación interior que la población de religiosos puede dar al sufrimiento. Se destaca la importancia de fomentar la satisfacción con las relaciones sociales y actitudes positivas hacia la vejez, ya que genera bienestar, reduce los niveles de ansiedad y evita la insatisfacción derivada de miedos ante el hecho de hacerse mayor.

Abstract The development of mathematical models with technical and scientific bases is important in forest management decision-making. The objective of this study was to model dominant height growth of Pinus ayacahuite Ehren to enable productivity projections. Data on stem analysis of 34 P. ayacahuite individuals were used to fit growth models, classic in forest biometry (Schumacher, Chapman-Richards, Levakovic II, Hossfeld IV and Gompertz), as well as the modeling strategies Guide Curve Method, Algebraic Difference Approach (ADA) and Generalized Algebraic Difference Approach (GADA), using non-linear least squares method. A simultaneous fit was used for the ADA and GADA equations and a 40-year base-age. The graphic and numerical results of the models were satisfactory, according to the statistical indicators of goodness of fit. The indicators of fit of Chapman-Richards polymorphic b 2 models in guide curve and ADA, polymorphic b 1 of Hossfeld IV in ADA and the Hossfeld IV model under the GADA approach were better than the other models. The models selected enabled the construction of families of site index curves. Of these, the Chapman-Richards polymorphic b 2 model in ADA had the best prediction capacity. Therefore, its use is recommended for determining the site index and to classify levels of timber productivity of P. ayacahuite stands.

Resumen El desarrollo de modelos matemáticos con bases técnicas y científicas es importante para tomar decisiones en el manejo forestal. El objetivo de este estudio fue modelar el crecimiento en altura dominante de Pinus ayacahuite Ehren, para realizar proyecciones de su productividad. Datos del análisis troncal de 34 individuos de P. ayacahuite se usaron para ajustar modelos de crecimiento, clásicos en biometría forestal: Schumacher, Chapman-Richards, Levakovic II, Hossfeld IV y Gompertz; además, con las estrategias de modelado: curva guía, el método de diferencia algebraica (ADA) y el método de diferencia algebraica generalizada (GADA), mediante mínimos cuadrados no lineales. Un ajuste simultáneo se empleó para las ecuaciones ADA y GADA y edad base de 40 años. Los resultados gráficos y numéricos de los modelos fueron satisfactorios de acuerdo con los indicadores estadísticos de bondad de ajuste. Los indicadores de ajuste de los modelos polimórfico b 2 de Chapman-Richards en curva guía y ADA, polimórfico b 1 de Hossfeld IV en ADA, y el modelo de Hossfeld IV bajo el enfoque GADA fueron mejores en comparación con los otros modelos. Los modelos seleccionados permitieron construir familias de curvas de índice de sitio. De ellos, el modelo polimórfico b 2 de Chapman-Richards en ADA mostró capacidad de predicción mayor. Por tanto, se recomienda su uso para determinar el índice de sitio y clasificar los niveles de productividad maderable de rodales de P. ayacahuite.

Abstract: Objective: To investigate the correlation among pro- or anti-inflammatory cytokines and the two main gut microbiota phyla in obese children. Materials and methods: Anthropometric data were obtained from 890 children under 14 years old to determine the degree of obesity. Serum cytokine concentration was measured by ELISA. Relative abundance of gut microbiota in feces was evaluated by quantitative Real-Time PCR assays. Results: Anthropometric and biochemical parameters were statistically higher in overweight /obese children than in lean ones. Increased TNF-α levels were found in obese children that also have a high relative abundance of Firmicutes. Conclusions: Obese children have a high relative abundance of Firmicutes that correlates with increased levels of TNF-α. This is the first study that shows a relation between Firmicute abundance and TNF-α serum concentration in obese children.

Resumen: Objetivo: Investigar la correlación entre las citocinas proinflamatorias o antiinflamatorias y los dos principales filos de la microbiota intestinal en niños obesos. Material y métodos: Se obtuvieron mediciones antropométricas de 890 niños de 6 a 14 años; posteriormente se clasificaron en normopeso y sobrepeso/obeso. Las concentraciones séricas fueron medidas por el método de ELISA. La abundancia relativa de la microbiota intestinal en heces se evaluó por PCR tiempo real. Resultados: Los parámetros bioquímicos y antropométricos fueron estadísticamente más altos en niños con sobrepeso / obesidad que en niños delgados. Se encontraron niveles más altos de FNT-α en niños obesos que también tenían una abundancia relativa alta de Firmicutes. Conclusiones: Los niños obesos tienen una alta abundancia relativa de Firmicutes, la cual se correlaciona con un incremento de los niveles de FNT-α. Este es el primer estudio que evalúa la reacción entre la abundancia de Firmicutes y la concentración sérica de FNT-α en niños obesos.

Abstract: Objective: To investigate the correlation among pro- or anti-inflammatory cytokines and the two main gut microbiota phyla in obese children. Materials and methods: Anthropometric data were obtained from 890 children under 14 years old to determine the degree of obesity. Serum cytokine concentration was measured by ELISA. Relative abundance of gut microbiota in feces was evaluated by quantitative Real-Time PCR assays. Results: Anthropometric and biochemical parameters were statistically higher in overweight /obese children than in lean ones. Increased TNF-α levels were found in obese children that also have a high relative abundance of Firmicutes. Conclusions: Obese children have a high relative abundance of Firmicutes that correlates with increased levels of TNF-α. This is the first study that shows a relation between Firmicute abundance and TNF-α serum concentration in obese children.

Resumen: Objetivo: Investigar la correlación entre las citocinas proinflamatorias o antiinflamatorias y los dos principales filos de la microbiota intestinal en niños obesos. Material y métodos: Se obtuvieron mediciones antropométricas de 890 niños de 6 a 14 años; posteriormente se clasificaron en normopeso y sobrepeso/obeso. Las concentraciones séricas fueron medidas por el método de ELISA. La abundancia relativa de la microbiota intestinal en heces se evaluó por PCR tiempo real. Resultados: Los parámetros bioquímicos y antropométricos fueron estadísticamente más altos en niños con sobrepeso / obesidad que en niños delgados. Se encontraron niveles más altos de FNT-α en niños obesos que también tenían una abundancia relativa alta de Firmicutes. Conclusiones: Los niños obesos tienen una alta abundancia relativa de Firmicutes, la cual se correlaciona con un incremento de los niveles de FNT-α. Este es el primer estudio que evalúa la reacción entre la abundancia de Firmicutes y la concentración sérica de FNT-α en niños obesos.

Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.

Introduction: Coca leaf has been traditionally used for medical purposes and contains high iron levels. Objective: To determine the effect of Erythroxylum coca spp. ethanol extract in iron-deficiency anemia induced by iron-deficient diet in male Holtzman rats. Design: Experimental. Setting: Institute of Pathology Laboratory, Universidad Nacional Mayor de San Marcos. Biologic material: Eighteen weaned male Holtzman rats 16 days old. Interventions: Rats were allocated to three groups of six rats each: a) iron-sufficient group (IS) received 25 g/d of balanced diet for 7 weeks; b) iron-deficient group (ID) received 25 g/d of iron-deficient diet for 7 weeks; and, c) iron deficient/E. coca extract group (ID-CE) received 25 g/d of iron-deficient diet for 7 weeks, and in the fifth week 18 g/d of E. coca extract were added. Main outcome measures: Serum hemoglobin level, weight and height. Results: At the end of the treatment, there was significant difference of hemoglobin in the ID-CE group (p=0.04). There was significant difference in serum hemoglobin levels between ID-CE and ID groups (p=0.0062). No significant difference was found in serum hemoglobin levels between ID-CE and IS groups (p=0.06). No significant difference was found in weight and height between ID and ID-CE groups (p=0.20 and p=0.23, respectively). Conclusions: E. coca had experimental antianemic effect supported by findings in the serum hemoglobin levels.

Introducción: La hoja de coca ha sido usada tradicionalmente con fines medicinales y contiene altos niveles de hierro. Objetivos: Determinar el efecto del extracto etanólico de Erythroxylum coca spp. frente a anemia ferropénica inducida por dieta deficiente en hierro, en ratas Holtzman macho. Diseño: Experimental. Lugar: Laboratorio del Instituto de Patología, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Material biológico: Dieciocho ratas Holtzman macho de 16 días de edad recién destetadas. Intervenciones: Se formó tres grupos de seis ratas cada uno: a) grupo hierro suficiente (HS), recibió 25 g/d de alimento balanceado durante 7 semanas; b) grupo hierro deficiente (HD), recibió 25 g/d de dieta ferropénica durante 7 semanas; y, c) el grupo hierro deficiente - extracto E. coca (HD-EC), recibió 25 g/d de dieta ferropénica durante 7 semanas y a partir de la semana 5 se agregó 18 g/d de extracto de E. coca. Principales medidas de resultados: Nivel sérico de hemoglobina, peso y talla. Resultados: Al finalizar el tratamiento, se observó aumento significativo de la hemoglobina en el grupo HD-EC (p=0,04). Se encontró diferencia significativa en los niveles séricos de hemoglobina entre los grupos HD-EC y HD (p=0,0062). No se encontró diferencia significativa en los valores de hemoglobina entre los grupos HD-EC y HS (p= 0,06). No se evidenció diferencia en el peso y la talla entre los grupos HD y HD-EC (p=0,20 y p=0,23, respectivamente). Conclusiones: E. coca presenta efecto antianémico experimental, sustentado en los resultados de los niveles de hemoglobina.

The complex incisional hernias are characterized by a ring wider than 10 cm, with a big sack, the volume of which is bigger than the capacity of the abdominal cavity and when reducing its content, it produces a syndrome of abdominal hypertension with changes of the lung and hemodynamic ventilation, which can result in a compartmental syndrome. Currently its prevention constitutes a challenge for the professionals who carry out this type of surgery, which is aimed at avoiding the complications and at decreasing recurrences. The treatment of the complex incisional hernias requires of the compulsory use of bioprosthesis, carried out by surgeons with deep anatomical and functional knowledge of the abdominal wall and ability of the surgical technique without tension, fixation of the mesh with suture of the same material and the use of prophylactic antibiotic therapy, besides the application of the progressive pneumoperitoneum with a correct preoperative evaluation of these sick persons. The protocolization and classification of these hernias is recommended; and at the same time to carry out multicenter studies for the unification of approaches regarding their diagnosis and treatment both preventive and curative.

Las hernias incisionales complejas se caracterizan por tener un anillo mayor de 10 cm, con un gran saco, cuyo volumen es mayor que la capacidad de la cavidad abdominal y que al reducir el contenido dentro de ésta produce un síndrome de hipertensión abdominal, con alteraciones de la ventilación pulmonar y hemodinámicas, el cual puede llegar a ser un síndrome compartimental. En la actualidad su prevención constituye un desafío para los cirujanos que realizan este tipo de cirugía cuyo objetivo es evitar las complicaciones y disminuir las recurrencias. El tratamiento de las hernias incisionales complejas requiere del empleo obligatorio de bioprótesis por cirujanos con profundos conocimientos anatómicos y funcionales de la pared abdominal y dominio de la técnica quirúrgica sin tensión, fijación de la malla con sutura del mismo material que ésta, y la utilización de antibioticoterapia profiláctica, además de la aplicación del neumoperitoneo progresivo con una correcta evaluación preoperatoria de estos enfermos. Se recomienda la protocolización y clasificación de estas hernias, así como realizar estudios multicéntricos para la unificación de criterios con respecto a su diagnóstico y tratamiento preventivo y curativo.

Objectives: To report one case of metastatic paratesticular rhabdomyosarcoma in a 14 years old patient, classified as stage IIb (IRSG). Methods: After treatment with radical surgery (orchiectomy and lymphadenectomy), polychemotherapy and radiotherapy, showed good evolution initially. Results: 12 months after surgery the patient is disease free. Conclusions: Adjuvant treatment is very important in the prognosis of this kind of tumors.

Objetivos: Presentar un caso de rabdomiosarcoma paratesticular metastásico en un varón de 14 años de edad, clasificado como estadio Ilb según el IRSG (Intergroup Rhabdomyosarcoma Study Group). Métodos: Tras recibir tratamiento mediante cirugía radical (orquiectomía más linfadenectomía retroperitoneal), poliquimioterapia y radioterapia, presentó buena respuesta inicialmente. Resultados: A los 12 meses de la intervención quirúrgica el paciente se encuentra libre de enfermedad. Conclusiones: Resultan fundamentales la quimioterapia y/o radioterapia adyuvantes para el tratamiento de estas neoplasias.

Background: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (V T) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. Aim: To set V T and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. Materials and methods: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. Results: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of V T: 11.6±2.8 to 14.1±2.1 cm H2O, and 9.7±2.4 to 8.8±2.2 mL/kg (p <0.01). Arterial to inspired oxygen fraction ratio increased from 158.0±66 to 188.5±68.5 (p <0.01), and oxygenation index was reduced, 13.7±8.2 to 12.3±7.2 (p <0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. Conclusion: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients

Pulmonary embolism is a common clinical problem. Its symptoms and signs are inespecific and the tests commonly used are either non sensitive or non specific. Pulmonary angiography is considered as the "gold standard" for pulmonary embolism diagnosis. However, it is usually unavailable, very expensive, invasive and sometimes of complex interpretation. Thoracic helical computed tomography is a new technique, available in our clinical setting. It has become the most sensitive and specific test for pulmonary embolism detection and whose results can change our therapy. We report a clinical case with a leg thrombosis and an undoubted pulmonary embolism on clinical basis. After presenting a leg thrombosis which was confirmed by Doppler ultrasound, the patient developed bilateral pulmonary infiltrates, and bilateral pleural effusion. He did not presented fever nor elevated white cell counting in peripheral blood. The patient improved with anticoagulant therapy. He did not receive antibiotics. Nevertheless the helical computed tomography was normal. Therefore if pulmonary tromboembolism is clinically indubitable, we should be cautious in taking clinical decisions, based on a single test, no matter how efficient it is

El tromboembolismo pulmonar constituye un problema clínico frecuente; sus síntomas y signos son inespecíficos y los exámenes habitualmente utilizados para su diagnóstico son a menudo poco sensibles y específicos. La Angiografía Pulmonar es el "Gold Standard", no obstante es de escasa disponibilidad en nuestro medio, de alto costo, constituye un método invasivo no exento de complicaciones y de difícil interpretación en algunas oportunidades. La tomografía helicoidal de tórax es una técnica nueva, de mayor accesibilidad, cuyo desarrollo tecnológico ha permitido lograr mejorías en su sensibilidad y especificidad diagnósticas y consecuentemente un cambio en nuestras decisiones terapéuticas. Presentamos el caso de un paciente con trombosis venosa de las extremidades inferiores y un cuadro clínico compatible con alta probabilidad para tromboembolismo pulmonar. Hubo desarrollo de infiltrados pulmonares bilaterales asociados a derrame pleural en ausencia de fiebre y leucocitosis. Se inició terapia anticoagulante con lo cual hubo mejoría clínica del cuadro. Sin embargo, la realización de una tomografía helicoidal de tórax no demostró presencia de émbolos en la vasculatura pulmonar. Es por ello que debemos ser cautos en el momento de tomar decisiones clínicas basadas en un solo test diagnóstico, sin importar cuan eficiente este sea