bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recurrent Flush: A Case and Review of Systemic Mastocytosis
Authors: Mansoor Wasim , Cavalcanti Rodrigo , Chugh Shaan
Published: July 2018

Systemic Mastocytosis (SM) is a hematologic neoplasm characterized by an abnormal proliferation of mast cells, which have the potential to infiltrate one or more visceral organs.  Patients can present with a wide constellation of symptoms making it a challenging diagnosis for clinicians.  Non-specific symptoms such as fatigue, headache, and weight loss may predominate; however, some patients may present with acute onset of urticaria, flushing, and diarrhea. Due to its rarity, clinicians often face a challenge in evaluating, diagnosing and effectively treating systemic mastocytosis.  Identification during the indolent phase is important as SM can progress to aggressive leukemias or myeloproliferative disorders. In this article, we present a case of SM, and discuss current practices in diagnosis, evaluation and management.  We conclude with future directions for treatments and diagnosis
Hydrophobia Associated with Severe Hypernatremia, Acute Kidney Injury, and Rhabdomyolysis
Authors: Almaani MD Mohammed , Kao MD Raymond
Published: July 2018

A 33-year-old male was brought to the emergency department (ED) by his family with a 10-day history of decreased to no oral intake and a progressive unsteady gait. He had a known history of major depressive disorder, agoraphobia, acrophobia, and hydrophobia, which had not been treated with any medications; he had been followed up by outpatient psychiatry.On arrival at the ED, he was noted to be drowsy, with a Glasgow Coma Score (GCS) of 14/15 (E4, V4, M6), blood pressure of 85/40 mm Hg, heart rate of 140 beats/minute, temperature of 38.5ºC, respiratory rate of 38 breaths/minute, and oxygen saturation at 95% on room air. He was noted to be severely dehydrated with dry mucous membranes, a flat jugular venous pressure, mottled skin, and anuria. He was resuscitated in the ED with 4 L of intravenous normal saline over 4 hours and started on empiric intravenous antibiotics, piperacillintazobactam 4.5 g IV q6h, for presumptive septic shock.
What an Internist Needs to Know about Statistics
Authors: Gardiner MBBS MBioEth Dale , Hird MBChB MPH Caroline
Published: July 2018

The basics of medical statistics can be readily understood but are often approached by clinicians as if mysterious or forbidding. This may be because statistics was poorly taught at medical school or due to a tendency for articles on statistics to rapidly overcomplicate concepts. It is our hope that this series will be enlightening and provide a solid grounding in the building blocks to all evidence-based medicine.This series is divided into the three main statistical areas: descriptive statistics as may be used commonly in audit projects, inferential statistics as may be used in therapeutic trials, and diagnostic tests in which sensitivity and specificity are important. Statistical concepts are illustrated with examples predominantly from the critical care literature. The choice of examples, however, should be regarded as non-significant when compared with any personal clinical practice. (There is no p value for this statement.)
Personal Observation: Intravenous Aminophylline Treatment for Migraine
Authors: Kenyon MD Michael , Phillips MD Barry , DeWit MBBCh Christiaan
Published: July 2018

Migraine is common condition, often affecting young patients and causing disruption in the home and workplace alike. The impact of patients presenting to emergency room services with intractable headache is significant, often tying up space and resources in the tedious wait for a narcotic and sedative “cure.” In Canada alone, 3.2 million adults suffer from migraines, and the condition costs the Canadian economy an estimated $500 million annually. Absenteeism and loss of productivity resulting from migraines cost $20 every second.
Clinical Update on Spondyloarthritis
Authors: Hebert MD FRCPC Isabelle , Fortin MD Isabelle
Published: July 2018

The spondyloarthritides encompass various clinical manifestations. The hallmark of the spondyloarthropathies is inflammatory axial and sacroiliac (buttock) pain. Associated findings include peripheral arthritis, uveitis, conjunctivitis, enthesitis, and psoriasis. Human leukocyte antigen (HLA) B27 is positive in a majority of patients. Radiographic abnormalities appear first on vertebral column/sacroiliac magnetic resonance imaging (MRI) and many years later on radiography, which makes the diagnosis challenging. Of course, rheumatoid factor is negative – hence the term seronegative arthritis. Other clinical clues that help identify this disease’s spectrum are a family history of ankylosing spondylitis (AS), psoriasis, or inflammatory bowel disease (IBD); intestinal or genitourinary symptoms; or the presence of psoriasis. All this heterogeneity makes an early diagnosis difficult.
Using Biologics in Inflammatory Arthritis: Assessing the Risks and Benefits
Authors: Rohekar MD FRCPC MSc Gina
Published: July 2018

Inflammatory arthritis, such as rheumatoid arthritis (RA), is not simply a disease that affects an individual with symptoms in the present. It also has tremendous impact on the patient’s future well-being. RA has been proposed to be an interrelated triad of disease activity, joint damage, and disability.1 In this triad, current disease activity (pain, swelling, and stiffness of joints) leads to disability and decreased quality of life. Furthermore, disease activity leads to joint damage, which also leads to disability.1 In the modern treatment of inflammatory arthritis, the goal is to not only treat the present symptoms (disease activity) but also, by doing so, to decrease damage and disability and improve quality of life. There is a movement to treat inflammatory arthritis aggressively and early, with the thought that there is a “window of opportunity” in which early intervention can prevent long-term consequences.
Acute Care SINS: Surgical Insights for the Non-surgeon - Chapter 2: Tubes, Drains, and Ostomies
Authors: Khadaroo MD PhD Rachel G. , Sutherland MD J. Drew , Brindley MD Peter G.
Published: July 2018

“Surgical Insights for the Non-surgeon,” or SINS, is composed of several short chapters intended to cover fundamental surgical knowledge for non-surgeons. The authors focus on surgical pearls, operative insights, and applied anatomy. In Chapter 2 of this series, the authors outline tubes, drains, and ostomies, including their indications and possible complications.
Diffuse Idiopathic Skeletal Hyperostosis
Authors: Jensen MD Jeanine , Ur Rehman MBBS Habib
Published: July 2018

An 82-year-old man with history of type 2 diabetes mellitus and primary hyperparathyroidism developed severe neck pain, worse on any movement of the cervical spine. Radiography and computed tomography were performed, revealing diffuse idiopathic skeletal hyperostosis (DISH), a condition that is characterized by calcification and ossification of soft tissues.
Academic Medicine: Reclaiming the Forest from the Trees
Authors: Wilson MD Ben J.
Published: July 2018

At the time of this writing, Ben Wilson was a 4th-year internal medicine resident at the University of Alberta, in Edmonton, Alberta. He is now a general internist at the Peter Lougheed Centre, in Calgary.
McMaster University Internal Medicine International Health Elective: A Survey-Based Study to Understand Achievements and Lessons Learned
Authors: Duncan MD Andrew W. , Waiswa MBChB MMed (Int Med) Musa , Prebtani BScPhm MD Ally P.H. , Verhovsek MD Madeleine M. , O’Shea MD MPH Tim M.
Published: July 2018

The McMaster Internal Medicine International Health Elective (IHE) has been placing senior medical residents (PGY-3) in an elective setting in a teaching hospital in Kampala, Uganda, for the past 7 years. This article discusses a study in which the authors electronically mailed a survey to alumni of this elective to evaluate important aspects of program participation from the residents’ point of view. The factors most commonly cited as being important in the decision to apply to the McMaster IHE were to gain experience practising medicine in a resource-limited setting and to gain exposure to diseases and conditions not commonly encountered in Canada. Most residents (61.5%) planned to have some involvement in global health prior to their elective, and 100% felt the elective experience made them more likely to take part in global health activities in the future. IHEs offer a unique opportunity for residents to explore global health. Residents participating in this survey found the McMaster Internal Medicine IHE to be a successful endeavour.
We All See the Same Patients: Reflections on the 2012 European School of Internal Medicine
Authors: Wilson MD Ben J.
Published: July 2018

The author shares his experiences after attending the 16th annual European School of Internal Medicine (ESIM), in Kusadasi, Turkey.
Harm Reduction: When Evidence Should Influence Health Policy
Authors: Mann MD Bikaramjit
Published: July 2018

Harm reduction can be thought of as any program or policy designed to reduce drug-related harm without requiring the cessation of drug use. An example of a successful harm reduction strategy is the use of needle exchange programs or syringe exchange programs. Unfortunately, decisions may be made by policy makers that conflict with scientific literature and the abundance of evidence supporting such harm reduction measures. Evidence in favour of harm reduction strategies is robust, and their implementation is required in any comprehensive public health policy attempting to improve the well-being of society as a whole. This article examines the evidence supporting the efficacy of one such harm reduction strategy, namely, needle exchange programs; it also outlines a simple approach for medical students, residents, physicians, and other health care professionals to be involved in change on a global scale by discussing the Vienna Declaration as a tool for influencing evidence-based drug policy.
Readmission Rates and Determinants in a Higher-Risk In-patient GIM Population
Authors: Gilmour MD Janet G. , Southern MSc Danielle A. , Ghali MD MPH William A.
Published: July 2018

Unplanned readmission to hospital is a costly and frequent event. The authors sought to study readmission rates and determinants in a higher risk in-patient general internal medicine population. They undertook a medical record review of discharges from such a unit. The chart review data were then linked to administrative discharge data and used to query for any readmission within 3 months or 1 year. The authors found that 219 in-patients were discharged alive. Of these, 51 (23.3%) were readmitted to a hospital within 3 months of discharge. In extended Kaplan-Meier analysis, there was a 47.6% readmission rate by 12 months after discharge. Important variables predicting readmission were liver disease, metastatic cancer, and a change in most responsible physician. The latter was a risk factor independent of length of hospital stay. The authors demonstrate that patients admitted to a general internal medicine service are at high risk for readmission to hospital. A change in the most responsible physician during the index admission is an independent risk factor for readmission. Processes around the transfer of care of patients between physicians may provide an opportunity for improvement in readmission rates and overall quality of care.
Acute Care SINS: Surgical Insights for the Non-surgeon - Chapter 4: Stomach SINS
Authors: Khadaroo MD PhD Rachel G. , Fathimani MD Kamran , Brindley MD Peter G.
Published: July 2018

“Surgical Insights for the Non-surgeon,” or SINS, is composed of several short chapters intended to cover fundamental surgical knowledge for non-surgeons. The authors focus on surgical pearls, operative insights, and applied anatomy. In Chapter 4 of this series, the authors discuss stomach anatomy, hiatal hernia, peptic ulcer disease, and gastric surgery.
Acute Care SINS: Surgical Insights for the Non-surgeon - Chapter 3: Head and Neck SINS
Authors: Khadaroo MD PhD Rachel G. , Williams MD David C. , Brindley MD Peter G.
Published: July 2018

“Surgical Insights for the Non-surgeon,” or SINS, is composed of several short chapters intended to cover fundamental surgical knowledge for non-surgeons. The authors focus on surgical pearls, operative insights, and applied anatomy. In Chapter 3 of this series, the authors outline anatomy of the head and neck, tracheostomy, thyroid/parathyroid surgery, and radical neck dissections/operations.
A Case of Thunderclap Headache during Pregnancy
Authors: Peyronnard MD Caroline , Leroux MD Elizabeth , Gaha MD Mehdi
Published: July 2018

Headache during pregnancy is a common issue for which there is a broad differential diagnosis, ranging from common benign primary headaches to certain life-threatening conditions. Although it can be a challenging diagnosis, the presence of previously unknown or new-onset headaches can alert the clinician to the possibility of an underlying secondary process, and orient the subsequent investigation.Here, we present the case of a 33-year-old migrainous patient presenting in her 36th week of pregnancy with recurrent thunderclap headaches (TCH) in association with multifocal cerebral arterial vasospasms, compatible with a diagnosis of reversible cerebral vasoconstriction syndrome. This case serves as a starting point to briefly discuss this syndrome, its particularities during pregnancy, and its management before reviewing some other important entities that can present with TCH during pregnancy. This case also underscores the paramount importance of identifying the presence of a different pattern of headaches in a patient consulting for this symptom, in order to plan further investigation.
Twenty-First Century Medicine: The Fall of Occam
Authors: Wilson MD Ben J.
Published: July 2018

Medicine has evolved a great deal over the past hundred years, and the automatic and subconscious application of shortcuts increases the risk of oversimplification and inaccuracy. In this article, the author presents a case to illustrate this point.
We Are General Internists
Authors: Chen MD Benjamin
Published: July 2018

The Canadian Society of Internal Medicine (CSIM) achieved a key milestone in December 2010: Royal College of Physicians and Surgeons of Canada (RCPSC) recognition of general internal medicine (GIM) as a distinct subspecialty. Much more work has been done since then, such as developing objectives of training for a new 2-year GIM training program, and additional challenges remain, for example, upgrading training programs across the country, developing a GIM examination for the new RCPSC Certificate in GIM, and attracting the best and brightest into careers in GIM. But it is clear that GIM in Canada has entered an exciting new era. Regular readers of this journal will appreciate that these successes have been through the tireless efforts of many general internists over many years.
Restricting Marketing of Unhealthy Foods: Should General Internists Engage?
Authors: Campbell MD Norm , Duhaney MHSc Tara
Published: July 2018

Unhealthy diet is the leading risk for death, years of life lost, and disability, causing an estimated 65,722 deaths and 864,032 life years lost in Canada in 2010.1 Although the causes of unhealthy diet are complex, unhealthy eating habits start early in life, and unhealthy food and beverage marketing to children is consistently associated with unhealthy dietary behaviours and childhood obesity. Although there have been recommendations from the World Health Organization (WHO) and the United Nations urging countries to restrict such marketing to children as a population strategy to improve diet, the food industry continues to direct millions of marketing dollars to increase the sales and consumption of the very foods that contribute to disease burden. While many countries have heeded the WHO recommendations, in Canada, outside of Quebec, the food industry largely self-regulates its marketing of unhealthy food to children, with no government monitoring or oversight. The result is that Canadian children are extensively exposed to marketing of unhealthy food products that would not be allowed in several other countries. Should Canadian internists accept that
Scurvy in the Context of End-Stage Liver Disease
Authors: Aujnarain MSc Amiirah , Hackett CD CCPA Michael , Wilson MD MSc Kumanan
Published: July 2018

The authors present a case of scurvy in a 38-year-old woman with a history of alcohol abuse and end-stage liver disease. Their case demonstrates that nutritional deficiencies are a concern in patients affected with alcoholic liver disease. The history, symptoms, and treatment of scurvy are also discussed.
High Incidence of Preoperative Mild Cognitive Impairment in Elderly Surgical Patients
Authors: Newman MSc, Daniel , Cummings MD MSc Beth-Ann , Chertkow MD Howard , Fraser MD MSc Shannon , Bergman MD MSc Simon
Published: July 2018

Post-operative delirium in elderly patients is associated with higher mortality and longer lengths of stay. This prospective observational study investigated the incidences of preoperative mild cognitive impairment (MCI) and post-operative delirium among elderly patients undergoing elective surgery at the authors’ institution, the relationship between MCI and delirium, and the impact of delirium on surgical morbidity and lengths of stay. The authors found that although MCI did not predict post-operative delirium, the high incidence of MCI in elective surgery patients warrants further study.
Quality of Bedside Procedures Performed on General Medical In-patients: Can We Do Better?
Authors: MacMillan MD Thomas E. , Wu MD MSc Robert C. , Morra MD MBA Dante
Published: July 2018

Little is known about the quality of procedures performed on general internal medicine inpatients. Many general medical in-patients require diagnostic or therapeutic procedures, such as thoracentesis, paracentesis, joint aspiration, and lumbar puncture. While some data exist regarding the safety of specific procedures, little is known about other important measures of quality, such as success rate, adequacy of the diagnostic specimens obtained, wait time, accuracy and completeness of clinical documentation, and patient satisfaction. Although increasing numbers of procedures are being performed by interventional radiologists, the impacts of this shift have not been well studied.During the course of a 2-week quality improvement audit, the authors observed a high frequency of unsuccessful bedside procedures, instances of inappropriate diagnostic testing, inadequate documentation, and lapses in communication. This should be a call to action for general internists to better characterize the quality of in-patient procedures.
Is All of Cancer Genetic?
Authors: Gilchrist MD Dawna M.
Published: July 2018

There is a genetic component, small or large, to every cancer. Understanding the location of the abnormality informs whether the cancer is heritable (germline) or not (somatic).
Reflections on the 2013 European School of Internal Medicine
Authors: Gan, MDCM Runye
Published: July 2018

In this article, the author relates some experiences and key learnings from time spent at the European School of Internal Medicine, in Cappadocia, Turkey.
Lemierre’s Syndrome
Authors: Behl MD Pearl , Wattam MD Phillip
Published: July 2018

A 67-year-old immunocompetent female with a history of recurrent parotiditis developed swelling of the right side of her neck and face, intermittent fever, dyspnea, and dysphagia. Her complete blood count revealed a neutrophilic leukocytosis. Blood cultures grew Staphylococcus aureus. A computed tomography scan showed right-sided facial and neck edema, and a thrombus in the right internal jugular vein (Figure 1). A prolonged course of antibiotic therapy was initiated. In some cases, surgical drainage of any abscesses, ligation of thrombosed vessels, and anticoagulation may be required.
Role Models: Just What the Resident Ordered?
Authors: Appleton MD, FRCPC Andrew
Published: July 2018

In postgraduate medical training, role models help our trainees as they work toward becoming competent practitioners. Along the way, however, trainees also desire these same role models to guide their career decisions as they transition into independent practice.
Accessing Information on a General Internal Medicine Consultation Service: The Value of a GIM Online Guide
Authors: Boden MLIS PhD Catherine , Ward MD MSc Heather A. , Esau Rebekah , Card MD MSc Sharon E.
Published: July 2018

The advent of copyright law changes made it difficult for the authors’ Division of General Internal Medicine to continue providing their internal medicine learners with a compilation of key articles on general internal medicine for the consultative rotation. This was seen as an opportunity for collaboration with the library to develop an online guide to key articles for general internal medicine. This guide has been very useful and well received by both faculty and learners.
Löfgren Syndrome Developing during Infliximab Therapy for Crohn's Disease: A Case Report
Authors: Coman MD, Isabel , Dominguez MD, J. Manuel , Belisle MD Annie
Published: July 2018

Tumour necrosis factor alpha (TNFα) antagonists are biological response modifiers increasingly used to effectively treat a wide array of inflammatory diseases such as Crohn’s disease and rheumatoid arthritis. Anti-TNFα agents are also used in the treatment of steroidrefractory granulomatous diseases, with reported success. Paradoxically, an increasing number of cases of anti-TNF–induced sarcoidosis are being reported. The acute form of sarcoidosis, Löfgren syndrome, is characterized by mediastinal adenopathy, erythema nodosum, arthralgia, and fever. This article describes the case of a patient with Crohn's disease who developed Löfgren syndrome during treatment with infliximab. To our knowledge, this is the first case of Löfgren syndrome developing during treatment with a TNFα antagonist.
The Ethos of Medicine in Postmodern America: Philosophical, Cultural and Social Considerations
Authors: Murray OC ONS MD Thomas
Published: July 2018

We need good data to practise good medicine. However, if a system becomes dominated by electronic health records (EHRs), computerized decision-making programs, and excessive guidelines and protocols, physicians can become pawns in “the silicon cage.” Arnold Eiser, professor of medicine and associate dean at Drexel University College of Medicine, is concerned about the erosion of both the patient-physician relationship and professionalism in the corporate world of American medicine. This postmodern world is characterized by what he calls “the three big C’s” of American medicine: consumerism, computerization, and corporatization. He notes that it is difficult to gain a broad perspective of the changes in health care when you are living through it. To provide an overview, he employs a wide-angle lens that includes postmodern philosophers, contemporary commentators, bioethicists, policy makers, and experiences from other countries (although this final aspect is relatively thin). Eiser begins by recounting the changes since 1970, when the health care system became more corporate. This business model increasingly viewed health care as marketable services and commodities, which was aided by challenges to the tradition of physician power and paternalism, coupled with social trends that favoured individualism, autonomy, and entitlements.
Acute Care SINS: Surgical Insights for the Non-surgeon - Chapter 8: Liver, Biliary System & Pancreatic SINS
Authors: Khadaroo MD PhD Rachel G. , Shapiro MD PhD James A. , Brindley MD Peter G.
Published: July 2018

“Surgical Insights for the Non-surgeon,” or SINS, is composed of several short chapters intended to cover fundamental surgical knowledge for non-surgeons. The authors focus on surgical pearls, operative insights, and applied anatomy. In Chapter 8 of this series, the authors address the liver and portal veins; their discussion includes anatomy, surgeries, and transplantation.
Assessment of the Validity of Self-Report as a Measure of Smoking Status in Patients Post-Myocardial Infarction
Authors: Grandi Sonia , Gervais André , Joseph Lawrence , O'Loughlin Jennifer , Paradis Gilles , Pilote Louise , Rinfret Stephane , Eisenberg Mark
Published: July 2018

Self-report is the standard method for assessment of smoking status in the outpatient setting for myocardial infarction (MI) patients. However, the validity of self-report in this patient population has not been previously investigated. Using data from a double-blind, placebocontrolled, randomized trial we examined the validity of self-report for assessment of smoking status in an outpatient setting for MI patients. Smoking was assessed by self-report and biochemical validation by expired carbon monoxide (CO). Abstinence was defined by a selfreport of no cigarettes smoked in the past week and a CO level of less than or equal to 10 parts per million (ppm). At 12 months, number of cigarettes smoked was positively correlated with CO level (r = 0.70). Results show that biochemical validation by CO does not substantially increase the likelihood of detecting smokers in MI patients. However, it may discourage patients from denying their smoking status and therefore should be considered for routine assessment of smoking status in the outpatient cardiac setting. Current clinical guidelines for secondary prevention in myocardial infarction (MI) patients recommend routine assessment of smoking status.1 In clinical trials, biochemical validation in conjunction with self-report is the conventional method for assessment of smoking status.2–4 In the outpatient
UMA ABORDAGEM INTERACIONAL DOS SABERES E DAS CULTURAS PROFISSIONAIS
Authors: Caria Telmo , Ramos Marise
Published: July 2018

O artigo aborda o conceito de saber profissional no âmbito das Ciências Sociais vinculado com ao tema culturas profissionais, considerando contribuições da microssociologia, vindas da fenomenologia social e do interacionismo simbólico, em diálogo interdisciplinar com as Ciências Cognitivas e com o pensamento histórico-dialético em alguns aspectos, visando a contribuir para estudos sobre o trabalho profissional em interação social. Conclui destacando a importância de investigações empíricas sobre os elementos que interconectam tais componentes interacionais no interior do grupo profissional e sobre os efeitos das interações multiculturais na reflexividade interna desse mesmo grupo.
POLÍTICAS DE EJA NO IFES: PERCURSOS DE ESCOLARIZAÇÃO, DE PROFISSIONALIZAÇÃO E DE RESISTÊNCIA NO PROEJA
Authors: Oliveira Edna , Ferreira Maria José
Published: July 2018

O texto explora algumas reflexões sobre a contrarreforma do ensino médio e suas implicações para a oferta da EJA, tomando como base a pesquisa documental com destaque para as tensões e historicidade de projetos societários distintos. A partir de dados de registros das práticas de construção coletiva, analisa o cotidiano escolar dos cursos do Proeja no campus Vitória com foco na escuta dos estudantes. Os resultados indicam que mesmo num contexto adverso à oferta da EJA na instituição, a ocupação dos cursos pelos trabalhadores evidencia marcas de resistência na manutenção da oferta e o exercício coletivo dos sujeitos na luta pelo direito à educação.
PROGRAMA BRASIL PROFISSIONALIZADO: A OFERTA DE CURSOS TÉCNICOS NA BAHIA E NO ACRE
Authors: Castioni Remi
Published: July 2018

O presente texto contempla um estudo descritivo sobre a oferta de Educação Profissional nos estados do Acre e da Bahia. A eleição desses estados tomou como premissa a ideia de que esses guardam características diferenciadas de gestão da Educação Profissional, no âmbito dos órgãos estaduais. Para este estudo, tomaram-se, como elementos de análise, algumas variáveis que permitem conhecer a forma de gestão do programa Brasil Profissionalizado.
QUALIFICAÇÃO PROFISSIONAL NO PRONATEC E AS DEMANDAS DO NEODESENVOLVIMENTISMO LULO-PETISTA: FORMAÇÃO VOLTADA PARA EMPREGABILIDADE
Authors: Vasconcelos Ricardo , Amorim Mário
Published: July 2018

Este artigo pretende realizar uma reflexão sobre a relação entre o ciclo de expansão econômica neodesenvolvimentista dos governos petistas de Lula e Dilma Rousseff e a redefinição da oferta de cursos de qualificação profissional por intermédio da criação e implementação do Programa Nacional de Acesso ao Ensino Técnico e Emprego (PRONATEC), criado no primeiro governo de Dilma, através da Lei nº 12.513/2011, cujo objetivo seria garantir a expansão da formação profissional massiva de trabalhadores, atendendo as demandas de um suposto “apagão” de mão de obra qualificada. Prioriza-se a discussão envolvendo o perfil de qualificação presente nos cursos do PRONATEC.
Esclerosis hepatoportal como causa de hipertensión portal no cirrótica en un paciente colombiano infectado con VIH
Authors: Barrera Herrera Luis Eduardo , Tapias Monica , Andrade Enrique , López Rocio Del Pilar , Idrovo Victor
Published: July 2018

Antecedentes: la esclerosis hepatoportal se manifiesta como hipertensión portal no cirrótica. Su etiología parece estar relacionada con alteraciones idiopáticas en la microvasculatura hepática. Las manifestaciones de la esclerosis hepatoportal incluyen sangrado de vías digestivas altas, pancitopenia, esplenomegalia e hipertensión portal no cirrótica. Presentamos el primer caso reportado en Colombia de esclerosis hepato- portal en un paciente con serología positiva para el virus de la inmunodeficiencia humana (VIH). Métodos: paciente masculino de 60 años de edad, VIH-positivo, quien ingresa a nuestra institución por hemorragia de vías digestivas alta (várices esofágicas y fúndicas) y ascitis, cuyo manejo requirió la toma de biopsia hepática. Resultados: se realizó biopsia Trucut de hígado que evidenció la presencia de 6 a 8 espacios porta con parénquima arquitectónico conservado que demostró fibrosis perivenular y dilatación sinusoidal pericentral severa. Conclusión: la esclerosis hepatoportal es una causa de morbilidad en pacientes VIH-positivos. Debe considerarse en cada paciente que manifiesta hipertensión portal no cirrótica asociada con hemorragia de la vía digestiva alta. Sin embargo, una investigación adicional es imprescindible con el fin de describir la relación entre el desarrollo de alteraciones intrahepáticas (microtrombosis), la patogénesis del VIH y el uso de terapia antirretroviral, particularmente el uso de didanosina.
Ameboma del recto con absceso hepático asociado: reporte de un caso
Authors: Erebrie Faruk Esteban , Valencia G William Hernán , Guevara Casallas Luis Gonzalo , Escobar René Marcelo
Published: July 2018

La infección por Entamoeba histolytica sigue siendo un problema mayor de salud pública en los países en desarrollo como Colombia. Aunque en la gran mayoría de casos se presenta como una disentería o un absceso hepático amebiano, existen casos donde la evolución genera una verdadera masa inflamatoria en el colon llamada ameboma. Estos amebomas son fácilmente confundidos con una lesión neoplásica y, de no tener un gran nivel de sospecha clínica o endoscópica, terminan en una resección de colon con un diagnós- tico posoperatorio dado por la presencia de trofozoítos sin malignidad. Sin embargo, cuando el diagnóstico se hace de manera preoperatoria, podría haber resolución del cuadro sin necesidad de cirugía. Exponemos el caso de una rara presentación de ameboma en el recto asociado con un absceso hepático perforado, en el cual se hizo un diagnóstico preoperatorio, pero dada la ruptura de la lesión en el hígado, requirió de una intervención quirúrgica.
Los xantomas gástricos están asociados con lesiones malignas y premalignas
Authors: Gómez Zuleta Martín Alonso , Otero Regino William , Buitrago D Melisa
Published: July 2018

Los xantomas gástricos son lesiones encontradas incidentalmente en la endoscopia digestiva alta. Consisten en la acumulación de lípidos en la mucosa gástrica. Estas lesiones se han reportado en serie de casos asociadas con metaplasia o atrofia y en reportes de casos vinculados con cáncer gástrico; sin embargo, no se han realizado estudios comparativos que busquen comprobar esta asociación. El objetivo de este trabajo es evaluar si los pacientes con xantomas tienen más lesiones malignas (displasia o cáncer) o condiciones premalignas (atrofia o metaplasia). Materiales y métodos: se trata de un estudio retrospectivo de casos y controles realizado en el Hospital El Tunal, en pacientes que fueron sometidos a endoscopia de vías digestivas altas (EVDA) para evaluación de dispepsia. A cada caso de xantoma se le asignó un control de endoscopia realizado el mismo día por el síntoma de dispepsia y escogido de manera aleatoria. Todos los pacientes fueron sometidos a biopsias para evaluación histológica y por infección de Helicobacter pylori. Resultados: en total se reclutaron 186 pacientes que cumplieron los criterios de inclusión, ya que tenían indicación de EVDA porque cursaban con dispepsia no investigada. Fueron comparados dos grupos de pa- cientes: el primero, con hallazgo de xantomas gástricos en la endoscopia (n = 90) y el segundo, sin estos hallazgos (n = 96). El promedio de edad de los pacientes con xantomas fue de 57, 4 versus 38,3 del grupo control, 35% sexo masculino versus 35,6%, respectivamente. Los xantomas fueron únicos en el 72%. La mayoría se ubicó en el antro (53%), cuerpo (32%), antro o cuerpo (10%) y fondo (5%). En los pacientes sin xantomas no se presentaron casos de displasia (0%), mientras que en el grupo con xantomas, 5,5% de los pacientes lo presentó (5 casos), de los cuales 2 fueron de bajo grado y 3, de alto grado. El 66% del grupo xantoma versus el 85% del control tenía infección por H. pylori. Tres pacientes presentaron cáncer gástrico temprano (3,3%) en el grupo de los xantomas versus 0% en el control. Conclusión: nuestro trabajo muestra que los xantomas gástricos son un factor de riesgo para la presencia de condiciones premalignas: atrofia o metaplasia intestinal. Lo más importante es que están asociados con displasia y cáncer gástrico, lo cual nos obliga a ser aún más cuidadosos en la evaluación endoscópica, cuan- do nos encontremos incidentalmente un xantoma, y probablemente a realizarles un mapeo gástrico, ya que por lo general es posible observar una condición premaligna. Sin embargo, se deben llevar a cabo estudios más grandes y multicéntricos para comprobar estas asociaciones.
Neoplasias hepáticas malignas: 1.a parte. Hepatocarcinoma: papel de la biopsia hepática, estudios de inmunohistoquímica y otros aspectos importantes
Authors: López Panqueva Rocio Del Pilar
Published: July 2018

Continuamos con la revisión de los tumores hepáticos. Nos referiremos a los tumores hepáticos primarios malignos más frecuentes. Tal como lo mencionamos anteriormente, los tumores malignos hepatobiliares son un espectro de tumores invasivos que reciben su nombre dependiendo de su célula de origen. De acuerdo con la Agencia Internacional para el Estudio del Cáncer (IARC), los tumores hepáticos malignos constituyen la segunda causa de muerte en el mundo, con aproximadamente 745 000 muertes/año (1). Al igual que en el artículo anterior, el objetivo es identificar aquellos aspectos más relevantes de estas neoplasias, en especial los hallazgos morfológicos que generan mayor problema diagnóstico en la utilidad de los estudios de inmunohistoquímica y sus diagnósticos diferenciales. La primera parte de esta revisión se centrará en el hepatocarcinoma, el más frecuente de los tumores he- páticos epiteliales malignos, algunas de sus variantes y sus lesiones precursoras. También en el controvertido papel de la biopsia hepática para su diagnóstico.
¿Cuál es el perfil de los pacientes en espera de nuevos tratamientos para la hepatitis C?
Authors: Martini Peruchi João Alberto , Oshiro Bansho Emilia Tiemi , Tonon Débora , Borgonovo Ariane , Maggi Dariana , Buzaglo Dantas-Corrêa Esther , De Lucca Schiavon Leonardo , Narciso-Schiavon Janaina Luz
Published: July 2018

Introducción: hasta hace poco, el tratamiento estándar de oro para la hepatitis C eran los interferones pegilados (Peg-IFN) en combinación con la ribavirina (RBV). Con la llegada de nuevos fármacos, se propuso evaluar los resultados del tratamiento y a los pacientes en espera de la nueva terapia. Materiales y métodos: este estudio analítico transversal evaluó el resultado del tratamiento en individuos con hepatitis C crónica, y luego comparó a individuos que tienen experiencia en no responder al tratamiento basado en interferón (IFN) con individuos sin experiencia de tratamiento previo. Resultados: el estudio incluyó 192 individuos. Entre 87 pacientes sometidos a tratamiento, se observaron bajas tasas de respuesta viral sostenida (RVS). La comparación de los 105 pacientes no tratados previamen- te y los 87 que habían recibido tratamiento con IFN previamente evidenció que entre los pacientes en espera de nuevas terapias, los individuos sin tratamiento previo presentaron mayor proporción de genotipo 1 (68% frente a 49%; p = 0,028), menores niveles de ALT (91,1 ± 73,0 frente a 126,0 ± 73,40 U/L; p = 017), de AST (70,1 ± 51,3 frente a 89,7 ± 47,40 U/L; p = 050), de GGT (85,3 ± 85,1 frente a 148,4 ± 123,9 U/L; p = 0,007) y menor proporción de fibrosis significativa (24,3 frente a 83,3; p <0,001). Conclusiones: las tasas de RVS fueron bajas. La mayoría de posibles candidatos para el tratamiento por VHC no lo han tenido y son de genótipo-1 con histología leve.
Fiebre, ictericia y hepatitis: no siempre es infección viral
Authors: León Lina Paola , Otero William , Gómez Martín
Published: July 2018

La fiebre tifoidea es una infección sistémica causada por Salmonella entérica serotipo tiphy a través de la ingesta de alimentos contaminados (fecal-oral). Es un problema de salud pública, especialmente en países en vías de desarrollo, debido a su alta prevalencia, relacionada con deficiencias sanitarias. En pacientes con fiebre tifoidea, la hepatitis se presenta en 1% a 26% de los pacientes y se debe sospechar cuando coexisten ictericia, fiebre y hepatitis. No obstante ser difícil de distinguir de las hepatitis por virus hepatotrópicos, la clave para el diagnóstico es que, en estas infecciones virales, la fiebre desaparece cuando el paciente presenta ictericia. El diagnóstico final de la entidad necesita el aislamiento de la Salmonella a través de coprocultivos y hemocultivos, especialmente de la médula ósea, que es el sitio con mayor rendimiento para el diagnóstico.
Tumores hepáticos malignos no hepatocelulares. 2.a parte. Aspectos morfológicos y estudios auxiliares de importancia útiles para el diagnóstico histopatológico
Authors: López Panqueva Rocio Del Pilar
Published: July 2018

Se continúa con la revisión de los tumores malignos hepáticos primarios. Se hablará de los aspectos más importantes de los tumores primarios no hepatocelulares, siendo más frecuentes los originados en el epitelio del ducto biliar como el colangiocarcinoma, el cistoadenocarcinoma y los tumores mesenquimales, y los más infrecuentes el hemangioendotelioma epitelioide y el angiosarcoma. La principal dificultad radica en lograr el diagnóstico definitivo, el cual se basa en la exclusión de una neoplasia primaria extrahepática o de lesiones hepáticas benignas. Estudios adicionales de inmunohistoquímica, estudios de clonalidad o moleculares pue- den ser de mucha utilidad.
Zanieczyszczenie gruntów pod nieuszczelnionym gminnym składowiskiem odpadów komunalnych
Authors: Wysocka Małgorzata
Published: July 2018

Analysis of the communal municipal waste landfill, situated in the Podlasie region, was performed in the paper. The landfill had been located randomly, without any barriers, and landfill operation was carried out without clearly defi ned rules. Execution of three research holes and collection of soil samples enabled an assessment of the soil chemical composition for selected pollution indicators, showing elevated values in groundwater, i.e. Zn, Cu, TOC, PAHs. The analysis of the pollutant movement was presented in relation to depth, occurrence of groundwater table and soil filtration coefficient.
Wpływ kształtu cząstek ilastych na wyniki analiz granulometrycznych gruntów spoistych
Authors: Gorączko Aleksandra , Topoliński Szymon
Published: July 2018

Laser diffraction particle sizing is an alternative method to determine grain size analysis in soils. However, for particle with high shape anisotropy LDA measurements usually produce different results than traditional hydrometric methods (HM), based on Stokes equation. The article contains the results of analyzes of Neogene clays characterized by significant lithological differentiation in regard to participation the clay fraction particles. The research was conducted for the clay samples taken in Bydgoszcz. A set of equations to transform LDM results to hydrometric results was proposed.
The value of plasticity index (IP) and liquidity index (IL) of North Polish ablation boulder clays and varved clays depending of the method of its determination
Authors: Krawczyk Dorota , Flieger-Szymańska Michalina
Published: July 2018

Article determins a correlation between the values of the plasticity and liquidity index (IP, IL) of cohesive soils achieved by various laboratory methods (on the basis of Casagrande apparatus and cone penetrometer method) and consists research results on natural clayey soils of known origin and strictly defined genetic features, described in detail in terms of particle size and mineralogy (the North Polish ablation boulder clays and varved clays).
Researching ‘Under the Radar’ practices: Exploring restorative practices in sexual violence cases
Authors: O’Nolan Caroline , Zinsstag Estelle , Keenan Marie
Published: July 2018

Sexual violence is a pernicious social phenomenon. The limited effectiveness
of traditional justice responses has resulted in a search for alternative
and innovative responses. This article highlights research and presents
findings regarding one such innovative response to sexual violence:
restorative justice. While the study adopted a multi-strategy research
design to explore the potential of restorative justice in cases of sexual
violence this article focuses in particular on one aspect of that design: a
webbased survey used to map the global population of programmes engaging in
these practices. The article highlights the many challenges inherent in
researching emerging social responses and suggests that web-based surveys
offer a means of mapping emerging or ?under the radar? practices and
harvesting important qualitative as well as quantitative data on sensitive
topics. They may be especially valuable when populations are geographically
dispersed. However, tailoring survey instruments for respondents who are
multi-lingual presents difficulties, particularly when the issues under
investigation are linguistically and cognitively complex.
Influence of plant developmental stage on DNA yield and extractability in MON810 maize
Authors: Taverniers Isabel , De Meyer Laurens , Van Droogenbroeck Bart , Messens Kathy , De Loose Marc
Published: July 2018

The amount and extractability of DNA in different parts of MON810 GM hybrid was studied during different developmental stages. To quantify GM contents, an evaluation was performed of the effect of plant development stage on DNA density. To this end, the evolution of weights, absolute DNA yields, DNA densities and ratios of endosperm and embryo relative to total maize kernel were studied. Sampling at four stages during the growth shows an influence on relative GM quantification based on haploid genome equivalents, due to the specific maize seed composition and differences in DNA extractability from different seed tissues. During plant growth, plant parts with potential GM genes (embryo in kernel and cob on total plant) increase in importance on weight and DNA concentration level, while the endosperm drops in relative importance. Expected % GM maize values are calculated for a whole field harvest of grain maize.
Effects of supplementary concentrate level and separate or total mixed ration feeding on performance of growing dairy bulls
Authors: Huuskonen Arto Kalevi , Pesonen Maiju , Joki-Tokola Erkki
Published: July 2018

A randomised complete block design was used to study the effects on animal performance of (1) the increasing level of supplementary concentrate with grass silage (GS), and (2) feeding GS and concentrates separately or as a total mixed ration (TMR). A feeding experiment comprised 32 dairy bulls with average initial live weight of 145 kg. The feeding treatments were: (1) GS (660 g kg-1 dry matter intake) plus medium level of rolled barley (330) offered separately, (2) GS (660) plus medium level of rolled barley (330) offered as TMR, (3) GS (330) plus high level of rolled barley (660) offered separately, and (4) GS (330) plus high level of rolled barley (660) offered as TMR. During the experiment (398 days) the bulls were fed ad libitum either GS or TMR. The increasing concentrate level increased energy intake, carcass gain and dressing proportion of the bulls but had no effects on carcass conformation or fat score. TMR feeding had no effects on carcass gain, dressing proportion, carcass conformation or fat score but increased dry matter and energy intake compared to the separate feeding.
Digestion of wood-based hemicellulose extracts as screened by in vitro gas production method and verified in vivo using sheep
Authors: Rinne Marketta , Kautto Outi , Kuoppala Kaisa , Ahvenjärvi Seppo , Kitunen Veikko , Ilvesniemi Hannu , Wilför Stefan , Sormunen-Cristian Riitta
Published: July 2018

The objective of the present study was to evaluate the potential of pressurized hot water extracted hemicellulose fractions from various wood species as feeds for ruminants. In Experiment 1, the fermentability of several hemicellulose extracts was screened using an in vitro gas production method. The samples were extracted from spruce (Picea abies) including mainly galactoglucomannan (GGM), from birch (Betula pendula) consisting mainly of xylan and from larch (Larix sibirica) consisting mainly of arabinogalactan. The GGM and xylan samples were readily fermented by rumen microbes while arabinogalactan was not. Based on the in vitro study, GGM was chosen for an in vivo digestibility trial using sheep, where it was fed at increasing proportions of diet dry matter (0, 47, 94 and 141 g kg-1) in a Latin Square design. The in vivo organic matter digestibility of GGM was relatively low, 0.58, but PHWE extracted hemicellulose has some potential as a feed for ruminants.
Effect of mulching systems on fruit quality and phytochemical composition of newly developed strawberry lines
Authors: Fan Li , Roux Valentine , Dubé Claudine , Charlebois Dennis , Tao Shutian , Khanizadeh Shahrokh
Published: July 2018

The effects of three mulching systems on total yield, average yield per plant, average fruit weight, soluble solids content (SSC), titratable acidity (TA), firmness and oxygen radical absorbance capacity (ORAC) of two newly developed lines (‘Orléans’ and ‘Saint Pierre’), one advanced selection (‘SJ8976-1’) and two commonly used cultivars (‘Jewel’ and ‘Kent’) were evaluated. The studied mulching systems were: plastic mulch (PM), mulch with row cover (PMRC), and matted-row system (MRS). Results showed that plastic mulch with row cover (PMRC) generally increased yield per plant, average fruit weight, SSC, firmness and ORAC, but differences varied within harvest times. No significant differences in total yield and TA were observed under the selected mulching systems. Both PMRC and PM accelerated the harvest periods compared to MRS. ‘Kent’ and ‘Jewel’ had the highest total yield while ‘SJ8976-1’ and ‘St-Pierre’ had the highest average fruit weight. The highest SSC, TA and ORAC were found in ‘Jewel’. There was no interaction between the mulching systems and genotypes, indicating that the effect of production system is independent of cultivars. PMRC seems to be a better growing system, improving fruit quality and increasing the nutritional value of all genotypes. By allowing off-season fruit production in cool climates, PMRC can be an alternative method to the costly high tunnels.