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La investigación planteó como objetivo general determinar la relación entre el clima laboral y el rendimiento de los trabajadores de la Municipalidad Provincial Mariscal Ramón Castilla, Loreto - 2021. El enfoque de la investigación fue cuantitativo de tipo básico y diseño no experimental de corte transversal de nivel descriptivo – correlacional; la población y muestra estuvo constituida por 44 trabajadores, se ha empleado como técnica la encuesta y como instrumento el cuestionario. Los resultados demostraron que el nivel de clima organizacional y rendimiento de los trabajadores es medio en un 82% y 95% respectivamente, además, que las dimensiones comportamiento organizacional, estructura organizacional y estilo de dirección están asociadas al rendimiento laboral, dado que el nivel de significancia es menor al 0.05, lo cual demuestra una correlación estadísticamente significativa. Conclusión: Existe relación significativa entre el clima laboral y el rendimiento de los trabajadores de la Municipalidad Provincial Mariscal Ramón Castilla, Loreto – 2021, en vista que, se obtuvo una correlación positiva débil (r=0.491). Asimismo, se obtuvo un nivel de significancia igual a 0.001 que es menor a 0.05 demostrando que, si existe significancia. Lima Norte Escuela de Posgrado Reforma y Modernización del Estado Biodiversidad, cambio climático y calidad ambiental Desarrollo económico, empleo y emprendimiento Alianza para lograr los objetivos

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.

After attending this presentation, attendees will be aware of a new application of micro-Computed Tomography (CT) for dealing with the identification of the signs of pressure of the neck in cases of subtle manual strangulation. This presentation will impact the forensic science community by suggesting a novel approach for the identification of laryngeal fractures by means of micro-CT analysis. It is widely accepted that there are no specific or fully determinate signs of asphyxia. In cases of subtle fatal neck compression, postmortem findings on external examination of a body as well as on autopsy may vary considerably depending on the type of violent trauma, the strength of the resistance exerted by the victim, and on the intensity and duration of neck compression. Based on the detection of a combination of morphological hallmarks such as external injuries to the skin, hyoid or laryngeal fractures, hemorrhages of the overlying soft tissues, and subconjuctiveal petechiae, the diagnosis of homicidal neck compression is generally accepted. A case is presented of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest. The patient was successfully resuscitated; nevertheless, brain death was declared after two days in a vegetative state. The roommate of the deceased, who was also schizophrenic, stated that “the voice of God told me to kill my roommate” and death occurred after a prolonged scuffle. The body showed only vague signs of violence at external inspection (i.e., a subtle bruise on the forehead and a minute scratch on the left arm). At autopsy, the identification of subepicardial petechiae and moderate pulmonary emphysema were not useful for the diagnosis of asphyxial death because these signs might be related to resuscitative maneuvers with prolonged artificial ventilation. Since focal hemorrhagic infiltration of the tracheal mucosa and the superior horns of the thyroid cartilage were observed, a CT scan of the entire larynx was performed, with the goal of identifying laryngeal fractures. Moreover, both superior horns of the thyroid cartilage were analyzed thorough a micro-CT, a radiological technique for tissue analysis with a spatial resolution of a few microns. The 3D reconstruction allowed for identification of multiple cartilage fragments of the larynx. Consequently, the cause of death was identified as asphyxia due to manual strangulation. Considering that micro-CT analysis is able to generate images with a high level of detail compared to conventional radiological techniques, in cases of subtle fatal neck compression this type of investigation could be useful for the morphological identification of comminuted bilateral fractures. This may be particularly useful in cases involving children and young adults where fractures or cartilage damages may be minimal or absent as a consequence of the elasticity of the ligaments around the larynx and hyoid bone as well as the early stage of ossification.

Hydranencephaly is a severe congenital condition where most of the cerebral hemispheres are replaced by a membranous sac. Despite the growing amount of case reports, most pathogenic, phenotypic, and prognostic aspects of hydranencephaly remain controversial. By matching the recent literature data with the findings of our own series (four cases: two fetuses at the twelfth gestational week, a 32-year-old man, and a 14-year-old female), we attempted to date back the insult leading to hydranencephaly to understand its pathogenesis and to explain the basis of its protean phenotype. The variable detection of cerebral remnants seems to mirror the developmental pathway of cerebral arteries. Moreover, fetal and postnatal neuroimaging data and histopathologic findings point toward an early bilateral internal carotid artery occlusion, mostly occurring between the eighth and twelfth gestational weeks, as the main pathogenic mechanism of hydranencephaly.

Objective To report an ataxic variant of Alzheimer disease expressing a novel molecular phenotype. Design Description of a novel phenotype associated with a presenilin 1 mutation. Setting The subject was an outpatient who was diagnosed at the local referral center. Patient A 28-year-old man presented with psychiatric symptoms and cerebellar signs, followed by cognitive dysfunction. Severe β-amyloid (Aβ) deposition was accompanied by neurofibrillary tangles and cell loss in the cerebral cortex and by Purkinje cell dendrite loss in the cerebellum. A presenilin 1 gene (PSEN1 ) S170F mutation was detected. Main Outcome Measures We analyzed the processing of Aβ precursor protein in vitro as well as the Aβ species in brain tissue. Results The PSEN1 S170F mutation induced a 3-fold increase of both secreted Aβ 42 and Aβ 40 species and a 60% increase of secreted Aβ precursor protein in transfected cells. Soluble and insoluble fractions isolated from brain tissue showed a prevalence of N–terminally truncated Aβ species ending at both residues 40 and 42. Conclusion These findings define a new Alzheimer disease molecular phenotype and support the concept that the phenotypic variability associated with PSEN1 mutations may be dictated by the Aβ aggregates' composition.

One of the neuropathological characteristics of Alzheimer's disease is the presence of a large number of reactive astrocytes, often, but not always, associated with senile plaques. The factors responsible for such an activation are as yet totally unknown. Other characteristic features of this disease such as betaA4 amyloid accumulation, senile plaques and neurofibrillary tangles represent well known pathological phenomena. Some studies suggest that betaA4 plays a major role in the reactive astrocytosis characteristic of Alzheimer's disease. In the normal human brain, metallothionein isoforms I and II are expressed in astrocytes but not in neurons. In the present study, we used anti-metallothionein antibodies to detect cells expressing metallothioneins isoforms I and II in normal and Alzheimer's disease (AD) brain sections. Results showed that expression of these proteins in the cortex, cerebral white matter and cerebellum is a relevant anatomopathological characteristic of Alzheimer's disease. Analysis of Alzheimer's disease brain sections revealed high expression of metallothioneins I/II in astrocytes and microcapillaries, and in the granular but not the molecular layer of the cerebellum. Furthermore, metallothionein expression can be used as a marker to identify subtypes of astrocytes.

Lectins belong to a class of proteins or glycoproteins able to bind carbohydrates. The study reported here describes the identification of lectin-binding sites in the adult rat brain. The results indicate that among the 31 lectins utilized, eight show a specific positive reaction with neurons. Staining was also observed with other cerebral structures such as myelin, leptomeninges, choroid plexus and capillaries. Lectins are, therefore, an important histochemical tool and can be easily and reliably used for the identification of cells and cerebral structures in the adult rat brain.

Aluminum lactate [Al(lact)3] (hydrophilic, hydrolytically unstable) and aluminum acetylacetonate [Al(acae)3] (lipophilic, hydrolytically stable) were tested as potential toxicants to rabbits upon IV administration both as aqueous solutions and as liposome suspensions. Both chemicals behaved as cardiotoxic agents when administered as aqueous solutions, but Al(acae)3 was at least two orders of magnitude more active than Al(lact)3. Al(acae)3, but not Al(lact)3, caused myocardial infarcts resembling those in humans (with contraction bands) at doses as low as 0.24 mg/kg body weight, as well as a prominent acanthocytosis. Al(lact)3, when administered as a liposome suspension, was about 300 times more toxic than in aqueous solution, although cardiac damage was not infarctual in character. Both chemical and physical speciation of aluminum(III) thus play an essential role in determining the toxicity of the metal. Images FIGURE 2. FIGURE 3.

✓ A tuberculoma, encasing the anterior optic pathways in a neoplastiform growth, was found in a 25-year-old man complaining of severe visual loss, diabetes insipidus, and sexual impotence following tuberculous meningitis. Following biopsy and anti-tuberculosis treatment, a satisfactory restoration of sight in one eye allowed the patient to resume an almost normal life.

Intravenous administration of aluminum(III) in the form of the hydrolytically stable and moderately lipophilic complex acetylacetonate induces in the rabbit a severe pathological picture, the most significant feature of which is the occurrence of a myocardial infarct.

The case is presented of a child with early manifestations of Hand-Schüller-Christian disease limited to exophthalmos, and rapid final progression towards a clinical picture dominated by intracranial hypertension and cerebeliar involvement, caused by massive histiocytic infiltration of the cerebellum, combined with discrete subdural deposits of xanthomatous tissue and minor deposits in other parts of the central nervous system and other organs.

Seven surgical patients have been selected from a series of 40 cases (24 pediatric) of anterior optic glioma as examples of the advantage of surgical (excision of nerve tumors; exploration and biopsy as a minimum program for chiasmal lesions) over conservative treatment. The results obtained in these seven cases reflect those seen in the total series and those to be gleaned from most of the literature

An aneurysmal bone cyst of the orbital roof, causing a monolateral exophthalmos in a 15-month-old child with no previous history of head injury, was operated upon and histologically misdiagnosed as a giant cell tumor. Radiation treatment in a dosage (3,740 rad) appropriate for the latter diagnosis apparently caused a massive calcification of the residual mass with persisting exophthalmos. At a second operation the lesion was removed completely and a radical change in the histopathological features was found. 12 years after surgery, there is no evidence of residuals upon roentgenographic and CT scan examinations and the exophthalmos has practically disappeared, while there is a normal visual function in the affected eye. Some points of histopathological and gross pathological differential diagnosis between aneurysmal bone cysts and giant cell (‘myeloplaxis’) tumors are discussed.

A series of 84 patients with exophthalmos caused by vascular lesions, or neoplastic lesions with a predominant vascular component, is discussed. All patients, observed in the period before CT scan, were investigated by traditional neuroradio-logical techniques, notably angiographic ones (carotid arteriogram and orbital phlebogram). In several cases, cerebral vascular lesions such as saccular aneurysms and arterio-venous malformations, cerebral angiomas and uncommon arterio-venous shunts, were the cause of the exophthalmos. The case is argued for the continuing importance of both types of angiographic examination, especially cerebral angiography, in the investigation of exophthalmos after ‘non-invasive’ techniques (CT scan, ultrasonography) have allowed a preliminary screening and established a firmer indication for ‘invasive’ examinations.

Gallium is an element of increasing biological interest: It is involved in problems related to environmental pollution (Ga compounds are used in electronics industry) and to clinical treatments (Ga radionuclides are employed to detect neoplastic lesions). Moreover, since its chemical behavior is similar to that of aluminum, gallium could play a role in the health effects attributed to this element. Data on naturally occurring Ga levels in human samples from healthy subjects are scanty; regarding the brain, the only reliable values available in the literature were published by Hamilton in 1972/73. In this work, the gallium distribution in several human brain areas, evaluated by radiochemical neutron activation analysis (RNAA), was found to be dishomogeneous. The element concentration determined in dry samples was, in any case, lower than the ppb level.

A clinicopathologic investigation was carried out in a patient with acromegaly from acidophylic adenoma of the hypophysis. Pronounced cardiomegaly and disturbances in impulse formation and conduction led to sudden death. The problem of acromegalic cardiomyopathy has been reviewed. Particular attention has been focused on the histopathologic findings in the working and specific myocardium, and in the intrinsic nervous supply to the sinoatrial node, which were correlated with the electrocardiographic features of atrioventricular conduction delay and sick sinus syndrome.

Sixteen patients (one with tuberculoma of the anterior optic pathways, the other 15 with opto-chiasmatic arachnoiditis) are presented. They are divided into three categories (definite, likely, possible) from the point of view of the pathogenetic link of their optic pathology with a primary tuberculous infection. Neurosurgical treatment had a positive effect upon the visual symptoms in five patients (31.25%), no effect in three cases (18.75%); in the other eight patients (50%) it could not prevent progression of visual impairment.

14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.

The clinicopathologic picture of a case of so-called 'sarcoglioma' is reported. This tumor is characterized by a core of sarcomatous tissue, surrounded by an area of gradual transition from reactive to neoplastic glial cells; it occurs in children or in young adults and is very rare in comparison with the secondary sarcoma deriving from the vascular component of a glioblastoma (so-called 'gliosarcoma'). The clinical and laboratory features and the pathology of this case are discussed in detail.

To ascertain the presence of free aldehyde radicals in elastic fibers, a histochemical method using the Sawicki reagent (N-methyl-benzothiazolone hydrazone) was employed. Three separate studies were conducted on the elastic tissue of bovine ligamentum nuchae. The elastic fibers were tested (a) in native state, (b) after extraction using an autoclave method and (c) after hot NaOH treatment. Free aldehyde radicals were detected histochemically in native and treated fibers, indicating a close attachment of the carbonyl groups to the fibrous-protein component of the elastic material. Pretreatment of the sections with NaBH4 or with NaHSO3 abolished the staining, indicating that the aldehydes in elastin can be reduced or blocked by the addition of bisulfite compounds. The presence of free carbonyl compounds in elastin was confirmed by chemical data with a new chromatographic technique. Using QAE Sephadex column pretreated with sodium bisulfite, aldehyde-bearing peptide fractions could be isolated from the elastin fibers.