Miniaturized liquid chromatography in environmental analysis. A review.

The greater and more widespread use of chemicals, either from industry or daily use, is leading to an increase in the discharge of these substances into the environment. Some of these are known to be hazardous to humans and the environment and are regulated, but there is a large and increasing number of substances which pose a potential risk even at low concentration and are not controlled. In this context, new techniques and methodologies are being developed to deal with this concern. Miniaturized liquid chromatography (LC) emerges as a greener and more sensitive alternative to conventional LC. Furthermore, advances in instrument miniaturization have made possible the development of portable LC instrumentation which may become a promising tool for in-situ monitoring. This work reviews the environmental applications of miniaturized LC over the last 15 years and discusses the different instrumentation, including off- and on-line pretreatment techniques, chromatographic conditions, and contributions to the environmental knowledge.

Portable determinations for legislated dissolved nitrogen forms in several environmental water samples as a study case.

In this work, we have studied the main species involved in determining total dissolved nitrogen (TDN) in water samples for accommodating a variety of quantitation methodologies to portable instruments and with the goal to achieve in situ analysis. The rise of water eutrophication is becoming an ecological problem in the world and TDN contributes markedly to this. Traditionally the several forms of DN are measured in the laboratory using conventional instrumentation from grab samples, but their analysis in place and in real time is a current demand. Inorganic nitrogen: NO3-, NO2- and NH4+, and organic nitrogen, such as amino nitrogen were tested here. For nitrate that presents native UV absorption suitable for direct water analysis, a portable optical fiber probe was compared with benchtop equipment and an in place analyzer. For nitrate, nitrite and ammonium, in situ solid devices that deliver reagents needed were tested and water color was measured by a smartphone coupled with a miniaturized optical fiber spectrometer and a miniaturized spectrometer or from images obtained and their RGB components. Amino nitrogen of some aromatic aminoacids with native fluorescence was followed by a portable optical fiber probe. Organic amino nitrogen and ammonium were determined by a portable luminometer and luminol supported in a measurement tube. Moreover, a portable miniaturized liquid chromatograph was shown suitable for monitoring priority nitrogen environmental pollutants. All options provided suitable results in comparison with lab estimations and were useful for evaluating if the legislation is fulfilled for the variety of tested waters. A discussion about the several portable options proposed for in place analysis, in function of the legislated determinations needed for each type of water was carried out.

The effect of two anionic membranes (AMI 7001s and Neosepta AMX) on the electrodeposition of manganese from sulphate solutions.

The effect of two different anionic membranes on manganese deposition was studied in a two-compartment electrochemical reactor with a titanium cathode and a dimensionally stable RuO2|Ti anode. Chronopotentiometry, ICP-OES, SEM, XRD and elemental mapping were used to understand the changes in concentration and characteristics of the metallic deposition at different current densities with the anionic membranes AMI 7001s and Neosepta AMX. The results demonstrate that AMI reduces more manganese than AMX below -100 A m-2, generating more metallic deposition but also more low-solubility manganous by-products, whereas both membranes exhibited similar behaviours above -100 A m-2 reaching the maximum current efficiency (63%) at -200 A m-2. It was also observed that the membranes have a significant effect on sulphate consumption since they are anions.

Towards in field miniaturized liquid chromatography: Biocides in wastewater as a proof of concept.

Solving and/or evaluating given problems or decision making in place and in real time is a goal of the analytical chemistry science. In this context, the performance of a commercial portable miniaturized liquid chromatograph (minLC) with LED UV (255 nm) detector was compared with those provided by two lab minLCs (capillary and nano) coupled on-line to in-valve in-tube solid phase microextraction (IT-SPME) with diode array detector (DAD). In addition, responses of the portable LC for in-field analysis in several conditions were tested. Besides, two evaluation tools, BETTER criteria for portability and HEXAGON pictogram for sustainability and greenness were applied for comparison purposes. The benchtop LCs provided lower limits of detection (LODs) as expected, in the order of low µg L-1, than those achieved by the portable LC, with LODs around mg L-1 for compounds covering several polarities (logKow between -1.72 and 3.82). The used portable LC gave excellent resolution, reducing the analysis time and being the consumption of solvents negligible. As a practical application, fruit washing residual waters, which contained a suitable level of concentrations of several biocides for employing the portable minLC, were analyzed and quantified from the three minLCs as a proof of concept with comparable results.

Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

Reconstrucción Mamaria Bilateral Inmediata Con Prótesis Prepectoral Tras Mastectomía / Bilateral Inmediate Reconstruction With Prepectoral Prosthesis After Mastectomy

Mujer de 65 años derivada por autopalpación de nódulo mamario izquierdo que se confirma durante la exploración en consulta.Tras la realización de pruebas complementarias se diagnostica un carcinoma de mama bilateral: carcinoma infiltrante tipo NOSen mama izquierda y carcinoma in situ en mama derecha. Ambas axilas están libres de afectación ganglionar tanto clínica comoradiológicamente. Se realiza mastectomía bilateral con incisión en piel en forma de T invertida (Weiss) seguida de colocación deprótesis de poliuretano prepectoral bilateral y biospsia de ganglios centinelas que resultan negativos. Evolución postoperatoriafavorable. (AU)

A 65-year-old woman is referred for self-palpation of a left breast nodule which is confirmed during the examination at the clinic.Furhter testings confirm the diagnosis of bilateral breast carcinoma: NOS infiltrating carcinoma in the left breast and “in situ”carcinoma in the right one. Both axillas are clinically and radiologically negatives. Bilateral mastectomy is performed with invertedT-shaped skin incision (Weiss) followed by bilateral prepectoral prosthesis implant and bilateral sentinel node biopsy with negativeresults. Post-surgical evolution was unnoticed. (AU)

Round-Block en el cáncer de mama. A propósito de un caso. / Round-Block Technique in Breast Cáncer: A Presentation of a Case

Introducción. La cirugía oncoplástica en el cáncer de mama tiene como objetivo realizar una resección oncológicamente seguracon un resultado estético satisfactorio. Caso clínico. Mujer de 51 años con cáncer de mama izquierda con tumor de 7 mm en uniónde cuadrantes superiores de mama izquierda intervenida mediante técnica de Round-block. Discusión. La técnica de Round Blockfue descrita por Benelli en 1990. Constituye un procedimiento sencillo, indicada en tumores cercanos a la areola, especialmenteen aquellos tumores localizados en el polo superior mamario. Presenta baja tasa de complicaciones y buenos resultados estéticos. (AU)

Introduction. Oncoplastic surgery in breast cancer aims to conduct an oncological safe resection while providing a satisfactorycosmetic result. Case report: 51-year-old woman with a 7 mm tumor in the upper quadrants of her left breast. Surgery used roundblock technique. Discussion. The round-block technique was first described by Benelli in 1990. It is a simple procedure, suitablefor tumors near the areola, and it is especially recommended for tumors located in the upper quadrant. It presents a low amount ofcomplications and good overall cosmetic results. (AU)

In-tube solid phase microextraction coupled to miniaturized liquid chromatography for both, noble metal nanoparticle assessment and sensitive plasmonic assay development.

Colorimetric localized surface plasmon resonance (LSPR) as analytical response is applied for a wide number of chemical sensors and biosensors. However, the dependence of different factors, such as size distribution of nanoparticles (NPs), shape, dielectric environment, inter-particle distance and matrix, among others, can provide non-reliable results by UV-vis spectrometry in complex matrices if NP assessment is not carried out, particularly at low levels of analyte concentrations. Miniaturized liquid chromatography, capillary (CapLC) and nano (NanoLC), coupled on line with in-tube solid phase microextraction (IT-SPME) is proposed for the first time for both, controlling suitability of used noble metal NP dispersions and developing plasmonic assays. Several capped noble NPs and target analytes were tested from variations in the chromatographic profiles obtained by using diode array detection. The IT-SPME step, which influenced the chromatographic fingerprint provided by noble NP dispersions, was studied by asymmetrical flow field flow fractionation (AF4) too. We monitored NP aggregation induced by interaction with several analytes like acids and spermine (SPN). Assessment of NPs was achieved in less than 10 min and it permitted to develop suitable plasmonic tests. Here, it was also demonstrated that these assays can be followed by IT-SPME-miniaturized LC-DAD and more sensitivity and selectivity than those provided by UV-Vis spectrometry were achieved. Analysing urine samples to determine SPN as a cancer biomarker as a proof of concept is presented.

Comparison of an artificial neural network and Gompertz model for predicting the dynamics of deaths from COVID-19 in México.

The present work is focused on modeling and predicting the cumulative number of deaths from COVID-19 in México by comparing an artificial neural network (ANN) with a Gompertz model applying multiple optimization algorithms for the estimation of coefficients and parameters, respectively. For the modeling process, the data published by the daily technical report COVID-19 in Mexico from March 19th to September 30th were used. The data published in the month of October were included to carry out the prediction. The results show a satisfactory comparison between the real data and those obtained by both models with a R2 > 0.999. The Levenberg-Marquardt and BFGS quasi-Newton optimization algorithm were favorable for fitting the coefficients during learning in the ANN model due to their fast and precision, respectively. On the other hand, the Nelder-Mead simplex algorithm fitted the parameters of the Gompertz model faster by minimizing the sum of squares. Therefore, the ANN model better fits the real data using ten coefficients. However, the Gompertz model using three parameters converges in less computational time. In the prediction, the inverse ANN model was solved by a genetic algorithm obtaining the best precision with a maximum error of 2.22% per day, as opposed to the 5.48% of the Gompertz model with respect to the real data reported from November 1st to 15th. Finally, according to the coefficients and parameters obtained from both models with recent data, a total of 109,724 cumulative deaths for the inverse ANN model and 100,482 cumulative deaths for the Gompertz model were predicted for the end of 2020.

Función del profesional en enfermería en la atención del acoso escolar en niños, niñas y adolescentes / Role of the nursing professional in the attention of bullying in children and adolescents / Papel do profissional de enfermagem na atenção do bullying em crianças e adolescentes

Actualmente se ha incrementado y visualizado el fenómeno del acoso escolar o bullying (por su traducción al inglés); sin embargo,\r\nllama la atención que esta práctica ha existido durante mucho tiempo, pero solo ahora se evidencian las consecuencias que genera\r\nen los niños, niñas y adolescentes; además, según diversos estudios, puede conducir a suicidios en esta población. Diversas profesiones\r\nhan profundizado en el tema; a pesar de ello, no se ha visto avance en el manejo y prevención del acoso, y ha aumentado\r\nel número de casos que llegan a instituciones de salud relacionados con los daños físicos y psicológicos en quienes lo padecen.\r\nPara la enfermería es un reto poder abordar esta situación y proponer estrategias de intervención para su manejo y prevención no\r\nsolo en la víctima y victimario, sino también en la familia, las escuelas e instituciones de salud en los diferentes niveles de atención,\r\nya que cuenta con las herramientas para diseñar intervenciones en el manejo de la comunidad y del paciente institucionalizado.

Currently the phenomenon of bullying has increased and\r\nvisualized, however, it is striking that this practice has existed\r\nfor a long time, but it is up until now where the consequences\r\nthat it generates in the children and adolescents are shown,\r\nwhere, according to various studies, can generate suicides in\r\nthis population. Various professions have deepened the issue;\r\ndespite this, there has not been progress in the management\r\nand prevention of harassment and it has increased\r\nthe number of cases that reach health institutions related to\r\nphysical and psychological damage that are caused in the\r\nchild victim of bullying. It is a challenge for nursing to tackle\r\nthis situation and propose possible intervention strategies for\r\nits management and prevention, not only in the victim and\r\nvictimizer, but also in the family, schools, and health institutions\r\nin the different levels of care, since it has the tools to\r\ndesign interventions in the management of the community\r\nand the institutionalized patient.

Atualmente, o fenômeno do bullying está cada vez maior e\r\nvisível; no entanto, é impressionante que esta prática exista\r\nhá muito tempo, mas só agora que suas consequências em\r\ncrianças e adolescentes que, de acordo com vários estudos\r\npodem gerar suicídios nesta população, estão evidentes. Várias\r\nprofissões se aprofundaram no assunto. Porém, não houve\r\nprogresso na gestão e prevenção de assédio e o número de\r\ncasos que chegam a instituições de saúde relacionados ao\r\ndano físico e psicológico causado à criança vítima de assédio\r\nescolar aumentou. É um desafio para a enfermagem abordar\r\nesta situação e propor possíveis estratégias de intervenção\r\npara a sua gestão e prevenção, não só na vítima e perpetrador,\r\nmas também na família, escolas e instituições de saúde nos\r\ndiferentes níveis de cuidados, uma vez que tem as ferramentas\r\npara conceber intervenções no manejo da comunidade e do\r\npaciente institucionalizado.

Forensic parameters for 15 autosomal STRs in Mestizo population from the state of Guerrero (South, Mexico).

Allele distribution and forensic parameters were estimated for 15 STR loci (AmpFlSTR Identifiler kit) in 251 Mexican-Mestizos from the state of Guerrero (South, Mexico). Genotype distribution was in agreement with Hardy-Weinberg expectations for all 15 STRs. Similarly, linkage disequilibrium test demonstrated no association between pair of loci. The power of exclusion and power of discrimination values were 99.999634444% and >99.99999999%, respectively. Genetic relationship analysis regarding Mestizo populations from the main geographic regions of Mexico suggests that the Center and the present South regions conform one population cluster, separated from the Southeast and Northwest regions.

Calidad de vida relacionada con la salud y determinantes socioeconómicos en personas con enfermedad renal crónica / Health-related quality of life and socioeconomic determinants in people with chronic kidney disease / Qualidade de vida relacionada à saúde e determinantes socioeconômicos em pessoas com doença renal crônica

Introducción: La salud es una necesidad, un recurso, y un derecho universal. Existen una serie de factores llamados Determinantes Sociales de la Salud (DSS) que actúan de manera interactiva y compleja sobre ella e influyen en la calidad de vida de las personas. La enfermedad renal crónica (ERC) es una de las patologías cuya etiología se está relacionando además de las causas tradicionales con los DSS, afectando la calidad de vida de quienes la padecen. Objetivos: Analizar el nivel de calidad de vida relacionada con la salud (CVRS) en personas con ERC de etiología desconocida. Identificar los determinantes socioeconómicos (DSE) que prevalecen en ellas y correlacionarlos con su nivel de CVRS. Metodología: Estudio observacional, transversal, descriptivo. La muestra estuvo conformada por 40 personas con ERC de etiología no específica. Resultados: El 70% de la población era del sexo masculino, en rangos de edad el 56% se encontraba entre los 18-30 años, 52.5% contaba con pareja, el 62.5% tenía escolaridad básica, únicamente el 22.5% de los sujetos se encontraba laboralmente activo, el ingreso familiar mensual era medio para el 57.7% de ellos, solamente el 15% recibía apoyo gubernamental, y 77.5% no contaba con una vivienda propia. Respecto a la ERC el 65% de los sujetos tenía menos de un año con el diagnóstico, 80% estaba bajo el tratamiento de hemodiálisis, 10% en diálisis peritoneal y el 10% restante en tratamiento farmacológico. En cuanto a la CVRS, los niveles más altos se obtuvieron en las dimensiones aspecto físico (42.5%), relaciones sociales (55%) y estado mental (47.5%). Los niveles medios predominaron en las dimensiones vitalidad (45%) y estado emocional (47.5%), mientras que el nivel más bajo se encontró en la dimensión funcionalidad (42.5%). Se encontraron diferencias estadísticamente significativas (p˂0.05) en los niveles de CVRS según el estado civil, la escolaridad, la suficiencia del ingreso económico, el lugar de origen, el material de la vivienda y el beneficio de programas sociales. Algunos DSE como el sexo, la escolaridad, la situación laboral, etc. se comportaron como factores de riesgo para obtener niveles bajos de CVRS, mientras que la edad, el estado civil y la ocupación entre otros se comportaron como factores protectores. Conclusiones: El nivel de CVRS de las personas con ERC de etiología no específica que acudieron a un hospital público de tercer nivel para su atención se encontró entre medio y bajo y estuvo determinado en cierta medida por sus características socioeconómicas. El estudio de la CVRS y su relación con los DSE representa un área de oportunidad para el profesional de enfermería con el fin de intervenir en los tres niveles de atención. Medir la CVRS puede ser usado como indicador de la calidad de la atención médica.

Introduction: Health is a necessity, a resource, and a universal right. There are a number of factors called Social Determinants of Health (DSS) that act in an interactive and complex way and influence the quality of life of people. Chronic kidney disease (CKD) is one of the pathologies whose etiology is related in addition to the traditional causes with DSS, affecting the quality of life of those who suffer. Objectives: To analyze the level of health-related quality of life (HRQL) in people with CKD of unknown etiology. Identify the socioeconomic determinants (SDH) that prevail in them and correlate them with their level of HRQoL. Methodology: Observational, transversal, descriptive study. The sample consisted of 40 people with CKD of non-specific etiology. Results: 70% of the population was male, in age ranges 56% were between 18-30 years old, 52.5% had a partner, 62.5% had basic schooling, only 22.5% of the subjects were the monthly family income was average for 57.7% of them, only 15% received government support, and 77.5% did not have a home of their own. Regarding CKD, 65% of the subjects had less than one year of diagnosis, 80% under hemodialysis treatment, 10% under peritoneal dialysis and the remaining 10% under pharmacological treatment. Regarding HRQoL, the highest levels were obtained in physical appearance (42.5%), social relations (55%) and mental status (47.5%). The mean levels predominated in the vitality (45%) and emotional (47.5%) dimensions, while the lowest level was found in the functional dimension (42.5%). Statistically significant differences (p0.05) were found in HRQoL levels according to marital status, schooling, and sufficiency of income, place of origin, housing material and the benefit of social programs. Some DSEs such as sex, schooling, employment status, etc. Were behaving as risk factors for low HRQoL, while age, marital status and occupation, among others behaved as protective factors. Conclusions: The level of HRQOL of people with non-specific etiology who attended a hird-level public hospital for their care was found between medium and low and was determined to some extent by their socioeconomic characteristics. The study of HRQOL and its relation with the DSE represents an area of opportunity for the nursing professional in order to intervene in the three levels of care. Measuring HRQL can be used as an indicator of quality of care.

"Introdução: Saúde é uma necessidade, um recurso e um direito universal. Existem vários fatores, chamados determinantes sociais da saúde (DSS), que agem de maneira interativa e complexa e influenciam a qualidade de vida das pessoas. A doença renal crônica (DRC) é uma das patologias cuja etiologia está sendo relacionada, além das causas tradicionais, com o DSS, afetando a qualidade de vida de quem sofre. Objetivos: Analisar o nível de qualidade de vida relacionada à saúde (QVRS) em pessoas com DRC de etiologia desconhecida. Identifique os determinantes socioeconômicos (DSE) que prevalecem neles e os correlacione com o nível de QVRS. Metodologia: Estudo observacional, transversal, descritivo. A amostra foi composta por 40 pessoas com DRC de etiologia inespecífica. Resultados: 70% da população era do sexo masculino, na faixa etária de 56% tinha entre 18 e 30 anos, 52,5% tinham companheiro, 62,5% possuíam ensino fundamental, apenas 22,5% dos indivíduos tinham Eu trabalhava, a renda mensal da família era média para 57,7% deles, apenas 15% recebiam apoio do governo e 77,5% não tinham casa própria. Em relação ao DRC 65% dos indivíduos tinham menos de um ano com o diagnóstico, 80% estavam em tratamento hemodialítico, 10% em diálise peritoneal e os 10% restantes em tratamento farmacológico. Em relação à QVRS, os maiores níveis foram obtidos nas dimensões aparência física (42,5%), relações sociais (55%) e estado mental (47,5%). Os níveis médios predominaram nas dimensões vitalidade (45%) e estado emocional (47,5%), enquanto o nível mais baixo foi encontrado na dimensão funcionalidade (42,5%). Foram encontradas diferenças estatisticamente significantes (p˂0,05) nos níveis de QVRS de acordo com o estado civil, escolaridade, suficiência de renda econômica, local de origem, material habitacional e benefício dos programas sociais. Alguns DSE, como sexo, escolaridade, status de emprego, etc. Eles se comportaram como fatores de risco para obter baixos níveis de QVRS, enquanto idade, estado civil e ocupação, entre outros, se comportaram como fatores de proteção. Conclusões: O nível de QVRS das pessoas com DRC de etiologia inespecífica que foram a um hospital público de terceiro nível para atendimento foi entre médio e baixo e foi determinado, em certa medida, por suas características socioeconômicas. O estudo da QVRS e sua relação com o DSE representa uma área de oportunidade para o profissional de enfermagem, a fim de intervir nos três níveis de atenção. Meça o O HRQL pode ser usado como um indicador da qualidade dos cuidados médicos.

Malformación adenomatoide quística pulmonar. Diagnóstico prenatal / Cystic adenomatoid malformations of the lung. Prenatal diagnosis

La malformación adenoidea quística (MAQ) es una infrecuente alteración del desarrollo pulmonar, que puede ser diagnosticada por ecografía a lo largo de la gestación. Se presenta el caso de una MAQ aislada que se resolvió de manera espontánea intraútero

Cystic adenomatoid malformations (CAM) are relatively rare developmental abnormalities of the lung, which can be diagnosed by ultrasound during pregnancy. We report a case of CAM with no other associated abnormalities that resolved naturally in-utero

Manejo actual de la microtia: redefinición anátomo-quirúrgica / Management of microtia based on a redefinition of its anatomical-surgical classification

Background: Incomplete development and growth of the pinna can lead to a small or deformed pinna, called microtia. Aim: To report and evaluate the effectiveness of a surgical technique previously described for the treatment of microtia, based on a new anatomical-surgical classification. Materials and Methods: Retrospective study of patients treated at two plastic surgery departments from January 2008 to December 2010. We recruited a total of 15 patients aged 9 to 25 years. Thirteen (87 percent) had unilateral and 2 (13 percent) bilateral microtia. All patients underwent the surgical reconstructive technique described by Firmin. Results: Among patients with unilateral microtia, seven belonged to Firmin type I, five to type II and one to type IIIa. Both patients with bilateral microtia, were classified as type IIIb. In all cases with unilateral microtia, a good initial projection of the cartilage frame was achieved during the first surgical procedure. Six patients were subjected to a second operation. During 18 months follow up, four patients (16 percent) had complications. Conclusions: This surgical technique that is based on an anatomical surgical classification, achieves favorable and satisfactory results.

Objetivos: Reportar y evaluar la efectividad de una técnica quirúrgica, previamente descrita para el tratamiento de microtias, basado en un nuevo concepto de clasificación anátomo-quirúrgica. Material y Método: Estudio retrospectivo de pacientes tratados en el Hospital Militar y Clínica Alemana de Santiago en el Servicio de Cirugía Plástica desde enero de 2008 hasta diciembre de 2010. Se reclutaron a un total de 15 pacientes, 13 (87 por ciento) de los cuales eran unilaterales y 2 (13 por ciento) bilaterales. A todos los pacientes se les realizó la reconstrucción mediante técnica quirúrgica de Firmin. Resultados: Se operó a 15 pacientes de rango de edad entre 9 y 25 años, con una mediana de 11 años. De los casos unilaterales; 7 correspondían a tipo I de Firmin, 5 casos a tipo II Firmin y un caso tipo IIIa. De los casos bilaterales, ambos tenían microtia tipo IIIb. Se logró en la totalidad de los casos unilaterales una buena proyección inicial del marco cartilaginoso durante el primer tiempo quirúrgico. Seis casos fueron sometidos a un segundo tiempo quirúrgico. Durante el seguimiento mínimo de 18 meses, se observaron complicaciones en 4 (16 por ciento) pacientes. Conclusiones: Se comprueba que mediante una técnica basada en la clasificación anátomo-quirúrgica, los resultados a corto plazo fueron favorables y satisfactorios.

Evaluación de un programa de valoración de adherencia al tratamiento antirretroviral / Evaluation of a program for assessing adherence to antiretroviral treatment

Introducción: Una baja adherencia al tratamiento antirretroviral (TARV) es la causa más frecuente de fracaso terapéutico tanto en niños como en adultos que viven con el VIH, siendo especialmente importante durante la adolescencia. En consecuencia, cualquier análisis de la efectividad del TARV deberá considerarse incompleto si no incluye una evaluación de la adherencia. El objetivo de este estudio es evaluar la utilidad de un programa de valoración de la adherencia al TARV en una población de pacientes pediátricos infectados por el VIH. Pacientes y métodos: Se trata de un estudio observacional y transversal, dentro del «Programa de educación sanitaria para la optimización de la adherencia en pacientes pediátricos con VIH», que forma parte del proyecto «No estoy solo». La adherencia se estudió simultáneamente mediante una combinación de diferentes métodos: entrevista personal, evolución de la carga viral y del recuento de linfocitos TCD4+, determinación de concentraciones plasmáticas de fármacos y registros de dispensación de farmacia. Resultados: Se incluyó un total de 20 pacientes (50% mujeres, edad mediana: 14,5 años). Se obtuvo un porcentaje de adherencia completa informada por el propio paciente o cuidador del 90% (IC 95%: 70-97,2%); sin embargo, el porcentaje medio de adherencia según los registros de dispensación fue significativamente inferior (83,3%; DE=32,88). La media de principios activos/día y de medicamentos/día fue de 3,5 (DE=0,83) y 5,5 (DE=2,72), respectivamente. Hubo una relación inversa entre el n.° de medicamentos/día y las puntuaciones de adherencia (F=13,8; p=0,002). Ninguno de los métodos de evaluación se relacionó de manera estadísticamente significativa con la adherencia, presentando la determinación de concentraciones plasmáticas una tendencia a la significación. Conclusiones: La adherencia global al TARV fue elevada y se vio favorecida por el uso de pautas posológicas sencillas. La adherencia informada por el paciente y/o el cuidador sobreestimó la verdadera adherencia al TARV. Recomendamos la utilización simultánea de diversos métodos de valoración de la adherencia en los niños y adolescentes que viven con el VIH (AU)

Introduction: Poor adherence to antiretroviral treatment (ART) is the commonest cause of treatment failure in children and adults living with HIV, and this is especially important during adolescence. Therefore, any analysis of ART effectiveness in children should include an evaluation of adherence to ART. The aim of this study is to assess the usefulness of an ART adherence monitoring program in an HIV-infected paediatric population. Patients and methods: An observational and cross-sectional study was performed, within the framework of the “Health Education Program for Optimising Adherence in Paediatric Patients with HIV”, which is part of the “I am not alone” project. Adherence was assessed simultaneously by different methods: personal interview, therapeutic drug monitoring, pharmacy dispensing records and evolution of viral load and T CD4+ lymphocyte count. Results: Twenty patients were included (50% female, median age 14.5 years). Percentage of self-reported full adherence was 90% (95% CI: 70-97.2%); however, the median adherence percentage according to pharmacy dispensing records was significantly lower (83.3%, SD=32.88). The average of drugs and dosage forms per day were 3.5 (SD=0.83) and 5.5 (SD=2.72), respectively. There was an inverse relationship between the number of dosage forms per day and adherence scores (F=13.8; P=0.002). No single method was statistically related to adherence, although therapeutic drug monitoring showed a trend towards significance. Conclusions: Global adherence to ART was high and was easier with simpler regimens. Self-reported adherence overestimated real adherence to ART in our cohort. The simultaneous use of different methods to assess adherence is recommended in HIV-infected children (AU)

[Evaluation of a program for assessing adherence to antiretroviral treatment]. / Evaluación de un programa de valoración de adherencia al tratamiento antirretroviral.

INTRODUCTION: Poor adherence to antiretroviral treatment (ART) is the commonest cause of treatment failure in children and adults living with HIV, and this is especially important during adolescence. Therefore, any analysis of ART effectiveness in children should include an evaluation of adherence to ART. The aim of this study is to assess the usefulness of an ART adherence monitoring program in an HIV-infected paediatric population. PATIENTS AND METHODS: An observational and cross-sectional study was performed, within the framework of the "Health Education Program for Optimising Adherence in Paediatric Patients with HIV", which is part of the "I am not alone" project. Adherence was assessed simultaneously by different methods: personal interview, therapeutic drug monitoring, pharmacy dispensing records and evolution of viral load and T CD4+ lymphocyte count. RESULTS: Twenty patients were included (50% female, median age 14.5 years). Percentage of self-reported full adherence was 90% (95% CI: 70-97.2%); however, the median adherence percentage according to pharmacy dispensing records was significantly lower (83.3%, SD=32.88). The average of drugs and dosage forms per day were 3.5 (SD=0.83) and 5.5 (SD=2.72), respectively. There was an inverse relationship between the number of dosage forms per day and adherence scores (F=13.8; P=.002). No single method was statistically related to adherence, although therapeutic drug monitoring showed a trend towards significance. CONCLUSIONS: Global adherence to ART was high and was easier with simpler regimens. Self-reported adherence overestimated real adherence to ART in our cohort. The simultaneous use of different methods to assess adherence is recommended in HIV-infected children.

[Osmolality of oral liquid dosage forms to be administered to newborns in a hospital]. / Osmolalidad de las formas farmacéuticas orales líquidas en un hospital para su aplicación en neonatos.

OBJECTIVE: Oral administration of hypertonic solutions can contribute to intestinal damage in the initial stages of neonatal necrotizing enterocolitis. The purpose of this study is to determine the osmolality of oral liquid dosage forms used in a division of neonatology and to establish some recommendations for their dilution. METHOD: The osmolality of 26 oral liquid dosage forms has been measured using the freezing-point depression method. RESULTS: Oral liquid dosage forms used in the division of neonatology present an osmolality greater than 350 mOsm/kg H2O. 19.2% of all the analysed forms presented an osmolality lower than 1500 mOsm/kg H2O, 80.7% were over that figure, while 23% presented an extremely high osmolality (> 5,000 mOsm/kg H2O). CONCLUSIONS: Knowledge of osmolality of oral liquid dosage forms in the division of neonatology enables the risk of intestinal aggression caused by enteral administration of the medication to be assessed.

Osmolalidad de las formas farmacéuticas orales líquidas en un hospital para su aplicación en neonatos / No disponible

Objetivo: La administración oral de soluciones hipertónicaspuede participar en la lesión intestinal en la fase inicial de la enterocolitisnecrotizante neonatal. El objetivo del estudio es determinarla osmolalidad de las fórmulas farmacéuticas orales líquidasutilizadas en una unidad de neonatología y establecer recomendacionesde dilución.Método: Se ha medido la osmolalidad de 26 fórmulas farmacéuticasorales líquidas por el método de descenso crioscópico.Resultados: Las fórmulas farmacéuticas orales líquidas utilizadasen la unidad de neonatología presentan una osmolalidad superiora 350 mOsm/kg H2O. Del total analizado, el 19,2% de las fórmulaspresentaban una osmolalidad inferior a 1.500 mOsm/kgH2O, el 80,7% superior y el 23% presentaban una osmolalidadextremadamente alta (> 5.000 mOsm/kg H2O).Conclusiones: El conocimiento de la osmolalidad de las fórmulasfarmacéuticas orales líquidas administradas en la unidad deneonatología permite valorar el riesgo de agresividad intestinalque produce la administración enteral de la medicación

Objective: Oral administration of hypertonic solutions can contributeto intestinal damage in the initial stages of neonatal necrotizingenterocolitis. The purpose of this study is to determine the osmolalityof oral liquid dosage forms used in a division of neonatologyand to establish some recommendations for their dilution.Method: The osmolality of 26 oral liquid dosage forms hasbeen measured using the freezing-point depression method.Results: Oral liquid dosage forms used in the division ofneonatology present an osmolality greater than 350 mOsm/kgH2O. 19.2% of all the analysed forms presented an osmolalitylower than 1500 mOsm/kg H2O, 80.7% were over that figure,while 23% presented an extremely high osmolality (> 5,000mOsm/kg H2O).Conclusions: Knowledge of osmolality of oral liquid dosageforms in the division of neonatology enables the risk of intestinalaggression caused by enteral administration of the medication tobe assessed

[Administration of anti-infective agents through the inhaled route]. / Administración de antiinfecciosos por vía inhalatoria.

OBJECTIVE: To report the doses of inhaled anti-infective agents described in the literature for both the adult and paediatric population. In the case of anti-infective agents which were not approved for inhaled administration, to propose the optimum manner in which these should be prepared in order to achieve osmolality and pH values as similar as possible to physiological values. METHOD: A search was carried out of Pubmed (between 1960 and 2005) for each of the anti-infective agents using the words "inhalation OR inhaled OR aerosol OR aerosolized OR nebulized". We also consulted text books, Micromedex and the technical specifications of the pharmaceutical products. Nebulised solutions were prepared using the drugs for which information was found. The drugs approved for inhaled administration were prepared according to the manufacturers recommendations. For anti-infective agents which were not approved for inhaled administration, the raw materials and the branded drug products for intravenous administration available at our hospital were diluted using physiological saline solution and/or water for injection up to a final volume of 4-5 ml. The osmolality and pH values of all the solutions were measured. The optimum form of preparation was considered to be one with values as close as possible to between 150 and 550 mOsm/kg for osmolatity osmolality and 7 +/- 0.5 for pH. RESULTS: Information about doses of 18 inhaled anti-infective agents was found (12 antibiotics, 5 antifungals and 1 antiviral); paediatric doses were described in 9 of these. Three of the anti-infective agents reviewed were approved for inhaled use in adult patients and four in paediatric patients. Of the 48 recommendations for dilution suggested for administration, two had an osmolality > 1,100 mOsm/kg and 5 an osmolality of < 100 mOsm/kg. Two dilutions had a pH > 8 and 14 a pH < 5. CONCLUSIONS: There is limited literature regarding the doses of anti-infective agents for inhaled administration. The majority of anti-infective agents are not approved for inhaled administration. The dilution of the raw material or proprietary drugs with water or physiological saline solution for intravenous administration achieved solutions with appropriate osmolality in the majority of cases. Some of the solutions have extreme osmolality and/or pH levels, implying that it is reasonable to expect a greater risk of bronchospasm.

Administración de antiinfecciosos por vía inhalatoria / No disponible

Objetivo: Describir las dosis de los antiinfecciosos inhalados descritas en la literatura tanto en la población adulta como en la pediátrica. Para aquellos antiinfecciosos que no tienen la vía inhalatoria aprobada, proponer la forma óptima de preparación para conseguir una osmolaridad y un pH lo más cercano posible a los valores fisiológicos. Método: Se realizó una búsqueda en PubMed (entre 1960 y 2005) con cada uno de los antiinfecciosos y las palabras "inhalation OR inhaled OR aerosol OR aerosolized OR nebulized". También se consultaron libros de texto, Micromedex y las fichas técnicas de las especialidades farmacéuticas. De los fármacos que se encontró información se prepararon las soluciones para nebulizar. Los fármacos con vía inhalada aprobada se prepararon según las recomendaciones del laboratorio fabricante. Para los antiinfecciosos que no tienen la vía inhalatoria aprobada se prepararon diluciones de la materia prima o de las presentaciones comerciales por vía intravenosa disponibles en nuestro hospital con solución salina fisiológica y/o agua para inyección hasta un volumen final de 4-5 ml. Se midió la osmolaridad y pH de todas las soluciones. Se consideró como forma óptima de preparación, la más próxima posible a una solución de una osmolaridad entre 150 y 550 mOsm/kg y a un pH de 7 ± 0,5. Resultados: Se encontró información sobre dosificación por vía inhalatoria de 18 antiinfecciosos (12 antibióticos, 5 antifúngicos y 1 antivírico), de los cuales en 9 se describe la dosis pediátrica. Tres de los antiinfecciosos revisados tienen la vía inhalatoria aprobada en adultos y 4 en pediatría. De las 48 recomendaciones de dilución propuestas para la administración, dos tienen una osmolaridad > 1.100 mOsm/kg y 5 una osmolaridad 8 y 14 un pH < 5. Conclusiones: La información bibliográfica sobre las dosificaciones de los antiinfecciosos por vía inhalatoria es escasa. La mayoría de antiinfecciosos no tienen aprobada la administración por vía inhalatoria. La dilución de la materia prima o de las especialidades por vía intravenosa con agua o solución salina fisiológica consigue soluciones con osmolaridad adecuada en la mayoría de los casos. Algunas de las soluciones tienen valores extremos de osmolaridad y/o pH con lo que cabe esperar un riesgo mayor de broncoespasmo

Objective: To report the doses of inhaled anti-infective agents described in the literature for both the adult and paediatric population. In the case of anti-infective agents which were not approved for inhaled administration, to propose the optimum manner in which these should be prepared in order to achieve osmolality and pH values as similar as possible to physiological values. Method: A search was carried out of Pubmed (between 1960 and 2005) for each of the anti-infective agents using the words “inhalation OR inhaled OR aerosol OR aerosolized OR nebulized”. We also consulted text books, Micromedex and the technical specifications of the pharmaceutical products. Nebulised solutions were prepared using the drugs for which information was found. The drugs approved for inhaled administration were prepared according to the manufacturers’ recommendations. For anti-infective agents which were not approved for inhaled administration, the raw materials and the branded drug products for intravenous administration available at our hospital were diluted using physiological saline solution and/or water for injection up to a final volume of 4-5 ml. The osmolality and pH values of all the solutions were measured. The optimum form of preparation was considered to be one with values as close as possible to between 150 and 550 mOsm/kg for osmolatity osmolality and 7 ± 0.5 for pH. Results: Information about doses of 18 inhaled anti-infective agents was found (12 antibiotics, 5 antifungals and 1 antiviral); paediatric doses were described in 9 of these. Three of the antiinfective agents reviewed were approved for inhaled use in adult patients and four in paediatric patients. Of the 48 recommendations for dilution suggested for administration, two had an osmolality > 1,100 mOsm/kg and 5 an osmolality of 8 and 14 a pH < 5. Conclusions: There is limited literature regarding the doses of anti-infective agents for inhaled administration. The majority of anti-infective agents are not approved for inhaled administration. The dilution of the raw material or proprietary drugs with water or physiological saline solution for intravenous administration achieved solutions with appropriate osmolality in the majority of cases. Some of the solutions have extreme osmolality and/or pH levels, implying that it is reasonable to expect a greater risk of bronchospasm