Neumoperitoneo benigno en paciente con ventilación mecánica no invasiva y gastrostomía / Bening pneumoperitoneum in patient trying non invasive mechanical ventilation and gastrostomy

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A systematic review of the use of quality-of-life instruments in randomized controlled trials for psoriasis.

Planners of interventional studies in psoriasis face the dilemma of selecting suitable quality-of-life (QoL) measures. Systematic reviews have the potential of identifying psychometrically sound measures in a given therapeutic area, while guiding the development of practice guidelines. The aim of this systematic review was to generate evidence of the use of QoL instruments in randomized controlled trials (RCTs) for interventions in psoriasis. The methodology followed the PRISMA guidelines. Six databases were searched with 388 search terms. Abstracts of articles were reviewed independently by two assessors, and a third adjudicator resolved any opinion differences. Risk of bias was assessed using the Jadad scale. Of 3646 screened publications, 99 articles (100 trials) met the eligibility criteria for inclusion, describing research on 33 215 patients. Thirty-three trials tested topical therapy, 18 systemic, 39 biologics, nine phototherapy and 10 other interventions. The Dermatology Life Quality Index (DLQI) was the most commonly used QoL instrument (83 studies, 83%), followed by the 36-Item Short Form Survey (SF-36) (31, 31%), EuroQoL-5D (EQ-5D) (15, 15%), Psoriasis Disability Index (14, 14%) and Skindex (five, 5%). There was widespread inconsistency in the way that QoL data were reported. Of the 100 trials identified, 37 reported minimal clinically important difference (MCID): 32 for DLQI, 10 for SF-36 and six for EQ-5D. QoL measurement is increasingly being reported in RCTs of psoriasis. Formal guidelines are needed for assessment and publishing of QoL data. Researchers should consider whether MCID information is available, and development of MCID data should be encouraged.

Effects of photoperiod, plant growth regulators and culture media on in vitro growth of seedlings of Cyrtochilum loxense (Lindl.) Kraenzl. an endemic and endangered orchid from Ecuador

Cyrtochilum loxense (Lindl.) Kraenzl. is an endemic and seriously endangered orchid species endemic in the Loja Province (Southern Ecuador). The main goals of this research were to analyze how culture media, plant growth regulators and photoperiod affect the growth of C. loxense. Eight month old plants (approximate 1 - 1.5 cm in height) obtained by in vitro germination, were cultivated on MS media or Knudson C; MS with three levels of naphthalene acetic acid (NAA) and 6-benzylaminopurine (BAP) (2/0.5; 1/0.5 y 0.5/ 0.5 mg-1L); and three photoperiodic regimes (24/0, 16/8, 8/16 h) on MS with and without plant growth regulators. No significant differences of shoot induction were observed on media with or without plant growth regulators, and all tested photoperiods. The highest growth (1.2 cm) was observed in plantlets cultivated on growth regulator-free media with a 16/8 photoperiod. Also the shoot and root formation was better in this species in absence of plant growth regulators. Probably this response is due to the endogenous hormone levels in the tissues or due to the kind and concentrations of PGRs used were too low to induce positive morphogenetic responses.

Cyrtochilum loxense (Lindl.) Kraenzl. es una orquídea endémica y críticamente amenazada, distribuida en la provincia de Loja (Sur del Ecuador). Los objetivos principales de esta investigación fueron analizar la influencia del medio de cultivo, reguladores de crecimiento vegetal y fotoperíodo en el crecimiento de C. loxense. Plantas de ocho meses (altura aproximada de 1 - 1.5 cm.) obtenidas por germinación in vitro, fueron cultivadas en medio MS y Knudson C; medio MS con tres niveles de ácido naftalen acético (ANA) y 6-bencil amino purina (BAP) (2/0.5; 1/0.5 y 0.5/ 0.5 mg-1L); y tres fotoperíodos (24/0, 16/8, 8/16 h) en MS con o sin reguladores de crecimiento vegetal (RCV). No se observaron diferencias significativas en la inducción de brotes en medio con o sin RCV, entre todos los fotoperíodos testados. El tamaño más grande (1.2 cm) se registró en plántulas cultivadas en medio libre de reguladores de crecimiento vegetal, incubadas en un fotoperíodo de 16/8. Además, la mayor brotación y enraizamiento se observó para esta especie en medio libre de reguladores de crecimiento vegetal. Probablemente esta respuesta es debida a los niveles endógenos de hormonas vegetales en el tejido o el nivel de RCV usado fue muy bajo para inducir alguna respuesta morfogénica.

Intraventricular hemorrhage treated with intraventricular fibrinolysis. A 10-year experience

Purpose We evaluate the results and complications of our intraventricular fibrinolysis protocol. Material and methods A retrospective analysis was made of the cases of intraventricular hemorrhage with 13-bed Intensive Care Unit. Graeb score 6 or above subjected to intraventricular fibrinolysis. We gathered demographic parameters, clinical risk scores, tomography data and case histories showing neurological status and complications related to intraventricular treatment. The results between those who died and the survivors were compared. Results Intraventricular fibrinolysis was performed in 42 patients (69% males) with intraventricular hemorrhage. The average age was 58.36 years (SD 16.67), with a median APACHE II score of 17.5 (r 3–29). A total of 16.7% were receiving acenocoumarol, and 7.1% were on antiplatelet drugs. The median Glasgow Coma Score at the start of treatment was 8 (r 3–13). The median Graeb score was 9 (r 6–12), and was severe (Graeb 9–12) in almost 62%. In turn, 26.2% of the patients developed ventriculitis, and there was further bleeding in 7.1%. Death occurred in 50% of the cases. None of the analyzed variables were significantly related to increased mortality. In the 21 survivors, the Glasgow Outcome Score at 3 months was 2 in 23.8% of the cases, 3 in 28.57%, 4 in 23.8% and 5 in 28.57% of the patients. Conclusions Intraventricular fibrinolysis does not appear to involve a high rate of complications, and may result in lesser mortality, with a better functional outcome after three months than that estimated and published in the literature in reference to intraventricular hemorrhage (AU)

Objetivo Evaluar los resultados y complicaciones de un protocolo de fibrinólisis intraventricular empleado durante 10 años. Ámbito de aplicación y métodos Servicio de Medicina Intensiva de 13 camas. Análisis retrospectivo de nuestra base prospectiva de pacientes con hemorragia intraventricular con Graeb mayor de 5 tratados con fibrinólisis intraventricular. Registramos datos demográficos, escalas de gravedad, datos tomográficos y evolutivos neurológicos, y complicaciones relacionadas con la fibrinólisis. Comparamos los resultados entre fallecidos y supervivientes. Resultados Recibieron fibrinolíticos intraventriculares 42 pacientes (69% varones) con hemorragia intraventricular. La edad media fue 58,36 años (DE 16,67), con una mediana de APACHE II de 17,5 (rango 3-29). El 16,7% tomaban acenocumarol y el 7,1% estaban en tratamiento antiagregante. La mediana del Glasgow Coma Score en el momento de inicio de la fibrinólisis fue de 8 (rango 3-13), y la mediana de Graeb fue 9 (rango 6-12). Más del 62% de las hemorragias fueron clasificadas como graves (Graeb 9-12). Se complicaron con ventriculitis el 26,2% y con sangrado el 7,1%. Falleció el 50% de la serie. Ninguna de las variables analizadas se relacionó de modo significativo con la mortalidad. De los 21 supervivientes, el Glasgow Out come Score a los 3 meses fue de 2 en el 23,8%, de 3 en el 28,57%, de 4 en el 23,8% y de 5 en el 28,57%.ConclusionesLa fibrinólisis intraventricular no parece asociar una alta tasa de complicaciones, y puede contribuir a una menor mortalidad con mejor resultado funcional a los 3 meses que la estimada y publicada en la hemorragia intraventricular (AU)

Intraventricular hemorrhage treated with intraventricular fibrinolysis. A 10-year experience.

PURPOSE: We evaluate the results and complications of our intraventricular fibrinolysis protocol. MATERIAL AND METHODS: A retrospective analysis was made of the cases of intraventricular hemorrhage with 13-bed Intensive Care Unit. Graeb score 6 or above subjected to intraventricular fibrinolysis. We gathered demographic parameters, clinical risk scores, tomography data and case histories showing neurological status and complications related to intraventricular treatment. The results between those who died and the survivors were compared. RESULTS: Intraventricular fibrinolysis was performed in 42 patients (69% males) with intraventricular hemorrhage. The average age was 58.36 years (SD 16.67), with a median APACHE II score of 17.5 (r 3-29). A total of 16.7% were receiving acenocoumarol, and 7.1% were on antiplatelet drugs. The median Glasgow Coma Score at the start of treatment was 8 (r 3-13). The median Graeb score was 9 (r 6-12), and was severe (Graeb 9-12) in almost 62%. In turn, 26.2% of the patients developed ventriculitis, and there was further bleeding in 7.1%. Death occurred in 50% of the cases. None of the analyzed variables were significantly related to increased mortality. In the 21 survivors, the Glasgow Outcome Score at 3 months was 2 in 23.8% of the cases, 3 in 28.57%, 4 in 23.8% and 5 in 28.57% of the patients. CONCLUSIONS: Intraventricular fibrinolysis does not appear to involve a high rate of complications, and may result in lesser mortality, with a better functional outcome after three months than that estimated and published in the literature in reference to intraventricular hemorrhage.

Acid ceramidase as a chemotherapeutic target to overcome resistance to the antitumoral effect of choline kinase α inhibition.

We have analyzed the response of primary cultures derived from tumor specimens of non small cell lung cancer (NSCLC) patients to choline kinase α (ChoKα) inhibitors. ChoKα inhibitors have been demonstrated to increase ceramides levels specifically in tumor cells, and this increase has been suggested as the mechanism that explain its proapoptotic effect in cancer cells. Here, we have investigated the molecular mechanism associated to the intrinsic resistance, and found that other enzyme involved in lipid metabolism, acid ceramidase (ASAH1), is specifically upregulated in resistant tumors. NSCLC cells with acquired resistance to ChoKα inhibitors also display increased levels of ASAH1. Accordingly, ASAH1 inhibition synergistically sensitizes lung cancer cells to the antiproliferative effect of ChoKα inhibitors. Thus, the determination of the levels of ASAH1 predicts sensitivity to targeted therapy based on ChoKα specific inhibition and represents a model for combinatorial treatments of ChoKα inhibitors and ASAH1 inhibitors. Considering that ChoKα inhibitors have been recently approved to enter Phase I clinical trials by the Food and Drug Administration (FDA), these findings are anticipating critical information to improve the clinical outcome of this family of novel anticancer drugs under development.

The influence of linear elements on plant species diversity of Mediterranean rural landscapes: assessment of different indices and statistical approaches.

This paper mainly aims to study the linear element influence on the estimation of vascular plant species diversity in five Mediterranean landscapes modeled as land cover patch mosaics. These landscapes have several core habitats and a different set of linear elements--habitat edges or ecotones, roads or railways, rivers, streams and hedgerows on farm land--whose plant composition were examined. Secondly, it aims to check plant diversity estimation in Mediterranean landscapes using parametric and non-parametric procedures, with two indices: Species richness and Shannon index. Land cover types and landscape linear elements were identified from aerial photographs. Their spatial information was processed using GIS techniques. Field plots were selected using a stratified sampling design according to relieve and tree density of each habitat type. A 50x20 m2 multi-scale sampling plot was designed for the core habitats and across the main landscape linear elements. Richness and diversity of plant species were estimated by comparing the observed field data to ICE (Incidence-based Coverage Estimator) and ACE (Abundance-based Coverage Estimator) non-parametric estimators. The species density, percentage of unique species, and alpha diversity per plot were significantly higher (p < 0.05) in linear elements than in core habitats. ICE estimate of number of species was 32% higher than of ACE estimate, which did not differ significantly from the observed values. Accumulated species richness in core habitats together with linear elements, were significantly higher than those recorded only in the core habitats in all the landscapes. Conversely, Shannon diversity index did not show significant differences.

Cáncer del tubo digestivo en el Hospital Carlos Andrade Marín / Cancer of the alimentary canal in the Hospital Carlos Andrade Marín

Analiza los datos de 1285 pacientes diagnosticados y tratados en el Hospital Carlos Andrade Marín del IESS, con tumores malignos del tubo digestivo, durante un período de 10 años comprendidos entre 1985 y 1994 y captados por el Registro Nacional de Tumores de SOLCA-Quito. Se encuentran interesantes diferencias con los datos de la población general de Quito y de otros registros de cáncer, por ser la población analizada una muestra escogida de personas aseguradas y también se observan diferencias relacionadas con el sexo y con la edad de los pacientes. El cáncer gástrico es el tumor más frecuente en el grupo constituyendo el 64.4xciento de los tumores del tubo digestivo y el 13.7xciento de todas las neoplasias malignas manejadas en el Hospital. Los tumores del tracto digestivo superior son más frecuentes en hombres, mientras que los de colon lo son en mujeres y en éstas se presentan además en edades más tempranas...

[10 years of literature on AIDS (1983-1992): bibliometric analysis]. / Diez años de literatura sobre el sida (1983-1992): análisis bibliométrico.

BACKGROUND: Reasons for the quantitative study of the Spanish publications on AIDS are both the huge volume attained by the printed material on the subject since the first case was described in 1981 by the Center for Disease Control, and the high incidence of the cases reported on this disease. METHODOLOGY: Searches have been performed on the subject through the database of the Indice Médico Español (IME), the Indice Español de Ciencia y Technología (ICYT), the ISBN and Bibliografía Española in order to retrieve all possible Spanish journal papers' and books. The references were distributed using criteria of documentary tipology, publication date, institutions involved, autonomous communities, and, finally, after its relation with the confirmed cases of AIDS. RESULTS: A total 2,013 items have been retrieved, 1,821 journal papers' and 192 books. More than 50% of the papers are published only by five journals, being 139 the total number of journals able to carry pertinent information. The most productive journals were Medicina Clínica and Enfermedades Infecciosas y Microbiología Clínica. CONCLUSIONS: The results confirm exponential growth of the publications from 1983, the first year when a paper was published on AIDS in Spain. The grow is similar to the tend observed in other countries. Parallelism has been detected between growth in the number of publications and in the number of journals publishing on the subject, the growth in the number of journals publishing on the subject, the growth in the number of institutions which collaborate and the growing tend of reported cases in Spain. The results of the bibliometric study, showing an epidemiological growth out of comparison in the history of the scientific literature, could be useful both to information scientists, and to the research inside this scientific field.

[Atypical presentations of strongyloidiasis: a report of 8 cases]. / Presentaciones atípicas de strongyloidiasis: reporte de ocho casos.

Eight clinical cases of patients with an atypical strongyloidiasis are reported. The clinical notes are reviewed, the nematode is demonstrated by serial coproparasitologic modified Baermann's method and in some cases, the parasite is found by direct test of sputum or enterotest. In all cases, the main factor has been the immunological deficiency being this nutritional, neoplasia, autoimmune disease, immunosuppression therapy, although the most frequent is the moderate to severe, nutritional failure, differing with the foreign literature. All of them had a good clinical evolution using Albendazole in high doses or Ivermectin. It is concluded that systemic strongyloidiasis has a clear physiopathological base in relation to cellular immunodeficiency and this must be carefully search in our patients, where the chronic autoinfection is a frequent clinical status, and there are immersed in some type of immunodeficiency, in our environment this is usually nutritional.