ABSTRACT
Thrombotic microangiopathy is a serious condition that can be precipitated by exposure to certain medications. Although rare, it is life threatening and requires a high index of clinical suspicion, appropriate laboratory testing and immediate cessation of the offending agent. We present a case of a 75-year-old man with a history of ischaemic heart disease treated with clopidogrel and aspirin. One month after initiating the treatment he developed microangiopathic haemolytic anaemia and thrombocytopenia. Extensive clinical and laboratory investigations suggested thrombotic microangiopathy secondary to clopidogrel. The drug was immediately discontinued and treatment with intravenous corticosteroids was started. Within a week the patient's laboratory parameters normalised, indicating successful recovery. This case highlights the role of early detection and immediate discontinuation of suspected medication in the effective management of clopidogrel-induced thrombotic microangiopathy. Healthcare professionals should consider drug-induced thrombotic microangiopathy as a possible diagnosis in patients receiving clopidogrel who present with thrombocytopenia and microangiopathic haemolytic anaemia.
ABSTRACT
Small-cell carcinoma of the bladder (SCCB) is an uncommon and aggressive malignancy of the urinary tract. Its clinical presentation often mimics that of other bladder neoplasms, posing a diagnostic challenge. This case report presents a rare instance of SCCB in a 65-year-old female, shedding light on the diagnostic journey and emphasizing the need for heightened and prompt clinical suspicion due to its aggressive nature. The patient presented to the urological department with hematuria, dysuria, and hypogastric pain. Initial investigations revealed a bladder mass, prompting biopsies with inconclusive results. A comprehensive histopathological examination, including immunohistochemistry, confirmed a SCCB. A computed tomography (CT) scan was used to evaluate local and distal extention. Following the initial evaluation, a referral to an oncological service was needed. Diagnoses encompassed SCCB, with interventions that comprise chemotherapy without radical cystectomy. Despite the rarity of SCCB, timely and accurate diagnosis facilitated a tailored multidisciplinary approach, leading to prompt clinical oncology management. This case demonstrates the importance of meticulous diagnostic evaluation in rare malignancies, guiding individualized therapeutic strategies for optimal patient outcomes.
ABSTRACT
Implicit Motives are non-conscious needs that drive human behavior towards the achievement of incentives that are affectively incited. Repeated affective experiences providing satisfying rewards have been held responsible for the building of Implicit Motives. Responses to rewarding experiences have a biological basis via close connections with neurophysiological systems controlling neurohormone release. We propose an iteration random function system acting in a metric space to model experience-reward interactions. This model is based on key facts of Implicit Motive theory reported in a broad number of studies. The model shows how (random) responses produced by intermittent random experiences create a well-defined probability distribution on an attractor, thus providing an insight into the underlying mechanism leading to the emergence of Implicit Motives as psychological structures. Implicit Motives' robustness and resilience properties appear theoretically explained by the model. The model also provides uncertainty entropy-like parameters to characterize Implicit Motives which hopefully might be useful, beyond the mere theoretical frame, when used in combination with neurophysiological methods.
ABSTRACT
The particle size distribution (PSD) of complex granular media is seen as a mathematical measure supported in the interval of grain sizes. A physical property characterizing granular products used in the Andreasen and Andersen model of 1930 is re-interpreted in Information Entropy terms leading to a differential information equation as a conceptual approach for the PSD. Under this approach, measured data which give a coarse description of the distribution may be seen as initial conditions for the proposed equation. A solution of the equation agrees with a selfsimilar measure directly postulated as a PSD model by Martín and Taguas almost 80 years later, thus both models appear to be linked. A variant of this last model, together with detailed soil PSD data of 70 soils are used to study the information content of limited experimental data formed by triplets and its ability in the PSD reconstruction. Results indicate that the information contained in certain soil triplets is sufficient to rebuild the whole PSD: for each soil sample tested there is always at least a triplet that contains enough information to simulate the whole distribution.
ABSTRACT
La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)
Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)
Subject(s)
Humans , Coloboma/physiopathology , Databases, Bibliographic , Optic Disk/abnormalities , Retinal Detachment/therapy , Review Literature as Topic , Laser Coagulation/adverse effects , Vitrectomy/adverse effectsABSTRACT
La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)
Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)
Subject(s)
Humans , Coloboma/physiopathology , Databases, Bibliographic , Optic Disk/abnormalities , Retinal Detachment/therapy , Review Literature as Topic , Laser Coagulation/adverse effects , Vitrectomy/adverse effectsABSTRACT
We investigated eleven particle-size distribution (PSD) models to determine the appropriate models for describing the PSDs of 16349 Chinese soil samples. These data are based on three soil texture classification schemes, including one ISSS (International Society of Soil Science) scheme with four data points and two Katschinski's schemes with five and six data points, respectively. The adjusted coefficient of determination r (2), Akaike's information criterion (AIC), and geometric mean error ratio (GMER) were used to evaluate the model performance. The soil data were converted to the USDA (United States Department of Agriculture) standard using PSD models and the fractal concept. The performance of PSD models was affected by soil texture and classification of fraction schemes. The performance of PSD models also varied with clay content of soils. The Anderson, Fredlund, modified logistic growth, Skaggs, and Weilbull models were the best.
Subject(s)
Models, Theoretical , Particle Size , Soil/chemistry , Weights and Measures/standards , China , Fractals , Soil/classification , United Nations , United States , United States Department of AgricultureABSTRACT
BACKGROUND: The International Classification of Functioning (ICF) has acquired a central role in the WHO Family of International Classifications and it has been extensively adopted as the reference framework for health-related functioning (HrF). This review aims to provide a description of the ICF/HrF to contextualise ICF/HrF in relation to other approaches to health functioning and to describe its application in policy and legislation with a special focus on Spain. METHODS: Narrative review based on the scientific literature and prior expert knowledge. RESULTS: ICF is both a coding system and a conceptual framework of HrF, which is framed as a unidimensional, bipolar and asymmetric construct with a negative pole (disability) and a positive pole (good functioning) with higher complexity. Other models of HrF include health promotion, quality of life and activities of daily living (ADL). The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples. CONCLUSIONS: The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field. This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.
Subject(s)
Disability Evaluation , Health Policy , International Classification of Diseases , Activities of Daily Living , Humans , Spain , World Health OrganizationABSTRACT
Se realizó un estudio prospectivo multicéntrico en diversas ciudades de la República Mexicana utilizando pantoprazol para el tratamiento de la enfermedad ácido-péptica. Se incluyeron 1,696 pacientes con diagnóstico de enfermedad ácido-péptica. Se recabaron datos personales y relacionados con la enfermedad, método de diagnóstico, tratamiento y resultado al final del mismo. Se encontró que la media de edad en los pacientes del sexo masculino fue 43.9 años y en las mujeres 42.4 años (p = 0.041). El porcentaje de hombres y mujeres fue de 49.6 respectivamente. Existe correlación entre el consumo de alcohol, el diagnóstico de úlcera péptica (p = 0.032) y el dolor epigástrico en ayunas (p = 0.004). De los diagnósticos establecidos, la gastritis tuvo la mayor proporción (21.19 por ciento). Al final del tratamiento, 68 por ciento (1.157 casos) reportaron ausencia total de los síntomas que los motivaron a buscar atención médica. El 96.26 por ciento de los tratamientos se ajustaron a la dosis diaria recomendada de 40 mg. La evaluación global sobre el tratamiento con pantoprazol en relación con los casos tratados fue que 96 por ciento de los investigadores lo consideraron excelente o bueno. Los resultados obtenidos demuestran la efectividad del pantoprazol en el tratamiento de la enfermedad ácido-péptica, con la dosis recomedada de 40 mg al día. En sólo dos casos se suspendió el tratamiento por probables reacciones adversas al medicamento
Subject(s)
Humans , Antacids/administration & dosage , Antacids/therapeutic use , H(+)-K(+)-Exchanging ATPase/antagonists & inhibitors , H(+)-K(+)-Exchanging ATPase/pharmacokinetics , Surveys and Questionnaires , Symptomatology , Peptic Ulcer/diagnosis , Peptic Ulcer/physiopathology , Peptic Ulcer/drug therapy , Mexico , Treatment OutcomeABSTRACT
Se presenta una revisión de un total de 11 estudios. Dos estudios realizados en México y 9 en diferentes países. Se incluyeron 429 pacientes con diagnóstico de onicomicosis con confirmación clínica y micológica. El tratamiento consistió en dos pasos: 1) Tratamiento inicial con aplicaciones en la uña infectada de bifonazol-urea cada 24 horas bajo vendaje oclusivo hasta el desprendimiento atraumático de la uña; 2) Tratamiento subsecuente del lecho ungueal con bifonazol crema (Solución o gel) 1 vez al día, durante 4 a 6 semanas. El tiempo del desprendimiento atraumático de la uña fue de 4 a 45 días. El porcentaje de curación micológica fue de 81.44 por ciento en los 9 estudios y en los de México de 79.7 por ciento. La combinación de bifonazol al 1 por ciento más urea al 40 por ciento por ser un medicamento antimicótico y queratolítico es una excelente alternativa terapeútica en los siguientes casos: en pacientes que no excedan de cuatro uñas parasitadas, en pacientes que no puedan ser sometidas a largos tratamientos con antimicóticos sistémicos, anicolisis por Candida y onicomicosis infantil
