Molecular structure and selective theophylline complexation by conformational change of diethyl N,N'-(1,3-phenylene)dicarbamate.

The receptor ability of diethyl N,N'-(1,3-phenylene)dicarbamate (1) to form host-guest complexes with theophylline (TEO) and caffeine (CAF) by mechanochemistry was evaluated. The formation of the 1-TEO complex (C12H16N2O4·C7H8N4O2) was preferred and involves the conformational change of one of the ethyl carbamate groups of 1 from the endo conformation to the exo conformation to allow the formation of intermolecular interactions. The formation of an N-H...O=C hydrogen bond between 1 and TEO triggers the conformational change of 1. CAF molecules are unable to form an N-H...O=C hydrogen bond with 1, making the conformational change and, therefore, the formation of the complex impossible. Conformational change and selective binding were monitored by IR spectroscopy, solid-state 13C nuclear magnetic resonance and single-crystal X-ray diffraction. The 1-TEO complex was characterized by IR spectroscopy, solid-state 13C nuclear magnetic resonance, powder X-ray diffraction and single-crystal X-ray diffraction.

Crystal structure and characterization of the sulfamethazine-piperidine salt.

Sulfamethazine [N1-(4,6-dimethylpyrimidin-2-yl)sulfanilamide] is an antimicrobial drug that possesses functional groups capable of acting as hydrogen-bond donors and acceptors, which make it a suitable supramolecular building block for the formation of cocrystals and salts. We report here the crystal structure and solid-state characterization of the 1:1 salt piperidinium sulfamethazinate (PPD+·SUL-, C5H12N+·C12H13N4O2S-) (I). The salt was obtained by the solvent-assisted grinding method and was characterized by IR spectroscopy, powder X-ray diffraction, solid-state 13C NMR spectroscopy and thermal analysis [differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA)]. Salt I crystallized in the monoclinic space group P21/n and showed a 1:1 stoichiometry revealing proton transfer from SUL to PPD to form salt I. The PPD+ and SUL- ions are connected by N-H+...O and N-H+...N interactions. The self-assembly of SUL- anions displays the amine-sulfa C(8) motif. The supramolecular architecture of salt I revealed the formation of interconnected supramolecular sheets.

Crystal structures of cocrystals of 2,7-dihydroxynaphthalene with isoniazid and piracetam.

Cocrystals of 2,7-dihydroxynaphthalene (DHN, or naphthalene-2,7-diol) with isoniazid (pyridine-4-carbohydrazide) (INH), denoted DHN-INH [C10H8O2·C6H7N3O, (I)], and piracetam [2-(2-oxopyrrolidin-1-yl)acetamide] (PIR), denoted DHN-PIR [C10H8O2·C6H10N2O2, (II)], were obtained by the solvent-assisted grinding method and characterized by IR spectroscopy, powder X-ray diffraction and single-crystal X-ray diffraction. Cocrystal (I) crystallized in the triclinic space group P-1 and showed a 2:2 stoichiometry. DHN and INH molecules are connected by O-H...N(pyridine) and O-H...N(hydrazide) hydrogen bonds. Cocrystal (II) crystallized in the space group Pca21 with a 1:1 stoichiometry. DHN and PIR molecules are connected by O-H...O=C hydrogen bonds. The supramolecular architecture of cocrystal (I) showed interlinked supramolecular tapes; meanwhile, in cocrystal (II), interlinked supramolecular sheets were observed.

Evaluación económica del tratamiento quirúrgico de la obesidad / Economic evaluation of surgical treatment of obesity

INTRODUCCIÓN: La cirugía bariátrica es el mejor tratamiento de la obesidad mórbida a largo plazo. El ahorro generado por la mejoría de las comorbilidades podría justificar el empleo de más recursos sanitarios. MÉTODOS: Estudio observacional, descriptivo, longitudinal y retrospectivo, de pacientes a los que se les realizó un bypass gástrico, en el Hospital Universitario Central de Asturias entre 2003 y 2012. El seguimiento mínimo se estableció en dos años. Calculamos de manera individualizada el coste para cada uno de los pacientes intervenidos (bottom-up), así como según el grupo relacionado por el diagnóstico (GRD) (top-down). RESULTADOS: De los 307 pacientes del estudio, el coste medio del ingreso calculado por GRD fue de 6.545,9€ y el calculado por paciente de 10.572,2€. El GRD 288 representa al 91% de la serie con un valor de 4.631€. El cálculo estimativo del ahorro que supuso en nuestro entorno sanitario la disminución del número de fármacos de 2,86 a 0,78 por paciente medicado, representó 4.433€ por paciente intervenido si padecía todas las comorbilidades analizadas. CONCLUSIONES: El bypass gástrico en el Hospital Universitario Central de Asturias a los dos años de la cirugía, en pacientes con pluripatología consiguió un ahorro solo en fármacos que podría compensar los gastos inherentes al tratamiento quirúrgico. El coste por proceso mediante GRD se mostró insuficiente a la hora de hacer una correcta evaluación económica, por lo que recomendamos un método de evaluación de coste por paciente

INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was €6,545.90, and the average cost per patient was €10,572.20. DRG 288 represented 91% of the series, with a value of €4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of €4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method

Economic evaluation of surgical treatment of obesity. / Evaluación económica del tratamiento quirúrgico de la obesidad.

INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was €6,545.90, and the average cost per patient was €10,572.20. DRG 288 represented 91% of the series, with a value of €4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of €4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method.

Obstrucción intestinal debido a hernia estrangulada en el espacio prevesical: presentación de un caso y revisión de la literatura / Intestinal obstruction caused by strangulated hernia in the prevesical space: one case and revision of the literature

Resumen Introducción El espacio prevesical es una localización infrecuente de hernia. La hernia prevesical es causa infrecuente de obstrucción intestinal. Presentamos el caso de un paciente intervenido en nuestro centro y realizamos una revisión de la literatura. Caso clínico Varón de 67 años sin antecedentes médico- quirúrgicos de interés que acude a Urgencias por dolor suprapúbico de 24 h de evolución. A la exploración destacan distensión abdominal y dolor en la localización previamente descrita. Se realiza estudio analítico completo y TC abdominal, en el que se objetiva dilatación de asas del intestino delgado con cambio de calibre a nivel pélvico. Se decide realizar laparotomía exploradora: herniación de 25 cm de íleon de aspecto isquémico en el espacio prevesical. Se realiza resección intestinal y anastomosis enteroentérica L-L manual monoplano. El estudio anatomopatológico de la pieza quirúrgica no revela otros datos de interés. El paciente presenta buena evolución postoperatoria con tolerancia oral progresiva y es dado de alta al quinto día de la intervención. Conclusiones Las hernias del espacio prevesical son causa infrecuente de dolor abdominal y de obstrucción intestinal. Se localizan entre los ligamentos umbilicales laterales y el fundus de la vejiga, donde se forma un anillo peritoneal. Deben sospecharse ante dolor inguinal o supra-púbico sin tumoración palpable en el piso abdominal inferior. El diagnóstico es radiológico, mediante TC. El tratamiento es quirúrgico y ocasionalmente puede precisar resección intestinal.

Introduction Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.

Crystal structure of pharmaceutical cocrystals of 2,6-diaminopyridine with piracetam and theophylline.

Pharmaceutical cocrystals are crystalline solids formed by an active pharmaceutical ingredient and a cocrystal former. The cocrystals 2,6-diaminopyridine (DAP)-piracetam [PIR; systematic name: 2-(2-oxopyrrolidin-1-yl)acetamide] (1/1), C5H7N3·C6H10N2O2, (I), and 2,6-diaminopyridine-theophylline (TEO; systematic name: 1,3-dimethyl-7H-purine-2,6-dione) (1/1), C5H7N3·C7H8N4O2, (II), were prepared by the solvent-assisted grinding method and were characterized by IR spectroscopy and powder X-ray diffraction. Cocrystal (I) crystallized in the orthorhombic space group Pbca and showed a 1:1 stoichiometry. The DAP and PIR molecules are linked by an N-H...O hydrogen-bond interaction. Self-assembly of PIR molecules forms a sheet of C(4) and C(7) chains. Cocrystal (II) crystallized in the monoclinic P21/c space group and also showed a 1:1 stoichiometry. The DAP and TEO molecules are connected by N-H...N and N-H...O hydrogen bonds, forming an R22(9) heterosynthon. A bidimensional supramolecular array is formed by interlinked DAP-TEO tetramers, producing a two-dimensional sheet.

Pseudodiverticulosis yeyunal. A propósito de tres casos / Jejunal pseudodiverticulosis. Three cases report

La pseudodiverticulosis yeyunal es una entidad infrecuente que cursa habitualmente de forma asintomática. Cuando produce sintomatología, en muchas ocasiones es como resultado de sus complicaciones (obstrucción, perforación o sangrado) y asocia una elevada morbimortalidad. Presentamos tres casos que debutaron como un cuadro de abdomen agudo (AU)

Jejunal pseudodiverticulosis is an uncommon entity. Pseudodiverticulum are usually asymptomatic and an incidental finding. They can have a less frequent acute onset with perforation, obstruction or bleeding and they could have high morbidity and mortality. We report three patients who debuted with an acute abdomen (AU)

Jejunal pseudodiverticulosis. Three cases report.

Jejunal pseudodiverticulosis is an uncommon entity. Pseudodiverticulum are usually asymptomatic and an incidental finding. They can have a less frequent acute onset with perforation, obstruction or bleeding and they could have high morbidity and mortality. We report three patients who debuted with an acute abdomen.

[Single port laparoscopic colostomy using the glove technique]. / Colostomía laparoscópica por puerto único con técnica de guante.

The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment. Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohn's disease and complex perianal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.

Los cocristales farmacéuticos: conceptos generales / Pharmaceutical Cocrystals: General concepts

Los cocristales farmacéuticos surgen como una posibilidad para mejorar las propiedades biofarmacéuticas y farmacotécnicas de un IFA (Ingrediente Farmacéutico Activo). Los cocristales farmacéuticos son sólidos cristalinos constituidos por un IFA y un formador, los cuales se encuentran en la misma celda cristalina. La búsqueda de nuevos cocristales farmacéuticos es competencia de la química supramolecular, ya que el IFA y el formador se mantienen juntos mediante interacciones no covalentes. Existen métodos en solución y en sólidos para la formación de cocristales. Además, este campo ofrece una posibilidad de desarrollo intelectual debido a la posibilidad de patentar los productos, considerando los parámetros regulatorios. Este trabajo presenta los principales conceptos que se consideran para el estudio de estos sólidos farmacéuticos

Pharmaceutical co-crystals emerge as a possibility to improve the biopharmaceutical properties and pharmacotechnical of an Active Pharmaceutical Ingredient (API). Theco-crystalsare crystalline solids composed of an API and a former, which are located in the same crystal cell. The search for new pharmaceutical co-crystals is the responsibility of supramolecular chemistry, since the formerand the API are held together by non-covalent interactions. Solution and solid state methods are employed for the formation of cocrystals. In addition, this field offers a possibility of intellectual development due to the patentability of products, without neglecting the regulatory aspects. This work presents the main concepts considered for the study of these pharmaceutical solids

Colostomía laparoscópica por puerto único con técnica de guante / Single port laparoscopic colostomy using the glove technique

La cirugía por puerto único con técnica de guante (glove port) es un abordaje adecuado al momento económico y tecnológico que vivimos. Entre las intervenciones susceptibles de su aplicación está la realización de colostomías. Describimos la técnica quirúrgica y resultados de los pacientes a los que se realizó colostomía por puerto único con técnica de guante, a lo largo de los años 2011 y 2012, en dos hospitales de Asturias, España. Realizamos seis colostomías sigmoideas. Cuatro pacientes presentaban enfermedad tumoral, otro caso fue por una fascitis necrosante perineal, y el sexto un paciente con enfermedad de Crohn y fístulas perianales complejas. La edad media de los pacientes, cuatro hombres y dos mujeres, fue de 54 años (rango 42-67 años). El tiempo medio de intervención fue de 42 minutos (rango 30-65 minutos). No hubo complicaciones durante la cirugía ni en el postoperatorio. En nuestro medio, el gasto en material se redujo a la mitad con respecto a otros dispositivos convencionales de puerto único. La técnica de guante representa el abordaje por puerto único más económico y mínimamente invasivo para la realización de estomas, siendo en nuestra experiencia una técnica sencilla, segura y fácilmente reproducible.(AU)

The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment .Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohns disease and complex peri-anal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.(AU)

Colostomía laparoscópica por puerto único con técnica de guante / Single port laparoscopic colostomy using the glove technique

La cirugía por puerto único con técnica de guante (glove port) es un abordaje adecuado al momento económico y tecnológico que vivimos. Entre las intervenciones susceptibles de su aplicación está la realización de colostomías. Describimos la técnica quirúrgica y resultados de los pacientes a los que se realizó colostomía por puerto único con técnica de guante, a lo largo de los años 2011 y 2012, en dos hospitales de Asturias, España. Realizamos seis colostomías sigmoideas. Cuatro pacientes presentaban enfermedad tumoral, otro caso fue por una fascitis necrosante perineal, y el sexto un paciente con enfermedad de Crohn y fístulas perianales complejas. La edad media de los pacientes, cuatro hombres y dos mujeres, fue de 54 años (rango 42-67 años). El tiempo medio de intervención fue de 42 minutos (rango 30-65 minutos). No hubo complicaciones durante la cirugía ni en el postoperatorio. En nuestro medio, el gasto en material se redujo a la mitad con respecto a otros dispositivos convencionales de puerto único. La técnica de guante representa el abordaje por puerto único más económico y mínimamente invasivo para la realización de estomas, siendo en nuestra experiencia una técnica sencilla, segura y fácilmente reproducible.

The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment .Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohn's disease and complex peri-anal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.

Colostomía laparoscópica por puerto único con técnica de guante. / [Single port laparoscopic colostomy using the glove technique].

The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment. Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohns disease and complex perianal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.

Helical supramolecular assembly of N2,N2')bis[3-(morpholin-4-yl)propyl]-N1,N1'-(1,2-phenylene)dioxalamide dimethyl sulfoxide monosolvate.

In the title compound, C(24)H(36)N(6)O(6)·C(2)H(6)OS, the carbonyl groups are in an antiperiplanar conformation, with O=C-C=O torsion angles of 178.59 (15) and -172.08 (16)°. An intramolecular hydrogen-bonding pattern is depicted by four N-H...O interactions, which form two adjacent S(5)S(5) motifs, and an N-H...N interaction, which forms an S(6) ring motif. Intermolecular N-H...O hydrogen bonding and C-H...O soft interactions allow the formation of a meso-helix. The title compound is the first example of a helical 1,2-phenylenedioxalamide. The oxalamide traps one molecule of dimethyl sulfoxide through N-H...O hydrogen bonding. C-H...O soft interactions give rise to the two-dimensional structure.

Soft plasma processing of organic nanowires: a route for the fabrication of 1D organic heterostructures and the template synthesis of inorganic 1D nanostructures.

Hierarchical (branched) and hybrid metal-NPs/organic supported NWs are fabricated through controlled plasma processing of metalloporphyrin, metallophthalocyanine and perylene nanowires. The procedure is also applied for the development of a general template route for the synthesis of supported metal and metal oxide nanowires.

Glucagonoma syndrome: a case report.

INTRODUCTION: Glucagonoma syndrome is a rare paraneoplastic phenomenon, with an estimated incidence of one in 20 million, characterized by necrolytic migratory erythema, hyperglucagonemia, diabetes mellitus, anemia, weight loss, glossitis, cheilitis, steatorrhea, diarrhea, venous thrombosis and neuropsychiatric disturbances in the setting of a glucagon-producing alpha-cell tumor of the pancreas. Necrolytic migratory erythema is the presenting manifestation in the majority of cases, so its early suspicion and correct diagnosis is a key factor in the management of the patient. CASE PRESENTATION: We present the case of a 70-year-old Caucasian woman with glucagonoma syndrome due to an alpha-cell tumor located in the tail of the pancreas, successfully treated with surgical resection. CONCLUSION: Clinicians should be aware of the unusual initial manifestations of glucagonoma. Early diagnosis allows complete surgical resection of the neoplasm and provides the only chance of a cure.