Filtro de vena cava inferior ante diagnóstico de trombosis venosa profunda en gestante en trabajo de parto. A propósito de un caso clínico / Inferior vena cava filter before diagnosis of deep venous thrombosis in a pregnant woman in labor: A case report

Introducción: El embarazo representa un estado procoagulante que aumenta el riesgo de fenómenos trombóticos en la mujer. Al igual que en la población no gestante, deberemos diagnosticar y tratar lo más precozmente posible dichos eventos para evitar la migración del trombo a otras localizaciones. La anticoagulación constituye la medida terapéutica de primera línea. Sin embargo, ciertas situaciones de aumento de sangrado como el trabajo de parto pueden suponer una contraindicación para iniciar dicha anticoagulación. En el siguiente artículo se desarrolla un caso clínico en el que el diagnóstico de trombosis venosa profunda tuvo lugar al inicio del trabajo de parto. Principales síntomas y/o hallazgos clínicos: Aumento de diámetro de miembro inferior izquierdo, con enrojecimiento del mismo y aumento de temperatura local. La paciente describía dolor a nivel de dicha extremidad desde hacía 15 días. No presentaba disnea y la saturación de oxígeno era del 100%. Diagnósticos principales: Trombosis venosa profunda, trabajo de parto. Intervenciones terapéuticas: La contraindicación de anticoagulación y la necesidad de un tratamiento inmediato plantearon el filtro de vena cava inferior como la opción más razonable. Resultados: Tras la colocación del filtro, el parto cursó sin incidencias; no migró el émbolo y el filtro se retiró a los 29 días del parto sin complicaciones. Conclusión: Pese a nuestra escasa experiencia clínica en el manejo de estos casos, podemos afirmar que el filtro de vena cava inferior representa una opción razonable y segura en los casos de trombosis de miembros inferiores en mujeres en trabajo de parto.(AU)

Introduction: Pregnancy represents a procoagulant state that increases women's risk of thrombotic phenomena. As in the non-pregnant population, we must diagnose and treat these events as early as possible to avoid the migration of the thrombus to other locations. Anticoagulation is the first-line therapeutic measure. However, certain situations of increased bleeding such as labor may be a contraindication to initiate such anticoagulation. The following article develops a clinical case in which the deep vein thrombosis diagnosis occurred at the onset of labor. Main symptoms and/or clinical findings: Increase in diameter of the left lower limb, with redness of the same and increase in local temperature. The patient described pain at the level of this limb for 15 days. He had no dyspnea and oxygen saturation was 100%. Main diagnoses: Deep vein thrombosis, labor. Therapeutic interventions: The contraindication of anticoagulation and the need for immediate treatment raised the inferior vena cava filter as the most reasonable option. Results: After the placement of the filter, the delivery proceeded without incident. The plunger did not migrate and the filter was removed 29 days after delivery without complications. Conclusion: Despite our limited clinical experience in the management of these cases, we can affirm that the inferior vena cava filter represents a reasonable and safe option in cases of thrombosis of the lower limbs in women in labor.(AU)

La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo / Dysphagia in intensive care, a real problem: analysis of risk factors

Objetivos: Determinar los factores de riesgo presentes en los pacientes con disfagia en relación con una población de pacientes críticos. Método: Serie de casos de una cohorte de pacientes reclutados en la unidad de cuidados intensivos (UCI) hasta el alta hospitalaria. Se reclutaron a aquellos pacientes que dieron su consentimiento y cumplían los criterios de inclusión. El método de exploración clínica Volumen-Viscosidad fue utilizado para la detección de la disfagia. Se realizó un análisis estadístico uni- y bivariante, a través del odds ratio (OR) para detectar los factores de riesgo en la disfagia. Resultados: 103 pacientes fueron reclutados de 401 posibles. La media de edad fue de 59,33±13,23; los hombres representaban el 76,7%. La gravedad media fue: APACHE II (12,74±6,17) y Charlson (2,98±3,31). Un 45,6% de los pacientes desarrollaron disfagia, obteniendo valores significativos de OR (p<0,050) para el desarrollo de disfagia: la mayor edad, los antecedentes neurológicos, COVID19, la alta estancia en UCI y hospitalización y la presencia de traqueotomía. Los pacientes COVID19 representaban el 46,6%, por lo que se realizó un análisis de este subgrupo observando resultados similares, con un riesgo de Charlson (OR:4,65; IC95%: 1,31-16,47; p=0,014) y una estancia hospitalaria (OR: 8,50; IC95%: 2,20-32,83; p<0,001). Al alta de UCI, el 37,9% de la población presentaba todavía disfagia, y mantenía este problema al alta hospitalaria el 12,6%. Conclusiones: Casi la mitad de nuestros pacientes presentaron disfagia. Fueron factores de riesgo la gravedad clínica y la presencia de traqueotomía. Se observó en estos pacientes una mayor estancia tanto en UCI como en hospitalización.(AU)

Aims: To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes: 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p=0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. Conclusions: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.(AU)

Dysphagia in intensive care, a real problem: analysis of risk factors.

AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

Anatomical configurations of the optic canal in the sphenoid sinus in a Hispanic population: computed tomography based study.

OBJECTIVE: The prevalence of the optic canal anatomical variants across the sphenoid sinus varies widely among different ethnic groups. This study aimed to analyse the anatomical variants of the optic canal and their relationship to sphenoid sinus pneumatisation in a Hispanic population. METHOD: A review of 320 sphenoid sinuses by high-resolution computed tomography was performed. DeLano's classification of the optic canal, presence of dehiscence, septa insertion, sphenoid sinus pneumatisation and presence of Onodi cells were established. RESULTS: Dehiscence of the optic canal was observed in 4.7 per cent (n = 15) of the analysed sinuses. Type 4 and 3 optic canals were significantly more frequent among postsellar sphenoid sinuses than other patterns of sphenoid sinus pneumatisation (p = 0.002 and p = 0.018). A type 4 optic canal has a higher tendency to present inserted septum than other optic canal types (p = 0.014). CONCLUSION: This study described the optic canal variants in a Hispanic population, which complements existing literature addressing other ethnicities.

Photoautotrophs and macroinvertebrate trophic relations in calcareous semiarid streams: The role of Cyanobacteria.

Photoautotrophs and macroinvertebrate trophic relations in Mediterranean streams, especially from semiarid areas, are still poorly known, as is the role of Cyanobacteria, which is the most frequently dominant photoautotroph. To investigate the role of Cyanobacteria as a food resource in these systems, the fatty acid composition of primary and secondary producers was investigated in two streams on a semiarid climatic gradient between 200 and 500 mm of rainfall in SE Spain. Fatty acid composition of photoautotrophs and macroinvertebrates differed among streams in summer and among seasons in each stream. Fatty acid fingerprints show that macroinvertebrates usually fed on the dominant photoautotroph assemblage and that Cyanobacteria represent the main food for all the feeding groups in the Alhárabe stream in winter although filamentous green algae were preferred in summer. Only scrapers consuming Chlorophyta displayed a selective feeding behaviour. The results show the importance of cyanobacteria as food for all collected macroinvertebrates in winter in some semiarid streams and confirm that fatty acids can be used as temporal and spatial markers in fluvial systems.

Influence of aquaculture waste on fatty acid profiles and gonad maturation of wild fish aggregations at fish farms.

Wild fish belonging to four species belonging to different trophic groups were captured at three distances from fish farm facilities: long distance (>5 Km), medium distance (1.5 Km) and close to sea-cages. Flesh, brain, liver and gonads were sampled for fatty acid analysis. Fish aggregated near sea-cages showed accumulation of fatty acids of vegetable origin in the studied tissues, due to surplus feed consumption or via predation of fish that consumed the feed. Gonads accumulated vegetable fatty acids in different manner in the different species, and the species least and most influenced by fish-feeds were selected for gonad histological examination. Results showed an acceleration of the final stages of the oocyte development in fish aggregated near fish farms compared to fish captured at long distance. Differences in oocyte development were more acute in the species which incorporated higher quantities of vegetable fatty acids.

Financing and implementation of adaptation measures to climate change along the Spanish coast.

Understanding how we are adapting to climate change in coastal areas is an essential issue in the long-term coastal planning. While most of existing studies focus on mapping the current state of adaptation plans, there is a significant lack of studies on the current implementation of adaptation strategies. This study addresses this challenge by assessing how coastal adaptation is being financed and implemented in Spain. In the absence of a detailed roadmap for implementing the Spanish Strategy for Coastal Adaptation to Climate Change, we have analysed how adaptation has been and is currently being funded; which the rationale for investments along the territory is; how adaptation investments compare to regular coastal protection costs; and assessed when implemented measures are really adaptation ones. Our results show that the financing source clearly conditions the type of measures implemented, with those funded under the Environment Promotion Plan for Climate Change Adaptation (PIMA Adapta initiative) being dominated by classical coastal engineering actions, whereas ecosystem-related actions are mostly funded under the LIFE programme. In territorial terms, the Mediterranean coastal regions present the most important problems under current conditions and attract most of the funding. Most of the funded actions have been designed to solve current coastal problems, and although they indirectly contribute to adaptation by improving the coastal base status, they are not specifically designed for climate change. This misuse of the concept of adaptation measure will tend to the society to be overconfident about adopted actions whereas we are not progressing to real adaptation. To overcome this risk, it is necessary to have a clear roadmap for implementing adaptation measures together a proper financing structure.

Pseudomonas fluorescens LBUM677 differentially increases plant biomass, total oil content and lipid composition in three oilseed crops.

AIMS: Pseudomonas spp. have been widely studied for their plant growth-promoting effects. However, their capacity to promote lipid accumulation in oilseed crops is not well characterized. In this study, we evaluated the effect of Pseudomonas fluorescens LBUM677 on lipid accumulation in three oilseed crops: soybean (Glycine max), canola (Brassica napus) and corn gromwell (Buglossoides arvensis), a plant of high nutraceutical interest for its accumulation of the omega-3 stearidonic acid. METHODS AND RESULTS: Pot experiments were conducted under controlled conditions where seeds were inoculated or not with LBUM677 and plants were harvested at 4, 8 and 12 weeks. A qPCR assay specifically targeting LBUM677 was used in parallel to correlate LBUM677 soil rhizosphere competency to growth promotion and seed lipid accumulation. Total oil seed content and fatty acid composition were analysed at seed maturity. Results showed that LBUM677 was able to establish itself in the rhizosphere of the three plant species at similar levels, but it differentially increased plant biomass, total oil content and lipid composition in a plant-specific manner. CONCLUSIONS: Despite some species-specific differences observed in P. fluorescens LBUM677's effect on different crops, the strain appears to be a generalist plant growth-promoting rhizobacteria of oilseed crops. SIGNIFICANCE AND IMPACT OF THE STUDY: LBUM677 shows great potential to be used as an inoculum to promote oil yield and fatty acid accumulation in oilseed crops.

[Mortality due to asthma in Spain, 1990-2015]. / Mortalidad por asma en España, 1990-2015.

INTRODUCTION: Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE: To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS: The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS: In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.

Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains.

BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

Susceptibility of Diaphorina citri (Hemiptera: Liviidae) and Its Parasitoid Tamarixia radiata (Hymenoptera: Eulophidae) to Entomopathogenic Fungi under Laboratory Conditions.

Diaphorina citri (Kuwayama) is a global pest of citrus that transmits the bacteria associated with the disease, Huanglongbing. Entomopathogenic fungi and the parasitoid Tamarixia radiata (Waterston) are important biological control agents of this pest and likely to interact in D. citri populations. As a basis for interaction studies, we determined the susceptibility of nymphs and adults of D. citri and adults of the parasitoid T. radiata to six fungal isolates from the species Beauveria bassiana s.l. (Bals.-Criv.) Vuill. (isolates B1 and B3), Metarhizium anisopliae s.s. (Metsch.) (Ma129 and Ma65) and Isaria fumosorosea Wize (I2 and Pae). We conducted experiments evaluating infection levels in all three insect groups following inoculation with a series of conidial concentrations (1 × 104-1 × 108 conidia mL-1). Results showed that D. citri nymphs and T. radiata were more susceptible to fungal isolates than D. citri adults. Overall, B. bassiana and M. anisopliae isolates caused the greatest infection compared with I. fumosorosea isolates in all three groups of insects. Isolates B1 (B. bassiana) and Ma129 (M. anisopliae) infected a greater proportion of adults and nymphs of D. citri, respectively. Both isolates of B. bassiana caused greater infection in T. radiata compared with isolates of the other fungal species. We propose that isolates B1 and Ma129 are the strongest candidates for control of D. citri. Our results represent the first report of entomopathogenic fungi infecting T. radiata, and the basis for future studies to design a biological control programme that uses both agents more efficiently against D. citri populations.

Fourth ventricle neurocysticercosis: Rigid endoscopic management. Description of direct transcerebellar approach.

BACKGROUND: Endoscopy has gained a crucial role in high specialty neurosurgery during the last decades. At present, there are well-defined flexible neuroendoscopic procedures to treat ventricular and subarachnoid space pathologies. Neurocysticercosis is recognized as a common cause of neurologic disease in developing countries and the United States. Surgical intervention, especially cerebrospinal fluid diversion, is the key for management of hydrocephalus. In 2002, a consensus suggested that ventricular forms should be treated with endoscopy as the first option. CASE DESCRIPTION: Here, we present the case of a 51-year-old right-handed male, from Estado de México. Two days before admission he experienced holocraneal headache 7/10 on the visual analogue scale which was intermittent, with no response to any medication, sudden worsening of pain to 10/10, nausea, and vomit. On physical examination, he presented with 14 points in the Glasgow coma scale (M6, O4, V4), pupils were 3 mm, there was adequate light-reflex response, and bilateral papilledema. The cranial nerves did not have other pathological responses, extremities had adequate strength of 5/5, and normal reflexes (++/++) were noted. Neuroimaging studies showed dilatation of the four ventricles as well as a cystic lesion in the fourth ventricle. Surgical position was Concorde, and the approach through a suboccipital burr hole was planned preoperatively with craneometric points. A rigid Karl Storz Hopkins II® endoscope was inserted directly through the cerebellum and the cystic lesion was extracted entirely. CONCLUSION: This article presents a useful technique with low morbidity and mortality. Further investigation is needed, especially in our Mexico, where neuroendoscopical techniques are still in the development phase.

The short-term effects of farmed fish food consumed by wild fish congregating outside the farms.

We simulated in the laboratory the possible effects on fatty acids and immune status of wild fish arriving for the first time in the vicinity of a sea-cage fish farm, shifting their natural diet to commercial feed consumption, rich in fatty acids of vegetable origin. The flesh fatty acid profile of golden mullet specimens was altered after 2weeks of commercial feed consumption, showing an increase in fatty acids of vegetable origin. The serum peroxidase and bactericidal activities, and head-kidney leucocyte phagocytic capacity, increased after eight weeks of the new diet, while the respiratory burst activity decreased. The extent of these changes cannot be considered large enough to regard them as compromising the health status of fish. More research is needed in order to elucidate whether the rapid assimilation of the dietary fatty acids could harm the immune status of fish when feeding for longer periods than two months.

Microbial source tracking in shellfish harvesting waters in the Gulf of Nicoya, Costa Rica.

Current microbial water quality monitoring is generally limited to culture-based measurements of fecal indicator bacteria (FIB). Given the many possible sources of fecal pollution within a watershed and extra-intestinal FIB reservoirs, it is important to determine source(s) of fecal pollution as a means to improve water quality and protect public health. The principal objective of this investigation was to characterize the microbial water quality of shellfish harvesting areas in the Gulf of Nicoya, Costa Rica during 2015. In order to achieve this objective, the specificity and sensitivity of 11 existing microbial source tracking (MST) PCR assays, associated with cows (BacCow), dogs (BacCan, DogBac), domestic wastewater (PMMoV), general avian (GFD), gulls (Gull2), horses (HorseBac, HoF), humans (HF183, HPyV), and pigs (PF), were evaluated using domestic wastewater and animal fecal samples collected from the region. The sensitivity of animal-associated assays ranged from 13 to 100%, while assay specificity ranged from 38 to 100%. The specificity of pepper mild mottle virus (PMMoV) and human polyomavirus (HPyV) was 100% for domestic wastewater, as compared to 94% specificity of the HF183 Bacteroidales marker. PMMoV was identified as a useful domestic wastewater-associated marker, with concentrations as high as 1.1 × 105 copies/ml and 100% sensitivity and specificity. Monthly surface water samples collected from four shellfish harvesting areas were analyzed using culture-based methods for Escherichia coli as well as molecular methods for FIB and a suite of MST markers, which were selected for their specificity in the region. While culturable E. coli results suggested possible fecal pollution during the monitoring period, the absence of human/domestic wastewater-associated markers and low FIB concentrations determined using molecular methods indicated sufficient microbial water quality for shellfish harvesting. This is the first study to our knowledge to test the performance of MST markers in Costa Rica as well as in Central America. Given the lack of wastewater treatment and the presence of secondary sources of FIB, this study highlights the importance of an MST toolbox approach to characterize water quality in tropical regions. Furthermore, it confirms and extends the geographic range of PMMoV as an effective tool for monitoring domestic wastewater pollution.

[Fixed-dose combination fluticasone propionate/formoterol for the treatment of asthma: a review of its pharmacology, efficacy and tolerability]. / Combinación a dosis fija de fluticasona propionato/formoterol fumarato para el tratamiento del asma: una revisión de la farmacología, eficacia y tolerabilidad.

The fixed-dose combination fluticasone propionate/formoterol (FPF) is a novel combination of a widely known and used inhaled glucocorticoid (IGC) and a long-acting ß2-adrenergic agonist (LABA), available for the first time in a single device. This fixed-dose combination of FPF has a demonstrated efficacy and safety profile in clinical trials compared with its individual components and other fixed-dose combinations of IGC/LABA and is indicated for the treatment of persistent asthma in adults and adolescents. FPF is available in a wide range of doses that can adequately cover the therapeutic steps recommended by treatment guidelines, constituting a fixed-dose combination of GCI/LABA that is effective, rapid, well tolerated and with a reasonable acquisition cost. Various assessment agencies of the Spanish Autonomous Communities consider this combination to be an appropriate alternative therapy for asthma in the primary care setting.

Preoperative low-dose weekly cisplatin and continuous infusion fluorouracil plus hyperfractionated radiotherapy in stage II-III esophageal carcinoma.

BACKGROUND: The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus. METHODS: Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy. RESULTS: From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04). CONCLUSIONS: Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.

[Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis]. / Calidad de vida del paciente asmático con beclometasona/formoterol. Análisis de coste-utilidad.

AIM: To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. RESULTS: Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY.

Specific Diversity of Metarhizium Isolates Infecting Aeneolamia spp. (Hemiptera: Cercopidae) in Sugarcane Plantations.

Spittlebugs from the genus Aeneolamia are important pests of sugarcane. Although the use of the entomopathogenic fungus Metarhizum anisopliae s.l. for control of this pest is becoming more common in Mexico, fundamental information regarding M. anisopliae in sugarcane plantations is practically non-existent. Using phylogenetic analysis, we determined the specific diversity of Metarhizium spp. infecting adult spittlebugs in sugarcane plantations from four Mexican states. We obtained 29 isolates of M. anisopliae s.str. Haplotype network analysis revealed the existence of eight haplotypes. Eight selected isolates, representing the four Mexican states, were grown at different temperatures in vitro; isolates from Oaxaca achieved the greatest growth followed by isolates from Veracruz, San Luis Potosi and Tabasco. No relationship was found between in vitro growth and haplotype diversity. Our results represent a significant contribution to the better understanding of the ecology of Metarhizum spp. in the sugarcane agroecosystem.

[Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia]. / Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna.

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level.