Individual spatial aggregation correlates with between-population variation in fine-scale genetic structure of Silene ciliata (Caryophyllaceae).

Fine-scale genetic structure (FSGS) can vary among populations within species depending on multiple demographic and environmental factors. Theoretical models predict that FSGS should decrease in high-density populations and increase in populations where individuals are spatially aggregated. However, few empirical studies have compared FSGS between populations with different degrees of individual spatial aggregation and microhabitat heterogeneity. In this work, we studied the relationship between spatial and genetic structure in five populations of alpine specialist Silene ciliata Poiret (Caryophyllaceae). We mapped all individuals in each population and genotyped 96 of them using 10 microsatellite markers. We found significant FSGS consistent with an isolation-by-distance process in three of the five populations. The intensity of FSGS was positively associated with individual spatial aggregation. However, no association was found between FSGS and global population density or microhabitat heterogeneity. Overall, our results support theoretical studies indicating that stronger spatial aggregation tends to increase the magnitude of FSGS. They also highlight the relevance of characterizing local plant distribution and microhabitat to better understand the mechanisms that generate intraspecific variation in FSGS across landscapes.

Exploiting nonreciprocity in BOTDA systems.

In this Letter, we present and demonstrate a novel technique for distributed measurements in Brillouin optical time-domain analysis based on the use of the nonlinear phase-shift induced by stimulated Brillouin scattering. Employing a Sagnac interferometer (SI), the position-resolved Brillouin phase-shift spectrum (BPS) along the fiber can be obtained, benefiting from the sensitivity to nonreciprocal phase-shifts of the SI scheme. This proposal simplifies the existing methods to retrieve the BPS distribution along an optical fiber since phase modulation, filtering, and high-bandwidth detectors are not required. The fundamentals of the technique are described theoretically and validated through numerical simulations and experimental measurements.

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. Intervention and variables: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p < 0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p < 0.05). Conclusions: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance

OBJETIVOS: Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar los factores que pueden influir sobre el cumplimiento y comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación. DISEÑO Y ÁMBITO: Se llevó a cabo un estudio observacional y prospectivo en una unidad de cuidados intensivos polivalente. PACIENTES: Se estudió a todos los pacientes consecutivos atendidos con MV y en los que no estaba contraindicada la reclinación parcial. Intervención y variables: Se observó la ECC durante 4 periodos de un mes a lo largo de un año, el primero de ellos con enmascaramiento. Se midió la ECC mediante un dispositivo electrónico 3 veces al día. Las variables principales fueron ECC, tipo de dispositivo para las vías respiratorias, tipo de cama, turno de enfermería, día de la semana y cumplimiento notificado mediante lista de verificación. No se recopilaron las características de los pacientes. RESULTADOS: Se recopilaron 2.639 observaciones durante los 4 periodos. La tasa global de cumplimiento con la ECC fue del 24.0%, mientras que la mediana del ángulo de elevación de la cabecera de la cama (M-ECC) fue de 24.0° (IQR 18.8–30.0). El cumplimiento con la ECC y la M-ECC por cada periodo fue: periodo con enmascaramiento: 13.8% y 21.1° (IQR 16.3-24.4); periodo 1: 25.5% y 24.3° (IQR 18.8-30.2); periodo 2: 22.7% y 24.4° (IQR 18.9-29.6); y periodo 3: 31.4% y 26.7° (IQR 21.3-32.6) (p < 0.001). Se observó una sobreestimación del 50-60% al comparar el cumplimiento autoevaluado por medio de una lista de verificación frente al cumplimiento evaluado mediante observación directa (p < 0.001). Un análisis de regresión logística multivariante concluyó que la presencia de un tubo endotraqueal (TE) y de una cama sin dispositivo de medición de ECC se asociaban de manera independiente a un mayor cumplimiento (p < 0.05). CONCLUSIONES: Si bien el cumplimiento aumentó de manera significativa durante el periodo del estudio, seguía sin ser el óptimo. El cumplimiento evaluado mediante lista de verificación sobreestimó de manera significativa el cumplimiento de la ECC. La presencia de un TE y una cama sin dispositivo de medición de ECC se asociaba a un mayor cumplimiento

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit.

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. INTERVENTION AND VARIABLES: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p<0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p<0.05). CONCLUSIONS: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance.

Evaluación del cumplimiento de la elevación de la cabecera de la cama en pacientes críticamente enfermos sometidos a ventilación mecánica en una unidad de cuidados intensivos polivalente / Evaluation of the compliance with the elevation of the head of the bed in critically ill patients undergoing mechanical ventilation in a polyvalent intensive care unit

Objetivos. Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar losfactores que pueden influir sobre el cumplimientoy comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación...

[Validation of a diagnostic questionnaire for migraine adapted for a computer assisted telephone interviewing]. / Validación de un cuestionario diagnóstico para migraña adaptado para encuesta telefónica asistida por ordenador.

INTRODUCTION: the use of questionnaires is a tool for obtaining information on cases and the variables to analyse in migraine study populations. METHODS: we have validated the questionnaire within the PALM study, based on IHS-II criteria and administered by telephone using computer assisted sampling (CATI). The questionnaire has been validated using 50 randomly selected subjects, who had been assessed blind by a neurologist expert in migraine. RESULTS: of the 24 patients diagnosed with strict migraine with the CATI interview, only in 2 (8%) of them did the neurologist determine that they did not suffer from migraine. Furthermore, of the patients in whom the diagnostic questionnaire concluded that they did not suffer from migraine, the specialist did not establish that diagnosis in any of them either. The analysis showed a sensitivity of 81.5% (95% CI, 66.8%-96.1%) and a specificity of 91.3% (95% CI, 79.8%-100%). The positive predictive value was 91.7% and the negative was 80.8%. CONCLUSIONS: the PALM questionnaire administered by telephone with computer support is a valid tool for use in determining the prevalence of migraine in study populations.

Validación de un cuestionario diagnóstico para migraña adaptado para encuesta telefónica asistida por ordenador / Validation of a diagnostic questionnaire for migraine adapted for a computer assisted telephone interviewing

Introducción: La utilización de cuestionarios es la fórmula de obtención de la información sobre los casos y las variables a analizar en los estudios poblacionales de migraña. Métodos: Hemos realizado la validación del cuestionario dentro del estudio PALM, basado en los criterios de IHS-II y administrado telefónicamente según un muestreo asistido por ordenador (CATI). Se ha validado mediante el estudio de 50 sujetos elegidos aleatoriamente y analizados de forma ciega por un neurólogo experto en migraña. Resultados: De los 24 pacientes diagnosticados de migraña estricta con la entrevista CATI, en tan sólo 2 (8%) de ellos el neurólogo determinó que no tenían migraña. Sin embargo, de entre los pacientes en que el cuestionario diagnóstico no concluyó que padecieran migraña no hubo ninguno en que el especialista estableciera dicho diagnóstico. El análisis reveló una sensibilidad del 81,5% (intervalo de confianza [IC] del 95%, 66,8%-96,1%) y una especificidad del 91,3% (IC del 95%, 79,8%-100%). El valor predictivo positivo fue del 91,7% y el negativo del 80,8%. Conclusiones: El cuestionario PALM, administrado telefónicamente con apoyo de ordenador, es un instrumento válido para su uso en la determinación de la prevalencia de migraña en estudios poblacionales (AU)

Introduction: The use of questionnaires is a tool for obtaining information on cases and the variables to analyse in migraine study populations. Methods: We have validated the questionnaire within the PALM study, based on IHS-II criteria and administered by telephone using computer assisted sampling (CATI). The questionnaire has been validated using 50 randomly selected subjects, who had been assessed blind by a neurologist expert in migraine. Results: Of the 24 patients diagnosed with strict migraine with the CATI interview, only in 2 (8%) of them did the neurologist determine that they did not suffer from migraine. Furthermore, of the patients in whom the diagnostic questionnaire concluded that they did not suffer from migraine, the specialist did not establish that diagnosis in any of them either. The analysis showed a sensitivity of 81.5% (95% CI, 66.8%-96.1%) and a specificity of 91.3% (95% CI, 79.8%-100%). The positive predictive value was 91.7% and the negative was 80.8%. Conclusions: The PALM questionnaire administered by telephone with computer support is a valid tool for use in determining the prevalence of migraine in study populations (AU)

Hidropesía vesicular como forma de presentación de la enfermedad de Kawasaki / Hydrops of the gallbladder as a form of presentation of Kawasaki disease

La enfermedad de Kawasaki (EK) es una vasculitis aguda de etiología desconocida. Clínicamente, se caracteriza por la presencia de fiebre, conjuntivitis, cambios en las extremidades, exantema, afectación de los labios y la mucosa oral, y linfadenopatía. La hidropesía vesicular se ha descrito en aproximadamente el 10-15% de los pacientes con EK. Esta enfermedad es el proceso febril más frecuentemente asociado a hidropesía vesicular. Es necesario sospechar la EK ante una hidropesía vesicular aguda febril para no demorar la instauración del tratamiento adecuado. Aportamos el caso de un paciente de 8 años de edad, ingresado por presentar fiebre e hidropesía vesicular, en el que se diagnosticó una EK (AU)

Kawasaki disease (KD) is an acute vasculitis of unknown aetiology. Clinically it is characterised by fever, conjunctivitis, changes in the extremities, exanthema, involvement of the lips and oral mucosa and lymphadenopathy. Hydrops of the gallbladder has been described in approximately 10-15% of patients with KD. This disease is the febrile condition most frequently associated with hydrops of the gallbladder. KD must be suspected in the event of acute febrile hydrops of the gallbladder so as to avoid delays in the start of an appropriate treatment. We present the case of an 8-year-old patient admitted for fever and hydrops of the gallbladder, and diagnosed with KD (AU)

[Afebrile convulsions and acute gastroenteritis: a more common than expected combination]. / Convulsiones afebriles y gastroenteritis aguda: una asociación más frecuente de lo esperado.

Afebrile seizures in association with acute gastroenteritis without electrolyte disturbances have been reported in children from Asiatic countries, but only few references are from Spain. It is a benign, self-limiting process, with no specific examinations or therapy needed. There is no increased risk of epilepsy or impaired neurodevelopment in the children affected. We present five children with seizures during acute gastroenteritis admitted to Hospital Universitari Arnau de Vilanova of Lleida (Spain) between December 2005 and March 2006, during the last seasonal rotavirus outbreak. Patients with febrile seizures, electrolyte disturbances or previous seizures have been excluded. Association between acute gastroenteritis and afebrile benign seizures is also common in our setting, and some cases associated to seasonal rotavirus outbreaks have been published. All papers agree with the good prognosis of this problem. To consider this diagnosis is important in order avoid unnecessary examinations or anticonvulsive therapies.

Convulsiones afebriles y gastroenteritis aguda: una asociación más frecuente de lo esperado / A febrile convulsions and acute gastroenteritis: a more common than expected combination

La presentación de convulsiones afebriles en el marco de una gastroenteritis aguda leve sin alteraciones hidroelectrolíticas es una entidad descrita en pediatría con relativa frecuencia en países asiáticos. En nuestro medio, las referencias son más reducidas. Se trata de un proceso benigno que no precisa exploraciones complementarias agresivas ni tratamiento anticomicial posterior, y que no aumenta el riesgo de epilepsia ni de deterioro neuropsíquico. Se presentan 5 casos de convulsión afebril asociada a gastroenteritis aguda, ingresados en el Servicio de Pediatría del Hospital Universitario Arnau de Vilanova desde diciembre de 2005 hasta marzo de 2006. Se han excluido las convulsiones febriles y los casos con alteraciones hidroelectrolíticas o antecedentes previos de convulsión. La asociación entre gastroenteritis aguda y convulsiones benignas afebriles es también frecuente en nuestro medio, y se han publicado casos asociados a brotes estacionales de infección por rotavirus. Todos los trabajos publicados coinciden en la benignidad y el buen pronóstico del proceso. Es importante considerar esta entidad para evitar exámenes complementarios innecesarios y tratamientos antiepilépticos prolongados

Afebrile seizures in association with acute gastroenteritis without electrolyte disturbances have been reported in children from Asiatic countries, but only few references are from Spain. It is a benign, self-limiting process, with no specific examinations or therapy needed. There is no increased risk of epilepsy or impaired neurodevelopment in the children affected. We present five children with seizures during acute gastroenteritis admitted to Hospital Universitari Arnau de Vilanova of Lleida (Spain) between December 2005 and March 2006, during the last seasonal rotavirus outbreak. Patients with febrile seizures, electrolyte disturbances or previous seizures have been excluded. Association between acute gastroenteritis and afebrile benign seizures is also common in our setting, and some cases associated to seasonal rotavirus outbreaks have been published. All papers agree with the good prognosis of this problem. To consider this diagnosis is important in order avoid unnecessary examinations or anticonvulsive therapies

Enfermedad invasiva por Streptococcus pyogenes en lactante sano de 38 días / Invasive disease due to Streptococcus pyogenes in a healthy, 38-day-old infant

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Secuencia de Poland: aportación de dos nuevos casos / Poland sequence: two new cases

La secuencia de Poland es una anomalía musculosquelética congénita caracterizada por la ausencia de la porción esternal del músculo pectoral mayor asociada a braquisindactilia. Se presenta con una incidencia aproximada de 1/20.000-30.000 nacidos vivos (un 75% de los casos corresponde a varones), y en un 70% está afectado el lado derecho. Además de la asociacióncon la braquisandactilial, aausencia del pectoral mayor puede presentarse aislada o bien asociada a otras malformaciones, especialmente de la zona pectoral o del brazo y la mano homolaterales, como sindactilia, ausencia del pectoral menor, hipoplasia de la extremidad o amastia. También se puede asociar a alteraciones de otros territorios, como dextrocardia, síndrome de Moebius o neurofibromatosis. La etiología es desconocida y habitualmente no presenta base hereditaria. Se ha propuesto como teoría patogénica una hipoplasia de la arteria subclavia fetal. El tratamiento es quirúrgico, fundamentalmente con fines estéticoso para corregirlas a1teraciones funcionales de la mano que esta anomalía conlleva. Aportamos dos casos tratados en nuestro servicio de pediatría: uno corresponde a un varón recién nacido, con afectacióndel pectoral mayor e hipoplasia del arco anterior de las costillas 2-5, y el otro a una niña de 9 años afectada de asma mediada por inmunoglobulina E (lgE), que asocia a la agenesia del pectoral mayor una hipoplasia de la mama, una hipoplasia de la mano y braquisindactilia

Poland sequence is a congenital musculoskeletal disorder characterized by agenesis of the sternal portion of the pectoralis major muscle and brachysyndactyly. The incidence is about 1/20,000 to 1/30,000 live births. The ratio of males to females is 3:1 and the right is the side aftected in 70% of cases. The agenesis of the pectoralis major muscle can be the only manifestation or can be associated with other lesions in the pectoral region and ipsilateral upper extremity: brachysyndactyly, absence of the pectoralis minar muscle, hypoplasia of the arm or hand or amastia. Its association with other conditions, like dextrocardia, Moebius syndrome or neurofibromatosisis also possible. The etiology is unknown, and it is usually not hereditary. Hypoplasia of the fetal subclavian artery has been proposed as an underlying cause. The treatment is surgical, mainly for cosmetic reconstruction or improvement in the function of the affected hand. We report two new cases observed in our service. One involves a male infant with agenesis of pectoralis major and hypolasia of anterior arch of the 2nd to 5th ribs. The other patient isa 9-year-old girl with IgE-mediated asthma and agenesis of the pectoralis, breast hypoplasia, Sprengel's deformity and brachysyndacty

[Satisfaction and recovery of normal activity with rizatriptan 10 mg. Results from the open, prospective, observational 4M study]. / Satisfacción y retorno a la actividad normal con 10 mg de rizatriptán. Resultados del estudio abierto, prospectivo y observacional 4M.

BACKGROUND: To evaluate the impact of the treatment with rizatriptan 10 mg (Maxalt) on the return to normal activity and satisfaction with treatment in the general population with migraine. PATIENTS AND METHOD: We conducted an open, prospective study in patients with migraine (International Headache Society [IHS] criteria) who were followed for up to 3 migraine attacks. We measured the degree of functional disability at 0 and 2 hours after treatment, and satisfaction at 24 hours. Other domains of satisfaction were evaluated after three migraine attacks. The relationship between baseline pain severity, satisfaction after 24 hours and functional disability was analyzed. RESULTS: 2,469 patients were enrolled who experienced 6,323 migraine attacks. A return to normal activity was achieved two hours after treatment in 67% of all attacks treated with rizatriptan 10 mg. The percentage of attacks causing severe functional disability decreased from 39% before therapy to 3.6% two hours after treatment. In more than 90% of moderate or severe attacks, a normal or slightly impaired functional capacity was restored two hours after treatment. In 76.3% of the attacks the patients were fully or very satisfied 24 hours after treatment with rizatriptan 10 mg. After treating three migraine attacks, the proportion of patients fully or very satisfied with rizatriptan was over 79% for all the domains explored. CONCLUSIONS: The patients were highly satisfied after 24 hours and following three migraine attacks treated with rizatriptan 10 mg. In more than two-thirds of the attacks treated with rizatriptan 10 mg, the patients returned to normal activity two hours after treatment.

Satisfacción y retorno a la actividad normal con 10 mg de rizatriptán. Resultados del estudio abierto, prospectivo y observacional 4M / Satisfaction and recovery of normal activity with rizatriptan 10 mg. Results from the open, prospective, observational 4M study

FUNDAMENTOS: Evaluar el impacto del tratamiento con 10 mg de rizatriptán (Maxalt®) sobre el retorno a la actividad normal y la satisfacción con el tratamiento en la población migrañosa general. PACIENTES Y MÉTODO: Estudio abierto, prospectivo, en pacientes con migraña (criterios de la International Headache Society [IHS]) durante 3 crisis. Se midió el grado de incapacidad funcional de 0 a 2 h tras el tratamiento y la satisfacción a las 24 h.Otros dominios de satisfacción fueron evaluados tras 3 crisis de migraña. Se analizó la relación entre intensidad basal del dolor, la satisfacción a las 24 h y la incapacidad funcional. RESULTADOS: Se reclutó a 2.469 pacientes que sufrieron un total de 6.323 crisis de migraña. El 67 per cent de las crisis tratadas con 10 mg de rizatriptán había retornado a la actividad normal a las 2 h del tratamiento. El porcentaje de crisis con incapacidad funcional grave descendió del 39 per cent antes del tratamiento al 3,6 per cent a las 2 h de éste. Más del 90 per cent de las crisis moderadas o graves había recuperado una capacidad funcional normal o levemente alterada a las 2 h del tratamiento. Los pacientes estaban completamente o muy satisfechos a las 24 h del tratamiento con 10 mg de rizatriptán en el 76,3 per cent de las crisis. Tras tratar 3 crisis de migraña, el porcentaje de pacientes que estuvieron totalmente o muy satisfechos con rizatriptán fue superior al 79 per cent en todos los dominios explorados. CONCLUSIONES: Los pacientes se sintieron muy satisfechos a las 24 h y tras 3 crisis tratadas con 10 mg de rizatriptán. Más de dos tercios de las crisis tratadas con 10 mg de rizatriptán recobraron una actividad normal a las 2 h del tratamiento (AU)

Perfil del paciente en tratamiento con heparinas de bajo peso molecular / Profile of patients under treatment with heparin of flow molecular weight

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Coste económico de la migraña en el entorno laboral de España: reducción potencial mediante tratamiento con Rizatriptán 10 mg / Economic cost of migraine in the Spanish occupational environment: potential reduction through therapy with Rizatriptán 10mg

En este trabajo se describen las características de un modelo que permite determinar el impacto económico de la migraña en el ámbito laboral, así como calcular el beneficio económico resultante del tratamiento de ese desorden con rizatriptán 10 mg. De acuerdo con dicho modelo, en una compañía española característica en la que trabajasen 10.000 empleados, padecerían migraña 1.512 personas, aproximadamente. Como resultado, la compañía perdería un total de 13.721 días laborables por año, un equivalente a 59,7 personas-año de esfuerzo productivo. El coste anual estimado de la migraña para la compañía asciende a 1,05 millones de euros (175,8 millones de pesetas). Se estima que el incremento potencial anual de la productividad o la pérdida de trabajo evitada que origina el tratamiento con rizatriptán 10 mg es de 5.744 días laborables, aproximadamente, o 24,9 personas-año por 10.000 empleados. El beneficio anual debido al incremento de la productividad resultante de la pérdida de trabajo evitada es, potencialmente, de 0,44 millones de euros (73,6 millones de pesetas) por 10.000 empleados. En conclusión, el coste que ocasiona la migraña a la compañía española de referencia es importante y puede ser reducido significativamente si se trata a los trabajadores afectados con la administración de rizatriptán 10 mg (AU)

Macroamilasemia y enfermedad celíaca / Macroamylasemia and celiac disease

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