Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol. / Manifestaciones clínicas y eventos adversos graves tras consumo de cannabis: efecto de la edad y análisis diferenciado en función del sexo y la coingesta de etanol.

OBJECTIVES: To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS: Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS: A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION: There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.

OBJETIVO: Investigar si existen diferencias en las manifestaciones clínicas por consumo de cannabis según la edad, y si estas se modifican en función del sexo o el consumo de etanol. METODO: Estudio observacional descriptivo de pacientes atendidos en 11 servicios de urgencias con consumo de cannabis como motivo de consulta. Se recogieron 11 manifestaciones clínicas y se analizó su frecuencia relativa en función de la edad mediante curvas spline cúbicas restringidas. Se analizó si existía interacción en el comportamiento etario de cada uno de los síntomas en función del sexo y del consumo de etanol. RESULTADOS: Se analizaron 949 pacientes, edad media 29 años, 74% varones y 39% con coingesta de etanol. Se identificaron tres patrones de síntomas según la edad: estable (vómitos, cefalea, convulsiones, hipotensión), incrementada en edades medias (agresividad-agitación, ansiedad, psicosis, palpitaciones, alucinaciones) y con aumento progresivo con la edad (dolor torácico e hipertensión). En la relación síntoma-edad, la frecuencia de palpitaciones, vómitos y cefalea tuvo un comportamiento significativamente diferente según el sexo, más constante en hombres y con un incremento marcado en edades medias en mujeres. La coingesta de etanol se asoció con más agitación-agresividad (34,0%/23,4%, p 0,001) y menos palpitaciones (9,8%/15,6%, p = 0,01), ansiedad (20,7%/27,8%, p = 0,01), psicosis (10,3%/16,6%, p = 0,007) y dolor torácico (3,8%/9,5%, p = 0,001). En cuanto a la relación síntoma-edad, el etanol solo modificó significativamente la frecuencia de vómitos y de psicosis. CONCLUSIONES: La edad condiciona efectos clínicos diferenciales en algunas manifestaciones agudas de la intoxicación por cannabis que precisa asistencia hospitalaria, y el sexo y el consumo simultáneo de alcohol modifican esta relación entre edad y frecuencia de algunos síntomas.

Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin. / Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica.

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment. METHODS: Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected. RESULTS: Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min. CONCLUSIONS: Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Perfil sociodemográfico y de intereses profesionales de los estudiantes de licenciatura en enfermería / Socio-demographic profile and professional interests of students of Bachelor's degree in nursing

Introducción: Aunque en los servicios de salud a nivel mundial existe deficiencia de personal de enfermería, en América Latina el índice de deserción en las escuelas de enfermería es elevado; esta problemática recae en trabajadores en ejercicio quienes deben brindar cuidado enfermero en situaciones de cansancio y estrés. La problemática lleva a pensar que no existen características adecuadas en los estudiantes que ingresan para cursar favorablemente la carrera. Objetivo: Determinar las características sociodemográficas, económicas, familiares, de antecedentes escolares e intereses profesionales de estudiantes que ingresan a estudiar la carrera de Enfermería. Suponemos una relación entre deserción e intereses u objetivos que guiaron a alumnos en la selección de carrera, sus características socio-económicas-familiares y del plantel que provienen. Metodología: Estudio transversal y descriptivo, se consideró el 100% de las cédulas de tutoría aplicadas a estudiantes de Enfermería que ingresaron entre 2001 y 2006. Los datos sociodemográficos, económicos y familiares se obtuvieron por medio de preguntas abiertas o cerradas, para clasificar nivel socioeconómico se utilizó la propuesta de Sigmarket, los intereses profesionales se evaluaron a partir de una escala tipo likert. Resultados: El perfil obtenido mostró una población joven, predominantemente solteros, que no realizan trabajo remunerado, dependen económicamente de sus padres, de condiciones socioeconómicas precarias, sus intereses están orientados hacia la obtención de conocimientos y aspectos de carácter social Conclusiones: Fue importante identificar una tendencia, aunque no significativa estadísticamente, de permanencia en mayor medida de los alumnos con condiciones sociales más precarias, y aquellos cuyos intereses de orden social se ubican en el nivel más alto.

Introduction: Although it exists a deficiency in nursing staff at a global level in health services, in Latin America the rate of dropout in nursing schools is high; this problem lies over workers who must provide nurse care in situations of fatigue and stress. The problem leads us to think there are no appropriate characteristics for students to successful fulfill their career. Objective: to determine the socio demographic, economic and family characteristics, school background and professional interests of students entering nursing. We assume an existing relationship between dropout, the interests or goals that guided students in the selection of the career in nursing, the socio-economic-family characteristics and the institution of origin. Methodology: cross-sectional and descriptive study that considered the 10000% of admission interviews made to incoming nursing students from 200001 to 200006. The socio-demographic, economical and familiar data were obtained from closed and openended questions; the Sigmarket proposal was used for the classification of the socioeconomic level, the professional interests were evaluate from a likert scale. Results; the obtained profile showed a young population, mainly single, that doesn't have a paid job and depends from their parents economically, from a low socio-economic conditions, their interests are focus towards the acquisition of knowledge and aspects of social nature. Conclusions: it was important to identify a mayor tendency, although not statistically significant, of continuing the career from part of the students with lower social conditions and those whose social interests are located in the highest level.

[Age and growth of the hybrid tilapia Oreochromis niloticus x Oreochromis aureus (Perciformes: Cichlidae) in the dam "Zimapan" Mexico]. / Edad y crecimiento del híbrido de tilapia Oreochromis niloticus x Oreochromis aureus (Perciformes: Cichlidae) en la represa "Zimapán" Hidalgo, México.

Studies on age and growth in fishes are essential to establish models on population dynamics. The previous issues were determined in this study by scale growth analyses. Between September 2003 and May 2004, 382 organisms were captured using gill and atarraya nets. Eight samples were developed every month a long this study. Standard length in centimeters (L(e)), total weight in grams (P9t)), scale length in centimeters (L(esc)) and growth rings were determined. The size and weight ranged from 38 to 232 mm (L(e)) and 8.7 to 311.9 g (P(t)), respectively. The growth rings analyses reveal four age groups, being the second group the most representative with 34.3% of the total sampled. The scale ring analyses showed two growth rings, one develops between November-January and the other between April-May, in good correlation with low temperature and gonad development, respectively. The growth parameters were established as: L infinity = 281.1mm, W infinity = 877.1g, K = 0.33 and T(0) = 0.88 year(-1). The growth curves based on length and weight were described by using the von Bertalanffy model: L(e) = 28.11[1 -e (-0.33(t+0.88))] and P(t) = 877.17[1-e (-0.33(t+0.88))]3. Finally, it is concluded that commercial catches in this dam are between a year and year and half-old when exploited.

"Full moon" endoscopic sign in intraventricular neurocysticercosis.

INTRODUCTION: Despite improvements in sanitation, diagnosis and treatment, neurocysticercosis is still a public health problem in many countries. In symptomatic patients, there is a broad spectrum of clinical manifestations. When cysticerci are lodged in the ventricles or the subarachnoid space, the flow of cerebrospinal fluid can be obstructed and lead to hydrocephalus and intracranial hypertension. The endoscopic view may be useful as a diagnostic tool. PATIENTS: This report clearly shows a common endoscopic pattern in 4 selected patients with ventricular cysticercosis (2 third ventricle/2 lateral ventricle). The endoscopic view of the cysts in the ventricles resembles a "full moon". This analogy helped to identify the features of cysticerci with intact walls and the vesicular stage, malleable due to its cystic content and having an irregular surface, as evidence of the microscopic structure of the cyst wall in a cysticercus. CONCLUSIONS: This finding is not seen in other intraventricular cysts or tumors that can actually be considered as an additional diagnostic criterion among the definitive findings to establish the diagnosis of cysticercosis, since it involves direct endoscopic visualization of a cysticercus under histopathological demonstration. Additionally, the endoscopic approach can be used as primary treatment for these cases, following the minimally invasive approach principle.

Edad y crecimiento del híbrido de tilapia Oreochromis niloticus x Oreochromis aureus (Perciformes: Cichlidae) en la represa “Zimapán” Hidalgo, México

Age and growth of the hybrid tilapia Oreochromis niloticus x Oreochromis aureus (Perciformes: Cichlidae) in the dam “Zimapan” Mexico. Studies on age and growth in fishes are essential to establish models on population dynamics. The previos issues were determined in this study by scale growth analyses. Between September 2003 and May 2004, 382 organisms were captured using gill and atarraya nets. Eight samples were developed every month a long this study. Standard length in centimeters (Le), total weight in grams (Pt), scale length in centimeters (Lesc) and growth rings were determined. The size and weight ranged from 38 to 232mm (Le) and 8.7 to 311.9g (Pt), respectively. The growth rings analyses reveal four age groups, being the sec-ond group the most representative with 34.3% of the total sampled. The scale ring analyses showed two growth rings, one develops between November-January and the other between April-May, in good correlation with low temperature and gonad development, respectively. The growth parameters were established as: L∞=281.1mm, W∞=877.1g, K=0.33 and T0=0.88year -1. The growth curves based on length and weight were described by using the von Bertalanffy model: Le =28.11[1-e-0.33(t+0.88)] and Pt =877.17[1-e-0.33(t+0.88)]³. Finally, it is concluded that commercial catches in this dam are between a year and year and half-old when exploited. Rev. Biol. Trop. 59 (2): 761-770. Epub 2011 June 01.

La edad y crecimiento de la tilapia Oreochromis niloticus x Oreochromis aureus fueron determinados por medio de la lectura de escamas. Un total de 382 individuos fueron capturados mediante el uso de redes agalleras y atarrayas. Ocho recolectas mensuales se llevaron a cabo entre septiembre 2003-mayo 2004; se registraron los datos de longitud estándar en cm. (Le), el peso total en g (Pt) y se obtuvieron muestras de escamas para registrar el largo de la escama en mm. (Lesc) y el número de anillos de crecimiento formados. Las tallas y pesos de recolecta variaron entre 38 a 232mm (Le) y de 8.7 a 311.9g de peso total (Pt) respectivamente. El recuento de los anillos anuales en escamas, permitió establecer cuatro grupos de edad, siendo el grupo de edad 2 el más representativo, con un 34.3% de la población muestreada. El cálculo de los incrementos marginales del crecimiento mensual de las escamas, sugirió la formación de dos anillos, uno de ellos se forma en los meses de noviembre-enero y otro en los meses de abril-mayo, los cuales coinciden con la época de bajas temperaturas y de madurez gonádica respectivamente. Los parámetros de crecimiento quedaron establecidos en: L∞=281.1mm, W∞=877.1g, K=0.33 y T0=0.88/año. Las curvas de crecimiento en longitud y peso se describieron mediante las ecuaciones de von Bertalanffy: Le=28.11 [1- e-0.33(t+0.88)] y Pt=877.17 [1-e-0.33(t+0.88)]³. Finalmente, se concluyó que los peces que se explotan en la represa mediante captura comercial presentan entre un año y año y medio de edad.

Pros y contras percibidos de la actividad física realizada por adultos mayores / Perceived pros and cons of physical activity by older adults

INTRODUCCION: La práctica de actividad física regular es una de las prioridades en salud pública para incrementar el bienestar y la calidad de vida especialmente en la tercera edad. Esta práctica depende de varios factores entre otros las experiencias previas de la conducta y la valoración de las ventajas y desventajas que tiene su realización. Propósito: Conocer los pros (ventajas) y Contras (desventajas) percibidos del ejercicio físico en adultos mayores. METODOLOGÍA: En este estudio se utilizó el balance decisional (Prochaska y Di Clemente1997). Se aplicó la aproximación cualitativa con muestreo teórico y análisis de contenido en una muestra de 15 participantes. Resultados: Estos mostraron tres categorías: Pros de la actividad física construida a partir de las subcategorías: mejorar la salud física y emocional e incrementar las relaciones interpersonales. La segunda categoría: Contras se construyó a partir de las subcategorías ambientales ocupaciones enfermedades y ser cuidadores de otras personas y una tercer categoría identificada se construyó con las razones para realizar la actividad física. CONCLUSIONES: Los pros y contras señalados por los participantes pueden ser la clave para el diseño de estrategias de programas de salud encaminados a incluir la actividad física en el adulto mayor.

Introduction: The practice of regular physical activity is one of the priorities in public Health to increase the well-being and the quality of life especially in the third age. This practice depends on several factors, among others the previous experiences of the conduct and evaluation of the advantages and disadvantages upon achievement. Purpose: Acknowledge pros and cons detected on physical exercise on older adults. Methodology: In this study the decisional balance (Prochaska and Di Clemente,1997) was used. The qualitive approach was applied by theoretical sampling and analysis of content sampling 15 participants. Results: They showed this categories: Pros of the physi cal activity, built from the subcategories: To improve the physical and emotional health and to increase the interpersonal relations. The second category, cons was formed from environmental Subcategories: Occupations, diseases and to carers of others persons and a third Identified category was the reasons of physical activity. Conclusions: The pros and cons distinguished by the participants can be the key for the strategic health programs design aimed to include physical activity on major adults.

Comparison of cefepime versus ceftriaxone-amikacin as empirical regimens for the treatment of febrile neutropenia in acute leukemia patients.

BACKGROUND: High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate. METHODS: We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/microl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started. RESULTS: Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity. CONCLUSIONS: Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides.

[Granulocyte colony-stimulating factor in the treatment of febrile neutropenia]. / Factor estimulante de colonias de granulocitos en el tratamiento de neutropenia febril.

PURPOSE: To determine whether granulocyte colony-stimulating factor (G-CSF) used in addition to antibiotic therapy, in patients with chemotherapy-induced febrile neutropenia shortens the period of fever, neutropenia and hospitalization. PATIENTS AND METHODS: The study was prospective. Patients with lymphoblastic acute leukemia (LAL) were included. They received intensive chemotherapy of induction, intensification, or consolidation. At random, a group received amikacin-ceftriaxone; if no had response after 3 days, we added vancomicin and, after 7 days, amphotericin. The other group received in addition these antibiotics, granulocyte colony-stimulating factor. RESULTS: The groups were comparable in the magnitude of the initial neutropenia (< 0.5 x 10(9)/L), site of the infection, chemotherapy received germs isolated, age, and sex. The patients of the group that received FEC-G were cured in the course of 3.1 days; in the group without FEC-G, this occurred in 7.2 days (p = 0.0001). At the end of the infectious episode, the number of neutrophils, in the group with FEC-G, was of 1.9 x 10(9)/L versus 0.7 x 10(9)/L (p = 0.0009). The mortality was of one and two cases (p = 0.46). The global mortality was 7.5%. CONCLUSIONS: The addition of FEC-G to the treatment with antibiotics, in febrile neutropenia, decreases duration of days with fever, hospitalization and neutropenia. However, the frequency of cure is not augmented.

[Long-term follow-up of 2 therapeutic programs for the treatment of high-risk childhood acute lymphoblastic leukemia. Experience at the 20 de Noviembre National Medical Center]. / Seguimiento a largo plazo de dos programas terapéuticos para el tratamiento de la leucemia aguda linfoblástica infantil de riesgo alto. Experiencia del Centro Médico Nacional 20 de Noviembre.

This paper reports the long-term, disease-free survival of children with high-risk (HR) acute lymphoblastic leukemia (ALL) treated with two different chemotherapy regimens. HR was defined in children with ALL, younger than 2 or older than 10 years, with or without initial extrahematopoietic disease, with a leukocyte count higher than 25 x 10(9)L, or with L3 FAB type. The first group, LAL1, included 67 patients; they received induction with vincristine (VCR) and prednisone (PDN), early consolidation with 3 cycles of 6-mercaptopurine (6MP), citarabine (ARA) and VCR: central nervous system (CNS) prophylaxis (PFX) consisted of both chemotherapy in induction, consolidation and maintenance, radiotherapy (RT) in consolidation. Maintenance was given with 6MP, methotrexate (MTX), VCR adriamycin (ADR), ARA, cyclophosphamide (CFA) and PDN. The second group, LAL2, with 45 patients, received induction with VCR, PDN, CFA, epirrubicin (EPI), L-Asparaginase (L-ASP); early and late consolidation with 6MP, ARA, VCR, carmustine (BCNU), CFA, EPI, MTX and teniposide 8VM26): CNS PFX consisted of both chemotherapy in induction, consolidation and maintenance, RT in consolidation, maintenance with 6MP, MTX, EPI, CFA, ARA VM26 and BCNU. At the time of diagnosis, both groups were comparable. Disease-free survival probability, for LAL1 group was 0.41 at 14 years and for LAL2 group 0.34 at 8 years (p = 0.45). In the LAL1 group there were three failures and 20 relapses, and in the LAL2 group, there were two failures and 22 relapses. CNS relapses were one and seven in LAL1 and LAL2 groups respectively (p = 0.04). In the LAL2, group relapses were more frequent in patients with dose reduction or difered dose due to marrow toxicity (p = 0.02). We believe that the increase in CNS relapse in the LAL2 group was caused by the late administration of CNS PFX. We also believe that although intensive chemotherapy can increase long-term survival, dose adjustments due to marrow toxicity have a negative effect on long-term, relapse-free survival.

Neutrophil recovery time and adverse side effects in acute leukemia patients treated with intensive chemotherapy and concomitant G or GM-CSF.

OBJECTIVE: Compare the speed of neutrophil recovery and the unwanted secondary effects in two groups of acute leukemia patients treated with intensive chemotherapy and G or GM-CSF. PATIENTS AND METHODS: Patients were randomly assigned to receive subcutaneous G-CSF at a daily dose of 300 micrograms for adults and 150 micrograms for children or GM-CSF at 400 and 200 micrograms respectively, starting With chemotherapy and stopping when the absolute neutrophil count (ANC) reached 500/microL. Secondary effects were attributed to growth factors only when not coincidental with infection, chemotherapy or hemoderivative transfusion. RESULTS: 34 patients were included in the G-CSF arm and 37 in the GM-CSF arm. Distribution by sex, age, type of acute leukemia, induction or post-induction therapy, as well as initial neutrophil count were comparable among the two groups. Mean time for ANC > 500/microL was 19 days for G-CSF group and 16 days for GM-CSF group (p = 0.08). There were no statistically significant differences in secondary unwanted side effects between the two groups. There were two cases of growth factor-related-fever in the G-CSF group and five in the GM-CSF group (p = 0.25). There was a case of systemic reaction in the G-CSF group. Twenty-nine patients in each group presented febrile neutropenia episodes (p = 0.45). The only factor that showed significance on neutrophil recovery speed was type of leukemia (p = 0.04). CONCLUSIONS: We found no clear advantage of one growth factor over the other for this indication.

[Comparison of 2 regimens of polychemotherapy in refractory acute leukemia or in relapse]. / Comparación de dos regímenes de poliquimioterapia en leucemia aguda refractaria o en recaída.

OBJECTIVE: To compare the effectiveness of two chemotherapy regimens for the treatment of relapsed and refractory acute leukemias. METHODS: We randomly assigned 24 patients in two groups: the LARR1 group received induction with 4 days of etoposide and 4 days of high-dose ara-C; the LARR2 group received induction therapy with 4 days of etoposide plus 3 days of mitoxantrone. Consolidation was given using the same drugs at the same dosage. Maintenance therapy was the same for both groups alternating methotrexate, vincristine, L-asparaginase, carmustine, cyclophosphamide and Ara-C. Every 15 weeks both groups repeated consolidation according to their group. Granulocyte-colony stimulating factor was used in both groups. RESULTS: Median survival for both groups was 5 months (range 1-17). Ten months after starting therapy three patients were disease free in the LARR1 group and two in the LARR2 group. There were no statistically significant differences in complete remission rate (p = 0.62), refractoriness (p = 0.58), deaths in induction (0.14) and other parameters. CONCLUSIONS: Our results were comparable with those of others. The only advantage we found was the possibility of using the LARR1 treatment in patients who have reached or are about to reach cardiotoxic-anthracycline doses.