Photo-Fenton treatment of valproate under UVC, UVA and simulated solar radiation.

The abatement of valproic acid sodium salt (VA) via photo-Fenton process was investigated to evaluate the effect of irradiation type. Three different light sources have been used: UVA (black light blue lamps, BLB reactor), UVC (UVC reactor) and simulated sunlight in a Solarbox (SB). Using the highest concentrations of Fe2+ (10mgL-1) and H2O2 (150mgL-1), 100% of VA degradation was observed in BLB and UVC devices, and 89.7% in Solarbox. Regarding mineralization, 67.4% and 76.4% of TOC conversion were achieved in BLB and UVC, respectively. In Solarbox, mineralization was negligible. Treated solutions under UVA or UVC radiation became biodegradable (BOD5/COD≥0.25), which was not observed in Solarbox where BOD5/COD achieved was only 0.20. Regarding to toxicity (Vibrio Fischeri method), all processes have promoted the overall toxicity reduction of VA solution. Transformation products were identified by a LC-ESI-TOF mass spectrometer, and degradation pathways were proposed. Operating costs and the energy needed by mg of VA removed were estimated and compared, for the different installations, showing that UVA can remove around 3 times more VA than SB and 2 times more VA than UVC, under the same conditions.

Computed Tomography Scan and ICD Interaction.

Although it has been considered a safe procedure, computed tomography scanning uses high doses of radiation and can cause malfunctioning in those patients with ICD when the radiation is directly incident on the device. We present a case of ventricular oversensing during a thoracic computed tomography.

Actualización sobre infecciones intraabdominales y posquirúrgicas / Update on intra-abdominal and post-surgical infections

The present article is an update of the literature onintra-abdominal infection, which represents a spectrumof diseases with a common pathogenesis. Establishinga prompt diagnosis and avoiding treatment delays arekey to achieving the best outcomes. Mortality dependson initiating early appropriate treatment to restore fluidand electrolyte imbalances, supporting the functionof vital organs, providing appropriate broad-spectrumantimicrobial therapy, and achieving adequate sourcecontrol.A multidisciplinary group of Spanish physicians with aninterest in these infections selected the most importantpapers produced in the field during 2005 and 2006.One of the members of the group discussed the contentof each of the selected papers, with a critical reviewby other members of the panel.After a review of the state of the art, papers from the fieldsof epidemiology, pathophysiology, basic science, causativemicroorganisms and microbiological diagnosis, mainclinical syndromes, principles of therapy, new antibioticsand surgical procedures, preventive measures,recommended antimicrobial regimens and guidelineswere discussed by the group. Faculty from this panel havemade an interesting contribution to our understandingand management of intra-abdominal infections at present.Their contribution is particularly relevant for clinicalpractice(AU)

El presente artículo es una puesta al día de la literaturasobre infecciones intraabdominales, que constituyen unagama de procesos con una patogenia común. Para lograrlos mejores resultados tiene una importancia decisivaestablecer un diagnóstico precoz y evitar los retrasos en eltratamiento. La reducción de la mortalidad se basaen iniciar precozmente un tratamiento apropiado pararestaurar los desequilibrios hidroelectrolíticos, en apoyarla función de los órganos vitales, en proporcionar untratamiento adecuado con antibióticos de amplio espectroy en controlar correctamente las fuentes de la infección.Un grupo multidisciplinario de médicos españolesinteresados en este campo seleccionó los trabajos másdestacados que se han publicado sobre el tema en 2005y 2006. Cada artículo seleccionado fue analizado por unmiembro del panel, y el resto de miembros efectuóuna revisión crítica.Después de revisar el estado del arte, el grupo discutiólos trabajos sobre epidemiología, fisiopatología,ciencias básicas, microorganismos causalesy diagnóstico bacteriológico, principales síndromesclínicos, fundamentos del tratamiento, nuevos antibióticosy procedimientos quirúrgicos, medidas preventivas,y pautas y normas antimicrobianas recomendadas.Los miembros de este panel han aportado unainteresante contribución a nuestros conocimientosy a la conducta a seguir actualmente antelas infecciones intraabdominales. Su contribuciónes especialmente relevante para la práctica clínica(AU

Update on intra-abdominal and post-surgical infections

El presente artículo es una puesta al día de la literatura sobre infecciones intraabdominales, que constituyen una gama de procesos con una patogenia común. Para lograr los mejores resultados tiene una importancia decisiva establecer un diagnóstico precoz y evitar los retrasos en el tratamiento. La reducción de la mortalidad se basa en iniciar precozmente un tratamiento apropiado para restaurar los desequilibrios hidroelectrolíticos, en apoyar la función de los órganos vitales, en proporcionar un tratamiento adecuado con antibióticos de amplio espectro y en controlar correctamente las fuentes de la infección.Un grupo multidisciplinario de médicos españolesinteresados en este campo seleccionó los trabajos másdestacados que se han publicado sobre el tema en 2005y 2006. Cada artículo seleccionado fue analizado por unmiembro del panel, y el resto de miembros efectuóuna revisión crítica.Después de revisar el estado del arte, el grupo discutiólos trabajos sobre epidemiología, fisiopatología,ciencias básicas, microorganismos causalesy diagnóstico bacteriológico, principales síndromesclínicos, fundamentos del tratamiento, nuevos antibióticos y procedimientos quirúrgicos, medidas preventivas, y pautas y normas antimicrobianas recomendadas. Los miembros de este panel han aportado unainteresante contribución a nuestros conocimientosy a la conducta a seguir actualmente antelas infecciones intraabdominales. Su contribuciónes especialmente relevante para la práctica clínica

The present article is an update of the literature onintra-abdominal infection, which represents a spectrumof diseases with a common pathogenesis. Establishinga prompt diagnosis and avoiding treatment delays arekey to achieving the best outcomes. Mortality dependson initiating early appropriate treatment to restore fluid and electrolyte imbalances, supporting the functionof vital organs, providing appropriate broad-spectrumantimicrobial therapy, and achieving adequate sourcecontrol.A multidisciplinary group of Spanish physicians with aninterest in these infections selected the most importantpapers produced in the field during 2005 and 2006.One of the members of the group discussed the contentof each of the selected papers, with a critical reviewby other members of the panel.After a review of the state of the art, papers from the fields of epidemiology, pathophysiology, basic science, causative microorganisms and microbiological diagnosis, main clinical syndromes, principles of therapy, new antibiotics and surgical procedures, preventive measures,recommended antimicrobial regimens and guidelineswere discussed by the group. Faculty from this panel havemade an interesting contribution to our understandingand management of intra-abdominal infections at present. Their contribution is particularly relevant for clinical practice (AU)

Update: sepsis and septic shock / Actualización: sepsis y shock séptico

Severe sepsis and septic shock are common causes of death in intensive care units (ICU). The incidence of sepsis has been increasing over the past two decades, and is expected to continue rising during the next few years. Despite the fact that we know much about the complex pathophysiologic alterations that occur in severe sepsis and septic shock, patients with sepsis remain at a high risk of death. However, in the last few years, new treatment strategies have significantly improved patient outcome. This article reviews nine major studies published during 2004 and 2005: two deal with incidence rates, distribution of pathogens and trends in antibiotic resistance among ICU patients with sepsis; two discuss selected aspects of antibiotic therapy, the usefulness of combination therapy for sepsis in immunocompetent patients and the impact of empirical treatment in Pseudomonas aeruginosa bloodstream infections; two consider the usefulness of risk assessment in the management of sepsis and the importance of dynamic clinical evolution of critically ill patients with infection. The remaining three studies analyze adjunctive therapy in severe sepsis: the effect of an intensive glucose-management protocol on the outcome of critically ill patients; the evaluation of relative adrenal insufficiency and the variability of cortisol plasma concentrations over a 24-hour period; and the use of Drotrecogin alfa (Activated) for adults with severe sepsis and a low risk of death

La sepsis grave y el shock séptico son causas frecuentes de fallecimiento en las unidades de cuidados intensivos (UCI). La incidencia de sepsis se ha incrementado durante los 2 últimos decenios y se considera que lo va a seguir haciendo durante los próximos años. A pesar de que actualmente poseemos mucha más información acerca de las complejas alteraciones fisiopatológicas que tienen lugar en la sepsis grave y en el shock séptico, los pacientes con sepsis siguen presentando un elevado riesgo de muerte. Sin embargo, durante los últimos años la introducción de nuevas estrategias terapéuticas ha mejorado significativamente el pronóstico de estos pacientes. En este artículo se revisan nueve estudios de gran envergadura publicados en 2004 y 2005: en dos de ellos se abordan las tasas de incidencia, la distribución de los patógenos y las tendencias en la resistencia frente a los antibióticos en los pacientes con sepsis atendidos en la UCI; en otros dos artículos se exponen diversos aspectos seleccionados del tratamiento antibiótico, la utilidad del tratamiento de combinación en los cuadros de sepsis que presentan los pacientes inmunocompetentes y el impacto del tratamiento empírico en los cuadros de sepsis causados por Pseudomonas aeruginosa; en otras dos publicaciones se consideran la utilidad de la evaluación del riesgo en el tratamiento de la sepsis y la importancia de una evaluación clínica dinámica en los pacientes con infección y en situación clínica crítica. En los tres estudios restantes se analiza el tratamiento complementario en la sepsis grave: el efecto de un protocolo de control intensivo de la glucemia sobre la evolución de los pacientes en situación clínica crítica; la evaluación de la insuficiencia suprarrenal relativa y de la variabilidad de las concentraciones plasmáticas de cortisol durante un período de 24 horas, y el uso de drotrecogina alfa (activada) en los adultos con sepsis grave y riesgo bajo de muerte

T wave oversensing by a cardioverter defibrillator implanted in a patient with the Brugada syndrome.

Oversensing of electrical signals in recipients of ICDs is a common complication causing the delivery of inappropriate therapy. The Brugada syndrome has a characteristic ECG pattern with dynamic temporal changes in response to various physiological or environmental conditions. This case report presents a patient with the Brugada syndrome and intermittent T wave oversensing by an ICD due to changes in T wave amplitude which could not be resolved by device reprogramming and required repositioning of the electrode.

Fever unmasking the Brugada syndrome.

This case report describes a 66-year-old woman with severe polymorphic ventricular tachycardia and syncope during a febrile state. The electrocardiogram revealed a right bundle branch block and pattern of elevated ST segment in the anterior and inferior leads similar to the Brugada syndrome. These electrocardiographic anomalies disappeared when the temperature returned to normal. The administration of procainamide reproduced the electrocardiographic changes. An electrophysiological study using two extrastimuli induced ventricular tachycardia. An automatic defibrillator was implanted.

A new member of the PBAN family in Spodoptera littoralis: molecular cloning and immunovisualisation in scotophase hemolymph.

In this article, we report evidence suggesting that the immunoreactive factor previously detected in Spodoptera littoralis scotophase hemolymph is PBAN, which supports a humoral route of the hormone to the pheromone gland. Western blot after native-PAGE of prepurified scotophase hemolymph extracts yielded an immunoreactive band with the same mobility as S. littoralis Br-SOG factor and the expected mobility for a noctuid PBAN. This band was not detected in photophase hemolymph extract. The identity of S. littoralis Br-SOG factor as PBAN was obtained from cDNA cloning using RT-PCR strategy. This allowed us to deduce the amino acid sequence of Spl-PBAN, which is highly homologous to other known PBANs. Moreover, we found that the PBAN encoding cDNA also encoded four other putative amidated peptides (Spl-DH homologue, Spl-alpha-NP, Spl-beta-NP and Spl-gamma-NP) that are identical or highly conserved among noctuids, and two non amidated peptides of unknown function. This cDNA organization is common to all known cDNAs encoding PBANs, leading to the release of different peptides after putative enzymatic cleavage of the preprohormone.