Socioeconomic inequalities in dental visits among high school students in Chile, years 2013 and 2017.

OBJECTIVE: To analyze prevalence changes in dental visits and socioeconomic inequalities among high school students in Chile, years 2013 and 2017. METHODS: Analysis of nationally representative data from 2013 and 2017 waves of the Chilean National Socioeconomic Characterization Survey (CASEN). In a sample of high school students aged 14 to 20 years old (n=12699 in 2013; n=11122 in 2017) we investigated prevalence of dental visits in the last 3 months, by urban-rural residence, sex, type of health insurance, type of school, income level and benefit of dental care at school. For inequality analysis we estimated prevalence ratio of dental visits in the last 3 months according to study variables. RESULTS: There was a significant increase in the prevalence of dental visits in the last 3 months and the receipt of dental care at school between years 2013 and 2017. The highest prevalence of dental visits in the last 3 months was found among students living in urban residence, women, with private insurance, in the highest income level, that attended private schools. Inequalities persist but the gap associated with type of residence, health insurance and between the lowest income quintiles decreased over the years. CONCLUSIONS: The Comprehensive Dental Care for senior year high school students, a public policy that began in 2015 in Chile, could have aided the gap reduction and the increase in visits to the dentist in the last 3 months in this group.

Two step esterification-transesterification process of wet greasy sewage sludge for biodiesel production.

Sewage sludge generated in municipal wastewater treatment plants was used as a feedstock for biodiesel production via esterification/transesterification in a two-step process. In the first esterification step, greasy and secondary sludge were tested using acid and enzymatic catalysts. The results indicate that both catalysts performed the esterification of free fatty acids (FFA) simultaneously with the transesterification of triacylglycerols (TAG). Acid catalyst demonstrated better performance in FFA esterification compared to TAG transesterification, while enzymatic catalyst showed the ability to first hydrolyze TAG in FFA, which were esterified to methyl esters. In addition, FAME concentration using greasy sludge were higher (63.9% and 58.7%), compared with those of secondary sludge (11% and 16%), using acid and enzymatic catalysts, respectively. Therefore, only greasy sludge was used in the second step of alkaline transesterification. The alkaline transesterification of the previously esterified greasy sludge reached a maximum FAME concentration of 65.4% when using acid catalyst.

[High flow nasal cannula in infants: Experience in a critical patient unit]. / Cánula nasal de alto flujo en lactantes: experiencia en una unidad de paciente crítico.

INTRODUCTION: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. OBJECTIVE: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. PATIENTS AND METHOD: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P≤.05. RESULTS: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7kg (2-10kg); 95 percentile: 3.7 months and 5.7kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P=.013), radiography (P=018), connection context (P<.0001), pCO2 (median 40.7mmHg [15.4-67 mmHg] versus 47.3mmHg [28.6-71.3mmHg], P=.004) and hours on HFNC (median 60.75hrs [5-621.5 hrs] versus 10.5hrs [1-29 hrs], P<.0001). The OR of the PCO2 ≥ 55mmHg for failure was 2.97 (95% CI; 1.08-8.17; P=.035). No patient died and no complications were recorded. CONCLUSION: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.

Cánula nasal de alto flujo en lactantes: experiencia en una unidad de paciente crítico / High flow nasal cannula in infants: Experience in a critical patient unit

Introducción: La cánula nasal de alto flujo (CNAF) es un método de soporte respiratorio cada vez más utilizado en pediatría por sus resultados y seguridad. Objetivo: Determinar la efectividad de la CNAF, evaluar factores asociados a fracaso y complicaciones relacionadas con su uso en lactantes. Pacientes y método: Se analizaron los datos demográficos, clínicos, gasométricos, radiológicos y complicaciones de los pacientes conectados a CNAF en una unidad crítica entre junio de 2012 y septiembre de 2014. Se compararon los pacientes que fracasaron con los respondedores a CNAF, considerándose fracaso la necesidad de un mayor soporte respiratorio durante las primeras 48 h de conexión. Se utilizó test de Kolmogorov Smirnov, U de Mann-Whitney, Chi cuadrado, test exacto de Fisher, correlaciones y Modelo de regresión logística binaria para p ≤ 0,05. Resultados: Un total de 109 pacientes. Mediana de edad y peso: 1 mes (0,2-20 meses) y 3,7 kg (2-10 kg); percentil 95: 3,7 meses y 5,7 kg respectivamente. El diagnóstico y patrón radiológico más frecuente fue bronquiolitis (53,2%) e infiltrado intersticial (56%). Un 70,6% respondió. Hubo diferencia significativa entre fracaso y respuesta en el diagnóstico (p = 0,013), radiografía (p = 0,018), contexto de conexión (p < 0,0001), pCO2 (mediana 40,7 mm Hg [15,4-67 mm Hg] versus 47,3 mm Hg [28,6-71,3 mm Hg], p = 0,004) y horas de CNAF (mediana 60,75 h [5-621,5 h] versus 10,5 h [1-29 h], p < 0,0001). El OR de PCO2 ≥ 55 mm Hg para fracaso fue 2,97 (IC 95%: 1,08-8,17; p = 0,035). Ningún paciente falleció ni registró complicaciones. Conclusión: El porcentaje de éxito observado fue similar a lo publicado. En esta muestra el fracaso de CNAF solo se asoció a una pCO2 inicial ≥ 55 mm Hg. Su uso se consideró seguro al no reportarse complicaciones relacionadas a su utilización. Se requiere de un estudio multicéntrico, aleatorizado y controlado para contrastar estos resultados.

Introduction: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. Objective: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. Patients and method: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48 hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P ≤ .05. Results: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7 kg (2-10 kg); 95 percentile: 3.7 months and 5.7 kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P = .013), radiography (P = 018), connection context (P < .0001), pCO2 (median 40.7 mmHg [15.4-67 mmHg] versus 47.3 mmHg [28.6-71.3 mmHg], P = .004) and hours on HFNC (median 60.75 hrs [5-621.5 hrs] versus 10.5 hrs [1-29 hrs], P < .0001). The OR of the PCO2 ≥ 55 mmHg for failure was 2.97 (95% CI; 1.08-8.17; P = .035). No patient died and no complications were recorded. Conclusion: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55 mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.

Reoperaciones posadenoidectomía por hiperplasia adenoidea obstructiva / Post-adenoidectomy reoperations due to obstructive adenoid hyperplasia

Introducción: La incidencia de reoperación posadenoidectomía, ya sea una segunda adenoidectomía o una amigdalectomía, no es conocida en nuestro medio. Publicaciones extranjeras muestran 2% de readenoidectomías y 8% de amigdalectomías posteriores. Objetivo: Describir las adenoidectomías efectuadas en nuestro centro, evaluar la prevalencia de reoperaciones y buscar posibles factores asociados a éstas. Material y método: Estudio retrospectivo descriptivo y analítico. Se revisaron fichas de pacientes adenoidectomizados por roncopatía con pausas respiratorias entre enero de 1999 y diciembre 2010. Se registraron datos demográficos, controles y nasofaringolaringoscopías (NFL). Se consignaron las reoperaciones (readenoidectomías y amigdalectomías). Resultados: Se revisaron 106 fichas. Un 55,7% de los pacientes eran hombres. A la NFL, 42% de los pacientes tenían adenoides grado 3y 58% grado 4 de Parikh. Un 5,6% de los pacientes fueron reoperados (1 adenoidectomía y 5 adenoamigdalectomías). Se observó diferencia significativa en edad (p =0,04) y tamaño amigdalino (p =0,004) entre los reoperados y lo no reoperados. No hubo asociación por sexo (p =0,45), asma (p =0,31) ni rinitis (p =0,18). Sin embargo, a la regresión logística multivariada, ninguna variable se asoció significativamente de manera independiente con la necesidad de reoperación. Conclusión: La prevalencia de reoperaciones fue similar a la publicada, no encontrándose asociación con otros factores.

Introduction: The incidence of post-adenoidectomy reoperation, be it a second adenoidectomy or a tonsillectomy, is unknown within our environment. Foreign publications show a 2% of re-adenoidectomies and an 8% of ulterior tonsillectomies. Aim: To describe the adenoidectomies performed at our center, to assess the prevalence of reoperations, and to seek possible associated factors to the latter. Material y method: Descriptive and analytical retrospective assessment. A review was performed of records for patients that between January of 1999 and December of 2010 underwent adenoidectomy on account of snoring pathology. Demographics, controls, nasopharyngolaryngoscopies and reoperations (re-adenoidectomies and tonsillectomies) were recorded. Results: The review entailed checking 106 records. 55,7% of patients were men. 42% of patients had Parikh?s Grade III adenoids and 58% showed Grade IV ones. 5,6% of patients underwent reoperation. A significant difference could be observed in age (p=0,04) and tonsillar size (p=0,004) between those that had and had not undergone reoperation. There was no gender association (p=0,45), neither for asthma (p=0,31) or rhinitis (p=0,18). Yet, by multivariate logistic regression, no variable was significantly associated by itself to the need for reoperation. Conclusion: Reoperation prevalence was similar to that published, and no association to other factors was discovered.

Degradation of pesticide mixture on modified matrix of a biopurification system with alternatives lignocellulosic wastes.

The biobed systems were designed to retain and to degrade pesticides through the properties of a biomixture composed of straw (ST), topsoil and peat (PT) 2:1:1 v/v. The ST is the main substrate in the biomixture, as it allows the proliferation of fungi that promotes pesticide degradation. The use of readily available components in the biomixture is an important aspect to build a biobed. Therefore, potential use of readily available wastes as barley husk (BH), sawdust (SW) and oat husk (OH), as total or partial substitutes of ST were tested in pesticide degradation studies. Metabolite formation and the biological activities were also evaluated. Biomixture composed of OH was highly efficient in pesticide degradation, with t½ values of 28.6, 58.9 and 26.8 d for atrazine (ATZ), chlorpyrifos (CHL) and isoproturon (ISP). On the other hand, comparable for degrading capacities with the ST based biomixture were obtained with SW and BH, but only as partial replacement. Contrarily, high t½ values (more than 100 d) were obtained in biomixtures with total substitution of ST by SW or BH. Metabolite formation was observed in all biomixtures tested, but without clear formation patterns. Moreover, high and stable biological activity was observed in the biomixtures composed of OH. Therefore, our results demonstrated that ST can be partial or totally replaced by OH in the biomixture allowing an efficient degradation of pesticide mixture. However, it is recommended that ST can be only partially replaced by BH and SW in the biomixture to allow efficient pesticide degradation.

Síndrome de Sjõgren y tratamiento protésico removible total con implantes mandibulares: caso clínico / Sjõgren syndrome and total removable prosthetic mandible implants treatment: a case report

El Síndrome de Sjõgren es una patología sistémica crónica autoinmune, cuyos síntomas principales son la xerolftalmia y la xerostomía. Por esta última el tratamiento con prótesis removible total convencional no es bien tolerado en estos pacientes. Se presenta un caso de un paciente género femenino, de 64 años, con síndrome de Sjõgren secundario, rehabilitada con prótesis removibles totales mucosoportada superior e implantorretenida inferior mediante dos implantes con fijaciones tipo O´ring. El presente caso se documenta para demostrar que no hay contraindicación en la atención de un paciente con este síndrome tanto para la rehabilitación protésica removible como para la colocación y pronóstico favorable de un tratamiento con implantes óseointegrados.

The Sjõgren syndrome is a chronic autoimmune systemic disease, which main symptoms are xerophtalmia and. xerostomy. Due to the latter treatment with total conventional removable prosthesis is not well tolerated in these patients. We report a case of a female patient, 64 years old, with secondary Sjõgren syndrome, treated with full archupper denture and lower implant-retained denture. O'ring type fixings. This case show that these is not contraindication to treat a patient with this syndrome with a conventional dentures or implant support denture.

Embolismo de líquido amniótico durante el parto / Amniotic fluid embolism during delivery

El embolismo de líquido amniótico (ELA) es un cuadro extremadamente grave e infrecuente. Su pronóstico es fatal, tanto para la madre como para el feto. Incluso en los países desarrollados, donde se ha logrado disminuir la morbimortalidad de múltiples afecciones del embarazo, como la preeclampsia, continúa teniendo unas consecuencias devastadoras. A ello contribuye el desconocimiento que existe aún respecto a su fisiopatología, lo cual redunda en una mayor dificultad para su diagnóstico y tratamiento. Hoy día, el diagnóstico del ELA continúa siendo clínico y un diagnóstico de exclusión y, en muchas ocasiones, se hace tras la necropsia (AU)

Amniotic fluid embolism is an extremely serious and infrequent syndrome. Prognosis is fatal for the pregnant woman and the fetus. Even in developed countries, where morbidity and mortality from many disorders of pregnancy, such as preeclampsia, has decreased, amniotic fluid embolism still has catastrophic consequences. The pathogenesis of this syndrome remains unclear, increasing the difficulty of diagnosis and treatment. Currently, diagnosis of amniotic fluid embolism continues to be clinical and made on the basis of exclusion. On many occasions, diagnosis is made at autopsy (AU)

[Impact of warning against procrastination of thrombolysis in ischemic stroke]. / Impacto de las advertencias contra la procrastinación sobre las demoras en la trombólisis del ictus.

INTRODUCTION: Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. PATIENTS AND METHODS: Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). RESULTS: Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CT-treatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the 'door-to-needle' period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. CONCLUSIONS: Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT)--about which there had been no action taken--had not been modified, but the time employed in the decision to treat (CT-treatment) and the 'door-to-needle' time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased.

Impacto de las advertencias contra la procrastinación sobre las demoras en la trombólisis del ictus / Impact of warning against procrastination of thrombolysis in ischemic stroke

Introducción. La fibrinólisis del ictus isquémico debe llevarse a cabo cuanto antes; conocer las causas de retraso permite su eventual corrección. En los primeros 17 casos que tratamos comprobamos que tendía a agotarse el período de ventana terapéutica; evaluamos si las advertencias frente a ello, sin otras modificaciones logísticas u organizativas, han tenido impacto en las demoras. Pacientes y métodos. Se estimuló la celeridad en el tratamiento. Con 51 pacientes tratados, comparamos características y tiempos de demora en los primeros 17 casos (febrero de 2002 a junio de 2004) y en los 17 más recientes (octubre de 2005 a abril de 2006), utilizando tests no paramétricos (significación si p < 0,05). Resultados. Ambos grupos son similares demográfica y clínicamente. El tiempo inicio-puerta se alargó (46 min frente a 75 min; p = 0,01) y dispersó. El tiempo entre tomografía axial computarizada (TAC) y tratamiento se redujo a la mitad (57 min frente a 30 min; p = 0,001), con el consecuente acortamiento del período ‘puerta-aguja’ (121 min frente a 90 min; p = 0,002). El tiempo puerta-TAC se mantuvo constante (50 min frente a 53 min; p = 0,9), y la demora total desde el inicio tampoco se modificó significativamente (165 min frente a 170 min; p = 0,7); la correlación lineal inversa entre tiempo de inicio-TAC y tiempo TAC-tratamiento perdió intensidad. Conclusiones. Las advertencias contra la procrastinación parecen haber sido eficaces para abreviar la toma de decisión de tratar (TAC-tratamiento) y el tiempo ‘puerta-aguja’, mientras que el tiempo utilizado en la evaluación clinicorradiológica (puerta-TAC), sobre el que no había habido actuaciones, no se modificó. Ello ha permitido realizar fibrinólisis a pacientes que llegan más tarde; así, aunque el tiempo inicio-tratamiento aparentemente no cambió, se incrementó la tasa de fibrinólisis

Introduction. Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. Patients and methods. Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). Results. Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CTtreatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the ‘door-to-needle’ period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. Conclusions. Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT) –about which there had been no action taken– had not been modified, but the time employed in the decision to treat (CT-treatment) and the ‘door-to-needle’ time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased

[The value of the internal capsule signs in the stimulation of the subthalamic nucleus in Parkinson's disease]. / Valor de los signos de cápsula interna en la estimulación del núcleo subtalámico de la enfermedad de Parkinson.

INTRODUCTION: The effectiveness of stimulating the subthalamic nucleus (DBS-STN) in advanced Parkinson's disease (PD) largely depends on the correct placement of the electrodes. Since the sensory-motor region of the STN lies beside the internal capsule (IC), we believe that the motor effectiveness of DBS-STN could be related to the stimulation threshold in which IC signs appear (IC threshold). PATIENTS AND METHODS: An examination of 17 consecutive patients with advanced PD who had been submitted to bilateral DBS-STN (one case was unilateral) was carried out to determine the motor improvement on each side of the body (n = 33) and the energy consumption one year after surgery according to the IC threshold obtained during the programming. RESULTS: A 45% improvement was observed in the UPDRS III in off and there was a 24% reduction in the equivalent dose of levodopa with bilateral DBS-STN. When the electrodes were considered, there was a statistically significant improvement that depended on the IC threshold. Energy consumption differed significantly between electrodes with an IC threshold of 3-7 V (1.5 +/- 1.2 microW) and those with an IC threshold > 7 V (8.3 +/- 9.4 microW). CONCLUSIONS: During the stimulation phase and following the correct location of the STN, which was achieved by neurophysiological recording, the IC threshold has prognostic implications in medium-long term motor effectiveness and in the consumption of the battery in the generator.

[Thrombolysis in stroke: inappropriate consideration of the 'window period' as the time available]. / Trombólisis en el ictus: consideración inapropiada del 'período de ventana' como tiempo disponible.

AIMS: The earlier r-TPA is administered in ischaemic strokes, the more effective it is. The aim of this study is to analyse the delay times in health care afforded in a consecutive series of cases that had received treatment, with a view to shortening them. PATIENTS AND METHODS: We analysed the medical records of the first patients to be treated in our centre. The paper describes several variables involving demographic and clinical factors, as well as the delay in entering the Emergency department, performing a CAT scan and especially the time elapsed between the CAT scan and starting treatment. We have examined the existence of an inappropriate correlation between delays that should be independent of one another. RESULTS: The mean age of the 17 patients treated was 68 years and they had a stroke severity score of 17 points on the NIHSS. The mean time of delay until arrival, arrival-CAT, and CAT-treatment were slightly under 1 hour each, and onset-treatment delay was 165 minutes, which is very close to the limit of the therapeutic window period. We found a strong inverse linear association between the time elapsed between onset and the CAT scan, and from the latter to the beginning of treatment (Spearman's r: -0.664, p = 0.004). CONCLUSIONS: Findings indicate that in our hospital, as in other centres in the initial phases of implementation, the therapeutic time window for intravenous thrombolysis in ischaemic stroke tends to run out. It must be highlighted that the resolve of the physician who indicates the treatment exerts a decisive effect on the delay.

Trombólisis en el ictus: consideración inapropiada del ‘período de ventana’ como tiempo disponible / Thrombolysis in stroke: inappropriate consideration of the ‘window period’as the time available

Objetivos. El r-TPA en el ictus isquémico es más eficaz cuanto antes se administra. Hemos analizado los tiempos de demora asistencial en una serie consecutiva de casos tratados con el fin de acortarlos. Pacientes y métodos. Se ha analizado el registro de los primeros pacientes tratados en nuestro centro, se han descrito las variables demográficas, clínicas y de demoras en llegada a puerta de Urgencias, realización de la TC y, especialmente, el tiempo desde la TC hasta el inicio del tratamiento. Se ha explorado la existencia de alguna correlación inapropiada entre aquellas demoras que debieran ser independientes entre sí. Resultados. Los 17 pacientes tratados tenían una mediana de edad de 68 años y de gravedad en la NIHSS de 17 puntos. Las medianas de las demoras hasta la llegada, entre la llegada y la TC, y entre la TC y el tratamiento, fueron ligeramente inferiores a una hora cada una, y la del debut hasta el tratamiento fue de 165 minutos, muy próxima al límite del período de ventana terapéutica. Se ha encontrado una fuerte asociación lineal inversa entre la demora desde el debut hasta la TC y desde ésta hasta el inicio del tratamiento (r de Spearman: 0,664, p = 0,004). Conclusiones. Los resultados apuntan a que en nuestro hospital, como en otros centros, en la fase inicial de implantación, el tiempo de ventana terapéutica para la trombólisis intravenosa en el ictus isquémico tiende a agotarse. Ponemos de manifiesto que, entre otros factores, la resolución del facultativo que indica el tratamiento influye decisivamente en la demora

Aims. The earlier r-TPA is administered in ischaemic strokes, the more effective it is. The aim of this study is to analyse the delay times in health care afforded in a consecutive series of cases that had received treatment, with a view to shortening them. Patients and methods. We analysed the medical records of the first patients to be treated in our centre. The paper describes several variables involving demographic and clinical factors, as well as the delay in entering the Emergency department, performing a CAT scan and especially the time elapsed between the CAT scan and starting treatment. We have examined the existence of an inappropriate correlation between delays that should be independent of one another. Results. The mean age of the 17 patients treated was 68 years and they had a stroke severity score of 17 points on the NIHSS. The mean time of delay until arrival, arrival-CAT, and CAT-treatment were slightly under 1 hour each, and onset-treatment delay was 165 minutes, which is very close to the limit of the therapeutic window period. We found a strong inverse linear association between the time elapsed between onset and the CAT scan, and from the latter to the beginning of treatment (Spearman’s r -0.664, p = 0.004). Conclusions. Findings indicate that in our hospital, as in other centres in the initial phases of implementation, the therapeutic time window for intravenous thrombolysis in ischaemic stroke tends to run out. It must be highlighted that the resolve of the physician who indicates the treatment exerts a decisive effect on the delay

Effect of acute cigarette smoking, alone or with alcohol, on gastric barrier function in healthy volunteers.

BACKGROUND: Smoking is a risk factor for gastroduodenal ulcer and gastric adenocarcinoma. However, the pathophysiological mechanisms induced by acute cigarette smoking in the human gastric mucosa are poorly understood. AIM: To evaluate the effect of acute cigarette smoking, alone or with alcohol, on the gastric permeability to sucrose, a specific marker of mucosal damage in the stomach. SUBJECTS AND METHODS: Twenty healthy volunteers (8 smokers/12 non-smokers) were studied. Each fasted subject ingested 500 ml of a 20% sucrose solution and the amount of sucrose excreted in a 5-hour urine collection was measured by gas chromatography Four sucrose permeability tests were carried out: 1. basal, 2. while smoking 5 cigarettes, 3. after drinking 50 ml of a 40 degrees alcoholic beverage, 4. a combination of 2+3. RESULTS: Sucrose excretion increased after alcohol ingestion (40.5 +/- 6.0 mg vs 143.1 +/- 28.9 mg, p = 0.002), but was not modified by acute cigarette smoking (34.4 +/- 5.9 mg). When alcohol and cigarettes were simultaneously consumed, the increase in alcohol-induced sucrose excretion was significantly reduced (73.1 +/- 16.6 mg, p = 0.03). Basal sucrose excretion was similar in smokers and non-smokers. However, in acute cigarette smoking, a decrease in sucrose excretion was observed in smokers (p = 0.02) but not in non-smokers. CONCLUSIONS: These results indicate that acute cigarette smoking may tighten the gastric mucosa in habitual smokers and this is associated with a smaller increase of gastric permeability induced by alcohol.

Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial.

BACKGROUND: Although more than 9500 patients have been enrolled in major clinical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated for acute coronary syndromes in Latin America with those in North America. METHODS: The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST-segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient groups, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. RESULTS: For patients in Latin America, the length of hospital stay was significantly longer (10 [7, 15] days vs 6 [4, 9], P <.001). Angiograms, angioplasty, and bypass surgery were significantly less common in Latin America (46.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P <.001). Thirty-day death/myocardial infarction was not significantly higher, although mortality alone was significantly higher (6.8% vs 3.1%, P <.001). After adjustment for baseline characteristics, enrollment in Latin America remained an independent predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4]). CONCLUSIONS: Latin American patients treated for acute coronary syndromes were managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not explained by imbalances in baseline risk.

Emission factors for gasoline light-duty vehicles: experimental program in Santiago, Chile.

The emission inventory of the city of Santiago, Chile, related to mobile sources was built up using constant emission factors extracted from international literature. To improve the estimate of mobile source emissions, an experimental program was designed, consisting of transient tests on a chassis dynamometer over a sample of about 166 vehicles, applying 9 local driving cycles with average speeds of 3-80 km/hr, and experimentally determined in previous research carried out by the authors. An analysis of the influence of fuel inlet technology, and a year time-length model over emissions, was undertaken. We proposed emission factors as a function of average speed and of CO, THC, and NOx for catalytic and noncatalytic light-duty gasoline vehicles, disaggregated on commercial and private cars. A comparative analysis with emission factors obtained for the application of the COPERT II and AP-42 models was also presented. Our current analysis gives solid evidence indicating that to obtain a reasonable accuracy on emission estimates and calculations, local emission factors must be used.