Uso fuera de indicación de la combinación a dosis fija de tramadol/dexketoprofeno en atención primaria de salud: ¿Basado en la evidencia científica o motivo de preocupación? / Off-label use of fixed-dose combination of tramadol and dexketoprofen in primary health care. Evidence-based or cause for concern?

Introducción: La utilización de la combinación a dosis fija de tramadol/dexketoprofeno en España y en otros países ha aumentado de forma conside-rable. La indicación terapéutica autorizada de este medicamento es el tratamiento sintomático a corto plazo del dolor agudo de moderado a intenso en pacientes adultos. El objetivo de este estudio fue describir el patrón de uso de tramadol/dexketopro-feno en el ámbito de la atención primaria de salud.Método: Se realizó un estudio transversal, descrip-tivo y multicéntrico. La población de estudio incluyó a todos los pacientes de una Dirección de Atención Primaria (53 equipos de Atención Primaria) que tenían activa la prescripción de tramadol/dexke-toprofeno el 28 de marzo de 2018. La población diana fueron aquellos pacientes a los que se les prescribió tramadol/dexketoprofeno durante más de 20 días.Resultados: Un total de 176 pacientes tenía activa la prescripción de tramadol/dexketoprofeno. Todos los pacientes (100%) tuvieron una duración del tratamiento superior a 5 días y el 72,7% (N=128) su-perior a 20 días. La duración media del tratamiento fue de 14±160,9 días en pacientes que tenían me-nos de 20 días de tratamiento y de 224±160,8 días en pacientes que tenían más de 20 días de trata-miento. El 35,1% de los pacientes estaban tratados con más de 2 medicamentos para aliviar el dolor de forma concomitante con tramadol/dexketoprofeno. El médico de atención primaria inició un 65,6% de las prescripciones.Conclusiones: La combinación a dosis fija de tramadol/dexketoprofeno se utilizó con frecuencia fuera de indicación, de acuerdo con la ficha técnica y la evidencia científica disponible. Este estudio alerta sobre los riesgos potenciales asociados a la utilización de este medicamento en la práctica clíni-ca, como son la falta de efectividad y/o la aparición de efectos adversos. (AU)

Introduction: The use of the fixed-dose combi-nation of tramadol/dexketoprofen in Spain and in other countries has increased considerably. The authorized therapeutic indication for this medicinal product is the short-term symptomatic treatment of moderate to severe acute pain in adult patients. The objective of this study was to describe the pat-tern of use of tramadol/dexketoprofen in the field of primary health care.Method: A cross-sectional, descriptive and mul-ticenter study was carried out. The study popu-lation included all patients from a Primary Care Department (53 Primary Care teams) with an active prescription of tramadol/dexketoprofen on March 28, 2018. The target population was those patients who were prescribed tramadol/dexketoprofen. dexketoprofen for >20 days.Results: A total of 176 patients had an active pre-scription for tramadol/dexketoprofen. All patients (100%) had a duration of treatment greater than 5 days and 72.7% (N=128) greater than 20 days. The mean duration of treatment was 14±160.9 days in patients who had less than 20 days of treatment and 224±160.8 days in patients who had more than 20 days of treatment. 35.1% of the patients were treated with >2 pain medications and concomi-tantly with tramadol/dexketoprofen. The general practitioner initiated 65.6% of the prescriptions.Conclusions: The fixed-dose combination of tra-madol/dexketoprofen was frequently used off-la-bel, according to the product characteristics and the available scientific evidence. This study warns about the potential risks associated with the use of this drug in clinical practice, such as lack of effec-tiveness and/or the appearance of adverse effects (AU)

Anatomy of the thoracic limb muscles of wild boars (Sus scrofa, Artiodactyla: Suidae).

The study of the muscular anatomy of wild boar (Sus scrofa) is important, because it allows the understanding of the locomotor and evolutionary aspects, besides the improvement of surgical techniques used by veterinarians in swine. Thus, the objective of this study was to describe the morphology and disposition of the shoulder and arm muscles of S. scrofa. Twelve young specimens of hybrid S. scrofa, six males and six females were fixed and dissected following usual anatomy techniques. The bones of two specimens were prepared to analyze the fixation points of the muscles. The shoulder muscles presented fixation at the scapula and humerus, in distinct bone accidents, and were divided on lateral and medial faces. On the lateral face, the deltoid (divided in acromial and scapular parts), supraspinatus, infraspinatus (divided in cranial and caudal parts) and teres minor (deep to the caudal part of the infraspinatus) muscles were found. In the medial face, the subscapular, coracobrachialis and teres major muscles were observed. The arm muscles were arranged essentially around the humerus and were seen largely on its medial face, namely biceps brachii (originated by a single tendon), brachialis, tensor fasciae antebrachii (fused with the long head of the triceps brachii), triceps brachii (divided in lateral, long and medial heads) and anconeus (located mostly on the lateral side) muscles. Thus, it can be concluded that the S. scrofa presented seven muscles in the shoulder region and six muscles in the arm region, all with morphological similarities to domestic and some wild animals. Some differences were found, for the most part, in the shape, division and fixation points of certain muscles.

Incidence of sternalis muscle in the Caldas population (Colombia): anatomical variations / Incidencia del músculo esternal en la población de Caldas (Colombia): variaciones anatómicas

The musculus sternalis is an anatomical variant that occurs in 3-8 % of the world population and its incidence is higher in women. It can be found unilaterally or bilaterally and is located in the anterior wall of the thorax, where its fibers run parallel to the sternum and superficial to the medial part of the pectoralis major muscle. The main objective of this study was to quantify the incidence of musculus sternalis in the population of Caldas (Colombia) and, therefore, 68 cadavers of adult individuals were used during a period of twenty years to determine the incidence of this muscle and describe its anatomical characteristics. Two cadavers had this muscle, which was equivalent to 2.94 % of the sample, where one was located unilaterally and in other bilaterally. In the case of unilateral presence, the muscle presented an oblique direction thatdoes not coincide with any subtype of the classification given for these muscles. In bilateral presentation, both muscles were continuous at their upper ends with the respective sternocleidomastoid muscle. In addition, the right musculus sternalis had a digastric shape, which also does not coincide with any subtype of the classification.

El músculo esternal es una variante anatómica que se presenta entre el 3 % y 8 % de la población mundial y su incidencia es mayor en mujeres. Puede hallarse de manera unilateral o bilateral y se localiza en la pared anterior del tórax, donde sus fibras corren paralelas al esternón y superficial a la región medial del músculo pectoral mayor. El objetivo del presente estudio fue cuantificar la incidencia del músculo esternal en la población de Caldas (Colombia). Fueron revisados 68 cadáveres de individuos adultos durante un lapso de doce años, con el fin de determinar el grado de presencialidad del músculo y sus características anatómicas. Dos cadáveres, que equivale al 2,94 % de la muestra, presentaron el músculo esternal, uno de manera unilateral y el otro bilateral, a los cuales se les hizo una descripción anatómica detallada. En la presentación unilateral, el músculo presentó una dirección oblicua que no coincide con ningún subtipo de la clasificación dada para estos músculos. En la presentación bilateral, ambos músculos se continúan por su extremo superior con el respectivo músculo esternocleidomastoideo. Además, el músculo esternal derecho tiene una configuración digástrica, que tampoco coincide con ningún subtipo de la clasificación.

Radiofrequency Ablation vs. Cryoablation for Localized Hepatocellular Carcinoma: A Propensity-matched Population Study.

BACKGROUND/AIM: To compare overall survival (OS) and liver cancer-specific survival (LCSS) of Surveillance, Epidemiology and End Results (SEER) hepatocellular carcinoma (HCC) database patients treated with cryoablation (cryo) or radiofrequency ablation (RFA). MATERIALS AND METHODS: This was a retrospective review of Stage I or II HCC patients from the SEER database treated with cryo and RFA from 2004-2013. Kaplan-Meier and Cox regressions were performed on pooled and propensity-matched cohort. RESULTS: Out of 3,239 patients, RFA showed a significant survival advantage over cryo in liver cancer specific survival (LCSS) (HR=1.634 p=0.0004). A total of 91 propensity-matched pairs had similar OS (HR=1.006 p=0.9768), but no difference in LCSS was observed between the groups [HR=1.412 (95%CI=0.933-2.137) p=0.1023]. Survival Cox models did not reveal treatment type as an independent prognostic factor. CONCLUSION: Propensity-matched cohort showed no significant difference in terms of OS and LCSS was found for patients treated with either cryo or RFA for localized HCC.

Descripción anatómica del músculo braquiorradial del tití gris (Saguinus leucopus Günther, 1877) y el hallazgo de una cabeza accesoria como variante anatómica / Anatomical description of white-footed tamarin (Saguinus leucopus Günther, 1877) brachioradialis muscle, and the finding of an accessory head as an anatomical variant

El Saguinus leucopus es un primate neotropical, endémico y monotípico de Colombia, con escasos estudios sobre su anatomía, en especial de sus músculos, siendo estos un elemento fundamental para la locomoción activa de este primate en los árboles. El objetivo del presente estudio fue describir la anatomía macroscópica del músculo braquiorradial del tití gris (Saguinus leucopus), tomando como base del estudio diez especímenes fijados con formalina al 10%, y a cada uno de ellos se les disecó los dos miembros torácicos de superficial a profundo, describiendo la forma, el origen, la inserción, la inervación y la irrigación del músculo braquiorradial. Se concluye que es un músculo que presenta una morfología, que debe contribuir a los movimientos flexores y supinadores del codo, y puede llegar a tener una cabeza accesoria en esta especie.

The Saguinus leucopus is a neotropical, endemic, and monotypic Colombian primate; few studies have been reported about its anatomy, specially about its muscles, this being a fundamental element for the active motion of this primate in the trees. The aim of this study was to describe the gross anatomy of the brachioradialis muscle on the white-footed tamarin (Saguinus leucopus). Ten specimens were included in the study, fixed with formalin at 10% and their thoracic limbs dissected, from the superficial to the deep plane, describing the form, origin, insertion, innervation and irrigation of the Brachioradialis muscle. The conclusion we made is that this muscle represents a morphology and in this way it must contribute to the flexor and supinator elbow movements, and would have an accessory head in this species.

The risk factors for mortality in non-human immunodeficiency virus infected children with pneumocys-tis carinii pneumonia / 中国小儿急救医学

Objective To analyze the epidemiologic characteristics and risk factors for mortality in non-(human immunodeficiency virus,HIV) infected children with pneumocystis carinii pneumonia(PCP). Methods The data of non-HIV infected children with PCP diagnosed in Beijing Children′s Hospital from January 1,2006 to December 31,2012 were collected. They were divided into survival and non-survival group according to the prognosis. The epidemiologic characteristics and risk factors for mortality were analyzed. Results Sixteen patients were enrolled in this study. Ten of them survived and 6 of them were non-survived. The basic diseases included malignant tumor in 5 patients and non-malignancy diseases in 11 of them. Com-pared with the survival group,the non-survival group had a higher average age [(12. 00 ± 2. 00) years vs. (6. 65 ± 4. 32)years,P=0. 01],higher ratio to need mechanical ventilation (6/6 vs. 4/10,P=0. 04),lower PaO2/FiO2[(73. 88 ±26. 95) mmHg vs. (167. 50 ± 97. 17) mmHg,1 mmHg=0. 133 kPa,P=0. 01] and lower pediatric critical illness score(75. 67 ± 5. 72 vs. 86. 40 ± 8. 88,P=0. 02). There were no differences on sex ratio,kinds of basic diseases,whether with co-infections,the time of immunosuppressant administration, the time from onset to diagnosis,the time from onset to beginning trimethoprim-sulfamethoxazole therapy, PaCO2 ,white blood cell counts,lymphocyte counts,CD4+ cell counts,C-reactive protein,and hemoglobin con-centrations between the survival and non-survival group. Conclusion A higher age, need for mechanical ventilation,lower PaO2/FiO2 and lower pediatric critical illness score were risk factors for mortality in non-HIV infected children with PCP.

Biological characteristics of Echinococcus f elidis / 中国人兽共患病学报

This review focuses on biological characteristics of Echinococcus f elidis including molecular genetic markers , species status ,host coverage ,geographical distribution ,epidemiological implications ,phylogeny ,and evolution .The molecular genetic markers are involved in mitochondrial cox1 (cytochrome C oxidase subunit 1) and nad1 (nicotinamide adenine dinucle-otide dehydrogenase subunit 1) genes ,nuclear protein-coding gene sequences such as elp (ezrin-radixin-moesin-like protein) , e f1a (elongation factor 1 alpha) ,pepck (phosphoenolpyruvate carboxykinase ) ,pold (DNA polymerase delta ) ,and ribosome RNA gene sequences such as ITS1 and 18S rRNA .The establishment of species status is based on distinctly discriminated mor-phological characteristics such as hooks on the rostrum with apparent rugae ,the special definitive host (lions) ,and divergence of DNA sequences ,etc .between E . f elidis and other Echinococcus species .In brief ,the review has provided researchers and ex-perts in the field of echinococcosis with fundamental background knowledge and guidelines for future research directions ,clinical and epidemiological investigations ,and prevention and control of echinococcosis .

Características clínicas y epidemiológicas de las quemaduras en pacientes ingresados en la Unidad de quemados. Hospital Luis Vernaza, Guayaquil. 2009 - 2010

Introducción. Las quemaduras representan una enorme injuria biológica y causan severas alteraciones metabólicas; son propensas a infección secundaria y producen alteraciones sistémicas, teniendo como consecuencias importantes deformidades, así como también limitaciones funcionales con su respectivo costo socioeconómico. Objetivos. Determinar la magnitud y características clínicas y epidemiológicas de las quemaduras en pacientes ingresados en la Unidad de Quemados. Métodos. El presente estudio es de tipo descriptivo realizado en pacientes que ingresaron a la Unidad de Quemados del Hospital Luis Vernaza, de la ciudad de Guayaquil. Resultados. Se observó predominio del sexo masculino (69.7%), con edad comprendida entre los 31 ­ 45 años (35,4%). La causa más frecuente se refiere a los accidentes domésticos (51,6%) y de trabajo (49,3%)

Introduction. Burns are an enormous biological and cause severe injury metabolic disorders, are prone to secondary infection and systemic alterations, with important consequences deformities as well as functional limitations with its own socio-economic cost. Objectives. To determine the incidence and prevalence of burns patients admitted to the Burns Unit. Knowing the causes of burns patients in the study. Set which gender is most affected. Identify the most vulnerable age groups. Prescribe the treatment to be established once the depth of injury. Knowing the place where most accidents occur frequently associated with burns. Methods. This study is descriptive. Study of patients admitted to the Burns Unit of Hospital Luis Vernaza, the city of Guayaquil. Results. There was a predominance of males (69.7%) between the 31 - 45 years (35.4%). The most frequently refers to domestic accidents (51.6%) and work (49.3%). Keywords: Epidemiologic Study Characteristics, Burns/complications, Burn Units, incidence, epidemiology/statistics & numerical data.

Epidemiologia das fraturas de acetábulo tratadas no instituto nacional de traumatologia e ortopedia (Into) / Epidemiology of acetabulum fractures treated at the instituto nacional de traumatologia e ortopedia (Into)

OBJETIVOS: O propósito do presente estudo é revisar aspectos epidemiológicos das fraturas desviadas do acetábulo tratadas cirurgicamente no Instituto Nacional de Ortopedia e Traumatologia (INTO). MÉTODOS: Analisamos, retrospectivamente, 126 fraturas de acetábulo tratadas cirurgicamente no INTO, no período de março de 2006 a novembro de 2008. Levamos em consideração: idade; sexo; mecanismo de trauma; classificação da lesão; tempo decorrido entre o trauma e o tratamento cirúrgico; lado acometido; lesões ósseas associadas. RESULTADOS: 76,8 por cento são do sexo masculino, a média da idade foi de 39,6 anos; quanto ao mecanismo de trauma, 59 por cento foram por acidente automobilístico; o tempo decorrido entre a lesão e o tratamento cirúrgico foi em média 16,4 dias; 55 por cento casos foram do lado direito; 30 por cento pacientes apresentavam fraturas associadas. CONCLUSÃO: A maior parte dos pacientes é do sexo masculino, na faixa etária economicamente ativa, e vítima de acidente de trânsito, sendo as fraturas da reborda e/ou coluna posterior as mais frequentes. Lesões associadas são comuns e a maior parte das fraturas operadas em nosso serviço é envelhecida.

OBJECTIVES: The purpose of this study is to review epidemiological aspects of displacement fractures of the acetabulum treated surgically at the Instituto Nacional de Traumatologia e Ortopoedia (INTO). METHODS: We retrospectively analyzed 126 acetabulum fractures treated surgically at the INTO in the period from March 2006 to November 2008. The following elements were taken in account: age, sex, mechanism of injury, classification, time elapsed between trauma and surgery, affected side, associated bone injuries. RESULTS: 76.8 percent were male, the mean age was 39.6 years. 59 percent of the traumas were due to traffic accidents; time between injury and surgery was on average 16.4 days; 55 percent of cases were on the right side; 30 percent of patients had associated fractures. CONCLUSION: Most patients are male, in an economically active age group, and are victims of traffic accidents. Fractures of edge and/or posterior column are the most frequent. Associated injuries are common and most of the fractures operated in our service are delayed.