The duration of ketamine detection in hair after treatment cessation: Case study and review of the literature in forensic and clinical casework.

The disappearance of drug from hair does not occur immediately after abstinence because dormant hair may contribute to the positivity of freshly grown hair. The aim of this study was to assess ketamine disappearance from hair after treatment cessation and to review the literature data. A 22-year-old female received three intravenous doses of ketamine (171 mg) for major depression treatment. Seventeen weeks later, a 26 cm lock of hair was sampled, and ketamine was determined by liquid chromatography tandem mass spectrometry (LC-MS/MS) on seven segments: A (proximal, 0-2 cm), B (2-4 cm), C (4-6 cm, period of ketamine therapy), and D to G (4 × 5 cm). Ketamine concentration was 58 pg/mg in Segment C and remained detectable over 4 months after treatment cessation at 67 pg/mg in Segment B and 2 pg/mg in Segment A, representing a 97% drop from the initial concentration. Ketamine elimination half-life in hair was estimated at 0.88 month, implying that indetectable concentration should be expected 7 months after cessation. Axial diffusion was excluded as ketamine was not detected in Segments D-G. Given the low ketamine concentrations, norketamine was not detected. While no data on ketamine disappearance from hair have been published to date, previous studies have shown that discontinuation resulted in negative hair results after 3 months for heroin, 3-4 months for cocaine and tramadol, 6 months for amphetamine and methamphetamine, and 6-7 months for THC-COOH. This study provides useful findings for ketamine hair concentration interpretation, which should be validated by more consistent and comprehensive investigations.

Monitoring of plasma concentrations of dabrafenib and trametinib in advanced BRAFV600mut melanoma patients.

BACKGROUND: Dabrafenib (D) and trametinib (T) improved survival in patients with BRAFV600mut melanoma. High plasma concentration of D (PCD) is weakly associated with adverse events (AE). We investigated the relationship between PCD/T and tumour control or AE. METHODS: We analysed PCD/T in patients treated with D+T for metastatic melanoma. We collected data of tumour response (RECIST 1.1) and AE (CTCAE 4.0) blinded to PCD/T results. RESULTS: We analysed 71 D and 58T assays from 34 patients. High inter-individual variability of PCD (median: 65.0ng/mL; interquartile range (IQR) [4-945]) and of PCT (median: 8.6ng/mL; IQR [5-39]) was observed. We found a weak relationship between PCD and progression-free survival, taking follow-up time into account (hazard ratio 0.991; 95%CI, 0.981 to 1.000; P=0.06). However, no difference was observed between mean PCD/T of progressing patients (n=21; 125±183ng/mL and 9.3±3.6ng/mL, respectively) and responders (complete, partial or stable response) (n=13; 159±225ng/mL, P=0.58 and 10.6±24.4ng/mL, P=0.29, respectively). No significant relationship was found between PCD/T and most common AEs (fever, lymphopenia, CPK increase, and hepatic cytolysis), body mass index, or age. Mean CPT (n=16) was significantly higher for female subjects (n=18; 11.5±4.8ng/mL) than for male subjects (8.8ng/mL±2.9, P=0.01), but no difference was observed between sex and CPD (P=0.32). CONCLUSION: Our study showed a weak relationship between PCD and progression-free survival, but no relationship between PCD/T and AE was found. Monitoring PCD and PCT alone is unlikely to be useful in assessing response to treatment.

Towards a better understanding of adult idiopathic epidermal necrolysis: a retrospective study of 19 cases.

BACKGROUND: Most cases of Stevens-Johnson syndrome and toxic epidermal necrolysis are drug-induced. A small subset of cases remain with unknown aetiology (idiopathic epidermal necrolysis [IEN]). OBJECTIVE: We sought to better describe adult IEN and understand the aetiology. METHODS: This retrospective study was conducted in 4 centres of the French national reference centre for epidermal necrolysis. Clinical data were collected for the 19 adults hospitalized for IEN between January 2015 and December 2019. Wide toxicology analysis of blood samples was performed. Histology of IEN cases was compared with blinding to skin biopsies of drug-induced EN (DIEN, 'controls'). Available baseline skin biopsies were analysed by shotgun metagenomics and transcriptomics and compared to controls. RESULTS: IEN cases represented 15.6% of all EN cases in these centres. The median age of patients was 38 (range 16-51) years; 68.4% were women. Overall, 63.2% (n = 12) of cases required intensive care unit admission and 15.8% (n = 3) died at the acute phase. Histology showed the same patterns of early- to late-stage EN with no difference between DIEN and IEN cases. One toxicology analysis showed unexpected traces of carbamazepine; results for other cases were negative. Metagenomics analysis revealed no unexpected pathological microorganism. Transcriptomic analysis highlighted a different pro-apoptotic pathway in IEN compared to DIEN, with an overexpression of apoptosis effectors TWEAK/TRAIL. CONCLUSIONS: IEN affects young people and is a severe form of EN. A large toxicologic investigation is warranted. Different pathways seem involved in IEN and DIEN, leading to the same apoptotic effect, but the primary trigger remains unknown.

Intubación submentoniana en osteosíntesis de fractura de macizo facial / Submental intubation in osteosynthesis of facial mass fracture

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Fatal intoxication with ivabradine: First case report.

Ivabradine is a bradycardic drug used worldwide in the treatment of chronic stable angina and chronic heart failure. We presented here a case of a 61-year-old woman who was admitted to emergency department for overdose. She presented with drowsiness, bradycardia (45bpm) and a low blood pressure (116/21mmHg). She died ten hours after admission from multiple organ failure. Ivabradine was quantified in different matrices sampled during autopsy using a method on LC-MS/MS (TSQ Vantage Thermo Fisher Scientific®), after a double liquid-liquid extraction with a mixture of hexane/ethyl acetate (1/1; v/v) and then chloroform/isopropanol (80/20; v/v). Chromatographic separation was achieved using a Hypersyl gold PFP column (200×2.1mm, 1.9µm) and an acetonitrile/formiate 2mM, 0.1% formic acid buffer gradient. Method was fully validated on whole blood. The mean overall recovery was 90%. Linearity was validated in the 5-500ng/mL range, with intra and inter-day precision lower than 14.3%. The ivabradine concentration found in patient post-mortem blood was 1210ng/mL. Ivabradine was also quantified in different viscera like lung (2910ng/g), kidney (1510ng/g), liver (1050ng/g), heart (900ng/g), and brain (110ng/g). The vitreous humor concentration was 760ng/mL. Pregabalin and zopiclone were also found in blood at 50µg/mL and 206ng/mL, respectively. This case seems to be the first report of a fatal intoxication involving ivabradine and the first published concentrations in organs.

Determinación de preíndices en pádel mediante análisis cinemático / Determining Pre-cues in Paddle Tennis by Using a Kinematic Analysis

El objetivo es determinar la existencia de indicadores visuales (preíndices) en el golpe de derecha desde el fondo de pista tras rebote en pared en padel para cada una de las posibles direcciones (derecha, centro e izquierda) mediante análisis cinemático. Han participado en el estudio cinco jugadores expertos de padel. Los valores encontrados para altura de la mano y la posición del talón izquierdo en el momento de inicio y final del movimiento se revelan como las zonas corporales que más información podrían proporcionar como pre-índices informacionales para el jugador en defensa (r=,896, p<,001 y r=,777, p<,001). Los datos confirman la existencia de tres patrones de movimiento en virtud de la dirección elegida (máxima altura de la mano y mayor ángulo del talón izquierdo respecto al plano transversal del cuerpo cuando la bola se dirige a la parte izquierda de la cancha, tomado como referencia el jugador que golpea)

Using a kinematic analysis, this study aims to find out the existence of visual signals (pre-cues) in drive strokes made from the back of the court after the ball hits a wall, considering each possible direction (right, centre and left). Five expert paddle tennis players took part in the study. The body areas that could be most useful to the defensive player as informative pre-cues (r=.896 p<.001 y r=.777 p<.001) were those related to the hand height and the position of the left heel, at the beginning and at the end of the movement. These data confirm the existence of three movement patterns according to the chosen direction (maximum hand height and most open left heel angle in relation to the transverse plane of the body when the ball goes to the left half of the court, with the striking player as reference)

Hallazgos clínicos, dermatoscópicos e histopatológicos de un dermatofibroma con inducción sebácea / Clinical, Dermoscopic, and Histopathologic Features of a Dermatofibroma With Sebaceous Induction

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Top 5.000 en el blog «Pediatría basada en pruebas» y el interés de la «blogmetría» / Top 5000 in the blog «Pediatría basada en pruebas» and the interest about «blogmetrics»

El blog «Pediatría basada en pruebas» es una fuente de información y formación contrastada tras 8 años de existencia en el entorno de la blogosfera pediátrica española y la web social. En este artículo se analizan las 2.486 entradas publicadas en este blog durante el periodo de revisión (desde agosto de 2008 hasta julio de 2016), con un estudio pormenorizado de los 59 posts que han recibido más de 5.000 visitas. Desde el punto de vista cuantitativo, se confirma la vida propia de un blog a lo largo del tiempo respecto a un estudio previo realizado en 2012. Las tres entradas más visitadas en estos 8 años son: «Por una sanidad Google Style», con 71.418 visitas (fecha de publicación: 08/04/13), «Cine y Pediatría (210): El milagro de Carintia, el milagro de cada día en una guardia», con 27.361 visitas (fecha de publicación: 18/01/14), y «Que no. Que la leche no produce mocos», con 19.850 visitas (fecha de publicación: 21/07/11). Desde el punto de vista cualitativo, los temas que más interesan a los lectores del blog «Pediatría basada en pruebas» se concentran en seis grupos bien consolidados en ese top 5.000: 19 posts como secciones ya establecidas del blog (principalmente Cine y Pediatría); 11 posts como Temas sociales (tabaquismo, accidentes, inmigración, acoso escolar, etc.); 9 posts como Polémicas (temas de especial debate social y/o médico, como el aborto, grupos antivacunas, mala praxis sanitaria, etc.); 7 posts como Enfermedades infecciosas (gripe, meningitis, sepsis, sarampión, varicela, vacunas, etc.), 7 posts como Perineonatología (temas de la gestación y del recién nacido) y 6 posts como Guías e informes de sociedades científicas. La mejor forma posible de mejorar en un blog es conocer la dinámica de nuestros lectores (desde los ámbitos cuantitativo y cualitativo) y la webmetría es una buena herramienta para ello. El análisis de los resultados permite mejorar la transmisión de formación e información a nuestros colegas de profesión, a los pacientes y sus familias y a la sociedad en general (AU)

The blog «Pediatría basada en pruebas» is a source of proven information and training after 8 years around the Spanish pediatric blogosphere and the social web. In this article, 2,486 public entries in this blog from August 2008 to July 2016 are analyzed, with a detailed study of the 59 posts with more than 5,000 visits. From the quantitative point of view, the life of a blog and changes are confirmed over time. The three most visited post over this 8 years are: «Por una sanidad Google Style», 71,418 visits (publication date: 08/04/13); «Cine y pediatría (210): El milagro de Carintia, el milagro de cada día en una guardia», 27,361 visits (publication date: 18/01/14); and «Que no. Que la leche no produce mocos», 19,850 visits (publication date: 21/07/11). From the qualitative point of view, the subjects that interest the most to the readers of «Pediatría basada en pruebas» blog gather around six groups, consolidate in this top 5,000: 19 posts as established sections in the blog (mainly Cinema and pediatrics); 11 posts as Social subjects (smoking, injuries, immigration, bulling, etc.); 9 posts as Controversies (subjects of special social and/or healthcare debate, such as abortion, anti-vaccination groups, medical malpractice, etc.); 7 posts as Infectious diseases (flu, meningitis, septicemia, measles, chickenpox, vaccinations, etc.); 7 posts as Perineonatology (pregnancy and newborn subjects), and 6 posts a Guidelines and reports of scientific societies. The initial best possible way of improve in a blog is to know our readers’ dynamics (from both areas, quantitative and qualitative) and webmetrics is a good tool. And with these results of the blog to build the information and training in the best possible way to our colleagues, patients and families, and to society in general (AU)

¿Qué aporta perampanel al tratamiento de la epilepsia? / ¿What does perampanel contribute to the treatment of epilepsy?

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No existen pruebas suficientes que recomienden la azitromicina para prevenir episodios de sibilancias recurrentes posbronquiolitis / There is no evidence to recommend azithromycin to prevent recurrent wheezing after bronchioliti

Conclusiones de los autores del estudio: la azitromicina disminuye la concentración de los niveles nasofaríngeos de interleucina 8 (IL-8) durante la duración del estudio y produce un retraso en la aparición de un tercer episodio de sibilancias recurrentes durante el periodo de seguimiento. Comentario de los revisores: los resultados de este ensayo no bastan para recomendar un uso indiscriminado de la azitromicina para el tratamiento de la bronquiolitis aguda durante su ingreso hospitalario y tampoco para prevenir los posibles episodios de sibilancias recurrentes posteriores. Si realmente la azitromicina posee algún tipo de efecto clínicamente importante sobre la bronquiolitis aguda y sus recurrencias, ello tendrá que ponerse de manifiesto en un ensayo clínico específicamente diseñado para tal fin, ya que los resultados de un ensayo piloto no pueden tomarse como base para establecer cambios en la práctica clínica cotidiana (AU)

Review and assessment of a selected paper. Authors' conclusions: azithromycin decreases interleukin-8 nasopharyngeal concentration during the study period, and delayed the onset of a subsequent third episode of recurrent wheezing during the monitoring period. Reviewers' commentary: the results of this trial are not sufficient to recommend indiscriminate use of azithromycin for the treatment of acute bronchiolitis during admission, nor to prevent possible further episodes of recurrent wheezing. If azithromycin actually had any clinically important effect on acute bronchiolitis and its recurrences, it should be demonstrated in a clinical trial specifically designed for this purpose, since the results of a pilot trial cannot be taken as a basis for changes in everyday clinical practice (AU)

Efectos de un programa perceptivo-motor en la respuesta de reacción en mayores / Effects of a perceptual-motor program in response reaction to older people

Diversos trabajos han mostrado que se puede reducir el tiempo de reacción en los mayores con la práctica de actividad física (Hunter et al., 2001) e incluso igualar al de los jóvenes (Light et al., 1996). 52 hombres y mujeres de la ciudad de Melilla distribuidos en dos grupos de estudio: un grupo control (n=26 ; M= 68,56 años) que participa en actividades físicas genéricas y un grupo experimental (n=26 ; M=67,32 años) que ha participado en las mismas actividades más un programa de entrenamiento específico para la mejora del equilibrio, ajuste postural y tiempo de reacción. Los resultados no muestran diferencias significativas en el postest ni en la prueba de transferencia, pero los sujetos del grupo experimental alcanzan mejores desempeños en las dos variables de estudio (Tiempo de reacción simple - TRs y tiempo de inicio del movimiento - TIm) (GE TRs M= .55 ; TIm M=. 53 ; GC TRs M=.60 ; TIm M=. 64). Por subgrupos de estudio, las mujeres del subgrupo 60-70 años participantes en el programa obtuvieron resultados significativamente mejores que el resto de subgrupos considerados (AU)

According to several studies, physical activity can reduce the reaction time of elderly people (Hunter et al., 2001) and even make it equal to that of young people (Light et al., 1996). This project included 52 men and women from the City of Melilla distributed in two groups of study: a Control Group (n=26; M=68, 56 years old) taking part in generic physical activities, and an Experimental Group (n=26; M=67, 32 years) undertaking these same activities and also a specific training programme designed to improve balance, postural adjustment and reaction time. The results do not show significant differences either in the post-test or in the transfer test. However, the subjects from the experimental group achieved better performances on the two study variables (simple reaction time or sRT and initial movement time iMT) (EG sRT M=.55; iMT M=.53; CG sRT M=.60; iMT M=.64). In the per-subgroup analysis, the women of the 60-70-years-old subgroup who participated in the programme obtained significant better results than the subjects of the other subgroups (AU)

Cannabinoids inhibit cholinergic contraction in human airways through prejunctional CB1 receptors.

BACKGROUND AND PURPOSE: Marijuana smoking is widespread in many countries, and the use of smoked synthetic cannabinoids is increasing. Smoking a marijuana joint leads to bronchodilation in both healthy subjects and asthmatics. The effects of Δ(9) -tetrahydrocannabinol and synthetic cannabinoids on human bronchus reactivity have not previously been investigated. Here, we sought to assess the effects of natural and synthetic cannabinoids on cholinergic bronchial contraction. EXPERIMENTAL APPROACH: Human bronchi isolated from 88 patients were suspended in an organ bath and contracted by electrical field stimulation (EFS) in the presence of the phytocannabinoid Δ(9) -tetrahydrocannabinol, the endogenous 2-arachidonoylglycerol, the synthetic dual CB1 and CB2 receptor agonists WIN55,212-2 and CP55,940, the synthetic, CB2 -receptor-selective agonist JWH-133 or the selective GPR55 agonist O-1602. The receptors involved in the response were characterized by using selective CB1 and CB2 receptor antagonists (SR141716 and SR144528 respectively). KEY RESULTS: Δ(9) -tetrahydrocannabinol, WIN55,212-2 and CP55,940 induced concentration-dependent inhibition of cholinergic contractions, with maximum inhibitions of 39, 76 and 77% respectively. JWH-133 only had an effect at high concentrations. 2-Arachidonoylglycerol and O-1602 were devoid of any effect. Only CB1 receptors were involved in the response because the effects of cannabinoids were antagonized by SR141716, but not by SR144528. The cannabinoids did not alter basal tone or contractions induced by exogenous Ach. CONCLUSIONS AND IMPLICATIONS: Activation of prejunctional CB1 receptors mediates the inhibition of EFS-evoked cholinergic contraction in human bronchus. This mechanism may explain the acute bronchodilation produced by marijuana smoking.

[Passive cocaine inhalation by a 25-month-old child]. / Intoxication passive à la cocaïne d'un enfant de 25 mois.

Cocaine and its principal metabolite were isolated from the urine, confirmed by urine chromatographic analysis, in a 25-month-old girl who had unsteady gait and a third fever seizure. She was premature, had intrauterine growth restriction (IUGR), and a psychomotor delay. The hair examination confirmed prolonged cocaine exposure. The concentration was significant and showed that she had been intoxicated for the 10 previous months. Passive cocaine inhalation may have caused and contributed to these symptoms.

Blogs médicos como fuente de formación e información. El ejemplo del blog Pediatría basada en pruebas / Medical blogs as a source of training and information: the example of the blog "Pediatría basada en pruebas

Los blogs se han convertido en una potencial fuente de información y formación en Medicina, en general, y en Pediatría, en particular, máxime en el actual entorno sanitario de la “web social”. La experiencia personal de los autores en relación con el blog Pediatría basada en pruebas ha permitido analizar el interés temático de los lectores del blog, así como los flujos de comunicación en el entorno de la “blogosfera” pediátrica española. Se analizan las 1311 entradas publicadas en el blog Pediatría basada en pruebas durante el periodo de revisión (de mayo de 2008 a septiembre de 2012), con un estudio pormenorizado de las 105 entradas que han recibido más de 1000 visitas. Los temas que más interesan a los lectores del blog Pediatría basada en pruebas se concentran en seis grupos: 1) enfermedades infecciosas (gripe, meningitis, sepsis, sarampión, varicela, vacunas, etc.); 2) Perineonatología (temas de la gestación y del recién nacido, algunos volcados en dos secciones ya consolidadas como Propositus y Neo-Dividencias); 3) temas sociales (tabaquismo, accidentes, inmigración, acoso escolar, etc.); 4) guías e informes de sociedades científicas; 5) secciones ya establecidas del blog (con cinco consolidadas: Propositus, Neo-Dividencias, Formación e Información en Pediatría, Resumen de la blogosfera pediátrica y Cine y Pediatría), y 6) polémicas (temas de especial debate social y/o médico y que corresponden con los más comentados, y donde se incluyen temas como el aborto, la circuncisión neonatal, grupos antivacunas, mala praxis sanitaria, etc.). Teniendo en cuenta que el entorno de los blogs ya es considerado por la propia Asociación Española de Pediatría como una fuente de información fiable, nuestro compromiso en el blog es construir esta información de la mejor forma posible. Y la mejor forma posible inicial es conocer la dinámica de nuestros lectores y, con ello, y sin dejar de ser rigurosos y éticos, podemos (y debemos) plantear como válida esta forma de transmitir formación e información a nuestros colegas de profesión, a pacientes y familias, y a la sociedad en general (AU)

Blogs have become a potential source of information and training in medicine in general and in pediatrics in particular, especially in the present health care environment in the social web. The authors’ personal experience relating to the blog Pediatría basada en pruebas has made possible to analyze the readers’ interests, as well as the communication movements around the Spanish pediatric blogosphere. The 1311 public entries from May 2008 to September 2012 are analyzed, with a detailed study of the 105 posts with more than 1000 visits. The subjects that interest the most to the readers of Pediatría basada en pruebas blog gather around six groups: 1) infectious diseases (flu, meningitis, septicemia, measles, chickenpox, vaccinations, etc.); 2) peri-neonatology (pregnancy and newborn subjects, some of them issued in two established sections named Propositus and Neo-Dividencias; 3) social subjects (smoking, injuries, immigration, bulling, etc.); 4) guidelines and reports of scientific societies; 5) established sections in the blog (five of them consolidated: Propositus, Neo-Dividencias, Training and Information in Pediatrics, Pediatric blogosphere summary and Cinema and Pediatrics; 6) controversies (subjects of special social and/or healthcare debate, that are the more commented ones and include subjects such as abortion, newborn circumcision, anti-vaccination groups, medical malpractice, etc.). Taking into account that blogs are already considered by the Spanish Pediatrics Association itself as a source of information, our compromise with the blog is to build this information in the best possible way. And the initial best possible way is to know our readers’ dynamics, and therefore staying rigorous and ethical, we can (and should) consider valid this way of transmitting training and information to our colleagues, patients and families, and to society in general (AU)

Validación en castellano de un cuestionario breve útil para cribado epidemiológico de epilepsia en España: Cuestionario EPIBERIA / Validation of a short useful questionnaire in Spanish for the epidemiological screening of epilepsy in Spain. EPIBERIA Questionnaire

Introducción: Existe una importante laguna de conocimiento sobre la epidemiología de la epilepsia en los países de la cuenca mediterránea. El grupo EPIBERIA nace con el objetivo de promocionar la realización de estudios epidemiológicos en este ámbito, capaces de paliar esta situación. El presente trabajo aborda la validación de un cuestionario breve de cribado de pacientes con epilepsia en población general. Métodos: Se seleccionó un cuestionario de origen anglosajón validado en inglés por el grupo de Ottman. Fue traducido, modificado para adaptarlo a las características de la población española y administrado a una muestra de 200 pacientes (93 epilépticos y 107 controles no epilépticos), extraídos de manera consecutiva de 5 unidades de epilepsia dispersas por España. Ambos grupos fueron homogéneos en variables demográficas y el grupo de control fue representativo de la población general. Se realizó una estimación de la sensibilidad (S), la especificidad (E), los valores predictivos positivos (VPP) y los valores predictivos negativos (VPN) para cuatro diferentes criterios de corrección del cuestionario. Resultados: Se obtuvieron una sensibilidad del 100% y una especificidad del 74,77% para el criterio menos riguroso y una sensibilidad del 94,62% y una especificidad del 99,07% para el criterio más estricto de corrección del cuestionario. Los VPP variaron entre el 7,48% en el primer supuesto y el 69,49% en el segundo, asumiendo una prevalencia pretest para la epilepsia del 2%. Conclusiones: El cuestionario EPIBERIA es un instrumento válido como cuestionario de cribado de epilepsia en la población general en castellano en España(AU)

Introduction: There is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this area in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening of patients with epilepsy in general population. Methods: We selected an English language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 Epilepsy Units scattered throughout Spain. Both groups were homogeneous in demographic variables, and the control group was representative of the general population. Results: We obtained a sensitivity of 100% and a specificity of 74.77% for the less rigorous correction criteria of the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent ones. The positive predictive values (PPVs) ranged from 7.48% for the first case to 69.49% in the second, assuming a prevalence for epilepsy of 2%. Conclusions: The questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening of epilepsy in the general population in Spain(AU)

El papel de la antibioterapia en la sinusitis aguda: revisión sistemática y metaanálisis / The role of antibiotics in acute sinusitis: a systematic review and metaanalysis

Introducción: El objetivo fue determinar si los antibióticos son más eficaces que el placebo o ninguna intervención en el tratamiento de la sinusitis aguda. Pacientes y métodos: Se revisaron las bases de datos y buscadores: PubMed, EMBASE, Cochrane Central Register of Controlled Trials y Google Académico para identificar ensayos clínicos aleatorizados (ECA) realizados en niños que compararan antibiótico frente a placebo. Se consideró sinusitis, la persistencia de sintomatología clínica compatible durante al menos 10 días. La calidad metodológica se evaluó mediante la escala de Jadad. Fueron seleccionados 4 ECA. Se evaluaron las siguientes variables: curación-mejoría clínica (a día 10-14), recaídas-recurrencias (a día 14-60) y presencia de efectos adversos. Los resultados se combinaron mediante metaanálisis. Se adoptó un análisis según modelo de efectos fijos o aleatorios en función de si existía o no heterogeneidad. El parámetro combinado que se estimó fue el riesgo relativo (RR) y su intervalo de confianza del 95% (IC 95%). Resultados: Dos ECA tenían una puntuación en la escala de Jadad ≥ 3. Variable curación-mejoría (4 ECA): RR: 1,11 (IC 95%: 0,9 a 1,3). Variable recaída-recurrencia (3 ECA): RR: 0,9 (IC 95%: 0,6 a 1,5); efectos adversos (4 ECA): 2,01 (IC 95%: 1,1 a 3,8). Conclusiones: En niños con sinusitis aguda, el tratamiento antibiótico a las dosis estudiadas no parece aportar beneficio alguno en cuanto a la curación-mejoría evaluada al 10-14 día de seguimiento. El porcentaje de recaídas-recurrencias no fue inferior entre los niños que recibieron antibiótico. Los antibióticos se asocian con mayor probabilidad a efectos adversos (AU)

Introduction: The aim of this systematic review is to assess whether antibacterial agents are more effective than either placebo or no intervention at all in the treatment of acute bacterial sinusitis. Patients and methods: We reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The results were combined using meta-analysis. We used the fixed effects model or random model depending on whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval. Results: Only two RCTs had a Jadad scale score ≥3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to 1.3). Variable relapse-recurrence (3 RCTs): RR 0.9 (95% CI: 0.6 to 1.5). Adverse effects (4 RCTs): 2.01 (95% CI 1.1 to 3.8). Conclusions: In children with acute sinusitis, antibacterial agents at the studied doses did not appear to provide benefit in terms of cure and improvement, assessed at 10 to 14 days of follow up. Similarly, the percentage of relapse-recurrence was not lower among children who received antibiotics. Antibiotics are associated more frequently with adverse effects( AU)

Suicidal and criminal immolations: an 18-year study and review of the literature.

We aimed to examine our autopsy data in order to analyze epidemiological and injury characteristics in criminal and suicidal immolation cases. During the 18-year period, we recorded 29 suicides and three homicides due to fire burns. In suicide group there was a majority of men (gender ratio: 3.1:1) and the mean age was 42.8 years (range 20-72). In the homicide group, the victims were two men and one woman. Their mean age was 44 years (range 39-54). The location of self-immolation was mostly the deceased's car or home and most suicides happened during the evening and the night. The main frequent motives for self-immolation were affective problems, financial problems, or both. One or several flammable fluids, usually petrol or alcohol, were used in 18 suicide cases and in one homicide. The median total body surface area burnt was 79.3% (range 10-100%) in self inflicted group and 83.3% (range 50-100%) in assault group. The sole of the feet was spared in all suicide cases. Blood CO-Hb level was measured in 27 self-immolation cases. It ranged between 1% and 10% in 11 cases and was superior to 10% in the remaining. Twenty-three self-immolation victims and one homicide victim had soot in their respiratory tracts. Soot in the respiratory tracts was associated to soot in the digestive tracts in six cases. Alcohol and drugs intoxication played a minor role. In six cases, the victim associated self incineration with one or more other methods of suicide (complex suicides). The presence of associated trauma raises the problem of vitality and interpretation of the lesions in determining the manner of death.

Blaschkitis del adulto (liquen estriado) en paciente tratado con adalimumab / Adult Blaschkitis (Lichen Striatus) in a Patient Treated with Adalimumab

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