Vibrational fundamental and overtone spectra of C2H4 in cryogenic liquid solutions.

Vibrational Fundamental and overtone transitions of C2H4 around the Δυ = 1-3 in liquid Ar, Kr, Xe and N2 solutions have been obtained using a low temperature cryostat and a Fourier transform infrared spectrophotometer for wavenumbers between 800 and 10,000 cm-1. The visible CH spectra for Δυ = 6 of ethylene in cryogenic solutions of the same solvents and liquid ethane have been measured with a low temperature cell and the thermal lens technique. Spectra in solutions show great simplification of the bands with respect to gas phase absorption bands. Assignments have been made based on gas phase transitions. Peak positions (ν), wavenumber shifts (Δν), and full widths at half maximum (Δω1/2) are reported. Changes of C2H4 frequencies in liquid Ar, Kr, and Xe seem to correlate with an increase in molar volume, dielectric constant, temperature, and polarizability of the solvents. Influence of the solvent on some fundamental vibrational frequencies are explored using the Onsager model and the polarizable continuum model (PCM). When used in conjunction with calculated anharmonic frequencies, the PCM model shows qualitative agreement with frequency shifts.

Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años / Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2 years of age

INTRODUCCIÓN: El epiblefaron es una malposición palpebral congénita ocasionada por un pliegue redundante de piel y músculo orbicular que invierte las pestañas hacia el globo ocular. OBJETIVO: Reportamos nuestra experiencia en la corrección no quirúrgica del epiblefaron sintomático usando una inyección en el músculo orbicular pretarsal de 5 unidades de toxina botulínica tipo A (TbA). MATERIAL Y MÉTODOS: Revisamos los expedientes de los pacientes menores de 2 años con epiblefaron tratados con TbA. Evaluamos los síntomas y los signos del epiblefaron, previo y posterior al tratamiento. RESULTADOS: Se incluyó a un total de 40 pacientes (28 niñas [70%]). La edad media de presentación fue 11 meses (rango 4-24). Se trataron 76 párpados con TbA. Obtuvimos una mejoría estadísticamente significativa de los síntomas, del contacto cilio corneal y de la afectación corneal tras la aplicación de 5 unidades de TbA. El periodo medio de seguimiento fue de 25,55 semanas (rango 4-92). CONCLUSIONES: Con este estudio demostramos que la aplicación de TbA es un tratamiento efectivo y seguro para la corrección del epiblefaron sintomático en niños menores de 2 años

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age

Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age. / Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años.

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.

Utilización de transporte sanitario urgente por los pacientes con ictus isquémico e impacto en los tiempos de atención / Use of emergency medical transport and impact on time to care in patients with ischaemic stroke

Introducción: Numerosos estudios han establecido que el traslado al hospital de los pacientes con ictus por los servicios de transporte sanitario urgente (TSU) implica demoras menores hasta el diagnóstico y tratamiento. Objetivos: Determinar la frecuencia de uso de TSU por los pacientes con ictus en Bizkaia (España), qué factores se asocian con el mismo y el impacto del medio de transporte en los tiempos de atención. Métodos: Se analizaron los datos de 545 pacientes con ictus isquémico agudo hospitalizados y reclutados consecutivamente. Se obtuvieron datos por entrevista a pacientes o acompañantes y de historia clínica. Se estudiaron variables sobre situación previa, síntomas y gravedad (NIHSS) del ictus, modalidad de traslado y tiempos de atención. Se realizaron análisis univariados y multivariados para identificar factores asociados al uso de TSU y con las demoras. Resultados: El 47,2% de los pacientes llegaron al hospital trasladados por TSU. Una mayor gravedad del ictus, la llegada al hospital en horario nocturno y un peor estado funcional previo resultaron asociados de forma independiente con el TSU. El TSU se asoció a una llegada más precoz al hospital. La demora puerta-imagen fue menor en el grupo TSU, pero la asociación desapareció al ajustar por gravedad. La revascularización fue más frecuente entre los trasladados por TSU. Conclusiones: El TSU se asoció a menor demora prehospitalaria. Es necesario desarrollar programas efectivos de educación sanitaria para incrementar el uso de TSU ante los síntomas del ictus. Debe mejorarse la gestión intrahospitalaria del ictus para reducir los tiempos de atención

Introduction: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. Objectives: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. Methods: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients’ medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays. Results: Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS. Conclusions: EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care

[Relationship between level of education and one-year survival after ischaemic stroke]. / Relacion del nivel de estudios con la supervivencia en el primer año tras un ictus isquemico.

INTRODUCTION: The relationship between socioeconomic status and incidence or stroke mortality rates is well established. The evidence of an association between this variable and survival is less conclusive. Level of education is a widely-used measure of socioeconomic status in elderly people. AIM: To assess the relationship between one-year survival after stroke and level of education. PATIENTS AND METHODS: We analysed data on 544 consecutively recruited patients admitted for acute ischaemic stroke in one the public hospitals of Bizkaia (Spain). Data were obtained through interviews with patients or accompanying persons and from medical records. We studied variables concerning previous functional status, stroke severity, cardiovascular risk factors and stroke care provided. Patients were followed up for 12 months and the dates of any deaths were recorded. Univariate and multivariate analyses were carried out to assess the relationship between level of education and survival. RESULTS: A total of 203 (86%) women and 273 (88.6%) men were alive at 12 months. In both sexes, individuals with a lower level of education had poorer previous functional status, more severe strokes and higher mortality rates. In the multivariate analysis, the association between level of education and survival remained significant in the adjusted model in men. CONCLUSIONS: In our setting, there are differences in the survival of patients with ischaemic stroke as a function of level of education. The impact of this factor was greater in men than women.

TITLE: Relacion del nivel de estudios con la supervivencia en el primer año tras un ictus isquemico.Introduccion. La relacion del nivel socioeconomico con las tasas de incidencia y de mortalidad por ictus esta bien establecida. La evidencia de la relacion con la supervivencia de los pacientes tras el ictus es menos concluyente. El nivel educativo es una medida de nivel socioeconomico muy utilizada en estudios con personas de edad avanzada. Objetivo. Estudiar la relacion de la supervivencia en el primer año tras el ictus con el nivel de estudios. Pacientes y metodos. Se analizaron los datos de 544 pacientes con ictus isquemico agudo ingresados en los hospitales publicos de Bizkaia (España), seleccionados consecutivamente. Se obtuvieron datos por entrevista a pacientes o acompañantes y de historia clinica. Se estudiaron variables sobre situacion funcional previa, gravedad del ictus, factores de riesgo cardiovascular y de atencion al ictus. Se hizo un seguimiento de 12 meses para registrar, en su caso, la fecha de fallecimiento. Se realizo un analisis univariado y multivariado para identificar la relacion del nivel de estudios con la supervivencia. Resultados. Tras 12 meses, sobrevivian 203 mujeres (86%) y 273 hombres (88,6%). En ambos sexos, las personas con menos estudios tuvieron peor situacion funcional previa, mayor gravedad y fallecieron en mayor proporcion. En el analisis multivariado, el nivel de estudios se mantuvo asociado con la supervivencia en el modelo ajustado para los hombres. Conclusiones. La diversidad de nivel educativo marca diferencias en la supervivencia de los pacientes con ictus isquemico en nuestro entorno. El impacto de este factor fue mayor en los hombres que en las mujeres.

Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. / Utilización de transporte sanitario urgente por los pacientes con ictus isquémico e impacto en los tiempos de atención.

INTRODUCTION: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays. RESULTS: Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS. CONCLUSIONS: EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.

C-H Infrared Absorption and Solubility of Ethylene, Propyne, 2-methyl-2-butene, and 2-methyl-1, 3-butadiene (Isoprene) in Liquid Argon Solutions.

The solubility of ethylene (H2C=CH2), propyne (CH3-C≡C-H), 2-methyl-2-butene (CH3-CH=C(CH3)2), and isoprene or 2-methyl-1, 3-butadiene (H2C=C(CH3)-CH=CH2) in liquid argon has been measured using mid-infrared and near-infrared (NIR) absorption. Spectra were recorded in the C-H infrared (IR) region. Spectra were obtained at increasing solution composition until the magnitude of the integrated absorption band reached a maximum value, indicating a saturated solution. The approximate experimental solubilities are: (600 ± 100) ppm at 92 K for ethylene, (22 ± 9) ppm at 100 K for propyne, (9 ± 5) ppm at 100 K for 2-methyl-2-butene, and (12 ± 2) ppm at 86 K for isoprene. The experimental solubility values at the corresponding temperature were used with solubility parameters of two separate models: the perturbed-chain statistical associating fluid theory (PC-SAFT) and the regular solution theory. Solvent-solute interaction parameters k12 (PC-SAFT) and [Formula: see text] (RST) were obtained for each solute in the presence of argon as the solvent. Data from experimental measurements are important for more realistic simulations of solubility of solids in cryogenic liquids.

Improved Automatic Detection of New T2 Lesions in Multiple Sclerosis Using Deformation Fields.

BACKGROUND AND PURPOSE: Detection of disease activity, defined as new/enlarging T2 lesions on brain MR imaging, has been proposed as a biomarker in MS. However, detection of new/enlarging T2 lesions can be hindered by several factors that can be overcome with image subtraction. The purpose of this study was to improve automated detection of new T2 lesions and reduce user interaction to eliminate inter- and intraobserver variability. MATERIALS AND METHODS: Multiparametric brain MR imaging was performed at 2 time points in 36 patients with new T2 lesions. Images were registered by using an affine transformation and the Demons algorithm to obtain a deformation field. After affine registration, images were subtracted and a threshold was applied to obtain a lesion mask, which was then refined by using the deformation field, intensity, and local information. This pipeline was compared with only applying a threshold, and with a state-of-the-art approach relying only on image intensities. To assess improvements, we compared the results of the different pipelines with the expert visual detection. RESULTS: The multichannel pipeline based on the deformation field obtained a detection Dice similarity coefficient close to 0.70, with a false-positive detection of 17.8% and a true-positive detection of 70.9%. A statistically significant correlation (r = 0.81, P value = 2.2688e-09) was found between visual detection and automated detection by using our approach. CONCLUSIONS: The deformation field-based approach proposed in this study for detecting new/enlarging T2 lesions resulted in significantly fewer false-positives while maintaining most true-positives and showed a good correlation with visual detection annotations. This approach could reduce user interaction and inter- and intraobserver variability.

Evaluating the effects of white matter multiple sclerosis lesions on the volume estimation of 6 brain tissue segmentation methods.

BACKGROUND AND PURPOSE: The accuracy of automatic tissue segmentation methods can be affected by the presence of hypointense white matter lesions during the tissue segmentation process. Our aim was to evaluate the impact of MS white matter lesions on the brain tissue measurements of 6 well-known segmentation techniques. These include straightforward techniques such as Artificial Neural Network and fuzzy C-means as well as more advanced techniques such as the Fuzzy And Noise Tolerant Adaptive Segmentation Method, fMRI of the Brain Automated Segmentation Tool, SPM5, and SPM8. MATERIALS AND METHODS: Thirty T1-weighted images from patients with MS from 3 different scanners were segmented twice, first including white matter lesions and then masking the lesions before segmentation and relabeling as WM afterward. The differences in total tissue volume and tissue volume outside the lesion regions were computed between the images by using the 2 methodologies. RESULTS: Total gray matter volume was overestimated by all methods when lesion volume increased. The tissue volume outside the lesion regions was also affected by white matter lesions with differences up to 20 cm(3) on images with a high lesion load (≈50 cm(3)). SPM8 and Fuzzy And Noise Tolerant Adaptive Segmentation Method were the methods less influenced by white matter lesions, whereas the effect of white matter lesions was more prominent on fuzzy C-means and the fMRI of the Brain Automated Segmentation Tool. CONCLUSIONS: Although lesions were removed after segmentation to avoid their impact on tissue segmentation, the methods still overestimated GM tissue in most cases. This finding is especially relevant because on images with high lesion load, this bias will most likely distort actual tissue atrophy measurements.

Spectroscopic observation of neutral carbon during photodissociation of explosive-related compounds in the vapor phase.

We perform time-resolved laser-induced fluorescence measurements of mononitrotoluenes (MNTs) and dinitrotoluenes (DNTs) in nitrogen and air. We observe the multipeak emission spectrum of NO and find that the emission peak intensity in the 247-248 nm range is stronger than expected compared to the other NO emission peak intensities. This increased emission intensity is believed to be due to neutral carbon [C(I)], which has a strong emission peak at 247.85 nm. By comparing the ratios of integrated emission peak intensities with those expected from the Franck-Condon factors for NO, we are able to identify samples that exhibit C(I) emission. We show that the DNTs exhibit C(I) emission for gate delays of 1500 ns and beyond, while the MNTs exhibit C(I) emission for gate delays of only up to about 500 ns. Carbon deposits in the analysis chamber confirm the presence of C. Ambient NO in air enhances the observed NO+C(I) signal from MNTs and DNTs.

Diplomado para docentes de ciencias de la salud: validación por criterio de expertos / A post-graduate course for teachers of health sciences: validation by expert criteria

Fundamento: La superación del claustro de profesores es una meta permanente en los centros de educación superior de Cuba. Esta garantiza que el proceso deenseñanza aprendizaje se perfeccione cada vez más. Tan importante como la superación sistemática de los claustros docentes, es la validación de los recursos e iniciativas encaminadas a ello. Objetivo: Validar, mediante criterio de expertos, un diseño de diplomadodirigido a profesores que se desempeñan en el ciclo clínico de las Carreras en Ciencias de la Salud.Métodos: Se aplicaron encuestas a 27 expertos a través de la utilización de dos métodos: el Ábaco de Régnier ylas Caras de Chernoff. Finalmente, se realizó una triangulación de los datos a evaluar, y ambos métodos aplicados. Resultados: El diseño de diplomado quedó aprobado por el criterio de expertos. Las respuestas positivas alcanzaron un porcentaje por encima del 94 por ciento, según ambos métodos. Solo con respecto a laadaptabilidad del diseño a otros contextos docentes, los expertos emitieron bajas calificaciones; mientras que la evaluación más alta fue otorgada a lo relacionado con el tratamiento de los contenidos. La triangulación finalentre métodos y resultados, también evidenció gran concordancia en la evaluación positiva de las respuestaspor ambas técnicas aplicadas. Conclusiones: Estos métodos han sido muy utilizados en investigacionespedagógicas. En el caso de su vinculación a la aplicación del criterio de expertos, permite obtener respuestas con mayor objetividad y menos viciadas por elementos subjetivos, inherentes a los métodos cualitativos(AU)

Background: Faculties training is a permanent goal in higher education institutions in Cuba. It is alsoapproached as a guarantee that the teaching-learning process is increasingly improved. The validation of the resources and initiatives to be used is considered to be as important as the systematic training of faculties.Objective: To validate, by expert criteria, a graduate course aimed at teachers who work in the clinicalcourses of the curricula in Health Sciences. Methods: Surveys were administered to 27 experts through theuse of the Régniers Abacus and Chernoff Faces. Finally, a triangulation of both methods and data to beevaluated was carried out. Results: The post-graduate course design was approved by the experts. The positiveresponse rate reached over 94 percent, according to both methods. Adaptability of the design to other learningenvironments received the lowest grade, while the treatment of contents received the highest. The final triangulation between methods and results also showed a match of the positive evaluations obtained through the responses of both techniques. Conclusions: These methods have been widely used in educational research In the case of their use along with that of experts criteria, they allow obtaining more objective answers that are less tainted by subjective elements inherent to qualitative methods(AU)

Logistics and strategy of multiorgan procurement involving total face allograft.

The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.

El consumo de sal: ¿Riesgo o necesidad? / Salt intake: a risk or need?

Se realizó una revisión acerca del consumo de sal y sus usos en las diferentes etapas de la historia de la humanidad. Se abordan elementos relacionados con su presencia en el organismo, las funciones fisiológicas esenciales para el mantenimiento homeostático en la vida, así como las complicaciones cuando sus niveles son inferiores a los límites fisiológicos, o superiores a estos. Se analizaron diferentes estudios y sus contradicciones sobre los daños que ocasiona a la salud el consumo de sal. Se precisan los grupos poblacionales sal sensibles (SS) y sal resistentes (SR), pautados por estudios realizados, así como las posibles causas de sus variaciones. Se emiten conclusiones en cuanto a riesgo y beneficio del consumo de sal. Se recomienda intervenir en un equilibrado consumo, tanto para los individuos como para las poblaciones(AU)

A literary review on salt intake and its uses throughout the different stages in the history of mankind was conducted. It addresses issues related to salt concentrations in the human body, its physiological functions that are essential for homeostatic control, as well as the complications when salt levels are below or over the physiological limits. Different studies were analyzed including the contradictions they all present on the damage that salt intake can cause to human health. Population groups are defined as salt sensitive (SS) and salt resistant (SR) according to study that was conducted as well as to the possible causes for their variations. Conclusions are drawn on the risks and benefits of salt intake. Intervention is recommended for balanced consumption, both for individuals and for populations(AU)

Síndrome metabólico en un área de salud de Cienfuegos: segunda medición de CARMEN / Metabolic syndrome in a health area of Cienfuegos: CARMEN second measurement

El conocimiento de las prevalencias de los principales factores de riesgos cardiovasculares y del síndrome metabólico en una comunidad, es determinante para establecer programas preventivos de salud. Objetivo: Determinar la prevalencia del síndrome metabólico en un área de salud de la ciudad de Cienfuegos, así como su relación con los principales factores de riesgo. Métodos: Se realizó un estudio de corte transversal del tipo descriptivo correlacional. La muestra se obtuvo mediante un método probabilístico y es representativa de la población mayor de 17 años del área de salud IV del municipio de Cienfuegos; se estudiaron 209 personas extraídas de un universo de 16577 individuos, se utilizó un porcentaje de prevalencia esperada del 18 por ciento, un intervalo de confianza (IC) del 95 por ciento, una precisión de ± 5 por ciento y una tasa de no respuesta del 35 por ciento. Resultados: La prevalencia de síndrome metabólico se determinó en 21,7 por ciento, la prevalencia de hipertensión arterial fue de 39,2 por ciento, la obesidad en 24,8 por ciento y la diabetes mellitus en 10,7 por ciento La prevalencia de síndrome metabólico en mayores de 40 años fue de 43,7 por ciento con una razón de prevalencia de 2,40 para el sexo masculino. Conclusiones: Existe una alta prevalencia de los principales factores de riesgo en la comunidad, la principal triada de asociación para el síndrome metabólico esta formada por la hipertensión, hipertrigliceridemia e hipocolesterolemia de HDL(AU)

Background: Knowledge on the prevalence of major cardiovascular risk factors and metabolic syndrome in a community is crucial to establish preventive health programs. Objective: To determine the prevalence of metabolic syndrome in a health area of the city of Cienfuegos, and its relation to major risk factors. Methods: A cross-sectional study of descriptive and correlational type was conducted. The sample was obtained using a probabilistic approach. It represents the population over 17 years old in health area # IV of the municipality of Cienfuegos. Out of a 16,577 people universe, 209 individuals were studied. The following numbers were used: expected prevalence percentage, 18 percent; confidence interval, 95 percent; accuracy, ± 5 percent and a non-response percentage, 35 percent. Results: Prevalence of metabolic syndrome was found in 21.7 percent of the studied cases (confidence interval 95 percent 14.5; 28.8 percent), prevalence of hypertension in 39.2 percent, obesity in 24.8 percent and diabetes mellitus in 10.7 percentPrevalence of metabolic syndrome in individuals older than 40 years old was 43.7 percent with a 2.40 prevalence ratio for males. Conclusions: There is a high prevalence of major risk factors in the community. The main triad associated to the metabolic syndrome is made up of hypertension, hypertriglyceridemia and HDL hypocolesterolemia(AU)

Estudio de la calidad de las prescripciones médicas en un servicio de urgencias pediátricas / Study on the quality of the medical prescriptions in a Pediatrics Emergency Service

Antecedentes: En los últimos años se han publicado algunos trabajos sobre el error médico. Los servicios de urgencias pediátricas (SUP) son especialmente susceptibles al error de prescripción, pero se han escrito pocos artículos específicos al respecto. Objetivos: Determinar la frecuencia y las variables asociadas con las desviaciones de la buena práctica médica en las prescripciones médicas en nuestro SUP. Métodos: Estudio retrospectivo observacional. Revisamos las prescripciones realizadas en 58 días elegidos de forma aleatoria (entre julio de 2003 y marzo de 2004). De cada una de ellas evaluamos la legibilidad, el cálculo de dosis, las unidades, el intervalo y la alergia medicamentosa. Recogimos el día de la semana, el turno y el grado de formación del médico responsable. Resultados: Durante los 58 días revisados se realizaron3.143 prescripciones. Detectamos una o más desviaciones de la buena práctica médica en 1.348 (43%). Ninguna de ellas fue clasificada como grave. La variable donde más desviaciones detectamos fue en la legibilidad, seguida del cálculo de la dosis. En el 11%, al menos uno de los elementos se consideró ilegible. Se encontraron diferencias estadísticamente significativas al analizar las variables correspondientes al día de la semana (fin de semana frente a lunes-viernes; p= 0,0036) y el grado de formación (residente frente a adjunto; p <0,0001). Conclusiones: Los errores en la prescripción médica son frecuentes en nuestro SUP; ninguno de ellos es grave, pero sí limitan el buen cumplimiento del tratamiento. Se pueden identificar circunstancias que hacen más frecuentes las desviaciones y, de esta forma, diseñar intervenciones para mejorar la calidad asistencial (AU)

Background: Several papers related to the medical mistakes have been published over the past years. The Pediatrics Emergency Services are specially susceptible as regards to the prescription mistake but there are few specific articles. Objectives: To determine the frequency and variables associated to the deviations of good medical practice in medical prescriptions in our Pediatrics Emergency Service. Methods: Retrospective observational study. We revised the prescriptions done during fifty eight days on a random basis(from July 2003 to March 2004). From every prescription: legibility, dose assessment, units, intervals and drug allergies were evaluated. The day of the week, shift and level of training of the prescribing physician were documented. Results: During the revised 58 day, 3,143 prescriptions were made. One or more deviations to the good medical practice were detected in 1,348 (43%) of the prescriptions. None of the mistakes were classified as severe. The variable where more deviations were detected was the legibility and dosage assessment. In 11% at least one of the elements were considered illegible. Statistical significant differences were found when analyzing the day of the week variables (week-end vs. Monday-Friday, p= 0.0036) and to the level of training (resident vs. pediatricians, p <0.0001). Conclusions: Medical prescription mistakes are very common in our Pediatrics Emergency Service. None of them were severe but limited the good compliance of the treatment. Some characteristics that make deviations more frequent can be identified in order to design interventions to improve the quality (AU)

[Multidrug-resistant tuberculosis in the pediatric age group]. / Tuberculosis mutirresistente en la edad pediátrica.

AIMS: To study the clinical and epidemiological features in eight pediatric patients with multidrug-resistant tuberculosis (MDR-TB) diagnosed from 1994 to 2005 in three hospitals in Madrid (Spain). METHODS: A retrospective study was performed in patients aged less than 15 years old with positive culture for multidrug-resistant Mycobacterium tuberculosis and patients with negative cultures diagnosed after contact with MDR-TB. RESULTS: Pulmonary tuberculosis was diagnosed in seven patients and arthritis in one. Fifty percent of the patients were immigrants and an adult source case was found in four (50%). M. tuberculosis was isolated in gastric juice in four patients and in synovial biopsy in one. In three patients cultures were negative but these patients had previously been in contact with MDR-TB. Two strains were resistant to isoniazid and rifampicin, four were resistant to isoniazid, rifampicin and streptomycin, one was resistant to isoniazid, rifampicin, streptomycin and pyrazinamide, and one was resistant to 11 drugs. Six patients initially received conventional treatment without improvement. Patients received therapy for 15 months (range: 12 to 18) with 3 to 5 drugs according to the sensitivity study. The following adverse effects were observed: creatine phosphokinase increase (one patient), tendinitis (one patient), alteration of visual evoked responses (one patient) and transitory psychosis (one patient). One patient required pulmonary lobectomy. All patients responded satisfactorily to medical treatment. CONCLUSIONS: MDR-TB should be suspected in patients not responding to TB treatment, especially those from countries with high resistance rates. In patients with negative cultures, treatment should rely on the results of a sensitivity study in the adult source case. MDR-TB requires the use of second-line anti-TB drugs for prolonged periods with possible toxic effects.

Tuberculosis mutirresistente en la edad pediátrica / Multidrug-resistant tuberculosis in the pediatric age group

Objetivos Estudiar las características clínicas y epidemiológicas de 8 pacientes pediátricos con tuberculosis multirresistente (TB-MDR) diagnosticados en 3 hospitales de Madrid entre 1994 y 2005. Métodos Estudio retrospectivo que incluye pacientes menores de 15 años con aislamiento de Mycobacterium tuberculosis multirresistente y sin aislamiento que empezaron tras contacto con TB-MDR. Resultados Se diagnosticaron 7 tuberculosis pulmonares y una artritis. El 50 % eran inmigrantes y en el 50 % se confirmó contacto con adulto enfermo. Se aisló M. tuberculosis en jugo gástrico (4) y biopsia sinovial (1). En 3 pacientes no se consiguió aislamiento, pero se confirmó contacto con TB-MDR. Dos cepas presentaron resistencia a isoniazida (H) y rifampicina (R), cuatro a H, R y estreptomicina (S), una a H, R, S y pirazinamida (Z) y una a 11 fármacos. Seis pacientes recibieron tratamiento convencional inicial sin presentar mejoría. Una vez conocida la sensibilidad de la cepa, se administró tratamiento durante una media de 15 meses (rango: 12-18 meses) con 3-5 fármacos efectivos. Los efectos secundarios observados fueron: aumento de creatinfosfocinasa (1), tendinitis (1), alteración de potenciales visuales (1) y psicosis transitoria (1). Un paciente requirió lobectomía. Todos los pacientes evolucionaron satisfactoriamente. Conclusiones La TB-MDR debe sospecharse en casos con mala evolución, especialmente si proceden de zonas con altas tasas de resistencia. En niños enfermos con cultivos negativos y expuestos a TB-MDR, el tratamiento se realizará según el estudio de resistencias del caso índice. La resistencia limita las opciones terapéuticas y conlleva la utilización de fármacos con posibles efectos tóxicos

Aims To study the clinical and epidemiological features in eight pediatric patients with multidrug-resistant tuberculosis (MDR-TB) diagnosed from 1994 to 2005 in three hospitals in Madrid (Spain). Methods A retrospective study was performed in patients aged less than 15 years old with positive culture for multidrugresistant Mycobacterium tuberculosis and patients with negative cultures diagnosed after contact with MDR-TB. Results Pulmonary tuberculosis was diagnosed in seven patients and arthritis in one. Fifty percent of the patients were immigrants and an adult source case was found in four (50 %). M. tuberculosis was isolated in gastric juice in four patients and in synovial biopsy in one. In three patients cultures were negative but these patients had previously been in contact with MDR-TB. Two strains were resistant to isoniazid and rifampicin, four were resistant to isoniazid, rifampicin and streptomycin, one was resistant to isoniazid, rifampicin, streptomycin and pyrazinamide, and one was resistant to 11 drugs. Six patients initially received conventional treatment without improvement. Patients received therapy for 15 months (range: 12 to 18) with 3 to 5 drugs according to the sensitivity study. The following adverse effects were observed: creatine phosphokinase increase (one patient), tendinitis (one patient), alteration of visual evoked responses (one patient) and transitory psychosis (one patient). One patient required pulmonary lobectomy. All patients responded satisfactorily to medical treatment. Conclusions MDR-TB should be suspected in patients not responding to TB treatment, especially those from countries with high resistance rates. In patients with negative cultures, treatment should rely on the results of a sensitivity study in the adult source case. MDR-TB requires the use of second- line anti-TB drugs for prolonged periods with possible toxic effects

Síndrome de «shock» tóxico: a propósito de dos casos / Toxic shock syndrome: a report of two cases

Los síndromes de shock tóxico y shock similar a tóxico son entidades causadas por superantígenos que ponen en marcha una respuesta sistémica que determina sus características clínicas. Exponemos dos casos detectados en nuestro hospital que cumplen los criterios diagnósticos de síndrome de shock tóxico al presentar una temperatura ³38,9 ºC, un exantema con posterior descamación, una hipotensión arterial y una afectación de 3 o más órganos. El primero evolucionó hacia un fallo multiorgánico con cultivos negativos, por lo que se diagnosticó de etiología probablemente estafilocócica. El paciente experimentó un deterioro progresivo, sin respuesta a las medidas de soporte, y falleció. El segundo caso se manifestó como una fascitis necrosante de la pared abdominal, que precisó un desbridamiento quirúrgico. El crecimiento de Streptococcus pyogenes se detectó en la faringe y en el exudado de la herida quirúrgica. Su evolución fue favorable, por lo que recibió el alta con una estenosis traqueal como única secuela. Los dos casos demuestran la importancia de la sospecha clínica en estos cuadros para pautar el tratamiento antibiótico e instaurar una terapia de soporte con rapidez

Toxic shock syndrome and toxic shock-like syndrome are diseases caused by superantigens that trigger a systemic inflammatory response, which is responsible for the clinical manifestations. We report two cases treated at our institution that meet the diagnostic criteria for toxic shock syndrome: body temperature ³38.9 ºC, rash with subsequent desquamation, hypotension and involvement of three or more organ systems. The first patient developed multisystem failure with negative cultures, suggesting a probable staphylococcal etiology. The patient experienced a progressive deterioration with no response to supportive care, and finally died. The second case presented as necrotising fasciitis of the abdominal wall, requiring surgical debridement. Streptococcus pyogenes was grown in the samples obtained from the pharynx and from the surgical wound. This patient had a favorable clinical course with tracheal stenosis as the only sequela at the discharge from hospital. High clinical suspicion is extremely important in this syndrome for the early initiation of antibiotic therapy and intensive care

[Do age and service influence on diagnostic quality of ischemic stroke?]. / ¿Influyen la edad y servicio en la calidad diagnóstica de los ictus isquémicos?

BACKGROUND: The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Alderegu a Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%. OBJECTIVES: To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient. PATIENTS AND METHODS: A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons. RESULTS: At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus. CONCLUSIONS: The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit

¿Influyen la edad y el servicio en la calidad diagnóstica de los ictus isquémicos? / Do the age and service influence on diagnostic quality of ischemic stroke?

Introducción. Los ictus isquémicos representan una causa importante de morbimortalidad hospitalaria. La variabilidad clínica de esta enfermedad y su frecuente evidencia morfológica en las necropsias motivaron el estudio de la concordancia clinicopatológica en dos instituciones de la atención secundaria, los hospitales Dr. Gustavo Aldereguía Lima y Camilo Cienfuegos, en las provincias de Cienfuegos y Sancti Spiritus, en Cuba. En ambos centros se exhiben indicadores de necropsia superiores al 80 por ciento.Objetivos. Determinar la correlación clinicopatológica en la enfermedad cerebrovascular isquémica como índice de calidad del diagnóstico, y la influencia de la edad del paciente y el tipo de cuidados recibidos. Pacientes y métodos. Estudio retrospectivo, descriptivo y correlacional, en el que se evaluaron 1.556 fallecidos con necropsia. Como principales variables, se estudiaron la edad y el servicio donde ocurrió el fallecimiento, así como los siguientes indicadores: concordancia observada, índice k, sensibilidad, especificidad, valores predictivos positivo y negativo, razones de verosimilitud positiva y negativa. Resultados. En los accidentes cerebrovasculares (ACV) isquémicos, la concordancia fue sustancial, con valores de k que no superaron 0,66 en ambos centros; sin embargo, la sensibilidad y el valor predictivo positivo fueron superiores en Sancti Spiritus (75,5 y 63,5 por ciento, respectivamente). De manera global, ser anciano no motivó discordancia diagnóstica en los ACV; significativamente, los indicadores de Sancti Spiritus en este grupo de edad fueron sustanciales: k, 0,70; sensibilidad, 80,4 por ciento, y valor predictivo positivo, 19,0. En los fallecidos de 15-60 años de la provincia de Sancti Spiritus se redujeron los resultados de las mediciones de calidad diagnóstica respecto a Cienfuegos y al general para este grupo de edad: k, 0,37; sensibilidad, 42,8 por ciento, y valor predictivo positivo, 37,5 por ciento. El análisis por servicios evidencia reducciones de la sensibilidad del 59,1 por ciento en los servicios clínicos de Cienfuegos respecto al 73,6 por ciento en cuidados progresivos para los ACV isquémicos, además de un valor predictivo positivo de 49,4 por ciento en cuidados progresivos, inferior a los resultados obtenidos por Sancti Spiritus. Conclusiones. La concordancia clinicopatológica y el resto de las mediciones fueron mayores en el hospital de Sancti Spiritus; la edad menor de 60 años favoreció la discordancia diagnóstica en dicho centro. Sin embargo, los mayores de 60 años no motivaron cambios importantes en la concordancia. Los indicadores de calidad fueron superiores en las unidades de cuidados progresivos con respecto a los servicios clínicos; la calidad de los resultados en el hospital de Sancti Spiritus está determinada por la presencia de una Unidad de Cuidados Intensivos al Ictus (AU)

Background. The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%. Objectives. To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient. Patients and methods. A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons. Results. At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus. Conclusions. The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn’t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit (AU)