Inbred SJL mice recapitulate human resistance to Cryptococcus infection due to differential immune activation.

IMPORTANCE: Cryptococcosis studies often utilize the common C57BL/6J mouse model. Unfortunately, infection in these mice fails to replicate the basic course of human disease, particularly hampering immunological studies. This work demonstrates that SJL/J mice can recapitulate human infection better than other mouse strains. The immunological response to Cryptococcus infection in SJL/J mice was markedly different from C57BL/6J and much more productive in combating this infection. Characterization of infected mice demonstrated strain-specific genetic linkage and differential regulation of multiple important immune-relevant genes in response to Cryptococcus infection. While our results validate many of the previously identified immunological features of cryptococcosis, we also demonstrate limitations from previous mouse models as they may be less translatable to human disease. We concluded that SJL/J mice more faithfully recapitulate human cryptococcosis serving as an exciting new animal model for immunological and genetic studies.

Improving the design and conduct of aquatic toxicity studies with oils based on 20 years of CROSERF experience.

Laboratory toxicity testing is a key tool used in oil spill science, spill effects assessment, and mitigation strategy decisions to minimize environmental impacts. A major consideration in oil toxicity testing is how to replicate real-world spill conditions, oil types, weathering states, receptor organisms, and modifying environmental factors under laboratory conditions. Oils and petroleum-derived products are comprised of thousands of compounds with different physicochemical and toxicological properties, and this leads to challenges in conducting and interpreting oil toxicity studies. Experimental methods used to mix oils with aqueous test media have been shown to influence the aqueous-phase hydrocarbon composition and concentrations, hydrocarbon phase distribution (i.e., dissolved phase versus in oil droplets), and the stability of oil:water solutions which, in turn, influence the bioavailability and toxicity of the oil containing media. Studies have shown that differences in experimental methods can lead to divergent test results. Therefore, it is imperative to standardize the methods used to prepare oil:water solutions in order to improve the realism and comparability of laboratory tests. The CROSERF methodology, originally published in 2005, was developed as a standardized method to prepare oil:water solutions for testing and evaluating dispersants and dispersed oil. However, it was found equally applicable for use in testing oil-derived petroleum substances. The goals of the current effort were to: (1) build upon two decades of experience to update existing CROSERF guidance for conducting aquatic toxicity tests and (2) to improve the design of laboratory toxicity studies for use in hazard evaluation and development of quantitative effects models that can then be applied in spill assessment. Key experimental design considerations discussed include species selection (standard vs field collected), test substance (single compound vs whole oil), exposure regime (static vs flow-through) and duration, exposure metrics, toxicity endpoints, and quality assurance and control.

The Challenges of Characterizing the Zooplankton Community Response Following Simulated Spills of Diluted Bitumen into Boreal Lake Limnocorrals.

We attempted to characterize zooplankton community response following spills of the unconventional crude oil, diluted bitumen (dilbit), into 10-m diameter, ~ 100 m3, ~ 1.5-m deep boreal lake limnocorrals, including two controls and seven dilbit treatments ranging from 1.5 to 180 L (1:100,000 to 1:1,000 v/v, dilbit:water). Community composition and abundances were monitored weekly to bi-weekly over three months. Total zooplankton biomass and abundance seemingly collapsed in all limnocorrals, regardless of treatment, though some rotifer species persisted. As a result, it was not possible to determine the impacts of dilbit. We theorize several potential non-oil-related reasons for the sudden community collapse - including elevated zinc levels, fish grazing pressures, and sampling biases - and provide guidance for future work using in-lake enclosures.

Surface oil is the primary driver of macroinvertebrate impacts following spills of diluted bitumen in freshwater.

The response of freshwater invertebrates following accidental releases of oil is not well understood. This knowledge gap is more substantial for unconventional oils such as diluted bitumen (dilbit). We evaluated the effects of dilbit on insect emergence and benthic invertebrates by conducting experimental spills in limnocorrals (10-m diameter; ~100-m3) deployed in a boreal lake at the IISD-Experimental Lakes Area, Canada. The study included seven dilbit treatments (spill volumes ranged from 1.5 L [1:66,000, oil:water, v/v] to 180 L [1:590, oil:water, v/v]), two controls, and additional lake reference sites, monitored for 11 weeks. Invertebrate emergence declined at the community level following oil addition in a significantly volume-dependent manner, and by 93-100 % over the 11 weeks following the spill in the highest treatment. Dilbit altered community structure of benthic invertebrates, but not abundance. One-year post-spill and following oil removal using traditional skimming and absorption techniques, benthic richness and abundance were greater among all treatments than the previous year. These results indicate that recovery in community composition is possible following oil removal from a lake ecosystem. Research is needed concerning the mechanisms by which surface oil directly affect adult invertebrates, whether through limiting oviposition, limiting emergence, or both. The response of benthic communities to sediment tar mats is also warranted.

Effectiveness of craniosacral therapy in the treatment of infantile colic. A randomized controlled trial.

OBJECTIVES: To determine the effectiveness of Craniosacral Therapy (CST) for the treatment of infantile colic. MATERIAL AND METHODS: This randomized controlled trial was conducted on 58 infants, aged 0-84 days, diagnosed with infantile colic. The babies received a 30-40 minute CST session once a week (experimental group) or no treatment (control group). Babies in the CST group received either 1, 2 or 3 CST sessions over a 14-day period. Data were collected at 4 different times over the 24-day period, day 0 (baseline), day 7, day 14 and day 24. Crying (primary outcome) and sleep (secondary outcome) were evaluated using a crying and sleep diary, and colic severity was measured using the Infant Colic Severity Questionnaire (secondary outcome). RESULTS: There was a statistically significant difference between groups (CST and control) in crying hours (F = 188.47; p < 0.0005; η2 = 0.78), sleep hours (F = 61.20; p < 0.0005, η2 = 0.54) and colic severity (F = 143.74; p < 0.0005, η2 = 0.73) across all the time points. In comparison with the control group, CST babies reported significant and clinically relevant effects in crying hours on day 7 (-2.47 h (95%CI, -2.95 to -1.99); p < 0.0005; d = 1.73), on day 14 (-3.29 h (95%CI, -3.7 to -2.8); p < 0.0005; d = 2.87) and on day 24 (-3.20 h (95%CI, -3.7 to -2.6); p < 0.0005; d = 2.54); in sleep hours on day 7 (-2.47 h (95%CI, -2.95 to -1.99); p < 0.0005; d = 1.73) on day 14 (-3.29 h (95%CI, -3.7 to -2.8); p < 0.0005; d = 2.87) and on day 24 (-3.20 h (95%CI, -3.7 to -2.6); p < 0.0005; d = 2.54). CONCLUSIONS: Craniosacral therapy appears to be effective and safe for infantile colic by reducing the number of crying hours, the colic severity and increasing the total hours of sleep.

Caffeine and paraxanthine in aquatic systems: Global exposure distributions and probabilistic risk assessment.

This study presents one of the most complete applications of probabilistic methodologies to the risk assessment of emerging contaminants. Perhaps the most data-rich of these compounds, caffeine, as well as its main metabolite (paraxanthine), were selected for this study. Information for a total of 29,132 individual caffeine and 7442 paraxanthine samples was compiled, including samples where the compounds were not detected. The inclusion of non-detect samples (as censored data) in the estimation of environmental exposure distributions (EEDs) allowed for a realistic characterization of the global presence of these compounds in aquatic systems. EEDs were compared to species sensitivity distributions (SSDs), when possible, in order to calculate joint probability curves (JPCs) to describe the risk to aquatic organisms. This way, it was determined that unacceptable environmental risk (defined as 5% of the species being potentially exposed to concentrations able to cause effects in>5% of the cases) could be expected from chronic exposure to caffeine from effluent (28.4% of the cases), surface water (6.7% of the cases) and estuary water (5.4% of the cases). Probability of exceedance of acute predicted no-effect concentrations (PNECs) for paraxanthine were higher than 5% for all assessed matrices except for drinking water and ground water, however no experimental effects data was available for paraxanthine, resulting in a precautionary deterministic hazard assessment for this compound. Given the chemical similarities between both compounds, real effect thresholds, and thus risk, for paraxanthine, would be expected to be close to those observed for caffeine. Negligible Human health risk from exposure to caffeine via drinking or groundwater is expected from the compiled data.

Drugs of abuse and benzodiazepines in the Madrid Region (Central Spain): seasonal variation in river waters, occurrence in tap water and potential environmental and human risk.

This work analyzes the seasonal variation (winter and summer) of ten drugs of abuse, six metabolites and three benzodiazepines in surface waters from the Jarama and Manzanares Rivers in the Madrid Region, the most densely populated area in Spain. The occurrence of these compounds in tap water in this region is also investigated and a preliminary human health risk characterization performed for those substances found in tap water. Finally, a screening level risk assessment that combines the measured environmental concentrations (MECs) with dose-response data to estimate Hazard Quotients (HQs) for the compounds studied is also presented. The results of this study show the presence of fourteen out of the nineteen compounds analyzed in winter and twelve of them in summer. The most ubiquitous compounds, with a frequency of detection of 100% in both seasons, were the cocaine metabolite benzoylecgonine (BE), the amphetamine-type stimulant (ATS) ephedrine (EPH), the opioid methadone (METH), the METH metabolite 2-ethylene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and the three benzodiazepines investigated, namely alprazolam (ALP), diazepam (DIA) and lorazepam (LOR). The highest concentrations observed corresponded to EPH (1020ngL(-1) in winter and 250ngL(-1) in summer). The only compounds not detected in both seasons were heroin (HER) and its metabolite 6-acetylmorphine (6ACM), lysergic acid diethylamide (LSD) and its metabolite 2-oxo-3-hydroxy-LSD (O-H-LSD), and Δ(9)-tetrahydrocannabinol (THC). In terms of overall concentration, all sampling points presented higher concentrations in winter than in summer. Statistical analyses performed to gather evidence concerning occasional seasonal differences in the concentrations of individual substances between summer and winter showed statistically significantly higher concentrations (p<0.05) of BE, EPH and the opioid morphine (MOR) in winter than in summer. Two out of the nineteen compounds studied, namely cocaine (CO) and EPH, were detected in tap water from one sampling point at concentrations of 1.61 and 0.29ngL(-1), respectively. The preliminary human health risk characterization showed that no toxic effects could be expected at the detected concentration level in tap water. The screening level risk assessment showed that MOR, EDDP and the THC metabolite 11-nor-9-carboxy-Δ(9)-tetrahydrocannabinol (THC-COOH) were present in at least one of the sampling sites in a concentration leading to a Hazard Quotient (HQ) value between 1.0 and 10.0, thus indicating some possible adverse effects. The cumulative HQ or Toxic units (TUs) calculated for each of the groups studied showed that opioids and cannabinoids were present at concentrations high enough to potentially generate some adverse effects on at least one sampling point.

Seasonal variation of pharmaceutically active compounds in surface (Tagus River) and tap water (Central Spain).

Numerous studies have shown the presence of pharmaceutically active compounds (PhACs) in different environmental compartments, for example, in surface water or wastewater ranging from nanograms per litre to micrograms per litre. Likewise, some recent studies have pointed to seasonal variability, thus indicating that PhAcs concentrations in the aquatic environment may depend on the time of year. This work intended to find out (1) whether Tagus fluvial and drinking water were polluted with different groups of PhACs and (2) if their concentrations differed between winter and summer seasons. From the 58 substances analysed, 41 were found belonging to the main therapeutic groups. Statistical differences were seen for antibacterials, antidepressants, anxiolytics, antiepileptics, and cardiovascular drugs, with higher concentrations being detected in winter than in summer. These results might indicate that the PhACs analysed in this study undergo lower environmental degradation in winter than in summer. In order to confirm these initial results, a continuous monitoring should be performed especially on those PhACs that either because of an elevated consumption or an intrinsic chemical persistence are poorly degraded during winter months due to low temperatures and solar irradiation. It is especially important to identify which of these specific PhACs are in order to recommend their substitution by equally effective and safe substances but also environmentally friendly.

Detection of pharmaceutically active compounds in the rivers and tap water of the Madrid Region (Spain) and potential ecotoxicological risk.

Concentrations of pharmaceutically active compounds (PhACs) in the order of ng L(-1) to µg L(-1) have been reported worldwide in waste, fluvial and even drinking water, raising concern about the efficacy of the currently employed waste water treatments in the elimination of this kind of compounds. Despite ranking 29th in terms of population, Spain is currently the 8th country on pharmaceutical prescription with an expense of 14×10(9) euros in 2008. In this context, the aim of this study was to determine the presence of 33 pharmaceutically active compounds in specific points of the main rivers of the Madrid Region (MR) as well as tap water samples from the metropolitan area of Madrid. Additionally, a screening level risk characterization by means of the Hazard Quotient (HQ) method was applied. A total of 25 pharmaceutical compounds and metabolites were detected in the 10 sampling points downstream the outlet of the major STPs of the MR. The highest concentrations were detected for the anticonvulsant carbamazepine and the stimulant caffeine. Concentrations for most of the analyzed compounds exceed levels previously reported in the literature. Moreover, we report the highest concentration of the cytostatic ifosfamide, detected for the first time in Spain in surface water. Preliminary risk characterization shows that a total of 16 compounds represent at least a low potential hazard based on their scored HQs, with five of them present in a concentration that exceeds the predicted no effect concentration (PNEC). Toxic Units calculation indicates that for all the selected sampling points high hazard is anticipated from the presence of the analyzed compounds in the measured concentrations (TUs>10). Caffeine and cotinine were detected in all (10) the analyzed tap water samples. Carbamazepine and nicotine were detected in six and venlafaxine in two samples. No studies venlafaxine in drinking water have been reported. These results clearly pinpoint the need for water quality monitoring and research in urban rivers, as well as the need for improved water treatment techniques able to eliminate this kind of compounds from the effluent waters as well as from drinking water sources.

Analysis of the presence of cardiovascular and analgesic/anti-inflammatory/antipyretic pharmaceuticals in river- and drinking-water of the Madrid Region in Spain.

Interest in the presence of pharmaceuticals in wastewater, in the water of our rivers and, to a lesser extent, in our drinking water, has been growing in recent decades. Many of these substances, currently classified as "emerging pollutants", are biologically active compounds and continuously released in effluents. As sewage treatment plants (STPs) are not adequately equipped to eliminate all of these substances completely, some are discharged directly into rivers. In Spain, as in most of its neighbouring countries, there is an elevated use of pharmaceuticals for the treatment of cardiovascular diseases (which are extremely prevalent among the older adult population) and anti-inflammatory medications, which are obtainable over the counter without a medical prescription. This study therefore sought to determine to what degree pharmaceuticals with the highest regional prescription and/or use rates, such as cardiovascular and analgesic/anti-inflammatory/antipyretic medications, were present in the principal rivers (Jarama, Manzanares, Guadarrama, Henares and Tagus) and tap-water samples of the Madrid Region (MR). Samples were taken downstream the discharge of 10 of the most important region's STPs and the most frequently used drugs in the region were analysed for. Of the 24 drugs analysed, 21 were detected at concentrations ranging from 2 ng L⁻¹ to 18 µg L⁻¹. The highest drug concentrations corresponded to ibuprofen, diclofenac, naproxen, atenolol, frusemide (furosemide), gemfibrozil and hydrochlorthiazide, and in most cases exceeded the amounts reported in the scientific literature. No traces of these groups of pharmaceuticals were detected in the drinking water analysed. On the basis of the high concentrations detected, we believe that an environmental surveillance system should be implemented to assess the continuous discharge of these pharmaceuticals and their possible ecotoxicological effects. At the same time, efforts to raise the awareness of the public about responsible use and the proper disposal of such substances at purpose-designated collection points should be increased. Furthermore sewage treatment processes should be suitably adapted to increase the rates of removal of these drugs.

Láser de baja potencia en el tratamiento de las calcificaciones de hombro / Low power laser in the treatment of shoulder calcifications

Introducción: La artropatía o enfermedad por depósito de cristales es la entidad en la que el factor desencadenante de la respuesta inflamatoria es la presencia de microcristales en las estructuras articulares, pudiendo conducir con el tiempo a la lesión articular. No necesariamente se asocia a manifestaciones clínicas, y frecuentemente es un hallazgo radiológico casual. Objetivos: Se evaluó la eficacia del láser de baja potencia en pacientes con calcificaciones periarticulares de hombro con respecto al tratamiento convencional con iontoforesis. Material y métodos: Se llevó a cabo un estudio longitudinal, prospectivo y explicativo, de corte experimental, donde se aplicaron 2 tipos de tratamientos, el convencional con iontoforesis y el láser de baja potencia utilizando las técnicas de la ser puntura y la serterapia, para lo cual se emplearon equipos de fabricación cubana. La muestra estuvo conformada por 46 pacientes con síndrome doloroso agudo localizado en hombro, que asistieron a la consulta de ortopedia y recibieron tratamiento en el Servicio de Rehabilitación de la Clínica Central Cira García. Para medir el grado de eficacia de la terapéutica utilizada en ambos grupos de trabajo se empleó el test de Constant. Resultados y conclusiones: Predominó el sexo masculino y el grupo de edad más afectado estuvo entre 38 y 57 años de edad. El uso del láser fue efectivo para el tratamiento del hombro doloroso por calcificaciones articulares, lo cual se evidencia en la disminución del dolor, el aumento de la movilidad y de la potencia muscular. Los pacientes tratados con láser notaron la mejoría inicial entre la primera y tercera sesiones de tratamiento. No aparecieron reacciones adversas con el uso del láser de baja potencia. En ambos tratamientos se logró curación, pero fue significativamente más evidente en el tratamiento con laser (AU)

Introduction: Arthropathy, or crystal deposition disease, is an entity in which the factor triggering the inflammatory response is the presence of microcrystals in the joint structures, which can eventually lead to joint lesions. Associated clinical manifestations are not always present and this disease is often identified as an incidental radiological finding. Objective: We evaluated the effectiveness of low power laser therapy in patients with calcifications of the shoulder joints compared with conventional treatment with iontophoresis. Material and methods: We performed a longitudinal, experimental, prospective, explanatory y study, in which two types of treatments were applied: conventional treatment with iontophoresis and low power laser using the laser puncture techniques and laser therapy, with devices manufactured in Cuba. The sample was composed of 46 patients with acute painful syndrome located in the shoulder attending the outpatient orthopedic clinic and receiving treatment in the Rehabilitation Service of the Cira Garcia Central Clinic. To measure the degree of effectiveness of the therapy used in the two groups, the Constant test was used. Results and conclusions: There was a predominance of male sex and the most frequently affected age group was between 38 and 57 years. The use of the laser was effective in the treatment of painful shoulder due to joint calcifications, demonstrated by decreased pain, and increased mobility and muscular power. Patients treated with laser noticed an initial improvement between the first and third treatment sessions. There were no adverse reactions with the use of low power laser therapy. Cure was achieved by both treatments but was significantly more evident with the laser treatment (AU)

Antibiotic prophylaxis for hernia repair.

BACKGROUND: The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES: The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY: In the present review, we searched for eligible trials in august 2006, using the search terms below. This revealed four new included trials (total of twelve). We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA: Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS: Twelve randomized clinical trials were identified. Six of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS: The total number of patients included was 6705 (treatment group: 4128, control group: 2577). Overall infection rates were 2.9% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 - 0.85). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.48, 95% CI 0.27 - 0.85). AUTHORS' CONCLUSIONS: Based on the results of this meta-analysis the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Nevertheless, its administration cannot either be recommended against when high rates of wound infection are observed.

[Atypical thyrogloss cyst]. / Quiste tirogloso atípico.

UNLABELLED: The thyrogloss cysts present themselves usually as unique tumorations in the anterior cervical zone, more frequently in the second decade of life and affecting equally the two sexs. They move typically with the movements of deglution and can increase its volume with infections processes. In seldom occasions, the thyrogloss cysts can present symptoms as dysphonia, dysphagia or dyspnea facts that can suggest its laryngeal extension. METHODS: We present a case of a patient affected by dysphonia of long evolution, associated to the presence of a cervical mass. The CT showed a cervical cyst with extension to the left preepiglottic and paraglottic space with compression of the left thyroid wing. Although the clinic impression was a laryngeal neoplasia, the CT helped to realize the diagnosis ofthyrogloss cyst. During the surgery the thyrogloss cyst was removed with success, with the technique of Sistrunk and the patient recovered the voice. CONCLUSIONS: We present this case and realize a bibliographic revision on thyrogloss cysts, with atypical symptoms. We discuss also the role of CT in the diagnostic process in these types of processes.

Quiste tirogloso atípico / Atypical thyrogloss cyst

Los quistes tiroglosos se presentan habitualmente como tumoraciones únicas en la zona cervical anterior, más frecuentemente en la segunda década de la vida y afectando por igual a ambos sexos. Se desplazan típicamente con los movimientos deglutorios y pueden aumentar de tamaño con los procesos infecciosos. En raras ocasiones, los quistes tiroglosos cursan con síntomas tales como disfonía, disfagia o disnea hecho que debe sugerirnos la extensión laríngea del mismo. Métodos: Se presenta el caso de un paciente con una disfonía de de larga evolución asociada a la presencia de una masa cervical. La TAC mostró un quiste cervical con extensión hacia el espacio preepiglótico y paraglótico izquierdo con compresión del ala tiroidea izquierda. A pesar de que la impresión clínica era la de una neoplasia laríngea, la TAC ayudó a realizar el diagnóstico de quiste tirogloso. Durante la cirugía, el quiste tirogloso fueextraído con éxito mediante la técnica de Sistrunk y el paciente se recuperó de su disfonía. Conclusiones: Se presenta este caso y se realiza una revisión bibliográfica sobre quistes tiroglosos que cursan con síntomas atípicos. Asimismo se discute el papele de la TAC en el proceso diagnóstico de este tipo de procesos

The thyrogloss cysts present them selves usually as unique tumorations in the anterior cervical zone, more frequently in the second decade of life and affecting equally the two sexs. They move typically with the movements of deglution and can increase its volume with infections processes. In seldom occasions, the thyrogloss cysts can present symptoms as dysphonia, dysphagia or dyspnea facts that can suggest its laryngeal extension. Methods: We present a case of a patient affected by dysphonia of long evolution, associated to the presence of a cervical mass. The CT showed a cervical cyst with extension to the left preepiglottic and paraglottic space with compression of the left thyroidwing. Although the clinic impression was a laryngeal neoplasia, the CT helped to realize the diagnosis of thyrogloss cyst. During the surgery the thyrogloss cyst was removed with success, with the technique of Sistrunk and the patient recovered the voice. Conclusions: We present this case and realize a bibliographic revision on thyrogloss cysts, with atypical symptoms. We discuss algo the role of CT in the diagnostic process in these types of processe

[Monoclonal gammopathy: a frequently overlooked diagnosis]. / Gammapatía monoclonal: un diagnóstico frecuentemente soslayado.

OBJECTIVE: To know the rate of occurrence of monoclonal bands in a clinical laboratory as an estimate of monoclonal gammopathy incidence, and to detect the proportion of these bands in which an explicit clinical diagnosis or follow-up request is not established. Other objectives are to describe its distribution and the characteristics of the patients. PATIENTS AND METHODS: 200 patients were studied in which a monoclonal band had been detected de novo. RESULTS: The incidence was 6.59 x 10(-4) year(-1). In 59.5% a diagnostic assumption was not stated. Most frequent diagnosis in the group of patients with a diagnosis was monoclonal gammopathy with uncertain meaning. Average age of patients was 74.4 years and the difference between percentages by sex was statistically significant. DISCUSSION: The data suggest a lack of clinical effort when the result is the appearance of a monoclonal band. There is no discrepancy in the distribution of the bands and in the characteristics of the patients with regard to what is described in other studies.

Antibiotic prophylaxis for hernia repair.

BACKGROUND: The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES: The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY: Searches in the Cochrane Colorectal Cancer Group specialized register were conducted crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search in Medline (WebSPIRS from Silver Platter, January/1966 to March/2004) and Embase (1976 to December/2003) was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA: Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS: Eight randomized clinical trials were identified. Three of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS: The total number of patients included was 2907 (treatment group: 1421, control group: 1486). Overall infection rates were 2.88% and 4.3% in the prophylaxis and control groups, respectively (OR 0.65, 95%CI 0.35 - 1.21). The subgroup of patients with herniorrhaphy had infection rates of 3.78% and 4.87% in the prophylaxis and control groups, respectively (OR 0.84, 95%CI 0.53 - 1.34). The subgroup of patients with hernioplasty had infection rates of 1.2% and 3,3% in the prophylaxis and control groups, respectively (OR 0.28, 95%CI 0.02 - 3.14). REVIEWERS' CONCLUSIONS: Based on the results of this meta-analysis, there was no clear evidence that routine administration of antibiotic prophylaxis for elective inguinal hernia repair reduced infection rates.

Antibiotic prophylaxis for hernia repair.

BACKGROUND: The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES: The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY: Searches in the Cochrane Colorectal Cancer Group specialized register were conducted crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot*, as free text and MeSH terms. A similar search in Medline (WebSPIRS from Silver Platter, January/1966 to November/2002) and Embase (1976 to December/2002) were conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA: Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS: Seven randomized clinical trials were identified. Two of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS: The total number of patients included was 2660 (treatment group: 1297, control group: 1363). Overall infection rates were 3.08% and 4.69% in the prophylaxis and control groups, respectively (OR 0.61, 95%CI 0.32 - 1.17). The number of patients who need to be treated with prophylaxis (NNT) to prevent one infection in at least 30 days was 50 (95%CI 25 to infinite). The subgroup of patients with herniorrhaphy had infection rates of 3.78% and 4.87% in the prophylaxis and control groups, respectively (OR 0.84, 95%CI 0.53 - 1.34). NNT was 100 (95%CI 34 - infinite). The subgroup of patients with hernioplasty had infection rates of 1.3% and 4.2% in the prophylaxis and control groups, respectively (OR 0.28, 95%CI 0.02 - 3.14). NNT is 25 (IC95% NNH 25 to NNT 8). REVIEWER'S CONCLUSIONS: Based on the results of this meta-analysis, there was no clear evidence that routine administration of antibiotic prophylaxis for elective inguinal hernia repair reduced infection rates.

[Acute recurring pancreatitis due to gastric duplication]. / Pancreatitis aguda recidivante por duplicación gástrica.

We report the case of a young female patient with a gastric duplication communicating with the pancreas, which manifested clinically as episodes of acute relapsing pancreatitis. We analyze the diagnostic procedures and treatment methods, and review similar cases reported in the literature.

Entrenamiento intenso de atletismo en personas con síndrome de Down: beneficios fisiológicos y socioeducativos / No disponible

El trabajo expone los resultados obtenidos en un grupo de adolescentes y jóvenes con síndrome de Down, que han seguido durante cuatro años un entrenamiento exigente en el campo del atletismo. El entrenamiento iba seguido de competiciones oficiales. El índice de asistencia a entrenamientos fue superior al 80%, lo que demuestra su motivación. Ya en el primer año experimentaron pérdida de peso graso y aumento de peso magro (muscular) y óseo, efecto que fue más marcado en las mujeres que tenían sobrepeso u obesidad. A lo largo del período de entrenamientos, mejoraron sus marcas en pruebas de resistencia, velocidad, saltos, lanzamiento y fuerza. Pero junto a la mejoría física, son de destacar las repercusiones en su estado psicosocial: mejora de la autoestima, modificaciones de actitudes, espíritu de superación, motivación, sentimiento de grupo. A la vista de los beneficios que el ejercicio físico exigente reporta al estado de salud, entendido en su más amplio sentido, y de la capacidad que los jóvenes con síndrome de Down tienen para realizarlo, se recomienda el desarrollo sistemático de programas que hagan posible la práctica ordinaria de atletismo

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