Identifying pollution dynamics using discrete Fourier transform: From an urban-rural river, Central Mexico.

The quality of life and human survival is dependent on sustainable development and sanitation of water bodies in an environment. The present research focuses on cyclicity data of more than 750,000 records of parameters associated with the water quality from a rural-urban river monitoring stations in real-time from River Atoyac in Central Mexico. The events detected in the instrumental records correlated with 2528 laboratory and instrumental determinations. The 64 polluting compounds were grouped into inorganic compounds (metals and metalloids) and organic compounds (pesticides, herbicides, hydrocarbons). Metal associated compounds were grouped along mechanical, pharmaceutical and textile industries which associates itself with the entry of polluting components. The cyclicity of the events was detected through Discrete Fourier Transformation time series analysis identifying the predominant events in each station. These highlight the events at 23-26 h corresponding to a circadian pattern of the metabolism of the city. Likewise, pollution signals were detected at 3.3, 5.5, and 12-14 h, associated with discharges from economic activities. Multivariate statistical techniques were used to identify the circadian extremes of a regionalized cycle of polluting compounds in each of the stations. The results of this research allow pollution prevention using a mathematical analysis of time series of different quality parameters collected at monitoring stations in real-time as a tool for predicting polluting events. The DFT analysis makes it possible to prevent polluting events in different bodies of water, allowing to support the development of public policies based on the supervision and control of pollution.

Terapéutica en Atención Primaria. Uso de los opioides en pacientes con dolor oncológico / Therapy in Primary Health Care. Use of opioids in cancer patients with pain

Los opioides representan la mejor arma terapéutica para el control del dolor en el paciente oncológico. Más de la mitad de los pacientes con dolor oncológico precisarán, a lo largo de su seguimiento, tratamiento con opioides del 3.er escalón de la Organización Mundial de la Salud (OMS) para ser controlados. El tipo de interacción con los receptores opioides determina las distintas acciones farmacológicas y sus efectos adversos. Pero además las sustancias opioides pueden interaccionar sobre otros sistemas de neurotransmisores y otros receptores. La codeína y el tramadol constituyen el segundo nivel de la escala de la OMS, eficaces en dolor moderado. Se caracterizan por tener techo analgésico. Dentro de este grupo se incluye a la buprenorfina. La morfina, la oxicodona, el fentanilo y la metadona son igual de eficaces para el control del dolor. La selección de uno u otro depende de la vía de administración, el coste del fármaco y los efectos secundarios. La morfina es el opioide mayor de elección aunque no existen estudios concluyentes. El tratamiento del dolor oncológico debe incluir siempre dosis de opioides de rescate para control del dolor irruptivo. Debemos de tener siempre en cuenta los efectos secundarios de los opioides y prevenirlos. La rotación o el cambio de opiáceos es una alternativa terapéutica para mejorar la relación entre la eficacia analgésica y la aparición de efectos secundarios de tratamiento opi

Opioids are the best therapeutic armamentarium for the control of pain in the oncology patient. More than half of the cancer patients with pain will need treatment with opioid treatment (WHO step 3) during their follow-up to be controlled. The type of interaction with the opioid receptors determines the different drug actions and their adverse effects. However, opioid substances can also interact on other neurotransmitter systems and other receptors. Codeine and tramadol make up the second level on the WHO scale, and are effective in moderate pain. They are characterized by having an analgesic ceiling effect. Buprenorphine are included within this group. Morphine, oxycodone, phentanyl and methadone are as effective to control pain. Choosing one or the other depends on the administration route, drug cost, side effects. Morphine is the opioid of choice, although there are no conclusive studies. Treatment of cancer pain should always include rescue opioid dose to control irruptive pain. We should always keep the side effects of opioids in mind and prevent them. Rotation or change of opiates is a therapeutic alternative to improve the relationship between analgesic efficacy and appearance of side effects of opiate treatment

A propósito de un caso de fiebre por picadura de garrapata africana / A case report of African tick bite fever

Durante muchos años, la única rickettsiosis conocida en España del grupo de las fiebres manchadas ha sido la fiebre botonosa mediterránea. Sin embargo, la existencia de viajes a países cada vez más lejanos por turismo y el continuo incremento de la inmigración ha dado lugar a un aumento de los casos de las rickettsiosis adquiridas de otros países. Presentamos el caso clínico de un paciente con fiebre por picadura de la garrapata africana (Rickettsia africae)

For many years, the only rickettsiosis known in Spain from the spotted fever group was Mediterranean boutonneuse fever. However, the existence of tourist trips to increasingly far away countries and the continuous increase of immigration have given rise to an increase in the cases of rickettsiosis acquired from other countries. We present the clinical case of a patient with African tick bite fever (Rickettsia africae)

Reduced intensity conditioning: enhanced graft-versus-tumor effect following dose-reduced conditioning and allogeneic transplantation for refractory lymphoid malignancies after high-dose therapy.

Non-myeloablative regimens have been proven to allow engraftment following allogeneic stem cells transplantation (allo-SCT) with minimal procedure-related toxicity. Conventional allo-SCT may produce remissions in patients with relapsed and refractory lymphoid malignancies (LM) but these good results may be achieved at the cost of high treatment-related morbidity and mortality. Application of allo-SCT using less intensive regimens may temper the frequency of these complications, allowing a potent graft-versus-tumor effect (GVT). We present our data on 11 patients with LM receiving allo-SCT with a reduced regimen. Ten patients had received previous high-dose therapy, and were at high risk for toxicity, thus precluding the use of allo-SCT. A fludarabine and low-dose busulfan combination facilitated engraftment while exerting GVT. Hematological recovery was quick, and full donor T cell chimerism preceded acute GVHD. GVHD and infections were the major problems. Spontaneous acute GVHD occurred in eight patients (72%). Five patients (45%) achieved complete remission, and the GVT effect was closely associated with GVHD. These results support the concept that GVT is effective against LM in patients who have been heavily pretreated. Further studies are needed to investigate strategies to generate more specific alloreactive effects providing optimal GVT and an acceptable risk of GVHD and infections.

Evaluación de una intervención educativa para el manejo de inhaladores en Atención Primaria / Evaluation of an educational intervention for the use of inhalers in primary health care

Fundamentos: la efectividad terapéutica de la medicación inhalada tiene estrecha relación con la corrección de la técnica utilizada. Objetivo: evaluación de la efectividad de una intervención educativa para el manejo de inhaladores. Diseño: estudio de evaluación antes-después. Material y métodos: estudio ubicado en Atención Primaria incluyéndose pacientes que seguían tratamiento al menos un mes, bien con inhaladores presurizados de dosis controlada (MDI), bien con inhaladores de polvo seco (DPI) tipo Turbuhaler. Se excluyeron los que presentaran dificultades físicas o psíquicas para aprender la técnica y los que rechazaran colaborar. La evaluación se realizó antes y después de la intervención mediante una escala basada en los criterios clásicos de Newman; considerándose puntuación "aceptable" si se obtenían más de 70 puntos. La intervención consistió en la explicación de la técnica a los pacientes en una entrevista individual. Se realizó una comparación de porcentajes mediante el test de McNemar para datos apareados y el método de ajuste de Mantel- Haenszel. Resultados: N=45, 64 porciento varones; edad media 56 (18-73) años. Diagnóstico más frecuente: enfermedad pulmonar obstructiva crónica (49 porciento). 38 porciento utilizaban MDI, 33 porciento DPI y 29 porciento ambos. 32 y 27 porciento, que utilizaban DPI y MDI respectivamente, obtuvieron una puntuación aceptable. Estos porcentajes aumentaron de forma estadísticamente significativa tras la intervención, alcanzando el 60 porciento para MDI (p=0,013) y el 79 porciento para DPI (p=0,001). No se observaron modificaciones con el ajuste por edad, sexo, tipo de patología y educador. Conclusión: la intervención educativa es efectiva, produciendo clara mejoría en la técnica de utilización de ambos inhaladores (AU)

[Crossed atrioventricular connection with straddling of the right atrioventricular valve]. / Conexion atrioventricular cruzada con cabalgamiento de la valvula atrioventricular derecha.

We describe one patient with crossed atrioventricular connection in situs inversus, concordant atrioventricular connection, double outlet right ventricle, and straddling of the right atrioventricular valve. Angiographic features are analyzed, pointing out the importance of selective angiography in order to define the atrioventricular and ventriculoarterial connections. The utility of bidimensional echocardiographic study before cardiac catheterization is emphasized in order to know the associated malformations.

[Osteodysplasty (Melnick-Needles syndrome) (author's transl)]. / Osteodisplastia: síndrome de Melnick-Needles. Una variedad de displasis ósea. Descripción de un neuvo caso.

Authors report a new case of osteodisplasty (Melnick-Needles syndrome) and describe radiological findings that are typical of this entity: bony sclerosis of base structures, abnormal dental alignment, sclerosis and irregularity of clavicles and ribs, described as "band-like" deformity, cortical irregularity of tubular bones with metaphyseal flaring and diaphyseal bowing. Flat bones are broadened, particularly iliac crest and vertebral bones. Facial features described by the majority of authors in this entity are present in our patient in an incomplete form: craniofacial disproportion, micrognatia, depressed temples, exophthalmus (not in our patient) and broadened forehead. The paper is intended to gather clinical data of already reported cases in order to facilitate clinical research in the future from the immunological, genetical and biochemical points of view. Our patient has the same clinical history as the patient studied in the original paper. Dr. Melnick was kind enough to send us clinical data and autopsy findings.