Uncommon case of Mycobacterium bovis brain abscess complicated by suppurative fistula, and review of the literature. / Caso insólito de absceso cerebral por Mycobacterium bovis complicado con fístula supurativa y revisión de la bibliografía.

INTRODUCTION: Mycobacterium bovis is an infrequent cause of central nervous system tuberculosis in Spain, with few cases described in the literature. Since compulsory pasteurization of milk and implementation of eradication programs on infected cattle, human sporadic illness with this organism has dramatically declined in developed countries. CASE REPORT: A 71-year-old immunocompromised male, who presented a calvarial lytic lesion. A craniotomy for the total resection of the lesion was performed and the microbiology results were positive for M. bovis, therefore antituberculous therapy was initiated. Despite of the correct treatment, the patient developed a tuberculous abscess that required an aggressive surgical management followed by a suppurative fistula. Based on the treatment of tuberculous lymphadenitis, we decided to perform a conservative management with antituberculous therapy (isoniazid + rifampicin + ethambutol + moxifloxacin + steroids during 12 months) and avoided new surgical cleanings of the surgical bed obtaining a good response and a good clinical evolution. CONCLUSIONS: As far as we know, this is the first case reported of a suppurative fistula after the resection of a cerebral abscess caused by M. bovis, therefore, there is no report in the literature about the treatment of this complication.

TITLE: Caso insólito de absceso cerebral por Mycobacterium bovis complicado con fístula supurativa y revisión de la bibliografía.Introducción. Mycobacterium bovis es una causa infrecuente de tuberculosis del sistema nervioso central en España, del cual existen pocos casos descritos en la bibliografía. Desde la pasteurización obligatoria de la leche y la implementación de programas de erradicación del ganado infectado, la enfermedad esporádica humana con este organismo ha disminuido drásticamente en los países desarrollados. Caso clínico. Varón inmunoafectado de 71 años, que presentaba una lesión lítica esporádica en la calota. Se realizó una craneotomía de la lesión y los resultados de microbiología fueron positivos para M. bovis, por lo que se inició tratamiento con terapia antituberculosa. A pesar del tratamiento correcto, el paciente desarrolló un absceso tuberculoso, que requirió un tratamiento quirúrgico agresivo, seguido de una complicación con una fístula supurativa. Sobre la base del tratamiento descrito para la linfadenitis tuberculosa, se decidió realizar un tratamiento conservador de la fístula supurativa, sin realizar nuevas limpiezas del lecho quirúrgico, y mantener de manera prolongada la terapia antituberculosa (isoniacida + rifampicina + etambutol + moxifloxacino + esteroides durante 12 meses), con lo que presentó una buena evolución clínica. Conclusiones. Hasta la fecha, éste es el primer caso descrito de una fístula supurativa después de la resección de un absceso cerebral causado por M. bovis, por lo que no existe en la bibliografía artículo alguno que describa el tratamiento adecuado de esta complicación.

Encefalopatía crónica postraumática: aquella gran desconocida / Chronic traumatic encephalopathy: the unknown disease

La encefalopatía crónica postraumática es una enfermedad neurodegenerativa fruto de la acumulación de numerosos traumatismos craneoencefálicos, para la cual no existe un diagnóstico premórtem definitivo ni un tratamiento específico. Entre los factores de riesgo asociados con la encefalopatía crónica postraumática se encuentran: la exposición a deportes de contacto, la presencia de la apolipoproteína E4 y la edad avanzada. Histopatológicamente, aunque comparte ciertas características con la enfermedad de Alzheimer, tiene una presentación más específica (depósito de proteína tau fosforilada en forma de ovillos neurofibrilares, asociados a acúmulo de elementos del neuropilo, acompañados en ocasiones de placas de beta-amiloide). Clínicamente se caracteriza por un curso lento que se inicia con síntomas cognitivos leves y emocionales, y progresa hacia la aparición de síntomas parkinsonianos y demencia. A pesar de que existen elementos diagnósticos prometedores, no son, actualmente, una realidad, y la clave en el manejo de esta enfermedad es la prevención y la detección precoz de sus primeros síntomas (AU)

Chronic traumatic encephalopathy is a neurodegenerative disease produced by accumulated minor traumatic brain injuries; no definitive premortem diagnosis and no treatments are available for chronic traumatic encephalopathy. Risk factors associated with chronic traumatic encephalopathy include playing contact sports, presence of the apolipoprotein E4, and old age. Although it shares certain histopathological findings with Alzheimer disease, chronic traumatic encephalopathy has a more specific presentation (hyperphosphorylated tau protein deposited as neurofibrillary tangles, associated with neuropil threads and sometimes with beta-amyloid plaques). Its clinical presentation is insidious; patients show mild cognitive and emotional symptoms before progressing to parkinsonian motor signs and finally dementia. Results from new experimental diagnostic tools are promising, but these tools are not yet available. The mainstay of managing this disease is prevention and early detection of its first symptoms (AU)

Chronic traumatic encephalopathy: The unknown disease. / Encefalopatía crónica postraumática: aquella gran desconocida.

Chronic traumatic encephalopathy is a neurodegenerative disease produced by accumulated minor traumatic brain injuries; no definitive premortem diagnosis and no treatments are available for chronic traumatic encephalopathy. Risk factors associated with chronic traumatic encephalopathy include playing contact sports, presence of the apolipoprotein E4, and old age. Although it shares certain histopathological findings with Alzheimer disease, chronic traumatic encephalopathy has a more specific presentation (hyperphosphorylated tau protein deposited as neurofibrillary tangles, associated with neuropil threads and sometimes with beta-amyloid plaques). Its clinical presentation is insidious; patients show mild cognitive and emotional symptoms before progressing to parkinsonian motor signs and finally dementia. Results from new experimental diagnostic tools are promising, but these tools are not yet available. The mainstay of managing this disease is prevention and early detection of its first symptoms.

Scaling of heat transfer and temperature distribution in granular flows in rotating drums.

Accurate prediction of the time required to heat up granular materials to a target temperature is crucial for several processes. However, we do not have quantitative models to predict the average temperature or the temperature distribution of the particles. Here, we computationally investigate the scaling of heat transfer in granular flows in rotating drums. Based on our simulations, which include a wide range of system and material properties, we identify the appropriate characteristic time that is used to derive equations that predict the particles' average temperature and the particles' temperature distribution.

¿Existe correlación clínica o radiológica a la existencia de inflamación detectable histológicamente en el disco lumbar herniado? Resultados de una serie consecutiva de pacientes operados de hernia discal lumbar / Is there a clinical or radiological correlate to the histological evidence of an inflammatory infiltrate in the herniated disc? Results of a consecutive series of patients surgically treated of herniated lumbar disc

Objetivo: Establecer la relevancia clínica de la presencia de infiltrados de células inflamatorias evidenciables histológicamente en muestras de hernias de disco lumbares operadas. Material y método: Se obtuvieron muestras de discos lumbares de 50 pacientes operados de forma consecutiva durante el año 2012. Se recogieron los datos clínicos y epidemiológicos de los pacientes antes de la cirugía, el tiempo de evolución de los síntomas, así como la presencia de radiculopatía, déficits neurológicos y la exploración. Se estableció el carácter extruido o contenido de la hernia en RM. Se estableció la presencia y cuantía de celularidad condrocitaria como signo de degeneración discal. Resultados: Aunque casi todos las muestras reflejaban proliferación condrocitaria, la presencia de infiltrados inflamatorios o neovascularización fue escasa. La presencia de inflamación se relacionó invariablemente con la formación de nuevos vasos en el disco, no relacionándose con ninguna variable clínica o radiológica. Conclusión: No hay relación entre la presencia de infiltrados inflamatorios y los datos clínicos registrados. La presencia de infiltrados inflamatorios en el interior del disco herniado no tiene relación ni con la degeneración discal ni con la producción de clínica dolorosa (AU)

Objective: To establish the clinical relevance of the histological evidence of inflammatory cell infiltrates in surgical samples of operated lumbar disc hernia. Material and method: Surgical samples, clinical, and epidemiological data were obtained from 50 patients consecutively operated on of lumbar disc herniation during 2012 were obtained. Also the MR appearance as extruded or contained hernia was recorded. All samples were processed using hematoxilin-eosin staining and different histological parameters were determined such as the presence and quantity of chondrocytes present in the disc as a sign of disc degeneration. Results: Even though the majority of samples examined showed signs of disc degeneration, such as the presence of chondrocyte proliferation, the evidence of neovascularisation or inflammatory infiltrates was scarce. The presence of inflammatory infiltrates was invariably related to the presence of neovascularisation. However, the presence of inflammatory infiltrates was not related to any radiological or clinical variable. Conclusion: There is no relation between the presence of inflammatory infiltrates and the clinical data registered. The presence of histological evidence of inflammation in herniated lumbar disc tissue is not related to disc degeneration or the presence of pain (AU)

Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

BACKGROUND AND PURPOSE: In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. MATERIALS AND METHODS: We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. RESULTS: There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. CONCLUSIONS: In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies. Ligamentous injury detected by MR imaging is not a dynamic finding; thus it proved to be useful in predicting neurologic outcome in patients for whom the MR imaging examination was delayed.

Intraparenchymal schwannomas: report of two new cases studied with MRI and review of the literature.

Intraparenchymal schwannomas are very rare tumours. We present two young adult patients operated for this type of lesion who show no signs of recurrence 2 years after surgery. These tumours have a bimodal peak of presentation: most occur in young patients under 25 years, and the rest present in the elderly. Characteristically they show both Antoni A and Antoni B areas, intense inmunoreactivity to S-100 and Vimentin protein, and none to EMA or CD34. Electron microscopy is diagnostic when basal membrane is found around the cytoplasmatic processes. MRI spectroscopy depicts increased myoinositol, choline and lipids, and perfusion MR demonstrates high rCBV with a characteristic curve due to the total absence of blood brain barrier. An origin in the Schwann cells of the perivascular nervous plexus in the subarachnoid space is the most accepted theory for the histogenesis of these tumours. We propose to perform the characterization of a series of markers such as SOX-10 in every new case in order to prove that theory.

Update of risk assessments of main marine biotoxins in the European Union.

This review is an up-to-date compilation of the available literature, including scientific papers, reviews, and EFSA's opinions, on toxicity and risk assessment data on the main marine biotoxins of importance in the European Union, including the legislated ones and the ones of recent appearance which are not legislated. Information about the hazard identification and hazard characterisation of okadaic acid, dynophysistoxins, pectenotoxins, yessotoxins, azaspiracids, domoic acid, saxitoxins, tetrodotoxins, brevetoxins, ciguatoxins, cyclic imines and palytoxins is reviewed and presented in the form of a collection of risk assessments. It is concluded that the importance of having an appropriate exposure assessment reiterates the urgency of establishing a database with representative and comparable data on exposure to food items possiby containing marine biotoxins. It is also concluded that a revision of the present regulation of marine biotoxins in the EU legislation could be considered, as some regulated toxins have been shown not to pose a risk for EU's population (as yessotoxin) and some non regulated toxins have been shown to be harmful and/or to occur in the EU (as tetrodotoxin, palytoxin, and some cyclic imines) while they are not regulated.

[Mortality in a cohort of sugar refinery workers in Arezzo Province, Italy]. / Mortalità negli addetti di uno zuccherificio nell'aretino.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate mortality of a cohort of 1,767 male workers employed in a sugar refinery plant located in the Province of Arezzo, Italy, where asbestos had been used from the 1960's for the insulation of thermohydraulic systems and for furnaces. In 1987-88 workers removed the asbestos-cement insulation from the plant. METHODS: The cohort was composed by male workers who were employed in the plant between 1 March 1962 and 1 February 1996, and had worked for at least 2 months. Follow-up started on 1 March 1962, and ended on 31 May, 2003. The population mortality for Tuscany Region was used as the reference. The relative risk was estimated by Standardized Mortality Ratio (SMR) and the confidence intervals were calculated at a 95% level (95% CI). RESULTS: The majority of workers were employed during the summer only. Significant decreases in mortality were observed for overall mortality (SMR = 78; 95% CI = 69-88), all cancers (SMR = 80; 95% CI = 65-97), cardiovascular diseases (SMR = 64; 95% CI = 50-81), lung cancer (SMR = 66; 95% CI = 43-98), and gastrointestinal diseases (SMR = 53; 95% CI = 26-98). Non-significant increases were observed for kidney cancer (SMR = 229; 95% CI = 92-472), and diseases of the nervous system (SMR = 155; 95% CI = 71-294). Kidney cancer mortality for workers employed for > = 5 years was significantly higher (SMR = 508; 95% CI = 105-1485). CONCLUSIONS: Mortality for asbestos-related diseases did not show any increase. The higher kidney cancer mortality for workers employed for > = 5 years could be due to exposures to various carcinogens, that occurred not only in the sugar refinery plant, given that the workers were seasonal and did other jobs during the rest of the year. Asbestos-related deaths could occur in the future among some workers who in 1987-88 were employed on the removal of asbestos-cement insulation from the plant.

Clinical pharmacokinetics of parenteral dexketoprofen trometamol in healthy subjects.

Dexketoprofen trometamol, a highly water-soluble salt of the active enantiomer of rac-ketoprofen, is a nonsteroidal antiinflammatory drug used for pain relief. Two studies were conducted to determine the pharmacokinetics of the drug in healthy subjects following single intravenous (i.v.) and intramuscular (i.m.) doses of dexketoprofen. In the first study, 6 male and 6 female volunteers received 50 mg dexketoprofen (74 mg dexketoprofen trometamol) by i.v. bolus. In the second one, another 6 male and 6 female subjects received 25 mg and 50 mg of dexketoprofen by the i.m. route. Dexketoprofen plasma concentrations were determined by reverse-phase high-performance liquid chromatography (HPLC). No serious adverse events were observed and all volunteers completed the study. The main pharmacokinetic parameters were determined by a noncompartmental approach. Following the i.v. bolus, mean (+/- SEM) area under the curve AUC0-x and clearance (CL) were 9005 +/- 422 ng.h/ml and 0.089 +/- 0.004 l/h/kg. Volumes of distribution Vi and Vss averaged 0.060 +/- 0.006 l/kg and 0.104 +/- 0.003 l/kg. Mean elimination half-life (t1/2e) and MRT were 1.05 +/- 0.04 h and 1.18 +/- 0.05 h. Following single i.m. 25 mg and 50 mg dexketoprofen, a rapid absorption was observed, with tmax values ranging from 0.17 h to 0.75 h. The corresponding Cmax averaged 1851 +/- 182 ng/ml and 3813 +/- 169 ng/ml, and mean AUC0-x were 3033 +/- 193 ng.h/ml and 5878 +/- 228 ng.h/ml, respectively. No significant differences by gender were obtained following both parenteral routes. A dose proportionality in Cmax and AUC0-x was observed. Dexketoprofen pharmacokinetics following i.v. and i.m. routes, together with the availability of a single 2 ml formulation, allows for a potential advantageous rapid switch to the oral formulation when clinically possible.

Single and repeated dose pharmacokinetics of dexketoprofen trometamol in young and elderly subjects.

Dexketoprofen trometamol, a high water-soluble salt of the active enantiomer of rac-ketoprofen, is a nonsteroidal antiinflammatory drug (NSAID) widely used for pain relief. This study was conducted to determine the pharmacokinetics of this analgesic agent in elderly subjects and to compare them with young volunteers following single and repeated oral doses. Twelve healthy young and 12 elderly subjects received 25 mg oral dexketo- profen (equivalent to 37 mg of its tromethamine salt) as a single dose (day 1) and 3-day repeated doses (1 dose every 8 h for a total of 10 doses). Serial concentrations of dexketoprofen were determined in plasma and urine by a reverse-phase HPLC/ultraviolet procedure over 24 h on day 1 and after the last 10th repeated t.i.d. dose. Compared to young subjects, elderly subjects showed significant increases in AUC and t1/2,z and decreases in CL/F following single and repeated doses. After single dosing, the corresponding mean +/- SD values were 5106.6 +/- 1873.0 vs. 3605.4 +/- 897.9 ng.h/ml (p = 0.015); 1.59 +/- 0.40 vs. 1.12 +/- 0.20 h (p < 0.001); and 1.11 +/- 0.29 vs. 1.63 +/- 0.36 ml/min/kg (p < 0.001). After the repeated dose, AUC, t1/2,z and CL/F averaged 5067.8 +/- 1373.4 vs. 3194.4 +/- 694.3 ng.h/ml (p < 0.001); 1.65 +/- 0.44 vs. 1.11 +/- 0.29 h (p < 0.005); and 1.12 +/- 0.23 vs. 1.87 +/- 0.42 ml/min/kg (p < 0.001). Median tmax was 0.5 h. Cumulative excretions in urine up to 24 h of unbound, conjugated and total dexketoprofen were similar among the groups. These results suggest that dexketoprofen elimination is reduced in the elderly. Although no drug accumulation in plasma was observed after single and repeated dosing, the renal function decline in elderly patients calls for a cautious dose-adjustment in this population.

Pharmacokinetics of dexketoprofen trometamol in subjects with mild and moderate chronic renal insufficiency.

The influence of mild to moderate chronic renal insufficiency on the pharmacokinetics of dexketoprofen trometamol was evaluated. Dexketoprofen was administered to volunteers with mild (n = 8) or moderate (n = 8) renal impairment and to healthy subjects (n = 8), as a single 12.5 mg oral dose (equivalent to 18.5 mg of the tromethamine salt). All subjects completed the study and no serious adverse events were recorded. Mild and moderate renal insufficiency increased Cmax by approximately 22% and 37%, respectively, as related to normal subjects (p < 0.05 for moderate renal dysfunction). No statistically significant differences between groups were obtained for tmax, AUC, CL/F, renal CL and V/F. The cumulative urinary excretion of unchanged dexketoprofen, assessed up to 24 hours postdose, was similar in all groups (median values of 7.0%, 8.1% and 9.7% of the administered dose). On the contrary, cumulative urinary excretions of conjugated dexketoprofen decreased in subjects with mild or moderate renal insufficiency when compared to healthy controls (median and 95% CI for differences: -3.3% (-14.8% to 2.6%) and -7.3% (-22.2% to -0.2%), respectively). Conservatively, a dose adjustment of dexketoprofen in patients with impaired renal function is recommended.

Single and repeated dose pharmacokinetics of dexketoprofen trometamol in patients with impaired liver function.

Dexketoprofen trometamol, a high water-soluble salt of the active enantiomer of rac-ketoprofen, is a nonsteroidal antiinflammatory drug (NSAID) used for pain relief. This study compared the pharmacokinetics of dexketoprofen in patients with impaired liver function and normal subjects following single and repeated oral dosing. Subjects with normal liver function (n = 6) and with Child-Pugh A (n = 7) or Child-Pugh B (n = 5) hepatic impairment scores completed this open-label and parallel study. They received 25 mg dexketoprofen (equivalent to 37 mg of its tromethamine salt) as a single (day 1) and a 3-day repeated dose (1 dose every 8 hours for a total of 10 doses). Dexketoprofen concentrations were determined in plasma and urine by reverse-phase high performance liquid chromatography (HPLC). Model-independent pharmacokinetic parameters were obtained. All subjects completed the study. No serious adverse events were recorded. Following the single dose, mean (+/- SEM) Cmax were 3027.7 +/- 429.3 ng/ml (healthy subjects), 2856.3 +/- 340.3 ng/ml (Child-Pugh A) and 1937.2 +/- 328.0 ng/ml (Child-Pugh B). Median tmax were 0.49 h (0.33-0.68) h, 0.50 h (0.33-0.67) h and 0.67 h (0.33-1.50) h. AUC0-x averaged 3778.0 +/- 439.0 ng.h/ml, 4890.4 +/- 539.1 ng.h/ml and 3985.0 +/- 712.0 ng.h/ml. Mean CL/F were 101.1 +/- 11.3 ml/h/kg, 73.3 +/- 9.9 ml/h/kg and 88.8 +/- 15.5 ml/h/kg and V/F averaged 0.192 +/- 0.018 l/kg, 0.162 +/- 0.006 l/kg and 0.214 +/- 0.044 l/kg. Following the repeated administration, similar results were obtained showing no drug accumulation. As related to the administered dose, median excretions of unchanged and conjugated dexketoprofen in urine were 2.1% and 67.1% in healthy subjects, 2.8% and 60.9% in Child-Pugh A subjects and 4.4% and 47.7% in Child-Pugh B volunteers. A trend towards a reduced urinary excretion of conjugated dexketoprofen in hepatic patients, more evident in the Child-Pugh B than in the Child-Pugh A groups, was observed when compared with healthy volunteers (median and 95% CI for differences: -5.4% [-19.9% to 2.0%] and -19.4% [-45.6% to 0.4%]). Conservatively, a dose adjustment of dexketoprofen trometamol in patients with impaired hepatic function is recommended.

Immunomodulatory therapy for Vogt-Koyanagi-Harada patients as first-line therapy.

PURPOSE: To report on the use of immunomodulatory therapy (IMT) in a group of patients with Vogt-Koyanagi-Harada disease (VKH) and to compare the outcomes with those of another group of patients with VKH who were treated for prolonged periods with corticosteroids. METHODS: Treatment regimens and their respective outcomes (visual acuity) were compared for the following groups: prolonged steroid with or without delayed addition of IMT (Group 1) and relatively prompt IMT with or without steroid (Group 2). RESULTS: The average duration of follow-up in Group 1 was 28.9 months and in Group 2 23.4 months. In Group 1, visual acuity deteriorated in three of the five patients (60%) and improved in one (20%). The fifth patient showed improvement in visual acuity in one eye, but decreased visual acuity in the other eye. In Group 2, seven of the eight patients showed improvement in their visual acuities (87.5%); visual acuity deteriorated in one patient (12.5%). CONCLUSIONS: The results suggest that IMT as first-line therapy for VKH is associated with a superior visual outcome when compared to steroid as monotherapy or with delayed addition of IMT.

Relevancia del diagnóstico y tratamiento precoz de la otitis media seromucosa en pacientes con fisura palatina / Significance of early diagnosis and treatment of otitis media with effusion in cleft palate pediatric patients

Introducción: La otitis media seromucosa afectaa casi el 95% de los pacientes con fisura palatina. Elresultado de esta lesión es la pérdida auditiva, el retrasoen el lenguaje y el retraso en el desarrollo escolar.La corrección quirúrgica del paladar fisuradono mejora la permeabilidad de la trompa de Eustaquio.Objetivo: Analizar los resultados del drenaje quirúrgicode las otitis medias seromucosas que aparecenen nuestra serie de pacientes afectos de fisuradel paladar.Material y Métodos: Revisamos las historias de72 pacientes fisurados en el período 1998-2004. Delos 72 pacientes pediátricos, sólo 57 fueron adecuadospara el estudio. En todos los pacientes se realizóotoscopia y audiometría para comprobar la movilidadde la membrana timpánica y la pérdida auditiva.El seguimiento se realizó en la consulta de ORLinfantil de forma trimestral durante el primer añoposterior al drenaje y cada 6 meses los 3 años siguientes.El seguimiento medio fue de 22 meses (6meses a 7 años).Resultados: La prevalencia de la otitis media seromucosauni o bilateral de los 57 pacientes estudiadospor otoscopia fue del 84.3%. De los 57 pacientesestudiados, 9 no tuvieron datos de otitis media ysus audiometrías fueron normales (15.7%). Otros 16pacientes fueron tratados médicamente de su otitisserosa debido a la conservada movilidad del tímpanoy no fueron inicialmente candidatos a drenajequirúrgico. En 20 casos se insertaron tubos de ventilacióna la vez que se realizó la palatoplastia mientrasque en 12 casos los tubos se colocaron posteriormenteal cierre del paladar. De los 32 pacientescon miringotomías y tubos de ventilación, 5 casospresentaron otorrea crónica sin pérdida auditiva. En7 de estos niños aparecieron episodios de otitis a lolargo del seguimiento si bien sólo 4 presentaban otitisseromucosa persistente en la última revisión. En5 pacientes fue necesario reinsertar otro tubo porpersistencia de la enfermedad tras la caída del tubooriginal. Pese al tratamiento quirúrgico efectivo, encasi un 15% de los niños de nuestra serie persiste laotitis media seromucosa (5 pacientes).Conclusiones: La miringotomía junto con la colocaciónde tubos transtimpánicos a la vez que lareparación del paladar es la mejor estrategia paraasegurar la mejor audición con la mínima morbilidad.Pese al tratamiento efectivo, en un 15% delos niños fisurados persiste la otitis media seromucosa

Introduction: Otitis media with effusion affects toalmost 95% of the patients with cleft palate. Theconsequences of this pathology are hearing loss, alterationin the language and delay in school development.The surgical correction of the cleft palatedoes not improve the permeability of the Eustachiantube. Aim: to analyze the results of the surgical drainageof Otitis media with effusion that appears in ourserie of patients with cleft palate.Material and Methods: we review the clinical dataof 72 cleft palate patients from 1998 to 2004. Ofthe 72 pediatric patients, only 57 they were adequatefor the study. In all the patients was carried outotoscopy and audiometry to verify the mobility of themembrane and the auditory loss. The monitoringwas carried out in the consultation of ORL during thefirst subsequent year drainage and each 6 monthsthe 3 following years. The mean follow-up was 22months (6 months to 7 years).Results: The prevalence of otitis serosa with effusionwas 84.3%. Of the 57 patients studied, 9 did notthey have data of otitis and their audiometries werenormal (15.7%). Other 16 patients were treated medicallyand they were not initially candidates to surgicaldrainage. In 20 cases ventilation tubes were insertedat the same time that the palatoplasty was carriedout. In 12 cases the grommets were placed afterthe palate surgery. Of the 32 patients with miringotomyand grommets, 5 cases presented chronicotorrea without auditory loss. Recurrent otitis duringfollow-up appeared in 7 of these children. But only 4cases presented otitis with effusion in the last revision.In 5 patients was necessary to insert anothertube by persistence of the effusion after the fall of theoriginal grommet. In 15% of the children of our seriespersists otitis seromucosa with effusion (5 patients).Conclusions: The miringotomy along with theplacement of grommets at the same time of the repairof the palate is the most accurate strategy to assurethe best hearing with the minimum morbidity

Factors associated with inadequate prenatal care in Ecuadorian women.

BACKGROUND: Although inadequate prenatal care has been associated with adverse perinatal outcomes, reports on the factors associated with poor prenatal care in developing Latin American countries are scarce. OBJECTIVE: To determine factors associated with inadequate prenatal care among women from low socioeconomic circumstances. METHOD: Women delivered after a pregnancy duration of more than 20 weeks at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, were surveyed. The questionnaire collected sociodemographic data and reasons for having inadequate prenatal care. Adequacy of prenatal care was measured with the Kessner index and correlated to the sociodemographic data. RESULTS: During the study period, 1016 pregnant women were surveyed. Among them, there were adolescents (23.7%), primigravidas (30.8%), and women with a high-risk pregnancy (29.3%). According to the Kessner index, prenatal care was considered adequate or inadequate in 24.5% and 75.5% of cases, respectively. Knowledge regarding the importance of adequate prenatal care and the effects of poor prenatal care was lower among women who had received inadequate prenatal care. The women that were considered to have had adequate prenatal care had at least one visit, and they were more often cared for by a specialist than women who considered having inadequate prenatal care. The three most important reasons associated to inadequate prenatal care in this series (n=767), were economic difficulties having to care for a small child, and transportation difficulties. Logistic regression analysis determined that women with undesired pregnancies who resided in rural areas and were para 5 or higher had an increased risk of inadequate prenatal care. On the other hand, an adverse outcome to a prior pregnancy (abortion, intrauterine fetal demise, or ectopic pregnancy) decreased this risk. Marital status and educational level were confounding factors. CONCLUSIONS: Although prenatal care at our institution is free, adequacy was thought to be low. The main factors associated with poor prenatal care were mostly conditions related to poverty.

[HIV/AIDS prevention in prisons: experience of participatory planning]. / Prevención del VIH/sida en el medio penitenciario: una experiencia de planificación participativa.

OBJECTIVE: To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. METHODS: Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts. RESULTS: Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice. CONCLUSIONS: The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.

Prevención del VIH/sida en el medio penitenciario: una experiencia de planificación participativa / HIV/AIDS prevention in prisons: experience of participatory planning

Objetivo: Describir la aplicación de metodologías participativas en el medio penitenciario en la identificación de los contenidos y métodos más adecuados para una intervención frente al VIH/sida. Métodos: Estudio comunitario en la población del Centro de Cumplimiento del Establecimiento Penitenciario de Valencia(1.250 internos/as). El estudio se ha realizado en dos fases: la identificación de informadores clave y la recogida de información. En esta etapa se ha realizado un Foro Comunitario con los internos e internas del centro, entrevistas personales a internas penadas, y un cuestionario autocumplimentado a los profesionales de la salud y directivos del centro, y a personas expertas en promoción de la salud. Resultados: Foro Comunitario. Las propuestas que los internos e internas del centro formularon con relación a cómo combatirla infección por VIH/sida fueron: a) las dirigidas a ellos/asmismos/as, en el sentido de aumentar las medidas preventivas en el uso de material de inyección de drogas y en las relaciones sexuales, y b) las dirigidas a la Administración (aumentarla distribución de preservativos, maquinillas de afeitar y lejía, e iniciar la entrega de material de inyección estéril). En las entrevistas personales, en relación a cómo debería ser un (..) (AU)

Objetive: To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. Methods: Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates)in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center’s male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center’s health professionals and management as well as to health promotion experts. Results: Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those (..) (AU)

[A hearing in prison: health needs perceived by women deprived of freedom]. / Una audición en prisión: necesidades de salud percibidas por mujeres privadas de libertad.

OBJECTIVE: To identify the perceived necessities and proposals for health action of women committed to a detention centre. DESIGN: A study of needs through a method of social intervention, the hearing. SETTING: The detention centre of the penitentiary of Valencia (Picassent). The area of application is primary care in the penitentiary. PARTICIPANTS: 38 women were chosen on criteria of proportional representation in line with the profile of the total number of women (112) who lived in module 8 of the centre, and according to agreed defining variables such as age, ethnic background and drugs consumption. RESULTS: The women's replies showed they had an integrated view of the concept of health. They identified HIV/AIDS infection, drugs and food as the health problems that most concerned them; and formulated proposals aiming at actions on these and other aspects such as personal relationships, psychological problems and their surrounds. CONCLUSIONS: The method employed was shown to be useful for identifying the needs and proposals of women deprived of liberty. This information could certainly be used to discuss and rework with the inmates themselves, so as to win their participation in the actions decided on.