Con respecto al artículo publicado Métodos y sustancias empleados en la conducta suicida en adolescentes, realidad en el Perú / Concerning the Published Article Métodos y sustancias empleados en la conducta suicida en adolescentes [Methods and substances involved in teen suicide]

El suicidio es un fenómeno que ha sido abordado a partir diversas disciplinas y, actualmente, es un problema mundial de salud pública, se considera la segunda causa más frecuente de muerte entre los jóvenes de 11 a 29 años1 y, en las Américas, constituye la causa principal número 21.2) Dentro de los métodos más comunes de suicidio descritos en la actualidad están el ahorcamiento, el envenenamiento con pesticidas y las armas de fuego. En el artículo de Cortés Alfaro se menciona el ahorcamiento como la causa más común de suicido registrada entre los años 2003 al 2005 dentro de la región.3 Sin embargo, esta situación no se ve reflejada dentro de la realidad en los años en mención de los países sudamericanos, como se puede evidenciar en datos procedentes de Perú; en donde entre los años 2004 y 2013 menciona que 22 por ciento de los suicidios se produjeron en la población peruana entre los 10 y 19 años y en los años 2004-2006 el método más común utilizado fue el envenenamiento por uso de sustancias toxicas, lo que contradice lo mencionado en el estudio. En los años 2007 al 2012 este método fue disminuyendo de manera gradual, fue reemplazado por otros métodos como por ejemplo el uso de armas de fuego, el ahorcamiento, lanzamiento al vacío y otros no especificados, según...(AU)

Intestinal obstruction due to a congenital band in a 28-week pregnant woman. Report of a case

La oclusión intestinal es una complicación rara en el embarazo. Se informa de un caso de oclusión intestinal mecánica por brida congénita en una gestante de 28 semanas. Se realiza laparotomía con lisis de brida, con buena evolución postoperatoria. Se hace una breve revisión del tema (AU)

Intestinal obstruction is a rare complication in pregnancy. We report a case of mechanical intestinal obstruction due to a congenital band in a 28-week pregnant woman. Laparotomy was performed with lysis of the band and good postoperative outcome. We provide a brief review of the topic (AU)

Septic shock without documented infection: an uncommon entity with a high mortality.

OBJECTIVES: To determine whether patients with clinically identified infection have the same outcome as patients with apparent sepsis but no identified infectious source. DESIGN: Retrospective analysis of patient data. PATIENTS: All patients treated with septic shock in a 31-bed intensive care unit (ICU) over a 3-year period. RESULTS: Data from 227 patients were analysed. Eighty-seven percent had a clinically identified source of infection. ICU mortality was higher in septic shock patients without a clinically identified source of infection than in those with an identified source of infection (86% versus 66%, p < 0.05). CONCLUSIONS: A small number of patients presenting with septic shock have no clinically identified infection. These patients have a higher mortality rate than patients in whom an infection is identified.

[Identification of suicide indicators in general patients by the primary care nurse]. / Identificación de indicadores suicidas en pacientes generales por la enfermera de atención primaria.

An informative descriptive study is conducted aimed at making nurses know about some essential aspects of suicide (characteristics, risk, indicators, methods for diagnosis and intervention) in order to increase the effectiveness of their role in the prevention of this health problem, having determined previously the information needs of these professionals. It is analyzed how useful it is the utilization of the nursing care process to approach those patients and families with suicide risk. The main signs of danger for suicidal behavior, as well as the essential risk factors and the most important methods to detect both indicators early are explained. Nurses are also instructed what to do with a patient with suicidal indicators and his family. It is concluded that a better training of these professionals will contribute to reduce the suicide impact on the community.

Leptospirosis en embarazadas / Leptospirosis in pregnats

Se investigaron 175 gestantes con suero pareado de leptospirosis durante el período de 1989 a 1990, en la provincia de Ciego de Avila, Cuba, con la técnica de microaglutinación, confirmándose 12 casos para el 6 porciento. La mayor frecuencia de enfermos aparecieron en casos con diagnósticos presuntivos de meningoencefalitis y sepsis urinaria. hubo un predominio de mujeres entre 20 y 24 años de edad, siendo la ocuapción más frecuente las amas de casa. Llamamos la atención que la vigilancia epidemiológica de esta entidad no debe limitarse solamente a los grupos de riesgos. Las principales fuentes de infección fueron contacto con aguas albañales y el baño en fuentes de agua dulce (ríos y lagos) ... (AU)

Intrapartum prophylaxis with ceftriaxone decreases rates of bacterial colonization and early-onset infection in newborns.

Because of high rates of neonatal gram-negative sepsis in many Latin American countries, we prospectively enrolled 784 high-risk pregnant women in a study designed to evaluate the effect of a single 1-g dose of ceftriaxone (n = 390) vs. that of no antibiotic prophylaxis (n = 394) on oral, rectal, and umbilical colonization and fatality rates among newborn infants. The mean ceftriaxone concentration in cord blood samples was 26 microgram/mL (range, 9-40 microgram/mL). Compared with infants of untreated mothers, children born to women who were given ceftriaxone were colonized at a lesser rate by gram-negative bacilli (54% vs. 35%; P < .001) and by group B streptococci (54% vs. 21%; P = .03) and endured significantly fewer sepsis-like illnesses in the first 5 days of life (8.1% vs. 3.1%; P = .004). There was also a tendency for them to have fewer episodes of culture-proven early-onset sepsis (2.8% vs. 0.5%; P = .06). Sepsis-related case-fatality rates (0.8% and 0.3%, respectively) were not significantly different. Although intrapartum administration of a single dose of ceftriaxone to high-risk mothers could be a safe and potentially useful strategy for reducing early-onset neonatal infections, additional information is required before this approach can be recommended for routine prophylaxis.

Observer variability in the process of medical care for amebic liver abscess.

The objectives of this study were to evaluate the degree of concordance between specialists (physicians) in relation to the process of medical care of patients with amebic liver abscess and to elaborate a model that contains the minimum elements considered as indispensable for the diagnosis, treatment and follow-up of an illness, based on the consensus of physicians that usually treat these patients. The design of the study was a comparative survey. Twenty eight specialists (physicians) were interviewed (nine infectologists, two gastroenterologists, six internists and eleven general surgeons) affiliated with second and third level hospitals (medical centers) of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) located in the southern part of Mexico City. A three-part structured questionnaire was applied: the first part consisting of 57 questions focused on the diagnosis, the second corresponded to treatment and consisted of 16 questions and the third part referred to follow-up and included five questions. The agreement among the internists for the overall process (diagnosis+treatment) was the highest (kappa (k) = 0.64), followed by the surgeons (k = 0.63) and the infectologists (k = 0.49); the difference among these three groups of specialists was considered statistically significant (p = 0.001). When the therapeutic process was analyzed in separated form, this same statistical difference was sustained, which on the other hand was not identified for the diagnosis and follow-up processes. When comparing each group, the degree of agreement obtained from the members of each group did not express statistically significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkali-labile sites are prevalent in kidney tissue DNA.

Inherent DNA damage in the form of single strand breaks and alkali labile sites is generated by essential intracellular processes, such as DNA replication and repair. Utilizing the in situ DNA unwinding assay and the comet assay (single cell gel), we have observed high levels of alkali induced DNA strand breaks in cells isolated from mouse kidney tissue homogenate. Kidney cell DNA demonstrated a 7.4 x increase in nucleoid expansion and a 7 x increase in comet length compared to negative control cells (thymocytes and splenocytes) in the two assay systems, comparable to epididymal sperm cells which have previously been demonstrated to contain abundant alkali-labile sites. These results argue for the existence of prevalent alkali-labile sites in kidney cell DNA.

Laser scanning microscopic analysis of DNA damage in frozen tissues.

DNA damage is central to research in many fields, especially cancer research and toxicology. The possible loss of DNA structural integrity during freezing or sustained maintenance at low temperatures may present difficulties in the interpretation of data accumulated in studies of tissues collected over a period of time and subsequently evaluated. Using laser scanning microscopic analysis of the recently developed single-cell gel (SCG) assay to measure DNA strand breaks in individual cells, we found that the basal levels of DNA damage in frozen tissue was higher than fresh tissue, but tissues frozen for greater lengths of time do not appear to contain significantly more DNA damage than those frozen for a short period. Evaluation of DNA damage in tumors stored by or collected using cryopreservation may produce artificially exaggerated levels of damage, which could limit analytical interpretations.

Indications for modification of coexisting dual atrioventricular node pathways in patients undergoing surgical ablation of accessory atrioventricular connections.

Concomitant susceptibility to atrioventricular (AV) node reentrant tachycardia has been demonstrated in certain patients having reentrant tachycardia utilizing accessory AV connections. For those patients undergoing accessory connection ablation, AV node surgical modification may be warranted during the same operative procedure. To assess indications for a combined operative procedure, this study evaluated potential predictors of subsequent spontaneous AV node reentrant tachycardia in patients undergoing ablation of accessory AV connections. Among 62 consecutive patients undergoing surgical ablation of an accessory AV connection, 13 (21%) manifested dual AV node pathways. The latter were identified preoperatively in five patients (four with concealed and one with bidirectional accessory connections) and postoperatively in seven (all seven with bidirectional accessory connections). In one patient with a bidirectional accessory connection, dual AV node pathways could not be demonstrated preoperatively, but AV node reentrant tachycardia was induced. Operative ablation of an accessory connection was successful in all patients. However, postoperatively, 2 of the 13 patients had inducible AV node reentrant tachycardia, 5 had AV node "echo" beats and 6 had no inducible arrhythmia. During 26 +/- 7 months of follow-up study, the two patients with inducible AV node reentrant tachycardia postoperatively had symptomatic AV node reentrant tachycardia. In addition, the one patient with inducible AV node reentrant tachycardia preoperatively had recurrence of this tachycardia 4 months after attempted surgical modification of the AV node. Consequently, although dual AV node pathways appear to be common in patients undergoing surgical ablation of an accessory AV connection (21%), only a small group (3 of 13) of these patients are at risk for subsequent clinical AV node reentrant tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of disopyramide for prevention of upright tilt-induced hypotension-bradycardia.

Susceptibility to transient hypotension-bradycardia of neurally mediated origin has been attributed in part to accentuated afferent neural traffic arising from cardiopulmonary mechanoreceptors, and consequently, may be diminished by agents with anticholinergic and negative inotropic effects, such as disopyramide phosphate. This study assessed electrocardiographic and hemodynamic responses to upright tilt testing (alone or during isoproterenol infusion) before and after disopyramide therapy in 10 patients (age range 16 to 74 years) with recurrent syncopal episodes of neurally mediated origin. Untreated, syncope occurred at less than or equal to 7 minutes of tilt alone (6 patients) or tilt plus isoproterenol at less than or equal to 3 micrograms/min (4 patients) and was associated with hypotension (mean arterial pressure, 40 +/- 16 mm Hg vs baseline 76 +/- 10 mm Hg, p less than 0.001) and inappropriate heart rate slowing (mean heart rate, 59 +/- 39 beats/min vs baseline 88 +/- 18 beats/min, p less than 0.005). After oral disopyramide 150 mg 3 times daily (mean plasma level, 3.0 +/- 0.64 micrograms/ml), all patients tolerated 10 minutes of both tilt and tilt plus isoproterenol (maximum dose, 3 micrograms/min) without symptoms, hypotension (mean arterial pressure; tilt 1 min, 79 +/- 7 mm Hg vs tilt 10 min, 77 +/- 8 mm Hg, difference not significant) or bradycardia (mean heart rate; tilt 1 min, 81 +/- 12 beats/min vs tilt 10 min, 83 +/- 11 beats/min, difference not significant). Furthermore, during subsequent 20 +/- 5 months of disopyramide therapy, all but 1 patient remain asymptomatic. Thus, oral disopyramide may be effective for preventing inducible and spontaneous neurally mediated syncope.

Timing and magnitude of serum creatine kinase-MB after transcatheter cardiac tissue fulguration in man.

This study examined the impact of transcatheter fulguration on creatine kinase-MB release in 21 patients (age range 17-71 years). Arrhythmia diagnoses were ventricular tachycardia 9, atrial fibrillation with a rapid ventricular response 7, atrioventricular nodal reentry 2, and reciprocating tachycardia utilizing a posteroseptal accessory pathway 3. Seven patients had apparently normal hearts while 8 had ischemic heart disease and 6 cardiomyopathy. Timing of initial elevated creatine kinase-MB activity (mean 1.34 +/- 0.69 SD hours) and peak creatine kinase-MB activity (mean 3.73 +/- 0.89 SD hours) was relatively uniform in all patients. Time to peak creatine kinase-MB activity was unrelated to either underlying cardiac disease (normal: 3.9 +/- 1.0 hours; ischemic heart disease: 3.5 +/- 0.9 hours; cardiomyopathy: 3.8 +/- 0.9 hours), or fulguration site (His bundle (n = 9): 4.2 +/- 0.9 hours, proximal coronary sinus (n = 3): 3.3 +/- 0.3 hours, ventricle (n = 9): 3.4 +/- 0.8 hours). The magnitude of peak serum creatine kinase-MB activity was independent of myocardial diagnosis or fulguration site, but was linearly related to total energy delivered (r = 0.5, P less than 0.022). The latter correlation was particularly strong within cardiac diagnosis subgroups (normal: r = 0.92, P less than 0.002; ischemic heart disease: 0.73, P less than 0.04; non-ischemic cardiomyopathy: r = 0.57, P = NS). Thus, serum creatine kinase-MB activity following transcatheter fulguration is linearly related to the magnitude of delivered energy, and is similar to that observed after transient coronary artery occlusion and reperfusion.

Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia.

It has been proposed that prolonged cardiac asystole mimicking an episode of sudden cardiac death may occur as a manifestation of neurally mediated hypotension-bradycardia syndrome. To assess this possibility, electrocardiographic and hemodynamic findings during upright tilt testing were evaluated in six survivors of suspected asystolic sudden cardiac arrest with normal conventional electrophysiologic evaluation (Group I). These observations were compared with findings in two control groups: six patients with syncope but without evident asystole and with normal conventional electrophysiologic evaluation but demonstrable neurally mediated hypotension-bradycardia (Group II), and six patients with syncope in whom conventional electrophysiologic evaluation provided a presumptive diagnosis (Group III). Patients in all three groups ranged in age from 16 to 59 years. During head-up tilt testing (either alone or with isoproterenol infusion), patients in both Groups I and II developed syncope in less than or equal to 5 min, whereas patients in Group III remained asymptomatic. Patients in Groups I and II exhibited a similar tilt-induced decrease in mean arterial pressure (-46 +/- 9 and -40 +/- 9 mm Hg, respectively, p = NS) and heart rate (-44 +/- 28 and -49 +/- 12 beats/min, respectively, p = NS). In contrast, patients in Group III manifested only a moderate decrease in mean arterial pressure (-14 +/- 5 mm Hg) and had an increase in heart rate (+14 +/- 8 beats/min). Both mean arterial pressure and heart rate changes in Group I and Group II patients differed significantly (p less than 0.001) from values in Group III patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Irradiance of visible light-curing units and voltage variation effects.

The irradiance in the wavelength of 450 to 500 nm of nine visible light-curing units was measured at 120 V input voltage. The highest irradiance was more than 20 times that of the lowest. Irradiance was also measured at 90 to 130 V input. Irradiance and depth of cure at lower input voltages were also examined.