Accident ahead? Difficulties of drivers with and without reading impairment recognising words and pictograms in variable message signs.

A timely and accurate acquisition of the information provided by variable message signs (VMS) can be crucial while driving. In the current study, we assess the difficulties of adults with dyslexia acquiring the information shown in VMS and provide evidence to discuss the controversial use of pictograms as potential countermeasures. Twenty-two adults with dyslexia and 22 matched controls completed a simulated driving session. The legibility of 12 VMS was assessed, including six text messages (e.g. "ACCIDENT") and six single pictograms (e.g. the icon for "accident ahead"). On average, participants with dyslexia started reading text messages when they were closer to the VMS. In addition, while approaching text VMS, they dedicated more gazes and manifested worse control of speed. Regarding pictogram VMS, we observed no differences in response distance, accuracy, response duration, or number of gazes. To sum up, the evidence provided reveals that adults with dyslexia, despite potential compensation effects, may still find difficulties reading text messages in VMS (shorter legibility distances, longer reading times, and increased cognitive effort), whereas we found no such differences in the recognition of pictograms (only some difficulties keeping a steady speed). Research on inclusive measures to improve reading in low-skilled or dyslexic drivers must be encouraged.

A portal dosimetry dose prediction method based on collapsed cone algorithm using the clinical beam model.

PURPOSE: Amorphous silicon electronical portal imaging devices (EPIDs) are widely used for dosimetric measurements in Radiation Therapy. The purpose of this work was to determine if a portal dose prediction method can be utilized for dose map calculations based on the linear accelerator model within a commercial treatment planning system (Pinnacle3 v8.0 m). METHODS: The method was developed for a 6 MV photon beam on the Varian Clinac 21-EX, at a nominal dose rate of 400 MU/min. The Varian aS1000 EPID was unmounted from the linear accelerator and scanned to acquire CT images of the EPID. The CT images were imported into Pinnacle3 and were used as a quality assurance phantom to calculate dose on the EPID setup at a source to detector distance of 105 cm. The best match of the dose distributions was obtained considering the image plane located at 106 cm from the source to detector plane. The EPID was calibrated according to the manufacturer procedure and corrections were made for output factors. Arm-backscattering effect, based on profile correction curves, has been introduced. Five low-modulated and three high-modulated clinical planned treatments were predicted and measured with the method presented here and with MatriXX (IBA Dosimetry, Schwarzenbruck, Germany). RESULTS: A portal dose prediction method based on Pinnacle3 was developed without modifying the commissioned parameters of the model in use in the clinic. CT images of the EPID were acquired and used as a quality assurance phantom. The CT images indicated a mean density of 1.16 g/cm3 for the sensitive area of the EPID. Output factor measured with the EPID were lower for small fields and larger for larger fields (beyond 10 × 10 cm2 ). Arm-backscatter correction showed a better agreement at the target side of the EPID. Analysis of Gamma index comparison (3%, 3 mm) indicated a minimum of 97.4% pass rate for low modulated and 98.3% for high modulated treatments. Pass rates were similar for MatriXX measurements. CONCLUSIONS: The method developed here can be easily implemented into clinic, as neither additional modeling of the clinical energy nor an independent image prediction algorithm are necessary. The main advantage of this method is that portal dose prediction is calculated with the same algorithm and beam model used for patient dose distribution calculation. This method was independently validated with an ionization chamber matrix.

La densitometría de calcáneo permite discriminar fracturas de muñeca en mujeres ancianas / Calcaneal densitometry as a tool for identifying wrist fractures in older women

Objetivo. Determinar si la densidad mineral ósea (DMO) obtenida mediante densitometría de calcáneo permite discriminar mujeres mayores de 60 años con y sin fractura de muñeca. Material y método. Estudio retrospectivo de casos-control, estableciendo como hipótesis de trabajo el mayor riesgo de fracturas distales de antebrazo, en mujeres mayores de 60 años cuya densitometría de calcáneo refleja una T-score < ­0,6. Desde el uno de octubre de 2003 hasta el 31 de marzo de 2004 se atendió a 66 mujeres mayores de 60 años con fractura distal de antebrazo, constituyendo los casos-muestra del estudio. De forma aleatoria se escogieron 60 mujeres con características similares a los casos y que no habían padecido fractura alguna, constituyéndose de esta manera el grupo control. La DMO se midió mediante absorciometría dual de rayos X (DEXA) en calcáneo (PIXI). Se utilizó para ello el equipo LUNAR (modelo 30200). Resultados. La media de la DMO medida obtenida mediante densitometría de calcáneo fue de 0,368 (0,273-0,542) para los pacientes con fractura distal de antebrazo, frente a 0,472 (0,289-0,668) para los pacientes sin fractura, estableciéndose diferencias significativas (p < 0,01). El cálculo de la odds ratio reflejó un riesgo de padecer fractura distal de antebrazo en mujeres mayores de 60 años con una T-score < ­0,6 obtenida mediante PIXI en calcáneo de 10,67 veces superior respecto a mujeres del mismo grupo de edad con una T-score > ­0,6. Conclusiones. La DMO de calcáneo mediante DEXA permite discriminar mujeres con y sin fractura de muñeca

Purpose. To determine whether bone mineral density (BMD) measured by means of calcaneal densitometry is a reliable means of discriminating between women over 60 with and without a wrist fracture. Materials and methods. This is a case-control retrospective study that established as its working hypothesis that women over 60 with a calcaneal densitometry T-score < ­0.6 are at a higher risk of sustaining distal forearm fractures. Between 1 October 2003 and 31 March 2004, 66 women older than 60 presented with a distal forearm fracture; these women constituted the sample cases of our study. Sixty women with similar characteristics to the ones mentioned but who had not sustained a fracture were randomly selected to make up the control group. BMD was measured through dual-energy x-ray absortiometry (DEXA) of the calcaneus (PIXI). A Lunar device (model 30200) was used. Results. The average BMD as measured through calcaneal densitometry was 0.368 (0.273-0.542) for patients with a distal forearm fracture, as compared with 0.472 (0.289-0.668) for patients without a fracture, which constitutes a significant difference (p < 0.01). The odds ratio revealed that the risk of sustaining a distal forearm fracture in women over 60 with a PIXI calcaneal T-score < ­0.6 is 10.67 times higher than in women in the same group but with a T-score > ­0.6. Conclusions. Calcaneal BMD measured by a DEXA scan is a reliable way to discriminate between women with and without a wrist fracture (AU)

Neovascularization by cardiomyoplasty.

UNLABELLED: Nowadays cardiomyoplasty is used in cases of cardiac insufficiency as an alternative to cardiac transplant for patients with very developed ischemic cardiopathy, refractory to pharmacological treatment and without possibility of revascularization by using conventional techniques. OBJECTIVES: Our Cardiovascular Research Group has proposed as an objective, the detection of any possible myocardial neovascularization through the muscle used for cardiomyoplasty. In the case that there are new blood vessels to the diseased myocardium through the latissimus dorsi muscle flap in which it is wrapped and which aids it mechanically, it would be possible to confirm the working hypothesis that cardiomyoplasty not only improves the cardiocirculatory function mechanically but also facilitates a better blood flow to the ischemic myocardium. MATERIALS AND METHODS: The cardiomyoplasty technique is described using an experimental model of myocardial ischemia. The vascular cast is achieved by injecting methacrylate simultaneously into both the coronary tree and the wide dorsal muscle. In 15 experiments the connections between the coronary vascular system and the vascular structure of the latissimus dorsil muscle flap are demonstrated by several methods. CONCLUSIONS: We have demonstrated that cardiomyoplasty, as well as improving ventricular function, favours the revascularization of the myocardium. Cardiomyoplasty could be indicated for cases of ischemic cardiopathy in patients in whom it is not possible to perform direct revacularization using conventional methods.

The systemic vasodilatory action of protamine: is it inhibited or mediated by heparin?

UNLABELLED: The administration of protamine to neutralize the circulating heparin is common practice in cardiovascular surgery. The use of this drug is sometimes associated with hemodynamic alterations of varying degree and intensity (systemic hypotension, pulmonary hypertension and even cardiogenic shock). An intrinsic action of protamine has been suggested to be the cause of these vascular reactions. This action is blocked when protamine forms a complex with heparin, although in other cases it appears that the heparin-protamine complex is the factor responsible for these hemodynamic alterations. The aim of this experimental study was to characterize the vasodilatory action of protamine on the systemic circulation, determining whether or not it is dose-dependent; to analyze the role of endothelium; and to evaluate whether this vasodilatory effect is modified by the presence of heparin. MATERIALS AND METHODS: The abdominal aorta was dissected from eight New Zealand rabbits and then sectioned into vascular rings for study in an organ chamber. Mechanical disruption of endothelium was performed on some rings (n = 14). Once submaximal contraction was reached (ClK 80 mM), protamine sulfate with a final concentration in the organ chamber of 80-400 micrograms/ml was added to one of the groups (n = 12). In the second group (n = 12), equal concentrations of protamine were tested in the presence of heparin at a final concentration of 100 U/ml. RESULTS: The mean vasodilatation reached in the group of rings exposed only to protamine was 95.4 +/- 1.5% with respect to the submaximal contraction induced with ClK. In the second study group, the rings were exposed to protamine at equally increasing concentrations (80-400 micrograms/ml) but with the presence of heparin in the organ chamber. The mean vasodilatation in this group was 90 +/- 1.5. No statistically significant differences in vasodilatation were found between this group and the protamine without heparin group. On the other hand, in the endothelium-denuded rings (n = 14) exposed to isolated protamine and to protamine-heparin, no vasodilatory response was observed. CONCLUSION: Our results show that the administration in vitro of protamine induces endothelium-dependent vasodilatation of the systemic circulation. Likewise, this relaxing effect mediated through endothelium is not blocked when protamine forms a complex with heparin in comparable concentrations of both drugs. Based on these preliminary findings, we believe that in high-risk patients the prevention of systemic vasodilatation and cardiovascular collapse produced by protamine should move towards the use of other substances that can neutralize the anticoagulant effect of heparin or towards pre-medication guidelines that prevent these secondary effects in the case of protamine administration.

[The rights of the hospital patient: the knowledge and perception of their fulfillment on the part of the professional. The Group in Catalonia of the Spanish Society of Care for the Health Services User]. / Derechos del enfermo del hospital: conocimiento y percepción sobre su cumplimiento por parte del profesional. Grupo en Cataluña de la Sociedad Española de Atención al Usuario de la Sanidad.

BACKGROUND: The Customer Service Department includes the protection of the patient's rights. To analyze the work performed in this setting, we planned to quantitate and evaluate the knowledge and perception of fulfillment by medical staff. METHODS: Multicentric cross-sectional study. The population included health care professionals in nine Catalonian hospitals. The sample was selected at random with reposition and was segmented according to professional category. Data collection was carried out by personal interview supported by a questionnaire. Differences according to institution size were analyzed. RESULTS: A total of 1,014 professionals were interviewed; 84.4% reported to know the patient's rights and 64.4% to observe them. Significant differences (p < 0.05) according to institution size were observed. CONCLUSIONS: Discussion and diffusion of patient's rights is an useful tool to improve knowledge and evaluate the perception of its fulfillment by health care professionals.

Integrity of the pericardium. Its beneficial effects on the protection of the right ventricle in the presence of acute pulmonary hypertension.

UNLABELLED: After cardiac transplant (CT), the right ventricle can be subject to an acute pressure overload, especially in cases where there is a pre-existing severe pulmonary hypertension. OBJECTIVES: To determine the maximum tolerance of the right ventricle (MxTRV) when faced with acute pressure overload. To study the function of both ventricles of the healthy heart (donor) when faced with different degrees of pulmonary hypertension. To detect possible interactions between the ventricles in the absence of the pericardium to approximate the experimental model to the clinical model of CT. METHODS: The pulmonary artery is progressively constrained in an experimental model until biventricular failure is detected. This experiment is performed in two different situations: with and without pericardial integrity. RESULTS: When pericardial integrity is maintained the MxTRV faced with a pressure overload is 73.2+/-8.56 mmHg. When this pressure is exceeded there is a circulatory collapse with a sharp fall in the cardiac output and in the aortic pressure. However, when pericardectomy is performed (model similar to CT), only 52+/-6.71 mmHg is tolerated (p< 0.001). CONCLUSIONS: With the pericardium open, as in CT, the maximum pressure that the right ventricle can support is significantly less than with the pericardium closed. The pericardium has a positive effect in protecting the systolic ventricular interaction.

Susceptibilidad antimicrobiana de bacilos gram negativos aislados de muestras clínicas a cuatro cefalosporinas / Antimicrobial susceptibility of gram negative bacteria isolated from clinical samples to 4 cefalosporines

Se estudio la susceptibilidad cuantitativa in vitro de 335 cepas de bacilos Gram negativos a 4 tipos de cefalosporinas: cefradina, cefuroxima, cefotaxima y fefoperazona, usando el método de Ericsson y Sherris. Los resultados obtenidos nos muestran que la cefalosporina más activa fue cefotaxima y que los grupos bacterianos más resistentes fueron Pseudomonas, Proteus, Providencia y Morganella

Susceptibilidad de escherichia coli frente a 13 drogas antimicrobiana / Susceptibility of escherichia coli against 13 antimicrobial drugs

Escherichia coli es uno de los bacilos gram negativos más aislados en nuestras clínicas, provocando diversos cuadros de tipo infeccioso. Por este motivo es importante conocer la susceptibilidad antimicrobiana de esta especie, con el fin de poder administrar drogas antimicrobianas realmente efectivas. Este trabajo determina la sensibilidad cuantitativa "in vitro" de 245 cepas de Escherichia coli, aisladas de diversas muestras clínicas frente a 13 drogas antimicrobianas para lo cual se utilizó el método de dilución en agar de Ericsson y Sherris. Los resultados obtenidos muestran que alrededor del 90 por ciento de las cepas fueron sensibles a Enoxacino, Cefotaxima, Aztreonam, Gentamicina, Ceftriaxzona, Amikacina, Cefuroximo, Cefoperazona y Nitrofurantoina y alrededor del 50 por ciento de las cepas fueron sensibles a Cefradina. Frente a los restantes antimicrobianos-Cloramfenicol, Cotrimoxazol y Ampicilina- se obtuvo un alto nivel de resistencia

Estudio de bacterias aerobias y anaerobias de muestras de bilis de pacientes operados por patología biliar en el Hospital de Valdivia, 1991 / Aerobic and anaerobic bacteria study in bilis samples of patients with biliary diseases surgery in the Hospital of Valdivia, 1991

La patología biliar es prevalente en Chile y en el Hospital de Valdivia motivó el 16,6 por ciento del total de operaciones en el año 1991. Durante cinco meses se realizó el estudio bacteriológico de la bilis de 67 pacientes intervenidos por patología biliar en el Hospital de Valdivia. Un 52 por ciento de los bilicultivos fueron positivos y de éstos un 54 por ciento correspondió a cultivos monomicrobianos. La positividad del cultivo se relacionó con la edad del paciente, tipo de patología biliar y operación realizada, siendo mayor en los pacientes con patología coledociana. La cuantificación de los microorganismos no es indispensable debido a que esta fue siempre mayor de 500.000 por ml en los casos estudiados. Los microorganismos más frecuentemente aislados corresponden a enterobacterias: escherichia coli y enterobacter sp entre los Gram (-) y strepcoccus grupo D entre los Gram (+). Sólo se aisló un anaerobio estricto en este estudio. La susceptibilidad in vitro de las cepas aisladas demostró un alto porcentaje de sensibilidad para cefalosporinas de 2ª y 3ª generación y para quinolonas, y baja para ampicilina para Gram (-) y penicilina para Gram (+)

Diagnóstico microbiológico de las uretritis en el hombre y evaluación de tres esquemas de tratamiento de la uretritis por U. urealyticum / Microbiological diagnosis of urethritis in male and evaluation of 3 treatment schemes of urthritis due to U. urealyticum

Se realizó estudio microbiológico de raspado uretral de 142 pacientes de sexo masculino que consultaron al policlínico de Venéreas del Hospital Base de Valdivia durante 1989, los cuales fueron enviados al Instituto de Microbiología Clínica de la Universidad Austral de Chile con diagnóstico clínico de uretritis. La prevalencia de Uretritis Gonocócicas (UG) y Uretritis no Gonocócica (UNG) fue de un 50 por ciento para ambos tipos. U. urealyticum fue aislado en el 38 por ciento de los casos de UG y en el 59.2 por ciento de las UNG. Además se evaluó la efectividad del tratamiento de las uretritis por U. urealyticum con tetraciclina en base a tres esquemas: 2g/día durante 7 días, 2 g/día durante 14 días y 2 g/dia durante 21 días. Por este motivo, se seleccionaron 59 pacientes con uretritis por U. urealyticum, obteniéndose un 57,6 por ciento de éxito en el total de los pacientes estudiados. La mayor efectividad en el tratamiento fue para el esquema de 21 días (77.8 por ciento) además a medida que aumentó la edad de los pacientes la efectividad fue disminuyendo y cuando U. urealyticum se encontró asociado a otros microorganismos se obtuvo un mayor éxito en los tratamientos

[Brief questionnaires for the early detection of alcoholism in primary health care]. / Cuestionarios breves para la detección precoz de alcoholismo en atención primaria.

The utility of two tests for the early detection of alcoholism (CBA and CAGE) is studied in a group of 247 adult patients of both sexes at the primary care environment. For the definition of the "problem drinker case", the Münchner alkoholismus test (MALT) protocol is used as "gold standard". A sensitiveness of 79 and 75% is obtained for the CBA and CAGE respectively, a specifity of 94 and 96%, and predictive positive value of 63 and 73%, with a prevalence of "problematic drinkers" of 12%. Both questionnaires are shown as efficient instruments for the secundary prevention of alcoholism in the primary care consulting rooms.

Ruptura prematura de membranas en embarazos de pretérmino y su relación con posible etiología infecciosa / Premature rupture of membranes in preterm pregnancies and its relationship with possible infeccious etiology

Se estudiaron microbiológicamente 20 embarazadas de más de 26 semanas de gestación con signos de RPM y que consultaron en el Servicio de Obstetricia y Ginecología del Hospital Regional de Valdivia. A cada paciente se les tomaron muestras de LA, secreción vaginal y endocervical; del recién nacido se obtuvo, cuando fue posible, muestras de secreción ótica y nasal. El 65,0 por ciento de las muestras de LA tuvieron cultivos positivos para los MO buscados, aislándose las mismas especies microbianas en la secreción vaginal y/o endocervical de estas pacientes. El microorganismo aislado con mayor frecuencia fue u. urealyticum con un 77,0 por ciento y el que tuvo menor porcentaje de aislamiento correspondió a c. albicans con un 7,7 por ciento El 45,= por ciento de los cultivos positivos de LA presentan un aspecto transparente. La tinción de Gram resultó ser una técnica poco fiable como predictora de cultivos positivos de LA. Al relacionar el período de membranas rotas con el resultado de cultivos se encontró un mayor porcentaje de cultivos positivos de LA en pacientes con períodos de membranas rotas entre 24-48 horas. La observación de polimorfonucleares al frotis Gram directo se correlacionó con un mayor porcentaje de cultivos positivos de LA. En el 50,0 por ciento de los recién nacidos estudiados se aislaron las mismas especies microbianas encontradas en las muestras de la madre

[Effect of follow-up offer versus counseling alone in a sample of dissonant smokers. Evaluation of the influence of the tobacco habit of health professionals in this intervention]. / Efecto de la oferta de seguimiento versus consejo aislado en una muestra de fumadores disonantes. Evaluación de la influencia del hábito tabáquico de los profesionales en esta intervención.

We report the results of an intervention trial comparing the counseling (group A) of the general practitioner to encourage to quit smoking in dissonant smokers and an intervention based on counseling and offer of follow up at 2 and 3 weeks and at 3 and 6 months (group B). Both interventions were globally evaluated to assess the influence of the smoking habits of health professionals on the results. In the 93 group B patients there was a higher quitting rate than in group A. The rates of success after one year follow up were 26.9% and 11.9% (p less than 0.05). Forty-seven of the 152 patients were counseled by smoking physicians and 105 by non-smoking physicians; at one-year follow-up, the verified quitting rates were 10.6% and 25.7%, although the difference was not significant. It was concluded that the reinforcement of counseling by follow-up may increase the rate of quitting smoking in dissonant smokers in a primary care setting, and that the influence of the habit of the health professional can be limited through more systematic interventions.

Detección de Chlamydia trachomatis en muestras uretrales mediante inmunofluorescencia directa / Detection of Chlamydia trachomatis in urethral samples by means of direct immunofluorescence

Em 82 doentes com uretrite foi pesquisada a presença de Chlamydia trachomatis, utilizando a prova da imunofluorescência direta, e de Neisseria gonorrhoeae, Mycoplasma e Ureaplasma, utilizando os métodos padröes. Ch trachomatis foi encontrada em 19.5 dos casos, sendo que em 11 deles (68,8) observou-se associaçäo entre Chlamydia e as outras bactérias pesquisadas. Nesses pacientes observou-se presença de secreçäo uretral escassa e de aspecto gelatinoso