Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital.

BACKGROUND: Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it. OBJECTIVE: To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU. DESIGN: Retrospective longitudinal study. AMBIT: Intensive care unit of a tertiary hospital. PATIENTS: People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019. INTERVENTIONS: None. This is an observational study. VARIABLES OF INTEREST: Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays. RESULTS: Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients. CONCLUSIONS: Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.

Concordance between freehand SPECT and conventional scintigraphy for sentinel lymph node detection in breast cancer.

INTRODUCTION: Freehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning. The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). MATERIALS AND METHODS: 100 patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60-90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. RESULTS: The observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). CONCLUSION: Freehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.

Exploring the opinion of Spanish medical specialists about the usefulness of radiomics in oncology.

AIM: To describe the knowledge and opinion of health professionals regarding the usefulness of radiomics in oncology. METHODS: A 12-question questionnaire (multiple-choice responses, Likert-type scale, and open response) was developed and sent to professionals related to diagnosis/treatment of oncological diseases (Oncology, Radiodiagnosis, Nuclear Medicine, Radiation Oncology, Hematology-Oncology, Radiophysics and Pathology). Participants were classified into two groups according to their level of training: attending physicians and residents. RESULTS: 114 professionals completed the survey (54% residents, mostly from Nuclear Medicine and Radiodiagnostic specialties). Attending physicians obtained a better performance in the area pf knowledge compared to residents. Both groups of respondents agreed regarding the usefulness of radiomics to help make more accurate diagnoses and promoting the work of medical teams and the most frequent disadvantages were related to the lack of systematization in the acquisition of images and extraction of parameters, the need for the training of professionals and concern about the replacement of human work by technological tools. CONCLUSIONS: Radiomics is a novel field and the most general aspects are known by health professionals. The professionals surveyed were optimistic about the benefits provided by radiomics and other types of tools. The main problem detected was the lack of systematization in its implementation. The replacement of professionals and job loss is a concern, albeit less prevalent, and may respond to a generational phenomenon.

Progress and current utility of radiomics in PET/CT study of non-metastatic breast cancer: A systematic review.

AIM: To synthesize the current evidence of the usefulness of radiomics in PET/CT image analysis in local and locally advanced breast cancer. Also, to evaluate the methodological quality of the radiomic studies published. METHODS: Systematic review of articles in different databases until 2021 using the terms "PET", "radiomics", "texture", "breast". Only articles with human data and that included a PET image were included. Studies with simulated data and with less than 20 patients were excluded. Were extracted sample size, radiotracer used, imaging technique, and radiomics characteristics from each article. The methodological quality of the studies was determined using the QUADAS-2 tool. RESULTS: 18 articles were selected. The retrospective design was the most used. The most studied radiomic characteristic was SUVmax. Several radiomic parameters were correlated with tumor characterization, and tumor heterogeneity proved useful for predicting disease course and response to treatment. Most articles showed a high risk of bias, mainly from the patient selection. CONCLUSIONS: A high probability of bias was observed in most of the published articles. Radiomics is a developing field and more studies are needed to demonstrate its usefulness in routine clinical practice. The QUADAS-2 tool allows critical assessment of the methodological quality of the available evidence. Despite its limitations, radiomics is shown to be an instrument that can help to achieve personalized oncologic management of breast cancer.

Double crush syndrome: Epidemiology, diagnosis, and treatment results.

BACKGROUND: Double Crush Syndrome (DCS) is a clinical condition that involves multiple compression sites along a single peripheral nerve. The present study aims to describe the epidemiology of DCS and surgical results. METHODS: A retrospective observational analytic study included patients with clinical diagnosis of cervical radiculopathy and carpal tunnel syndrome who underwent surgery between January 2009 and January 2019. General demographic characteristics were noted, and 3 groups were distinguished: spinal surgery, carpal tunnel release, and bimodal decompression (BD); statistical differences were analyzed between them. RESULTS: The sample comprised 32 patients. DCS prevalence was 10.29%. Mean age at presentation was 59.25±10.98 years. There was female predominance (75%). Paresthesia was the main symptom (65.6%). Post-surgical results of BD showed significant improvement in sensory nerve conduction velocity, motor nerve conduction velocity (both P=0.008), and disability on Douleur Neuropathique 4 questions, Neck Disability Index, and Boston Carpal Tunnel Questionnaire (P=0.001, 0.004, 0.008, respectively). CONCLUSIONS: Diagnosis and management of DCS are a challenge. It is necessary to determine the site with maximal compression and risk of complications to decide on treatment. If first-line surgery is adequate, proximal and distal symptomatology can be improved. To maximize success, we recommend BD, according to the present results.

Assessment of the use of ethanol instead of MTBE as an oxygenated compound in Mexican regular gasoline: combustion behavior and emissions.

The energy reforms implemented in Mexico promote the use of ethanol in gasoline but exclude the country's ozone nonattainment areas oxygenated with methyl-tert-butyl ether (MTBE) in view that further scientific studies are required. To address a potential implementation scenario in areas of ozone high VOC-sensitive regimes, the impact on performance and emissions characteristics between the regular MTBE fuel available and a formulated gasoline containing 10% v/v ethanol having similar Reid vapor pressure (RVP) were compared in a single cylinder spark-ignited engine and a set of tier I vehicles. Included in the assessment were the "criteria" pollutants (THC, CO, and NOx), toxic compounds, and speciated hydrocarbons in order to calculate the ozone-forming potential (OFP). The change in combustion speed of ethanol fuel vs. regular gasoline seems to be small and depends mainly on base gasoline formulation. Vehicle dynamometer testing showed no statistically significant differences in the average THC, CO, and NOx results when comparing both fuels. Statistically significant differences were seen in total speciated hydrocarbons, total carbonyls emitted, the increases in acetaldehyde emissions, and the decreases in OFP with E10. The results show roughly 20% increase in evaporative emissions when E10 is used, but the OFP of the emissions is lower than that of the Metropolitan Area of Mexico City fuel (MAMC). The increase in the oxygen content using ethanol fuel seems to have no deleterious effect on the vintage of vehicles tested. Taking into consideration that the evaporative emissions standard in Mexico is less stringent than that in other countries, the substitution of the actual regular gasoline for ethanol fuels should uphold the least volatile AA class in areas with ozone problems.

Comparative studies of cellular viability levels on 2D and 3D in vitro culture matrices.

In this study, the cellular viability and function of immortalized human cervical and dermal cells are monitored and compared in conventional 2D and two commercial 3D membranes, Collagen and Geltrex, of varying working concentration and volume. Viability was monitored with the aid of the Alamar Blue assay, cellular morphology was monitored with confocal microscopy, and cell cycle studies and cell death mechanism studies were performed with flow cytometry. The viability studies showed apparent differences between the 2D and 3D culture systems, the differences attributed in part to the physical transition from 2D to 3D environment causing alterations to effective resazurin concentration, uptake and conversion rates, which was dependent on exposure time, but also due to the effect of the membrane itself on cellular function. These effects were verified by flow cytometry, in which no significant differences in viable cell numbers between 2D and 3D systems were observed after 24 h culture. The results showed the observed effect was different after shorter exposure periods, was also dependent on working concentration of the 3D system and could be mediated by altering the culture vessel size. Cell cycle analysis revealed cellular function could be altered by growth on the 3D substrates and the alterations were noted to be dependent on 3D membrane concentration. The use of 3D culture matrices has been widely interpreted to result in "improved viability levels" or "reduced" toxicity or cellular "resistance" compared to cells cultured on traditional 2D systems. The results of this study show that cellular health and viability levels are not altered by culture in 3D environments, but their normal cycle can be altered as indicated in the cell cycle studies performed and such variations must be accounted for in studies employing 3D membranes for in vitro cellular screening.

Evidence-based management of vitiligo: summary of a Cochrane systematic review.

Vitiligo affects around 1% of the world's population. Despite it being relatively common, there is still no effective treatment. The objective of this study was to update the Cochrane systematic review of randomized clinical trials (RCTs) to evaluate the efficacy of treatments for vitiligo. We carried out searches of a range of databases to October 2013 for RCTs of interventions for vitiligo regardless of language or publication status. At least two reviewers independently assessed study eligibility and methodological quality and extracted data using data extraction forms approved by the Cochrane Skin Group. Our primary outcomes of interest were quality of life, > 75% repigmentation and adverse effects. We retrieved 96 studies, of which 39 were new studies, with an overall total of 4512 participants. Repigmentation was assessed in all studies, although only five reported on all three of our primary outcomes. Regarding our two secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation at 2 years' follow-up. Most of the studies evaluated combination treatments, which generally showed better repigmentation than monotherapies. Of the new studies, seven were surgical interventions. The majority of the studies had fewer than 50 participants. The quality of the studies was poor to moderate at best. Very few studies specifically included children or participants with segmental vitiligo. Five years after the last update of this review, there are still important variations in study design and outcome measures in clinical trials for vitiligo, limiting the evidence for the efficacy of different therapeutic options. The best evidence from individual trials showed short-term benefit from topical corticosteroids and various forms of ultraviolet radiation combined with topical preparations. Long-term follow-up and patient-rated outcomes should be incorporated into study design, and more studies should assess psychological interventions.

Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review.

INTRODUCTION: Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation. PRESENTATION OF CASE: Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation. DISCUSSION: The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs. CONCLUSION: These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.

Estudio descriptivo del uso de antidepresivos en pacientes bipolares en una unidad de trastornos afectivos bipolares en el sistema público / Descriptive study of the use of antidepressants in bipolar patients in an affective disorders unit in the public system

Introduction: the use of antidepressants in the depressive phase of the bipolar disorder is controversial. Currently there are two conflicting positions, the purists are inclined to avoid them in a hospital in the public health system. Method: a descriptive study of cross section. Cards of 81 patients with diagnosis of bipolar disorder from “las Higueras” Hospital in Talcahuano were analized, we obtained different information such as sex, subtype of bipolar disorder, suicide attepts and indication of psychotropic drugs like mood stabilizers, antidepressants, antipsychotics and anxiolytics. For the analysis of the information obtained we utilized the program SPSS 17.0 using the x2 test and descriptive statistics. The results are de followings: 54.3 percent have a diagnosis of bipolar affective disorder type I and 45.7 percent has type II. 50.6 percent of all patients were using some type of antidepressant. From that group, 65.7 percent had at least one suicide attempt, while 37.2 percent never had. This turned out to be statistically significant. In patients who had attempted suicide there was no significant difference between patients who were using lithium fro those who were not. Discussion: half of the studied patients were receiving some type of antidepressants, which allows us to conclude that in our hospital, there is a liberal position in relation to its use in spite of the medical personnel being trained in the American position. Lithium was the most suitable stabilizer; though there was no effectiveness against suicide attempt.

Introducción: el uso de antidepresivos en la fase depresiva bipolar es controversial. Actualmente existen dos posturas, la purista proclive a evitarlos y la liberal que favorece las ventajas en su uso. Nuestro objetivo es dilucidar cuál de ellas prevalece en un hospital del sistema público de salud. Método: estudio descriptivo de corte transversal. Se analizaron fichas de 81 pacientes con diagnóstico de trastorno bipolar del Hospital Higueras Talcahuano, obteniéndose variables como sexo, subtipo de trastorno bipolar, edad de inicio, intentos suicidas, hospitalizaciones e indicación de psicofármacos, diferenciado estabilizadores del ánimo, antidepresivos, antipsicóticos y ansiolíticos. Para el análisis se usó programa SPSS 17.0, utilizando las pruebas de x2 y estadísticos descriptivos. Resultados: un 54.3 por ciento presentan diagnóstico de trastorno afectivo bipolar (TAB) tipo I y un 45.7 por ciento TAB tipo II. Un 50.6 por ciento del total de pacientes usaban algún tipo de antidepresivo. Un 65.7 por ciento presentaron al menos un intento suicida y un 37.2 por ciento nunca lo presentaron. Estos resultados fueron estadísticamente significativos. En los que presentaron intento suicida, no hubo diferencias significativas en cuanto al empleo de litio. Discusión: la mitad de los pacientes estudiados recibían algún tipo de antidepresivo, lo que permite concluir que en esta establecimiento se mantendría una postura liberal en relación a su uso a pesar de capacitar al personal médico en la postura americana. El litio fue el estabilizador más indicado, sin evidenciarse eficacia antisuicida.

Effect of inmersion desinfection with 0, 5 percent sodium hypochlorite and 2 percent glutaraldehyde on alginate and silicone: microbiology and SEM study / Efecto de la desinfección en inmersión con 0, 5 por ciento de hipoclorito sódico y glutaraldehído al 2 por ciento sobre alginato y silicona: estudio de la microbiología y SEM

The disinfection of dental impression materials has become an essential topic of universal concern, as it may be the first instance of microbial contamination during dental care. The purpose of this study is twofold: To determine the effectiveness of disinfection with 0.5 percent sodium hypochlorite and 2 percent glutaraldehyde solutions in irreversible hydrocolloid (alginate) and silicone impressions and to analyze the effect of disinfection on surface quality with a scanning electronic microscope. Atotal of 32 impressions (16 made of irreversible hydrocolloid and 16 made of silicone) were taken from maxillary dentate patients. Samples of 1cm2 (80 , irreversible hydrocolloid, 80 silicone) were obtained and distributed in ten groups: alginate in no disinfectant (control group 1, AL), alginate in 0.5 percent sodium hypochlorite (NaOCl) for 5 (AH5) and 10 minutes (AH10), alginate in 2 percent glutaraldehyde for 5 (AG5) and 10 minutes (AG10), silicone in no disinfectant (control group 2), silicone in 0.5 percent NaOCl for5 (SH5) and 10 minutes (SH10), and silicone in 2 percent glutaraldehyde for 5 (SG5) and 10 minutes (SG10). Each sample was divided into two segments (one for the microbiological and one for the SEM study). Microbiological samples were planted on blood agar, Mac Conkey agar, and Sabouraud agar, and identification was made by Gram´s stain. The samples were then processed by an SEM. Immersion in the 5 percent NaOCl and 2 percent glutaraldehyde for 10 minutes completely eliminated bacteria in the impressions, compared with the control group (P=0.000004). Immersion in 0.5 percent NaOCl and 2 percent glutaraldehyde for 5 and 10 minutes significantly inhibited bacterial growth in both the irreversible hydrocolloid and silicone impressions compared with control group (P<0.05). However, in the SEM study, immersion in both disinfectant solutions for 5 and 10 minutes did not significantly affect the surface quality of the irreversible hydrocolloid...

La desinfección de los materiales de impresión dental se ha convertido en un tema esencial, ya que puede ser el primer caso de contaminación microbiana durante la atención dental. El propósito de este estudio es doble: determinar la eficacia de la desinfección con hipoclorito sódico al 0,5 por ciento y 2 por ciento de glutaraldehído en soluciones de hidrocoloide irreversible (alginato) y las impresiones de silicona, para analizar el efecto de la desinfección en la calidad de la superficie con un microscopio electrónico de barrido. Un total de 32 impresiones (16 hechas de hidrocoloides irreversibles y 16 de silicona) superiores de pacientes dentados fueron estudiadas. Las muestras de 1cm2 (80, hidrocoloide irreversible, el 80 de silicona) fueron obtenidas y distribuidas en diez grupos: alginato sin desinfectante (grupo de control1, AL), alginato en el 0,5 por ciento de hipoclorito sódico (NaOCl) durante 5 (AH5) y 10 minutos (AH10), alginato en glutaraldehído al 2 por ciento durante 5 (GA5) y 10 minutos (AG10), silicona sin desinfectante (grupo de control 2), silicona en 0,5 por ciento de NaOCldurante 5 (SH5) y 10 minutos (SH10) y, en glutaraldehído al 2 por ciento durante 5 (SG5) y 10 minutos (SG10). Cada muestra se dividió en dos segmentos (uno para los análisis microbiológicos y uno para el estudio SEM). Las muestras microbiológicasse sembraron en agar sangre, agar MacConkey y agar Sabouraud, y la identificación se realizó por tinción de Gram. Las muestras fueron procesadas por un SEM. La inmersión en 5 por ciento NaOCl y 2 por ciento de glutaraldehído durante 10 minutos eliminó completamente las bacterias de las impresiones, en comparación con el grupo control (P = 0,000004). La inmersión en 0,5 por ciento de NaOCl y glutaraldehído al 2 por ciento durante 5 y 10 minutos, inhibió el crecimiento de bacterias, tanto en el hidrocoloide irreversible e impresiones de silicona en comparación con el grupo control (P <0,05). Sin embargo, en el estudio SEM...

Comparación de la efectividad de cuatro protocolos de kinesiterapia respiratoria en niños hospitalizados por infección respiratoria aguda / Comparison of the effectiveness of four protocols of chest physical therapy in hospitalized children with acute respiratory infection

Objetivo: Comparar los efectos de las técnicas Kinésicas Respiratorias agrupadas en cuatro protocolos de tratamiento (K1, K2, K3 Y PVA) en lactantes y preescolares hospitalizados con afecciones respiratorias, usando un diseño cuasiexperimental, longitudinal prospectivo. Método: Se evaluó a 80 niños, edad promedio de 14.3 meses (SD 12.3) con diagnóstico de Síndrome Bronquial Obstructivo (SBO) y Bronconeumonía (BNM) entre el primer y tercer día de hospitalización. El efecto de la Kinesiterapia Respiratoria (KTR) fue medido en cada paciente a través del Índice Kinésico de Carga de Trabajo Ventilatorio (IKCTV), ejecutado por un único evaluador (KA) al inicio y al final de un turno de 12 horas. Cada protocolo fue definido tanto en la metodología de las técnicas como en el número de atenciones. Cada uno de los protocolos fue seleccionado al azar y aplicado por otro kinesiólogo (KB). Resultados: No se encontraron diferencias estadísticamente significativas al comparar las variables biomédicas de los pacientes evaluados. Los resultados muestran un descenso, una mantención y un incremento en el puntaje final del IKCTV en el 57.5%, 27.5% y un 15% de los pacientes, respectivamente. Tampoco existieron diferencias estadísticamente significativas al comparar la efectividad de los protocolos de tratamiento entre sí. Conclusión: No existió asociación directa entre cantidad de atenciones de KTR, el Protocolo de tratamiento y la disminución en el 1 KCTV.

Objective: Compare the effects of the different techniques dealing with chest physical therapy (CPT) grouped in four treatment protocols (K1, K2, K3, PVA) in infants and preschool children that were hospitalized with respiratory infection, using a prospective longitudinal experimental design. Method: 80 children were assessed, with an average age of 13.8 months (SD 11.8) with a diagnosis of obstructive bronchial syndrome and pneumonia between the first and third day of hospitalization. The effects of CPT measured through the Physical Therapy Index of Ventilatory Work Load (PTIVWL), performed by a single therapist (KA) before and after the therapy in a 12-hour shift. The treatment was grouped in form of protocols; they differed in the methodology of the techniques and number of applications of the therapy. The protocol, chosen randomly, was applied by a different therapist (KB) who didn't know the previous evaluations. Results: There was no statistically significant difference in the biomedical variables of the assessed patients. The results show a decrease of the PTIVWL final score in the 57.5% of patients, maintenance in the 27.5% and increase in the 15% in the PTIVWL. Similarly, there was no statistically significant difference between the four protocols of treatment. Conclusion: There was no relationship between the number of CPT.

Systemic antifungal therapy for tinea capitis in children.

BACKGROUND: Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. OBJECTIVES: To assess the effects of systemic anti-fungal drugs for tinea capitis in children. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (June 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (2003 to June 2005), EMBASE ( 2003 to June 2005), LILACS (1982 to July 2005), CINAHL (1982 to July 2005), the ACP journal club (1991 to July 2005) and Healthstar (1975 to July 2005). SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated systemic antifungal therapy in people with normal immunity under the age of 18 who had tinea capitis confirmed by microscopy or growth of dermatophytes in culture or both. DATA COLLECTION AND ANALYSIS: At least two authors independently examined each retrieved trial for eligibility and quality. MAIN RESULTS: We included 21 studies (1812 participants). Infections involving Trichophyton species: Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy in 3 studies involving 382 participants (RR 1.09; 95% CI 0.95 to 1.26). Cure rates following treatment with itraconazole and griseofulvin for 6 weeks were similar in 1 study of 35 children (RR 1.06; 95% CI 0.81 to 1.39). Another study of 100 children did not show any significant difference in cure between itraconazole for 2 weeks compared with griseofulvin for 6 weeks (RR 0.89; 95% CI 0.76 to 1.04). There was no difference between itraconazole and terbinafine for treatment periods lasting 2 to 3 weeks in 2 studies involving 160 children (RR 0.93; 95% CI 0.72 to 1.19). Two studies that included 140 children found similar cure rates between 2 to 4 weeks of fluconazole with 6 weeks of griseofulvin (RR 0.92; 95% CI 0.80 to 1.05). Microsporum infections: There was no significant difference in cure between terbinafine and griseofulvin in children with Microsporum infections in 1 small study of 29 children (RR 0.64; 95% CI 0.19 to 2.20). AUTHORS' CONCLUSIONS: The best evidence suggests that newer treatments including terbinafine, itraconazole and fluconazole may be similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Newer treatments may be preferred because shorter treatment durations may improve treatment adherence, although they may be more expensive. There is not enough evidence on the use of systemic treatments in children with Microsporum infections. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles.

[The Cochrane Skin Group]. / El Grupo Cochrane de Piel.

Over the last 10 years, the advent of evidence-based medicine has caused a paradigm shift in medical thinking and clinical practice. The Cochrane Skin Group organizes, drafts, publishes, and updates systematic reviews of randomized clinical trials of therapeutic interventions in skin diseases to assist in evidence-based clinical decision making. This article provides background information on the history and operation of this group, including the process by which systematic reviews are prepared.

Investigación en kinesiología: presencia en los Congresos de Medicina Intensiva (1997-2005) / Kinesiology investigation: presence in intensive medicine congresses (1997-2005)

Introducción: El desarrollo científico de la medicina intensiva ha sido progresivo en los últimos años en nuestro país, pudiéndose objetivar el importante y creciente número de publicaciones médicas. No se ha estudiado si esto ocurre también en el ámbito kinésico, según lo reflejado en las presentaciones en congresos. Objetivo: Conocer la realidad chilena de las publicaciones kinésicas en la Revista Chilena de Medicina Intensiva, derivadas de las Jornadas de Kinesiología. Método: Se revisaron los trabajos libres relacionados con kinesiología (K) del paciente crítico (adulto o pediátrico) en los Congresos Chilenos de Medicina Intensiva (período 1997-2005). Se analizó información según lugar donde fueron realizados (origen de autor principal), diferenciando en instituciones privadas de salud (IP) y públicas (P), según origen único o múltiple, según procedencia geográfica, región metropolitana (RM) o regiones (R); también se clasificó según diseño utilizado, temática de los trabajos. Se correlacionó con la cantidad de trabajos médicos (M) y de enfermería (E), para el mismo período. Resultados: De un total de 671 trabajos libres publicados; 548 (82 por ciento) eran M, 78 (12 por ciento) de E y 45 (6,7 por ciento) de K, estos últimos eran 37/45 (82 por ciento) de población adulta y 8/45 (8 por ciento) pediátrica. Según origen geográfico un 96 por ciento eran de RM. Del total, un 60 por ciento eran originados en centros IP. En los P, un 61 por ciento provenían de un solo centro. En la IP un 52 por ciento son originados por un mismo centro. Se observó un incremento no significativo en el período analizado para las publicaciones kinésicas a partir del año 2001 en adulto (máximo 11) y 2002 en pediatría (máximo 4); desde el año 2005 ambas presentaron un decremento. La categorización de los temas, permite observar que un 53 por ciento corresponde a terapia con Ventilación Mecánica (VMC 29 por ciento, VMNI 20 por ciento, VAFO 4 por ciento).

Introduction: In our country, the scientific development of the intensive medicine has been progressive in the last years, being able to know the important and increasing number of medical publications. It has not been studied if this also happens in kinesiology. Objective: To know the Chilean reality of the kinesiology publications in the Journal of Chilean Critical Care derived from the meeting of Kinesiology.Method: The free works related to the kinesiology (k) of the critical patient (adult or paediatric) in the Chilean Intensive Medicine Congresses were reviewed (period 1997-2005). The information was analyzed according to the place in where they were made (origin of main author), differentiating between private Institutions of health (IP) and public institutions (p), according to unique or multiple origins, according to geographic origin, metropolitan region (RM) or regions (R); also it was classified according to the used design and the subject of the work. It was correlated with the amount of medical (M) and infirmary works (E), for the same period. Results: Of a total of 671 published free works: 548 (82 percent) were M, 78 (12 percent) were E and 45 (6.7 percent) were K, of these last ones 37/45 (82 percent) were of adult population and 8/45 (8 percent) were paediatric. According to geographic origin a 96 percent were of RM. Of the total, a 60 percent were originated in IP institutions. In P, a 61 percent came from a single centre. In the IP a same centre originates a 52 percent. A no significant increase was observed in the period analyzed for kinesiology publications since year 2001 in adult (maximum 11) and 2002 in paediatrics (maximum 4); from the year 2005 both displayed a decrement. The categorization of the subjects, allows to observe that a 53 percent correspond to therapy with Mechanical Ventilation (VMC 29 percent, VMNI 20 percent, VAFO 4 percent). Either randomized or collaborated works were identified.

Interventions for vitiligo.

BACKGROUND: Around 1% of the world's population has vitiligo, which causes a loss of skin colour in patches. The methods currently available to treat vitiligo are largely unsatisfactory and vary widely between cultures and within health systems. OBJECTIVES: To assess the effects of interventions used to manage vitiligo. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and other databases (last searched September 2004). Reference lists of articles and conference proceedings were searched. Authors of reviews were contacted. SELECTION CRITERIA: Randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS: At least two reviewers independently assessed study eligibility and methodological quality and carried out data extraction. The included studies compared different interventions and used different outcome measures so we considered it inappropriate to combine their results. MAIN RESULTS: Nineteen trials with a total of 1350 participants were included. The RCTs generally had low numbers of participants and only RCTs of repigmentation and not other methods of managing vitiligo were able to be included. In one study, potent topical steroids resulted in better repigmentation than placebo and they were also better than oral psoralens plus sunlight in another study (RR 4.70 95% CI 1.14 to 19.39) although their long-term use is limited by adverse effects. Two studies suggested that topical calcipotriol enhanced repigmentation rates from PUVAsol and PUVA when compared with placebo. Another two studies showed higher repigmentation rates with oral PUVAsol versus placebo plus sunlight (RR 19.20 95% CI 1.21 to 304.50 in 79 adults and RR 2.29 95% CI 1.14 to 4.58 in a study of 50 children). The safety of these interventions was poorly described and none of the studies was able to demonstrate long term benefits. Very few studies were carried out on children or included segmental vitiligo. No trials evaluating micropigmentation, melanocyte transplantation, depigmentation or cosmetic camouflage could be found. Despite the fact that the main impact of vitiligo is psychosocial only one study on psychological therapy was found and it is awaiting assessment. AUTHORS' CONCLUSIONS: This review has found some evidence to support existing therapies for vitiligo, but the different designs and outcome measurements, lack of quality of life measures and adverse effect reporting in the studies limit the usefulness of their findings. There is a pressing need for high quality randomised trials using standardised measures of repigmentation and which address relevant clinical outcomes including quality of life.

Is what I have just a cold or is it dengue? Addressing the gap between the politics of dengue control and daily life in Villavicencio-Colombia.

In Colombia, dengue has been a target for public health interventions since the 1950s, with inadequate results. Furthermore, during the last few years in Colombia, the reported cases of dengue have increased. The social and cultural realities of the disease has been shown to be important and has not been considered when creating and implementing prevention and control programs. The paper draws on qualitative research of low- and high-income communities in the vicinity of Villaviecencio, South East Colombia to describe changing practices and direction of dengue prevention and control. It can be clearly observed from individuals' therapeutic itineraries and their perception of disease that public policies advertised in booklets and flyers and on television differ radically from people's everyday reality. This difference influences the success or failure of these policies.

Correlación entre score de Tal e Indice Kinésico de Carga de Trabajo Ventilatorio en lactantes con infección respiratoria aguda / Correlation between Tal score and kinesic index of charge of ventilatory work in infants with acute respiratory infection

Objetivo: Establecer el nivel de correlación que existió entre el score de Tal (ST) e Indice Kinésico de Carga de Trabajo Ventilatorio (IKCTV) en pacientes pediátricos con infección respiratoria aguda (IRA) que consultaron en el servicio de urgencia del Hospital Padre Hurtado durante la campaña de invierno 2003. Diseño: De los 288 niños sometidos a evaluación con ambos métodos, 174 (60,41 por ciento) fueron de sexo masculino con un promedio de edad de 11,3 ± 12,6 meses; y 114 (39,58 por ciento) de sexo femenino con un promedio de edad del 12,8 ± 13,5 meses, durante los meses de junio - julio, sumando el 43 por ciento del total de niños atendidos en la unidad. Los pacientes una vez valorados con el ST fueron registrados seguidamente con IKCTV, con los datos obtenidos se realizó un estudio correlacional, analítico, prospectivo el cual comparó los dos métodos de evaluación clínica para una misma muestra. Resultados: Se observó una correlación substancial de 0,69 calculada por el índice de Kappa para ambos indicadores.Conclusión: El IKCTV, muestra suficiente correlación respecto al score de Tal como para ser utilizado como un método de evaluación alternativo en pacientes con IRA, especialmente en aquellos con niveles de obstrucción leve.