Chile Crece Contigo: Implementation, results, and scaling-up lessons.

BACKGROUND: Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio-economic status. METHODS: This case study was developed on the basis of grey literature review and key informants' interviews. RESULTS: ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects. CONCLUSIONS: Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well-trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system.

[Spinal subacute combined degeneration after intrathecal chemotherapy. Report of two cases]. / Síndrome de degeneración combinada de la médula espinal y radiculopatía en dos pacientes por quimioterapia intratecal con metrotrexato y citarabina. Casos clínicos.

Intrathecal chemotherapy may be complicated with the development of myelopathies or toxic radiculopathies. This myeloradicular involvement, of toxic character, is unpredictable, since these patients have repeatedly received Intrathecal chemotherapy with the same drugs without apparent injury. The toxic effect should be mainly attributed to Cytarabine and not to methotrexate, since the central nervous system lacks Cytidine deaminase, the enzyme that degrades Cytarabine. We report two patients, an 18-year-old woman and a 16 years old male, who received systemic and intrathecal chemotherapy (methotrexate, cytarabine) for the treatment of an acute lymphoblastic leukemia and developed, in relation to this procedure, a spinal subacute combined degeneration. They had a proprioceptive and motor alteration of the lower extremities and neuroimaging showed selective rear and side spinal cord hyper intensity produced by central axonopathy. Two weeks later the woman developed a quadriplegia and the young man a flaccid paraplegia due to added root involvement.

The use of experimentally evolved coral photosymbionts for reef restoration.

The heat tolerance of corals is largely determined by their microbial photosymbionts (Symbiodiniaceae, colloquially known as zooxanthellae). Therefore, manipulating symbiont communities may enhance the ability of corals to survive summer heatwaves. Although heat-tolerant and -sensitive symbiont species occur in nature, even corals that harbour naturally tolerant symbionts have been observed to bleach during summer heatwaves. Experimental evolution (i.e., laboratory selection) of Symbiodiniaceae cultures under elevated temperatures has been successfully used to enhance their upper thermal tolerance, both in vitro and, in some instances, following their reintroduction into corals. In this review, we present the state of this intervention and its potential role within coral reef restoration, and discuss the next critical steps required to bridge the gap to implementation.

[Ventricular dysfunction and acute pulmonary edema related to intraoperative hypertensive crisis: a case report of clinical and echocardiographic assessment]. / Disfunción ventricular y edema agudo de pulmón asociado a crisis hipertensiva intraoperatoria. Evaluación clínica y ecocardiográfica.

A 39-year-old obese woman underwent surgery to open an obstructed tear duct under general anesthesia. After reversal of the neuromuscular block, the patient had a sudden, severe increase in blood pressure related to nonsustained monomorphic ventricular tachycardia. Acute pulmonary edema and cardiogenic shock developed minutes after treatment with propranolol, labetalol, and nitroglycerin. Intraoperative transesophageal echocardiography showed severe diffuse left ventricular hypokinesis with an ejection fraction under 15%. Hemodynamic stability was achieved with inotropic infusions. Angiography ruled out coronary artery injury and echocardiographic follow-up revealed progressive improvement of ventricular function. We analyze diagnostic possibilities and describe the benefits of echocardiography in the diagnosis and treatment of intraoperative acute heart failure.

Characterization of inflammatory bowel disease in Colombia: Results of a national register. / Caracterización de la enfermedad inflamatoria intestinal en Colombia: resultados de un registro nacional.

AIM: To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register. METHODS: A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted. RESULTS: A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000). CONCLUSION: In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.

[Neurological complications associated with extracorporeal membrane oxygenation (ECMO) therapy in adult patients. A study of a case series]. / Complicaciones neurológicas asociadas al tratamiento con oxigenación por membrana extracorpórea (ECMO) en pacientes adultos. Estudio de una serie de casos.

INTRODUCTION: ECMO is an advanced technique of ventilatory and circulatory support. However, it can be associated with neurological complications. The proposal is to describe the clinical characteristics and neurological complications profile in patients under ECMO support. PATIENTS AND METHODS: To descriptive a case series study. A descriptive and retrospective analysis and a bivariate analysis were performed in order to compare the main clinical variables of interest. RESULTS: 136 adults undergoing ECMO with an average age of 51 years (17-78) were evaluated. Neurological complications were observed in 51 patients (37.5%), corresponding to stroke 22 (16.17%), hypoxic encephalopathy 13 (9.5 %), cerebral hemorrhage (HIC) in 12 (8.8%) and subarachnoid hemorrhage (HSA) in 4 patients (2.9%). Seven (13.7%) of patients with neurological complications had seizures. Neurological complications occurred in 23.53% in venovenous ECMO and in 76.47% with veno-arterial ECMO (p = 0.86). The overall mortality was 51.47% (70/136) for all patients in ECMO and 64.7% (33/51) for the population with neurological complications. The mortality in stroke was 54.5% (12/22), 91.6% (11/12) in HIC and 100% (4) in HSA (p = 0.03). Mortality was higher in veno-arterial ECMO (77.14%) versus venous-venous ECMO (22.86% of total), (p = 0.015). CONCLUSIONS: ECMO is a useful therapeutic tool in cases of high clinical severity. In our study, we identified a high rate of neurological complications that contribute to associated morbidity and mortality. Early neuroimaging studies in these cases could allow early detection of these complications.

TITLE: Complicaciones neurológicas asociadas al tratamiento con oxigenación por membrana extracorpórea (ECMO) en pacientes adultos. Estudio de una serie de casos.Introducción. La ECMO es una técnica avanzada de soporte ventilatorio y circulatorio. Sin embargo, puede asociarse a complicaciones neurológicas. Se propone describir las características clínicas y el perfil de las complicaciones neurológicas en pacientes sometidos a ECMO. Pacientes y métodos. Estudio descriptivo retrospectivo de una serie de casos. Se realizó un análisis descriptivo y un análisis bivariado con la finalidad de comparar las principales variables clínicas de interés. Resultados. Se evaluó a 136 adultos sometidos a ECMO con edad promedio de 51 años (17-78). Las complicaciones neurológicas se presentaron en 51 pacientes (37,5%), de los cuales correspondieron a ictus 22 (16,17%); a encefalopatía hipóxica, 13 (9,5%); a hemorragia intracerebral (HIC), 12 (8,8%), y a hemorragia subaracnoidea (HSA), cuatro (2,9%). Siete (13,7%) de los pacientes con complicaciones neurológicas presentaron crisis epilépticas. Las complicaciones neurológicas se presentaron en 12 pacientes (23,53%) con la ECMO venovenosa y en 39 (76,47%) con la ECMO venoarterial (p = 0,86). La mortalidad global fue del 51,47% (70/136 pacientes) y del 64,7% (33/51) para la población con complicaciones neurológicas. La mortalidad en el ictus fue del 54,5% (12/22), del 91,6% (11/12) en la HIC y del 100% (4/4) en la HSA (p = 0,03). La mortalidad en la ECMO venoarterial fue del 77,14%, frente al 22,86% de la de la ECMO venovenosa (p = 0,015). Conclusiones. La ECMO es una herramienta terapéutica útil en casos de elevada gravedad clínica. En nuestro estudio, identificamos una elevada tasa de complicaciones neurológicas que contribuyen a la morbimortalidad asociada. La realización temprana de estudios de neuroimagen en estos casos podría permitir una detección temprana de estas complicaciones.

Parallel activation of Ca(2+)-induced survival and death pathways in cardiomyocytes by sorbitol-induced hyperosmotic stress.

Hyperosmotic stress promotes rapid and pronounced apoptosis in cultured cardiomyocytes. Here, we investigated if Ca(2+) signals contribute to this response. Exposure of cardiomyocytes to sorbitol [600 mosmol (kg water)(-1)] elicited large and oscillatory intracellular Ca(2+) concentration increases. These Ca(2+) signals were inhibited by nifedipine, Cd(2+), U73122, xestospongin C and ryanodine, suggesting contributions from both Ca(2+) influx through voltage dependent L-type Ca(2+) channels plus Ca(2+) release from intracellular stores mediated by IP(3) receptors and ryanodine receptors. Hyperosmotic stress also increased mitochondrial Ca(2+) levels, promoted mitochondrial depolarization, reduced intracellular ATP content, and activated the transcriptional factor cyclic AMP responsive element binding protein (CREB), determined by increased CREB phosphorylation and electrophoretic mobility shift assays. Incubation with 1 mM EGTA to decrease extracellular [Ca(2+)] prevented cardiomyocyte apoptosis induced by hyperosmotic stress, while overexpression of an adenoviral dominant negative form of CREB abolished the cardioprotection provided by 1 mM EGTA. These results suggest that hyperosmotic stress induced by sorbitol, by increasing Ca(2+) influx and raising intracellular Ca(2+) concentration, activates Ca(2+) release from stores and causes cell death through mitochondrial function collapse. In addition, the present results suggest that the Ca(2+) increase induced by hyperosmotic stress promotes cell survival by recruiting CREB-mediated signaling. Thus, the fate of cardiomyocytes under hyperosmotic stress will depend on the balance between Ca(2+)-induced survival and death pathways.

Effect of different cooking methods on lipid oxidation and formation of free cholesterol oxidation products (COPs) in Latissimus dorsi muscle of Iberian pigs.

The aim of this work was to study the influence of different cooking methods (grilled (GR), fried (FP), microwave (MW) and roasted (RO)) on lipid oxidation and formation of free cholesterol oxidation products (COPs) of meat from Iberian pigs that have been fed on an intensive system. Moisture and total lipid content, TBARs, hexanal and COPs were measured in Latissimus dorsi muscle samples. Cooking did not produce changes in total lipid content in meat but induced significantly higher lipid oxidation (TBARs and hexanal values) (p<0.001) and cholesterol oxidation (COPs) (p<0.01). When the different cooking methods were studied, the grilled method was the least affected by lipid oxidation (TBARs and hexanal) compared to the others. There were no significant differences among different cooking methods on COPs values. The most abundant cholesterol oxides were both 7α-hydroxycholesterol and 7ß-hydroxycholesterol in all groups studied.

Control of atopic eczema with pimecrolimus cream 1% under daily practice conditions: results of a > 2000 patient study.

BACKGROUND: Pimecrolimus cream 1% has been shown to effectively control atopic eczema (AE) when applied twice daily from the first signs or symptoms of AE until clearance. Moreover, pimecrolimus cream 1% has a favourable safety profile, lacking topical corticosteroid-related side-effects such as skin atrophy, making it particularly useful to treat delicate body regions (e.g. the face). OBJECTIVE: The objective of this naturalistic study was to monitor the safety, tolerability and efficacy of pimecrolimus when used in the long-term management of AE in a real-life setting. METHODS: A multicentre, open-label study was conducted in 2034 patients aged >or= 3 months with mild to moderate AE for up to 12 months' duration. Patients applied pimecrolimus cream twice daily, initiating treatment at first signs or symptoms of AE, continuing until clearance. RESULTS: Patients (n= 1847; 91%) completed 3 months of the study. Treatment success (clear or almost clear AE) after 3 months of treatment was observed on the whole body in 59% of patients and on the face in 81% of patients. Disease improvement of whole body and face was seen in 77% and 63% of patients, respectively. Pruritus was absent or mild in 79% of patients. Pimecrolimus cream was well tolerated throughout the study. CONCLUSION: In a daily practice setting, pimecrolimus cream 1% effectively and safely controls AE.

Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery.

BACKGROUND AND OBJECTIVE: Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques. METHODS: Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 +/- 14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12 degrees C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre- and post-cardiopulmonary bypass. RESULTS: Echo-Doppler measurements were obtained in 44 patients (88%). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland-Altman analysis revealed a bias of 0.015 L min(-1), with narrow limits of agreement (-1.21 to 1.22 L min(-1)) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study. CONCLUSIONS: The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.

The STIM1 inhibitor ML9 disrupts basal autophagy in cardiomyocytes by decreasing lysosome content.

Stromal-interaction molecule 1 (STIM1)-mediated store-operated Ca2+ entry (SOCE) plays a key role in mediating cardiomyocyte hypertrophy, both in vitro and in vivo. Moreover, there is growing support for the contribution of SOCE to the Ca2+ overload associated with ischemia/reperfusion injury. Therefore, STIM1 inhibition is proposed as a novel target for controlling both hypertrophy and ischemia/reperfusion-induced Ca2+ overload. Our aim was to evaluate the effect of ML9, a STIM1 inhibitor, on cardiomyocyte viability. ML9 was found to induce cell death in cultured neonatal rat cardiomyocytes. Caspase-3 activation, apoptotic index and release of the necrosis marker lactate dehydrogenase to the extracellular medium were evaluated. ML9-induced cardiomyocyte death was not associated with increased intracellular ROS or decreased ATP levels. Moreover, treatment with ML9 significantly increased levels of the autophagy marker LC3-II, without altering Beclin1 or p62 protein levels. However, treatment with ML9 followed by bafilomycin-A1 did not produce further increases in LC3-II content. Furthermore, treatment with ML9 resulted in decreased LysoTracker® Green staining. Collectively, these data suggest that ML9-induced cardiomyocyte death is triggered by a ML9-dependent disruption of autophagic flux due to lysosomal dysfunction.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. OBJECTIVES: To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). METHODS: 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. RESULTS: Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (p = 0.029), as well as for ANAS in SpA (49.5%) and IBD (37.9%) (p < 0.001) and abdominal pain (p = 0.012) between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms (p < 0.05) and IgA (p = 0.007). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14-13.56; p = 0.030). CONCLUSIONS: Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS.

Antidepressant effect of transdermal nicotine patches in nonsmoking patients with major depression.

BACKGROUND: A high frequency of cigarette smoking has been reported among individuals with major depression. In a previous study, transdermal nicotine produced short-term improvement in the mood of depressed patients. This study was undertaken to determine the effects of 4 days' administration of transdermal nicotine on mood in nonsmoking patients with major depression. METHOD: The effects of nicotine patches (17.5 mg) on 12 nonmedicated outpatients with major depression (DSM-III-R) were studied for 4 continuous days. Patients had to score 18 points or more on the Hamilton Rating Scale for Depression (HAM-D) (21 items) for admission into the study. The HAM-D (10 items), a visual analog scale, and a side effects scale were scored daily during the trial (baseline, 4 days of nicotine patches, and 4 days of follow-up). RESULTS: Two patients dropped out of the study owing to nausea and vomiting. Results of the visual analog scale and HAM-D (10 items) showed a significant (p < .01) improvement in depression after the second day of nicotine patches. Patients relapsed 3 or 4 days after the last nicotine dose. The side effects observed were an increase in saliva production, nausea, loss of appetite, and mild insomnia. CONCLUSION: Nicotine patches produced short-term improvement of depression with minor side effects. Because of nicotine's high risk to health, nicotine patches are not recommended for clinical use in depression. Analogue drugs may be developed in the future that may help improve depression without the risk of other major health problems.

Critically-ill patients receiving total parenteral nutrition show altered amikacin pharmacokinetics.

The purpose of this clinical study was to characterise the kinetic behavior of amikacin in the parenterally-fed critically-ill adult patient. 22 critically-ill adult patients treated with amikacin (15.5 +/- 7.9 mg/kg/day) for severe gram-negative infections were enrolled into a non-randomised control trial. Malnourished patients were administered total parenteral nutrition (TPN, n = 11), while well-nourished patients received fluid therapy (FT, n = 11). Amikacin pharmacokinetic parameters were estimated by non-linear regression analysis, assuming a one-compartment model and central first-order elimination. Patients receiving TPN showed an expanded amikacin distribution volume (0.403 +/- 0.0961/kg vs. FT 0.298 +/- 0.083 l/kg, p < 0.05), and a tendency towards increased total body clearance (0.089 +/- 0.029 l/kg/h vs. FT 0.069 +/- 0.0201/kg/h, p = 0.09). TPN produced lower peak concentrations (19.3 +/- 3.1 mcg/ml vs. 23.1 +/- 3.5 mcg/ml, p < 0.05), but had no significant influence on trough concentrations (p = 0.56). Patients on TPN also showed increased body temperature (p < 0.05) and fluid intake (p < 0.05), and decreased hematocrit (p < 0.05). Stress, malnutrition, parenteral nutrition itself, fluid and osmotic overload, and fever often occur concurrently in parenterally-fed patients and appear to produce lower amikacin serum levels. Consequently, critically-ill patients receiving TPN need higher amikacin doses and individualised treatment by monitoring serum concentrations, to ensure optimal therapeutic response.

Phacomatosis pigmentokeratotica: another epidermal nevus syndrome and a distinctive type of twin spotting.

The name epidermal nevus syndrome could be applied to a group of clinically and histopathologically different entities as has been pointed out by Happle. Phacomatosis pigmentokeratotica is a further type of epidermal nevus syndrome distinguished by the presence of a sebaceous nevus and a contralateral speckled lentiginous nevus of the papular type, associated with skeletal or neurological abnormalities. Three new cases of this recently delineated syndrome are presented. A common origin may account for the temporal and spatial relationship between the epidermal and the speckled lentiginous nevus. The concept of melanocytic-epidermal twin spotting similar to the interpretation of vascular twin spotting could explain the pathogenesis of this entity.

[The characteristics, management and prognosis of the acute myocardial infarct patient in the Valencian Community in 1995: the results of the PRIMVAC Registry (The Registry Project of Acute Myocardial Infarct in Valencia, Alicante and Castellón). As representatives of the PRIMVAC investigators]. / Características, manejo y pronóstico del paciente con infarto agudo de miocardio en la Comunidad Valenciana en 1995: resultados del registro PRIMVAC (Proyecto de Registro de Infarto Agudo de Miocardio de Valencia, Alicante y Castellón). En represntación de los investigadores del PRIMVAC.

BACKGROUND AND OBJECTIVES: Regional registers of patients with acute myocardial infarction are scarce in Spain. The PRIMVAC register (Proyecto de Registro de Infarto agudo de Miocardio de Valencia, Alicante y Castellón) was initiated to obtain updated information on the management of these patients in the Valencia Autonomous Community. Data of the first twelve months of the register are presented. METHODS: The 17 participating hospitals cover 2,833,938 inhabitants. Demographic, clinical, procedural and outcome data as well as predictive variables of mortality were analysed in the patients with acute myocardial infarction during their stay in the coronary care units from 1 December 1994 to 30 November 1995. RESULTS: During 12 months, 2,377 patients were included. Mean age was 65.3 years (SD 11.9) and 23.2% were female. Left ventricular failure was present in 39.8%. Thrombolytic therapy was applied in 42.1% with a median time delay of 195 min from chest pain onset. This time was longer in the women (250 min) and in the elderly (210 min). The in-coronary-care-unit-mortality rate was 13.9%. Age, female gender, diabetes, previous myocardial infarction, Q wave and right ventricular infarction independently predicted increased early mortality. CONCLUSION: Present data show the feasibility of an acute myocardial infarction register in the Valencia Autonomous Community. Although an acceptable level of thrombolysis has been reached, the mortality rate is still high. The long delay in initiating thrombolysis, particularly in female and elderly patients is remarkable.

[Sinusal teratocarcinosarcoma]. / Teratocarcinosarcoma sinusal.

We present a case of a very rare naso-sinusal malignant, teratoid neoplasia, recently called "terato-carcinosarcoma". The tumor appeared in right sinuses of a 18 year old male with nasal obstruction, headache and unilateral proptosis. In spite of surgery and radiotherapy, the patient showed, 4 months later, local massive relapse. Treatment was considered to not be possible. We review the literature about this topic, and we only find 26 published cases; the presented case would be the first published one in our country.