Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border.

BACKGROUND: Over the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting. METHODS: This cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants' experience caring for patients in ILE custody, including the perception of respect, violations of patients' privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments. RESULTS: 332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees' medical care, detainees' privacy rights, or ILE's authority in patient care. CONCLUSIONS: This study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.

Laparoscopic or laparoscopic-assisted cystopexy for pelvic bladder in 3 dogs.

The techniques and clinical outcomes of laparoscopic or laparoscopic-assisted cystopexy in 3 dogs diagnosed with pelvic bladder are reported herein. The medical records of 2 dogs with pelvic bladder which underwent laparoscopic cystopexy, and 1 dog which underwent laparoscopic-assisted cystopexy were reviewed. Data retrieved included signalment, clinical signs, diagnostic imaging, surgical technique, and clinical outcome. Long-term follow-up was obtained by verbal interviews with owners. Laparoscopic or laparoscopic-assisted cystopexy was successfully performed to reposition the urinary bladder within the abdominal cavity in all dogs. An intracorporeal suture technique was used in 2 dogs, whereas an extracorpreal technique was used in 1 dog. Two dogs with stranguria experienced complete resolution immediately following surgery and remained disease-free at 18 mo after cystopexy. A third dog with urinary incontinence subjectively improved (according to the owner) but had not resolved completely 2 d following surgery. Key clinical message: Laparoscopic or laparoscopic-assisted cystopexy may be an effective treatment for pelvic bladder in dogs and may offer a minimally invasive alternative to laparotomy. Male dogs with stranguria as the primary clinical sign may experience complete resolution following cystopexy.

Cystopexie laparoscopique ou assistée par laparoscopie pour une vessie pelvienne chez trois c hiens. Les techniques et les résultats cliniques de la cystopexie laparoscopique ou assistée par laparoscopie chez trois chiens diagnostiqués avec une vessie pelvienne sont rapportés ici.Les dossiers médicaux de deux chiens ayant une vessie pelvienne ayant subi une cystopexie laparoscopique et d'un chien ayant subi une cystopexie assistée par laparoscopie ont été examinés. Les données récupérées comprenaient le signalement, les signes cliniques, l'imagerie diagnostique, la technique chirurgicale et les résultats cliniques. Le suivi à long terme a été obtenu par des entrevues verbales avec les propriétaires.La cystopexie laparoscopique ou assistée par laparoscopie a été réalisée avec succès pour repositionner la vessie dans la cavité abdominale chez tous les chiens. Une technique de suture intracorporelle a été utilisée chez deux chiens, tandis qu'une technique extracorporelle a été utilisée chez un chien. Deux chiens atteints de strangurie ont connu une résolution complète immédiatement après la chirurgie et sont restés sans maladie à 18 mois après la cystopexie. Un troisième chien souffrant d'incontinence urinaire s'est amélioré subjectivement (selon le propriétaire) mais celle-ci n'a pas complètement disparu 2 jours après la chirurgie.Message clinique clé :La cystopexie laparoscopique ou assistée par laparoscopie peut être un traitement efficace pour une vessie pelvienne chez le chien et peut offrir une alternative peu invasive à la laparotomie. Les chiens mâles atteints de strangurie comme signe clinique principal peuvent connaître une résolution complète après la cystopexie.(Traduit par Dr Serge Messier).

In vivo acoustoelectric imaging for high-resolution visualization of cardiac electric spatiotemporal dynamics.

Acoustoelectric cardiac imaging (ACI) is a hybrid modality that exploits the interaction of an ultrasonic pressure wave and the resistivity of tissue to map current densities in the heart. This study demonstrates for the first time in vivo ACI in a swine model. ACI measured beat-to-beat variability (n=20) of the peak of the cardiac activation wave at one location of the left ventricle as 5.32±0.74µV, 3.26±0.54mm below the epicardial surface, and 2.67±0.56ms before the peak of the local electrogram. Cross-sectional ACI images exhibited propagation velocities of 0.192±0.061m/s along the epicardial-endocardial axis with an SNR of 24.9 dB. This study demonstrates beat-to-beat and multidimensional ACI, which might reveal important information to help guide electroanatomic mapping procedures during ablation therapy.

Anatomic and volumetric characterization of the cisterna chyli using CT lymphangiography and computer-assisted design software in dogs with idiopathic chylothorax.

The objectives of this retrospective, observational study were to characterize the anatomical features of the cisterna chyli (CC) in a cohort of dogs diagnosed with idiopathic chylothorax that underwent CT lymphangiography (CTLa), and to evaluate the feasibility of computer-assisted design (CAD) software to quantify volumetric measurements of the CC. Twenty-three client-owned dogs with idiopathic chylothorax were included. Additionally, CTLa was performed in three canine cadavers to assess the ability of CAD software to accurately acquire volumetric measurements. Injection sites, attenuation values, anatomic location, dimensions, and aortic diameter to CC ratio (Ao:CC) were recorded. Video records of video-assisted thoracic surgery (VATS) thoracic duct ligation (TDL) were reviewed in eight out of 23 dogs to compare operative and CTLa findings. The CC was dorsal and right-sided in 18 out of 23 dogs, located between L1 and L4 in 21 dogs, and extended as far cranially as T11 in two dogs. The median measurements for length, height, and width were 150.0, 5.5, and 13.3 mm, respectively. Median total volume was 1.82 mL. Median volumes to the right and left of the aorta were 1.46 and 0.49 mL, respectively (P = .014). Median total CC volume to body weight ratio (CC:bw) was 0.07 mL/kg. The presence of an intrathoracic CC was observed intraoperatively in six out of eight cases that underwent VATS TDL. Findings supported the use of CTLa and CAD as feasible methods for characterizing the CC in dogs diagnosed with chylothorax. These methods may facilitate interventional planning involving the CC such as embolization.

Automated detection of geological landforms on Mars using Convolutional Neural Networks.

The large volume of high-resolution images acquired by the Mars Reconnaissance Orbiter has opened a new frontier for developing automated approaches to detecting landforms on the surface of Mars. However, most landform classifiers focus on crater detection, which represents only one of many geological landforms of scientific interest. In this work, we use Convolutional Neural Networks (ConvNets) to detect both volcanic rootless cones and transverse aeolian ridges. Our system, named MarsNet, consists of five networks, each of which is trained to detect landforms of different sizes. We compare our detection algorithm with a widely used method for image recognition, Support Vector Machines (SVMs) using Histogram of Oriented Gradients (HOG) features. We show that ConvNets can detect a wide range of landforms and has better accuracy and recall in testing data than traditional classifiers based on SVMs.

Acoustoelectric Time-Reversal for Ultrasound Phase-Aberration Correction.

Acoustoelectric imaging (AEI) is a technique that combines ultrasound (US) with radio frequency recording to detect and map local current source densities. This study demonstrates a new method called acoustoelectric time reversal (AETR), which uses AEI of a small current source to correct for phase aberrations through a skull or other US-aberrating layers with applications to brain imaging and therapy. Simulations conducted at three different US frequencies (0.5, 1.5, and 2.5 MHz) were performed through media layered with different sound speeds and geometries to induce aberrations of the US beam. Time delays of the acoustoelectric (AE) signal from a monopole within the medium were calculated for each element to enable corrections using AETR. Uncorrected aberrated beam profiles were compared with those after applying AETR corrections, which demonstrated a strong recovery (29%-100%) of lateral resolution and increases in focal pressure up to 283%. To further demonstrate the practical feasibility of AETR, we further conducted bench-top experiments using a 2.5 MHz linear US array to perform AETR through 3-D-printed aberrating objects. These experiments restored lost lateral restoration up to 100% for the different aberrators and increased focal pressure up to 230% after applying AETR corrections. Cumulatively, these results highlight AETR as a powerful tool for correcting focal aberrations in the presence of a local current source with applications to AEI, US imaging, neuromodulation, and therapy.

Current Source Density Imaging Using Regularized Inversion of Acoustoelectric Signals.

Acoustoelectric (AE) imaging can potentially image biological currents at high spatial (~mm) and temporal (~ms) resolution. However, it does not directly map the current field distribution due to signal modulation by the acoustic field and electric lead fields. Here we present a new method for current source density (CSD) imaging. The fundamental AE equation is inverted using truncated singular value decomposition (TSVD) combined with Tikhonov regularization, where the optimal regularization parameter is found based on a modified L-curve criterion with TSVD. After deconvolution of acoustic fields, the current field can be directly reconstructed from lead field projections and the CSD image computed from the divergence of that field. A cube phantom model with a single dipole source was used for both simulation and bench-top phantom studies, where 2D AE signals generated by a 0.6 MHz 1.5D array transducer were recorded by orthogonal leads in a 3D Cartesian coordinate system. In simulations, the CSD reconstruction had significantly improved image quality and current source localization compared to AE images, and performance further improved as the fractional bandwidth (BW) increased. Similar results were obtained in the phantom with a time-varying current injected. Finally, a feasibility study using an in vivo swine heart model showed that optimally reconstructed CSD images better localized the current source than AE images over the cardiac cycle.

Effect of Nanometric Particles of Bentonite on the Mechanical Properties of a Thermoset Polymeric Matrix Reinforced with Hemp Fibers.

The influence of the addition of bentonite nanoparticles on the tensile and flexural strength of a thermosetting polymer matrix composite material reinforced with hemp fibers was de-terminated. All composites were manufactured with 5% of bentonite in the polymer mass-weight ratios and 10 to 45 wt% of fibers with a step of 5%. For mechanical characterization, tensile and flexural tests were performed: scanning electron microscopy and energy-dispersive X-ray spectroscopy analyses were carried out. The tensile strength of the samples containing bentonite compared to the polymer samples with the fiber addition was affected for all fiber addition percentages, except for 35% while the flexural resistance improved with the addition of bentonite in the percentages of 20, 30, 35, and 45% of fiber addition. With the addition of bentonite, the maximum values of tensile and flexural strength were both obtained for the 35% addition of fibers, with values of 34.28 MPa and 98.04 MPa, respectively. The presence of bentonite favored the rigidity of the material to traction and bending, which was reflected through an increase in the elastic modulus compared to the composite that only had fiber. The maximum values obtained were 9065 MPa in tension and 8453 MPa in flexion for the 40% and 35% of addition of fiber, respectively. Microscopy showed a good distribution of fibers in the matrix, the absence of internal porosities, and a good interaction between matrix and reinforcement.

DSCAM is differentially patterned along the optic axon pathway in the developing Xenopus visual system and guides axon termination at the target.

BACKGROUND: The Xenopus retinotectal circuit is organized topographically, where the dorsal-ventral axis of the retina maps respectively on to the ventral-dorsal axis of the tectum; axons from the nasal-temporal axis of the retina project respectively to the caudal-rostral axis of the tectum. Studies throughout the last two decades have shown that mechanisms involving molecular recognition of proper termination domains are at work guiding topographic organization. Such studies have shown that graded distribution of molecular cues is important for topographic mapping. However, the complement of molecular cues organizing topography along the developing optic nerve, and as retinal axons cross the chiasm and navigate towards and innervate their target in the tectum, remains unknown. Down syndrome cell adhesion molecule (DSCAM) has been characterized as a key molecule in axon guidance, making it a strong candidate involved in the topographic organization of retinal fibers along the optic path and at their target. METHODS: Using a combination of whole-brain clearing and immunohistochemistry staining techniques we characterized DSCAM expression and the projection of ventral and dorsal retinal fibers starting from the eye, following to the optic nerve and chiasm, and into the terminal target in the optic tectum in Xenopus laevis tadpoles. We then assessed the effects of DSCAM on the establishment of retinotopic maps through spatially and temporally targeted DSCAM knockdown on retinal ganglion cells (RGCs) with axons innervating the optic tectum. RESULTS: Highest expression of DSCAM was localized to the ventral posterior region of the optic nerve and chiasm; this expression pattern coincides with ventral fibers derived from ventral RGCs. Targeted downregulation of DSCAM expression on ventral RGCs affected the segregation of medial axon fibers from their dorsal counterparts within the tectal neuropil, indicating that DSCAM plays a role in retinotopic organization. CONCLUSION: These findings together with previous studies demonstrating cell-autonomous roles for DSCAM during the development of pre- and postsynaptic arbors in the Xenopus retinotectal circuit indicates that DSCAM exerts multiple roles in coordinating axon targeting and structural connectivity in the developing vertebrate visual system.

Synthesis of BiOI/Mordenite Composites for Photocatalytic Treatment of Organic Pollutants Present in Agro-Industrial Wastewater.

Recently, bismuth oxyiodide (BiOI) is an attractive semiconductor to use in heterogeneous photocatalysis processes. Unfortunately, BiOI individually shows limited photocatalytic efficiency, instability, and a quick recombination of electron/holes. Considering the practical application of this semiconductor, some studies show that synthetic zeolites provide good support for this photocatalyst. This support material permits a better photocatalytic efficiency because it prevents the quick recombination of photogenerated pairs. However, the optimal conditions (time and temperature) to obtain composites (BiOI/ synthetic zeolite) with high photocatalytic efficiency using a coprecipitation-solvothermal growth method have not yet been reported. In this study, a response surface methodology (RSM) based on a central composite design (CCD) was applied to optimize the synthesis conditions of BiOI/mordenite composites. For this purpose, eleven BiOI/mordenite composites were synthesized using a combined coprecipitation-solvothermal method under different time and temperature conditions. The photocatalytic activities of the synthesized composites were evaluated after 20 min of photocatalytic oxidation of caffeic acid, a typical organic pollutant found in agro-industrial wastewater. Moreover, BiOI/mordenite composites with the highest and lowest photocatalytic activity were physically and chemically characterized using nitrogen adsorption isotherms, scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and diffuse reflectance spectroscopy (DRS). The optimal synthesis conditions prove to be 187 °C and 9 h. In addition, the changes applied to the experimental conditions led to surface property modifications that influenced the photocatalytic degradation efficiency of the BiOI/mordenite composite toward caffeic acid photodegradation.

High resolution transcranial acoustoelectric imaging of current densities from a directional deep brain stimulator.

OBJECTIVE: New innovations in deep brain stimulation (DBS) enable directional current steering-allowing more precise electrical stimulation of the targeted brain structures for Parkinson's disease, essential tremor and other neurological disorders. While intra-operative navigation through MRI or CT approaches millimeter accuracy for placing the DBS leads, no existing modality provides feedback of the currents as they spread from the contacts through the brain tissue. In this study, we investigate transcranial acoustoelectric imaging (tAEI) as a new modality to non-invasively image and characterize current produced from a directional DBS lead. tAEI uses ultrasound (US) to modulate tissue resistivity to generate detectable voltage signals proportional to the local currents. APPROACH: An 8-channel directional DBS lead (Infinity 6172ANS, Abbott Inc) was inserted inside three adult human skulls submerged in 0.9% NaCl. A 2.5 MHz linear array delivered US pulses through the transtemporal window and focused near the contacts on the lead, while a custom amplifier and acquisition system recorded the acoustoelectric (AE) interaction used to generate images. MAIN RESULTS: tAEI detected monopolar current with stimulation pulses as short as 100 µs with an SNR ranging from 10-27 dB when using safe US pressure (mechanical indices <0.78) and injected current of ~2 mA peak amplitude. Adjacent contacts were discernable along the length and within each ring of the lead with a mean radial separation between contacts of 2.10 and 1.34 mm, respectively. SIGNIFICANCE: These results demonstrate the feasibility of tAEI for high resolution mapping of directional DBS currents using clinically-relevant stimulation parameters. This new modality may improve the accuracy for placing the DBS leads, guide calibration and programming, and monitor long-term performance of DBS for treatment of Parkinson's disease.

Inhibidores de la bomba de protones: el impacto en la salud cognitiva de los adultos mayores / Proton pump inhibitors: the impact on cognitive health in older adults

RESUMEN Los inhibidores de la bomba de protones (IBP) son los medicamentos más potentes para inhibir la secreción gástrica ácida, y se utilizan en el tratamiento de la mayor parte de las afecciones inflamatorias de la mucosa gástrica. Forman parte de los fármacos más recetados y sobreprescritos en todo el mundo; por ejemplo, en los Estados Unidos, según la Encuesta nacional de salud y nutrición, casi duplicaron su uso en los adultos de 40 años de un 4,9 % hasta un 8,3 %, entre los años 1999 a 2012. Aunque, en general, se consideran bien tolerados, algunos estudios epidemiológicos ―que extraen información a partir de grandes bases de datos― han reportado una serie de efectos adversos asociados con su uso prolongado, entre los cuales están el deterioro cognitivo, la enfermedad renal crónica, el infarto de miocardio, el accidente cerebrovascular, las fracturas óseas e incluso la muerte, entre otros. El objetivo fue realizar una revisión narrativa de la literatura acerca de los efectos del uso crónico de los IBP sobre el deterioro cognitivo en los adultos mayores. Se revisaron artículos a partir de una búsqueda en las bases de datos Pudmed, Scopus y Scielo con las palabras clave y términos Mesh/DeCS relacionados tanto en inglés como en español. Los efectos secundarios a nivel neurológico inducidos por el uso crónico de los IBP pueden estar relacionados indirectamente con la presencia de alteraciones sistémicas secundarias (deficiencia de magnesio y vitamina B12) o con efectos directos sobre el funcionamiento neuronal después de pasar a través de la barrera hematoencefálica. Si bien se han descrito varios mecanismos neurobiológicos por medio de los cuales los IBP podrían favorecer el desarrollo de la demencia ―que comprenden el funcionamiento de la proteína tau, la acumulación de beta amiloide (βA) y la deficiencia de cobalamina, entre otros―, la mayor parte de la evidencia clínica disponible no ha encontrado una asociación significativa entre el uso de los IBP y el riesgo de demencia o el deterioro cognitivo. Para establecer de una manera más clara los efectos clínicos adversos del uso crónico de los IBP, en especial, en el funcionamiento cerebral, se necesitan estudios de cohorte bien diseñados, con tamaños de muestra grandes y periodos de seguimiento prolongados, con un método confiable para ajustar los factores de confusión estandarizados y, además, realizar análisis por subgrupos.

ABSTRACT Proton pump inhibitors (PPIs) are the most potent drugs to inhibit gastric acid secretion, being used in the treatment of most inflammatory conditions of the gastric mucosa. They are among the most prescribed and overprescribed medications worldwide; for example, in the United States, according to the National Health and Nutrition Examination Survey, they almost doubled their use in adults aged 40 years and older from 4.9 % to 8.3 % between 1999 and 2012. Although they are generally considered well tolerated, some epidemiological studies extracting information from large databases have reported a number of adverse effects associated with their prolonged use, including cognitive impairment, chronic kidney disease, myocardial infarction, stroke, bone fractures and even death, among others. The objective was to conduct a narrative review of the literature on the effects of chronic use of PPIs on cognitive impairment in older adults. Articles were reviewed based on a search in the PubMed, Scopus and SciELO databases using both English and Spanish keywords and related MeSH/DeCS terms. Neurological side effects induced by chronic PPI use may be indirectly related to secondary systemic disorders (magnesium and vitamin B12 deficiency) or to direct effects on neuronal functioning after passing through the blood-brain barrier. Although several neurobiological mechanisms by which PPIs could favor the development of dementia-which involve Tau protein function, beta-amyloid [βA] accumulation and cobalamin deficiency, among others-have been described, most of the available clinical evidence has not shown a significant association between PPI use and the risk of dementia or cognitive impairment. To establish the adverse clinical effects of chronic PPI use more clearly, especially on brain functioning, well-designed cohort studies with large sample sizes and long follow-up periods, with a reliable method to adjust for standardized confounders, as well as subgroup analyses are needed.

Altered Immunity and Microbial Dysbiosis in Aged Individuals With Long-Term Controlled HIV Infection.

The introduction of highly active antiretroviral therapy (HAART) resulted in a significant increase in life expectancy for HIV patients. Indeed, in 2015, 45% of the HIV+ individuals in the United States were ≥55 years of age. Despite improvements in diagnosis and treatment of HIV infection, geriatric HIV+ patients suffer from higher incidence of comorbidities compared to age-matched HIV- individuals. Both chronic inflammation and dysbiosis of the gut microbiome are believed to be major contributors to this phenomenon, however carefully controlled studies investigating the impact of long-term (>10 years) controlled HIV (LTC-HIV) infection are lacking. To address this question, we profiled circulating immune cells, immune mediators, and the gut microbiome from elderly (≥55 years old) LTC-HIV+ and HIV- gay men living in the Palm Springs area. LTC-HIV+ individuals had lower frequency of circulating monocytes and CD4+ T-cells, and increased frequency CD8+ T-cells. Moreover, levels of systemic INFγ and several growth factors were increased while levels of IL-2 and several chemokines were reduced. Upon stimulation, immune cells from LTC-HIV+ individuals produced higher levels of pro-inflammatory cytokines. Last but not least, the gut microbiome of LTC-HIV+ individuals was enriched in bacterial taxa typically found in the oral cavity suggestive of loss of compartmentalization, while levels of beneficial butyrate producing taxa were reduced. Additionally, prevalence of Prevotella negatively correlated with CD4+ T-cells numbers in LTC-HIV+ individuals. These results indicate that despite long-term adherence and undetectable viral loads, LTC-HIV infection results in significant shifts in immune cell frequencies and gut microbial communities.

Diseño e implementación del sistema de gestión ambiental en la Droguería La Habana / Design and implementation of the environmental management system in Drogueria La Habana

INTRODUCCIÓN: cualquier actividad empresarial para ser sostenible, debe asumir una actitud preventiva que le permita reconocer la necesidad de integrar la variable ambiental en su sistema de dirección y gestión empresarial. OBJETIVO: diseñar e implementar el sistema de gestión ambiental en la Droguería La Habana según la norma ISO 14001:2004. MÉTODOS: se creó un equipo de trabajo para el diseño, planificación y verificación de la implementación del sistema de gestión ambiental, el cual abarcó el período de enero del 2009 al primer semestre del 2012. Se realizó la revisión ambiental inicial a través de una entidad acreditada y se ejecutaron las fases requeridas para el diseño e implantación del referido sistema. RESULTADOS: en la revisión ambiental inicial se detectó que solo se cumplía con el 55 por cientoe los requisitos legales aplicables. Como parte de la fase de implementación se estableció la política integrada de la Empresa Comercializadora de Medicamentos (EMCOMED) como política ambiental de la entidad y el Programa de Gestión Ambiental. Se elaboraron y ejecutaron de manera eficaz los planes de formación y se implantaron 50 documentos que permitieron alcanzar un 82 por ciento de cumplimiento de los requisitos legales aplicables. No hubo sobreconsumos de agua potable ni de portadores energéticos respecto a lo planificado. En el 2011 se redujo la generación de desechos de medicamentos en un 64 por ciento. Se manejaron adecuadamente los desechos de medicamentos generados, eliminando más del 80 por ciento de estos y en el 2011 se incrementó la recuperación de materiales reciclables hasta 48 toneladas. Los resultados mostraron que la gestión ambiental en el período 2010-2011 fue eficaz. CONCLUSIONES: el cumplimiento de las tres primeras fases del diseño del sistema de gestión ambiental permiten llevar a cabo de forma exitosa su implementación(AU)

INTRODUCTION: For any business activity to be sustainable, it is necessary to assume a preventive attitude that allows it to recognize the need of integrating the environmental variable into the business administration and management system. OBJECTIVE: To design and to implement the environmental management system of Drogueria La Habana in compliance with ISO 14001:2004 standard. METHODS: A working team was appointed for design, planning and checking of the implementation of an environmental management system which covered the period of January 2009 through the first semester of 2012. The initial environmental review was made by a credited agency and the three phases established for the design and the implementation of the quoted system were fulfilled. RESULTS: The initial environmental review detected that just 55 percent the applicable legal requirements was met. As part of the implementation phase, the integral policy of Empresa Comercializadora de Medicamentos (EMCOMED) was adopted as the environmental policy of Drogueria as well as the environmental management program. The formation plans were effectively prepared and carried out in addition to the incorporation of 50 documents that allowed reaching 82 percent ompliance with the applicable legal requirements. There was not overconsumption of either drinking water or energy components in relation to the planned figures. In 2011, the generation of drug residues dropped by 64 percent. The handling of generated drug wastes was better since over 80 percent of them were eliminated and in this same year, the recovery of recyclable materials increased to 48 tons. The results showed that the environmental management was effective in the 2010-2011 period. CONCLUSIONS: The fulfillment of the first three phases of the design of the environmental management system allows its successful implementation(AU)

Taquicardia ventricular polimórfica catecolaminérgica / Catecholaminergic polymorphic ventricular tachycardia

La taquicardia ventricular polimórfica catecolaminérgica es una entidad de reciente descripción gracias a los avances diagnósticos en genética y electrofisiología. Consiste en una patología hereditaria que se caracteriza por la inducción de taquicardia ventricular bidireccional en la presencia de catecolaminas sin una anormalidad estructural cardiaca de base. Mutaciones en el gen RyR2 del receptor de rianodina se han identificado como responsables por la forma hereditaria autosómica dominante, mientras que mutaciones en el gen de la calsecuestrina CASQ2 se relacionan con formas autosómicas recesivas. La edad media de inicio es entre los siete y los nueve años de edad, y sus implicaciones clínicas van desde síncope hasta muerte súbita. Su diagnóstico se confirma documentando la inducción de taquicardias ventriculares con una prueba de esfuerzo o durante una infusión de agentes simpaticomiméticos como isoproterenol, apoyado con la codificación de los genes RyR2 o CASQ2. El manejo farmacológico con anti-arrítmicos aun no ha demostrado eficacia por lo que la implantación de cardiodesfibriladores se mantiene como una opción válida. Para casos especiales una alternativa es la denervación simpática cardiaca. Esta entidad abre un campo en la investigación de nuevos medicamentos antiarrítmicos y de la posible utilización de la terapia génica en electrofisiología.

Catecholaminergic Polymorphic Ventricular Tachycardia is an inherited heart rhythm disorder recently discovered by genetic and electrophysiological diagnostic advancements. It consists of an inherited disorder characterized by the induction of bi-directional ventricular tachycardia in the presence of catecholamines, without a structural cardiac abnormality. Mutations in the Ryanodine receptor gene RyR2, have been linked with an autosomic dominant form, while mutations in the Calsequestrin gene CASQ 2 have showed correlation with an autosomic recessive form. The average age of onset is between 7 and 9 years of age, and clinical symptoms vary from syncope to sudden cardiac death. The diagnosis is confirmed by inducting ventricular tachycardia through a stress test or during an infusion of sympathicomimetic drugs like Isoproterenol, aided by the identification of mutations in the RyR2 and CASQ2 genes through gene analysis. Implantable cardiodefibrillator devices remain a valid therapeutic option in many cases due to the fact that antiarrhythmic drugs have not shown efficacy. Sympathetic cardiac denervation can be useful in some special cases. Catecholaminergic Polymorphic Ventricular Tachycardia opens a wide field for the development of new antiarrhythmic drugs and the use of gene therapy for cardiac rhythm disorders.

Iatrogenia en la atención al obeso / Iatrogenic disease in the medical care of the obese patient

La obesidad constituye un riesgo para la salud, su atención resulta dificil y los resultados terapéuticos son con frecuencia defraudantes. A esto contribuye el desconocimiento de los pilares básicos del tratamiento del obeso, la poca importancia que se le presta a su educación nutricional y física y la tendencia a generalizar las recomendaciones a seguir, sin considerar las características individuales de cada paciente. Para señalar las situaciones más frecuentes, capaces de producir iatrogenia en el obeso, se agrupan en aquellas producidas por el médico, por la repercusión psicosocial y por el mal tratamiento en la niñez. En cada grupo se detallan los errores más comunes, con lo que esperamos contribuir a que se eviten al máximo y, de este modo, lograr mejores resultados terapéuticos

Cetoacidosis diabética / Diabetic ketoacidosis

Se actualizan los aspectos más importantes de la cetoacidosis diabética: concepto, clasificación, factores desencadenantes y diagnóstico clínico. Se hace un análisis exhaustivo de su fisiopatología y patogenia, así como de los estudios complementarios y su tratamiento

Disgenesia gonadal pura con cariotipo 46, XY/45, X/46, XX / Pure gonadal dysgenesis with karyotype 46, XY/45, X/46, XX

Presentamos una paciente con fenotipo femenino sin malformaciones turnerianas, amenorrea primaria, talla normal, infantilismo sexual, hipoplasia de genitales internos y streak gónadas, en la que se hizo el diagnóstico de disgenesia gonadal pura. Su fórmula cromosómica fue 46,XY/45,X/46,XX. No hemos encontrado en la literatura ninguna observación de disgenesia gonadal pura con este cariotipo. Se hace una breve revisión bibliográfica del tema

Importancia del Doppler testicular en la detección subclínica del varicocele / Significance of testicular Doppler in subclinical detection of varicocele

Se estudiaron 110 pacientes infértiles masculinos, los cuales fueron sometidos a riguroso examen físico general y de genitales, a los que además se les realizó el Doppler testicular a fin de precisar la presencia de varicocele subclínico. Al examen físico, 50 pacientes (45,5 %) presentaron varicocele, y se encontró predominio de localización en el lado izquierdo en 45 pacientes (90,0 %); mientras que con el Doppler testicular el número de pacientes afectados se elevó a 77 (70,0 %); de ellos, 27 (45,0 %) presentaron varicocele grado I (subclínico) dentro de éstos, 18 tenían varicocele unilateral y 9 varicocele bilateral. Con estos resultados se demuestra la alta sensibilidad de este proceder diagnóstico para la detección de esta enfermedad en estado subclínico