[Hepatic hydrothorax: presentation of 3 cases with different therapeutic approaches]. / Hidrotórax hepático: presentación de 3 casos con diferentes enfoques terapéuticos.

Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.

Mesozoic origin for West Indian insectivores.

The highly endangered solenodons, endemic to Cuba (Solenodon cubanus) and Hispaniola (S. paradoxus), comprise the only two surviving species of West Indian insectivores. Combined gene sequences (13.9 kilobases) from S. paradoxus established that solenodons diverged from other eulipotyphlan insectivores 76 million years ago in the Cretaceous period, which is consistent with vicariance, though also compatible with dispersal. A sequence of 1.6 kilobases of mitochondrial DNA from S. cubanus indicated a deep divergence of 25 million years versus the congeneric S. paradoxus, which is consistent with vicariant origins as tectonic forces separated Cuba and Hispaniola. Efforts to prevent extinction of the two surviving solenodon species would conserve an entire lineage as old or older than many mammalian orders.

Laparoscopic treatment of right colic flexure perforation by an ingested wooden toothpick.

INTRODUCTION: Ingestion of a toothpick, both accidentally and intentionally, is a rare event. PRESENTATION OF CASE: We present the case of a 42-years old man who was admitted to the emergency department at our Institution presenting with a 5-days history of right sided abdominal pain. Laboratory blood count reported leukocytosis and alteration of principal inflammation index; at the abdominal ultrasound no signs of perforation or collection were described. DISCUSSION: Indication to surgery was posed and an explorative laparoscopy was performed. The presence of local peritonitis at the right colonic flexure secondary to a full thickness bowel perforation caused by a toothpick was found. There was also an acute phlegmonous appendicitis. A laparoscopic appendectomy and a full-thickness double running suture of the perforation were performed. CONCLUSION: Awareness about dangers of ingested toothpicks needs to be taken and the intestinal track/trace of the toothpick is mandatory until its expulsion.

Biochemical reference intervals and intestinal microflora of free-ranging Ricord's iguanas (Cyclura ricordii).

Caribbean iguanas, including the Ricord's iguana (Cyclura ricordii) are ranked as critically endangered on the International Union of the Conservation of Nature (IUCN) Red List. The taxon is endemic to Hispaniola, where it inhabits xeric lowlands and is found in a very limited range in two subpopulations in the southwestern area of the island. The goals of this study were to obtain and analyze plasma biochemical and intestinal microbiological data from Ricord's iguanas in the subpopulation of the Neiba Valley, on Cabritos Island National Park, Dominican Republic, and to establish biochemical reference intervals. A total of 23 blood samples from clinically healthy iguanas (16 males, 7 females) and 14 fecal samples from clinically healthy iguanas were analyzed. Adult female iguanas had higher concentrations of cholesterol, phosphorus, triglycerides, urea, uric acid, and aspartate transaminase activity compared with male iguanas, although the difference was not statistically significant. Seventeen bacterial isolates were obtained, including: Salmonella sp. (serogroup B; serogroup D negative) Escherichia coli, Brevibacterium sp., Enterobacter cloacae, and Enterococcus durans. These data will help contribute to the management and recovery of Ricord's iguana populations.

[Description of postauthorisation observational prospective studies with drugs in the valencian region between 2010 and 2015. Factors associated with their authorisation.] / Descripción de los estudios posautorización observacionales prospectivos con medicamentos en la Comunitat Valenciana entre 2010 y 2015.

OBJECTIVE: Postauthorisation observational studies are crucial source of information on drug effectiveness and safety. The objectives of this work were to describe the characteristics of the postauthorisation observational prospective studies (EPA-SP) for which authorisation was requested in the Valencian region, as well as to explore which factors influenced the aforementioned authorisation. METHODS: We performed a retrospective analytical study comprising all the EPA-SP for which authorisation was requested in the Valencian region between 2010 and 2015.The variables associated to the studies (e.g., objectives, studied drug, target disease) as well as those concerning the authorisation process itself (e.g., authorisation status, reason for authorisation refusal, current status of the study) were obtained from relevant databases. The analysis was divided into descriptive and analytical stages. RESULTS: We included a total of 249 studies, out of which 192 (77, 1%) aimed at estimating effectiveness or quality of life. The most frequent types of drugs involved in the studies were the antineoplastic and immunomodulating agents (42%). Only 57% of the studies were granted authorisation, with prescription induction and unusual practice being the most common causes for refusal (40.1% and 39.3%, respectively). The authorisation was linked to the diagnosis (circulatory system OR 10,7, IC95% 2,3 to 49,1), ATC L group (OR 4,2, IC95% 1,9 to 49,1) as well as to whether it had been advocated by the industry (OR 0,5, IC95% 0,3 to 0,9). CONCLUSIONS: Given the importance of having information on effectiveness and safety in usual practice, it is a priority for EPA-SP to be directed towards these aims and to promote independent research.

OBJETIVO: Los estudios posautorización observacionales son una fuente de información clave sobre efectividad y seguridad de los medicamentos. Los objetivos del estudio fueron describir las características de los estudios observacionales de seguimiento prospectivo (EPA-SP) que solicitaron autorización en la Comunitat Valenciana (CV) y explorar qué factores se asociaron con su autorización. METODOS: Se realizó estudio observacional analítico retrospectivo, en el que se incluyeron todos los EPA-SP que solicitaron autorización en la CV desde 2010 hasta 2015. A partir de las bases de datos de la Dirección General de Farmacia y Productos Sanitarios y GESTO se obtuvieron variables referentes al estudio (objetivos, medicamento estudiado, enfermedad diana, etc) y referentes al procedimiento de autorización (autorización, motivo de no autorización y estado actual del estudio). El análisis se organizó en una fase descriptiva y otra analítica mediante regresión logística con variable dependiente la autorización. RESULTADOS: Fueron incluidos un total de 249 estudios, de los que 192 (77,1%) estaban diseñados para estimar efectividad o calidad de vida. Los medicamentos más frecuentemente estudiados fueron los agentes antineoplásicos e inmunomoduladores (42%). Sólo consiguieron la autorización el 57%, siendo las causas más frecuente de denegación la inducción a la prescripción (40,1%) y la práctica no habitual (39,3%). La autorización se asoció con el diagnóstico (aparato circulatorio OR 10,7, IC95% 2,3 a 49,1), grupo ATC L (OR 4,2, IC95% 1,9 a 49,1) y el haber sido promovidos por la industria (OR 0,5, IC95% 0,3 a 0,9). CONCLUSIONES: Dada la importancia de contar con información sobre efectividad y seguridad en la práctica habitual, es prioritario que los EPA-SP sean orientados a estos fines y que se potencie la investigación independiente.

Mitogenomic sequences support a north-south subspecies subdivision within Solenodon paradoxus.

Solenodons are insectivores found only in Hispaniola and Cuba, with a Mesozoic divergence date versus extant mainland mammals. Solenodons are the oldest lineage of living eutherian mammal for which a mitogenome sequence has not been reported. We determined complete mitogenome sequences for six Hispaniolan solenodons (Solenodon paradoxus) using next-generation sequencing. The solenodon mitogenomes were 16,454-16,457 bp long and carried the expected repertoire of genes. A mitogenomic phylogeny confirmed the basal position of solenodons relative to shrews and moles, with solenodon mitogenomes estimated to have diverged from those of other mammals ca. 78 Mya. Control region sequences of solenodons from the northern (n = 3) and southern (n = 5) Dominican Republic grouped separately in a network, with FST = 0.72 (p = 0.036) between north and south. This regional genetic divergence supports previous morphological and genetic reports recognizing northern (S. p. paradoxus) and southern (S. p. woodi) subspecies in need of separate conservation plans.

Vitamin D status of wild Ricord's iguanas (Cyclura ricordii) and captive and wild rhinoceros iguanas (Cyclura cornuta cornuta) in the Dominican Republic.

Calcidiol (25-hydroxyvitamin D) values are reported for 22 wild Ricord's iguanas (Cyclura ricordii) and seven wild rhinoceros iguanas (Cyclura cornuta cornuta). Calcitriol (1,25-hydroxyvitamin D) values are reported for 12 wild Ricord's iguanas and seven wild rhinoceros iguanas. These animals were captured as part of a larger health assessment study being conducted on Ricord's iguanas in Isla Cabritos National Park, Dominican Republic. A total of 13 captive rhinoceros iguanas held outdoors at Parque Zoológico Nacional were also sampled for comparison. Mean concentrations of 25-hydroxyvitamin D were 554 nmol/L (222 ng/ml) with a range of 250-1,118 nmol/L (100-448 ng/ml) for wild Ricord's iguanas, 332 nmol/L (133 ng/ml) with a range of 260-369 nmol/L (104-148 ng/ml) for wild rhinoceros iguanas, and 317 nmol/L (127 ng/ml) with a range of 220-519 nmol/L (88-208 ng/ml) for captive rhinoceros iguanas. On the basis of these results, serum concentrations of at least 325 nmol/L (130 ng/ml) for 25-hydroxyvitamin D should be considered normal for healthy Ricord's and rhinoceros iguanas.

[Children's relative age in class and medication for attention-deficit/hyperactivity disorder. A population-based study in a health department in Spain]. / Edad relativa de los niños en clase y tratamiento farmacológico del trastorno por déficit de atención/hiperactividad. Estudio poblacional en un departamento de salud.

BACKGROUND AND OBJECTIVE: Previous studies in various countries have shown that the youngest school children in the same class-grade are more likely to be treated for attention-deficit/hyperactivity disorder (ADHD) than their older classmates. The aim of this study is to determine in the Spanish setting whether younger relative age children in each grade have a higher prevalence of treatment for ADHD. SUBJECTS AND METHODS: Population, observational, cross-sectional study in a health department, using prevalence data (November 2013) of treatment for ADHD in children aged 6-12 years. Data was obtained from the information systems of the Valencia Ministry of Health and multivariate models were used to estimate the prevalence ratio of treatment according to the month of birth of children in each grade. RESULTS: Twenty thousand two hundred and thirty-seven children were included of whom 1.73% were treated for ADHD (boys: 2.70%; girls: 0.71%) in October 2013. The prevalence of treatment increased with age, in males, and in youngest children (born in the last months of each year). In the multivariate analysis, the prevalence of treatment in the youngest children (born in the months of August to December) was 2.5 to 3 times higher than in their older classmates (born in January). CONCLUSIONS: The younger children relative to their classmates are more likely to be treated pharmacologically with methylphenidate and/or atomoxetine.

Hidrotórax hepático: presentación de 3 casos con diferentes enfoques terapéuticos / Hepatic hydrothorax: presentation of 3 cases with different therapeutic approaches

El hidrotórax hepático (HH) se define como un derrame pleural mayor de 500 ml en pacientes con cirrosis e hipertensión portal. Representa una complicación infrecuente por lo general asociada con ascitis y su origen se relaciona con el paso de líquido ascítico a través de pequeños defectos en el diafragma de predominio en el hemitórax derecho. Una vez establecido el diagnóstico por imágenes, la toracentesis diagnostica permite confirmar un trasudado. La terapia inicial está basada en la restricción de sodio y el uso combinado de diuréticos. El 20-25% de los pacientes desarrolla un HH refractario, el cual requiere intervenciones invasivas tales como la derivación percutánea portosistémica intrahepática (DPPI), la reparación de los defectos diafragmáticos por videotoracoscopia asistida asociada a pleurodésis química y el uso de un catéter pleural tunelizado. No se recomienda la inserción de un tubo de tórax por su elevada morbilidad y mortalidad. El tratamiento definitivo del HH es el trasplante hepático el cual alcanza una excelente sobrevida. Presentamos tres casos de hidrotórax hepático con diferentes enfoques terapéuticos que incluyeron el manejo conservador con dieta y diuréticos, la inserción fallida de un tubo de tórax con pleurodesis y una DPPI.

Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.

Amiloidosis gastrointestinal (AG): presentación de caso / Gastrointestinal amyloidosis (AG): presentation of case

La amiloidosis es una enfermedad de etiología desconocida, que se caracteriza por el depósito de sustancia amorfa (amiloide), en los espacios extracelulares de diversos órganos y tejidos condicionando alteraciones funcionales y estructurales según la localización e intensidad del depósito. Alrededor del 75 por ciento de los pacientes que la padecen tienen una amiloidosis primaria, el 5 por ciento del total presenta amiloidosis secundaria, y menos del 5 por ciento desarrolla una amiloidosis familiar. Las manifestaciones clínicas son inespecíficas, determinadas por el órgano o el sistema afectado. El diagnóstico se basa en la sospecha clínica y la demostración de la sustancia amiloide en los tejidos. La evolución de la amiloidosis es difícil de comprobar debido a que casi nunca se conoce con precisión el inicio de la misma. En cuanto al tratamiento médico, se observa respuesta favorable con melfalán más prednisona; respecto al transplante de órganos, no se cuenta con un protocolo de aceptación universal, éste depende de cada caso, extensión y estadio evolutivo de la enfermedad. A continuación presentamos un caso de amiolidosis primaria sistémica, en donde se encuentra comprometido el sistema gastrointestinal.

Dispepsia orgánica persistente de causa infrecuente: presentación de un caso / Persistent organic dyspepsia of infrequent cause: case presentation

Por los criterios del consenso de Roma III, la dispepsia se define como cualquier dolor o malestar localizado en la parte central del abdomen superior y que puede estar asociado a una sensación de plenitud, saciedad precoz, distensión, eructos, náuseas y vómitos que pueden mejorar o empeorar con las comidas, iniciados en los últimos 6 meses y con síntomas presentes una vez a la semana en los 3 meses previos. La dispepsia está constituida por dos grandes grupos: la orgánica y la funcional y puede ser secundaria a alteraciones locales o sistémicas. Se estima que entre el 60 y 70% de las dispepsias son funcionales y que un 30 a 40% son de origen orgánico. La gastritis, la ulcera péptica ya sea gástrica o duodenal, el cáncer y algunos fármacos, son los factores orgánicos más frecuentemente implicados. La incidencia de la dispepsia por alteraciones sistémicas es poco conocida y su aparición es variable. Presentamos un caso que fue derivado al servicio de gastroenterología por presentar una dispepsia relacionada con Helycobacter pylori que persistió luego de la erradicación de la infección, evidenciando luego del estudio clínico y paraclínico una hipercalcemia sintomática secundaria a hiperparatiroidismo primario (HPTP) como causa de su cuadro gastrointestinal; y a continuación se hará la revisión de la patología en mención y de su componente gastrointestinal.

For the Rome III consensus criteria, the dyspepsia is defined as any pain or "discomfort" located in the central part of the superior abdomen and that it can be associated to a sensation of fullness, satiety precocious distension, burps, nauseas and vomits that can improve or to worsen with the foods, begun in the last 6 months and with present symptoms once a week in the 3 previous months. The dyspepsia this incorporated one for two big groups: the organic one and the functional one and it can be secondary to local or systemic alterations. Considered that between the 60 and 70% of the dyspeptic they are functional and that a 30 to 40% are of organic origin. The gastritis, ulcerates peptic either gastric or duodenal, the cancer and some medications, they are the frequently implied organic factors. The incidence of the dyspepsia for systemic alterations is not very well-known and its appearance is variable. We present a case that was derived to the gastroenterology service to present a dyspepsia related with Helycobacter pylori that persisted after the eradication of the infection, evidencing after the clinical study and paraclinic a symptomatic hypercalcemia secondary to primary hyperparathyroidism (HPTP) like cause of their gastrointestinal square; and next the revision of the pathology will be made in mention and of its gastrointestinal component.

Desórdenes eosinofílicos gastrointestinales (DEGI): presentación de dos casos / Gastrointestinal Eosinofilic Disorders

Los desórdenes eosinofílicos gastrointestinales (DEGI) son enfermedades poco frecuentes, de etiopatogenia poco clara, que se caracterizan por la presencia de un infiltrado eosinófilo que puede afectar a las distintas capas de la pared del tubo digestivo en ausencia de causas conocidas de eosinofilia. Las manifestaciones clínicas son variables y los síntomas están condicionados por el grado de infiltración eosinófila de la pared, el número de capas afectadas y del segmento del tracto gastrointestinal implicado. Los síntomas de presentación varían desde diarrea, vómitos, dolor abdominal y pérdida de peso hasta la obstrucción intestinal aguda. Se caracterizan por presentar eosinofilia periférica, aunque no es un criterio obligado. Su diagnóstico definitivo es anatomopatológico. El uso de esteroides es considerado como la piedra angular del tratamiento. Presentamos dos casos, con diferentes formas de presentación clínica, con respuesta inicial a los esteroides y posterior recaída después de la suspensión de éstos, permaneciendo asintomáticos actualmente con dependencia de dosis bajas de esteroides. Seguidamente haremos la revisión de la literatura disponible subrayando los datos fisiopatológicos, evaluación clínica y aspectos terapéuticos

Humanismo y pediatría en el siglo XXI / Humanism and pediatrics in the 21st century

Contenido: Qué es el humanismo. Precursores del humanismo literario. Humanistas célebres del mundo. Elogio de la pediatría y los pediatras. Una opción preventiva preferencial. Ideas para mejorar el bienestar de niños, niñas y adolescentes. Personalidades del humanismo argentino ineludibles. Humanistas platenses destacados. Abuelidad humanizante

Utilidad de la anamnesis y de las pruebas cutaneas en el diagnóstico de la alergia medicamentosa / Usefulness of anamnesis and skin tests in the diagnosis of drug allergy

Se estudiaron 2.479 pacientes que concurrieron por una presunta alergia a medicamentos. Se realizaron en dicha población una minuciosa anamnesis y pruebas cutáneas con los fármacos sospechosos, cuyos resultados destacan la importancia de estos métodos en el diagnóstico de alergia a medicamentos