Características epidemiológicas y clínicas de gestantes y mujeres postparto con cefalea en una institución de alta complejidad en el período comprendido entre 2014-2016 / Clinical and epidemiological characteristics of pregnant and postpartum women with headache in a highly complex institution in the period between 2014 and 2016

Resumen Objetivo: determinar las características epidemiológicas y clínicas de las pacientes embarazadas y en postparto con cefalea atendidas en una institución de alta complejidad. Métodos: estudio descriptivo retrospectivo que incluyó gestantes y mujeres en postparto que presentaron cefalea durante 2014-2016 atendidas por el servicio de neurología de un centro de referencia. La información de las variables se obtuvo a partir de la revisión de historias clínicas; la clasificación de las cefaleas se realizó con base en los criterios propuestos por la IHS (International Headache Society) en su tercera edición. Resultados: se revisaron las historias clínicas de 1253 pacientes, de las cuales 95 cumplieron los criterios de elegibilidad del estudio. De estas, 74 (77,9%) estaban embarazadas y 21 (22,1%) estaban en período postparto. La mayoría de las gestantes, 41 (55,4%) estaban en tercer trimestre. La cefalea se clasificó como primaria en 69 (72,6%) pacientes, siendo más frecuente la migraña en 60/69 (87%). Los síntomas más frecuentes fueron: náuseas en 66 (69,5%), fotofobia en 64 (67,4%), y fonofobia en 58 (61,1%) pacientes. Se presentaron complicaciones en 19 pacientes (20%) durante la hospitalización; de estas, la más común fue el estado migrañoso, en 12 (63,2%) pacientes. Conclusiones: el tipo de cefalea más común fue la migraña, que, aunque es benigna, genera mucha morbilidad. Es de vital importancia determinar la presencia de banderas rojas de cefalea con el fin de descartar una patología causal subyacente que puede poner en riesgo la vida de la madre y del bebé.

Abstract Objective: to determine the epidemiological and clinical characteristics of pregnant and postpartum patients with headache treated in a highly complex institution. Methods: retrospective descriptive study that included pregnant women and postpartum women who presented headache during 2014-2016 attended by the neurology service of a referral center. The information was obtained from the review of clinical histories; Headache classification was carried out based on the criteria proposed by the IHS (International Headache Society) in its third edition. Results: the clinical histories of 1253 patients were reviewed, of which 95 met the eligibility criteria of the study. Of these, 74 (77.9%) were pregnant and 21 (22.1%) were in the postpartum period. Most of the pregnant women, 41 (55.4%) were in the third trimester. Headache was classified as primary in 69 (72.6%) patients, migraine being more frequent in 60/69 (87%). The most frequent symptoms were nausea in 66 (69.5%), photophobia in 64 (67.4%), and phonophobia in 58 (61.1%) patients. Complications were found in 19 patients (20%) during hospitalization; of these, the most common was migraine status, in 12 (63.2%) patients. Conclusions: the most common type of headache was migraine, although it is benign, generates a lot of morbidity. It is vitally important to determine the presence of headache red flags to rule out an underlying pathology that can put the life of the mother and the baby at risk.

Paralytic shellfish toxins in Peruvian scallops associated with blooms of Alexandrium ostenfeldii (Paulsen) Balech & Tangen in Paracas Bay, Peru.

In recent years, dense Alexandrium ostenfeldii blooms have been reported in different coastal areas. In this study, we report for the first time the occurrence of A. ostenfeldii blooms associated with the detection of paralytic shellfish toxins (PSTs) in the Peruvian scallop (Argopecten purpuratus) from Paracas Bay. Alexandrium ostenfeldii blooms occurred at the end of summer and early fall, after the increase of riverine input and under stratified conditions following a decrease in wind velocity. The highest abundances occurred during warm sea surface temperatures (18-27 °C). High PST concentrations that exceed the maximum permissible level (800 µg STX eq. kg-1) occurred even under low A. ostenfeldii abundances (20 × 103 cells l-1). Our results contribute to a better understanding of the dynamics of A. ostenfeldii in coastal systems influenced by riverine inputs and upwelling and can be used to improve monitoring programs and allow the implementation of mitigation measures along the Peruvian coast.

Plant Movements as Concept Generators for the Development of Biomimetic Compliant Mechanisms.

Plant movements are of increasing interest for biomimetic approaches where hinge-free compliant mechanisms (flexible structures) for applications, for example, in architecture, soft robotics, and medicine are developed. In this article, we first concisely summarize the knowledge on plant movement principles and show how the different modes of actuation, that is, the driving forces of motion, can be used in biomimetic approaches for the development of motile technical systems. We then emphasize on current developments and breakthroughs in the field, that is, the technical implementation of plant movement principles through additive manufacturing, the development of structures capable of tracking movements (tropisms), and the development of structures that can perform multiple movement steps. Regarding the additive manufacturing section, we present original results on the successful transfer of several plant movement principles into 3D printed hygroscopic shape-changing structures ("4D printing"). The resulting systems include edge growth-driven actuation (as known from the petals of the lily flower), bending scale-like structures with functional bilayer setups (inspired from pinecones), modular aperture architectures (as can be similarly seen in moss peristomes), snap-through elastic instability actuation (as known from Venus flytrap snap-traps), and origami-like curved-folding kinematic amplification (inspired by the carnivorous waterwheel plant). Our novel biomimetic compliant mechanisms highlight the feasibility of modern printing techniques for designing and developing versatile tailored motion responses for technical applications. We then focus on persisting challenges in the field, that is, how to speed-boost intrinsically slow hydraulically actuated structures and how to achieve functional resilience and robustness, before we propose the establishment of a motion design catalog in the conclusion.

4D pine scale: biomimetic 4D printed autonomous scale and flap structures capable of multi-phase movement.

We developed biomimetic hygro-responsive composite polymer scales inspired by the reversible shape-changes of Bhutan pine (Pinus wallichiana) cone seed scales. The synthetic kinematic response is made possible through novel four-dimensional (4D) printing techniques with anisotropic material use, namely copolymers with embedded cellulose fibrils and ABS polymer. Multi-phase motion like the subsequent transversal and longitudinal bending deformation during desiccation of a natural pinecone scale can be structurally programmed into such printed hygromorphs. Both the natural concept generator (Bhutan pinecone scale) and the biomimetic technical structure (4D printed scale) were comparatively investigated as to their displacement and strain over time via three-dimensional digital image correlation methods. Our bioinspired prototypes can be the basis for tailored autonomous and self-sufficient flap and scale structures performing complex consecutive motions for technical applications, e.g. in architecture and soft robotics. This article is part of the theme issue 'Bioinspired materials and surfaces for green science and technology (part 3)'.

Geographical variability of the venoms of four populations of Bothrops asper from Panama: Toxicological analysis and neutralization by a polyvalent antivenom.

Bothrops asper is the medically most important venomous snake in Central America. In Panama, the country having the highest incidence of snakebites in Latin America, B. asper is widely distributed throughout the country and is responsible for the vast majority of snakebites. This study was performed to analyze whether there are variations in the toxicological profile and in some biochemical parameters between the venoms of B. asper from four different regions in Panama. The venoms showed a similar profile of lethal, hemorrhagic, in vitro coagulant, defibrinogenating, edema-forming, myotoxic and indirect hemolytic activities, with subtle quantitative variations between samples of some regions. The venoms also had similar SDS-PAGE patterns and reverse phase HPLC profiles. A polyvalent antivenom manufactured in Costa Rica, and regularly used in Panama, was effective in the neutralization of lethal activity of the venoms of the four populations, with Mean Effective Doses (ED50) ranging from 5.98 to 9.72 mg venom/mL antivenom. In agreement, a widespread pattern of cross-reactivity between this antivenom and the four venoms was observed by immunoblotting. Overall, results highlight the lack of marked differences between the venoms of the various populations of B. asper in Panama, and that the antivenom from Costa Rica is effective in neutralizing lethality.

Late toxicity after intensity-modulated radiation therapy for localized prostate cancer: an exploration of dose-volume histogram parameters to limit genitourinary and gastrointestinal toxicity.

PURPOSE: To characterize the late genitourinary (GU) and gastrointestinal (GI) toxicity for prostate cancer patients treated with intensity-modulated radiation therapy (IMRT) and propose dose-volume histogram (DVH) guidelines to limit late treatment-related toxicity. METHODS AND MATERIALS: In this study 296 consecutive men were treated with IMRT for adenocarcinoma of the prostate. Most patients received treatment to the prostate with or without proximal seminal vesicles (90%), to a median dose of 76 Gy. Concurrent androgen deprivation therapy was given to 150 men (51%) for a median of 4 months. Late toxicity was defined by Common Toxicity Criteria version 3.0 as greater than 3 months after radiation therapy completion. Four groupings of DVH parameters were defined, based on the percentage of rectal or bladder tissue receiving 70 Gy (V(70)), 65 Gy (V(65)), and 40 Gy (V(40)). These DVH groupings, as well as clinical and treatment characteristics, were correlated to maximal Grade 2+ GU and GI toxicity. RESULTS: With a median follow-up of 41 months, the 4-year freedom from maximal Grade 2+ late toxicity was 81% and 91% for GU and GI systems, respectively, and by last follow-up, the rates of Grade 2+ GU and GI toxicity were 9% and 5%, respectively. On multivariate analysis, whole-pelvic IMRT was associated with Grade 2+ GU toxicity and age was associated with Grade 2+ GI toxicity. Freedom from Grade 2+ GI toxicity at 4 years was 100% for men with rectal V(70) ≤ 10%, V(65) ≤ 20%, and V(40) ≤ 40%; 92% for men with rectal V(70) ≤ 20%, V(65) ≤ 40%, and V(40) ≤ 80%; and 85% for men exceeding these criteria (p = 0.13). These criteria were more highly associated with GI toxicity in men aged ≥70 years (p = 0.07). No bladder dose-volume relationships were associated with the risk of GU toxicity. CONCLUSIONS: IMRT is associated with low rates of severe GU or GI toxicity after treatment for prostate cancer. Rectal dose constraints may help limit late GI morbidity.

The use of anticoagulants improves biochemical control of localized prostate cancer treated with radiotherapy.

BACKGROUND: : Substantial experimental evidence suggests that anticoagulants (ACs) may inhibit cancer growth and metastasis, although the limited data from clinical trials have been inconsistent. The potential antineoplastic effect of ACs was investigated in patients who received radiotherapy for localized prostate cancer. METHODS: : The study cohort consisted of 662 patients with adenocarcinoma of the prostate who received radiotherapy (RT) with curative intent. Among those 622 men, 243 (37%) were receiving ACs (warfarin, clopidogrel, and/or aspirin). All patients received external-beam RT, permanent seed implantation, or a combination of both. Prostate-specific antigen (PSA) values were monitored for biochemical control of disease. RESULTS: : At a median follow-up of 49 months, the biochemical control rate at 4-years was significantly better in patients who received ACs at 91% compared with 78% in patients who did not receive ACs (P = .0002). The distant metastasis rate at 4 years also was reduced in the AC group compared with the non-AC group (1% vs 5%; P = .0248). In subgroup analysis, the improvement in biochemical control was significant only for patients with high-risk disease. Along with Gleason score, T classification, and initial PSA, the use of AC therapy was associated independently with improved biochemical control in multivariate analysis. CONCLUSIONS: : AC therapy was associated with an improvement in biochemical control in patients with prostate cancer who received RT with curative intent. The effect was most prominent in patients who had high-risk disease. Cancer 2010. (c) 2010 American Cancer Society.

Dose-escalated radiotherapy for high-risk prostate cancer: outcomes in modern era with short-term androgen deprivation therapy.

PURPOSE: Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. MATERIALS AND METHODS: A total of 184 men with any single risk factor of prostate-specific antigen >or=10 ng/mL, clinical Stage T2b or greater, or Gleason score >or=7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level. RESULTS: With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose <74 Gy (4-year FFBF rate, 64% vs. 80%) had a poorer outcome on univariate analysis. However, clinical Stage T3 disease and radiation dose were not significant on multivariable analysis, although a statistical multivariable trend was seen for both (p = .0650 and p = .0597, respectively). CONCLUSION: Short-term ADT and RT might be acceptable for men with intermediate- and high-risk prostate cancer, especially for clinically localized disease treated with doses of >or=74 Gy.

Dose-escalated radiation therapy for intermediate-risk prostate cancer: patient selection for androgen deprivation therapy using percentage of positive cores.

BACKGROUND: Randomized trials supported the use of androgen deprivation therapy (ADT) with radiation therapy (RT) for intermediate-risk prostate cancer. However, the value of concurrent ADT was less certain with dose-escalated RT. Better methods of stratifying patients in this risk group may help select patients who are most likely to benefit. METHODS: A total of 238 men with intermediate-risk (prostate specific antigen [PSA] 10-20, Gleason 7, or stage T2b-c) adenocarcinoma of the prostate were treated with external beam RT between 1989 and 2006. Patients had Gleason< or =6 (39%) or 7 (61%) tumors; median PSA was 10.5 ng/mL. A median of 37.5% of biopsy cores were positive from a median of 9 biopsy cores sampled. The median RT dose was 74 Gy to the prostate. A total of 112 patients (47%) received neoadjuvant and concurrent ADT (median, 4 months). Median follow-up period was 49 months. RESULTS: The freedom from biochemical failure (FFBF, nadir + 2 definition) was 93% at 3 years, 86% at 4 years, and 80% at 5 years. On univariate analysis, the only factor associated with FFBF was percentage of positive cores (PPC, P = .0340). The prognostic value of PPC> or =50 was not evident in patients receiving ADT (FFBF at 4 years 90% vs 91%, P = .3015). For patients not receiving ADT, the impact of PPC> or =50 (FFBF at 4 years 76% vs 93%, P = .0844) was more pronounced. On multivariate analysis, PPC (P = .0388) was significantly associated with FFBF, whereas Gleason sum, ADT, RT dose, PSA, and T-stage were not. CONCLUSIONS: After dose-escalated external beam RT, intermediate-risk prostate cancer patients with PPC> or =50 had the highest risk for biochemical failure and may be most likely to derive a benefit from ADT.

Influence of intensity-modulated radiotherapy on acute genitourinary and gastrointestinal toxicity in the treatment of localized prostate cancer.

The objective of this investigation is to compare acute genitourinary (GU) and gastrointestinal (GI) toxicity results of radiotherapy to localized fields delivered using intensity-modulated radiotherapy (IMRT) versus conventional radiotherapy (ConvRT). The records of 481 consecutive prostate cancer patients receiving RT to localized fields at a single institution were reviewed; 108 received IMRT and 373 received ConvRT. Acute GU and GI toxicity, as defined by the Radiation Therapy Oncology Group (RTOG) grading system, were compared using the chi-square test. Ordered logit regression analyses were performed using all major disease and treatment factors as covariates. Acute GU grade 0, 1, 2, 3, and 4 toxicity rates were 23%, 40%, 34%, 3%, and 0%, respectively, in the IMRT cohort and 31%, 37%, 30%, 1%, and 1%, respectively, in the ConvRT cohort -- these rates were not significantly different (p=0.118). Acute GI grade 0, 1, 2, 3, and 4 toxicity rates were 42%, 37%, 22%, 0%, and 0%, respectively, in the IMRT cohort and 33%, 32%, 35%, 0%, and 0%, respectively, in the ConvRT cohort--this lower toxicity in the IMRT group was significant (p=0.013). The regression analyses showed that only IMRT use (p=0.046) predicted reduction in acute GI toxicity but no factors correlated with acute GU toxicity rate. In conclusion, in our retrospective single-institution analysis, IMRT was not associated with reduction of acute GU toxicity but was associated with a reduction of acute GI toxicity over ConvRT in the treatment of prostate cancer to localized fields.