miR-146a rs2431697 identifies myeloproliferative neoplasm patients with higher secondary myelofibrosis progression risk.

Myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PV) and essential thrombocythemia (ET), and remarkably shortens survival. Although JAK2V617F and CALR allele burden are the main transformation risk factors, inflammation plays a critical role by driving clonal expansion toward end-stage disease. NF-κB is a key mediator of inflammation-induced carcinogenesis. Here, we explored the involvement of miR-146a, a brake in NF-κB signaling, in MPN susceptibility and progression. rs2910164 and rs2431697, that affect miR-146a expression, were analyzed in 967 MPN (320 PV/333 ET/314 MF) patients and 600 controls. We found that rs2431697 TT genotype was associated with MF, particularly with post-PV/ET MF (HR = 1.5; p < 0.05). Among 232 PV/ET patients (follow-up time=8.5 years), 18 (7.8%) progressed to MF, being MF-free-survival shorter for rs2431697 TT than CC + CT patients (p = 0.01). Multivariate analysis identified TT genotype as independent predictor of MF progression. In addition, TT (vs. CC + CT) patients showed increased plasma inflammatory cytokines. Finally, miR-146a-/- mice showed significantly higher Stat3 activity with aging, parallel to the development of the MF-like phenotype. In conclusion, we demonstrated that rs2431697 TT genotype is an early predictor of MF progression independent of the JAK2V617F allele burden. Low levels of miR-146a contribute to the MF phenotype by increasing Stat3 signaling.

Impacto de intervención educativa en administración de antibióticos de alto riesgo en paciente pediátrico / Impact of educational intervention in the administration of high-risk antibiotics in pediatric patients

Introducción: La administración intravenosa de antibióticos de alto riesgo implica tener conocimientos y habilidades para su administración segura. Esta práctica es más delicada en pediatría, por ser grupo vulnerable por sus cambios fisiológicos e inmadurez y por las dosis que se manejan, es importante realizarla con la técnica correcta, una mala praxis puede provocar eventos adversos que generan incremento en la estancia hospitalaria, morbimortalidad y costo de los servicios. Objetivo: Determinar el impacto de una intervención educativa en la administración intravenosa de antibióticos de alto riesgo en pacientes pediátricos. Metodología: se realizó un estudio cuasi experimental, en población de enfermeras con grupo control y experimental. Recolección de datos con instrumento de auditoría previo consentimiento informado, con validación de contenido por jueceo de expertos y la confiabilidad de .751 con prueba Kunder Richardson. Se utilizó el programa SPSS versión 21, para el análisis estadístico de los datos con pruebas paramétricas de comparación t de Student de muestras relacionadas, análisis de varianza ANOVA de muestra independiente. Resultados: Edad media del grupo experimental 32±6 años, 37% tiene una especialidad, grupo control 35±5 años, 47% son licenciados. Índice de eficiencia global (IEG) pretest en el grupo experimental 76% y en postest 90% después de la intervención educativa, en el grupo control 77% y 79%. Se comparó el (IEG) entre el pretest y postest del grupo experimental con la prueba t Student para muestras relacionadas, se encontraron diferencias estadísticas en el grupo experimental (t= - 10.234, gl= 29, p<0.05). Respecto IEG se comparó con el postest del grupo experimental y el grupo control se encontraron diferencias significativas entre grupo experimental y grupo control (t = 9.919, gl = 58, p<0.05). Conclusión: Se comprueba la hipótesis, después de la intervención educativa el IEG se incrementó de 76% a 90% en el grupo experimental, encontrando significancia estadística, mientras que en el grupo control se mantuvo IEG, el impacto de la intervención repercute en una práctica segura durante este procedimiento y reducción de los riesgos.

Introduction: Safety in the intravenous administration of high-risk antibiotics requires knowledge and skills; in pediatrics, it is no exception because it is a vulnerable group because of aspects of physiological immaturity; A malpractice can provoke adverse events leading to greater days of stay in hospital, morbidity and mortality and a high cost for health systems. Aim: To determine the impact of an educational intervention on the safety of the intravenous administration of high-risk antibiotics in pediatric patients. Material and Methods: A quasi-experimental study, with a sample of 60 nurses from pediatric hospital: 30 control group and 30 experimental group. Sociodemographic variables, independent (educational intervention), dependent (administration of antibiotics).After consent of the hospital's research committee, data collection was performed through an audit instrument, content validation by expert judgment, .751 reliability with Kunder Richardson test, SPSS Version 21 database, test Parametric Student's T comparison of related samples and analysis of variance ANOVA of independent sample. The Global Efficiency Index was also determined to determine the Level of Compliance. Results Mean age of the experimental group 32 ± 6 years, 37% have a specialty, control group 35 ± 5 years, 47% with a bachelor ́s degree in nursing. Global efficiency index (IEG) pretest in the experimental group 76% and posttest 90% after the educational intervention, in the control group 77% and 79%. The IEG was compared between the pretest and posttest of the experimental group with the Student t test for related samples, statistical differences were found in the experimental group (t = -10.234, gl = 29, p <0.05). IEG was compared with the posttest of the experimental group and the control group were found significant differences between experimental group and control group (t = 9,919, gl = 58, p <0.05). Conclusions. The hypothesis was verified. After the educational intervention, the IEG increased from 76% to 90% in the experimental group, finding statistical significance, while in the control group IEG was maintained; an educational had a positive impact on the practice and reduction of risks in intravenous administration of high risk antibiotic in pediatric patient.

[Cervical ischaemic neuronopathy and cardioembolism: another cause of man-in-the-barrel syndrome]. / Neuronopatia isquemica cervical y cardioembolismo: otra causa de sindrome del hombre en el barril.

INTRODUCTION: Spinal infarction accounts for 1% of all strokes. Cardioembolism is a rare cause. Common areas of ischemic spinal damage are watershed in the dorsal or lumbar regions; however cervical spinal cord infarction has been reported previously. CASE REPORT: We present a new case of a man-in-the-barrel syndrome produced by cardiac embolization associated with atrial fibrillation during an acute myocardial infarction, which caused cervical ischemic neuronopathy (infarction of the anterior horn). CONCLUSIONS: Classic features of cervical spinal cord ischemia are acute tetraplegia, bladder, bowel and cardiovascular dysfunction and dissociate sensory loss. Incomplete collateralization and anatomical characteristics of the circulation of the anterior spinal artery in the cervical spinal cord, makes of the portion C3 to C5, the most vulnerable portion to ischemic damage, since the radicular arteries supply begins bellow C5 and the pathophysiology of a fast fresh clot lysis produced unique bilateral neuronal horn cells damage.

TITLE: Neuronopatia isquemica cervical y cardioembolismo: otra causa de sindrome del hombre en el barril.Introduccion. Los infartos de la medula espinal ocurren aproximadamente en el 1% de todos los infartos del sistema nervioso. El cardioembolismo es una causa rara. Las areas comunmente afectadas en infartos medulares son zonas de circulacion limitrofe en la region dorsal o lumbar; sin embargo, se han descrito previamente infartos medulares en la zona cervical asociados a la diseccion de arterias vertebrales. Caso clinico. Se presenta un nuevo caso de sindrome del hombre en el barril asociado con fibrilacion auricular durante un infarto agudo de miocardio, que causo una neuronopatia cervical isquemica (infarto de astas anteriores). Conclusiones. Los hallazgos clasicos de isquemia medular cervical son tetraplejia aguda, disfuncion vesical, intestinal y cardiovascular, asi como perdida de la sensibilidad disociada. La colateralizacion incompleta y las caracteristicas anatomicas de la arteria espinal anterior en la medula cervical hacen de la porcion C3-C5 la region mas vulnerable de daño isquemico, ya que la irrigacion de las arterias radiculares se inicia debajo de C5 y la fisiopatologia de la lisis rapida de un coagulo fresco produce unicamente daño bilateral de las celulas de las astas neuronales.

A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results.

We have previously reported the short-term radiological results of a randomised controlled trial comparing kinematically aligned total knee replacement (TKR) and mechanically aligned TKR, along with early pain and function scores. In this study we report the two-year clinical results from this trial. A total of 88 patients (88 knees) were randomly allocated to undergo either kinematically aligned TKR using patient-specific guides, or mechanically aligned TKR using conventional instruments. They were analysed on an intention-to-treat basis. The patients and the clinical evaluator were blinded to the method of alignment. At a minimum of two years, all outcomes were better for the kinematically aligned group, as determined by the mean Oxford knee score (40 (15 to 48) versus 33 (13 to 48); p = 0.005), the mean Western Ontario McMaster Universities Arthritis index (WOMAC) (15 (0 to 63) versus 26 (0 to 73); p = 0.005), mean combined Knee Society score (160 (93 to 200) versus 137 (64 to 200); p= 0.005) and mean flexion of 121° (100 to 150) versus 113° (80 to 130) (p = 0.002). The odds ratio of having a pain-free knee at two years with the kinematically aligned technique (Oxford and WOMAC pain scores) was 3.2 (p = 0.020) and 4.9 (p = 0.001), respectively, compared with the mechanically aligned technique. Patients in the kinematically aligned group walked a mean of 50 feet further in hospital prior to discharge compared with the mechanically aligned group (p = 0.044). In this study, the use of a kinematic alignment technique performed with patient-specific guides provided better pain relief and restored better function and range of movement than the mechanical alignment technique performed with conventional instruments.

Conocimientos, actitudes prácticas sobre diabetes en comerciantes del mercado municipal Masaya agosto- diciembre 2008 / Knowledge, attitudes, practices on diabetes in Masaya municipal market traders August-December 2008

El presente estudio se realizó con el objetivo de conocer el nivel de conocimiento en relación a diabetes y su prevención, así como las actitudes y prácticas de las personas encuestadas. Para tal efecto se realizó un estudio descriptivo de corte transversal aplicado a comerciantes del mercado municipal de Masaya, tomando una muestra de 212 personas, en edades correspondientes entre 15 años a > de 75 años de ambos sexos, diabéticos y no diabéticos, obteniendo en la muestra un nivel de confianza del 99%, en tipo aleatorio simple, a través de encuestas directas. El estudio arrojó información que determina el nivel de conocimiento de las personas encuestadas, cumpliendo así los objetivos planteados en este trabajo. Los encuestados fueron clasificados en diabéticos y no diabéticos, determinando que en un total de 106 diabéticos, predominó el sexo masculino, y las edades de 31 á 45 años. En un total de 106 personas no diabéticas, predominó el sexo femenino. El total de la muestra indicó el predominio del sexo masculino en el sector urbano, y un predominio del sexo femenino en el sector rural. Otros datos de perfil del encuestado, tales como tiempo de evolución de la enfermedad y la escolaridad predominaron 34% de personas que cursan secundaria y que tienen entre 0 á 10 años de padecer la enfermedad. Según el tiempo de la enfermedad y el conocimiento adquirido de los encuestados diabéticos observamos que los que presentan de 0 á 10 años de evolución de enfermedad coinciden 50% que es hereditaria contra un 28% en las mismas edades quienes dicen que la diabetes es curable...

Miniglosario de términos de uso más frecuente en las especialidades de cardiología, anestesiología, gastroenterología, neurología y psiquiatría pediátricas / Mini-glossary of the most frequently used terms in Pediatric Cardiology, Anesthesiology, Gastroenterology, Neurology and Psychiatry

Con el propósito de desarrollar un miniglosario español-inglés de términos de uso frecuente, se procedió a identificar la terminología médica de uso más común en los servicios pediátricos de cardiología, anestesiología, gastroenterología, neurología y psiquiatría. El material, organizado en forma alfabética, consta de 476 palabras en español y 487 equivalentes en inglés.

Aimed at developing a Spanish-English miniglossary of frequently used terms, the most common medical terminology used in the pediatric services of Cardiology, Anesthesiology, Gastroenterology, Neurology and Psychiatry, was idenitified. The material alphabetically organized includes 476 words in Spanish and 487 equivalents in English.

[Effects of clonidine++ administration in children with familial short stature and retarded body growth]. / Efectos de la administración de clonidina en niños con talla baja familiar y retardo constitucional del crecimiento.

The effect of chronic clonidine administration on the height velocity of two groups of children with short stature either familial (FSS) or with constitutional growth delay (CGD) is presented. The patients whose age ranged between 5 to 12 years had a height below the third percentile; otherwise they were healthy. Both groups received 100 micrograms/m2 of clonidine orally during 12 months. In the group with FSS there was an increase in height velocity from 3.6 +/- 0.6 cm/years pretreatment values to 5.1 +/- 0.9 cm/years. The group with CGD showed an increase from 3.6 +/- 0.7 cm/years to 6.5 +/- 3.4. No secondary reactions were observed. The possible impact of this treatment on final height is discussed.

Meptazinol and morphine in postoperative pain assessed with a new method for onset and duration.

Meptazinol, m-(3-ethyl-1-methyl-hexahydro-1-H-azepin-3-yl) phenol hydrochloride is a centrally active opioid analgesic with a specificity for the mu-1 receptor. It has been reported to lack many of the side effects commonly observed with morphine and morphinelike drugs in man. The objective of this study was to assess the analgesic efficacy and safety of meptazinol (50 mg and 100 mg) relative to morphine (5 mg and 10 mg) when administered intramuscularly for the treatment of postoperative pain. In addition, a new clinical method for measuring onset and duration and a statistical technique for evaluating the study data are presented. One hundred and seventeen patients were evaluated for 6 hours in a randomized double blind, single dose, parallel-groups trial. Estimates of relative potency for hourly pain and relief parameters, and the summary variables sum of pain intensity differences (SPID) and total pain relief (TOTPAR) were performed. The estimate of relative potency of meptazinol to morphine for pain relief was 0.19 at 1/2 hour (i.e. 100 mg of meptazinol was approximately equivalent to 20 mg of morphine). Thereafter, there was a rapid decline of efficacy for meptazinol, with a relative potency estimate of 0.12 at 1 hour and 0.06 at 2 hours. The distribution functions for several time related events were estimated including time to onset, duration and time to remedication. The two drugs had approximately equal onset, but meptazinol had significantly shorter duration. More patients on meptazinol required remedication with a rescue analgesic and at an earlier time than patients on morphine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Internal migration in Guatemala]. / Les migrations internes au Guatemala.

PIP: Recent trends in internal migration in Guatemala are reviewed. The author notes that inequalities in land distribution are as great as anywhere else in Latin America and are a major cause of migration. The pressures caused by population increase and the mechanization of large landholdings with a consequent decline in the demand for labor are seen as the cause of both social conflict and migration.^ieng