Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices / Óxido nítrico exhalado «fuera de línea¼ en niños: comparación entre equipos de quimioluminiscencia y electroquímicos

Abstract Background: Exhaled nitric oxide (eNO) is a noninvasive marker of airway inflammation that has been used in children, using the "offline" technique. To the extent of our knowledge, no article reported in literature compares the concordance and correlation between the two different technologies used to measure eNO at tidal volume offline. This study aimed to report the concordance and correlation of the eNO measured "offline" at tidal volume, using chemioluminiscence (cl) vs electrochemical devices (eq). Methods: A cross-sectional, observational, and prospective study was conducted in the National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias), Mexico City. Healthy children and those with a lung disease between 1 and 11 years of age were included. The exhaled air sample at tidal volume was obtained by attaching a mask connected to a Mylar® bag. Results: We studied 36 children. The mean ± standard deviation (SD) age of the study population was 6 ± 2.6 years; 25% of the subjects included were healthy, and the rest had a lung disease. The concordance correlation coefficient between the two measuring devices was 0.98 (p < 0.001), with a mean difference of 1.46 ± 3.5 ppb and 95% limits of agreement from -5.3 ppb to 8.3 ppb. The linear regression model equation for the estimation of eNO was eNOcl = (eNOeq·1.0718) - 0.1343 (r2 = 0.97). Conclusions: The measurement of eNO at tidal volume by the offline method can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed by chemiluminescence technology.

Resumen Introducción: El óxido nítrico exhalado (eNO) es un marcador no invasivo de inflamación de la vía aérea que se ha utilizado en niños mediante técnica «fuera de línea¼. Por lo que sabemos, en la literatura no existen reportes que comparen la concordancia y la correlación entre dos técnicas diferentes a volumen corriente. El objetivo de este trabajo es informar la concordancia y la correlación del eNO obtenido por la técnica fuera de línea a volumen corriente en los equipos de quimioluminiscencia (cl) y electroquímico (eq). Métodos: Se realizó un estudio transversal, observacional y prospectivo en el Instituto Nacional de Enfermedades Respiratorias, en Ciudad de México. Se incluyeron niños sanos y con enfermedad pulmonar de 1-11 años de edad. La muestra de aire exhalado se obtuvo a volumen corriente mediante una máscara con conexión a una bolsa de Mylar®. Resultados: Se estudiaron 36 niños. La edad promedio con su desviación estándar de la población de estudio fue de 6 ± 2.6 años. El 25% de los sujetos incluidos estaban sanos y el resto tenían alguna enfermedad pulmonar. El coeficiente de correlación de concordancia entre los dos equipos fue de 0.98 (p < 0.001), con una diferencia media de 1.46 ± 3.5 ppb y unos límites de concordancia del 95% de −5.3 a 8.3 ppb. La ecuación del modelo de regresión lineal del eNO fue eNOcl = (eNOeq·1,0718) − 0.1343 (r2 = 0.97). Conclusiones: La medición del eNO por el método fuera de línea a volumen corriente puede analizarse en dispositivos electroquímicos. Los resultados son intercambiables con los de quimioluminiscencia.

Uretroplastia bulbar con injerto: Una actualización sobre las diferentes técnicas quirúrgicas / Graft Urethroplasty for Bulbar Strictures: An Update on the Different Surgical Techniques

En pacientes con estrechez uretral bulbar de una longitud mayor a 2 cm, que no sean candidatos a otras técnicas, se realiza uretroplastia con injerto. Actualmente se emplean diversas técnicas, cada una con ventajas y desventajas propias. Describir las ventajas y desventajas de las técnicas quirúrgicas empleadas actualmente en la uretroplastia con injerto, así como sus tasas de éxito. Se hizo una búsqueda en PubMed, ClinicalKey y en ScienceDirect, utilizando las palabras claves: "urethral stricture," "urethroplasty," "oral graft" y "flap." Se utilizaron los estudios más relevantes, tanto originales como revisiones sistemáticas y metaanálisis, en inglés y en español. Las diferentes técnicas quirúrgicas ofrecen ventajas y desventajas teóricas frente a las otras, aunque las tasas de éxito en todas es cercana al 90%, sin ser una francamente superior frente a las demás. La elección de la técnica quirúrgica a realizar depende de las preferencias y experiencia del cirujano, dado que la tasa de éxito para todas las técnicas es similar.

In patients with urethral stricture longer than 2 cm who are not candidates for other techniques, graft urethroplasty is the most performed surgery. Currently, several techniques are used, each with their own advantages and disadvantages. Describe the advantages and disadvantages of the surgical techniques currently used in graft urethroplasty, as well as their success rates. A search was made in PubMed, ClinicalKey and ScienceDirect, using the keywords: "urethral stenosis," "urethroplasty," "oral graft" and "flap." The most relevant original studies, systematic reviews and meta-analyzes were used, both in English and Spanish. The different surgical techniques offer theoretical advantages compared with the others, although the success rates in all are close to 90%, without being frankly superior compared with the others. The choice of the surgical technique to be performed depends on the preferences and experience of the surgeon, given that the success rate for all techniques is similar.

Echocardiographic features of pre- and postcapillary pulmonary hypertension with a focus on the right ventricle in dogs / Características ecocardiográficas da hipertensão pulmonar pré e pós-capilar em cães com foco no ventrículo direito

Pulmonary hypertension (PH) in dogs is a syndrome that can occur secondary to several causes, including left heart disease (postcapillary) and chronic respiratory disease (precapillary). This study evaluates morphological and functional consequences in the right ventricle (RV) of dogs with pre- and postcapillary PH through echocardiography, and also considers the severity of PH (mild, moderate or severe). Echocardiography was performed on 66 dogs of various breeds and weights (age >3 years old) which were assigned to three groups: postcapillary PH, which included mitral valve disease/endocardiosis, precapillary PH, which included chronic respiratory diseases (bronchitis, collapse of the trachea and primary lung cancer or metastasis), and finally, a healthy group of controls. The parameters for RV morphology were RV1, RV2, and RV3 for systole and diastole. The following measurements were used to assess RV systolic function: tricuspid annular plane systolic excursion (TAPSE), TAPSE:Ao (aorta), maximum velocity of the tricuspid systolic wave obtained by tissue Doppler (S'), S':Ao, right ventricle end-diastolic area (RVEDA); RVEDA:BSA (body surface area); flow velocity integral (FVI) and FVI:Ao. The variables were assessed using ANOVA. The results showed that RV3d, RV1s, S':Ao, S', and FVI were able to distinguish cases of pre- and postcapillary PH in this study. Remodeling of the RV of dogs with PH was observed, which can be influenced by the pre- or postcapillary origin of the PH, with dilation in dogs with postcapillary PH and severe PH. The results for RV systolic function were similar, with FVI and FVI:Ao showing that RV ejection function is reduced in dogs with postcapillary PH and with severe PH.(AU)

A hipertensão pulmonar (HP) em cães é uma síndrome que pode ocorrer secundária às diversas causas, dentre elas, a doença cardíaca esquerda (pós-capilar) e a doença respiratória crônica (pré-capilar). Essa é uma condição importante que motivou os objetivos do estudo: avaliar ecocardiograficamente as consequências morfológicas e funcionais no ventrículo direito (VD) dos cães acometidos com HP pré- e pós-capilar, considerando também o estágio de severidade da HP (leve, moderada ou severa). A ecocardiografia foi realizada em 66 cães de diversas raças e pesos, com pelo menos quatro anos de idade, que compuseram um grupo com doença valvar mitral, ou endocardiose, outro com doença respiratória crônica (bronquite, colapso de traqueia e neoplasia pulmonar primária ou metástase), e por último, um grupo saudável. Os parâmetros para a morfologia do VD foram RV1, RV2 e RV3 na sístole e na diástole. Para a avaliação da função sistólica do VD foram mensurados: excursão sistólica do plano anular tricúspide (TAPSE), TAPSE:Ao (aorta), velocidade máxima da onda sistólica da tricúspide obtida pelo doppler tecidual (S'), S':Ao, área do ventrículo direito no final da diástole (RVEDA); RVEDA:BSA (body superficie area); integral tempo velocidade (FVI) e FVI:Ao. As variáveis foram avaliadas por meio da ANOVA. Os resultados mostraram que RV3d, RV1s, S':Ao, S' e FVI foram capazes de distinguir casos de HP pré e pós-capilar neste estudo. Observou-se que há remodelamento do VD de cães com HP e este pode ser influenciado pela origem pré ou pós-capilar da HP, encontrando-se dilatado em cães com HP pós capilar e com HP severa. Os resultados para a função sistólica do VD foram similares, uma vez que o FVI e FVI:Ao mostraram que a capacidade de ejeção do VD está reduzida nos cães com HP pós-capilar e com HP severa.(AU)

Echocardiographic features of pre- and postcapillary pulmonary hypertension with a focus on the right ventricle in dogs

ABSTRACT: Pulmonary hypertension (PH) in dogs is a syndrome that can occur secondary to several causes, including left heart disease (postcapillary) and chronic respiratory disease (precapillary). This study evaluates morphological and functional consequences in the right ventricle (RV) of dogs with pre- and postcapillary PH through echocardiography, and also considers the severity of PH (mild, moderate or severe). Echocardiography was performed on 66 dogs of various breeds and weights (age >3 years old) which were assigned to three groups: postcapillary PH, which included mitral valve disease/endocardiosis, precapillary PH, which included chronic respiratory diseases (bronchitis, collapse of the trachea and primary lung cancer or metastasis), and finally, a healthy group of controls. The parameters for RV morphology were RV1, RV2, and RV3 for systole and diastole. The following measurements were used to assess RV systolic function: tricuspid annular plane systolic excursion (TAPSE), TAPSE:Ao (aorta), maximum velocity of the tricuspid systolic wave obtained by tissue Doppler (S), S:Ao, right ventricle end-diastolic area (RVEDA); RVEDA:BSA (body surface area); flow velocity integral (FVI) and FVI:Ao. The variables were assessed using ANOVA. The results showed that RV3d, RV1s, S:Ao, S, and FVI were able to distinguish cases of pre- and postcapillary PH in this study. Remodeling of the RV of dogs with PH was observed, which can be influenced by the pre- or postcapillary origin of the PH, with dilation in dogs with postcapillary PH and severe PH. The results for RV systolic function were similar, with FVI and FVI:Ao showing that RV ejection function is reduced in dogs with postcapillary PH and with severe PH.

RESUMO: A hipertensão pulmonar (HP) em cães é uma síndrome que pode ocorrer secundária às diversas causas, dentre elas, a doença cardíaca esquerda (pós-capilar) e a doença respiratória crônica (pré-capilar). Essa é uma condição importante que motivou os objetivos do estudo: avaliar ecocardiograficamente as consequências morfológicas e funcionais no ventrículo direito (VD) dos cães acometidos com HP pré- e pós-capilar, considerando também o estágio de severidade da HP (leve, moderada ou severa). A ecocardiografia foi realizada em 66 cães de diversas raças e pesos, com pelo menos quatro anos de idade, que compuseram um grupo com doença valvar mitral, ou endocardiose, outro com doença respiratória crônica (bronquite, colapso de traqueia e neoplasia pulmonar primária ou metástase), e por último, um grupo saudável. Os parâmetros para a morfologia do VD foram RV1, RV2 e RV3 na sístole e na diástole. Para a avaliação da função sistólica do VD foram mensurados: excursão sistólica do plano anular tricúspide (TAPSE), TAPSE:Ao (aorta), velocidade máxima da onda sistólica da tricúspide obtida pelo doppler tecidual (S), S:Ao, área do ventrículo direito no final da diástole (RVEDA); RVEDA:BSA (body superficie area); integral tempo velocidade (FVI) e FVI:Ao. As variáveis foram avaliadas por meio da ANOVA. Os resultados mostraram que RV3d, RV1s, S:Ao, S e FVI foram capazes de distinguir casos de HP pré e pós-capilar neste estudo. Observou-se que há remodelamento do VD de cães com HP e este pode ser influenciado pela origem pré ou pós-capilar da HP, encontrando-se dilatado em cães com HP pós capilar e com HP severa. Os resultados para a função sistólica do VD foram similares, uma vez que o FVI e FVI:Ao mostraram que a capacidade de ejeção do VD está reduzida nos cães com HP pós-capilar e com HP severa.

Manifestaciones pulmonares y radiológicas del Sars-Cov2 en pediatría / Pulmonary manifestations and radiological findings of SarsCov2 in children

Las infecciones respiratorias agudas son causa de alta morbi-mortalidad a nivel mundial. El Coronavirus descubierto en Wuhan, China en el 2019 es de interés mundial por las diferentes manifestaciones clínicas que pueden aparecer en niños. Nuestro objetivo principal es revisar las manifestaciones del COVID-19 en el aparato respiratorio y los hallazgos a nivel radiológicos en pediatría. Se estiman que solo el 5,7% de los niños han sido hospitalizados, siendo los niños con comorbilidades y menores de 1 año los que suponen un riesgo mayor para enfermedad grave. A nivel global la mediana de edad de presentación de los casos es alrededor de 7 años, detectándose más casos a mayor edad, pero siendo la gravedad inversamente proporcional a la edad. La forma asintomática o leve son las presentaciones más comunes reportadas en niños, siendo de hasta en el 90% de los niños infectados. Los estudios de laboratorio pueden ser normales o presentar leucocitos alterados en un 69,2% y a nivel radiológico se ha observado en niños que en un 69% presentan opacidades bilaterales en vidrio despulido. En este momento, cualquier infección respiratoria aguda hay que descartar COVID-19, para poder evitar complicaciones en el paciente...(AU)

Validation of the German patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE™).

BACKGROUND: Integrating the patient's perspective has become an increasingly important component of adverse event reporting. The National Cancer Institute has developed a Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™). This instrument has been translated into German and linguistically validated; however, its quantitative measurement properties have not been evaluated. PATIENTS AND METHODS: A German language survey that included 31 PRO-CTCAE items, as well as the EORTC QLQ-C30 and the Oral Mucositis Daily Questionnaire (OMDQ), was distributed at 10 cancer treatment settings in Germany and Austria. Item quality was assessed by analysis of acceptability and comprehensibility. Reliability was evaluated by using Cronbach's' alpha and validity by principal components analysis (PCA), multitrait-multimethod matrix (MTMM) and known groups validity techniques. RESULTS: Of 660 surveys distributed to the study centres, 271 were returned (return rate 41%), and data from 262 were available for analysis. Participants' median age was 59.7 years, and 69.5% of the patients were female. Analysis of item quality supported the comprehensibility of the 31 PRO-CTCAE items. Reliability was very good; Cronbach's' alpha correlation coefficients were >0.9 for almost all item clusters. Construct validity of the PRO-CTCAE core item set was shown by identifying 10 conceptually meaningful item clusters via PCA. Moreover, construct validity was confirmed by the MTMM: monotrait-heteromethod comparison showed 100% high correlation, whereas heterotrait-monomethod comparison indicated 0% high correlation. Known groups validity was supported; PRO-CTCAE scores were significantly lower for those with impaired versus preserved health-related quality of life. CONCLUSION: A set of 31 items drawn from the German PRO-CTCAE item library demonstrated favourable measurement properties. These findings add to the body of evidence that PRO-CTCAE provides a rigorous method to capture patient self-reports of symptomatic toxicity for use in cancer clinical trials.

Electrocardiographic exam in female spotted pacas (Cuniculus paca) / Exame eletrocardiográfico em pacas fêmeas (Cuniculus paca)

Considering the limited physiological information available on neotropical rodents and the importance of this information for pathophysiological and conservation studies of these species, the aim of this study was to evaluate the cardiac electric physiology of healthy captivity spotted pacas (Cuniculus paca) under chemical restraint, due to wild nature of these animals. Eleven adult female pacas were evaluated by blood count and biochemical dosage to rule out any associate disease. Each animal was evaluated in three periods every 15 days. After chemical restraint with intramuscular midazolam 0.5mg/kg and ketamine 25mg/kg, animals were subjected to a computerized electrocardiogram, where bipolar (DI, DII and DIII) and augmented unipolar leads (aVR, aVL, aVF) were obtained. Descriptive statistics were calculated for each parameter and built the confidence interval (CI) at significance level of 95%. The electrocardiographic examination was performed without difficult. ECG tracing in DII represents a QRS complex with positive polarity, preceded by a P wave of the same polarity and proceeded by T wave of variable polarity. Heart rate mean was 150±17 bpm, and cardiac electrical axis 33.4±21.9°. All animals showed sinusal rhythm. The ECG recording technique associated with chemical restraint was well tolerated, allowing quick acquisition of reliable ECG tracings with high repeatability, which produced sufficient results to determine the heart rhythm and suggest measures of ECG complexes duration and amplitude.(AU)

Considerando a limitada informação sobre a fisiologia cardíaca em roedores neotropicais e a importância desta informação para estudos fisiopatológicos e de conservação desta espécie, objetivou-se com este estudo avaliar a atividade elétrica cardíaca de pacas saudáveis mantidas em cativeiro, sob restrição química, devido à natureza selvagem destes animais. Onze fêmeas adultas foram avaliadas clinicamente e por meio do hemograma e testes bioquímicos no intuito de descartar qualquer co-morbidade associada. Cada animal foi submetido a três períodos experimentais a cada 15 dias. Após a restrição química com 25mg/kg de cetamina e 0,5mg/kg de midazolam pela via intramuscular, os animais eram submetidos a eletrocardiografia (ECG) computadorizada, aonde as derivações bipolares (DI, DII E DIII) e unipolares aumentadas (aVR, aVL, aVF) foram obtidas. A estatística descritiva foi calculada para cada parâmetro e o intervalo de confiança (CI), construído a um nível de significância de 95%. O exame eletrocardiográfico foi realizado sem dificuldade. O traçado eletrocardiográfico em DII apresentou QRS com polaridade positiva, precedido por onda P da mesma polaridade e seguida por onda T de polaridade variável. A frequência cardíaca média foi de 150±17 bpm e o eixo elétrico cardíaco de 33.4±21.9°. Todos os animais mostraram ritmo sinusal. A técnica eletrocardiográfica associada com restrição química foi bem tolerada permitindo a pratica aquisição de traçados de confiança e alta reprodutibilidade, que produziram resultados suficientes para determinar o ritmo cardíaco e sugerir medidas de duração e amplitude dos complexos de ECG.(AU)

Epimastigogénesis de Trypanosoma cruzi: método para estudiar in vivo la transformación de tripomastigota en epimastigota / Trypanosoma cruzi epimastigogenesis: a method for studying Trypomastigote to epimastigote transformation in vivo

La epimastigogénesis de Trypanosoma cruzi ocurre naturalmente en el intestino del hospedador invertebrado. Se desconoce si los cambios morfológicos que ocurren durante la transformación de los tripomastigotas sanguíneos en epimastigotas son idénticos para diferentes aislados de T. cruzi. Aquí mostramos un método útil para estudiar los eventos que ocurren durante la epimastigogénesis, comparando parásitos de diferentes procedencias epidemiológicas. Se alimentaron artificialmente ninfas de V estadio de Rhodnius prolixus con una solución ad hoc conteniendo tripomastigotas tipo-sanguíneo y siguiendo los cambios morfológicos por 8 días. Los contenidos del intestino anterior de las ninfas se obtuvieron decapitando y comprimiendo el abdomen lo que permitió obtener rápidamente casi 100% del inóculo con cargas entre 1,9 y 8,9 × 106 tripomastigotas/ninfa. El número de parásitos por ninfa y los cambios morfológicos se determinaron por Microscopia de Contraste de Fases y coloración con Giemsa. Las ninfas ingirieron 7,4 veces su peso de solución infectante, con volúmenes entre 101 y 357 µL (229 ± 66 mg), 50% de esa ingesta se eliminó como orina durante las primeras 24 h. Los tripomastigotas se transformaron en formas redondeadas antes de evolucionar a epimastigotas, siguiendo cinéticas diferentes según el aislado. Proponemos esta metodología para estudiar rápida y cuantitativamente los eventos tempranos de la epimastigogénesis de T. cruzi in vivo.

Trypanosoma cruzi epimastigogenesis naturally occurs in the intestine of the invertebrate host. It is not known whether the morphological changes that occur during transformation of bloodstream trypomastigotes to epimastigotes are identical for different T. cruzi isolates. This research shows a useful method for studying the events that occur during epimastigogenesis, comparing parasites from epidemiological sources. Rhodnius prolixus V stage nymphs were fed artificially with an ad hoc solution containing blood-like trypomastigotes and the morphological changes were examined during eight days. Anterior intestinal contents were removed by decapitation and squeezing the abdomen of the nymphs, which permitted obtaining quickly almost 100% of the inoculate with loads between 1.9 and 8.9 × 106 trypomastigotes/nymph. The number of parasites per nymph and morphological changes were determined using phase microscopy with Giemsa staining. The nymphs ingested 7.4 times their weight of the infecting solution with volumes between 101 e 357 µL (229 ± 66 mg); 50% of the ingest was eliminated as urine during the first 24 hours. The trypomastigotes transformed to rounded forms before evolving into epimastigotes following different kinetics according to the isolate. This method is proposed for rapid, quantitative study of the early events of epimastigogenesis for T. cruzi in vivo.

Acute liver failure secondary to khat (Catha edulis)-induced necrotic hepatitis requiring liver transplantation: case report.

We describe the case of a 26-year-old man with acute liver failure secondary to ingestion of khat (Catha edulis) leaves. In fact, this is the first case of acute liver failure due to khat reported outside the United Kingdom. The combination of specific epidemiologic data (young man of East African origin) and clinical features (central nervous system stimulation, withdrawal reactions, toxic autoimmune-like hepatitis) led to the diagnosis. Mechanisms of action and potential side effects of khat are elaborated on.

Diseño y fabricación de una celda de carga para mediciones fisiológicas en distracción alveolar / Design and manufacturing of a load-cell for physiological measuring in alveolar distraction

Un factor de vital importancia para el diseño mecánico de distractor osteogénico alveolar es el conocimiento de las cargas fisiológicas para la simulación computacional, existe muy poca información o trabajos previos sobre este tema. Para obtener estas cargas, ha sido desarrollada una celda de carga constituida de una lámina de acero inoxidable en voladizo instrumentada con galgas extensométricas, la cual ha sido empotrada en una férula como la usada en tratamientos de ortodoncias. Luego de calibrar la celda de cargas fisiológicas, se realizó un ensayo in vivo sobre un paciente parcialmente edéntulo del maxilar inferior, obteniéndose registros digitales de cargas para diferentes condiciones de protrusión de la lengua, retracción del labio inferior y la combinación de ambas.

A key aspect involved in the mechanical design of alveolar distractor is the accurate evaluation of physiological loading for computer simulation. Very few information and previous work are available about this subject. A stainless steel load cell having strain gauges has been developed and manufactured. This cell was attached to a splint, like those used in orthodontia. The load cell was calibrated and then an “in vivo” test was carried out on a partially-edentulous patient. Digital registers of load were obtained for three cases: tongue protrusion, lower lips retraction and a combination of both.

Estudio Comparativo de los Servicios de Mantenimiento Utilizando Técnicas de Minería de Datos / A comparative study of maintenance services using the data-mining technique

Objetivos: Comparar la calidad del servicio de mantenimiento de dos entidades de salud. Una posee los servicios de mantenimientos tercerizados y la otra propios. El indicador de calidad bajo estudio es el tiempo de cambio de estado. Estudiar el comportamiento de la productividad del servicio de salud versus la disponibilidad. Materiales y Métodos. Se realizó un levantamiento del inventario de los equipos médicos y no médicos en dos servicios de diálisis ubicados en dos instituciones de salud. Ambas de tercer nivel. Estos poseen características similares en cuanto a las unidades de dializado y equipos médicos. Cada una de ellas posee 16 unidades para la atención a pacientes y 92 equipos médicos. La diferencia consiste en el servicio de mantenimiento; uno es tercerizado mientras que el otro es propio. Se recolectaron las órdenes de trabajo de mantenimiento por un período de 6 meses y se calcularon los indicadores: Tiempo de Respuesta, Duración Real, Tiempos Perdidos y Tiempo de cambio de estado (TAT) para cada orden de trabajo. Se construyó un predictor para la variable TAT (variable dependiente) en función de las otras variables. Resultados. La calidad del servicio de mantenimiento por la entidad que posee su propio personal es mejor que la entidad con servicios tercerizados. El indicador TAT es como promedio de 2,95 horas para la entidad con mantenimiento propio, mientras que para la otra entidad es de 3,4 horas. Conclusiones: El comportamiento de la productividad del servicio versus la disponibilidad resultó ser de tipo positiva lineal.

Objectives The main goal in this research was comparing two hospitals’ maintenance service quality. One of them had a contract service; the other one had an in-house maintenance service. Materials and methods The authors followed the next stages when conducting this research: domain understanding, data characterisation and sample reduction, insight characterisation and building the TAT predictor. Multiple linear regression and clustering techniques were used for improving the efficiency of corrective maintenance tasks in a clinical engineering department (CED). The indicator being studied was turnaround time (TAT). Results The institution having an in-house maintenance service had better quality indicators than the contract maintenance service. Conclusions There was lineal dependence between availability and service productivity.

Cancer presenting as fatal pulmonary tumour embolism.

Rapidly fatal pulmonary tumour embolism is a rare complication of malignancy, and often presents as progressive dyspnea without obvious cause. We describe two cases presenting with a dramatic clinical picture of lactic acidosis and cardiopulmonary arrest soon after admission on ICU. The first patient was a 29-year old woman with a breast cancer seeming in remission who was admitted with rapidly increasing dyspnea since two weeks. The second patient was a 46-year old woman with HIV and no history of malignancy, who developed dyspnea and lactic acidosis over the course of a few days while she was investigated for an occipital brain lesion. Both patients died soon after admission and massive tumour emboli were found on autopsy. Breast cancer was the origin of the emboli in both cases. Symptoms were out of proportion to the initial physical cardiopulmonary findings and radiographic features. Clinical signs of pulmonary tumour embolism are non-specific and subacute. Prognosis is poor and definite diagnosis is usually made post-mortem. Solid malignancies such as breast cancer account for most of the cases. Pulmonary tumour embolism should be considered in critically ill patients with unexplained hypoxemia and lactic acidosis, mild or no radiological abnormalities and fast clinical deterioration. It may occur in young patients and in patients without history of malignancy.

A survey on gastroenterology training in Europe.

BACKGROUND: Specialist training in gastroenterology and hepatology is not standardised in different European countries. AIM: The aim of this survey was to assess the different teaching and socioeconomic aspects of training programmes in Europe. METHODS: Seventy questionnaires were distributed to last year trainees or newly graduated gastroenterologists. Forty two respondents (60%) from 34 major training centres in 10 different European countries replied. RESULTS: Overall, the data revealed major diversity for all aspects analysed, between and within the different European countries. Both the duration of training (range 4-10.4 years) and workload (range 48.5-89.2 hours per week) differed markedly between countries. The average number of endoscopic procedures (gastroscopies, range 300-2600; colonoscopies, range 73-550; endoscopic retrograde cholangiopancreatographies, range 1-385) differed also. One third of last year trainees reported that they felt uncertain in some endoscopic procedure. The European trainee was on call for 5-6 nights a month on average (range 1-8). Monthly wages differed considerably between countries, ranging from 767 to 2180 Euro. CONCLUSION: We found major differences in the professional aspects and socioeconomic conditions of gastroenterologist/hepatologist training in 10 different European countries, probably leading to differences in quality of training. In several countries or centres the average number of procedures was below the threshold issued by the European Board of Gastroenterology or the American Gastroenterological Association. Issuing a European diploma for gastroenterology is a valuable effort towards meeting this problem. Further studies are needed to re-evaluate the training programmes in Europe and to define threshold numbers and technical end points for assessment of endoscopic skills.

Update on the management of acute severe pancreatitis.

Acute severe pancreatitis is an aggressive disease with a mortality rate of up to 30 percent. In recent years therapy has shifted away from early surgery to intensive medical care. This article focuses on several issues of the management of acute severe pancreatitis emphasising evidence from recent clinical trials and recommendations from recent consensus conferences. Since a correct assessment of the severity of the disease is mandatory as early as possible in the treatment, several multiple scoring factor systems and individual risk factors are explained. The indications and the optimal timing of ERCP are discussed. Prophylactic administration of antibiotics, intravenously or by means of a selective digestive decontamination scheme, seems to be beneficial in decreasing morbidity but not mortality. Adequate nutritional support, preferably achieved by enteral feeding, is an important component in the supportive therapy. Protease inhibitors and anti-secretory drugs have not proven to be of benefit in improving outcome. Immunomodulating substances like platelet activating antagonists are promising but further studies are necessary to confirm the results of the early studies. Finally, indications for surgery are discussed.

Deficit de carnitiva palmitoil transferasa II (CPT II): Descripción de un caso / Deficit of carnitina palmitoil transferasa II (CPT II): Description a case

En la Unidad de Terapia Intensiva del Departamento de Urgencias y Medicina Crítica del Hospital Pediátrico "Dr. Agustín Zubillaga" de Barquisimeto, se realizó una investigación retrospectiva, explicativa no experimental en un lactante de 8 meses de edad, con déficit de Carnitina Palmitoil Transferasa II (CPT II); se presenta la evolución clínica del caso, los métodos diagnósticos y el tratamiento médico

Duodenogastroesophageal reflux and esophageal mucosal injury in mechanically ventilated patients.

BACKGROUND & AIMS: Esophagitis has been reported to be the most frequent cause of upper gastrointestinal bleeding in intensive care patients. The mechanisms causing esophagitis are unclear. The aim of this study was to measure esophageal acid and bile reflux and to examine the relationship between reflux and mucosal injury in mechanically ventilated patients. METHODS: Twenty-five critically ill, mechanically ventilated patients with nasogastric tubes were prospectively included for 24-hour esophageal pH and duodenogastroesophageal bile reflux studies (Bilitec 2000 system). All patients received acid-suppressive therapy for stress ulcer prophylaxis with ranitidine. On the day before the study, patients underwent esophageal endoscopy to determine the presence or absence of esophagitis. RESULTS: After approximately 5 days of mechanical ventilation, 12 patients (48%) had erosive esophagitis, 2 patients had pathological acid reflux, and 12 patients had pathological bile reflux. The presence of esophagitis was significantly associated with pathological bile reflux (P = 0.017, Fisher exact test). The severity of esophagitis was significantly correlated with the volume of gastric residual volume and with increasing times of bile reflux. The latter was significantly correlated with the number of organ failures. CONCLUSIONS: Despite acid-suppressive therapy, esophagitis is a frequent finding in critically ill patients after less than a week of mechanical ventilation. In these patients, besides mechanical irritation by the nasogastric tube, chemical injury caused by duodenogastroesophageal reflux seems to have a major role in the pathogenesis of esophageal mucosal lesions.

Tufted angioma.

Tufted angioma is a rare, slow growing, benign, vascular tumour. We describe two young male patients, each with a solitary erythematous plaque on the lateral aspect of the chest. In one case, the cutaneous lesion had been present since birth, in the other the tumour developed at the age of ten. Clinically appearing as a reddish, livid, partly papulous plaque, on histological examination they showed typical features of small, circumscribed, angiomatous lobules, particularly in the reticular layer of the dermis. These lobules were composed of poorly canalized, endothelial-lined vessels and solid regions. Cellular atypia and irregular mitotic figures were not observed. We report on our experience with s.c. interferon alpha treatment, in one case leading to a partial remission. Considering the differential diagnoses of malignant angiomatous tumours such as angiosarcoma or Kaposi's sarcoma, the awareness of the possibility of tufted angioma, which is a benign vascular proliferation, is of paramount importance.

Ambulatory small intestinal manometry. Detailed comparison of duodenal and jejunal motor activity in healthy man.

The aim of this study were to provide a detailed comparison of duodenal and jejunal motor activity in healthy individuals by utilizing prolonged ambulatory manometry in combination with computer-aided analysis. Intraluminal pressure profiles were studied in the duodenum and jejunum of 18 healthy volunteers over 24 hr. The subjects ingested two meals, both of 800 kcal and of equal chemical composition, at two different times of the day. Over the whole interdigestive period, phase III motor activity started more frequently distal than proximal to the ligament of Treitz. However, an increasing time of fasting was linearly related to an increasing number of phase IIIs originating proximal to the ligament of Treitz (r = 0.95). Both meals induced a postprandial motor pattern of similar duration and contractile activity. As compared to the jejunum, individual duodenal contractions during the postprandial period and during phase II had a higher duration and amplitude. Propagated clustered contractions occurred more frequently in the duodenum than in the jejunum, both in the interdigestive and digestive state. Jejunal clusters comprised a higher number of individual contractions of lower amplitude and duration. In healthy man duodenal and jejunal motor activity are different, both in the digestive and interdigestive state. The differences include the number of activity fronts traversing these segments of the gut, the number and organization of propagated clustered contractions, and subtle changes in the amplitude, duration, and coordinated propagation of individual contractions. These changes presumably reflect a regulatory capability of the small intestine to modulate the rate of transit of intraluminal content through different segments of the gut.