Bacterial colonisation and the effect of a cleaning regime on iPad patient side electronic devices used in a veterinary healthcare setting.

OBJECTIVES: This study aimed to determine the prevalence of clinically relevant bacteria on the surface of hospital-issued iPads and to assess the effectiveness and residual effect of a new cleaning regime using 70% alcohol and 2% chlorhexidine wipes. METHODS: Hospital-issued iPads were swabbed to determine the presence of clinically relevant organisms. The iPads were wiped using 70% alcohol and 2% chlorhexidine. Further samples were taken 5 mins, 6 h and 12 h after implementation of the cleaning regime. Cultured bacteria were tested for antimicrobial resistance. RESULTS: A total of 25 hospital-issued iPads were analysed. Seventeen iPads (68%) sampled in this study were contaminated. Bacillus species (21%) were the most predominant, followed by Pasteurella species (14%), Acinetobacter species (11%), Eikenella species (11%), beta-haemolytic streptococci (11%), coagulase-positive staphylococci (7%), Escherichia coli (7%), coagulase-negative staphylococci (7%), alpha-haemolytic streptococci (3%), Enterococcus species (4%) and Pseudomonas species (4%). Of the isolated bacteria, 89% were resistant to at least one of the tested antibiotics. Of our isolates, 24 (75%) were resistant to clindamycin. After the cleaning regime, there was no bacterial growth from any of the devices at 5 mins, 6 h and 12 h despite repetitive use within the hospital. CONCLUSIONS AND RELEVANCE: A variety of nosocomial pathogens, including antibiotic resistant pathogens, were isolated from the iPads. Cleaning with 70% alcohol and 2% chlorhexidine wipes is recommended every 12 h during use, between patient contacts and after witnessed contamination. A variety of nosocomial pathogens, including antibiotic-resistant pathogens with potential devastating effects on both human and animal health, were isolated from the iPads. Infection prevention strategies related to the devices should be employed in a hospital setting.

Feline Diaphyseal Fractures: Management and treatment options.

PRACTICAL RELEVANCE: Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant trauma; for example, as a result of road traffic accidents, high-rise syndrome and dog bite wounds. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a fracture. CLINICAL CHALLENGES: Surgical management of diaphyseal fractures can be challenging due to the surgical approach for some bones being technically demanding, for example because of the presence of important neurovascular structures, and the small size of feline bones, which limits the choice of implant size and strength. Further, it may be difficult to visualise fracture alignment when using minimally invasive techniques, although the use of intraoperative fluoroscopy can aid with this, and malalignment can be common for some fracture repairs, particularly in cases where anatomical reconstruction is not possible. AIMS: This review focuses on diaphyseal long bone fractures and aims to assist decision-making, with an overview of the management and treatment options available. EVIDENCE BASE: Many textbooks and original articles have been published on aspects of managing fractures in small animals. The authors also provide recommendations based upon their own clinical experience.

Use of beta-blockers and risk of aseptic loosening in total hip and knee arthroplasty: a nested case - control study.

OBJECTIVES: To analyze the effect of beta-blockers on the risk of aseptic loosening (AL) in Total Hip (THA) or Knee (TKA) Arthroplasty. METHODS: A nested case-control study was conducted. Cases were patients who underwent revision surgery for THA or TKA due to AL. Controls were patients who sustained primary THA or TKA and were matched to cases in respect to age, sex, type of prostheses and follow-up in a 4:1 ratio. The use of beta-blockers was achieved. A logistic regression analysis adjusted to potential confounders was performed to determine the risk of AL. Analysis was also adjusted to cardioselectivity of the beta-blocker and the adherence to treatment, measured as Proportion of Days Covered (PDC). RESULTS: 24 cases and 96 controls were selected. Compared to non-users, any use of beta-blockers was associated with a reduced risk of AL [adjusted OR 0.141 (Confidence Interval (CI) 95% 0.04-0.86)]. Use of selective beta-blockers showed significant lower risk of AL [adjusted OR 0.112 (CI95% 0.01-0.91)]. PDC ≥50% was associated with reduced risk of AL compared to non-users [adjusted OR 0.083 (CI95% 0.01-0.66)]. CONCLUSION: The first clinical evidence showing an association between the use of beta-blockers and lower risk of aseptic loosening in THA and TKA is provided.

Avulsion Fractures of Posterior Calcaneal Tuberosity: Identification of Prognostic Factors and Classification.

Avulsion fractures of the posterior calcaneal tuberosity are rare injuries, and little is known about the underlying factors, outcomes, and prognosis. Furthermore, classifications described previously focus on fracture morphology, with uncertain clinical utility. We present the results of a retrospective study of 21 patients treated for this pathology from January 2002 to December 2015. Features analyzed were age; sex; mechanism of injury; medical comorbidities; type of fracture, as proposed by Beavis; fracture displacement; fragment size; type of treatment; complications; need for secondary surgery; and the American Orthopaedic Foot and Ankle Society score after treatment and follow-up care. Mean age was 56.95years. A total of 61.9% were females, and 71.4% were secondary to low-energy trauma. In addition, 19% were diabetic. Mean follow-up was 57.24 months. Surgery was performed in 81%. Complications rate was 61.9%, and secondary surgery was needed in 38.1%. Mean fracture displacement was significantly higher when complications occurred (25.91mm versus 7.61 mm) (p = .03) and when soft tissues complications appeared (30.65mm versus 14.68 mm) (p = .02). Female gender was associated with the secondary loss of reduction (p = .04). The Beavis classification was not related significantly with any outcome variable. When fracture displacement was ≥2cm, complication rate increased from 30% to 90.9% (p = .008) and soft tissue compromise increased from 0% to 45.45% (p = .035). A new classification system with prognostic value is described, based on fracture displacement. We present 1 of the largest series published to date; fracture displacement is a major variable that influences the outcomes of these injuries, and a new classification attending to a prognostic factor is developed.

Sjögren's Syndrome Associated with Fanconi's Syndrome and Osteomalacia.

BACKGROUND Sjögren's syndrome is a chronic inflammatory autoimmune disease, which is also known as sicca syndrome, due to the symptoms of dry eyes and dry mouth, and is associated with other connective tissue diseases and autoimmune diseases. Sjögren's syndrome can also be associated with renal involvement. Fanconi's syndrome is associated with impaired reabsorption in the proximal renal tubule associated with tubulointerstitial nephritis and is associated with renal tubular acidosis and hypophosphatemia. Osteomalacia is a rare association with Sjögren's syndrome, which may result from renal disease. CASE REPORT We report the case of a 34-year-old woman who presented with xerostomia, xerophthalmia, bone fractures, and osteomuscular pain. A Schirmer test showed reduced tear production, and a biopsy of a minor salivary gland of the lip, with high titers of antinuclear antibodies (ANA), and positive anti-SSA/Ro and anti-SSB/La antibodies confirmed the diagnosis of Sjögren's syndrome. Serum and urinary laboratories tests and clinical manifestations confirmed Fanconi's syndrome associated with osteomalacia. The patient was treated with potassium supplements, 25-hydroxyvitamin D (25(OH)D), hydroxychloroquine, mycophenolate mofetil, and prednisone, with a favorable response. CONCLUSIONS This case is of a rare association between Sjögren's syndrome, Fanconi's syndrome, and osteomalacia. Even though these are rare clinical associations, early detection can improve the quality of life and prevent further complications.

Intoxicación por plomo y nivel de marginación en recién nacidos de Morelos, México / Lead poisoning and marginalization in newborns of Morelos, Mexico

Resumen: Objetivo: Determinar la prevalencia de intoxicación por plomo (IPb) al nacimiento en Morelos, analizar su distribución por nivel de marginación y estimar la asociación con el uso de barro vidriado (BV). Material y métodos: Se midió plomo en sangre (PbS) en cordón umbilical de una muestra representativa de 300 nacimientos seleccionados aleatoriamente de aquéllos atendidos por los Servicios de Salud de Morelos e IMSS estatal. Resultados: La prevalencia de IPb al nacimiento (PbS>5µg/dL) fue 14.7% (IC95%: 11.1, 19.3), y 22.2% (IC95%: 14.4, 32.5) en los municipios más marginados. 57.1% (IC95%: 51.3, 62.7) de las madres usaron BV durante el embarazo y la frecuencia de uso se asoció significativamente con PbS. Conclusión: Este es el primer estudio que documenta la proporción de recién nacidos con IPb que están en riesgo de sufrir los consecuentes efectos adversos. Se recomienda monitorear PbS al nacimiento y emprender acciones para reducir esta exposición, especialmente en poblaciones marginadas.

Abstract: Objective: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Materials and methods: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. Results: The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. Conclusion: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.

Melatonin reduces endothelin-1 expression and secretion in colon cancer cells through the inactivation of FoxO-1 and NF-κß.

Melatonin is an indoleamine that is synthesised from tryptophan under the control of the enzymes arylalkylamine N-acetyltransferase (AA-NAT) and acetylserotonin methyltransferase (ASMT). Melatonin inhibits colon cancer growth in both in vivo and in vitro models; however, a precise mechanism responsible for inhibiting tumour growth has not been clearly described. Endothelin-1 (ET-1) is a peptide that acts as a survival factor in colon cancer, inducing cell proliferation, protecting carcinoma cells from apoptosis and promoting angiogenesis. The data presented show that melatonin inhibits edn-1 mRNA expression (the first step in ET-1 synthesis), ECE-1 protein expression and the release of ET-1 from colorectal cancer cells in vitro. ET-1 levels in cultured media present a similar inhibition pattern to that of edn-1 mRNA expression despite the inhibition of ECE-1 protein after melatonin treatment, which suggests that an endopeptidase other than ECE-1 could be mainly responsible for ET-1 synthesis. The inhibition of edn-1 expression is due to an inactivation of FoxO1 and NF-κß transcription factors. FoxO1 inactivation is associated with an increased Src phosphorylation, due to elevated cAMP content and PKA activity, whereas NF-κß inactivation is associated with the blockade of Akt and ERK phosphorylation due to the inhibition of PKC activity after melatonin treatment. Melatonin also inhibits edn-1 promoter activity regulated by FoxO1 and NF-κß. Finally, a significant correlation was observed between AA-NAT and edn-1 expression downregulation in human colorectal cancer tissues. In conclusion, melatonin may be useful in treating colon carcinoma in which the activation of ET-1 plays a role in tumour growth and progression.

Role of fetal echocardiography in stepwise sequential screening for chromosomal disorders (combined test associated with modified genetic sonography).

OBJECTIVES: To evaluate the contribution made by fetal echocardiography in identifying Down's syndrome (DS) and other chromosomal disorders in a stepwise sequential screening method (first step: combined test (CT), second step: modified genetic sonography (MGS) (major malformation and nuchal fold)), for DS in the general population of pregnant women. METHODS: Prospective study. During a 5-year study period (July 2005-June 2010) 17,911 pregnant women underwent CTs with MGS (with fetal cardiac morphological evaluation performed by obstetricians in a tertiary hospital) as a screening method for DS. We evaluated the sensitivity and false positive rate (FPR) (95% confidence interval (CI)) of three screening methods for DS and all chromosomal disorders: CT, CT + MGS, and CT + fetal echocardiography. RESULTS: A total of 17,911 cases were analyzed with 67 chromosome disorders and 45 DS cases being found. For DS, the CT sensitivity was 80% (95% CI; 68.3-91.7) (36/45) and 79.1% (95% CI; 69.4-88.8) (53/67) for all chromosome disorders, with a FPR of 4.2% (95% CI; 3.9-4.5) (752/17,866) and 4.1% (95% CI; 3.8-4.4) (735/17,844), respectively. For CT + MSG and CT + fetal echocardiography, the sensitivity for DS was 93.3% (95% CI; 85.9-0.99) (42/45) and 95.5% (95% CI; 90.5-0.99) (64/67) for all chromosome disorders. The FPR for CT + MSG was 4.8% (95% CI; 4.5-5.1) (860/17,866) and 4.6% (95% CI; 4.3-4.9) (836/17,844), respectively. The FPR of CT + fetal echocardiography was 4.4% (95% CI; 4.1-4.7) (792/17,866) for DS screening and 4.3% (95% CI; 4-4.6) (770/17,844) for chromosome abnormality screening. CONCLUSIONS: Fetal echocardiography is highly capable of identifying DS and other chromosomal disorders as a part of genetic sonography in stepwise sequential screening.

Perfil situacional y estrategias de intervención en la región mesoamericana en el área de salud materna, reproductiva y neonatal / Situational profile and intervention strategy in the Mesoamerican region in maternal, neonatal and reproductive health area

Presentar los principales resultados del diagnóstico situacional y plan regional de intervenciones en salud materna, reproductiva y neonatal elaborado como parte de los trabajos del Sistema Mesoamericano de Salud por el grupo de salud materna, reproductiva y neonatal (SMRN) en 2010. Se conformó un grupo de expertos y de representantes de los países de la región (que incluye Centroamérica y nueve estados del sur de México). Se hizo una revisión documental para conformar un diagnóstico situacional, una revisión de prácticas efectivas y se conformó un plan regional de acción. El diagnóstico situacional indica que las tasas de mortalidad materna y neonatal se mantienen inaceptablemente altas en la región. Se propuso como meta regional reducir la mortalidad materna y neonatal de acuerdo a los Objetivos de Desarrollo del Milenio. Se conformó un plan regional que identifica intervenciones específicas en SMRN con énfasis en la atención adecuada a las emergencias obstétricas y neonatales, atención calificada al nacimiento, y en planificación familiar. Se sugiere asimismo un plan de implementación a cinco años y una estrategia de evaluación y de capacitación. El plan regional en SMRN puede tener éxito siempre y cuando los aspectos de implementación sean atendidos debidamente.

To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.

Caracterización de perovskitas La1-XSrXNiO3 Y La2-2XSr2XNiO4-sigma obtenidos a partir del método de auto combustión / Characterization of La1-xSrxNiO3 and La2-2xSr2xNiO4-sigma perovskites obtained through the auto combustion method

El método de auto-combustión fue utilizado para sintetizar una serie de óxidos tipo perovskita La1-xAxNiO3, donde el catión La³+ es sustituido parcialmente por Sr²+ y Mg²+. Los análisis de difracción de rayos X indican que el Sr ejerce un efecto notable sobre la estructura de los sólidos sintetizados, obteniéndose una fase simple de óxido tipo perovskita para un grado de sustitución x<= 0,1 y una mezcla de fases de óxidos tipo espinelas y NiO para x>= 0,2. Se observa que el estado de oxidación formal del Ni disminuye desde 3+ (x= 0) hasta 2,6+ (x= 0,4), indicando que el Sr facilita la reducción ya que promueve la capacidad de aceptación de electrones sobre la muestra. El Mg, por otra parte, no produce un sólido con estructura perovskita. Los estudios de reducción a temperatura programada (RTP) revelan que estos procesos ocurren a través de especies intermediarias hasta formar Ni0, SrO y La2O3, fases que se relacionaran con la actividad presentada durante los estudios catalíticos sobre estos sólidos precursores

Synthesis and biological evaluation of new selective cytotoxic cyclolignans derived from podophyllotoxin.

Podophyllotoxin and some of its derivatives are cyclolignans currently used for removing warts and in the clinical treatment of malign neoplasms. As such, they have been an objective of the scientific community for decades, in the search for more potent and more selective anticancer agents. Our interest in the chemoinduction of drug selectivity led us to the design and preparation of new podophyllotoxin derivatives by reaction of podophyllic aldehyde with aliphatic, aromatic, and heteroaromatic amines. Several of the resulting imines displayed a significant selectivity against human colon carcinoma cells, even higher than that of the starting aldehyde. Additional biological studies indicate that these derivatives induce microtubule depolymerization, arrest cells at the G2/M phase of cell cycle, and are able to induce a delayed apoptosis after 48 h of treatment, characterized by caspase-3 activation.

Importancia de la prótesis obturadora maxilar en la rehabilitación del paciente oncológico / Importance of the maxillary obturator prosthesis in the rehabilitation of oncological patients

Un defecto posquirúrgico en el maxilar o paladar blando, luego de una cirugía oncológica, puede crear problemas funcionales significativos en el individuo, donde las funciones motoras orales como la masticación fonación y deglución pueden verse totalmente afectadas estableciendo barreras que impiden su normal integración al medio familiar y social. Una etapa fundamental dentro de la rehabilitación del paciente que será sometido a una cirugía oncológica de cabeza y cuello, la constituye el tratamiento protésico, el cual deberá reestablecer las funciones básicas perdidas en el paciente, permitir una estética aceptable y por ende mejorar su calidad de vida. El propósito del presente trabajo es describir uno de los tipos de prótesis utilizadas con mayor frecuencia para la rehabilitación oral del paciente oncológico, y analizar la irrelación del odontólogo protesista como parte del equipo quirúrgico, destacando su importancia en el tratamiento integral del paciente

[Typification and screening of irregular antibodies. Establishing its use at a urology department]. / Tipificación y detección de anticuerpos irregulares (type and screen). Implantación de su uso en una unidad de urología.

OBJECTIVES: To achieve a better use of the packed red blood cells stock at our centre's blood bank, and to analyse cost-savings associated with the implementation of the type and screen (T/S) technology. METHODS: We analyse the results, complications and cost-savings achieved with the use of T/S at the Urology Department in our centre, for the transurethral resection of bladder tumour and prostate. RESULTS: A total of 232 T/S were performed; 3 patients required blood transfusions (1.3%). No complications appeared. Total cost-savings from December 1999 to December 2001 were 7.620 Euros (1,267,861.3 pesetas). CONCLUSIONS: T/S is a safe procedure allowing a better use of blood stocks in a hospital with a substantial economic saving.

Algunos dilemas éticos en los procesos de investigación sobre reproducción con adolescentes y jóvenes / Some ethical dilemmas in the research processes on reproduction with adolescent and young people

En el presente trabajo se cuestiona la imágen de la ética como algo acabado y al margen de las condiciones sociales e históricas de la población; esto es, no se presenta una defensa del relativismo sino que más bien se incursiona en una visión "dialogada" de la ética. En este sentido, se cuestionan las figuras de autoridad para hablar de los y las adolescentes al tiempo que se señala la necesidad de recuperar la presencia ciudadana en la redefinición de la ética. Aunado a lo anterior, se hace una crítica a la visión de la salud reproductiva basada simplemente en problemas (y por lo mismo necesitada de un marco asistencial) ya que debido a ello se ignora la dimensión prositiva de la sexualidad (que es y debe ser saludable y responsable). Como complemento, en este documento se recupera el avance en la discución actual que pasa de lo demográfico (como prioridad) al ámbito de los derechos en donde se busca privilegiar la dimensión de la igualdad y equidad entre los hombres y las mujeres, pero sobre todo, se hace énfasis en el que la adolescencia debe ser considerada como una etapa crucial en los procesos de elección reproductiva