Anatomical assessment of intrathoracic cardiovascular structures using fast spin-echo double inversion recovery and steady-state free precession magnetic resonance imaging in a normal cat.

In human medicine, non-contrast cardiac magnetic resonance imaging (CMRI) is routinely used to assess the cardiovascular system. In this study, using non-contrast CMRI, we provide a thorough description of the normal appearance of the intrathoracic cardiovascular structures in one healthy cat using a magnet operating at a field of 1.5-Tesla. The CMRI protocol was based on the use of fast spin-echo double inversion recovery and steady-state free precession pulse sequences in oblique short-axis, vertical long-axis, and horizontal long-axis imaging planes. After imaging the feline heart, four cadaver cats injected with latex substance into their arterial and venous systems were sectioned to facilitate interpretation of the intrathoracic cardiovascular structures to the corresponding CMRI. The fast spin-echo double inversion recovery images showed the best evaluation of gross intrathoracic anatomy, giving excellent contrast of the myocardium and vessels walls as they appeared with intermediate signal intensity compared to the lumen that appeared with low signal intensity. By contrast, steady-state free precession images showed details of the heart cavities and vascular lumen due to the high signal intensity of fast-flowing blood. The results of this study provide some anatomic detail for the heart and associated vessels as seen by non-contrast CMRI in the domestic cat.

Age of Haemonchus contortus third stage infective larvae is a factor influencing the in vitro assessment of anthelmintic properties of tannin containing plant extracts.

The larval exsheathment inhibition assay (LEIA) of infective larvae (L3) is an in vitro method used to evaluate the anthelmintic (AH) activity of tannin-containing plant extracts against different species of gastrointestinal nematodes, including Haemonchus contortus. Some conditions remain to be defined in order to standardize the LEIA, i.e. the optimal age of larvae produced from donor animals to use in the assays. Therefore, this study aimed at identifying the effect of age and age-related vitality of H. contortus infective larvae produced under tropical conditions, on the in vitro AH activity measured with the LEIA. The same acetone:water (70:30) extract from Acacia pennatula leaves was used to perform respective LEIA tests with H. contortus L3 of different ages (1-7 weeks). Each week, the L3 were tested against different concentrations of extract (1200, 600, 400, 200, 100, 40µg/mL of extract) plus a PBS control. Bioassays were performed with a benzimidazole (Bz) resistant H. contortus (Paraíso) strain. In order to identify changes in L3 vitality on different weeks (1-7), two assays testing larval motility were included only with PBS: the larval migration assay (LMA) and the larval motility observation assay (LMOA). Mean effective concentrations causing 50% and 90% exsheathment inhibition (EC50, EC90) were obtained for every week using respective Probit analyses. On the first week, the larvae had lowest EC50 and EC90 (39.4 and 65.6µg/mL) compared to older larvae (P<0.05). The EC50 and EC90 for weeks 2-5 were similar (P>0.05), while older larvae tended to show higher EC50 and EC90 (P<0.05). Motility showed strong negative correlations with age of larvae (r≥-0.83; P <0.05) and EC50 (r≥-0.80; P<0.05), suggesting that the lower extract efficacy could be associated with decaying vitality of larvae associated with age. More stable efficacy results were found between two to five weeks of age.

Surgical site infections in patients who undergo radical cystectomy: Excess mortality, stay prolongation and hospital cost overruns.

BACKGROUND: The aim of this study was to analyze the impact of surgical site infections (SSI) in patients who underwent radical cystectomy, in terms of excess hospital mortality, stay prolongation and cost overruns. MATERIAL AND METHODS: A retrospective observational study was conducted on a sample of patients who underwent radical cystectomy as recorded in the basic minimum data sets of 87 Spanish hospitals from 2008-2010. RESULTS: We studied 4377 patients who underwent radical cystectomy (3904 men and 473 women) of whom 849 (19.4%) experienced an SSI. The patients with SSI were predominantly men, elderly and had a higher prevalence of alcohol-related disorders and more comorbidities. The patients with SSI had significant excess mortality (125.6%), undue stay prolongation (17.8 days) and cost overruns (14,875.70 euros). CONCLUSIONS: After controlling for demographic variables, hospital type, addiction disorders and comorbidities using multivariate pairing, the onset of SSI in patients who underwent radical cystectomy significantly increased the mortality, stay and cost. Certain preventive measures already established in previous studies could reduce the incidence of SSI and its healthcare and financial impact.

Assessment of the risk of salmonellosis from internally contaminated shell eggs following initial storage at 18 °C (65 °F), compared with 7 °C (45 °F).

In the U.S., chicken-breeder farms that supply hatcheries typically store and transport eggs intended for broiler production at a temperature of 18.3 °C (65 °F). However, in case of surplus, some of these eggs may be diverted to human consumption. According to the U.S. Food and Drug Administration's 'Egg Safety Final Rule,' shell eggs intended for human consumption are required to be held or transported at or below 7.2 °C (45 °F) ambient temperature beginning 36 h after time of lay. We adapted a risk assessment model developed by the U.S. Department of Agriculture's Food Safety Inspection Service, to quantify human exposure to Salmonella Enteritidis and the risk of human salmonellosis if eggs are held and transported at 18.3 °C for up to 5.5 days after time of lay, as has been observed when hatchery eggs are diverted to human consumption, rather than held and transported at 7.2 °C within 36 h after time of lay. Storage at 18.3 °C leads to considerable bacterial growth in internally contaminated eggs. The model predicted that more than 10% of internally contaminated eggs would remain contaminated after in-shell pasteurization resulting in a 5-log10 reduction, and that some bacteria would survive after home-cooking. The model predicted that, alternatively, eggs stored at 7.2 °C after lay would have limited bacterial growth prior to pasteurization, and Salmonella would be very unlikely to be present after pasteurization. The predicted risk of salmonellosis from the consumption of eggs held and transported at 18.3 °C and subsequently diverted to human consumption is 25 times higher than the risk when eggs are held and transported at 7.2 °C.

[Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease]. / Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector.

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.

Percepción de trato digno de usuarias que acuden al servicio de interrupción legal del embarazo (ile) / Users´ perception about worthy relationship in care of the service of legal abortion

Las mujeres embarazadas que desean interrumpir su embarazo de forma voluntaria deben recibir un trato digno durante su atención. El Trato Digno incluye saludo amable, presentación del personal de salud, hablar a la paciente por su nombre, explicación e información de procedimientos a realizar, salvaguardar la intimidad, trato respetuoso, y la satisfacción del paciente con respecto al trato del personal que le atendió. Objetivo: Evaluar la percepción que tienen las usuarias del cumplimiento del indicador de calidad: "Trato Digno" proporcionado por personal de enfermería en el servicio de ILE. Metodología: Estudio de tipo cuantitativo, descriptivo y transversal. Muestreo por conveniencia conformado por 54 pacientes que acudieron al servicio de ILE. Resultados: La edad de las mujeres osciló entre 15 y 45 años. El 66% de las mujeres del estudio refirieron haber esperado más de 60 minutos para recibir tratamiento; a pesar de ello 56% reportó estar satisfecha con el tiempo de espera. El 93% consideró que recibió información clara y concisa acerca de su tratamiento y evolución. Un porcentaje igual valora como respetuoso el trato del personal. El 89% de las mujeres del estudio recibió cuidados de enfermería durante su atención. También 96% dice estar satisfecha con la atención recibida. Conclusión: La atención a las pacientes que acuden al servicio de ILE corresponde a un trato digno, ya que se brinda con respeto, amabilidad, humanismo e informando acerca de los procedimientos a realizar, medidas diagnósticas y/o terapéuticas necesarias.

Pregnant women seeking to terminate voluntary her pregnancy on a basis should be treated with dignity in their health. The worthy relationship includes friendly greeting, presentation of professional health, and call to the patient by name, explanation and information about to make procedures, safeguard privacy, respectful, and patient satisfaction regarding the care of staff who attended her. Objective: To evaluate the users' perception of quality care indicator fulfillment with worthy relationship provided by nurses in ILE service. Methodology: quantitative, descriptive and transversal study. Convenience sample comprised of 54 patients who attended the ILE service. Results: The age of the women ranged between 15 and 45. 66% of women in the study reported having waited more than 60 minutes for treatment, despite that 56%reported being satisfied with the waiting time. 93% felt that was clear and concise information about their treatment and evolution. The same percentage was observed respectful relationship by staff. 89% of women in the study nursing care received during your stay. 96% also say they are satisfied with the medical care. Conclusion: The care of patients attending the ILE service corresponds to a worthy relationship, as it provides with respect, kindness, humanism and report on procedures performed, diagnostic measures and / or treatment required.

Emerging properties of financial time series in the "Game of Life".

We explore the spatial complexity of Conway's "Game of Life," a prototypical cellular automaton by means of a geometrical procedure generating a two-dimensional random walk from a bidimensional lattice with periodical boundaries. The one-dimensional projection of this process is analyzed and it turns out that some of its statistical properties resemble the so-called stylized facts observed in financial time series. The scope and meaning of this result are discussed from the viewpoint of complex systems. In particular, we stress how the supposed peculiarities of financial time series are, often, overrated in their importance.

El Programa de Crecimiento y Desarrollo: otro factor de inequidad en el sistema de salud / The Growth and Development Program: another inequity agent in the health system

El Programa de Crecimiento y Desarrollo ha sido considerado como una importante acción de salud pública, impulsada por el sistema de salud desde hace más de 20 años. Este programa, como todas aquellas acciones de promoción de la salud y prevención de la enfermedad, han sufrido importantes cambios con la implantación de la Ley 100. La presente investigación, de corte cualitativo, pretendió identificar cuáles fueron estos cambios, sus causas y su impacto para la calidad de las acciones promovida por el programa y por ende, para la promoción de la salud de los niños menores de 6 años y sus familias en la ciudad de Medellín. La información se recolectó revisando fuentes secundarias y realizando entrevistas a padres y funcionarios vinculados al programa, así como con la observación de las sesiones. La investigación concluyó que se han producido importantes cambios en la forma como se administra y se ejecuta el programa, encontró especialmente una gran diferencia de la calidad del servicio entre los programas ofrecidos por el régimen contributivo y el régimen subsidiado, lo que ha generado una situación de marcada inequidad que está afectando a las familias más vulnerables, que precisamente serían las que requerirían mayores esfuerzos del sistema de salud

Evaluation of a sampling methodology for the Rapid Assessment of Aedes aegypti infestation levels in Iquitos, Perú

An epidemic of dengue during 2001 in Northwestern Peru has re-emphasized the need for efficient, accurate, and economical vector surveillance methods. Between November 1998 and January 1999 we carried out extensive entomological surveys in two neighborhoods (Maynas and Tupac) of 600 contiguous houses (14-20 blocks) each located in the Amazonian city of Iquitos, which has provided a unique opportunity to evaluate the Aedes aegypti rapid assessment survey strategy. This strategy is based on PAHO recommendations employed by the Peruvian Ministry of Health (MOH). All household locations from 4 surveys (2/neighborhood), including closed and unoccupied houses were georeferenced and displayed in a Geographic Information System (GIS), facilitating simulations of 10 MOH surveys based on hypothetical systematic sampling transects for 3 work groups (15-25 houses per group starting from randomly selected blocks). Larval, pupal and adult mosquito indices were calculated for each simulation and compared to the indices calculated from the complete data set. Infestation rates were highest in Maynas where House Indices (HI: proportion of houses positive for larvae) were 45% and 38% in surveys 1 and 2, respectively. In Tupac Amaru the HI was 30% in survey 1 and 27% survey 2. The observed range in simulated House indices in Maynas survey 1 and 2 were 38-56% and 36-42%; whereas in Tupac they were 21-34% and 13-33%. Index stability was evaluated by comparing the coefficient of variation to the mean of the simulation results. HI, Breteau index, pupae/ha, adult index, and adults/ha were more robust entomological indicators (CV/mean=0.1-2.9), than the container index, pupae/person, pupae/house, adults/person, and adults/house (CV/mean>20). Results demonstrate that the MOH's Aedes aegypti risk assessment program provides reasonable estimates of actual indices; however, the further understanding of the association of these indices with rates of virus transmission...

Economic and outcomes assessment of magnetic resonance imaging in the evaluation of headache.

We sought to evaluate the economic impact and diagnostic utility of magnetic resonance imaging (MRI) in the management of patients with headache and nonfocal physical examinations. Computerized medical records were retrospectively reviewed of 1,233 patients presenting for MRI of headache at our institution over a 3-year period (1992-1995). Patients with focal findings at physical examination, prior brain surgery, head trauma, or immunocompromise were excluded. A model was developed to assess the cost associated with the MR test results, and actual average institutional costs of performing an examination applied. Correlative statistical analysis of referring specialties and positive tests was also performed. Three hundred twenty-eight patients who met the above criteria were retained in the sample. One hundred sixty-three patients (50%) had negative MR test results. Of the 50% of patients with positive studies, only 5 (1.5%) had clinically significant MR results. The average cost of an MR examination was 517 dollars (1998 dollars). The cost per clinically significant managed case detected was 34,535 dollars. No statistically significant difference was found among referring specialties and clinically significant MR results. Our results indicate that MRI of nonfocal headache yields a low percentage of positive clinically significant results and has limited cost-effectiveness. Referring specialty had no significant bearing on these outcomes, regardless of specialist experience.

Community's role in the promotion of recovery from addiction and prevention of relapse among women: an exploratory study.

OBJECTIVE: This exploratory study examined the community's role in the promotion of recovery from addiction and the prevention of relapse among women, and the differences in women's addiction and recovery by ethnicity. Community was defined as six institutions: home, church, workplace, school, law enforcement and medical care system. METHODS: The study sample consisted of 39 Anglo and 24 ethnic minority women (21 African American; 3 Hispanic) between the ages of 21 and 70, living along the Gulf Coast of Texas, who had been in continuous recovery from addiction to alcohol or other drugs for at least six months. The study was cross-sectional, and data were collected through the use of structured interviews utilizing the Women in Recovery Questionnaire, an instrument developed by the investigative team. RESULTS: This study found that community institutions (church, school, home, workplace and law enforcement and medical systems) were seldom involved in promoting recovery or preventing relapse in women, with the exception of the home, which supported recovery. Anglo and ethnic minority women differed by primary drug usage, number of times in treatment, religion, perception of sexism, and likelihood of citations for traffic violations. CONCLUSION: Large, randomized studies are needed to investigate the community's role in women's recovery from alcohol and other drugs.

[Adiposity and fat distribution in preschool children from low socioeconomic levels in Caracas]. / Adiposidad y patrón de distribución en un grupo de preescolares de estratos socioeconómicos bajos de Caracas.

Epidemiological studies suggest that body fat distribution in adults is associated with chronical nontransmissible diseases, less is known during the growing years. The current study was undertaken to explore the relationship between level of fatness, fat patterning and some socioenvironmental variables in a group of 449 children aged 3 to 6, living in Caracas, who belong to the poorest Venezuelan socio-economic stratum. Data was analyzed taking nutritional status (weight-for-age), an index of socioeconomic conditions (ICSA), sex and age, as control variables. Using a multivariate analysis we derived first, two groups of households (G1 and G2) as determined by socioeconomic variables, to which principal component analysis was applied to elicited fatness and relative fat patterning through six skinfolds. First component identify level of adiposity, second extremity/trunk fatness, and third upper/lower pattern. Comparison of normal children with those of low weight-for-age showed differences in adiposity and in the upper/lower patterning as detected by the skinfolds involved in the differences: subscapular (-0.53) and supraspinale (0.32) in children with low weight-for-age; triceps (-0.46) and thigh (0.29) in those classified as normal. We found that gender, nutritional condition, environmental variables and age, were significant predictors of the differences in adiposity level; while age and households conditions, appear to be related to upper/lower patterning. The data equally suggests that body fat is more centrally distributed in boys with low weight-for-age. Since these patterns are indicators of risk in the ongoing years, we call tha attention about environmental circumstances.

Health care access among Mexican Americans with different health insurance coverage.

This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.