Mitochondrial network dynamics in pulmonary disease: Bridging the gap between inflammation, oxidative stress, and bioenergetics.

Once thought of in terms of bioenergetics, mitochondria are now widely accepted as both the orchestrator of cellular health and the gatekeeper of cell death. The pulmonary disease field has performed extensive efforts to explore the role of mitochondria in regulating inflammation, cellular metabolism, apoptosis, and oxidative stress. However, a critical component of these processes needs to be more studied: mitochondrial network dynamics. Mitochondria morphologically change in response to their environment to regulate these processes through fusion, fission, and mitophagy. This allows mitochondria to adapt their function to respond to cellular requirements, a critical component in maintaining cellular homeostasis. For that reason, mitochondrial network dynamics can be considered a bridge that brings multiple cellular processes together, revealing a potential pathway for therapeutic intervention. In this review, we discuss the critical modulators of mitochondrial dynamics and how they are affected in pulmonary diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), acute lung injury (ALI), and pulmonary arterial hypertension (PAH). A dysregulated mitochondrial network plays a crucial role in lung disease pathobiology, and aberrant fission/fusion/mitophagy pathways are druggable processes that warrant further exploration. Thus, we also discuss the candidates for lung disease therapeutics that regulate mitochondrial network dynamics.

Bio-directed Chemical Study of Pleurotus ostreatus Spent Substrate and Its Nematicidal Activity.

PURPOSE: In the present study, the nematicidal activity of the chemical fractionation of the spent substrate of the edible mushroom Pleurotus ostreatus against eggs and L3 larvae of Haemonchus contortus was evaluated. METHODS: The hydroalcoholic extract of the spent substrate was subjected to a bipartition with ethyl acetate giving two fractions: one aqueous (F. Ac) and one organic (F. AcOET). Both fractions were evaluated against eggs and L3 larvae at different concentrations (5, 2.5, 1.25, 0.625 and 0.3125 mg/mL) and 2% methanol, PBS and thiabendazole (5 mg/mL) as controls. Chemical fractionation of F. AcOET was performed in open column chromatography where 76 fractions were obtained and when analyzed by thin layer chromatography (TLC) were grouped into 11 mixtures (R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11). These mixtures were evaluated at 10 mg/mL against eggs and L3 larvae. The data obtained were analyzed by ANOVA and a Tukey test in the SAS V9 program. RESULTS: The results showed that, in the evaluation of F. AcOET and F. Ac, for the inhibition of egg hatching, the highest percentages were 78.80 and 76.89% at 5 mg/mL, respectively. As for the percentage of larval mortality, F. AcOET obtained 60.91 and F. Ac 29.77% at 5 mg/mL. The results of the evaluations of the mixtures showed that mixtures R4, R5 obtained 100 and 95.41% larval mortality and mixtures R6 and R7 presented 100% inhibitory activity of egg hatching, so these were analyzed by gas chromatography mass spectrometry finding compounds such as vanillin, ß-sitosterol, ρ-methyl ρ-hydroxycinnamate and ρ-hydroxybenzaldehyde. CONCLUSION: The results of the present study demonstrate that the spent substrate of P. ostreatus has potential anthelmintic activity against H. contortus. Moreover, by reusing and taking advantage of this substrate, its environmental pollution effects can be reduced.

Fauna silvestre con valor de uso en la Reserva de la Biosfera Sierra de Huautla, Morelos, México / Wild fauna with use value in the Biosphere Reserve Sierra de Huautla, Morelos, Mexico

Resumen El objetivo de este trabajo fue sistematizar las especies apropiadas, formas de apropiación y valores de uso asignados a la fauna silvestre en comunidades de la Reserva de la Biosfera Sierra de Huautla, México, mediante un análisis documental y trabajo de campo. Se registraron 46 especies con valor de uso pertenecientes a 31 familias. La clase con mayor número de especies apropiadas son las aves (42.5%), seguidas de los mamíferos (34%). El 64% de las especies se apropian con fines alimentarios y el 38.3% se utilizan para el tratamiento de enfermedades en la medicina tradicional. Otros usos son adornos, amuletos, elaboración de herramientas y como animal de compañía. La apropiación de fauna silvestre se realiza por medio de la cacería, la recolección y la pesca. Las armas de fuego como la escopeta es el principal instrumento para la cacería. También se utilizan perros, machetes, resorteras, tarrayas, anzuelos, nudos corredizos y se capturan manualmente. La apropiación puede ser una actividad oportunista u organizada por medio de las arreadas, espiadas, lampareadas, campeadas, acorralamiento y recolección manual. La apropiación de fauna silvestre es una actividad culturalmente arraigada en las comunidades de la reserva. Sin embargo, el análisis de la relación sociedad-fauna en la región es limitado, por lo que es necesario generar información que promueva el manejo sostenible del recurso faunístico.

Abstract The aims of this paper were the systematization of appropriated species, appropriation forms and assigned use values of wildlife species in the Biosphere Reserve of the Sierra de Huautla, Mexico, by means of documentary analysis and field work. We recorded 46 species with use value pertaining to 31 families. Birds accounted for the highest number of appropriated species (42.5%), followed by mammals (34%). Of the total species, 64% are appropriated for alimentary purposes and are used in the treatment of diseases in traditional medicine. Others are used as ornaments, talismans, in tool manufacture and as pet animals. Wildlife appropriation is achieved by hunting, collection and fishing. Fire arms such as shotguns are the main instrument used in hunting. Dogs, machetes, slingshots, nets, hooks, slipknots, are also used, or they are captured by hand. Appropriation can be an opportunistic or organized activity by means of "arreadas" (herding), "espiadas" (opportunistic observation), "lampareadas" (spotlighting), "campeadas" (scouring), "acorralamiento" (cornering) and manual collection. Wildlife appropriation is a culturally rooted activity in the reserve communities. Nevertheless, the analysis of the relationship society-fauna in the region is limited and this is why the generation of information that may enable a sustainable management of the faunistic resource is necessary.

Activation of the mechanosensitive Ca2+ channel TRPV4 induces endothelial barrier permeability via the disruption of mitochondrial bioenergetics.

Mechanical ventilation is a life-saving intervention in critically ill patients with respiratory failure due to acute respiratory distress syndrome (ARDS), a refractory lung disease with an unacceptable high mortality rate. Paradoxically, mechanical ventilation also creates excessive mechanical stress that directly augments lung injury, a syndrome known as ventilator-induced lung injury (VILI). The specific mechanisms involved in VILI-induced pulmonary capillary leakage, a key pathologic feature of VILI are still far from resolved. The mechanoreceptor, transient receptor potential cation channel subfamily V member 4, TRPV4 plays a key role in the development of VILI through unresolved mechanism. Endothelial nitric oxide synthase (eNOS) uncoupling plays an important role in sepsis-mediated ARDS so in this study we investigated whether there is a role for eNOS uncoupling in the barrier disruption associated with TRPV4 activation during VILI. Our data indicate that the TRPV4 agonist, 4α-Phorbol 12,13-didecanoate (4αPDD) induces pulmonary arterial endothelial cell (EC) barrier disruption through the disruption of mitochondrial bioenergetics. Mechanistically, this occurs via the mitochondrial redistribution of uncoupled eNOS secondary to a PKC-dependent phosphorylation of eNOS at Threonine 495 (T495). A specific decoy peptide to prevent T495 phosphorylation reduced eNOS uncoupling and mitochondrial redistribution and preserved PAEC barrier function under 4αPDD challenge. Further, our eNOS decoy peptide was able to preserve lung vascular integrity in a mouse model of VILI. Thus, we have revealed a functional link between TRPV4 activation, PKC-dependent eNOS phosphorylation at T495, and EC barrier permeability. Reducing pT495-eNOS could be a new therapeutic approach for the prevention of VILI.

Pediatric Solid Gastric Emptying Scintigraphy: Normative Value Guidelines and Nonstandard Meal Alternatives.

INTRODUCTION: Adult standards for gastric emptying scintigraphy, including the type of meal and range of normative values for percent gastric emptying, are routinely used in pediatric practice, but to date have not been validated. The purpose of this study is to determine whether the use of adult criteria for gastric emptying scintigraphy is valid for children and whether alternative nonstandard meals can also be offered based on these criteria. METHODS: This retrospective study analyzed patients (n = 1,151 total) who underwent solid-phase gastric emptying scintigraphy. Patients were stratified into normal and delayed gastric emptying cohorts based on adult criteria, i.e., with normal gastric emptying defined as ≤10% gastric retention at 4 hours. Patients were further stratified based on the type of meal, namely complete or partial adult standard meals or alternative cheese-based meals. Percent gastric retention values at 1, 2, 3, and 4 hours were compared. RESULTS: The median (95% upper reference limit) percentage gastric retention values for the complete standard meal were 72% (93%) at 1 hour, 39% (65%) at 2 hours, 15% (33%) at 3 hours, and 6% (10 %) at 4 hours. By comparison, the values for cheese-based meals were 60% (87%) at 1 hour, 29% (61%) at 2 hours, 10% (30%) at 3 hours, and 5% (10%) at 4 hours. Consumption of at least 50% of the standard meal yielded similar retention percentages; 68% (89%) at 1 hour, 32% (57%) at 2 hours, 10% (29%) at 3 hours, and 5% (10%) at 4 hours. There were no significant age- or sex-specific differences using the adult criteria. DISCUSSION: The adult normative standards for gastric emptying scintigraphy are applicable for use in the pediatric population. These same standards can be also be applied to nonstandard meal options, including cheese-based alternative meals and partial standard meals.

Integrative study of microbial community dynamics and water quality along The Apatlaco River.

The increasing demand for clean water resources for human consumption, is raising concerning about the sustainable worldwide provisioning. In Mexico, rivers near to high-density urbanizations are subject to irrational exploitation where polluted water is a risk for human health. Therefore, the aims of this study are to analyze water quality parameters and bacterial community dynamics to understand the relation between them, in the Apatlaco river, which presents a clear environmental perturbance. Parameters such as total coliforms, chemical oxygen demand, harness, ammonium, nitrite, nitrate, total Kjeldahl nitrogen, dissolved oxygen, total phosphorus, total dissolved solids, and temperature were analyzed in 17 sampling points along the river. The high pollution level was registered in the sampling point 10 with 480 mg/L chemical oxygen demand, 7 mg/L nitrite, 34 mg/L nitrate, 2 mg/L dissolved oxygen, and 299 mg/L of total dissolved solids. From these sites, we selected four samples for DNA extraction and performed a metagenomic analysis using a whole metagenome shotgun approach, to compare the microbial communities between polluted and non-polluted sites. In general, Proteobacteria was the most representative phylum in all sites. However, the clean water reference point was enriched with microorganism from the Limnohabitans genus, a planktonic bacterium widespread in freshwater ecosystems. Nevertheless, in the polluted sampled sites, we found a high abundance of potential opportunistic pathogen genera such as Acinetobacter, Arcobacter, and Myroides, among others. This suggests that in addition to water contamination, an imminent human health risk due to pathogenic bacteria can potentially affect a population of ∼1.6 million people dwelling nearby. These results will contribute to the knowledge regarding anthropogenic pollution on the microbial population dynamic and how they affect human health and life quality.

Primary placement of a skin-level Cecostomy Tube for Antegrade Colonic Enema Administration Using a Modification of the Laparoscopic-Assisted Percutaneous Endoscopic Cecostomy (LAPEC).

PURPOSE: Children failing medical management for severe constipation and/or fecal incontinence may undergo surgical intervention for antegrade enema administration. We present a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure that allows primary placement of a skin-level device. METHODS: A single-institution retrospective review was performed from 2009 to 2015. In the modified technique the colonoscope is advanced to the cecum, cecal suspension sutures are placed under laparoscopic visualization, and percutaneous needle puncture of the cecum is performed under direct laparoscopic and endoscopic visualization. A skin-level cecostomy tube is then placed over a guide wire. Patient characteristics and 30-day results were analyzed by Fisher's exact test. RESULTS: Fifty-two patients underwent attempted LAPEC. Successful LAPEC using both laparoscopic and endoscopic guidance was achieved in 46 (88.5%). A MIC-KEY device was placed in 38. Corflo PEG tube placement was necessary in 14 due to high BMI (mean 28.4). Colonoscopy failed to reach the cecum in 6 and laparoscopy alone was utilized to achieve successful tube placement. Cecostomy site infections occurred in 3 (5.8%), only in those undergoing PEG placement using a pull technique (p < 0.05). CONCLUSION: Primary placement of a skin-level device was successful in the majority of patients undergoing cecostomy tube placement for bowel management utilizing antegrade colonic enemas. This technique avoids a second anesthesia for tube conversion. Visualization via colonoscopy with the use of cecal suspension sutures is recommended. High BMI necessitates initial placement of a PEG tube and complications exclusively occurred in this group. TYPE OF STUDY: Clinical. LEVEL OF EVIDENCE: IV Case series study.

Abordaje interdisciplinario del tabaquismo en la consulta odontológica: Aplicación de técnicas de intervención psicológicas / Interdisciplinary Approach to Smoking in Dental Practice: Psychological Intervention Techniques Application

Resumen Actualmente, en la comunidad odontológica existe confusión y duda sobre la extensión de la responsabilidad del profesional en la intervención y prevención del tabaquismo, lo cual se podría atribuir, en gran medida, al desconocimiento al respecto. Sin embargo, el odontólogo tiene el compromiso de participar activamente en esta adicción como parte del tratamiento bucodental. Por lo tanto, este artículo presenta una revisión actualizada de la literatura internacional relacionada con el tabaquismo desde la perspectiva de la consulta odontológica, enfocada al empleo de estrategias psicológicas para ofrecer un abordaje interdisciplinario, donde se enmarca el rol del odontólogo y su equipo de trabajo. De esta forma, la psicología de la salud ofrece diversas técnicas de intervención que resultan altamente efectivas para reducir o eliminar el tabaquismo, a saber: entrevista motivacional, exposición con prevención de respuesta, control de estímulos, entrenamiento en solución de problemas, terapia cognitivo-conductual, entrenamiento progresivo en reducción de la ansiedad y el estrés, entrenamiento en habilidades sociales, manejo de la ira y la agresividad, manejo de contingencias, autocontrol, técnicas de estimulación aversiva, técnica de reducción gradual de ingestión de nicotina y alquitrán (RGINA), terapia de pareja y familiar para atender situaciones de conflictos en relaciones interpersonales y terapia grupal.

Abstract Currently, in the dental community there is confusion and doubt about the extent of professional responsibility in the intervention and prevention of smoking, which could be attributed, to a large extent, to lack of knowledge about it. However, the dentist is committed to actively participate in this addiction as part of oral treatment. Therefore, this article presents an updated review of the international literature related to smoking from the perspective of dental consultation, focused on the use of psychological strategies to offer an interdisciplinary approach, which frames the role of the dentist and his team. In this way, health psychology offers several intervention techniques that are highly effective in reducing or eliminating smoking, namely: motivational interviewing, response prevention, stimulus control, problem solving training, cognitive-behavioral, progressive training in anxiety and stress reduction, social skills training, anger management and aggressiveness, contingency management, self-control, aversive stimulation techniques, gradual reduction technique of nicotine and tar consumption (RGINA), couple and family therapy to deal with conflict situations in interpersonal relationships and group therapy.

Plantas útiles de los huertos frutícolas tradicionales de Coatetelco, Morelos, México, frente al potencial emplazamiento minero / Useful plants of the traditional fruit orchards of Coatetelco, Morelos, Mexico, in front of the potential mining site

La pérdida de los procesos productivos tradicionales vigentes en los huertos familiares tradicionales debido a los emplazamientos mineros pone en riesgo la producción de las plantas con valor de uso medicinal y alimentario, cuya cosecha permite mitigar la pobreza entre las familias de las comunidades campesinas e indígenas. El objetivo del presente trabajo fue determinar las plantas con valores de uso que mitigan la desigualdad social de los habitantes de Coatetelco, Morelos, México. Mediante técnicas etnobiológicas, se registró una riqueza de 99 especies de plantas correspondientes a 88 géneros y 48 familias botánicas. Se registraron ocho valores de uso, de los cuales destaca el medicinal con 49.5% y el alimentario con 47.5%. Además de los usos antes mencionados, destacan funciones ecosistémicas que aseguran agua, aire limpio y alimentos orgánicos del territorio a las zonas urbanas del sur del estado. Los conocimientos tradicionales expresados en los valores de uso de las plantas aportan elementos susceptibles de integrarse a políticas públicas que garanticen la conservación de la diversidad biológica y cultural para la reproducción social de las comunidades nahuas del Poniente de Morelos, México.

Management of pediatric patients with refractory constipation who fail cecostomy.

BACKGROUND: Antegrade continence enema (ACE) is a recognized therapeutic option in the management of pediatric refractory constipation. Data on the long-term outcome of patients who fail to improve after an ACE-procedure are lacking. PURPOSE: To describe the rate of ACE bowel management failure in pediatric refractory constipation, and the management and long term outcome of these patients. METHODS: Retrospective analysis of a cohort of patients that underwent ACE-procedure and had at least 3-year-follow-up. Detailed analysis of subsequent treatment and outcome of those patients with a poor functional outcome was performed. RESULTS: 76 patients were included. 12 (16%) failed successful bowel management after ACE requiring additional intervention. Mean follow-up was 66.3 (range 35-95 months) after ACE-procedure. Colonic motility studies demonstrated colonic neuropathy in 7 patients (58%); abnormal motility in 4 patients (33%), and abnormal left-sided colonic motility in 1 patient (9%). All 12 patients were ultimately treated surgically. Nine patients (75%) had marked clinical improvement, whereas 3 patients (25%) continued to have poor function issues at long term follow-up. CONCLUSIONS: Colonic resection, either segmental or total, led to improvement or resolution of symptoms in the majority of patients who failed cecostomy. However, this is a complex and heterogeneous group and some patients will have continued issues.

Acercamiento homeopático a la conjuntivitis alérgica / Homeopathic Approach to allergic conjunctivitis

La conjuntivitis alérgica (CA) es un proceso inflamatorio de la conjuntiva ocular, generado por una alteración de la respuesta inmune desencadenada por la presencia de antígenos ambientales. Aunque se considera como una hipersensibilidad de tipo I, aún se tienen varias interrogantes sobre su desarrollo fisiopatológico. Se le reconocen dos fases: la primera, o de sensibilización, donde se lleva a cabo el primer contacto con el antígeno que, a su vez, desencadena una serie de mecanismos que conducen a la producción de IgE específica, la cual se fija a su receptor en las células cebadas conjuntivales. La segunda fase, también llamada efectora, se presenta cuando aparece un segundo encuentro con el antígeno desencadenante, el cual se fija a las IgE en la superficie de las células cebadas y genera una serie de eventos fisiopatológicos que producen las manifestaciones clínicas de la CA. En este articulo se realiza un análisis profundo de los mecanismos que generan la conjuntivitis alérgica y de los medicamentos homeopáticos que más frecuentemente se adaptan a los síntomas de dicha enfermedad, como es el caso de la Calcarea carbónica, que tiende a ser uno de los más importantes cuando el proceso alérgico se manifiesta no sólo en los ojos, sino en la piel; la Belladonna atropa, indicada en conjuntivitis con dilatación pupilar acompañada de enrojecimiento conjuntival intenso, y la Euphrasía ofticinalis, uno de los medicamentos más organotrópicos para la conjuntiva.

Acercamiento homeopático a la conjuntivitis alérgica / Homeopathic Approach to allergic conjunctivitis

La conjuntivitis alérgica (CA) es un proceso inflamatorio de la conjuntiva ocular, generado por una alteración de la respuesta inmune desencadenada por la presencia de antígenos ambientales. Aunque se considera como una hipersensibilidad de tipo I, aún se tienen varias interrogantes sobre su desarrollo fisiopatológico. Se le reconocen dos fases: la primera, o de sensibilización, donde se lleva a cabo el primer contacto con el antígeno que, a su vez, desencadena una serie de mecanismos que conducen a la producción de IgE específica, la cual se fija a su receptor en las células cebadas conjuntivales. La segunda fase, también llamada efectora, se presenta cuando aparece un segundo encuentro con el antígeno desencadenante, el cual se fija a las IgE en la superficie de las células cebadas y genera una serie de eventos fisiopatológicos que producen las manifestaciones clínicas de la CA. En este articulo se realiza un análisis profundo de los mecanismos que generan la conjuntivitis alérgica y de los medicamentos homeopáticos que más frecuentemente se adaptan a los síntomas de dicha enfermedad, como es el caso de la Calcarea carbónica, que tiende a ser uno de los más importantes cuando el proceso alérgico se manifiesta no sólo en los ojos, sino en la piel; la Belladonna atropa, indicada en conjuntivitis con dilatación pupilar acompañada de enrojecimiento conjuntival intenso, y la Euphrasía ofticinalis, uno de los medicamentos más organotrópicos para la conjuntiva. (AU)

Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video).

BACKGROUND: The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC). OBJECTIVE: To compare LAPEC to laparoscopic cecostomy in terms of operative time, hospital length of stay, and procedure-related morbidity. DESIGN: Retrospective review of children undergoing the ACE procedure. SETTING: Two tertiary-care centers. PATIENTS: This study involved children with defecation disorders. INTERVENTION: The ACE procedure. MAIN OUTCOME MEASUREMENTS: Procedure complications, length of stay, and operative time. RESULTS: Fifty patients underwent LAPEC, and 15 underwent laparoscopic cecostomy. Of the LAPEC patients, 70% were male, with mean age 12 ± 4.2 years, mean operative time 100.1 ± 16.6 minutes, and mean length of stay 3.4 ± 1.4 days. Of the laparoscopic cecostomy patients, 56% were male, with mean age 10.5 ± 4 years, mean operative time 100.8 ± 19.1 minutes, and mean length of stay 3.8 ± 1.6 days. There was no statistical difference between the 2 groups. The single intraoperative complication during LAPEC was a cecal hematoma. Postoperative complications after LAPEC included 6 patients with low-grade fever, 3 patients with tube dislodgement (2 treated by repeat LAPEC and the other by open surgery), and 2 patients with skin breakdown. Of the 50 LAPEC patients and their families, 48 were satisfied with the outcome. LIMITATIONS: Retrospective study. CONCLUSION: LAPEC is a safe, minimally invasive procedure for cecostomy placement in children with refractory constipation or fecal incontinence.

Ginkgo biloba decreases acute mountain sickness in people ascending to high altitude at Ollagüe (3696 m) in northern Chile.

OBJECTIVE: To determine the prophylactic effect of Ginkgo biloba (doses 80 mg/12 h, 24 h before high-altitude ascension and with continued treatment) in preventing acute mountain sickness (AMS) at 3696 m in participants without high-altitude experience. METHODS: Thirty-six participants who reside at sea level were transported to an altitude of 3696 m (Ollagüe). The participants were divided into 3 groups and received G biloba (n=12) 80 mg/12 h, acetazolamide (n=12) 250 mg/12 h, or placebo (n=12) 24 hours before ascending and during their 3-day stay at high altitude. The Lake Louise Questionnaire constituted the primary outcome measurement at sea level and at 3696 m. A Lake Louise Self-Report Score greater than 3 was indicative of AMS. Oxygen saturation, heart rate, and arterial pressure were taken with each evaluation for AMS. RESULTS: A significant reduction in AMS was observed in the group that received G biloba (0%, P<.05) comparison with the groups receiving acetazolamide (36%, P<.05) or placebo (54%). No difference was observed in arterial oxygen saturation in the G biloba (92+/-2) vs the acetazolamide (89+/-2) groups. However, a marked increased saturation in arterial oxygen was seen in comparison with the placebo group (84+/-3, P<.05). No statistically significant differences were observed in mean arterial pressure or heart rate. CONCLUSIONS: This study provides evidence supporting the use of G biloba in the prevention of AMS, demonstrating that 24 hours of pretreatment with G biloba and subsequent maintenance during exposure to high altitude are sufficient to reduce the incidence of AMS in participants with no previous high-altitude experience.

Medicina basada en evidencia: análisis critico de un artículo / Evidence based medicine: critical analysis of an article

Homeopathic medicine is one of the different types of "alternative" medicine that frequently are used by our patients and followed by some clinical , without a real utility measured by systematic analyses of its real utility, given the ample biases to which they expose this type of therapy compared with the traditional medicine. We make a critical analysis of a systematic revision that compares 110 traditional medicine studies and 110 homeopathic medicine studies in multiple areas. The analyzed studies were in most cases of low methodological quality, with a tendency to demonstrate that the studies of worse quality show more beneficial effects in homeopathic medicine that those of high quality. Analyzing only those of high quality odds ratio 0.88 (0.65 - 1.19) for homeopathy and 0.58 (0.39 - 0.85) for traditional medicine. No statistics differences exist between homeopathic medicine and placebo, which doesn't happened in traditional medicine. Homeopathic medicine presents effectiveness attributable to placebo effect.

La medicina homeopática es una de los distintos tipos de medicina "alternativa" que son frecuentemente usados por nuestros pacientes y seguida por algunos clínicos, sin que se haya establecido su real utilidad mediante análisis sistemáticos de su real utilidad, dado los amplios sesgos a los que se exponen este tipo de terapia comparado con la medicina tradicional. Se presenta un análisis crítico de una revisión sistemática que compara 110 estudios de medicina tradicional y 110 estudios de medicina homeopática en múltiples áreas de la medicina. Se observa que los estudios analizados fueron en su mayoría de baja calidad metodológica, con tendencia a que aquellos de peor calidad muestran más efectos benéficos en homeopatía que los de alta calidad. Analizando solo los de alta calidad se aprecia odds ratio 0,88 (0,65 - 1,19) para homeopatía y 0,58 (0,39 - 0,85) para medicina tradicional. Se concluye que la medicina homeopática presenta eficacia atribuible a efecto placebo.

Management of intractable constipation with antegrade enemas in neurologically intact children.

OBJECTIVES: To assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center. METHODS: From 1997 to 1999, 12 children (9 male, aged 8.7 +/- 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow-up included a questionnaire to interview caregivers 13.1 +/- 8.5 months after cecostomy placement. RESULTS: For all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 +/- 9.1 months after beginning treatment. CONCLUSION: Antegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.