Cannabis. Usos y aplicaciones en la práctica odontológica diaria: revisión de la literatura / Cannabis. Uses and applications in daily dental practice: a review of the literature

La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)

The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)

Selenium and impaired physical function in US and Spanish older adults.

BACKGROUND: Selenium (Se) is a trace element with a narrow safety margin. OBJECTIVES: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DESIGN: NHANES 2011-2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017-2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. RESULTS: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 µg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 µg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DISCUSSION: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.

Aspectos bioéticos desde la visión personalista de la espiritualidad en el manejo de las personas en el área de la salud / Bioethical aspects from the personalist vision of spirituality in the management of people in the health area

Introducción: Por regla general todos los trabajadores de la salud han sido modelados por el paradigma científico de la modernidad que ha hecho una separación drástica entre cuerpo y mente y entre ser humano y naturaleza. Pero porque no se ha considerado en el abordaje de la espiritualidad en paciente sanos o con patologías que no necesariamente amenazan la vida? Esta interrogante debe darse respuesta tanto desde el punto de vista holístico y como parte de la ética del cuidado. No se puede separar al ser humano al cuidarlo solo en lo biológico o psicológico, el aspecto espiritual ha de ser abordado. Objetivos: Determinar qué aspectos de la Bioética están relacionados con la espiritualidad en el manejo de los pacientes. Paciente y Métodos: estudio cualitativo mediante Revisión sistemática de la literatura médica publicada en los siguientes buscadores: scielo, HINARI, pubmed, revisión de artículos publicados y manuales de Bioética y Espiritualidad, revisión de publicaciones en congreso, conferencias sobre Bioética y Espiritualidad. Resultados: El número total de artículos identificados fue de 101 (MEDLINE) y 135 (CINAHL). Después de tamizar, la recopilación de otros artículos que hablan sobre un aspecto de la espiritualidad, pero no el término en sí mismo (por ejemplo, la esperanza); la realización de búsquedas manuales en bibliografías o referido por sus compañeros que no se encuentran en la búsqueda de la literatura original, 58 artículos se consideraron pertinentes y se discuten aquí en el análisis temático. Los investigadores, que se sitúan en este campo, inevitablemente sugieren estudiar la espiritualidad desde una perspectiva más cualitativa, con el argumento de que porque la espiritualidad ha de ser experimentado que no se puede medir. Las palabras de McGrath encarnan la idea central de esta perspectiva, "conceptualmente, la espiritualidad no puede ser entendido como una entidad independiente que se mide y se registra. Los investigadores tienen que estar abiertos a la gran cantidad de formas en que los individuos construyen significado". Las necesidades espirituales de los pacientes de cuidados paliativos la naturaleza de la esperanza en los cuidados paliativos; herramientas y terapias relacionadas con la espiritualidad; efectos de la religión en los cuidados paliativos; y la espiritualidad y los profesionales de cuidados paliativos. En otros estudios se han informado que la espiritualidad y aspectos relacionados (por ejemplo, la oración, la meditación) han tenido un efecto positivo en: dolor crónico; psoriasis en pacientes que reciben fototerapia; función inmune; menos efectos adversos en pacientes cardíacos; mayor apoyo social y menos síntomas depresivos entre los pacientes geriátricos; aumento de la salud física y mental. Conclusión: existen evidencias para nada despreciables de que la espiritualidad tiene relación con el estado de salud y calidad de vida de las personas, que explorarlas, trabajarlas produce un bien en el ser persona del paciente, visto en su totalidad como ser digno en cualquier circunstancia, por tanto es ético tener que abordarlo adecuadamente

Introduction: As a general rule all health workers have been modeled by the scientific paradigm of modernity that has made a drastic separation between body and mind and between human and nature. But because it has not been considered in the approach of spirituality in healthy patients or with pathologies that do not necessarily threaten life? This question must be answered both holistically and as part of the ethics of care. It is not possible to separate the human being by taking care of it only in the biological or psychological, the spiritual aspect has to be approached. Objectives: To determine which aspects of bioethics are related to spirituality in the management of patients. Patient and Methods: qualitative study through Systematic Review of medical literature published in the following search engines: scielo, HINARI, pubmed, review of published articles and manuals Of Bioethics and Spirituality, review of publications in congress, conferences on Bioethics and Spirituality. Results: The total number of articles identified was 101 (MEDLINE) and 135 (CINAHL). After sifting, the compilation of other articles that speak about an aspect of spirituality, but not the term itself (eg, hope); The accomplishment of manual searches in bibliographies or referred by his companions that are not in the search of the original literature, 58 articles were considered pertinent and are discussed here in the thematic analysis. Researchers, who are in this field, inevitably suggest studying spirituality from a more qualitative perspective, arguing that because spirituality has to be experienced it can not be measured. McGrath's words embody the central idea of this perspective, "conceptually, spirituality can not be understood as an independent entity that is measured and recorded "Researchers have to be open to the myriad ways in which individuals construct meaning" the spiritual needs of palliative care patients the nature of hope in palliative care; Tools and therapies related to spirituality; Effects of religion on palliative care; And spirituality and palliative care professionals. Other studies have reported that spirituality and related aspects (eg, prayer, meditation) have had a positive effect on: chronic pain; Psoriasis in patients receiving phototherapy; Immune function; Fewer adverse effects in cardiac patients; Greater social support and fewer depressive symptoms among geriatric patients; Increased physical and mental health. Conclusion: there is no evidence that spirituality is related to the health and quality of life of people, to explore them, to work them produces a good in the person of the patient, seen in its totality as being worthy in any circumstance, So it is ethical to have to address it properly.

Green tea compound epigallo-catechin-3-gallate (EGCG) increases neuronal survival in adult hippocampal neurogenesis in vivo and in vitro.

Epigallo-catechin-3-gallate (EGCG), found in the leaves of Camellia sinensis (green tea), has antioxidant- and scavenger-functions and acts neuroprotectively. It has been publicized as anti-aging remedy but data on potential cellular mechanisms are scarce. Recent studies claimed that EGCG specifically promotes neural precursor cell proliferation in the dentate gyrus of C57Bl/6 mice, without changes at the level of immature and mature new neurons. We here analyzed the effects of EGCG on adult hippocampal neurogenesis in male Balb/C mice and saw a different pattern. Two weeks of treatment with EGCG (0, 0.625, 1.25, 2.5, 5 and 10mg/kg) showed a dose-response curve that peaked at 2.5mg/kg of EGCG with significantly increased cell survival without affecting cell proliferation but decreasing apoptotic cells. Also, EGCG increased the population of doublecortin-(DCX)-expressing cells that comprises the late intermediate progenitor cells (type-2b and -3) as well as immature neurons. After EGCG treatment, the young DCX-positive neurons showed more elaborated dendritic trees. EGCG also significantly increased net neurogenesis in the adult hippocampus and increased the hippocampal levels of phospho-Akt. Ex vivo, EGCG exerted a direct effect on survival and neuronal differentiation of adult hippocampal precursor cells, which was absent, when PI3K, a protein upstream of Akt, was blocked. Our results thus support a pro-survival and a pro-neurogenic role of EGCG. In the context of the conflicting published results, however, potential genetic modifiers must be assumed. These might help to explain the overall variability of study results with EGCG. Our data do indicate, however, that natural compounds such as EGCG can in principle modulate brain plasticity.

Pharmacologic characterization of GSK-961081 (TD-5959), a first-in-class inhaled bifunctional bronchodilator possessing muscarinic receptor antagonist and ß2-adrenoceptor agonist properties.

The objective of the present studies was to characterize the pharmacologic properties of GSK-961081 [TD-5959; (R)-1-(3-((2-chloro-4-(((2-hydroxy-2-(8-hydroxy-2-oxo-1,2-dihydroquinolin-5-yl)ethyl)amino)methyl)-5-methoxyphenyl)amino)-3-oxopropyl) piperidin-4-yl [1,1'-biphenyl]-2-ylcarbamate], a novel first-in-class inhaled bifunctional compound possessing both muscarinic antagonist (MA) and ß2-adrenoceptor agonist (BA) properties (MABA). In competition radioligand binding studies at human recombinant receptors, GSK-961081 displayed high affinity for hM2 (Ki = 1.4 nM), hM3 muscarinic receptors (Ki = 1.3 nM) and hß2-adrenoceptors (Ki = 3.7 nM). GSK-961081 behaved as a potent hß2-adrenoceptor agonist (EC50 = 0.29 nM for stimulation of cAMP levels) with 440- and 320-fold functional selectivity over hß1- and hß3-adrenoceptors, respectively. In guinea pig isolated tracheal tissues, GSK-961081 produced smooth muscle relaxation through MA (EC50 = 50.2 nM), BA (EC50=24.6 nM), and MABA (EC50 = 11 nM) mechanisms. In the guinea pig bronchoprotection assay, inhaled GSK-961081 produced potent, dose-dependent inhibition of bronchoconstrictor responses via MA (ED50 = 33.9 µg/ml), BA (ED50 = 14.1 µg/ml), and MABA (ED50 = 6.4 µg/ml) mechanisms. Significant bronchoprotective effects of GSK-961081 were evident in guinea pigs via MA, BA, and MABA mechanisms for up to 7 days after dosing. The lung selectivity index of GSK-961081 in guinea pigs was 55- to 110-fold greater than that of tiotropium with respect to systemic antimuscarinic antisialagogue effects and was 10-fold greater than that of salmeterol with respect to systemic ß2-adrenoceptor hypotensive effects. These preclinical findings studies suggest that GSK-961081 has the potential to be a promising next-generation inhaled lung-selective bronchodilator for the treatment of airway diseases, including chronic obstructive pulmonary disease.

Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study.

BACKGROUND: Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population. SUBJECTS AND METHODS: A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged ≥ 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g). RESULTS: Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)). CONCLUSIONS: The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.

High rate of extra-haematological toxicity compromises dose-dense sequential adjuvant chemotherapy for breast cancer.

BACKGROUND: A dose-dense strategy has been considered to improve results of adjuvant chemotherapy for breast cancer. This randomised phase II trial investigated the feasibility of this approach with sequential anthracyclines and taxanes-based chemotherapy. METHODS: Patients with high-risk node-positive breast cancer were treated with three cycles of fluorouracil 500 mg m(-2), epirubicin 100 mg m(-2), cyclophosphamide 500 mg m(-2) (FEC 100) followed by three cycles of docetaxel 100 mg m(-2) delivered at 2-weekly intervals supported by primary prophylaxis with filgrastim. All patients were randomised to either uninterrupted treatment (arm A) or to have a 2-week additional period of rest between the FEC and docetaxel (arm B). The primary endpoint was the rate of success of chemotherapy delivery. Using a two-stage Fleming design, 120 patients were required with one interim analysis. RESULTS: In March 2005, enrolment was stopped into arm A after the observation of severe skin toxicities. Following the planned interim analysis, the study was closed because of the high rate of grade 3/4 skin toxicities in both arms (arm A: 32.4% and arm B: 18.9%). CONCLUSION: Sequential dose-dense FEC 100 followed by docetaxel 100 mg m(-2) is not feasible. Feasibility still depends largely on several factors including the choice of drugs, dosage and sequence of administration.

Percepción de docentes y alumnos sobre documentos Odontológicos legales utilizados en la práctica clínica de Facultades de Odontología del Paraguay año 2011 / Perception of teachers and students on legal documents used in the Dental Clinical Practice of Dental Schools in Paraguay in 2011

El odontólogo tiene grandes responsabilidades en la sociedad, en función de la misma existen normas éticas y legales que le dan un norte a ese profesional. Todas las actividades odontológicas deben ser plasmadas en documentaciones que son el medio por el cual se demuestra la actuación del mismo. La confección del consentimiento informado es obligatoria según los Códigos Penal y Sanitario y la historia clínica lo es para asegurar una medicina de calidad. El mejor lugar para impartir esta enseñanza es la facultad durante la formación del estudiante. Se evaluó la percepción de docentes y estudiantes sobre documentos odontológicos legales utilizados en la práctica clínica de Facultades del Paraguay con el propósito de tomar medidas correctivas necesarias inculcando el verdadero objetivo de estos documentos en la Institución. Es un estudio observacional descriptivo y componente analítico, se aplicó un cuestionario auto administrado a 233 sujetos. Se observó percepción del 63%; sólo el 3% considera la confección del consentimiento informado como un acto médico y el 92% cree necesario un centro de admisión de pacientes en su Institución. No se observó significancia estadística en relación del tipo de Institución pública o privada y la percepción sobre los documentos odontológicos p= 0,1 p> 0,05

Eficacia analgésica de la infusión continua de anestésico local en la herida quirúrgica tras histerectomía abdominal / Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy

OBJETIVO: Evaluar la calidad de la analgesia postoperatoriaen mujeres sometidas a histerectomía abdominal,valorando dos técnicas diferentes de analgesia intravenosa(paracetamol, ketorolaco y bolos de morfina) con osin infusión continua de anestésico local en la herida quirúrgica.Se valoró además el índice de satisfacción experimentadopor las pacientes.MATERIAL Y MÉTODO: Estudio preliminar, prospectivoy aleatorio, en pacientes ASA I-II, divididas en dos grupos:grupo catéter, mujeres que recibieron analgésicosintravenosos y bupivacaína (0,25%) en infusión continua(2 ml/h) a través de un catéter subcutáneo; grupo control,recibieron exclusivamente analgesia intravenosa.Las variables de estudio fueron la intensidad del dolor(evaluado mediante escala verbal numérica) en reposo ymovimiento, requerimientos de morfina durante las primeras48 horas y complicaciones relacionadas con losfármacos utilizados y con la técnica.RESULTADOS: Se incluyeron 26 pacientes, 10 pacientesen el grupo catéter y 16 en el grupo control. Las diferenciasencontradas con respecto al dolor, tanto en reposocomo en movimiento, fueron estadísticamente significativasen la URPA. También existieron diferencias significativasen el dolor al movimiento a las 24 h (p < 0,004) y alas 48 h (p < 0,020). Asimismo los requerimientos de morfinaen la URPA fueron significativamente mayores en elgrupo control (3,20 ± 1,79 mg frente a 8 ± 2,27 mg,p < 0,002). La deambulación fue más temprana en el grupocatéter. No hallamos diferencias en las complicaciones.CONCLUSIONES: El tratamiento del dolor postoperatoriomediante infusión continua de anestésico local en la heridaquirúrgica tras histerectomía abdominal es una técnicaanalgésica eficaz, que proporciona un muy buen control delmismo con un reducido consumo de morfina, escasos efectosadversos, un alto índice de satisfacción de las mujeres yla percepción de éstas de recibir una analgesia de calidad(AU)

OBJECTIVE: To assess the quality of postoperativeanalgesia provided by intravenous administration ofparacetamol and ketorolac plus morphine in bolus doseswith or without continuous infusion of local anestheticinto the surgical wound after abdominal hysterectomy.Patient satisfaction was included among the outcomesassessed.MATERIAL AND METHODS: Prospective pilot study inASA 1-2 patients randomized to 2 groups: women in thesubcutaneous catheter group received intravenousanalgesics plus a continuous infusion (2 mL/h) of 0.25%bupivacaine whereas women in the control groupreceived only the intravenous analgesics. The outcomemeasures were pain intensity assessed on a verbalnumerical scale at rest and with movement, morphinerequirements in the first 48 hours after surgery, andcomplications related to the drugs used or the technique.RESULTS: Twenty-six patients were enrolled; 10 wererandomized to the catheter group and 16 to the controlgroup. Statistically significant between-group differencesin pain both at rest and with movement were found whilethe women were in the postoperative recovery unit.Postoperative pain with movement was also significantlydifferent at 24 hours (P<.004) and 48 hours (P<.02).Similarly, mean (SD) morphine requirements in therecovery unit were significantly greater in the controlgroup, at 8 (2.27) mg, compared with 3.20 (1.79) mg inthe catheter group (P<.002). Walking began earlier in thecatheter group. No differences were found in theincidences of complications.CONCLUSIONS: Postoperative pain is effectivelyrelieved by continuous infusion of local anesthetic intothe surgical wound after abdominal hysterectomy. Thistechnique provides good analgesia with less morphineconsumption and scarce adverse effects. Patientsatisfaction and the sense of receiving quality painmanagement are high(AU)

Evaluation of CSF neurotransmitters and folate in 25 patients with Rett disorder and effects of treatment.

BACKGROUND: Rett disorder (RD) is a progressive neurodevelopmental entity caused by mutations in the MECP2 gene. It has been postulated that there are alterations in the levels of certain neurotransmitters and folate in the pathogenesis of this disease. Here we re-evaluated this hypothesis. PATIENTS AND METHODS: We evaluated CSF folate, biogenic amines and pterines in 25 RD patients. Treatment with oral folinic acid was started in those cases with low folate. Patients were clinically evaluated and videotaped up to 6 months after therapy. RESULTS: CSF folate was below the reference values in 32% of the patients. Six months after treatment no clinical improvement was observed. Three of the four patients with the R294X mutation had increased levels of a dopamine metabolite associated to a particular phenotype. Three patients had low levels of a serotonin metabolite. Two of them were treated with fluoxetine and one showed clinical improvement. No association was observed between CSF folate and these metabolites, after adjusting for the patients age and neopterin levels. CONCLUSION: Our results support that folinic acid supplementation has no significant effects on the course of the disease. We report discrete and novel neurotransmitter abnormalities that may contribute to the pathogenesis of RD highlighting the need for further studies on CSF neurotransmitters in clinically and genetically well characterized patients.

Pie diabético: evolución en una serie de 121 pacientes / Evolution of diabetic foot in a series of 121 patients

Cohorte única de 121 pacientes portadores de pie diabético (PD) tratados entre 1998 y 2005. Se analiza la evolución, a través de incidencia de cicatrización, recidiva, amputación al año, a los tres años y letalidad. El origen del PDfue predominantemente neuropático en 52 pacientes (43 por ciento), predominantemente isquémico en 44 (36.4 por ciento) y mixto en 25 casos (20.6 por ciento). En 78 casos (64.5 por ciento) había infección asociada. Las lesiones mayores que Wagner 1 tuvieron cicatrización significativamente menor, p < 0.05. La media de antigüedad de la úlcera fue 10.8 semanas. La tasa de cicatrización, 31.4 por ciento y el tiempo medio de cicatrización, 6.2 semanas; la tasa de recidiva de la úlcera durante el primer año fue 52.1 por ciento. La media de tiempo para la recidiva de la úlcera fue 5.1 meses. La tasa de amputación al año de diagnosticada la úlcera fue 95.9 por ciento y 98.3 por ciento a los tres años. La tasa de reamputación de amputaciones menores fue 55.4 por ciento y de amputaciones mayores fue 24.4 por ciento, p < 0.05. La media entre el inicio del tratamiento y la amputación fue 11 semanas. La cirugía de rescate no modificó el desenlace de amputación (p =0.98). La letalidad fue 4.1 por ciento. Los grupos de riesgo de amputación fueron: diabéticos tipo 2 y lesiones Wagner 2 y superiores. Nuestro pobre desenlace del PD requiere implementar un plan de educación para reducir la aparición de úlcera y/ o infección local, disminuir la recidiva, mejorar la educación de los diabéticos respecto al cuidado de los pies y, replantear los niveles de amputaciones en el PD avanzado.

Background: Fifteen percent of diabetic patients will develop a foot ulcer during their lifetime. The predisposing conditions are neuropathy, ischemia and infections. Aim: To report the incidence of healing, relapse, amputation and mortality of diabetic foot in a period of eight years. Material and methods: A cohort of 134 patients hospitalized in a Surgical Service with the diagnosis of diabetic foot was studied; however in 13 patients, the clinical history was not available. Therefore the series included 81 males aged 68 + 11 years and 40 females aged 72 + 11 years. Results: Diabetic foot was predominantly neuropathic in 52 patients (43 percent), predominantly ischemic in 44 (36 percent) and mixed in 25 (21 percent). An associated infection was found in 78 patients (65 percent). The mean ulcer duration was 11 weeks. The rate of healing was 31 percent and the mean healing lapse was 6.2 weeks. The rate of relapse in the first year was 52 percent. The mean relapse time was 5.1 months. The amputation rate was 96 percent one year after diagnosis and 98 percent, three years after diagnosis. Minor and major amputation rates were 55 and 24 percent, respectively. The mean lapse between treatment onset and amputation was 11 weeks. Rescue surgical procedures did not modify the evolution of diabetic foot. Four percent of patients died. Conclusions: The overall results of diabetic foot treatment are poor. Therefore the efforts must be placed on prevention and education of patients to prevent the appearance of foot ulcers, local infections, diabetic foot relapse.

Exploración y tratamiento fisioterapéutico de la hiperhidrosis palmar / Exploration and physiotherapy treatment of palm hyperhidrosis

En este artículo, se estudian las técnicas de valoración más utilizadas en la exploración de la hiperhidrosis palmar. Así mismo se describe detalladamente la técnica fisioterapéutica aplicada en la citada afección, mediante iontoforesis por agua corriente (del grifo), con distintas guías terapéuticas, lo que permite una mayor versatilidad en relación a la idiosincrasia de los pacientes. (AU)

Folic acid supplementation does not prevent ribavirin-induced anemia

Treatment of chronic hepatitis C consists of inteferon plus ribavirin. The major adverse effect of ribavirin is hemolytic anemia, a complication that limits therapy. Folic acid supplementation is used to improve erythropoiesis in chronic hemolytic anemia. The aim of this study was to evaluate the effectiveness of folic acid supplementation in the prevention of ribavirin-induced anemia in patients being treated for hepatitis C. Twenty one patients enrolled in treatment protocols for hepatitis C received folic acid 1 mg daily and 22 did not. Groups were similar in age, gender, ribavirin dose and baseline hemoglobin. Folic acid supplementation had no effect in the decrease in hemoglobin or the measured parameters of hemolysis. No difference between males and females was noted for hemoglobin decrease or lowest hemoglobin levels. In our study, folic acid showed no beneficial effect in the prevention of ribavirin-induced anemia.

Antifungal activities of nine traditional Mexican medicinal plants.

Eighteen plant extracts from nine traditional Mexican medicinal plants were tested for antifungal activity against two dermatophyte fungal species (Trichophyton mentagrophytes and Trichophyton rubrum), one non-dermatophyte (Aspergillus niger), and one yeast (Candida albicans). The strongest effect was manifested by the hexane extracts from Eupatorium aschenbornianum and Sedum oxypetalum, as well as the methanol extracts from Lysiloma acapulcensis and Annona cherimolia.

Conditional deletion of brain-derived neurotrophic factor in the postnatal brain leads to obesity and hyperactivity.

Brain-derived neurotrophic factor has been associated previously with the regulation of food intake. To help elucidate the role of this neurotrophin in weight regulation, we have generated conditional mutants in which brain-derived neurotrophic factor has been eliminated from the brain after birth through the use of the cre-loxP recombination system. Brain-derived neurotrophic factor conditional mutants were hyperactive after exposure to stressors and had higher levels of anxiety when evaluated in the light/dark exploration test. They also had mature onset obesity characterized by a dramatic 80-150% increase in body weight, increased linear growth, and elevated serum levels of leptin, insulin, glucose, and cholesterol. In addition, the mutants had an abnormal starvation response and elevated basal levels of POMC, an anorexigenic factor and the precursor for alpha-MSH. Our results demonstrate that brain derived neurotrophic factor has an essential maintenance function in the regulation of anxiety-related behavior and in food intake through central mediators in both the basal and fasted state.

Sterols, triterpenes and biflavonoids of Viburnum jucundum and cytotoxic activity of ursolic acid.

The triterpenes ursolic acid (1), 27-p-Z-coumaroyloxyursolic acid (2), 27-p-E-coumaroyloxyursolic acid, alpha-amyrine-3-palmitate and lupeol-3-palmitate were isolated through a bioactivity-guided fractionation from the acetonic extract of the aerial parts of Viburnum jucundum Morton in addition to amentoflavone, an epimeric mixture at C-2 of 2,3-dihydroamentoflavone, beta-sitosterol and beta-sitosteryl glucopyranoside. Ursolic acid (1) was the only constituent that exhibited cytotoxic activity toward three human cancer cell lines in culture. This is the first phytochemical and cytotoxic analysis performed to this plant species.

Cytotoxic activity of moronic acid and identification of the new triterpene 3,4-seco-olean-18-ene-3,28-dioic acid from Phoradendron reichenbachianum.

The cytotoxic compound moronic acid (1) and the new tetracyclic triterpene 3,4-seco-olean-18-ene-3,28-dioic acid (2), were isolated from the aerial parts of the medicinal plant Phoradendron reichenbachianum (mistletoe, Loranthaceae) through a bioassay-guided fractionation. In addition, squalene, glycerol trilinoleate, morolic acid, betulonaldehyde, betulinaldehyde, alpha-germanicol, lupeol, beta-sitosterol and beta-sitosteril glucopyranoside, were identified in this plant species. The structures were elucidated on the basis of chemical and spectroscopic evidence.

High-dose platinum versus standard dose in advanced ovarian carcinoma: a randomized trial from the Gynecologic Cooperative Group of the French Comprehensive Cancer Centers (FNCLCC).

OBJECTIVE: The aim of this study was to evaluate the impact of platinum dose intensity on pathological response rate and overall survival in patients with advanced ovarian adenocarcinoma. METHODS: Between February 1992 and December 1996, 195 previously untreated patients with FIGO stage IIb-c, IIIb-c, or IV with macroscopic residual disease after suboptimal debulking surgery were randomized to receive CCC (100 mg/m(2) of cisplatin, 300 mg/m(2) of cyclophosphamide, 300 mg/m(2) of carboplatin, n = 96) or CC (100 mg/m(2) of cisplatin, 600 mg/m(2) of cyclophosphamide, n = 99) for six courses at 28-day intervals. A second-look laparotomy was planned at the end of chemotherapy. RESULTS: In the CCC arm, the platinum compound received dose intensity and relative total dose were 85 and 76%; in the CC arm, they were 94 and 85%. Grade 3-4 toxicity was more frequent in the CCC arm than in the CC arm for leukopenia (56% vs 26%, P < 0.001), febrile neutropenia (18% vs 4%, P = 0.002), anemia (31% vs 5%, P < 0.001), thrombopenia (55% vs 4%, P < 0.001), and ototoxicity (8% vs 0%, P < 0.001). The pathologic complete response rate was 22 and 14% in the CCC and CC arms, respectively (P = 0.19). With a median follow-up of 53 months, the median time to failure and the 3-year treatment failure-free survival rate were 17.4 months and 22% vs 13 months and 11% in the two arms, respectively (P = 0.01). The median survival time and the 3-year overall survival rate were, respectively, 30 months and 42% vs 25 months and 33% (P < 0.20). CONCLUSION: The platinum dose intensification (1.6-fold increase) obtained with the CCC association improves the treatment failure-free survival without significant impact on overall survival when compared with the CC regimen in suboptimal debulked ovarian adenocarcinoma. However, because of its high rate of hematologic toxicity and ototoxicity, this association cannot be recommended for routine practice.

Effect of iodine supplementation on a pediatric population with mild iodine deficiency.

A cross-sectional study in two stages consisted of healthy children to assess the effect of iodine supplementation on a pediatric population with mild iodine deficiency in an ongoing program in the Province of Pontevedra, northwestern Spain. In the first survey (1984), 1565 schoolchildren and in the second survey (1995) 907 schoolchildren were randomly selected from the population. In January 1985, a mandatory consumption of iodized salt in our region was begun. In both surveys we studied prevalence of goiter, urinary iodine excretion, and prevalence of thyroid dysfunction. Similar prevalences of goiter were observed in both surveys, 3.7% versus 3.9%; however, significantly lower prevalence of Ib and II degree goiters were observed in the second survey. The mean iodine excretion was 88.6 +/- 73 microg/L (median 66.3) and 146.4 +/- 99 microg/L (median 115.7), p < 0.01 for the first and second surveys, respectively. Finally, the overall prevalence of thyroid dysfunction was similar in both surveys, 9.2% versus 7.0%; however, significantly lower prevalence of suppressed serum thyrotropin (TSH), considered as a marker of subclinical hyperthyroidism, was observed in the second survey when compared to the first, 0.1% versus 2%, p < 0.01. Our results are in agreement with the recent data from Denmark, where the prevention of subclinical hyperthyroidism occurring in the elderly as a consequence of longstanding mild iodine deficiency is the reason that the Danish finally started iodine supplementation on a national basis. In conclusion, long-term correction of mild iodine deficiency in a pediatric population has beneficial effects on the prevalence of high-degree goiters, and this correction reduces significantly the prevalence of subclinical hyperthyroidism. The present observation constitutes a strong argument for correcting even mild iodine deficiency.

Neoadjuvant chemotherapy interferon for epidermoid penile cancer: a case report

Antecedentes. El carcinoma avanzado de pene es un tumor con un pronóstico malo con el tratamiento estándar por lo que la quimioterapia neoadyuvante se ha estado evaluando para mejorar la preservación del órgano y la supervivencia. Caso clínico. Paciente de 56 años visto en el Instituto Nacional de Cancerología en noviembre de 1993 siendo diagnosticado de cáncer de pene T3 N3 MO. El tratamiento consistió en cisplatino 100 mg/m2 cada 21 días por cinco ciclos alternados con metotrexato intravenoso a dosis de 250 mg/m2 más rescate con leucovorín oral a dosis de 10 mg/m2 cada ocho horas por seis dosis. El metotrexato y leucovorín se administraron cada 15 días en siete ocasiones. Además recibió interferón-alfa 4.5 x 10 6 U por vía subcutánea cada tercer día durante las 12 semanas del tratamiento. Resultados. El tratamiento fue bien tolerado alcanzando una respuesta clínica del 70 por ciento en el tumor primario y completa en los ganglios inguinales. Fue sometido a penectomía radical en abril de 1994 y actualmente está libre de enfermedad a los 61 meses de seguimiento. Conclusiones. Esta modalidad de quimioinmunoterapia parece ser muy activa en el cáncer de pene y debería evaluarse en un número mayor de pacientes con el fin de preservar el órgano e incrementar la supervivencia