Thermal insulation impact on overheating vulnerability reduction in Mediterranean dwellings.

Heat waves are expected to increase the use of air conditioning (AC), deriving in higher energy consumption. This research aims to determine whether thermal insulation is an effective retrofit strategy for tackling overheating. Four occupied dwellings in southern Spain were monitored: two houses built prior to any thermal criteria and two with current thermal standards. Thermal comfort is assessed considering adaptive models and user patterns for the operation of AC and natural ventilation. Results show that a high level of insulation combined with a proper use of night-time natural ventilation can increase thermal comfort hours under heat waves, lasting 2-5 times longer than in poorly-insulated houses and with up to 2 °C temperature difference at nights. Long-term effectiveness of insulation under extreme heat presents a better thermal performance, especially in intermediate floors. Yet, the activation of AC usually occurs with indoor temperatures of 27-31 °C, regardless of the envelope's solution.

Experimental optical trapping with frozen waves.

We report, to the best of our knowledge, the first optical trapping experimental demonstration of microparticles with frozen waves. Frozen waves are an efficient method to model longitudinally the intensity of nondiffracting beams obtained by superposing copropagating Bessel beams with the same frequency and order. Based on this, we investigate the optical force distribution acting on microparticles of two types of frozen waves. The experimental setup of holographic optical tweezers using a spatial light modulator has been assembled and optimized. The results show that it is possible to obtain greater stability for optical trapping using frozen waves. The significant enhancement in trapping geometry from this approach shows promising applications for optical tweezers micromanipulations over a broad range.

Non-alcoholic fatty liver in hereditary fructose intolerance.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation affecting >5% of the liver volume that is not explained by alcohol abuse. It is known that fructose gives rise to NAFLD and it has been recently described that the ingestion of fructose in low amounts in aldolase B deficient mice is associated with the development of fatty liver. Therefore, it is reasonable that patients with HFI (Hereditary Fructose Intolerance) present fatty liver at diagnosis, but its prevalence in patients treated and with adequate follow-up is not well documented in the literature. The aim of this study is to analyze the association between HFI and NAFLD in treated patients. METHODS: A cross-sectional observational study was conducted. The population comprised 16 genetically diagnosed HFI patients aged from 3 years to 48 and in dietary treatment of fructose, sorbitol and sacarose exclusion at least for two years. Blood samples were obtained for analytical studies and anthropometric measurements of each patient were performed. RESULTS: Patients presented a Body Mass Index (BMI) of 17.9 ± 2.9 kg/m2. The HOMA index and Quick index were in normal range for our population. The S-adenosyl-methionine (SAM)/S-adenosyl-l-homocysteine (SAH) ratio was increased in the patients in whom this analysis was performed. By imaging techniques it was observed that 9 of the 16 patients presented fatty liver (7 by hepatic MRI). Of these 9 patients, only 3 presented hepatomegaly. 7 of 9 patients affected by the c.448G > C mutation had fatty infiltration, of which three of them presented in addition hepatomegaly. CONCLUSIONS: There is a high prevalence of fatty liver in HFI patients and it is not related to obesity and insulin resistance. The diagnosis of fatty liver in HFI patients and, above all, the identification of new therapeutic approaches, can positively impact the quality of life of these patients.

Quality management, a directive approach to patient safety. / Gestión de la calidad, un enfoque directivo para la seguridad del paciente.

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals.

Hemichorea/Hemiballism Associated with Hyperglycemia: Report of 20 Cases.

BACKGROUND: Hemichorea/hemiballism associated with nonketotic hyperglycemia is a well-recognized syndrome, but few case series have been reported in the literature. CASE REPORT: We describe 20 patients with hemichorea/hemiballism associated with hyperglycemia (9 males and 11 females) with mean age of 67.8 years. Ten patients had a previous diagnosis of type 2 diabetes mellitus, and one had type 1 diabetes mellitus. Six of them had documentation of poor diabetic control over at least the last 3 months. Nine patients had new-onset hyperglycemia with a diagnosis of diabetes mellitus made after discharge. Seventeen patients had unilateral chorea/ballism, while three had bilateral chorea/ballism. Eighteen cases had striatal hyperdensities on computed tomography (CT) and/or hyperintense signals on magnetic resonance imaging (MRI). The putamen was affected in all cases, and the caudate nucleus was involved in nine. DISCUSSION: Hemichorea/hemiballism associated with nonketotic hyperglycemia can be the presenting sign of diabetes mellitus in almost half of cases or can occur after a few months of poor glycemic control in patients with diagnosed diabetes. This case series is one of the largest to date and adds valuable information about clinical and neuroimaging features that are comparable with published data but also emphasize the role of adequate diabetes mellitus control.

Reply #1 to: Glycemic Choreoballism.

In Response To: Lee D, Ahn TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Cosentino C, Torres L, Nuñez Y, et al. Hemichorea/hemiballism associated with hyperglycemia: report of twenty cases. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8DN454P.

Systematic review: An approach to identifying health inequalities through case studies / Revisión sistemática: un enfoque para identificar desigualdades en salud a través de estudios de casos

Introduction: Health inequalities, among other factors, reflect the wellbeing level of a population. Interventions aimed at eliminating or preventing such inequalities require an understanding of their origins. Objective: To perform a systematic review to identify case studies reporting health inequalities worldwide. Methodology: Case reports, case studies and case series written in English, Spanish and Portuguese reporting health inequalities were included. Databases like Medline and EMBASE, and grey literature sources such as LILACS, OpenGrey, Google, and others were included. Results: Initially, the search produced 1272 articles. 139 articles were selected by their title, while, based on their abstract, 28 articles were chosen for full text reading. Finally, 23 articles were included. Gender difference was the most frequent factor in terms of health inequalities (23.2%), followed by socio economic condition (20%), belonging to a migrant population (13.3%), ethnic origin (13.3%), age (10%), geographic origin (3.3%), and others (16.6%). Discussion: This approach, which is based on reviewing case reports to study health inequalities, contrasts with the majority of the studies carried out in this field. This research proposes to study inequalities specific to population groups that suffer such inequalities within communities in a particular geographic area and are not able to access to optimal health services.

Introducción: las desigualdades en salud, entre otros factores, reflejan el nivel de bienestar de una población. Para realizar intervenciones dirigidas a eliminar o prevenir estas desigualdades es necesario comprender su origen. Objetivo: realizar una revisión sistemática para identificar estudios de casos en los que se reportan desigualdades en salud en todo el mundo. Metodología: en este estudio se incluyeron reportes de caso, estudios de casos y series de casos, escritos en inglés, español y portugués, en los que se informan desigualdades en salud. Se utilizaron bases de datos como Medline y EMBASE, así como fuentes de literatura gris como LILACS, OpenGrey, Google, entre otras. Resultados: la búsqueda inicial arrojó 1272 artículos; de los cuales se seleccionaron 139 por su título; luego, basándose en su resumen, se escogieron 28 para realizar una lectura completa. Finalmente se incluyeron 23 artículos. En términos de inequidad en salud, la diferencia de género fue el factor más frecuente (23.2%), seguido por condición socioeconómica (20%), pertenecer a una población migrante (13.3%), origen étnico (13.3%), edad (10%), origen geográfico (3.3%) y otros (16,6%). Discusión: este enfoque, que se basa en la revisión de reportes de caso para estudiar las desigualdades en salud, contrasta con la mayoría de estudios que se han realizado al respecto. En esta investigación se propone analizar las desigualdades en salud que son específicas a poblaciones que viven dentro de comunidades en un área geográfica en particular y que no tienen acceso a servicios óptimos de salud.

Bionimbus: a cloud for managing, analyzing and sharing large genomics datasets.

BACKGROUND: As large genomics and phenotypic datasets are becoming more common, it is increasingly difficult for most researchers to access, manage, and analyze them. One possible approach is to provide the research community with several petabyte-scale cloud-based computing platforms containing these data, along with tools and resources to analyze it. METHODS: Bionimbus is an open source cloud-computing platform that is based primarily upon OpenStack, which manages on-demand virtual machines that provide the required computational resources, and GlusterFS, which is a high-performance clustered file system. Bionimbus also includes Tukey, which is a portal, and associated middleware that provides a single entry point and a single sign on for the various Bionimbus resources; and Yates, which automates the installation, configuration, and maintenance of the software infrastructure required. RESULTS: Bionimbus is used by a variety of projects to process genomics and phenotypic data. For example, it is used by an acute myeloid leukemia resequencing project at the University of Chicago. The project requires several computational pipelines, including pipelines for quality control, alignment, variant calling, and annotation. For each sample, the alignment step requires eight CPUs for about 12 h. BAM file sizes ranged from 5 GB to 10 GB for each sample. CONCLUSIONS: Most members of the research community have difficulty downloading large genomics datasets and obtaining sufficient storage and computer resources to manage and analyze the data. Cloud computing platforms, such as Bionimbus, with data commons that contain large genomics datasets, are one choice for broadening access to research data in genomics.

Evaluation of quality of life following treatment with etoricoxib in patients with arthritis or low-back pain: an open label, uncontrolled pilot study in Mexico.

An open-label study was undertaken at multiple centers in Mexico to assess the impact of treatment with etoricoxib - a selective cyclo-oxygenase-2 (COX-2) inhibitor - on quality of life (QoL) and pain relief among patients with osteoarthritis (OA), rheumatoid arthritis (RA) or chronic low-back pain (CLBP). The study involved 191 adult patients (aged > 18 years old) who had used non-selective non-steroidal antiinflammatory drugs (NSAIDs) for the treatment of OA, RA or CLBP during the month prior to study enrolment. After discontinuation of prior therapy, patients were treated with etoricoxib 60 mg for OA and CLBP,or 90 mg for RA once daily for 2 weeks. Patient and physician questionnaires were used to collect information about drug treatments, patients' QoL (Short Form-8 Health Survey [SF8] and EQ-5D VAS), patients' pain assessment, and physicians' and patients' satisfaction with treatment at baseline and at follow-up visits. Relative to prior NSAID use, etoricoxib use was associated with improvements in all SF-8 QoL domains and component scores as well as in measures of pain and physical functioning. Current pain was reduced from 59.1 mm (0-100mm VAS) at baseline to 27.1mm at follow-up and the physical component score of the SF-8 improved from 33.3 to 46.3 (on a scale from 0 to100). At follow-up, 91% of patients were satisfied with the pain control provided by etoricoxib compared with 34% who were satisfied with the pain control provided by previous NSAIDs. Among physicians, 93% reported satisfaction with the analgesic effect, 95% with the anti-inflammatory profile, and 82% with the side-effect profile of etoricoxib relative to pre-study NSAID treatment. During etoricoxib therapy, use of concomitant medications was reduced. The results of this study are limited due to the lack of a control group, the un-blinded design, and the small number of patients. Large naturalistic trials are needed to confirm the results.

Uso de tirofiban en angioplastia coronaria de alto riesgo / Tirofiban for hight risk coronary angioplasty

Los eventos cardíacos adversos posterior a angioplastia coronaria pueden ser hasta del 15 por ciento, los medicamentos antiplaquetarios reducen estas complicaciones, el tirofíban produce un bloqueo selectivo de los receptores de GP IIblIIa en la plaqueta. Nuestro propósito es mostrar el uso del tirofíban usado como terapia adjunta a angioplastia coronaria en pacientes considerado de alto riesgo, y analizar a aparición de eventos cardíacos mayores (MACE) intrahospitalarios y a tres meses. Se tomaron todas las angioplastias en las cuales se usó el medicamento (n: 170) desde enero de 1999 hasta marzo del 2000; describiendo en ellas la indicación, aparición de eventos adversos, mortalidad, complicaciones, y se realizó un seguimiento telefónico a tres meses. Se usó tirofíban en el 11.2 por ciento de todas las angioplastias en el período estudiado, el 73 por ciento fueron hombres con edad promedio 52 años; el 83.5 por ciento tenían factores de riesgo para enfermedad coronaria; la presentación clínica fue 42 por ciento con IAM Q (4.7 por ciento en choque cardiogénico) 13 por ciento IAM no Q, 31.2 por ciento anginas inestables, 11 por ciento anginas estables y 2.8 por ciento isquemia silente. Se trataron 235 vasos, lesiones complejas (Tipo B2 y C) 884.2 por ciento; el uso del medicamento fue electivo (Primario) 53.5 por ciento. Se implantaron 13 Stents por vaso. La mortalidad intrahospitalaria fue 2.35 por ciento (tres pacientes en choque cardiogénico y uno por hemorragia vía digestiva); no se requirieron procedimientos de revascularización urgentes y sólo hubo un IAM no Q. Se realizó seguimiento a tres meses en 91.2 por ciento, la necesidad de revascularizar el vaso tratado fue del 7.08 por ciento (10 pacientes con PTCA y uno con cirugía de RVM). En este grupo se muestra el uso de tirofiban adjunto a la angioplastia como una estrategia segura con bajas complicaciones isquémicas y mortalidad intrahospitalarias y a tres meses

Epidemiología de las malformaciones congénitas letales en Venezuela 1950-1986 / Epidemiology of congenital malformation lethals in Venezuela 1950-1986

Se hace un recuento del desarrollo de la embriología y de los estudios de las malformaciones congénitas en el país, señalando los aspectos metodológicos y las dificultades en relación con las diferencias en las definiciones de los términos utilizados en la clínica, patologia, estadística, bibliografia y la traducción de los de la nomenclatura internacional, indicando la conveniencia de uniformar éstos en los países hispanoamericanos. Así como también lo referente a la recolección de datos y la necesidad de dar entrenamiento al personal encargado de esta labor. En cuanto a la epidemiología, sólo se presentan algunos aspectos importantes debido a la premura con que se hizo este estudio. Se hace un breve recuento de lo realizado anteriormente y se señala la situación mundial (en 34 países incluida Venezuela); respecto a la mortalidad por malformaciones congénitas (total) en 1986, presenta Venezuela una tasa de 9,7 (x 100.000 hab.), y ocupa el segundo lugar; con respecto a la mortalidad por malformaciones del aparato circulatorio (todas las edades), presentó 52,3(7mo lugar), y en menores del año, una tasa de 49,4(7mo lugar. Se presentan además los datos, tasas y comentarios desde 1950 a 1986 de la mortalidad general, infantil y por malformaciones, y la natalidad. Se señala la importancia relativa de las malformaciones congénitas entre la mortalidad infantil y las malformaciones del aparato circulatorio. Se estudia el problema a nivel nacional desde 1950 a 1986, y se señala que el puesto ocupado por la mortalidad por malformaciones congénitas ha variado desde el puesto N§20 en 1950, hasta el 10mo en 1986..

Carcinoma seromucinoso papilar de superficie del ovario: presentación de un caso / Serous-mucinus surface papillary carcinoma of the ovary: report of a case

Se presenta un (1) caso de carcinoma sero-mucinoso papilar de superficie, con su descripción clínica, histológica, histoquímica, microscopia electrócnica e inmuno-histoquímica, y su tratamiento