Impact of 70 years urban growth associated with heavy metal pollution.

Historical trends in trace element deposition were analyzed using herbaria specimens. We determined Al, Fe, Mg, Mn, Ca, Na, P, K, S, As, Cd, Cr, Cu, Ni, Pb and Zn contents in leaves of eight specimens collected in 1941. To assess changes, we collected the same plants from a botanical garden in 2012. The concentrations of major elements showed large species variability. However, temporal trends were predominately detected for heavy metals. The Cd, Ni and Cr contents in the 2012 leaves were 10, 13 and 16 times higher, respectively, than in 1941. Urban activities have substantially raised the levels of these metals in urban atmospheres due to changes in human activities over 70 years of urban growth. Nevertheless, Pb has decreased (126%) in recent decades thanks to controlled lead fuel combustion. In short, metal deposition trend to increase Cr, Ni and Cd levels.

Reuso y sustitución del material y equipo desechable de inhaloterapia / Reuse and replacement of disposable materials and equipment for inhalotherapy", "_i": "

Los profesionales de la salud utilizan diariamente para el cuidado de las personas enfermas diversos artefactos llamados dispositivos médicos, que generalmente son de un solo uso; sin embargo, el aumento de los costos en salud, la necesidad de reducir los gastos en la adquisición de dispositivos médicos, el pago del procesamiento de residuos hospitalarios y el cuidado del medio ambiente, son factores que han llevado a una práctica de reuso en el material rotulado como desechable; para ello se debe contar con disposición técnica, personal capacitado, características físicas y funcionales del área de reprocesamiento, procesos normatizados y validados, controles estrictos de seguridad que garanticen la funcionalidad e integridad de los dispositivos médicos, que eliminen el riesgo de infecciones o de reacciones endotóxicas; así mismo, que avalen la seguridad del personal, todo esto bajo un marco legal y ético. Uno de los principales problemas que se enfrenta con el reuso de los dispositivos médicos es la falta de estándares centrados en el proceso que nos direccione a conocer ¿cómo? y ¿cuántas? veces es viable realizarlo, por lo que los esfuerzos deben encaminarse a desarrollar estrategias de mejora para promover la estandarización del proceso y mantener un estricto control del número de reusos y con ello garantizar la integridad y esterilidad del material. La presente información se sustenta con el análisis de riesgos y validación del proceso de limpieza, desinfección y esterilización que requieren los dispositivos desechables reusados en el servicio de inhaloterapia.

Health professionals use every day to care for sick persons, several artifacts called medical devices, which are generally single use; however, rising health costs, the need to reduce costs in the acquisition of medical devices, payment for processing medical waste and environmental care, are factors that have led to the practice of reuse in the material labeled as disposable; to do this, there must be technical provisions, trained personnel, physical and functional characteristics in the reprocessing area, normed and validated processes, strict safety controls to guarantee the functionality and integrity of the medical devices, that eliminate the risk of infections or endotoxic reactions; while supporting the safety of staff, all this under a legal and ethical framework. One of the main problems that faces the reuse of medical devices is the lack of standards focused on the process that addresses us to know how and how many times it is feasible to reuse them, so efforts should be directed towards developing improvement strategies to promote standardization of the process and maintain strict control on the number of reuses and thereby ensure the integrity and sterility of the material. This information is supported with risk analysis and validation of the cleaning, disinfection and sterilization processes required by the reused disposable inhalation therapy devices.

Incidencia de neumonía asociada con el cambio de circuito en pacientes con ventilación mecánica invasiva / Incidence of ventilator-associated pneumonia in patients related circuit change", "_i": "

La prevención de la neumonía asociada a la ventilación mecánica (NAV) radica en la alta morbimortalidad; los factores de riesgo están claramente identificados y existen recomendaciones bien establecidas encaminadas a disminuirla; sin embargo, para el manejo de los circuitos de ventilación mecánica (CVM) no hay un consenso sobre el tiempo que deben permanecer sin cambio. Con los resultados obtenidos en esta investigación se pretende estandarizar la frecuencia de cambio del CVM, teniendo como prioridad la calidad y seguridad en la atención de los pacientes. Objetivo: Establecer la asociación entre la incidencia de NAV y la frecuencia en el cambio de CVM. Metodología: Estudio retrospectivo, correlacional y longitudinal con una intervención, que consistió en modificar la frecuencia del cambio de CVM, de cada 48 horas a cada 7 días, durante el período del 2005 al 2009. La muestra intencionada estuvo constituida por 188 pacientes asistidos con ventilación mecánica que presentaron NAV después de las 48 horas. Las variables de estudio fueron: incidencia de NAV y frecuencia del cambio de CVM. El análisis se realizó en SPSS versión 17.0 con frecuencias, porcentajes y correlación de Spearman, considerando significativo p ‹ 0.05. Resultados: El cambio de CVM se realizó a las 48 horas en 95 casos (50.5%) y a los 7 días en 93 casos (49.5%). La incidencia de NAV con cambio de CVM cada 48 horas estuvo entre 2 y 4.3%; con el cambio cada 7 días entre 2 y 1%, sin ser estadísticamente significativo (rs = 0.093, p = 0.103). Conclusión: Los resultados permitieron confirmar que el tiempo que permanecen sin cambio los CVM no interviene directamente en la presencia de NAV y permitió identificar factores de riesgo que podrían ser analizados para mejorar las prácticas y disminuir la incidencia de NAV en este grupo de pacientes, por lo tanto el CVM se puede cambiar cada 7 días.

The ventilator-associated pneumonia (VAP) prevention is due to is high morbidity and mortality; the risk factors are clearly identified and there are well established recommendations intended to diminish it. Nonetheless, there has not been a consensus on the mechanical ventilator circuits (MVC) management and on the time that they must be changed. With the results obtained in this investigation it is aimed to standardized the MVC frequency change, having as priority the quality and safety in the patients’ attention. Objective: Establish the relation between VAP incidence and MVC frequency change. Methodology: A retrospective, co relational and longitudinal study with an intervention consisting of modifying MVC frequency change, from every 48 hours to every 7 days, during the period between 2005 and 2009. The deliberate sample was constituted of 188 patients with mechanical ventilation who suffered from VAP after 48 hours. The study variables were: VAP incidence and MVC frequency change. The analysis was carried with SPSS version 17.0 with Spearman correlations, frequencies and percentages, considering significant p ‹ 0.05. Results: The MVC change was performed after 48 hours in 95 cases (50.5%) and after 7 days in 93 cases (49.5%). VAP incidence with MVC change every 48 hours was between 2 and 4.3%; with change every 7 days was between 2 and 1%, without being statistically significant (rs = 0.093, p = 0.103). Conclusion: The results allowed confirming that the time without MVC change has no direct effect on VAP incidence. It also allowed identifying the risk factors that could be analyzed to improve the practice and diminish VAP incidence in this group of patients; as such the MVC can be changed every 7 days.

Guía clínica para la atención de la persona con insuficiencia renal crónica / Clinical guide for the attention of people suffering from chronic renal insufficiency", "_i": "

En México la población con alteraciones renales va en aumento y la insuficiencia renal crónica (IRC) constituye una de las principales causas de atención hospitalaria para padecimientos crónico-degenerativos. Esta atención hospitalaria involucra directamente al personal de enfermería el cual realiza una serie de toma de decisiones con el objetivo de mejorar y/o mantener la salud de la persona con insuficiencia renal crónica; para lograrlo es necesario estandarizar los cuidados proporcionados a dicha población basándose en la evidencia científica y en las mejores prácticas. Lo anterior es posible con la aplicación de una guía clínica de cuidado enfermero dirigida a la persona con insuficiencia renal crónica, la cual a partir de la relación de los diagnósticos de enfermería con las intervenciones específicas de enfermería nos permita identificar los cuidados prioritarios, unificar criterios de atención y otorgar un cuidado de calidad. Esta guía de cuidado enfermero se basa en los conceptos metodológicos de Virginia Henderson, contemplando como punto de abordaje las necesidades alteradas ante la situación clínica pre-existente.

Kidney disease in the mexican population have increased, chronic renal failure (CRF) is the leading cause of hospital care. Nursing care aims to improve and maintain the health of the person with CRF; is necessary to achieve standardized care to such persons, based on scientific evidence and best practices of nursing, this is possible with the implementation of clinical guidelines or nursing care directed to the person with CRF, the relationship between nursing diagnoses and specific nursing care let us prioritize care, standardizing criteria of attention and providing high quality nursing care. This nursing care guideline is based on Virginia Henderson´s theoretical model, beginning with needs attention secondary to altered pre-existing medical condition.

Melatonin expression in periodontal disease.

BACKGROUND AND OBJECTIVE: It was the purpose of this study to examine the relationship between periodontal diseases and melatonin level. MATERIAL AND METHODS: Forty-six patients with periodontal disease, together with 26 age- and gender-matched healthy controls, were included. Periodontal status was assessed using the Community Periodontal Index. Plasma and salivary melatonin levels were determined using specific commercial radioimmunoassays, whereas lymphocyte subpopulations (e.g. CD3, CD4, CD8, C19 and natural killer cells) were analyzed using flow cytometry. RESULTS: Patients with periodontal disease had significantly (p < 0.001) lower plasma (9.46 +/- 3.18 pg/mL) and saliva (2.55 +/- 0.99 pg/mL) melatonin levels than healthy control patients (14.33 +/- 4.05 and 4.22 +/- 0.87 pg/mL, respectively). A biphasic relationship was observed between plasma melatonin levels and Community Periodontal Indices. The plasma melatonin level was reduced in patients with a lower Community Periodontal Index value (1 or 2) and increased in patients with a higher Community Periodontal Index value (3 or 4). Salivary melatonin parallels the changes of plasma melatonin. The higher the Community Periodontal Index, the older the patient and the higher the total lymphocyte counts. CD4 concentrations also increased as the disease worsened. CONCLUSION: The results obtained from this study suggest that melatonin could act as a protective function in fighting periodontal infection. However, further studies in this area are encouraged.

An in vitro tissue model to study the effect of age on nucleus pulposus cells.

Differentiation between age (physiological) and disease-induced changes in the nucleus pulposus will facilitate our understanding of the mechanism(s) leading to the development of degenerative disc disease. The aim of this study was to develop an in vitro model that would allow the study of age-induced alterations of cell function in nucleus pulposus. Nucleus pulposus (NP) cells were isolated from intervertebral discs obtained from either calves (<9 months) or cows (>18 months). The cells were placed in culture and grown for 19 days. Although nucleus pulposus tissue was formed by the cells of the two different ages the more mature (older) cells formed less tissue as determined histologically by light microscopy. This was confirmed biochemically as the wet weight and proteoglycan content of the tissue formed by the older cells were significantly less than that of the younger tissue. The older cells accumulated less proteoglycans as determined by quantifying radioisotope incorporation. The older cells showed lower constitutive gene expression of collagen type II and aggrecan whereas collagen type I and link protein levels were similar to those of the younger cells. Metalloprotease (MMP) 13 gene and protein expression increased with age. There was no change in the levels of gene expression of MMP 2 and TIMP 1, 2, or 3 with age. Cells obtained from NP tissue harvested from younger or mature animals showed both genotypic and phenotypic differences in vitro that resulted in the inability of the older cells to reconstitute their extracellular matrix to the same extent as the younger cells. This suggests that this in vitro NP tissue model will be suitable to determine the mechanism(s) regulating age-induced changes.

Hereditary blood coagulation disorders: management and dental treatment.

Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.

Familial hypertrophic cardiomyopathy mutations in the regulatory light chains of myosin affect their structure, Ca2+ binding, and phosphorylation.

The effect of the familial hypertrophic cardiomyopathy mutations, A13T, F18L, E22K, R58Q, and P95A, found in the regulatory light chains of human cardiac myosin has been investigated. The results demonstrate that E22K and R58Q, located in the immediate extension of the helices flanking the regulatory light chain Ca(2+) binding site, had dramatically altered Ca(2+) binding properties. The K(Ca) value for E22K was decreased by approximately 17-fold compared with the wild-type light chain, and the R58Q mutant did not bind Ca(2+). Interestingly, Ca(2+) binding to the R58Q mutant was restored upon phosphorylation, whereas the E22K mutant could not be phosphorylated. In addition, the alpha-helical content of phosphorylated R58Q greatly increased with Ca(2+) binding. The A13T mutation, located near the phosphorylation site (Ser-15) of the human cardiac regulatory light chain, had 3-fold lower K(Ca) than wild-type light chain, whereas phosphorylation of this mutant increased the Ca(2+) affinity 6-fold. Whereas phosphorylation of wild-type light chain decreased its Ca(2+) affinity, the opposite was true for A13T. The alpha-helical content of the A13T mutant returned to the level of wild-type light chain upon phosphorylation. The phosphorylation and Ca(2+) binding properties of the regulatory light chain of human cardiac myosin are important for physiological function, and alteration any of these could contribute to the development of hypertrophic cardiomyopathy.

[Bacteremia and recurrent arthritis caused by Streptococcus pyogenes in a heroin addict with AIDS]. / Bacteriemia y artritis recurrente por Streptococcus pyogenes en un heroinómano con SIDA.

BACKGROUND: Streptococcus pyogenes is a bacteria which, at present, is seldom isolated in blood and articular fluid. An intravenous drug addict with human immunodeficiency virus infection, with bacteremia and arthritis by S. pyogenes, associated with tuberculosis is presented. METHODS: Blood and articular fluid cultures were collected in the usual and Löwenstein-Jensen media. RESULTS: The patient improved with penicillin and tuberculostatic drugs. Nine months after this episode, the patient reinitiated intravenous drug addiction, and developed another presentation of bacteremia and arthritis by S. pyogenes. CONCLUSIONS: Heroin addict patients constitute a risk group for bacteremias ans severe infections by S. pyogenes.

Sindrome de Miller-Fisher / Miller-Fisher syndrome

Se presenta un caso de sindrome de Miller-Fisher, hospitalizado en el servicio de urgencias del HUSVP el cual llena todos los criterios a saber: ataxia, arreflexia osteotendinosa, oftalmoplejia externa y disociacion albumino-citologica del LCR. El paciente se recupero en forma lenta. Se hace una revision de la literatura y algunas consideraciones sobre su fisiopatogenia, planteandose las posibilidades de que se trata de una polineuropatia o de un compromiso de tallo cerebral

Use of information sources at a university hospital drug information service.

The frequency of use of various sources to answer drug information requests in a university hospital drug information service was studied. All of the drug information requests received by the University of Minnesota Drug Information Service (UMDIS) between November 1, 1983, and January 27, 1984, were included in the evaluation. A total of 1448 requests from health-care professionals and consumers were reviewed. The 10 most frequently used information sources in order of most to least often used were Facts and Comparisons, previous knowledge or experience of the UMDIS staff, Drugdex, Martindale: The Extra Pharmacopoeia, USP DI, the UMDIS files, information from pharmaceutical manufacturers, Goodman and Gilman's the Pharmacological Basis of Therapeutics, and Meyler's Side Effects of Drugs. Forty percent of the requests were from consumers. Pharmacists should characterize the type and number of drug information requests they receive and should consider the accessibility of a drug information service and biomedical library when deciding which references to purchase.

The clinical utility of a published nomogram to predict aminoglycoside nephrotoxicity.

Moore and colleagues recently published a nomogram for predicting the risk of aminoglycoside nephrotoxicity. This study was undertaken to evaluate the clinical usefulness of this nomogram. The nephrotoxicity risk scores of 61 patients were determined using parameters suggested by Moore et al. Thirteen patients (21%) could not be scored because their initial creatinine clearances exceeded the upper limit of the nomogram. Six patients (9.8%) developed nephrotoxicity (defined as a greater than or equal to 50% decrease in creatinine clearance). In five of these patients in whom risk scores could be determined, the scores were estimated at 14% or less. Twenty patients had risk scores of 10% or more (four patients, greater than or equal to 50%) without developing nephrotoxicity. These results demonstrate that this nomogram may have limited clinical application in predicting patients likely to develop aminoglycoside nephrotoxicity.