Graphene oxide obtention via liquid phase exfoliation from high-rank coal: A comparison of mineral matter removal by alkaline bath.

Colombia is one of the world's leading exporters of coal and coke, with significant reserves of high-quality coal. Most of the coal exported from Colombia is used for power generation, but there is also a class of coal that is suitable for making coke. Coke is a raw material required for making steel, and it is produced by heating coal to high temperatures in the absence of air. Colombia is the third-largest global exporter of coke, with a significant portion of its exports going to the steel industry in countries such as Brazil, Mexico, and the United States. The country's high-quality coal reserves and proximity to major markets make it an important player in the global coal and coke trade. On the other hand, graphene and its derivative Graphene Oxide (GO) have unique properties that make them suitable for a wide range of commercial applications. Graphene has exceptional mechanical strength and high electrical conductivity, which make it an attractive material for a variety of electronic and structural applications. For example, graphene-based materials are being developed for use in flexible electronic devices, sensors, and high-strength composites. GO, on the other hand, is highly resistive but still retains exceptional mechanical strength. This makes it useful in applications where electrical conductivity is not necessary but mechanical strength and durability are important. Graphene production using current techniques can be expensive and inefficient, which limits its widespread adoption for commercial applications. However, new production methods, such as Liquid Phase Exfoliation (LPE), are being developed to address these challenges. LPE is a method for producing graphene and graphene oxide that involves using a liquid solvent to break apart graphite into individual graphene sheets. This method is more efficient and cost-effective than traditional methods such as mechanical exfoliation and chemical vapor deposition. In recent years, there has been increasing interest in using high-rank coal from Colombia as a raw material for graphene production using LPE. This is because high-rank coal from Colombia is known to have a high carbon content and low impurity levels, which makes it an ideal raw material for graphene production. Researchers have successfully produced GO using the LPE method and high-rank coal from Boavita, Colombia. This has the potential to significantly increase the supply of graphene and graphene oxide, making it more accessible for commercial applications. Additionally, using coal as a raw material for graphene production has the potential to create a new market for coal, which could benefit the Colombian economy. In order to synthesize GO, it is important to establish a suitable protocol for the grinding procedure and particle size selection. (i. more than 0.15 mm, ii. 0.15 mm to 0.05 mm, and iii. less than 0.05 mm) were defined. To compare the yield, the mineral matter removal procedure was carried out with a basic leaching bath. Coal oxidation was performed using the modified Hummers process, and GO was then obtained using LPE. This method has the following advantages:•It is feasible to produce GO from high-rank coal with acceptable quality and particulate size smaller than 0.15 mm, yields that are close to 5%, and flakes with fewer than 15 layers.•This approach also could eliminate dependence on graphite as the carbon feedstock for graphene production.•It is an alternative to manufacture GO from coal dust collected from mines.

Real-world persistence to first-line DMTs in relapsing-remitting multiple sclerosis.

BACKGROUND AND PURPOSE: disease-modifying treatments (DMT) for Multiple Sclerosis (MS) have expanded in recent years making the shared-decision process challenging. Moreover, no head-to-head studies are available within the first-line options. Our aim is to compare therapeutic persistence within first-line DMT: teriflunomide (TER), dimethyl fumarate (DMF), and injectable drugs (INJ) in a real-world setting. METHODS: Retrospective observational study analyzing diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) who started DMT between January 2015 and April 2022 (TER=117, DMF=117, INJ=123). Clinical, radiological, and demographic variables were collected. The primary outcome was the median time to discontinuation of any DMT. Dropout was defined as discontinuation for 6 months for any reason. RESULTS: Of the total of 357 patients, 155 withdraw with a median time-to-discontinuation of 1.427 years (IQR 2.410). The discontinuation rate was higher in the injectable group, 49.6%; compared to teriflunomide 40.2%, and dimethyl fumarate 39.8% (p = 0.201). The most frequent reason of discontinuation differs within groups (lack of efficacy in TER, 63.8%, and adverse effects in DMF and INJ (40.4% and 40.9% respectively). No difference in persistence was observed between DMT (p = 0.30). After 2018 there has been a tendency to treat in a quick and early manner (lower EDSS; relapse rate and number of naïve patients), statistically significant for TER (p = 0.005, p = 0.010, and p = 0.045). CONCLUSIONS: Our study demonstrated no differences in persistence between the actual first-line DMT in a real-world setting, although a trend to favor oral-DMT was seen. Reasons for discontinuation differs within groups.

Development of a scale for the evaluation of the quality of the shared decision process in multiple sclerosis patients.

In the last years, therapeutic decisions in multiple sclerosis (MS) have become challenging due to expanded options with different treatment profiles attending to efficacy, safety, and route and frequency of administration. Moreover, patients with multiple sclerosis (PwMS) increasingly wish to be involved in their therapeutic decision process. Therefore, a new, patient-centric shared decision model (SDM), is gaining relevance. However, validated scales oriented to assess the quality of the process itself are lacking. The AGA-25 scale is a fit-for-purpose 25-item scale based on two validated scales in MS (Treatment Satisfaction Questionnaire for Medication (TSQM) and Decisional Conflict Scale (DCS)). The aim of this work is to develop and validate the AGAS-25 in Spanish. Two hundred and three PwMS (aged 17 to 67; 155 [76.4%] females) undergoing stable disease modifying treatment in the last 6 months were consecutively recruited. The Principal Component Analysis suggested a four-factor structure for the 25-item version of the questionnaire: 1) satisfaction with the SDM process 2) adverse events with the DMT, 3) convenience of the chosen-DMT and 4) information reliability. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.88). Our results support the use of the AGAS-25 scale to assist SDM in Spanish-speaking PwMS.

Sick leave and occupational burnout among nurses caring for patients with multiple sclerosis.

BACKGROUND: Sick leave is a common problem among healthcare professionals. Nurses play a critical role in the multidisciplinary management of multiple sclerosis (MS). However, limited information is available on the phenomenon of sick leave among MS nurses. OBJECTIVE: The aim of this study was to assess the presence of sick leave among nurses caring for patients with MS and to identify associated factors. METHODS: We conducted a multicenter, non-interventional, cross-sectional, web-based study. Nurses involved in MS care from across Spain answered a survey composed of demographic characteristics, professional background, questions about their standard practice, and a behavioral battery including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A multivariable logistic regression analysis was conducted to determine the association between nurses' characteristics and sick leave. RESULTS: Ninety-six nurses were included in the study. Mean age (SD) was 44.6 (9.8) years, and 91.7% were female. Participants had a median of 6 (IQR 3.0, 11.0) years of expertise in MS managing a median of 15 (5.0, 35.0) patients per week. Sixteen participants (16.7%) had been on sick leave in the last 6 months, with a median absence of 14.5 days (7.0, 30.0). Sixteen nurses (16.7%) reported severe burnout. Participants on sick leave had higher levels of emotional exhaustion (mean MBI-HSS scores of 22.3 and 16.0, p=0.01) and inadequate interactions with their colleagues (mean Practice Environment Scale - Nursing Work Index scores of 11.8 and 13.1, p=0.01) than their counterparts. Burnout was associated with higher risk of sick leave in the multivariable analysis (OR=1.06 [95% CI 1.00, 1.13], p=0.04) after adjustment for confounders. CONCLUSIONS: Occupational burnout is associated with increased risk of sick leave among nurses managing patients with MS. Identifying burnout may be critical for implementing specific intervention strategies to maintain an adequate functioning of MS care units.

Preferences Toward Attributes of Disease-Modifying Therapies: The Role of Nurses in Multiple Sclerosis Care.

ABSTRACT: BACKGROUND: Nurses play an essential role in coordinating the care of patients with multiple sclerosis (MS) throughout their disease trajectory in a complex treatment landscape. The aim of this study was to assess nurses' preferences toward different disease-modifying therapy attributes. METHODS: We conducted a multicenter, noninterventional, cross-sectional study in collaboration with the Sociedad Española de Enfermería Neurológica. Nurses actively involved in MS care were invited to participate in the study. Prevention of disability progression, preservation of cognitive function, side effect profile and safety monitoring, and method of administration were the treatment attributes tested. Conjoint analysis was used to assess preferences in 8 simulated treatment options and rank them from most to least preferred. RESULTS: A total of 98 nurses were included in the study. The mean (SD) age was 44.7 (9.8) years, and 91.8% were female with a mean (SD) time of experience in MS care of 7.5 (5.4) years. Participants prioritized preservation of cognition (38.6%), followed by preventing disability progression (35.2%) and side effect risk and safety monitoring (13.5%). Route and frequency of administration were the least preferred attributes (7.4% and 5.3%, respectively). Estimated utilities were consistent across the sample according to sociodemographic and professional practice characteristics. CONCLUSIONS: Nurses' preferences toward treatments were mainly driven by efficacy attributes. This information may support the role of nurses in the multidisciplinary management of MS facilitating shared decision making.

Training data enhancements for improving colonic polyp detection using deep convolutional neural networks.

BACKGROUND: Over the last years, the most relevant results in the context of polyp detection were achieved through deep learning techniques. However, the most common obstacles in this field are the small datasets with a reduced number of samples and the lack of data variability. This paper describes a method to reduce this limitation and improve polyp detection results using publicly available colonoscopic datasets. METHODS: To address this issue, we increased the number and variety of images from the original dataset. Our method consists on adding polyps to the dataset images. The developed algorithm performs a rigorous selection of the best region within the image to receive the polyp. This procedure preserves the realistic features of the images while creating more diverse samples for training purposes. Our method allows copying existing polyps to new non-polypoid target regions. We also develop a strategy to generate new and more varied polyps through generative adversarial neural networks. Hence, the developed approach enriches the training data, creating automatically new samples with their appropriate labels. RESULTS: We applied the proposed data enhancement over a colonic polyp dataset. Thus, we can assess the effectiveness of our approach through a Faster R-CNN detection model. Performance results show improvements over the polyp detections while reducing the false-negative rate. The experimental results also show better recall metrics in comparison with both the original training set and other studies in the literature. CONCLUSION: We demonstrate that our proposed method has the potential to increase the data variability and number of samples in a reduced polyp dataset, improving the polyp detection rate and recall values. These results open new possibilities for advancing the study and implementation of new methods to improve computer-assisted medical image analysis.

Frequency of Aspirin Resistance in Ischemic Stroke Patients and Healthy Controls from Colombia.

OBJECTIVE: To evaluate the aspirin resistance prevalence in patients with previous ischemic cerebrovascular disease undergoing aspirin therapy for secondary prevention. MATERIALS AND METHODS: Three hundred fifty patients presenting ischemic strokes and 100 healthy controls under aspirin treatment were evaluated using the optic platelet aggregation test. RESULTS: Aspirin resistance was found in 7.4% of the patients with ischemic stroke and 4% of controls. Aspirin resistance was associated with stroke recurrence in univariate analysis (p = 0.004). Aspirin resistance was not associated with smoking, diabetes, or hypercholesterolemia. CONCLUSION: Aspirin resistance is present in Colombian patients with ischemic stroke as well as in healthy controls.

Recaídas del trastorno de espectro de la neuromielitis óptica e influencia estacional en una cohorte de un país ecuatorial / Neuromyelitis optica spectrum disorders relapses and seasonal influence in an equatorial country cohort

Introducción La evidencia sobre la distribución estacional de las recaídas del trastorno del espectro de la neuromielitis óptica (NMOSD), especialmente en países tropicales, es limitada y diversa. Objetivo Evaluar la influencia de las variaciones estacionales en las recaídas del NMOSD en un país localizado sobre la línea ecuatorial. Pacientes y métodos Se llevó a cabo un estudio ecológico, con información retrospectiva de una cohorte de pacientes con NMOSD atendida entre enero de 2003 y diciembre de 2020 en Medellín, Colombia. Se recolectaron datos demográficos y clínicos de los pacientes, así como información sobre variables estacionales y climáticas. Se calculó la frecuencia de recaídas por estación, mes y año, y se realizó una regresión binomial negativa para evaluar la asociación entre el número de recaídas, y las variables estacionales y climáticas. Resultados Se incluyó a 113 pacientes, de los cuales el 89,38% eran mujeres, con una edad media en el momento del diagnóstico de NMOSD de 44,97 (±13,98) años y una mediana de tres recaídas (rango intercuartílico: 1-2). Se registraron 237 recaídas, la mayoría en pacientes seropositivos para anticuerpos antiacuaporina 4 (87,76%) y con mielitis longitudinal extensa como la presentación clínica más común (53,59%). Las recaídas se presentaron con mayor frecuencia durante la segunda temporada lluviosa (28,69%; n = 68), y en los meses de noviembre y diciembre. Sin embargo, en la regresión binomial negativa no se observó una asociación significativa entre el número de recaídas y las variables climáticas y estacionales, los meses y los años. Conclusión Las variables climáticas y los patrones estacionales no muestran una asociación significativa con cambios en el número de recaídas del NMOSD en pacientes residentes en un país localizado sobre la línea ecuatorial. (AU)

INTRODUCTION Information about seasonal distribution of Neuromyelitis optica spectrum disorders (NMOSD) attacks, particularly in tropical countries, has rarely been described and the reported data are diverse. OBJECTIVE. To evaluate influence of seasonal variation in NMOSD relapses in an equatorial country. PATIENTS AND METHODS Exploratory observational, retrospective ecological study in a cohort of patients with NMOSD followed from January 2008 to December 2019. Data of demographic, clinical information, characteristics of relapses and seasonal temporal variation were recorded. Also, the annual, monthly and intra-annual seasonal variation of relapses was quantified. A negative binomial regression was used to estimate the associations between the number of relapses and climatic and temporal variables. RESULTS One hundred thirteen patients were included, most of them were female (89.38%), with a mean age at NMOSD diagnosis was 44.97 (±13.98) and the median of relapses per patient were 2 relapses (IQR 1-3). The patients presented 237 relapses, most of these in AQP4 seropositive patients (87.76%) and longitudinal extensive myelitis was the most frequent type of relapse (53.59%). According to the temporal variation, relapses were more common in the second rainy season (28.69%) during November and December. However, there weren’t significant differences in the number of relapses between seasons and climatic variables in the multivariable model. CONCLUSION. The number of NMOSD relapses in this equatorial country cohort did not exhibit any significant associations with climatic variations, including changes in rainy or dry seasons. (AU)

Neuroimaging Characteristics of Small-Vessel Disease in Older Adults with Normal Cognition, Mild Cognitive Impairment, and Alzheimer Disease.

INTRODUCTION: Cerebral small-vessel disease (SVD) represents the most frequent type of vascular brain lesions, often coexisting with Alzheimer disease (AD). By quantifying white matter hyperintensities (WMH) and hippocampal and parietal atrophy, we aimed to describe the prevalence and severity of SVD among older adults with normal cognition (NC), mild cognitive impairment (MCI), and probable AD and to describe associated risk factors. METHODS: This study included 105 older adults evaluated with magnetic resonance imaging and clinical and neuropsychological tests. We used the Fazekas scale (FS) for quantification of WMH, the Scheltens scale (SS) for hippocampal atrophy, and the Koedam scale (KS) for parietal atrophy. Logistic regression models were performed to determine the association between FS, SS, and KS scores and the presence of NC, MCI, or probable AD. RESULTS: Compared to NC subjects, SVD was more prevalent in MCI and probable AD subjects. After adjusting for confounding factors, logistic regression showed a positive association between higher scores on the FS and probable AD (OR = 7.6, 95% CI 2.7-20, p < 0.001). With the use of the SS and KS (OR = 4.5, 95% CI 3.5-58, p = 0.003 and OR = 8.9, 95% CI 1-72, p = 0.04, respectively), the risk also remained significant for probable AD. CONCLUSIONS: These results suggest an association between severity of vascular brain lesions and neurodegeneration.

Manejo de Otitis Media Aguda en los Servicios de Pediatría y Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas / Treatment of Acute Otitis Media in the Pediatrics and Otorhinolaryngology, Head and Neck services in the Clinical Hospital

La otitis media aguda (OMA) es una patología muy común en pediatría y constituye la indicación más frecuente de prescripción de antibióticos en la infancia. Para el diagnóstico se tienen en cuenta hallazgos en la otoscopia, diversos signos clínicos y el tiempo de evolución de los síntomas principales. La decisión de iniciar antibioticoterapia debe determinarse según cada paciente. La espera vigilante como alternativa a la antibioticoterapia inmediata en casos seleccionados reduce el uso de antibióticos sin aumentar el riesgo de daño al paciente y ha demostrado ser una medida costo-efectiva. El fármaco de elección para el tratamiento empírico de la OMA es la amoxicilina, aunque según nuestros resultados es la amoxicilina-IBL la utilizada como primera línea en ambos servicios.

Acute otitis media (AOM) is a pathology commonly found in pediatrics, and the most frequent cause of antibiotics prescription in infants. For its diagnostics, several criteria are taken in consideration, such as otoscopy observations, diverse clinical signs, and the time of evolution of the main symptoms. The decision to initiate antibiotic therapy must be determined particularly for each patient. As an alternative to immediate antibiotic therapy, watchful waiting is preferred in certain cases to reduce the antibiotic use without elevating the patients' risk and has been proven to be a cost-effective approach. The preferred drug for empiric antibiotic therapy in AOM is amoxicillin, although we have observed that the first choice in both our services, pediatrics and otorhinolaryngology, is amoxicillin-IBL.

[Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis]. / Trombosis de senos venosos cerebrales: epidemiología, características clínicas, imaginología y pronóstico.

INTRODUCTION: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. OBJECTIVE: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. MATERIALS AND METHODS: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. RESULTS: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. CONCLUSIONS: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease.

Uso de anticonvulsivantes en epilepsia secundaria a gliomas en adultos: serie de casos / Antiepileptic drugs use in adults with glioma - associated epilepsy: case series

RESUMEN INTRODUCCIÓN: La mayoría de gliomas difusos de bajo grado y un gran porcentaje de gliomas de alto grado desarrollan epilepsia en la historia natural de la enfermedad. Los anticonvulsivantes permiten el control de la epilepsia en la gran mayoría de pacientes con gliomas. Sin embargo, la politerapia anticonvulsivante es necesaria en aproximadamente 1/3 de casos, lo que puede potenciar la incidencia de efectos adversos neurocognitivos y afectar la calidad de vida. OBJETIVO: Establecer la frecuencia de epilepsia y el uso de anticonvulsivantes en un grupo de pacientes adultos con gliomas difusos que acuden a la consulta externa del Instituto Neurológico de Colombia. PACIENTES Y MÉTODOS: Estudio tipo serie de casos descriptivo retrospectivo que incluyó pacientes adultos con diagnóstico de glioma difuso con confirmación histológica atendidos en consulta externa entre agosto 2014 y enero 2016. Las características epidemiológicas, clínicas, radiológicas y terapéuticas fueron analizadas mediante estadística descriptiva y se utilizó el test exacto de Fisher para comparación de variables. RESULTADOS: Se incluyeron 42 pacientes (edad promedio 41 años, rango 15-71) incluyendo 15 gliomas grado II (7 astrocitoma, 4 oligodendroglioma, 2 gliomas mixtos, 2 gliomas no especificados) y 27 gliomas de alto grado (14 glioblastoma, 8 astrocitoma III, 3 oligodendroglioma, 2 gliomas mixtos). Durante la evolución de la enfermedad 36 (85 %) pacientes presentaron epilepsia sintomática. Las convulsiones fueron la manifestación clínica inicial en 28 (66 %) de casos siendo significativamente más frecuente en gliomas de bajo grado (93 % bajo grado vs. 51 % alto grado, p=0,07). El uso de monoterapia anticonvulsivante fue reportada en 23 casos (63 %). En el grupo de gliomas de bajo grado, solo 40 % respondieron a terapia con 1 solo medicamento, requiriendo politerapia más frecuentemente que los gliomas de alto grado (9 de 15 bajo grado vs. 4 de 21 alto grado, p=0,01) mientras que en gliomas de alto grado fue tratada con monoterapia en 80 %. CONCLUSIÓN: La epilepsia fue más frecuente en gliomas de bajo grado y este grupo requirió politerapia en la mayoría de casos comparado a gliomas de alto grado. Es necesario optimizar la terapia anticonvulsivante en pacientes con gliomas identificando los grupos de riesgo de pobre respuesta y evitando el uso de politerapia en aquellos con alta probabilidad de buena respuesta a la monoterapia.

SUMMARY INTRODUCTION: Seizures are frequent as initial symptom in low grade gliomas and it occurs commonly in follow-up in high grade glioma. Antiepileptic drugs achieve seizure control in most of cases. However, in aproximately 1/3 of cases multiple antiepileptic drugs are needed which could increase neurocognitive side effects and impair quality of life. Objectives: To establish frequency of seizures and antiepileptic drugs use in a group of patients with diffuse brain gliomas at the outpatient neurology department. PATIENTS AND METHODS: Retrospective, descriptive case series of adult patients with brain diffuse glioma confirmed by histological criteria. Clinical data was analised by descriptive statistics and Fisher's test was used to compare variables. RESULTS: We included 42 patients (age average 41 years, range 15-71) 15 grade II gliomas (7 astrocitoma, 4 oligodendroglioma, 2 mixed gliomas, 2 gliomas not specified) and 27 high-grade gliomas (14 glioblastoma, 8 astrocitoma III, 3 oligodendroglioma, 2 mixed gliomas). During follow-up 36 (85%) of patients had seizures and it was the initial symptom in 28 (66%) of cases significantly more frequent in low-grade gliomas (93% low grade vs 51 high grade, p=0.07). Overall, monotherapy with antiepileptic drugs were possible in 23 cases (63%). For low-grade glioma only 40% of patients responded to monotherapy whereas it was successful in 80% of high-grade gliomas (p=0.01). CONCLUSION: Seizures were more frequent in low-grade gliomas and often it required a combined antiepileptic drugs regimen to achieve epilepsy control compared to high-grade gliomas.

Trombosis de senos venosos cerebrales: epidemiología, características clínicas, imaginología y pronóstico / Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis

Introducción. La trombosis de senos venosos cerebrales representa entre 0,5 y 1 % de las enfermedades cerebrovasculares en adultos, y sus factores de riesgo son diferentes a los del resto de dichas enfermedades. Objetivo. Determinar la epidemiología, las características clínicas e imaginológicas, así como los resultados en pacientes con trombosis de senos venosos cerebrales, y explorar los aspectos asociados con los puntajes desfavorables en la escala modificada de Rankin. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de corte transversal en el Instituto Neurológico de Colombia entre marzo de 2006 y junio de 2011, periodo en el que se analizaron las historias clínicas de 37 pacientes con diagnóstico confirmado por neuroimágenes. Resultados. El 86,5 % de los pacientes eran mujeres, con una edad promedio de 41 años. El síntoma más frecuente fue la cefalea (86,5 %), el cual se presentó como único síntoma en el 40,5 % de los casos. El 68 % tenía, por lo menos, un antecedente de riesgo para trombosis de senos venosos cerebrales, siendo el más frecuente la obesidad (24,3 %), seguido del uso de anticonceptivos hormonales (21,9 %). El examen neurológico fue normal en el 43,2 %. El hallazgo más frecuente en la tomografía fue la hiperdensidad de los senos venosos (33 %) y, en la resonancia magnética, el infarto venoso (37,5 %). El promedio de senos comprometidos fue de 2,27+1,3, siendo más frecuente el compromiso de los transversos. La estancia hospitalaria promedio fue de 7,8+3,6 días. El 92 % de los pacientes presentaba resultados funcionales favorables al dárseles de alta. La mortalidad hospitalaria fue de 5,4 % y se relacionó directamente con la trombosis de senos venosos cerebrales. Conclusiones. La trombosis de senos venosos cerebrales difiere de los otros tipos de enfermedad cerebrovascular en cuanto a su perfil epidemiológico, factores de riesgo, presentación clínica y pronóstico. Es una condición que exige un alto grado de sospecha diagnóstica, pues su presentación clínica es inespecífica.

Introduction: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. Objective: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. Materials and methods: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. Results: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. Conclusions: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease.

Electrochemical deposition of poly(trans-[RuCl2(4-vinylpyridine)4]) and its reductive desorption: cyclic voltammetry and electrochemical quartz crystal microbalance studies.

The electropolymerization of trans-[RuCl(2)(vpy)(4)](vpy = 4-vinylpyridine) on Au or Pt electrodes was studied by cyclic voltammetry and the electrochemical quartz crystal microbalance (EQCM) technique. Cyclic voltammetry of the monomer in DMSO on Au shows reductions at -2.0 and -2.2 V. Potential cycling over the first wave leads to polymer formation; however, scanning over the second wave leads to desorption of the polymer. These observations were confirmed by EQCM measurements which also revealed a high polymerization efficiency. Electrolysis, EQCM and XPS measurements showed that desorption was associated with substitution of chloride ligands by DMSO when the polymer was in a highly reduced state. The film also showed reversible mass changes due to the oxidation and accompanying ingress of charge-balancing anions and solvent into the film. Measurements on the dried films revealed that large quantities of solvent are trapped in the film during the electropolymerization process.

Antioxidant activity of new ruthenium compounds.

Many biological properties have been attributed to ruthenium complexes including anti-tumor activity and the attenuation of reperfusion damage and infarct size. In this work, we characterize the antioxidant activity of trans-[RuCl2(nic)4] where nic is 3-pyridinecarboxylic acid and trans-[RuCl2(i-nic)4] where i-nic is 4-pyridinecarboxylic acid by (i) evaluation of total antioxidant potential (TRAP); (ii) prevention of DNA damage induced by hydrogen peroxide using the alkaline comet assay; and (iii) the prevention of lipid peroxidation and cell death induced by iron in liver slices. Our results suggest that nic has stronger antioxidant potential when compared to the i-nic. Higher doses (above 200 microM) of these compounds gave genotoxic effects, but the antioxidant potential could be obtained with the use lower doses (0.1-10 microM).

Sonohisterografía en exploración de infertilidad / Sonohisterografía in exploration of infertility

Explica que la técnica consiste en el relleno con solución salina de la cavidad uterina, a través de un catéter y bajo control sonográfico. El examen propuesto permite una mejor diferenciación de las capas de tejidos entre endometrio y miometrio durante el ciclo menstrual. Entre las alteraciones uterinas son mejor visualizadas lesiones intracavitarias, con mayor precisión que la obtenida con la ecografía transvaginal solamente: pólipos, sinequias, miomas submucosos o carcinoma endometrial. Constituye un procedimiento valioso en la diferenciación de alteraciones de localización intracavitaria, endometrial y submucosa, sin el uso de medios de contraste ni de radiaciones ionizantes. Se reporta una experiencia inicial de 45 pacientes, seleccionadas entre 180 exploradas previamente con Histerosalpingografía, durante los años 1995 y 1996. Se describe la técnica de exploración y la correlación diagnóstica radiológica-ecográfica de las alteraciones intracavitarias, endometriales y submucosas. Por último se menciona las ventajas y recomendaciones de la Sohohisterografía, tomándose en cuenta que se trata de una exploración rápida y de bajo costo, realizada en consulta externa de pacientes ambulantes.

Labor de enfermería en el hogar de ancianos / Nursing work at the old people home

Por la importancia que ha tomado en nuestro país la medicina geriátrica, se analiza la aplicación de la misma en el Hogar de Ancianos "Carmen Ribalta" de Sagua La Grande. Se señala que en el éxito de los resultados obtenidos merece destacarse la labor realizada por el Departamento de Enfermería, que paulatinamente ha cambiado su visión en lo que representa la atención del anciano, lo que abre camino a los demás departamentos de la institución para la realización de un trabajo colectivo en beneficio de los albergados. Se analiza, asimismo la relación albergado-familia-Departamento de Enfermería, cuya labor ha sido positiva

Experiencia con venlafaxina en Venezuela / Experience with venlafaxine in Venezuela

Se realizó un estudio abierto, no comparativo, multicéntrico, prospectivo en el cual fueron incluidos 171 pacientes con diagnóstico de depreción mayor (leve, moderada y severa), fue realizado por 39 psiquiatras en 10 ciudades de Venezuela. Los objetivos del estudio fueron determinar la eficacia, seguridad y tolerancia de la venlafaxina, una nueva droga antidepresiva en pacientes ambulatorios. La Sociedad Venezolana de Psiquiatría aprobó el protocolo del estudio. Los pacientes llenaban los criterios diagnósticos para depresión mayor de la DSM-III-R. La escala para evaluación de depresión de hamilton y la de impresión clínica global (ICG) fueron utilizadas para determinar la respuesta clínica de los pacientes a la medición. Los pacientes fueron distribuidos en diferentes grupos de dosis (37,5 - 75 mg, 100 - 150 mg y de 175 - 300 mg) de acuerdo a su puntuación al inicio del estudio en la escala de hamilton. Los pacientes fueron evaluados durante 6 semanas. Un total de 118 pacientes completaron el estudio (69 por ciento) de los 118 casos, 50 tenían depresión leve, 39 moderada y 29 severa. Después de 7 días de tratamiento con venlafaxina se apreció una mejoría estadísticamente significativa en pacientes con depresión leve a moderada en la escala ICG como se observa a continuación: en dosis de 37,5 a 75 mg hubo una mejoría marcada a los 7 días en el 36,8 por ciento, después de 14 días en el 76,3, después de 28 días en el 91,1 por ciento y a los 42 días en el 94,7 por ciento. En el grupo de dosis de 100 a 150 mg hubo una mejoría marcada a los 7 días del 37,5 por ciento, en el día 14 del 53,3 por ciento, en el día 28, 78,1 por ciento y al día 42 de 89,3 por ciento. Todos estos resultados fueron estadísticamente significativos. En el grupo de dosis de 150 a 300 mg a los 7 días fue de 0 por ciento, al día 14 de 33,3 por ciento, al día 28 de 55,6 por ciento y al día 42 de 41,4 por ciento. Todos estos resultados fueron estadísticamente significativos. De acuerdo a la esc...

Retratamiento en tuberculosis: experiencia del programa de control de tubrculosis en el distrito de Villa el salvador Hospital San José periodo 1985-1990 / Tuberculosis retrestment experiencied from TBC control programme, et the Hospital San Jose Villa el Salvador Lima Peru 1985-1990

Se evaluaron 127 casos de retratamiento del Programa de Control de Tuberculosis en el Hospital San José, Villa El Salvador, 1985-1990. La edad promedio fue 31.2 años. La causa de retratamiento fue falla en el 69.3 por ciento de casos, recaida en el 29.1 por ciento y R.A.D en el 1.6 por ciento. Un 80.3 por ciento de casos negativizó el BK. Como respuesta al retratamiento un 56.7 por ciento de casos fueron altas, 28.3 por ciento abandonados, 3.9 por ciento transferencias y 11.17 por ciento fracasos. El abandono es una importante causa que impide alcanzar el alta del paciente. Del total de casos con destino conocido, 12.8 por ciento fallecieron por tuberculosis. Considerando los pacientes que terminaron su retratamiento, los que ingresaron por recaida tuvieron un 96 por ciento de altas y los que ingresaron por falla 78 por ciento (p menor 0.05). El tratamiento previo influyó sobre la respuesta al retratamiento: los fracasos tuvieron mayor irrregularidad (71.4 por ciento), mayor número de tratamientos previos (2.9) y mayor promedio de fármacos recibidos (4.9) (p menor 0.01). El BK de ingreso fue positivo en un 91.1 por ciento de casos. Se clasificó el compromiso pulmonar por radiografías según cuadrantes, predominando el superior derecho (88.5 por ciento); 73 por ciento de casos presentó compromiso bilateral. La presencia de cavernas se correlacionó con ausencia de negativización del BK. Para los casos cuya causa de retratamiento fue falla, la ausencia de drogas nuevas en el esquema de retratamiento se asoció con fracaso; para los que ingresaron por recaida, su uso no influyó en la repuesta al retratamiento. Se uso la cirugía en un paciente, cuya respuesta al retratamiento fue el alta.